Oral Answers to Questions

Huw Merriman Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I recognise the very strong arguments my hon. Friend makes and the strong campaigning he does on behalf of his constituents. We are waiting for the final recommendations to come from his local CCG, but I agree that too often we have closed beds in the NHS when we do not have alternative capacity in the community, and we need to be very careful not to repeat that mistake.

[Huw Merriman (Bexhill and Battle) (Con)]

The cost of presenting with a minor ailment at a pharmacy is only 10% of the cost of presenting at A&E. What more can be done to help persuade those who present themselves to A&E that the pharmacy sector could be a better use of their time?

[Mr Hunt]

I entirely agree with my hon. Friend on that. Despite the current debates, the pharmacy sector has a very bright future, and we have set up a £40 million integration fund precisely to help pharmacists to play more of a role in the NHS and, in particular, to reduce pressure on A&Es.

Oral Answers to Questions

Huw Merriman Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

We have committed, and the Prime Minister affirmed the commitment only last month, to spend £1 billion more every year on mental health services, but we recognise that it is not just about money. It is also about having a proper suicide prevention plan—we have updated the plan—and making sure that, across the NHS, we properly investigate and learn from avoidable deaths. That is why, following the tragedy of what happened at Southern Health, we have now started a big new programme—the first of its kind in the world—whereby every trust will publish its number of avoidable deaths quarterly.

[Huw Merriman (Bexhill and Battle) (Con)]

21. A year ago, East Sussex Healthcare NHS Trust was rated inadequate. Thanks to the hard work, dedication and care of all its staff, the hospitals are now good on many measures, albeit further improvements need to be made. Will the Secretary of State join me in thanking the staff? Does he agree that we need to talk up our successes, as well as recognising challenges?

[Mr Hunt]

I join my hon. Friend in doing that. It is really important, contrary to what the former shadow Health Secretary, the hon. Member for Lewisham East (Heidi Alexander), says, that we praise NHS staff when they do remarkable things. There is a lot of pressure everywhere in the NHS, and praising NHS staff is not being self-congratulatory; it is recognising when a good job is being done.

NHS and Social Care Funding

Huw Merriman Excerpts

Wednesday 11th January 2017 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

We need to look afresh at the entire health and social care pathway, which is why I am delighted to be able to contribute today. From visiting the pharmacist, to attending a GP appointment, to spending time in hospital, whether planned or through A&E, to being able to reside beforehand and afterwards at home or in a care home, we need to find the most efficient and dignified way to treat and look after people. We must avoid using one treatment centre as a default option—that is not the best option either for the individual or for the public purse—because it is the only one available owing to difficulties with individual funding pots, opening hours or lack of access to better forms of provision. We must also be encouraged to speak freely about the pressures in the system and to provide ideas. It has frustrated me for years that anyone who thinks aloud about ideas that could change health and social care for the better is denigrated as seeking to harm it when the opposite is true.

To that end, I listened with interest to the Secretary of State’s interview on Radio 4 on Monday morning. It struck me as measured and thoughtful about new ideas. I was particularly interested in the suggestion about how we could deliver more capacity in the GP system, because an increasing number of people attending A&E are neither accident victims nor in need of emergency treatment; they do, however, need some form of medical intervention, as the Secretary of State mentioned. It was then thoroughly depressing to read the Secretary of State’s words taken out of context. I hope that he will continue to think outside the box and that all Members will recognise the benefits of his so doing.

Speaking of ideas, I have the following suggestions for each of the treatment centres in the health pathway, starting with pharmacies. In the event that we have too many pharmacy clusters, I completely agree with the need to ensure that they are spread out across the country, with the money saved being recycled. At the same time, we should find ways to help pharmacies deliver more interventions to free up capacity at GP surgeries. We must do more to signpost patients to pharmacies before they go to their GP. A recent report costed common ailment treatment in community pharmacies at £29 a patient. The cost rises to £82 for GP practices and to £147 for A&E. Treatment results across all three were equally good. The research estimated that 5% of GP consultations for common ailments could be managed by community pharmacies, equating to more than 18 million GP consultations that could be diverted.

I was buoyed by the Secretary of State’s suggestion that more GPs should be placed in A&E departments and in care homes. The new NHS pilot requiring GPs to undertake weekly ward rounds in care homes is the right type of thinking to prevent emergency treatment in our hospitals. I welcome GP surgeries opening on Sundays, but surely only one surgery in each area needs to be open. I do not believe that having all GP surgeries open seven days a week is a good use of scarce resources, in the same way that Government funding of two pharmacies across the road from each other is not a good use of such resources.

I have long taken the view that we need to find ways to free up our GPs’ time, so that they can focus on the patients who need them most. There are too many wasted or cancelled appointments because the service is free. If there was a cost to unjustifiably failing to keep an appointment, it may demonstrate how precious this resource is—just as NHS dentists would charge for a missed appointment when I was younger.

Some of the reforms of pharmacies and GPs are designed to ensure that patients only attend A&E if they have had an accident or in an emergency, which is clearly not the case for some who are now attending. We are also facing demand for hospital places because of a need to reform the way we look after an ageing population.

Time does not allow me to talk about social care, which is so important in my constituency, but the Government’s delivery of more social care funding before Christmas is welcome. However, it is crucial that we question the operating model in social care. The NHS benefits from a national funding programme, but social care is largely the responsibility of local authorities and local rate payers in areas where retirement rates may be high but employment and council tax receipts are not. We have to think radically to ensure that we get the best out of our health and social care system. To do so will not only make resources stretch further but will deliver innovation that improves the lives of the sick and infirm, who are most in need of our care.

Social Care

Huw Merriman Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.

[Huw Merriman (Bexhill and Battle) (Con)]

I am grateful that my right hon. Friend has mentioned the CQC and also touched on wages. When I met the south-east director of the CQC, it was clear that there is an issue of staff not being paid properly and then moving around the care home sector for a small amount of extra money, which is vital to them. Does my right hon. Friend agree that the living wage will stop that occurring and result in more people staying in jobs for longer?

[Mr Hunt]

That is a very important point. We have heard suggestions that the Government have been about words, not action, but the national living wage will do an enormous amount to help keep people in jobs for longer and help them to start to think about their jobs as a career, with potential progression into other parts of the health and care system, such as nursing. I commend my hon. Friend for the work that he does on this in Sussex.

--- Later in debate ---

[Huw Merriman (Bexhill and Battle) (Con)]

My constituency has one of the highest rates of over-65-year-olds. They comprise 28% of my constituents, compared with the national average of just 17%. Indeed, the town of Bexhill has more 85-year-olds per head of population than any other part of the UK. Given those statistics, adult social care is a key driver in the success of our local public services. Not only is it directly relevant to the wellbeing of many of my elderly constituents, but it determines the ability of all my constituents to gain rapid access to their hospital and GP. It also determines the amount of money that is diverted away from other local public services, such as education and transport.

I want to touch on two issues where there is more to do to improve social care. First, of 35 care homes in my constituency that have been rated by the CQC, none has been rated outstanding and only six have been rated good. The remainder require improvement or are inadequate, and they have six months to turn performance around or they may be closed. If our local schools were failing in the same way, there would be outrage. That our often vulnerable residents, who are often without a voice, are being subject to that standard is a national disgrace that I do not believe should be tolerated, and I welcome the Government’s tougher approach to the inspection regime.

Having met the CQC to get behind the reason for the failure of those inspections, I believe that much of it is down to the design of care home buildings, many of which, because of their age, cannot easily be adapted from traditional residential homes for the elderly into modern care facilities. More people can use technology to enable them to stay in their own homes, so care homes tend to have a higher proportion of patients who have complex health needs.

Many homes are failing CQC inspections because they cannot demonstrate that they can evacuate residents in an emergency, and they do not have the right spatial design to keep residents active and engaged. The state of our care homes means that not only do residents not have the best wellbeing, but when individuals have to stay in hospital, authorities may be unable to discharge them back to care homes because no places are available if those homes are failing the inspection regime and are thus out of bounds. That leads to bed shortages in hospitals and to expensive longer stays.

There is an alternative. I recently attended the opening of a new state-of-the-art apartment block in Bexhill that offers shared ownership and rentals to the over-60s, some of whom are local authority-supported. Residents live independently and share in-house restaurants and amenities, which are also open to the public. For younger residents, it feels like any other smart apartment block with its mod cons. Crucially, however, the building offers facilities and care packages, so that as residents get older, they can access care but remain in their apartments. They can arrive at 60, and the design allows them to remain there for life. It is an excellent model for the future, but it was possible only because our county and district councils provided land and funding for our amazing housing association, AmicusHorizon, to build out.

Across our constituencies, land is being developed for housing. Every developer is required to provide infrastructure such as schools, GP surgeries and other public amenities. Care homes are private businesses, however, so there is no requirement to provide them. Since 50% of our care home patients are funded by the state, I suggest to Ministers that they fold in a requirement for developers to provide land or section 106 moneys to enable housing authorities and care companies to deliver the innovative new accommodation that will take people to their last days. Such accommodation should be part of the design as much as a school or a GP surgery is.

The second issue pertains to the joining up of our NHS and local authority social care providers. Much has been made of sustainability and transformation plans and of integrating adult social care and clinical care. I therefore congratulate East Sussex County Council and our NHS team in East Sussex, which have recognised that the £200 million of savings required from the STP and the delivery of a better care package can be better achieved if they join up and work together. Their “Better Together” project is designed, in their words, to

“spend £850m wisely, not saving £200m badly.”

To deliver that programme, our local team is implementing a single point for health professionals to access support, integrating social and community care under one management structure, offering frailty practitioner support for the over-75s for early intervention and putting prevention teams together for high-risk members of our community. The results thus far have being encouraging for adult social care: the number of clients going under early intervention watch has increased by 20%; early intervention has kept people out of hospital; 77% of clients have remained at home following early intervention; and there has been a notable reduction in the number of falls. I highlight those issues because they are key drivers for the improvement of social care.

The delivery by the Government of an extra £3.5 billion is welcome. However, it is crucial that we question the operating model in social care. To do so will not only make resources stretch further, but deliver the ideas and innovation that will improve the lives of those who rely on social care in their latter years.

Community Pharmacies

Huw Merriman Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is right, and Government Ministers, including the Health Secretary even on Monday, justify these as part of a package of efficiencies. Indeed when I raised this a few months ago with the previous Minister, the right hon. Member for North East Bedfordshire, he told me in correspondence that these cuts were necessary as part of delivering the £22 billion-worth of efficiency savings. So this is more proof that when they talk of efficiency savings, they are actually talking of cuts to frontline services.

[Huw Merriman (Bexhill and Battle) (Con)]

rose—

[Jonathan Ashworth]

I am sorry, but I need to make progress.

The NHS is going through the worst financial crisis in its 68-year history. Even the previous Health Secretary, who is now in the other place, said he did not expect another five years of such tight budgets for the NHS.

The black hole in hospital finances last year was £2.45 billion. Under Labour, we spent the European average on health as a proportion of GDP; we are now spending less than Greece. We are seeing a huge financial squeeze on the NHS and the cuts are part of that squeeze agenda.

We want the Government to think again on the cuts, because they will lead to more pressures on GP surgeries and A&E departments. There is a consensus not just among the Labour party, but among our constituents, the sector, clinicians and indeed Conservative Members against the cuts. It is Ministers who stand outside that consensus. The hon. Member for Stevenage (Stephen McPartland) has said:

“It does not make sense that we are encouraging pharmacies to take on a bigger role in the NHS, while potentially reducing the number of them.”

The right hon. Member for Broxtowe (Anna Soubry) has said:

“I do not think this 4% cut is a wise move.”—[Official Report, 20 October 2016; Vol. 615, c. 974.]

The hon. Member for Colne Valley (Jason McCartney) said

“when our A&Es are under so much pressure, we need community pharmacies”.—[Official Report, 17 October 2016; Vol. 615, c. 598.]

I agree and our message to Conservative Members who want to stand up for their constituents and who have been lobbied by pharmacists is, “Join us in the Division Lobbies and get Ministers to think again on these damaging cuts.” I commend the motion to the House.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I beg to move an amendment, to leave out from “NHS services” to the end of the Question and add:

“welcomes the Government’s proposals to further integrate community pharmacy into the NHS, including through the Pharmacy Integration Fund, and make better use of pharmacists’ clinical expertise, including investing £112 million to deliver a further 1,500 pharmacists in general practice by 2020; supports the need to reform the funding system to ensure better value for the taxpayer; and welcomes the establishment of a Pharmacy Access Scheme which will ensure all patients in all parts of the country continue to enjoy good access to a local community pharmacy.”.

I welcome the opportunity to set out again the Government’s approach to pharmacy in general and community pharmacy in particular over the next few years. I will also address some of the points that we just heard, which were, frankly, alarmist scare-mongering.

The proposals I announced two weeks ago are directed at four main areas: first, the need to better integrate pharmacy with GPs, primary care and the NHS more widely; secondly, the need for the existing community pharmacy network to move from a dispensing-based model to a value-added services-based model; thirdly, the need to continue to work with NHS England to ensure value for every penny we spend on the NHS; and fourthly, the need to ensure that, as we undertake these reforms, everybody in the country continues to have ready access to a community pharmacy.

First, on integration with the NHS, especially in general practice, over the weekend Simon Stevens, the NHS England chief executive, again reiterated the importance of that and why he supports this process. We know we need to expand the number of GPs, and by 2020 we will have a further 5,000 doctors working in this area, but as well as recruiting and retaining more doctors, we need to provide them with further support. The “General Practice Forward View”, published by NHS England, has set out fully costed plans to recruit a further 1,500 clinical pharmacists into GP practices by 2020. By then there will be one pharmacist working within a GP practice for every 30,000 of population. Most of these will be prescribing pharmacists, and all will have a role in performing medicine reviews and leveraging GP time. This is a major investment and it is already happening.

[Huw Merriman]

The point I wanted to make when trying to intervene on the hon. Member for Leicester South (Jonathan Ashworth) was that I recently went to a pharmacy in my town of Bexhill, and it is making deliveries to every single customer who asks for a delivery, not just the vulnerable and the elderly. It does so because if it did not Lloyds would put it out of business. Does the Minister agree that that shows that there are efficiencies to be made, and the fact that those efficiencies are recycled in the health service has got to be good for all our constituents?

[David Mowat]

It does show that. This is a competitive business. My hon. Friend mentions Lloyds; it is one of the two big players in this industry, in which two players own 30% of all pharmacies.

Young People’s Mental Health

Huw Merriman Excerpts

Thursday 27th October 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

It is a great pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I hope I have got that correct.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It is pronounced “Stray-ven and Lez-ma-hay-go”.

[Huw Merriman]

Thank you, Madam Deputy Speaker. I am suitably corrected and admonished at the same time. I am glad that you did not ask me to repeat that after you.

I particularly applaud the point that has been made about making this a cross-party matter on which we can all work together. As the young people have shown us in their fantastic report, working together will help to ensure that all voices are heard and recognised.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes)—her constituency is much easier for me to pronounce—for sponsoring the debate. I apologise for going back and forth from the Chamber, and perhaps I may explain to those who are watching why there are so few MPs on the Benches. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said that it would be good to hold such debates during Government time, when Members may not be in their constituencies. Of course, Thursday afternoon is also a time when Bill Committees sit, so Government and Opposition Members are required to attend those Committees. I hasten to add that I should also be in a Bill Committee, but I was so determined to speak on this matter that I have come to the Chamber. It is probably for that reason that I will always be asking Ministers for more from the Back Benches, rather than being on the Front Bench and able to deliver those things myself.

I commend the 2015 Youth Select Committee report, and I particularly applaud the 90,000 young people—many more took part in the vote—who voted that mental health services for young people should be the priority concern. They are absolutely right to focus on this subject, and I submit that they are in the best position to give their opinion on it.

I similarly decided that the subject would be a chief priority for me when I was elected as an MP in East Sussex 18 months ago. The severity of this issue, particularly among young people, became all too apparent to me. I found—I still do—the stories of carefree, confident and happy lives being shut down as young people enter a dark world of fear, anxiety and isolation to be incredibly upsetting.

As a result of my concern, I chose this issue as the topic of my question when my name was first pulled out of the hat for Prime Minister’s questions. I told the then Prime Minister that I had spent an afternoon in the small town of Battle in my constituency visiting three families, each of whom had a child who had not been given the early-stage intervention that they expected from the child and adolescent mental health services. I asked the Prime Minister for more focus on early-stage treatment so that young people’s conditions do not become more acute.

Providing such services is not only our civic duty, but an economic and social imperative. When my constituents ask me why the roads in East Sussex are in a state, I explain that I recently secured £250,000 from our county team to fund just one year of acute mental health treatment for one constituent. Fixing people has to come before fixing holes in the tarmac. The phenomenon may not have existed so openly when many of my constituents were younger, but it is now a huge financial concern to my county council colleagues.

I firmly believe that too much pressure is being loaded on to people too young. Social media and the internet, as pioneering as they are, are a curse on wellbeing, and internet service providers must be forced to do more. Every young person should have the right to have their web history expunged. Cyber-bullying is at last being recognised as a crime, but every school must ensure that its pupils are aware of good internet practice and the sanctions for abuse. We also need to be aware that young people and children are accessing graphic images and media on the internet that they cannot understand, process or cope with.

In the report’s consideration of education, I absolutely commend the recommendation

“that the Government develop and introduce statutory levels of attainment for mental health education…Schools should have autonomy to deliver mental health education flexibly but must be able to demonstrate how pupils reach the attainment levels.”

May I suggest that in so doing the Government should ensure that the curriculum combines a consideration of social media and the internet with wellbeing training?

We also need training for our GPs. The situation is summed up perfectly by the experience of a young person that is detailed in paragraph 32 of the excellent report. It is essential that the GP does not diagnose a mental health condition, but merely refers the young person to a specialist. I know that mental health specialists find it frustrating if GPs diagnose a mental health condition when the specialist does not regard it as such. Once that badge is given to someone, it is difficult to remove it. Equally, brilliant local GPs, such as those in Battle who have helped my constituents in their surgeries, have championed young people and become their advocate. They are incredibly frustrated by the delay in early intervention in mental health services. I work closely with my local CAMHS team, and I have the highest regard for the many excellent specialists who do their best. However, I am worried that constituents face lengthy waiting times and that some have been passed from pillar to post when receiving treatment.

Building up trust is a key ingredient of successful diagnosis and treatment. I hear stories about young people finding the courage and trust to open up about their condition, only to find a new practitioner at the subsequent session. It disappoints me that the young person can then regress because of that change of personnel. I would like a commitment to giving treatment on a fixed one-to-one basis. If we can do that for maternity provision, surely we can do it for mental health treatment.

When I attended the launch of the mental health taskforce, I was buoyed by the commitment of the then Minister and the chief executive of NHS England to implement the excellent “Five Year Forward View”. I was cheered by the commitment to funds to ensure that our acute hospitals have adequate mental health expertise on A&E wards to deal with those who are hospitalised as a result of mental health issues, or who have such a condition in addition to a physical illness.

My concern was driven by the experience of a family in my constituency following a suicide attempt. The NHS staff did not have the ability to deal with the mental health condition, and my constituent, a young man in his teens, was forced to wait until CAMHS staff could make their way over from another town miles away. I understand the need for specialist treatment, but it strikes me that there is a need for a culture change across the entire NHS, and that all staff should be trained to understand mental health and provide a basic level of treatment. Specialisation in health is important, but if the NHS becomes over-specialised, it can lead to a lack of general involvement in such care for patients.

I welcome the news that the Government will fund 24/7 mental health provision in our hospitals, but I was alarmed at the suggestion by the chief executive of my local trust that the funding may not stretch far enough. I also want to ensure that that specific coverage will not mean that other NHS staff with the necessary technical understanding and empathy will feel that they are not empowered to assist those many hospital patients who need help with their mental healthcare, in addition to their physical wellbeing.

Ultimately, getting early-stage intervention right is a key part of achieving a proper diagnosis for people with a mental health condition. We should not misdiagnose young people who are suffering growing pains and need the coaching and guidance of family and friends to overcome the problems of adolescence. However, I have met too many young children who face a difficult future because their mental health condition was not treated at an early stage. Funding mental health treatment is a most important investment, not only for people’s welfare and wellbeing, but to enable these amazing young people to fulfil their hopes and dreams in their careers, and to make something of themselves and their country.

I applaud the amazing work of all of those in the British Youth Council, many of whom live in my county of East Sussex, who have done so much to produce this excellent report. Those young people are leading the charge to ensure that the nation supports all those who are affected by this terrible condition. We owe it to them, and to all young people, to deliver a better mental health service, and many of the report’s recommendations will do just that.

--- Later in debate ---

[Wes Streeting]

It really does. One of the things that concerns me most about young people’s poor experience of mental health services—this was reflected at the discussion by the all-party group—is that it is not just GPs and headteachers who recognise that young people are being failed and turned away; young people themselves recognise that. I cannot imagine what it must be like to be a young person who is suffering from anxiety, depression or another form of mental ill health, who knows they have a problem, seeks help and is left to feel ignored, dismissed and unsupported. I have mentioned the proportion of lesbian, gay and bisexual young people who are affected, and it is even higher for trans young people.

I represent a constituency that is highly diverse ethnically and religiously. It worries me that Asian communities seem to be far less likely to seek access to mental health services. There is a job to do there to tackle stigma and to make the services more accessible. People from African-Caribbean communities face inequality. The failures of public policy on African-Caribbean people should shame our country. It is a further indictment that the majority of African-Caribbean people who come into contact with the mental health system seem to do so through the criminal justice system. That is a terrible state of affairs. Therefore, the issue of access and support is crucial if we are to deal with the problem.

This is partly about funding. We have had a good-natured debate this afternoon, so I do not say this to be objectionable or churlish, but on Wednesday, three or four Members on both sides of the House raised the issue of mental health with the Prime Minister, and her response was, to put it politely, inadequate. Beyond general statements about parity of esteem, she seemed unable to point to any meaningful actions her Government were taking on the issue of mental health.

I am sure that the Minister has come better briefed this afternoon, but the Prime Minister also needs to make this a priority. Much of this is about joined-up government—this will be a theme of mine this afternoon—and that requires leadership from the centre. It is not good enough for the Prime Minister to be sure-footed, although wrong-headed, when it comes to home affairs issues, but completely blind-sided on issues outside her comfort zone. We need stronger leadership on mental health from her and I was genuinely disappointed with what we saw during Prime Minister’s questions this week.

Parity of esteem is not about sentiment—it is about resources. About 11% of the NHS budget is spent on mental health and just 6.36% of that 11% is spent on children’s mental health. I recognise that the Government have made a commitment to invest £1.4 billion in child mental health in the next five years, and I welcome that, but I urge the Government to ensure that that funding is delivered sooner rather than later. Locally—other Members have referred to this—budgets are being cut or frozen in three in four mental health trusts. Seven in 10 CCGs and local authorities are freezing their budgets because of pressures from central Government reductions. My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) has, through written parliamentary questions, highlighted that decisions coming down the track will make that picture even worse.

In the London Borough of Redbridge, the council is doing fantastic work with limited resources. However, I can say from first-hand experience—I declare an interest as an elected member of the council—that local government cuts are biting. The picture is compounded by the state of our local health economy. Both our NHS trusts are in special measures, although I hope one of them will be leaving special measures sooner rather than later. I hope that they will both leave, but I suspect one is nearer to the end of that journey than the other. Primary care is creaking, it is fair to say that our clinical commissioning group is struggling, and our community health trust has a rating that requires improvement. The challenge for Redbridge is not simply the funding reductions that affect my borough, but the fact that the funding formula does not lead to a settlement for Redbridge—for the local authority and for the wider health economy—that genuinely reflects the needs of our population. I urge the Minister to look carefully at how Redbridge has been disadvantaged through the funding formula, particularly in public health funding, and at what can be done.

[Huw Merriman]

I do not wish to get into a skirmish on funding, but does the hon. Gentleman agree that, as in my area of East Sussex, the way to find the efficiency savings that the NHS is required to make, in addition to the £10 billion that this Government have put in, is to have a “better together” organisation so that hospitals and all the other healthcare providers—at county level and so on—can talk together? That would not only save money, but mean that everyone is joined up, which is the way forward on such issues, as he has rightly said.

[Wes Streeting]

I very much welcome the hon. Gentleman’s intervention. He has anticipated some of my closing remarks about looking to the future. I will have some positive words to say about the direction of Government policy in that respect.

This issue is not simply about funding, but about leadership and accountability. I must say that the damning CQC report on the Brookside unit in the constituency of my hon. Friend the Member for Ilford South (Mike Gapes) has more than raised eyebrows. Some of its judgments about this facility for children’s mental health provision were:

“The ward environments were not safe, clean or suited to the care of children and young people… The wards were not adequately staffed… There was a high usage of restraint and rapid tranquilisation at the unit… The ethos of the unit was containment rather than therapy… Care plans reviewed were not recovery orientated and more behaviour orientated… During the inspection we saw staff refuse to facilitate the requests of young people… Young people stated the food was of poor quality and cultural and religious foods were not available”—

and those who know the London Borough of Redbridge will know how totally inappropriate that is. My question for the North East London NHS Foundation Trust is very simple: why did it take a damning inspection by the Care Quality Commission for sufficient action to be taken? From what I can see and from my conversations with colleagues in the local authority, there is clearly a road to improvement. It should not take inspectors coming in to highlight the fact that we have failed some of our most vulnerable young people in such a gross and unforgivable way.

Among my worst experiences as a constituency MP—these are universally my worst experiences—are in my surgeries on Friday afternoons when I see absolutely awful cases of people who have been very badly failed by public services. One case I will never forget was that of Simon Harris, a young man—he was 30 years old—who was failed by Goodmayes hospital because he was insufficiently cared for. While under the care of the NHS, he was allowed to take his own life, although he was in the very place that his family thought would keep him safe. I never again want to have a conversation with a constituent like the one I had with his incredibly stoic and courageous grandmother, Brenda. That is the consequence of mental health failure: it is simply the difference between life and death. I do not think that young people like Simon should ever be failed in such a way by the services that are there to keep them safe and well.

This subject is not just about public service provision, but about celebrating the work done by the voluntary sector. In the past year, I have visited a number of programmes in my constituency. I have visited Audacious Veg, a social enterprise that involves helping people suffering from mental ill health to set up their own social enterprise, growing and selling vegetables. This wonderful project runs in conjunction with the Forest Farm Peace Garden, another environmental and sustainability project, which gets people with mental ill health outside, interacting with others and active.

I cannot commend strongly enough to the Minister the importance of social prescribing. Here, public policy has a role to play. When Redbridge Youth Council, for example, commissioned the Redbridge Drama Centre to design and deliver a play on mental health to reach young people, 5,000 young people and counting across the London Borough of Redbridge were reached by that fantastic way of engaging young people in conversations about mental health.

Music can play a powerful role in therapy, as can sport. One of the most impressive projects I have visited in the past 12 months was Coping With Football, sponsored by the London Playing Fields Foundation and run in conjunction with the North East London Foundation Trust. Again, that project got young people outside, interacting and developing their skills and, most importantly, their self-esteem.

That brings me on to looking to the future, and I will press the Minister to take policy in a few directions. I have asked her to look at Redbridge’s funding formula, on public health in particular, and I hope she will undertake to do so. I also ask her to work with her colleagues in Government to think about funding nationally. The hon. Member for Bexhill and Battle talked about the value of joining up services locally, in particular local government and the NHS. I commend the approach being taken by the Government through the introduction of the accountable care organisations. In the pilot with Redbridge, the London Borough of Barking and Dagenham and the London Borough of Havering, that approach is bringing the local authority together with stakeholders from across the local health economy to join up public service provision. That will bear fruit.

We also need joined-up Government nationally, however. Other Members have made a compelling case for the Minister to fight her corner in public health, because investment in public health and early intervention is a money saver—and not just across Government; within her own Department we can reduce A&E admissions and the pressure on urgent and primary care if we get public health funding right.

The Minister also needs to make the case, along with the Secretary of State, across Government. For example, it is no good the Treasury making cuts to local government if that leads to cuts in public health funding and undermines the work of the Department of Health. It is no use cutting mental health provision if that leads to a spike in crime, an increase in the prison population and greater demand on the criminal justice system.

In education, it is no good asking Ofsted to inspect schools on mental health provision if school referrals to CAMHS are going unheard. We need to make sure the services are there to support schools. We also cannot continue with the postcode lottery on sex and relationships education and personal, social and health education. I hope we can revisit the issue of compulsory SRE and PSHE.

Finally, and most importantly—it is the reason we are here this afternoon—I urge the Minister and her colleagues in Government to listen to young people. That she is here this afternoon shows the importance the Government place on this report and the views of young people. My hon. Friend the Member for Dulwich and West Norwood talked about the importance of co-production and involving young people in the design of public services, and that is absolutely critical. But the Youth Select Committee has made a whole series of other recommendations that deserve not just the serious attention of this House but the response of Government. If that happens, we will get better public policy, and, I hope, we will have a generation of young people whose voices have not just been heard but, most importantly, listened to.

Junior Doctors Contract

Huw Merriman Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

The way patients have suffered—there have been over 20,000 cancelled operations during this process—has been very disappointing. My hon. Friend is absolutely right to campaign on issues of hygiene and cleanliness, which lead to so many tragedies when they are not properly attended to. I hope we can move on now. I do believe that, despite the disappointing rejection of this deal in the ballot, some trust has been established between the leaders of the BMA and the Government, and we have had a productive dialogue. We have made a number of changes to the May contract since announcing it—things that they suggested and that we agreed to. I would like to continue that process and build that trust.

[Huw Merriman (Bexhill and Battle) (Con)]

Having been somewhat of a burden on the NHS myself over the months as a result of playing football—unsuccessfully—with the hon. Member for Ellesmere Port and Neston (Justin Madders) in December, I spent an hour on the day of the all-out strike talking to the junior doctors who treated me. They asked me if I could tell the Secretary of State and the BMA that there is a need and a desire for more talks. May I thank the Secretary of State for showing flexibility? He does a difficult job extremely well, and it is appreciated on the Government Benches. I am absolutely saddened that a deal on this contract has not been brokered in the way we thought it would in May. Will he ensure that those junior doctors who move on to this contract are made well aware of how unpopular the previous contract was in the medical profession and that this contract’s terms are well sold so that junior doctors are reassured about them?

[Mr Hunt]

I am more than happy to do that. I think that the vast majority of junior doctors think that what has happened is a tragedy and are keen to move on. I hope they take seriously my assurances this afternoon that we will be monitoring every stage of the implementation of this contract, and if there are further things that we can improve, we will do exactly that, because we want a contract that is good for them and good for patients.

Carers

Huw Merriman Excerpts

Thursday 9th June 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate. I thank my hon. Friend the Member for Eastleigh (Mims Davies) not only for securing the debate, but for bringing to the Chamber her powerful experiences and sharing them with us. I also want to thank the Minister for all that he does to ensure that carers are given the support they need and deserve.

I want to sign up to the suggestion made by my hon. Friend the Member for Chippenham (Michelle Donelan) that we should extend the pupil premium to all young carers. There are 160,000 young carers whose life chances are disadvantaged by the amazing duty that they perform. Extending the pupil premium to all those young people seems to me to be a very fair exchange for all that they do.

Looking at the other end of the age spectrum, 28% of my constituents in Bexhill and Battle are over 65. By comparison, the national average is 17%. Accordingly, I have a very high number of older carers in my constituency. That is what I want to focus my contribution on today. The 2011 census revealed that there are over 1.8 million carers aged 60 and over in England—almost 16% of the population in that age range. The number of carers aged 85 and over grew by 128% in the past decade, according to a report published last year by Carers UK and Age UK, and it is expected to double over the next 20 years, according to a Government report from 2014.

East Sussex has the highest proportion of over-85s in the UK. Again, that group will be highly pertinent to my constituency. Supporting this army of carers is absolutely essential if we are to ensure that our NHS continues to function. Given the Government’s welcome desire to support keeping people at home in their advancing years, rather than placing them in hospital, that support is even more important. I welcome the passing, by this Government when in coalition, of the Care Act 2014. The Act granted significant new rights to carers in England and placed duties on local authorities to ensure that support is delivered, advice is given and information is provided. It also placed a duty on NHS bodies to co-operate with local authorities in delivering Care Act functions, which, if the clinical commissioning groups in East Sussex can work as a whole, will lead to a “Better Together” integrated health system in East Sussex.

I am conscious that the delivery of those rights is contingent on local authorities having the necessary financial resources in place. I welcome the devolution of business rates to my county, but the yield in East Sussex is low and the demands from a population with above-average ageing is high. Our county will need more time to deliver and more investment in infrastructure to attract new businesses to the coast if this is going to provide for carers and other groups who need local authority finance and support.

I welcome the new 2% levy that local authorities can apply to council tax, provided that it is spent on adult social care. While I champion the rights of carers within the home, many carers are caring for loved ones who reside in care homes due to complex or advanced needs. It is absolutely essential that those carers have the comfort of knowing that their loved ones will be well cared for when they are not in the home to deliver it. I have championed the care home industry, which features heavily in my constituency. Funding them properly via the new 2% levy will, I hope, result in better Care Quality Commission ratings than those that have been awarded following recent investigations.

Across East Sussex, 60% of our care homes were found to be inadequate or needing improvement. It concerns me greatly that, because of these poor ratings, many of our carers may choose to soldier on at home when a care home would be the better choice for their loved ones. All the care homes that I have visited in my constituency have been fantastic. It is important that those that need to improve do so with the extra funding that the Government have procured.

In a rural constituency such as mine, social isolation can be a particular concern. This is exacerbated for older carers looking after loved ones. According to a report published in 2011, more than two thirds of older carers reported not getting breaks away from caring at all, with a further third getting a break only once every two or three months, or less. Let me therefore take this opportunity to thank all those constituents who do so much to give carers a break. While I am at it, let me name-check my mother and my two sisters, who regularly host teas at home attended by carers who do not get the chance to get out of the house and get looked after by someone else for a change. While it is right to look to the Government to be the ultimate support, very often it is the community and their acts of kindness, via visits, conversations, moral support and basic errands, who improve the welfare and wellbeing of our elderly carers. I salute all those who do it.

I am keen for the Government to look at the following suggestions that were made to me by the fantastic Care for the Carers team in East Sussex. First, we should help national partners reach more carers. Would it be possible to make it a duty for the NHS to identify carers, in the same way that the Care Act does for local authorities? Secondly, we should ensure that carers have good support. Would it be possible to ensure that local authorities do not charge carers for the support that they are entitled to? East Sussex is currently not charging carers, which I recognise and celebrate.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the hon. Gentleman for his point about the NHS having a duty to identify carers. I have tried three times to introduce that in a private Member’s Bill, so I am really pleased to find support for it among Conservative Members.

[Huw Merriman]

I am pleased, as a novice in the House, that there is agreement across the House on that cause.

Thirdly, there should be help for carers in complex situations—those caring for people with dementia or mental health problems. It seems to me to be an obvious ask to promote good practice recommendations to commissioners and health professionals and to promote it in national policy making.

Finally, I thank and express huge admiration for all those who care for others in my constituency and beyond. I know that they seek little praise, but it is right that we should praise them this afternoon.

Defending Public Services

Huw Merriman Excerpts

Monday 23rd May 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield) in this debate on the Queen’s Speech. In the time afforded to me, I want to focus on the defence of three key public services—the NHS, schools and the BBC.

On the first, 28% of my constituents in Bexhill and Battle are over the age of 65, versus a national average of 17%. There are forecasts that the national average will reach 25% by 2050, which is a cause for great celebration. However, as a result of an ageing population, my constituency has the highest rate of dementia in mainland Britain. East Sussex has the highest percentage of over-90s in the UK, and is predicted to be able to make the same claim for the over-75s and the over-85s in the years to come. Accordingly, the state of the NHS is of particular importance to my constituents—not just those who rely on it in their older age, but those who need to access it across the age spectrum.

I have ruptured, and this week re-ruptured, my Achilles tendon, so I have been something of a drain on NHS resources. It has, however, given me the opportunity to witness, at first hand, the NHS and the first-class people who work in it. I want to say a huge thank you to every clinician and employee for what they do for my constituents. Their clinical expertise, dedication and care make me incredibly proud to be British and equally determined that we should listen to their ideas for and concerns about the NHS.

The decision by our junior doctors to call the first ever all-out strike was a deeply depressing outcome of the breakdown of the contract negotiation. On the day of the strike, I went to the picket line to meet the junior doctors who had looked after me following my first Achilles tendon rupture. I spent an hour listening to the concerns of those junior doctors. Some concerns were linked to their personal circumstances and their feeling that it was unfair, in their position, to have only the same rights as a fixed-term employee when it came to the unilateral imposition of contract terms. Other concerns were about their workplace and their ability to do their best in the face of increased demand from patients.

On that day, I was asked whether I would write to the leader of the BMA and the Secretary of State for Health and pass on those junior doctors’ desire for talks to resume and a negotiated settlement to be reached. I duly did so and was delighted when talks were subsequently held and a resolution was reached. I hope that the junior doctors will consider the settlement negotiated by the BMA a fair compromise that is worthy of acceptance, and I thank the Secretary of State for going the extra mile.

It is clear to me that, once the contract is finally negotiated, we should have a grown-up debate about the future of the NHS. Can we expect it to meet the needs of an ageing population, carry on purchasing ever more expensive drugs, deliver innovative treatment and cope with an increasingly obese population when we as a nation only put 8% of GDP towards health? In the French and German model, it is 11% of GDP. Inflationary patient demands on the NHS equate to a 4% increase per annum, yet the increase in spending, welcome as it is, is running at 2%. This Conservative Government have spent record amounts on the NHS, but does the current situation make it reasonable that those who fail to take individual responsibility, or who waste the time of our doctors or nurses or disrespect them, should pay towards their care or be denied it? I welcome the Government’s decisions to introduce a new Bill to tax sugar content and to strengthen existing rules to ensure that all health tourists from abroad pay for their treatment. However, we could also look closer to home in expecting patient responsibility in return for treatment.

I am intrigued by the requirement for the NHS to deliver £22 billion of savings at the same time as introducing a seven-day NHS. If we are to have a fully functioning NHS on a Sunday, it means absorbing all the costs of running and supporting such a service. I ask myself whether I want to have my physiotherapy on a Sunday, and the answer is that I do not.

[Dr Murrison]

I share my hon. Friend’s confusion, but in fairness, it is only right to point out that weekend working means meeting the four key clinical standards that Sir Bruce Keogh outlined. I fear that my hon. Friend will probably not be getting his physiotherapy at the weekend.

[Huw Merriman]

I thank my hon. Friend for that clarification—it turns out that I will be satisfied, then. However, the point is that when we talk about a truly seven-day NHS, we need to be absolutely clear what services there will be on a Sunday. Those who work in the profession want the flexibility and freedom to work hours that allow them to experience an enriched life and to raise a family. They want to succeed in the workplace and to make a contribution in their field. If they cannot, they will decide to work in another profession. I hope that that will be taken into account when changes are made to Sunday operating practices.

From discussing the pressures on the modern-day NHS with Government, clinicians and managers, it appears to me that there are many shared views on patient safety and individual patient responsibility. Like most of my constituents, I yearn for the day when politicians and clinicians join together and recommend the difficult decisions that both parties know are required. Our NHS would be stronger for it, and our patients would be better served.

I turn to our schools. I was particularly pleased by the introduction of the new White Paper on education. The day after it was announced that schools would be forced to become academies, I spoke in this place about the need to allow good and outstanding schools to make their own choice. I am delighted that the Government have made that alteration, although rightly not for schools for which local education authorities are not fit for purpose or those that are no longer of a viable size.

That is not to say that becoming an academy is not a good idea for a school that wants to. I have just spoken of junior doctors’ desire to take control of their career and their destiny, and it strikes me that we now have a generation of headteachers who are no longer willing to be told what to do by their LEA but want to make their own decisions about how to run their school and whether to expand. It comes down to choice, which drives up standards. I hope that my local schools will consider making their own determination on expansion.

[Tristram Hunt]

The “Educational Excellence Everywhere” White Paper, published in March, states that every school will become an academy. Is that choice?

[Huw Merriman]

The choice to become an academy will be there for every school that wants to take it. As has been made clear, if the LEA is no longer fit to deliver and is not functioning properly, a school will be required to do so. [Interruption.] I see that the hon. Gentleman is now having a separate conversation having asked me that question, but I have done my best.

Somewhat unusually, I have a high proportion of Church of England and Roman Catholic schools in my constituency. For academisation to work in my community, a local cluster of schools forming a multi-academy trust looks the most feasible idea. I welcome the Department for Education’s guidance to help the Church to become a part of that, and I look forward to working with my diocese to ensure that it is able and willing to do so. Without it, the advantages of academisation will be hard to deliver.

Overall, I am incredibly excited by the proposals contained in the White Paper, which will deliver fairer funding to a rural constituency such as mine, where our spend per pupil is almost half of that in parts of London. They will also give headteachers more freedom to train and recruit, which is a particular challenge in a rural constituency such as Bexhill and Battle.

In the past 12 months I have visited a school a week in my constituency and have been fortunate enough to spend time with my brilliant local heads and teachers. I welcome the Government’s ring-fencing of schools spending, but I am conscious that schools are addressing a funding gap following increased national insurance and pension contributions and the advent of the national living wage. The more power my local schools are granted to determine how to spend their budget, the better they will deliver education. I look forward to playing my part in helping the education Bill become law.

I confess that I am a happy and enormous supporter of the BBC. The programme for its future that the Government are seeking to deliver is intended to promote social mobility and empower people from all backgrounds to succeed to their true potential. Having failed my 12-plus exam and attended a secondary modern school, I found that much had passed me by in the years between 12 and 16. It was only when I went to a further education college for my A-levels and experienced independent thought and working that I discovered a love of learning. Having the BBC as an additional source of learning and inspiration was essential in getting me to university. This rarely comes up in debate, perhaps because many in positions of influence had the benefit of a more rounded education, but for those of us who have had to grab every opportunity to better ourselves, the BBC has been an essential rung on the ladder in the advancement of social mobility. Having got involved in discussions on the details, I am delighted that the Government’s charter renewal will preserve and improve the BBC, and I thank them for that.

The programme that the Government outlined in the Queen’s Speech is evidence that they will fight to defend public services, not just by preserving all that they do well, for instance through the BBC’s charter renewal, but by introducing reforms that enable more innovation and provide more power for decisions to be taken locally, such as through the education White Paper. I look forward to supporting the Government when difficult decisions on reform have to be made for the benefit of my constituents in Bexhill and Battle.

World Autism Awareness Week

Huw Merriman Excerpts

Thursday 28th April 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

Although I am aware that my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) is not in her place, I start by thanking her for her work in this area. I am aware from my constituents that she has bestowed so many rights on them through legislation and that she has started this whole chain. I pay tribute to her and give her my thanks on behalf of my constituents.

I was elected only 12 months ago. Before the election, I had no direct experience of autism. On being selected, a group of mothers who had autistic children or children with Asperger’s reached out to me and explained how difficult their lives were, what they needed and how hard it was to navigate through the system. I made a pledge to do all I could to help people with very special children.

On election, I was faced with one of my first cases. A mother told me how she had applied to the Driver and Vehicle Licensing Agency for a blue badge because her child, who was six, had such a difficult condition. Whenever he saw anybody in the street, he just collapsed on to the floor. As a result, she had to carry her child everywhere. She applied for a blue badge, but because the DVLA’s tick-box system did not register any physical disability her application was turned down. We had to fight on her behalf. We were fortunate to be able to go in at a higher level and get somebody to understand the complex needs of her child. That taught me that those with autism, who have such unique and differing needs, do not fit into the tick-box system. I ask the Minister whether he can find some way of ensuring that anybody who works in a tick-box employment system—or a Q and A system—has autism training. It is often impossible for the families of autistic children to navigate the system.

Since then, I have dealt with more cases, and I have been involved in some very special groups dealing with autism in my constituency of Bexhill and Battle. I have two points on which I wish to focus: education and the workplace.

I am fortunate that in Bexhill we have two very special schools that cater for those with autism, as well as those with other conditions. The first is Glyne Gap School, a day school which is rated “outstanding” in all areas. The Ofsted report in 2015 referred to

“the inspirational leadership of the headteacher and assistant headteachers”,

with the result that

“all staff have an uncompromising focus on the quality of learning for all pupils.”

Surely that must be the goal of every school that looks after children with autism.

The second school is St Mary’s, also in Bexhill, where young people do not just learn, but live. The school has had a difficult time owing to a crisis of confidence in the chief executive. I visited the school the day the chief executive left and I was amazed at how caring, supportive and dedicated those teachers were to children with incredibly difficult and challenging conditions. I take my hat off to all who work in that environment. The school still requires improvement, but I believe that better times are ahead.

Constituents have raised with me a number of points in respect of schools. I have two very good schools but, as I mentioned, autistic children have individual and different needs and often need a different school to cater for them, but my council, East Sussex County Council, tends to favour just one school. As a result, it is very difficult for parents to get their choice of school. I would like to see more freedom. I welcome the fact that we have trained 90,000 teachers in autism, but another comment that I have had is that a child was felt by their parents to have been isolated and restrained, rather than experiencing positive handling strategies, which Team Teach and other strategies provide. As has been mentioned, my constituents struggle because of the long time it takes to get a diagnosis.

I have only 30 seconds left, but I want to mention employment. Tomorrow I have a jobs and apprenticeships fair, and I am delighted that St Mary’s in Bexhill will be bringing its young people down so that we can try and get them apprenticeships. I am fortunate to have in my constituency an organisation called Little Gate Farm, which helps people find employment opportunities. It tries to bridge the gap between school and employment in rural communities. I salute what that organisation does, and I salute what everybody does in my constituency for those very special and gifted people.