GP Contract

Rachael Maskell Excerpts

Monday 16th March 2026 Commons Chamber

[Stephen Kinnock]

I thank the hon. Gentleman for the GP-related questions, for which I was grateful when he finally got to them.

On clinical evidence for advice and guidance, I think that the evidence speaks for itself. We introduced advice and guidance in the last contract with an £80 million investment, and it has been a stunning success. Take-up across the country has been huge, and—this is the statistic that matters most of all—1.3 million referrals that would otherwise have gone to electives have been dealt with by GPs. [Interruption.] The hon. Gentleman, who is chuntering from a sedentary position, seems not to care about what actually matters for patients, but through advice and guidance they are able to get a response from their GPs within about 48 hours. I can assure him that it takes a great deal longer to secure an out-patient appointment. If he is looking for statistics on advice and guidance, let me give him that one again: 1.3 million referrals have been taken off electives and dealt with by GPs. That is part of the hospital-to-community shift.

The hon. Gentleman asked for a definition of “urgent”. We trust our clinicians. We know that general practitioners are experts in their field. They know when they see an urgent issue, but they also know that that the symptoms might be a more acute manifestation of chronic obstructive pulmonary disease, or that a child’s rash suddenly looks more dangerous than it did the day before. We trust our GPs to make those decisions, and it is a real pity that Opposition Members do not seem to do the same.

The hon. Gentleman also wanted a statistic in relation to access. In July 2024, patient satisfaction with access to a GP was languishing at a miserable 60% after 14 years of Tory neglect and chaos. Today it stands at 76%, which is a 16 percentage point improvement. The hon. Gentleman asked for statistics; perhaps he should take that statistic and deal with it.

[Rachael Maskell (York Central) (Lab/Co-op)]

My hon. Friend the Minister mentioned the Carr-Hill formula. York had the lowest funding under the primary care groups, the primary care trusts and the clinical commissioning groups, and it now has the lowest funding under the integrated care boards. It is because it is not the most affluent place that it is really important that the new funding formula works for areas such as York. Could the Minister say a bit more about how that will be determined, so that my community gets the health spending that it deserves?

[Stephen Kinnock]

The Carr-Hill review is happening as we speak, and I expect to get a submission from officials on the first round of analysis that is being conducted by the National Institute for Health and Care Research. That will be the first step towards agreeing on how we make the formula work, with a view to implementing the new Carr-Hill formula from 1 April 2027.

Palliative Care

Rachael Maskell Excerpts

Thursday 5th March 2026 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op) [R]]

I beg to move,

That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.

I am grateful to you, Madam Deputy Speaker, and to the Backbench Business Committee for granting today’s debate on the future of palliative care. Although I applied for it last summer, it could not be more timely, as the Government consider their modern service framework.

Dame Cicely Saunders said:

“How people die remains in the memory of those who live on.”

By addressing what she called “total pain”—physical, psychological, emotional, spiritual and social pain—palliative medicine could transform not only the way we approach death, but how we embrace life. Her legacy has since driven palliative medicine, with dedicated teams delivering care. Someone told me in York that they did not know

“that such outstanding care was even possible.”

Every complexity is embraced and addressed.

In 2024, 532,000 people died in England. Marie Curie evidence published two weeks ago showed that one in three people fail to get the interventions they need. Despite requiring specialist palliative care, over 100,000 people received none. Demand is rising, and will grow by 42% in a decade. Where someone dies, on what day or at what time determines the care that they receive. Some 42% of all deaths occurred in hospital, 28% at home, 21% in care homes, 5% in hospices and 4% in other settings, such as prisons. According to Sue Ryder, just 50% died in the place of their choosing.

I have had the sheer privilege of working with leading academics and clinicians, health leaders, international experts, charities and people with lived experience, in establishing, with Baroness Finley, the independent commission on palliative and end-of-life care, which is chaired by Professor Sir Mike Richards. We sought solutions to establish equitable access to high-quality palliative and specialist palliative care. I am beyond grateful; I have been inspired and I have learned much.

I am also indebted to Professor Fliss Murtagh from the Wolfson Palliative Care Research Centre at the University of Hull. I make particular mention of Professors Katherine Sleeman and Irene Higginson of King’s College London; Oxford consultant Professor Bee Wee; Hospice UK; Marie Curie; Sue Ryder; the Association for Palliative Medicine; Together for Short Lives; my local hospice, St Leonard’s; and so many more. We held 10 evidence sessions and eight roundtables, received 506 written submissions from experts, and spoke to 129 witnesses. We then presented our report to the Minister.

Now that the Government have progressed to the modern service framework, they must commission a single pathway across all settings, focused on excellence, crisis prevention and investing in the community. We found that early identification for access to high-quality specialist interventions was transformative for patients. At the point of terminal diagnosis or increasing frailty, a serious illness conversation undertaken by well-trained clinicians—as recommended by Professor Sir Chris Whitty—injects an honest understanding to ensure the best patient-centred care, while capturing the patient’s wider social needs, priorities and goals. It facilitates good clinical planning. Co-produced, personalised and optimal care is supported with palliative medicine.

In York, the frailty hub brings all sectors, clinicians and services together. When that is intersected with palliative care, crisis admissions are avoided. Emergency services do not escalate without cause; rather, medicine integrates with the hospice at home team—one team, one set of records, one plan. Avoiding the need for crisis management avoids distress. In the last three months of life, however, almost half of people visited their emergency department, and one in eight spent more than 30 days in hospital. Placing palliative care professionals in emergency departments furthers the model, and allows patients to be triaged to the right service. Clinicians at the back door discharge into community palliative care teams. On the wards, hospital specialists connect with patients, introduce palliative care where appropriate, and seek to discharge to the community, hospice or special hospital unit, reducing hospital deaths and improving disease management.

As our bodies fail, high-stakes interventions add little to the quality or quantity of life, yet they carry risk—as do hospital stays—through infection, deconditioning and disorientation. In a far cry from what happened on the Liverpool care pathway, the focus is on enhancing life, not hastening death.

GPs have a significant role, and I ask the Minister to review the retiring of the palliative care register, which focuses GPs on identifying patients for palliation early, so that interventions can be considered. Can she set out how she will still achieve those aims? People are identified far too late for palliative support—just 56 days prior to death for cancer, and 27 days for non-malignant disease, like respiratory, neurological, renal or cardiac disease. Those with conditions like dementia are rarely ever referred.

While there has been a move away from prognostication of life expectancy, due to its unreliability and often significant inaccuracy, recognition of palliative needs early is key. Marie Curie’s “Better End of Life 2024” report identified that 40% of families had no conversation about deterioration or possible death; 20% were alerted in the last three months of life, and 15% in the last week. Its report, “Measuring unmet need for palliative care”, highlighted that one in three people do not receive specialist care. Its post-bereavement survey in 2024 showed a doubling of unmet need, compared with the 2015 VOICES—views of informal carers: evaluation of services—post-bereavement survey by the Office for National Statistics, which should be reintroduced. That highlights the fact that there is higher demand and poorer access.

Furthermore, we know that those from low socio- economic and ethnic minoritised communities are significantly disadvantaged, and face late identification of needs and poor palliative care access. Without agency and advocacy, outcomes are worse, and that is also the case for those with physical and intellectual disabilities. Such injustice demands change.

Variation exists across integrated care boards. The responses to Hospice UK’s freedom of information requests showed that spend ranged from just 23p to £10.33 per person. The National Audit Office’s report on this subject shows the inequity, too; figures range from one hospice bed per 2,900 patients to one per 54,300, yet provision is mandated by the Health and Care Act 2022. At night and over weekends, 75% of the time, the availability of advice and interventions available to relieve distress, difficulties and discomfort is inconsistent, although 24/7 services are needed. By day, a single point of contact is essential, as the Association for Palliative Medicine has impressed upon me.

Specialist palliative care from highly trained professionals must be commissioned to manage complex pain and symptoms through effective drug titration and interventions like palliative radiotherapy, nerve blocks and neuromodulation, which are often not available. The commission advised rapid escalation of complex cases to specialists, to improve outcomes across all settings. Psychological support is pivotal, yet only 19% of hospices can access clinical psychology. Early assessments can palliate depression or anxiety and their consequences.

Young people with life-limiting and life-threatening illnesses must have equal access to care. Paediatric palliative care differs from adult care but is as ambitious in driving excellence. Tailored, age-appropriate care is needed, and expert parents need recognition for their advocacy, too. I particularly note the concerns about transition into adult services; special attention is needed to get that right.

I turn to training. Family carers provide £28.7 billion-worth of care annually. They need training and support, to be listened to, and, above all, space to love, be and spend time. In addition to training and accreditation of the whole palliative health and social care workforce in domiciliary and residential settings, hospices and hospitals, we need a workforce plan for the whole pathway. All undergraduate programmes must have palliative care content. Specialist training to support GPs aspiring to consultant status needs dual accreditation, and the commission heard that overseas-trained staff need specific orientation to palliative medicine, as each jurisdiction approaches death differently. Across the whole service, we need high standards and united objectives.

In 2024, the cost of dying in England was £24,222. The total for England was £12.8 billion, and 78% of that was spent in hospital settings. By contrast, just £1,017 is spent per person on specialist palliative provision, and £862 on community nursing. Research published today shows that specialist palliative care can save the NHS £7,908 per patient when delivered at home, and £6,480 per patient in hospital. That would save around 1.5 million bed days, or £817 million. Funding for hospice provision—essential healthcare—can no longer depend on bake sales and parachute jumps. Two in five hospices are making cuts, and 380 beds have been lost in a year, according to Hospice UK. Staff reductions and redundancies have occurred. Paediatric palliative care faces a £310 million shortfall, and there has been an overreliance on charitable funding, which is inherently inequitable.

[Monica Harding (Esher and Walton) (LD)]

The hon. Member is making such a powerful speech. I wish to draw attention to Princess Alice hospice in my constituency. It receives 20% of its funding from the Government, and the rest through selling woolly jumpers. Most constituents are not aware of this, but the hospice says that it can provide only a quarter of the provision that is needed in Esher and Walton because of the state of its funding. Does the hon. Member agree that the situation needs to change, not least if we are to make things equitable for everybody in our society?

[Rachael Maskell]

The hon. Member makes such a powerful case. We are talking about essential medicine. We would not do this in any other field of medicine, yet we are dependent on charities, which do phenomenal work to fund essential healthcare. We must ensure that we fund it properly. I will come on to make a few suggestions about that.

Although I recognise the dedication of St. Leonard’s hospice in my constituency, and the whole community around it in York, which is both generous and caring, it receives less than 24% NHS funding. This year, it got just a 2% uplift from the integrated care board. To invest in equipping it, in staffing in the community, and in building the capacity to meet need, funding will be needed, and there is already a significant shortfall. Without that funding, transition will slow and the model will fail. The sector agrees. ICBs have no transition funding, and without a health transformation fund, how will the Minister be able to deliver proper care for everyone? If patients are moving into domiciliary or hospice settings, funding should follow. Clinical staff, pharma, capital, utilities, and other essential costs should be covered by the NHS, since patients are now transferred from secondary care into the community. The modern service framework is due for publication in a matter of months, and implementation is due in April 2027. It requires a strong framework of accountability and governance, and it would be helpful for the Minister to set out how the MSF will be evaluated, and how outcomes will be measured.

[Martin Vickers (Brigg and Immingham) (Con)]

I congratulate the hon. Lady on the work that she has done on this issue. Two hospices serve my constituency—Lindsey Lodge in Scunthorpe, and St Andrew’s in Grimsby—and the percentage of funding that they get through the NHS, as opposed to from charity, varies dramatically. Does she agree that, at very least, we must regularise the proportion of funding that hospices receive from the Government?

[Rachael Maskell]

The hon. Member is right, and we know how much palliative care, including specialist palliative care, costs. That must be built into the commissioning process at population level, so that we see equity. I am sure that many in his constituency will see certain demographics in his community excluded from being able to access that specialist care. We must drive the model, and if we do not have the funding, resources or staffing, it will be very difficult to deliver the comprehensive service that everybody deserves at the end of life, should they need palliative care.

[Gideon Amos (Taunton and Wellington) (LD)]

I am sure the whole House congratulates the hon. Member for York Central (Rachael Maskell) on her immense work on this topic—I certainly do. I am sure that she would sympathise with one of my constituents, whose case was brought to my attention by Marie Curie. The lack of a doctor on duty over a weekend meant that proper palliating medicine could not be prescribed, resulting in a distressing death. Does she agree that as well as consistency in funding, we need care to be consistently available seven days a week and 24 hours a day?

[Rachael Maskell]

I am grateful to the hon. Member for raising 24/7 provision, and provision in the evenings and at weekends. Research shows that only a small proportion of services are available at those times and access to them is inequitable across the country. We need to ensure that a specialist is available at the end of the phone to support clinicians, family members and patients themselves, and that we have the workforce available to come out to deliver changes to medication or an escalation in care. It is crucial that this is not a nine-to-five service, but a 24/7 service.

Finally, I want to mention bereavement. Bereavement support varies and is often underfunded, if funded at all. Grief costs the economy £23 billion a year, but it costs individuals far more. It can be complex and have a profound impact, especially on children. It is vital that we commission appropriate bereavement support, including counselling and, for some, social prescribing.

In conclusion, palliative care affirms life and regards death as a normal process. It neither hastens nor postpones death. However, to date, access to palliative care has been inequitable. This debate must be a catalyst to providing outstanding care. Our ambition must go beyond the modern service framework. Our duty is to secure excellence in life, until the final breath is taken.

[Several hon. Members rose—]

--- Later in debate ---

[Karin Smyth]

My hon. Friend pre-empts my next paragraph; I thank him for his contribution.

As part of the development of the MSF, we will be looking at some of the important aspects of care that my hon. Friend the Member for York Central mentioned, such as early identification of need, care delivered closer to home by integrated generalist and specialist teams, and strengthened out-of-hours community health support, including a dedicated phone line. I assure the right hon. Member for New Forest East that children, parents and carers will be included in that endeavour. As my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) said, the experiences of people like Amy inform such work. Let me say to my hon. Friend the Member for Alloa and Grangemouth (Brian Leishman) that the experience of Calum and the Turner family must not be repeated.

Hospices do an amazing job for people at the end of life, those with life-limiting conditions, and the whole community of family and friends who support their loved ones on that journey, including through bereavement support, as we have talked about today. The quality of care, the compassion and the love that hospices provide are second to none. We absolutely recognise that the sector faces challenges, and we are determined to work with all our partners to understand those challenges. We are not talking about spending more; we are talking about focusing on the money we have at the moment and spending it better. We are developing a values-based, outcome-focused financial model to reflect people’s experience of care throughout their lifetime. While there are no easy answers, we are supporting them with record funding and reform.

[Rachael Maskell]

I am grateful to the Minister for her speech, but we have heard throughout the debate that 100,000 people are not getting the care they need. One in three people needs additional support. By maintaining the financial cap, how are we going to build enough capacity to ensure that everybody has access to excellent care at the end of life?

[Karin Smyth]

I thank my hon. Friend for her contribution. This issue warrants a longer debate, so that we can understand how to move the resources that exist. As we have heard this afternoon, when people are unnecessarily admitted to hospital, which is terribly distressing for them and their families, the resources follow them. It is about moving those resources towards neighbourhood health services, in which this cohort of people will be absolutely central, as I have said. That is what we need to be doing, and we will continue to discuss this with people as we move the service towards being community-based.

Colleagues are right to champion their cause in the House today, and we will continue to work on this issue to make sure that people have good-quality care across the country. Given the measures I have outlined this afternoon, I hope Members will agree that we are listening. We look forward to working with colleagues to make sure that we develop these services for the future.

[Rachael Maskell]

Will the Minister give way?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The Minister has finished speaking, but the hon. Member does get to wind up the debate.

[Rachael Maskell]

I thank all hon. Members for their contributions. We have had 20 contributions to the debate, with 12 excellent speeches from Back Benchers; I have to say that it has been a debate of the highest calibre. I heard so clearly such praise for the staff working in palliative medicine right across the country—in Scotland and in England—and I thank them myself, too.

I particularly acknowledge the speeches made by my hon. Friends the Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer), who talked about the loss of their mothers, with very contrasting experiences. That demonstrates the inequity across palliative medicine, and it cannot be right that people are not getting the care that they absolutely must get.

I wanted to ask the Minister a follow-up question about how the transition takes place. If we do not frontload the funding, we will never see the development of community provision, because we will not be able to pull people out without the resourcing in the community. The challenge really arises from the whole model, which was the emphasis of my speech. I trust we will look very carefully at enabling the flow of patients into the community and getting care in the right place, but also at the sufficiency of funding, as so many hon. Members said, to ensure the excellence of the care itself.

We also heard about the challenges that all hon. Members have had, whether for child or adult services, and we need to ensure that we train the workforce and have a sufficient workforce in the future. We need to get the commissioning right, and address those very pertinent issues. Above all, we must invest in the time and the compassion that is needed to give families and patients excellence in palliative care. As a clinician, I have witnessed working with people at the end of life. In such special moments, the whole workforce crowds around the patients, and supports them and their families. It is so moving, and today I also heard my hon. Friends’ moving reflections, which is what the debate is all about. It is about ensuring that we have those really special moments at the end of life, and we should really invest in that time so people can have those memories and cherish everything they possibly can.

We have debated assisted dying so much in this place over the last year or so. I have heard so many examples of poor care, where I know that specialist palliative medicine could have made such a difference to the individuals. That is why today’s debate is not only timely, but necessary. We must really invest so that everyone has the opportunity to receive that amazing care, love and support at the end of life, and so they do not have to even contemplate assisted dying. I think we have a responsibility to put this front and centre. Let us move on from the debate on assisted dying to make sure we get care right for everyone.

I want to close by saying a huge thank you to everyone here; I really do appreciate it. I should put on record that I am the co-chair, with Baroness Finlay, of the all-party parliamentary group on dying well. I invite all hon. Members to join us as we really try to advance this debate.

Question put and agreed to.

Resolved,

That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.

National Cancer Plan

Rachael Maskell Excerpts

Thursday 5th February 2026 Commons Chamber

[Ashley Dalton]

I offer the hon. Member my deepest condolences on the news that she has shared with the House. I share her concern that we have to reach others. Some less survivable cancers can be tackled if they are caught early, and we have specifically committed in the plan to reducing significantly the number of rare and less survivable cancers that are diagnosed in an emergency setting, which she described as happening to her family. Primary care is where most people first raise concerns. GPs rarely see rare cancers, because they are rare, so we are rolling out AI-driven decision support tools to help GPs think cancer sooner, think cancer earlier and make decisions about referral more quickly.

[Rachael Maskell (York Central) (Lab/Co-op)]

I, too, thank the Government for bringing forward this cancer plan. I visited York Against Cancer’s Leveson centre last Friday, and I really welcome the holistic care it gives to cancer patients. I want to highlight prevention. We know that four in 10 cancers are preventable, and the right interventions can be transformative, particularly for people from low socioeconomic communities. Will the Minister talk a little bit more about the public health approach that will be taken? In York we have seen a 30% cut in our public health budget over the past 10 years, which means less resource is available to prevent cancers.

[Ashley Dalton]

Prevention is a key part of this plan. As I have mentioned, we are doing an awful lot on that—for instance, on illegal under-age sunbed use. We are also eliminating cervical cancer through HPV vaccination and tackling obesity. Fundamentally, we are creating the world’s first smoke-free generation with our groundbreaking Tobacco and Vapes Bill. We do not ignore the communities hit the hardest, and the cancer alliances are promoting new schemes to enable young people to catch up on vaccinations, such as HPV, that they may have missed. We are tackling harmful alcohol consumption by introducing new mandatory health warnings and nutritional information on alcohol labels. We have reformed the public health grant in recent years—we have wrapped it up—and many places have seen an overall increase. We are also giving local authorities more flexibility in how they use their public health grant and, for the first time in many years, multi-year settlements so that they can plan.

ADHD Diagnosis

Rachael Maskell Excerpts

Tuesday 20th January 2026 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

Thank you, Ms Vaz. It is a pleasure to see you in the Chair. I will be brief. In York, we know that children are waiting for two and a half years to get an ADHD diagnosis. Adults are not even on a waiting list; they are literally in a car park. They fill in a form and then they go no further, although I am assured by services that if people face a crisis, the services will be there—although I am less than convinced of that. In York, therefore, we have been thinking about how we can reconfigure services.

This is my specific ask to the Minister. We know that, over a child’s life, the local authority is the controlling mind in providing holistic support for children, particularly those with special educational needs, yet we have a segregated service in child and adolescent mental health services. The two services are not integrated and, as a result, we are not looking at a child holistically. We are seeing them in two sections: their mental health and their holistic needs. That does not work. Therefore, I ask the Minister: can we bring those services together, at least through a formal partnership? If not that, can we put the controlling mind under the director of children’s services, to ensure that they can deliver for that holistic need?

As my hon. Friend the Member for Sefton Central (Bill Esterson) said so eloquently, we need to ensure that the functional needs of those children are met. A diagnosis, of course, is an important part of that pathway, but when we are talking about people across a whole spectrum of needs, a diagnosis only partially describes the needs of an individual.

If we are able to build the holistic support that a child needs, we can ensure that a child gets the security they need in a timely way, integrate that with the rest of the work being done on SEND by the Department for Education, and ensure that we really see the integration and transformation that this Government can bring.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 13th January 2026 Commons Chamber

[Wes Streeting]

This Government are putting record levels of capital investment into the NHS to correct more than 14 years of Conservative failure. We are using public investment. We are certainly learning the lessons of the past in relation to PFI. We are able to do that only because people voted Labour and elected a Labour Government. I look forward to working with the city’s Labour MPs to deliver the improvements in services that it deserves.

[Rachael Maskell (York Central) (Lab/Co-op)]

To date, Baroness Casey’s review of adult social care has been pretty impenetrable, but in York we want to engage and innovate. Will my hon. Friend provide Parliament with a briefing on the progress, scope and scheduling of the review? The clock is ticking and the crisis is growing.

[Stephen Kinnock]

My hon. Friend and I have discussed this matter. I hope that her issues in accessing the commission, which I know has made contact with her, have been resolved. The commission is, of course, an independent body, but I am in no doubt at all that parliamentarians will hold it to account through the mechanisms at their disposal—the Select Committee, for example. The Government are not sitting on our hands; we are delivering the fair pay agreement, we have delivered the biggest uplift to unpaid carers since 1976, and we are pursuing a range of other measures to get our adult social care system fixed and fit for purpose.

NHS: Winter Preparedness

Rachael Maskell Excerpts

Monday 15th December 2025 Commons Chamber

[Wes Streeting]

There is no shortage of the vaccine, which makes things even more frustrating for our constituents, and for the hon. Member; they know that there are flu vaccines available, but they are not in the right place at the right time. I am extremely sorry that her constituent has suffered that inconvenience and setback three times. She has placed her concerns on record, and we will look at what has happened in her constituency. We will look at the supplies, and I will make sure that my Department works with her to resolve that situation. More generally, where we have seen reports of shortages, or of suppliers being caught short, we have acted rapidly to remedy the situation.

[Rachael Maskell (York Central) (Lab/Co-op)]

I refer the House to my entry in the Register of Members’ Financial Interests as a former leader on healthcare in a trade union, and also as a clinician in respiratory medicine. I am deeply concerned about patients right now. I recognise that the Health Secretary shared a lot of information with the House on Wednesday evening about how he wants to take things forward. Could he set out the process of engagement, not least with ACAS? Could ACAS sit down with the BMA, and work through the proposals to see if they could be enhanced or tweaked, so that we achieve the right resolution for patients and the NHS, and abate these forthcoming strikes?

[Wes Streeting]

I have lost count of the number of times I have met the BMA personally, or spoken on the telephone, including as recently as this afternoon, with the chair of the resident doctors committee and his predecessors. Of course, we are always willing to consider bringing in people who can help to close the gap between those on either side of the table. In the past, the BMA has not been too fond of ACAS. We will let this round of strikes pass. Our first priority now has to be managing our way through this period and recovering the NHS into the new year. There will then, by my reckoning, be at least six weeks without strikes, and of course we will do our best to resolve the situation with the BMA.

I would just say to my hon. Friend, to the House and to the BMA that there really is not much further for the Government to go. We have given a 28.9% pay rise already. The BMA wants to talk about future years’ pay, but we have not even had a recommendation from the Doctors and Dentists Review Body. I think it is extraordinary that BMA members are out on strike on pay after the 28.9% pay rise. On jobs, the BMA peddles to its members the idea that there were just 4,000 extra specialty training places up for grabs; it seems to completely sideline the point about emergency legislation to deal with UK graduate prioritisation, which is exactly what it asked from us, in all the meetings that I had with it. Since it has rejected that offer, it should not expect to see the legislation. If BMA members want to see the Government move forward constructively with them, they really need to stop striking, stop harming the NHS and maybe start thinking about patients while they are at it.

Children of Alcoholics

Rachael Maskell Excerpts

Wednesday 26th November 2025 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

I am really grateful for all that the hon. Gentleman does in this place. I want to raise the issue of foetal alcohol spectrum disorder. We know that its prevalence is now 4%, which is higher than autism, and there is no screening programme for pregnant women, as the hon. Member for Strangford (Jim Shannon) just mentioned. It is really important that we understand these issues and find a sensitive way to protect children from developing such a disorder.

[George Freeman]

The hon. Lady makes another excellent point. As I know the Minister and his Department understand, not only is there no magic bullet but many of these issues circulate and form secondary complications that cost—which is the least of it—huge amounts to the health system later.

I will touch on some of the mental health issues. In our society, 80% of us are reasonably lucky, but 20% of us struggle to escape these difficult syndromes related to living with addiction or suffering from mental health. Many of our prisoners are people who are still suffering—they are prisoners, actually, of mental health and addiction—and many of our children are born to parents who have no chance of giving them a start in life. There is a circularity here that drives a lot of underlying health conditions, predispositions and comorbidities.

Without indulging my own back story too much, I want to make the point that this affliction knows no class or geographical boundaries. When I first joined the all-party group back under the coalition Government as a newly elected Conservative MP, I went with some trepidation because it was—very proudly—led by Labour MPs pointing out that poverty is a major cause of addiction and alcoholism, and they were right. The point I made was that it is a curse that goes across our society, too.

I was very lucky to have one of the most materially privileged childhoods—packed off to the greatest schools money can buy and given all the material support—but as a child in a family of two alcoholic parents, in the end it does not matter. If you are suffering that experience, you are lonely and you are on your own. I acquired at a very young age a habit of spotting which adults could see below the line. By that I mean those adults who would look at an eight-year-old, see what was going on and quietly acknowledge it, saying, “And how are you, young man? Things can’t be easy.” That is all you need as a child—to know that somebody has spotted it.

Children are very loyal. The last thing they would ever do is dob their parents in. In fact, it is quite the opposite: many children end up having to lie for their parents to get them out of difficult situations. Those are habits that no child should learn. The thing I learned above all is that there are two types of adults: those who understand—who look, who acknowledge, who see—and those who do not see below the line. That is not shaped by class or geography at all. It is the same in this House: there are some colleagues who really understand the importance of children, who do not have a voice in here unless we speak for them.

I am speaking today on behalf of all those children, wherever they are, whoever they are and whatever background they come from, to let them know that we are listening. This Parliament is here to speak for them. They may not vote, and they may feel silent or unheard, but it is not the case. Many of us here do understand and want to help them.

You probably know a child of alcohol, Mrs Harris, as do colleagues. I say that because people often say, “No, I don’t.” Well, they probably do, because there are sadly over 2.5 million children in this country who are living not with parents who drink a little bit too much—that probably applies to many of us—but with one or two parents with a serious alcohol dependency problem.

Alcohol is part of our cultural history and something that we have come to live with, accept and in many ways encourage as part of our society. However, that often means that we forget the difficult consequences for the children who live with the aftermath, whether of social drinking, binge drinking, the habits that alcoholics acquire—the habits of deceit and often forgetting what they said or did—or the unintended consequences that undermine their ability to parent and that lead to children normalising those behaviours. I am speaking for those children, wherever they are and whoever they are.

Myalgic Encephalomyelitis

Rachael Maskell Excerpts

Wednesday 19th November 2025 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Mr Mundell. I congratulate the hon. Member for Wells and Mendip Hills (Tessa Munt) on securing this debate, and pay tribute to her for her continued advocacy on behalf of people living with myalgic encephalomyelitis. Her work has ensured that the voices of those affected are heard at the highest levels of Government, and I am happy to accept her invitation to meet her and stakeholders, and the invitation from my hon. Friend the Member for Leigh and Atherton (Jo Platt), the chair of the APPG.

I thank all hon. Members who have contributed today, and I particularly acknowledge all the constituents they have referred to. They all deserve the very best care from our NHS. I will endeavour to respond to as many of the issues raised as I possibly can. If I have not covered something, my officials will take notes and follow up in writing.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am really grateful to the Minister. We know that, at the heart of this, we need to ensure that all clinicians have a basis of training, and that is certainly missing at the moment. We see misdiagnosis, and we see some provision, including fatigue clinics, providing the wrong interventions. Will she ensure that there is a strategy around training clinicians and making it mandatory?

[Ashley Dalton]

I will come later in my remarks to the training that is being rolled out as part of the delivery plan.

Myalgic encephalomyelitis—better known as ME—and chronic fatigue syndrome, which I will refer to from now on as ME/CFS, is a condition that affects an estimated 390,000 people in the UK. Its symptoms can be profoundly debilitating, impacting every aspect of daily life, from work and education to family and social life. For those with severe or very severe ME/CFS, even basic tasks such as sitting up, eating or speaking can become impossible. We recognise the devastating impact this condition has on individuals and families. For too long, people with ME/CFS have faced stigma, misunderstanding, disbelief and inconsistent care.

Mental Health and Hoarding

Rachael Maskell Excerpts

Wednesday 22nd October 2025 Commons Chamber

[Paulette Hamilton]

The hon. Member is right, but this is not just about a solution. A number of people in our society are living with a mental health condition, and it needs to be treated. At the moment, there are no strategies in place, but I will answer his question as I go on. I thank him for his contribution.

[Rachael Maskell (York Central) (Ind)]

I am really grateful to my hon. Friend for securing tonight’s debate. I have met York’s Community Bees, who have developed strategies for supporting people in the community. They dearly need money, because they are not only addressing mental health needs but de-risking a situation. Hoarding risks infection, infestations, fire and structural damage to homes, so they play a really crucial role.

[Paulette Hamilton]

Again, my hon. Friend raises a valuable point. The issue of financing is vital, but I will discuss that more as I go on.

Hoarding disorder is a widespread condition affecting between 2% and 5% of the population, which equates to approximately 1.2 million to 3 million people in Britain. Let me be absolutely clear: hoarding is not a lifestyle choice, or a matter of laziness. It is a complex mental health condition, deeply rooted in emotional distress and underlying trauma, often stemming from adverse childhood experiences. For hoarders, it can result in unsafe living conditions, social isolation and a diminished ability to manage day-to-day responsibilities. If left untreated, it has a huge cost for families, the NHS, housing providers and emergency services.

On top of that, hoarding is a long-term condition with few effective treatment options, meaning that behaviours are often left unresolved. My professional experience showed me the heartbreaking reality of individuals drowning in clutter, their mental health deteriorating and their relationships broken. Dealing with hoarding can be very time-consuming and expensive. Providing support falls disproportionately to ill-equipped local authorities and overstretched third-sector organisations, such as Birmingham’s Clouds End CIC, led by the inspirational Heather Matuozzo.

The challenges can be broken down into four key areas. The first area is public health and safety. Hoarding does not just hurt individuals, but has knock-on effects on the entire community. The hazardous living conditions that it creates, from severe fire risks and blocked escape routes to unsanitary and unsafe housing, pose a direct danger not only to the individual, but to their neighbours and the brave professionals, firefighters, social workers and others who are called in to intervene.

The second challenge has to do with public awareness and education. We cannot combat what we do not understand. We urgently need to educate our communities, and our frontline professionals working in social care, housing, health and the emergency services, to recognise hoarding as a mental health issue, so that we can reduce stigma and promote more compassionate and effective intervention.

The third challenge has to do with mental health and support gaps. Mental health services and treatments that address hoarding specifically remain scarce and underfunded. Many people affected feel reluctant to seek help because of stigma, lack of awareness, or fear of eviction or other legal consequences. Closing this support gap is not optional; it is essential.

The final challenge concerns the legal and housing implications. Housing providers can be faced with challenging legal situations in which tenants’ hoarding behaviours lead to breaches of tenancy agreements or safety policies. Unfortunately, these cases are too often handled through eviction or legal action, rather than support being provided, so that the root causes of the problem can be addressed. We need policies that balance legal responsibilities with compassionate mental health support. As a society, we have a responsibility to support those living with hoarding disorder. In Birmingham, the number of people needing support has risen exponentially since the covid pandemic, and the story is the same across the country, as Members have highlighted. The seriousness and scale of this issue demands a co-ordinated national response, led by Government. We need a national strategy to bring consistency, reduce risk and improve lives.

The current legal framework is simply not fit for purpose. The Care Act 2014 recognises that people who hoard may be considered vulnerable or entitled to advocacy. However, there are no national guidelines for the agencies that encounter hoarding in their work. Without guidance, responses to hoarding will remain inconsistent and ineffective. In the absence of national guidelines, agencies are forced to rely on outdated legislation, such as the Public Health Act 1936, which refers to “filthy or verminous premises”. Under these powers, a person can be forced to clear their property, even if they own it. If they cannot afford clearance, it is undertaken on their behalf and charged to the property. This approach is deeply flawed. It treats hoarding purely as a practical or environmental issue, rather than recognising that these are vulnerable human beings in need of help. Failing to recognise hoarding as a mental health condition risks traumatising individuals, worsening hoarding behaviours and, in the most extreme cases, contributing to suicidal thoughts. The human impact should not be understated. Lack of proper support and compassion leads to further trauma, distress and a greater risk of re-accumulation.

National guidelines would provide clarity on what constitutes appropriate and effective practice, a consistent framework for agencies across the UK, a balance between addressing practical risks and meeting underlying mental health needs, and clear routes for advice, support and specialist referral.

That brings me to my central ask of Ministers. We need a co-ordinated national strategy for hoarding disorder. Although the Care Act 2014 provides a foundation by recognising vulnerability, the absence of specific national guidelines leads to a postcode lottery of care, and to inconsistent and often ineffective intervention. A national framework would provide clarity, consistency and compassion by balancing risk management with mental health support and establishing clear pathways for specialist help.

I was proud that the Labour manifesto committed to recruiting 8,500 extra mental health staff, and to delivering a transformative 10-year plan for mental health. It is essential that those welcome initiatives explicitly include and address hoarding disorder.

[Rachael Maskell]

My hon. Friend is being incredibly generous with her time. Community Bees in York has helped 600 people over the past seven years. It has a lot of expertise, not just in how to sensitively support people in decluttering, but in upcycling; it makes a positive contribution by selling things on. It has sold 7,000 books, and collected 5,323 items from landfill and passed them on. That not only helps people who have hoarded, but contributes to the future. Does she agree that that should be part of the holistic model?

[Paulette Hamilton]

My hon. Friend makes an absolutely brilliant point. Yes, that should be part of the holistic model, but there is no model in place at the moment. It is like the wild, wild west—everybody is just doing as they see fit. That is why I secured this debate.

I urge the Government to prioritise the development of national guidelines, in order to equip all frontline workers with the tools to identify and address hoarding compassionately and effectively; to ensure a truly integrated, multi-agency approach that brings together mental health services, social care, housing and emergency responders; and to invest in research and data collection, so we can properly understand the scale, causes and economic impact of hoarding in the UK, and ensure that our policies are evidence-based and our resources are allocated wisely. In my nursing career, we were taught that prevention is always better than cure. That holds true for hoarding. Early intervention is more humane and more cost-effective than crisis response.

This issue has remained in the shadows for too long. We have a duty to bring it into the light, to replace judgment with understanding, and to offer a hand up to the millions of our citizens who live with this devastating condition. I look forward to hearing in the Minister’s response how the Government intend to lead this vital change.

--- Later in debate ---

[Dr Ahmed]

The impact of hoarding can be severe. The clutter can compromise hygiene, strain relationships and pose safety risks, so let me be clear: these people deserve compassion and support from this Government and from every corner of society.

My hon. Friend asks whether the Government will introduce a national hoarding strategy. There are no plans for a specific strategy, but we absolutely recognise that people who hoard must have access to the right support. At the moment, that requires more co-ordination than is currently in place. As she knows better than anyone as a district nurse and an independent lay manager, mental health services have been decimated over the last 14 years. This Government are doing the hard yards of rebuilding those services while transforming our mental health system, so people can access the right support at the right time and indeed the right place. Through our 10-year health plan, we have set long-term reforms to make mental health a core priority of the NHS and to move from crisis care to prevention and early intervention.

This transformation will include: investing up to £120 million to expand the number of mental health emergency departments to 85 across England; a modern service framework for severe mental illness to support consistent high-quality and high-value care; and, as my hon. Friend mentioned, recruiting 8,500 new mental health workers across the NHS to increase capacity and make sure help is available where and when needed.

We are already piloting six 24/7 neighbourhood mental health centres, which will bring together a range of professionals and imbibe that holistic concept—professionals such as psychologists, peer support workers, housing specialists and employment advisers. The pilots are testing out mechanisms that will enable that whole-team approach to capture people who otherwise remain hidden, including collaborative planning of care and treatment, communication and engagement, single patient records and shared outcome measures. This joined-up approach presents an opportunity for people, including those with hoarding disorder, to be identified and to get holistic support and treatment, and then to better join up between social services and mental health support.

We know, too, that there are people in contact with social care right now who have a suspected hoarding disorder. Digital social care records, which have been implemented by 80% of Care Quality Commission providers, are already improving that quality and safety, and that personalisation of care. We are also investing in the development of a national infrastructure for social care, which will lay the foundations for ensuring greater interoperability and integration between care and health services, so that, again, fewer people slip through the net, as is often the case with hoarding disorders.

People who hoard may be isolated, may not recognise their behaviour as a problem and may be reluctant to engage with services. That is why safeguarding plays such an important role. The Care Act 2014 and its statutory guidance make clear that self-neglect, which explicitly includes hoarding, is a safeguarding concern. Where a local authority has cause to suspect that an adult appears to be at risk of self-neglect and is unable to protect themselves as a result, that authority must carry out a safeguarding inquiry. The purpose of that inquiry is to establish what action is required and by whom, and to keep that person safe and ultimately get them the support they need. The guidance also advises that each case of self-neglect should be assessed on an individualised case-by-case basis. Professionals, whether social workers, carers, housing officers, emergency services or clinicians, have a responsibility to spot the signs, raise concerns, and support people and direct them towards help.

One of the most effective treatments of hoarding disorder is cognitive behavioural therapy, otherwise known as CBT. CBT is a form of talking therapy that helps individuals to understand the thoughts and feelings that influence their behaviour and supports them gradually to make practical changes to their living environment. Through NHS talking therapies, people with a hoarding disorder can access evidence-based psychological interventions such as CBT.

This Government are expanding access to talking therapies this year and have committed to continuing this expansion over the coming years. We aim to increase the number of people completing a course of talking therapy by 384,000 by the end of this Parliament and to increase the number of sessions someone can access, meaning that more people will be able to access timely and high-quality mental health support in their local area, and that these services can be accessed not only through their GP, but through self-referral.

We know, however, that accessing these services can be difficult for those who feel isolated or who feel shame about their condition. As advised by national charities, therefore, during National Hoarding Awareness Week, we encourage friends and family members of people suspected of having a hoarding disorder to gently encourage them to speak to their GP, who can help to assess their needs and refer them to the appropriate mental health and community support. No one should face this condition alone.

Of course, hoarding can also be associated with serious mental illnesses, including severe depression and obsessive compulsive disorder, which can require more specialist or intensive forms of support. That is why the Government are transforming services for people living with severe mental illnesses by investing in new models of integrated community care, expanding priceless support and increasing access to physical health checks and tailored interventions.

At its heart, this debate is about dignity and compassion. We are talking about members of our own communities who deserve the same compassion, care and support as anyone else with any other illness. The Vice-Chair of the Health and Social Care Committee, my hon. Friend the Member for Birmingham Erdington, deserves real credit for her work on this issue. We will continue to work with her, mental health professionals, voluntary organisations and people with lived experience to smash the stigma while improving access to care.

[Rachael Maskell]

I am grateful to the Minister for giving way. From listening to, meeting and engaging with those from York Community Bees, I know that their big cry is for funding. These people are specialists in the work that they do to support my residents, but they need funding. Will the Minister send a message to commissioners to ensure that they commission these support services?

[Dr Ahmed]

My hon. Friend brings a great deal of experience in these matters to this House. I can certainly give her an assurance that as part of this Government’s 10-year health agenda, we encourage all commissioners to commission strategically on the basis of what will prevent ill health in the long term. I believe this issue is an exemplar of where we could think about commissioning mental health services differently to try to pick up the signs earlier.

For too long, people with mental health conditions, including those who hoard, have not received the understanding or support that they deserve. I want to end, however, on a note of optimism. With love from families, patience from friends and the ongoing support of charities and third sector organisations, countless people with hoarding disorder have managed to live safe, healthy and fulfilling lives. We will continue to work closely with these partners, local authorities and charities to ensure that this Government are also playing our full part.

Question put and agreed to.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 21st October 2025 Commons Chamber

[Karin Smyth]

All of us as constituency MPs are fully aware of the state of mental health services, particularly for young people, which is why my hon. Friend the Minister for Care is working at pace on our manifesto commitments to support young people, particularly through schools. We also understand the difficulties that her ICB in particular has with its financial situation—something we are also targeting as part of our reforms to ensure that ICBs develop services for local people in line with the expectations that we have set them.

[Rachael Maskell (York Central) (Ind)]

Likewise, in York, children and adolescent mental health services are just not working for children, who are left on waiting lists often with no management or treatment. In order really to achieve reorganisation in our NHS, would our Government look at local authorities commissioning mental health services, to deliver such services and to meet the holistic needs of young children’s development and mental health wellbeing?

[Karin Smyth]

Again, I echo comments on the state of mental health services, as the hon. Member has done. As it says in our manifesto, we are committed to those 8,500 extra mental health support workers in local areas such as hers. It is important that commissioners work closely with their local authorities on mental health services, and I know my hon. Friend the Minister for Care is ensuring that that happens as part of the reforms we are undertaking.