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The Minister for Defence People and Veterans (Johnny Mercer)
It is a pleasure to speak under your leadership this morning, Mr Stringer.
I pay tribute to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for his interest and for the way he continually drives the debate. Clearly, I have a script that talks about all the stuff we are doing, but I want to answer some of the specific points that he has raised this morning. I am delighted that he shows such an interest in the subject. He will know that support for veterans was a driving force for me in coming to Parliament; I wanted to drive through change. I can honestly say to him that there a shift in strategy is under way in how we support armed forces veterans. For too long, colleagues in charities and in this House have asked the Government to step up and do more, and we are now starting to do that. I do not pretend for an instant that we have always got it right. That has led to some of the challenges that we face today, and I came into Government specifically to try to lead the change.
I want to challenge a couple of things that were said, and the first relates to the portrayal of veterans. There is no doubt that some of our people are extremely poorly because of what we have asked them to do over a number of years. I am acutely aware of that. The Prime Minister and I are acutely aware that the nation has a debt of gratitude to them that must be realised by more than words and ceremonies in Whitehall; it must be repaid by provision to look after them throughout life. It is important to me to challenge the portrayal of the problem as greater than it is. There is in the country undoubtedly a way of portraying veterans—exacerbated by the media and TV programmes—that suggests that military service or combat experience equal mental health problems. In reality, we all know that that is not so, and we cannot say that too much, because the problems that that view causes are significant. This week we are bringing in changes with respect to national insurance contributions, and that is important because although there are pretty good veterans programmes at big firms in cities, for people who can get access to those workplaces, sometimes when I have been to towns and cities someone from the CBI has stood up and said, “I can’t take the risk on a veteran.” They are worried about whether they will be off sick, and all the concomitant issues with service. We must be careful about the narrative that veterans are all broken. I would not advance this view if it were not true: the vast majority leave their service greatly enhanced by their time in the military. The reason I raise that is that is that if we do not get it right we will simply be unable to meet the challenge of those who are genuinely poorly and unwell because of what the nation asked them to do. I am committed to getting those people the help they deserve.
Bob Stewart
I support exactly what my good Friend the Minister is saying. I am backed up by other Members here, such as my hon. Friend the Member for Bracknell (James Sunderland). The vast majority of members of the armed forces go through their service and do not have a problem at the end of it—that is absolutely true; but please, Minister, give more resources to PTSD Resolution, because it deserves them.
Johnny Mercer
I thank my hon. Friend, who knows the impression he left on me in my formative journey into this place. I think that I am speaking for him at a dinner tonight, where we can take the matter further. I shall come on to the question of funds for specific charities in a minute.
Dr Murrison
The Minister is of course right that service in the armed forces is positive, generally speaking, in terms of mental health, and veterans probably have better mental health than a non-serving cohort would. However, does he agree that that slightly misses the point, because if PTSD is service-attributable, then in accordance with the military covenant and “no disadvantage” we have an obligation to do what we can to resolve any problems that may have been caused as a result of service? I pointed that out in my report, “Fighting Fit” about 10 years ago.
Johnny Mercer
My right hon. Friend is absolutely right to point out that it is no good sitting down with the widow of somebody who has taken their own life, or with their family, and saying, “Actually, statistically, we are in a pretty good place in this country when it comes to suicide.” The reality when it comes to figures and so on is that we are—the rate of suicide in the service community is eight in 100,000; in the civilian equivalent cohort it is 32 in 100,000. People who have served in the military are less likely to take their own life. However, he is absolutely right that each one of these suicides is a tragedy not only for the individual and their family, but for us as an institution, because we owe this unique debt of gratitude towards those who serve.[Official Report, 16 March 2020, Vol. 673, c. 6MC.]
We are beginning to really shift the debate. We have invested a lot of early money in data. We started from a very low point when it came to veterans’ data and data on suicide. We have put money into a cohort study, looking at 16,000 people from the beginning of the Iraq process through to where they are now. Clearly, most of them are civilians, but we are watching what happens in their lives, the cause of death if they die and so on. We are marrying that with an exercise in the MOD, going over the records of every individual who served who has died since 1991—almost three quarters of a million people —to have a look at the cause of death and the incidence rates. We have just signed the contract to give some money to the University of Manchester to look at cases in which veterans take their lives, to undertake a comprehensive study of the events in their life in the 12 months leading up to that, to answer the question whether we could or should have done anything more to intervene. I totally accept that the Government have not started from a strong start point when it comes to data around suicide and what we have done on it, but I want to make clear this morning that that is changing.
When it comes to this strategic shift in healthcare provision for our service people, I start by paying tribute to the service charities. They have done an amazing job—there are no two ways about that. When Combat Stress started, and throughout the period where mental health really was a Cinderella service—we talk now about winning that battle on the stigma of mental health, but 30 years ago that was not the case—Combat Stress held a candle for this stuff and was the only port in a storm. It has done an incredible job over the years.
However, for a long time Combat Stress and others have talked about the increasing presentation and understanding of mental health versus a decline in giving from the public. That has presented a unique challenge about what we do now. I am very clear, as is the Prime Minister, that that basic underlying mental health provision is owed to those people by this country and the NHS must step forward to provide that. With the problems with Combat Stress that have come to light recently, which everybody knows about, I have brought forward a third service to try to fill the mental health provision gap for our veterans. We have the complex treatment service, which was introduced last year and has been very successful, and we have the TIL—transition, intervention and liaison—service to speed up access to talking therapies and so on, but there is a requirement for a high-intensity service to look after some of our most poorly people on the NHS. I have brought that commissioning forward. The bidding process is going through now and in April I will be launching that. We will have those three services—CTS, the high-intensity service and TILS. That will be the framework through which this Government will see through their commitment to veterans on mental health.
The NHS requires people to deliver those services, and that is where the charities are absolutely critical. They have bid into the services and they are indeed running CTS and TILS in other parts of the country. We have had a lot of bids for high-intensity service. Those charities are going to go through a change as they fit in around this framework and leadership, which they have asked us for for a long time. The challenge then is to make sure that every single veteran and every service member in this country when they leave service knows about the programme of mental health care, so that they cannot honestly look me in the eye and say to me, “I did not know where to turn.” That is the challenge I am absolutely determined to meet. I will come on to talk about funding for that at the moment.
Jamie Stone
I accept the generous intent of the Minister’s remarks, and I thank him for that. It is worth making the point in passing that, if we could get this right and if the general public could see us getting it right, that in turn would surely help recruitment to our armed forces—something that is a real problem for all three services.
Johnny Mercer
The hon. Gentleman makes a good point. I come back to the point I made earlier: when this goes wrong, when we do not get this right, it is not only a tragedy for the individual and their families, but a tragedy for us as an institution if people come and give the best years of their lives, and we do not then have the follow-on care and so on that so many of them need.
I am confident that when we launch this service in April, it will provide the framework and the leadership that will bring in all the charities and all the brilliant little groups such as PTSD Resolution and others. They will fit in around this framework and deliver parts of the course. That is critical for the charities, because they will be able to focus on some things and not on others, but cognisant of the fact that that need is being met. There will be more long-term sustainability and contracts that they can enter into with the NHS that will give them financial stability. I am confident in 12 or 18 months’ time we will have a world-class offering for mental health for our veterans in this country.
When it comes to money, the Prime Minister is absolutely clear that we will provide the resources required to meet the demand. This healthcare model is the future of veterans’ care in this country. As he came into office, we saw a fundamental shift—this from someone who has irritated colleagues in this place over many years on this subject—towards this nation, particularly this place, being the ultimate guarantor of services for those who have served. It is not always the deliverer, but it is the guarantor.
Finally, we are going to get there with the programme. I am speaking at King’s College about it tomorrow and the formal launch is in April. I have a huge job of work to do to ensure that everybody in this country understands what it is, and I look forward to that challenge, but it is a team effort. This is not my mental healthcare plan. There are people who have done some amazing stuff in this field. All I am doing is bringing it together and providing that leadership, because that good stuff is there already. I genuinely think we are going to see a fundamental change in the next 12 to 18 months.
James Sunderland (Bracknell) (Con)
I thank the Minister for his comments and remarks—
James Sunderland
Thank you, Mr Stringer, and apologies for that. I was going to apologise for being late and not being here. I was at the Procedure Committee. My humble apologies. I know we are short of time, but I want to clarify with the Minister that there are an estimated 2.3 million veterans in the country at the moment and we have a fantastic framework already across the UK, through the armed forces champions and also through the fantastic civil military partnership boards. The framework is already there, but there is a bit of fine-tuning that we need to get this put into statute and therefore give the veterans the help they need.
Johnny Mercer
My hon. Friend is absolutely right that there are some areas in this country where mental health care works extremely well, and models of care that should be promulgated further and rolled out nationwide. The challenge is that we have perpetually judged ourselves by what we are putting into the machine in terms of money and organisation. We have an event in London and we say, “We are providing this for veterans’ mental health.”
The key for me is that the experience of being a veteran in this country in 2020 should be equalised across the country. Plymouth, where I come from, is a military city, so there are some wonderful relationships, and generally speaking someone’s chances of accessing good mental health care are pretty good, but that is not the same all over the country. That is why this kind of leadership in the centralised framework is so important. It is going to shift the dial on what we can present.
In closing, I come back to my initial remark: the vast majority of people leave genuinely enhanced by their service. If we do not have that conversation, my concern is that we will never meet the demand, because it is unrealistically inflated. No one wants to look after these people more than I do, or than anybody else here in this Chamber does, but we must have an honest conversation about it. I believe this structure will enable us to do that, and that we will have a very good service in the years ahead.
Question put and agreed to.