NHS Long-Term Plan

Victoria Prentis Excerpts

Monday 18th June 2018 Commons Chamber

[Victoria Prentis (Banbury) (Con)]

On Friday, I was lucky enough to visit the award-winning neck of femur service at the great Horton General Hospital. The length of time that patients stay is very dependent on great links between the hospital and social care. Does my right hon. Friend agree that spending to save is possible, so that even more of this great funding can be spent on patient returns?

[Mr Hunt]

Absolutely. The most important way of spending to save is to invest in prevention, and a lot of that work comes from strong local hospitals. Before my hon. Friend finally leaves this place, I have no doubt at all that her local hospital will be called not the Horton General Hospital, but the Great Horton General Hospital.

Oral Answers to Questions

Victoria Prentis Excerpts

Tuesday 8th May 2018 Commons Chamber

[Steve Brine]

We want to get on and tackle all avoidable harms, including alcohol. The vast majority of our constituents enjoy a drink and have a healthy relationship with alcohol, but that is not the case for everybody. Some people can harm themselves, society and, as we have heard, their children. What is happening north of the border in Scotland is very welcome. I think that there will be an early evaluation there at the one-year point, and we will be watching that like a hawk.

[Victoria Prentis (Banbury) (Con)]

13. What steps the Government are taking to tackle obesity.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

Childhood obesity is one of the biggest public health challenges we face, which is why we are committed to reducing the sugar in products consumed by children by 20% over four years.

[Victoria Prentis]

I recently met my constituent, Professor John Wass, at an Obesity Health Alliance tea, where—the Secretary of State will be pleased to know—no cake was served. Professor Wass shares my concerns about the availability of hospital services for those with established obesity. Will my right hon. Friend set out what plans his Department has to treat those who are already obese?

[Mr Hunt]

We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.

Learning Disabilities Mortality Review

Victoria Prentis Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

I thank the hon. Lady for raising that case. It was a truly horrible case. The Mental Capacity Act 2005 is all about making sure that we have care that is centred around the individual, and that parents’, families’ and carers’ thoughts are taken into consideration when making decisions about how we care for people.

[Victoria Prentis (Banbury) (Con)]

We can be confident that the right legal framework is now in place, with the Equality Act 2010 and the Health and Social Care Act 2012, but what further steps can the Minister take to ensure that those who work in NHS organisations are aware of them?

[Caroline Dinenage]

Of course it is the responsibility of individual employers to ensure that their staff are appropriately trained and competent to fulfil the responsibilities that we ask of them, but we have commissioned Health Education England, Skills for Health and Skills for Care to develop a learning disabilities core skills education and training framework, which sets out a tiered approach to that kind of training and how it needs to be improved.

National Bereavement Care Pathway

Victoria Prentis Excerpts

Tuesday 24th April 2018 Commons Chamber

[Will Quince]

I thank the hon. Gentleman for his further intervention. He raises a good point, because hospital chaplains provide amazing support for those who have gone through this horrific experience. Whether someone is of a religion or of none, there is an important role for the calm, comforting voice and listening ear of a chaplain, who can sit with them and give them the time that NHS professionals are not always able to give in a busy, hustling and bustling maternity or neonatal department.

[Victoria Prentis (Banbury) (Con)]

My hon. Friend is being generous in giving way. Does he agree that the baby loss services that we have organised, particularly last year, have helped many couples across the UK come to terms with their grief? We had a fantastic one at St Mary’s church in Banbury and a fabulous one downstairs in the Crypt here. Whether or not people are of faith, those services enable them to demonstrate their grief in a public place, which is very helpful.

[Will Quince]

I thank my hon. Friend for that intervention and for the considerable work that she has put into both the formation and the ongoing work of the all-party group. She makes a really good point. Those services are not always religious, although most of them tend to be in some way, shape or form, and they are hugely important and comforting to families. I know that she has organised several, and various charities organise them too. They are about not just the religious element but people being able to come together and pay their respects to the children they have lost. They bring about a community and show people that they are not alone and that there are others who have gone through the same or very similar experiences. Long-lasting friendships often flow from them. I remember a service that I attended with my wife—I think it was the year after we lost our son. There was a lady there in her 80s who still came to the service every year to remember the child she lost in her late teens. That shows that the experience stays with people forever, and that these services are really important.

With the evidence showing that the pathway is making a really big difference in improving the quality of bereavement care in the hospital trusts in which it is being piloted, the aim is to roll it out across the country in October. As I said at the beginning, 11 sites launched last October and a further 21 last week, and a nationwide launch in October is very much the ambition. Sands established the project on behalf of the core pathway group, entirely thanks to £50,000 of funding from the Department of Health and Social Care. I am extremely pleased to see my hon. Friend the Member for Ludlow (Mr Dunne), the former Care Quality Minister, in his place, because he did so much with the Secretary of State to help secure that funding.

NHS Staff: Oxfordshire

Victoria Prentis Excerpts

Tuesday 20th February 2018 Westminster Hall

[Victoria Prentis (Banbury) (Con)]

Thank you, Mr Hollobone, and it is a pleasure to take part in the debate. I thank the hon. Member for Oxford West and Abingdon (Layla Moran) for securing it.

It is great to see all my fellow Oxfordshire colleagues present today. If I may say so, they have all been great allies in my fight to save acute services at the Horton General Hospital. Talking about recruitment in some detail is particularly useful, because that is our greatest local challenge with regard to good healthcare.

It is also good to see the Minister in his place. Since he took up his role, he and I have spoken many times about the issues faced at the Horton. We in Banbury are waiting patiently to hear the outcome of the Independent Reconfiguration Panel’s initial assessment of the permanent downgrade of our maternity services. Our hopes are pinned on a full review, and we were due to find out 10 days ago whether that would take place. We have heard nothing yet, but I am watching the post with interest.

The Independent Reconfiguration Panel is familiar with our situation, having looked at similar proposals to downgrade maternity at the Horton back in 2008. Just as recruitment was the contributing factor almost 10 years ago, the failure to fill middle-grade vacancies at the Horton’s obstetric unit was the straw that broke the camel’s back in 2016. However, failures in recruitment are not, as we have heard, unique to maternity services at the Horton. We have spoken briefly about chemotherapy services at the Churchill, and at a meeting in January with local GPs, many expressed concerns about the sustainability of their practices in the current recruitment climate. Last week, the Care Quality Commission observed the following in its full and, if I may say so, quite critical review of the local system, which the hon. Member for Oxford West and Abingdon has quoted and which I will carry on a little:

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades, especially acute hospital staff…and in the domiciliary…market. This resulted in staff shortages, heavy workloads and impacted upon seamless care delivery and integration of services.”

I am reassured that the Department takes recruitment seriously and has invested significant time and resources in addressing current workforce challenges across the nation. Attracting more people to the profession and training them takes many years. The cost of living in our area is high and London weighting is a significant pull factor out of our area, particularly given our very reliable transport links to the capital. We may be a wealthy county but we must think creatively to overcome the current challenges. The future of our services depends on that.

When I called for help, I was overwhelmed by the generosity of local schools and businesses in my area, which offered discounted school fees, free shirts from Charles Tyrwhitt, and free beer from Hook Norton—that made the headlines—to any prospective obstetricians who wanted to apply for a job at the Horton General. As a leading house building authority, Cherwell District Council has been exemplary in its support for the Horton, exploring the possibility of golden handshakes and providing key worker housing. A local developer came forward to offer one of its new build properties to any obstetrician looking to relocate to our area. Yet all of these offers remain completely unexplored by the local hospital trust, which has refused repeatedly to engage with me on this issue.

Last September, the Secretary of State announced plans to offer salary supplements to GPs in rural and coastal regions, which was a really welcome development. Market towns such as Banbury, Bicester, Abingdon and the many others represented in this Chamber desperately need similar incentives to attract newly trained professionals, whether through an Oxfordshire weighting or a ring-fenced housing allowance. I have no particular view about which would be the more effective incentive—I am happy to explore both. More money is always welcome, but it does not have to be the only answer. Just yesterday, I heard from a Banbury GP who has not been able to recruit a fully qualified international GP who is a resident outside the EU, because of problems with the tier 2 visa requirements. The person is an Australian who trained in Banbury and is very familiar with the local system, and we would really value having her back.

It is important that we consider specialties such as general practice and obstetrics when looking at the shortage occupation list that needs to be filled, because there are gaps in those areas too. We must think outside the box and talk across Departments to find the solutions that we desperately need. We must also have some clarity. When obstetric services at the Horton were suspended in August 2016, we were told that the rota needed six obstetricians to operate safely. But the goalposts were moved; the trust now tells us that nine are needed before the unit can reopen. Those decisions have real consequences. We must know the potential domino effect that shortages can have on other medical rotas. Since maternity services at the Horton were downgraded, the hospital has, in turn, lost one of its anaesthetic rotas. Difficulties attracting professionals to CT1 and CT2 posts pose a very real risk to the future sustainability of the one remaining rota. Until that can be full resolved, the threat to all acute services at the Horton cannot be fully ruled out.

Finally, we must learn, as I say repeatedly, to communicate openly and transparently. Extracting recruitment information from the trust is painfully slow. Rather than offer updates, it leaves us to ask for meetings. We are still waiting for the meeting that my hon. Friend the Member for Witney (Robert Courts) requested for us to discuss recruitment at the Churchill. Yet when I made remarks on local radio about a perceived culture of secrecy, the trust chairman was very quick to summon me to meet her. I was told by the trust that all Oxfordshire MPs would be sent a detailed briefing on recruitment and retention challenges by 1 February. I have not had such a briefing and I do not know whether other hon. Members have.

Time and again I have offered assistance with tackling recruitment. Schools and businesses made generous offers to attract obstetricians, and I am furious that the trust continues to fail to engage. I am hopeful that the CQC report provides a long overdue reality check and that we start to see a real step change in its approach. I have made clear numerous times that we MPs are ready and waiting to help. I am really hopeful that under the new excellent interim head of the clinical commissioning group, we will start to develop a vision for our future healthcare, which we have so desperately lacked for so long.

This year we mark 70 years of the NHS. I am hopeful that many of the hard-working staff in Oxfordshire will be recognised at the upcoming parliamentary awards. I am particularly grateful to the dedicated Horton midwives who now face an almost three-hour round commute to and from the John Radcliffe, following the downgrade of our unit. Experience has taught us that we need to keep up the pressure.

--- Later in debate ---

[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—

Acute and Community Health

Victoria Prentis Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

Only one member of the board co-operated with the review, from which we can deduce that all the rest did not. Given that I am relatively new to the Department, it would probably be wise for me to seek clarification on the extent to which individuals should be named, but I am happy to confirm that the chair of the board did not co-operate.

[Victoria Prentis (Banbury) (Con)]

Does the Minister agree that the report shows that leadership really matters in our local NHS? What further steps can he take to ensure that hospital trusts fully understand the importance of transparency to clinical quality and patient safety?

[Stephen Barclay]

My hon. Friend is absolutely right. That is why we are increasing the number of doctors we train by 25%. We are also looking into how we can increase the number of clinicians in leadership positions in trusts, and how we can reduce variance. That is one of the key issues. The NHS has some brilliant leaders, but the variance between trusts is far too wide.

NHS Winter Crisis

Victoria Prentis Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth]

I did say that I would try to make progress. It is clear that a lot of Members want to speak, so I will continue if I may. I have been generous in giving way.

Now we are beginning to hear that it is not just routine non-urgent operations being cancelled. Today, The Times reports of a hospital in Oxford considering delaying the start for chemotherapy due to staff shortages and lack of capacity—a four-week delay on all new patients needing chemotherapy—and there are proposals for those on the first cycle to have full chemo, but then discriminate against those on cycles 2, 3 and 4—second, third and fourth-line chemo—giving those patients a reduced number of cycles, which is a two-tier chemotherapy system.

[Victoria Prentis (Banbury) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Let me make some progress.

In The Guardian today, we read the story of Carly O’Neill, who went into hospital for her cancer operation and who was waiting in her gown with wristbands on in the hospital, only to be told her operation would have to be cancelled because there was no bed available.

[Victoria Prentis]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Let me finish the point.

How about my constituent Mr Geoff Brooker, who was diagnosed with cancer of the bladder? He has had his planned operation cancelled twice this winter. When Mr Brooker was asked about the Secretary of State’s apology, he said:

“He may have apologised for postponements but it was as if he was apologising for the cancellation of a jumble sale.”

My constituent went on to say that Ministers were “uncaring” and he blamed “poor planning”. He added:

“If operations like mine are postponed then it’s likely it will cause deaths. The decision could even be the death of me”.

There we have it: cancer patients having operations cancelled and trusts looking at delaying chemotherapy, yet these Ministers sit there with their NHS badges on their lapels. They should be ashamed of what is happening in the NHS today.

[Victoria Prentis]

rose—

[Jonathan Ashworth]

I will give way for the last time and then I will make progress.

[Victoria Prentis]

Goodness knows the hon. Gentleman knows I am no apologist for Oxford University Hospitals Trust, but it is important that we do not make a crisis where there is not one. I have been assured by the University Hospitals Trust today that the leaked memo does not represent the current reality. I, like him, have concerns about recruitment, and I, like him, am worried about the future of recruitment in the NHS, but it is really important that we do not worry current cancer patients who will continue to receive their treatment.

[Jonathan Ashworth]

I thank the hon. Lady for her contribution. The memo was emailed to oncology department staff in the last few days. If the trust is now backing down on that, all of us across the House will welcome it, but the point still stands: the trust was looking at delaying chemotherapy by four weeks and it referred to a lack of staff and capacity. As we know, this trust has cut many, many beds in recent years, including cancer beds and renal beds, and we know that it is under huge pressures.

Maternity Safety Strategy

Victoria Prentis Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.

[Victoria Prentis (Banbury) (Con)]

As a bereaved parent, but also as a lawyer who has conducted many inquests, I ask the Secretary of State to consider two points. The first is the fact that not many families will need an inquest to determine what went wrong during the birth of their child. Secondly, will he commit to the training of special coroners, just as we have in military inquests, to ensure that those who deal with these very sad cases are the best equipped people to do so? Finally, on behalf of the all-party group on baby loss, may I thank him for today’s announcement and encourage him in his work to make maternity care kinder, safer and closer to home—and may I encourage him to save Horton General Hospital?

[Mr Hunt]

First, may I apologise to my hon. Friend, because I should have mentioned her in my statement as someone who has spoken very passionately and movingly on this topic in the House? I will take away her point about specialist coroners, because we are now going to have specialist investigators, which we have never had before. I would make one other point. I hope she does not think I am doing down her former profession, but really when people go to the law, we have failed. If we get this right—if we can be more open, honest and transparent with families earlier on—it will, I hope, mean many fewer legal cases, although I am sure that the lawyers will always find work elsewhere.

Mental Health Units (Use of Force) Bill

Victoria Prentis Excerpts

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

[Victoria Prentis (Banbury) (Con)]

I am most grateful to have been called first, Mr Speaker, out of the smorgasbord of choice available to you.

It gives me genuine pleasure to rise to support the Bill and to be the first to congratulate the hon. Member for Croydon North (Mr Reed) on his hard work. The Bill stems from great tragedy, but it is always good to see a piece of constituency casework come to fruition and get as far as the Floor of the House. I have enormous respect for the hon. Gentleman, and the all the work he has done with people across the House and outside to get this far. I wish him all the best.

[Wera Hobhouse]

Is it not also time to pay tribute to my right hon. Friend the Member for North Norfolk (Norman Lamb), who as Health Minister introduced the “Positive and Safe” guidelines, a two-year programme with funding to end the deliberate use of face-down restraint in all health and care settings? Unfortunately, those guidelines have not always been followed.

[Victoria Prentis]

I thank the hon. Lady for her intervention. It is very important in these cases to congratulate Members from across the House and to work together on cross-party lines to achieve the consensus needed, so we support those in our communities who need laws like this to keep them safe.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

May I add my voice to my hon. Friend’s in congratulating the promoter of the Bill on not just bringing it to the House but gathering a consensus? Does she, like me, welcome the fact that he is willing to look at constructive suggestions in Committee to ensure the Bill is in a proper and fit state?

[Victoria Prentis]

I thank my hon. Friend for his intervention. We have begun to understand and talk about mental health only very recently. As we do so, we learn both from those patients who have suffered tragedies and those who have had better experiences with law enforcement agencies. It is important that we learn and listen as the debate progresses. Issues may well come up in Committee that nobody has given a moment’s thought to. A constituent will have a story to tell and we can learn from it as we go forward.

From my own constituency casework, I know that for those at the point of crisis the use of restraint can be both humiliating and traumatising. I discussed this issue with the Causeway Carers, a great organisation comprised largely of parents and other family members of victims with very severe mental health problems. They meet in Bicester once a month. Many have first-hand experience of sectioning and restraint, which they shared with me. That was a great privilege and I do not feel able to share any of those stories with the House today. From what we have heard about Seni, we can all imagine the sort of stories that are taking place even on the high street in Bicester from time to time, often at night. They are also taking place in all our communities. They are not isolated stories, and none of us can feel that we are untouched by them.

These families are suffering enormously because they are dealing with a very ill family member, often a child, and restraint is added to that dreadful suffering that they already have to cope with. I recognise that the use of police cells in England as places of safety under the Mental Health Act 1983 is declining, and that more cases than ever are now referred to health-based places of safety, which is real progress. We should also welcome the significant reduction in the number of deaths in, or following, police custody since 20 years ago. I imagine that this reflects improved training, guidance and practices in a number of areas, most significantly in suicide prevention. My background is as a lawyer for the Prison Service, and it strikes me that this is in sharp contrast to the dramatic and worrying rise in suicide rates recorded in the last 20 years in prisons.

[Clive Lewis (Norwich South) (Lab)]

We are being consensual across the House, and I would like to retain that spirit, but would also make the point that one of the linking factors in terms of both prisons and mental health is funding for the institutions. Staff and service users at the Norfolk and Suffolk mental health trust, which is in special measures, are concerned that a reduction in the number of staff—nurses and doctors—over the past five years means they have less ability to watch and monitor patients, so it is more likely that those patients are using medication, and that means restraint is more likely to be used, so we end up with the situation that the Lewis family were in. Will the hon. Lady comment on that?

[Victoria Prentis]

Rather than get too party political, I think it is appropriate to talk about other difficulties that have led to reductions in staffing in real terms in the Prison Service, because we on this side of the House can give lots of facts and figures about how much more is being spent. The difficulty that I know about personally now in my Banbury constituency is in recruiting and retraining staff—not with the money to pay for them, but with finding the right people. I pay tribute to all who choose to work in the very difficult mental health sphere, with patients who suffer from dreadful illnesses; the House should pay tribute to the work they do day in, day out with people who are often very difficult to deal with while they are ill.

One matter on which I am sure we can agree is the importance of reducing further the number of black, Asian and minority ethnic people detained for mental health reasons in police cells. The figures are disproportionately high. It simply cannot be right that black people are four times more likely to be detained under the 1983 Act than white people. The hon. Member for Croydon North mentioned the Angiolini review and the importance of standardised data recording. I apologise for again referring to my Prison Service experience, as the mental health system is completely different from the criminal justice system, but there are themes that run through the way BAME people are treated in both systems which we increasingly find utterly unacceptable.

[Victoria Atkins (Louth and Horncastle) (Con)]

I pay tribute to the hon. Member for Croydon North (Mr Reed) for bringing the Bill to the House. Does my hon. Friend join me in welcoming clauses 8 and 9 requiring mental health units to record the relevant characteristics of the patient on every occasion in which force is used, and to submit an annual report to the Secretary of State, so that health units and also the Secretary of State can review and understand where there are patterns of behaviour?

[Victoria Prentis]

I could not agree more. The provision of statistics and retention of figures and then the crunching of them is vital. It might not sound exciting, but it is the only way to deal with the big problem of racial imbalance in both the mental health and the criminal justice system. It sounds absurd to say that figures are what will push through action on racial imbalances, but I truly believe that facts and figures—such as those provided recently in the report on the Prison Service, where we learned that 277 black women are in prison for every 100 white women—will help achieve that. Such figures are unacceptable on any level. The more we can talk about such figures, backed up by good evidence, the better. A civilised society cannot put up with such things.

I have strayed far from my brief. I am proud that the Government have committed to addressing the disproportionately high rates of BAME people detained for mental health reasons, and I am proud of the work the Government have done generally on mental health.

We all know that the 1983 Act is outdated, and it will be reformed to make it fit for the modern era. In October 2017, the Prime Minister announced a comprehensive review of the Act, with a planned end date for the report of autumn 2018. I am pleased that the review is being led by Professor Simon Wessely, former president of the Royal College of Psychiatrists. I worked closely with him in my previous role. We were working on a case concerning the pardoning of first world war prisoners who had been shot for cowardice, and he was able to recreate their mental health states from the limited records we had available and give invaluable evidence to the court. He is a great man and I am sure he is the right person to lead this review. He has said that he expects some of the solutions to the difficulties in the mental health system to lie in practice, leadership and culture, as well as in potential legislative change.

I have been encouraged by the work on mental health in my constituency, including in the veterans support group. It meets at Behind the Wire in Heyford Park, next to my constituency office, about once a month. It is a former military establishment and the veterans who access it feel very comfortable in that environment. It is well known that veterans as a group are more prone to experience mental health issues. This particular group offers drop-ins for veterans living in the local area so they can meet organisations including the Support, Empower, Advocate, Promote service, Help for Heroes, the Royal British Legion, Veterans UK and Rethink Mental Illness, which the hon. Member for Croydon North mentioned, and which does a great deal of good work across the country.

I have other local organisations who are doing great things in supporting my constituents, including Restore in Banbury, which I was also lucky enough to meet recently. I visited the local branch of Mind in September, which has contacted me in recent days urging me to support the Bill. Its letter said that

“the proposals in this Bill are crucial to protecting people experiencing a mental health crisis...With your support this Bill would lead to better training for staff, better data, improving transparency and highlighting problem areas”.

It therefore gives me great pleasure not only to support the hon. Member for Croydon North, but to stand up for those of my constituents who have asked me to attend this debate and to speak in it.

As a former civil servant, I cannot emphasise enough how important it is that we have a joined-up approach across Departments. It is very much not just a matter for the Department of Health; the Ministry of Justice is also involved. I speak to it frequently about mental health and prisoners and the use of restraint in the criminal justice system, and I hope that the Minister will reaffirm the importance of cross-governmental co-operation, including work with NHS England, on the delivery of reforms to detention.

Healthcare in Oxfordshire

Victoria Prentis Excerpts

Tuesday 17th October 2017 Westminster Hall

[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 ---

[Victoria Prentis]

Quite.

At our last meeting, the trust’s chief executive told me that my fears about the Horton were “irrational”, but those fears are shared by the IRP—at least they were nine years ago, and I hope they still are—and by about 170,000 people who are served by the Horton. Rather than try to answer my questions, the chief executive simply dismissed them. I do not think that that is an acceptable way to behave.

We still do not know whether a father can transfer with a labouring mother from the midwife-led unit at the Horton. If not, how on earth is he supposed to get to north Oxford while she gives birth? We still do not know—although I have asked more often than I care to remember—whether the static ambulance will be stationed permanently at the Horton while all this is sorted out. As we have heard from all hon. Members, the CCG and the trust do not communicate with us elected representatives or with the general public, and often not even with each other. It has been left to me to organise public meetings locally. NHS Improvement was absolutely appalled when I showed it the pile of unanswered letters that I had written to the CCG and the trust. Hon. Members beyond the county boundary whose constituents use the Horton are completely overlooked.

Local health services may well be devolved to commissioners and providers, but if this is devolution, Minister, it is not working. The chief executive and the clinical lead of the CCG are leaving before the end of the year. I cannot pretend that I am unhappy about that—I have hardly been uncritical of how the CCG runs its affairs—but I have to say that I am not optimistic that the necessary changes will be made. The new clinical lead, whose appointment was announced yesterday, will be the former maternity lead. Although I will work with her, and I hope very much that she will engage with the issues we face, I am not optimistic. The CCG is hellbent on continuing the split consultation, despite various judicial reviews—I can tell it that there will be more to come, if necessary—and three referrals to the IRP, which presumably will not have changed its mind since nine years ago, particularly given the unprecedented growth in the town. Whoever takes on the CCG job is inheriting a poisoned chalice.

I am not going to give up, and nor are the constituents I represent. After all, I do not think that Banbury elected a bereaved mother with a passion for maternal safety, 20 years’ experience of judicial review and a 15-year background of voluntary work for the trust by accident. In 2008, local GPs were pivotal in the fight to save the Horton, but this time, poor leadership and an ever increasing workload—particularly given the town’s growth—have prevented them from being the vocal force that they once were. However, I have found allies in NHS Improvement, which has been investigating the trust, and in the Care Quality Commission, which can prosecute. I look forward to working further with those allies.

If help with recruitment is the answer, we need the Department to step in. Salary supplements for trainee GPs are really welcome, not just for rural or coastal areas but for market towns that face unprecedented growth. The catchment is predicted to increase from 170,000 to 207,000. We really need obstetricians. The district council has made sensible suggestions for developing and improving the Horton site; I just wish the CCG and the trust would look at them. They were included in the response to the consultation—I also made a very extensive response—but when I mentioned them at the last meeting in August, none of this had registered with the decision makers. I do wonder about the depth and quality of the work they do.

I know that the Horton has a future as a provider of acute services. I am sorry to use the language of war, but I welcome the sight of my hon. Friend the Member for Witney defending my right flank, as he so often does. Ever since he was elected, he has been a real ally and friend in this fight. We in Banbury are most grateful to him for all his work and for securing this debate. I also welcome the support of my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and my right hon. and learned Friend the Member for Kenilworth and Southam (Jeremy Wright), who are both in Cabinet this morning but will be interested in this debate. They both feel as we do about our hospital in Banbury. My hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) was present earlier; his district council has been a great ally, has brought one of the judicial reviews, and continues to support us—even though, as far as I can tell, it is not consulted about anything by the Oxfordshire CCG. I really feel that we are beleaguered, so it is lovely to see hon. Members appearing like battalions, with patients and GPs in their wake, to support all of us who use the Horton General Hospital.

We are not irrational, but we are passionate. We want a reasoned and evidence-based conversation about the future. We are very, very determined, so I am afraid everyone in this Chamber will have to listen to this speech many, many more times.

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I begin by thanking the hon. Member for Witney (Robert Courts) for securing a debate on this important subject. It gives us an opportunity to discuss a subject that I would suggest goes beyond Oxfordshire.

Forgive me if I am not as familiar with the healthcare scene in Oxfordshire as many of the hon. Members who have spoken today, but I have listened closely and what they have described resonates with similar situations across the country. I applaud their commitment and dedication on behalf of their constituents, which, by the sound of things, are quite justifiable. It is clear from what hon. Members have said that the people of Oxfordshire seem to be very unhappy about the proposals, and my research shows me that perhaps they have good reason to be.

The proposed changes will mean less hospital beds; changes to acute stroke services; changes to care at the Horton General Hospital, as the hon. Member for Banbury (Victoria Prentis) has just explained to us in great detail; changes to critical care; changes to maternity services; and changes to the special baby care services. I gather that there has been lots of vociferous opposition to these proposals on the ground, which has been reflected in hon. Members’ comments today. I understand that local people have said in a petition that they believe these proposed changes will lead to poor services, a cheaper service, overcrowding and long waits. I particularly noted what a local A&E doctor said about the process way back in August:

“This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours…We are not coping”.

I also note that there is a proposal to reduce the number of hospital beds in the first instance by 110 further beds. Clearly, no one is listening to the NHS staff there in Oxfordshire.

Oxford City Council has also expressed its concerns and has quite rightly commented on the lack of a workforce plan. Interestingly, however, it also said that it understands the position that the clinical commissioning group finds itself in. We have heard a lot of criticisms of the CCG this morning and it has obviously been remiss in its consultation process. However, the council says it understands that the CCG is up against national policy.

That point is very important, because what we have heard this morning is not only a problem that affects Oxfordshire. The hon. Member for Witney spoke about his constituency being one of the few that still has snow. My constituency, too, still has snow—lots of it—and we also have in common a great dissatisfaction with the health services that we are receiving, particularly as we look forward, or maybe dread, the introduction of the sustainability and transformation plans.

At this stage, we have a national health service, and the changes that we have heard about this morning are Oxfordshire’s response as part of the STP group that takes into account Buckinghamshire, Oxfordshire and west Berkshire. The STP ordered by Government is one of the 44 they have ordered. In total, those STPs will look to save the NHS £22 billion and the share of the savings that have to be made by Oxfordshire, Buckinghamshire and west Berkshire is £480 million. That, I would suggest, is at the root of the changes.

[Victoria Prentis]

I accept that I could not possibly expect the hon. Lady, coming from Burnley as she does, to have the encyclopaedic knowledge of Oxfordshire health services that, sadly, we Oxfordshire MPs have to, but the changes to the Horton General Hospital apparently stem from recruitment—the inability to recruit obstetricians—and not a lack of money. Indeed, the changes started when the STP was just a twinkle in someone’s eye, so the situation is slightly more nuanced.

[Julie Cooper]

I note the hon. Lady’s points, and there is another issue we could talk about. Our NHS has a crisis on three fronts—a funding crisis, a workforce crisis and a systemic crisis—and I think that is what we are looking at today: some of the systemic problems.

Going forward, £480 million has to be saved. This is not something that the CCG has decided to do, and it does not matter how transparent the consultation is—it sounds like it needs to up its game on that—because it still has to make its share of that saving.

As for the national health service, I note with absolute horror that, when it comes to the percentage of GDP that we spend on our NHS, we are well down the league—indeed, we are close to the bottom—compared with nations that we would expect to be up there with. We are behind France, Germany, Canada, Switzerland, Denmark, Belgium, New Zealand, Portugal and Japan—I do not have time to list them all, but we are well down the list.

The hon. Member for Henley (John Howell) quite rightly mentioned the issue of beds and how it is not really a bad issue—people ought to receive care at home where possible. I totally support that; the problem is that the cart is being put before the horse. The care, including social care, is not there in the first instance to allow us to reduce hospital beds and provide the excellent care in the community that we all want to see. When it comes to the number of hospital beds per head of population, we are again close to the bottom of the league.

For obvious reasons, healthcare in the modern NHS is delivered in a different way. In all comparable nations, the number of hospital beds has reduced, but nowhere near to the extent that it has been reduced in England. I particularly note with horror the reduction in maternity beds and mental health beds. There has been a lot of talk about standing up for the mentally ill, but beds in mental health care have actually been reduced by over 90%. That is very worrying when we all see that the necessary care is not there in the community. In fact, Oxfordshire County Council has said it is worried that there would be no impact assessment of some of the proposed changes. How was the community going to cope? Were the services in place in the community to provide support when, for example, hospital beds were removed? The council was not convinced that that was the case.

So, we are bottom of the league on spending as a percentage of GDP and close to the bottom—we are just bumping along the bottom—on hospital beds.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to speak under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing the debate and on the manner in which he spoke. I share the admiration of my right hon. Friend the Member for Wantage (Mr Vaizey) of the forensic skills he has brought here from a former life, and I feel somewhat fortunate that I am sitting on the same side of the Chamber as he is.

We have heard many powerful contributions about the strength of feeling in Oxfordshire from its many impressive elected representatives, and about how a large number of the service changes that are under consideration in the county have suffered from a lack of engagement, with the clinical commissioning group in particular failing to explain to local residents the purpose of and the objectives behind the changes. I take that on board, as something that needs to improve, and I will come back to it at the end of my remarks.

It is very clear, from the Government and the Department of Health, through the NHS leadership, that all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. That is at the heart of why service change is proposed. We have made an explicit commitment to the public that all proposed service changes should meet four tests. Just to rehearse them, they are that they should have support from GP commissioners, be based on clinical evidence, consider patient choice and, most specifically for the purposes of this debate, demonstrate public and patient engagement. In the case of the service change proposals that have been made thus far in Oxfordshire, when they are capable of coming to us for determination, for ministerial decision making on appeal, my colleague the Secretary of State and I are placed in some difficulty, because we need to remain impartial and consider the issues on their merits. I am sure that my hon. Friend the Member for Witney and other colleagues will therefore appreciate that I am unable to offer opinions on the merits of the proposals from the two transformation consultations, whether actual or anticipated.

We recognise that Oxfordshire, like many areas across England, faces unprecedented demand for its services. We are all aware of the growing number of older people, many of whom are living with more complex, chronic conditions, partially thanks to the success of the NHS in keeping people going for longer, but we have also heard from a number of colleagues that Oxfordshire faces particular population pressures, with welcome increases in house building planned for the coming decades. In addition, as my hon. Friend the Member for Banbury (Victoria Prentis) said when she intervened on the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), there are particular challenges in recruiting high-quality NHS staff into many of our facilities, not just in rural and coastal areas but across the country. We accept that, and are looking to increase the numbers of medical and nursing staff being trained. There was an unprecedented 25% increase in doctors in training, announced last year by the Secretary of State, and earlier this month a record increase of 25% in the number of nurses in training was announced for the next two years. Those are all reasons why the Oxfordshire transformation programme has been reviewing the model of care to ensure that future health service provision in the county is clinically and financially sustainable.

My hon. Friend the Member for Witney began his remarks by referring to the closure of the Deer Park medical practice in Witney. I will not go into the full history, but he acknowledged that the closure took place in March this year. In the previous December, a judicial review had been requested and, as my hon. Friend pointed out, this was the first time in recent years that such a thing had happened to a primary care facility. The judge who heard the case refused permission to bring it for judicial review, and it was therefore passed to the independent review panel in March of this year. The panel concluded that the referral was not suitable for full review because further local action could address the issues raised.

The Secretary of State considered and accepted the recommendations—some of which my hon. Friend the Member for Witney read out—and the Oxfordshire CCG is now working to address them. Foremost among the recommendations was that all former patients of Deer Park medical practice should be registered at an alternative practice as soon as possible. My understanding is that, of the 4,400 patients who were registered with the practice, more than 4,000 had been reregistered, as of mid-September, and that the CCG is acting to encourage the remaining 400 patients to register at one of the three other GP practices in and around Witney, whose lists remain open so that patients can register at a practice of their choice, as long as they live within its catchment area. I believe that a further letter will be sent out to all those remaining patients, to encourage them to register with another GP.

The second key recommendation, which my hon. Friend the Member for Witney also referred to, was that a primary care framework be developed to provide direction for a sustainable GP service in Witney and the surrounding area. That is at the crux of his concern about the way in which the CCG engages. I happen to have a copy of its locality place-based plan for primary care, and I note that the consultation on how primary care services should be developed for west Oxfordshire opened last week. I strongly encourage my hon. Friend to engage with the CCG and to encourage his residents to do so, so that it learns from the lessons of the Deer Park lack of consultation and, in devising services for the future, fully takes into account local residents’ concerns. I believe that the consultation period is six weeks and is due to conclude at the end of November. A common theme in colleagues’ contributions today has been that lack of engagement, as they see it, with the local CCG.

My hon. Friend the Member for Banbury raised again today her historic championing of the cause of Horton General, which clearly goes beyond primary care into secondary care. She gave us another history lesson. She has been campaigning on this issue since she was seven years old, and I think she could probably trump any Member who wanted to stand up and say that they had been consistently campaigning on any issue since a young age. Having said that, I suspect that one or two older Members have been campaigning on the same issues for longer, but certainly not from such a young age.

My hon. Friend referred to the temporary suspension last October of the obstetric-led service in the Horton because of the difficulties in recruiting doctors and midwives. It has temporarily become a midwife-led unit. As she also pointed out, at a public board meeting this August, the CCG accepted recommendations following consultation. [Interruption.] She may regard that as inadequate, but there has been some consultation. Those recommendations include one to centralise Oxfordshire’s obstetric facilities in the John Radcliffe Hospital and one to make the midwife-led unit at Horton General a permanent establishment. As she has pointed out, that decision is subject to judicial review and referral to the Secretary of State, so no action will be taken to make that recommendation permanent until the referral process has run its course.

My hon. Friend has referred to a number of the challenges posed for local residents and for pregnant women in labour in getting access to Horton General. I have taken note of the comments made by her and other Members on the reliance on Google Maps to determine travel times. I understand that the CCG has undertaken an extensive travel survey. If a mother is in labour and is in an ambulance, she has the benefit of the blue light service to get through the traffic. That can mean a more rapid journey time than ordinary residents would expect or experience.

[Victoria Prentis]

I am so grateful to the Minister for giving way and for the comments he is making. Most people who go to hospital while in the later stages of labour to have a baby are not in an ambulance. The ambulance times relate only to transfers from the midwife-led unit to the Radcliffe. Although a significant number of the people who give birth in the MLU have to transfer during or immediately after labour—we are told that it is up to 40%—that is nothing compared with the vast majority of women, who travel in a private car, if they are lucky enough to have one.

[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.