NHS Dentistry

Rachael Maskell Excerpts

Thursday 20th October 2022 Commons Chamber

[Peter Dowd]

That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.

Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.

Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.

Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.

Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.

In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.

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

I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.

[Peter Dowd]

I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.

As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.

Liver Disease and Liver Cancer: Diagnosis

Rachael Maskell Excerpts

Tuesday 11th October 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this important debate, as well as on the important work that she and my hon. Friend the Member for Caerphilly (Wayne David) do with the APPG.

While there are multiple causes of liver disease, such as from viral hepatitis, obesity and alcohol, I particularly want to focus on alcohol. Successive Health Ministers will know that, over a period of time, I have consistently raised concerns about the absence of a comprehensive alcohol strategy. This afternoon we have heard only too clearly why that is so important. For too long, alcohol has been promoted as a social norm, and not to imbibe as an anomaly, yet the scale of alcohol harm, psychologically and physically, is off the radar. It is something that is causing me significant concern, whether it is used for pleasure or to address pain. It must become a priority of this Government.

In a city where I see more and more licensing of premises, I am aware of the impact and harm that that is having on livers. We see it in the statistics. My discussions with the British Liver Trust over the summer highlighted the fact that more and more people with liver harm were younger and sicker. Our excellent public health team in York says that it is their No. 1 concern. When we match that against the fact that 90% of liver harm is preventable, we realise that there must be a more comprehensive strategy. As the profile of those with liver disease changes, so must investment in prevention, diagnostics and disease management.

Astoundingly, since 2010 hospital admissions for liver disease have risen by a staggering 45%. NHS Humber and North Yorkshire ICS currently has no clinical pathway for the early detection of liver disease. I have written to express my concern, and the ICS tells me it will respond on 4 November.

There are many causes of liver disease and cancer, but prevention and early detection can make a significant difference to outcomes. In Yorkshire and the Humber, our pressurised NHS is seeing a 13% increase on the national average for admission rates due to liver disease, and rates are 38% higher for alcohol-related liver disease. In York, alcohol is a major factor in A&E attendance. For women in York, admissions due to liver disease are 30% higher than the national average. As we focus on York being a drinking capital, we have to look at those correlations.

Over the covid period, many people turned to alcohol as a means of addressing other needs. When so many people are dying from alcohol-related disease, the Government must turn their attention to that matter—not least because we know the impact it has on the most deprived communities, as we have heard. In York, the mortality differential is 10 years between the most deprived communities and the wealthiest. One in four with alcohol-related liver disease will die in hospital within 60 days of detection.

I know from working on a ward specialising in hepatology how important this subject is, but also how tragic it is for families. That is why I urge the Government to focus attention on this public health matter in a way akin to Dame Carol Black’s work on drug-abuse harms. There were 4,859 drug deaths in 2021. I am not belittling that statistic at all, but the fact that there are 10,000 liver deaths—over double—really demands the Government’s attention and a strategy. However, there is none in place.

That is why the Minister has a unique opportunity—one that she must take hold of. Ministers can turn their attention to so many things, but getting on top of this issue, driving a strategy that makes that difference and ensuring that every community has a diagnostic centre, as York longs to, could make a serious difference to our communities and our nation. I trust that she will embark on an alcohol strategy and ensure that there are community diagnostic centres, that alcohol harm is properly addressed and focused on, and that we also understand and focus on non-alcohol related fatty liver disease. We have an opportunity to double down on tackling liver disease, and I trust that this Government will not let this moment pass.

[Mr Clive Betts (in the Chair)]

To co-operate with the timing, we head to the Front Benches, with five minutes for the Opposition, 10 minutes for the Minister and a couple of minutes at the end for the mover to wind up.

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.