Healthcare in Oxfordshire

Nadhim Zahawi Excerpts

Tuesday 17th October 2017 Westminster Hall

[Robert Courts (Witney) (Con)]

I beg to move,

That this House has considered the future of healthcare in Oxfordshire.

It is an honour to serve under your chairmanship, Sir Roger. May I, at the outset, thank colleagues from both sides of the House for attending and the Minister for replying? I have deliberately left the wording of the motion quite open, because I want all colleagues to have the chance to set on the record any of their thoughts about the future of healthcare in Oxfordshire.

This is a multifaceted, complex topic. I will of course concentrate on west Oxfordshire and hope I will be forgiven for doing so. We all have particular concerns, and this topic perhaps matters to our constituents more than any other. I would like to broadly separate the debate into the following sections. I will review what was done within the first phase of the sustainability and transformation plan process, how it was handled, the split of the consultation into two phases, how the public were involved in the matter and the outcomes. I will then look forward to phase 2, the proposed changes that have been included and how the clinical commissioning group can work better with the public and all stakeholders throughout the process. I will explore ways in which we can move forward and give Members the chance to raise specific concerns from their constituencies. I will review the past, but for the sake of learning for the future.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

Horton General Hospital is unique in that it serves not only Oxfordshire but Warwickshire, Northamptonshire and even Gloucestershire. I was very concerned about the lack of engagement by Oxfordshire CCG with relevant stakeholders in Warwickshire in phase 1 of its consultation. There was very little communication between the Oxfordshire and South Warwickshire CCGs, despite the fact that there is obviously a knock-on effect on Warwick Hospital. Why was there not greater communication? Colleagues have raised that repeatedly, but with few outcomes.

[Robert Courts]

That intervention precisely illustrates the point I will make in the course of this small speech about a lack of public consultation. That is most marked in the areas we will be talking about—in my case, Witney in west Oxfordshire, and in the case of my hon. Friend the Member for Banbury (Victoria Prentis), Banbury and the Horton. The point is that the issues surrounding the Horton go far further than Banbury; they relate to Warwickshire, Northamptonshire and the north of west Oxfordshire. The lack of engagement is perhaps the main theme of my speech, so I am grateful for that intervention.

I will start by talking about Deer Park surgery. I was elected just under a year ago today, when I faced an unfolding local press crisis. There was a lot of press attention and, understandably, an extremely distressed patient group centred around the closure of its much-loved practice, Deer Park medical centre. To give a short history, the practice was run by Virgin Care. The contract ended and was retendered, and Oxfordshire CCG health bosses received a bid from Virgin that, in their view, did not meet the requirements they were looking for, so they decided to close this small but very well-performing and popular surgery that provided an outstanding and much-needed service for Witney and its immediate surroundings.

The real kicker was that there was no real or meaningful consultation with the people of Witney before that took place. There was little discussion with the district or county councils as to how they may be able move things forward or help or to discuss the building that was coming down the line, nor with patient groups, who might have been able to suggest a way forward. The patients and elected representatives were simply told that it was happening. I met the CCG, Virgin and the patient groups many times, including here in Parliament, but the CCG was resolute: it had decided that the practice would close. Its view was that the lower level of service offered in the tender was not sufficient and that it could not justify spending that money on the surgery, even though the significant growth, to the tune of thousands of houses that we know Witney will have in the years to come, means that the need for the practice is not only present now but will remain so in the future.

The decision to close the practice led to legal action by a patient, funded by legal aid, to keep it open. After sustained campaigning by myself, the patient group and local councillors, the Oxfordshire joint health overview and scrutiny committee voted that making that change without consulting was a substantial change in service, which—I hope I am not going beyond my remit in saying this—it clearly was.

The matter was referred to the Secretary of State for Health, who referred it to the Independent Reconfiguration Panel. That was the first time a primary care decision had been referred to that level—the highest possible level. Ultimately, the IRP ruled that the CCG did not have to reopen the practice, but it did provide specific strictures about the way the decision had been handled and about consultation. It specified that the CCG needed to improve the way that it engaged and further to consider Witney’s healthcare needs.

I hope everybody will forgive me if I quote a short chunk of the IRP report that is pertinent to my point:

“The CCG should immediately commission a time limited project to develop a comprehensive plan for primary care and related services in Witney and its surrounds. At the heart of this must be the engagement of the public and patients in assessing current and future health needs, understanding what the options are for meeting their needs and co-producing the solutions. This work should seek to produce a strategic vision for future primary care provision in line with national and regional aims and should not preclude the possibility of providing services from the Deer Park Medical Centre in the future.”

It is quite clear from that report that the CCG requires a separate project to assess the primary healthcare needs of Witney. Its immediate surrounding areas are included, but that wider reading should not include the entirety of west Oxfordshire, which would enable the CCG to—as it seems to wish—simply wrap this piece of work into the wider STP work it is carrying out in any event.

The IRP is clear that the CCG is required to produce a specific, specially focused piece of work on Witney and its primary care needs. That is what the people of Witney should have. That should include a consideration of the impact upon projected housing growth in and around the town and a roadmap for primary care, covering what will be provided, by whom and at what place. Above all, the people of Witney should be presented with a range of options and scenarios, because if there is only one, there is no consultation. The CCG’s approach is a little bit like Henry Ford saying to the customer, “You can have whatever colour car you like, provided it’s a black one.”

I opened with that story and took some time over it because it is a microcosm of the problems that west Oxfordshire is facing with its CCG, and I suspect—we will hear from them in due course—that other Members in Oxfordshire feel the same. Oxfordshire has been facing a systemic issue with its CCG. The public have not been fully consulted and engaged in a dialogue about the overall picture of the future of healthcare in Oxfordshire any more than they were over the future of Deer Park medical centre.

The CCG is embarking on a consultation regarding primary care in Oxfordshire over the next month, and I am sure all colleagues will join me in engaging with that process, but there are lessons to be learned from Deer Park. I focus on it today because I want those lessons to be learned, and I am keen that we look at how we can avoid this happening again, rather than simply look back and dwell on the mistakes of the past.

Let me be quite clear: I am not a doctor. I do not presume to tell doctors, healthcare professionals or those who commission them how to do their job. I am one of those who feel that, by and large, the profession should be left in peace to do what they do best and to practise their job. However, I expect the people of Witney to be consulted at all times. I expect their voice to be heard and listened to, and for their needs to be met.

The impression should not be gained that I am against any change. I accept that healthcare professionals must allocate their resources in the most efficient way to ensure the best treatment for patients. I might not disagree with changes being made per se, if there was a clinical need, they worked well with other healthcare provision in the area and they were in the interests of the people of Witney and west Oxfordshire, including when we consider the challenges of the future, particularly in respect of housing. I might not be against what is suggested, but if there is to be change, the public and local stakeholders must be fully informed and involved in decision making at the earliest opportunity. The local community must not be surprised by changes being sprung on them. They must be aware of how any proposed changes will affect them and why those changes, in the CCG’s view, need to be made. If the changes are indeed for the better, the sensible, reasonable people of Witney and west Oxfordshire will support them, provided that they are properly explained.

I shall move on to the far wider issue of the STP process across west Oxfordshire. As I said, I do not necessarily disagree with decisions that are made from a clinical perspective. I might or might not agree with decisions, although let me be clear that I do disagree with some of the decisions that have been made. However, what always concerns me in every case is the way in which they are handled.

I have made my response to phase 1 of the STP publicly available—it is on my website—and it clearly outlines my concerns. I will not go through it all in detail now, but I will go through the headlines. The first is “Process”. I do not feel that the STP should ever have been split into two phases, and I made that abundantly clear to the CCG at the time. It is a simple headline point. How can we assess Oxfordshire’s healthcare needs when we hive off the decisions for the Horton, which have an impact on Chipping Norton, Warwickshire and Northamptonshire, and then say that there are some other decisions that are linked inextricably to the first section that we will look at at some future point—a date that keeps going further back into next year? The whole point of the STP process is to look at healthcare needs in the round, not piecemeal, with penny-packet decisions made earlier, making that process impossible. As I have said, the CCG has a duty to the public to provide multiple viable solutions to enable true choice and real consultation.

I shall give an example of how local communities have not been involved. The projected ambulance times from the Horton or Chipping Norton to the John Radcliffe Hospital are simply improbable. Indeed, the journey times are wildly optimistic. There is an over-reliance on Google Maps. Anyone who lives locally in Chipping Norton or Banbury can tell us how long it actually takes to get from either of those towns to the John Radcliffe in traffic, because they do that journey all the time. There is a serious lack of indication of any involvement with South Central Ambulance Service, and they are the people who will be taking heavily pregnant mothers in the late stages of labour from north Oxfordshire or the north of west Oxfordshire to the John Radcliffe. The decision permanently to downgrade maternity services at the Horton, which was made by the CCG board in August, has been unanimously referred by the health overview and scrutiny committee to the Secretary of State, alongside the judicial review appeal that we know about. I go no further at this stage than to say that that indicates a seriously flawed decision-making process.

I make it clear at this stage that for those who live in the north of my constituency, around Chipping Norton, the downgrade of the Horton is greeted with utter dismay. It is important to understand why. Chipping Norton is rural. It is one of the highest places in Oxfordshire; it is one of the few places that still gets snow in winter—people do not get it anywhere else, but they do in Chipping Norton. A journey to Oxford takes, with traffic, the best part of an hour, or more if someone is in one of the outlying villages. I made it clear in the baby loss debate last week that I fear the consequences of an absence of proper obstetric services in the north of Oxfordshire, even more so if the Horton midwife-led unit does not have a standby ambulance. Those proposals are simply not safe, and the deeply moving baby loss debate reminded us last week, if we ever needed reminding, of the consequences of getting this wrong.

For the same reasons, the services at Chipping Norton hospital itself must be safeguarded. Chipping Norton is seeing significant development and needs its own NHS services, which are based in a new building alongside a superb GP medical centre. Perhaps the best example of the mess caused by the split consultation is the confusing reference to the possible closure of the Chipping Norton MLU in phase 1, which purports to deal only with the Horton. How on earth can we say, “We’ll have as a possible solution in phase 1 the possible closure of Chipping Norton; oh, but we won’t make any decisions about Chipping Norton until we come to phase 2”—which will be at some stage in the future—when that clearly impacts on the Horton? How can we decide what is right at the Horton unless we know what there will be at Chipping Norton? It is the same point again. We cannot decide on the future of Oxfordshire’s services unless we look at them as a whole. They ought not to be hived off piecemeal.

Let us look ahead to phase 2. I hope that it is clear from the points I have made that the consultation around phase 1 was inadequate. I stress again that I am not a doctor. If the decisions are in the interest of public safety, I of course appreciate their importance.

--- Later in debate ---

[John Howell]

I thank the Minister for that point; I was not suggesting that it was an inevitability. However, at this stage let me extend an invitation to him to visit the hospital so he can see how it works and how it has integrated social care with the medical activities there. It is based around a RACU—a rapid access care unit—which is similar to the EMU—emergency multidisciplinary unit—in Abingdon that is being proposed elsewhere. As I said, it turns the hospital into a diagnostics hospital, similar to a hospital developed in Welwyn Garden City that I went to see.

I saw the difficulty for the CCG with regard to its consultation when I went to a SELF—a South East Locality Forum—meeting. People from Henley were sitting around the table with big beaming smiles on their faces saying how wonderful the hospital was, and a member of the CCG had to stop them and say, “Well, it is a pity you didn’t say that when we were developing the hospital. Right to the end of the consultation you were attacking us on this and on taking the beds out and putting them in a care home at the side of the hospital. That is working very well and now you say that it is absolutely wonderful.” The fact is that, apart from some minor snags with the new hospital, it is a fantastic new investment by the Department of Health. It shows the way a community hospital should be developed not just in Oxfordshire but across the country. I repeat my invitation to the Minister to come and visit.

The great thing about the hospital was not the consultation initiated by the CCG but the support that I got from the Royal College of Physicians, which came out very strongly in favour of an ambulatory healthcare model and very favourably in support of the hospital. That is an interesting point, which goes back to my comments in support of my hon. Friend the Member for Witney about the lack of consultation experience on the part of the CCG. That organisation is willing to learn, and I hope that it will. I also hope that we, as MPs who meet it from time to time, will be able to keep up our pressure on it to deliver the sort of services that we feel our constituents want.

[Nadhim Zahawi]

On the point about learning, the Oxfordshire clinical commissioning group has only one district council from Warwickshire—Stratford-on-Avon District Council—on its board. In phase 1 of the consultation, which began in January, it only met the council in March; the council’s overview and scrutiny committee had requested a much earlier meeting. Should that not be part of the learning process?

[John Howell]

I fully agree that it should be. As I said, I am not here to defend how the CCG does its consultation. If I had the chance, I would make many changes to the consultation, and including others on the list of people who will be consulted as part of the decision-making process would be an important part of that.

I think I have probably said enough both to support my hon. Friend the Member for Witney and to make the point that it is possible to get through even a bad consultation by a CCG and get a fantastic hospital—ours is doing a brilliant job for all the constituents of south Oxfordshire, not just for one town.