Oral Answers to Questions

James Heappey Excerpts

Tuesday 7th May 2019 Commons Chamber

[Stephen Hammond]

I will not comment on the specifics of a leak from an outdated version of the plan. The NHS has always recruited nurses internationally and there are no plans to change that. The workforce plan will set out how more nurses, doctors and nursing associates will be recruited and retained inside the NHS.

[James Heappey (Wells) (Con)]

Many surgeries in my constituency augment the work of GPs with nurse practitioners. Will the Minister join me in praising the work of nurse practitioners and say what more the Government could do to grow their number so that they can continue their excellent work in surgeries around the country?

[Stephen Hammond]

I absolutely agree with my hon. Friend. Nurse practitioners do an extraordinarily valuable job across the country. The Government are committed to training more nurses and more nursing practitioners. As I said in an earlier answer, that will be set out in the workforce plan.

Community Hospitals

James Heappey Excerpts

Tuesday 12th March 2019 Commons Chamber

[Fiona Bruce]

I am sure the Minister will have heard what the hon. Gentleman has said. Indeed, that is why I entitled the debate “Community Hospitals” rather than simply “Congleton Community Hospital”.

As I have said, the hospital at Congleton has a family feel. I can testify to that following my most recent visit, just last week. I met kindly nursing staff who were clearly dedicated and committed to serving the community in and around Congleton, and who were proud to tell me that they had, through sound management, recently achieved an increase in the number of in-patients treated. About 350 are currently cared for each year in the Aston unit.

In addition to the minor injuries unit and in-patient care facilities, the hospital provides out-patient clinics, with approximately 9,000 out-patient attendances each year in a wide range of specialties. For instance, there are about 1,600 appointments a year for adult audiology treatment and about 1,000 for general surgery, and a similar number of gynaecology treatments. There are also about 2,000 trauma and orthopaedic appointments. Other services include blood tests, occupational therapy, a physiotherapy gym, district nursing, dementia services, and a highly popular GP out-of-hours service.

[James Heappey (Wells) (Con)]

In my constituency, Burnham On Sea War Memorial Hospital, West Mendip Community Hospital and Shepton Mallet Community Hospital do so much of the great work that my hon. Friend is describing. Does she agree that in areas where the main hospitals are somewhat distant—in my case, Bristol, Yeovil, Taunton or Bath—community hospitals are vital in filling that gap, and it is essential for them to remain a core part of our future NHS?

[Fiona Bruce]

My hon. Friend has made one of my points for me. None of the major hospitals in east Cheshire lie within my constituency, although it is reasonably large, so my constituents must travel some distance to use their services.

I have mentioned the four-hour GP appointments on Saturdays and Sundays. They are always full, and are meeting a very clear local need. The convenience of such services cannot be overstated. During my visit, an elderly gentleman, clearly frail, arrived asking for directions to the X-ray department. I watched as he was directed to it immediately. He was seen, and he departed. All that happened within what seemed to me to be about three minutes flat.

The value of such local services for a population like mine, which contains a higher than average number of older residents, cannot be overstated. They are particularly appreciated by those who are less mobile owing to age or infirmity, or for whom a lack of convenient public transport facilities would make travel to the larger hospitals outside my constituency very difficult, if not impossible. Moreover, 9,000 fewer out-patient appointments across east Cheshire must reduce congestion.

The trust informs me that the Congleton Hospital site also has space for use by other NHS organisations, including providers of mental health and health visiting services. As local health partners and providers increasingly work together in support of their local communities’ health and wellbeing, Congleton Hospital, located as it is almost in the centre of the town, is ideally placed to become an even more strategic community health hub for additional services.

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

I would like to start by thanking my hon. Friend the Member for Congleton (Fiona Bruce) for bringing forward this incredibly important matter for debate, and for articulating so beautifully the great value of the Congleton War Memorial Hospital to her constituency. I would also like to reiterate the important role that community hospitals play in local areas. She could not have articulated those great values more beautifully this evening.

Community hospitals provide vital in-patient care for people who need it most. As a whole, patients should be supported to recover in the most appropriate setting, which is quite often back in the heart of their local community and closer to home. However, community hospitals do far more than just provide hospital beds. They also offer a range of out-patient services that provide much-needed support to patients, including physical therapy, lab tests, X-rays and counselling. They can also contain minor injuries units, which, as we have heard, can have people in and out and back to work or back home much more quickly. They also offer a welcome local alternative to the big emergency facilities at an acute hospital that is many miles away. To its credit, Congleton Hospital already does all this for its local community and for local people. It is these services, this outreach and these minor injuries units that place these institutions firmly at the heart of their local communities.

The Government are absolutely committed to ensuring that patients have access to care that is as close as possible to where they live. This is very evident in the NHS long-term plan, which focuses on shifting to a new way of delivering care, with services in the community at the very forefront of planning. Community hospitals represent much more than just medical services. Many, such as Congleton Hospital and my own, the Gosport War Memorial Hospital, were originally built through the donations of local people to address local need many decades ago. It is this history, along with the important services that they provide, that make community hospitals the object of affection and appreciation in local communities. It is therefore important that any planning decisions about these much-loved institutions must be taken locally, and with enormous care and the utmost sensitivity. Fundamentally, this is about developing sustainable health and care services in the community. We care deeply about ensuring that residents in all areas can access excellent health and care services, both now and in the future.

[James Heappey]

Our social media timelines are busy enough at the moment, so in order to avoid attracting the ire of a quarter of my constituents, I must remedy the fact that I neglected to mention the brilliant Weston-super-Mare General Hospital in my intervention. I am putting it on the record now.

[Caroline Dinenage]

I am glad that my hon. Friend said that, because if he had not, I would have been forced to do so. We should all celebrate the hospital provision in Weston-super-Mare and the great work that is being done there.

We care deeply about ensuring that residents in all local areas can access excellent health and care services, both now and well into the future, and that is why the NHS is this Government’s No. 1 spending priority. The NHS budget will increase by £33.9 billion in cash terms by 2023-24, which is the single biggest cash increase in the NHS’s history. We have set out the what, and we now have to set out the how, which is why we are focusing on successfully implementing the NHS long-term plan. The NHS will develop a clear implementation framework, setting out how the long-term plan’s commitments will be delivered by local systems. This will be shared shortly, and it is being led by NHS England.

My hon. Friend asked whether some of the additional resources from the NHS funding settlement could be earmarked for community care so that valuable community resources such as Congleton Hospital can continue to deliver their vital services. I can confirm that we have prioritised investment in primary and community healthcare through the long-term plan, in which we have committed at least an extra £4.5 billion a year to primary medical and community health services. That additional money will fund expanded community multi-disciplinary teams and will help to ensure that, within five years, all parts of the country will have improved community health response services that can be delivered by flexible teams working across primary care and local hospitals, and developed to meet local needs.

Oral Answers to Questions

James Heappey Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

We welcome people working in social care from the EU and from the rest of the world, and we need to ensure that that can continue, but we also need to ensure that we can train people locally to work in social care. That is incredibly important.

[James Heappey (Wells) (Con)]

T2. GP surgeries across the Wells constituency are innovating with the employment of nurse practitioners, paramedics and other types of clinician to fill vacancies when recruitment of GPs has not been possible. While this often works well, we still have too many vacancies for doctors. What steps will my right hon. Friend be taking to encourage the thousands of GPs in training to consider practice in rural and coastal areas like mine in Somerset?

[Matt Hancock]

My hon. Friend makes an incredibly important point. As important as new technology is and new ways of working and nurse practitioners are, we still need more GPs, and we need more GPs especially in rural and coastal areas. The targeted enhanced recruitment scheme offers a £20,000 salary supplement to attract GPs to parts of the country where there are serious shortages, including in Somerset.

 Orkambi and Cystic Fibrosis

James Heappey Excerpts

Monday 19th March 2018 Westminster Hall

[Luke Hall]

Absolutely—that example highlights the positive work that the Cystic Fibrosis Trust is doing. I want to put on record my thanks and appreciation to all the parents and campaigners, whom I find completely inspirational. Not only are they parents, which is challenging enough in itself sometimes, but they are parents of children with CF, and on top of that they manage to find time to lobby their MPs, to get groups of people together, and to get support for petitions and debates such as today’s.

[James Heappey (Wells) (Con)]

My hon. Friend speaks eloquently about the many parents and children who have been campaigning for this cause. I add to them the voice of Helen Mann, my constituent, who has written the most wonderful, compelling book about her daughter’s life with cystic fibrosis and, indeed, her treatment with Orkambi. Her daughter, Clara, came to knock on my door yesterday lunchtime to make sure that I came to today’s debate. It was amazing to see her stood on my doorstep so full of life—a living example of just what an amazing drug it is, and how many others could benefit if only it were available to all.

[Luke Hall]

I pay tribute to all the young people such as Clara who are getting involved and making a difference in the campaign to ensure that Orkambi is available.

I was probably as disappointed as every Member in the Chamber to read the statements that came out on Friday about how a deal on the February offer by Vertex had not been reached. The petition for today’s debate was signed by 470 people from my constituency. I am here speaking on their behalf, and on behalf of Annabelle Brennan, and her parents Elizabeth and Shane. Annabelle is three years old, and is a lovely young girl. I met her at a CF campaigning event in my constituency. She does things that other three-year-olds do, of course, but she also has to endure a complex daily routine of physiotherapy, nebulisers, medication and antibiotics to help her to manage and live with the illness.

I received an email from Annabelle’s nursery leader, who is also my son’s nursery leader, explaining that Annabelle’s time at nursery, and her interaction with the other children in the group, is affected by her condition, because she is under constant supervision and is not always able to be involved in all the activities like the other children. Every winter, there is an added risk of further infection due to the common cold, and, as time passes, the potential for more complications increases. I remember hearing a devastating description from Annabelle’s parents of how every day is like waking up on a cliff edge, not knowing when irreparable damage caused by CF will come. That highlights the importance not only of these debates and the pressure, but of getting a deal, so that Orkambi can be made available as quickly as possible. That would ensure that children such as Annabelle, and people living with CF throughout the country, can realise their full potential.

A number of colleagues have laid out evidence today that shows that Orkambi works. We heard about Carly’s story from the hon. Member for Dudley North (Ian Austin)—I thank him for all he has done. We have seen international examples of the difference that Orkambi has made, but the reality is that progress on reaching a deal has been devastatingly slow. We know that Orkambi can help about 50% of people with CF. The other point we should remember is that precision medicines such as Orkambi are not just the better option—for some people, they are the only option. People have stated the countries around the world where it is already available: Austria, Germany, France, Ireland, Italy, the USA, Luxembourg, the Netherlands, Greece, Denmark, and many more. Despite the prevalence of CF in the UK, it is still not available here.

The set of statements released on Friday was disappointing, but although an agreement has not been reached, that must not be the end of those discussions; they should continue, ensuring that a deal is reached as soon as possible. It is also important that NHS England ensures that any deal is sustainable in the long term, and flexible enough to enable us to take into account any future advances in CF medication, either by Vertex or another company. The aim of NHS England and the National Institute for Health and Care Excellence should be to negotiate the best possible long-term access for people living with CF. That has to be reflected in the deal.

I ask the Minister to convey to both Vertex and NICE the importance of ensuring that a deal is reached as quickly as possible, and I encourage him to take a seat round the table himself, so that Annabelle and other people around the country have access to these drugs. I also ask him to update us on what conversations his Department has had with NHS England and Vertex since the announcement on Friday to see where progress is likely to be made in the coming weeks and months. I finish by saying to the Minister, NHS England and Vertex, “Can we please ensure that a deal is reached as quickly as possible, because this drug has the potential to change thousands and thousands of lives?”

Mental Health Act: CQC Report

James Heappey Excerpts

Tuesday 27th February 2018 Commons Chamber

[James Heappey (Wells) (Con)]

Does the Minister agree that a better laydown of mental health services, involving crisis houses and step-down facilities, might end the need for people to be admitted to acute mental health facilities in the first place, or else support them immediately after their discharge? Will she join me in encouraging the Somerset CCG to ensure that such facilities are available in that county as well?

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

Shepton Mallet Community Hospital

James Heappey Excerpts

Tuesday 21st November 2017 Westminster Hall

[James Heappey (Wells) (Con)]

I beg to move,

That this House has considered the temporary closure of in-patient beds at Shepton Mallet community hospital.

It is a pleasure to serve under your chairmanship, Mr Gray. I thank the Minister and her team not only for coming to respond today but because they, like me, have been speaking to local health authorities in Somerset in preparation for the debate.

There are two parts to today’s discussion: the temporary closure of the in-patient beds at Shepton Mallet and the longer-term future of the site—the redevelopment of existing facilities to create a community health campus.

The decision on temporary closure was announced very late indeed. Only about three weeks’ notice was given to patients and the community and, worst of all, to the staff. The reason given for temporary closure was that insufficient nurse cover was available. Understandably, that was very vigorously challenged by the staff at the hospital, who knew that the overall rota statistics for both day and night shifts were 100%. Shepton Mallet Community Hospital was fully manned, was running well and had some of the lowest agency costs in the entire county. Under scrutiny at an excellent public meeting held in Shepton Mallet two weeks ago, Somerset Partnership NHS Foundation Trust was forced to accept that actually, what it was seeking to do was to break up a team that was working well and was fully staffed, in a hospital that was fully operational and able to deliver all that it should in the beds that it had, in order to fix rotas elsewhere.

I do not know about you, Mr Gray, but I have always believed that “if it ain’t broke, don’t fix it” is a pretty good motto to live by, and that would appear to make the trust’s decision to close temporarily a hospital ward that was functioning well to try to fix the system elsewhere somewhat nonsensical, not least because when the temporary closure comes to an end—I am sure the Minister will agree that the local health authorities are adamant that the closure is temporary—the trust will have to reconvene those staff and get everything up and running again. What everyone is agreed on—it is important to emphasise this—is that this is not a financial measure. No one—we are told—is seeking to make a saving from it. Indeed, the chief executive of the Somerset clinical commissioning group told me on the telephone yesterday that if there was an option to just put more money into this he would have done so.

The reality is that there is a challenge with nursing availability elsewhere in the county; I understand that about 34 vacancies within the county need to be filled. That clearly cannot be sorted overnight. It does not excuse the temporary closure of Shepton just because it had a full rota, but I accept that there is a wider county issue and, if my disagreement with the decision over Shepton is lodged, there is clearly a challenge for the local health authorities, for NHS England and, indeed, for the Government in filling those nursing vacancies in the county as quickly as possible.

One area where there has been some disagreement, and where I think Shepton Mallet Community Hospital has been left unnecessarily vulnerable, is that for the past few years, urgent repairs to the fabric of the hospital building, including the boiler, have been postponed by NHS Property Services, under cover of an enthusiastic discussion about redevelopment on the site and the creation of a health campus. That would have meant the addition of a new build extension to the Shepton Mallet treatment centre, into which the in-patient ward, the out-patient clinics, a GP practice and some public health facilities would have gone. However, we are now in a really frustrating position where the outgoing chief executive of the trust said at the public meeting the other week that when the staff of the trust were looking at options for managing the shortage of nurses, they looked around and, as Shepton Mallet and Chard were small hospitals and the fabric of their buildings was causing them concern, they made the decision to close them, regardless of their success in filling their rotas.

My constituents’ anger is understandable. They know that NHS Property Services, which is responsible for the maintenance of the existing community hospital, knows that there is a big maintenance burden and has chosen not to maintain those buildings, on the basis that we were going to get a new hospital. In the process, however, that decision has meant that Shepton has been a soft target for temporary closure.

That leads me to my first ask. The Minister will hopefully agree that, from this moment on, no matter what the prospects for redevelopment into a community health campus, NHS Property Services should be required to get in there and urgently fix the buildings, as they are—the local health authorities have been clear that this is just a temporary closure and, therefore, an in-patient bed facility at Shepton Mallet Community Hospital is expected to resume in the near future. The conversation about redevelopment can go on concurrently, but repairs can no longer be postponed on the basis that something new might be built.

My second ask is that the nonsensical decision is challenged once more. I hope that the Minister might just go back and ask, as I have on a number of occasions, “Really?” There is an opportunity here to put back in place a team that was succeeding. The Minister will be keen to know, I am sure, about the excellent crowdfunding campaign in the town. It has raised thousands of pounds for a legal challenge, because there is a suggestion that the temporary closure may be illegal, in that it has not been properly consulted on. I encourage the Minister to go back and ask again whether the hospital can really be closed when it was succeeding so well.

Thirdly, I hope that the Minister will direct NHS England and her colleagues in UK Visas and Immigration to make it as easy as possible for the immediate needs of the staffing rotas for nurses in Somerset as a whole to be met by migrant nurse labour as urgently and quickly as possible. Of course, we would like to say that it would be great to bring British nurses who have left the career back into service, but the reality, in trusts all over the country I believe, is that the most immediate way to supply nurses at short notice is to go overseas. I understand that the Government have previously been able to expedite the visa process and I hope that the Minister will be able to assist in that.

Fourthly, if the temporary closure decision must stand, will the Minister agree to work with me to ensure that, first, the local health authorities are required to give us, in writing, a clear timeline for the reopening of the beds in Shepton Mallet? Secondly, will she agree to meet me in early January and again in early February, after speaking to the Somerset Partnership NHS Foundation Trust, so that she and I may take stock of the progress the trust is making in filling the vacancies, and so that we may satisfy ourselves that the temporary closure will end on the date to which the trust has committed? Will she ask the Secretary of State to agree to a meeting in March, shortly after the date on which I believe the trust says the temporary closure will come to an end? I would hope that such a meeting would not be needed, but at least it would focus minds, and should the ward not reopen on the agreed date, all those responsible for the failure could come up and explain to the Secretary of State why the deadline had not been met.

As I said in starting this speech, with the temporary closure of the ward—as frustrating as it is and as much work as there is to do to ensure that it is genuinely temporary and as short term as possible, so that the ward is reopened as early as possible—there is a wider discussion about the future of the Shepton Mallet Community Hospital. The vision for a Shepton Mallet health campus is exciting. While I was campaigning for election in 2013, the Secretary of State visited Shepton Mallet Community Hospital and met with the league of friends. He was excited about the plans they and local health authorities had for a health campus on the site. There have been years of meetings to discuss that vision.

The idea was that there would be a GP surgery, out-patient clinics, public health and a pharmacy on site in addition to the hugely successful Shepton Mallet treatment centre, which is run by Care UK and does elective procedures as commissioned by the health authorities. The idea also included two ambulatory care beds, two assessment beds and eight in-patient ward beds. That was the vision. All of that made it into Somerset’s sustainability and transformation plan, and we were hugely pleased to have that vision there. Since then, the GP practice has fallen by the wayside because there are issues over releasing the GP practice from its mortgage on its current site. That is a private business issue for the GP practice and NHS England, and it has been frustrating that that has not been unlocked. I hope that the clouds may part and the sun will shine and it will somehow still happen, but that is a separate issue, which I do not want to labour today.

Other than the GP practice, everything else was still in the plans. As recently as January, I sat down with the hospital director for Shepton Mallet treatment centre and the then chief executive of the Somerset clinical commissioning group, and I was shown the plans for this amazing health campus. It looked fantastic. It felt so close that you could smell the freshly painted corridors, Mr Gray. The problem is that since then things have gone horribly wrong for Somerset clinical commissioning group. From nowhere, it is now forecasting a significant deficit, which has brought with it the requirement for a change in leadership. Worse still, it turns out that after years of work, the STP needs to be revised because NHS England has reservations about the strategy underpinning it. I understand that when Simon Stevens visited a couple of weeks ago, there was not much coffee being served at the meeting.

The situation is a very bitter pill to swallow for me and for those in the community who have been working so hard to secure the vision of a health campus. I now understand that everything is back under review. I look forward to resuming the debate with local health authorities about what that health campus should look like. Nothing has changed, in that the vision is obviously for community hubs to deliver healthcare. I accept that there is some discussion about the validity of in-patient beds, but with a population as sparse and a demographic as challenging as Somerset’s—along with the acute pockets of deprivation within the county—the demand for beds in Somerset has perhaps been higher than elsewhere, and those occupancy levels might indicate why Somerset has maintained a higher level of in-patient beds than some other places.

After so many years of discussion, the situation is disappointing. So many hours have been spent in committee developing first the STP and then the plans for a community health campus in Shepton Mallet. First, because of the nursing shortage, which must have been known about months and months ago by the Somerset Partnership NHS Foundation Trust, a successful and winning team at Shepton will be broken up to try to plug gaps elsewhere in the county. Secondly, the plans we had for a health campus in Shepton were hugely exciting. It is surely the model we should be transitioning to for a community-based healthcare system that keeps people out of acute hospital facilities and facilitates their discharge from acute hospitals as quickly as possible. That is not to mention the fact that the geography of my constituency lends itself to such community facilities, because I have no significant hospital in or very near my constituency. My constituents divide in equal measure between Weston-super-Mare and Bristol to the north-west, the Royal United Hospital in Bath to the north-east, Yeovil to the south-east and Taunton to the south-west. Having those community facilities when hospitals are all 20 miles or so distant in each direction is an important part of maintaining the right health network for my community and ensuring that we get people out of acute hospitals or stop them going there in the first place.

The argument for good, well-developed community healthcare facilities is easily made, and I am disappointed that after years of trying to develop such facilities at Shepton Mallet, the Somerset clinical commissioning group appears to have failed. I am disappointed that the STP is now up for revision, especially when we had won the argument over having eight plus two plus two beds in a redeveloped Shepton Mallet health campus. I hope very much that the Minister will join me in applying as much pressure as she can to the Somerset clinical commissioning group to ensure that the STP is revised as quickly as possible, and that Shepton Mallet does not lose out in that process.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Gray. It is also a pleasure to respond to my hon. Friend the Member for Wells (James Heappey), who has brought the required amount of passion to this argument. He is doing exactly what he should do to stand up for his constituents after the local health establishment made a very rapid decision regarding his hospital. It certainly came out of the blue for many people, but I would like to give some explanation as to why the decision was made and perhaps a message about where we may go in the future.

In the short term, we have the closure, but what happens beyond that is very much up for review. I commend my hon. Friend on the constructive way in which he has engaged with local health practitioners while still giving them a challenge. That is always the way to go with these debates. As we all know, the challenged situation we are facing is not only in terms of money. As he acknowledged, in this case the issue is not money; it is workforce across the trust. The challenged situation means that we will have to make some difficult decisions, and we should make them on the basis of constructive dialogue, not who shouts loudest. I certainly agree to his request to have more discussions on this matter in January. Although the decision-making process is independent, we as Ministers will want to satisfy ourselves that processes are being properly followed and representations are being properly heard.

The reality is that any decision of this kind has to be taken with full transparency and full accountability. Robust argument will withstand challenge. I look forward to taking the dialogue with my hon. Friend further. I also welcome the forward-looking points he made about the future campus and looking at future needs. All too often in such debates we look at the immediate short-term challenges without addressing the long-term ones. If we looked more at the long term, we might come to better decisions, rather than short-term ones.

I understand my hon. Friend’s concern about the impact that changes at Shepton Mallet Community Hospital will have on his constituents. I reassure him that changes will always be in the best interests of patients and the local community. Decisions must be driven by what is best clinically, what is best for the health service in the area and what is of most benefit to the greatest number of people in the area. He asked me to direct the trust to reverse the closure. We are very much of the opinion that it is right that such matters are addressed at the level where the local healthcare needs are best understood, rather than in Whitehall. I give him the assurance that I will join him in holding local decision makers to account to ensure that their decision making has been properly accountable and robust.

It is worth reiterating that all proposed service changes should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. In addition, NHS England introduced a new test applicable from 1 April 2017 for the future use of beds. It requires commissioners to assure NHS England that the proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

I will first outline what led Somerset Partnership NHS Foundation Trust to announce on 11 October the temporary closure of in-patient wards at two of its 13 community hospitals across the county. As my hon. Friend has pointed out, the decision was not financial; it was based on patient safety. Overall, Somerset Partnership provides 222 community hospital beds, spread out over 13 community hospitals. Plans drawn up for an expected increase in patients over this winter made it clear that although sufficient funding was in place to maintain services, the trust was facing vacancies in a quarter of its registered nursing posts, meaning that the trust nursing workforce was spread far too thinly at the time. Following a review, it was found not to be sustainable to continue to safely deliver in-patient services across all 13 sites.

To address safety concerns, the trust made the decision to move 10 beds at Shepton Mallet hospital and 14 beds at Chard hospital, along with their staff, to other community hospitals in Somerset. I fully appreciate the case that my hon. Friend has made about the services at Shepton Mallet being robust. I understand why the move feels particularly unfair, but we will have to address that in consultation as we take the matter forward.

The trust has said that the two in-patient wards are likely to be temporarily closed until at least the end of March 2018, but that the current total of 222 community beds and all current services across Somerset will be maintained. Somerset CCG has endorsed the move and is in the process of considering community hospital services and provision as part of a wider clinical services review across the county next year.

We talked earlier about criteria and how trusts should come to decisions: in full openness and consultation with staff and the public. I understand that the trust communicated with a wide range of staff and stakeholders on its plans to temporarily close the wards, including with the local county council, which supported the action taken by the trust on the grounds of patient safety. I am also pleased to say that the trust held all day face-to-face drop-in sessions with members of the public, as well as a public meeting organised by the League of Friends of Shepton Mallet Community Hospital, which was attended by 120 people, including my hon. Friend and local councillors.

The trust has also organised a workshop event in the town for key local stakeholders on 30 November to seek the views of patients and carers while the ward is temporarily closed, and has developed a wider consultation document to inform its next board meeting on 6 February. I urge my hon. Friend and his constituents to engage in that process and make their voices heard. I want to reassure him that Somerset CCG has not put the trust under any financial pressure to temporarily close the wards at Shepton Mallet Hospital.

As my hon. Friend has pointed out, the issue is not about money. It is solely down to the issues around nurse recruitment, and the trust is working hard to improve on that. It has recruited two specialists who have extensive experience of specialised nursing recruitment. It is also offering more intensive support for potential recruits to increase the rate at which they take up posts. It is also working with Yeovil District Hospital to recruit nurses from the Philippines. I am pleased to learn that already there is a large number of interested nursing staff, which the trust hopes will be recruited and in post from April 2018. Furthermore, the trust is revisiting its current golden hello bonus of £1,000 to see how it can be better tailored to individual needs and it is looking at how else it can attract nurses to the trust.

Owing to staffing issues, the CCG supports the closure on the basis that, as my hon. Friend has pointed out, it is temporary and has been made on patient safety grounds, not on financial ones. It has been made clear that there can be no permanent closure of the wards at the community hospitals without prior patient and public engagement and formal public consultation. The CCG fully expects the beds to be reopened after the winter.

By taking planned measures now, the CCG is reassured that that represents the safest way of avoiding the potential risk of disruption to patient care should we see severe winter weather or the predicted higher than average levels of sickness from flu.

[James Heappey]

There is some concern locally about what the consultations look like. The Minister, briefed by local health authorities, has relayed that a “consultation” was conducted in the last few weeks of November ahead of the temporary closure. The reality is that that, including the agreement of Somerset County Council, was done after the solution was presented as a fait accompli. Can the Minister reassure me that the health authorities will be explicit with the community and all other stakeholders when having such a consultation about permanent closure and that the discussions going on right now about the temporary closure will not in due course be dressed up as the consultation leading to permanent closure?

[Jackie Doyle-Price]

My hon. Friend has the nub of the issue completely. To inspire confidence among his constituents, we as decision makers need to be very clear about the basis on which the decision was made and how future decisions will be made. The short-term consultation was about a decision made purely to get us through winter for patient safety reasons. For any long-term closure there would have to be a full consultation, fully transparent and fully accountable. I know he will hold me as well as his local trust to that. I do not think I can be firmer. We inspire confidence in the public and in patients who use the services only if we are fully transparent in making decisions. It is unfortunate that the speed with which this particular decision had to be made in order to get us through the winter will have undermined confidence. Of that there is no doubt, but rest assured I will continue to engage with him to make sure we can restore public confidence among his constituents in future.

As I have mentioned, the decision taken has allowed the trust to consolidate beds and staff into fewer hospitals, but larger wards. Closing the wards has reduced the number of unfilled shifts by 60 shifts a week: the equivalent of 13 nurses. Regrettably, since the closure, three Shepton Mallet patients have been admitted to surrounding community hospitals—one patient is in West Mendip and two are in Wincanton. I am advised that, as a result of the temporary closures, the trust has provided support budgets to enable carers and relatives who need financial assistance to visit patients. I should also add that all of Somerset CCG community hospitals have free car parks, so if people are visiting their loved ones, they will not have to pay. I should point out that that is not a privilege enjoyed by many other areas.

My hon. Friend talked about the long-term plans for a health campus. Both Chard and Shepton Mallet have been assessed as requiring significant redevelopment. Chard Community Hospital infrastructure was assessed as not fit for purpose by a 2015 Care Quality Commission inspection. As he pointed out, Somerset CCG is developing a clinical services review that will take into consideration the views of patients before developing a series of service proposals, which will ensure that family doctors, community hospital and district hospital services are joined up with social care services and provide financially sustainable and high quality care. It expects to engage with the public on those proposals in the new year. I know he will engage in that process.

The decision to temporarily close wards at the hospital is an important issue and the decision was not taken lightly. However, the decisions made by the trust have not been made because of financial concerns, but because of nurse recruitment issues. I know that the decision will cause concern to the residents of Chard and Shepton Mallet and the surrounding villages, but I urge my hon. Friend to encourage his constituents to attend the trust’s local public meetings and listen to what is said about addressing the issues that have caused the temporary ward closures, as well as making sure their voice is heard. We will all understand each other better with that dialogue. The people affected by the changes need to be involved in expressing their views and making key decisions.

Our starting point for discussing service change is that no permanent changes to the services that people currently receive will be made without formal public consultation. I reiterate that strongly to my hon. Friend. I conclude by encouraging him to continue to engage with Somerset Partnership Trust, Somerset CCG and me in the new year as the proposals are brought forward.

Question put and agreed to.

Oral Answers to Questions

James Heappey Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

With respect, the Red Cross was not called in. As the hon. Lady well knows—as a doctor working at Tooting hospital—NHS trusts contract with the Red Cross throughout the year. However, she is right to say that what happened last year was not acceptable. We have done a huge amount: perhaps most important is our provision of an extra £1 billion for this year’s social care budget and a further £1 billion for next year’s budget, because that is where particular pressures were, but we have also allocated £100 million to a capital fund to help A&E departments to improve their facilities.

[James Heappey (Wells) (Con)]

A shortage of nurses has led to the closure of the in-patient ward at Shepton Mallet Community Hospital this winter. What have the Government done to increase the number of nurses available in rural areas such as Somerset, and to encourage the Somerset clinical commissioning group to recommit itself to the hospital’s future as a matter of urgency?

[Mr Hunt]

I congratulate my hon. Friend on the close interest that he takes in his local community hospital, which matters so much not just to his constituents but to the NHS, because many people are discharged to it from busy district general hospitals. As he says, there has been a shortage of nurses. That is why we have decided to increase the number of training places by 25%, which is the biggest increase in the history of the NHS.

Mental Health Units (Use of Force) Bill

James Heappey Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[James Heappey (Wells) (Con)]

May I add my congratulations to the hon. Member for Croydon North (Mr Reed) on bringing forward this Bill? I warmly support it and applaud his willingness to work with people across the House to ensure that the Bill fully meets the concerns of Seni’s parents and family and others who have been in such circumstances—I will share another story with Members on behalf of one of my constituents shortly—and works properly for those who are involved in mental healthcare in our country and who, like our police, will occasionally have cause to restrain those who are mentally ill. Those people work in very challenging circumstances and it is important that the Bill fully reflects that and is workable and fair to them as much as it is fair and transparent for those who are on the receiving end of its provisions.

I wish to discuss three areas, the first of which is the story of my constituent, James Herbert, who died in police custody in 2010. He was mentally ill and had been restrained shortly before his death. Secondly, I wish to look at how this Bill might have helped in that situation and how, in so many ways, it will certainly help to ensure that those sorts of events do not happen again. Thirdly, I will consider what additional training we might offer not only to our police, but to those who work in mental health. We need to make sure that, yes of course, there are safer techniques for restraint, but that there is also a much greater understanding of how we de-escalate those circumstances so that restraint might not be necessary.

James Herbert was known to the Avon and Somerset police, particularly those serving locally in and around Wells, as being mentally ill. Over the course of the day on which he died, there were a number of occasions when the police had had cause to observe his behaviour. On the evening after a hot June day, he was detained by the police. In the process of that detention, he was restrained. He was then put into a police van and driven for 45 minutes to a custody suite where he was stripped naked and put into a police cell. He died later that night of a cardiac arrest. The Independent Police Complaints Commission has looked in full into his death in the seven years since, and its report “Six missed chances” is rightly very critical of what happened that night. It is important to note that the police officers involved—one of whom is still a constituent of mine; the other, very sadly, took his own life a year or two ago—have not been held personally responsible for what happened. The failings that were identified were systemic, institutionalised failings—that sort of misunderstanding of mental health and the way that the processes were handled.

The Bill brings forward a very important aspect of how we deal with those with mental ill health. Sometimes, restraint is unavoidably necessary, but how that is done can have a profound impact on people such as the constituent of the hon. Member for Croydon North and my constituent, James Herbert.

Undoubtedly, the Bill will help. Staff not deliberately restraining people in a way that constrains an airway is clearly a very important and necessary provision, so, too, is restricting the intervention of a restraining technique that causes pain. Similarly, people should always seek to use the least restrictive method of restraint possible. Those are necessary de-escalatory measures, which in themselves could help, not quite to calm the person but at least not aggravate them further, which happens so often. The more that I have spoken to police officers about James Herbert’s case, the more they tell me that their concern to get their job done and retain the person means that they find themselves naturally going up through their levels of force and the application of their physical power. As both sides seemed to rub off of one another, they both got more and more aggravated, and the use of force became all the greater. The police reflected afterwards that they might have approached the situation differently in the first place.

[James Cleverly]

I do not know the ethnicity of the constituent who died in custody, but does my hon. Friend agree that it can be intimidating for police and medical professionals when the person they are dealing with is physically big and robust? As well as the measures in the Bill, they need our support to ensure safety for them and for the people for whom they are caring.

[James Heappey]

My hon. Friend, as ever, makes an excellent point. These are highly challenging, confrontational situations. James Herbert was white, but he was a big guy. As his anger and emotions built, so did the efforts of the police officers who were trying to restrain him for his own safety. My hon. Friend is right to observe that there some people who require restraint are physically very intimidating. The police officers or mental health workers involved in the restraint often fear for their own physical safety, which may lead them to use overly aggressive techniques. They may really be focusing on self-preservation, instead of on de-escalation. A great confidence is required in the techniques that have been taught for restraint, and in understanding how to deal with those who have acute mental health challenges. That confidence is absolutely necessary so that people are able to apply the right skills in the right way to bring about the right outcome, instead of fearing the physical situation in which they find themselves.

I agree very much with some of the other provisions in the Bill. Seclusion should be an absolute last resort. It is an alienating and escalatory measure. Then there is the immediate, confident and sympathetic engagement of other people involved in the care of the mental health patient. When the police were detaining James Herbert, they phoned his mother to talk to her about something very different, rather than to ask her about James’s condition and what she might be able to share with them in order to manage him much more appropriately in the situation.

I agree passionately with the use of body cameras. I have seen the profound impact of James Herbert’s case not only on his own family and friends, but on the careers, lives and mental health of those involved in his detention and, sadly, his death. Body cameras would have made an enormous difference in this case.

[Mrs Sheryll Murray (South East Cornwall) (Con)]

I welcome body-worn cameras. However, when someone is subjected to immediate harm in an emergency case, the absence of a body-worn camera should not prevent someone from coming in to address the situation. Does my hon. Friend agree?

[James Heappey]

I accept that there are situations that require immediate intervention. As a former soldier who was used to working on immediate notice to move at times, I suggest that the solution is that there must always be somebody in a custody suite or a mental health ward who is wearing the right kit and is on immediate notice to move. It should be a requirement, and it should be a simple drill for those managing the facilities. That is not to say that everybody needs to be sat around at all times, wearing their stab vest and their camera. But one person in a custody suite should be required to be wearing the appropriate kit at all times. Perhaps that is something to include in the Bill. The cameras are a great addition to what police officers wear. In fact, they are a de-escalatory measure in themselves. Away from cases of people suffering with mental health issues, I have been told by the local police commander for my part of Somerset that the simple act of turning them on has such an effect. People on the high street who have had a few too many drinks see themselves on the screen and know that their behaviour is being recorded; things immediately start to calm down and responsibility returns.

[Mr Reed]

I am grateful to the hon. Gentleman for raising this important point and I agree with the point made by the hon. Member for South East Cornwall (Mrs Murray). The hon. Gentleman will be interested to know that there is a weight of published academic evidence showing that the mere presence of police wearing body cameras reduces the likelihood of force being used in these circumstances by nearly 50%. That alone is reason enough to require police to wear body cameras.

[James Heappey]

The hon. Gentleman is absolutely right. It is great on days like today when the House is in such violent agreement. The cameras really are a great addition for our police forces. They give transparency for those who want to complain about perceived unfair treatment. But they also give a protection as important as the stab vest, by reassuring police officers that they will have a video record of what they did.

[Will Quince (Colchester) (Con)]

I accept points from both sides of the House on body-worn cameras. The Bill makes it clear that the officer has to turn the device on as soon as practically possible from the point at which they are called. Does my hon. Friend think that it would be more practical to say that that should be at the point they attend the mental health unit, not the point at which they take the call? Is not that a little too onerous for the officers? I am just posing the question.

[James Heappey]

From discussions with local police constables and with the police commander, it seems that police officers have an instinct for when they are going into certain types of situation. One would imagine that if an officer were on the custody desk and heard that something required their intervention, they would obviously flick on their camera as a matter of drill while they were going down to the cell or wherever something was happening. That is assuming what we were just discussing—that it should be standard practice that somebody in those circumstances is always fully kitted out.

[Kevin Foster]

The requirement in the Bill is for officers to wear body-worn cameras when attending a mental health unit. My understanding is that that means that the unit has an issue and has called the police to attend. In many instances, custody suites have cameras, even though they may not be body-worn. The real solution is that response officers—those who are deployed ready to attend 999 calls—should have body-worn cameras. That would help not just in these instances, but in many other circumstances.

[James Heappey]

My hon. Friend is right, but whenever attending a call-out to a mental health unit—just as in attending any other event in the community—the police officer would have deployed in their patrol car wearing their full kit. They would already have been wearing the camera and would have switched on it on as they were entering the situation, if they thought that were necessary. The much more likely scenario, as perhaps would have been the case with James Herbert, is of people being called into a situation when they are not out on the street, but are just nearby and lending a hand. The fixed cameras in the building may be obscured by those doing the detention, so I also see real merit in body-worn cameras being used in those situations.

This is not just about how to ensure that acute, immediate interventions are handled properly. It is also about the additional training that might be offered to police and mental health workers to make sure that these situations do not arise in the first place. Training is key. That goes without saying for mental health workers, who, by vocation, understand this stuff very well indeed, but the police are much less confident in dealing with people with mental health issues than they should be.

Training for the police so that they can spot those signs and intervene appropriately with concern and care would be helpful and would prevent a large number of the instances that we are debating. There are techniques for reassuring people, for de-escalating, and for managing the anxiety that often manifests itself in people with mental illness. Equipping police with those skills would be very welcome indeed.

[James Cleverly]

A number of years ago, when I served on the London Assembly, I visited Feltham young offenders institution. I cannot help but think that there are a number of young men in Feltham who had mental health problems but whose interactions with the police and authority during mental health episodes reached a stage at which they became violent and ultimately found themselves incarcerated, perhaps at least in part because of that lack of understanding and training on the part of the police. It is not a moral criticism but an observation that training could help the police officers and some of those young men, who were ultimately incarcerated in what was not necessarily the most appropriate institution.

[James Heappey]

I very much agree. It is interesting to reflect on conversations I have had with police and community support officers in my constituency. The nature of their job means that they understand or know more intimately the community they serve. Very often they have an insight into the mental health of people they routinely see around town who are on the edges of antisocial behaviour or even breaking the law. They can often deal with them very differently because they understand who they are dealing with. The PCSO job description is such that PCSOs naturally seek to de-escalate and deter, rather than enforce the law. My hon. Friend makes an interesting observation, and I certainly agree that it is possible to avoid these circumstances arising as often as they do.

[Wera Hobhouse]

The hon. Gentleman has pointed out the importance of PCSOs, but many police authorities are having to cut those services. Does he not agree that it is regrettable that police services have been cut and that important PCSO services have been taken away from the community?

[James Heappey]

My near neighbour, with whom I share probably the most beautiful diocese in the country, makes an interesting point, which she and I might jointly take up with the police and crime commissioner for Avon and Somerset. The decisions on how PCSOs are allocated are hers. It is not my experience in my constituency that PCSO numbers have been cut. In fact, I have been impressed by the service that we have received from PCSOs in Somerset during my time as MP for Wells. The Bill is not exclusively about the police—it is about the way in which we deal with people with mental health challenges.

[Kelly Tolhurst (Rochester and Strood) (Con)]

It is really good that my hon. Friend has highlighted the role of PCSOs. In January, we will increase the number of PCSOs who police our communities in Kent, because we recognise that they play a key role in the transition from meeting people with mental health issues on the streets to being able to direct them to the right care at local level, rather than getting police officers directly involved at the first point. Does my hon. Friend agree that that is a good thing, and we must recognise that we are increasing numbers in some places?

[James Heappey]

I very much agree. I have no first-hand experience of policing in Kent, my hon. Friend will be pleased to know, but I certainly agree that PCSOs are important. I do not see them in any way as a poor substitute for police officers. The way in which PCSOs carry out their job is excellent. I am fortunate to have some excellent PCSOs serving towns and villages in my constituency, and they make a big difference by intervening and making sure that crime levels stay low.

We have spoken a lot about the police—inevitably so in my case, because my experience has come about as the result of a death in custody, and I wanted to share that with the House. This is really about a wider way in which we care for people with mental health conditions. Mental health is something I am passionate about, and I learned a great deal about it while serving in both Iraq and Afghanistan. Before doing so, I was very much a member of the club that said that people should just pull themselves together. The reality is that when you see people who are absolute heroes—strong, strong people—who have served in the Army for 20 years, and you see their head break, you stop making the distinction between someone having their leg blown off and someone having their head break because they have witnessed a trauma that was so profound that it did something to them and over which they had no more control that someone who has lost a limb. That led me to look keenly at what mental health provision looks like in my community.

I had quite an epiphany when I realised how important mental healthcare is. Today we are discussing how to deal with people in the moment of most acute crisis. That is a necessary discussion, but it must not distract us from the urgent need to discuss how to stop people getting to crisis point in the first place. Somerset’s mental health provision is quite hollow. We have more than adequate provision of acute mental health beds, and we have reasonable provision of community nursing, but we do not have the stuff in between: the crisis houses—the step-up, step-down facilities—that can help people to find a bit of space to avoid or see off the imminent danger of a critical episode. That could prevent their having to go to an acute facility where things might escalate even further and might stop the horrible situations we have been discussing arising.

We must also look at how we do much more upstream prevention involving mental health charities in particular. Their role is enormously important. In Wells, Heads Up, of which I am a patron, and Charley’s Memory in Burnham-on-Sea—again founded as a result of a real tragedy to do with mental health—do amazing work in our communities. They work voluntarily and charitably, but they do something that should be a really important part of a broad, deep network of mental health provision that helps to manage people through mental illness at the appropriate level and prevent their slipping into crisis as much as possible.

We must push even harder to break the taboo on mental health in our communities. If there were greater acceptance of mental health conditions and people were more willing to be open and to talk about the issue and support people with mental illnesses, fewer people would find themselves in crisis because they had become isolated and their vulnerability had become such a problem that they made a big cry for help or their illness escalated to crisis point. Parity of esteem is not just about money, although in Parliament the debate often focuses on that. It is about attitudes and acceptance too. We need a mental health system that has real depth so that we can make sure that people who are living with mental health conditions can do so with dignity, not being unnecessarily aggravated because they have unreasonable waiting times for mental healthcare, but supported by an understanding and supportive community.

Mental health workers do amazing things, and so do the police who have to work with those who are suffering from mental illness. Nothing that we are discussing today should be seen a criticism of what they do. They should understand that we understand, fully, the extraordinarily challenging circumstances in which they work day in, day out. I thank them for the extraordinary hard work that they do.

NHS Pay

James Heappey Excerpts

Wednesday 13th September 2017 Commons Chamber

[Chris Philp (Croydon South) (Con)]

rose—

[James Heappey (Wells) (Con)]

rose—

[Jonathan Ashworth]

I will make a little progress now, if I may. I promise I will take more interventions later.

I say directly to the Chief Secretary to the Treasury, who will be responding to the debate later, that if Ministers are given flexibility to set pay rates, and if the pay cap has indeed been abandoned, she also needs to grant the NHS the funding that it needs. The NHS is underfunded and it is going through the biggest financial squeeze in its history. On the published figures, head-for-head NHS spending will fall in the next year. Hospitals are in deficit, waiting lists are at 4 million, the A&E target is never met and the 18-week target has been abandoned. Hospital bosses are warning that there will not be enough beds this winter. Last winter, hospitals were overcrowded, ambulances were backed up and social care was at a tipping point. Some even characterised it as a humanitarian crisis. It is not good enough for the Chief Secretary to the Treasury just to grant “flexibility” and expect hospitals to fund a staff pay increase from existing budgets.

--- Later in debate ---

[Jonathan Ashworth]

The Chief Secretary says it is not true. These amounts are based on her own Treasury figures.

[James Heappey]

The shadow Minister has been very generous in giving way. May I be helpful and invite him perhaps to revise his earlier statement that the pay rise should be universal across the public sector? Surely that would advantage those in more senior, management positions, who would disproportionately benefit from such a pay rise, and perhaps actually the Government’s position of offering Ministers flexibility to increase pay where there is a clear need is a much better proposal than the universal pay rise that would only benefit fat cat managers.

[Jonathan Ashworth]

There we have it—the Conservative party playing one part of the public sector off against the other. We believe the whole of the public sector deserves a pay rise.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right about that. The whole problem with the tone of the argument made by the shadow Health Secretary is that he is saying that the difference between the Government and Labour is about our support for public sector workers, but we all agree, in all parts of the House, that they do a fantastic job. I see that in the NHS every week. The difference between us and Labour is about knowing what harms public sector workers the most; it is between ignoring and repeating the mistakes of the 2008 crash, as Labour Members are, and what we think, which is that we need to learn from those mistakes and not repeat them.

[James Heappey]

Does my right hon. Friend agree that Labour was not the only party with an irresponsible policy at the general election on funding health and social care, and that although the Liberal Democrats can muster only one MP to debate this important subject today, their 1p on income tax gimmick would have gone nowhere far enough to funding the properly increased services they promised?

[Mr Hunt]

I will allow the Liberal Democrats to speak for themselves, but suffice it to say that even one MP is quite a large proportion of the Liberal Democrat parliamentary party and we are grateful that it does have some representation here this afternoon.

NHS and Social Care Funding

James Heappey Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

We stood on a manifesto that would have delivered more doctors and nurses for our NHS; the hon. Gentleman stood on a manifesto that said the Conservatives would cut the deficit and not the NHS. They are cutting the NHS and failing on the deficit.

I have a few direct questions for the Secretary of State about Royal Worcestershire hospital. I was grateful for his remarks on Monday, but I want to press him a little further. It has been reported that NHS England was warned of a bed crisis as early as 22 December. Will he update the House on what urgent meetings he is having on Royal Worcestershire? When will we be closer to knowing the outcome of an inquiry? In that context, there is a proposal in the sustainability and transformation plan for the Worcestershire area for a significant reduction in the number of acute beds. The Secretary of State will say that these are local plans and so on, but in the context of the issues in Worcestershire, will he comment on whether he thinks that is the right proposal to follow?

On STPs more generally, the NHS is going through a winter crisis, and it is about to go through another top-down reorganisation—[Interruption.] Someone says it is bottom-up, but it is not; we know it is coming from the top. Those making the STPs are being told that they have to fill a financial gap of £21.764 billion—that is the reality that STPs throughout the country now have to face. We have seen the plans, so we know that that is going to mean a number of community hospitals being closed, a number of A&Es being downgraded, and acute beds being lost.

In places such as Devon, where the STP talks of an over-reliance on hospital beds, the implication is that beds will be lost. Closures and downgrades are being considered throughout Somerset, with their priority list of vulnerable services including maternity and paediatrics. In London, a city with the very worst health inequalities, the STPs are expected to deliver better health outcomes for the city’s growing 10 million residents with £4.3 billion less to spend. Will the Secretary of State explain to the House how he expects the NHS to perform in future winters, when we have a growing elderly population and STPs are pursuing multibillion-pound cuts to beds, A&Es and wider services?

[James Heappey (Wells) (Con)]

I was recently briefed by an excellent and well-respected local GP and a clinical psychiatrist, who were the authors of our county’s STP. Will the shadow Secretary of State explain how on earth they are responsible for a top-down reorganisation?

[Jonathan Ashworth]

Because they were being told by NHS England, which was in turn told by the Secretary of State.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I appreciate the opportunity to speak in this debate. For the record, the last time I was in an NHS hospital was when I was working a night shift on Saturday. I declare an interest in that I am a nurse who has worked during this year’s winter crisis, but I have also worked during winter for the past 20 years.

[James Heappey]

I apologise for intervening so early in my hon. Friend’s speech, but the hon. Member for Dewsbury (Paula Sherriff) is too busy congratulating herself on her own speech to note that my hon. Friend was working in an NHS hospital on Saturday night.

[Maria Caulfield]

I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.

--- Later in debate ---

[James Heappey (Wells) (Con)]

The Wells constituency faces some real challenges in healthcare. We have an ageing population, and demand for the local NHS is growing rapidly. There is no doubt that our primary healthcare system is under considerable strain, as is our adult social care system. Our hospitals, too, face record demand. However, to call this a crisis does a disservice to those in the clinical commissioning group and our local hospital trust who have worked so hard to prepare for the incredible challenges that they face this winter.

Demand in the four A&Es that serve my constituency was significantly higher in the week between Christmas and the new year than in the same week the previous year. In two A&Es, demand almost doubled. I know that the A&E staff had to work extraordinarily hard to meet that demand and I know, too, from some constituents who contacted me that some people were not seen within the time that they might expect. However, I have heard from others who arrived at A&E expecting bedlam, only to be seen in well under four hours. Indeed, during last year’s Christmas recess, I spent the early hours of Christmas eve in Weston general hospital’s A&E with my then three-year-old. Like this year, the Labour Front Benchers were claiming crisis, yet I saw some incredible clinicians doing an incredible job well within the required timelines. Moreover, an outpatient appointment needed in the week between Christmas and new year was easily arranged and kept. My personal experience is just one of the millions of experiences within our NHS each year, but I highlight it because if we are to have an honest, factual debate about our health system, we should caution against the emotion of individual experiences, for there will always be at least one that illustrates whatever point we seek to make.

Further into the hospital system, three of the four hospitals that serve the Wells constituency had more beds available in the last week of 2016 and the first week of 2017 than they did in the corresponding period in the previous year. Although occupancy at Taunton and Yeovil was 81% and 82% respectively last week, it is true that occupancy in Bath was 93%, and in Weston-super-Mare 100%. Make no mistake: occupancy levels such as those are a cause for real concern. But it is also important to note that although things are tight, so far the trusts are managing. However, I know that in all four of those hospitals, particularly in Weston, far too many beds are blocked by those who would be discharged if care at home could be arranged.

The Government have made more money available for adult social care and have given councils greater flexibility to increase council tax in the interim, but Somerset County Council and our local NHS organisations are justifiably still very concerned. I encourage the Government to look again at the local government funding settlement and adjust it to ensure that the funding gap between urban and rural areas does not widen and that funding for adult social care clearly and fully reflects the places in the country where the demographic is most top-heavy and where rurality increases the costs of delivering that support.

Finally there is the challenge that we face locally in primary healthcare. Local practices have assured me that anyone requiring an emergency appointment is seen on the day. However, it is true that my constituents are too often expected to wait a week or more if they ask to see their regular GP. Quite understandably for those with longstanding and complex health issues, they expect to see the doctor they know, so these waits are unacceptable, but it is wrong to connect the waits solely with funding. The greater challenge in Somerset is not the primary healthcare budget, which has risen for each of the past three years, but our ability to recruit new GPs.

The Secretary of State has worked hard to deliver more GPs into the whole system, but now rural CCGs such as Somerset’s will need to look at what initiatives could be developed to encourage new GPs to ply their trade in rural general practice. Furthermore, we must listen to and support those responsible for our STPs. We have called again and again for politicians to keep our noses out of NHS planning. Now that we have and local clinicians are now at the helm, the Opposition dismiss their work as well because it is politically expedient to do so.

The STP in Somerset has been written by people who really know their craft. When I asked them whether they would have written the plan as it is, even if there were no resource constraints, they told me that they would. They say that the demand has changed and that the thinking on public health has changed, and they tell me that the clinical view of how and where people should recover after they have been in hospital has changed too. Things will change still further over the years ahead.

Some of the things that the STP proposes are very challenging to me and some will be very unpopular with the community I serve, but the analysis is based on an expertise that far outstrips mine, so unless I am being implored now to reassert the supremacy of politicians in these matters—we have, after all, apparently had enough of experts—I think we owe it to the clinicians empowered to now design and run our local healthcare systems to scrutinise, of course, and to support them. Moreover, those clinicians deserve to do that work without the partisan hullabaloo being stirred up by the Opposition. Our inboxes give us a great feel for how things are. Our conversations with constituents, clinicians and patient participation groups, such as the one in Cheddar that I will see tomorrow night, shape that view, too. To claim that all is perfect right now is not true, but to claim that there is a crisis is not true either. Our population and the practice of medicine are changing. This debate needs to happen—not in a partisan furore, but in an honest, constructive and supportive way.