Covid-19 Update

Rachael Maskell Excerpts

Monday 29th November 2021 Commons Chamber

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

Without in-country manufacturing of the vaccine in the global south, we will never get the protection that we need against this pandemic, and no matter how many donations the Government make, supplies will never meet the demand. Will the Secretary of State therefore look again at the issue of in-country manufacturing, whether that involves release of the patent or other mechanisms, so that we can see a proper scaling up of the delivery of the vaccine in the global south?

[Sajid Javid]

The hon. Lady is right to talk about the importance of in-country manufacturing in the developing world. She will know that India, for example, is one of the largest manufacturers of vaccines, including the covid-19 vaccine, but she rightly points out that this capacity needs to grow and become available in other countries, and it is right to look to see how we can support that.

Covid-19 Update

Rachael Maskell Excerpts

Friday 26th November 2021 Commons Chamber

[Sajid Javid]

As always, the analysis provided by my right hon. Friend is absolutely correct. On the severity of the new variant, I am afraid we do not know enough yet. From what we can tell from what we might call a desktop analysis, the number of mutations that have been identified—double those for the Delta variant—does indicate that there is a possibility that it might have a different impact on an individual, should they get infected. But as I said earlier, there is a lot we do not know about it and we are working with our international partners to find out more.

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

I thank the Secretary of State for his statement and for emphasising the importance of vaccination. However, his statement makes it clear that we are seeing new variants and the risks still remain. Therefore, taking further public health measures is really important. I ask him again to give clear leadership on ensuring that face coverings, social distancing and high levels of hygiene are instituted, as well as better ventilation. Those measures make a difference, as we have seen throughout the past two years.

[Sajid Javid]

The hon. Lady makes a good point about the need to follow guidance and the rules currently in place. The plan A policies that we put in place remain the policies we need at this time, but she will not be surprised to know that we keep them under review and, if we need to go further, we will.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend has raised this issue with me before, but he is right to raise it again, because proper use of data is important to the future of the NHS. He may have noted our announcement yesterday that we are merging NHS Digital and NHSX with NHS England, which will enable us to do a much better job with data. I will of course look carefully at that report, and I should be happy to meet him to discuss it further.

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

Poppy is just eight. She has severe epilepsy, with ever more frequent and enduring episodes. Her specialist consultant has said that surgery is her only hope, but Sheffield and Leeds have refused to assess her for capacity and administration reasons, not clinical reasons. Will the Minister work with me to ensure that Poppy receives the treatment that she needs?

[Sajid Javid]

I am sorry to hear about the hon. Lady’s constituent, and of course a Minister will meet her.

Health and Care Bill

Rachael Maskell Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

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

Fifteen years is a long time in workforce planning. The make-up of the workforce could change significantly over that time, not least as we are trying to address some real workforce crises now. Will the Minister put in place a road map to fill those vacancies over that time, and interim reports so that we can review progress?

[Edward Argar]

I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.

Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.

The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.

I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.

--- Later in debate ---

[Justin Madders]

New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.

[Rachael Maskell]

Anyone who on Sunday was on the March with Midwives will understand the real crisis now facing that profession—a particularly acute once since it is also about women’s health. Is there not a need to ensure that plans are not just on paper, but expedited, so that we are sure of seeing real delivery of those much-needed staff?

[Justin Madders]

Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.

--- Later in debate ---

[Justin Madders]

I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.

With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.

Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.

There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.

If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.

[Rachael Maskell]

Does my hon. Friend agree with me that many of the recruitment challenges often sit in outsourced services in the private sector, and as a result it is really difficult to find the complement of staff required because people want to work in the NHS? That needs to be taken into consideration in any workplace plan.

[Justin Madders]

I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment.

The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity. There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part.

On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that. For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.

Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said:

“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.

The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.

It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”

That conclusion shows what we are trying to achieve today. That is the nub of it: if not now, when? When will the Government finally accept the obvious that has been staring them in the face for years?

New clause 29 would require the Secretary of State to lay before Parliament a fully funded health and care workforce strategy to ensure that the numbers, skill and mix of healthcare staff are sufficient for the safe and effective delivery of services. It builds on other amendments, and seeks further assurances by putting patient safety and safe staffing levels at the heart of workforce planning, by setting out how the Government will be required to act to assess and rectify shortages. It seeks to ensure that the workforce will be on a sustainable footing in future. Patient safety should be our primary concern. We have the evidence base: when there are not enough registered nurses, mortality rates change and health outcomes are worse. I accept that the level of detail in the new clause is significant, but we consider that necessary to underscore the importance of setting out how this will be delivered.

--- Later in debate ---

[Jeremy Hunt]

My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.

[Rachael Maskell]

One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.

Covid-19 Update

Rachael Maskell Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

Yes, I absolutely agree with my hon. Friend: the facts and figures now speak for themselves. He referred to the latest data from the UK Health Security Agency today that shows there is more than 90% protection when someone has had their booster dose; as he says, that is protection not just for that individual but for their loved ones.

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

The NHS is under severe pressure. Too many people, including those who are vaccinated, are sick and too many people are still dying. Why will the Secretary of State not meet directors of public health, who are tearing their hair out because although the Government have rightly put so much investment into the vaccine programme, they are not investing in other public health measures that would stop covid becoming a disease of inequality?

[Sajid Javid]

The hon. Lady will know that, as I said in my statement, the vaccines are absolutely central to protecting us against this virus, but it would be wrong for anyone to suggest that they are the only thing the Government are focusing on. There is of course a lot more; for example, I draw the hon. Lady’s attention to our recent announcements on antivirals.

Covid-19 Update

Rachael Maskell Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

I thank my right hon. Friend for his support. On the assessments that we have done, I have shared some information with the House, and there will be an impact statement followed by an impact assessment that will give him more information. It may be helpful for him to know that studies already in the public domain show that against the delta variant, the AstraZeneca vaccine is 65% effective and the Pfizer vaccine is 85% effective in preventing infection. The fewer people who are infected in these settings, the less spread there will be.

I think I have set out the Government’s thinking on flu, but it remains under review. There are many reasons why we have focused on the 1 April date, but the main one is to give those in the NHS who have not yet had a single jab—there are 100,000 of them—to make the positive decision to get vaccinated.

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

In York, vaccination rates are high at 87%, but transmission rates of covid are also extremely high, and transmission is happening in the community. As a result, directors of public health such as my own are absolutely despairing that the Secretary of State and others in the Department are not listening to public health experts who are asking for the tools to be restored to manage the virus. That is about moving contact tracing immediately into local authorities, where they got on top of the virus and locked it down. It is also about ensuring that greater public health measures are taken—hands, face, space needs restoring in all settings.

[Sajid Javid]

The hon. Lady is right to point to the high vaccination rates in York, and everyone involved is to be commended. When it comes to other measures that may or may not be taken, I think the plan A approach that the Government set out is the right one. There may be reasons to take a slightly different approach in certain regional areas, and that is also possible with the right evidence. This is something that we always keep under review.

Covid-19 Vaccinations

Rachael Maskell Excerpts

Thursday 4th November 2021 Commons Chamber

[Maggie Throup]

I can reassure my hon. Friend that there is no problem at all with the supply of vaccines; we have plenty of supply. He talks about schools. The vaccine programme in schools is being carried out by the school-aged immunisation service, which is very experienced in carrying out vaccinations for different conditions in schools. If there is a problem in his area, I will definitely look into it on his behalf.

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

I cannot accept that the deaths of 217 people yesterday and 293 the day before shows good management of this pandemic. The fact that so many people are now dying of this virus is a call on Government to take urgent action. With the Minister’s own confession that 5 million people are yet to be vaccinated and the fact that my constituents are not able to get access to the flu vaccine either, it is clear that we are heading for a real health crisis. Will she urgently take back the message that we need greater public health measures to be introduced in order to keep our communities safe?

[Maggie Throup]

No death is acceptable and my condolences go to everyone who has lost somebody in this terrible pandemic. Our best wall of defence is through vaccinations. Vaccinations do work, so my message is: get your booster. If people have not had their first jab, they should get their first jab and continue to build that wall of defence.

Endometriosis and Polycystic Ovary Syndrome

Rachael Maskell Excerpts

Monday 1st November 2021 Westminster Hall

[Taiwo Owatemi]

I thank the hon. Gentleman for making an important point, but I think what that highlights is the need to ensure that endometriosis and PCOS are included on the medical curriculum for GPs and healthcare professionals. That is why funding is so important: to make that difference.

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

I rise to support the petition as well. My constituents have also written heartfelt letters about their experiences; it took one constituent 11 years to receive a diagnosis. Is not the crux of the issue that we need a diagnostic framework to get on top of the conditions quickly so that they do not reach the severity that many women experience?

[Taiwo Owatemi]

I thank my hon. Friend for making that important point. I agree, and I will come on to that issue in my speech.

To add insult to injury, funding for symptoms such as excess facial hair and chronic acne has decreased over the years. Endometriosis can cause chronic bowel and bladder-related symptoms and depression, yet I have heard from countless women that, after finally being diagnosed with endometriosis or PCOS, they are told by their GP to come back when they want to get pregnant and are then sent on their way, without targeted treatments.

It is extraordinary to think that there are the same number of women in the UK who have endometriosis as there are people diagnosed with type 2 diabetes. Nobody would suggest that a person suffering from diabetes come back when they decide to get married, so that they can manage swelling in their fingers before buying a wedding ring—that would be absurd. One in 10 people in the UK suffers from asthma, yet it would be completely unthinkable to tell someone with asthma to come back when they decide they want to run a marathon. Endometriosis and PCOS are about so much more than having difficulty conceiving.

Smoking Cessation: Prescription of E-cigarettes

Rachael Maskell Excerpts

Monday 1st November 2021 Commons Chamber

[Maggie Throup]

I thank my hon. Friend for his question. I am looking forward to our debate in a couple of weeks’ time. As I mentioned earlier, the NHS already has measures in place through the long-term plan to help those who are pregnant to stop smoking. That is important. Should e-cigarettes be licensed as a medicinal product, it will be a gateway for those smokers to stop smoking through that method and hopefully stop smoking completely.

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

What investment will the Government put into research into the long-term use of e-cigarettes, so that we can understand the impact that will have? Will the Minister also commit to invest in health checks, so that we can screen people for public health issues, such as smoking and other forms of harm, and get the right interventions at the right time and address these issues?

[Maggie Throup]

This Government are determined to level up, and as part of that we are levelling up for health, as well as some of the issues that the hon. Lady mentioned. Our Office for Health Improvement and Disparities will play a big role in moving forward with this issue.

Dame Carol Black’s Independent Review of Drugs Report

Rachael Maskell Excerpts

Wednesday 27th October 2021 Westminster Hall

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

It is a pleasure to serve with you in the Chair, Ms Fovargue. I congratulate my hon. Friend the Member for Liverpool, Walton (Dan Carden) on securing today’s debate, and I thank Dame Carol Black for putting forward such strong recommendations: 32 in all that must be adopted in full.

Some 3 million people have used drugs in the last year—an indicator of why the issue is so urgent. As we have heard, in the last year 4,561 people have lost their lives, including a young boy in my constituency. That brings it home how important it is to tackle the issue and move it into a public health framework. We know that it preys on people whose lives have been afflicted with trauma and many complex needs, but it can also be indiscriminate. That path is not inevitable. Things can change, and the report describes a pathway for bringing about change.

I was struck by the call for a change in governance and ensuring that there is a central drugs unit. That should be a priority for No. 10 and a sub-committee of the Cabinet in order to bring together Government Departments to bring the laser-like focus that is needed. When money, time and people are focused, it can shift agendas. We need leadership. We need to build an evidence base and to invest in research on the best treatments and early intervention. If we take a half-hearted approach, we will not shift the dial. That is why the Minister should step up and make it possible to bring about change.

We need to see diversion as well so that people are not sucked into the criminal justice system, but brought out of it through diversion and ensuring that, for instance, young people are not arrested but pushed down the line of education, giving them a pathway out into apprenticeships and work, and giving them the chances in life that they have never had. We need to invest in and mentor young people so that their future goes a different way. Many of the people dealing drugs are being exploited by criminal gangs, and they too deserve a future that is very different from the paths that they are on.

We need investment in treatment, as has been articulated, not only for mental health but for physical health as well. We need to build stability, too, with a housing first approach so that people have a house. When people leave the criminal justice system, they need a house, a treatment plan, a bank account, and also a job to move into if that is appropriate. We should look at the person and not just the issue.

We need to go further, so I urge the Minister to look at how we can create drug consumption rooms where people can engage with services, while recognising that it will take people six or seven attempts on average to move out of a life on drugs. Also, I want the Minister to look into heroin-assisted treatment so that we can take a different approach to break the cycle of substance misuse. There is a real opportunity ahead of us, and I trust the Minister will step up and deliver.