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.”
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“It is a pleasure to see you in the Chair, Mr Sharma. I congratulate the hon. Member for St Ives (Derek Thomas) on opening today’s debate and focusing on the digital economy. We must remember that digital can be used as a positive, as well as a negative, and we need to focus. As we move at an even greater pace into a new age of AI and so many other technologies, we need to make sure that they work for everyone. The inequality that has been driven through the digital sphere has really shown itself, particularly among more marginalised groups. It is a pleasure to follow the hon. Member for Westmorland and Lonsdale (Tim Farron), who focused on public services that have been withdrawn.”
“There used to be luncheon clubs for older people, but they have just gone. The funding crisis in local authorities is making things even more difficult, so my third request is that we invest in a public health strategy that enables pilot projects to move forward and to make those connections once again.”
“If a question was asked in every interaction to find out whether people were experiencing loneliness or isolation, we could start to put strategies in place to address those needs. There is a real need to look at statutory services and to ask how we can build a framework, but also to look at what is happening across society. As we get older, these issues get more difficult. As we have heard, there are 7.8 million people on waiting lists. People are frailer and they get more withdrawn and isolated from communities and society, so it is harder and takes more effort to make those connections. It is important that we really look into that to find out not only the scale of what is happening locally and to ask those difficult questions, but to provide the necessary services, and particularly youth services.”
“People have not asked questions, so others are left very much in the margins. Young people are now the group who experience the most loneliness in our society. What are schools doing to intervene and ensure that there is good socialisation? Children are so stressed at the moment because they are having to meet the requirements set down by the state, but are they confident individuals who can make social connections? How do we facilitate that to help them to navigate the ever more complex world in which they are growing up? What about the GP and every other connection, such as the Department for Work and Pensions, for those who need support—not least the disabled people in our communities? What about local authorities?”
“I am grateful to my hon. Friend, who never misses an opportunity. I pay tribute not only to the incredible work she does in this place, but to Jo, who put this agenda on all our radars and did a phenomenal piece of work in raising its importance. Another major point I want to make is about the interventions that we need—I have been reading a speech I made in this place two and a half years ago, and it feels like we have not moved the framework forward since that time. Recently, in the Health and Social Care Committee, we had some incredible witnesses, who talked about dealing with suicide among men, although there is a lot of cut-across and move-across. I was struck by a piece of data we were given showing that 45% of males who take their own lives live alone. That really brings out the pain and the isolation.”
“If Rwanda is a safe jurisdiction, as the Home Secretary is trying to legislate to say that it is, can he explain why he believes there needs to be a provision in his Bill to override the powers of the courts?”
“On public services, City of York Council area comes 152 out of 152 when it comes to public funding. As a result, services are now having to be cut in the area, as the council has £55 million less than when we last had a Labour Government. How will the Secretary of State ensure that fair funding stretches across all public services when looking at the new funding formula?”
“The humanitarian situation is escalating; the disease burden is rising at such a pace that, without intervention, this will end up as a real humanitarian catastrophe. What discussions is the Minister having with the World Health Organisation and the UN to put in place what the aid agencies are calling for—a ceasefire—so that they can get on top on the disease burden across Gaza?”
“There is a global skills shortage of health and care workers, so they have choices to go to other countries that will accept dependants. What message does the Home Secretary have for the 7.8 million people currently on the NHS waiting list, when we will not have the skills to provide the care they desperately need?”
“On the issue of pre-trial therapy, will the Minister be taking on board the recommendations from the Bluestar Project, which has been working to ensure that the victims code is up to date and that pre-trial therapy is readily accessible to all survivors of child sexual abuse?”
“Secondly, there is not enough availability of pre-trial therapy and support. Amendment 146 would ensure that child survivors access therapeutic services. I ask that that is within a month of requesting these services, that they are made aware of the support they are entitled to, that there are minimum standards on the quality of support and that this support should continue throughout the criminal justice process, but also after that process has been completed. I again urge the Minister to look carefully at the amendments I have tabled to ensure that all child survivors can access justice and the vital therapeutic interventions to help them through the criminal justice process and beyond.”
“It is often 18 months on average, but it can go beyond three years for a child. Pre-trial therapy services are a specialism that is currently massively overstretched and inconsistent. My amendments would involve training to ensure that services could be expedited judiciously by the CPS, the police, and other people. Currently, there is no trust that information will not be passed on to a trial, so therapists are concerned that the notes they make, and the therapy they provide, could cause a case to collapse. We need absolute clarity within training to ensure that more than just a video is provided, that in-person training is robust so that there can be a reasonable line of inquiry, and that all those involved are properly trained with regard to limitations on the information that is provided to court on content and delivery.”
“I thank the Minister for what he said about consultation on the victims code. It is important that we get this right, and I trust that he will be attentive to amendments 145 and 146, tabled by me and other hon. Members. Declan Curran was just 14 years old when he took his life for not being able to access pre-trial therapy. His abuser was eventually sentenced to two years and served just one. Since then his brother, Kev Curran, has taken up the campaign to ensure that all children can access pre-trial therapy, and that is why I stand in this House today. The challenges around access to pre-trial therapy continue, despite new CPS guidance from 2023 that removed previous restrictions to accessing therapy, as identified by the Home Office-funded Bluestar Project. The wait for court access is extensive.”
“Member for St Austell and Newquay mentioned the impact on the local economy—people are clearly needed in the jobs but unable to live in the area—and our vital public services are not able to provide the staffing required to serve the local community. We also know about the impact on our communities. Finally, I want to raise the issue of York’s local plan. We are still waiting for its approval. Next year we will mark 70 years as a city, without a local plan. Developers are taking advantage of the lack of a plan and, as many colleagues have said, building high-value accommodation when we have a real need for social and affordable housing in the city. I ask for that plan be expedited so that we can get on and start developing the housing that the city needs.”
“We have to make sure that whatever system is introduced is compatible with His Majesty’s Revenue and Customs, because many people do not pay tax on their property to the Treasury. Some estimate that as much as £6 billion is missing. There is a lot we can do with £6 billion, so we need to address that deficit. There is a particular issue with the impact of our visitor economy on housing. Will the Minister—and, indeed, the shadow Minister—consider setting up a taskforce to look at the specific issues that press down on the urban, rural and coastal communities with a prevalent visitor economy to ensure that we can address the issues in such areas? The hon.”
“It is becoming more inaccessible to rent or to buy and, as so many colleagues have said, that is partly because of the rise in short-term holiday lets. According to AirDNA, we have more than 2,000 such lets in the city, with a 29% increase between August 2021 and August 2023. As a result, we are struggling. We need to bring in regulation. It is 891 days since I first raised this issue in the House and we are no further forward. It has been 355 days since I introduced a private Member’s Bill in the previous Session. As we heard, the consultation closed on 7 June but we are still waiting for the outcome. Will the Minister say when the Government will bring forward the response to the consultation and legislate to help constituents like mine? We have heard about using local revenue to address this issue, but there is also national revenue.”
“Some people cannot get into social housing because we simply do not have the supply. If they have to go into the private rented sector, in the BRMA—the broad rental market area—people get just £650 when they are having to pay £1,045 for a two-bedroom property. Will the Minister ensure that there is a deep dive into what is happening with the BMRA? The price is set around such a broad region, and the lower prices in North Yorkshire mean that York is more of an outlier than the other high-priced areas because of the differential in prices. As a result, people cannot go into the private rented sector, so sadly have to go into hostel accommodation or on to the streets. That has to change. With such high demand, rent is rising faster than the national average. The average increase was 4.9% in England last year and 6.3% in York.”
“The city centre generates £1.2 billion. We know how important tourism is to our post-industrial city; in the last 40 years or so, it has really played an important role in our economy. As everyone has said, though, tourism has its serious consequences. For York, the situation is descending, as many colleagues have said of other areas, into a dire housing crisis. There are consequences from having significant levels of tourism. We can look, first, at house prices in York, where demand outstrips supply. We know that has a real impact on affordability, the ratio for which is 10.9 in York. Last year, the cost of housing in the city went up 23%, pricing people out of local housing. York has the fourth highest rent in the country behind Oxford, Brighton and London.”
“It is a pleasure to serve under your chairmanship, Sir Charles, and I congratulate the hon. Member for St Austell and Newquay (Steve Double) on securing this debate. Also, I welcome the new Minister, who is the 16th Housing Minister of this Government; the fact that there is such churn in the Department may well be part of the reason why we are struggling so much. There is a danger that this debate could descend into the sketch about the four Yorkshiremen, as we all talk about the challenges we face. Nevertheless, I will speak as a York woman—at the centre of that—and say a little about York. We have a thriving tourism industry in our city and we really value it. Last year, 8.9 million visitors came to York. Tourism creates 17,000 jobs in the city and is a vital part of our economy, generating £1.7 billion.”
“How will the employer be compliant with GDPR requirements in a multi-union environment where lists will be going to different unions and where the employer itself will not know which unions individuals belong to? How will the Minister ensure that the names of employees will not go to unions that do not organise those particular workers?”
“I am specifically talking about a multi-union environment. Where a number of trade unions are involved, how will the Minister ensure that GDPR requirements are met?”
“Every single day this Government are in office, they are unable to maintain minimum service levels across a vast array of our public services, so why does the hon. Gentleman think they are requiring more workers to attend work on strike days than the rest of the year?”
“I think the fact that he has brought this measure forward today just shows that he has not taken the time to understand the way industrial action ballots actually work and the consequences of this legislation.”
“The Minister has not said what will happen to the worker’s protection if the worker does not receive the notice, and whether their protections will be removed and, as a result, they could end up with a dismissal, with no right of restitution at all. It is really important that the Minister brings clarity as to what will happen in those circumstances and, indeed, what will happen to the trade union if it makes efforts to comply with the legislation but is unable to do so because of the format and the way the data is provided. The Minister makes a lot of assumptions that the employer knows their workforces and who will be taking industrial action or not. I have to inform him that that is often not the case in these complex industrial environments. The Minister is above this.”
“When it comes to balloting for industrial action, it takes months to organise an industrial action ballot. We are talking about complex public sector ballots on the whole. As a result, it is important to get the information accurate and permissible under the law. However, an anti-union employer will have only four days in which to provide the information to a trade union, and then it will be a case of cross-matching, getting a notice out by post, because obviously the union does not need to collect information on the email addresses of its members, and then giving the notification. It is an employer who has the responsibility for whether a worker goes to work or not. I say to the Minister that that obligation should not be placed on trade unions.”
“Thank you, Ms Nokes; I will keep my comments incredibly short. I refer to my declaration in the Register of Members’ Financial Interests. I am completely shocked and baffled as to why the Minister has brought forward these provisions today when he does not even understand the context of the impact that this will have on a multi-union workplace and the breaches of the GDPR that the employer will be subject to in sharing sensitive information about their employees with different trade unions. They will be able then to identify the people who are members of other trade unions. Therefore there will be a complete breach, which will clearly be challengeable in the courts. [Interruption.] The Minister shakes his head, but that will be the consequence. I am also completely baffled in relation to the timetable.”
“I refer the Committee to my entry in the Register of Members’ Financial Interests. Does my hon. Friend agree that the regulations are completely unnecessary because life and limb cover is covered in the Trade Union and Labour Relations (Consolidation) Act 1992, so it is already in statute?”
“My hon. Friend is making a powerful speech. The Health and Social Care Committee had an inquiry looking at the ambulance service and industrial action therein. NHS Employers and the NHS Confederation said they did not want the regulations, and they would not use them. Could the Minister give us his response to the employers saying they do not want the regulations?”
“I should mention that I used to be the head of health at Unite, and I organised industrial action ballots across the country, which would have included the ambulance service. The reality is that during industrial action good dialogue is needed between the employer and the trade union to ensure that safety and that those critical calls are responded to. Does my hon. Friend agree that this will sully that relationship and put more patients at risk rather than that protection and support that the Ambulance Service and the trade unions already work towards?”
“My hon. Friend talks about the impact that the Government have had on NHS staff across the system. The NHS workforce survey shows that there is a disproportionate impact on people working in the ambulance service and in patient transport, where sickness levels are double that of many other professions. When I visit picket lines, I hear that people are there because they are so broken and burned out, and these regulations will only exacerbate that. They are on those picket lines to save their profession and ensure their patients are protected. Is it not right that these regulations do not come forward before the workforce crisis is addressed?”
“My hon. Friend is making such powerful points. In the Strikes (Minimum Service Levels) Act 2023, the employer has the right to remove a worker’s protection. Surely that will just escalate the retention crisis and make things even worse not only for the other workers but for the employer.”
“The employer does not want the regulations to be brought forward, so they do not issue a notice. They sit down in a voluntary capacity, as they always do, with the trade unions to come to local arrangements. How will that change things for the Minister? He is not the employer and does not have jurisdiction over any of the industrial environment, so what difference will the regulations make?”
“When asylum seekers requiring medical care are moved to a new location out of area, they go to the bottom of the waiting list, and as a result their health requirements are not met in a timely way. How will the Minister ensure that they do not slip back from receiving medical care that they urgently require?”
“I, too, call for the pause to transition into a ceasefire. What discussions have the Minister and the Foreign Secretary had about opening up corridors for humanitarian aid to cross between Israel and Gaza, in the light of the poor infrastructure in Gaza for moving humanitarian aid from the south to the north?”
“In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know— [ Interruption. ] It looks like the Minister is in some pain; perhaps he needs my physio skills.”
“I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment. I turn to diagnosis.”
“The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer. I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call.”
“We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that. I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.”
“I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke.”
“For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.”
“Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that. As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack.”
“I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.”
“Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that. Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity.”
“I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process. As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon.”
“If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be. I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.”
“Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function. If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training.”
“But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation. Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens?”
“Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism. This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time.”
“Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it. We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area? We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible.”
“Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about. We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%.”