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.

Cancer Strategy

Rachael Maskell Excerpts

Thursday 22nd February 2018 Commons Chamber

[Steve Brine]

Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.

Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.

We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.

Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.

How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.

Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.

The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.

The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.

To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.

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

I have listened patiently and, unfortunately, I was not here at the beginning. However, my constituent has a very rare form of cancer. He has had to self-fund his treatment in Germany and Southampton, but he has run out of money. The treatment meant he did not die within the weeks he was given and is now living. However, he needs top-up therapy, and his individual funding request has been refused. Without his treatment, he will not live. Could the Minister look into this case?

[Steve Brine]

Obviously, I will not comment on the case. I was going to suggest that the hon. Lady gets the clinicians to make an IFR, but she can by all means bring the case to me.

My hon. Friend the Member for North Warwickshire talked about breast density. The UK National Screening Committee commissioned a Warwick University study to investigate the link between breast density and breast cancer. Once complete, if the review suggests that there should be changes to the national breast screening programme, the UK National Screening Committee, which we work with, will consider that under its modification programme. I am in touch with Breast Density Matters, which is a small charity—small but perfectly formed.

The hon. Member for Coventry North East and others talked about blood cancer. We had a very good Westminster Hall debate last month led by my hon. Friend the Member for Crawley (Henry Smith). As has been said, many patients with blood cancer diagnosis will sadly never be cured; they will be on the regime of watch and wait, often over many years, to see whether the cancer has progressed to a point where treatment needs to begin. That can take a huge psychological toll, which Members have mentioned, on the patient and their families.

By 2020, every patient will receive a holistic needs assessment as part of the recovery package, which is excellent. For the blood cancer patient, their recovery plan will be personalised to take account of the unique characteristics of blood cancer and will include their mental health needs. That is why the Secretary of State announced the additional £1.3 billion last July to expand the mental health workforce. My hon. Friend the Member for Dumfries and Galloway (Mr Jack) made that point very well in his speech—I say this as I am passed a note. I love the notes from the Whips.

PACE Trial: People with ME

Rachael Maskell Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan]

I thank the hon. Gentleman for his intervention. It is typical, because the PACE trial had such publicity and was lauded by many as the answer. One participant in the original trial has contacted me:

“I was determined to be a part of the...trial because I wanted to get better—so if this ‘treatment’ could make me better I wanted to give it the chance to do so. I was assigned Graded Exercise Therapy. It never occurred to me that it would actually make me more ill. Nor did it occur to me that decline would not be documented, and that despite patients not recovering (or in some cases worsening), they would publish that the treatment was successful...It was stressed that I would only get better if I tried harder, and even though the graded exercise was clearly making me worse, my struggle and pain was dismissed.”

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

As a former physiotherapist, I recognise that all therapeutic interventions must be patient-led—led by people with the lived experience. Does the hon. Lady agree?

[Carol Monaghan]

Absolutely. In fact, I will be calling for the patient voice to be heard in any treatments.

Calls to publish the raw data—basic protocol in good research—were ignored. Queen Mary University spent an estimated £200,000 on keeping the data hidden. Finally, after a long battle, patients won a court order to force the PACE authors to release the data. It was discovered that the authors had altered the way in which they measured improvement and recovery, to increase the apparent benefit of the therapies. Re-analysis showed that the improvement rate fell from 60% to 21% and the recovery rate fell from 22% to just 7%.

The method of patient reporting has also been questioned. As one participant says:

“After repeatedly being asked how severe...my symptoms were—in the context of…it’s just me not trying hard enough...I started to feel like I had to put a...positive spin on my...answers. I could not be honest about just how bad it was, as that would...tell the doctors I wasn’t trying and I wasn’t being positive enough. When I was completing questionnaires...I remember second guessing myself and thinking for every answer: ‘Is it really that bad? Am I just not looking at things positively enough?’”

NHS Winter Crisis

Rachael Maskell Excerpts

Wednesday 10th January 2018 Commons Chamber

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

I am pleased to follow the hon. Member for North Dorset (Simon Hoare) because I, too, want to touch on transitional healthcare.

Before I do so, I want to acknowledge the incredible, amazing, professional care that is provided across our healthcare service. We all agree that the love and care that is there is incredible. However, there are clear challenges, and we note those too. We have heard so much about them in the evidence provided today. This is not just about the long hours and the complex challenges that are placed at the door of health professionals. It is about the stress of not having the additional conversation that you need to have, the stress of not being able to treat somebody as a whole person but only being able to focus on the acute situation before you, and the stress of trying to keep somebody alive as their respiratory condition is deteriorating but you cannot get the doctor down because you know they are caring for someone in an even more acute situation. I know; I have been there. I have worked in acute medicine for 20 years, and I know very well what has happened over those 20 years. I agree with hon. Friends who hark back to the 1990s, when, as today, our NHS was in a terrible state. It did improve when Labour put the investment into the NHS, and we cannot deny that finance is at the heart of what is happening.

Bed occupancy is an issue for my local trust, which has faced a real crisis in acute care over this winter. I commend it for all it has tried to do to avert the situation, but we have had multiple days of 100% capacity in our acute medical facilities. The council has closed care homes. The trust has closed a transitional care unit. We have an empty hospital adjacent to our acute hospital, sitting on land that NHS Property Services is going to flog off as opposed to seeing how it can invest in better care for the people of my community. We need to really invest in the facilities that we need for the future, particularly around transitional care. We should have a complete review of what is needed with regard to the NHS estate.

The influenza outbreak this winter has had a more serious impact in York than across the rest of Yorkshire and has been one of the worst in the country. That has had a real impact on staff as well as the acuity and volume of patients coming through the door. On top of that, we have had norovirus and DNV—diarrhoea and vomiting. This is all putting challenges into the system.

We absolutely must have a coherent public health strategy as we move forward. We know that there is social inequality in who gets access to inoculations. We also need to make sure that we lay out a proper strategy. That is not happening. The fact that public health is separated off from acute health is a barrier. We need to draw them together to make sure that we have a proper public health workforce in the community.

I want to touch on funding. Our trust is in the capped expenditure process. I am still waiting for a meeting with the Minister to discuss the impact of that. The trust does not have the flexibility and the resources that it needs, and that is having a serious impact on the health crisis we are seeing in York. We need to move the situation forward to make sure that we have the resources where we need them.

At the moment, the NHS is really sick. When patients are sick, they need solutions. I trust that we will start hearing solutions from the Government.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.

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

The NHS patient declaration form for free dental care and prescriptions requires patients to determine the difference between contribution and income-related employment and support allowance. Getting it wrong attracts really hefty fines. Will the Minister ensure that patients first get the opportunity to make the right choice before fines are applied?

[Steve Brine]

Yes, of course. The NHS Business Services Authority issues the penalty charge notices for incorrect claims for exemption from NHS dental care and prescription charges. We have recently increased the number of checks, however, because ultimately this is taxpayers’ money, and we need to ensure that it is spent properly and legally.

Mental Health Provision: Children and Young People

Rachael Maskell Excerpts

Tuesday 12th December 2017 Commons Chamber

[Luciana Berger]

I thank the hon. Lady. I believe that we both share the concern about the challenge of recruitment within the mental health workforce. The Government themselves acknowledge that there is an issue by way of the fact that they have put forward a plan to recruit these extra thousands of mental health workers between now and 2021. In the context of our conversation this evening about young people in particular, it is particularly disheartening and dispiriting that the specific plan that was set out only a few months ago contains nothing to expand the number of child psychiatrists—something that we desperately need. In the north-west, we really struggle to fill vacancies for those posts.

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

My hon. Friend is making a great speech about the real crisis in child mental health. Does she agree that the Green Paper places more and more focus on teachers, as opposed to health professionals, providing mental health support? Teachers are already really stressed by the volume of work that they have to do and they are not trained as medical professionals, so should that emphasis change?

[Luciana Berger]

I thank my hon. Friend for that important contribution. Another question that I hope the Minister will answer is how we can properly equip and train teachers to contend with the responsibility that they will be given if the plan set out in the Green Paper goes ahead. At the same time, the Department for Education is piling extra pressure on students with more testing. There are fewer teaching staff, which adds to the pressure on the remaining staff, and class sizes are larger. Cuts have been made to mentors, pastoral care and counselling. There has been a 13% reduction in the number of educational psychologists in our schools. The Royal College of Nursing points out that the number of school nurses has dropped by 16%, while the number of school-age pupils has gone up by 450,000. Young people face bullying, online threats, dysmorphic body image and advertising in a way that no previous generation has done.

Like many hon. Members, I am upset, appalled and outraged every week by the heartbreaking cases that constituents and their families raise with me in person or via email. Many Members in this House will recall the case in August of 17-year-old Girl X. She was restrained more than 100 times in a place that was not fit for her care, and she was left without a secure bed. The UK’s most senior family court judge, Sir James Munby, raised her case and warned us that we would have “blood on our hands” if this suicidal and vulnerable young woman did not get the treatment that she needed. But why was his continued intervention needed?

The case of Jack was brought to me this weekend. Jack is eight years old, and he has autistic spectrum disorder. He is in a severe state of anxiety and distress, and he has spent the last eight weeks on a ward in Alder Hey Children’s Hospital. He has had no specialist support from CAMHS and no specialist in-patient bed. He is getting more ill, and his family are, in the words of his mum Kerry, “in complete crisis.”

Just this afternoon, I heard about the case of Martha, who is 15 and has a history of self-harm. She has been admitted to A&E twice after taking an overdose. From a referral in June, Martha is still waiting to see a mental health professional. In the cases that I have described and thousands like them, every day counts, but young people are waiting weeks and months for treatment while their conditions worsen and their families are left distraught.

I do not believe that the Green Paper does anything for young people such as Jack, Martha or Girl X, or for thousands of other young people, whose lives should be filled with optimism and wonder as they look to a future laden with promise. I am concerned that instead, they are going to face years of torment, anguish and pain, made worse by the fact that so much of it is preventable. The majority of adults with diagnosable mental health conditions will have developed them under the age of 18. The life chances of thousands are being blighted. We are leaving a generation in pain; they are being let down because the care is not there.

Ultimately—I agree with the point made by the hon. Member for Cheltenham (Alex Chalk) —what is missing is the proper focus on prevention. How can we prevent mental ill health and keep our children well? We know that the first 1,001 days of a child’s life determine their life chances and life outcome, and that is why the previous Labour Government invested millions in Sure Start and children’s centres. We need to remove the factors that create mental ill health in the first place: neglect, childhood trauma, domestic abuse, bullying, insecure housing and poverty. Unfortunately, the Green Paper does not address those issues. Indeed, the words Sure Start, deprivation, homelessness and inequality do not appear in the Green Paper even once.

We do not need to be economists to understand that it is far more expensive to run a service that is based on crisis than a service that is based on prevention, not just in human terms, but in terms of taxpayers’ cash. What a wasted opportunity. I sincerely hope that the consultation on the Green Paper will be meaningful, that Ministers will listen to the voices of young people and experts across the country who are crying out for change, and that we will see some action.

In conclusion, will the Minister tell the House—I have asked this question, but let me reiterate it—whether the pilot, which I know is only a pilot, will introduce a four-week waiting target for assessment or for treatment? The Green Paper guarantees funding only for the period of the spending review, so what guarantees can the Minister offer us for maintaining funding after the initial three years are up? What will happen then? How will the lucky fifth of schools be selected for the first wave of support? How will her Government address the aim of real parity of esteem between mental and physical health? Reading the Green Paper, it seems to enshrine imparity by supporting only 20% of children over the next six years. Finally, is she convinced that this really is the best her Government can do for the greatest asset that we possess—our young people, who are our nation’s future?

--- Later in debate ---

[Rachael Maskell]

What is the Minister going to do to prevent the causes of poor mental health in young people?

[Jackie Doyle-Price]

The point of the Green Paper is that we are looking to put support mechanisms in place so that children facing mental health issues have access to care. That is very much the focus of today’s debate and the Green Paper.

To conclude, as we are running very short of time, I am grateful to the hon. Member for Liverpool, Wavertree for bringing this subject forward for debate. I am sure it will not be the last time we debate it—in fact, I know for certain that it will not. We are trying to achieve a step change in the support we are giving to children and young people. We know that the situation is far from perfect at the moment, but we fully anticipate that we will meet our ambition in the five year forward view to be treating 70,000 more children by 2021.

Question put and agreed to.

Healthcare Optimisation Plan: Kirklees

Rachael Maskell Excerpts

Tuesday 12th December 2017 Westminster Hall

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

It is pleasure to serve under your chairmanship, Mr Hollobone. I want to start by thanking my hon. Friend the Member for Dewsbury (Paula Sherriff) for making such a powerful case about why the health optimisation programme is failing the public, failing patients and failing all of us. Her contribution to today’s debate reminded me of the Adjournment debate that I brought to the Chamber on 28 February, which the Minister attended. My speech was parallel. That reinforces how urgent it is that this issue is addressed.

I am proud of so many things about York, but one thing I am really ashamed about is the way that it has gone about rationing healthcare. It was one of the first places to ration healthcare. When the Health and Social Care Act 2012 came in, it had to back-pedal, and then it stepped forward in 2016 in rationing healthcare, particularly surgery for patients who urgently needed it to be provided. There seem to be some key issues that we need to address that are not being addressed in the debate. I had a very helpful meeting with the Minister the other day, but there was little progress on the back of it. We need the Minister to make an intervention and not to say that it is a matter for CCGs to change their practices.

What is evolving is a massive postcode lottery across the country. My hon. Friend referred to a BMI of 30, which her CCG uses as an indicator to draw the line to provide access for surgery. I know that other CCGs use a BMI of 35. That absolutely demonstrates that this is not based on clinical evidence, but is about the financial expediency of CCGs. Therefore, it is absolutely crucial that we go back to clinical evidence when making decisions about patients. That is why we invest so heavily in our medical profession: to go through that training, to have the skills and the ability to do that. They are being completely undermined by these arbitrary figures that are being put into use for the basis of saving money. That is what this is all about, but they are not saving money, because people come back more poorly in future and require even greater resources. It may be save today, but it is spend more tomorrow. Surely that should not be the policy of any Government, let alone the one we have at a time when they keep claiming that there is not enough money.

It is absolutely crucial that the Minister intervenes because we are talking about a population with health inequality. All the demographics and the research show—I am particularly grateful for the University of York’s work on epidemiology—that there is a correlation between health inequality and social and economic inequality. The very people who are being denied surgery are the people who are most disadvantaged in society. There is a whole predication against those individuals. We know that there is a correlation with shorter life expectancy.

It is absolutely crucial that the Minister makes an intervention to improve the quality of life for these individuals. Therefore, although it seems that my hon. Friend’s CCG is attempting to do more than mine in the health optimisation programme, the problem is deeply concerning. This is not about health optimisation at all. I want to see the Minister step forward on a case of health optimisation. I absolutely agree that we have to address the obesity crisis in our country. Twenty five per cent of people are obese—that has an impact on the draw around diabetes and on other needs. I would welcome a health optimisation programme being in place in my CCG, but that is not what is happening. As I demonstrated to the Minister last week, patients in my constituency are being handed a letter that refers them to a website about some health programmes that may be far away—they are certainly not in our city because the local authority has cut them, such as the health walks. Therefore, individuals themselves have no choice about how to lose weight.

Looking at the issue of losing weight or smoking, I know as a clinician—as a former physiotherapist—those individuals need to be taken by the hand and walked through that journey, looking at all the markers around either their weight or their relationship with smoking. In the case of smoking, people need help to deal with an addiction. In the case of obesity or a high BMI, those issues need to be addressed.

I would welcome a health optimisation programme because that means that people will have a better life and they will probably not have the wear and tear on their joints. I welcome early intervention. We need to see that right through our school system, which is why I am worried about the massive fall in the number of health visitors, who could make those interventions at any early stage—as could school nurses, who have virtually disappeared—to enable people to have better, healthier lifestyles. I am particularly disappointed that the local authority withdrew the money from the NHS Health Checks, which enabled people to get their lives back on course from the age of 40 and have a healthier existence.

We fail people right through the system. At the point of crisis when they are in pain and needing surgical intervention, the system says to them, “No, you can’t access healthcare because of your behaviour over the years.” We have let people drift into that position. It is a completely failed system, which is causing individuals to be denied the surgery that they need. There is the complete nonsense of the amount of weight that people have to lose. People are told they have to lose 10%, but for somebody who is morbidly obese, 10% may take them down to the weight of somebody who is obese and who has to lose 10%. It is not a measure of a weight or a BMI figure at all. That is complete nonsense. Any clinician will absolutely recognise that this is a completely failed system. Therefore, I urge the Minister to make an intervention with the CCGs and to set the standards and the bar to enable clinicians to make the right decisions.

We had a discussion with our CCG in York and with the Minister about the programme. Obviously, we addressed the inadequacy of the healthcare optimisation programme, but we also talked about particular groups of patients who are denied treatment. Some people are on drug therapy that causes them to gain weight and are being denied the surgery they need. I gave examples of people with polycystitis, which has a particular impact on women, who are denied fertility treatment and the free surgery that would enable them to receive that treatment, because their condition is causing them to put on weight. That shows that the programme is discriminatory not only on grounds of economic status, but against women.

We have to look at the issue in the round. What we are trying to achieve? If we are trying to improve people’s health, let us put in the measures to achieve that, but let us ultimately move to a place where the right people in the system are making the decisions. Surgeons will not proceed with or recommend surgery if it puts someone’s life at risk. They know those parameters. That is what they are trained for, and they need to assess each patient in turn. I have had patients who have needed only an arthroscopy—an operation given under local, not general, anaesthetic—who have been denied surgery. We need to ensure that the surgeon makes the decision. No disrespect to GPs, but they are not specialists, and that should be a specialist’s call. I therefore urge the Minister to move clinical decision making to the right place in the health service and to ensure that surgeons, who have a responsibility to their patients, are able to put things in place.

Finally, I call on the Minister to look at NHS finances, which we know really drive the equation. We have had a bit of an exchange about that previously, too. We cannot ignore the driving factor. The Vale of York CCG in my area has done everything—it has put in the most draconian rationing system there is—but its finances do not add up. We have to be cognisant of what has happened at King’s College Hospital and the real concerns there, but CCGs up and down the country are wrestling with their finances. Public health is being cut massively by local authorities as they become risk averse, trusts themselves are in a desperate state as they gear up for a winter crisis, and the social care system is not working. We have real financial pressure.

In York, we have a capped expenditure process that limits CCGs’ choices. We need to be able to release the money to address the need. The NHS is not being fed the money it needs, and it is therefore in crisis. We cannot keep saying that it has to do more and there has been personal failure. This is becoming a national crisis, which is deeply concerning because, as my hon. Friend the Member for Dewsbury said, lives are at risk as a result. We cannot go to that place.

This is about funding. It was always going to be about funding. I remember having an exchange with Andrew Lansley about the funding formula back in 2011, when he was introducing the Health and Social Care Bill and I was head of health at Unite, to highlight this risk. I therefore feel it on my conscience. I raised these very concerns about the failed funding formula and the way that finances in the NHS work against each other rather than together. That is what creates these issues, so we can avoid them not only by ensuring that there is enough money in the system, but by ensuring that the relationship is right and the funding formula works in the right way.

In my exchange last week with the Minister, we talked about individuals in the system being able to put their hand up, in the light of the massive inequality they face and the big no on money, and say, “By the way, can I have an individual funding request? I don’t like the decision that’s been made, so I’m going to challenge what my doctor”—let us face it, doctors have stature in society—“has said and say, ‘Actually, I want to have an individual funding request.’” Making that point to a GP is a massive step, and it shifts the risk in a system that is there to care for people on to the individual patient—the smallest person in the whole health system. Patients have to say, against the weight of the system, “You got it wrong over my healthcare, and I want you to review that and put the money in,” when there is no money in the pot. That is a complete nonsense of the process. We therefore need to shift the debate back to putting the right funding into the NHS so that patients are not discriminated against and clinicians can make the choices they are trained to make.

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[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure, as always, to serve under your chairmanship, Mr Hollobone. I am conscious that there is the possibility of a vote coming rather earlier than we had anticipated; in which case, I will try to ensure I do not use up all the available time. I congratulate the hon. Member for Dewsbury (Paula Sherriff)—Dewsbury, Mirfield, Denby Dale and Kirkburton, but I will use Dewsbury for shorthand—on securing the debate and securing the support of the hon. Member for York Central (Rachael Maskell), who made a compelling case today. She referred to our recent meetings on this subject and previous debates on it in the Chamber, demonstrating her clear commitment to the cause.

It is no secret that the NHS faces significant challenges. All the Opposition Members who spoke referred to some of the financial pressures currently acknowledged as affecting the NHS. However, I do not think they quite recognised that the NHS’s own five year forward view identified some significant challenges that need to be addressed in relation to the way in which the nation supports the healthcare of the population as a whole. Throwing money at it inexorably is not always the right solution. Some difficult choices have to be made about the way in which the public lead their lives. What we can do, through a combination of public health support, advice and education, to encourage the public to lead healthier lives is an important responsibility of Government. It is important for individuals to help to ensure that they lead long, independent lives in as healthy a condition as possible.

[Rachael Maskell]

The five year forward view was put in place long after people established lifestyles either of being overweight or of smoking. To penalise them after the event was not the intention of the five year forward view. That strategy is about improving people’s health, whereas this programme is about causing health to deteriorate.

[Mr Dunne]

I do not accept that. It is important that we use all the tools at our disposal to encourage the public to lead healthy lives where possible. These measures form part of the suite of measures that are necessary to bring that about.

The Government have backed the five year forward view. Opposition Members raised the issue of finances. We have committed to a real-terms increase in funding through the spending review period. Most recently, in the Budget only last month, we committed an additional £2.8 billion on top of the £8 billion real-terms increase by 2020. We are providing significant extra resource, but we recognise that different areas of the country will face different challenges and so will develop different approaches to how they use their resources most effectively in patients’ interests. That will inevitably involve making difficult decisions. It is right that we trust local NHS organisations, clinically led, to make those decisions, rather than second-guessing them centrally.

Having said that, we have set certain expectations of the system, one of which is that blanket bans on treatments are completely unacceptable and incompatible with the NHS constitution. That is why I refute the challenge from Opposition Members to say whether or not we are imposing rationing on the NHS. The local management responsible for the NHS in their areas have to respect the constitution and should not introduce blanket bans, but they do have to look at ways to provide care for their populations in a manner that lives within the budgets they have been provided with.

[Mr Dunne]

The hon. Lady made that point in her remarks, and I will try to address it. She can pick me up on that again.

[Rachael Maskell]

To put this into the context of how it is working in reality, patients who do not meet the thresholds are automatically put through a system, and therefore it is completely in breach of the NHS constitution. There is no individual input about the clinical needs of a patient.

[Mr Dunne]

I will come on to that. We are talking primarily about what is happening in North Kirklees and Greater Huddersfield CCG areas, which have not yet implemented this policy. I will explain why I do not think that that should be the case.

On the healthcare optimisation plan, I take the gentle chiding from the hon. Member for Ellesmere Port and Neston (Justin Madders) about the way in which the NHS describes proposals. I have some sympathy with what he says about the way in which language is used, but this is a plan to encourage greater public health among the population of North Kirklees and Greater Huddersfield CCG areas, for which they are responsible. I talked to the CCGs in preparation for the debate and was advised that they do not see this as a blanket ban on treatment. I have emphasised to them that they should not do so and that there should not be a blanket ban on treatment.

I will describe the proposals, as I understand them. They have been developed by the CCGs since autumn 2016, and the objective is that patients who are overweight with a body mass index of 30 or above will have 12 months to lose at least 10% of their overall weight or to reduce their BMI to less than 30, while patients who smoke will be encouraged to take up to six months to quit smoking before undergoing routine surgery. Those who quit smoking for four weeks or achieve their target weight loss will be able to be referred for surgery under the policy.

The development of the plan coincided with the UK’s childhood obesity strategy and the proposed introduction of the soft drinks industry levy, reflecting the Government’s commitment to tackling the major public health problems affecting large sections of society. The hon. Member for Dewsbury and the hon. Member for York Central recognised the need to address the obesity crisis in this country. I am grateful for their support and that of the Opposition spokesman, the hon. Member for Ellesmere Port and Neston. I think we are united in recognising that something has to be done about this. I hope they support the proposals that the Government have made for the obesity strategy and the considerable progress we have made in reducing smoking since 2010. Hon. Members have made the point that the policy should not be at the expense of treatment if treatment is urgent or, if there is no treatment, it might lead to degradation of the health condition of the patient subject to the policy.

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[Mr Dunne]

As the hon. Gentleman knows, CCGs are subject to appraisal and are accountable to NHS England, which is accountable to Ministers. It is not for Ministers to direct individual CCGs as to how they should enact their policies, but there is a route through which we can provide some encouragement to NHS England to ensure that these policies reflect its national position. That is what we will do.

On where the process is, in October the two CCGs presented details of the proposed plans to Kirklees Council’s health and social care scrutiny committee. The committee requested that the CCGs undertake a further six weeks of engagements, especially with hard-to-reach communities in the area of the hon. Member for Dewsbury. The CCGs have assured me that they are committed to that further engagement with the local community to ensure that the plan is fit for purpose, so there is a continuing opportunity to reflect on the revised iteration of the proposals. I am also advised that the CCGs have not yet made firm decisions on the plans. Instead, as a result of the engagement with local stakeholders, they are considering four options, and variations on the four options, for implementing the proposed plan, including not proceeding with the programme, which remains on the table.

Those options include: first, a phased approach, beginning with applying the programme initially only to patients who smoke and subsequently rolling it out further to obese patients if appropriate; secondly, only implementing the plan for smokers; thirdly, introducing health optimisation periods across clinical thresholds and pathways, in line with NICE guidance; or fourthly, moving away from implementation of the plan as previously defined and focusing on a strengthened education campaign to reinforce the benefits to patients of stopping smoking and losing weight. Those options remain on the table and there will be a further period of engagement. A decision on which option will be taken forward is due to be made by the CCGs in January, and further engagement on the implementation of the recommended approach will then take place later in the new year.

I said earlier that the plan is not a blanket ban on treatment. Instead, the intention is to encourage patients who are obese or who smoke to lose weight and/or quit smoking. There is evidence that that will have benefits, in terms of both surgical outcomes, as I have said, as well as reduced risk for general medical conditions, and there are clearly also benefits to patients’ general health in the long term. Hon. Members can be assured that the CCGs are providing support to the patients on weight loss and smoking cessation, and have agreed to invest £133,000 a year in such services to account for any health optimisation-related increase in uptake.

The hon. Member for Dewsbury asked how we will assure that the plan is in accordance with national guidelines. As she would expect, NHS England has been closely reviewing this and similar proposals where they have been made to ensure that there is robust supporting clinical evidence and appropriate safeguards. The Government expect NHS England to ensure that the responsible CCG is not breaching its statutory responsibility to provide services that meet the needs of the local population. I can confirm to hon. Members that NHS England has had ongoing discussions with both CCGs about the health optimisation plan and will continue to do so to ensure that it works in the best interest of patients. That is the right approach, in terms of both protecting patients and both encouraging the population to put themselves in a condition to maximise the benefits from surgical procedures, without allowing CCGs to introduce an inappropriate blanket ban.

NHS England carries out regular assurance of CCGs and holds them to account through the CCG improvement and assessment framework to ensure that they are fulfilling their statutory requirements, and NHS England can and will intervene if a CCG is failing to discharge its key responsibilities. NHS England’s regional teams also have regular discussions with CCGs about their commissioning activities and plans.

It is important in a debate like this, in which there are allegations of there being a postcode lottery, that we recognise that it is down to clinicians at a local level, through their CCG bodies, to make decisions that affect their local population, rather than, as has happened in the past, central diktat from Whitehall. Those may lead to perverse consequences and a less relevant healthcare capacity and treatments for patients on the ground.

[Rachael Maskell]

The Minister is being very generous with his time. Is it not important in a national health service that we use the very best clinical evidence on how to produce the best outcomes for all patients? Falsely drawn boundaries should not have any relevance to the kind of treatment people receive.

[Mr Dunne]

The hon. Lady will recognise that there are different health challenges in different areas, reflecting patients’ differing needs. Encouraging the public to stop smoking and to reduce their weight is, as she acknowledged, an ambition that is shared by Members across the House and across clinical leads.

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[Rachael Maskell]

Will the Minister give way?

[Mr Dunne]

I will not let the hon. Lady intervene again because, amazingly, I am about to run out of time, despite what I said at the beginning. I have taken a lot of interventions.

I conclude by assuring hon. Members that we are paying close attention to what is happening in Kirklees and Greater Huddersfield, and York Central. Other areas of the country may be considering similar proposals, and we need to ensure that it is done in a responsible manner, whereby clinicians stay at the heart of making referrals where appropriate and retain that discretion. We will not get to the situation that the hon. Member for Dewsbury described in her opening remarks, in which she said that people’s lives will be put at risk by policies such as this. That is not the case.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 14th November 2017 Commons Chamber

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

Constituents in York who have experienced sexual trauma have no clinical pathway to address their psychological support. Will the Secretary of State therefore take action to ensure that we have a national framework to support women in particular, but also the staff who provide that service?

[Mr Hunt]

Such issues are much in people’s minds at the moment, and the hon. Lady makes an important point, so I will take that away with me and come back to her with some thoughts once I have looked into it carefully.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Speaker]

It is interesting to hear about the thoughts of the hon. Gentleman when he is on the treadmill or the exercise bike—it is always useful to have a bit of additional information.

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

20. Despite co-operation between the CCG and the local authority, we have had severe rationing and cuts and a seriously underfunded mental health service: the funding formula is seriously failing the health economy in York. In particular, the capped expenditure process will make it far, far worse. Instead of just slashing budgets, will the Secretary of State meet me to understand York’s health economy and to put real solutions in place?