Public Health

Rachael Maskell Excerpts

Tuesday 1st March 2022 Commons Chamber

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

In the light of these really important regulations and the protections they have provided for so long, I believe it is important to scrutinise the Minister on how we will maintain public safety as we move forward, in particular for vulnerable groups who have had protections during the pandemic. For instance, there is currently no guidance in place for visitors to care homes or staff working in care homes. It would be helpful to hear from the Minister how she is going to handle that, as well as any outbreak of covid, and what forms of test and trace will be in place to address those issues.

Access to NHS Dentistry

Rachael Maskell Excerpts

Thursday 10th February 2022 Westminster Hall

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

Thank you, Mr Efford, for allowing me to speak in this debate to highlight how the dental crisis is impacting on my city of York.

Healthwatch York has been at the forefront of campaigning on dental services, and I pay tribute to York dentists and the wider dental community, who have been generous in sharing the challenges that they face on a daily basis. I have also been inundated with correspondence from constituents, asking me for help. I hasten to add that they do not want me to get out my Black & Decker. They want me to stand in the gap between my city and the Minister in order to find the solutions. It is getting harder, because dentists are disappearing, waiting lists are growing and oral health is deteriorating rapidly.

Healthwatch York carried out a study in 2018. It found that it taken over two years for 45% of York residents to find a dentist, so none of this is new. Back then, 84% of respondents had an NHS dentist; last year, that figure fell to just 59%. Of those who did not have an NHS dentist, 71% could not find an alternative. The number of people who have not seen a dentist in the last two to three years has risen sixfold. According to the national data, the number of children who have seen a dentist has fallen by 44%. In York, it can take five years before people can see a dentist, and no practices are seeing new patients. Out of 39 practices, only one is accepting NHS patients on to a waiting list, but it already has 2,000 people on it.

In the midst of this crisis, many are receiving letters to say that their NHS dentist is going private, and they are therefore left without. One constituent said that they had spent their burial savings on tooth treatment, and another extracted his own tooth. This is a time of real crisis.

Some of my constituents have found a dentist 40 miles or more away, and some say it is cheaper to travel abroad. Many have no dentist at all. The cost of living crisis is bearing down on York because of housing costs, meaning that people simply cannot afford to go private. And nor do they want to. The principle of the NHS is so important to them, so they seek solace at A&E or with their GP in order to address the pain that they are experiencing, at a time when, as we all know, oral health inequality is growing sharply.

A third of people now see a dentist privately, but 71% of them say that it is not by their choice. Accessing NHS healthcare is really important for them. People just cannot afford it any more. There is also a two-year waiting list for an appointment at the only orthodontic practice for children in York.

We need to address the real challenges. First, we need a workforce plan. Things are getting much worse. Last month a BDA survey showed that over 40% of dentists plan to change career or seek early retirement in the next year, so this is urgent. We need dentists, hygienists, technicians, nurses and receptionists. A practice in my constituency has already lost three receptionists because of the abuse they get from very frustrated members of the public. And, of course, they are only on the minimum wage. We need to fill those vacancies. One practice in York has only one and a half full-time-equivalent dentists, rather than the required six, to see 10,000 patients. This is detached from reality.

We also need to make sure that the failed dental contract goes. Since covid, things have got much worse. The need will not be addressed simply by setting compliance at 85% or, as might happen in the coming days, at 100%. Putting more pressure on dentists will make them more stressed and more sick, while also heaping more stress on their colleagues as they take up the slack. Things will just spiral downwards. That approach will not work. It provides the wrong incentives and no solutions.

In York, we have been working through opportunities and plans, because at this point it is really important to look to the future. First, we need to create a national dental service; the system is so broken that we need to build it from scratch. The service must be free at the point of need and should never be dependent on people’s ability to pay.

Secondly, the school service must be reinstated. The Government are struggling to institute the supervised toothbrushing programme that they promised in the general election. Let us get that in place, because prevention is better than cure. And while we are at it, let us make sure that older people also access those services, because poor dental health leads to malnutrition and is actually one of the leading causes of premature death in older people.

We also need to look at the new structures emerging in our health system. I appreciate that this is still going through Parliament, but the integrated care system footprint should have responsibility for those services and we need to take advantage of the opportunities. The York Health and Care Alliance will cover the footprint of our city and integrate mental health, physical health and social care—and I would add dental care to that list. Supporting the alliance will enable us to deliver an integrated healthcare service. That is, of course, important, because our mouths are not divorced from the rest of our bodies. In York we are looking at how to pull all the services together, as we have done with diagnostic and treatment hubs and vaccines. There is a community of expertise that knows about integration, and we need to make sure that it pulls things together for dental services, too.

Finally, our city has called for a new dental school. Our city’s medical school is a unique model. We believe that we should not just look around the world but grow our own talent in order to provide dental services. That is why York—along with Hull, given the shape of our medical school—should have a dental school.

Our dental service has decayed. Oral health is regressing, and now we need a national dental service.

Elective Treatment

Rachael Maskell Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

My right hon. Friend is absolutely right about the importance of making sure that every penny spent in the NHS, or social care for that matter, is spent wisely and in the very best interests of taxpayers. I absolutely agree with him on that, and that also has to translate into the ambition. My right hon. Friend, like other hon. Members, will not have had time yet to look at the plan. I am happy to discuss it with him afterwards if he wishes. I hope he agrees that it is full of ambition. Indeed, if the NHS can go much further than the targets I set out earlier, that is what we all want. As I said in my statement, it does depend on how many people come back to the NHS, and that is very hard to estimate, but I want as many people as possible to come back.

My right hon. Friend is right to raise the importance of social care and the need for much better integration between healthcare and social care. We will set out more detailed plans on just that very shortly.

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

As a clinician, I am astounded by what the Secretary of State has brought forward today. First, he talks about health inequality, then puts forward a solution that will exclude people who experience the greatest health inequality because they also experience digital inequality. Not only that, but people on waiting lists are in a lot of pain. They are put on waiting lists because of the advancement of their condition. They do not need a website; they need clinicians surrounding them to give them the physical and psychological support they need over the two or more years they will have to wait. What plans has the Secretary of State got to ensure that they get the physical and psychological support that they need over that time?

[Sajid Javid]

The hon. Lady is of course right to talk about the importance of health inequalities. I hope that when she has had time to look at the plan she will see just how seriously the NHS and the Government take that. More broadly, I will have a lot more to say about tackling health inequalities shortly. Of course, the hon. Lady is right that there need to be alternatives to digital access for those who cannot easily access digital, be it through a web platform or the NHS app. There are alternatives in place, but I hope she agrees that for those who can use digital tools, we should make them part of the offering. The new “my planned care” service will be hugely important in providing more transparency than ever before, but also in helping people prepare for their surgical procedures. She may have heard me say earlier than one third of on-the-day cancellations of surgical procedures happen because people were not prepared.

Elective Care Recovery in England

Rachael Maskell Excerpts

Monday 7th February 2022 Commons Chamber

[Edward Argar]

I can give my hon. Friend that reassurance. The clinical decision making will rightly inform the approach we adopt to the diagnosis and treatment of cancers, as my hon. Friend would expect, but he is absolutely right that we cannot neglect blood cancer in that context, and nor will we.

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

The elective recovery fund had perverse thresholds written into it, so those hospitals that really struggled and battled with the pandemic were the very ones that did not get any money. Will the Minister ensure a fair distribution of funding in his plan, so that hospitals such as my local one in York that are still battling with very high levels of covid get the resources they need?

[Edward Argar]

I am happy to reassure the hon. Lady that our approach, and that of NHS England and Improvement, is designed to ensure that all hospital trusts can make progress—hopefully rapid progress—in tackling their waiting lists and get the resources they need to do that.

Vaccination: Condition of Deployment

Rachael Maskell Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

I am happy to clarify the point raised by my right hon. Friend. The Government have made a decision on this matter, which I hope I was very clear about in my statement, but for statutory reasons there needs to be a consultation. There will be a two-week consultation and then a statutory instrument will be presented to the House and will be subject to the will of the House.

The Government have made their decision on this, and the Department will write today to all NHS trusts and contact care home providers and wider social care settings, such as domiciliary care, to make it clear that the deadline my right hon. Friend referred to is no longer applicable. I am very happy to make that clear. She has raised an important point. While the decision is subject to this House, there will be no further enforcement of the regulations, for the reasons I have set out today.

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

The Health Secretary has not only bullied and threatened NHS staff at a time when they are so fragile, but ignored the royal colleges and all the trade unions when they said that the initial statutory instruments should not have been made. In fact, he has not made it clear today that both will be withdrawn, so I ask him to make that clear. I also ask him to say whether or not all those staff who have lost their employment to date will be reinstated with continuity of employment, including their pensions and other conditions?

[Sajid Javid]

I am happy to answer those questions. First, the Government’s decision is to revoke both statutory instruments; I am happy to confirm that. On those who, following the statutory instrument on care home settings, chose not to get vaccinated and preferred to leave their job than do the professional thing and get vaccinated, that was their choice, and that does not change. That policy was right at the time—I have set out the reasons why—because the dominant variant was delta. Should those people choose to apply for a job in a care home once the restrictions have been lifted, that is a decision for them. However, I continue to encourage them to make the right positive decision and get vaccinated.

Skin Conditions and Mental Health

Rachael Maskell Excerpts

Tuesday 25th January 2022 Westminster Hall

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

Thank you for calling me in this debate, Mr Gray. I also thank the right hon. Member for Gainsborough (Sir Edward Leigh) for bringing this issue to the Floor of the House.

I want to raise the case of one of my constituents who experienced topical steroid withdrawal and the side effects of that as a result of the treatment she received for her eczema. I very much concur with the conclusions of the right hon. Member for Gainsborough on the steps that now need to be taken, not least in instituting mental health support in the care pathway.

Having been prescribed topical corticosteroid medicines over a long time, my constituent experienced a very severe reaction upon withdrawal that caused far worse symptoms than those her eczema preparations were intended to treat. The nerve pain was unbearable and inescapable; the skin split and bled; it was sore and painful. The oedema impacted on her care and was debilitating in itself. Those symptoms, exacerbated by the insomnia she experienced and by not going out—being housebound—therefore had a massive toll on her mental health.

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines have reviewed the impact of withdrawal and the over-prescribing of those preparations, which they often are because people need to treat their skin condition continually. As a result of an investigation under the yellow card system, they identified how poorly managed the condition is and how little known.

It comes back to the need for education around dermatology. At each GP practice, there should be a doctor who not only specialises in dermatology but has a good understanding of topical steroid withdrawal, who can therefore manage the pathway of patients. Patients should regularly see their GP for a review of the application of their medicine. It is even harder to trace what happens because there is no coding for this condition. We need to see coding to help to trace exactly what is happening. However, without proper research and investment in research into dermatological conditions, alternative preparations for the treatment of skin conditions are not being advanced at the pace that they should.

The debilitating process that my constituent suffered over not just days and weeks but months and years had a massive impact on her mental health. Depression is one of the side effects listed for these preparations. However, there is no point listing such conditions in the small print; we need to ensure that those side effects do not happen in the first place. We therefore need to ensure a proper review process within the education given to patients and the availability of other services.

That is why I support IAPT—improving access to psychological therapies—services being made available to people undergoing this treatment so that they can get the support they need. It is also worth noting that 81% of the people who experience topical steroid withdrawal are women; I notice that imbalance across healthcare and I will raise it every time. We continually fail on women’s health, and that needs to be looked at specifically.

Finally, I would like to say that there is good support from charitable organisations. Globally, the International Topical Steroid Awareness Network is looking at this issue, as well as Scratch That—I know it is quite a name for a charity—which does fantastic work supporting people and building a network, particularly to help people with their mental health issues. It suggests that it can advance support by building a community, but also by giving people hope. People with a debilitating illness often particularly need hope. I trust that a proper pathway for people with TSW—but, more importantly, prevention—will be developed.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

Although evidence shows that the omicron variant causes less severe disease than previous variants, yesterday in England we still had over 16,000 covid patients in hospital and over 84,000 reported cases. Plan B measures are currently in place in England, and will be reviewed before the regulations expire on 26 January. The best thing everyone can do to help to keep the virus under control is to keep coming forward for booster jabs to help to stop the spread of infection and manage the immediate pressures on the NHS.

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

I am seriously concerned about the rapidly depleting efficacy of the vaccine—at 10 weeks, between 40% and 50% protection—and therefore my question to the Minister is: what happens next? Already we are talking about a mandatory programme of vaccine for NHS staff which will see depletion after 10 weeks, but also public health measures may be removed: what next after the booster?

[Maggie Throup]

I would like to reassure the hon. Lady that the Joint Committee on Vaccination and Immunisation is monitoring this all the time, and we take advice from the JCVI.

Midwives in the NHS

Rachael Maskell Excerpts

Monday 17th January 2022 Commons Chamber

[Siobhan Baillie]

I could not agree more with both interventions. I think we are going to hear more from other Members about continuity of care, which is the way to manage pregnancy and how most midwives want to work. But that can be achieved in many hospitals and many midwife teams only if we have the staffing. Given the numbers at the moment, this is a key issue.

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

I am grateful to the hon. Member for securing today’s debate and also wish her well with her pregnancy.

I have spoken to midwives in York and visited maternity services. Many women find that they are diverted from York to other maternity services at the time of delivery—clearly, very stressful for them—because we just do not have adequate staffing. Does the hon. Member not agree that we need a proper workforce plan to ensure that women have the safety that they require through their pregnancy and particularly at the time of birth?

[Siobhan Baillie]

I think what we will hear from the Government is that there is a plan for recruitment, but we need more details. The Royal College of Midwives is certainly asking questions. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) knows from the work of the Health and Social Care Committee that when the current Culture Secretary was maternity services Minister last year, she was incredibly passionate about this issue. She accepted that the NHS was short of the equivalent of 1,932 full-time midwives—but since then, sadly, the number has fallen by a further 222, leaving the shortage at over 2,000. Since records began in 2009, the number of NHS midwives has fallen in England year on year. We are in a really difficult situation at the moment.

To put this into perspective, there were more than 613,000 births in England and Wales in 2020. At the last count of midwives in 2021, there were 26,901 in England, but that drops to 22,301 if we look at part-time figures. By looking at the birth rate and the number of midwives, we can see just how stretched midwives are.

The Association for Improvements in Maternity Services says that

“urgent action is certainly needed to shore up what seems to be a maternity service that is losing staff at a catastrophic rate.”

Over half of midwives surveyed by the Royal College of Midwives say they are considering leaving their job. I know personally a wonderful midwife, Stevie, who has chosen to retire this year, and I wonder how many midwives are making the same choice. My mother, who is a nurse, not a midwife, is choosing to retire as well. They have had a pretty tough two years in the NHS, as we know, but the most worrying feature of the RCM survey, which the hon. Member for Strangford (Jim Shannon) mentioned, is that the highest levels of dissatisfaction are among newer midwives—those who have spent five years or less working in the NHS. So we have a pipeline problem, a new intake problem and a problem with retention of experienced staff.

Vaccination Strategy

Rachael Maskell Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

It is important to go back to some of the stats I set out earlier. Those who are unvaccinated are eight times more likely to be hospitalised, and more than 60% of people in intensive care units are unvaccinated. If we can stop people getting the virus in the first place, it will not be transmitted and people will not catch the disease and be hospitalised. It is important to note that it was the will of the House to introduce that policy in December. As I have said repeatedly, the JCVI keeps all the data under constant review, which obviously has an impact on Government policy.

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

I wish to follow the question raised by the right hon. Member for South West Wiltshire (Dr Murrison), because the reality is that the facts have changed, and depleting efficacy, as well as transmissibility, is presenting a challenge for the Government and their longer term management of covid. Rather than forcing NHS staff to have their first vaccine by 3 February, which will present a massive risk to the NHS—the Government’s own assessment is that between 64,000 and 115,000 NHS and healthcare staff will be sacked—will the Government go back and review the issue, and ask the JCVI what the best strategy is for managing the pandemic from this point forward?

[Maggie Throup]

We have our plans in place. We have our vaccination programme, our testing, and our antivirals. Part of the purpose of the vaccination programme is to ensure that some of the most vulnerable in our society are protected. As I said earlier, having the vaccine as a condition of employment is about patient safety and ensuring that people who are in hospital or care homes are protected from this deadly virus.

Public Health

Rachael Maskell Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

We all want to relax. I wish I was more relaxed now than I already am. My hon. Friend is absolutely right on that, and I agree with him.

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

I appreciate that this is an escalating situation which needs urgent attention, but the fact is that if we are enabling social mixing, that is the very context in which we will see transmission, as we did with delta last December. Will the Secretary of State review these measures, as it seems that the statutory instruments before us today are already out of date?

[Sajid Javid]

It is of course important that we keep measures under review, but, for the reasons I gave earlier, I will continue to present this set of measures to the House. They strike the right balance and are a proportionate response.

--- Later in debate ---

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

I rise to express my serious concerns about the principle of mandatory vaccination, not for any ideological reasons but because it will have the contrary effect to that intended and therefore is wrong.

My concerns are first and foremost for public safety and also patient safety. That is the analysis I bring; having worked in the NHS for 20 years as a clinician, that is drilled into us from day one. The Government’s lack of strategy in managing this pandemic is astounding and they must understand that we need to get ahead of the virus in order to lock it down, as opposed to locking people, and their futures, down. A lack of consistency also continually comes through their policies. They cannot have it both ways; there must be one approach that carries that thread of containing the virus. They cannot say to one venue that they are are going to lock it down but tell another venue it has all the freedoms it needs, because that simply does not work; in fact, it is dangerous, and therefore the Government need to get a grip.

The very people we revered—who just a year ago we were clapping and calling our heroes—are the very people who are now exhausted, traumatised and frightened, and the legislation before us will sack them. For two decades I was their colleague and I know the dedication, compassion and care they give to their patients; I was their trade union leader and I know their professionalism and the sacrifice they give for the people they care for. I will not undermine that trusted relationship, which is absolutely essential in delivering healthcare in our country, and I will not ride roughshod over Labour’s NHS constitution, which pledges to assist people to participate fully in their own healthcare decisions and to support them in decision making. I will not turn my back on working people, and I will never forget my roots and those I served alongside. While the Prime Minister partied, NHS workers put on layers of personal protective equipment and fought for lives. That is what those in the NHS do: you make sacrifices and while traumatised you just keep going.

[Jeremy Corbyn (Islington North) (Ind)]

My Friend’s excellent work as a trade union leader in the NHS is well understood. She is speaking on behalf of NHS workers; has she any idea how many will be affected by this totally wrong attempt to force vaccinations and passports on people?

[Rachael Maskell]

I am grateful to my hon. Friend for making that intervention and he makes a point I wanted to make myself. The Government’s estimate on that in their impact assessment is 123,000, and even in the best-case scenario 62,000 will lose their jobs, which the NHS simply cannot afford.

[Ms Rimmer]

My hon. Friend knows about health and care workers—

[Ms Rimmer]

I apologise. I know my hon. Friend knows about care and health workers so she knows how dedicated they are; they have a vocation. Does my hon. Friend agree that the Government can and should stop going too far? Let us not break the trust between patient and worker and between Government. Let us go down the route, which has been proven to work, of persuasion and education, and ask them and work with them to distil the fear.

[Rachael Maskell]

I thank my hon. Friend, who represents her constituents so well. There is an alternative path and we can take it today. We know that the Prime Minister is allowing people to go to pubs and clubs unmasked, while he is sacking NHS staff who are wearing full PPE and testing. Some 93% of NHS staff are vaccinated; figures from the Office for National Statistics show that 4% of people are vaccine-hesitant, which rises to 21% among minoritised communities. As 22.1% of NHS staff are from minoritised communities, the regulations will target black workers. In fact, 26.8% of workers of mixed race are not vaccinated; that is in the Government’s impact assessment, which also gives the figures for black workers. The regulations therefore indirectly discriminate against black workers.

Unvaccinated staff are frightened. On Friday, I spoke to someone in my constituency who has worked for the NHS for 16 years. Her father had a vaccine. His heart stopped. Miraculously, NHS workers brought him back to life; he is now in a critical condition. She is frightened. She tests; she wears PPE; she has sacrificed everything. She will be sacked.

I want all NHS and care staff to have vaccine counselling and education with a qualified practitioner who holds the right competencies so that concerns can be explored, not with line managers, who just do not have the competencies. I want everyone to be vaccinated—I cannot stress that enough—but I want to win the trust of staff, not push them further away, as the Government’s approach will. In York, where we have focused on those trusted conversations, we have seen 99% of our social care staff vaccinated. It just shows what works and what makes the difference.

We do not want to push people further away. We want to bring them in, win their trust and win their confidence, because we will have to ask more from our health and care staff as things get harder—we certainly will if there are fewer people to deliver the service. Let us do what works—enforcement never does. The regulations are vaccine-illiterate.

If 123,000 people lose their job in the midst of a health and care crisis, it will be catastrophic, not least as people are starting to hand in their notice now. Why go through another tough winter of trauma when we do not have to? The regulations will make it worse. We know that two vaccines, or even three, will reduce transmission of the virus, so get your jabs! But they will not stop transmission, so let us move to better PPE, FFP3 masks, daily testing and better biosecurity. Rather than pushing the regulations today, I urge the Government to go away and come back to the House with a plan for us to vote on in January. That is good governance and the way forward.

As a trade unionist, I am not prepared to be complicit in the sacking of our NHS and care staff. Trade unionists fight for working people; we are never complicit in writing their P45. As a trade unionist, I came to this place to fight for working people. I therefore urge that we change course and put staff and the care that they have for their patients first.