Social Care Funding

Rachael Maskell Excerpts

Tuesday 1st October 2019 Westminster Hall

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

We hold this debate against the severe cuts we have seen in local authorities, with £7.7 billion taken out of the budget. Of course, we had the Dilnot report in 2011 and the promise of a social care Bill in 2012. In 2015, we had a manifesto promise; in 2017, we had the promise of a paper and then a disgraceful offer in the manifesto. In 2018, we were promised a Green Paper before the summer, before the autumn, by Christmas, in the new year and then “soon”, and then it was summer again in 2019, and of course this Green Paper has not seen the light of day. Meanwhile, 1.4 million people are not getting the care they need and 87 people each day die before they get the care they desperately need.

I want to tell the story of Mr Stewart, in my constituency. The love of his life, Nancy—they have been married for more than 60 years—was taken into hospital and then discharged to a care home. He wanted her home, and it was refused and refused, and then an inadequate trial was done without the right care support in place. He longed to have her back at home, but she was permanently moved to a care home outside Harrogate, which is over 20 miles away, and each visit costs £88. City of York Council will pay for him to visit his wife once a week, but he wants to spend his whole life with her. He pays for two additional visits despite not having the means, but the visits are all too short. He cannot afford to go every day; he cannot afford to live with her; and he cannot afford to have her cared for at home. The system is broken, and poor Mr Stewart has been broken by the system. Hope came last week when Labour announced that it will pay for the personal care that people need, which would enable Mr Stewart to live with his wife. It is right that we reform our care system and turn it into a therapeutic system as we do so.

I praise our diligent careworkers, but we must end the pressure placed on them by zero-hours contracts and short visits. They need time to care and to apply their expertise. Training should be put in their hands, so that they can be at the frontline of delivering care with confidence. I worked as a carer, so I know what it is like to work under that pressure. I then moved on to be a physiotherapist, and trying to discharge people into the system was a massive challenge. We need to respect our careworkers and pay them well. No more talking; we will make it happen. It is the right thing to do. It is the Labour thing to do.

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[Caroline Dinenage]

My hon. Friend is right to say there were teething problems, but in the most recent reporting cycle, 93% of local areas agreed that joint working had improved as a result of the better care fund. We want to use it to drive much better integration and to look at how we undertake more joint commissioning in future.

We are committed to working alongside all partners in adult social care to attract and support a growing workforce with the right skills and the right values to deliver quality and compassionate care. Earlier this year, we launched the “Every Day Is Different” national adult social care recruitment campaign to raise the profile of the sector. We have secured a further £3.8 million for the next wave of that campaign, which will start later this month. We fund Skills for Care to support the sector in recruitment and retention.

[Rachael Maskell]

Will the Minister give way?

[Caroline Dinenage]

I do not have time. We also fund the workforce development fund, and social care employers can bid for this funding to pay for their staff to gain training qualifications at all levels.

There were lots of questions raised across the Chamber, and I want to deal with them all. The hon. Member for Totnes spoke about the impact of Brexit. As the Prime Minister has said, he wants our immigration system to help to attract the brightest and best talent from across the world. This includes delivering an Australian-style points-based immigration system as a first step. The Home Secretary has commissioned an independent migration advisory committee to review this and the appropriate salary threshold. Clearly, we want to attract people to work in adult social care.

We are aware that the system is already under pressure and recognise that EU exit could add to this. We have been working on this for a long time alongside partners, including ADASS, the Local Government Association and local authorities, to ensure robust contingency plans are in place. [Interruption.] I am going to have to make progress as I will have to sit down in a second.

There is still much more to do. The funding announced in the spending round is a down payment on much more fundamental reforms to social care that we need to introduce. As the Prime Minister said on the steps of Downing Street, the Government will set out plans to fix the crisis in social care once and for all, to give every older person the dignity and security they deserve. We want to ensure that nobody has to sell their home to pay for care. The Government will not shy away from the long-term challenges that face social care. Our proactive approach to funding and reform means that we will ensure that our social care system can respond to the challenges that lie ahead with confidence that the most vulnerable in our society will be able to live with dignity and respect and receive the care they deserve.

Health Infrastructure Plan

Rachael Maskell Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

My right hon. and learned Friend makes an important point that is close to my heart, as a former co-chair of the all-party parliamentary group on dementia. I recently, or relatively recently, had the opportunity to visit Leicester Royal Infirmary, which has done exactly that and worked with the Alzheimer’s Society and others to create a dementia-friendly ward. He is right that that sort of thing should be hardwired into our designs as we upgrade hospitals.

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

Had the Minister conducted an appraisal of the full NHS estate, he would have realised that mental health hospitals are not on his list. In the light of the urgent need for a new child and adolescent mental health services unit in York, how did he miss CAMHS from his list? This will have a real impact on clinical services.

[Edward Argar]

The hon. Lady makes an important point about mental health and the services for those with mental health needs. This announcement is very much focused on acute hospitals, and investment was recently announced for mental health services in, for example, Mersey Care and Manchester. Indeed, my own county recently invested in a new unit.

The hon. Lady raises a specific point, and it would be wrong to suggest that this Government are not investing in mental health services. However, if she wishes to discuss the specifics of her constituency and of the needs in Yorkshire, I would be happy to meet her.

Spinal Muscular Atrophy

Rachael Maskell Excerpts

Thursday 25th July 2019 Commons Chamber

[Sir John Hayes]

Exactly. That is why, in the exciting conclusion to this speech, I shall make demanding suggestions. I think they are demanding because of the demands of those who need this drug, not because of any particular interest I might have in this matter beyond a passion to ensure that my constituent and others like her get what they need so desperately.

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

I am grateful to the right hon. Gentleman for introducing today’s debate. We have had many debates in the House on the procurement of drugs. I have been working with health economists at the University of York who are leading in this field. They very much recommend the model now being adopted by Canada around a national rebate scheme, which takes away some of the tension over cost that we seem to return to time and again. Is not that a way forward that the Government should at least explore?

[Sir John Hayes]

The hon. Lady had the great pleasure of shadowing me when I was at the Department for Transport, and I have had the greater pleasure of listening to her on so many subjects. She speaks with such knowledge, understanding and wisdom. Once again, she has shown all those things today.

The Government and the new Prime Minister must do as much as they can to ensure that those with rare diseases have every chance possible to live the very best lives they can. So, here is exactly what to do: first, as Spinraza has been shown to be both safe and effective, the NHS should provide the treatment for all those who would benefit from it; secondly, in addition to making Spinraza available for all, the Minister should set up a rare drugs fund, similar to the successful cancer fund, to ensure that those battling debilitating degenerative diseases are supported at every stage of their journey; and thirdly, I ask the Minister to implement an immediate review of the criteria used by NICE to determine access to new medicines.

We all want to do the right thing. I described earlier what I said was a crude approach. These things develop; they metamorphose. This is a chance to look again at how we can administer treatment to have the best effect on those in the greatest need. Hegel said:

“Life has a value only when it has something valuable as its object.”

Chamberlain said:

“In great deeds something abides.”

There is no better great deed, no more noble object, no more abiding purpose than the care for those in the greatest need. I ask this Minister to make her abiding object a war on want, a campaign against suffering, a crusade for those in pain—Madam Deputy Speaker, nothing less will do.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 23rd July 2019 Commons Chamber

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

A year on, NHS Property Services is now having to remarket the site of Bootham Park Hospital. In the light of this complete failure and the failure to listen to health professionals locally, will the Minister ensure that the One Public Estate bid is seriously considered as the sale moves forward?

[Stephen Hammond]

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

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.

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[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.