Community Pharmacies

Rachael Maskell Excerpts

Wednesday 2nd November 2016 Commons Chamber

That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; welcomes the Government’s proposals to further integrate community pharmacy into the NHS, including through the Pharmacy Integration Fund, and make better use of pharmacists’ clinical expertise, including investing £112 million to deliver a further 1,500 pharmacists in general practice by 2020; supports the need to reform the funding system to ensure better value for the taxpayer; and welcomes the establishment of a Pharmacy Access Scheme which will ensure all patients in all parts of the country continue to enjoy good access to a local community pharmacy.

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

On a point of order, Madam Deputy Speaker. Has the Secretary of State for Environment, Food and Rural Affairs given notice of whether she intends to make a statement to this House in the light of today’s High Court judgment, which found against the Government for the second time on the matter of being in breach of air quality standards and putting in place an inadequate air quality plan? I am sure that you will appreciate the level of interest in the outcome of those proceedings, given that between 40,000 and 50,000 people in our country die prematurely each year as a direct consequence of the Government’s failure to reach those air quality standards.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I understand the hon. Lady’s concern about the matter and thank her for raising it, but she and her colleagues will understand that it is not a matter for the Chair. If she wishes a Minister to come to the House, the correct procedure is to submit a request for an urgent question. I am sure that if the hon. Lady believes that she has sufficient grounds for asking for an urgent question, she will submit a request and Mr Speaker will give it due consideration.

Kentmere Mental Health Ward, Westmorland General Hospital

Rachael Maskell Excerpts

Monday 13th June 2016 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

Kentmere ward is the 12-bed adult mental health ward at Westmorland general hospital. It provides essential in-patient acute mental health services to people in South Lakeland and beyond. Four weeks ago, the Cumbria Partnership NHS Foundation Trust, which looks after mental health in the county, proposed to close the ward by the end of June, with new admissions ceasing at the end of May.

This is the second time in my time as our Member of Parliament that the ward has faced the threat of closure. Ten years ago, similar proposals sparked a huge outcry from local residents. Thousands of people signed petitions and wrote to health bosses, and about 3,000 of us marched through Kendal town centre in pretty shocking weather to voice our opposition.

The campaign took many, many months, but we won. Our victory in saving the ward was a hugely important moment for our community. Mental health is often a taboo, so the suffering of those living with mental health conditions, and of their families, often happens in silence and in private. In the face of a threat to the services that those with mental health conditions rely on, far too many people would choose to look the other way—but not in South Lakeland. The campaign showed that local people were prepared proudly to stand up in solidarity with those living with mental health conditions and with their families. I am therefore extremely proud of my community. In the face of this latest threat, the character of our community is once again shining through.

Westmorland general hospital is the main hospital serving the Lake district, the western Yorkshire Dales, Kendal and much of the rest of rural southern Cumbria. I have learned over the years that the tendency to overlook the health needs of rural communities such as ours means that I need to be permanently vigilant in my defence and promotion of our hospital. The campaigns we have run to win new cancer services, to prevent the closure of the hospital itself and to increase surgery at Westmorland general are testament to the fact that ours is a special community, which will fight with unique energy and tenacity for mental and physical healthcare that is high quality and accessible. Once again, it appears that we must roll up our sleeves and fight to defend our services.

As I said, the ward provides 12 beds, the majority of which are usually full at any given time. The people occupying these beds are often suffering from the most serious mental health conditions. For much of the time, the majority of patients staying on the ward are under section.

The apparent trigger for the proposed closure came after the Cumbria Partnership NHS Foundation Trust was inspected as part of Care Quality Commission’s comprehensive inspection programme last November. Its report, which was published in March, awarded a rating of “requires improvement” to the Kentmere ward. In particular, the CQC highlighted concerns relating to privacy, access to outdoor areas and the internal physical structure of the ward. Having visited the ward myself, most recently on Saturday, I have to say that the quality of staffing and patient care is absolutely outstanding. In fact, the CQC itself was surprised that the trust’s response to the report was to close the ward, believing that the upgrades needed to meet required standards were perfectly feasible. Let me be clear: this ward is providing excellent care from outstanding staff in a physical setting that requires some improvement. It most definitely does not require closure. Indeed, the CQC has been clear that it did not recommend closure, or anything of the sort.

As I said, the ward is situated in Westmorland general hospital. The partnership trust that is responsible for mental health in Cumbria is a tenant of University Hospitals of Morecambe Bay NHS Foundation Trust. The hospital is a fairly modern building, with plenty of car parking and a beautiful setting looking out towards the Lakeland fells and the Howgills. Put bluntly, if you have to go to hospital, I cannot think of anywhere more pleasant you could be, and that is not unimportant when supporting people living with mental health conditions. The hospital building is not full. There is a great deal of space on the site, with ward space that is not used or under-used. There are enormous opportunities, with a little bit of imagination, to seek more spacious, more suitable, better-quality accommodation elsewhere in the hospital.

It is clear, then, that Kentmere ward needs upgrading. It is not ideal that it is on the first floor. There could do with being more space for the unit as a whole and greater privacy for the patients. There will be projected costs of a completely new building to meet the requirements of an upgrade. The Minister may have seen those projections. They will no doubt be expensive, and the conclusion that he is probably meant to draw from whatever scary numbers he has been given is that the only affordable solution is to close the ward. He is expected to read his brief and fob me off. However, I know him well, rate him highly, and know that he has much better judgment than that.

The reality is that the needs of patients in South Lakeland could be met on the current Westmorland general hospital site. An immediate project should be launched, alongside the hospitals trust, to ensure that there is a larger unit with ground-floor access that has greater levels of gender segregation, greater privacy, greater dignity, and greater safety. If there is a will, then the way is staring us in the face. Whatever the challenges, which we acknowledge, in upgrading this unit, it is obvious from my conversations with patients, their families, staff, the CQC and the trust that there are serious concerns about the incredibly detrimental impact that closure will have on patients’ conditions.

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

What the hon. Gentleman is saying very much echoes what happened in York when the hospital closed nine months ago. The consequence has been loss of life to my constituents. It seems that primacy in decision making is given not to clinical need, but more to the physical environment, and that has to be wrong, does it not?

[Tim Farron]

I am extremely grateful to the hon. Lady for her intervention and wish to express great solidarity with her in the campaign that she is running in York. It is of great concern to me that the CQC will make recommendations that will require improvements, and potentially not offer solutions to maintain a plausible and sustainable provision instead. The judgment we have to make is, “Is a good service that is not perfect better than no service?”, and of course the answer is going to be yes.

As I said, the quality of care in Kentmere ward at Westmorland general hospital is excellent, as stated in the report, and the staff are excellent. The ward needs upgrading—that is a given—but its closure would harm the health of some of the most vulnerable people in our community. It is utterly unacceptable that those people will have to be shipped off to Barrow, Whitehaven or Carlisle rather than being treated much closer to home in Kendal. What is more, there is no guarantee that those far distant wards will have the capacity to accommodate them. Already, patients sometimes face the immense journey to Manchester, for example. For many less well-off residents, a round trip to these alternative wards of up to 100 miles, with many hours on the bus or train, will put family and loved ones beyond easy reach. It is the patients who would be harmed if they were cut off from their families and friends and missed out on all-important visits. Instead of the reassurance of familiar faces and surroundings, they would face this dark time alone and in an unknown place.

Junior Doctors Contracts

Rachael Maskell Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I am absolutely prepared to talk about anything that could be improved in the contract that will be introduced and, indeed, extra-contractual things such as the way in which rota gaps are filled and the training process. However, at the moment we do not have such a dialogue, and that has been the problem. The imposition of a new contract is the last thing in the world that we wanted as a Government. It followed 75 meetings—it was a totally exhaustive process—but in the end we found that our counterparty was not interested in sitting down to talk about this; it just wanted a political win. We had to make an absolutely invidious choice about doing the right thing to make patients safer. I wish we had not got to that point. We have got to it and we need to carry on, but the door is always open for further talks and discussions.

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

The Secretary of State is the one person who can stop this strike. Why will he not now take a step back, engage the services of ACAS—specialists in negotiations—remove the conditionality and address the remaining issues? Proper dialogue will get a resolution.

[Mr Hunt]

Had Nye Bevan given way to the BMA there would be no NHS.

Junior Doctors Contracts

Rachael Maskell Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I will tell the hon. Gentleman one of the things we are doing, which is turning around the hospital in his own constituency, which is no longer in special measures because the quality of care has improved dramatically. What else are we doing? Over three years, there have been 75 meetings, 73 concessions and three different independent processes. We have tried everything to get a negotiated outcome, but in the end we have to do the thing that is right for patients.

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

The Secretary of State needs to face reality: there is a recruitment and retention crisis of junior doctors in paediatrics, A&E, intensive therapy units and acute medicine. Those specialisms demand seven-day working and people working unsocial hours. The junior doctors know that these contracts will make the situation worse, so why is the Secretary of State not doing everything in his power to get people to sit around the table—even if that does not include him personally or David Dalton—to have negotiations to address the real issues concerning junior doctors?

[Mr Hunt]

That is exactly what we have been doing. Indeed, there are a number of changes in the contracts that will be beneficial for people working in A&E departments, as has been recognised by the president of the Royal College of Emergency Medicine, Cliff Mann. The difficulty we have had in terms of morale is that we have been faced with the BMA, which has consistently misrepresented the contents of the new contract to its own members. Nothing could be more damaging for morale than that. What we will need to do, I am afraid, is wait until people are on the new contracts, and then they will actually see that they are a big improvement on their current terms and conditions. That is the right thing for doctors and the right thing for patients.

Mental Health Taskforce Report

Rachael Maskell Excerpts

Wednesday 13th April 2016 Westminster Hall

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

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

I thank the hon. Member for Halesowen and Rowley Regis (James Morris) for setting out the framework of this excellent report by Paul Farmer and his taskforce on addressing concerns about mental health. What stood out for me was that it was a very practical report—with time lines and specificity about how the debate should be taken forward, the resources required and the instruments we put in place to make the report a reality—but the hon. Gentleman was absolutely right: it is important that it should be accountable at every step of its journey. I will come to that later.

The report also sets out a clear action plan for some of the areas that need a focus, including the setting of key targets. I welcome the ambition in the report to improve access to services and reach a much wider community than they do now. It sets out a new chapter in this journey about how we build capacity for mental health services in future. I doubt that there will be disagreement in the Chamber about some of the emphasis in the report on funding and the requirement to put more resources into the service. What stood out for me was the startling figure that poor mental health costs us, economically and socially, £105 billion, a figure that compares with only £34 billion being spent on the service.

There is a lot of opportunity to move the debate about funding and finances forward, as well as addressing issues to do with facilities. That has been a particular issue for us in York, as we have seen the closure of our acute service and the slow rebuilding of that service, with more emphasis on community delivery. It is important to ensure that we have the right number of beds as we put in a new facility for the people of our city. When we look at capacity issues, we should not look backwards at how a service was delivered, but look forward to the future needs and requirements of the service.

It is also important to reflect issues of workforce planning. We have seen a serious shortfall in people working across the mental health services. I welcome the recommended drive-up of, for example, 1,700 therapists. Will the Government be producing an action plan, as they did for health visiting, to ensure proper mentoring and support in the system to ensure that those therapists come online, while also ensuring a proper regulatory framework for the health professions across mental health? We do not have one currently, and I know that many of the professions are calling for proper regulation.

The other figure that really stood out for me concerned when people require support, with 50% of mental health problems established by age 14 and 75% by age 24. What stands out for me is the need to shift resources into early intervention and prevention services. I welcome the investment to be made into perinatal mental health, but we need to build up from those services, as we look at the provision that will be needed into the future.

In particular, if we are looking at that focus, I know from talking to teachers in my community that too much of the burden is being placed on them. We need to ensure that it shifts to the real professionals in the service, who are properly trained to provide support, diagnosis, signposting and screening for young people. There is urgent need to look across services for young people as they move out of school. We have also had specific issues with transition, and I still think there are cliff edges, as commissioning and service provision are done by different bodies. As a result, we get cliff edges—not smooth transition—based on a date of birth rather than clinical need. That really needs to be addressed.

In the short time remaining, I want to mention the raising of concerns in mental health services. The current system is quite inadequate—HealthWatch has contacted me today specifically about this issue. There are too many places where concerns can be raised. We have the Care Quality Commission and NHS Improvement; we also have regulators who look at the professions and other places, such as the healthcare safety investigation branch. There are so many different places. We need one place where concerns can be raised, so that service users and staff know where to go and can get a clear response. I hope the Minister will address that as well.

BMA (Contract Negotiations)

Rachael Maskell Excerpts

Monday 21st March 2016 Westminster Hall

[Helen Jones]

I am grateful to my right hon. Friend for defending the university in his town. I am sure that he is right.

Any experienced negotiator will say that beginning negotiations by insulting the staff is never a good tactic. That is part of what the Government have attempted in muddying the waters: first, by drawing conclusions from the research that are not there, and secondly, by not being clear what they mean by a seven-day NHS. They have constantly said, “We need a seven-day NHS”. What they fail to tell us is whether they want a seven-day emergency service, which we already have but everybody accepts that it could be improved, or a seven-day elective service, which will require a huge investment not only in doctors and nurses but in diagnostics, support staff, lab technicians and so on. That failure to be clear has made doctors very wary of what the Secretary of State is trying to achieve.

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

There is also a real issue around capacity for a seven-day service. If elective surgery is increased over the weekend, where will those patients go, because hospitals are already at capacity?

[Helen Jones]

My hon. Friend makes a very good point, and she is right.

The Government need to make clear what they are trying to do, then they need to negotiate with the staff in good faith. Unfortunately, there is not much good faith around at the moment. That is why 90% of junior doctors have said they would consider leaving the NHS if the new contract is imposed on them. I do not think for one minute that 90% of junior doctors will go, but the Government have proceeded—as they do in a lot of cases—as if those junior doctors had nowhere else to go. Unfortunately, in this case they do: they can go to Scotland, or to Wales; or they can go and work abroad, where their skills are in high demand and where they will find, in many cases, they are paid more and work fewer hours than they do here. If even a small percentage of junior doctors go, what will the Government do to fill the gaps? We already have gaps in certain specialities, such as A&E, and paediatrics. What is the Government’s plan?

--- Later in debate ---

[Helen Jones]

It is a real failure, given the commitment of doctors and other staff to the NHS.

This dispute is taking away energy and focus from dealing with the real problems facing the NHS. The NHS is under huge pressure and many trusts have big deficits, yet the service as a whole is still expected to make over £20 billion worth of so-called efficiency savings, which no one with real knowledge of the NHS thinks can be made without cutting services. One in 10 people in A&E now wait longer than four hours for treatment, which is the worst result for a decade.

There is also huge pressure from the Government’s ill-conceived cuts to local council budgets, which has led a slashing of social care and which the Government were warned at the time would have an impact on the NHS. The real problem those cuts are causing is more admissions to A&E, often of elderly people who have had falls or who have become ill because of lack of care. There is also the problem at the other end, whereby people cannot be discharged because there is no care package in place for them.

[Rachael Maskell]

I thank my hon. Friend for giving way again; she is being incredibly generous with her time. Does she agree that it causes real concern that the specialisms that require people to work longer and unsocial hours are also the ones that are most difficult to recruit for, and that the contract is therefore putting clinical safety at risk?

[Helen Jones]

My hon. Friend is quite right, and I will come on to that point later. There are staff shortages in the NHS that the contract may well make worse.

In the end, as in any dispute, the issues can be resolved only by negotiation, and in truth the two sides are not all that far apart. Huge progress was made when Sir David Dalton was brought into the talks, but there are still outstanding issues to be resolved. For instance, the Government trumpet a 13.5% increase in basic pay. What they do not say is that that increase will be paid for by cuts elsewhere. For example, payments that are made as a reward for length of service will go. I have yet to hear from the Government their assessment of what impact that change will have on retaining staff in the NHS, or how it will work for members of staff who take time out, whether for academic study—we need doctors who are both academics and good clinicians—or for maternity leave. What will happen to women who work part time, and so on? If we lose a number of women doctors in the NHS, the service will be in a great deal of difficulty.

Guaranteed pay rates when people change specialties are also going. In the past, if someone changed specialty later on in their career, their pay was guaranteed. That will not be the case any more. That change is bound to have an effect on recruitment in areas where we are already short of doctors, and I have seen no real impact assessment of that yet.

Of course, the big issue for many doctors is the change to standard time and premium time. The Government are increasing standard time from 60 hours a week to 90 hours a week. In the past, doctors were paid extra for working between 7 pm and 7 am, and for working at weekends. Standard time will now increase to run to 9 pm on weekdays and 5 pm on Saturdays. Doctors who work more than one in four weekends will get a premium payment. It is difficult to work out the effect of that change on individual doctors; it depends on how many weekends they work now, what their specialty is and so on.

The Government’s pay guarantee lasts for only three years, and given the Secretary of State’s remarks, junior doctors fear that the change is a back-door way of introducing longer hours. It certainly makes it cheaper to roster doctors at weekends. The Government say they will fine hospitals that roster people for more than a certain number of hours, but the doctors say that offer is not good enough. That is not an unbridgeable gap; it could be resolved. However, the result of what has happened and the Secretary of State’s comments is distrust and suspicion among doctors about what his real motives are. That is combined with a disastrous drop in morale in the NHS. The latest NHS staff survey shows that the percentage of junior doctors reporting stress has risen from 20% to 35% in five years. The proportion of staff saying that they feel pressurised to come into work when they are ill has gone up from 16% to a whopping 44%.

That loss of good will and drop in morale matters, because NHS staff are known for going the extra mile, working longer than they are paid for and doing things they do not have to do. That extends from the consultants who come in on their day off to see certain patients to the nurses and support staff who bring in a birthday card for an elderly person who has got no one else. I well remember that when my son was born, I was there for three shifts in the maternity department. After he was born, the registrar from the first shift came back to see me, to check that I was all right and to see whether I had had a boy or a girl. It is impossible to put a price on such things, and the Government risk losing all that and doing huge damage to the NHS if they do not solve the dispute.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir David.

It is a privilege to be able to say that I worked in the NHS as a physiotherapist for 20 years—I remain on the professional register—and to bring that experience to the debate. The service that I worked on was changed to cover seven days. The complement of staff was the same, but spread over the whole week. To provide a full seven-day service with every specialism in place would require a massive investment of resources on a scale nothing like what the Government are talking about, given that they are set on making £22 billion of efficiency savings. Before being elected to Parliament I had a dual career, because I was also head of health at Unite, representing more than 100,000 health workers. I therefore have real experience of dealing with the Government and of how the Department of Health handles disputes.

On 5 December 2011, proposals were introduced to cut unsocial hours for all “Agenda for Change” staff. The proposals were discussed with NHS employers throughout the country and with the trade unions. We sat around tables and discussed the proposals, and they were turned away, but the fear is that they could be coming back on to the table. The NHS Pay Review Body report said that the Department of Health and NHS employers recognise that

“the cost of the unsocial hours premia makes the delivery of seven-day services prohibitive”.

That is why the whole NHS is worried: the real prize for the Government is the savings they will make from cutting unsocial hours throughout the NHS.

If the Government are planning to expand services to cover seven days, if only in name, they will need more people to work at weekends. The cost of having more people working at weekends cannot currently be met, so if the service is to be expanded, obviously the prize the Government are after is the NHS’s “Agenda for Change” staff, who are often very low paid. According to a survey I conducted of these professional NHS employees, they are giving eight hours of unpaid overtime to the NHS every week, doing the many things we have already heard that NHS staff do. Why? Because they care, because they are professional, and because that is what happens in the NHS.

I do not recognise at all the caricature painted by the hon. Member for Morley and Outwood (Andrea Jenkyns). What she described is not my experience of some of the most highly professional people in our land. They deserve our respect and awe, not to be degraded as she degraded them today and as the Secretary of State has previously. I am ashamed to have heard her comments. I had a meeting with junior doctors in my constituency on Friday and listened to their concerns. They are seriously concerned about recruitment and retention in the medical profession, particularly in accident and emergency, where there is a serious recruitment and retention problem in my local hospital.

They explained to me that as junior doctors are leaving they are being replaced by locums. That destabilises the multi-professional team. It destabilises the ability of clinicians to work in teams where clinicians know one another, which is the safest way to operate. All the tutoring, mentoring and other input that staff so value and need—learning on the job right through their professional careers—is lessened by that destabilisation. They are seriously concerned about recruitment and retention because they want to get the best professional development so that they can give the best service to patients. That is why we are seeing junior doctors applying to work overseas: they want to ensure that their careers are enriched so that they can give patients the best care.

We should be really concerned that there are such problems with recruitment and retention in many of the specialisms that require weekend working and are involved in emergency services. We are not discussing some of those services that, frankly, could operate according to clinical need during a Monday-to-Friday service because the demand is not there for such professionals to be there at the weekend. We should be very worried, as should the public, because the reality is that if doctors are not in A&E, who is going to care for us in our time of need? That is the reality of what is happening.

Psychiatry is another profession that is currently finding it difficult to recruit, as are other areas of emergency medicine and the intensive therapy unit at my local hospital. They face real challenges, and they have concerns about the new regime that is being introduced to try to deter hospitals from making doctors work long hours—the new guardian of safe working role. They are concerned because the new regime is like the trust marking its own homework. If doctors report that they are working excessive hours, the trust will be fined, but the fines will go into a training and development fund, so we will just see less money going into that fund in the first place. It is a case of playing with the accounts and shuffling the deckchairs on the Titanic as it is sinking under the proposal.The reality is that it will not be an effective measure for preventing people from working longer hours, and doctors have real concerns about it.

[Dr Whitford]

I, too, have concerns about the hours guardian, because it will require junior doctors to complain. The NHS is a hierarchical system, and those doctors, who are often on the lowest rung of the ladder, will have to step up and make a noise. Something that depends on their whistleblowing on their own hours will not provide strong protection.

[Rachael Maskell]

The hon. Lady is absolutely right. Although Government Members say that the NHS has a much more open culture, the reality on the ground is that it is difficult to raise concerns in the NHS. Shopping the boss if they are making someone work longer hours will be difficult. The hon. Lady makes an excellent point.

We want to maintain the best in our NHS; we do not necessarily want to give that gift to the world. That is why it is so important that we return to the negotiating process. There was pressure from the Opposition to ensure that there was a process of independent arbitration so the talks could be resumed. When Sir David Dalton became involved, the dynamic of the dialogue changed, so a deal could be brokered and progress could be made. All that we ask—hundreds of thousands of people who understand industrial relations have written to us about this—is for professional dialogue with professionals to ensure a proper negotiating process so we can find a solution to this dispute. That is how negotiations work. That is the process of industrial relations. It is about sitting around a table and working through the difficult issues before us. When great minds come together, solutions can always be found.

I urge the Minister not to impose the contract and to withdraw from that position. Of course it is possible to do that. Anything is possible if the will is there. Withdraw, calm down, stand back and let some dialogue continue. We need to find a solution that is good for NHS employers, for our doctors—do they not deserve a solution to this dispute?—for the rest of the NHS, for patients and for the public. Why not make that small concession and open talks immediately?

[Thangam Debbonaire (Bristol West) (Lab)]

Thank you, Sir David, for allowing me to make my first speech on my return to Parliament after a nine-month absence in the care of the NHS. [Applause.] Thank you. Forgive me if I am a little unsure of the procedure. I thank my hon. Friend the Member for Warrington North (Helen Jones) for making an excellent opening speech and other colleagues for their contributions. My constituents asked me to speak in this debate on behalf of patients, junior doctors and other NHS professionals in Bristol West, and I am grateful for the opportunity to do so.

Junior doctors in my constituency told me that they already work in a seven-day NHS, and so do other NHS professionals. Although the subject of this debate pertains to junior doctors, it is relevant to mention other NHS professionals. As other Members have said, pushing this contract onto junior doctors appears to be a proxy for pushing for a fully seven-day NHS—indeed, that is what Government Members seem to be hinting at—so it will affect all NHS professionals.

I have had a lot of opportunity recently to observe at first hand, and at close quarters, over nine months how hard NHS professionals, including junior doctors, work and how dedicated they are to all of their patients. During my treatment for breast cancer, the radiology department found just after Christmas that it was under severe pressure. There was a backlog of patients who all needed daily radiotherapy. I was one of them. People cannot just wait for radiotherapy to happen; it has to happen when it needs to happen. The staff worked out a way of meeting patient needs by offering extra appointments at evenings and weekends. Indeed, I went for my radiotherapy at 8 o’clock in the morning on a Saturday, such was my dedication to my treatment.

Much more important than my approach was what the staff did. The doctors went out of their way to help and advise me and other cancer patients. For instance, I received text messages from my surgeon over a weekend and inquiries on my progress following an infection from a breast cancer nurse in the evenings. All the staff seemed to me, and to the breast cancer and other cancer patients around me, to routinely go out of their way to meet patient needs.

All of that is by way of explaining to Government Members that my experience and that of other patients is that NHS professionals are dedicated, professional, caring and willing to be flexible about working over seven days. As other hon. Members have said, there already is seven-day care for patients. The junior doctors I met individually in Bristol West confirmed that that was the case, and the BMA representatives I consulted told me that they wanted a negotiated settlement. The Secretary of State appears not to understand that there are more than 56 medical specialties, each with different work patterns. They all need rostering, and they do not all work in the same way. Lab technicians, nurses and others, such as receptionists and cleaners, would all need to work weekends for the proposal to work. I have not seen any sign from the Conservative party that the Government would provide funding for that. If they would, I urge the Minister to tell us about it.

My overwhelming conclusion is that the Government do not seem to be aware of where they are starting from or where they are going to. They definitely do not know how to work respectfully and honourably with the people they need to work with professionally to make the changes they want to make, whatever they are.

[Rachael Maskell]

My hon. Friend is making an excellent speech. On the delivery of a seven-day service, where are the professionals going to go, as we have a recruitment crisis and have to use agency staff?

[Thangam Debbonaire]

I thank my hon. Friend for that excellent point. The Opposition are only too aware of that.

NHS: Learning from Mistakes

Rachael Maskell Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

This, I am afraid, is the problem with some elements in the BMA, who are putting politics ahead of patients. As we have heard today, that is the problem in the Labour party as well.

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

Action on Sir Robert Francis’s “Freedom to Speak up” review is very welcome. There are so many cases I could cite, but when a senior junior doctor reported unsafe levels of care in an intensive therapy unit, he was subject to unacceptable behaviour such as bullying and blacklisting, and now can only work as a locum. When he wrote to the Secretary of State, the Secretary of State refused to engage, listen and learn from his experience. Learning cultures have to start at the top with the Secretary of State. Will he set out how he will address retrospective cases of whistleblowing when people have been subject to discrimination?

[Mr Hunt]

I hope that the hon. Lady is not quoting selectively from my reply to the person concerned, because when people raise issues of patient safety with me, I usually refer them to the CQC, which is able to give a proper reply. I would be very surprised if I had not done that in this case. Retrospective cases are particularly difficult, and much as we want to help, it is difficult constitutionally to unpick decisions made by courts. We are trying to separate employment grievances from safety grievances and make that the way that we solve these difficult situations.

Mental Health Taskforce

Rachael Maskell Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

The engagement of the NHS with the taskforce needs to be recognised and emphasised. The NHS set up the taskforce because it wanted to be clear about the state of mental health services and take a five-year forward view. That is what the taskforce does, but it goes beyond that to say that it has a 10-year vision, which I welcome. Not everything can be done in neat, parliamentary-cycle chunks, so it is important that people have a continuing sense of commitment. The certainty that my hon. Friend wants is demonstrated by the involvement of the NHS, the endorsement of the recommendation by the chief executive, and the work on transparency, which is important to us, to make sure that we can all see where money has been spent. That should hold clinical commissioning groups and the NHS to account on the expenditure issue.

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

Paul Farmer’s report highlights the fact that 50% of diagnoses of mental health challenges are made by the age of 14, and 75% are made by the age of 24. He also says in the report:

“Yet most children and young people get no support.”

Will the Minister explain what specific work will be undertaken to look at prevention and early intervention, including early diagnosis?

[Alistair Burt]

I thank the hon. Lady for her interest and her considerable knowledge of these issues, which she has raised a number of times.

There are two things to say. First, on expenditure on children and young people’s mental health services, £1.25 billion will be spent over the next five years to improve the baseline for child and adolescent mental health services, including early prevention. I would also mention the full roll-out of IAPT—improving access to psychological therapies—services for children by 2018. That is already in place for, I think, 70% of the country, and it will be completed by 2018. It is a way of ensuring that children have early access to the psychological therapies that they need. That is an important development, which I hope the hon. Lady welcomes.

Community Pharmacies

Rachael Maskell Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas]

That is absolutely superb—my next line is: “Community pharmacies have a vital role in giving advice and in diverting patients from GPs and emergency departments,” exactly as my hon. Friend said. In tourist areas such as Cornwall, they take their share of the extra demand during the height of the season. Most recently, my local community pharmacists administered flu jabs to increase uptake. Pharmacies regularly get prescriptions to patients out of hours when no alternative is otherwise available, and Cornwall has led the way, with ground-breaking work in enhanced services. That is an example of how community pharmacists are very much part of the solution to integrated community health provision.

Healthwatch Cornwall recently surveyed Cornish residents about access to community pharmacies. Some 69% of participants said that they regularly visit their pharmacy, and 74% of those felt comfortable talking to the pharmacist about their health, while 78% felt well informed by their pharmacists when taking new drugs and 93% said that the pharmacist was polite and helpful.

One constituent of mine, a retired doctor, Professor Dancy, wrote to me as follows:

“I am a warm supporter of Nigel, our local pharmacist, and proud to be so. He is always ready to help when I forget (as one does at the age of 95) to re-order a medicament, and when my doctor is unavailable, or just pushed for time, I do not hesitate to ask Nigel for advice, which I follow with a confidence that is always rewarded.”

Community pharmacists are highly trained and trusted healthcare professionals, qualified to masters level and beyond. Their knowledge base covers far more than just drugs, making them the ideal healthcare professionals to relieve pressure on GPs and other areas of the NHS. Equally importantly—perhaps even more importantly—community pharmacists are welcoming change and embracing new clinical opportunities.

However, the proposed funding cut will not sustain the transition from a supply-based service to the more clinically focused service that the Government desire and our patients deserve. Cuts will discourage progress and can only result in small, independent and much-loved businesses failing, at the expense of patients, the public and the wider NHS.

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

In York, the local authority has made cuts to smoking cessation services, as well as NHS health checks, and the community pharmacists I have spoken to have said that they see their future role as filling some of those gaps. However, with further cuts to community pharmacy itself, where are people meant to go—back to queues in GP surgeries?

[Derek Thomas]

I thank the hon. Lady for that intervention. That is exactly why we are having this debate. I want the Government to examine the value of community pharmacists and to consider how they can do some of the work—in fact, a large part of the work—that would save money for NHS acute services.

I am well aware that there is a need to secure better value for money in areas of the NHS. Over the weekend, I met four community pharmacists and they all talked of the opportunities to make savings that they have identified. They are willing and able to see more patients. Pharmacists give free, over-the-counter advice to thousands of people every day, promoting self-care and diverting patients from GP and urgent care services. However, it is estimated that £2 billion-worth of GP consultations a year are still being taken by patients with symptoms that pharmacists could treat.

Pharmacists want to have a greater role in prescribing drugs, so as to reduce waste. Last year in Cornwall alone, £2 million-worth of unused drugs were returned to community pharmacists to be destroyed. Pharmacists are best placed to reduce this waste. They want to do more to support people with mental illnesses; they are keen to provide continued care of people with diabetes and other long-term conditions; and my local community pharmacists want to work with the Department of Health to improve services, engage in health and social care integration, reduce drug waste and improve access to records, in order to support the giving of prescriptions.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing this debate.

I am the chair of the all-party group on pharmacy in Parliament and I have been for more than five years. I have a keen interest in public health and lifestyle issues, and I have quite enjoyed chairing the group. After the letter of 17 December, the all-party group—three Members of this House and one from the other place—met the Minister, on 13 January. We had what I described afterwards as “straightforward talking” about the letter—a letter that posed more questions about the future of pharmacy than it gave answers. The Minister was straightforward, and he said that one issue was that, in October of this year—so just for the second half of the financial year—£170 million will be taken out of the community pharmacy budget. That leaves a number of questions to be answered, including that of what will happen in a full financial year.

The Government make great claims about putting an extra £8 billion into the national health service, but the truth is that that £170 million, which is part of the £22 billion of efficiency savings, is being taken out of the NHS, so it is hardly new money. It is not the £8 billion—that comes in a few years’ time. We are talking here about major cuts to vital services.

Since the publication of that letter, it has become clear that as many as 3,000 community pharmacies could close in England alone—a quarter of them. How would that happen? Would it be by stealth, which is suggested in the letter and in the consultation currently coming out of the Department, or is there some sort of plan? We have seen in the letter, and in others, that if there is a 10-minute walk between pharmacies, that might be looked into, but there seems to be no plan whatsoever.

What we have to accept—I put to this to the Minister in that meeting on 13 January—is that pharmacists do not work for the national health service, yet more than 90% of community pharmacies’ income comes from the NHS. The idea that we could change that mechanism and close community pharmacies is outrageous. The pharmacists may not work for the national health service, but their income depends massively on it—I wish it did not.

For many years I have been promoting lifestyle issues and the idea of pharmacists getting paid for doing things other than just turning scrips over, but that is how it works at the moment and there needs to be some serious talking. What happens if someone who has a 10-year lease on a property they took over to run the local pharmacy is forced out of business? All those questions remain unanswered, yet there is the threat of up to 3,000 pharmacies in England closing.

[Rachael Maskell]

I am following the argument that my right hon. Friend is putting forward. Does he agree that, instead of cutting services, we should be looking at opportunities for community pharmacies to extend healthcare further into their communities? It should be about investment at this time, particularly in prevention, which is all about saving money further down the line.

[Kevin Barron]

I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.

It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.

Junior Doctors Contracts

Rachael Maskell Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for her campaigning on that issue. She could not be more right. Just before Christmas, a report by Professor Paul Aylin said that the mortality rates for neonatal children were 7% higher at weekends, which underlines just how important it is to get this right.

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

On 5 December 2011, the Government tried to cut unsocial hours for “Agenda for Change” staff. At a time when morale right across the NHS is so low, will the Secretary of State guarantee that he will not bring forward cuts, because the reason behind the unsocial hours cut that I mentioned was to introduce seven-day working?

[Mr Hunt]

We have no plans to do so, but I cannot be drawn any further, except to say that we do have to deliver our manifesto commitments. The specific issues that we have identified with respect to seven-day working relate to consultant and junior doctor presence, and that is what we are focused on putting right.