Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 27th November 2018 Commons Chamber

[Caroline Dinenage]

I am happy to work with our colleagues in Scotland to push forward best practice in helping to support community facilities and to ensure that they are investing in facilities at the heart of people’s local areas, which is where they are needed.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage Community Hospital was built and opened by the local community in 1927, but it has been closed for two years. Moves are afoot to improve both our local health centre and health facilities in Didcot, but all that must be joined up and the community needs an answer. Will the Minister use her power to convene a meeting of local stakeholders and her officials to find a way through the maze and a future for our hospital?

[Caroline Dinenage]

I am always happy to speak to my right hon. Friend about such things. I understand that the intention is now to move to a more place-based approach to health and care planning in his local area, but all such changes are subject to consultation.

Lung Cancer

Lord Vaizey of Didcot Excerpts

Thursday 26th April 2018 Commons Chamber

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

It is a real privilege to respond to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) because he genuinely is a friend and has been a great friend to me. The public see this bear pit where we rip each other apart on a regular basis, but I am sure you will agree, Mr Deputy Speaker, that this is also a very special place.

The House takes a judgment of people and views us all as honourable Members, and my right hon. Friend is known for being one of the most decent men in this place. The genuine outpouring of concern and love when he was forced to make his announcement was tangible. I am not surprised that he was surprised to hear where some of the good messages came from, but he should take that as well deserved. He has talked today about a very personal and traumatic experience, and he did so with real purpose and dignity. In doing so, he has shown the best parts of being a Member of this House, and I warmly congratulate him. It has made it very difficult for me to answer, but there we are.

I congratulate my right hon. Friend on securing this debate. He suggested he was lucky to get an early diagnosis and the outcome that he has. There is an element of luck in it, but I will come back to that. The most important point he made was the fact that he followed up with his doctors and did not let it go. The most important thing in getting a good outcome from cancer is being vigilant and taking that early action.

In my right hon. Friend’s speech, he has humanised his story. We all recognise the behaviours that he outlined. It must have been a very painful decision for him to make—at the top of his game, having entered the Cabinet as Secretary of State and done really good stuff, he was suddenly faced with physical health issues but knew it was the right thing to do and took comfort from his family. The rightness of that is here for all to see.

Luck forms part of it, but we also need to properly engage with health professionals. Some people are dogged, others do not want to face up to it, but we all need to have a much more open conversation. The days when cancer was a death sentence are gone. Cancer survival rates in this country have never been higher. As my right hon. Friend pointed out, that is down to early diagnosis and good treatment. The latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS treatment than three years ago, and that is testament to the hard work of our dedicated NHS staff, but we must do better. Our aim is to save an additional 30,000 lives by 2020. Some 130,000 people die from cancer every year, so there is much to do, which is why the Government have accepted all 96 recommendations in the cancer strategy and backed up this commitment with £600 million of additional funding up to 2021.

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) on a superb speech. It sounds a provocative thing to say perhaps, but it is becoming increasingly apparent that we have cured cancer, in the sense that if diagnosed early enough survival rates shoot up. This might also sound provocative, but it pays for itself. If we can screen people and catch it early, treatment is cheaper than when it is caught later, so although screening would entail a big upfront cost, it would not only save many lives but pay for itself.

Surgical Mesh

Lord Vaizey of Didcot Excerpts

Thursday 19th April 2018 Commons Chamber

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate the hon. Lady on this important debate. She is right to call this a scandal. A constituent of mine now has a colostomy bag and severe internal pain and probably cannot give birth safely in future. She is 24. She makes the point that ventral rectopexy mesh procedures are not included in the audit, apparently because there is no code for surgeons to enter. May I join the hon. Lady in pressing the Minister to go back and include that in the audit so that my constituent’s suffering can be recorded?

[Emma Hardy]

I absolutely agree, and I hope that will be included in future.

Analysis conducted by Carl Heneghan, professor of evidence-based medicine at the University of Oxford and clinical adviser to the APPG on surgical mesh implants, reveals that the 100,516 women who have undergone mesh surgery in England since 2008 have required follow-up treatment in 993,035 out-patient appointments. He has calculated the total cost to the NHS for all incontinence and out-patient appointments to be £245 million. His analysis of the trend in out-patient appointments also shows that more are required by women as each year passes after their surgery, which is completely the opposite of what you would expect after a successful surgery.

The data shows that the number of operations using mesh has halved over the last decade, which shows that doctors and patients are voting with their feet and telling the world that they do not want to use mesh.

NHS Staff: Oxfordshire

Lord Vaizey of Didcot Excerpts

Tuesday 20th February 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing this debate, and I echo her praise for NHS staff who do a fantastic job—indeed, only the other day I was approached in the street by a constituent who told me just how fantastic his NHS treatment had been.

The issue under discussion is not a new problem or something that started only in the past year. I have chaired a group of Oxfordshire MPs and the clinical commissioning group for a number of years, and this issue has been there from the beginning. If I can segment the NHS market a bit, perhaps we can consider how different elements of the NHS can play their part. First, however, let me say that the release of information to The Times by Churchill Hospital must be opposed. It created much stress among patients, and it bore no resemblance to the policies of that hospital. We should send a firm message to Churchill Hospital that the way it behaved was unacceptable.

Perhaps my constituency is very fortunate, but on several occasions I have been told by constituents that a surgery is full and can take no more people, and that that is all down to new housing. Each time I rang the GP surgery, however, I was assured that that is not the case and it still had a tremendous amount of room to take more people. Nevertheless, that does not reflect the current problem with the GP practice system which, however we look at it, we must admit is in need of considerable reform. There are at least two reasons for that. First, we have the problem of young doctors who are unable or unwilling to take on the stress burden created by taking out the loans necessary to buy into the surgery. Secondly, there is a limitation on the ability of GP practices to do some of the minor operations that they have done in the past, and which allowed them to carry on the excellent work that they do for their communities. I urge the Minister to look at that, and perhaps to remove some of the restrictions that apply to the ability to operate in GP surgeries.

Of course GPs need to adapt to new ways of working, and they need to use the internet in a much better way. My own results from what is, I hasten to say, a minor health issue are dealt with by the internet. I email the information in on a regular basis, and the results come back on the internet—fortunately they come back clear each time. [Interruption.]

[Mr Edward Vaizey (Wantage) (Con)]

We are all speculating now.

[John Howell]

I know, and I will leave that issue there.

Social care has been mentioned in terms of its competition with the retail sector in Oxford, which I think is a very real threat. Another issue goes back to one of the more substantial points in the Care Quality Commission report, which is that the joining up and interlinking of different aspects of social care in Oxfordshire leaves a lot to be desired. For example, the amount that was paid by the NHS health trust was different to the sum paid by the county council for the same number of people doing the same amount of work. Evening up that difference must be something to concentrate on, and I wish people success in doing that.

The income of the clinical commissioning group amounts to about £880 million. Staff costs are about 70% of that, at just over £600 million. A 1% pay increase means at least £6 million to £7 million as an unfunded pressure on the health care system, and that is not a very productive way forward. There is no getting away from the fact that the biggest problem with recruitment and retention is living costs in Oxfordshire. There are a number of ways that we can tackle that problem, such as by building more houses—the Oxford-Milton Keynes-Cambridge express way is a good joined-up process for dealing with that, and I hope it comes to fruition.

The second thing we can do, I am afraid to say, is change the housing policies in Oxford city. That goes back to conversations that I had ad nauseam with the predecessor of the hon. Member for Oxford East (Anneliese Dodds). We were known for our fighting over the green belt, and I am glad to infer from what the hon. Lady has said that Oxford is changing the way it deals with issues of planning and housing.

We are talking about a marginal increase across the board, and the uplift that that will bring will not have a big impact on retention and recruitment. It would be much better for us to focus any increase in funds on the issue itself. I ask the Minister, formally, to agree to a weighting for Oxfordshire that gives it some of the strength that London has. As we have already heard, housing costs in Oxfordshire are at least as great as those in London, and that must be tackled. We need a specific weighting, not a marginal increase in pay, and since there will be only a limited pot of resources for increasing pay, it makes a lot of sense to concentrate the impact of that in those places with more intractable problems, such as the housing market and living costs in the city.

[Mr Edward Vaizey (Wantage) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I thank you for saving the best till last. I congratulate my Oxfordshire colleague, the hon. Member for Oxford West and Abingdon (Layla Moran), on securing this important debate and on her extremely eloquent speech. I echo the way that she opened the debate by paying tribute to our colleagues who work in the NHS. When talking about the problems faced by our NHS locally, we should not lose sight of the fact that we are supremely well served by some extraordinary men and women in our hospitals and GP surgeries, who go well beyond what is required of them to provide first-class care. As Oxfordshire MPs we are also lucky to represent a population that, on the whole, is pretty healthy—indeed, the greatest health care challenge we face is the fact that a lot of our constituents, thankfully, live to a serious old age.

I also want to pay tribute to the hon. Member for Oxford East (Anneliese Dodds) and my two hon. Friends the Members for Henley (John Howell) and for Banbury (Victoria Prentis), for their fantastic speeches. It may be frustrating for the Front Bench that, although potentially there were plenty of goals to be scored, the debate was conducted as all Oxfordshire debates have been since I became a Member in 2005, in the spirit of doing the best for the county.

I want to mention particularly the work of my hon. Friend the Member for Banbury on the Horton General Hospital, which relates to the problem I want to focus on. She has worked tirelessly to maintain services there, and has made it clear to me that although the Horton is geographically well away from my constituency the services that it provides mean that my constituents benefit from choices. The pressures on the local NHS are spread further, enabling a better service to be provided for all. My hon. Friend has come up time and again, as she pointed out, against a culture of secrecy. There have even been court proceedings in which she has been involved. The mind boggles at how the local NHS goes about its business.

Perhaps when the Front Benchers speak we shall go back to playing the traditional national blame game. However, I want to play a bit of a blame game myself—but placing the blame squarely on local NHS management. I do not want to put words into my colleagues’ mouths, but whenever I go to meetings with local NHS management—ably convened by my hon. Friend the Member for Henley—I find that they are passive, unimaginative and deeply bureaucratic. I find the local NHS system completely opaque, and mired in jargon, endless consultation—or non-consultation—and a woeful lack of action.

The CQC report well illustrates the inability of silos to come together for conversations for the greater good of healthcare in Oxfordshire. An example of that is provided by the biggest local issue for me and my constituency: the closure, coming up for two years ago, of Wantage Community Hospital. It closed in April 2016, apparently for justifiable reasons. It is a very old building and its pipes are ageing. There were continual outbreaks of Legionnaire’s disease, so it was closed for safety reasons; but one would have expected some rapid developments to solve that problem. We were promised a consultation that was going to happen in October 2016; that never happened. Then we got a consultation in January 2017, but because of the opaque bureaucracy that my local NHS enjoys that was a phase 1 consultation. Apparently the community hospital was going to be in phase 2, which of course—like the gold at the end of the rainbow—has not materialised.

I took it upon myself at the end of last year to convene a meeting—ultra vires, you might say—of local stakeholders, my local GPs and health managers. It was the first time they had all met together, convened by me, the local MP, not by the health authority. Again, there was complete passivity. I shall not bore my colleagues with the complexities of the attempts to untie the Gordian knot, but clearly one of the solutions for local healthcare in Wantage is the expansion of the local GP surgery. It is owned by a private landlord, Assura, but it seems to me a benign landlord that wants to do the best thing; it would be happy to expand the building. Of course it would receive increased rent as a result. We need, potentially, some financing from the Department of Health and Social Care, but at the very least we need some engagement from health management. I am the one who has effectively brought Assura to the table to discuss how we can develop the GP surgery, to put some proposals on the table and to search for a funding solution. That could involve all sorts of imaginative solutions. I think there will be a meeting at the end of the month to take things forward, but I find it deeply frustrating that I am the one having to drive the process, and not my local NHS management—not that I am complaining, as it is the only way we shall get results.

[Mr Nigel Evans in the Chair]

As to the quasi-national issues that have been raised, I echo much of what has been said. As a convinced remainer—although, sadly, the horse has bolted—may I get well behind the hon. Member for Oxford West and Abingdon and point out that we have, proportionately, twice as many EU citizens working in our local NHS as elsewhere? As the hon. Lady said, it is absolutely reasonable to say that the Government must do more to reassure our European colleagues who live and work here, who contribute their taxes and want nothing more than to be good citizens of our communities, that they are welcome here and that we have nothing against them. I am sure that now that we have Mr Nigel Evans in the Chair that sentiment will be echoed by him at the earliest opportunity.

Housing is clearly an issue, and although I am sure that all our postbags are full of letters from people who do not want an increase in the amount of housing, we need to speak up for all the people for whom it is essential. They include the very people charged with keeping us healthy. I had not appreciated the issue of visas—that is why the debate is so important. I am driven mad by the lack of imagination on the part of the people running our local health service. That came up in what my hon. Friend the Member for Banbury said about the imaginative solutions that her community came up with to secure a senior obstetrician. Shift patterns are an example of what I mean. Nurses leaving the John Radcliffe after 9 o’clock in the evening is something that needs to be looked at.

Parking at the JR is appalling. Surely it is possible for representatives of the local council and the JR to sit down and find a parking solution. An imaginative health authority and imaginative health leaders would look holistically, if I may put it in that way, at the entire working environment for nurses and doctors, particularly in hospitals: how do they get there, how much does that cost, how can parking arrangements be improved and how can permits be given to people who need them for their shift working pattern? That could make such a difference, above and beyond pay. It needs everyone to come to the table. It sounds incredibly boring to keep talking about getting people together for discussions; however, in my time as a Minister—and as a Back-Bench MP—I have often discovered, on bringing together people who I thought probably had regular conversations, that they never sit down to discuss the issues.

[Victoria Prentis]

My right hon. Friend is making the most marvellous speech I have ever heard him make, on a number of issues. I regret interrupting him, but I want to echo what he said and suggest that, as we despair slightly of anyone else taking the action in question, perhaps we as a group—with the Minister if he is willing to be involved—could take the baton and go forward. When I was in charge of fundraising as a volunteer at my local hospital, as I was for many years, I offered charitable funds to look at car parking. That was ridiculous, really, but it was an attempt to break through the bureaucratic impasse that we so often came up against. Let us take matters forward together.

[Mr Vaizey]

I am happy to work with my hon. Friend, particularly considering her back-handed compliment. She has heard hundreds of speeches from me, so for this to be the best she has heard—

[Anneliese Dodds]

I agree that it is a marvellous speech, and I thank the right hon. Gentleman for that. On the point he was making, we must be sanguine, of course, and I am sure that colleagues will be. There is a tension that I have discussed many times with the trust, and with others; it wants a green and pleasant environment for patients and staff, but intensifying car parking, as many want, might go against that. There could also be planning implications. To be fair, the trust is actively looking at the issues.

As to innovation, the new district heating system that has just been put in is pretty unique. We should give credit where it is due, sometimes: it will ultimately save the trust hundreds of thousands of pounds.

[Mr Vaizey]

I thank the hon. Lady for a course correction in my so-called brilliant speech. I have perhaps been too hard on the NHS management locally to make that point. I am sure that there are hundreds of examples of great innovations that they have introduced. I want to re-emphasise what I said at the beginning of my speech about my huge admiration for nurses, doctors, consultants, surgeons and indeed NHS managers, who do a difficult job. However, I hope that there is appreciation of the frustration that I feel as Wantage Community Hospital’s closure comes up to its second anniversary and there appears to have been no movement.

I do not have time to discuss pay but I noted what my hon. Friend the Member for Henley said. He is a bold and brave advocate for pay locally, and if he thinks that an Oxfordshire weighting is a good idea I am happy to support that, because of his venerable experience in the area. I would be delighted for us to get together as all the MPs of Oxfordshire and with key stakeholders. Personally, I would leave the Minister out of it, because the key message for me in this debate is that Oxfordshire has its issues, but a lot of them can be solved locally.

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.

NHS Fertility Services

Lord Vaizey of Didcot Excerpts

Thursday 19th January 2017 Westminster Hall

[Mr Edward Vaizey (Wantage) (Con)]

I am grateful for the opportunity to speak in this important debate under your chairmanship, Mrs Gillan. I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing it. I appeared with him in front of the rather intimidating Backbench Business Committee, but thanks to his eloquence and advocacy we now have time to raise this issue in the House. Hon. Members frequently table questions about IVF, but I do not recall when we last had a debate on the subject. It is right that we have the chance to raise the issue, which has frequently crossed my desk since I was lucky enough to be elected to represent the Wantage constituency. Like the hon. Gentleman, I will talk about some of the cases that have come across my desk. They will sound very similar to those that he raised, because couples not being able to have children and not being able to access the treatment that can help them have children has a huge emotional and health impact on them.

As the hon. Gentleman said in his eloquent opening speech, which covered all the issues, it is important to stress that infertility is a disease. Choosing to have children—I hate to put it like this—is not a lifestyle choice; it is a fundamental choice that many people are lucky enough to be able to make. People who are not able to conceive children suffer from a disease, and I think it is therefore incumbent on the national health service to help combat the impact of that disease, as it does for many other diseases. This issue is much more prevalent than people realise: it affects one in seven couples in the UK. I am sure everybody in this House knows people who have been affected directly, and our constituents contact us about it. As the hon. Gentleman pointed out, it is the second most common reason why women visit their GP.

We have also heard how more and more clinical commissioning groups are now disinvesting in NHS fertility services. The signals from NICE, the Government and the CCGs themselves clearly show that fertility services are seen as second-class NHS services that do not rank alongside other, more important services. We in this House know from the many debates we have had, and not least from the huge increase in the profile of and focus on mental health services, that treating something as a second-order issue stores up significant problems. We can reverse that attitude through sustained campaigning. As has been pointed out, in 2016 North East Lincolnshire, Somerset, Wiltshire, Herts Valley, Cambridgeshire and Peterborough, and Bedfordshire CCGs all cut their fertility services and now offer the bare minimum: one funded IVF cycle. Approximately 10% of CCGs are currently considering disinvestment.

The NICE clinical guidance has been around for more than 10 years. It is important to remember that this is not a static issue: the cost of infertility treatment has fallen dramatically and its effectiveness has increased. The second or third cycle tends to be the one that helps a couple to conceive, so I think NICE was visionary and right to say that three full cycles should be offered to women under 40. It is important to remember that CCGs restrict fertility services not only through the front door by making it clear that they will offer only one cycle, but through the back door by restricting the age at which women can access them. In Oxfordshire, for example, the age limit is 35, not 40.

There is also the issue of how a cycle is defined. In Oxfordshire, one fresh cycle is offered to those under 35, and no frozen transfers are allowed. Other definitions of a cycle allow frozen embryos that have been created from the first cycle to be used, so Oxfordshire does not comply with what I understand to be NICE’s definition of a cycle.

Going back to fertility services being seen as second-class services, Oxfordshire CCG’s response to me when I asked it to comply with the NICE guidelines was, “How are you going to fund it? What other services are we going to have to cut to fund fertility treatment?” It was clearly posited as an either/or, and the undercurrent of the message was, “We are funding the important services. Additional fertility services are a luxury. You are asking us to spend £x million on a luxury.”

To defend Oxfordshire CCG, it uses the NICE cost guidelines when it works out what the additional costs would be. It claims that they would be £2.5 million in year 1, four-and-a-bit million pounds in year 2, £5 million in year 3 and just under £5 million in years 4 and 5. What depresses me about that is the fact that it simply took the off-the-shelf guidance from NICE, which gives the game away: it is simply a desktop exercise by a CCG that is not really interested in addressing the issue. It should be possible for it to investigate with a range of different providers how it can potentially reduce the cost. The cost variation in fertility treatment can range from something like £2,000 to up to £8,000 for a cycle, so it is possible to at least engage with providers to investigate how one can provide a cost-effective service.

I also challenged the CCG on how rigorous it is in stopping services that are out of date and past their usefulness. My understanding—I am sure the Minister will confirm this—is that CCGs should be carrying out an ongoing process of reviewing all the services they are currently funding, because there are probably many services that are out of date or falling into misuse but are still being funded.

I pay tribute to Fertility Fairness, which campaigns assiduously on this issue. It made the point that treatment can cost about £2,000 in the north of England, £6,500 in the south and £3,500 across the UK as a whole. One of its asks, which perhaps the Minister can respond to, is this. CCGs can take refuge by charging the highest cost possible, which acts as a barrier to what we want to achieve. If there were a national tariff, more CCGs might be tempted to come to the table and increase what they are doing to support fertility services.

The Minister is not only a fellow Oxfordshire MP but an absolutely brilliant Health Minister. I know that to a certain extent I am knocking at an open door, because she has spoken very strongly about this issue in public. She said:

“Fertility problems can have a serious and lasting impact on those affected. It is important that the NHS provide access to fertility services for those who need clinical help to start a family. I am very disappointed to learn that access to IVF treatment on the NHS has been reduced in some places and it is unacceptable that some Clinical Commissioning Groups have stopped commissioning it completely. I would strongly encourage all CCGs to implement the NICE Fertility guidelines in full, as many CCGs have successfully done. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing to ensure CCGs can get best value for their local investment.”

That is very welcome news indeed.

The hon. Member for Birmingham, Selly Oak pointed out that there are knock-on costs to not providing fertility treatment in the UK. We know, for example, that many couples understandably go abroad to fund and access fertility services, but different regulations apply abroad. Often, many more embryos are implanted in treatment abroad, which can lead to multiple pregnancies. Multiple pregnancies can lead to greater complications, so paradoxically that can lead to increased costs for the NHS. We would all much prefer people living in the UK to be able to access more familiar services, instead of having to go abroad and take those risks.

I mentioned that all of us speaking in the debate will have real stories to tell. We are speaking not in a vacuum about some impersonal procedure, but about a disease that affects the lives of our constituents significantly. The reason why I supported the hon. Member for Birmingham, Selly Oak in securing the debate, and the reason why I am present, is the letters I receive as a Member of Parliament from my constituents.

One 33-year-old constituent wrote to ask how the situation was fair given that in Wales, Scotland and Northern Ireland, people are entitled to three full cycles of IVF—I understand that the Scottish Government are moving to three full cycles early this year. For four and a half years she and her husband have been trying to conceive. They have been through every test, but all the results have come back as normal, so they have what is called unexplained fertility. They pinned all their hopes on a single funded cycle of IVF, although that was difficult to accept. She points out that infertility is not a choice made by women; they have no control over it. Her first cycle, in August, failed and she went on to a frozen egg cycle, but unfortunately miscarried. Her emotional status is now such that she sees her GP regularly, has been referred to TalkingSpace, an NHS service, and awaits counselling. She was quoted £6,000 for a private cycle—her parents helped with the cost of the treatment—although it transpired that the overall cost was about £8,000. That second cycle failed, too, and the couple will now remortgage their property to fund a third cycle.

Those who think of infertility as a second-order issue should consider that some people will mortgage their financial future to treat the disease, as people might do for other diseases. The idea that infertility is something that one can simply put to one side is absolutely ludicrous. Another constituent wrote about having to go to Barcelona for treatment, which cost about £12,000. A third constituent, at the age of 36, was again refused IVF treatment, and she is now funding her treatment privately.

Infertility is clearly a disease, and one that affects many couples throughout the UK, and some of the devolved Administrations are moving forward on it. I respect the difficult choices that clinical commissioning groups have to make, but the NICE guidance is crystal clear and fair. The guidance sanctions not unlimited cycles but only three, recognising that the first cycle often fails. The technology continues to advance, prices continue to fall and there is little evidence from my CCG or, I suspect, many others of active engagement on the issue, such as research on the ground in real time into what it might cost to procure fertility services, as opposed to simply using off-the-shelf NICE cost guidance to rebut my constituents’ concerns.

The lack of infertility treatment has hidden costs, as the hon. Gentleman said, in mental health and emotional issues and the ongoing costs when people go abroad for treatment that might have an impact back home. A great step forward would be if the Minister were to bring forward a national tariff, or if research were commissioned into some of the ongoing costs of not providing infertility treatment. I encourage the Minister to continue to hold CCGs to account for not complying with NICE guidance.

Community Pharmacy in 2016-17 and Beyond

Lord Vaizey of Didcot Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

The right hon. Gentleman makes an extremely good point. They are not yet in place, but they will be by 1 December.

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate the Minister on his statement. It is worth reminding the House that many urban pharmacies are located in clusters and are very close to one another. It is therefore quite right that we should look at how they are subsidised. I am pleased that, as a result of these savings, he will be looking out for rural pharmacies, which are more dispersed. They are the ones that really need the help.

[David Mowat]

The access scheme to which I referred will apply to rural and urban pharmacies. Indeed, there is more urban than rural in it, but it will protect rural pharmacies in the way my right hon. Friend mentions.

Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

The STP process is an attempt to upgrade our public health and mental health provision and cancer outcomes. Every STP will be expected to provide an assessment of local public health priorities and the timetable for progress towards that.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage community hospital in my constituency has recently closed because of the threat of Legionnaires’ disease, and it will not reopen until we have finally concluded consultation on the sustainability and transformation plan—if it reopens at all. This consultation has been delayed, and that naturally worries my constituents. Will the Minister join me in urging Oxfordshire to get on with consulting on this very important plan, so that we can have a reasonable discussion?

[David Mowat]

I will join my right hon. Friend in doing that. I am not familiar with the specifics of the Wantage case, but it does not sound right that it is an ongoing thing that is not fixed quickly.

Defending Public Services

Lord Vaizey of Didcot Excerpts

Monday 23rd May 2016 Commons Chamber

[The Minister for Culture and the Digital Economy (Mr Edward Vaizey)]

I am pleased to respond to this debate, and I apologise that I slipped out for a while to attend the Oscars—I refer, of course, to the fantastic Oscar’s book prize, which was started by the journalist James Ashton and his wife, Viveka, in honour of their son, who sadly died at a young age. It is a prize for children’s literature and picture books, and I am pleased that the award went to the fantastic Spanish author, Gemma Merino—are we not pleased that in this country we are able to award a prize to a Spanish author, one of our European brethren?

The winning book was called “The Cow Who Climbed a Tree”. I have not read the book, but I do know that it features a cow that does something unusual—it climbs a tree. That reminded me of this debate, which has been a bit topsy-turvy. A former Trade and Industry Secretary condemned a trade treaty with the United States, my right hon. Friend the Member for Wokingham (John Redwood) called for more investment in public services and not for tax cuts, and the hon. Member for Huddersfield (Mr Sheerman), who is not in the Chamber, recommended that hon. Members read The Sunday Times, a Rupert Murdoch paper, and in particular columns by Max Hastings, to get a real taste for the truth in public policy.

This is a special day, and I want to mark two important occasions. First, it is the Chancellor’s 45th birthday, which was mentioned in the debate. Secondly, I may be the first to congratulate the leader of the Scottish Conservatives, Ruth Davidson, on her engagement. Many others have congratulated her on eclipsing the Scottish Labour party and on the fact that she is breathing down the neck of the Scottish Nationalist party.

The debate has very much been about football. The right hon. Member for Leicester East (Keith Vaz) was not wearing his scarf but still managed to mention his championship-winning team—a team that wins rather than a party that loses, such as the SNP.

[Ian Blackford]

The SNP won the election and increased its share of the vote—it got nigh on 47% of the vote. The Tories got 22% of the vote, which is less than they got when Thatcher was in power. If the Minister calls that breathing down the neck, I do not know what he would think about a real challenge.

[Mr Vaizey]

The hon. Gentleman doth protest too much, and he certainly spoke extensively. As well as Leicester, we heard mention of Sheffield Wednesday, and I wish them the best of luck in the premier league play-off. The hon. Gentleman is a fan of Hibernian, so he obviously had a good weekend. We also had a brief mention of West Ham, who are ably led by the Conservative peer Karren Brady.

Before I mention individual speeches, may I reject the persistent criticism from the Opposition about this being a thin Queen’s Speech? We focus on sugar-free drinks and the sugar tax, but the Queen’s Speech is packed with fantastic nuggets. My Bill will push forward the digital economy. The Department for Transport will focus on autonomous vehicles and on spaceports. We have a commitment to 1 million more homes; the devolution of business rates to give more powers to local councils; rigour for our universities; much needed changes to adoption rules; greater freedom for headteachers and teachers; prison reforms; and a focus on skills and apprenticeships.

We have heard formidable speeches, but I hope hon. Members forgive me if I single out the maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). It was a fantastic speech, and particularly poignant for the fact that it came within a year of the maiden speech of her late husband Harry Harpham, who is sadly missed from the House. She talked about skills, housing and libraries. I may not agree with the hon. Member for Huddersfield that we should always read Max Hastings, but I agreed with him when he followed her speech by saying that she will be a formidable Member of the House and a fantastic spokeswoman for her constituents.

Much of the debate focused on the national health service, and my right hon. Friend the Secretary of State gave a robust exposition of his important reforms. He has worked incredibly hard over the past four years to put patients first. The key point is to put patient safety and patient outcomes first.

Many Members spoke in the debate, including my right hon. Friend the Member for Basingstoke (Mrs Miller), my hon. Friends the Members for Harrow East (Bob Blackman), for South West Wiltshire (Dr Murrison) and for Dudley South (Mike Wood), the right hon. Member for Leicester East, and the hon. Members for Ross, Skye and Lochaber (Ian Blackford), for Huddersfield, for North Antrim (Ian Paisley), and for Scunthorpe (Nic Dakin), but I should like to mention the hon. Member for Dulwich and West Norwood (Helen Hayes) and the right hon. Member for North Norfolk (Norman Lamb), who focused on mental health. For a long time, mental health has been the Cinderella, but my right hon. Friend the Secretary of State deserves a great deal of credit for raising its profile and importance, and for investing in it. We need to focus on that incredibly important service as much as possible.

We had mentions of education. The right hon. Member for Leicester East talked about prison reform, which is an extraordinarily important issue, and with my cultural hat on may I say how important culture could be in giving prisoners life chances and aiding their rehabilitation?

I notice from your glance in that direction, Mr Speaker, that I was warned by several of my colleagues not to mention them in my peroration, such is the terror with which you are held, in case they were not in the Chamber to hear their names mentioned, so I had better stop mentioning hon. Members and hon. Friends. I will, however, turn briefly to the BBC, which has been much maligned by those on the Opposition Benches.

The hon. Members for Washington and Sunderland West (Mrs Hodgson), for Manchester, Withington (Jeff Smith), for Sheffield Central (Paul Blomfield) and for Merthyr Tydfil and Rhymney (Gerald Jones) all spent their time talking down the BBC. I found it particularly surprising that the hon. Member for Sheffield Central—he obviously had not heard the hon. Member for Huddersfield extolling the virtues of the Murdoch press—dared to suggest that we were somehow shaping our approach to the BBC at the behest of Rupert Murdoch. I tell you this, Mr Speaker, with utter sincerity and truthfulness that the only organisation that has ever lobbied me to clip the wings of the BBC is The Guardian.

Mr Speaker, I know you well enough to know that you may not know what The Guardian is. It is a left-wing newspaper and website that has been going through some interesting changes recently in terms of its chief executive and the chairman of its trust. It comes to me regularly—quite legitimately, I have to say—to say that it is trying to make a living, as it were, digitally in the digital world. It has been opening websites. It opened an office in Australia and came to complain about the presence of the BBC in Australia taking talent from The Guardian in Australia and paying too much. It also lobbied me about the presence of the BBC in the US, where The Guardian also wants to have a presence.

The serious point is that we have to be aware not just of the fantastic virtues of the BBC, but that it is seen by other media groups, such as The Guardian, as a competitor. We have carried out much needed reform of the BBC. We have put its regulation on a proper footing—it will be regulated by Ofcom, with a unitary board. We have emphasised, in deference to The Guardian, the importance of the BBC being distinctive. We have strengthened its independence by ensuring that it can appoint half the members of the unitary board, and we have put in place a mid-term review so that the BBC can keep pace with technological change. That is only right and proper.

The other important aspect of the Queen’s Speech is the digital economy Bill, which was mentioned by my hon. Friends the Members for Mid Worcestershire (Nigel Huddleston) and for Salisbury (John Glen), my right hon. Friend the Member for Basingstoke, my hon. Friend the Members for Rossendale and Darwen (Jake Berry), my right hon. Friend the Member for for Arundel and South Downs (Nick Herbert), and my hon. Friends the Members for High Peak (Andrew Bingham) and for Harrow East. This is an important point. The hon. Member for Garston and Halewood (Maria Eagle) asked me to talk about the universal service obligation we are bringing in to make it a right to get superfast broadband, and what the extra costs might be for people applying for it. She well knows that if one applies now for a telephone landline under the universal service obligation, one has to make a contribution if the costs exceed a certain level. Of course, that level is many, many thousands of pounds, so it is not as if we will be asking many people, if any, to make a contribution. We will consult after we have legislated for this important right. I hope the hon. Lady will make a contribution to that consultation and perhaps advise us on what level she thinks any threshold should be set at.

I welcome the hon. Lady’s welcome for the cultural protection Bill in relation to The Hague convention. The Bill should have been passed by the previous Labour Government. In fact, I was the Opposition spokesman at that time—as you know, Mr Speaker, I was made Opposition spokesman in about 1874. I was ready and willing to take it on as my first Bill as an Opposition spokesman, but have had to wait eight long years to take it through as a Minister.

This is a Queen’s Speech packed with passion, packed with aspiration and packed with ambition. It is a one nation Queen’s Speech that focuses on the life chances of those who are hardest to reach. This has been a vigorous and important debate. I have to say with utter sincerity that it has been an absolute pleasure to listen to hon. Members on both sides of the House and to hear the passion and the principles that they bring to these issues. Their knowledge, expertise and independence of mind are everything that makes this House of Commons great and everything that makes this country great; a great country and a great member of the European Union. [Interruption.] I am just trying to match the rhetoric.