Healthcare in Oxfordshire

Lord Vaizey of Didcot Excerpts

Tuesday 17th October 2017 Westminster Hall

[Mr Edward Vaizey (Wantage) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger, and I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing this important debate. He spoke with verve and passion; in fact, throughout his speech I was grateful that I was never prosecuted by him when he was at the Bar, because I would not have stood a chance. He made his points cogently and those were ably supported by my hon. Friend the Member for Henley (John Howell). I, too, am a trade envoy—I missed a trick in not informing you of that before the debate, Sir Roger—but I wish my hon. Friend luck with his forthcoming meeting, and I quite understand why he cannot stay for the entire debate.

Let me speak briefly, because I know that my hon. Friend the Member for Banbury (Victoria Prentis) also wants to speak and she is particularly passionate about this subject. I fully support the comments that my hon. Friend the Member for Witney made about the consultation process, which has been, not to put too fine a point on it, pretty tortuous. That has not been helped by the fact that the chief executive and the chairman of the clinical commissioning group both left in the summer, although this gives me an opportunity to congratulate the new chairman, Kiren Collison, who has just been elected on a 97% turnout of GPs in Oxfordshire.

There is clearly great passion for health services in our county—an affluent county that is capable of providing very good services to the people here. But we are getting older, and over the next few years, the population of people aged over 85 will rise by almost 100% and the population of those aged over 60 will increase by 58,000. We are also getting more houses, which are much needed, but that also means that the population as a whole will rise from its current 700,000 to almost 900,000 in the next decade or so. There are great pressures on our local health service, and it has not been helped by this consultation period.

Let me highlight three issues in my constituency, starting with Wantage Community Hospital, a much loved local amenity, which previously had maternity services, with about 60 births a year. I regularly bump into people in Wantage who were born there—many of my constituents were. The hospital was closed in April 2016 because legionella kept being found in the pipe system. Some 4,000 people signed a petition asking simply for the physiotherapy and maternity services to remain open. As I said, there is huge support and there have been great demonstrations in favour of it.

The process that has followed has been appalling. The consultation was due to start in October 2016, but as my hon. Friends know, the clinical commissioning group split the consultation into two phases, with the first covering acute hospitals and the second covering community hospitals. My hon. Friend the Member for Banbury might comment on that strange way of going about a consultation. In any event, the first consultation did not take place until January 2017, three months late. As the hon. Member for Oxford West and Abingdon (Layla Moran) pointed out, community hospitals are not covered in that phase.

In addition, we have now lost our physiotherapy services. They were retendered, and Healthshare won the tender, but it informed my local newspaper that it would not provide physiotherapy services in Wantage as it otherwise would have done, because it was not offered the opportunity. The only service that the hospital can offer is limited maternity care; it has effectively been closed for more than a year, and will have been closed for two years when we get to the phase 2 consultation that might decide its future. That is a completely unacceptable position. I have said again and again to my constituents that I will support anything that provides good healthcare services in Wantage, whether in the community hospital or elsewhere, but at the very least I would like the consultation to start so that my constituents can participate in the discussion.

That leads me to my next point about the pressure on some of my local GP surgeries. For example, Wantage health centre, which could provide some of the services formerly offered by the community hospital—not maternity care, clearly—is home to two practices and is located in a relatively new building on a large site, purpose-built with a view to expansion in future. Its current capacity is 29,000 patients, but over the next 10 years it is likely to reach 45,000.

The landlords, Assura, made a bid to EFTA in March 2016, offering to meet the capital provision and proposing to ask Oxfordshire CCG to meet the additional rent reimbursement. That bid was not successful. I am told that Assura is still committed to investing in the building and that any capital provided by the NHS will be offset by reduced rent, but it needs reassurance that the NHS wants to progress the project; otherwise, it will have to consider alternative uses for the land. The current rent reimbursement is around £350,000, and would rise to around £550,000 with the increase in capacity.

The trouble is that Oxfordshire CCG has not engaged in any imaginative approach to the conundrum that the building is owned by a private landlord—albeit one that is a specialist healthcare provider—meaning that it would incur a revenue cost to the NHS rather than a capital cost. However, at least some sense that a creative discussion is taking place is needed, and I am afraid that there is none.

The White Horse medical practice in Faringdon also has problems. It is two practices merged in one large building, but the internal configuration is far from ideal: for example, it has two waiting rooms. The practice put in a bid for £375,000 to enable internal alterations that would provide five much-needed extra consulting rooms. It received funding for the plans to be drawn up and costed, but was unsuccessful in the final bid, and the CCG has no funding for this project. I do not necessarily lay the blame at the CCG’s door, but it is intensely depressing that relatively small sums of capital that would make a tremendous difference seem to be completely unavailable.

Finally, the Elm Tree surgery in Shrivenham faces issues as well. It is managed by a different CCG in Swindon. The trouble is that because Swindon is mainly an urban area, the CCG has drawn up plans that are perfectly sensible for urban areas, whereas the Elm Tree surgery is a rural practice with completely different needs. Inappropriate decisions have been taken, such as about payments and the surgery’s relationship with care homes. I have met GPs from the Elm Tree surgery and written to Swindon CCG to highlight the problem, but although I have requested a meeting, Swindon CCG has refused, which I find slightly disheartening.

I conclude by echoing the comments of my hon. Friend the Member for Witney, who opened this excellent debate. The whole consultation process has been completely unacceptable. All of us recognise the pressures on the local health authorities and the pressures from a changing population; all that my constituents ask for is a reasonable, open and transparent conversation about the services that they need in their towns and communities.

[Victoria Prentis (Banbury) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I made my first speech about the Horton General Hospital when I was seven. I apologise that many people in this Chamber will have heard it before, but I do not know that you have had that pleasure, so with your permission, I will carry on.

Let us remember what we are talking about. The Horton is not a community hospital. It has been a pleasure to listen to colleagues talk about their community hospitals; we have heard about Wantage and Abingdon, and one rarely meets my hon. Friend the Member for Henley (John Howell) without hearing him mention the Townlands, of which he is very proud. I love community hospitals too; my mother helped run Brackley Cottage Hospital for most of my childhood and until recently, and I think that the marvellous hospital in Bicester still has untapped potential. However, the Horton General Hospital, which I will talk about, is quite different.

The Horton has hundreds of beds and treats about 39,000 people in accident and emergency every year—nearly one third of Oxfordshire’s A&E attendances. What happens at the Horton affects all my colleagues, due to the knock-on effects of closure. Our surgeons are among the top five in the UK for neck and femur operations. It is not a community hospital; it is a fully functioning, very busy district general.

We feel beleaguered. For more than 40 years, the John Radcliffe Hospital has viewed us as a smaller and less academic sibling that can be treated with contempt when staffing is short. In 2008—this is not ancient history; it is nine years ago—the Independent Reconfiguration Panel was asked to consider the last proposed downgrade of paediatrics, obstetrics and gynaecology and the special care baby unit. It conducted, as I hope it will again, a full five-month review and made five excellent recommendations, which I will read once more.

The first recommendation was:

“The IRP considers that the Horton Hospital has an important role for the future in providing local hospital-based care to people in the north of Oxfordshire and surrounding areas. However, it will need to change to ensure its services remain appropriate, safe and sustainable.”

On the proposed downgrades, it said:

“The IRP does not consider that they will provide an accessible or improved service to the people of north Oxfordshire and surrounding areas.”

Other recommendations were:

“The PCT should carry out further work with the Oxford Radcliffe Hospitals NHS Trust to set out the arrangements and investment necessary to retain and develop services at the Horton Hospital. Patients, the public and other stakeholders should be fully involved in this work… The PCT must develop a clear vision for children’s and maternity services within an explicit strategy for services for north Oxfordshire as a whole… The ORH must do more to develop clinically integrated practice across the Horton, John Radcliffe and Churchill sites as well as developing wider clinical networks with other hospitals, primary care and the independent sector.”

I am afraid that none of that happened. The recommendations were made nine years ago, but none of them were followed. The only things that changed were that the traffic got worse and the population of the area grew. Our district council, I am proud to say, tops the leader board for house building.

Less than 10 years later, we now have no obstetrics or SCBU. They went in the blink of an eye, without any real attempt to address recruitment issues or work with us to do so, although we offered and offered. Locally, we remain deeply unhappy and frightened. Patients in the later stages of labour are travelling for up to two hours, and emergency gynaecological operations take place in a portakabin in the Radcliffe car park. We have heard stories locally—in fact, they are all people talk about—of babies born in lay-bys and in the back of ambulances. The data that show statistics of complete births—defined by when the placenta has been delivered—tell a different story; they do not register the reality of people’s experience.

I pay tribute to what my hon. Friend the Member for Witney (Robert Courts) said about Google Maps. Locally, the impression is that the CCG and the trust massage the figures and use them when it suits their argument. I conducted a travel survey of nearly 400 people on their real-life experiences of how long it takes to get from our area to the John Radcliffe Hospital in Oxford. Sadly, those data were not taken on board in any of the CCG’s reports, although the data set was bigger and better than the CCG’s. The CCG provided real data only when we had harangued, pestered and begged it to do so.

I will not go on about how worried I am; I will focus on what we can do to put the situation right. It is true, as all hon. Members have said, that local health providers do not talk to one another. Health Education England’s decision to remove training accreditation for middle-grade obstetricians was the straw that broke the camel’s back for recruitment, yet it remains aloof and makes decisions in a vacuum. Its recent decision to remove accreditation from certain grades of anaesthetists puts all the acute services provided by the Horton at risk. The dean did not communicate that decision to decision makers at the trust or the CCG; I had to tell them at a meeting in August. I do not think that that is an acceptable way to run a healthcare system.

The trust usually tells the CCG what to do. When it does not agree, there is stalemate. The trust, the clinicians and everyone else locally know that the A&E at the Horton cannot possibly be shut, because the knock-on effects on the rest of Oxfordshire and the surrounding counties would be catastrophic. The CCG, however, is determined to press ahead with its consultation that suggests otherwise. Owing to this impasse, we have ended up with a split consultation that means nothing to any of us. Patients’ needs appear to be an afterthought. South Central Ambulance Service, which bears the brunt of the transfers, is carried along as a consultee with no voice at the table when decisions are taken.

One of the main complaints is that local health decision makers do not listen to us. Our latest consultation report described the “universal concerns” of more than 10,000 people from my area who responded to our consultation. I cannot overemphasise the strength of local feeling. We all feel the same: all the elected representatives, of whatever party; a great campaigning group, Keep the Horton General; and even the local churches, which are praying for sense in the clinical commissioning group’s decision making. [Interruption.] My right hon. Friend the Member for Wantage (Mr Vaizey) laughs, but I am afraid it is impossible to overstate how essential our local hospital is to people in our area. He may think it is funny, but we do not.

[Mr Vaizey]

For the record, I am laughing because I have never heard of a church praying for sense from a clinical commissioning group. That highlights the parlous state that we find ourselves in.

--- Later in debate ---

[Mr Dunne]

Indeed, I recognise that. If we are moving to an obstetric-led service at the John Radcliffe, any mother who is high-risk or is expected to give birth will have time to travel in good order, rather than in an emergency. I accept that emergency transfers do take place from midwife-led units during the course of labour.

I have heard the criticism about the overall transformation programme for Oxfordshire being divided into two phases. At this point, we are where we are. The first phase has come to a conclusion, and we are entering the second phase. I recognise some of the criticisms that it is hard to comprehend a coherent system without seeing it all laid out together.

[Mr Vaizey]

I hate to interrupt the Minister’s flow as he is getting stuck into the STP, but as time is running out, will he prevail on his officials to write to me after this debate and answer two questions? First, when will the next tranche of capital funding be available for GP surgeries in Oxfordshire? Secondly, what engagements could his Department facilitate between Assura, myself and the clinical commissioning group to try to break the logjam at the Wantage surgery? I do not want to waste any more of his time, and I feel reluctant to prevail upon his officials’ time, but that would be very helpful.

[Mr Dunne]

I can do better than that; I can answer my right hon. Friend’s first question directly. The bids for STP capital funding have been made by all 44 STP areas. They are being assessed at the moment, and we will be making submissions to the Chancellor for the Budget to see whether there will be a capital release for phase 2 of STPs. It is a competitive process. I can confirm that the STP area covering Oxfordshire has made a bid, but I cannot confirm whether it will be successful, because we will not know until we know how much the Chancellor is prepared to release in the Budget. I will happily write to him on his second question and his concerns about Wantage.

Members have said much about some of their concerns about their community hospitals. In his absence, I thank my hon. Friend the Member for Henley (John Howell) for his invitation to visit his hospital and look at the rapid access care unit. I am pleased that he supports the impact it is having in ensuring that elderly and frail people are seen quickly and can return to their homes without needing to be admitted. As he pointed out, and I think we all agree, care at home is how we should be seeking to treat as many people as possible, because that allows people to lead longer independent lives instead of having a prolonged stay in hospital.

The second phase of the Oxfordshire transformation programme is continuing. As has been pointed out in the debate, the CCG leadership is going through a transition period. We have a process under way to recruit a new chief executive, who is expected to be in post in the coming weeks. I am sure that the chairman will read this debate and take note of the comments that have been made on the challenges in engaging in recent years, as will the new clinical lead, who was appointed only yesterday. It is important that Oxfordshire CCG undertakes full public engagement for the second phase of the transformation, and I am aware that that is what it is intending to do. It is likely to begin early in the new year, and I strongly encourage all Members to engage with that consultation in as forceful and impressive a way as they have with this debate, led by my hon. Friend the Member for Witney. I pay tribute to the passion with which everyone has spoken about their commitment to their local residents in providing high-quality healthcare in Oxfordshire.