Children and Mental Health Services

Rachael Maskell Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths]

I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.

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

The hon. Gentleman is giving an excellent speech. In York, we have seen a 26% increase in referrals into CAMHS over the past five years. As a result of such high demand, one referral in four is turned away from the service, including children who are self-harming and have experienced abuse. Surely we need to focus on investment in the workforce, as well as on funding.

NHS Long-Term Plan: Implementation

Rachael Maskell Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

Few people make the case for their constituencies better than my right hon. Friend, and nobody makes the case for Harlow better than him. He invited me around Harlow hospital. I went into the basement to see some of the work that is needed, and the basement of Harlow hospital is in a worse state of disrepair than the basement of this building. That means that it needs work, so I am considering his proposal. The future NHS capital budget will be settled in the spending review, so I suggest that he has a conversation with Treasury Ministers as well. I look forward to seeing the case progress.

My right hon. Friend is also right about how important degree apprenticeships are. Both of us are former Skills Ministers and have heralded the arrival of degree apprenticeships as a route for people into high-paid, high-quality jobs without them having to go to university.

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

Delayed discharge has a knock-on effect on the whole NHS. The fact that the Secretary of State has said today that all he will do is review the better care fund and that he will not publish a White Paper on social care shows what a low priority this is. When will we see the White Paper on social care for which we have been waiting not just months, but years?

[Matt Hancock]

The statement was about the implementation of the NHS long-term plan, to which of course the future of social care is vital, which is one reason why the spending power available within social care has risen by more than 10% over the past three years. We continue to work on the long-term future of social care. We will have to wait for a new Prime Minister before publishing the Green Paper—I think that is fairly obvious—but it would also be good to get a bit of cross-party collaboration. When my right hon. Friend the Member for Ashford (Damian Green) made some proposals that were in line with the cross-party work of two Select Committees of this House, within half an hour the shadow Secretary of State’s friend, the shadow Chancellor, had rubbished the idea—I do not think he took the time even to read it. We could do with a bit of cross-party work on the future of social care in this country.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is quite right to celebrate the development of the NHS app. More than 80% of people are now able to use the NHS app to link to their GP practice. Our plans for the year ahead include API-based connections to a number of third-party products, including the NHS app. More importantly, I want the opening of this system to allow other innovators to be able to develop products for patients to use in a way that we have not imagined before. I want a load of innovations so that people can get the best possible access to their NHS.

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

T6. In York, it has taken 46 weeks for children and young people to commence the diagnosis process for autism—and demand and the number of referrals is going up. It takes a further 12 months, once there is a positive diagnosis, for parents even to access the SEND—special educational needs and disability—course. Precisely what service improvements can families expect to see in the next 12 months, and how will they be achieved?

[Caroline Dinenage]

The hon. Lady is absolutely right to draw attention to this issue. We are very concerned about the diagnosis times, which is why we are reviewing our autism strategy this year and are extending it to include children, whereas before it catered only for adults. We want to ensure it remains fit for purpose. We have launched a national call for evidence and have already received in excess of 1,000 responses.

Cystic Fibrosis Drugs: Orkambi

Rachael Maskell Excerpts

Monday 10th June 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bailey.

Leading up to this debate, I spoke to constituents, one of whom described the mental strain of knowing that a drug was available but could not be prescribed to their child. Another parent talked about the administration of 22 drugs, and the physio and hospital appointments that were needed, as well as the stress of their child being admitted to hospital. Their child is now 21 years old and there have been no changes, even though there is a miracle drug that could transform their life. Another constituent, Jack, who is seven years old and at the start of his journey, desperately wants hope for his future.

We are at the cutting edge of a generation of pharmaceutical breakthroughs that have the power to transform the lives of people who experience a range of medical diagnoses. It is an exciting point in our journey with medicine, and it could be transformative to patients and carers. To deny therapy is ethically abhorrent. Many Members today have said that this is about negotiation, but I say that negotiation is not the answer. We should not be wrestling over drugs time and time again; we need a completely different framework for addressing the cost of pharmaceuticals.

NICE needs an overhaul to ensure it is fulfilling its role and looking at patients’ life course. I know that it does that work, but it needs to look at its effectiveness over a patient’s life course and at the economic value it can bring not just to medicine, but to the wider economy. It also needs to ensure that the levers are in place for it to look at a portfolio of drugs, as opposed to looking at drugs one by one.

We need to understand how much the NHS can afford to pay for the benefits of new drugs, taking into account the health benefits that could be achieved with the money the NHS must find to pay for them. This assessment, based on a NICE appraisal, could inform a debate about national rebate agreements in the current pharmaceutical price regulation scheme. There are several costs involved: the manufacturing cost, the price the NHS can afford, the NICE assessment and the market price, which is driven primarily by the US market. That is a cause of frustration.

The argument among academics is that a mechanism of a national value-based rebate should reflect the difference between the amount the NHS is willing to pay for the benefits and the manufacturer’s asking price. That would provide better incentives for manufacturers to make long-term investment choices, recoup costs and deliver for the NHS. It would also provide fairer rewards for innovation; manufacturers that produced more effective drugs at affordable prices would not need to pay a rebate, but those that charged more would pay a higher rebate. That would not impact the list price for the global market, and the rebate could be spread across the portfolio to provide better opportunities for manufacturers to bring new products to market.

That would take the politics out of NICE and NHS England. Canada is currently developing something similar, to ensure that drugs reach the places they need to reach. It can be further incentivised: should a manufacturer not supply a product when its production costs mean it could do so without making a loss, it could lose its patent. That would provide the required leverage. We need to hold discussions about this not just across the sector, but with the European Medicines Agency; the impact could be greater with more countries on board.

[David Hanson in the Chair]

People will have seen reports about the generic drug from Argentina, and we have heard about it in the debate today. We cannot allow inequality in access to pharmaceuticals in our country to grow, because it creates health inequalities. People who can pay will be able to afford that drug, and they will have better health outcomes. In the light of the ethics of the debate, the Department of Health and Social Care needs to move fast, now.

We need to be alert when it comes to trade deals with the United States, which is significant to the debate. The US will clearly want to drop the carrot of big pharma in front of Ministers, but that is a serious trap. The President talked about the NHS being “on the table” in his speech about trade negotiations, and we must be alert to the real agenda. It is through big pharma that he will get access to the NHS. As we have already heard, with respect to the size of the NHS drugs budget, that is a way of controlling it. We need to be on top of that.

Instead of drug-by-drug negotiation, we need a framework leading automatically to the leverage required to procure medicines. That will make such a difference. It will remove the uncertainty about different pharmaceuticals, as we move forward through the exciting developments that are taking place. Let us take the politics out of the process and enable NHS England and NICE to do their jobs, even under a new contract. I ask the Minister to do her job and to put a new framework in place.

Health

Rachael Maskell Excerpts

Tuesday 14th May 2019 Commons Chamber

[Matt Hancock]

We have not discussed obesity much during this debate, but the Government have a whole programme to tackle it. That includes tackling advertising and, in particular, tackling the pro-obesity environment in which too many children grow up. There is a broad range of actions on our agenda, with more to come.

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

Will the Secretary of State give way?

[Matt Hancock]

I will give way one final time, but I want to leave some time for Back-Bench speeches.

[Rachael Maskell]

The Secretary of State has boasted about the amount of money that is going into the NHS, but the Government have transferred public health services to local authorities, whose funding is being slashed, and as a result funding for those services is also being cut. Can the Secretary of State say how much of that NHS money will support the role of local authorities in delivering the public health agenda?

[Matt Hancock]

Local authorities and the NHS work very closely in delivering a huge number of services, and authorities often commission services back from the NHS. I can tell the hon. Lady that between 2013 and 2017, the number of attendances at sexual health centres increased by 13%. The suggestion made by many Opposition Members that there has been a cut in the number of such attendances is not supported by the facts.

We will not rest until we can solve these problems.

--- Later in debate ---

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

It is always a pleasure to follow my hon. Friend the Member for Heywood and Middleton (Liz McInnes), who brings her health expertise to this debate.

The discord between the Government’s narrative and reality could not be more stark. The long understood centrality of public health to addressing health inequalities was ably brought to the fore by Michael Marmot’s report a decade ago that highlighted the social determiners of poor health. We therefore cannot just look at health in this debate; we have to look at the wider impact of health across our society.

Of course the Government’s 10-year plan and long-term approach are welcome, but the reality is that there are serious funding cuts to the delivery of public health by local authorities. Half a million pounds is proposed to be slashed from York’s public health spending, which will have an impact on the services to be delivered.

Public health is about the long term, and the disadvantage for local authorities is that, with their strained budgets, they are having to focus on the emergencies today. Of course, local authorities have no levers over the NHS, which ultimately picks up the tab for the failure to deliver a public health agenda. Controls over the system is not in the right place.

Of course, the advantage of moving public health back out of health and into local authorities is that it impacts on education, the environment, the economy, housing and the wider community. We are deeply worried about the ending of public health grants. To date, there is no clear vision of how public health will be funded as we move past the comprehensive spending review. The clock is ticking and plans need to be made now.

In York, the health inequality is eight years between Clifton, the poorest area of my city, and the richest area. The council has slashed long-term contraception services, which has meant a rise in the number of unwanted pregnancies. Health checks have been cut, although they are a major intervention in prevention. We have also had smoking cessation services ceased; in 2010, we had 1,948 people using the smoking cessation service, whereas last year we had just 92.

On substance misuse, I must thank my friend Councillor Michael Pavlovic, whose forensic scrutiny of drug and alcohol service funding highlighted the serious £550,000 cut over a five-year period when usage was at a crisis. Shockingly, the drug death figures for York are the worst not only in Yorkshire, but in the whole country. The Government have not been taking a public health approach to substance misuse and it is vital that that now moves into a public health arena.

We have also seen alcohol being used hazardously in York, with 7% of my constituents—15,000 people—doing so. Some 10% of accident and emergency admissions were alcohol-related in 2014, and in December last year it was found that 33% of admissions to York Teaching Hospital involved people who were using alcohol. Of course, that leads to premature death. We also see the impact it has on the criminal justice system, with 75% of arrests involving alcohol. Alcohol is the influencing factor in a third of crimes. So investing in public health saves not only NHS spend, but wider service spend. Of course alcohol has an impact on the safeguarding of young people. In York it also has an impact on domestic violence. Yet York has 799 premises that sell alcohol. We know there is cost, risk and devastation, and we know there is an impact on wider public services, families and wider society. We therefore need a more comprehensive approach and properly funded public health services.

I ask the Minister whether the Government will look again to ensure that there is a comprehensive screening programme for people across the country, so that they can check in at the key point and transition phases in their lives to ensure their mental and physical wellbeing is reinstated. Local authorities being able to cut these services is of serious detriment.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

Mr Speaker, I am glad that you have used your considerable flexibilities to bring this question in, because I wanted to say that NICE is in the process of developing a guideline on the management of chronic pain, which will look at the biological, physiological and social factors, including some treatments mentioned by my hon. Friend. There is progress in this space, and I am glad that we have been able to raise this matter in the House today.

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

As well as looking at best practice in the NHS, it is vital that we look at best practice in social care. Given that 70,000 people with dementia were admitted to hospital unnecessarily with falls, dehydration and infections just last year, how is the Secretary of State going to put a laser-beam focus on standards in social care?

[Matt Hancock]

The hon. Lady is absolutely right. I am glad that this discussion of improving quality across the NHS and social care has united the House in its enthusiasm to see best practice and ensure that people learn from it. We have seen an awful lot of learning in social care, as most social care is delivered by private sector providers, but there is more to do and there are different levers that we can pull. When social care providers lose their good or outstanding status, they also often lose their contracts, so there is an awful lot of pressure on them to learn from best practice around the country, and I would only emulate that.

Mental Health Services: Leeds

Rachael Maskell Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Fabian Hamilton]

I thank my hon. Friend—if I may call her that—and my colleague from Leeds for her intervention, because she makes a very important point, namely that we need to begin at the earliest possible age. It is tragic to me, and I am sure to every Member of this House, that an increasing number of young people are showing signs of depression and other mental health problems, and that is evident in our schools. The role of charities is very important, but so is the role of the national health service. Although we need to support those charities, as she rightly says, we also need to ensure that we have the resources within our NHS too.

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

I am really grateful to my hon. Friend for securing this debate, because the Leeds and York Partnership NHS Foundation Trust lost the main contract with our clinical commissioning group as the result of a litany of failures in my constituency, including ignoring three Care Quality Commission reports, which put mental health patients in my constituency at serious risk. My question today is this: will the Minister review the licence of that trust to operate, or not, in light of the consequences of its actions and the harm it has caused?

Mental Health Support: Young People

Rachael Maskell Excerpts

Tuesday 9th April 2019 Commons Chamber

[Ruth George]

As a parent of four children aged between nine and 27, I agree that there are strains from modern life, but when parents need support, they find it far too difficult to access.

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

The waiting times in York are also horrendous. The funding, which has, in fact, gone down in the last year, is just £40 per child. Is not that so insufficient to match need?

[Ruth George]

Absolutely. It will not surprise my hon. Friend to hear that I will come to the issue of funding later, but that is a chronically low figure for the number of young people and children who are suffering.

The number of suicides of teenagers has risen by two thirds since 2010. I pay tribute to my constituent, who says that she is too scared to leave her 14-year-old daughter alone anymore. Having seen her daughter try to take her own life using paracetamol, my constituent is campaigning for the sale of paracetamol to under 16-year-olds to be banned. I ask the Minister to look into that.

We should do what we can to prevent access to the means for young people to take their own lives, but even more, we should look at stemming the reasons why they are driven to such desperation and making sure that treatment can reach them far earlier. Our children are suffering under the weight of demands at the same time as the people who have always been there to support them are disappearing.

Young people suffer from exam pressure, driven by school league tables. An 11-year-old in my constituency, who had always been perfectly happy and is incredibly intelligent, had a panic attack before his standard assessment tests. He said that the children knew that if they did not do well in their exams, their small village school could be driven to close through a lack of parents applying for places. Pressures on children aged 10 and 11 are just too much. My secondary schools say that children come to them in year 7 bearing such a weight of emotional stress that it is almost impossible to support.

There are higher numbers of children with special needs at our schools and less support for them as school cuts bite. There are exclusions from schools, with thousands of children taken off the roll. With fewer support staff in our schools, there is more opportunity for bullying. As the hon. Member for Strangford (Jim Shannon) said, social media enables the continuation of that bullying throughout the day and the night.

--- Later in debate ---

[Jackie Doyle-Price]

My hon. Friend makes an important point. Just as we have the 999 service for physical health emergencies, we need the same provision for mental health emergencies, and that is what we intend to deliver through the 111 service. That is a clear ambition articulated in the forward plan.

[Rachael Maskell]

The Minister said that this is a matter of clinical judgment, but clinicians are unable to make those choices if they lack the necessary staff and resources.

[Jackie Doyle-Price]

There will be cases when it comes down to a clinical decision on whether a referral to a mental health professional is needed. However, we need to ensure that mental wellbeing is embedded throughout our health services.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

My right hon. Friend is absolutely right to raise this issue. We know that the outcome of Lyme disease depends on whether it is diagnosed and treated at an early stage. That is why my Department commissioned four separate independent systematic reviews of all the relevant literature on the diagnosis, treatment, transition and prevention of the disease, which were published in December 2017 and which assess the existing evidence for the research community, research funders and the public. We welcome all independent researchers who want to do more work on that basis.

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

My constituents have faced many challenges in relation to Lyme disease. They have had to go overseas to be tested and given a diagnosis. However, the NHS does not recognise those tests. What is the Minister doing about that?

Health and Care Professions Council: Registration Fees

Rachael Maskell Excerpts

Thursday 14th March 2019 Westminster Hall

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

It is a pleasure to serve under you in the Chair, Mr McCabe. I was also registered with the HCPC and the preceding bodies. Although I am no longer registered, I recognise the impact this issue has on NHS staff.

There are nine different regulators in the NHS, regulating 32 different professions. They provide a very important function: this is about protecting not only the public, but health professionals themselves in the course of their practice. The regulators are there to set, maintain and raise standards and to give confidence to the public, as well as to hold a register and protect the title of a profession, so that other people cannot set up a business pretending that they hold the professional qualifications, which people across the NHS work hard for.

Increasingly, regulators also ensure continuing professional development. The most advanced programme of professional development has been put in place by the Nursing and Midwifery Council in recent times. The regulations around that ensure that registrants are compliant with continuing professional development. The function of regulators is to ensure that professionals who fail to uphold professional standards and their duty of care are called to account, so that sanction is applied where necessary and recourse is taken.

We have already heard that—thankfully—a miniscule number of professionals are taken through disciplinary processes. That is a tribute to the great professionalism across the NHS. However, such cases do occur, and it is appropriate that rigorous processes are in place so that individuals can defend their position and have recourse to justice before appropriate action is taken. To have someone practising who is not fit for practice risks the whole profession, so it is vital that that is put in place.

However, the cost of that process has escalated substantially, as hon. Members have mentioned. When I first registered as a physio, I had to pay only £17. In 2015, the last year that I was registered, there was a huge increase—from £80 to £90. The suggested increase to £106 is, quite frankly, unacceptable, particularly given the background, as set out by hon. Members, of a decade of pay regression, pension cuts and student loan repayments. In my time we had grants, so things have changed significantly.

More and more burdens are being placed on health professionals. That means that more risk is placed on health professionals. When we had adequate staffing in the NHS, mistakes were less frequent and caseloads were safer. Unfortunately, in many professions people’s caseloads are now too big. The pressure on those individuals increases.

I was formerly head of health at Unite. We focused on organisations’ duty of care. Managers in particular must say no to the organisation and argue the case for more staff, rather than increase the pressure on health professionals by making their caseloads unsafe—that would mean that managers were failing in their duty of care, in breach of their standards of professional conduct.

[Mike Hill]

I am also a former Unison official. In view of that, does my hon. Friend agree that, as my hon. Friend the Member for Heywood and Middleton (Liz McInnes) rightly pointed out, the professional bodies cover not only full-time and part-time staff, but student social workers and student nurses? They are under the same constraints.

[Rachael Maskell]

Students do have responsibility, but the registered health professional is responsible for ensuring that they are safe under their practice while they are training in their profession. Training the future workforce is an incredibly important additional function of health professionals.

The Law Commission came forward with a set of recommendations for registrant bodies in 2012. In 2019, we still have not seen the implementation of those recommendations in full. I would like the Minister to explain why that is the case. Implementing a substantial piece of work about ensuring patient safety should surely be at the forefront of the Minister’s agenda. I am interested to hear the reasons for the delay, and what plans there are to put those recommendations in place. Training programmes for health professionals need to focus on the ethics, behaviour and conduct of health professionals, if we want to see a reduction in the number of cases. Managing that risk is really important.

I want to raise a number of points to move this case forward. First, as we have heard, 38,000 people signed a petition to register their discontent with the fee rise. That cannot be ignored. These are valuable NHS workers. Their call must be heard and reflected on. However, the HCPC hardly seems to have taken that into consideration. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, the number of fitness-to-practise cases being taken forward—currently, 59% of them involve social workers—will disappear. Therefore, surely the registrant body’s costs will decrease. We want to hear how that will benefit health professionals.

This is a tax on professionals. Will the Minister consider funding that regulation fee through the NHS? It does not make sense for nurses, physios and speech therapists, for example, to pay a different amount. That is a tax on professionals who have put in the training and the hours, and go over and above the hours. Why can the Government not pay the amount for each health professional? More than a gesture, it is a responsibility of the NHS to ensure that its registrants, including part-time workers, have that support. I completely concur with the suggestion made by my hon. Friend the Member for Heywood and Middleton that there should be a part-time rate.

[Dr Drew]

Forgive me if I am being simple, but do we know where the extra money is going and what the HCPC is doing with it? Can it explain that? Are the Government holding it accountable? Can my hon. Friend throw some light on that?

[Rachael Maskell]

My hon. Friend makes such a good point. I wish I could explain that, but to me it seems to be more money and less work. I am as baffled as he is about why health sector workers have to pay into this institution to do less work. I worked as a part-timer when I was head of health at Unite. Although I worked at weekends, I had to pay the full fee, so I certainly understand the frustration. Of course, that mainly affects women, who are more likely to work part time.

Finally, I ask that an expansion of the number of registered health professionals should be considered—after all, this is about keeping the public safe. We should know that the title under which the professional acts is secure and represents them. Certainly psychological services, such as psychotherapists, have requested to be registered, as have community nursery nurses. It is perplexing that the registration of nursing associates on a register—not this one—has been accelerated, but the registration of community nursery nurses, who have long asked for that, has not happened.

I would go further and say that, as we are looking at the future of the social care workforce across the country, we should also look at individuals who are singlehandedly going into people’s homes but who do not have the protection of being on a professional register. Ultimately, that is about keeping the public and our health professionals safe and secure. What steps is the Minister taking to ensure that a greater number of professionals are protected under the existing regulatory regimes?