William Mead: 111 Helpline

Rachael Maskell Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

The hon. Lady is right about the importance of involving patients when such tragedies occur, and I said in my response to the urgent question how grateful I was to the Mead family for their co-operation. One of the things the report identifies as important is earlier involvement and more listening to parents and families in such situations. I caution the hon. Lady against a blanket dismissal of the service offered by 111. There are many clinicians and call-handlers who work extremely hard and who deal with about a million calls a month, and the vast majority of those cases have satisfactory outcomes. But does that mean that there are not significant improvements that we need to make to that service? No, it does not. Of course there are things that need to be done better and we must learn the lessons from this terrible report.

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

My thoughts, too, are with the Mead family today. The diagnosis of conditions, including sepsis, must be carried out by those with the highest level of clinical skills. Triage by algorithms is unsafe. Can the 111 system be put back into the hands of highly trained clinicians, those trained to drill down in diagnosis, instead of non-qualified staff?

Care Homes: England

Rachael Maskell Excerpts

Wednesday 13th January 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Main. I thank my hon. Friend the Member for Hove (Peter Kyle) for securing today’s timely and important debate. As a country, we need to give deep thought to the importance we place on social care. We have heard in this debate that constrained finances are skewing the opportunity to do that. I have always said that we can judge a country by the way it treats its older people, and I wonder how we really think we are doing against that test. Those who have served our country in so many different ways deserve the very best care, and I am not sure that our system is built on that model. In fact, the model is now built more on minimal provision as opposed to optimal provision. I wrestle with that approach, and I believe that we really need to think about the direction in which we are going.

The current black hole in state funding for care has been made more challenging as the years have gone on by local authority cuts. We have heard clearly about the impact of a 10.7% budget cut over five years, and the fact that care providers have to pay more has added further challenge. I really welcome an uplift in the pay of care staff, because they are paid a ridiculously low amount of money. They are also faced with pension uplifts, and they have had to wrestle with the rise in national insurance and steep rises in the cost of energy, food and other services. That has all happened at the same time as they face the increasing demands of a challenging and changing demographic, including people with multiple needs, and tighter budgets. What we are seeing is unrealistic: the demand is greater, but the money is less.

[Joan Ryan]

Will my hon. Friend add to that list the fact that the CQC rates more than 50% of nursing homes as inadequate and needing improvement? The people living in those homes are therefore living in inadequate situations. How will that change, given the circumstances she outlines?

[Rachael Maskell]

My right hon. Friend makes a really pertinent point. There has to be a debate about safety and about providing good, secure homes for individuals. If people are living in substandard conditions, that is simply unacceptable. If there are not the resources to put that right, we obviously fear for the future.

Another thing we know is that the pressure being put on so many care organisations will make older people far more vulnerable. As we have heard, tens of thousands of beds could be lost. If people do not have security in later life, it can have a real impact on their wellbeing.

As others right across the Chamber have said in the debate, the autumn statement has left many question marks, and one of the issues we are going to see as a result is inequality. Some of the communities with the most demand for investment in social care will get the least money from the precept the Chancellor set out. Taken with the further cuts that local authorities will experience, that will have a cumulative negative impact on the provision of social care. That is happening at the same time as the NHS is really struggling with discharges, because the provision is not there in the community. In my constituency of York Central, some of the transitional beds will be lost because of a care home closure programme, which I will return to.

Cuts to support services for the elderly, such as day care placements, are happening because of the cuts to local authorities, and they are having a detrimental impact. The little things that local authorities could provide that kept people safe in their homes and connected in their communities are now very much part of history, as opposed to part of the solution. We keep hearing that finances are tight, but we must remember that it was not the people in our care homes who caused the financial crash—but, my, how they are paying for it.

A care provider in my constituency has highlighted the challenges of the new minimum wage rate and asked how on earth they are going to pay it. They already have staff who are engaged on zero-hours contracts. They tell me they cannot pay for staff to travel between visits. I obviously question that, and I support paying staff proper wages, but I really worry about how providers will deal with these issues in the future and how they will survive. I have written to the Government to raise those concerns.

The issues I have outlined are particularly challenging in a city such as York, which has a high cost of living and high housing costs. When those are combined with low wages, it is virtually impossible to recruit care staff, and that adds to the sector’s challenges. As a result, the care model we have does not really address people’s needs. That has had a real impact on discharges from the NHS and on being able to give individuals timely care in the community. We are now seeing the cumulative impact of these things, as the care home closure programme across York means that fewer beds are available.

The problem we have is that care is seen as a zero-hours, minimum wage, low-esteem industry, when it should be regarded as a high-skilled, professional service and the funding should match that. Those who have the means can afford to pay for what they get—only just, but they can. However, for the rest, care packages are being driven to the absolute minimum. It would therefore be appropriate for us all to agree that current provision is totally unacceptable. We need to draw a line under that and to have a real debate about what needs to be done. After all, who are we talking about? Who are we providing care for? It is our mums and dads. It is the most vulnerable in our society—those with multiple disabilities, those with learning challenges, those with mental health challenges and those whose bodies are not quite working as they once did. One day, it will be us.

Who do we expect to care for those individuals? It is highly trained professionals—the very best—who are rewarded appropriately, motivated and driven to learn more and deliver more. Like everybody else, I have met care workers right across the sector—in fact, I spent time doing care work myself—and I know the passion they have for providing the optimum care for individuals, but if they are not given the time to care, how can they deliver that service?

The Kingsmill review “Taking Care”, which Labour brought forward before the last general election, set out a clear programme for improving care standards and providing training and remuneration. It also dealt with the important issue of registration. It is really important that care workers are state-registered to ensure public safety. The steps the review set out show how we can secure high standards in care and safeguard service users.

We then need to think about how and where care needs to be provided. Of course people have different needs, including physical needs. In my own clinical practice as a state-registered physiotherapist, I would often get people’s confidence up and get them back on their feet, only for them to go home and lose the support and stimulation they had had, because support was not available continually in the community. Falls prevention work, which really puts in investment upstream and provides care, means that individuals avoid things such as a fractured neck of femur, which is so expensive to treat, putting more pressure on the health service. Little steps can make such a difference in the community and in care homes, keeping people well and addressing their physical needs.

Likewise, we know that so many people have mental health challenges in later life—two thirds of the occupants of care homes experience some form of mental health challenge. It is really important that the setting individuals are placed in appropriately addresses those needs. We need to start thinking big on these issues. The Dutch—I hope I say this right—Hogeweyk dementia care village is a fantastic scheme. It is about state provision. We need that kind of investment and that imaginative, big thinking around how we provide care in our country.

The issues I have mentioned are exacerbated by some of the most prevalent diseases in our country—loneliness and isolation, and the social and emotional health of the most vulnerable in our society. The tightening of budgets is having a major impact on the wellbeing of old people. Investment in the issue can mitigate the worst aspects. I am totally passionate about that. It is heart-breaking that older people are just given 15-minute appointments, often with a stranger, as opposed to a full support network and a real life. Our goal should be helping people to live, not preparing them to die.

On the challenges we face, we need to take a step back and think about what we want from care provision in future. These are political choices and are possible if somebody believes they can deliver them. I talk to carers who share the vision I have outlined and who want the very best for the people they serve. I also talk to people in residential care, who want hope in their future. Those people would give momentum to a Government who would dare to grasp the nettle to make sure that we provide appropriate care in future.

I want quickly to set out the situation we have in York. I have had many conversations with the residents of care homes, their families and the staff. We are going through a transition. That has already resulted in two care homes closing, and a further two—Oakhaven and Grove House—are set to close early this year. Residents and their families are distraught about the fragmentation that that is causing. Residents are being moved to placements across the city and away from their families. Some placements are on the other side of the city from where their families live, so family members can no longer just pop in to see mum as they do at the moment. Residents are being moved away from their friends in the care home—for some, these are the only friends they have in the world. Staff are also being moved away from their homes. Residents feel that they have not been listened to and that they have been ignored, which is unacceptable.

The council has put its plans ahead of the support that it purports to want to deliver. It is remodelling social care. I very much support the last Labour Administration’s vision for that. However, the sequencing of the changes is detrimental. It is about putting money before people’s needs. We need to hold back on the transition that is taking place, to make sure that there is investment upstream, as opposed to making people fit the system and sacrifice some of the only bonds that they have.

We have gone badly wrong in many areas of social care, and do not currently place the value on care users and staff that we should. As I have said, this is about political choices and political priorities. I ask the Minister whether there could be any greater priority than getting this right. I urge Parliament from today to take the debate forward. I want all those who have participated in today’s debate to make sure that we prioritise social care so that it is seen as an urgent need to be addressed by the Government in this term, so that we do not have to face challenges and struggles we face at the moment of questioning the finances and the value we put on social care. The question is whether the Government are willing.

Specialist Neuromuscular Care and Treatments

Rachael Maskell Excerpts

Tuesday 15th December 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Brady. I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on speaking with such passion once again about her constituent and neuromuscular disorders. Such disorders often do not receive the profile of other medical conditions, yet for each of the 70,000 people affected, they are all-encompassing. I want to talk about a range of services and the challenges within them. I recognise that the conditions affect adults as well as children. I declare my interest as a physiotherapist who has worked in this field in the NHS for 20 years and is registered with the Health and Care Professions Council. I want to examine three themes: specialist services and how they are delivered; transition; and a timely response at the time of need.

I will deal first with specialist services. A multidisciplinary team is essential for delivering services to people with neuromuscular disorders, but access can often be challenging. District hospitals have teams of staff who specialise in paediatrics, neurology or other fields, but those people might not have the specific skills that are needed when dealing with neuromuscular disorders. Practitioners are practised in the principles of such conditions, but might not be as familiar with particular syndromes, given that there are so many—60 or more, as we have heard. This situation is likely to be exacerbated in the community when general practitioners and community physios do not have the specific skills, so it is important to ensure that people with these conditions can access those with the right skills who understand the pathology of the disorder and the specialist treatment that is required.

For instance, there are two specialist centres in London and one in Oxford for the whole of the south-east, so people have to travel vast distances to consult a specialist team. Owing to the nature of their disability, that can be very challenging, and the centres can even prove to be inaccessible, especially as their disease advances. How do we bring specialist services to those with neuromuscular disorders? How do we train staff to provide optimum care in the community, and how do we provide a rapid self-referral service when that is needed?

If I take muscular dystrophy as an example, paediatric patients in York benefit from Leeds general infirmary’s outreach service. That provides an opportunity for families to meet specialist practitioners but, obviously, some have to travel to those services. Will the Minister ensure that funding for that outreach hub-and-spoke model of service provision will continue and that clinicians will be able to travel to deliver their services, either individually or as a team?

It is important that services are placed in appropriate locations. For example, if a patient will benefit from hydrotherapy, we need hydropools to be available. Anisa Kothia, a member of the York muscle group, has a son, Yusef, who has Duchenne muscular dystrophy, and hydrotherapy is a vital component of his treatment. It relaxes his muscles so that his limbs can be taken through their range of movements, and the buoyancy of the water helps his movement. Will the Minister support a national review between the Department of Health and the Department for Communities and Local Government into hydrotherapy provision and ensure that any deficits are addressed?

Ongoing services rely on clinicians with less of a specialism, however, so that requires professionals to be trained and the provision of regular updates, which is why Gita Ramdharry, associate professor at St George’s, University of London, and Kingston University, has been working with Muscular Dystrophy UK to develop new online physiotherapy training. Will the Minister set aside resources to ensure that we can have specialist online training to equip professionals to provide the optimum treatment? Obviously, more specialist care training is also needed which, for physio, can be very hands-on.

I have had discussions with senior clinicians in other fields about global medical education. I think that that is relevant for neuromuscular disorders, because such disorders often require a global view that enables recruitment from around the world to participate in webinars, to examine case studies and academic papers, and to demonstrate learning by making a submission. We need to take medical training to another level, so will the Minister look at that more deeply, particularly with regard to neuromuscular conditions?

Before I move on, I want to highlight that much of the care for long-term progressive conditions is provided by the family. Good self-management is key, as Labour’s expert patient initiative has proven. If the professional knows the patient and their condition, the treatment will be optimal and will provide the best support. For example, a chest infection often accompanies a neuromuscular disorder, and a chest physio who knows the patient will know how best to support sputum clearance with a combination of the best postural drainage, manual support, and expectoration or suction techniques. Knowing exactly what the patient needs is critical, and can be life-saving.

All physios have the competencies required to treat a patient, but knowing the individual can make the difference. Rapid access to services can be transformative, and self-referral is very important, so will the Minister ensure that all services provide rapid-access routes to the appropriate clinicians and that all patients can self-refer, rather than having to go through the normal access channels? In north and west Yorkshire, we have only one neuromuscular care adviser to cover more than 3,500 adults and children. Will the Minister recognise the need to provide additional professionals in that role, including in north Yorkshire?

I have previously talked about the need to review the transition between child and adolescent mental health services, and adult mental health services. We should do the same for neuromuscular disorders, because using someone’s age as a measure is arbitrary. The pathology of Duchenne muscular dystrophy is more likely to be understood in paediatric services than adult services, owing to the number of children who, sadly, still do not make it to adulthood. A person’s medical team and physios know that individual and know how to progress their treatment. It is entirely arbitrary and nonsensical that someone’s birthday should determine that they have to transfer to another team.

Continuity of service provision is important. The condition of those who do reach adulthood is often at an advanced stage, so they need continuity. The findings in the field are that young adults are often lost in the service and then re-emerge later with problems that were preventable. Will the Minister take a serious look at the interface between paediatric and adult services right across the Department of Health, and particularly with regard to neuromuscular disorders, because surely specialism should override age?

We should be making a timely response to need. A worsening situation has been observed across the spectrum of neuromuscular disorders. It has been seen by clinicians in practice, and now constituents are writing to me about it. Orthotics, wheelchairs and equipment must be in place when they are needed. Infants and children grow, and disease processes may degenerate, so the combination of the two means that expediency is important. Patients are waiting far too long for appropriate equipment, and that is essentially an issue of under-resourcing and poor prioritisation.

If someone is measured for a chair, they need that chair, but people are waiting month upon month before their chair arrives. While they are waiting, they will be positioned inappropriately and might not even have enough support for their frame. That can exacerbate pain, as well as compromise a patient’s musculoskeletal situation and, dangerously, their respiratory function. There is absolutely no excuse for that. When a chair arrives, a patient needs it, so we need to ensure that we get the right equipment in the right place at the right time.

Planning for what equipment will be required is part of the management process, because people must always be prepared for the next stage, and the outsourcing of services has made the situation far worse. With life-limiting conditions, there is no time to wait. Will the Minister agree to carry out an urgent review of the situation? Will he ensure that, starting on 1 April 2016, there will be a waiting-time marker for the renewal and provision of equipment so that the time between the initial request for an assessment and the patient receiving the equipment is measured?

For someone with a rare condition, their future depends on the whole NHS and care service working around them to provide optimum support. I have not touched on research and pharmaceuticals, nor on advances in science, but there are things that can be done immediately that can really change someone’s outcomes. We need the best provision and to give individuals hope to ensure that we can extend their life and improve their quality of life. I look forward to hearing the Minister’s response.

Mental Health

Rachael Maskell Excerpts

Wednesday 9th December 2015 Commons Chamber

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

I, too, want to talk about Bootham Park hospital, which closed suddenly, in just under four working days. We must remember the impact that that closure had on patients—the confusion, the fear and the anger, with some withdrawing and some wanting to die. We must also sing the praises of the professionalism of the staff in dealing with it. However, the closure was avoidable. There were too many people involved in decision making—commissioners; providers; Historic England; Prop Co, the owner of the buildings; and others. That is one of the failings in what happened at Bootham. With the change of provider, politics and blame ensued, and that must be investigated, because it had an impact. We must also look at the role of the CQC, which has acknowledged that its role in having to inspect the building before registering it with the new provider had an impact on patient safety.

It is therefore absolutely vital that we have an independent inquiry, as I, and 8,000 people in my constituency, have requested. I want the Minister to say that we can have that public inquiry, which is needed to ensure patient safety for the future. It might be an embarrassing situation, but we have to push on to make the service safe. Patients were scattered across our city for their out-patient appointments, and scattered across our region, travelling miles in a crisis. That is unacceptable.

It is not only essential that we have answers on what happened at Bootham Park hospital, but that we look back at the Health and Social Care Act 2012, which lies at the heart of the problem. Because of it, there is nobody with overarching responsibility for patient safety in the NHS. Different jurisdictions and different regulators have different responsibilities, and there are no mechanisms for responding to such situations. There is also the role of the Secretary of State in now having a duty to promote the NHS, and no longer to provide and secure it. That has an impact, because people can point a finger but do not have to lift a finger. We need to look at that, and also at the role of the CQC.

My second plea is that we have clarity about a replacement for Bootham Park hospital. When the Chancellor gave the autumn statement, he said that three new hospitals would come to fruition, but one for York was not mentioned. Was that because mental health is not getting parity of status, or because we are not getting a hospital? We need that clarity today. I trust that we will start to have some answers on those two points—the need for an independent inquiry and a new hospital.

Cystic Fibrosis

Rachael Maskell Excerpts

Tuesday 8th December 2015 Westminster Hall

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

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

I thank my hon. Friend the Member for Dudley North (Ian Austin) for proposing today’s debate on cystic fibrosis and on the future of the drug therapy. I thank the cystic fibrosis team at York hospital. I have met with them and discussed at length their innovative service, which is at the cutting edge of provision for those with cystic fibrosis and takes on board the need for clinical excellence and the sterile conditions that we have heard about—they work the service around the patient, not the patients around the service. I also thank the people at the Cystic Fibrosis Trust for their time.

I emphasise the points made by the right hon. Member for Chesham and Amersham (Mrs Gillan). Her tireless campaigning was triggered by the inspiration of Archie Hill from her constituency and presses for the need to make progress on the right therapeutic responses for those with Duchenne muscular dystrophy. We would all like to see progress with Translarna.

I want to take a wider view of the therapeutic measures for those who experience cystic fibrosis. I am a physiotherapist by training and have worked for 20 years in the NHS with respiratory and neurological conditions, so I have a real understanding of the people who experience cystic fibrosis. There has been massive change in the management of that condition in my time in practice, in particular in physical therapy. Treatment is now more dynamic in support of individuals—physical treatment, rather than a more static treatment, especially when dealing with mucus clearance and building up lung capacity. That is all about the treatment and management of symptoms, however, similar to the drug regime that accompanies the physical therapy.

We have seen progress, therefore, but today we are debating a step change in our approach to cystic fibrosis. We are trying to provide hope to the 10,000 people who happen to have cystic fibrosis. Looking at a new generation of drugs might provide that hope. Orkambi is a drug that targets abnormal proteins, which will deal with the symptoms. When we look at drug therapy for cystic fibrosis, we should be looking not only at the immediate impact, which so many drugs do, but at the long-term effect. Every instance of a chest infection brings about damage to the lungs, as people have to expectorate continually, and that has long-term implications that can be fatal for some.

It is vital that we look at early intervention, which is what Orkambi is all about—about bringing a step change in the treatment process for those with cystic fibrosis. By targeting the proteins we have the opportunity to ensure that the cells in the lungs are healthy, which will produce longevity among patients. It is hoped that the new drug will bring improvement to about 50% of people with cystic fibrosis, which in itself will be a seismic change in the outcomes for them. It will have a profound impact.

I encourage the Government not to be nervous about cost, because costs for someone with cystic fibrosis are already high and cannot be underestimated. I will focus on existing costs, such as the cost of frequent visits to hospital, including the frequent use of intravenous drugs. A large proportion of people are on IV drugs for approximately one month a year, which is costly. People also have to be in sterile conditions, because the risk of further infection is incredibly high. Ongoing therapeutic intervention with drugs or physiotherapy has significant bearing on costs. There are also costs to do with managing a high-calorie but healthy diet.

Another expense is the drugs. Cystic fibrosis is not on the list of diseases for which people get free medication. Will the Minister look at that? When the list was drawn up, people with cystic fibrosis were not living into adulthood, so we should re-examine it. There are the costs of having lung transplants, if people require one, and any drugs that prevent future lung transplants have to be a positive, despite the risks, because people will be brought long-term hope.

There is the cost to an individual of education, which for many will have a disturbed pattern—in and out of school—and the impact on long-term employment opportunities. Even if in work, many people find it difficult to hold down a job, because the nature of the disease often takes them out of the workplace and they have to organise and balance their day with fitting in physio and the demands of drug therapy and diet.

Finally, there is the cost of care. Rarely is only one person involved in care for any of the diseases that we are talking about—a network of care is put around an individual with such a disease. Moving to a precision, early-intervention drug, therefore, is a way to bring in resource management, which can be positive not only for the individual, but for the NHS as a whole.

The result of what is being called for today would be positive economically and for people’s lives. In my short contribution, I want to ask the Minister to address the timeline for progress. There is obviously discussion in Europe, such as on the European regulations for Orkambi, and we want to see the timeline tightened up, so that people can have real hope in the new year that they will get access to the drug, because each time someone has a chest infection it has an impact on their long-term future. Time is not something that so many have, so my plea is for progress on securing access to the drug for those with cystic fibrosis.

--- Later in debate ---

[George Freeman]

My hon. Friend raises an important point. Over the past few decades, the NHS across the UK has played an inspiring role in leading a lot of the breakthroughs in new treatments, but we have become latterly a slower adopter of the very treatments we often helped to discover. That is partly because the pressure of an ageing society and the rising cost for the health system today of just treating existing conditions are extremely challenging. In some areas, that has made innovations appear a cost to the system, when in fact good innovations may come with a cost spike on day one but generally lead to downstream savings in years 2, 3 and 4.

My hon. Friend puts his finger on a profound challenge at the heart of this landscape: in order really to assess the impact of innovative treatments, we need a much better handle on the existing costs, many of which are hidden, that come with a diagnosis. For that reason, I am spearheading work in the Department of Health to drive through a system of per-patient costing, so that we can begin to get a much clearer handle on what a CF diagnosis means on day one for both the patient and the health economy. That will allow NICE and NHS England to develop much more intelligent systems for assessing whether an innovation really represents good value.

Genomics and informatics are changing the landscape; for that reason the Prime Minister has created my post and we have launched a series of initiatives. On genomics, we have launched a groundbreaking £300 million initiative to sequence the genomes from 100,000 NHS patients of cancer and rare diseases. We have also launched 11 genomic medicine centres across the NHS, so that genomics is fundamentally embedded in our health system. On informatics, we have released huge amounts of cohort data to drive research, and we just announced in the comprehensive spending review a major £3.5 billion programme to invest in NHS digital infrastructure to support that.

We have launched precision medicine and cell therapy catapult centres with the Medical Research Council and industry partners to lead in both understanding causal mechanisms of rare diseases and developing and accelerating new treatments. We continue to fund the excellent National Institute for Health Research, for which it is my privilege to be responsible, to the tune of £1 billion a year, and we committed this year in the CSR to fund it throughout this Parliament, at a cost of £5 billion. We have funded the £700 million Francis Crick Institute, and roughly £2 billion of the drugs budget is allocated to new medicines and new treatments in this Parliament.

There is a major commitment, in terms of science and funding, to trying to tackle this issue, but crucially we need policy reforms to ensure that breakthroughs in science can be harnessed for much quicker benefits for patients. That is what the accelerated access review and a number of other initiatives, such as the test bed programme and the vanguards I am running with NHS England, are about—trying to ensure we can change the pathways for getting innovation into our health system for much quicker patient benefit.

I want to say something about the accelerated access review and the specialist commissioning reforms that NHS England is putting in place. I know all Members here take an interest in this subject, so I hope they will be aware that I have launched the independent AAR to ask and answer one big question: what can we better do to harness the extraordinary infrastructure here in the UK in terms of our deep science research base, our NHS-NIHR research base and our NHS daily treatment platform?

The NHS is the fifth biggest organisation in the world, making millions of diagnoses and carrying out millions of treatments every day. Its original founding mission was to be a research organisation, but unless we better capture the data on those interventions, we are still practising, in many cases, blind medicine; we are not harnessing that intelligence enough to inform treatment.

I have asked that the AAR tackles three big questions. First, what can we do to allow the innovators—the developers of new drugs and innovations—quicker access to patients, to reach the all-important moment of proving an innovation works in patients? Secondly, what can we do to harness our leadership in genomics and informatics in order to create a more intelligent system for NICE and NHS England, with more flexibilities, so that they can assess, adopt, approve and reimburse innovations using real-time data about real patients? That will allow us to develop a more flexible set of pathways and adaptive tools with which to embrace this revolution.

When a drug comes to us with a genomic biomarker and we know that it will work for a certain sub-cohort of patients, that profoundly changes the risk dynamic of a traditional pharmaceutical clinical trials programme and should allow us to accelerate adoption for particular patient groups.

[Rachael Maskell]

Within those considerations, will the Minister also look at international evidence, so that we are looking at not only our own clinical trials but those on a global scale? Clearly, developments are global rather than just national.

[George Freeman]

The hon. Lady makes an important point. I have been to Washington three times and to Berlin, Paris and Brussels to highlight that while the UK is leading in this field, we need a transatlantic—European and American—agreement on how we move things forward. That is why I am convening and chairing a summit this afternoon with the Washington-based FasterCures campaign, which is a cross-party group on the Hill pushing for innovations in this space. I have been talking to the Commission about the European framework. I want the UK to be the best entry point into the European market, but I also want the European regulatory framework to be consistent and coherent; that is an important point.

The second question I have asked the AAR to look at is: what freedoms, flexibilities and new pathways can we envisage giving NICE and NHS England, particularly in the field of specialist commissioning? For CF, the decision to purchase ivacaftor is a national one, made by an NHS England specialist commissioning unit. I would like that unit to work much more closely with the Department of Health pricing team, so that where we can offer a company faster access to a key patient cohort, data and genomic information, we are able to do a much better deal with the company.

At the moment, we are operating the Translarna and Vimizim programme in the existing landscape. I share colleagues’ frustration, but it is important we go through due process. I do not think anyone wants a world in which Ministers decide what drugs come through on the basis of political pressure, tempting though it may be. I have done everything I can this year to expedite the existing process.

Following the positive news on Vimizim, I am hopeful about Translarna—a similar drug. NICE has been consulting on the process, and I believe the company has been engaging with NICE on pricing. I am hopeful that there will be a decision in the next few months to parallel the one on Vimizim, but that decision is not in my gift: it is up to NICE, which is rightly working on the basis of the very best clinical evidence.

Junior Doctors Contract

Rachael Maskell Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

My hon. Friend gets to the heart of the matter. The clinical director of the NHS, Professor Sir Bruce Keogh, has said that the negotiations and the new contract are about safety and ensuring that a seven-day NHS is safe. They are about dealing with the issue of what happens at weekends, which is generally accepted to be a problem right across the medical world. The Secretary of State has put forward proposals to make people safer. They are backed by those in the NHS who are responsible for patient safety. The Secretary of State is perplexed, like everyone else, that the opportunity for negotiations is not being taken. That is what is needed to end the dispute. The Secretary of State has repeatedly made that clear.

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

The Secretary Of State was here last year in relation to the rest of the NHS staff. First, the DDRB is an advisory body to government, not a mediator, whereas ACAS is a mediator. Secondly, the dispute has provided an opportunity for both sides to step back and explore the issue with a blank sheet of paper. Will the Minister take that opportunity by entering into ACAS talks to explore the grounds for moving the dispute forward?

[Alistair Burt]

The hon. Lady’s commitment to the health service is very clear from her background and everything else. I ask her to recognise that the 2008 contract is outdated and challenging. By 2012, we reached the stage where people had to negotiate around it because it was unsafe. After three and a half years, we have got to where we are. The idea that the process should start again is just unfeasible and very unfair on doctors working long hours who need to be relieved of that. She talks about the DDRB as a mediator. No, it is not a mediator, but it does provide the independent basis for the recommendations, which the BMA took part in, on which to negotiate. Anyone concerned with patient safety would say the time for direct negotiations to restart and take up the Secretary of State’s offer is now.

Male Suicide and International Men’s Day

Rachael Maskell Excerpts

Thursday 19th November 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gapes. I was not going to speak in this debate, but I felt moved to do so by events that have occurred in York over the last few days. It is a pleasure to follow the right hon. Member for Basingstoke (Mrs Miller), who raised many issues, and my hon. Friend the Member for Bridgend (Mrs Moon), who has expertise in the subject. I thank the hon. Member for Shipley (Philip Davies) for securing this debate, which is important, although I do not concur with many of the comments that he made. I like to think that we debate based on evidence; anecdotal comments often do not add to debate. However, it is an important debate, so I thank him for securing it.

It is important that we recognise the needs of men and the challenges they face in our communities. Just last week, I had the pleasure of meeting with a group of men and Age UK to highlight the problem of isolation for men in later life and to consider establishing a men’s shed—a safe place where men can gather to discuss issues—in York. A countrywide project has been successful, giving men a space to talk about the challenges they face, particularly health challenges, of which mental health is obviously one.

I rose to speak in this debate because there has been a big debate in York about International Men’s Day and whether we should recognise it. In fact, as has unfortunately reached national headlines, the university was going ahead with a programme for today but has withdrawn from engagement with the process. I say that with regret; the decision comes on the back of a petition from 200 students saying that they did not think the day should be recognised. The university is committed to equality and to progressing the equality agenda, and two male students lost their lives just before I took office, so I think it is important that the university speaks out on the issues and the services available.

What has not been reflected in this debate is the necessity of recognising separately the importance of raising women’s issues. I am not saying that men’s issues and women’s issues are mutually exclusive, just that it is important to recognise ongoing women’s issues, because there is huge inequality across our society. However, I recognise that there are some areas of inequality for men, which is why this debate is important.

Suicide rates across our country are far too high. One person taking their own life is too many, and the fact that in 2013 6,233 people felt that they could not carry on living—a 4% rise on the previous year—means that we have much work to do. As I was researching for this debate, I found, shockingly, that the male suicide rate in my own city, York, is the fourth highest in England, behind Darlington, County Durham and Calderdale. That is worrying. Those places are in the north-east and Yorkshire, so there is a geographical issue to address as well, and behind that we might want to consider some of the causes of suicide, because unless we face up to the challenges as other people are and use this place to address the causes of suicide, we will never change those shocking statistics.

Suicide in York has risen to its highest level: 22 people lost their life in 2013. Even since I have taken office, people have taken their life. Looking at the causes, we know that the last few years have been particularly challenging for many in terms of personal debt, austerity and unemployment, which can have an impact on why people feel that they can no longer go on. We know that people are struggling with mental health challenges and facing changes, whether a loss of or reduction in benefits or other factors, that result in serious life changes or financial challenges to their family.

[Mr Andrew Turner (Isle of Wight) (Con)]

I am interested by that suggestion. All sorts of things have been examined relatively recently, but can the hon. Lady explain why the suicide rate is less likely to decrease for men than for women?

[Rachael Maskell]

That is why the research to which my hon. Friend the Member for Bridgend referred is so important. There are so many causes of suicide that we need to understand. If we look at Greece and the impact of the recession there, we see that male suicide rates have increased tenfold. It is a serious issue. Some serious research has been done, but more needs to be done about the shape of our economy and the impact it has on personal life and the challenges that people face as a result.

In addition to those very difficult statistics, with which we all wrestle, one thing that I want to highlight is the services available to support people with mental health challenges. We know that those services are currently overwhelmed by demand. I look at York Mind —a fantastic organisation with great leadership. In just the last three years, demand for its services has doubled, from 650 people three years ago to 1,300 this year. We are seeing increasing demands on not-for-profit organisations, which always find it a challenge to know where their next pennies or their next resources are coming from. If we are going to take a strategic approach, we need to ensure that the infrastructure bodies are well resourced to deal with the issues, but of course it is always important to get upstream and address the causes.

In York, we have been faced with another challenge, which is the closure of Bootham Park hospital. It was our mental health hospital in York, but it was closed because of the suicide risk the old building, which was constructed in the 18th century, presented, which had not been addressed. To reduce the risk to individuals the hospital was closed, but that created a new risk because people are scattered perhaps more than 50 miles away from the services they need. Some of them have to go as far away as Harrogate to reach a place of safety; having a crisis in the back of an ambulance is not appropriate at all. It is really important that facilities are in the right place, so that people can access them at their time of need.

One of the consequences of the closure of Bootham Park hospital is that there has been an investment in the street triage team. That is why I very much concur with the remarks of my hon. Friend the Member for Bridgend. The street triage team is there at the scene, at the earliest possible point of intervention. None the less, overall risk has increased because there are no facilities locally for somebody then to go to. The insecurity that that causes individuals is a real concern.

Lead clinicians who were working at Bootham Park hospital have highlighted the risk factors of closure, and that is why my continual plea is that we look at the infrastructure and the interrelationship between the not-for-profit organisations, the health service and the other agencies when we are addressing the issues associated with suicide, because we have a responsibility—I would say an obligation—to ensure that those organisations are working seamlessly together. If we have not got those things right, it is also our responsibility if someone is pushed to the point of taking their life.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for raising that issue, which is incredibly important for his constituents and for Dorset as a whole. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, will be going there very soon. The clinical standard says that anyone admitted to hospital in an emergency should be assessed by a consultant within 14 hours. Across every day of the week and all specialties, that happens in only one in eight of our hospitals. That is why it is so important to get this right.

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

Bootham Park mental health hospital and York’s place of safety shut with four working days’ notice, so York no longer has a seven-day service, nor even a one-day service in our hospital. That would have been totally avoidable if one NHS body had overarching responsibility for patient safety. Will the Secretary of State agree to meet me and to have an independent inquiry so that mental health patients are not put at serious risk again and we can have a full seven-day service before 2020?

[Mr Hunt]

Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.

Off-patent Drugs Bill

Rachael Maskell Excerpts

Friday 6th November 2015 Commons Chamber

[Nick Thomas-Symonds]

I agree entirely with my hon. Friend. It is precisely that kind of benefit that the Bill would bring.

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

Today, a constituent of mine, Mark Hamilton, is laying to rest the ashes of his father, who lost his life very suddenly in September. Had these drugs been available then, he might well be with us today. Is that not why it is so important that the Bill proceeds to its next stage?

[Nick Thomas-Symonds]

I am grateful for that intervention, because the Bill could have a positive impact on the lives of many people. That is why it should move forward.

This is a common-sense solution to an acknowledged problem. There is even a precedent for it. The Secretary of State, who is not in his place, but whom I am sure will be ably represented by the Minister, is the licence holder for a chemotherapy drug called Erwinase. It is manufactured by a state-owned pharmaceutical company called Porton Biopharma Ltd, which was established in July and in which the Secretary of State is the sole shareholder. There is, therefore, a precedent for the type of intervention I am talking about to deal with this market failure. The Bill will bring enormous benefits to people. It is a sensible solution to the problem.

Junior Doctors’ Contracts

Rachael Maskell Excerpts

Wednesday 28th October 2015 Commons Chamber

[Mr Hunt]

We do have regular dialogue. I suggest that the reason doctors in Northern Ireland might be angry is that they have been listening to misinformation about what the Government in England are proposing, which has, very disappointingly, made doctors all over the UK very angry. I hope that the assurances I am giving, which I gave to the BMA last month and the month before, face to face and in letters, will encourage the hon. Lady to report to the doctors she mentions that the right thing for the BMA to do is to come and talk to the Government. Regrettably, the BMA’s junior doctors committee has refused to negotiate since last June. Instead, it put up a pay calculator on its website that scared many doctors by falsely suggesting that their pay could be cut by between 30% and 50%. It has now taken that pay calculator down, but the damage to morale as a result of it continues.

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

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress. Some people say that this is a battle between the interests of patients and those of doctors, but that is profoundly wrong. Doctors who are happy and supported in their jobs provide better care to patients, and the link between a motivated workforce and high-quality care is proven in many studies, as well as in hospitals such as that in Northumbria, where staff have become the greatest advocates for seven-day services since their introduction. Our proposed new system is intended to provide better support to doctors who work weekends, and make seven-day diagnostics more widely available across the NHS.

[Mr Hunt]

If the BMA is serious about wanting to do the right thing for doctors and patients, there is no reason for it not to negotiate with the Government to get the right solution. This is a test of how serious it is—my hon. Friend’s point is well made.

[Rachael Maskell]

This debate is reminiscent of 12 months ago and the “Agenda for Change”, when the Government refusal to negotiate with 1 million NHS staff caused industrial action and a strike. The same thing seems to be happening again. Will the Secretary of State take the shackles off the negotiations and enable the professionals to put their case on the table? Will he listen to them and let them lead negotiations?

[Mr Hunt]

That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.

Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.