NHS Long-term Workforce Plan

Rachael Maskell Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important.

The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff. When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.

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

Despite the significant desert of dentists, I note from the plan that we will not see an increase in dental training places next year, the year after or the year after that, meaning that we will not see more dentists for nearly another decade. We have a crisis now, so what is the Secretary of State going to do about it?

[Steve Barclay]

We are already seeing a fifth more work than last year, due to the flexibilities that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) announced, including the ability for dentists to take on more work within their commission and the changes to the units of dental activity pricing to better reflect more complex work. Of course, we have 6.5% more dentists than in 2010, but we also recognise that within the £3 billion budget, we want to go further. That is why we are looking at proposals to go further than the measures announced, but progress is being made, with a fifth more activity than last year.

Mental Health In-patient Services: Improving Safety

Rachael Maskell Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

In my discussions with my right hon. Friend and colleagues, I found the compassion that they showed and the way they championed the family voice compelling. I absolutely agree that it is important that families take confidence from the decision to move the inquiry on to a statutory footing and come forward with their evidence. I know that she plays an active part in that. Of course, we want families to be part of the discussion on the terms of reference. I know that, with her significant experience, my right hon. Friend is keen to be part of that too, and we are keen to engage with her on it.

My right hon. Friend is right to highlight the evidence that has already been gathered through the excellent work of Dr Strathdee. I had a meeting with her yesterday to ensure that we capture that as part of the work that is moving forward. I hope—I reinforce my right hon. Friend’s point—that families will take confidence from today’s announcement and that those families who have not come forward to date will be able to do so. I know that in my right hon. Friend they will have a resolute champion supporting them to do so.

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

I, too, welcome the Secretary of State’s statement, but I am disappointed that he did not say more about the serious risks that we have raised in the House—not least about timely access to services and the significant risk that many of my constituents have faced out in the community—in respect of Tees, Esk and Wear Valleys NHS Foundation Trust, which serves York. I wonder whether he can expand on that, and on his proposals for taking things forward at the trust. I am meeting one of his Ministers next month, but I would like to hear his position on addressing the serious concerns that have been raised.

[Steve Barclay]

The hon. Lady raises a very valid point. There are real concerns about Tees. We considered that when considering the scope of the statutory inquiry. Given that significant work had been done in Essex, we decided to strike the balance by putting that on a statutory footing but enabling work to proceed at pace through HSIB on Tees and some other areas. The hon. Lady will know that the Care Quality Commission prosecuted the trust in May for a regulation 12 breach, and that significant work has already gone in; the report of the system-wide independent investigation was published last March. They are very serious issues on which I think there is concern across the House, and we stand ready to work with her and other elected representatives from that area as part of the wider work.

Lung Cancer Screening

Rachael Maskell Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

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

Of course those most at risk must be fast-tracked into diagnostic services, but when we are 2,000 radiologists short, 4,000 radiographers short and 5,000 other health staff short in those diagnostic services, how can people get the diagnostic services they need? When will we have the workforce in place to service this policy?

[Steve Barclay]

Clearly, the earlier we detect cancer, the less pressure it puts on the workforce. There is much more work involved in the treatment of a later cancer than of an earlier cancer. That is why we are investing in our community diagnostic programme, with 108 community diagnostic centres already open and delivering 4 million additional tests and scans. As part of the wider £8 billion investment in our electives recovery, over £5 billion is going into that capital programme. Yes, the workforce plan is a key part of that, but so is getting the CT scanners and the other equipment in place. That is exactly what our community diagnostic programme is doing, and it is being furthered by our screening programme through announcements such as this.

Hospice Services: Support

Rachael Maskell Excerpts

Wednesday 14th June 2023 Westminster Hall

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

It is a pleasure to serve with you in the Chair, Ms Nokes, and I thank the hon. Member for Eastleigh (Paul Holmes) for securing this timely and important debate.

For children in York, hospice care is provided by Martin House, and for adults by St Leonard’s. I pay tribute to all the staff at both hospices for their services and their love, care, professionalism, sacrifice and dedication for their patients and the families they serve. Where would we be without them? I will never forget the doctor, who had experience right across the NHS, who told me that before she came to St Leonard’s she had never seen care like it. That is what people across this country experience as they pass from this world.

Hospices are special places, as we have heard at lot in this debate, but they are also important places whose funding we cannot just leave to the rattling of tins. That is why it is so important that we focus on their funding, which is the call from today’s debate that the Minister must hear loud and clear. It is not good enough just to say that ICBs have the money and it is their decision, because ultimately hospices need funding from the Government. Now that the Government have put it on the statute book, thanks to the Lords, they need to make sure that they put the money behind this service.

Let me talk about St Leonard’s, which this year faces a £1 million deficit. It has not received the increase in funding to cope with the pressures of inflation. It received just £340,000 from the better care fund, which is the same amount as in 2016. There has been no increase, despite the fact that there has been an increase in the number of patients, moving from 200 back then, with the hospice-at-home service, to 700 patients a year now. St Leonard’s provides excellent care in the home, allowing people to choose where they die and the support they receive when they die.

The hospice faces fuel costs that are up by 180% for that hospice-at-home service. Of course, the in-patient service has seen energy costs rising, alongside the rising cost of food and so many other things. Indeed, staffing costs have also increased and are up by 31% over the last three years. We cannot just keep rattling tins when the cost of living crisis is impacting on everyone; we need to find a secure, assured and long-term funding solution for the services we are talking about.

Less than 30% of St Leonard’s funding comes from statutory sources. That situation cries out to this Government: “Surely, ensuring that people have a good death is worth finding the money for.” That is why I call on the Minister to think about what this means not just for NHS budgets but for families, carers and all the people who depend on hospice services. We need to move urgently to find that security, just as people find that security at the end of life.

--- Later in debate ---

[Helen Whately]

I commit to continuing to dig into getting visibility on the extent to which extra funding is going through to hospices. Of course, there is a balance to be struck when giving integrated care boards the freedom to do what we want them to do, which is to understand fully the needs for care in their populations, and make good decisions about how they fund care for their populations. None of us believes that a Minister in Westminster has the answers about what should happen and exactly how funding should be distributed in every single one of our communities. I will continue to get that visibility, because it is important that we know the extent to which our hospices are getting support for the extra financial pressures that we have been discussing.

[Rachael Maskell]

Will the Minister give way?

[Helen Whately]

I will make a bit of progress, because I am conscious that the clock is ticking.

Integrated care boards are responsible for ensuring the provision of the end of life and palliative care that is needed in our communities across England. In addition to the funding, I am working with NHS England to ensure greater visibility relating to what that means in practice and what is being commissioned.

The shadow Minister’s point about inequality of access was very important. We know that there is inequality of access to palliative and end of life care. Some communities are much better served than others, in part due to the fantastic legacy of our hospices: where there is a really good hospice, there is often much better access to end of life and palliative care around it. We want to improve equality and reduce some of the disparities in access to end of life care. As part of that, people should be able to do what most people want—to die at home with the right support in place.

I want to talk about the funding for children’s hospices, which several hon. Members brought up. Recognising the importance of palliative and end of life care for children and young people, NHS England provided £25 million specifically for that, via the children’s hospice grant during this financial year. I have, of course, heard the calls for that grant to be continued, and for greater continuity and visibility of funding further out. I cannot say more on that today, but I can assure hon. Members that I have been speaking to NHS England about that funding beyond this year. I do expect further new to be communicated about that shortly, appreciating the level of concern among hon. Members and children’s hospices in their communities.

[Rachael Maskell]

I am grateful to the Minister for giving way. The Health and Care Act 2022 put a responsibility to fund palliative care on the statute books. Will the Minister set out what has changed, to enable that funding to come forward? We know there are people in our communities who are not receiving that care, although they need to now under the law. The funding needs to be in place for them to receive the care that they need at the end of life.

[Helen Whately]

That alludes to exactly the point I made a moment ago. As flagged in that 2022 Act, ICBs have responsibility for commissioning that care, using the budgets they receive through NHS England. I am working to ensure the visibility of the commissioning, to be assured that that is taking place, so that we can be assured about the availability of end of life and palliative care for our communities.

I want to make a final point as I close; I am looking at the clock ticking. Against the backdrop of financial concerns, which I of course recognise and which we are discussing, is the strength of hospices in their communities, and the importance, as mentioned by hon. Friends, that they are not solely financially dependent on the state and the NHS for funding. They receive some NHS funding, but it is important that hospices are successful in fundraising and gaining support from our communities. That is one of the strengths of their model, and I want to continue to support that.

I pay tribute to all the volunteers and those involved in fundraising, including many hon. Members this morning who mentioned the fundraising efforts that they are personally making for hospices in their communities. I wish very good luck to my hon. Friend the Member for Eastleigh for his forthcoming skydive. All credit to him for having the courage to jump out of an aeroplane. I sincerely hope that he is successful.

Recovering Access to Primary Care

Rachael Maskell Excerpts

Tuesday 9th May 2023 Commons Chamber

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

The impact of today’s announcement will be miniscule compared with the scale of the challenge facing primary care right now. In York, our GPs are innovative and ambitious—far more ambitious than the Secretary of State—and want to bring real change to the way pathways operate. In light of that, will additional money be available for innovation in primary care, so that GPs can meet the challenge and lead the change that is needed?

[Steve Barclay]

There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.

Vaping: Under-18s

Rachael Maskell Excerpts

Tuesday 2nd May 2023 Westminster Hall

[Dr Hudson]

Again, this is about the differentiation between adult use of vaping products and young people’s use of vaping products.

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

I am grateful to the hon. Member for making such an excellent speech. Does he agree that recruiting a new generation of addicts is the business model that the industry has forever driven, no matter whether the product kills or harms? The industry itself needs to be tackled on the issue.

[Dr Hudson]

I agree with the hon. Member. The industry needs to take a close look at itself, but it is also the case that a lot of the vapes that are ending up with children are coming through illicit means. We need to have a targeted approach to look at how best we can prevent our young people from accessing those products.

--- Later in debate ---

[Rachael Maskell]

Will the Minister also put in place services, similar to smoking programmes, to support people who are now addicted to vaping, to enable them to come off vaping?

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

Reforms to NHS Dentistry

Rachael Maskell Excerpts

Thursday 27th April 2023 Commons Chamber

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

The ever-growing despair has left York and North Yorkshire a dental desert. Thousands of my constituents cannot even get on a waiting list. If they are lucky as they phone around, they may be put on a list, but they then have to wait a minimum of five years to see a dentist. Children are having their teeth pulled out, and adults are getting the pliers out. Although this Government have to own the last 13 years, I want to look forward, not back, because we have a crisis to solve.

Dentistry being left like this is a reminder of what things were like before the NHS was created, and before Labour stepped in and demanded equality of health for all. The model does not work; the system of payment does not work. We need radical reform—not tweaking of the system of units of dental activity. In my constituency, three dental practices have withdrawn from NHS contracts and, over the past four years, 126,130 UDAs have gone. We know that that crisis is deepening. In fact, by the coming June, Bupa NHS—an oxymoron in itself—will have seen a loss of 6,000 more NHS dental spaces. My community cannot get dental healthcare, and they are suffering and struggling because of that.

I, too, sit on the Health and Social Care Committee, and I listened carefully to the Minister, as well as to the chief dental officer, who I thank for her candour and for restoring my hope. She set out a programme of how it can be possible to deliver a future NHS dental service creatively through the integrated care boards, as did the chair of my local dental committee and the associate postgraduate dental dean for primary care dental foundation training in my constituency. They set out a vision which is practical, with purpose and can deliver. If I mesh that with my dental charter, which I have given to my ICB, starting with the ambition to have a children’s dental service within a year, we can start building back. The second year could aim to help older people and those in care homes, as well as those who live in the greatest deprivation. In years 3, 4 and 5, we could build back for the rest of the adult population so that people can get their timely oral health appointments.

However, we need co-operation from the Government, who have now become the servants, with the ICBs as masters. In particular, we need Government support to train more professionals. I too welcome the meeting with the Minister about the proposed York dental school, and I have met the University of York to prepare the way for that. It is important that we train more dentists, but it is also an opportunity to embed a centre of dental development in our city. The ambition is there and the vision has been created.

In addition, we need to ensure that we have good foundation training. I recognise what the hon. Member for Hartlepool (Jill Mortimer) said about having a training bond, because if we are spending £100,000 on dental training, we need to see a return on that investment. A foundation training programme that consolidates practice will upskill dentists in a more coherent way, with supervision and mentoring to ensure that they are the very best professionals. I have to challenge the GDC about its oversight of the dental profession particularly in primary care, and say “Up your game.”

On top of that, we need to ensure that our whole communities can have confidence in what is being created. Through prioritising our young people and ensuring that we take a preventive and proactive approach to dental healthcare, we will start to see other people taking on those competencies and drive that through a public health agenda.

Listening to the opportunities set out by our chief dental officer, the professional on the pitch, it is clear that the Government are not up to the job, and in some places they have been an active block. She has the ideas and the formula, and, my goodness, she has the drive and the energy. Just meeting her and hearing her set out that vision gave me hope that I can go back to my constituents in York and say that there are some people who can really deliver the national dental health service that we need for the future.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I thank my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) for securing this important and timely debate as we work on our dental plan and the NHS workforce plan. We have had some excellent and useful contributions, and all the ideas that have been put forward are extremely timely.

The hon. Lady said it is time for real change, not patching, and I completely agree. The Chair of the Select Committee, my hon. Friend the Member for Winchester (Steve Brine), made too many important points to list, but he made an important point about the need for greater transparency on data and delivery, and I completely agree.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) listed some of the problems that are firing our ambition to fundamentally change the system. My hon. Friend the Member for Waveney made a series of important points, and I am grateful for his contribution not only today and in previous debates but outside the Chamber. He has many thoughtful observations to make about ringfencing, changing the UDA system, fluoridation and so on, and all those ideas are flowing into our work. The right hon. Member for Kingston upon Hull North (Dame Diana Johnson) was the first in this debate, but not the last, to emphasise the importance of where dentists do their training and foundation training to getting more dentists into under-served places, which we are looking at.

My hon. Friend the Member for Hartlepool (Jill Mortimer), like my hon. Friend the Member for Waveney, talked about the perverse effect of the contract bands. That was brought home to me by the conversation she engineered for me with some of her local dentists. I found that conversation incredibly useful. Their passion for NHS work and dentistry shone forth, and it brought home the central role of local commissioners in making the choices of the kind she raised in this debate.

The hon. Member for City of Durham (Mary Kelly Foy) talked about the importance of prevention, not just treatment, and we are thinking about that. My hon. Friend the Member for Broxtowe (Darren Henry) raised the important issues for Sacha and Joan, and I am happy to meet him and his local ICB to talk about how we can address those cases.

The hon. Member for Bootle (Peter Dowd) asked whether we have gone far enough. No, we have not, hence the need for a dental plan. My hon. Friend the Member for Milton Keynes North (Ben Everitt) emphasised the need for housing plans to take better account of the need for primary care facilities and dentists, which we have discussed outside the Chamber. Some places do it well, but that does not happen everywhere, including in his local authority.

The hon. Member for York Central (Rachael Maskell), as always, made interesting comments about prevention among young people, which we are certainly looking at. My hon. Friend the Member for Barrow and Furness (Simon Fell) was the first person to mention that the overseas registration exam is much too long-winded, and that it takes people much too long at the moment. The legislation to enable that to change came into force last month, and we now need the GDC to move quickly to address the backlog and those problems.

It is always a pleasure to hear the hon. Member for Strangford (Jim Shannon) speak in a debate to bring a UK-wide perspective, and he asked a straight question about how we are engaging with the profession. We are generating these ideas by talking directly to dentists. My right hon. Friend the Member for Tatton (Esther McVey) said that dentists had told her that the 2006 contract had never worked, and I have certainly heard that from many dentists.

I am happy to meet my hon. Friend the Member for Bolsover (Mark Fletcher) and his ICB to discuss the recommissioning of services. He raised the issue of Bupa, and I agree that having a three-way meeting would be useful. My hon. Friend the Member for Don Valley (Nick Fletcher) got to the nub of the issue when he talked about basic incentives.

When I visited my hon. Friend the Member for North Devon (Selaine Saxby), I was once again reminded of the particular challenges of coastal communities, and that is especially true in dentistry. We have talked about this before and are thinking about how to get dentists to go places that are historically under-served.

My hon. Friend the Member for Broadland (Jerome Mayhew) raised the same point, as well as a deep question about the historical allocation of funding in dentistry. We are certainly looking at that. I reassure him that we are also looking at the whole issue of centres for dental development, and the proposals emerging in his area are extremely interesting.

Last but not least, my hon. Friend the Member for Keighley (Robbie Moore) mentioned our new requirement for dentists to keep their records on the NHS website up to date. We are keen to drive that forward and to ensure that records are accurate for exactly the reasons that he mentioned.

Dentistry was hit much harder than most other health services because of its fundamental nature: dentists are looking down people’s throats and creating a lot of aerosols, so of course during the covid pandemic the sector was particularly hard hit. We allocated £1.7 billion of funding to carry NHS dentists through the pandemic, which enabled many to survive, but dentistry was clearly hard hit, and it is a hugely important part of the NHS, as many Members have said.

The package of changes that we brought in last July were an important first step—only a first step—in addressing the challenges facing the sector. We have started to reform the contract, with the first significant changes since 2006, to make NHS dentistry more attractive. We have created more UDA bands to better reflect the fair cost of work and to incentivise NHS work. We introduced for the first time a minimum UDA value to help sustain practices where values are lower, and to address unfair and unjustified inequalities in UDA rates, which are now based on quite historical data. We have enabled and allowed dentists to deliver 110% of their UDAs for the first time to encourage more activity and to allow those who want to deliver more NHS dentistry to do so. We have also made it a requirement for the first time for dentists to keep their availability up to date on the NHS website.

We have also made it easier—a number of hon. Members have made this point today—for dentists to come to the UK. The legislation came into force last month to enable the GDC to increase the capacity of the overseas registration exam. As of 1 April, people will no longer have to pay the charges that they used to pay. The Chair of the Select Committee stressed how important it was for the GDC to respond to those increased flexibilities and to work at pace to get through the backlog, and we are actively in discussions with it about how best to do that. Plans are advancing for centres for dental development, as a couple of different hon. Members have mentioned, not just in Suffolk or Norfolk, but further afield, such as in Cumbria. We are watching those plans closely and working with local partners to see what is possible.

Hon. Members raised the matter of prevention. We have already started the process of expanding fluoridation across the entirety of the north-east, which would—subject to consultation—encompass about 1.6 million more people. We will be launching that consultation this year in order to provide the benefits of fluoridation to a large new area for the first time since the 1960s.

All these changes are starting to have some positive effects. In the year to March, about a fifth more patients were seen compared to a year earlier. In total there are about 6.5% more dentists doing NHS work now than in 2010, and UDA delivery is going up from that huge hit it took in the covid pandemic, but of course we must go further; I am the first person to say that. I can see that some of the reforms are working. The proportion of dentists making the new band 2b claims is increasing and it is great to see that practices are prioritising those with higher needs. But this is absolutely just the start and I know that we must go further.

[Rachael Maskell]

Will the Minister set out with great clarity the data that is required, so that we do not just measure how many people are working in NHS dentistry, but we understand the number of sessions they are providing, and we marry that up with need and demand in order to understand what gap is there?

[Neil O’Brien]

The hon. Lady is right; in dentistry, not only do we have headcount measures showing that six and a bit per cent. more dentists are doing NHS work, but we can see the amount they are delivering and we can see those UDA rates starting to go back up again. Of course, we want them to go up further, and I am keen to start publishing more data so that there is greater transparency about what is being delivered where.

There are further changes we must make. We are trying to drive activity back up to at least pre-pandemic levels and to address the fundamental shortfalls that were there even before the pandemic. When I speak to dentists, they have a keen sense of whether the payments they are offered under the 2006 contract make work profitable or unprofitable. Often, for some of those bands, they feel that they are not being fairly remunerated for the cost of the work they are doing. We need to make sure that they do feel fairly remunerated so that they are more attracted to doing NHS work. We could go further in addressing some of those historical, and potentially now unjustified, variations in UDA rates. In particular, the move to ICBs and away from regional commissioning provides an opportunity for not just more transparency, but much more accountability. Instead of a remote regional body, hon. Members will be able to talk to their local ICB about what it is doing to drive up delivery. When we arm Members of this House with greater transparency and greater data, they will be able to have those conversations about what we are doing collectively to drive up the levels of delivery.

Oral Answers

Rachael Maskell Excerpts

Tuesday 25th April 2023 Commons Chamber

[Maria Caulfield]

We also ensure that those eligible for safe and wellbeing reviews get one. Last year about 87% of those who were eligible did so.

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

10. What recent assessment he has made of the adequacy of the availability of NHS dental services.

[Christine Jardine (Edinburgh West) (LD)]

22. What progress his Department has made on improving access to NHS dentist appointments.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

There are 6% more dentists doing NHS work than in 2010, and activity levels are going up. In March the number of patients seen over the past year was up by nearly a fifth on the year before. The initials reforms we have made to make NHS work more attractive are having positive effects but there is much more to do and we will be publishing a plan to improve access to dentistry.

[Rachael Maskell]

In York alone, practices are closing, turning private and handing back contracts. Units of dental activity are down 126,130 compared with four years ago and it can take five years to see a dentist. This is an unacceptable crisis after 13 years of complete failure. Will the Minister enable integrated care boards to have full flexibility to establish an under-18s NHS dental service in schools, along with a full elderly service and one for the most disadvantaged?

[Neil O’Brien]

We will look at all those things. We have introduced additional flexibilities, as the hon. Lady knows, and we are allowing dentists to do more to deliver 110% of their UDAs and bringing in minimum UDA values, but we are also interested in prevention and I would be happy to look particularly at what we can do for younger people.

NHS Strikes

Rachael Maskell Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I agree; it is extremely surprising that the BMA has asked its members not to liaise with NHS managers as they put in place those contingency plans. I urge the BMA junior doctors committee to think of those colleagues who have to provide the cover for those strikes. I reaffirm my thanks to all those staff in the NHS who provided cover following the Easter period, but it puts more pressure on other NHS staff if the BMA junior doctors committee is not willing for its members to liaise with management on sensible contingency measures, as I urge them to do.

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

The bigger dereliction of duty by the Secretary of State is not addressing the retention crisis among junior doctors, who have the choice of going to New Zealand or Australia, to be paid more than double what they receive now, or to move over to work as locums, where they will not carry the stress levels they currently do. What is he doing to address the retention crisis of junior doctors in the NHS?

[Steve Barclay]

In part, that is why my door is open and I am keen to discuss with junior doctors the pressure they face not just on pay, but on non-pay issues. There is the issue of support for the number of doctors and the workforce plan we have committed to bring forward to boost recruitment, but other non-pay issues are also frequently raised by junior doctors, such as booking annual leave and rostering. I am keen to work constructively with junior doctors to address those, but for us to do so they need to move from an unrealistic and unaffordable 35%, which the Leader of the Opposition himself has recognised is an unreasonable position.

National No Smoking Day

Rachael Maskell Excerpts

Thursday 9th March 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing today’s debate. I was really sorry to learn about the circumstances that have brought him here; they really do account for why he is such a passionate advocate for non-smoking.

For decades, tobacco companies have used every manipulative means possible to recruit the next generation of smokers. For them, it is about big profits—£900 million at last count. With around 75,000 victims of their exploits dying every year, those companies have to market their products to new generations to replace those who die. I am angry because they are deliberately causing harm and taking advantage of marketeering, peer pressure and a pack of lies around a pack of cigarettes to make their victims feel good about succumbing to the powers of their addictive means. Once people are hooked, companies draw their prey into a lifetime of handing over precious savings to deposit in their bank accounts.

Those companies are using their resources wisely. British American Tobacco has bankrolled the Institute of Economic Affairs, a Tory think-tank that wants to privatise the NHS. One of its trustees has reported funding a former Health Secretary with £32,000 between 2010 and 2018—the less said about him, the better. With 30 Tory MPs benefiting in all, what could their motivation be? What could BAT’s motivation be? We will never forget Margaret Thatcher taking $1 million from Philip Morris as a consultant.

It is children that these despicable companies are targeting. I have been following the vaping debate, and child vaping is the latest fad. British American Tobacco and others are at it again, addicting children to their products, using different products at different times, with different flavours and colours and cheap devices. They are once again addicting a generation. Among young people, vaping is now seen as cool, as smoking once was, but the harms of these stimulants are unknown, and a lifetime of expense lies ahead, costing users physically, mentally and financially. These wolves in sheep’s clothing need calling out, and today’s debate is a good place to start.

Tobacco is still the biggest killer, luring people into horrible diseases such as cancers—including lung cancer—stroke and heart disease, as well as dementia, which, as we have heard, is the focus of national No Smoking Day. Given that that costs the NHS £2.2 billion a year and social care £1.3 billion, I have to ask why the Government are content not to set out an ambitious plan that is ruthless with the tobacco giants yet compassionate with their victims, taking every step to draw people out of their addictions and recover their health. Why are Government paralysed when the evidence is screaming at them?

This is the difference between the Tory party and the Labour party: Labour knows that health inequality is unjust. We want to take people to a safer, healthier place. That will be our priority. Thirty years ago, I did my dissertation on this very issue for my degree, and my conclusions were simple: money buys silence. Labour must never touch dirty money, and nor will it. That money kills, whether directly or indirectly. Instead, we must invest in health.

According to Action on Smoking and Health, 9.2% of the community in my city of York smoke. While that is lower than the national average of 13%, it costs our city £46.9 million. In my ICB area of Humber and North Yorkshire, 2,500 people, sadly, die each year. The healthcare costs are £8.2 million, adding to economic costs of £19.9 million due to lost earnings and £10.9 million due to smoking-related unemployment. What a lot of money. Let us reflect: 6.6 million people smoke across the UK. There are 150 new cancer cases a day, and 54,300 a year. Every minute, another victim is admitted to hospital, with 506,100 hospital admissions attributed to smoking. Last year, the cost to the public finances was £2.6 billion.

These wretched companies are fleecing their victims of their hard-earned living, with an average smoker spending £2,500 a year. Some 70% of smokers want to quit, so we need to ensure they have the means to achieve that. Let us remember that these multimillion-pound companies prey on the poorest, with 31% of households with somebody who smokes falling below the poverty line—if ever there was exploitation, this is it. Many new communities of people coming into the UK from challenging places across the world also have a high prevalence of smoking, presenting a new challenge for public health teams, and it is important to get on top of that too.

The UK Government aim to reduce the level of smoking to just 5% by 2030, but there is no tobacco control plan. In York, the local authority’s public health grant has been cut by 40% over the term of this Government, yet we do not know what is to come in 22 days’ time, when the public health grant runs out. On top of that, we have not seen the health disparities White Paper. We understand that it has been scrapped, so what on earth is going on? Tobacco companies make an annual profit of £900 million, yet only £2.2 million is spent on prevention. We need funding, we need professionals, we need education and we urgently need to move people to a space where their lungs and bodies can start to recover.

Despite Javed Khan’s independent review of tobacco control, published nearly a year ago, the Minister has been silent. Mr Khan recommends spending £125 million each year to enable the UK to hit its target, which will be missed without the investment that we absolutely need to see; increasing the age at which people can buy tobacco products; and ensuring that every public health intervention is made. I take the point made by my hon. Friend the Member for Blaydon (Liz Twist) about the illicit trade in tobacco, which we also need to crack down on. There are 15 strong recommendations in Mr Khan’s review, and I want to see the Government taking action, responding to that report and publishing their plan.

Unlike the Minister, Humber and North Yorkshire ICB is not sitting back. Its outstanding public health team are engaging in driving down smoking levels, with a new centre of excellence to co-ordinate population-level interventions, and investing in programmes of activity targeted at those who most need them. With stop smoking support and lung health check screening, work is under way to screen and divert. Like many colleagues across the House, I am asking the Government to publish the tobacco control plan; to publish a strategy to tackle the rise in vaping, particularly among our young people; to give local authorities the means and tools to safeguard a generation; and to introduce an annual public health windfall tax on these companies in the Budget next week. It is all about profit for them, and that profit should be used for public health.

[Mr Sharma]

Does my hon. Friend agree that the Government’s strategy and plan should include special provision for black, Asian and minority ethnic communities, so that they can be targeted and helped to give up this dirty habit?

[Rachael Maskell]

I thank my hon. Friend for making that really important intervention. We must help communities that are finding it hard to quit, including new communities. We really welcome the large number of asylum seekers who have come to York, but we know that there is a higher prevalence of smoking in that community. We must ensure that proper interventions are targeted at BAME communities too.

The figures speak for themselves, and the Minister cannot afford to sit back any longer. Labour will not. We want to save lives, and we want to save the health of our NHS too.