Covid-19: Deteriorating Long-Term Health Conditions

Debate between Rachael Maskell and Judith Cummins

Thursday 10th March 2022 Westminster Hall

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Judith Cummins (in the Chair)]

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

Nationality and Borders Bill

Debate between Rachael Maskell and Judith Cummins

2nd reading
Monday 19th July 2021 Commons Chamber

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

Judged while seeking justice. Criminalised while fleeing criminals. Expelled while being exploited. Scapegoated while escaping some of the worst violations against human dignity or human rights. In breach of global agreements. The words in the Bill should never enter the minds of anyone, let alone those entrusted to protect us. They should never be echoed in the Chamber, let alone be brought forward in legislation. In our country—the place that founded human rights—the Government have reached the depths of stigmatising people fleeing war, terror, trafficking, climate catastrophe and, yes, destitution, judging them on how they arrived, not what they have left. As the Government play on the global stage by cutting aid to the world’s poorest and removing their last hope of being able to stay home and support family and community, play with our climate, which is burning our planet and every grain that could feed the most destitute, play war by selling arms while walking away from building peace, fail to use their voice, power and influence on the global stage to stem some of the worst violations against humanity, and preside over a broken asylum system and do not fix it, they must recognise their contribution to the decimation of the global order before pointing the blame at its victims.

From centuries of imperial abuse to withdrawing from reparation today, the Government are now prepared to suppress a small number of the 80 million people forced from their homes and land without shelter or hope. They are prepared to criminalise people who, for the want of safety and survival, and some just to be reunited with their families, have been subject to criminal gangs. Worse, the Bill will stop people even fleeing danger as the Government force them to apply to enter the UK from a place of peril or some offshore hidden place, creating more risk, more trauma and more harm.

I appeal to all Government Members not to tread those dark paths. I appeal to all who say they live by a moral code and are here to further justice and advance human rights not to support their Government tonight but to uphold our British values, which welcome the repressed and offer people somewhere to live safely. I am so proud to represent York, the UK’s only human rights city and a city of sanctuary, where we put the needs of others before our own, tear down walls and create bridges, and take care of those whose stories break us as they recount the trauma they have endured in their lives. We listen and we act. We quicken our resolve to speak up and stand up for human rights and against violations and abuses. That is why I speak out to oppose this oppressive legislation and say: not in my name.

[Madam Deputy Speaker (Judith Cummins)]

I call Sir John Hayes.

NHS Dentistry and Oral Health Inequalities

Debate between Rachael Maskell and Judith Cummins

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins]

The single most important thing that the Government can do is reform the dental health contract with a view to more prevention.

During the initial period of lockdown, between March and June, all routine dental care in England was paused and urgent dental care hubs were set up to provide emergency treatment to patients. That period of closure has clearly led to an enormous backlog of patients requiring treatment. The British Dental Association estimates that in April and May only about 2% of patients were able to access dental care, compared with last year, and that between March and October 19 million appointments were lost. One local Bradford dentist told me:

“Our phones are ringing hot with new patients who have no dentist access, which has certainly been made worse by this year’s lockdown. On top of this we are facing significant staffing pressures, due to increased triage requirements and the need to thoroughly clean the practice between patients.”

Just yesterday, I was contacted by one of my constituents who has been trying to get a dental appointment for five months and is living with gum disease and toothache. That is simply unacceptable.

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

I am grateful to my hon. Friend for securing this debate and for all her campaigning work on dentistry services. In York, it is really challenging to get registered with an NHS dentist, let alone access their services. One of the things that has exacerbated that during the pandemic is access to personal protective equipment for people who are overseeing our oral health. Does my hon. Friend believe, as I do, that oral health has not been seen as an equal partner in the provision of healthcare? We seriously have to address that, including access to PPE.

[Judith Cummins]

I certainly agree with my hon. Friend about access to PPE and the fact that dentistry is very much seen as the Cinderella service of the NHS.

Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70% of practices are operating at less than half their pre-pandemic capacity. The primary reason for that is the requirement for a period of fallow time after each appointment to allow any aerosols that may have been produced by treatments such as drilling or even scale and polish to settle, and then for a long deep clean to take place. The fallow period can be for up to one hour.

In October, the number of NHS treatments carried out was a third the level of the year before. In the BDA’s members survey published earlier this month, 87% of dentists in England cited fallow time as a top barrier to increasing patient access. That could be significant reduced. The number of patients seen could be increased by installing high-capacity ventilation equipment. However, the price of such equipment and ventilation is estimated to start at about £10,000, and the cost is considerably more for larger practices with a high number of surgeries.

The British Dental Association members survey shows that the majority of dental practices in England are not currently in a financial position to afford such an outlay for investment. However, the practices least likely to have had the appropriate equipment tend to serve the most deprived communities, and are also the least likely to be able to afford that investment, increasing oral health inequalities further. That vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.