Budget Resolutions

Rachael Maskell Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

As the hon. Lady knows, life expectancy is increasing, and we are forecast to see an increasing number of people live to a good old age. Indeed, the number of people aged 75 and over is set to double in the next 30 years. That is a brilliant achievement, which is in part down to the hard work of our NHS. Cancer survival rates are at a record high, strokes are down by a third and deaths from heart failure are down by a quarter. Of course, those successes have brought new challenges. The biggest health challenge we face is that people are living longer, often with multiple chronic conditions. The money is only one part of the plan to safeguard the NHS and ensure it is fit for the 21st century. The Budget delivers the funding, and later this year we will deliver the plan for how we will set the NHS fair for the future.

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

I have very little hope for the older people of our country given that the Government have cut £7 billion from the social care budget and replaced it with only £240 million. How is that safeguarding our old people for the future?

[Matt Hancock]

Of course, in Scotland social care is devolved, so—[Interruption.] And in York, the amount of money for social care is going up thanks to the decisions announced yesterday.

Social Care Funding

Rachael Maskell Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

I am grateful for my hon. Friend’s work in making the case for more support for adult social care in Solihull, and to support the NHS in Solihull through that. I hope the funding we have announced today will help in Solihull, and the people of Solihull should know they have an excellent champion who has helped them to get that funding.

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

To address delayed discharges, it is crucial that we have transitional care and extra care in place. Will the Secretary of State look at York’s proposal for building facilities on an adjacent site to make that happen?

[Matt Hancock]

That is an interesting proposal, and I have seen others similar to it. We are looking at the link with housing as part of the Green Paper, and I have been discussing that with the Department concerned. The point the hon. Lady raises is important. I note that £731,800 has been allocated today to improved adult social care in York, to take the pressure off the NHS in York this winter. I hope that she will acknowledge that fact.

Access to Orkambi

Rachael Maskell Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

I think that most people would accept that now is the time for a review of the criteria that are applied and the processes that are undertaken. Any organisation needs to be continually improving. We do not condemn NICE. In fact, we acknowledge that it has got many difficult decisions right, but it has also got some wrong. Time and again, the reason that it has got those decisions wrong—arguably—is that the criteria it is applying and the criteria it has been given by the Department of Health are out of date and flawed. I think we would all want to see a review of NICE’s remit and the way in which it carries out its work over a reasonable period of time. It would be helpful if the Minister would respond to that point when he concludes the debate.

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

My hon. Friend is making a very important speech. As I know from being a physio who worked with cystic fibrosis patients, when making an assessment of the cost of treating cystic fibrosis, we must look at the social cost, the economic cost and the immense cost of keeping somebody alive. Does he agree that Orkambi would be a solution to that, let alone addressing the human cost?

[Mr Lewis]

I entirely agree—my hon. Friend makes absolutely the right point. When there is an incomplete assessment in looking at value for money versus outcomes, that will lead to flawed decisions that are incredibly difficult to justify. We have a mismatch between the basis on which NICE is expected to make these decisions and appropriate processes. Instead of everybody hinting, “Yes, of course there’s a need to review NICE—of course that would be a good thing”, we would like to hear from the Minister a timescale as part of the response to the specific issue of Orkambi in terms of NICE’s roles and responsibilities.

Management of NHS Property

Rachael Maskell Excerpts

Wednesday 4th July 2018 Westminster Hall

[Karin Smyth]

I recognise that the management of NHS property is not the most enthralling subject, but many hon. Members from across the country will recognise that it is a growing problem in their constituencies. The problems are varied and many. My focus today will be on the community and primary care estate.

I will not talk about bricks and mortar or leaking pipes, or outline the detailed and manifold operational challenges posed by an NHS estate that in many parts of the country still relies on pre-1948 infrastructure. Instead, I want to talk about the places our constituents go to when they need care, where they welcome their children into the world and where they say a final goodbye to those they love. They are places where some of our most precious memories are forged, capable of delivering huge happiness and hosting unimaginable grief. They are hard-wired into our emotional DNA and the fabric of the communities in which they sit. They are places that are paid for by our constituents through their taxes, which our constituents feel ownership of and an enormous attachment to. It is in this difference that the notion of local or personal ownership is blown apart. The harsh reality is that our constituents do not own these properties. Moreover, they do not even have a say in how they are run or in their future.

Who owns them? Who runs them? How do they operate? How can users or stakeholders such as MPs influence change? Those questions are hard to answer as control of these special buildings is opaque to the point of absurdity. The lines of accountability are unfathomable and, as so many colleagues will know, incredibly frustrating to deal with. I have spoken to numerous colleagues across the House about these issues.

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

I am grateful to my hon. Friend for giving way, and grateful to the Minister for listening to my concerns about the Bootham Park Hospital site and intervening on that. A real programme of change for healthcare in York has now been put together. Does my hon. Friend agree that when looking at the estate it is important to develop plans that improve healthcare rather than seeing it just as buildings?

[Karin Smyth]

I agree. The building that my hon. Friend has been working on is iconic, and that case is a good illustration. My hon. Friend the Member for Bristol West (Thangam Debbonaire) has been dealing with a GP surgery in her constituency for a long time and can get no resolution. I have also spoken to my hon. Friends the Members for Stoke-on-Trent Central (Gareth Snell), for Stroud (Dr Drew), for Bishop Auckland (Helen Goodman) and for High Peak (Ruth George)—these problems are happening across the piece.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Speaker]

Order. I am sorry, but we have run out of time. However, the person whom I think has been standing the longest is Rachael Maskell.

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

Thank you, Mr Speaker. NHS Property Services intends to sell the Bootham Park Hospital site, but reinvesting in that site would make such a difference to the health needs of our city. Will the Minister ensure that that happens?

[Stephen Barclay]

I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.

NHS Outsourcing and Privatisation

Rachael Maskell Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

Will the hon. Gentleman give way?

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

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.

[Rachael Maskell]

I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?

[Jonathan Ashworth]

My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.

I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.

--- Later in debate ---

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

It is a pleasure to follow my hon. Friend the Member for Oxford East (Anneliese Dodds). I could not agree more with her astute analysis, which also—yet again—applied to what is happening in York.

I want to begin by thanking Pat Crowley, the chief executive of York Teaching Hospital NHS Trust, who has just announced his retirement. He has steered our hospital through unprecedented challenges. I have met the Minister to discuss so many of those challenges—the failed funding formula, the perverse financial incentives, the failed budget integration and the placing of the private profit motive at the heart of our NHS—but I am still waiting for his response to that meeting.

Let me turn to the issue of how money flows. We have talked about private finance in the NHS, but we should also bear in mind that money is not going into primary care and GP services. That is forcing people to use accident and emergency departments, which are the most expensive part of the NHS. Let us follow through the money that people are drawing down. People cannot get in through the front door of the NHS because people are not being cleared out of the back door as a result of the bed-blocking that has resulted from the Government’s cuts in local authority budgets. Those cuts have also caused public health services to be slashed so severely that a massive health crisis is being created. The shocking statistics relating to drug deaths in York are now the worst in the country. We desperately need more resources there. If we invest in people’s health, the health service will save money in the long term. Our teaching hospital is over £20 million in debt—it is the same with the clinical commissioning group—because of the failed funding formula set out under Lansley’s plans for the NHS and the ideology behind that.

I want to take on the argument that the private sector is helping the NHS. The private sector is offloading the low-risk, high-volume work from the NHS—that which under the tariff produces money and profit for the private sector. Formerly that money was invested in the most expensive parts of the NHS to stop the deficits in the NHS; the money went to the ITU, the A&E and the renal units which have a high demand for expensive drugs. The private sector sucking out resources from the NHS in this way is causing the financial failure of the NHS today. Therefore, it is incumbent upon the Minister to withdraw that failed model under the Health and Social Care Act 2012 and to ensure that instead we see real investment in the NHS, which will make a vast improvement to the health service as we move to its 70th anniversary.

NHS 70th Anniversary

Rachael Maskell Excerpts

Wednesday 16th May 2018 Westminster Hall

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

Thank you, Mr Hosie, for chairing this morning’s important debate, and I thank my hon. Friend the Member for Blaenau Gwent (Nick Smith) for introducing it in the way that he did.

The incredible tributes that we have heard this past week to Dame Tessa Jowell have reminded us what a formidable politician she was, and how she centred her work around the important agenda of public health, backed up by the epidemiological evidence. We have had so many fantastic evidence-based reports, not least the work done by Michael Marmot in identifying the importance of the social determinants of our health outcomes. We know that various agendas meet around public health—social, economic, health and education agendas, and many more. That is why it is really important that we put our focus on the whole person and the impact that life has on people.

We have seen severe cuts, not least to our Sure Start centres, hundreds of which have closed. From the evidence that they produce, we know about the real impact that they have, particularly on our young people. Health visitors are an initiative that the Government took up in 2010, following Labour’s urging that we must increase the number of health visitors. That number has now fallen, from the 4,200 additional health visitors that David Cameron put right at the heart of his Government, back to the numbers before that Government. There is a real crisis among that vital workforce, with ever-increasing workloads.

We have had workforce cuts, financial cuts and service cuts in public health. Public health is about long-term outcomes, and when we are dealing with austerity and cuts, we are looking at having to support tomorrow, not the future. Public health has been a very poor relative in the austerity programme, and I can witness that in my city. In Acomb in York, since 2011 I have seen childhood obesity more than double among my community. I have also seen health checks cut; those are vital at the age of 40 to ensure that we put people’s health back on track.

Long-term contraception has been cut, and smoking cessation services demolished—unless, of course, people pay for them. We have seen a 90% fall in the number of people able to access smoking cessation services, in an area where the number of people who smoke is higher than the national average. Those are the real consequences of cuts. In York, the clinical commissioning group denies surgery to people who have a high body mass index or who smoke, yet the support services to help people change their lifestyle and behaviours are not there any more—a complete nonsense. That is why it is really important to put the focus back on public health.

Over the past week, I was most shocked by a letter I received about substance misuse services in York. York is now 148th out of 148 authorities when it comes to drug-related deaths of people in treatment and across the community as a whole. Most people will be shocked to hear that about York, but when I look at what our local council have done in absolutely slashing funding to those vital services, I am not really surprised—and, of course, the most severe cuts are still to come. What will that mean to the people in my community whose life chances are being taken away from them?

Across mental health services, the sustained lack of investment over such a long period is having a real impact on health outcomes. People have been hurt by cuts and hurt by political decisions. It need not be that way. We all know it is the most vulnerable, the poorest, the people who really need the state’s help who fall down when the state stands back.

We have heard so much about young people in the debate, for whom interventions are even lower than for older people. For people in their latter years, public health virtually does not feature. Yet, in the health service that Bevan created, everyone from cradle to grave could access the necessary good public health services. Such interventions save the NHS so much money—it is a no-brainer—so why cut those services? That question comes not just from me, but from directors of public health I meet regularly in my constituency, and across the board. They want to understand what will happen when the public health grant is withdrawn. I hope the Minister can reassure them today that he will ensure that they will receive the funding needed to sustain services into the future. They also want to know how the Department of Health and Social Care will work with directors of public health to ensure that their long-term goals for improving the community’s public health will be funded.

We need to look seriously at the workforce in public health, which has been decimated. We have to look at funding to sustain that for the future health of our nation. We need to look at outcomes, not just inputs. Let me take the child measurement programme as an example. It is a nonsense that we know now how obese children are, but we cannot afford the interventions to change the trajectory of those children’s lives. That means that the programme does not work. We need to examine how we change the life chances of so many people across the country.

I want to touch on the 70th birthday of the NHS, which is so important for so many of us, and draw the Minister’s attention to what we are doing in York. When I heard what his Department was rolling out, I thought it quite lacklustre—it lacked ambition—so I pulled together the health leaders in York to drive forward a public health initiative to mark the 70th birthday. It includes the clinical commissioning group, the acute trust, the mental health trust and the local authority. We are working together to launch in July, as part of that fantastic celebration, a whole programme intended to transform the health of our whole community.

I have a meeting with businesses to talk about how employers can change the life chances of people who work for them. We are meeting faith and community groups to talk to them about people that they engage with. We are going to have a touring pop-up event across the city over the NHS birthday to provide advice, health checks and services, and simple programmes, because we do not have a lot of money. I know from Health questions that the Minister will meet with me, as the Secretary of State said, to talk about this initiative. We are going to have health walks at lunchtimes. We are going to have basic tests to understand health measures, as well as advice, information, encouragement and the promotion of better understanding, looking at diet, exercise, behaviour and the choices that people made. We are determined to touch the thousands of lives of people in York on this 70th birthday, because we want to celebrate the future with everyone.

We know that so many people are being failed, and the most vulnerable are being failed the most, but we can change things around. Public health does not actually cost a lot of money compared with acute services. So, I trust that from today, we will take the spirit of Nye Bevan and ensure that we invest in the very people who will depend on our NHS in the future.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.

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

Obesity- related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?

[Mr Hunt]

I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.

Privatisation of NHS Services

Rachael Maskell Excerpts

Monday 23rd April 2018 Westminster Hall

[Kevin Hollinrake]

I am very grateful for that historical clarification. One thing I used to say in my business to any people who came to me with new ideas was that ideas are 10 a penny. What matters is how we implement things. What matters is how we implemented things then and how we implement things today. That is what makes the critical difference in whether something will succeed or fail.

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

I am grateful to be able to make an intervention, but will the hon. Gentleman not recognise that the Lansley reforms, which brought in a new funding formula, have completely broken the NHS? I am talking not only about the fragmentation, but about the fact that the funding fights against itself, and therefore it is a complete distraction from providing a planned NHS service, which is the solution that is needed in the system.

[Kevin Hollinrake]

I am grateful for the hon. Lady’s intervention. I absolutely think that funding needs to be fair. There are certain instances we can look at as to whether the funding for certain CCGs in York and north Yorkshire is unfair. We need to ensure that the funding is got right wherever people are. It is incredible that we have a postcode lottery for healthcare in this country; things differ in different parts of the country, based on many of those issues. They are issues that we absolutely need to resolve.

--- Later in debate ---

[Kevin Hollinrake]

It is only corrosive if it is not in the patient’s interest. There are clear commissioning rules that it must be in the patient’s interest for this commissioning to take place. The key is what is right for the patient. I do not doubt that the hon. Gentleman may be right that some of the commissioning is wrong, but whether it is private or public should not be the overriding principle; it should be what is right for the patient.

[Rachael Maskell]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I will make some progress, having given way a number of times. Some years ago, when I first became an MP, I met the chief executive of York Teaching Hospital Trust, Patrick Crowley. He talked about the fact that private providers are providing care in York—in the hon. Lady’s constituency—just as they are in my constituency. He was very comfortable with the relationship between the public sector provision at York Hospital and the private sector provision at Ramsay Health Care, where I have experienced treatment. It was incredibly efficient, and the people I spoke to who worked for that organisation spoke very highly of it. There should not be this ideological rejection of the private sector.

I want to make some key points. According to The Health Foundation’s report, more than 50% of people said that the NHS often wastes money. That is not a criticism but a reality in an organisation with 1.7 million people working for it. The way to try to reduce waste—again, this is our responsibility to the taxpayer—is to ensure that we eliminate it wherever we can. The public sector does a brilliant job in the NHS. I am not calling that into question. However, in my view, good businesses—I have been in business all my life—can have a positive impact on healthcare provision. Good businesses focus on the customer first, and therefore the patient first. They make the most of their most precious resource, which clearly is their people. They are good at innovating and reducing waste, and they should deliver at the best possible value. After all those things have been taken into account, a good business should then consider whether it can still make money, and if it cannot it should not enter that field. The principle should be what is right for the customer, or the patient.

I met one of the nation’s most successful and prominent business people, who told me—to illustrate how we can drive out waste and bureaucracy from a service—that he was approached in 2007 or 2008 by Tony Blair and Gordon Brown and asked to look at reshaping the health service to make it more efficient. He came back to them and said that he would be prepared to take this project on. He said that the first thing he wanted to do was to give all nurses a 30% pay rise—this is a private sector business man; I am not saying that Brown and Blair were going to privatise the NHS—but that he wanted no more money from central Government. He would put matrons back on the wards. He would put in a clinician-first approach, with admin and management second, and strip away the bureaucracy, which must be music to the ears of every nurse and doctor working in the health service. He planned to reduce admin and management by 20,000 people. He was also going to look at the purchasing system in the NHS.

Clearly, the private sector can look at these issues and drive out waste in whatever capacity as long as it is in the interests of patients. Waste in purchasing is a key element. John Abercrombie, the consultant who looked at purchasing in the NHS, established that one trust was paying £126 for a wound protector and another was paying 36p. There clearly are private sector providers that could come into this sector and help to reduce waste, delivering a better deal for the taxpayer.

My final point is about the long-term funding settlement. I echo the comments of my hon. Friend the Member for Gloucester. We need a long-term funding settlement not just for the NHS, but for social care, because they are inextricably linked, although we need different funding settlements for the two different elements. Unless we have that long-term funding settlement, whatever we discuss today, because of demand—and more money is going in—we will just be shuffling deckchairs on the Titanic. It should be cross-party and take into account rural needs. I have constituents who have seen services centralised to the point where they have to travel long distances to access healthcare. An elderly couple in Scarborough have to go to York for treatment because heart treatment has been centralised into York from Scarborough. They do not drive, so they have to take a bus to York and stay in a hotel overnight to get to the consultation appointment on time. The quantum needs to be greater and we need to ensure that we keep delivering our services right across the country, including in those rural areas. I agree with my hon. Friend that we should look at a hypothecated tax—either direct or indirect taxation—to increase the quantum of money to a significant degree.

The Select Committee on Housing, Communities and Local Government looked at the German system of social insurance for social care, in which people make a small payment from their monthly salary on a pay-as-you-go system. When they need care, instead of suffering the catastrophic cost in later life, on the basis of an independent assessment, that support can be provided through third-party care, or they can draw down the money and pay it to relatives to look after them in their own home, which can have a positive social consequence.

We need to look at these things in detail and on a cross-party basis. I believe in a taxpayer-funded system on the basis of the best outcomes for patients and the best deal for the taxpayer, and that we should move towards a long-term funding solution, so that ultimately we can let the clinicians get on with the job.

[Stewart Hosie in the Chair]

--- Later in debate ---

[Rachael Maskell]

York Teaching Hospital is going down the same lines in creating a wholly owned subsidiary company, yet the staff want to belong to the NHS—that is their ethos and that is what drives them. It is also important for full integration across the whole service, because people who work as porters and cleaners are as much about patient care as anybody else in the NHS. Does my hon. Friend agree?

[Alex Sobel]

Absolutely. When I go into our local hospitals as an MP or as a patient, I see that they are the beating heart of the NHS.

I ask trusts, such as Leeds, that are considering setting up a subsidiary company to put a halt to those plans and to work with their staff, representative trade unions and local MPs prior to making the decision. I ask them to do what is best for all involved, whether patients, staff or the community.

Cost pressures create perverse incentives for people to consider privatisation. We have rehearsed that argument quite well. They affect not just NHS hospital trusts but clinical commissioning groups for primary care services, NHS England and other NHS bodies. We need to take those perverse incentives out of the system so that privatisation does not happen by the back door—instead of being done by the Government through statute—which is what is happening.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Hosie. I apologise for not being here at the start of the debate but I was serving on a statutory instrument Committee. I am grateful that you are allowing me to speak in today’s important debate about our NHS.

I felt motivated to speak when I entered Westminster Hall and listened to the debate, particularly on the assertion that privatisation is not such a bad thing. I want to draw out the issue of NHS funding. The funding system is broken. I am grateful to the Minister for meeting me recently to discuss the real challenges in York’s funding system. I look forward to hearing that progress has been made as a result of that, but there are real challenges within the funding system and I want to challenge some of the assertions made about that.

We must understand that the NHS was designed to work as a whole. The types of services that move to the private sector are low risk and high volume, such as hips, knees and cataracts. If we add those together, someone can cream a profit—I would prefer a reinvestment—off the top of providing those services. The NHS used to take the additional money and reinvest it in the more expensive parts of the NHS, such as intensive therapy units, the renal service, for which the drugs are very expensive, and A&E. The fine balances of NHS finances worked. However, when we remove those opportunities, because the hips and knees are being delivered by another organisation that makes a profit out of the NHS, although the risk is left with the NHS, NHS finances collapse because the cross-funding is not going into those services, which is exactly what we are seeing at the moment. I first had that debate with Andrew Lansley when he put his proposals forward, and it has come to pass that NHS finances are not working because that balance has been taken out of the finances. The opportunity for the NHS to generate the resources that are vital for the critical care parts of the NHS is removed.

[Kevin Hollinrake]

The hon. Lady makes a good point, but the reason the NHS is under pressure is hugely increased demand. There is more money going into the NHS, and we would all concede that we need to put more money in, but demand is the essence of the problem. It is not because we have private sector companies operating within it.

--- Later in debate ---

[Rachael Maskell]

The hon. Gentleman is right that demand on the NHS is huge, which takes me to a further point that I will raise shortly. We recognise that we need more resource in the NHS, but the fragmentation and the fact that so much money is taken out for contract management as opposed to reinvestment into health services creates challenges. We now have lawyers and managers managing those contracts in the NHS instead of the money filtering through to healthcare, as it would in a planned health system. Of course, when we have fragmentation, we have to work with multiple systems across multiple agencies, and trying to get the organisations to talk to each other also puts pressure on the system.

We have a growing ageing demographic and increased pressures on the health service, but, because we now see a disconnect between some of the NHS’s other services, such as prevention and public health, we do not have the levers in the system to drive better health in the community, and more risk therefore ends up back at the door of the acute services. As the situation escalates, the acute system is more and more challenged, not least because of the different funding mechanisms and interests of the CCGs and the acute trusts. If we look at a tariff system versus the CCGs’ interests, we see that they clash with each other, which then means we have a waste of resource.

I can give examples of how the funding is broken and not working within York. I have had discussions with the CCG and the acute trust. The CCG has to fund tests and other services that are not picked up elsewhere in the tariff system. Where do those services go? They go out to the private sector, so there is a cycle of decline and trying to manage a system where the fundamentals of how NHS funding works are not addressed. I suggest to the Minister that if we brought together a planned health service with proper funding, the rest of the system would fit in place, but we have to take out the private motive within the NHS, which is clearly why many organisations are involved.

We have only to look at some of the services that are provided. I think of the Serco contract in Cornwall, where only one GP was in service for the whole of the county. I think of Serco again in Suffolk and how it provided community services. When it was not generating a profit, it said, “We’re off. We’re not interested in this service any more”, leaving some of our most vulnerable people in the community high and dry, with the NHS of course picking up the cost every single time and picking up the pieces. That is no way to run a critical health service in our country. That is why we need to move to a fully planned health service in public hands.

I want to draw on one other example of a private company: Virgin Healthcare. It was first of all an incubator within the forerunners to CCGs, seeing what was coming along the tracks and the opportunities there. I can cite many services provided by Virgin Healthcare and how it has looked to profiteer and cut services. I was head of health at Unite overseeing sexual health workers. Virgin cut sexual health services and as a result there was a rise in the prevalence of sexual disease. The services also became fragmented. The community was not provided with a service, and there was a complete failure to achieve the objective of the service.

Elsewhere, we see Virgin suing the NHS because it is not winning contracts. The business of Virgin is about generating as much money out of the state as it possibly can. Private companies use the NHS for their own interests to fill the pockets of shareholders as opposed to supporting patients. We must take the profit motive and private companies out of the NHS because that model is completely broken.

I will move on to two other issues. The first is staff in the NHS. I worked in the NHS for 20 years, so I know what it feels like. People do not want to work for private companies. They want to have one set of terms and conditions, and to engage with one set of training. They want one set of rules, and most of all they want the pride of working for the NHS.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Rachael Maskell]

No, I will make some progress. People want to work in the interests of patients. It is important that we maintain that, because it is healthcare workers who give all the hours of unpaid overtime that nobody ever talks about. Why would they want to do that for a private company? They do it because of the sense of public service that comes from our country’s greatest pride: the NHS. We therefore need to listen to what our NHS staff say. That is why I take issue with the hon. Member for Cleethorpes (Martin Vickers), who spoke about union leaders shouting off. They represent more than 1 million people working in our NHS. They are the voice of people working in the NHS.

[Kevin Hollinrake]

rose—

[Rachael Maskell]

As a union leader who spent 20 years working in the NHS, I certainly spoke up for all my members, who were deeply concerned about the destruction of the NHS because of the privatisation and fragmentation that was happening across it.

The second issue is what is happening to NHS buildings. We know that buildings were moved into NHS Property Services, which is a wholly owned company with one shareholder: the Secretary of State. He is looking through the Naylor report, which is not included in legislation at the moment, to reduce the estate. There may be some good cases for that, but profit should not be at the head of the argument. We should look at how the estate can be reinvested for the benefit of the community.

Parkland at Bootham Park Hospital in my constituency would make a fantastic public park and would address some of the mental health challenges in our city, which was the purpose of the hospital. I ask the Minister to take a further look at that opportunity. Under Treasury rules, the building and the parkland have to be sold to one private provider. Clearly, that would not work for my city. With regard to the rest of the estate at Bootham Park Hospital, it would be great to see the old mental health hospital converted into key-worker housing to support the rest of the NHS. York is in real crisis with regard to recruiting staff, because they cannot afford to live in the city. If we had key-worker homes on that estate, it would create a sea change. That is about putting public interest at the front, not private profit.

Finally, I want to talk about the future, because I am aware that time is moving on. I truly believe that the only way forward for our NHS is to have one planned public service, with full integration of mental health, physical health, public health and social care, provided in the interests of the community. We need play-space to look after the community, and no more fragmentation. It is ridiculous that we have so many regulators and so many different providers. The whole system is fragmented and fighting against itself. If we had one planned system, it would not only simplify the system, but ensure that the money is invested back into the heart and needs of patients.

[Andrew Selous]

rose—

[Rachael Maskell]

That is exactly how we should move forward, whether with consensus across all parties, which of course I would like to see, or just by putting forward what is logical.

[Gillian Keegan]

rose—

[Rachael Maskell]

NHS staff are calling for it, managers are calling for it, and I trust that the Minister has heard the call in today’s debate.

Patient Safety

Rachael Maskell Excerpts

Wednesday 28th March 2018 Commons Chamber

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

This issue is not just the preserve of doctors; it, of course, cuts across all health professionals. One of the biggest triggers is the pressure that NHS staff are put under, particularly in respect of their not being able to fulfil their duty of care. Does the hon. Lady recognise that when we have a staff crisis it creates the biggest risk to patients?

[Dr Johnson]

I thank the hon. Lady for her intervention, and I agree that this issue of accountability and blame applies equally to all professionals across the health service. Everyone makes mistakes; I was reading online the incident report for the serious investigation done into this young boy’s death and I noticed that, although no doubt all care and attention had been paid to ensuring that personal information was redacted, the child’s initials appeared in at least one place where someone had forgotten to do that. That is a sign that none of us is ever infallible.

Sanctioning doctors for honest mistakes also runs the risk of discouraging people from joining the profession. At a time when the Government are looking to increase the number of people entering medical careers, through the creation of more places at universities and the establishment of new medical schools, the perception that an honest mistake made later in someone’s medical career could end up with their being struck off the register, or even behind bars, risks alienating just the type of young, forward-thinking, ambitious students whom the NHS needs to pursue a career in medicine. It is a testament to the youth of today that medicine still continues to attract the brightest and the best. However, by the same token, these straight-A students have other, more lucrative career paths open to them, and those will become all the more attractive when the risks inherent in a medical career become too high.

This culture of fear not only risks discouraging people from joining the profession, but drives away highly skilled doctors already working in the NHS. As an NHS doctor, one is already expected to work in very challenging conditions, working long hours in an incredibly high-pressure environment. Again, if a perception develops among doctors that they may be treated as a criminal even if when working to the best of their ability, it will quite simply drive doctors away. The world-renowned medical schools we have here in the UK mean that British doctors are in high demand, and they may take their skills to the private sector or further afield to less litigious health services.

The Government recognise these problems and have commissioned an urgent review to look at the threshold for what constitutes gross negligence. This will report by the end of April. I understand that the GMC has also commissioned its own review, although it is not expected to report until the end of the year. Will the Minister tell the House how the Government will act in the meantime to reassure doctors, especially those in high-risk specialties such as paediatrics and obstetrics, that they will not be unduly punished for mistakes?

Overall, it is important that the Government act swiftly on the findings of this report, and consider carefully the impact of the threshold on both the recruitment and retention of medical staff, and safety and improvements to patient care. Doctors want to make people better—it drives all they do. We must stand with them and for them, for all our futures will depend on it.

--- Later in debate ---

[Caroline Dinenage]

The hon. Gentleman is absolutely right. The more we can innovate and put in place the technology that helps to streamline day-to-day processes, the more that will help NHS staff, who do such a marvellous job, to do their job even more effectively and efficiently.

As my hon. Friend the Member for Sleaford and North Hykeham rightly said, to err is human. I am told that every year, 30,000 motorists put diesel fuel into their petrol cars—that is around 15 every hour. Those people are not intentionally destructive or feckless, they are human. Of course, I am not making an analogy with medical mistakes, which can be significantly more damaging and life-changing than the need to get a new engine, but in the same sort of way we need to move away from a blame culture in health—away from investigations that single out one individual rather than seeing their actions in the context of a complex overarching system.

[Rachael Maskell]

Robert Francis’s report included 290 recommendations to address these issues, not the least the duty of candour. However, people are still fearful to report—why is that?

[Caroline Dinenage]

I think it is for a variety of reasons. The hon. Lady is absolutely right to raise that issue; if she bears with me, I shall come to it a little later.

A first step in our new direction, based on an aviation model, is the Healthcare Safety Investigation Branch, which became fully operational in April last year and will independently investigate some of the most serious patient safety incidents every year. It is the first investigatory body of its kind in the world and demonstrates our commitment to learning and innovation. As part of the Government’s drive to make the NHS the safest place in the world to give birth, HSIB will standardise investigations of cases of unexplained severe brain injury, intrapartum stillbirths, early neonatal deaths and maternal deaths in England.

As an MP who represents a constituency in the area served by Southern Health, I am particularly aware that tragedy can spiral when an organisation loses sight of systematic problems in its provision of care. Our Learning from Deaths programme is a direct response to such events. Trusts are now expected to have proper arrangements for learning from the deaths of patients and are subject to new reporting arrangements, including evidence of learning and improvements. I should add that we are one of the first countries in the world to measure deaths in this way. Through Learning from Deaths, NHS England is supporting improved engagement across the NHS with bereaved families and carers.

As my hon. Friend the Member for Sleaford and North Hykeham rightly says, healthcare professionals need to feel safe to speak out about problems in the workplace. To support that, we have introduced an independent national officer for whistleblowing, and new regulations to prevent discrimination against whistleblowers who move jobs. Recent commentary in the media and among professionals has highlighted a possible brake on openness and transparency arising from high profile convictions of healthcare professionals for gross negligence manslaughter, which is exactly the same example as the one that she cited. That is why the Secretary of State for Health and Social Care announced in February that he was asking Professor Sir Norman Williams, former President of the Royal College of Surgeons, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

Absorbing the review’s recommendations into our healthcare system will be crucial to ensure that our healthcare professionals feel valued and secure, and that includes the GMC. The deadline for submitting evidence is April, and I encourage patients, families and professionals to contribute.

It is essential that infants have the best possible start in life, and the safety of mothers and their babies is a fundamental starting point for safer care. In November 2017, the Secretary of State announced his intention to bring forward the ambition to halve the rate of maternal deaths, neonatal deaths, birth-related brain injuries and stillbirths by 2025—a full five years ahead of our previous target. Pre-term birth is a major health inequality with mothers, and the Secretary of State has set an ambitious target to reduce the national rate of pre-term births from 8% to 6%.

Continuity of care is a key factor in a healthy pregnancy. Evidence shows that women who continue to receive care from the same midwives are 19% less likely to miscarry, and 16% less likely to lose their baby. That is why, yesterday, the Secretary of State announced important steps towards ensuring that the majority of women receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021. That announcement includes 650 new training places for midwives in 2019, which represents a 25% increase in the number of midwives in the UK.

We can never be complacent. Zero harm might sound impossible to achieve, but it should always be our aim. By learning lessons when things go wrong, listening to patients and their families, and working across the whole system to create a genuine culture of improvement, this Government are making a significant and lasting contribution to patient safety.

Question put and agreed to.