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.