NHS Federated Data Platform

Rachael Maskell Excerpts

Thursday 16th April 2026 Westminster Hall

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

It is a pleasure to serve under your chairship, Dame Siobhain. I thank the hon. Member for Newton Abbot (Martin Wrigley) for securing this excellent debate today. I agree with every word that has been spoken about this US spy tech company, which is now deep into our NHS data and our constituents’ patient data. We have got to take the example of the Swiss Government, who withdrew Palantir’s access to their data because of the risks of US intelligence gaining access to sensitive data, the potential loss of national sovereignty and the dependence on foreign specialists.

As has been mentioned, we know that Palantir has been used in the US to power up the ICE teams in targeting their actions. I fear what a future Government could do with this data. While I am sure that this Government would not even consider such measures, a future Reform UK Government might use it to target vulnerable people. We know that there are already significant health inequalities in our health system. We can just imagine minoritised groups not sharing vital health information with clinicians for fear of what may happen in the future. That would widen health inequalities and put those individual patients at risk. As a former clinician in the NHS, I know that trust is key. If a clinician does not have the confidence and trust of their patients, that will result in worse health outcomes. In the interests of our constituents’ health, I urge the Government to end this contract.

I note that the former Secretary of State for Health who signed the contract, the right hon. Member for North East Cambridgeshire (Steve Barclay), has not turned up to this debate to defend his record. That says everything about the lack of accountability on the signing of these contracts. Palantir has eight major footprints across Departments and public services, to the tune of more than £800 million. Palantir is not the only company. Other clients of Global Counsel, such as with the pharma deals, have signed deals and are unaccountable to this House. It comes back to this question: how do we hold the Government to account for the contracts they sign? Often it feels like we are negotiating on legislation, but not on the big decisions, such as the signing of major financial contracts in the NHS.

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[Dr Ahmed]

If the hon. Gentleman will allow me, I think I will answer his point shortly; in the interests of time, we have to be careful about interventions.

We live in a fast-paced technological world, and that means that we always look to the next possible provider to provide value for money, so it is right that there are break clauses in the contract to allow evaluations to take place. I can reassure all hon. Members that, as a clinician and a Minister, my north star is always patient safety and quality, and of course value for money. If, at the point of the break clause, we evaluate and find that there are other providers that can do the job better, then of course that needs to be looked at and reflected upon. More generally, as the Minister for Health Innovation, Patient Safety and Life Sciences, I would not be doing my job properly if I did not try to champion British business at every opportunity or to champion British small and medium-sized enterprises to become British plcs. I hope hon. Members will take that as read.

The contract has extension provisions and will be reviewed in line with standard contract management processes. We will decide later this year whether to extend it. NHS England will be transparent about the process and the evidence used, as we have been throughout our regular performance reviews for this contract and the FDP.

On digital sovereignty, our priority is to give patients the care they need. As Members will no doubt understand, for some essential IT services, it is simply not possible to develop in-house solutions, as we seek the best from the market. I reflect on my own practice in Glasgow, in the Queen Elizabeth university hospital, which the hon. Member for Aberdeenshire North and Moray East seems to think has found a panacea of publicly delivered technology. I can tell him that when I walk into that hospital, I login through Microsoft Windows. Then I open a programme built by a North American tech company to order test results. Then I open another programme built by a North American tech company to look at the results of those tests. Finally, if I want to check X-rays, I open a fourth programme built by a North American technology company to evaluate CT scans, MRI scans and X-rays.

[Rachael Maskell]

Will my hon. Friend give way?

[Dr Ahmed]

In the interests of time, I will continue. I apologise to my hon. Friend.

In the future, our goal is to see a vibrant UK market in digital and technology, which would give the NHS more choices and help to improve standards. Of course, I would be unashamedly pro-British about my ambitions for that mix, because that is the way that we not only serve our NHS but also support economic growth. At the moment, what matters is who controls the data and how that is governed. I appreciate the sensitivities around that, I really do. Rightly for the FDP, this is a matter for the NHS and UK regulators.

I have also been asked about vendor lock-in and whether it is possible to remove companies like Palantir from the NHS. The answer is unequivocally yes, it is possible. Of course, it would take time and planning to safely transition from one supplier to another, as it always does in the NHS, when patient safety is the primary concern. At the moment, there are unfortunately only a small number of companies that can do what we genuinely need them to do at the scale that we need them to do it, but the contract has multiple measures built in to allow greater freedom of choice. That includes making sure that the NHS owns the intellectual property for all products and that it is possible to migrate them to other providers.

Data security is also at the heart of our health innovation programme. Protecting personal data is at the heart of the FDP and the health innovation strategy. Most importantly, we have separated church and state, in terms of service provision and data security. A separate company, IQVIA, provides the highest standard of privacy-enhancing technology for that data in the FDP, which means that we can remove personal identifiers from the data where they are not required, ensuring that privacy is maintained throughout. NHS England and NHS organisations retain full control as data controllers, including over decisions about how data is used, who can access it and which products are deployed. Palantir does not own the data, the products or the intellectual property, nor can it use the NHS data for its own purposes.

The FDP is a secure data environment. Security is built into its design and operation, and it has been through national, technical and cyber-assurance, with external oversight. It should also be understood that the FDP is only for health and care purposes; it cannot be legally used for non-health purposes such as immigration enforcement, as has been promulgated.

As Members will expect, my position on the owners and executives of Palantir is very much the same as that of my right hon. Friend the Secretary of State—we are no fan of their politics. However, the FDP, and the principles that underpin it, are critical to the future of the NHS. Palantir operates strictly within a UK-regulated contract where the NHS controls all data, access is tightly governed and information can be used only for agreed purposes that benefit patients. I would expect any member of staff who did not in all conscience feel that they could work with Palantir to raise that with their employer.

[Rachael Maskell]

I raised the issue of patient trust. We know that over 50% of the public do not have confidence in this system, so they might not share vital health information with their clinicians. As a result, will the Minister include that point in the consultation? He has only 10 months until this first period ends, so can he say more about the public perspective on the Government consultation?

[Dr Ahmed]

My hon. Friend will know that no NHS system or pathway can ever work without the confidence of the public, and that needs to be reflected in any evaluations that take place. I have heard my hon. Friend’s concerns loud and clear, as well as those of Members across the House. It is right that we look to maintain the highest standards for our NHS. It is also true that the FDP has a role to play in delivering for the NHS and helping people get the care they need more quickly and efficiently. Those are real outcomes that will improve people’s lives, all through the better use of data.

Members on both sides of the House often rightly challenge me to go further, faster on rare diseases, rare tumours and rare cancers. None of that is possible in modern medicine without data, and the analysis of data. Just as I have a responsibility to ensure that we get value for money out of all contracts in the national health service, and that we evaluate them regularly, Members also have a responsibility to be careful not to aggregate different components of the NHS and present them as a monolithic technological solution.

The FDP is, and will continue to be, an important component of delivering patient care in the NHS in England. Of course, who contracts with the FDP will be open to question as we go forward and think about future contractual arrangements. It would be disingenuous to suggest that the FDP is somehow the only technological solution or database in the NHS; there are many others that do good work—whether that is the single patient record, the health data research service, the NHS app or clinical systems for NHS primary care providers. We must be careful not to conflate one technology with the next, and in doing so, alarm citizens and patients about what is happening with their data.

I can assure Members across the House that in my ministerial service—just as in my 20 years of clinical service—my north star is transparency, patient safety, quality and providing the best care to all patients up and down the country.

Women’s Health Strategy

Rachael Maskell Excerpts

Thursday 16th April 2026 Commons Chamber

[Karin Smyth]

Again, my hon. Friend raises a shocking case on behalf of her constituents, and I agree with her and her constituent. Access to diagnostics is a key part of our 10-year health plan, which is why, as we were able to announce this week, we are rolling out more community diagnostic centres to improve diagnostic capacity more generally. I am also working with the Minister for patient safety, my hon. Friend the Member for Glasgow South West (Dr Ahmed), to look at how clinical pathways can be streamlined. That work is informing how we are developing NHS Online and making sure that we shorten those pathways, as my hon. Friend has rightly called for. All those cases—including, unfortunately, her constituent’s experience—have informed that work. We are linking our work on the 10-year-plan with that work and putting women, gynaecology and menstrual health front and centre as trailblazers, because unfortunately, those are the areas in which this work is needed. That is what this strategy does.

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

As the Minister knows, I have long campaigned around mental health. The strategy highlights that women disproportionately have poor mental health, and I welcome that recognition. However, action 49 says:

“we will improve mental health support for women and girls”,

but it does not say what the Government will do. Will they produce a strategy for delivering on this, and how will progress against this document be measured, so that we can hold the Government to account?

[Karin Smyth]

I thank my hon. Friend for her question. The document contains a long list of actions, with clear dates alongside them, so that she and others—including her constituents—can see what we are saying, and can measure progress.

National Suicide Prevention Standard

Rachael Maskell Excerpts

Tuesday 14th April 2026 Westminster Hall

[Liz Twist]

I thank the hon. Member for that question. I had great pleasure in working with his constituents on the quilt exhibition in the Upper Waiting Hall; it was a tremendous experience, and they do tremendous work. Farming is indeed one of the industries most affected by these circumstances. I certainly commend the work being done on the agricultural side, by organisations such as Yellow Wellies, to ensure that those issues are addressed.

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

I really appreciate all the work that my hon. Friend does in this area. I was very moved when a constituent, a police officer, came to me to share the experiences from his force when somebody took their life. The force did not have the tools available to support him, leading to his own mental health challenges, and to those of his colleagues. Therefore, it is really important, as part of this standard, that employers are equipped to identify those pressures—often overwork and stress, or bullying at work and the culture set in the workplace—and to then address the challenges that people face with trauma. Does my hon. Friend agree that we need that holistic approach to people’s wellbeing at work?

[Liz Twist]

I thank my hon. Friend for that question. Certainly I agree that we must do all that we can. I hope that, in this debate today, we will be able to take steps forward to implement the standard.

I want briefly to touch on the work that the British Standards Institution does. It plays a vital role in workplace standards of all kinds in this country. The BSI is 125 years old this year. I am sure the Minister will join me in congratulating the BSI on that achievement, and the enormous contribution it has made to businesses and the everyday life of people throughout the United Kingdom since 1901.

British standards have helped with everything from saving lives with medical devices to air raid shelters during the war, crash helmets and now addressing suicide. I thank colleagues from the BSI for being here in the Public Gallery today to raise awareness of their organisation’s hard work, particularly on the new standard BS 30480: “Suicide and the Workplace”. I know that the BSI has a positive impact on society through its work. As chair of the APPG on suicide and self-harm prevention, I am pleased to have supported work on that standard. I am also delighted that the House has endorsed the standard and is seeking to adopt it following internal consultation.

The publication of the world’s first standard on suicide and the workplace represents a significant milestone in supporting mental health and wellbeing at work across the UK and beyond. The BSI, acting as convenor, brought together many leading individuals and organisations to develop it. The standard itself calls for assigning a named senior leader to take responsibility for the organisation’s suicide prevention strategy and provide targeted training so that line managers are confident in spotting warning signs.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for securing this debate on a topic that is especially close to her heart and for her work more generally to promote action on suicide prevention. I am also grateful to hon. Members across the Chamber for their interventions.

Every suicide is nothing short of a tragedy. It has lasting and devastating impacts on families, friends and communities. Ensuring that the right care and support are available to someone who may be struggling when and where they need it can make all the difference in saving a life. That is why reducing the numbers of lives lost to suicide is a key priority for this Government, and we are committed to taking forward the suicide prevention strategy for England. The strategy focuses on harnessing efforts across civil society to help identify and support people at risk.

Standards such as the one produced by the British Standards Institution play an important role in raising the profile of suicide prevention in England and in supporting employers to play their part. I take this opportunity to congratulate the BSI on 125 years of tireless work, ensuring quality not only in British society, but across the world. The British Standards Institution is the UK’s national standards body—an independent organisation that develops standards that shape and encourage best practice across myriad professional sectors. The Government’s relationship with the BSI is through a memorandum of understanding, primarily to support the UK standards system, rather than to direct or enforce implementation of standards by businesses.

Decisions on adoption and implementation remain with individual organisations, although the Government may play a role in encouraging awareness of those standards to support best practice. In November last year, as we heard, the BSI launched a new voluntary standard entitled “Suicide and the Workplace”. That standard was particularly notable, given that it was not just the UK’s but the world’s first national standard supporting suicide prevention efforts in the workplace—a truly commendable achievement. My ministerial counterpart, the Minister with responsibility for mental health and women’s health, Baroness Gillian Merron, was particularly pleased to speak at the launch of that standard.

As with other BSI standards, this voluntary British standard is published as guidance; it is designed to support organisations of any size and across all sectors in strengthening their approach to suicide prevention, intervention and bereavement support in the workplace.

On uptake, I was pleased to hear that the standard has been well received so far, with more than 11,000 downloads since its publication in November. It is overwhelming to hear that businesses across the country are putting the standard into practice, including Heathrow airport and Inclusion Education, which have publicly adopted it.

The standard is advisory and is intended to be integrated into existing organisational policies and health, safety and wellbeing arrangements, and therefore to be flexible. In terms of supporting its implementation, decisions on how to use it rest with individual organisations, but the Government recognise that some employers may choose to use it as a reference point or benchmark alongside their existing workplace mental health and wellbeing policies.

My hon. Friend the Member for Blaydon and Consett knows I am not a Department for Business and Trade Minister, but I am committed to making sure that she is linked in with the appropriate Minister in that Department, particularly around her asks on how smaller and medium-sized enterprises can access and implement the standard and overcome the regulatory and financial hurdles to doing so, and I would be delighted to try to organise that meeting for her.

[Rachael Maskell]

In 2003, the last Labour Government introduced a programme called Dignity at Work. It looked at bullying in the workplace, which we know is significant, and there are a lot of parallels we can draw on. A partnership was formed between trade unions, Government, businesses and public sector bodies to implement a programme of work to address bullying in the workplace, and it was incredibly successful. Will the Minister look at the Government being more interventionist on this standard and perhaps adopting a similar programme of work?

[Dr Ahmed]

My hon. Friend is always knowledgeable about these matters and she tempts me to egress across the confines of my departmental portfolio. I am happy to cite her recommendations in my correspondence with colleagues in the Department for Business and Trade when I try and set up a meeting for my hon. Friend the Member for Blaydon and Consett.

The role of employers generally cannot be understated. As the suicide prevention strategy clearly sets out, by improving support practices and conversations employers can and do save lives from suicide. Almost three quarters of people who take their own lives are not in contact with NHS mental health services. That points to the importance of public and private sector organisations—well beyond the confines of what we see as the traditional NHS—that are well placed to reach those vulnerable people most at risk. Workplaces provide the perfect opportunity to signpost people to the support they need. Employers should support practices and conversations that help to prevent suicides—for example, by having employment assistance programmes, line manager training and support networks in place for employees. Every employee should feel supported, and every employer should ensure that support is known of and available to their staff.

As has been highlighted, we know that some sectors are disproportionately affected by suicide. For example, suicide rates in construction are four times higher than in other business sectors. The Construction Leadership Council’s mental health project has focused, through the lens of prevention, on identifying the primary root mental health causes impacting construction workers. The project, in partnership with Mates in Mind and the University of Warwick, held a series of regional focus groups with on-the-ground workers and identified those causes as including late payments, a lack of stable work, and workers having to travel and stay far away from family and loved ones. The Department for Business and Trade consulted on those issues and received around 3,000 responses. An action plan, together with a joint code of practice setting out how employers across the sector can provide a more supportive environment to address and prevent those issues specifically, will be published this summer.

With suicide prevention, we often talk about the importance of meeting people where they are. Ensuring that people are supported by their workplaces is one valuable way of doing that, and the Government are committed to finding more opportunities to ensure that every person requiring support can access it readily. For example, my counterpart Baroness Merron, alongside co-chairs Money and Mental Health, convened senior stakeholders from financial services to discuss the role they could play in supporting people at risk—both their customers and their employees. I understand there was a great appetite in the room to take further action on this matter, and Baroness Merron is working closely with officials to progress this work at pace.

I encourage all workplaces and employers to familiarise themselves, and align their work practices, with the Government’s suicide prevention strategy and to consider how they can best support their staff. I would also encourage them to consider drawing on the BSI standards as an exemplar tool to help embed suicide prevention in working practices.

Finally, as the BSI standard highlights, the importance of community, both inside and outside the workplace, cannot be overstated. That is why so many of the Government’s ambitions surrounding suicide prevention, and indeed wider prevention, hold community at their core. With our 10-year health plan, we are shifting care and support from traditional institutions into the community, and our focus is more firmly on prevention. Through the new community-based mental health centres that are being piloted, people and families can receive care and treatment when they need it, in their community, 24 hours a day, and in a much calmer environment than one finds in traditional A&E departments.

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.