Urgent and Emergency Care

Rachael Maskell Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.

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

The Secretary of State is right to talk about the back door rather than focusing on the front door when it comes to the crisis in social care. About a quarter of the patients in our hospital in York are experiencing delayed discharges. However, if we do not pay care staff, we will never resolve the issue. What consideration has the Secretary of State given to putting those staff on a national pay scale, using “Agenda for Change” as a model?

[Steve Barclay]

This obviously involves debates with Treasury colleagues about pay—not just on the social care side, but in respect of the NHS and the interplay with pensions—but it is not just about that; it is also about ensuring that we have the right data, and through the integrated care systems we are acquiring much better data to improve our ability to join up what is being spent on delayed discharge within the NHS with what is being done in the social care setting. I am sure Members will agree that not only is it often very damaging for frail elderly patients to spend a long time in hospital, but hospital is usually the most expensive place in the system for them to be. It is not just a question of having more money, although that is often the default; it is a question of thinking about how to get flow into the system in a way that will deliver not only patient care, but a more efficient service.

Ambulance Pressures

Rachael Maskell Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

My right hon. Friend, partly through the direct experience he brings to these issues, highlights the integrated nature of the challenge we face and in particular the importance of getting the right domiciliary care and care home support in place. Part of that challenge in the coming weeks, ahead of any autumn and winter pressure, will be to understand what the capacity is and what the constraints on it are, so that through the integrated care boards we can better focus on unlocking that capacity to relieve the pressure on ambulance handovers, as he sets out.

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

Older and more vulnerable patients can become medically compromised very quickly in extreme heat. In Yorkshire, category 1 calls can be waiting for 9.5 minutes over the expected time, category 2 calls can be waiting for 18 minutes over, and those with other medical conditions can be waiting 2 hours 41 minutes over. People clearly need support and assessment far earlier. What is the Secretary of State doing to deploy first responders in such areas so that people can get a medical assessment and early intervention far quicker?

[Steve Barclay]

I broadly agree with the hon. Lady on providing targeted support, particularly to those in domiciliary care; we are working with those in primary care on that. In coming days, that will happen specifically through local resilience forums, but in the medium term it will be more through the integrated care boards. That is part of a wider package of support measures that need to be put in place. It will include working with primary care, looking at mental health support, and looking at what can be done to raise productivity through better use of innovation and technology. We will look at all the interventions available across the board to assist us in dealing with the pressures that she highlights.

Ambulance and Emergency Department Waiting Times

Rachael Maskell Excerpts

Wednesday 6th July 2022 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate, which we all, across the House, recognise is needed, as are the solutions.

The issues in York are no different from those that I have heard about today from Members of all parties. We know the diagnosis of what is wrong: we do not have the staffing or the capacity and our hospitals are running hot the whole time. In York, we have been in OPEL 4—that is the operational pressures escalation level—for a considerable amount of time. We are all wrestling with sufficiency in the ambulance service.

The statistics I have heard this morning map on to many of the statistics in York. In May, handover took more than an hour in 752 cases—24.6% of arrivals—and then there are the trolley waits for hours on end. The mean waiting time for non-admitted patients was four hours and 18 minutes in A&E, while for admissions it was nine hours and 22 minutes. There are then the challenges on the wards as patients progress through their journey. We know that there are challenges across the system, but receiving timely emergency care is the most important thing and what we are focusing on today.

Before proposing a couple of solutions to the Minister, I want to reflect on the impact that this situation is having on staffing. We have heard about the need for a workforce plan, which is crucial, but retaining staff is important too. Many people are leaving because the pressures are bearing too heavily on them. Working long hours is one thing—it is almost a social contract that people have to acknowledge, wrongly, I say, as part of working in the service, in either an emergency department or an ambulance service—but on top of that there is the trauma that people face. We cannot describe the impact that has on individuals.

What hurts the most is hearing the radio and knowing that there is another call, another person, another life that could be saved, but being tied down and unable to reach that call, or turning up incredibly late to see a patient, knowing that the life chances of that person in your hands have been changed because of the minutes or even hours of delay. Those are the pressures that bear down on our incredible NHS staff, making the job intolerable and eventually breaking them.

We have to look specifically at what we are doing for staff so that they can carry on with their jobs. Some 69% of emergency responders said that their mental health deteriorated during the pandemic, while just 26% described their mental health as good or very good. We know about the impact this situation is having on people day in, day out, while working those long hours. It is unsustainable. We are seeing that in the retention rates. My plea to the Minister is to introduce a good mental health support programme for staff to maintain that sufficiency. That means fixing the system as well; we cannot have one without the other.

I want to pick up on something I am very mindful of, having spent time talking to paramedics. A constituent contacted me about the poor mental health of their patients, its increased acuity and the impact of that on the service. I have met a group of campaigners who are calling for a specific mental health service with a specific phone number—instead of people having to call 999 or 111—through which people can be triaged by mental health experts and put in the right place in the service. It is about building a proper acute mental health service around people, because A&E may not be the right place for them, yet where else can we take them? It is important not only to look at the whole clinical pathway for people in crisis but to ensure that paramedics can focus on and spend their time on people with acute physical illness. I would like the Minister to reflect on the opportunity that that could bring.

In the short amount of time I have left, I want to touch on an issue in Germany, where they are doing medical thrombectomies in ambulances at the side of the road, as opposed to losing precious time taking people to A&E departments. We can do a lot more to reformulate the way our acute services work to take medicine to the patient, as opposed to taking the patient to hospital. [Interruption.] The Minister is nodding, so I will stop there but I look forward to his response.

Draft Mental Health Bill

Rachael Maskell Excerpts

Monday 27th June 2022 Commons Chamber

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

I welcome the Bill. The acuteness of people’s mental health challenges while in the community is escalating before appropriate intervention is taken. How will the Bill ensure that earlier interventions are made, so that people do not have to go into secure accommodation for their safety?

[Sajid Javid]

Once the Bill is law, it will require the use of secure accommodation to be limited to those who absolutely need to be detained, either for their protection or for the protection of others. Alongside the Bill, we need to make sure that the right resources are there. I mentioned earlier the extra resources that are going in, to a record level, including today’s announcement of the £150 million.

NHS Dentistry in England

Rachael Maskell Excerpts

Wednesday 22nd June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for opening the debate and making many of the points that I intended to make. The simple fact is that we do not have time for further delay. We have four and half weeks left until the summer recess, and our constituents want answers. They want answers because they need to see a dentist but they are experiencing the deficit of NHS dentistry across the country. I would add to the list of areas mentioned that Yorkshire is also deeply affected, and my city, York, is struggling.

In 2009, Labour committed to reform the dental contract, realising that it was not going to deliver what it aspired to. The coalition Government followed in 2010 with a similar commitment, yet here we are in 2022 still making the same argument that we desperately need reform. As has already been said, this is not just something that has emerged through the pandemic; it is an issue that predates us. That is why it is essential that we have a pathway from today showing how we are going to move out of the crisis. Our constituents deserve to know what the Government’s agenda is.

Two years ago, NHS dentistry fell by 13%. Since covid-19 there has been a mass exodus in my city of York, but I realise that has also occurred across the country. Last April, NHS dentistry fell by a further 19%. It is believed that since the start of the pandemic, NHS commitments have fallen by 45%. Next year, 75% of dentists are planning to make changes and reduce their NHS commitments. Of those, some 45% say they will go fully private and 47% say they will change career or take early retirement, so if we wait another 12 months we will be in a deeper mess than we are now.

Since the start of the pandemic, we have lost 43 million dental appointments, 30 million of which were for children. In my constituency, 41% of children have not seen a dentist in the last year—they are the children who are now presenting in more acute services, requiring even more expensive interventions.

To put the situation in York into context, 9,695 UDAs were delivered in March 2021, at a time when 45% of UDAs needed to be delivered. A year later, in April 2022, 8,730 UDAs were delivered, fewer than the year before, and yet the requirement was for 95% of UDAs to be delivered. Instead of the number of my constituents accessing NHS dentistry going up when the number of UDAs that were expected to be delivered more than doubled, it has gone down. With 965 fewer UDAs, despite a doubling of the expectation, will the Minister explain how my constituents are meant to get access to services?

Fewer than half my constituents have seen a dentist in the last year. Of course, dentists have offered them private dental plans but my constituents simply cannot afford that, not least because of the cost of living crisis and the housing crisis in my city. Some travel long distances and others get nothing at all, and we know about other health inequalities that are similarly embedded.

[Sir John Hayes]

It is the least well-off people who suffer most, as the hon. Lady rightly said. Working-class people cannot afford these expensive plans. Surely the answer is that we should train more of our own dentists and make it more attractive to work for the NHS, rather than go private. My own dentist is Turkish by origin. He is a fine NHS dentist, and I could not speak more highly of him, but we cannot simply import dentists; we need to train more.

[Rachael Maskell]

The right hon. Member is absolutely right that we have to train more dentists. One reason for that is that it takes about 10 years for somebody to be fully professionally competent and able to provide the highest level of dentistry. We must not look just at what is happening now, but into the future too.

Before we get to that point, we have to look at retention and at bringing people back from private contracts and services into NHS contracts. With fewer dentists available, the toll and the mental stress felt by those who have stayed in the NHS and remained committed to it is building. Some 87% of dentists experience mental stress, and 86% have experienced abuse as a result of people being so frustrated by the time they reach the dentist’s door. The people working in dental reception areas are at the forefront of that, and I know of a practice in York that cannot recruit anyone to be on the front desk. We need significant changes to be brought forward, and that will require money and dedication.

It is not just about the contract; it is also about having a complete strategy around dentistry. I have never understood why oral health was taken outside the wider NHS, and I believe that the solution to the problems we face is to have a proper NHS dental strategy and to put the NHS dental service back into the heart of the NHS. However, while we are working on those issues, we have to look at the crisis before us.

In Parliament last week I mentioned a practice that has been fantastic at accommodating people with dental needs throughout the pandemic. I said that three dentists were leaving that practice; I was wrong—it is now four. That is the pace of people leaving the profession. We have heard about the wider consequences for oral health, and particularly oral cancers, for which a delayed diagnosis means the worst prognosis. Therefore, it is absolutely right that we see a move on this issue.

I want to raise a couple of issues about dentists waiting to come to the UK. We know that 700 dentists are waiting to sit exams. The Government have had a consultation, which has closed, and we are awaiting a response. I am sure everybody in the House would want to accelerate legislation on that, but we need to know the Government’s plan. I hope the Minister will be able to tell us about that today.

However, 700 dentists will not fill the gap. Just last week, I was speaking to Ukrainians who have come to the UK. They want to work, they want to put their skills into practice and they want to have fast-track English language training so that they are competent in terms of their language skills. They want to see their qualifications passported, so that they can get to work and practise their profession. They do not want to deskill or de-professionalise. They want to learn the clinical language that they will require, and therefore to shadow dentists getting ready for practice. However, I have not seen a strategy from the Government on how we will work with refugees who have those skills and can put them to work. Perhaps the Minister will share that in her closing remarks, because it seems such a waste of talent when many refugees absolutely want to address that local need but cannot do so.

I turn now to the future training of dentists—a point raised by the hon. Member for St Ives. I have had discussions with Hull York Medical School, which is a fabulous partnership between the two cities, and it would be prepared to help support a dental school. Of course, that would need investment, so we need proper investment for the future. To look at how that would work, I spoke to the commissioners, and there certainly is an appetite in our city to host such a school in the future. That would be helpful in bringing dentists onstream, but we also must recognise that students currently in training are struggling to get placements in the NHS. Of course, the more dentists who leave, the harder it will be to train the current cohort. Unless we see a quick increase in the number of NHS dentists, we will be in even more difficulty. That is why the urgency is there now. We must build back an NHS service for the future to ensure that we have those professionals in place.

Finally, we know that integrated care systems will be taking over the commissioning of dental services next year. My concern is that Government are waiting for that moment to act. We must see action now, because the integrated care systems will not be able to solve a problem that the national Government won’t.

--- Later in debate ---

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

[Rachael Maskell]

rose—

[Maria Caulfield]

I will take one last intervention, because I am conscious of the time.

[Rachael Maskell]

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

[Maria Caulfield]

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

[Rachael Maskell]

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

[Maria Caulfield]

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

Like many across the House I have been deeply disturbed by the reports we have all seen from Shanghai and my thoughts are with the people affected. It shows what a dangerous fallacy this whole idea of zero covid was, and it also shows that we are the most open country in Europe and that we have got the big decisions right. We did not listen to the Opposition when they said we should not open up in the summer, and we did not listen to them when they again called for restrictions in the winter. We are showing the world how to live with covid.

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

T3. My constituents have been forced on to private and unaffordable dental plans or they have to wait up to five years to see an NHS dentist. The situation is getting worse and worse, so I met with the groundbreaking Hull York Medical School to see if it can assist in training a future generation of dentists and it is keen to help; what is the Minister doing to work with medical schools?

[Several hon. Members rose—]

Health and Care Bill

Rachael Maskell Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I hope the hon. Lady will forgive me, because I will finish discussing the workforce amendments before I turn to the so-called genocide amendments and the organ sales amendments. I will come to her point, but I hope she will allow me to do it in that way; I have heard what she has said.

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

Will the Minister give way?

[Edward Argar]

I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.

We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.

[Edward Argar]

I will make a little more progress, then I will give way to the hon. Member for York Central (Rachael Maskell) and then, if I have time, I will give way to her. I want to address the points of the hon. Member for Lewisham East (Janet Daby) in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.

We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.

[Rachael Maskell]

When looking at workforce planning, it is really important not only that the Government depend on NHS professionals trained overseas, but that they look at commissioning more training places here. In particular, I would point to the dentistry profession, as the Government are currently waiting for 700 dentists to pass their exams. It really does highlight the shortage of training for our own dentists when one in three dentists practising has trained overseas. Will the Government look at the commissioning of more training places so that we can grow our own workforce?

[Edward Argar]

The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.

--- Later in debate ---

[Wes Streeting]

I thank my hon. Friend for his intervention. It is certainly the case that refugees fleeing Ukraine—indeed, other conflict zones around the world—bring enormous skills to our country. For as long as they are here and living with us, we should enable them to make whatever contribution they wish. If some of the people from Ukraine or elsewhere want to work in the NHS, we should absolutely welcome them with open arms.

[Rachael Maskell]

I am grateful to my hon. Friend, who is making an excellent speech. This debate is concentrated on physical health, but if we look at workforce planning on mental health we know we are at a significant deficit. If we are talking about parity of esteem, surely Lords amendment 29 is absolutely imperative, so that we can start investing in the future of our mental health services?

[Wes Streeting]

My hon. Friend is absolutely right and she will know of our party’s ambitious commitments, outlined by my hon. Friend the Member for Tooting (Dr Allin-Khan), to ensure that patients receive guaranteed mental health treatment within a month. That would be revolutionary. It will require investment and require recruiting the people we need to help provide that care, but this country is living through a mental health crisis on top of everything else. This has been a deeply difficult two years for our country during the pandemic. Many people bear not just the physical scars and ongoing physical health consequences of long covid, but the grief, the loss and the injury to their mental health and wellbeing caused by this deadly pandemic. Many of those people who are suffering mental health crises are the very people who are still turning up for their shifts in the hospitals, still turning up for their shifts in the GP surgeries, and still turning up at work to help care for others even though they are in need of care themselves.

Lords amendment 29 does not commit the Government to hire thousands more doctors and nurses, although they should. It does not commit to new funding for the NHS, although it desperately needs that. It does not even commit the Government to finally publish the workforce strategy the NHS is crying out for, despite the fact that the NHS has not had a comprehensive workforce strategy since the Labour Government’s plan was published in 2003. All we are talking about today is an independent review of how many doctors, nurses and other staff the NHS needs for the future. That is not just a view put across by Labour Members: it is supported by many Members right across the House, including the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey, who is a former Health Secretary. It is not the first time that he has helped to unite the sector, although I remember the days when it was sometimes united in opposition to, rather than in support of, his proposals.

I will say this, actually: when the right hon. Member for South West Surrey took over as Chair of the Health and Social Care Committee, I was really nervous about the prospect of a former Health Secretary effectively marking his own homework, but on this issue, he has shown a degree of honest reflection and has genuinely contributed his experience to the debate about the future of health and social care in this country. Not only has he been honest about where he fell short, and where other Conservative Ministers may have fallen short, but he is determined to make sure that we improve the quality of the health and social care debate in this House. I very much welcome his contribution to the debate about the NHS workforce challenge.

Lateral Flow Tests in Healthcare Settings

Rachael Maskell Excerpts

Monday 28th March 2022 Commons Chamber

[Mr Sharma]

I thank the hon. Member for that important intervention. I am sure that the Minister took note of his concerns.

We all know that we are experiencing and facing an increasing cost of living crisis, and earlier this month the Foreign Secretary agreed that the escalating crisis in Ukraine will only drive inflation higher, so in the midst of the most serious cost of living crisis for a generation, with a national insurance tax rise and with covid remaining a global threat, it would be wrong to add a further burden on to families wanting to stay safe from covid and visit friends and families in care settings. The introduction of charges for lateral flow tests risks introducing a serious cost on many for visiting their closest family when those visits mean so much to visitor and host.

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

I am grateful to my hon. Friend for bringing forward the debate. In York, the case rate is now 977.7 per 100,000, 261 patients are in hospital poorly, five more deaths have just been announced and four people are in intensive care, so the virus is far from leaving us. In Labour-run Wales, an extension to the lateral flow test programme has been announced so that we can know where the virus is, manage it and protect our NHS. Should we not be doing that in England?

[Mr Sharma]

I thank my hon. Friend for that intervention. Again, the Minister has taken note. I am certain she will make that comparison and try to assist and to follow the best practices in other parts of the country.

Low-income and frontline workers will be hit the hardest by the introduction of charges, but regular testing is vital to minimise the spread of covid-19. The money saving expert Martin Lewis said last week that he was out of ideas. There is nothing left for families to do. Inflation is just too high. In my constituency, I have spoken to staff and volunteers at Ealing food bank who do amazing work to help those most in need. They are deeply concerned about the move to charge for lateral flow tests. Their service users will have to make the choice between paying to test and heating and eating.

In January, I raised this issue with the then Minister for the Cabinet Office, the right hon. Member for North East Cambridgeshire (Steve Barclay), who agreed that testing

“has played a key role in our response”.—[Official Report, 13 January 2022; Vol. 706, c. 629.]

But now we are cutting off that limb of the response. The Government are choosing to weaken their arsenal in the fight and to lessen the effect of two years of hard work and sacrifice.

Even before the newest wave of inflation struck, families in my constituency were struggling to feed themselves. Now it will get only worse, with a cost of £12 for just one pack of tests. At the end of February I asked the Secretary of State for Health and Social Care how much the packs cost his Department, but he could not give me the figures for commercial reasons.

But please, Madam Deputy Speaker, do not think it is just the cost that is the problem: no, it is the fairness too. Throughout the country, nearly 1.5 million people are eligible for treatments such as antivirals if they get covid-19, because the UK Government have identified them as being at the highest risk of severe illness. We know that those people are more at risk, less safe, and less protected by natural or acquired immunity. Around 500,000 of these people are immunocompromised, meaning it is less likely that they receive the same level of protection from covid-19 vaccines. The vaccines have been incredible and have reopened the world for many, but not for everyone. Infection is still a terrifying and uncertain prospect for many of the 500,000 immunocompromised.

There is more. The national health service has worked tirelessly to keep us safe and to save lives. I again pay tribute to the incredible staff of Hillingdon Hospital who did so much for me when I had my own covid infection. They saved my life, and I am eternally grateful to them. What payment to them for two years of danger and worry is it that they will have no certainty that their patients are covid free?

I recall the fuss from Members on the Government Benches when they were asked to wear masks to help to prevent the spread of covid-19. There were ludicrous comments from some. One compared wearing a mask to abuse, agreeing with the statement that masks were

“germ or bacteria ridden cloths”.

Well, those in the NHS still have to wear masks for their own safety. Perhaps more testing, and allowing people to take responsibility without having to pay for tests, would allow a few more people in hospitals and GP surgeries to take their masks off.

[Rachael Maskell]

My hon. Friend is making an excellent speech, I must say, but could I mention care homes as well? People have made huge sacrifices over the last two years in not seeing their loved ones in care homes, and not being able to afford a test will put another barrier in their way. Does my hon. Friend agree that in the care home setting it is vital that relatives have access to tests?

[Mr Sharma]

I thank my hon. Friend very much, and I was going to talk next about care homes, but her intervention has certainly confirmed my argument and point of view that this is the most important area the Government need to look at very seriously if we want to control the effects of covid-19 on our society.

We could also speak about dentists, whose industry is struggling with the pandemic, while they are driven by targets in NHS contracts that they cannot meet. There is no help from the Government to meet the massive costs of making their practices safer, but now patients are being robbed of the opportunity to test before going to the dentist’s. We cannot erase risk, but we can try to minimise it for everyone working in healthcare and in healthcare settings.

We have all gone through so much to combat covid-19, suffered so much and sacrificed so much. I do not argue for lockdowns and closing the economy or closing the country off from the world, but now is the wrong time to cut this specific key lifeline for millions. It is the wrong time to take away peace of mind, and the ability to do the right thing in checking whether we have covid-19 and acting responsibly. I urge the Minister to work with the Chancellor of the Exchequer to find a way to pay for lateral flow tests, and to protect this tool in the fight to ensure that the worst-off in society are not cut off from their loved ones and that the most vulnerable feel more secure leaving their homes.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

First, I thank the hon. Member for Ealing, Southall (Mr Sharma) for bringing forward this debate about lateral flow tests in healthcare settings. He speaks so passionately about health issues more broadly, and I am grateful for his speech on this important topic today. He has spoken previously about access to covid-19 testing, particularly in specific settings, and I want to put on record my thanks for his contributions on these matters.

As the hon. Member highlighted, the pandemic has provided this country with a monumental challenge. When coronavirus first emerged, we knew very little about it, other than reports that people were becoming seriously ill and, very sadly, passing away. The Government moved quickly with unprecedented measures that affected every single person on these isles, building and scaling up our testing capability to levels not seen before, sponsoring the development of groundbreaking vaccine technology and being the first country in the world to approve a vaccine.

Our huge thanks go to all those who supported the vaccine roll-out and mass testing. From our NHS staff on the frontline, primary care workers and individuals in the community to the military providing expertise in logistics and planning, colleagues from the private sector and civil servants deployed from their normal roles, we recognise the immense effort and long, exhausting hours they have put in working to keep the nation safe.

I am proud of how the Government responded at pace to the challenges that health and social care staff faced. Since April 2021, we have dispatched over 5.8 million rapid lateral flow tests to NHS workers in England—directly to NHS trusts, care settings and the homes of individual staff members—with over 60,000 of those going directly to the hon. Member’s local NHS trust in Ealing.

Testing has been a crucial countermeasure throughout the pandemic. The world-beating scaling up of our PCR testing capability proved invaluable, enabling us to diagnose symptomatic individuals when facing a growing but relatively unknown threat from a new virus.

We introduced lateral flow devices in November 2020 as a tool in addition to the highly sensitive PCR tests. LFTs were a significant step change in our battle against covid-19, enabling us to open up greater levels of asymptomatic testing and tackling asymptomatic transmission when the vaccine roll-out was in its infancy yet still ahead of the rest of the world.

Since April 2021, 13,500 positive but asymptomatic NHS-linked individuals have been identified by LFTs. Through their tireless dedication to regular testing, staff in the NHS and in care drove that most pressing fight to protect those most at risk—their colleagues at work, their friends, their families and, most importantly, their patients. All were protected because we were able to break the chains of infection using LFTs. I want to put on the record my immense thanks to each and every NHS and care worker for their valiant and unwavering efforts.

Since the early months, we have learned a lot more about covid-19, including what makes someone more at risk of contracting the virus and how best to mitigate the risk of transmission. That applies in all settings, although especially in healthcare and social care ones, where the close nature of the care provided creates greater opportunity for transmission. In these places, LFT testing has helped to ensure that staff can continue to safely carry out essential care for those most at risk.

By relying on the expert advice of our medical and scientific advisers, many of whom have become household names because of their immense contributions, we have been able to take steps to mitigate the rate of transmission of covid-19. We are now in a much better position, where the link between infection and severity of disease is substantially weaker than in earlier phases of the pandemic. We have severely weakened the link between infection and severe disease. As the hon. Member for York Central (Rachael Maskell) said, cases are rising again. However, we are on the front foot thanks to vaccines and community covid-19 treatments.

The UK’s investment in groundbreaking vaccine technology and our world-beating vaccination programme has put us one step ahead of the virus. Vaccination is now the UK’s first line of defence. Thanks to the actions taken by the people of the United Kingdom, as of 24 March 2022 more than 85% of those over 12 have had two doses. Now we are also inviting those aged 75 and over, residents in care homes for older adults, and individuals of 12 years and over who have a weakened immune system to take up the offer of a spring booster jab.

Importantly, we now have widespread availability of targeted community covid-19 treatments. For people who are eligible, those can significantly minimise the chance of developing severe disease. I hope that the spring booster and the community covid-19 treatment programme reassure the hon. Member for Ealing, Southall that we take very seriously the situation of the immuno-suppressed.

[Rachael Maskell]

My concern is that in York, where about 90% of people are vaccinated, the rate of people getting very poorly with covid is going up. The antiviral treatments are not effective, because there is an increase in mortality as well. Putting the additional line of defence—testing to prevent transmission—in the system is one way to save lives. I cannot understand why the Government will not move the issue on for three months; we could then review the situation again.

[Maggie Throup]

I thank the hon. Lady for that intervention; I know she is passionate about this issue, which she has spoken about many times. It is important that we should recognise that we have moved on. We have broken the chain of transmission with the vaccination programme, which is our first line of defence along with antivirals and therapeutics within NHS settings.

Core to continuing to stay ahead of the virus and learning to live with covid is a move to everyone embodying safer behaviours in their day-to-day lives. The Government recommend continued vaccination, which ensures that everyone is as protected as possible and reduces the chance of their becoming infected and transmitting it to others and of developing severe disease. We have the spring booster programme, and there is an evergreen offer to those who have not yet come forward for their first dose—there are a few of them every day—or who have delayed their second dose or booster. They are welcome to book their vaccines at any time.

We recommend ventilation to ensure that harmful particles are blown away, and the wearing of face coverings in crowded and enclosed spaces to minimise transmission, particularly where prevalence is higher. People should stay at home if they are unwell, to ensure that they do not spread the virus to their friends and family, as well as washing hands regularly and following NHS advice to “catch it, bin it, kill it.” In addition to that advice, NHS England for NHS staff, and the Department of Health and Social Care and the UK Health Security Agency for social care staff, provide expert infection prevention and control guidelines to ensure that healthcare staff, their families and their patients are kept as safe as possible.

Over the past two years we have worked relentlessly to ensure that the people of the United Kingdom have been protected from the virus, reacting to learnings and putting them into practice, as well as using them to implement pragmatic long-term plans. The approach to managing covid-19 in NHS and social care services has evolved over time, giving us the opportunity to learn what works best to keep people safe. We have the opportunity to put that learning into practice, while continuing to focus on providing care for those who need it and supporting those at risk from covid-19.

As we know, the pandemic is by no means over. The UK Health Security Agency continues to monitor the virus and has recommended a package of contingency capabilities that form a reasonable insurance scenario to enable us to respond to resurgences or new variants of concern. I reassure the House that in line with recommendations, the Government have secured a supply of lateral flow devices to use if necessary. Limited ongoing free testing will be available for a small number of high-risk groups within the settings we have discussed, plans of which will soon be set out in further detail by the Government. Once again I thank the hon. Member for Ealing, Southall for securing this debate on such an important issue and expressing his remarks so well.

Question put and agreed to.

Covid-19: Deteriorating Long-Term Health Conditions

Rachael Maskell Excerpts

Thursday 10th March 2022 Westminster Hall

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

It is always a pleasure to serve with you in the Chair, Mrs Cummins. I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for opening the debate and for putting a lot of material as well as a lot of data before us to consider, which is incredibly useful. I am also indebted to the Backbench Business Committee for allowing today’s debate to go ahead.

Even pre-pandemic, there were many challenges for people with long-term health conditions and their management. There was a really good focus on the acute phase, but as people moved into the more chronic phase of their illness, the amount of rehabilitation and support individuals received waned. It was dependent on geography, where someone lived, and on how many in-person interventions they had. Through that time people’s baselines lowered as their function decreased, but it did not need to decrease. That is why it is so important to look at the issue today.

I echo the remarks of the hon. Member for Bromley and Chislehurst on prevention. Of course, prevention is always better than cure, and having a strong public health strategy is crucial. In the acute and early intervention phases, many people missed out during the pandemic. We think about delays in diagnosis, the scale of treatment that people had because clinicians were placed elsewhere, and the value of input. We have talked about strokes today, and people having fewer rehabilitation sessions and less intervention from some of the leading clinicians, which meant they did not leave hospital at the same level that perhaps they did pre-pandemic. We need to pick that up now.

Early discharge has put more pressure on achieving a good baseline for somebody to move into the more chronic phase, the longer phase, of their rehabilitation. We know that once somebody goes home they do not have the physio nagging them every day and telling them to do certain things, so their function deteriorates unless there is good community intervention, which is what I want to focus my remarks on today.

We are talking about a broad range of conditions—neurodegenerative and other neurological conditions. The hon. Member for Bromley and Chislehurst set out some of those, but we can think about motor neurone disease, where time is simply not on your side, or Parkinson’s, where intervention is really important to ensure people maintain function.

We have learnt a lot about respiratory conditions over the last two years with covid, and suddenly lungs have come into central view. Cystic fibrosis has been mentioned. Chronic obstructive pulmonary disease is a condition that really does need good management in the community. There are cardiovascular, psychological and other conditions. We must remember that comorbidity is an issue that impacts on and intersects with many conditions. Somebody who has a combination of COPD and Alzheimer’s will often not remember or be able to steer the management of their condition. As a result, they are perhaps more susceptible to getting an infection and then finding it difficult to clear their lungs or to follow whatever treatment is prescribed, so they are more at risk and early morbidity is a serious risk factor. Therefore, we need to consider these issues in that context.

As I said, intervention at the acute phase of a disease can be intense, but it is about what happens next. We know that often there are not enough rehabilitation beds available to continue someone’s treatment. I have always argued that the convalescent stage is also really important for people to build their confidence, which is often what is needed after the acute stage. That is where the biggest challenge lies.

As the hon. Member for Bromley and Chislehurst outlined, some services have been able to be delivered through new mechanisms, such as Zoom, that simply were not there before. However, as a physiotherapist myself who spent 20 years working in this area, I must say that I would find stroke rehabilitation very difficult on Zoom, and anything involving respiratory medicine as well, because it is all about diagnosing and treating people through the physiotherapist’s hands. Body-to-body contact is absolutely crucial in the development of interventions. Clearly, the lack of it has impeded people’s rehabilitation and had an impact on it. It is not just physiotherapy or occupational therapy that are affected; other services, from dietetics right through to psychological therapies, are also affected. For somebody who is already impaired, face-to-face contact is vital, particularly if they are neurologically impaired and have just had a new diagnosis. Therefore, the risks of a patient regressing and not reaching their baseline, and then regressing further from that, are even greater.

The NHS is in some ways now coming under greater pressure than it did during the covid period. My concern is that the focus, politically and clinically, will be on the elective list and those numbers—we will drive up those numbers for sure and the Government will look at them—and will move on to dealing with acute care as it appears and to dealing with the elective backlog. GPs will of course make the same call, saying, “Look at our waiting lists, look at what is happening here.” Consequently, people with long-term conditions will be squeezed out of the system. That is why I am really grateful to the hon. Member for securing this debate. People absolutely need intervention. Without it, their progress and even their functions will decrease, and that will put even more pressure on both social care and the health system. The debate today is therefore really timely, allowing us to consider the new pathways that need to be created in order to support people with long-term conditions. They have been the poor relation for some time and we cannot let that situation continue.

In the last decade or so, Labour in particular has been looking at pathways that could be developed, such as the expert patient, which enabled people to have control and management of their own disease. Enabling the patient to lead wherever possible is really important. New technology has come on board. Under this Government there has been a particular focus on how new technology can help to provide support, measure things and move medicine forward. All those interventions are absolutely welcome, but they should not detract from the importance of the physical interventions that are necessary. We must ensure we maintain that baseline, so that if somebody does regress, we can give them an injection of rehabilitation to get them back up again to their normal functioning. It is really important to do that in a timely way.

I very much look at this issue from a physical perspective because of my professional background, but I recognise that people with other clinical expertise and competencies will look at their particular field and the need that particular types of intervention. As the hon. Member said, it is right that people have the correct balance between physical and psychological health, and they have to be brought into one space. Sadly, if someone has a physical diagnosis, the psychological aspect is often left behind, because doctors are looking at the primary root of someone’s condition. We must look at people far more holistically than we do currently.

I therefore want to set out a four-stage rehabilitation service to support the physical and psychological needs of people living with chronic ill health. Taking that approach forward will need funding and a workforce plan, which the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), has been incredibly powerful in calling for. I see a concept in which the first phase looks at assessment and measurement, the second at self-management, the third at therapeutic interventions, and the fourth at the psychosocial support, which is also needed.

First, interventions clearly need to be individualised. Everybody is unique in their presentation. We need to recognise that there is an opportunity to develop the service not only in domiciliary settings, but in rehab settings and, for some, in group settings. We have lost some of the collective healthcare that is important for not only the socialisation of health, but the encouragement from one patient to another. We have to capture that again. Often, a patient will be encouraged by seeing somebody else doing what they want to do and that will spur them on to go that little bit further.

Secondly, we have to look at patient management and how people enter services. It should be a given that patients will continue with their interventions once they leave formal healthcare settings. We need to make sure there is a continuum of regular assessment and monitoring. For some individuals, some of that assessment and monitoring can be done at home, but some of it will need external intervention.

Thirdly, regular support may not always require an intensive burst of intervention—sometimes it will—but if it can enhance function, it does need to be examined. I looked at some statistics provided by the Chartered Society of Physiotherapy. Only 15% of people with lung disease deemed eligible for pulmonary rehab are able to access it, which is quite shocking and we really need to address that. Some 50% of people eligible for cardiac rehab cannot access it. From running cardiac rehab classes, I know how people gain confidence from rehab to do things they never thought they would be able to do. They no longer live in fear, but live a confident life.

One in five people receive post-hip fracture rehab on discharge. I know of many cases where all the money is spent on repairing somebody’s hip or getting them a new hip, then getting them up, standing and walking in hospital, only for them to go home and just sit in a chair. Those patients then become fearful, which means social care has to come in, costing the NHS and the care system. It also means that somebody loses their independence, which is the biggest cost of all. This issue needs to be addressed.

Some 44% of people with a neurological condition do not access the services they need. We have a big amount of catching up to do. The biggest thing is that if somebody loses their confidence there is a rapid decline. We must remember that many of these people are elderly and live on their own. They do not have the interventions and the injection of hope that they need. We are talking about life-changing events—people’s whole world is reoriented. We need to make sure that patients maintain social connection, where possible, and are able to access that support.

Waiting lists for elective treatment have become so long. I cannot remember if we are at 6.2 million people or more, but with those kinds of figures many people will need additional support—for example with their diet, or they may be less mobile—so as not to trigger other thresholds that further delay their surgery. It is important that people do not become sedentary and that they have the support they need. If people have a lung disease, it is important that they do not increase the damage to their lungs, lose function or become psychologically impaired, because it is then harder to regain function. We do not want to see people spiralling, which can happen very quickly. Once people get into that place—which is not a great place to be—it is much harder to get people back, so let us really focus on that area.

Fourthly, I want to talk about people living with chronic conditions. Often, people get locked into a space where their life has changed so much that they become more isolated. They lose those social connections, and they also lose their ability to move forward. That might be because, for instance, they have lost their speech, or they might not have the same ability to communicate with people in all sorts of ways. We need to look at how we bring social prescribing into this agenda, as well as the voluntary sector and community support, which is necessary. I want the Minister to look at different pathways to bring that whole family of measures together. Often, we have isolated that into the various parts of someone’s body or mind, as opposed to looking at the person holistically.

Of course, if someone is more isolated, they may experience more loneliness and that impacts on anxiety, depression, motivation and function. People’s skills and confidence then decline even further. We need to ensure the programme has the resources it needs. People are whole beings, and we need to recognise that in our health systems. For too long, we have talked about arms and legs or lungs and brains, but we do not talk about people, and it is people who need that support. If we can look at such a model, we need to think carefully about how we socialise our health system.

I have been looking, in a completely different context, at fostering. There is a programme called the Mockingbird programme. I do not know if the Minister has heard of it, but groups and different people come and support the family. It may be an individual, a partner and their carer, or a family unit. They get that more community- based support. In the context of fostering, it is different families, so there is that concept of a community raising a child. Why do we not look at that for later in life for people with chronic conditions and for how we can provide support? Carers are often with their partners for weeks at a time with hardly any social interaction, and that can be quite telling if someone has an acute psychological condition as well.

Much more can be done for carers, as well as patients, as we move forward. We need a strategy, a workforce plan and funding. In this new world of integrated care partnerships, we have an opportunity to deliver that. July is day one. That is the moment to break out of the past which has let down people with long-term health conditions and move into a new era. I very much hope the Minister will be able to bring that forward.

[Judith Cummins (in the Chair)]

I aim to start the Front- Bench speeches no later than 2.28 pm.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 1st March 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for all her hard work on campaigning for more dental appointments for her constituents. I believe that she met the Secretary of State last night to push him further on this. Her local area has an allocation of £4.7 million from the £50 million fund, and I encourage her to speak to her local commissioners to make use of that allocation. We are also looking at improving dental training so that we can get more dentists into her area.

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

Since dentistry was debated just a few weeks ago, another 10,000 of my constituents have received letters to tell them that they will have to go private. They are already waiting for five years to get an appointment. When will they actually get to see a dentist, or are they expected to have poor teeth?

[Maria Caulfield]

I am not sure where those constituents’ letters have come from, but if a contract has been handed back and that is the reason for the letter, the local commissioners should be looking for new providers, so I am very happy to meet the hon. Lady and her commissioners to see what is going on to make that happen.