On Tuesday 7th September I have a public meeting in Sutton to discuss the future of local healthcare including both ensuring St Helier has a long future and the possibility of building a new specialist acute healthcare facility in Sutton.
Joining me will be Daniel Elkeles, Chief Executive of Epsom and St Helier University Hospitals NHS Trust who will outline the Trust’s vision for the coming years. We need you to get behind this. You can find out more information here.
Come along to the meeting, look at the video on the Trust’s website, Fill in one of our surveys. Please get involved and rather than just talk about saving St Helier, let’s do something together, speaking with one voice and go further.
Tomorrow the deadline closes to have your say on changes to Controlled Parking Zone (CPZ) charges in Sutton.
The proposed scheme will base charges on the amount of emissions your car generates. I wrote about this last year when the proposal was introduced, and I believe it has some major flaws in it.
In particular, I am concerned that with the CPZ being in force during working hours, people who don’t take their cars to work, i.e. leaving them at home, means they will be penalised for not using it, which could result in more residents choosing to use their cars, leading to more emissions and cars on the road, which is exactly what the scheme is trying to avoid. In addition, it seems unfairly harsh on motorists who don’t have their own drives and need to park on the road, as they will have no opportunity to install electric charging points for their vehicles if they wanted to switch to an electric vehicle – again, as this scheme is trying to encourage.
Big vehicles, which use a lot of fuel, are more likely to be sitting in a garage or a driveway, whereas key workers such as nurses, who may not have a flash car but rely on it to get to work, are going to be more heavily hit by this scheme just because they don’t have a their own driveway or garage.
Just like the chaotic new bin collection scheme, this is an idea that Lib Dem-run Sutton Council has dredged up from many years ago – another example of it running out of ideas yet arrogant enough to push this through.. This was something being talked about when I was a councillor nearly a decade ago and nothing has changed.
To look at the plans in more detail, you can view the public notice here, and to have your say on the proposals, click here to respond to the consultation.
Make sure you have your say, especially if you live in a CPZ.
Given the concerns expressed over the last weekend about social care, it is important to explain the government’s plans properly, cutting through some of the political spin.
The Conservative manifesto includes our commitment to strengthen the social care system with more and sustainable funding to cope with the long-term pressures caused by the fact that we are living in an increasingly ageing society. After all, there will be two million more people over 75 years old in Britain over the next decade alone and a third more people aged 85-plus in 2024 than there were in 2014. Furthermore, the growing number of long-term conditions such as dementia is putting increasing pressure on the social care system. At the moment, elderly people in need of care face high costs and inadequate treatment, as well as the risk of seeing the assets they built up over a lifetime depleted to virtually nothing. I believe the social care system will collapse unless we make some important decisions now about how we fund it.
That is why we have to act. And it is why – to give people security – the government included in their plans, measures to make sure no one should have to sell their family home to pay for their immediate care needs. They have also said that they would protect a minimum of £100,000 of your savings so, however expensive your care, you will be able to pass something on to your family.
Most people don’t have to think about long term care and as a result it is important to understand how the present system operates, for despite the comments by some, care and support services in England have never been free. Right now, most people have to pay something towards their own care and some will already have to pay for all of the costs. The current lower limit, where all their remaining savings will not be used, is when savings fall to £23,250 at that point they will be on a sliding scale means test until their savings reach £14,000. For those in residential care the value of their house is taken into consideration as well.
Whilst local authorities may cover some or all of the cost of care in some circumstances, its help is “means-tested.” Right now whether you are in a Care Home or receiving support in your own home you will be expected to make a financial contribution. Furthermore, property has always been calculated in personal care package, evidenced by the existence of a “12 week disregard.” Worse, the present system can be a lottery, with some local authorities requiring the payment whilst the person needing care is in the home. This has often resulted in people having to sell their homes, causing real anxiety and worry to those who are in need of the care when the system should be supportive. These new proposals will bring an end to the need to sell your home whilst you are alive.
So, this plan would replace and in so doing improve the existing system where people often get poor quality care – and stand to lose almost all their savings and assets, including the family home. This plan addresses the worry people have when they have a loved one with a long-term condition, and they don’t know how they’re going to afford to care for them.
Furthermore, these proposals will be presented in the form of a Green Paper, (a government consultation document) and they provide the beginning of a solution to social care without increasing taxes on younger generations. That consultation will include an absolute limit on the amount people have to pay for their care costs. Importantly everyone will get to comment on what is in the paper and the government will listen carefully to the concerns of all of you before setting the final policy.
But since the manifesto was published, the proposals have been subject to fake claims made by Jeremy Corbyn. It is sad that he has resorted to whipping up fear and scaremongering. That is why I hope Theresa May’s statement, that there will be an upper limit to the amount that people will have to contribute should reassure you that you will not eat into all of your savings and satisfy those who have been worried by some of the scaremongering from the Labour party.
So for the avoidance of doubt, let me reiterate:
We will make sure there will be an absolute limit on what people will need to pay for their care by capping the amount they will have to pay.
We will put more money into health and social care.
We will generate more money for social care by including the home into the test for people getting care in their own home. This is what already happens with people in residential care, and will mean people’s assets are treated equally wherever they are looked after.
We will protect people from the huge costs that can accumulate from elderly care, by protecting people’s assets up to a minimum of £100,000 from social care costs. This will be done with a capital floor that is four times the current level of protection of assets.
We will make sure no one has to sell their home within their lifetime to pay for care, by extending deferred payment agreements for people getting care in their own home. This will take the anxiety out of obtaining support.
We will improve the care people receive by improving co-operation between the NHS and the care system, relieve unnecessary and sometimes unhealthy stays in hospital, and examine how to make best use of specialist housing and new technology approaches that enable people to live independently, with dignity, for longer.
We will give people the right to request unpaid leave from work to care for a relative for up to a year, because the vast majority of care is provided informally, usually within the family.
For surely the greatest unfairness is if we dump the costs of social care on to our children, for this is the likely alternative. Despite all the scaremongering from Labour, that is what their proposals will do. Labour’s fantasy manifesto with over £10’s of billions of uncosted spending pledges will result in enormous tax increases. First, Jeremy Corbyn plans to drag some 3.9 million more homes, including half of all homes in London, into paying inheritance tax. Jeremy Corbyn has even said he could increase the basic rate of income tax for millions of people from 20 to 25 per cent to fund social care. So Labour will hit those families with heavy taxes, at the very point they might expect to receive the money from their parents.
I believe we save first and foremost so that we are not a burden on our children and so that we can all have a better than basic retirement without the need for our children to have to finance our support. Whatever is left over of our savings and capital, of course should go, if we wish it to our closest relatives
Our welfare reforms are getting more people into work and then ensuring they save through our recently introduced automatic enrolment scheme will make sure there are fewer people in future who fail to save sufficiently for their retirement, reducing the future burden on our children.
Theresa May has shown determination and boldness in tackling this issue head on, I believe she is right to do so, for the alternative is a Corbyn led government which will tax us so much that any thought of passing on savings to one’s children will become a folk memory.
I hope this explains what the government is proposing and reaffirms the fact that a full consultation will take place before any policy is put in place. I also hope that on 8th of June, you will balance this issue alongside the very real damage that a Corbyn led government – shored up by the Scots Nationalists, Plaid Cymru, The Greens and the Lib Dems, (in effect a coalition of chaos), would do to our country.
Whether you voted leave or remain in the referendum, I hope you will agree it is vital our government gets a good deal from the negotiations with the EU. Given that the Prime Minister will sit down with the EU to start those negotiations very soon,only Theresa May’s strong and stable leadership could achieve a good outcome for this great country of ours.
Over the last 25 years we have had politicians queuing up to ‘Save St Helier’ but precious few coming forward with a realistic plan to do so. I believe that this needs to change which is why I invited Jeremy Hunt, Secretary of State for Health, to come to St Helier Hospital and meet me and the chief executive to discuss how we can secure St Helier’s future. Wouldn’t it be great if at the next general election, the future of healthcare in Sutton had been transformed permanently for the better? The chief executive kindly showed us around the best of St Helier and the worst.
The best included ‘board rounds’, an initiative in the hospital’s acute care centre where a group of doctors considered each patient on the ward in a multi-disciplinary approach, looking at everything together. This has led to mortality rates being at their lowest ever, despite treating ever more patients and recovery being so much better. We saw a new CT scanner adding much more capacity, enough to take in patients from right across South London. We also dropped in on the new restaurant which opened yesterday and which will free up space for a new renal unit.
The conditions of the existing renal unit was less satisfactory. As with everywhere on site, the staff do amazing things in the most challenging of conditions. Beds for dialysis are too closely packed in. The single lift is not big enough for a trolley bed, leading to the incredible situation of the Trust having to spend £10,000 a week on an ambulance shuttle service to take patients from the back of the hospital to the front.
We then went to the boiler room, which contains huge steam-powered boilers from the 1950s. If this is the heart of the hospital, it’s suffering from acute angina. Clearly hugely inefficient in its running, if anything went wrong, the hospital would struggle to stay open for any length of time. Two members of the maintenance staff go around the hospital every day, testing water for legionella and flushing through systems if and when it is found.
The back of the building is largely blocked off by hoarding. Not because of maintenance work but to protect passers-by from crumbling masonry. The trust has to find an estimated £5m of its budget to go to extra maintenance every year simply down to the state of the building. Despite these risks, the staff work so hard to achieve patient outcomes that are among the best in London.
Finally we had a chance to talk to Jeremy Hunt about creating a vision for the future. The NHS cannot start a public debate during the election ‘purdah’ period but I can. The views here are mine, I don’t speak for the trust, nor the government and I am open to change my mind through meaningful discussion with residents. To my mind there are three options for a new hospital. St Helier, Epsom or the Sutton Hospital site co-located with the Royal Marsden. If we went for the latter, the Marsden would benefit from extra intensive care and acute facilities to support its work. The vast majority of services at both Epsom and St Helier would remain where they are but the trust could remove some duplication thus releasing more money to spend on front-line treatment. To be clear, I do not want St Helier to close, neither does anyone in the trust. The reported one-for-one replacement with a super-hospital in Belmont is a non-starter. The key thing is to get residents involved and focus on care, outcomes for patients and the best locations for services here in Sutton, rather than just buildings. Each site should be able to retain their full urgent care centre with the A&E placed in the best location on clinical grounds, but we should remove the matter as a party political matter, instead discussing this in a pragmatic way that brings everyone behind a solution that we can secure from the NHS and the Treasury.
Once we have agreed on how we configure services over the three sites, we need to look at the difficult issue of funding. Building a new hospital now will cost in the region of £300m. Delaying this for five years will increase the cost to £400m, purely through the effect of construction inflation. One way of securing this funding is to work across London to realise the value of NHS-owned land that is surplus to requirements. It is estimated that there are a small number of trusts in London with around £1bn worth of surplus land. However, the challenge is to release this and then to see that money shared across other trusts, when they will want to keep it for themselves. Another possibility is prudential borrowing via Sutton Council or through pension funds. Sutton Council has borrowed money to buy Oxfam’s head office in Oxford and an office block in Wallington. When I was on the pensions committee for the council, we used to review Sutton Council’s pension investment in a number of shopping centres across the country. I can see no reason why this investment could not be better used to invest in our infrastructure. Either way, pension fund managers are on the lookout for low-risk, long-term investments like hospitals. As a loan, ownership would remain with the NHS, not in private hands. The challenge in this case is how to account for the debt which would sit on the government’s books at a time when they are trying to get to a point that they can reduce debt, not increase it.
If we can secure alternative funding for the largest part of investment, we would then need to secure funding for ensuring that the existing buildings are up to the job for the next 20 years. I have talked about £75m for this as an estimate. However, this figure is bound to increase as time moves on and the buildings continue to degrade. The trust has secured £12m, the biggest investment into the building at St Helier for years, to refurbish B and C blocks. They won’t look that different to the eye but that money will allow the windows at the back to be replaced and to firm up more of the crumbling structure. They have bid for £10m of energy efficiency grant funding to sort out the boiler but more will be required.
St Helier needs the brightest and the best to continue the great work there. As long as some politicians talk down the future prospects of the hospital, staff may be put off going there, instead looking to other hospitals like St George’s. Well, St Helier is not closing and the training and systems there work incredibly well, giving great opportunities to staff. It is therefore sad to see the continuing tales of woe from politicians with a campaign to fight, dragging down morale. It would be easier for me to take the default position of joining others in making supportive noises without any clue of what to do next. But I am a local resident first; one who wants to help to shape a solution. Whilst others petition, I have been trying to engage with decision makers to get answers. They won’t necessarily listen to political sloganeering but they just might to a reasoned, well-evidenced solution that is affordable, practical and deliverable.
Jeremy Hunt said after the meeting: “St Helier has made huge strides in recent years and I was delighted to hear more on my visit about progress and plans for the future. There is no question that St Helier hospital is here to stay, but we do need a plan for improving the facilities and the services on which local people rely. So it was great to see how Theresa May’s local Conservative candidates are working with the local NHS leadership to deliver a vision for St Helier.” I am pleased that he took the time to come, to listen carefully and really take on our thoughts as to how best to keep St Helier performing at its best for Sutton residents.
From the body of Alan Kurdi, the three year old boy washed up on on a beach near Bodrum, to the bewildered boy sitting upright covered in dust and encrusted blood in a hospital in Aleppo, images from the atrocities in Syria and their fall out have been pulling at the emotions of people in the West for years now. People feeling helpless in their comfortable homes, rightly demand that their government acts to tackle the misery, the pain and the suffering felt by those fleeing for their lives, especially the children that have known nothing else.
However difficult to see, working out how we can help every child in every circumstance, we need to remain focused, making sure our support has the best effect on as many lives as possible. This is how I have based my approach to voting in Parliament and I am pleased to say this is how the UK government has approached its policy. Some clickbait media write deliberately provocative articles, either through misinformation or by exclusion. The refugee crisis is complicated. That’s why it is still an issue years after the Syria crisis started. It can’t be boiled down to a three line article throwing accusations without any attempt to explain the background that has led to much debate in Parliament and in the Council of Europe. People may not accept the UK government’s approach but I still believe it to be the right one and it deserves the chance to explain its reasoning.
From the beginning, the UK government took the view that it was best to support refugees as close to their homes as possible. Most Syrians do not want to permanently relocate across the other side of the world. They just want peace and the ability to go back, return to their homes and start once again to educate their children. The UK has been a major supporter of humanitarian aid in Syria, Lebanon (the country with the most refugees per capita) and Jordan (number 2 in the list), second only to the USA with more than £2.3bn of our aid budget providing places of safety where we are caring for more than a million people. The government has taken the view that this approach reduces the pull-factor that encourages people into the hands of human traffickers, making the perilous journey across the sea. I have been to the Moria hot-spot on the Greek island of Lesbos with a delegation of European politicians all members of the Council of Europe. We saw a protest of predominately North African migrants who pelted our bus, complaining that Syrians were getting preferential treatment. Regular fires break out on the camp burning down tents and often ending in fatalities. I met children who were able to receive some education in makeshift camps run by the Greek navy in Athens. There I met a Yazidi Christian from Iraq who explained how he and his five children fled from Daesh, crossing the mountains and making that boat trip. The youngest of his children was only 10 days old at the time they travelled. Bearing in mind the modus operandii of those making the crossing is to deliberately capsize the boat when approached by a boat from the navy to force them to be rescued and relocated, it is a miracle that this tiny scrap of a lad managed to survive. He did and was a healthy 3 month old when I saw him.
I also saw the makeshift camp in Syntagma Square, Athens’ equivalent of Trafalgar Square where migrants who were mistrustful of the authorities camped down each night rather than going to one of the formal camps. They had arrived believing that they would be able to travel freely to a country of their choice, predominately Germany, Sweden, Norway and Switzerland, only to find that the borders have been shut and they were stuck in Greece with no prospect of moving on. This situation had been exarcebated by Angela Merkel’s short-lived offer to allow 1 million refugees to come to Germany. She shut the border within a week and admitted that she was unprepared. In the meantime, 200,000 migrants had walked across Slovenian countryside (population 2m), tensions in Hungary grew and Macedonia closed their border with Greece trapping people in the most terrible conditions by the border. Essentially this started with a kneejerk policy, undoubtedly well-intentioned, but with little regard to the likely consequences. It started as a reaction to the photo coverage rather than a response to a review of what was possible. The UK has taken another tack based on refugees closer to the conflct zone, one which the Commissioner for Human Rights at the Council of Europe told me with hindsight was the correct decision.
We have a number of schemes for resettlement beyond the Dubs Amendment. We will resettle 20,000 Syrians over the course of this parliament and we will also resettle 3,000 children and their families from the wider region. In the last year, the UK has granted asylum or another form of leave to over 8,000 children and of the 4,4000+ individuals resettled through the Syrian Vulnerable Persons Resettlement Scheme so far, around half are children.
This week the Government announced that in accordance with section 67 of the Immigration Act (known as the Dubs amendment), they will transfer 350 children to meet the intention and spirit behind the amendment. This number includes 200 children already transferred from France and will include a further 150 over the coming months. The scheme has not closed as has been reported by some. The legislation obliged the government to put a specific number on how many children they would take based on a consultation with local authorities about their capacity. We need to make sure that these children have the intense level of support and care that they need.
I am not aware that Sutton council is suggesting that they have extra capacity. I would be surprised given the number of local people who come to my surgery about their emergency accommodation which is located out of borough in places like Mitcham, Thornton Heath and South Norwood. However if they have, like any council, they can still participate in the National Transfer Scheme. Each year the UK has around 3,000 unaccompanied asylum seeking children arrive in Britain and currently a small number of councils are taking a disproportionate share of the burden in caring for these children. Kent alone, supports almost a quarter of all child refugees in Britain. That’s five times more than the whole of Scotland – and 12 times more than Wales.
The only way to solve this crisis is to end the conflict; anything else is a method to manage it. The UK is in an incredibly difficult position as are other European countries. For every child taken in from one country, another stays behind elsewhere. However in the meantime the UK will continue to play its important role in supporting people fleeing from conflict, each and everyone a human being with a tragic story, not just a statistic.
Much as I love my job, the one thing that I knew I’d hate about becoming an MP was returning to a daily commute. I was right and it’s clear from my twitter feed, emails and letters that I’m not the only one who bemoans the atrocious performance of Southern Trains. I even managed to miss a ‘Meet the Manager’ event at Victoria station after my train was delayed. Last year, I started the call for Transport for London to take over the organisation of Sutton’s train services as they’ve done a reasonably good job in running the London Overground routes and TfL Rail to Shenfield. I was pleased that the Department of Transport have now agreed this albeit at the end of Southern’s franchise in 2021. TfL will take over the organisation of the parts of the Southern network that is predominately in London, though that is not the same as actually providing the services themselves.
That bodes well for the long term but doesn’t address the short term problems. I had thought that stripping GTR (who run Southern and Thameslink) of the franchise would help, but on further investigation I believe it wouldn’t change much immediately even if it did make us feel better for a while. The overall situation is complicated and is further exacerbated by unofficial union action which is providing commuters with a real summer of misery. It is this union action that we need to tackle first in order to strip back the underlying ongoing issues with Southern and Thameslink.
Some of the problems with the network are out of Southern’s control. The London Bridge station refurbishment is not due to be completed until the end of 2018. Signalling is woefully inadequate especially around the major junctions such as Purley and Selhurst. Because the Sutton lines join up with the mainline coastal routes, these all have knock-on effects even if they are not directly en route. Our franchise is the busiest in Europe, taking 22% of all rail passengers in the UK. Victoria station has more people passing through the barriers in the 90 minutes of the morning rush that fly from Heathrow in a day. The only way to increase capacity on the Southern routes is to move to digital signalling. Rather than having one train sitting between each set of traffic lights, digital signals monitor and regulate gaps between trains allowing them to travel closer together. This is how capacity and efficiency has increased markedly on the London Underground. There are several stretches of rail, especially closer to London where trains are only allowed to travel at a crawl because of the quality of the track. Replacing this requires significant investment and will entail many weekends of work. All of these issues are the responsibility of Network Rail, the government owned organisation that controls the rail infrastructure. Southern liaises with Network Rail but has no more input than that.
Long term solutions
Of course there are many faults that do lie solely with Southern. Trains breaking down are because of outdated rolling stock. Not enough staff until recently was down to a lack of recruitment by Southern although the unofficial union action has made this far worse. Southern are gradually introducing more carriages. The process is starting now but will take several months for the whole programme to roll out. This will eventually lead to more reliable trains. Southern started a major staff recruitment programme in 2014 but of course it takes time to train people once they’ve been hired. The old contracts that staff have been hired on date back to the steam age where rest periods reflected the physical nature of stoking furnaces and suchlike. Building up a staff roster who can look forward to a modern rail service will help tip the balance towards better management/staff relations where serving the customer is at the forefront of the job.
There had been some signs of improvement in April but things have got hugely worse since. The primary reason for this is RMT and ASLEF fighting against the introduction of Driver-Only Operated (DOO) trains. At the moment 40% of all routes in this franchise are already DOO including all of the services that go through Sutton. Most of the London Underground runs on this basis. Essentially the responsibility for closing the train doors before departing each station is with the driver using CCTV and platform staff, rather than with the guard on the train who can then be redeployed to more passenger-facing activities such as ticket sales and enforcement. No jobs are to be lost. At the moment the guard controlling the doors has to be specifically trained on their particular route and so cannot be moved to cover any other route to cover staff shortages, a significant hindrance to improved productivity. ASLEF had agreed to DOO trains on a number of routes but when an extra carriage were added to the Gatwick Express, they considered this a significant changeand so refused to keep the DOO system despite this already being operated successfully on this service. DOO has been in existence for more than quarter of a century. ASLEF representatives have been calling on members to “dig the trenches and prepare for war” when it comes to combating DOO.
The RMT recently talked about withdrawing the threat of industrial actions which is fine but what they need to do is to get their members to call off their unofficial action too. There is an extraordinary high level of ‘sickness’ where people are calling in to take a day off. Apart from disrupting the route that they are due to run, this leads to trains being in the wrong place so drivers who attend work on time are unable to operate anything and cover cannot be called in because of the need for route-trained guards. This go-slow is wreaking havoc on services. With Southern already underperforming, this further frustrates and indeed, annoys commuters. People have reportedly lost their jobs as a result of persistent lateness. One train in four arriving at Victoria on time is just ridiculous. Stripping the company of this franchise will do nothing to solve this immediate issue. DOO will be introduced across the network on August 21st. As it happens, their talk of withdrawal didn’t last long with a fresh five day strike announced for the 8th August onwards.
Southern have temporarily cancelled 341 trains each day claiming that this will be allow them to ensure the rest of the service can better cope with the unofficial action. This has had had mixed results but I was one of a number of MPs that told them that this was not the sensible way forward. Cutting further services is creating a hostage to fortune and adding to the woes of the paying public. There are also still too many services being delayed after this measure has been put in place. People have also complained about trains missing out stations in order to make up time. The Southern franchise works on a different basis to most others. GTR have a management contract with the Department of Transport for which they are paid a fee. They are not mitigating the risk of fines by skipping stations so this is simply an operational decision to ensure that services run as best as possible and that the rolling stock remains in the right position for the next service.
No easy answers
I have been working with the Department of Transport, GTR and the very many MPs from across the parties whose constituents are equally as affected. The union action must be resolved by September when people come back from their summer holidays. Demand dips by 20% in August but that clearly doesn’t last and so the pressure will soon return. GTR need a clear plan that can actually be delivered. The new Secretary of State for Transport is Chris Grayling, my neighbouring MP in Epsom & Ewell. His constituents are affected by the very same train routes as Sutton & Cheam. This situation is one of the most important items on his agenda (along with the impending airport expansion decision). I have already spoken to Chris about the situation and know that he is working hard on resolving the situation. It’s frustrating but it’s going to take time. It is scant comfort to remember the British Rail days when I had two unreliable trains an hour from Carshalton Beeches to Victoria. Demand has increased but so has expectation. We have plenty to do to make the service bearable, let alone world-class. But it is a top priority of mine to aim for both.