NHS Outsourcing and Privatisation

Rachael Maskell Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

Will the hon. Gentleman give way?

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

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.

[Rachael Maskell]

I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?

[Jonathan Ashworth]

My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.

I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.

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

It is a pleasure to follow my hon. Friend the Member for Oxford East (Anneliese Dodds). I could not agree more with her astute analysis, which also—yet again—applied to what is happening in York.

I want to begin by thanking Pat Crowley, the chief executive of York Teaching Hospital NHS Trust, who has just announced his retirement. He has steered our hospital through unprecedented challenges. I have met the Minister to discuss so many of those challenges—the failed funding formula, the perverse financial incentives, the failed budget integration and the placing of the private profit motive at the heart of our NHS—but I am still waiting for his response to that meeting.

Let me turn to the issue of how money flows. We have talked about private finance in the NHS, but we should also bear in mind that money is not going into primary care and GP services. That is forcing people to use accident and emergency departments, which are the most expensive part of the NHS. Let us follow through the money that people are drawing down. People cannot get in through the front door of the NHS because people are not being cleared out of the back door as a result of the bed-blocking that has resulted from the Government’s cuts in local authority budgets. Those cuts have also caused public health services to be slashed so severely that a massive health crisis is being created. The shocking statistics relating to drug deaths in York are now the worst in the country. We desperately need more resources there. If we invest in people’s health, the health service will save money in the long term. Our teaching hospital is over £20 million in debt—it is the same with the clinical commissioning group—because of the failed funding formula set out under Lansley’s plans for the NHS and the ideology behind that.

I want to take on the argument that the private sector is helping the NHS. The private sector is offloading the low-risk, high-volume work from the NHS—that which under the tariff produces money and profit for the private sector. Formerly that money was invested in the most expensive parts of the NHS to stop the deficits in the NHS; the money went to the ITU, the A&E and the renal units which have a high demand for expensive drugs. The private sector sucking out resources from the NHS in this way is causing the financial failure of the NHS today. Therefore, it is incumbent upon the Minister to withdraw that failed model under the Health and Social Care Act 2012 and to ensure that instead we see real investment in the NHS, which will make a vast improvement to the health service as we move to its 70th anniversary.

NHS 70th Anniversary

Rachael Maskell Excerpts

Wednesday 16th May 2018 Westminster Hall

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

Thank you, Mr Hosie, for chairing this morning’s important debate, and I thank my hon. Friend the Member for Blaenau Gwent (Nick Smith) for introducing it in the way that he did.

The incredible tributes that we have heard this past week to Dame Tessa Jowell have reminded us what a formidable politician she was, and how she centred her work around the important agenda of public health, backed up by the epidemiological evidence. We have had so many fantastic evidence-based reports, not least the work done by Michael Marmot in identifying the importance of the social determinants of our health outcomes. We know that various agendas meet around public health—social, economic, health and education agendas, and many more. That is why it is really important that we put our focus on the whole person and the impact that life has on people.

We have seen severe cuts, not least to our Sure Start centres, hundreds of which have closed. From the evidence that they produce, we know about the real impact that they have, particularly on our young people. Health visitors are an initiative that the Government took up in 2010, following Labour’s urging that we must increase the number of health visitors. That number has now fallen, from the 4,200 additional health visitors that David Cameron put right at the heart of his Government, back to the numbers before that Government. There is a real crisis among that vital workforce, with ever-increasing workloads.

We have had workforce cuts, financial cuts and service cuts in public health. Public health is about long-term outcomes, and when we are dealing with austerity and cuts, we are looking at having to support tomorrow, not the future. Public health has been a very poor relative in the austerity programme, and I can witness that in my city. In Acomb in York, since 2011 I have seen childhood obesity more than double among my community. I have also seen health checks cut; those are vital at the age of 40 to ensure that we put people’s health back on track.

Long-term contraception has been cut, and smoking cessation services demolished—unless, of course, people pay for them. We have seen a 90% fall in the number of people able to access smoking cessation services, in an area where the number of people who smoke is higher than the national average. Those are the real consequences of cuts. In York, the clinical commissioning group denies surgery to people who have a high body mass index or who smoke, yet the support services to help people change their lifestyle and behaviours are not there any more—a complete nonsense. That is why it is really important to put the focus back on public health.

Over the past week, I was most shocked by a letter I received about substance misuse services in York. York is now 148th out of 148 authorities when it comes to drug-related deaths of people in treatment and across the community as a whole. Most people will be shocked to hear that about York, but when I look at what our local council have done in absolutely slashing funding to those vital services, I am not really surprised—and, of course, the most severe cuts are still to come. What will that mean to the people in my community whose life chances are being taken away from them?

Across mental health services, the sustained lack of investment over such a long period is having a real impact on health outcomes. People have been hurt by cuts and hurt by political decisions. It need not be that way. We all know it is the most vulnerable, the poorest, the people who really need the state’s help who fall down when the state stands back.

We have heard so much about young people in the debate, for whom interventions are even lower than for older people. For people in their latter years, public health virtually does not feature. Yet, in the health service that Bevan created, everyone from cradle to grave could access the necessary good public health services. Such interventions save the NHS so much money—it is a no-brainer—so why cut those services? That question comes not just from me, but from directors of public health I meet regularly in my constituency, and across the board. They want to understand what will happen when the public health grant is withdrawn. I hope the Minister can reassure them today that he will ensure that they will receive the funding needed to sustain services into the future. They also want to know how the Department of Health and Social Care will work with directors of public health to ensure that their long-term goals for improving the community’s public health will be funded.

We need to look seriously at the workforce in public health, which has been decimated. We have to look at funding to sustain that for the future health of our nation. We need to look at outcomes, not just inputs. Let me take the child measurement programme as an example. It is a nonsense that we know now how obese children are, but we cannot afford the interventions to change the trajectory of those children’s lives. That means that the programme does not work. We need to examine how we change the life chances of so many people across the country.

I want to touch on the 70th birthday of the NHS, which is so important for so many of us, and draw the Minister’s attention to what we are doing in York. When I heard what his Department was rolling out, I thought it quite lacklustre—it lacked ambition—so I pulled together the health leaders in York to drive forward a public health initiative to mark the 70th birthday. It includes the clinical commissioning group, the acute trust, the mental health trust and the local authority. We are working together to launch in July, as part of that fantastic celebration, a whole programme intended to transform the health of our whole community.

I have a meeting with businesses to talk about how employers can change the life chances of people who work for them. We are meeting faith and community groups to talk to them about people that they engage with. We are going to have a touring pop-up event across the city over the NHS birthday to provide advice, health checks and services, and simple programmes, because we do not have a lot of money. I know from Health questions that the Minister will meet with me, as the Secretary of State said, to talk about this initiative. We are going to have health walks at lunchtimes. We are going to have basic tests to understand health measures, as well as advice, information, encouragement and the promotion of better understanding, looking at diet, exercise, behaviour and the choices that people made. We are determined to touch the thousands of lives of people in York on this 70th birthday, because we want to celebrate the future with everyone.

We know that so many people are being failed, and the most vulnerable are being failed the most, but we can change things around. Public health does not actually cost a lot of money compared with acute services. So, I trust that from today, we will take the spirit of Nye Bevan and ensure that we invest in the very people who will depend on our NHS in the future.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.

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

Obesity- related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?

[Mr Hunt]

I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.

Privatisation of NHS Services

Rachael Maskell Excerpts

Monday 23rd April 2018 Westminster Hall

[Kevin Hollinrake]

I am very grateful for that historical clarification. One thing I used to say in my business to any people who came to me with new ideas was that ideas are 10 a penny. What matters is how we implement things. What matters is how we implemented things then and how we implement things today. That is what makes the critical difference in whether something will succeed or fail.

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

I am grateful to be able to make an intervention, but will the hon. Gentleman not recognise that the Lansley reforms, which brought in a new funding formula, have completely broken the NHS? I am talking not only about the fragmentation, but about the fact that the funding fights against itself, and therefore it is a complete distraction from providing a planned NHS service, which is the solution that is needed in the system.

[Kevin Hollinrake]

I am grateful for the hon. Lady’s intervention. I absolutely think that funding needs to be fair. There are certain instances we can look at as to whether the funding for certain CCGs in York and north Yorkshire is unfair. We need to ensure that the funding is got right wherever people are. It is incredible that we have a postcode lottery for healthcare in this country; things differ in different parts of the country, based on many of those issues. They are issues that we absolutely need to resolve.

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[Kevin Hollinrake]

It is only corrosive if it is not in the patient’s interest. There are clear commissioning rules that it must be in the patient’s interest for this commissioning to take place. The key is what is right for the patient. I do not doubt that the hon. Gentleman may be right that some of the commissioning is wrong, but whether it is private or public should not be the overriding principle; it should be what is right for the patient.

[Rachael Maskell]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I will make some progress, having given way a number of times. Some years ago, when I first became an MP, I met the chief executive of York Teaching Hospital Trust, Patrick Crowley. He talked about the fact that private providers are providing care in York—in the hon. Lady’s constituency—just as they are in my constituency. He was very comfortable with the relationship between the public sector provision at York Hospital and the private sector provision at Ramsay Health Care, where I have experienced treatment. It was incredibly efficient, and the people I spoke to who worked for that organisation spoke very highly of it. There should not be this ideological rejection of the private sector.

I want to make some key points. According to The Health Foundation’s report, more than 50% of people said that the NHS often wastes money. That is not a criticism but a reality in an organisation with 1.7 million people working for it. The way to try to reduce waste—again, this is our responsibility to the taxpayer—is to ensure that we eliminate it wherever we can. The public sector does a brilliant job in the NHS. I am not calling that into question. However, in my view, good businesses—I have been in business all my life—can have a positive impact on healthcare provision. Good businesses focus on the customer first, and therefore the patient first. They make the most of their most precious resource, which clearly is their people. They are good at innovating and reducing waste, and they should deliver at the best possible value. After all those things have been taken into account, a good business should then consider whether it can still make money, and if it cannot it should not enter that field. The principle should be what is right for the customer, or the patient.

I met one of the nation’s most successful and prominent business people, who told me—to illustrate how we can drive out waste and bureaucracy from a service—that he was approached in 2007 or 2008 by Tony Blair and Gordon Brown and asked to look at reshaping the health service to make it more efficient. He came back to them and said that he would be prepared to take this project on. He said that the first thing he wanted to do was to give all nurses a 30% pay rise—this is a private sector business man; I am not saying that Brown and Blair were going to privatise the NHS—but that he wanted no more money from central Government. He would put matrons back on the wards. He would put in a clinician-first approach, with admin and management second, and strip away the bureaucracy, which must be music to the ears of every nurse and doctor working in the health service. He planned to reduce admin and management by 20,000 people. He was also going to look at the purchasing system in the NHS.

Clearly, the private sector can look at these issues and drive out waste in whatever capacity as long as it is in the interests of patients. Waste in purchasing is a key element. John Abercrombie, the consultant who looked at purchasing in the NHS, established that one trust was paying £126 for a wound protector and another was paying 36p. There clearly are private sector providers that could come into this sector and help to reduce waste, delivering a better deal for the taxpayer.

My final point is about the long-term funding settlement. I echo the comments of my hon. Friend the Member for Gloucester. We need a long-term funding settlement not just for the NHS, but for social care, because they are inextricably linked, although we need different funding settlements for the two different elements. Unless we have that long-term funding settlement, whatever we discuss today, because of demand—and more money is going in—we will just be shuffling deckchairs on the Titanic. It should be cross-party and take into account rural needs. I have constituents who have seen services centralised to the point where they have to travel long distances to access healthcare. An elderly couple in Scarborough have to go to York for treatment because heart treatment has been centralised into York from Scarborough. They do not drive, so they have to take a bus to York and stay in a hotel overnight to get to the consultation appointment on time. The quantum needs to be greater and we need to ensure that we keep delivering our services right across the country, including in those rural areas. I agree with my hon. Friend that we should look at a hypothecated tax—either direct or indirect taxation—to increase the quantum of money to a significant degree.

The Select Committee on Housing, Communities and Local Government looked at the German system of social insurance for social care, in which people make a small payment from their monthly salary on a pay-as-you-go system. When they need care, instead of suffering the catastrophic cost in later life, on the basis of an independent assessment, that support can be provided through third-party care, or they can draw down the money and pay it to relatives to look after them in their own home, which can have a positive social consequence.

We need to look at these things in detail and on a cross-party basis. I believe in a taxpayer-funded system on the basis of the best outcomes for patients and the best deal for the taxpayer, and that we should move towards a long-term funding solution, so that ultimately we can let the clinicians get on with the job.

[Stewart Hosie in the Chair]

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[Rachael Maskell]

York Teaching Hospital is going down the same lines in creating a wholly owned subsidiary company, yet the staff want to belong to the NHS—that is their ethos and that is what drives them. It is also important for full integration across the whole service, because people who work as porters and cleaners are as much about patient care as anybody else in the NHS. Does my hon. Friend agree?

[Alex Sobel]

Absolutely. When I go into our local hospitals as an MP or as a patient, I see that they are the beating heart of the NHS.

I ask trusts, such as Leeds, that are considering setting up a subsidiary company to put a halt to those plans and to work with their staff, representative trade unions and local MPs prior to making the decision. I ask them to do what is best for all involved, whether patients, staff or the community.

Cost pressures create perverse incentives for people to consider privatisation. We have rehearsed that argument quite well. They affect not just NHS hospital trusts but clinical commissioning groups for primary care services, NHS England and other NHS bodies. We need to take those perverse incentives out of the system so that privatisation does not happen by the back door—instead of being done by the Government through statute—which is what is happening.

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

It is a pleasure to serve under your chairmanship, Mr Hosie. I apologise for not being here at the start of the debate but I was serving on a statutory instrument Committee. I am grateful that you are allowing me to speak in today’s important debate about our NHS.

I felt motivated to speak when I entered Westminster Hall and listened to the debate, particularly on the assertion that privatisation is not such a bad thing. I want to draw out the issue of NHS funding. The funding system is broken. I am grateful to the Minister for meeting me recently to discuss the real challenges in York’s funding system. I look forward to hearing that progress has been made as a result of that, but there are real challenges within the funding system and I want to challenge some of the assertions made about that.

We must understand that the NHS was designed to work as a whole. The types of services that move to the private sector are low risk and high volume, such as hips, knees and cataracts. If we add those together, someone can cream a profit—I would prefer a reinvestment—off the top of providing those services. The NHS used to take the additional money and reinvest it in the more expensive parts of the NHS, such as intensive therapy units, the renal service, for which the drugs are very expensive, and A&E. The fine balances of NHS finances worked. However, when we remove those opportunities, because the hips and knees are being delivered by another organisation that makes a profit out of the NHS, although the risk is left with the NHS, NHS finances collapse because the cross-funding is not going into those services, which is exactly what we are seeing at the moment. I first had that debate with Andrew Lansley when he put his proposals forward, and it has come to pass that NHS finances are not working because that balance has been taken out of the finances. The opportunity for the NHS to generate the resources that are vital for the critical care parts of the NHS is removed.

[Kevin Hollinrake]

The hon. Lady makes a good point, but the reason the NHS is under pressure is hugely increased demand. There is more money going into the NHS, and we would all concede that we need to put more money in, but demand is the essence of the problem. It is not because we have private sector companies operating within it.

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[Rachael Maskell]

The hon. Gentleman is right that demand on the NHS is huge, which takes me to a further point that I will raise shortly. We recognise that we need more resource in the NHS, but the fragmentation and the fact that so much money is taken out for contract management as opposed to reinvestment into health services creates challenges. We now have lawyers and managers managing those contracts in the NHS instead of the money filtering through to healthcare, as it would in a planned health system. Of course, when we have fragmentation, we have to work with multiple systems across multiple agencies, and trying to get the organisations to talk to each other also puts pressure on the system.

We have a growing ageing demographic and increased pressures on the health service, but, because we now see a disconnect between some of the NHS’s other services, such as prevention and public health, we do not have the levers in the system to drive better health in the community, and more risk therefore ends up back at the door of the acute services. As the situation escalates, the acute system is more and more challenged, not least because of the different funding mechanisms and interests of the CCGs and the acute trusts. If we look at a tariff system versus the CCGs’ interests, we see that they clash with each other, which then means we have a waste of resource.

I can give examples of how the funding is broken and not working within York. I have had discussions with the CCG and the acute trust. The CCG has to fund tests and other services that are not picked up elsewhere in the tariff system. Where do those services go? They go out to the private sector, so there is a cycle of decline and trying to manage a system where the fundamentals of how NHS funding works are not addressed. I suggest to the Minister that if we brought together a planned health service with proper funding, the rest of the system would fit in place, but we have to take out the private motive within the NHS, which is clearly why many organisations are involved.

We have only to look at some of the services that are provided. I think of the Serco contract in Cornwall, where only one GP was in service for the whole of the county. I think of Serco again in Suffolk and how it provided community services. When it was not generating a profit, it said, “We’re off. We’re not interested in this service any more”, leaving some of our most vulnerable people in the community high and dry, with the NHS of course picking up the cost every single time and picking up the pieces. That is no way to run a critical health service in our country. That is why we need to move to a fully planned health service in public hands.

I want to draw on one other example of a private company: Virgin Healthcare. It was first of all an incubator within the forerunners to CCGs, seeing what was coming along the tracks and the opportunities there. I can cite many services provided by Virgin Healthcare and how it has looked to profiteer and cut services. I was head of health at Unite overseeing sexual health workers. Virgin cut sexual health services and as a result there was a rise in the prevalence of sexual disease. The services also became fragmented. The community was not provided with a service, and there was a complete failure to achieve the objective of the service.

Elsewhere, we see Virgin suing the NHS because it is not winning contracts. The business of Virgin is about generating as much money out of the state as it possibly can. Private companies use the NHS for their own interests to fill the pockets of shareholders as opposed to supporting patients. We must take the profit motive and private companies out of the NHS because that model is completely broken.

I will move on to two other issues. The first is staff in the NHS. I worked in the NHS for 20 years, so I know what it feels like. People do not want to work for private companies. They want to have one set of terms and conditions, and to engage with one set of training. They want one set of rules, and most of all they want the pride of working for the NHS.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Rachael Maskell]

No, I will make some progress. People want to work in the interests of patients. It is important that we maintain that, because it is healthcare workers who give all the hours of unpaid overtime that nobody ever talks about. Why would they want to do that for a private company? They do it because of the sense of public service that comes from our country’s greatest pride: the NHS. We therefore need to listen to what our NHS staff say. That is why I take issue with the hon. Member for Cleethorpes (Martin Vickers), who spoke about union leaders shouting off. They represent more than 1 million people working in our NHS. They are the voice of people working in the NHS.

[Kevin Hollinrake]

rose—

[Rachael Maskell]

As a union leader who spent 20 years working in the NHS, I certainly spoke up for all my members, who were deeply concerned about the destruction of the NHS because of the privatisation and fragmentation that was happening across it.

The second issue is what is happening to NHS buildings. We know that buildings were moved into NHS Property Services, which is a wholly owned company with one shareholder: the Secretary of State. He is looking through the Naylor report, which is not included in legislation at the moment, to reduce the estate. There may be some good cases for that, but profit should not be at the head of the argument. We should look at how the estate can be reinvested for the benefit of the community.

Parkland at Bootham Park Hospital in my constituency would make a fantastic public park and would address some of the mental health challenges in our city, which was the purpose of the hospital. I ask the Minister to take a further look at that opportunity. Under Treasury rules, the building and the parkland have to be sold to one private provider. Clearly, that would not work for my city. With regard to the rest of the estate at Bootham Park Hospital, it would be great to see the old mental health hospital converted into key-worker housing to support the rest of the NHS. York is in real crisis with regard to recruiting staff, because they cannot afford to live in the city. If we had key-worker homes on that estate, it would create a sea change. That is about putting public interest at the front, not private profit.

Finally, I want to talk about the future, because I am aware that time is moving on. I truly believe that the only way forward for our NHS is to have one planned public service, with full integration of mental health, physical health, public health and social care, provided in the interests of the community. We need play-space to look after the community, and no more fragmentation. It is ridiculous that we have so many regulators and so many different providers. The whole system is fragmented and fighting against itself. If we had one planned system, it would not only simplify the system, but ensure that the money is invested back into the heart and needs of patients.

[Andrew Selous]

rose—

[Rachael Maskell]

That is exactly how we should move forward, whether with consensus across all parties, which of course I would like to see, or just by putting forward what is logical.

[Gillian Keegan]

rose—

[Rachael Maskell]

NHS staff are calling for it, managers are calling for it, and I trust that the Minister has heard the call in today’s debate.

Patient Safety

Rachael Maskell Excerpts

Wednesday 28th March 2018 Commons Chamber

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

This issue is not just the preserve of doctors; it, of course, cuts across all health professionals. One of the biggest triggers is the pressure that NHS staff are put under, particularly in respect of their not being able to fulfil their duty of care. Does the hon. Lady recognise that when we have a staff crisis it creates the biggest risk to patients?

[Dr Johnson]

I thank the hon. Lady for her intervention, and I agree that this issue of accountability and blame applies equally to all professionals across the health service. Everyone makes mistakes; I was reading online the incident report for the serious investigation done into this young boy’s death and I noticed that, although no doubt all care and attention had been paid to ensuring that personal information was redacted, the child’s initials appeared in at least one place where someone had forgotten to do that. That is a sign that none of us is ever infallible.

Sanctioning doctors for honest mistakes also runs the risk of discouraging people from joining the profession. At a time when the Government are looking to increase the number of people entering medical careers, through the creation of more places at universities and the establishment of new medical schools, the perception that an honest mistake made later in someone’s medical career could end up with their being struck off the register, or even behind bars, risks alienating just the type of young, forward-thinking, ambitious students whom the NHS needs to pursue a career in medicine. It is a testament to the youth of today that medicine still continues to attract the brightest and the best. However, by the same token, these straight-A students have other, more lucrative career paths open to them, and those will become all the more attractive when the risks inherent in a medical career become too high.

This culture of fear not only risks discouraging people from joining the profession, but drives away highly skilled doctors already working in the NHS. As an NHS doctor, one is already expected to work in very challenging conditions, working long hours in an incredibly high-pressure environment. Again, if a perception develops among doctors that they may be treated as a criminal even if when working to the best of their ability, it will quite simply drive doctors away. The world-renowned medical schools we have here in the UK mean that British doctors are in high demand, and they may take their skills to the private sector or further afield to less litigious health services.

The Government recognise these problems and have commissioned an urgent review to look at the threshold for what constitutes gross negligence. This will report by the end of April. I understand that the GMC has also commissioned its own review, although it is not expected to report until the end of the year. Will the Minister tell the House how the Government will act in the meantime to reassure doctors, especially those in high-risk specialties such as paediatrics and obstetrics, that they will not be unduly punished for mistakes?

Overall, it is important that the Government act swiftly on the findings of this report, and consider carefully the impact of the threshold on both the recruitment and retention of medical staff, and safety and improvements to patient care. Doctors want to make people better—it drives all they do. We must stand with them and for them, for all our futures will depend on it.

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[Caroline Dinenage]

The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.

As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.

[Rachael Maskell]

Robert Francis’s report included 290 recommendations to address these issues, not the least the duty of candour. However, people are still fearful to report—why is that?

[Caroline Dinenage]

I think it is for a variety of reasons. The hon. Lady is absolutely right to raise that issue; if she bears with me, I shall come to it a little later.

A first step in our new direction, based on an aviation model, is the Healthcare Safety Investigation Branch, which became fully operational in April last year and will independently investigate some of the most serious patient safety incidents every year. It is the first investigatory body of its kind in the world and demonstrates our commitment to learning and innovation. As part of the Government’s drive to make the NHS the safest place in the world to give birth, HSIB will standardise investigations of cases of unexplained severe brain injury, intrapartum stillbirths, early neonatal deaths and maternal deaths in England.

As an MP who represents a constituency in the area served by Southern Health, I am particularly aware that tragedy can spiral when an organisation loses sight of systematic problems in its provision of care. Our Learning from Deaths programme is a direct response to such events. Trusts are now expected to have proper arrangements for learning from the deaths of patients and are subject to new reporting arrangements, including evidence of learning and improvements. I should add that we are one of the first countries in the world to measure deaths in this way. Through Learning from Deaths, NHS England is supporting improved engagement across the NHS with bereaved families and carers.

As my hon. Friend the Member for Sleaford and North Hykeham rightly says, healthcare professionals need to feel safe to speak out about problems in the workplace. To support that, we have introduced an independent national officer for whistleblowing, and new regulations to prevent discrimination against whistleblowers who move jobs. Recent commentary in the media and among professionals has highlighted a possible brake on openness and transparency arising from high profile convictions of healthcare professionals for gross negligence manslaughter, which is exactly the same example as the one that she cited. That is why the Secretary of State for Health and Social Care announced in February that he was asking Professor Sir Norman Williams, former President of the Royal College of Surgeons, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

Absorbing the review’s recommendations into our healthcare system will be crucial to ensure that our healthcare professionals feel valued and secure, and that includes the GMC. The deadline for submitting evidence is April, and I encourage patients, families and professionals to contribute.

It is essential that infants have the best possible start in life, and the safety of mothers and their babies is a fundamental starting point for safer care. In November 2017, the Secretary of State announced his intention to bring forward the ambition to halve the rate of maternal deaths, neonatal deaths, birth-related brain injuries and stillbirths by 2025—a full five years ahead of our previous target. Pre-term birth is a major health inequality with mothers, and the Secretary of State has set an ambitious target to reduce the national rate of pre-term births from 8% to 6%.

Continuity of care is a key factor in a healthy pregnancy. Evidence shows that women who continue to receive care from the same midwives are 19% less likely to miscarry, and 16% less likely to lose their baby. That is why, yesterday, the Secretary of State announced important steps towards ensuring that the majority of women receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021. That announcement includes 650 new training places for midwives in 2019, which represents a 25% increase in the number of midwives in the UK.

We can never be complacent. Zero harm might sound impossible to achieve, but it should always be our aim. By learning lessons when things go wrong, listening to patients and their families, and working across the whole system to create a genuine culture of improvement, this Government are making a significant and lasting contribution to patient safety.

Question put and agreed to.

 Orkambi and Cystic Fibrosis

Rachael Maskell Excerpts

Monday 19th March 2018 Westminster Hall

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

I want to start by thanking the 75 constituents of mine who signed the petition, not least the inspiring parents and patients who have really brought this debate to the fore. I want to mention Dr Aaron Brown, who is based in York and is living proof of what it is to live with cystic fibrosis. He was the first person with cystic fibrosis to graduate to the Royal College of Surgeons and is a GP in York. However, for him, living with cystic fibrosis asks many questions, not least as he has a young son and a child on the way. He says,

“Having CF has given me something to battle against all of my life, to prove that it won’t get me and I can achieve.”

We know that this debate is not just about the impact of cystic fibrosis but the hope that a drug such as Orkambi can bring. Although the drug may not be a panacea to all things, it certainly does slow down the disease process, including scarring of the lungs and deterioration of the lung tissue. It is also paving the way for a new generation of precision medicines. It is so important that we are at the leading edge of that research to give people real hope for the future, not just the 50% of people who will benefit from precision medicines should Orkambi be approved, as it must be, but for the next generation.

In the next five years there is potential for 13 new drugs and in seven years, 18 new drugs, impacting on 90% of the cystic fibrosis population. What an amazing opportunity that presents us. That is why we are resolute to make sure that the Minister moves on the issue.

We have heard a lot about cost, but I want to put a cost in everybody’s mind. We are talking about £285 a day. Let us think about the cumulative impact and cost of hospitalisation, perhaps of transplants, drugs and economic loss. We are talking about just £285 a day, a figure that Ministers of State will be familiar with because it matches how much they earn. We can recognise that this is a cost that the NHS can and must afford. Even if there are final negotiations to be had about a portfolio of medication, which is important, to ensure that we usher in this new generation of drugs, what is the cost of a life? I leave that question in the air. I am sure we would all argue that it is a lot more than £285 a day. If we are determined to save lives, that is affordable.

I worked as a physio in respiratory medicine for 20 years, so I have first-hand experience of making this journey with so many patients. The physio may not be pummelling, but it is certainly intense. I celebrate the way that physio has developed over that time. It has become much more dynamic, rather than passive, and a number of techniques have been developed. We heard about active exercise—that is so important for building lung capacity—positive pressure techniques and postural drainage to ensure that we minimise stress on the lungs as we clear secretions. Just think what a life-changing opportunity those advances in physiotherapy, as well as a good diet and precision medicine, present for people with cystic fibrosis compared with their opportunities just a few years ago.

We have a real opportunity to change people’s life chances, but systems have got in the way, and that is what we plead with the Minister to change. The European Medicines Agency approved these drugs two years ago. It is therefore incumbent on us to stress to the Minister that we need effective movement, quickly. NICE itself recognises the benefits of the drugs: in July 2016, it called them important and effective treatment. So much time has been lost through so-called negotiations.

The Minister cannot hide behind NHS England or other bodies. It is time for leadership. It is time for him to step up, step into the debate and ensure that access to the drugs is delivered. I plead with him to call Vertex, to ensure that discussions are held with NICE and NHS England before Easter and to get the table set for finalising the negotiations. If a portfolio of drugs can be achieved in Northern Ireland and the Netherlands, it can be achieved here. Even if there has to be an interim agreement to ensure that people with cystic fibrosis have immediate hope, it is his responsibility to deliver that. With each day that passes, people’s future lung capacity, and therefore their lives, are seriously impacted.

Of course, some people already have access to these precision drugs, and the outcomes for people who benefit from access to Orkambi are really positive. It really is unethical and both economically and clinically illiterate to make Orkambi available to people who are seriously deteriorating but not to people who could stop their lungs being damaged in the first place if they had access to it in advance.

I am grateful to the many constituents who contacted me, but I want to relay the words of Abigail, who wrote very passionately. She has children aged four and seven, both of whom have been diagnosed with cystic fibrosis, and she expressed the real hope that these drugs would bring:

“Those drugs…are here now, which makes it even more heartbreaking that Orkambi, which could benefit 50% of people with CF, is not available on the NHS. To know that there is a drug out there that could change my children’s lives and allow them to live longer and in better health, but which they have been denied access to is absolutely devastating…simply because of cost reasons…It is absolutely imperative that some kind of agreement is reached that makes these drugs available to everyone with CF who could benefit from them. Living with CF is already difficult enough, please don’t make it any harder.”

Mental Health Services: Children and Young People

Rachael Maskell Excerpts

Thursday 8th March 2018 Commons Chamber

[Steve Brine]

That is a good point—and one that sits at the centre of my portfolio. GPs are generalists. As the Minister for cancer, I know that there is always criticism of their specialism in that, but, by their very nature, GPs cannot be specialists in everything. That is why the mental health support teams, which are at the heart of the proposal in the Green Paper, are a key part of our strategy, and we expect them to work closely with GPs and the Royal College of General Practitioners to upskill GPs, working within the multi-disciplinary teams, to help young people when they need that help.

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

Tomorrow, I am meeting the chief executive of my local mental health trust because we are so desperately worried about the mental health provision for young people in York. We are not only short of staff but short of resources. It takes time to train mental health staff, so what are the Government going to do in the interim to ensure that we have staff in the service?

[Steve Brine]

I hope that when the hon. Lady meets that person in her constituency tomorrow she will recognise the good work that is going on and the number of people who are going over and above to deliver the services to children and people. I should also say that one of her responsibilities as a Member of Parliament, as it is ours as Ministers, is to see to it that the sustainability and transformation partnerships in her area collaborate with all the various organisations in her constituency and that the traditional health and social care services are joined up with schools, police, probation services and mental health services, because ultimately it is one NHS.

NHS Wholly Owned Subsidiary Companies

Rachael Maskell Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

I beg to move,

That this House has considered wholly-owned subsidiary companies in the NHS.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this albeit brief debate on the issue of NHS wholly owned subsidiaries, and this fairly recent but rapidly developing situation spreading across the NHS. What are these companies? They are organisations set up by NHS trusts as subsidiary companies to the trust, into which a range of NHS facilities management staff are transferred. When I say facilities management staff, I mean all the porters, cleaners, catering staff, estates and maintenance staff, and others who keep our hospitals going. Those staff are an essential part of the NHS.

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

York Teaching Hospital is about to enter into an alternative management company for the facility staff there. Those are staff that want to work for the NHS, not least because they get the benefit of NHS terms and conditions and pensions. Does my hon. Friend agree that the loopholes in the taxation of the NHS need to be addressed so that those people can remain working for the NHS?

[Liz Twist]

I most certainly do agree with my hon. Friend. We know that NHS trusts are under incredible financial pressure and are looking for ways to stretch the available funds. Some trusts have seen wholly owned subsidiaries as a way of reducing costs. Those trusts include the Gateshead Health NHS Foundation Trust, which provides excellent hospital services to many of my constituents.

The cost savings come about in two main ways: through saving VAT and by saving on staffing costs. For some, there may be a third area of income—advising other NHS trusts on going down the same path, which is one of the reasons why they are spreading across the country. In November 2017, the then Health Minister, the hon. Member for Ludlow (Mr Dunne), stated that:

“NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts”—[Official Report, 14 November 2017; Vol. 631, c. 129.]

We know that more are being created even now.

--- Later in debate ---

[Liz Twist]

I certainly agree that this is the wrong medicine for the NHS’s problems, which, as hon. Members said, derive from the pressure on NHS finances and the underfunding of the NHS.

[Rachael Maskell]

The last time there was a segmentation of facilities management, we saw the rise of MRSA and other communicable diseases, so the evidence shows that this is a bad move.

[Liz Twist]

That is a very valid point, and it must be considered carefully.

We are creating divisions between staff in the facilities management companies and other NHS staff by introducing a two-tier workforce, which health service unions such as Unison—my union—have worked hard to move away from. The setting up of these wholly owned subsidiaries is a retrograde step. It insults and undervalues the staff who do essential but less visible jobs in the NHS. It deprives them of the pension scheme that their colleagues have access to and exposes trusts to equal pay claims. Equally important, it risks breaking up our NHS—perhaps not today, but in the near future.

I have been looking at the health press in preparing for this debate, and I have seen that there are plenty of companies out there willing to advise on setting up NHS subsidiary companies and look at the benefits of such companies. There are no such advantages. There is no reason why NHS staff working together cannot produce a better NHS. Indeed, they are doing so all over the country. We need to stop this trend of establishing wholly owned subsidiaries in the NHS. We must respect all our hospital staff and prevent the fragmentation and privatisation of our NHS.

--- Later in debate ---

[Stephen Barclay]

The slightly puzzling issue here is that the savings accrued from the subsidiaries are for the benefit of the local health economy, of the trust. This is a subsidiary company 100% owned by its host trust. The more efficient the subsidiary is, the better it is at dealing with things such as its pathology—not only do we avoid samples being lost, but we run a more efficient system in a more commercial manner, which brings more money into the healthcare economy and gives the flexibility to compete effectively in the local job market for maintenance staff and others.

The benefits of those arrangements accrue to the trust that owns 100% of the subsidiary. That is why, under legislation of the previous Labour Government—correctly in my view, but clearly not in the view of the Labour Members—the local trust is empowered to empower in turn the local members of staff. That is then reflected in the staff survey, which shows a more favourable result in this trust.

[Rachael Maskell]

I am grateful to the Minister, who has been generous with his time, but does he not acknowledge that the failing finances of the NHS are forcing trusts down that route? I am meeting the Minister next week to talk about York Teaching Hospital’s failed finances. That is the driver of the changes and, therefore, the fundamental issue still has to be addressed.

[Stephen Barclay]

I do not know whether we are moving away from the subject to a wider debate about finance, but the Chancellor’s Budget settlement makes the Government’s finance commitment clear. The fact is that the issue of subsidiary companies is about using the resources of the NHS in the most efficient manner. That is the view not just of the Government and of the previous Labour Government, but of the trust itself. It is delivering a better outcome for patients and delivering savings—I repeat, the savings accrued go to the benefit of the trust that owns 100% of the subsidiary. It is a shame that those on the Labour Benches seem to want to deprive staff of choice and opportunity. Staff are benefiting, and that is reflected in the staff survey.

I hope that in responding to the debate I have allayed a number of the concerns of the hon. Member for Blaydon about the setting up of subsidiary companies by trusts. I am sorry that there is such concern about the legislation put on the statute book by the previous Labour Government and that it is being deemed to be a form of privatisation.

Eating Disorders Awareness Week

Rachael Maskell Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar]

I will come very shortly to overall spending, but part of that is not just the overall size of the pot, but how that money is spent and works its way through the system to reach the frontline. In 2016-17, we spent a record £11.6 billion on mental health services, and that amount will continue to rise year on year until 2020-21, by which point 21,000 new mental health posts will be in place. This is all very welcome, and I commend the Health Secretary and his colleagues in the Department for it. Funding is vital. However, although £30 million per annum will be available over the next five years to fund eating disorder services, the way in which such funds are spent by clinical commissioning groups sometimes lacks transparency. At times it is hard to follow the funding from its source to ensure that it reaches the frontline. Implementation is key, and I hope the Minister will tell us how the Government are working to ensure that every penny reaches the frontline eating disorder services for which it is needed.

Community-based mental health services are often the most effective local services to help people, but they and in-patient mental health services are commissioned separately, by the CCG and by NHS England respectively. That can lead to a sense of a lack of joined-up care, and it can mean that people have to receive treatment many miles from their homes and families. That can place a huge strain on families, and, indeed, on family finances. Beat’s report suggests that in some instances the cost can be up to £32,000 as a result of lost earnings, travel and a range of other expenses. I believe that funds for eating disorder treatment should be held locally by the same budget holder in the same pot to create incentives for the development of improved treatment and reduced costly in-patient care, with CCGs working to extend their focus on early intervention to include the earlier stages of the illness.

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

Will the hon. Gentleman give way?

[Edward Argar]

Very briefly.

[Rachael Maskell]

I am grateful to the hon. Gentleman, who is making an excellent speech. Would what he is suggesting include support in schools?

[Edward Argar]

That is indeed very important. A key issue is the need to ensure that, as far as possible, there can be school referrals or, indeed, self-referrals as well as referrals made via a professional medical route. Some people may choose those ways of reaching out for the help that they need.

I hope that the Minister can update us on the progress of NHS England’s “Testing New Care Models in tertiary mental health services” pilot, which I understand is currently under way, and can tell us whether any initial findings are emerging in respect of the opportunity to put in-patient and community funding into a common pot.

I cannot end my speech without highlighting the impact that eating disorders have on the families and loved ones of those with the illness. Many of them care for people patiently and lovingly, and delays in securing the help that is needed can have devastating consequences for them. While in some cases it may not be appropriate, for good reasons, in many others, engaging those who are caring for someone receiving treatment—the “whole family” approach that I understand is used in Leicester, which will serve some of my constituents—can be hugely positive. I would welcome any reflections on that from the Minister.

Finally, I pay tribute to the work of Beat, which has campaigned tirelessly to highlight this issue, and to the work of those who operate its advice helpline. I commend its report to the Minister, and to all colleagues. However, I pay the greatest tribute to all those who suffer from an eating disorder and have had the bravery to talk about it, to seek the help that they need, and to face down an illness that depends on secrecy, isolates sufferers, and affects every aspect of their lives and those of their families. We must ensure that we match the courage of those who face it, determined to beat it, with an equal determination to give them the support, treatment and investment that they deserve. We must continue to drive down the delays and waiting times, raise awareness, and strip this disease of some of the power that it has over people by talking about it. We must stand shoulder to shoulder with all who face it, with the clear message that, together, we will beat eating disorders.

Diabetes

Rachael Maskell Excerpts

Monday 26th February 2018 Commons Chamber

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

Young people find it incredibly difficult to do glucose testing. The FreeStyle Libre device is a mechanism through which young people can have regular testing without that fear. However, they have to go through an individual funding request to access that. Should that not be available on the NHS?

[Liz McInnes]

I completely agree, and I will discuss FreeStyle Libre patches later on. I am beginning to feel like everybody here has had sight of my speech before I have even delivered it.

The next point arising from the survey is that people living with diabetes want better access to healthcare professionals who understand diabetes. Many respondents said that they felt they were being treated as a condition and a set of symptoms rather than as a human being.

--- Later in debate ---

[Steve Brine]

I will not take another intervention, because I will conclude in just a second. The spending review made provision for significant transformation funding through to 2020-21, and I expect that to be spent in line with the priorities set out in NHS England’s mandate, including for diabetes.

We have talked about the childhood obesity programme and the national diabetes prevention programme. I am responsible for other public health initiatives, such as Change4Life and the One You programme. People like me with young children will see the Change4Life branding coming through in book bags for them. It has been an incredibly successful campaign. The programmes are crucial in both encouraging a healthy lifestyle and promoting exercise among young people, as are such things as the Golden Mile, which is almost universal in primary schools across England. The benefits of such programmes should be acknowledged in reducing not only the incidence of diabetes, but other debilitating and life-threatening conditions such as cancer and heart disease, in which I also have a great interest.

[Rachael Maskell]

Will the Minister give way?

[Steve Brine]

Yes, but then I might not be able to conclude.

[Rachael Maskell]

Very quickly on the issue of exercise, children are now reduced to just one hour of PE. Will the Minister speak to his colleagues in the Department for Education about increasing that?

[Steve Brine]

I am not responsible for the Department for Education, but the hon. Lady is absolutely right to say that I talk to it. I was in the Department with the Secretary of State and a Minister just last week talking about what further action we need to take on school food standards and the Golden Mile, because I want children to be more active. It is not just about what happens in school, though: the exercise through the Golden Mile in schools should be mirrored in out-of-school activity. There is so much more that we can and should be doing to help to prevent diabetes.

In conclusion, diabetes is emblematic of many challenges that the health and care system and my desk face. Prevention is critical, as is working in partnership with people in a way that tailors support and intervention. I, this Government and this Prime Minister are committed to improving outcomes not only for the millions of people in this country who are living with diabetes, but for the many more who are at real risk of developing the condition. We need to help both.

Question put and agreed to.