Social Care Reform

Rachael Maskell Excerpts

Thursday 18th March 2021 Westminster Hall

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

It is a pleasure to see you in the Chair, Dr Huq. The arguments are well rehearsed, the need well understood, the unfairness deeply felt and the failure exposed in countless reports, but nothing changes. Like an annual custom, the Government announce a social care White Paper to be published later in the year, but nothing ever emerges. Meanwhile, the most vulnerable families have to pay out tens of thousands of pounds, and one in 10 over £100,000, for care by underpaid, undervalued and overworked care staff, either at home or in some institution. This year, they have even been denied seeing familiar faces—imprisoned for the crime of growing old or disabled as their lives have faded into a so-called care industry that largely seeks profit out of frailty.

We must establish the core principle that the state recognises its responsibility to care with parity of esteem with the NHS. My report into care homes in York exposed the failure of governance of funded care, with a business model that protects commissioners and providers, but not residents. We cannot continue to sell the lives of our most vulnerable in the marketplace of social care. Instead, we must make a pact with people who just want to be safe and not exploited. Principle one is that the state has the duty to care. Principle two is simple: social care must be a universal benefit. None of us knows the twists and turns of life that will lead us to need help. A caring society will reach out and meet that need.

Principle three is funding—public not private insurance. As we see in healthcare and care systems around the world, the private insurance industry’s lucrative revenue has driven the sick and the frail out of health and care. Every penny must be reinvested in enhancing care. If we are ever to bring funding together, we need to have one system. We have to be honest—high-quality care costs. And a Government will pay for what they value.

Principle four is quality. First, the care must be safe. My report into care homes showed that the larger care home companies provided some of the worst care. Secondly, the care must be person-focused and meet aspiration; it should not just meet basic need or be based on ability to pay. These are our mums and dads. We need a high-quality care standard, driving up quality.

Principle five is robust accountability. Although the Care Quality Commission has its role, I have to say that it seriously needs to beef up its whistleblowing processes; commissioners of care hide under layers of contract confidentiality. We need transparency. The sequencing of the Department’s White Papers has meant that the governance White Paper has been published before we know what the social care White Paper will say. So, can the Minister give assurances that the social care White Paper will be published before the Health and Care Bill comes to the House?

Principle six is about staffing. Care professionals must be paid a professional wage, but 1.6 million of them earn less than the real living wage and a quarter of them are on zero-hours contracts. They need associated registration to keep them and the public safe. As for insecure jobs—every person needs to know that they will be loved, cared for and kept safe when they need care.

Covid-19 Vaccine Update

Rachael Maskell Excerpts

Thursday 4th February 2021 Commons Chamber

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

Pharmacies cannot contribute in the vaccine programme unless they commit to deliver at least 1,000 vaccines a week. That precludes many community pharmacies embedded within those communities where some residents cannot access the vaccination centres. So will the Minister allow local pharmacies to work together to deliver smaller volumes, so that they can reach more residents who would not otherwise get a vaccine?

[Nadhim Zahawi]

I am grateful for the hon. Lady’s question. Community and independent pharmacies have a significant role to play; she may have heard me refer earlier to the hundreds that are already in the programme, delivering vaccines. The reason for the 1,000 vaccinations a week minimum is that, when vaccine supply is finite and every dose matters, we cannot afford for vaccines to just sit in a fridge in a smaller pharmacy. As vaccine supply begins to improve, we can look at bringing in more pharmacies. At the moment, 98% of the country is within 10 miles of a vaccination site; for the 2%, we will go to them with a pop-up site. I want us to get to a stage, once we have done phase 1, where we are maybe able to be more convenient and where people can pop into their local pharmacy once supply allows.

Vaccine Roll-out

Rachael Maskell Excerpts

Thursday 21st January 2021 Commons Chamber

[Matt Hancock]

[Inaudible.] the date when it will open. There is a huge amount of investment going into Harwell to make sure that we have cutting-edge vaccination manufacturing facilities for the future. The project is being led by my right hon. Friend the Secretary of State for Business, Energy and Industrial Strategy, so I will write to my hon. Friend with all the details.

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

I have serious concerns that, after people have had their first and, indeed, second vaccines, they will have a false sense of security about their level of immunity; we know that the efficacy even after two vaccines is not 100%. Will the Secretary of State ensure that it is communicated clearly that people will still need to follow the public health guidance of hands, face and space of at least 2 metres, even after two vaccines and until it is safe to do otherwise?

[Matt Hancock]

The hon. Lady raises an incredibly important point: someone who has been vaccinated can still catch coronavirus for several weeks. It is really important that people know that. When people are vaccinated, they are told the time that it takes and the limit of the effectiveness, especially in that early period, and they are told very clearly that they still have to follow the rules. That is an important part, especially until we can measure the effectiveness of the vaccination programme on transmission. Only yesterday, I reviewed the communications that go to people when they have been vaccinated, and they are very clear and robust, but it is important that everybody, post-vaccination, continues to follow those rules, both to bring the number of cases down because of the impact on transmission and to protect themselves. The vaccine is the way out, but it does not work immediately, and people still need to be cautious.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 12th January 2021 Commons Chamber

[Edward Argar]

I reiterate, as I did earlier, my thanks to the hon. Lady and all her colleagues in the NHS for everything they are doing. I reassure her, as I do and as my right hon. Friend the Secretary of State does at every opportunity, just how valued and supported our NHS is. We have put in place just over 1,000 additional critical care bed capacity at this time—the right thing to do. In addition, in respect of supporting staff, we are investing about £15 million—just one example—for mental health hubs and mental health support for staff. I saw, from the hospital that she works in, or has worked in, in her constituency, a number of staff—it was on the BBC recently—setting out just how flat out they are. The best way we can thank them, alongside what we are doing—I make no apologies for reiterating it, Mr Speaker—is by all following the rules to stay at home to help to ease the pressure on those phenomenally hard-working and valued staff in our NHS hospitals.

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

If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Yesterday, we launched our UK vaccines delivery plan, which sets out how we will vaccinate hundreds of thousands of people every day, starting with the most vulnerable and staff in the NHS and social care. I am delighted that across the UK 2.3 million people have already been vaccinated. We are on track to deliver our commitment to offer a first dose to everyone in the most vulnerable groups by 15 February. At the same time, I add my voice to all those who are passing on their very best wishes to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire), who is undergoing further treatment on the NHS. I personally thank all those in the NHS who are looking after him and all the other patients in their care.

[Rachael Maskell [V]]

The NHS is overwhelmed, and critical clinical choices are having to be made due to the limitations of estate and staffing. So I ask the Secretary of State if he will do two things: first, bring all independent hospitals under the NHS to provide a response to the national crisis and, in particular, provide cancer care capacity; and secondly, call all former health professionals to return to practice and re-register even if they are beyond the three years out of practice limit, so they can work with an element of supervision and no one is denied the clinical need they have.

[Matt Hancock]

Of course, all these things are being looked at. The pressures on the NHS are very significant. I also want to say to people who have a healthcare condition that is not covid-related that they should come forward to the NHS. The promise of the NHS, of always treating people according to their clinical need and not ability to pay, is crucial. It is just as crucial in these pressured times as it is at any other time. If you find a lump or a bump, if you have a problem with your heart, or if there is a condition for which you need to come forward for urgent treatment, then the NHS is open and you must help us to help you. So, yes, we absolutely will do everything we possibly can to address the pressures, including looking at the measures the hon. Lady set out, but also let the message go out that, if you need the NHS for other conditions, please do come forward.

Ockenden Review

Rachael Maskell Excerpts

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

I pay tribute to my hon. Friend for not only his work at Watford General Hospital—he is probably there more often some of the patients—but his commitment to mental health in his constituency. He has launched a programme of 1,000 mental health first aiders, which is a tremendous boost to his constituents. I am aware of his work, and I thank him for it.

My hon. Friend has hit the nail on the head. Midwifery leadership has been strengthened this year by the appointment of seven regional chief midwives, working with local maternity services to ensure the provision of safer and more personal care for women, babies and their families. I am sure that the hon. Member for Ellesmere Port and Neston (Justin Madders) had the same thoughts that I did on reading the report. There is a lack of collegiate working—“Let’s not let the doctors have this. Let’s keep this for the midwives”—and a lack of team working. The recommendations in the report put forward solutions to end that culture and to introduce one where doctors, nurses and midwifery champions work together, as a team, with the mother, who is in control of and owns her birth plan, because that is what it should be about.

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

It is devastating to read about the families involved in this. We have been here so many times. I think back to the publication of the Robert Francis report in 2013, which particularly talked about the duty of candour and the way that those issues are addressed. Clearly the system is quite passive; it is dependent on people raising concerns. What is the Minister doing to ensure that it is more interrogative of families and those involved in order to draw out people’s concerns at what is perhaps their most vulnerable time, as is the case for many women when giving birth?

[Ms Dorries]

The hon. Lady is right: there is a theme. Whether it is Paterson, the Cumberlege review or Morecambe Bay, central to all this is women, and so much of this report is familiar in that women are not listened to. The way some of those mothers were spoken to when they were delivering their babies or during the most tragic hours and days afterwards is just appalling. It is about women being downgraded almost, as though their complaints, their voices or their concerns, and the awful circumstances in which they find themselves are not worthy of the same consideration as patients in other hospitals in other situations.

The hon. Lady is absolutely right. We already have national guardians—they immediately spring to mind. We have 600 national guardians in hospitals. NHS workers wear lanyards and, when people want to highlight something that they have seen going wrong in terms of patient safety, they may speak to that person, who will assist them and raise their concerns. It is quite something when we need that, when patients need such assistance. It is also for staff to raise patient concerns. She is absolutely right—it is about listening and treating the complaints and issues of women seriously.

Covid-19 Vaccine Roll-out

Rachael Maskell Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

Some of the stories we have heard this morning have been really heart-warming, of people being able to have the confidence to do the things that in normal life we take for granted. I heard the story that my hon. Friend refers to and it was truly charming. I look forward to seeing the roll-out in Carshalton and Wallington, and then I look forward to building a new hospital in Sutton for his constituents.

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

Huge demands are being placed on our NHS staff and they are being asked to step up yet again today, so we thank them for all their efforts. Let me ask about one thing the Secretary of State could help with: instead of every vaccine being individually prescribed, he could issue a patient group directive. Is that in his plan? Will he be doing it?

Childhood Cancers: Research

Rachael Maskell Excerpts

Monday 7th December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank all hon. Members for the way they have spoken so movingly. I put on the record my thanks to Chris Copland, from my constituency, who helped me prepare for the debate, and to all the petitioners, who obviously signed the petition wanting to see real change in the life chances of children.

Grace did not lose her battle with cancer. The truth is that Grace’s battle was lost before she was even given a chance to fight. The battle was lost by the lack of research into the No. 1 medical cause of death of children in the UK: childhood cancer. I was struck by the words of Dr Jen Kelly, who told me of her little girl, Grace, and how she died in her arms, just four and a quarter years old, of a rhabdoid tumour. I am grateful to her for sharing the story of her little girl, Grace, with me. She continues to fundraise and champion the cause of all children.

Every year, 1,900 children receive the devastating news that they have cancer. Parents have to equip themselves to deal with that, often without the information that they need at that time being readily available. For Grace’s family, the time was too short, and they were simply told to do research on the internet. They have used the legacy of Grace to turn that around for other parents.

Just two weeks ago, many of us spoke in this place about the opportunity to extend research in certain medical areas. The Association of Medical Research Charities called on the Government to establish a life sciences-charity partnership fund. I listened intently to the Chancellor’s statement and was sorry that no announcement was made. Cancer Research UK alone has had to cut its research budget by £44 million this year due to covid. Charities have also lost £10 billion to date, and this year is not getting any easier for them. However, today marks the start of UK Charity Week, with its slogan, “What will you be doing?”. I put that question to the Minister, because this week again provides an opportunity for action. It is worth recalling that, for every £1 spent on childhood cancer, there is a potential £3 return, not to mention the human benefit that this brings.

There is an opportunity for us to go further. We trail behind our European counterparts in early diagnosis. A prime goal of at least catching up with all European countries would be a first step.

We also need to ensure that we are part of that global community of research, and that we play our role in leading that. Before the closure of talks with the EU, we need to make sure that opportunities to participate with other European countries are not diminished at this time but accelerated. There is hope on the horizon. There has been much discussion about Horizon research funding over the years. This new round, which is coming over the horizon, is very much related to cancer, and discussions are certainly taking place about the role it can play in advancing research into paediatric cancers. I trust that the Minister will tell us how she is participating in that debate in order to make what all of us have called for today a reality for the families who desperately need that help.

Coronavirus Vaccine

Rachael Maskell Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

I enjoyed the conversations that I had with my hon. Friend on the approach to the Division Lobby. I can confirm that the answer to his question is yes.

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

I also congratulate the scientific community on their achievements today. But will the Secretary of State look with precision at the York model of delivering contact tracing? It has been a phenomenal story. Precision of contact tracing interviews has reduced the rate right down. They need the information on day one, not after 48 hours, which is being held back, but they also need to ensure that they get payment and support for people isolating. It works, so will the Secretary of State now follow that model?

[Matt Hancock]

We will not only follow the model; we will promote it. The link between the local authority and the national system in York has indeed had the effect that the hon. Member rightly describes, and the teamwork between the two has meant that the figures in York—I was looking at them this morning—are coming right down. I pay tribute to everybody in York. It is an example of the national and local systems working together. We have to get the case rates right down all the way across North Yorkshire—indeed, everywhere in Yorkshire—and I am sure that we can.

NHS Dentistry and Oral Health Inequalities

Rachael Maskell Excerpts

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

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

I am grateful to my hon. Friend for securing this debate and for all her campaigning work on dentistry services. In York, it is really challenging to get registered with an NHS dentist, let alone access their services. One of the things that has exacerbated that during the pandemic is access to personal protective equipment for people who are overseeing our oral health. Does my hon. Friend believe, as I do, that oral health has not been seen as an equal partner in the provision of healthcare? We seriously have to address that, including access to PPE.

[Judith Cummins]

I certainly agree with my hon. Friend about access to PPE and the fact that dentistry is very much seen as the Cinderella service of the NHS.

Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70% of practices are operating at less than half their pre-pandemic capacity. The primary reason for that is the requirement for a period of fallow time after each appointment to allow any aerosols that may have been produced by treatments such as drilling or even scale and polish to settle, and then for a long deep clean to take place. The fallow period can be for up to one hour.

In October, the number of NHS treatments carried out was a third the level of the year before. In the BDA’s members survey published earlier this month, 87% of dentists in England cited fallow time as a top barrier to increasing patient access. That could be significant reduced. The number of patients seen could be increased by installing high-capacity ventilation equipment. However, the price of such equipment and ventilation is estimated to start at about £10,000, and the cost is considerably more for larger practices with a high number of surgeries.

The British Dental Association members survey shows that the majority of dental practices in England are not currently in a financial position to afford such an outlay for investment. However, the practices least likely to have had the appropriate equipment tend to serve the most deprived communities, and are also the least likely to be able to afford that investment, increasing oral health inequalities further. That vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.

--- Later in debate ---

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.

[Rachael Maskell]

Will the Minister give way?

[Jo Churchill]

I am all but out of time.

Sugar plays a crucial role as well, and dental professions are important in healthcare more broadly: diet, spotting oral cancers, diabetes and so on. NHS England is working on a number of key initiatives to reduce inequalities for children, the elderly and the frail. I know that all dentists seek to put prevention at the heart of what they do, recognising that good oral hygiene and diet are the foundation of a lifetime of good oral health.

Through more flexible commissioning, dentists can be partially remunerated for carrying out initiatives such as outreach to schools, care homes and other settings—the homeless are often very compromised with their teeth as well. I hope that provides some reassurance that we are determined to tackle both the long and short-term issues with dental access and the continuing and very concerning inequalities around health, and I am happy to continue this conversation informally.

Question put and agreed to.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 17th November 2020 Commons Chamber

[Matt Hancock]

Yes, I do, and so does the Prime Minister. We feel very strongly about this. It is so important that we have the work across the country to tackle obesity; this has only been made more urgent because we know of the link between obesity and the risk of dying from covid. I look forward to working with my hon. Friend and others to make this happen.

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

York’s contact tracing work has proved to be incredibly effective, not just in its reach but in persuading people to isolate. However, it is not getting data through until around day five, when people are having a test, and it could be so much more effective if it had that data on day one. Will the Secretary of State look at York being a pilot for having immediate access to the data and the resources necessary to get on top of this virus and lock it down?

[Matt Hancock]

I am happy to work with the hon. Lady and the director of public health in York, and obviously with NHS Test and Trace, to make sure that the link-up is as effective as possible.