ME: Treatment and Research

Robert Courts Excerpts

Thursday 21st June 2018 Westminster Hall

[Carol Monaghan]

ME receives practically no biomedical research funding, which I will come back to. Because of the misunderstanding of the condition, the treatments available are often more damaging to the person than no treatment at all.

Merryn Crofts was just 15 when she experienced hives and swelling in her joints after a family holiday in Majorca. Tests revealed that she had contracted glandular fever. Despite dozens of medical appointments, Merryn’s condition deteriorated; she suffered breathing problems, exhaustion and excruciating hypersensitivity to touch, light and sound. She was eventually diagnosed with ME. This once bright young woman was forced to wear an eye mask and suffered from severe migraines, brain fog, slurred speech and persistent infections. Stomach problems and difficulties swallowing meant that her weight plummeted to just 5½ stone. Merryn was eventually fitted with an intravenous nutrition line but was given a terminal diagnosis in 2016. Merryn wrote in her blog:

“Having severe ME, is like being trapped in your own body every single day. There is no rest, you are bedbound all day every day. It snatches the most simple things away from you like being able to wash yourself, even in bed. Being cared for in every way possible. In terrible pain, from everything. Not being able to talk on the phone or have visitors, and feeling worse about saying no every time someone asks again. Months and months in hospital. Severe infections. Breathing problems. Low immunity. Problems anywhere and everywhere in the body. Paralysis. Severe hypersensitivity. The list is endless, and if I was physically able to type I would carry on. Spread awareness and remember all of us and all of those who have lost their lives.”

Merryn died on 23 May 2017, just days after her 21st birthday.

Why is the treatment for people with ME so poor? The lack of understanding shown by some healthcare professionals of a person’s suffering is one of the greatest frustrations to the ME community. Much of that stemmed from the publication of the controversial PACE trial. The treatments investigated in the PACE trial were based on the hypothesis that ME patients harbour “unhelpful” convictions about having a disease and that the continuation of their symptoms is the result of deconditioning.

The PACE trial compared different treatments, including cognitive behaviour therapy—CBT—and graded exercise therapy, or GET. The results that were published in The Lancet in 2011 seemed to show that GET and CBT could bring about some improvements in a person with ME. Although that may seem positive, if we dig a little deeper we discover that the parameters for recovery were changed midway through the trial and the results depended on self-reporting. Patients have told me that they were pressurised to describe improvements they really did not feel. One participant in the original trial said:

“After repeatedly being asked how severe...my symptoms were. ..I started to feel like I had to put a...positive spin on my...answers. I could not be honest about just how bad it was, as that would...tell the doctors I wasn’t trying and I wasn’t being positive enough.”

[Robert Courts (Witney) (Con)]

The hon. Lady is making a powerful speech and is drawing attention to this much misunderstood but very serious condition. My constituents will be grateful to her for that. She made some powerful comments on the PACE trial; will she comment on the way that NICE guidelines have an impact on how the condition is viewed?

[Carol Monaghan]

I will come on to the NICE guidelines. They are under review, and all politicians can help with that. I have already written to NICE about the issue and I will ask the Minister about that later.

We now know that 13% of the participants in the PACE trial qualified at baseline as “recovered” or “within the normal range” for one of the study’s two primary measures—self-reported physical function—even though they were classified on the same measure as disabled enough to enter the study. That anomaly, which occurred because the investigators weakened key outcome thresholds after data collection, invalidates any claim that patients recovered or got back to normal. The overlap in entry and outcome criteria is only one of the trial’s unacceptable features.

For patients, the impact of PACE is severe. The recommendation of GET as a treatment for ME has provoked a backlash from patient groups, who report that many people with ME end up more severely disabled after a course of GET than before. I have spoken to people living with ME who have tried to do GET because they are so desperate to get better and have ended up in a wheelchair or bedbound as a result of this programme.

Gosport Independent Panel: Publication of Report

Robert Courts Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his championing of the GIRFT programme, which is incredibly powerful and successful. He will have noticed that we announced last week that we are expanding it into a national clinical information programme, which will cover more than 70% of consultants. What is disturbing in this case, though, if I may say so, is that the data was really around mortality, and we have actually had that data for this whole period. There is really nothing to stop anyone looking at data, and we can see a spike in the mortality rates in this hospital between 1997 and 2001. They go down dramatically in 2001, when the practices around opiates were changed. That is why we have to ask ourselves the very difficult question about why no one looked at that data or, if they did, why no one did anything about it.

[Robert Courts (Witney) (Con)]

Will the Secretary of State commit to look at the wider structural issues that affect patient safety, and particularly at things such as staffing levels and pressures on doctors and nurses?

[Mr Hunt]

Absolutely. One of the big lessons from this report is that we have to look at systemic issues as much as at the practice of an individual doctor or nurse.

Helen and Douglas House Hospice

Robert Courts Excerpts

Friday 11th May 2018 Commons Chamber

[Layla Moran (Oxford West and Abingdon) (LD)]

I am so grateful that the House has allowed me to speak about funding for the Helen and Douglas House Hospice in Oxford. It is an incredibly important matter, not least because Helen House was the world’s first children’s hospice, starting the children’s hospice movement that spread around the world. It opened in 1982 to provide a home for terminally ill babies, children, young adults and their families. In 2004, Douglas House was opened by Her Majesty the Queen to provide care for 16 to 35-year-olds, not just in Oxfordshire but throughout the whole south-east. It provides specialist services for young adults, bridging that crucial gap between children’s and adult hospices.

I am sorry to say that we have to be here today because those services are under threat. Indeed, 48,000 people signed a local petition—that is extraordinary for a local petition—calling on the Prime Minister to intervene to stop the closure of Douglas House and to make sure that those services are properly funded. That is a staggering amount of public support and I hope that the Minister takes that to heart today.

Let me start by outlining the value and importance of Helen and Douglas House. I think that it is best summed up by my constituent Alison, who is a volunteer in the hospice. She said:

“Helen and Douglas House really is one of a kind, providing a lifeline both to those needing end of life care, and their families—from befriending and home support services, to The Elephant Club for bereaved siblings; to the annual remembrance service. Helen and Douglas House brings these families together, providing a support network to help them enjoy the time they have left together, and to face the future afterwards.”

Families rely on the work of Helen and Douglas House and they are indebted, as we all are, to the dedicated army of staff, volunteers and fundraisers who go above and beyond, and also to the nurses and the medical team.

[Robert Courts (Witney) (Con)]

The hon. Lady is making a very powerful and moving speech. Helen and Douglas House is not far from my constituency—it borders my constituency. I have visited it, and I am sure that she has, too. Perhaps she will agree with me that it is an oasis in the centre of Oxford. I wish to pay tribute—as I am sure that she does too—to everybody who works there, to all the volunteers, to the extraordinary therapy provided for the patients and to the support network that is provided for the family.

[Layla Moran]

I very much thank the hon. Gentleman for his intervention, and completely endorse what he says. The care that the hospice provides is world class and one of a kind. With the closure of Douglas House—I will get to this later—we will see hospices across the area having to deal with the extra need. Helen House is truly unique. I wish to pay tribute to some amazing fundraising efforts. Paul Townsend of Abingdon and Stuart Ryan of Farringdon are looking to raise £92,000 for Helen and Douglas House, and also for Sobell House in Oxford, with a tour of 92 football grounds in the 2018-19 football season—I suspect that there may also be an ulterior motive to their fundraising efforts, but I wish them well. Golfer Eddie Pepperell from Abingdon will wear a Helen and Douglas House cap for the televised BMW PGA championship in Wentworth later this month. He has also raised £7,500 via JustGiving.

Local businesses, including Stagecoach, radio station Jack FM—of which I am a huge fan—and Reed recruitment are just a few examples of the local businesses that have taken Helen and Douglas House into their hearts. The strength of feeling in the community across the whole of Oxfordshire is palpable.

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing a debate on this really important matter. As MPs, we are all aware of the crucial role that hospices play in supporting our local communities at a time of need. That is a testament to the dedication of staff, the incredible efforts of volunteers and the amazing feats of fundraisers, many of whom have been inspired by hospices’ incredible support to their loved ones in the last days of their life, or the respite care that children’s hospices often give. Hospices step up to deliver amazing care at some of the toughest times of life, and I pay tribute to all of them. I totally understand the concerns that the hon. Lady raises and share many of them myself.

Hospices across England have been delivering exceptional end-of-life care and supporting their local communities for many years. A testament to that is the fact that the Care Quality Commission’s “State of Care” report, which was published in October 2017, showed that 70% of hospices are rated as good and 25% as outstanding—the figures are higher than those for any other secondary care service in the country.

In 2017, Helen and Douglas House was rated as good by the CQC. Like the hon. Lady, I congratulate its incredible hard-working staff and volunteers on ensuring that children and young people get the personalised care and support that they need and deserve, both at the hospice and through its outreach services. In the same year, I understand that Helen and Douglas House raised an impressive £8.8 million through fundraising and trading activities. That was £300,000 more than the previous year, which shows its value to the local community.

Historically, the hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices are primarily funded through charity, but they receive statutory funding from clinical commissioning groups, and in some cases from the Government, for providing local services. According to its annual report and accounts, Helen and Douglas House received more than £500,000 of statutory funding in 2016-17, including £280,000 via NHS England’s children’s hospice grant, which is awarded annually.

I am aware of recent announcements by the hospice of plans to close Douglas House, which provides support to young adults between 16 and 35, and I recognise the concerns raised by the hon. Lady and her wider community. The fact that more than 40,000 people have signed a petition shows the strength of feeling in her local community, and it is important that young adults with life-limiting conditions can access the support and care they need. Of course the local community is desperate to hold on to that specific facility, but I am sure the hon. Lady welcomes, as I do, reassurance from Oxfordshire CCG that it is working with the hospice to ensure that local patients being cared for at Douglas House continue to receive the essential healthcare they need.

[Robert Courts]

I thank the Minister for her kind words, which are appreciated. Concern about this issue is felt all over Oxfordshire and throughout the wider south-east. Does she agree that it is important that the CCG continues to engage with all interested parties locally, including Members of Parliament, and that this underlines the importance of a close link between care and the NHS?

[Caroline Dinenage]

I believe that my hon. Friend has visited the hospice and I know that he works keenly on this subject. I totally understand the feelings of local people, and I feel strongly that CCGs need to engage with local communities and ensure that the services they commission meet local needs and support local people.

With Douglas House planning to close from July, the hospice has been discussing with Oxfordshire CCG the future of Helen House, which provides hospice beds for children aged between nought and 18. Oxfordshire CCG wants to look at a more collaborative approach to end-of-life commissioning once its current contract for adult hospices finishes in September 2019. The hon. Lady spoke about how the hospice has been excluded for bidding for certain contracts because of the wide nature of what they entail, but the process allows smaller providers such as Helen and Douglas House to work with others to bid for contracts. In the meantime, Oxfordshire CCG is keen to pilot collaborative working with the hospice, which is why it has offered £100,000 for a pilot project until September 2019. Wider discussions are taking place between the hospice trustees and local partners, including Oxfordshire CCG, NHS England and Oxford University Hospitals NHS Foundation Trust, to examine future models of care and the longer-term sustainability of the hospice. NHS England has also been involved in those discussions.

Across England, there are 223 registered independent hospices and a very small number of public hospices that are run by NHS trusts. Around three quarters of those provide adult services, with the remainder caring for children and young people. Funding amounts vary among CCGs, but on average adult hospices receive approximately 30% of their overall funding from NHS sources. CCGs are responsible for determining the level of NHS-funded hospice care locally, and for ensuring that they meet the needs of their local populations.

In addition to NHS funding for locally commissioned services, in 2017-18 children’s hospice services received £11 million through the children’s hospice grant. This is awarded annually and administered by NHS England. Children’s hospices tend to receive smaller amounts of statutory funding because of the way they have developed and the services they provide, and the grant provides the additional support they need. Unlike adult hospices, which are focused on end-of-life care, children’s hospices can provide support through much of a child’s life. Children’s hospices encompass much more than clinical care, including family support, recreational support, respite care and so on.

In 2016, as I think the hon. Lady mentioned, the Government published the end-of-life care choice commitment, which encompasses a whole-system approach to transforming end-of-life care, placing the patient, and their choices, needs and preferences, at the heart of planning. That is so important. The Government and NHS England need to collaborate with partners in the voluntary sector, including key hospice and end-of-life care charities, to ensure that the quality and availability of services continues to improve, and that our end-of-life care commitment is delivered.

One key objective is to strengthen the provision of services in the community so that when people are approaching the end of their life, they can be supported to be wherever they choose to be—whether in their home, a hospice or a care home. Work is ongoing nationally—the hon. Lady talked about how we can join it up in local areas—to provide sustainability and transformation partnerships with the tailored information they need to address and enhance the services in their own areas. NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospices and their interventions in the community. Amazingly, there is very little evidence in this area, but these resources will build on the range of guidance and support provided by NHS England, Public Health England and our charitable partnerships.

It is very important—today’s debate underlines this—to be able to assess how effectively commissioners are working to improve their services, to measure progress and to improve accountability. We will soon have a new indicator in place, which is designed to measure how well patients are supported in the community. This will help to drive improvements in sustainability, which is the big issue in this case, as well as quality and choice. It is very clear that hospice care remains a key part of the Government’s vision for high-quality end-of-life and respite care both in Oxfordshire and throughout the rest of the country.

Question put and agreed to.

Breast Cancer Screening

Robert Courts Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

That is an important question. One of our top priorities has been to construct a resolution to the problem that will not have an impact on the regular screening programme for women between the ages of 50 and 70, which is so important. All I can say is that a huge amount of trouble has been taken to try to ensure that we are putting additional capacity into the system to deal with the extra work.

[Robert Courts (Witney) (Con)]

I also welcome the compassionate tone used by hon. Members on both sides of the House today, and my thoughts are with all those affected. Will the Secretary of State reassure those in west Oxfordshire and beyond who will be concerned that this IT failure may be present in other critical systems that he will do everything possible to ensure that that is not the case?

[Mr Hunt]

Yes, absolutely. We are doing this review because we want to understand precisely why this happened and what the proper counter-measures are.

Austerity: Life Expectancy

Robert Courts Excerpts

Wednesday 18th April 2018 Westminster Hall

[Robert Courts (Witney) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I shall keep my comments brief because many other Members wish to speak. I also take the opportunity to congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing a debate on this important matter.

When people think of the rolling hills of west Oxfordshire, I appreciate that poverty is not one of the things that immediately springs to mind, but that is to ignore some of the very real issues present in my constituency. There are real factors and pockets of deprivation, and rural poverty in particular is a real concern, so the issue is very live for those of us in the green shires, as well as for those in urban environments. I would like the House to bear that in mind.

The hon. Lady made some important points today, but I suggest that it is simplistic to look at a straightforward line between necessary control of public spending and an impact on life expectancy. As we have heard, a whole range of factors affect life expectancy and mortality—quality of life, mental health, obesity, housing, air quality—and simply to draw that straightforward causation line is to make things far too simple, when in fact we are dealing with a complex issue.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

The hon. Gentleman talked about it being simplistic to talk about the cuts, austerity and so forth, but let us talk, for example, about the cost of a pupil going to a pupil referral unit being 10 times more expensive, or the cost of someone in prison being £35,000 per year. If we invested such money earlier in education, mental health support or support for our young people, we would save money. Indeed, he is the one coming out with the simplistic argument.

[Robert Courts]

The hon. Lady will not be surprised to hear that I do not agree with her. She made a number of points, but I am simply suggesting that the issue is complex. Saying simply that necessary control of public spending leads to an increase in mortality, as is being suggested, is too simplistic.

Let us look at the example of Scotland—this is a simple and important point—where free adult social care is offered and more is spent on healthcare per head than in England. However, life expectancy there is still lower than in England. That simply underlines my point, which I make in response to the hon. Member for Sheffield, Heeley, that it is too simplistic to say that that link between spending and outcomes is as straightforward as she would make out. That cannot be the case, or the situation in Scotland would not be as it is.

For that matter, let us look at the outcomes across Europe. The Public Health England figures are quite striking, particularly in graph form. They show that not only do we have a slight dip in life expectancy figures over the course of the past year or so, but so too do Italy, Spain and, strikingly, France—a dip almost identical to what we have seen in the UK, despite the fact that I understand the French spend the highest amount in Europe on healthcare. We are clearly dealing with a much more complicated situation, and lifestyle factors are crucial. Those are not restricted to the UK.

I am glad that the hon. Member for Sheffield, Heeley has accepted that life expectancy cannot be expected to increase forever. That is of course common sense and a point that she readily accepts, but the point bears repeating and remembering. For a number of reasons we have had extraordinary success in increasing healthcare over the past few years, but we are now faced with the results of that—an ageing and increasing population, therefore with increased complexity of morbidity factors.

I therefore applaud the approach being taken by the Government. We are not only investing as much as possible within the constraints of sensible Government spending, but ensuring that we address the lifestyle factors that can affect life expectancy in the round. However, as I continue to speak, I can see you looking at me with concern, Mr Paisley, so I will confine myself to those remarks.

GP Recruitment and Retention

Robert Courts Excerpts

Wednesday 28th March 2018 Westminster Hall

[Steve Brine]

I will not give way at the moment.

As everybody has said, we recognise the importance of general practice as the heart not only of our NHS, but in many ways of the country. It is as much about prevention before people get into the NHS as it is a gateway to it. That point was made well by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the SNP. As others have kindly said, I am absolutely committed to ensuring that the NHS has the resources, workforce and Government backing to make it fit for the future.

As the hon. Lady said, it is a great success that we are living longer, but an ageing population and more people living with long-term conditions, or so-called comorbidities, means that general practice will become more important than ever in keeping well and living independently for longer. On Friday, I spent a morning sitting and observing—lucky patients—a general practitioner in Hampshire, not in but near my constituency. I watched him do his morning surgery. It was a brilliant thing to do as the Minister with responsibility for primary care, but I would recommend it to any Member who has that relationship with GPs in their area. By sitting and watching, it is possible to see what comes through the door and the pleasures of general practice, which is not dissimilar to the surgeries we hold as MPs.

The number of people over the ages of 60 and 85 is set to increase by about 25% between 2016 and 2030, and the number of people living with long-term conditions is increasing. In 2017, almost 40% of over-60s had at least one long-term condition. I am sure we can all think of people in our families who are in that position—I certainly can. We recognise that that places general practitioners in England under more pressure than ever before, and are taking comprehensive action to ensure that general practice can meet the demand.

The NHS set out its own plan for general practice in the general practice forward view. We have backed that with additional investment of £2.4 billion a year by 2020-21, from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms. That is not made up—those are genuine figures, on the record. As has been said, we have also announced our ambition to grow the medical workforce to create an extra 5,000 doctors in general practice by 2020, as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target—it is double the growth rate of previous years—but it shows our commitment to growing a strong and sustainable general practice for the future.

This debate is about recruitment and retention, so let me break those down. NHS England, which we work with—it is approaching its fifth birthday—and Health Education England are working together with the profession to increase the GP workforce. That includes measures to boost recruitment, address the reasons why GPs are leaving the profession and encourage GPs to return to practice. We recognise that GPs are under more pressure than ever, but we want them to remain within the NHS and are supporting them to do so.

The hon. Member for Stroud (Dr Drew) made the point about recruiting and then following through. As I said at oral questions last week, there are things we can do, but there are things the profession can do too. If doctors in general practice are a counsel of despair, it is little wonder that people do not want to follow them. There are some good, positive voices in general practice, ably led by Helen Stokes-Lampard, who leads the Royal College of General Practitioners. She is a brilliant example of the cup being half full. That kind of positivity is very important—it is a partnership.

[Robert Courts (Witney) (Con)]

Will the Minister give way?

[Steve Brine]

I will, but just once.

[Robert Courts]

I am grateful to the Minister, because I am conscious of the time. He spoke about the support that can be given with regards to recruitment and retention. In my area, the cost of housing is part of the conundrum that we have to solve for everybody, but particularly for key workers. Does he agree that excellent, well-run district councils such as West Oxfordshire—ones that think creatively, outside the box, and help to provide affordable housing in a new way that is targeted at key workers—can be part of the solution to the recruitment and retention challenge?

[Steve Brine]

They can certainly be part of the attractiveness of coming to an area. My council in Winchester is one of the few authorities that is building new council houses—all power to it. My hon. Friend makes his point well, as always.

Increasing training in general practice is important. It is a top Government priority, which is why HEE has made 3,250 places in GP speciality training available every year since 2016. As a result, the number of doctors entering training has increased year on year. In 2017, a record 3,157 new starters were recruited to GP training posts.

The hon. Member for Houghton and Sunderland South spoke very well in introducing the debate, but hon. Members may not be aware that she asked me my first question as a Minister at Health questions in July. She said:

“Does the Minister accept that new medical school places should be created in areas such as Sunderland, where there is the greatest need to recruit and retain general practitioners?”—[Official Report, 4 July 2017; Vol. 626, c. 1008.]

All I can say is that we were listening. I did not say yes at the Dispatch Box, but we looked at the under-doctored areas and at the areas where it is hardest to recruit, which is why Sunderland’s bid was successful. I am glad she welcomed that.

The hon. Lady also welcomed the University of Sunderland putting that in place. As she said, the medical school will encourage general practice as a speciality after students have completed the two years of foundation training. It is envisioned that 50 new students will enrol in 2019 and 100 students in 2020. Experience tells us—this will be encouraging to the hon. Member for West Lancashire (Rosie Cooper), who is no longer in her place—that GPs tend to stay longer in the area where they train, so it is an exciting development for general practice in Sunderland. Once someone has gone there, why would they leave?

As we have heard, the Government have introduced the targeted enhanced recruitment scheme, which funds a £20,000 salary supplement for GP trainees who commit to work for three years in areas of the country where GP training places have been unfilled for a number of years. The hon. Member for West Lancashire is back in her place now—she missed her mention, but I am sure she will catch up on it. The scheme was launched as a one-year pilot in 2016. It was extended for a further year in 2017 and again in 2018. It is a positive innovation.

I am whipping through my brief because of the time. There are a lot of points to try to respond to, and if I do not respond to them all, I will write to hon. Members. A number of hon. Members asked about international recruitment. In August 2017, NHS England announced plans to accelerate its international recruitment to 2,000 GPs in the next three years.

A small number of pilot areas started recruitment last year. The next stage of the recruitment programme is on track to start at the end of the financial year as planned. The aim is to recruit 600 doctors by the end of March 2019 and the remainder by the end of March 2020. As the hon. Member for Houghton and Sunderland South said, that is part of the north-east and Cumbria submission to the national scheme, which runs from this year to source qualified GPs from abroad to work in England. She welcomed that, as do we.

On retention, in addition to our significant efforts to train and recruit more GPs, we want experienced GPs to stay in the NHS and are supporting them to do so. The GP retention scheme, which the hon. Lady mentioned, is a package of financial and educational support to help doctors who might otherwise leave the profession to remain in clinical general practice. It was launched to support GPs who cannot work more than four sessions per week and who cannot secure a suitable substantive post. In September, 218 GP retainers were working in general practice, which is a 40% increase on two years previously.

The induction and refresher scheme provides a safe, supported and direct route for qualified GPs to join or return to NHS general practice in England. By December, it had received 600 registrations. Of those, 368 GPs have completed or are progressing though the scheme back into general practice.

Several hon. Members rightly mentioned pensions. We need experienced GPs to stay. Pensions are an issue for them, alongside workload and indemnity. They are ultimately a matter for the Treasury—it would be a foolish junior Health Minister who wrote Budgets in Westminster Hall—but my hon. Friend the Member for South West Bedfordshire (Andrew Selous) recently made the point in Prime Minister’s questions—the Prime Minister assured him that the Chancellor was listening. He will also listen to hon. Members who have raised it today. We certainly need to address it. As the hon. Member for Central Ayrshire said, to have a full pension pot is a nice problem in some ways, but I take her caveat on board.

We recognise that indemnity is one of the challenges to people staying in the profession. It is a great source of concern to GPs and to me. We want to put in place a more stable and affordable system of indemnity for general practice. At the Royal College of General Practitioners conference in Liverpool in October, the Secretary of State announced that we would develop a state-backed indemnity scheme for general practice in England. We are working with GP representatives and those conversations are going very well. We expect to announce further details of the scheme in May, with the scheme going live in April next year.

Several hon. Members rightly mentioned the partnership model. The Secretary of State and I believe in the partnership model and that it has a role to play in the future of general practice, but times have changed, as the hon. Member for Stroud said in his first point. The Secretary of State announced at the RCGP earlier this year that we are setting up a review with the BMA and the RCGP to consider how it can be reinvigorated and sustained for the future. We hope to announce further details soon. I encourage hon. Members to engage with it.

I get excited about multidisciplinary teams and the wider workforce in primary care, because they are so important. They allow experienced GPs to deal with people with long-term conditions and comorbidities. Pharmacists working in general practice through the pharmacy integration fund, who will number 2,000 by 2020, are very important, as is community pharmacy. The hon. Member for Burnley is passionate about that, as am I. They are part of one NHS and are funded through public funds, so they should absolutely be part of sustainability and transformation partnership discussions. I discussed that with the Royal Pharmaceutical Society at the Department yesterday. The wider workforce is critical to us.

General practice is and always has been the heart of the NHS. GPs play a crucial role in our communities in terms of treatment and prevention. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) said that the majority of feedback that we get is negative—he mentioned the feedback from some of his GPs—but that is not what the GP patient survey says. In answer to his question, he should bring those GPs in. I would very much like to see them and I may even make them a cup of tea. He should contact me and I will do that.

I thank hon. Members for their contributions. A tremendous amount is going on, and we face a tremendous challenge, but good things are happening across the country and I am out and about visiting all the time. We have to take that best practice and not just share it, but implement it across the NHS in England to address many of our primary care challenges.

NHS Staff: Oxfordshire

Robert Courts Excerpts

Tuesday 20th February 2018 Westminster Hall

[Layla Moran (Oxford West and Abingdon) (LD)]

I beg to move,

That this House has considered recruitment and retention of NHS staff in Oxfordshire.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am delighted to have secured this important debate on the retention and recruitment of NHS staff in Oxfordshire. It is a pleasure to see fellow Oxfordshire MPs in the Chamber.

Since my election last summer, the state of the NHS in our county has been one of the issues that my constituents have raised with me most frequently. I pay tribute to all those who work in the NHS in Oxfordshire at every level for their outstanding dedication and commitment to delivering first-class care. We owe it to them, and to patients and their families, to ensure we are providing the best possible service across Oxfordshire and, indeed, the country. I am sure all hon. Members will agree that the staff do an incredible job, but they are under increasing pressure. Some have described the situation as a crisis. Although politicians are prone to hyperbole, I fear that that word is increasingly apt.

Last month, our local NHS hit the headlines nationally, as a leaked memo suggested that Oxford University Hospitals NHS Foundation Trust is considering rationing rounds of chemotherapy at the Churchill Hospital for terminally ill cancer patients because of a 40% shortfall in the number of specialist nurses needed to deliver care. I spoke with the trust bosses, as I am sure many other hon. Members did, and they assured me that the leaked suggestion is not their policy—it is important to reaffirm that point—but they confirmed that it is one option among many being considered by senior staff in the privacy of internal conversations. It is alarming that they are having such conversations at all. That points to a wider issue that needs to be addressed urgently.

The problem, of course, goes beyond cancer services at the Churchill. I am sure Oxfordshire colleagues have their own experiences. In my advice surgery, junior doctors, who prefer to remain nameless, have told me in confidence that staff shortages at the John Radcliffe Hospital and high workloads are leaving some departments dependent on less experienced doctors. They tell me that that would not have happened in years past, and that they are now anxious about patient safety. They work far more than their allocated hours to catch up with paperwork, and they are especially concerned about the night shift, when the problem is most prevalent.

In recent years, the NHS in our area has been propped up by the good will of staff at all levels—doctors, nurses and ambulance workers alike—who put patients first, but the stress of the job is affecting them and their families, and I am afraid that some are voting with their feet. In nursing, the shortage is most acute. In Oxford, we had 560 unfilled vacancies at the end of last June. The vacancy rate increased from 6% to 10% at OUH trust between October 2016 and October 2017.

Mental health is another area of concern. The child and adolescent mental health services in Abingdon provide outstanding care and support to young people with mental health issues and their families, but I have been contacted by residents who are worried that experienced staff are leaving the profession and the NHS altogether due to the pressure on the service and their workloads. According to the Royal College of Psychiatrists, in the Thames valley area, we have a below average number of consultant psychiatrists per 100,000 people, below average numbers of junior doctor psychiatrists, and below average numbers of psychiatric nurses.

The Department of Health’s pledge to expand the mental health workforce to the tune of 570 extra consultant psychiatrists by 2021 is welcome, but the number of medical students specialising in psychiatry has flatlined. The Government must do more to ensure Oxfordshire has sufficient mental health specialists to make parity of esteem between mental and physical health a reality. I am interested to hear from the Minister what they are doing about that.

On the mental health of NHS workers themselves, there is a huge if perhaps unsurprising problem relating to stress and sick leave. A freedom of information request by the Liberal Democrats found that nurses took 5,869 days off for stress and mental health-related illnesses in Oxfordshire in 2016-17—up 11% on the previous year.

Why are we having all these issues? There are several strands to the problem, some of which are specific to Oxfordshire and some of which are represented more widely in the country. I will take each in turn. My Oxfordshire colleagues on the Conservative Benches, in particular, would be disappointed if I did not take the opportunity to speak about Brexit, so let me do that first. To put it bluntly, the Government need to do more to reassure the EU citizens working in the NHS that they are not just welcome in the UK but valued. They face uncertainty about their future status, whether they will be settled and the cost and bureaucracy of it all, and they do not have faith in the Home Office to manage the gargantuan administrative burden. More than 2,700 EU nurses left the NHS in 2016—a 68% increase since two years ago. Separate figures from the Royal College of Nursing show that the number of EU nationals registering as nurses in England has dropped by 92%. I am told by local EU nurses that one of the main sticking points is uncertainty about whether their time spent in the UK will count towards career progression in their country when they go back home, so people are making the decision not to come to the UK lest they risk being at a disadvantage in their career. Is the Minister aware of that problem? If so, what is the Department doing to tackle it? I would also like to see the introduction of an NHS passport, or an equivalent with a different name, to secure the rights of EU citizens who have made their home here and to encourage others to come now, because we cannot wait to address this crisis.

Coming back to our home-grown population, the Royal College of Nursing suggests that the next generation of British nurses is deterred by pressure, a lack of funding and poor pay. It also says that the cuts to training places are exacerbating the problem. Just a fortnight ago, we learned of a 13% reduction in the number of UCAS applications for nursing, compared with the year before. This is the second year in a row that applications for nursing courses have fallen, and 700 fewer nurses are even starting. NHS Digital figures show that one in 10 nurses is leaving the NHS every year, and that those leaving now outnumber those joining.

I recently visited Abingdon Community Hospital, and the staff there told me that the shortages mean that they are increasingly using agency staff to fill the gap. Although those staff are well trained, there is strain associated with bringing them up to speed while managing everything else. It is not a sustainable situation.

The RCN is clear that the Government’s attempts to increase the number of trainee nurses are not working, and that care failings are becoming more likely. The Government must address this situation urgently so the public can have confidence in safe staffing levels in our NHS. The Department has pledged an extra 5,000 places for student nurses in 2017. Again, that is welcome, but how does it square with the collapse in applications? I would like to hear what the Minister and the Department are doing about that.

I think we can lift the 1% pay cap for NHS staff, who deserve a decent, fair and long overdue pay rise. The Minister must be aware of what the cap is doing to morale across the NHS—especially in areas such as Oxfordshire, where the cost of living is high.

[Robert Courts (Witney) (Con)]

I congratulate the hon. Lady on securing this important debate. She may be about to address this point—I apologise if I am foreshadowing her speech—but she mentioned the cost of living, and of course the cost of housing is a big issue for all of us in Oxfordshire, no matter where we live. Does she agree that one of the most helpful things we can do is to follow the example of schemes such as the partnership in my constituency between Blenheim Estates and West Oxfordshire District Council, which is looking at providing substantially reduced market-rent housing for all key workers—not just those in the health sector? There is a great deal to be done there. Furthermore, institutions such as hospitals may be able to look at similar practices. The clinical commissioning group might take up the long-standing invitation for it to attend growth board meetings, in which it will be able to have some input into the housing provided for key workers, what it costs and where it is located. I am sorry that there are so many points there, but perhaps the hon. Lady can consider them.

[Layla Moran]

Not at all; I thank the hon. Gentleman for his helpful intervention. He is right to foreshadow what is coming later. The more times we make the point, the better, because it is the crux of the issue in Oxfordshire. On the pay cap, when will we see the timetable for the pay review? We need to ensure that the basic cost of living at least is covered. I will come on to housing later.

I am glad about the renewed focus on social care in the Department since the reshuffle, but I sincerely hope that it extends beyond just a name change. Staffing levels for the sector are even worse than in nursing in Oxfordshire. One of the more surprising facts I have learned in recent months has been about how many social care staff are leaving the service locally to fill positions in the retail sector created by the opening of the shiny new Westgate centre in Oxford. Pay is at a similar level, but the work is less stressful, so the people doing those vital social care jobs are deciding that they would rather do something else and take the easier path.

It is not just pay that we are talking about; Oxfordshire pays well for such jobs in comparison with other parts of the country. Our area still struggles to recruit and keep people. The recently published Care Quality Commission report for Oxfordshire found that

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades”,

and that “countless” concerns had been expressed about recruitment and retention, and their impact on developing a skilled and sustainable workforce.

The report goes on to highlight the need to do more to increase professional development. We must ensure that budgets are available for continuous professional development within the NHS, allowing existing staff to train, develop and build their career over time. Without such opportunities, it is little wonder that they move on. That has been raised vociferously by nursing leads as another key factor in the retention crisis. I will be interested to hear what the Minister has to say about CPD and whether the budget for that will be increased.

Then there is overall funding. At the election, all political parties pledged more, but it was not enough. Rather than just talking about how much, I want to talk about how we can be honest with the public about how to pay for more funding, if we are all agreed that that is needed. In the short term, my party would like to see a ring-fenced penny in the pound on income tax, providing a £6 billion cash injection. In the longer term, and as a replacement for national insurance, on the basis of wide consultation, we advocate a dedicated health and social care tax. The advantage of that would be that people could see in their pay packets exactly what we were paying for.

We also want an NHS and care convention to bring together all political parties and stakeholders, so we stop using the NHS and social care as the political football it was during the election. Recently a letter on the issue backed by nearly 100 MPs was sent to the Prime Minister, but I was saddened to see that it was not taken up. I therefore urge the Minister not only to continue to ask the Prime Minister and the Treasury for more money for the NHS but, critically, to back something along the lines of a cross-party NHS and care convention, so that we can take the NHS out of the hands of political pundits and put it back into the hands of patients, where it belongs.

I have talked about what I would like to see from the Government: an open and generous offer to EU citizens; a decent pay rise; better funding, which is not kicked about as much; improved working conditions; and action on bursaries and training for nurses. But, to come to the point made so eloquently earlier, that will not cut the mustard for Oxfordshire, because our biggest issue by far is the prohibitive cost of housing in the county.

I will share an email I received from one of my constituents in Kidlington who works for the NHS. She contacted me to say that she feels as though she will never be able to afford a house of her own:

“I work for the NHS and although it comes with fantastic benefits and, I hope, great security it doesn’t pay like those who would be doing the same job as me as an office manager, in the private sector.

My situation is that I have been working for NHS nearly 9 years now. I want to move out and I live in Kidlington. To have a slight chance I would have to do shared ownership. Although not ideal it is a great stepping stone, and you have to start somewhere. However, if I was to look outside Kidlington, the Bicester area where there is up and coming new builds, the prices are still out of my range. It is disheartening to be rejected, especially when you are literally outside the affordability, yet you have worked, paid taxes and generally contributed to society.”

That is a damning indictment, and the despair is shared by so many public sector workers across Oxfordshire. A 2017 study by Lloyds bank listed Oxford as the most expensive city in which to live in the UK, with the average house price now 11 times average earnings. The recent CQC report on Oxfordshire found that staff at every level cited cost of living and housing as barriers to staff recruitment and retention.

There have been some steps in the right direction. As the Minster will know, in March 2016 the OUH trust launched a scheme in which new nursing recruits were offered a cash incentive equivalent to their first month’s rent and a deposit. I have no doubt that the council, the NHS and other organisations in other parts of the county, as we have heard, are doing everything they can—I am not here to bash them—but the fact is that the new houses to be built will not fix the problem. At best, the models show that house prices may flatline over time, but the definition of affordable as 80% of the value of incredibly expensive houses is still nowhere near enough to tackle the problem for public sector workers.

I can propose a solution. I would like to see some kind of Oxfordshire housing allowance for public sector workers given to local NHS staff to help them meet the extremely high cost of living and to tackle our recruitment crisis. Unison’s Oxfordshire health branch has called for the reintroduction of an Oxford weighting to help staff with living costs in the area, in line with the NHS weighting already paid to staff in London. I prefer not to do that, simply because “more pay” can be seen as “more valued”, which is not what that is meant to be. I would prefer to see the introduction of a specific payment for housing—a specific payment for a specific problem.

I am open to exploring all options, and I am very keen to hear what fellow Oxfordshire MPs and others think. Without an Oxfordshire housing allowance in some form, we will always struggle to recruit the NHS staff we require. Moreover, we need to start doing something now.

To conclude, the Government can and must take a role collaboratively with stakeholders to recognise the unique situations and challenges that we face in Oxfordshire. If we do nothing, we risk the rationing of care and treatments and, rightly, a backlash from our constituents. God forbid that anything should happen to a single patient as a result of any of the issues I have described today. It is our duty to tackle the problems head on and to ensure that we recruit and retain the staff whom patients deserve and our local NHS desperately needs.

King’s College Hospital Foundation Trust

Robert Courts Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I cannot understand how the hon. Lady can make such an interpretation from any discussions that have been held, either in this urgent question or further afield. The Government have just given an additional £2.8 billion over and above that asked for by the chief executive of NHS England when he set out the five year forward view and up to £10 billion of capital. This is nothing whatever to do with privatisation.

[Robert Courts (Witney) (Con)]

Will the Minister confirm that the trust has been in discussions with NHS Improvement with regards to reducing its deficit for some time and that the forecast of double the deficit is an unacceptably poor standard of financial leadership at a time when other trusts have made great successes in improving patient care and finding successors?

Tobacco Control Plan

Robert Courts Excerpts

Thursday 19th October 2017 Commons Chamber

[Robert Courts (Witney) (Con)]

May I say what a pleasure it is to follow the hon. Member for North Tyneside (Mary Glindon)? I am glad that vaping has been of assistance to her family, and that things are on the up from that point of view. May I also thank the right hon. Member for Rother Valley (Sir Kevin Barron) for securing the debate? We have had a really important debate this afternoon. He raised some critical points, and I thank him for doing so.

May I also take this opportunity—I have not yet had such a chance—to welcome the Minister to his place? I know he is absolutely passionate about healthcare, and that he will bring to his role all the dedication and enthusiasm of someone who is in the lucky position of having a job that is also his passion. It is good that he will be responding to the debate.

I gave a lot of thought to how I would approach the debate. For a Conservative who generally takes the approach of pursuing individual liberty, there is perhaps some tension in favouring a control mechanism that takes away people’s individual choice. Some excellent points have been made, and two speeches in particular really nailed it. The first was by my hon. Friend the Member for Chippenham (Michelle Donelan), who made the point that were tobacco discovered today, it is inconceivable that it would be freely available on the high street in the way that it is. It seems to me that that is an historical anomaly. The second was by my hon. Friend the Member for Harrow East (Bob Blackman), who spoke movingly about his parents’ deaths from cancer. I am very sorry to hear of that, but it really emphasises everything we are saying in the debate. Of course, we always have to balance the libertarian desire for freedom with the public health interest, and I hope that those two important points have really hit home with hon. Members.

I have spoken at length this week about healthcare in Oxfordshire, its future and my concerns about the way it has been managed. While we must always look at treatment—ensuring that we will one day find a cure for cancer, and in the meantime that we care for those who have cancer with every means at our disposal—we really must continue to fight. What I mean is that we must continue to decrease as much as possible the number of people who suffer cancer in the first place.

We are in the presence of some particularly cold and hard facts. The cost of having 7.3 million smokers is that smoking is the biggest killer. It is clearly identified and open to view as the biggest cause of cancer. It leads to more than 200 smoking-related deaths a day, or 16% of those who die. There are 79,000 deaths per annum —79,000 preventable deaths, 79,000 personal tragedies—to say nothing of the 20 times the number of people who, for every death, are suffering from preventable smoking-related conditions. It seems to me that there is an enormous emotional imperative: we must tackle smoking and the damage it causes.

If I have not persuaded hon. Members on an emotional level, let us just look at the hard economic facts. Smoking costs the economy £11 billion. There is a £2.5 billion cost to the NHS, with 474,000 hospital admissions. Let us just think what we could do for the NHS if we could divert that funding towards the care of conditions that are not avoidable or preventable. There is a £4.3 billion cost to employers, and a £4.1 billion cost to wider society, including the £760 million going to social care. Let us just think about how we could treat dementia or Alzheimer’s if we could divert the money from conditions that are preventable towards those that are not.

Moreover, not only is smoking a cost to the economy and a personal tragedy for those affected, but it is overwhelmingly targeted on the poorest. This health condition is actively feeding inequality. Children of smokers are two to three times more likely to be smokers themselves. The Prime Minister has spoken—very powerfully, in my view—of how the poorest are dying up to nine years earlier than the richest, and half those deaths are smoking related. This condition affects the poorest in society the most.

Surely the economic, moral and health arguments are overwhelming when it comes to the Government’s ambition of creating a smoke-free Britain. It is into that arena that the Government step with this plan.

The good news is, of course, that stopping smoking produces health benefits in months and it is easier, relatively speaking—I appreciate that it is not easy—to give up now than it ever has been. There is the technology. We have heard about the help given by vaping or e-cigarettes; last Stoptober, 53% of those who gave up did so with the assistance of e-cigarettes.

Happily, yes, the prevalence of smoking is declining more sharply than for many years, and this is where the tobacco control plan stands. The last one hugely exceeded expectations: the percentage of people smoking declined from more than 20% to 15%. I applaud the Government for taking forward bold, imaginative and forward-thinking measures as we tackle this public health crisis. The Government wish to reduce the inequality gap that I mentioned, get adult smoking rates down from 15.5% to about 12% and reduce the percentage of 15-year-olds who regularly smoke from 8% to 3%. That is so important, given that the early years govern people’s health choices for the rest of their lives.

My hon. Friend the Member for Colchester (Will Quince) and I spoke in the baby loss debate earlier this week; I mentioned that smoking was one cause of problems during pregnancy. I am glad that my hon. Friend brought that issue up again today. He is right to say that it is difficult to give up smoking. We are not being censorious in talking about pregnant women who smoke, but it would be much better for everybody if we reduced the proportion who do from 10% to 6%.

The Government are providing £16 billion for public health funding to local councils, which are best placed to marshal resources and help people in their areas. Perhaps most effective has been the mass media campaign. Many years ago now—it is a distant memory—the campaign against drink-driving started, and it has had an incredible effect in shaping public expectations. I am not suggesting that smoking is on the same level—there is a recklessness in drink-driving that is not so stark in smoking—but as my hon. Friend the Member for Chippenham said, the issue is education and making it clear that someone is much more likely to hurt themselves and others if they continue to smoke.

I will not speak for much longer, but I want to make one or two brief further points. The first is that the Government propose a joined-up approach between local authorities and NHS England, which I encourage as it produces results. I am also encouraged by the “smokefree NHS” section of the plan—the NHS leading by example. I have discussed the impact on employers; the NHS is a large employer, so it is important that it should lead the way.

Lastly, I want to comment briefly on mental health. The NHS is leading the way as far as those using, working in or visiting the NHS are concerned, and the practice of escorting people from mental health hospitals on and off premises is due to end now that the health problems have been identified. Let us be clear: although 40.5% of people with serious mental health difficulties do smoke, they want to stop smoking just as everybody else does. I hugely encourage that. This is an example of the Government’s taking an approach to mental health in the round. Yesterday, I asked the Prime Minister about help given to military personnel, but this is another example of how to ensure that the issue is not just addressed in only one silo of society.

Thank you for letting me speak for a little while, Madam Deputy Speaker. Like the British Heart Foundation and Action on Smoking and Health, I welcome the plan enormously. It builds on recent Government work on tackling smoking. The proposals are ambitious and bold, and I ask everyone to support the Government’s plan to create a smoke-free generation.

Healthcare in Oxfordshire

Robert Courts 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.

[Layla Moran (Oxford West and Abingdon) (LD)]

My constituents in Oxford West and Abingdon will be heartened by the hon. Gentleman’s speech so far. The points have been extremely well made and the nail has been hit on the head about the lack of proper engagement. As he probably knows, Abingdon Community Hospital is part of phase 2, and there is a real risk that beds will be removed from the hospital without the meaningful engagement about which he so eloquently speaks. Does he agree that the approach is not just flawed because it misses out that local knowledge, but erodes public trust in the democratic process?

[Robert Courts]

The hon. Lady foreshadows remarks that I will make in due course, because the issues that relate to Abingdon and Witney are linked. It is absolutely right to say that the approach erodes trust in the decision-making process and even in the democratic process. One has to have the support and understanding of the people in the communities that one is serving. That is just as true in Oxford West and Abingdon as it is in Witney and west Oxfordshire. I am very grateful for that intervention, which encapsulates precisely the point that I am making. I am interested to hear that the same things are occurring in Oxford West and Abingdon.

I stress yet again that I am not a doctor and am not seeking to tell healthcare professionals how to do their job, but as the hon. Lady’s intervention shows, all of us expect there to be proper engagement and the support of the public. I suggest that the past year and a half has been littered with mistakes and characterised by rushed and lazy consultation or no consultation at all. Now we are looking at phase 2, which is not just about the relatively isolated issue, however important, of the Horton and Chipping Norton, but about the entirety of Oxfordshire’s healthcare.

I understand that we are looking to go to full public consultation in summer 2018, with the final decisions to be made towards the end of 2018. At least, that is the case that the CCG makes; my hon. Friend the Member for Banbury may have comments about it in due course. We understand that the plan is to enhance certain regional community hospitals so that they can handle much more in house and become locality hubs, ensuring that fewer patients have to make the long journey along the A40 or the A34 to the John Radcliffe in the centre of Oxford. The aim is people being treated closer to home. That is, in itself, a laudable, sensible, clinically wise decision. It is an aim that we all have. No one wants to trek into Oxford if they can be treated in Witney, Abingdon or Chipping Norton. We are told that there will also be neighbourhood hubs, providing a centre for district nurses, general practitioners and physiotherapists.

The proposals already, at this early stage—we do not have the full proposals yet—suggest that although there is the promise of joined-up thinking and a structure for facilities, further points have not yet been fully considered. We have seen the re-emergence of some of the same issues that bedevilled Deer Park. I am talking about stroke beds at Witney Community Hospital. I hate to say it, but the CCG does not appear to have listened to the lessons that were learned in the first phase and with regard to Deer Park. We are seeing the same thing: specific issues are hived off from the wider STP process and forced through on their own, without consultation. The wider changes are meant to be considered in the round, looked at in conjunction with other facilities, with due regard to population growth. That is the whole point of an STP. We should not be seeing this balkanisation of the STP process so that within west Oxfordshire, decisions are taken outside the STP process and without the full consultation that is required.

For example, stroke beds, of which there are currently 10 each in Witney Community Hospital and Abingdon Community Hospital, will all be moved to Abingdon in November, which is only a few weeks away. The CCG’s case is that this will increase patient safety, as staff will not be spread across two sites. Again, I do not pretend to be a doctor, a healthcare professional or a clinical expert. There may be a case for that, but there are worrying signs already that it has not been thought through. For example, physiotherapy facilities have been retendered and awarded to Healthshare, which is moving into the former Deer Park medical centre in Witney. The flaw is that stroke patients needing rehab physio will now be 10 miles away in Abingdon, rather than those services being together. That also seems not to take account of the human aspects of rehabilitation: it is important to see friends and family.

[Layla Moran]

The problem in Abingdon is that people are concerned that the physiotherapy unit has been moved away. That point about access is incredibly important, especially in our area, where we frankly cannot get anywhere for the traffic.

[Robert Courts]

I am grateful for that intervention, which is the mirror image of the point that I am making about Witney. The hon. Lady and I face exactly the same problem, but from other ends of the same road. We have the A40, the A34 and the roads inside and around Oxford. Whichever direction a patient is going in it is not a happy prospect for them, whether they originate in west Oxfordshire or in Oxford West and Abingdon.

Again, my point is that this has not been consulted on in any meaningful sense. It has been sprung upon the public when everybody understood, until now, that the future of the wider services would be considered in the round as part of phase 2 of the STP. Suddenly, these proposals were made public at the county council’s joint health overview and scrutiny committee meeting in September, only a matter of weeks ago.

The devil lies in the detail, as always. When we consider what we do not yet know, it becomes clear why it is so important to have a consultation. I would like to see, for example, a map showing where stroke patients come from—where the preponderance of those treated at Witney or Abingdon happen to be, so that we know where they can best be treated. That is not something the public have seen. We should know whether the Witney catchment area includes just the town, or whether it includes west Oxfordshire or Chipping Norton to the north of it. What will the interplay be between Witney hospital and the physiotherapy that is to be just down the road at Deer Park? What hours of care are being delivered now, and what is proposed for the future?

There may or may not be force to those points. We simply do not know. Once again, without a comparison of the status quo and the proposed changes, it is impossible to know whether what is being proposed is a downgrade to, and a reduction in, the services provided. That is the whole point of scrutiny. That is the whole point of consultation. That is not what we are seeing in Witney and west Oxfordshire at present. All this comes just a couple of months before the changes are due to come into effect, with no consultation in any meaningful sense, over a very compacted time period. It simply is not good enough for the people of Witney and west Oxfordshire.

The public can hardly be blamed if they wonder what the future of their hospital in Witney is, whether a ward is going to close or whether the hospital itself is in danger of closing—whether this is the beginning of a death by a thousand cuts, where Witney hospital becomes less and less viable as specialisms are removed from it. The ball is firmly in the CCG’s court. The public need to be reassured loudly and clearly by the CCG that no beds are closing. They need to be reassured that the loss of a specialism is not the beginning of a death by a thousand cuts, where the hospital is downgraded to the point at which it becomes unviable. They need to be reassured that a new specialism for the beds will be proposed, so that Witney hospital can look forward to a bright future in which it receives more services through phase 2, perhaps becoming a locality hub, building on the excellent, innovative emergency multidisciplinary unit that is already in place.

Of course, the CCG’s response will be that that work has not yet been done, but that just is not good enough. Why are we hearing the proposals now if some of the work that is still to be done lies a year in the future? At best, this is a situation that could result in exemplary healthcare services, structured to face the pressures on healthcare of a modern town, and the public are only seeing the negatives. At worst, something is being hidden. We need clarity. This is not about cuts or a lack of funding. This is about a failure to communicate with the public about what is happening to their treasured services. The future of Witney Community Hospital is paramount, and I look forward to the CCG making a statement that makes its bold and bright future clear very soon.

Hon. Members will be glad to know, I am sure, that I am coming to the end. I am very grateful to the Minister, to you, Sir Roger, and to all hon. Members for having listened to my rather wide-ranging speech. I have focused on Witney, with regard to Deer Park and the community hospitals, because those happened to be live issues recently, but the same issues apply to Chipping Norton hospital, which was a particularly live issue six months ago and I know will become an issue again in the future.

We have a CCG that does not seem to understand the duty—it is a duty—to involve the public in its decision making. That does not mean it necessarily has to bend to the will of what people say. It is entitled to come up with proposals itself, but it does have a duty to explain them and to explain why it feels that what it is proposing is in the interests of the people that it serves. It cannot just explain the decisions that it has already made, without explaining what is coming up on the horizon.

The fact that there have been three referrals by the HOSC to the Secretary of State in a year—over Deer Park, the temporary closure of maternity services at Horton and the permanent closure of full maternity and obstetric services at Horton—and multiple judicial reviews by the public, local councils and NHS groups, shows that there is a real danger, if it has not already happened, of a breakdown in relationships. That needs to be fixed, as the whole structure of decision making around healthcare in Oxfordshire is being called into question. I hope that this situation is unique to Oxfordshire and is not systemic across the whole country, but in any event, what has been happening over the last year is no way to construct the future of Oxfordshire’s healthcare.

I finish by saying that I and everybody here would like a constructive relationship with the CCG. That can be achieved, and it will be achieved when the CCG takes a look at the health services of Oxfordshire in the round; when it works in partnership with the county and district councils and the patient groups, which have so much to offer; and, above all, when the public and their representatives alike are properly consulted and not simply told of decisions. I know we can get to that stage and I very much look forward to doing so in the months ahead.

[Sir Roger Gale (in the Chair)]

Mr Howell has indicated to me very courteously that as one of Her Majesty’s trade ambassadors he has an unavoidable commitment. I know that the Opposition and Government Front Benchers will understand that he will therefore not be able to be present for their winding-up speeches, but he has undertaken to read them in Hansard.

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[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.

[Robert Courts]

I understand that the hon. Lady has her job to do, but I am quite keen that this debate, which is about a much more complicated local healthcare issue, is not reduced to one in which—if she will forgive me for saying so—some rather crude political points are made. For what they are worth, the statistics are that the NHS Oxfordshire CCG has received a funding increase of 2% in 2017-18 compared with the previous financial year, and another 2% increase is forecast for the following financial year, so more money is going into the CCG. What is clear—the CCG was quite open about this in the phase 1 consultations instigated and organised by my hon. Friend the Member for Banbury (Victoria Prentis) and I—is that the issue is not funding. It is about transparency of consultation and organisation, so I would be grateful if the hon. Lady did not reduce this debate to a political or money issue.

[Julie Cooper]

I am grateful to the hon. Gentleman for his intervention. I am sorry that he thinks I am reducing the debate; actually, I am looking at the national health service—we do still have a national health service, and I am thankful that we do. I take the points that he has made. These local reconfigurations of healthcare services are very complex; I understand that. However, underpinning all this—it is well documented—is that the STP for the region must make a saving of £480 million. That will be the funding gap if things continue as they are. The changes are not being made for patient gain, and that is why right hon. and hon. Members are rightly upset. They listen to their constituents, and their constituents, as they begin to see the changes coming forward, know they are definitely not an improvement. There is a financial motivation behind them.

I am grateful to the hon. Member for Witney for introducing the debate. It is really important. I sympathise with the people of Oxfordshire, as I do with people across the country in the 44 different STP groups—we are hearing the same story in each of them. I hope that the Minister will address the points raised and that he will encourage clinical commissioning groups to consult more widely, thoroughly and transparently and will equip them with the tools they need. In case anyone does not believe me, did anyone really think that Simon Stevens, head of NHS England, was lying when he said that the NHS did not have enough funding? When the chair of the Care Quality Commission said that social care was close to its tipping point—that has a bearing on this matter—did anyone think he was lying? Of course not. These are very important issues, and I hope that the Minister is listening, because this is part of a Government’s national plan for our health service.

--- Later in debate ---

[Robert Courts]

I thank every Member who has contributed with such passion, in such detail and in such a thoughtful way to a debate that is of overriding importance to all our residents in all our constituencies.

In particular, I thank those Members who have brought extra elements into the debate. I am now under time pressure, but I am grateful to Members for listening to me when I spoke in some detail on some things. My hon. Friend the Member for Henley (John Howell) mentioned ambulatory care; as we all know, treatment close to or at home is ideal. He also told us about his community hospital of which he is so proud. It sounds very much as if it is the way in which things should be done.

My right hon. Friend the Member for Wantage (Mr Vaizey) mentioned the population growth of 700,000 to 900,000, which illustrates the challenge we face in Oxfordshire. I also thank him for mentioning the pressure on GP services, including on a number of the surgeries in his constituency. Through pressure of time, I have not been able to mention all those in my constituency, but I am well aware of the pressures on primary care, which go wider than Deer Park. Other hon. Members will feel the same.

My right hon. Friend mentioned the lack of an imaginative approach to the use of buildings, which is absolutely right. That is what I asked the CCG to do and that is really why I was talking about engagement with the local community and with patient groups; they are the ones who have those imaginative ideas.

We all bow down before the passion and knowledge of my hon. Friend the Member for Banbury (Victoria Prentis). She is a formidable voice in fighting for her constituents at the Horton and more widely. She quoted the IRP recommendation from nine years ago, and it is extraordinary how that almost directly foreshadows the remarks I made. As she said, patients must be fully involved.

I am very grateful to the hon. Member for Burnley (Julie Cooper) for attending. She is in the Opposition and so has a political job to do, but I slightly regret her tone, because the issue is not political. She does not realise that locally this has been a cross-party issue. I am grateful to people from other parties in Witney—I know that my hon. Friend the Member for Banbury feels the same—where we have been fighting for the common good.

The Minister gave us some statistics, but there are many others. I alluded to the increase in funding received by the CCG, and I thank the Government for the fact that we have record investment in the NHS, record numbers of doctors and nurses in training, and record investment in mental health in particular. Let us not lose sight of that. The issue is clear and it is not about funding—I echo that now.

I thank the Minister for his understanding. I understand the limits of what he can say. Service charges must be based on clear evidence—that is absolutely right. I shall of course engage with the primary care location plan. Oxfordshire is a wonderful place to live and if we all work together with the CCG we will secure the future of Oxfordshire’s healthcare.

Motion lapsed (Standing Order No. 10(6)).