Rachael Maskell
MP for York Central · Labour (Co-op) · United Kingdom
“I welcome today’s statement and I welcome the Secretary of State to her place. York hospital was heralded as a cheap build, but we are paying a heavy price today. We know that heat in that hospital will have an impact on clinical outcomes as well as on staffing.”
“The conflict is moving beyond traditional warfare; we are now seeing extensive drone use, mercenaries being brought from Colombia, and the exchange of money too. We also know that Russia has its own interests in weapons and gold. We must look at the minimal interest in Sudan and the developments in Port Sudan at this time.”
“When we think about the fact that 33.7 million of the Sudanese population are in need of humanitarian assistance, 13 million have been displaced, 19.5 million are at levels of food insecurity and need urgent attention, and there are 8 million children who are not in the safety of school every day, getting their education, which will fuel…”
“Will the Minister tell us what progress has been made in that area, how that money has been spent and its impact to date? As we see increasing brutalisation in war, we have to focus even more on how we use international law to hold actors to account, and on the pace of that process, because it takes forever and a day to bring people to ac…”
“In the assault on El Fasher in particular, we saw the systematic raping of women, the burning of people and places, and the escalation in the next chapter of the civil war that has raged since April 2023.”
“It is a pleasure to see you in the Chair, Dr Allin-Khan. I congratulate my hon. Friend the Member for Gillingham and Rainham (Naushabah Khan) on securing such an important debate.”
The complete record
Every one of 5,723 lines we hold for Rachael Maskell, in date order, each linked to its source. Free to read, in full, without an account. Page 21 of 115.
“We need greater investment, not just through ringfenced and protected finance and funding, but to ensure that the NHS long-term workforce plan focuses on the mental health workforce that is needed now and into the future. As we have heard, whether workforce issues are due to the impact of covid or other factors, they will have a significant impact; and unless we make the right interventions early, there will clearly be consequences. I particularly want to focus the Minister on the issue of leadership, because in an ever more complex health system—we have heard again today about the challenges of trying to navigate local authority and health systems—we need to have very clear leadership in this area.”
“It is a pleasure to serve with you in the Chair, Mr Pritchard. I congratulate my hon. Friend the Member for Tooting (Dr Allin-Khan) on securing the debate and on all the work that she has contributed in looking at mental health and, in particular today, children’s mental health. I believe that no one has the monopoly of wisdom in this area—every day we are learning how to move forward—but key components need to be put in place. We know, and have heard in the debate, the role that trauma plays and its impact on children’s mental health. We also know that the environment to which a child is exposed can trigger and escalate the challenges they face. We have heard about the shortfalls in the number of professionals required in the services.”
“The changes in the visa rules for international students and their dependants are having a significant impact, not only on the number of students coming to universities such as the University of York, a Russell Group university, but on these universities’ finances. Universities will have to make significant cuts if this visa programme reaches fruition. Will the Minister meet vice-chancellors and the Home Office, together, to talk about the impact this is having?”
“Co-operatives and social enterprise businesses provide a fairer way of doing business, involve members in greater business decisions and provide economic growth for local areas. However, they are being held back by financial and regulatory constraints. Will the Government match the Labour party’s and the Co-operative party’s ambition of committing to address those challenges and doubling the size of the co-operatives sector?”
“We were promised “before the summer”, we were promised “after the summer”, we were promised “before Christmas”, we were promised “soon” and now we have been promised “shortly”. The reality is that Labour has a plan and the Government have not. In York, we cannot get an NHS dentist either. Blossom Family Dental Care is just handing back its contract. My constituents have nowhere to go. What is the Minister going to do to ensure that my constituents can access NHS dentistry?”
“I trust that Parliament will have further opportunity to scrutinise these developments.”
“It is vital that the Government and the GMC, in formally setting up the statutory register over the coming three years, work closely with the professionals to ensure that they are engaged in the process and that their concerns are picked up and addressed along the way. I am asking the Minister to commit to that today, as I know my hon. Friend the Member for Bristol South will when she has the opportunity later in the year. Patients, the wider public and fellow clinicians need to understand these fine lines and distinctions for their safety and safe practice across the NHS. The culture of “get it right first time” must be central to this debate and all that flows from it. If regulation lands in the wrong place, the Minister and the GMC need to be candid and ensure that it is changed so that it is fit for purpose.”
“Holding information separately would enable greater access for the public to the information they seek with respect to the new associate roles. The register must be robust and easy to navigate and, like the register for doctors, provide the public with all the information that they require. I know that the GMC has agreed to put a simple prefix ahead of registration numbers, but the professions are calling for more distinction so that there can be no confusion. I am mindful of the higher proportion of cases generated from AAs and PAs. Will the Minister ensure that the registration fees reflect that?”
“Furthermore, with the envisaged rapid expansion in the number of AAs and PAs, the GMC needs to determine that supervision is safe and appropriate, and at the level required to enable people to mature into highly skilled professionals. It must also ensure that there is not a spike in fitness-to-practise cases due to lack of investment. The call from the medical profession is for us to slow down and properly evaluate and understand the consequences, seen and unforeseen. On part 3 of the order, which concerns the register, can the Minister clarify that the associates will be on a separate register to doctors at the GMC, and that they will have their own register, as identified in article 5(2)(a)? I note that AAs and PAs will be on one register, but in separate parts. Will he explain to the Committee exactly how that will operate?”
“With registration, AAs and PAs will be autonomous practitioners, liable for their own conduct and practice. How will the regulator ensure that liability is apportioned in the right way between them and those who provide supervision? Will they receive one-to-one supervision, and how far will liability carry on to, say, the consultant or senior registrar? That is a really important issue to consider in the immediate future, not only for AAs and PAs, but for doctors and doctors in training, who must receive supervision too. We need to ensure that a new generation of doctors in training are able to receive the support that they need, and that it is not all dedicated to AAs and PAs.”
“There is serious concern about the diagnostic skills of PAs; there have been examples of failure, as we heard so powerfully about Emily Chesterton, the daughter of the constituent of my hon. Friend the Member for Worsley and Eccles South. These functions need serious reconsideration and tight regulation. The GMC must ensure that their scope is clearly defined and that, before further role reforms occur, there are assurances that there will be no further scope creep. Clarity of role is really important in prescribing too. Some AAs and PAs may have transitioned from professions where they were already prescribers. We need to hear from the Minister how that situation will be managed, with clear delineation. I want to touch on the issue of liability—where responsibility lies.”
“We need to look at how we can move beyond traditional silos and create skills pathways that honour professions and the level of their skills, so that competencies can be gathered, tested and examined along the way. I believe that there needs to be a full job evaluation to understand the challenges between the professions—yes, across the two core NHS pay structures—and then a clear delineation of roles. For example, senior doctors in training in anaesthetics are now in a logjam, unable to progress to a consultant post due to the rise in the redeployment of anaesthetist competencies to AAs. The same could be said of the Government’s prioritisation of PAs over, for instance, traditional senior house officers.”
“We have seen some, for example with advanced practitioners reaching across professional silos, and in developing a focus on primary care it could bring strong benefits. We need to ensure that new regulatory frameworks address that. The blueprint for a future professional regulation framework must account for this opportunity. As with all professions, medicine must not be exempt from looking at how it can be reshaped. However, when someone who has had two years’ training is paid more —ironically, 35% more; Members might recall that number—and assumes more authority than a doctor of seven years’ training with a higher level of competency, there is clearly a problem in the design of the role and cause for concern.”
“I urge the Minister to find a common language so that there is simplicity and accuracy, and so the public understand the distinctions between these roles and those of the established professions. In talking to the British Medical Association, I heard how people are now working above their competencies as AAs and PAs—carrying the consultant’s bleep, for example. That is deeply disturbing and just reinforces the public confusion over the distinct identity and purpose of each clinical role. Boundaries must be clear and distinct and, for the sake of safety, defined nationally rather than determined locally. While the Government are very much focused on vertical integration, which can exacerbate things such as skill mix, I urge the Minister to further consider the power of horizontal integration.”
“The public are nearly universally unaware of different roles in the NHS, let alone what they can or cannot do. In a clinical setting, if someone with a stethoscope around their neck calls themselves part of the medical team and they assess, diagnose and treat a patient, it will generally be assumed that they must be a doctor. I remember that when I started practising, if you were a woman, you were a nurse, and if you were a man, you were a doctor, so I certainly know that the distinctions are not always there. However, some use the title “Dr” because they hold a doctorate in another field, and that needs to be looked at. Further, there is a new lexicon of technicians, assistants, associates, advanced practitioners, and no doubt many more.”
“Friend the Member for Bristol South that we need to ensure that that is rigorous and upholds standards, but I also welcome the fact that they may be expedited within the new system. I have been asked whether the GMC is the right regulatory body. I understand the arguments for and against. This is where a lot of the concern comes from, which is why regulation is important. The challenge to this order is the lack of clarity about titles, roles and the competencies associated with each role. It could be argued that, for greater distinction, the HCPC, for example, is a more relevant registrant. I believe that that should have been examined further, not least as AAs and PAs are professionals allied to health and sit within the “Agenda for Change” family.”
“It is important that at every stage there is protection for the professional and, most importantly, the patient. The reality behind the order is that the professional silos of the last 150 years or more are rapidly evolving and morphing in new ways, and the regulatory framework has to capture that and catch up. I agree that we urgently need a system of statutory regulation for anaesthesia associates and physician associates. They are working at a significant level of decision making, and they have a duty to uphold professional standards, their training must be of the highest standard, and there must be a fitness-to-practise process through which they can be called to account. I agree with my hon.”
“When Agenda for Change was piloted in 2003 and fully instituted in 2004, a job evaluation scheme was designed for this very purpose, and was overseen by the formidable Sue Hastings. However, emergent professions cannot just be add-ons to existing regulation. They required their own registers, governance and accountability, not least to ensure professional competence. The order is the first expression of that, 20 years on. Also, the knowledge and skills framework enabled people to grow in their professional competencies and provide a higher level of care. That could lead to hybrid roles forming. I remember Alan Milburn saying at the time that the NHS career framework should enable someone to move from the role of porter to neurosurgeon—I do not know if that has ever been achieved.”
“It is a pleasure to serve on the Committee, Dame Caroline. Before I begin, I declare that I was a registered professional with the Health and Care Professions Council, and worked in the NHS for 20 years before coming to this place. I was also the head of health at Unite, so I have a strong background in understanding the regulatory frameworks in the NHS. I understand the issues that the Government are trying to resolve, given the changing nature of the NHS, the emergence of new professions, and the need to protect patients. I agree that all NHS professionals must be registered, and regulatory reform is long overdue, including for anaesthesia associates and physician associates.”
“Building resilience for the future is vital if this Government are to address the challenges around climate change. York’s resilience measures cost over £100 million to protect my city this winter, but the estimated cost to businesses in Newry alone is £37 million as a result of the winter weather. When will the Minister bring forward a proper amount of money—not just £15 million, which may be a deposit—to ensure that Northern Ireland can build its resilience for the future?”
“On Friday I visited five Co-op stores and every one of them had daily experience of theft, with one losing £35,000-worth of goods over six months and staff experiencing assaults. In light of Labour’s pledge to introduce 13,000 more community police and a law on retail crime, what is the Secretary of State really doing? Clearly his plan is not working.”
“While the Prime Minister has clarified that the strikes in Yemen are disassociated from Gaza, the Iranian arc has drawn a different conclusion, not least as the strikes took place the same day as the International Court of Justice case brought by South Africa. We know that the only way forward is de-escalation. Given that assaults continue on the merchant navy, and assaults in Gaza continued over the weekend, when will the Prime Minister condemn Israel’s attacks on civilians and call for an immediate ceasefire?”
“Labour has a programme for a new generation of youth hubs, because we know that our young people are struggling with mental health challenges, school, themselves and others, and some are being picked off by criminal gangs. In contrast with our programme, the YMCA has identified a 70% cut in funding since 2010 and a loss of 4,500 frontline youth workers. When will the Government invest in our young people and in a comprehensive youth service?”
“In a multimedia age, there are 2 million people in the UK who are housebound, and globally many Christians across the persecuted church are unable to gather with others. With good Christian online content such as services and podcasts, and popular series such as “The Chosen” through to the Alpha course, how is the Church equipping people to navigate that content safely and easily, in order to extend its mission with the equipment and skills needed to access it?”
“When we ask written questions and when our offices require information from Government Departments, our constituents expect a comprehensive response. However, we are getting standardised responses from UK Visas and Immigration, in particular. We have desperate people who fear for their future, so will the Leader of the House talk to the Home Office about how we can have comprehensive responses so that we can know the timelines, the details and the reasons for the delays in processing cases?”
“It will give them the opportunities in life that they are currently being denied; it will help to heal the relationships between children and parents, which are often so stressed as they struggle to get by, week by week; and it is the right thing to do.”
“They are stressed and stretched because they are trying to deliver far more than their time allows. We value every penny spent in their direction, but we need to look again at the funding formula, which is simply not working, and ensure that we see it as an opportunity for the future. Invest in these children—ensure that they have the opportunities they need. Finally, we need a complete overhaul of the SEN improvement plan. It needs to be far more evidence-based, based on the data as well as the best therapies possible. We need to look around the globe at where they get things right first time, and ensure that our children get that benefit too. Ensuring that services are properly funded will make such a difference to these young people.”
“I thank York Inspirational Kids, Snappy, Choose2, the Island and so many more for the provision that they offer, but their funding is also challenged. We need to ensure that they get the resources that they need to provide support for children outside school. For far too long, parents have battled. They are battling, they are fighting, and they are exhausted because they are not getting support. They wait for months and years to get the diagnosis that is key to unlocking everything. We need to ensure that parents who are waiting for a diagnosis get the advice and help that they need to best support their children in those early years. What a difference that could make for them. I thank all those who work in SEND in my constituency. I know how desperate they are.”
“We know from the data that autistic children are almost twice as likely to be excluded with or without a plan, which comes at a heavy cost. The disciplinary process at South Bank Multi Academy Trust in my constituency, about which I am meeting the Minister shortly, is turning away children with SEND at such a high rate. Children there are melting down at home because they are not getting the support they need. My third ask of the Minister is that, when he leaves the Chamber, he goes to the Department, rips up the draconian guidance on discipline, and starts again by instituting therapeutic schools. Fourthly, we need to have a look at the shortage of childcare and special support after school, during holidays and out of school.”
“Goodness knows the long-term costs. We need to smarten up when it comes to children with needs. This is not just about health or local authority funding; it is also about education. I have seen the travails of teaching assistants in York who have been stripped of 52-week contracts and given term-time only contracts. They are juggling at least two jobs just to survive on the lowest pay scales imaginable. Every day, they teach, nurse and support emotional, physical and mental health needs with a high degree of skill. We need a proper job evaluation scheme and a national pay spine for teaching assistants. They need recognition and wages that reflect it. As we have heard this week, we also need to consider excluded children.”
“We need those rises to be met with increased funding for the workforce—health visitors, physios, psychologists and speech and language therapists —and for special school places and mental health services. We need a comprehensive, multi-agency workforce plan. That is my first ask of the Minister. Secondly, we know that early investment saves money over a lifetime. We should see that not as spending but as investment in young lives. We need to ensure that children with physical impairments have the equipment they need, so that they are not waiting forever for a wheelchair, for example, but getting it on spec and on time. One of my constituents has now been placed in residential care halfway across the country because they need an accessible shower in their home. As I read this week, saying goodbye brought tears to both parents’ eyes.”
“Such is the need in York that I have undertaken a comprehensive project on SEND. At a recent constituency SEND summit of parents, agencies and charities, all were desperate to see children have their care needs met. To put it into context, York is the 17th worst area for school funding, and it is in the bottom third for higher needs funding. Children in York deserve the same as children across the country; there should be no differentiation. I recently met York Hospital’s paediatric team. They highlighted the change that they are seeing. In 2018, they assessed 42 children for autism. By 2022 that figure had risen to 118, and last year it rose again. The story is that funding is not rising with the needs that those children have. The same is occurring for education, health and care plans.”
“I wish the regulations success, but how has the Minister determined whether the penalties, which are incredibly small compared with the value of land, will have their due effect?”
“In the light of Tzipi Hotovely’s statement on LBC radio that the destruction of Gaza should continue and be extensive, why have the Government not condemned those words, which drew back on her previous comments about a two-state solution? What is the Minister going to do, because this is inconsistent with everything he is saying at the Dispatch Box?”
“We have had 14 Tory winters. One would have thought that they would learn by now that the real crisis in our NHS is that social care is not up to scratch. A quarter of patients in my local hospital are waiting for social care. As a result of jamming the back door, the front door becomes inaccessible to so many patients. After all these years, when will the Secretary of State publish a proper plan for social care, or will she leave it to my right hon. Friend to take over?”
“I understand how complicated it is to calculate compensation for individuals. My constituent’s numbers disappeared off their screen as transactions were being put through. Will the Minister ensure that more resources are put into supporting the process so that compensation can be paid more expediently?”
“Right now, council leaders up and down the country are having to make very difficult decisions on cutting vital services—not because of profligacy, but because of Government cuts to their funding. What steps is the Chancellor taking to ensure that local authorities—such as that in York, which is the lowest-funded area—are adequately funded?”
“While the Government should be leading the call for an immediate, complete and permanent ceasefire, what assurances has the Minister, the Foreign Secretary or indeed the Prime Minister had that actors in the conflict will abide by today’s UN Security Council resolution, should it pass?”
“York is now the 15th least affordable place to live in the country. My constituents will have no confidence in what the Minister and the Secretary of State have set out today, because they have been waiting for a local plan for 76 years and counting. The sticking point has been with the Government Department, not the will of the Labour council. When will York receive its local plan, be able to protect the precious space we have and build the tenure of housing we need, as opposed to developers moving in and building luxury flats that no one can afford?”
“From my citywide consultation of parents of children with SEND, it came to light that the particularly harsh and punitive disciplinary processes being exercised in schools are having a very harmful effect on many of those children. Will the Secretary of State or the Schools Minister meet me to discuss a particular multi-academy trust in my constituency where those processes are having a very negative impact on young people?”
“Given that the UN Security Council was unable, regrettably, to achieve a ceasefire because of the decisions of the US and UK Governments, what discussions have taken place about creating a ceasefire in the south of Gaza, to which many Palestinians in Gaza have been sent for their security and safety, and would the Minister advocate such a position?”
“When we come to clause 27, will the Secretary of State clarify whether “best value” applies to leaseholders or to freeholders? It certainly seems that leaseholders do not get best value when testing what additionalities and enhancements are put into their schemes.”
“This is a point that I wanted to make to the Secretary of State as well. There is a long-standing injustice for leaseholders who experience flooding as they currently do not have access to the Flood Re scheme. Will my right hon. Friend seek—I hope she will—to ensure a level playing field for leaseholders and freeholders in accessing the Flood Re scheme?”
“3. If she will hold discussions with Cabinet colleagues on consulting the International Criminal Court on potential breaches of international law in the conflict between Hamas and Israel.”
“I thank the Attorney General for her response. In the light of the brutality and sexual violence perpetrated against Israeli civilians by the terrorists of Hamas, and the scale of the indiscriminate bombing of tens of thousands of Palestinians, including children, in Gaza, how is she urging the UK Government to advocate for the end of the killing to ensure that the International Criminal Court can gather the most detailed evidence to weigh the actions of all parties against international law at the earliest opportunity?”
“I declare that I am a member of Unite the union, and met with trade union members yesterday. The urgency of this matter cannot be overstated—the clock is ticking, and those jobs will be consulted on in the very near future if contracts cannot be found. The Minister wrote in September, but what has he been doing over the past three months to bring forward contracts that will enable the plant to remain open?”
“Punitive disciplinary policies in schools are significantly harming children’s mental health, particularly neurodivergent children. It seems that multi-academy trust leaders are not accountable for their actions and are impossible to hold to account, not least at South Bank MAT, where children are experiencing significant harm, school refusal and an escalation in issues with their mental wellbeing. Can we have an urgent debate on calling the leadership of multi-academy trusts to account and ensuring that governance structures are fit for purpose?”
“We have the structure; we know the problems; we have identified the need; we understand the causes; and we have definitions. We need to move beyond that now.”
“My local community group, York Neighbours, helps with one-off projects, ensures that there are regular phone calls to individuals, and arranges connectivity groups and outings. I take issue with the point that the hon. Member for St Ives made about needing a new national strategy. We have a very comprehensive national strategy. In fact, it is exhausting to read, because it covers every single Department in detail. We have that as a background, but the question is whether it delivers and meets the needs of people in our communities. I think we need to take a different approach, and to bring it into a public health framework. We should look at how we can deliver more locally. Ultimately, we can talk about grand plans, but this is about delivery.”
“Many of those services, such as post office and rail services, were once in public ownership, and the Government could drive the opportunities to enable connectivity. I think particularly of Royal Mail and the opportunities that we have there, if we see it not as a business, but as a public service that serves communities and checks in on individuals who are elderly or isolated; we know that would make a significant difference. I thank the organisations that contribute so much, both locally in our communities and nationally. Age UK, the Marmalade Trust, the Jo Cox Foundation—it is a real pleasure to see my hon. Friend the Member for Batley and Spen (Kim Leadbeater) here—and the Red Cross do phenomenal work.”