Orkambi and Cystic Fibrosis

Rachael Maskell Excerpts

Monday 19th March 2018 Westminster Hall

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

I want to start by thanking the 75 constituents of mine who signed the petition, not least the inspiring parents and patients who have really brought this debate to the fore. I want to mention Dr Aaron Brown, who is based in York and is living proof of what it is to live with cystic fibrosis. He was the first person with cystic fibrosis to graduate to the Royal College of Surgeons and is a GP in York. However, for him, living with cystic fibrosis asks many questions, not least as he has a young son and a child on the way. He says,

“Having CF has given me something to battle against all of my life, to prove that it won’t get me and I can achieve.”

We know that this debate is not just about the impact of cystic fibrosis but the hope that a drug such as Orkambi can bring. Although the drug may not be a panacea to all things, it certainly does slow down the disease process, including scarring of the lungs and deterioration of the lung tissue. It is also paving the way for a new generation of precision medicines. It is so important that we are at the leading edge of that research to give people real hope for the future, not just the 50% of people who will benefit from precision medicines should Orkambi be approved, as it must be, but for the next generation.

In the next five years there is potential for 13 new drugs and in seven years, 18 new drugs, impacting on 90% of the cystic fibrosis population. What an amazing opportunity that presents us. That is why we are resolute to make sure that the Minister moves on the issue.

We have heard a lot about cost, but I want to put a cost in everybody’s mind. We are talking about £285 a day. Let us think about the cumulative impact and cost of hospitalisation, perhaps of transplants, drugs and economic loss. We are talking about just £285 a day, a figure that Ministers of State will be familiar with because it matches how much they earn. We can recognise that this is a cost that the NHS can and must afford. Even if there are final negotiations to be had about a portfolio of medication, which is important, to ensure that we usher in this new generation of drugs, what is the cost of a life? I leave that question in the air. I am sure we would all argue that it is a lot more than £285 a day. If we are determined to save lives, that is affordable.

I worked as a physio in respiratory medicine for 20 years, so I have first-hand experience of making this journey with so many patients. The physio may not be pummelling, but it is certainly intense. I celebrate the way that physio has developed over that time. It has become much more dynamic, rather than passive, and a number of techniques have been developed. We heard about active exercise—that is so important for building lung capacity—positive pressure techniques and postural drainage to ensure that we minimise stress on the lungs as we clear secretions. Just think what a life-changing opportunity those advances in physiotherapy, as well as a good diet and precision medicine, present for people with cystic fibrosis compared with their opportunities just a few years ago.

We have a real opportunity to change people’s life chances, but systems have got in the way, and that is what we plead with the Minister to change. The European Medicines Agency approved these drugs two years ago. It is therefore incumbent on us to stress to the Minister that we need effective movement, quickly. NICE itself recognises the benefits of the drugs: in July 2016, it called them important and effective treatment. So much time has been lost through so-called negotiations.

The Minister cannot hide behind NHS England or other bodies. It is time for leadership. It is time for him to step up, step into the debate and ensure that access to the drugs is delivered. I plead with him to call Vertex, to ensure that discussions are held with NICE and NHS England before Easter and to get the table set for finalising the negotiations. If a portfolio of drugs can be achieved in Northern Ireland and the Netherlands, it can be achieved here. Even if there has to be an interim agreement to ensure that people with cystic fibrosis have immediate hope, it is his responsibility to deliver that. With each day that passes, people’s future lung capacity, and therefore their lives, are seriously impacted.

Of course, some people already have access to these precision drugs, and the outcomes for people who benefit from access to Orkambi are really positive. It really is unethical and both economically and clinically illiterate to make Orkambi available to people who are seriously deteriorating but not to people who could stop their lungs being damaged in the first place if they had access to it in advance.

I am grateful to the many constituents who contacted me, but I want to relay the words of Abigail, who wrote very passionately. She has children aged four and seven, both of whom have been diagnosed with cystic fibrosis, and she expressed the real hope that these drugs would bring:

“Those drugs…are here now, which makes it even more heartbreaking that Orkambi, which could benefit 50% of people with CF, is not available on the NHS. To know that there is a drug out there that could change my children’s lives and allow them to live longer and in better health, but which they have been denied access to is absolutely devastating…simply because of cost reasons…It is absolutely imperative that some kind of agreement is reached that makes these drugs available to everyone with CF who could benefit from them. Living with CF is already difficult enough, please don’t make it any harder.”

Mental Health Services: Children and Young People

Rachael Maskell Excerpts

Thursday 8th March 2018 Commons Chamber

[Steve Brine]

That is a good point—and one that sits at the centre of my portfolio. GPs are generalists. As the Minister for cancer, I know that there is always criticism of their specialism in that, but, by their very nature, GPs cannot be specialists in everything. That is why the mental health support teams, which are at the heart of the proposal in the Green Paper, are a key part of our strategy, and we expect them to work closely with GPs and the Royal College of General Practitioners to upskill GPs, working within the multi-disciplinary teams, to help young people when they need that help.

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

Tomorrow, I am meeting the chief executive of my local mental health trust because we are so desperately worried about the mental health provision for young people in York. We are not only short of staff but short of resources. It takes time to train mental health staff, so what are the Government going to do in the interim to ensure that we have staff in the service?

[Steve Brine]

I hope that when the hon. Lady meets that person in her constituency tomorrow she will recognise the good work that is going on and the number of people who are going over and above to deliver the services to children and people. I should also say that one of her responsibilities as a Member of Parliament, as it is ours as Ministers, is to see to it that the sustainability and transformation partnerships in her area collaborate with all the various organisations in her constituency and that the traditional health and social care services are joined up with schools, police, probation services and mental health services, because ultimately it is one NHS.

NHS Wholly Owned Subsidiary Companies

Rachael Maskell Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

I beg to move,

That this House has considered wholly-owned subsidiary companies in the NHS.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this albeit brief debate on the issue of NHS wholly owned subsidiaries, and this fairly recent but rapidly developing situation spreading across the NHS. What are these companies? They are organisations set up by NHS trusts as subsidiary companies to the trust, into which a range of NHS facilities management staff are transferred. When I say facilities management staff, I mean all the porters, cleaners, catering staff, estates and maintenance staff, and others who keep our hospitals going. Those staff are an essential part of the NHS.

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

York Teaching Hospital is about to enter into an alternative management company for the facility staff there. Those are staff that want to work for the NHS, not least because they get the benefit of NHS terms and conditions and pensions. Does my hon. Friend agree that the loopholes in the taxation of the NHS need to be addressed so that those people can remain working for the NHS?

[Liz Twist]

I most certainly do agree with my hon. Friend. We know that NHS trusts are under incredible financial pressure and are looking for ways to stretch the available funds. Some trusts have seen wholly owned subsidiaries as a way of reducing costs. Those trusts include the Gateshead Health NHS Foundation Trust, which provides excellent hospital services to many of my constituents.

The cost savings come about in two main ways: through saving VAT and by saving on staffing costs. For some, there may be a third area of income—advising other NHS trusts on going down the same path, which is one of the reasons why they are spreading across the country. In November 2017, the then Health Minister, the hon. Member for Ludlow (Mr Dunne), stated that:

“NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts”—[Official Report, 14 November 2017; Vol. 631, c. 129.]

We know that more are being created even now.

--- Later in debate ---

[Liz Twist]

I certainly agree that this is the wrong medicine for the NHS’s problems, which, as hon. Members said, derive from the pressure on NHS finances and the underfunding of the NHS.

[Rachael Maskell]

The last time there was a segmentation of facilities management, we saw the rise of MRSA and other communicable diseases, so the evidence shows that this is a bad move.

[Liz Twist]

That is a very valid point, and it must be considered carefully.

We are creating divisions between staff in the facilities management companies and other NHS staff by introducing a two-tier workforce, which health service unions such as Unison—my union—have worked hard to move away from. The setting up of these wholly owned subsidiaries is a retrograde step. It insults and undervalues the staff who do essential but less visible jobs in the NHS. It deprives them of the pension scheme that their colleagues have access to and exposes trusts to equal pay claims. Equally important, it risks breaking up our NHS—perhaps not today, but in the near future.

I have been looking at the health press in preparing for this debate, and I have seen that there are plenty of companies out there willing to advise on setting up NHS subsidiary companies and look at the benefits of such companies. There are no such advantages. There is no reason why NHS staff working together cannot produce a better NHS. Indeed, they are doing so all over the country. We need to stop this trend of establishing wholly owned subsidiaries in the NHS. We must respect all our hospital staff and prevent the fragmentation and privatisation of our NHS.

--- Later in debate ---

[Stephen Barclay]

The slightly puzzling issue here is that the savings accrued from the subsidiaries are for the benefit of the local health economy, of the trust. This is a subsidiary company 100% owned by its host trust. The more efficient the subsidiary is, the better it is at dealing with things such as its pathology—not only do we avoid samples being lost, but we run a more efficient system in a more commercial manner, which brings more money into the healthcare economy and gives the flexibility to compete effectively in the local job market for maintenance staff and others.

The benefits of those arrangements accrue to the trust that owns 100% of the subsidiary. That is why, under legislation of the previous Labour Government—correctly in my view, but clearly not in the view of the Labour Members—the local trust is empowered to empower in turn the local members of staff. That is then reflected in the staff survey, which shows a more favourable result in this trust.

[Rachael Maskell]

I am grateful to the Minister, who has been generous with his time, but does he not acknowledge that the failing finances of the NHS are forcing trusts down that route? I am meeting the Minister next week to talk about York Teaching Hospital’s failed finances. That is the driver of the changes and, therefore, the fundamental issue still has to be addressed.

[Stephen Barclay]

I do not know whether we are moving away from the subject to a wider debate about finance, but the Chancellor’s Budget settlement makes the Government’s finance commitment clear. The fact is that the issue of subsidiary companies is about using the resources of the NHS in the most efficient manner. That is the view not just of the Government and of the previous Labour Government, but of the trust itself. It is delivering a better outcome for patients and delivering savings—I repeat, the savings accrued go to the benefit of the trust that owns 100% of the subsidiary. It is a shame that those on the Labour Benches seem to want to deprive staff of choice and opportunity. Staff are benefiting, and that is reflected in the staff survey.

I hope that in responding to the debate I have allayed a number of the concerns of the hon. Member for Blaydon about the setting up of subsidiary companies by trusts. I am sorry that there is such concern about the legislation put on the statute book by the previous Labour Government and that it is being deemed to be a form of privatisation.

Eating Disorders Awareness Week

Rachael Maskell Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar]

I will come very shortly to overall spending, but part of that is not just the overall size of the pot, but how that money is spent and works its way through the system to reach the frontline. In 2016-17, we spent a record £11.6 billion on mental health services, and that amount will continue to rise year on year until 2020-21, by which point 21,000 new mental health posts will be in place. This is all very welcome, and I commend the Health Secretary and his colleagues in the Department for it. Funding is vital. However, although £30 million per annum will be available over the next five years to fund eating disorder services, the way in which such funds are spent by clinical commissioning groups sometimes lacks transparency. At times it is hard to follow the funding from its source to ensure that it reaches the frontline. Implementation is key, and I hope the Minister will tell us how the Government are working to ensure that every penny reaches the frontline eating disorder services for which it is needed.

Community-based mental health services are often the most effective local services to help people, but they and in-patient mental health services are commissioned separately, by the CCG and by NHS England respectively. That can lead to a sense of a lack of joined-up care, and it can mean that people have to receive treatment many miles from their homes and families. That can place a huge strain on families, and, indeed, on family finances. Beat’s report suggests that in some instances the cost can be up to £32,000 as a result of lost earnings, travel and a range of other expenses. I believe that funds for eating disorder treatment should be held locally by the same budget holder in the same pot to create incentives for the development of improved treatment and reduced costly in-patient care, with CCGs working to extend their focus on early intervention to include the earlier stages of the illness.

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

Will the hon. Gentleman give way?

[Edward Argar]

Very briefly.

[Rachael Maskell]

I am grateful to the hon. Gentleman, who is making an excellent speech. Would what he is suggesting include support in schools?

[Edward Argar]

That is indeed very important. A key issue is the need to ensure that, as far as possible, there can be school referrals or, indeed, self-referrals as well as referrals made via a professional medical route. Some people may choose those ways of reaching out for the help that they need.

I hope that the Minister can update us on the progress of NHS England’s “Testing New Care Models in tertiary mental health services” pilot, which I understand is currently under way, and can tell us whether any initial findings are emerging in respect of the opportunity to put in-patient and community funding into a common pot.

I cannot end my speech without highlighting the impact that eating disorders have on the families and loved ones of those with the illness. Many of them care for people patiently and lovingly, and delays in securing the help that is needed can have devastating consequences for them. While in some cases it may not be appropriate, for good reasons, in many others, engaging those who are caring for someone receiving treatment—the “whole family” approach that I understand is used in Leicester, which will serve some of my constituents—can be hugely positive. I would welcome any reflections on that from the Minister.

Finally, I pay tribute to the work of Beat, which has campaigned tirelessly to highlight this issue, and to the work of those who operate its advice helpline. I commend its report to the Minister, and to all colleagues. However, I pay the greatest tribute to all those who suffer from an eating disorder and have had the bravery to talk about it, to seek the help that they need, and to face down an illness that depends on secrecy, isolates sufferers, and affects every aspect of their lives and those of their families. We must ensure that we match the courage of those who face it, determined to beat it, with an equal determination to give them the support, treatment and investment that they deserve. We must continue to drive down the delays and waiting times, raise awareness, and strip this disease of some of the power that it has over people by talking about it. We must stand shoulder to shoulder with all who face it, with the clear message that, together, we will beat eating disorders.

Diabetes

Rachael Maskell Excerpts

Monday 26th February 2018 Commons Chamber

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

Young people find it incredibly difficult to do glucose testing. The FreeStyle Libre device is a mechanism through which young people can have regular testing without that fear. However, they have to go through an individual funding request to access that. Should that not be available on the NHS?

[Liz McInnes]

I completely agree, and I will discuss FreeStyle Libre patches later on. I am beginning to feel like everybody here has had sight of my speech before I have even delivered it.

The next point arising from the survey is that people living with diabetes want better access to healthcare professionals who understand diabetes. Many respondents said that they felt they were being treated as a condition and a set of symptoms rather than as a human being.

--- Later in debate ---

[Steve Brine]

I will not take another intervention, because I will conclude in just a second. The spending review made provision for significant transformation funding through to 2020-21, and I expect that to be spent in line with the priorities set out in NHS England’s mandate, including for diabetes.

We have talked about the childhood obesity programme and the national diabetes prevention programme. I am responsible for other public health initiatives, such as Change4Life and the One You programme. People like me with young children will see the Change4Life branding coming through in book bags for them. It has been an incredibly successful campaign. The programmes are crucial in both encouraging a healthy lifestyle and promoting exercise among young people, as are such things as the Golden Mile, which is almost universal in primary schools across England. The benefits of such programmes should be acknowledged in reducing not only the incidence of diabetes, but other debilitating and life-threatening conditions such as cancer and heart disease, in which I also have a great interest.

[Rachael Maskell]

Will the Minister give way?

[Steve Brine]

Yes, but then I might not be able to conclude.

[Rachael Maskell]

Very quickly on the issue of exercise, children are now reduced to just one hour of PE. Will the Minister speak to his colleagues in the Department for Education about increasing that?

[Steve Brine]

I am not responsible for the Department for Education, but the hon. Lady is absolutely right to say that I talk to it. I was in the Department with the Secretary of State and a Minister just last week talking about what further action we need to take on school food standards and the Golden Mile, because I want children to be more active. It is not just about what happens in school, though: the exercise through the Golden Mile in schools should be mirrored in out-of-school activity. There is so much more that we can and should be doing to help to prevent diabetes.

In conclusion, diabetes is emblematic of many challenges that the health and care system and my desk face. Prevention is critical, as is working in partnership with people in a way that tailors support and intervention. I, this Government and this Prime Minister are committed to improving outcomes not only for the millions of people in this country who are living with diabetes, but for the many more who are at real risk of developing the condition. We need to help both.

Question put and agreed to.

Cancer Strategy

Rachael Maskell Excerpts

Thursday 22nd February 2018 Commons Chamber

[Steve Brine]

Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.

Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.

We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.

Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.

How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.

Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.

The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.

The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.

To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.

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

I have listened patiently and, unfortunately, I was not here at the beginning. However, my constituent has a very rare form of cancer. He has had to self-fund his treatment in Germany and Southampton, but he has run out of money. The treatment meant he did not die within the weeks he was given and is now living. However, he needs top-up therapy, and his individual funding request has been refused. Without his treatment, he will not live. Could the Minister look into this case?

[Steve Brine]

Obviously, I will not comment on the case. I was going to suggest that the hon. Lady gets the clinicians to make an IFR, but she can by all means bring the case to me.

My hon. Friend the Member for North Warwickshire talked about breast density. The UK National Screening Committee commissioned a Warwick University study to investigate the link between breast density and breast cancer. Once complete, if the review suggests that there should be changes to the national breast screening programme, the UK National Screening Committee, which we work with, will consider that under its modification programme. I am in touch with Breast Density Matters, which is a small charity—small but perfectly formed.

The hon. Member for Coventry North East and others talked about blood cancer. We had a very good Westminster Hall debate last month led by my hon. Friend the Member for Crawley (Henry Smith). As has been said, many patients with blood cancer diagnosis will sadly never be cured; they will be on the regime of watch and wait, often over many years, to see whether the cancer has progressed to a point where treatment needs to begin. That can take a huge psychological toll, which Members have mentioned, on the patient and their families.

By 2020, every patient will receive a holistic needs assessment as part of the recovery package, which is excellent. For the blood cancer patient, their recovery plan will be personalised to take account of the unique characteristics of blood cancer and will include their mental health needs. That is why the Secretary of State announced the additional £1.3 billion last July to expand the mental health workforce. My hon. Friend the Member for Dumfries and Galloway (Mr Jack) made that point very well in his speech—I say this as I am passed a note. I love the notes from the Whips.

PACE Trial: People with ME

Rachael Maskell Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan]

I thank the hon. Gentleman for his intervention. It is typical, because the PACE trial had such publicity and was lauded by many as the answer. One participant in the original trial has contacted me:

“I was determined to be a part of the...trial because I wanted to get better—so if this ‘treatment’ could make me better I wanted to give it the chance to do so. I was assigned Graded Exercise Therapy. It never occurred to me that it would actually make me more ill. Nor did it occur to me that decline would not be documented, and that despite patients not recovering (or in some cases worsening), they would publish that the treatment was successful...It was stressed that I would only get better if I tried harder, and even though the graded exercise was clearly making me worse, my struggle and pain was dismissed.”

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

As a former physiotherapist, I recognise that all therapeutic interventions must be patient-led—led by people with the lived experience. Does the hon. Lady agree?

[Carol Monaghan]

Absolutely. In fact, I will be calling for the patient voice to be heard in any treatments.

Calls to publish the raw data—basic protocol in good research—were ignored. Queen Mary University spent an estimated £200,000 on keeping the data hidden. Finally, after a long battle, patients won a court order to force the PACE authors to release the data. It was discovered that the authors had altered the way in which they measured improvement and recovery, to increase the apparent benefit of the therapies. Re-analysis showed that the improvement rate fell from 60% to 21% and the recovery rate fell from 22% to just 7%.

The method of patient reporting has also been questioned. As one participant says:

“After repeatedly being asked how severe...my symptoms were—in the context of…it’s just me not trying hard enough...I started to feel like I had to put a...positive spin on my...answers. I could not be honest about just how bad it was, as that would...tell the doctors I wasn’t trying and I wasn’t being positive enough. When I was completing questionnaires...I remember second guessing myself and thinking for every answer: ‘Is it really that bad? Am I just not looking at things positively enough?’”

NHS Winter Crisis

Rachael Maskell Excerpts

Wednesday 10th January 2018 Commons Chamber

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

I am pleased to follow the hon. Member for North Dorset (Simon Hoare) because I, too, want to touch on transitional healthcare.

Before I do so, I want to acknowledge the incredible, amazing, professional care that is provided across our healthcare service. We all agree that the love and care that is there is incredible. However, there are clear challenges, and we note those too. We have heard so much about them in the evidence provided today. This is not just about the long hours and the complex challenges that are placed at the door of health professionals. It is about the stress of not having the additional conversation that you need to have, the stress of not being able to treat somebody as a whole person but only being able to focus on the acute situation before you, and the stress of trying to keep somebody alive as their respiratory condition is deteriorating but you cannot get the doctor down because you know they are caring for someone in an even more acute situation. I know; I have been there. I have worked in acute medicine for 20 years, and I know very well what has happened over those 20 years. I agree with hon. Friends who hark back to the 1990s, when, as today, our NHS was in a terrible state. It did improve when Labour put the investment into the NHS, and we cannot deny that finance is at the heart of what is happening.

Bed occupancy is an issue for my local trust, which has faced a real crisis in acute care over this winter. I commend it for all it has tried to do to avert the situation, but we have had multiple days of 100% capacity in our acute medical facilities. The council has closed care homes. The trust has closed a transitional care unit. We have an empty hospital adjacent to our acute hospital, sitting on land that NHS Property Services is going to flog off as opposed to seeing how it can invest in better care for the people of my community. We need to really invest in the facilities that we need for the future, particularly around transitional care. We should have a complete review of what is needed with regard to the NHS estate.

The influenza outbreak this winter has had a more serious impact in York than across the rest of Yorkshire and has been one of the worst in the country. That has had a real impact on staff as well as the acuity and volume of patients coming through the door. On top of that, we have had norovirus and DNV—diarrhoea and vomiting. This is all putting challenges into the system.

We absolutely must have a coherent public health strategy as we move forward. We know that there is social inequality in who gets access to inoculations. We also need to make sure that we lay out a proper strategy. That is not happening. The fact that public health is separated off from acute health is a barrier. We need to draw them together to make sure that we have a proper public health workforce in the community.

I want to touch on funding. Our trust is in the capped expenditure process. I am still waiting for a meeting with the Minister to discuss the impact of that. The trust does not have the flexibility and the resources that it needs, and that is having a serious impact on the health crisis we are seeing in York. We need to move the situation forward to make sure that we have the resources where we need them.

At the moment, the NHS is really sick. When patients are sick, they need solutions. I trust that we will start hearing solutions from the Government.

Oral Answers to Questions

Rachael Maskell Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.

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

The NHS patient declaration form for free dental care and prescriptions requires patients to determine the difference between contribution and income-related employment and support allowance. Getting it wrong attracts really hefty fines. Will the Minister ensure that patients first get the opportunity to make the right choice before fines are applied?

[Steve Brine]

Yes, of course. The NHS Business Services Authority issues the penalty charge notices for incorrect claims for exemption from NHS dental care and prescription charges. We have recently increased the number of checks, however, because ultimately this is taxpayers’ money, and we need to ensure that it is spent properly and legally.

Mental Health Provision: Children and Young People

Rachael Maskell Excerpts

Tuesday 12th December 2017 Commons Chamber

[Luciana Berger]

I thank the hon. Lady. I believe that we both share the concern about the challenge of recruitment within the mental health workforce. The Government themselves acknowledge that there is an issue by way of the fact that they have put forward a plan to recruit these extra thousands of mental health workers between now and 2021. In the context of our conversation this evening about young people in particular, it is particularly disheartening and dispiriting that the specific plan that was set out only a few months ago contains nothing to expand the number of child psychiatrists—something that we desperately need. In the north-west, we really struggle to fill vacancies for those posts.

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

My hon. Friend is making a great speech about the real crisis in child mental health. Does she agree that the Green Paper places more and more focus on teachers, as opposed to health professionals, providing mental health support? Teachers are already really stressed by the volume of work that they have to do and they are not trained as medical professionals, so should that emphasis change?

[Luciana Berger]

I thank my hon. Friend for that important contribution. Another question that I hope the Minister will answer is how we can properly equip and train teachers to contend with the responsibility that they will be given if the plan set out in the Green Paper goes ahead. At the same time, the Department for Education is piling extra pressure on students with more testing. There are fewer teaching staff, which adds to the pressure on the remaining staff, and class sizes are larger. Cuts have been made to mentors, pastoral care and counselling. There has been a 13% reduction in the number of educational psychologists in our schools. The Royal College of Nursing points out that the number of school nurses has dropped by 16%, while the number of school-age pupils has gone up by 450,000. Young people face bullying, online threats, dysmorphic body image and advertising in a way that no previous generation has done.

Like many hon. Members, I am upset, appalled and outraged every week by the heartbreaking cases that constituents and their families raise with me in person or via email. Many Members in this House will recall the case in August of 17-year-old Girl X. She was restrained more than 100 times in a place that was not fit for her care, and she was left without a secure bed. The UK’s most senior family court judge, Sir James Munby, raised her case and warned us that we would have “blood on our hands” if this suicidal and vulnerable young woman did not get the treatment that she needed. But why was his continued intervention needed?

The case of Jack was brought to me this weekend. Jack is eight years old, and he has autistic spectrum disorder. He is in a severe state of anxiety and distress, and he has spent the last eight weeks on a ward in Alder Hey Children’s Hospital. He has had no specialist support from CAMHS and no specialist in-patient bed. He is getting more ill, and his family are, in the words of his mum Kerry, “in complete crisis.”

Just this afternoon, I heard about the case of Martha, who is 15 and has a history of self-harm. She has been admitted to A&E twice after taking an overdose. From a referral in June, Martha is still waiting to see a mental health professional. In the cases that I have described and thousands like them, every day counts, but young people are waiting weeks and months for treatment while their conditions worsen and their families are left distraught.

I do not believe that the Green Paper does anything for young people such as Jack, Martha or Girl X, or for thousands of other young people, whose lives should be filled with optimism and wonder as they look to a future laden with promise. I am concerned that instead, they are going to face years of torment, anguish and pain, made worse by the fact that so much of it is preventable. The majority of adults with diagnosable mental health conditions will have developed them under the age of 18. The life chances of thousands are being blighted. We are leaving a generation in pain; they are being let down because the care is not there.

Ultimately—I agree with the point made by the hon. Member for Cheltenham (Alex Chalk) —what is missing is the proper focus on prevention. How can we prevent mental ill health and keep our children well? We know that the first 1,001 days of a child’s life determine their life chances and life outcome, and that is why the previous Labour Government invested millions in Sure Start and children’s centres. We need to remove the factors that create mental ill health in the first place: neglect, childhood trauma, domestic abuse, bullying, insecure housing and poverty. Unfortunately, the Green Paper does not address those issues. Indeed, the words Sure Start, deprivation, homelessness and inequality do not appear in the Green Paper even once.

We do not need to be economists to understand that it is far more expensive to run a service that is based on crisis than a service that is based on prevention, not just in human terms, but in terms of taxpayers’ cash. What a wasted opportunity. I sincerely hope that the consultation on the Green Paper will be meaningful, that Ministers will listen to the voices of young people and experts across the country who are crying out for change, and that we will see some action.

In conclusion, will the Minister tell the House—I have asked this question, but let me reiterate it—whether the pilot, which I know is only a pilot, will introduce a four-week waiting target for assessment or for treatment? The Green Paper guarantees funding only for the period of the spending review, so what guarantees can the Minister offer us for maintaining funding after the initial three years are up? What will happen then? How will the lucky fifth of schools be selected for the first wave of support? How will her Government address the aim of real parity of esteem between mental and physical health? Reading the Green Paper, it seems to enshrine imparity by supporting only 20% of children over the next six years. Finally, is she convinced that this really is the best her Government can do for the greatest asset that we possess—our young people, who are our nation’s future?

--- Later in debate ---

[Rachael Maskell]

What is the Minister going to do to prevent the causes of poor mental health in young people?

[Jackie Doyle-Price]

The point of the Green Paper is that we are looking to put support mechanisms in place so that children facing mental health issues have access to care. That is very much the focus of today’s debate and the Green Paper.

To conclude, as we are running very short of time, I am grateful to the hon. Member for Liverpool, Wavertree for bringing this subject forward for debate. I am sure it will not be the last time we debate it—in fact, I know for certain that it will not. We are trying to achieve a step change in the support we are giving to children and young people. We know that the situation is far from perfect at the moment, but we fully anticipate that we will meet our ambition in the five year forward view to be treating 70,000 more children by 2021.

Question put and agreed to.