Oral Answers to Questions

Debate between Robert Courts and Layla Moran

Tuesday 7th March 2023 Commons Chamber

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

19. What steps is he taking to increase the number of GPs.

[Robert Courts (Witney) (Con)]

20. What progress his Department has made on increasing the number of primary care staff.

Oxford to Cambridge Expressway

Debate between Robert Courts and Layla Moran

Friday 11th January 2019 Commons Chamber

[Layla Moran]

I am grateful for the hon. Gentleman’s intervention. I will deal with that point later, but no, I do not.

If the expressway is routed round the north of Oxford, there is likely to be a negative effect on the already heavily congested road network around Kidlington, Yarnton and Begbroke. Some investment is already planned to try to improve congestion on the A40, as was mentioned earlier this week, but probably not enough to cope with the existing problem, let alone the additional housing developments already planned. As far as I am aware, the potential impact of the expressway has not yet been looked at in relation to that.

The route will also run close to several important ecological sites. My constituent Judy, who lives in Kidlington and is an ecological consultant and wildlife expert, says:

“I have studied and loved the wildlife areas in the path of the Expressway, especially Cothill Fen, Wytham Woods and Oxford Meadows for many years. All these wildlife areas of national and international importance are potentially at risk of damage from the Expressway. Either by direct damage”—

which is obvious—

“or by damaging effects of air pollution from increased traffic or things like hydrology change, noise or light pollution. These areas are our irreplaceable natural heritage and need to be preserved intact for future generations.”

It is worth noting that Wytham Woods is one of the most studied woodland areas in the world.

If the expressway utilises the A34 west of Oxford, that is likely to lead to homes being demolished, a worsening of the already poor air quality around Botley, and impact on the Commonwealth war graves that are close to local schools—the Minister knows that well, because we had a walkabout and he saw it for himself. The expressway will also—indeed, it already does—impact on house prices. While shopping at the butchers recently, I met a gentleman who was concerned that the spectre of the expressway was having a negative effect on his ability to sell his house, and he desperately wanted to move. In our meeting, the Minister and Highways England seemed sympathetic to those arguments, not least because demolishing so many houses in an area that needs more houses, not fewer, seems nonsensical, and would be extremely expensive.

[Robert Courts (Witney) (Con)]

The hon. Lady mentions environmental factors, which I agree are important. Does she agree that the impact on the environment could be minimised and mitigated if we use existing roads, and upgrade and utilise existing sections, rather than routes that involve virgin grassland?

[Layla Moran]

I do not rule out the use of existing roads, but where the proposed route would impact on a community as directly as it would in Botley, it should be ruled out. Again I ask the Minister to do that today, because that particular section is horrific, and if we do not rule it out, the wider impacts felt not only there but in other nearby communities could be massive. Sophie from Abingdon contacted me on that point. She strongly opposes the plan because of air pollution in the Wootton area. Jane from Botley repeats concerns about what will happen to schools and says:

“I regularly walk on Westminster Way which runs parallel to the A34 and frequently find the fumes so strong that I have to cover my face and change my route.”

As an asthmatic she sometimes finds that she cannot even walk near the A34 as it is now.

Villages, including South Hinksey and Wytham, currently have direct access to the A34, and residents in those communities are worried about what will happen to that access. South Hinksey is already dealing with the start of the Oxford flood alleviation scheme, which will cause chaos to access to the village. The expressway could be an even bigger scheme, and I wonder whether that has been taken into account.

On the final option, if the expressway is routed to the south of Oxford it will have to go through the green belt, bringing a large amount of additional traffic to an already congested Oxford ring road and the A34 south of Oxford. That stretch of the A34 is already at capacity and has regular gridlocks. Any incident on the A34, however minor, leads to a rapid build-up of traffic, and long tailbacks result in commuters using local towns and villages as rat runs just to get out. We should not make that problem worse in the long run by including an expressway.

I would love the Department to focus on delivering the long-awaited A34 safety review, and I would be extraordinarily grateful for an update on that project, which has been promised for months. I also believe that long-promised and overdue investment in upgrading the Lodge Hill junction must be finished before we can assess how to handle extra traffic on the A34. Will the Minister keep pushing the county council to press on with that project, because there have been yet more delays?

It is not clear whether dealing with the many potential impacts of the expressway has been fully costed, or whether those impacts will be left as problems for local communities to sort out after it has been completed. Many of my constituents argue that the value-for-money and environmental impact of the expressway scheme as a whole should be tested actively against other options. Sophie, again, said:

“I would like to see a plan to reduce congestion in the area, as I feel it is at an all-time high. I would like to see this plan focus on public transport improvements, particularly rail transport and cycle infrastructure.”

We know that that is happening to an extent, but it could be so much more if we reinvested that money.

As we know, the expressway follows a route similar to east-west rail. However, as plans for the expressway have been worked up, the plans for east-west rail have been downgraded. In particular, plans for electrification have been dropped. A growing list of other rail schemes in and linking to Oxfordshire have been delayed or not delivered—the electrification of the line between Didcot and Oxford has been delayed; Oxford commuters look with envy at the quieter, more comfortable trains serving Didcot and Reading; and plans for the expansion of the very overcrowded Oxford station have taken years to make progress.

With the right approach, not only could the capacity and quality of rail travel be improved, but much better facilities could be provided for cyclists, as has already happened in Cambridge. Other rail projects, which would cost much less than the expressway, include reopening the station at Grove, on which there is cross-party endeavour; introducing passenger trains through to Cowley; and upgrading facilities at Radley and Culham. All those projects could tie in better with the local cycling network. I am grateful to the Minister for debating with me in the House on a previous occasion the recent report by Andrew Gilligan, which sets out a clear and coherent strategy for investment that could transform Oxford and surrounding communities by making them cycle-friendly. All those things together would cost a tiny fraction of the expressway.

Crucially, there is a huge amount of peer-reviewed evidence showing that when Governments choose to invest money in additional road capacity, although in the short term there may well be an alleviation effect, the long-term impact is more traffic, more pollution and higher carbon dioxide emissions, at a time when we should be bearing down on all those things. However, when Governments choose to invest in public transport, the result is the opposite. At the very least, the Government should have given equal consideration to all the other approaches first before making this decision. If they are looking to achieve the best long-term value for taxpayers’ money and are committed to switching from the car to other forms of transport, this is their chance.

In conclusion, I share my residents’ deep concern that this Conservative Government are forcing an expressway on our area without fully consulting people about their premise. I am sorry to say that, to add insult to injury, Conservative MPs in Oxfordshire have lobbied the Minister to use the existing road, and I am concerned that that includes Botley. I would love clarification that that was not part of the lobbying effort and that Members did not ask for Botley to be bulldozed. If that were the case, I would let the Minister know, and, as I am sure he is aware, I will not let that or any other part of the scheme drop.

Helen and Douglas House Hospice

Debate between Robert Courts and Layla Moran

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.

Community Transport

Debate between Robert Courts and Layla Moran

Thursday 10th May 2018 Westminster Hall

[Robert Courts]

My hon. Friend says we will get six opinions—I am sorry all the barristers are agreeing with each other.

My hon. Friend the Member for Cheltenham is absolutely right that there is clearly space for interpreting the law here, and that is exactly what we have to do. The sections 19 and 22 system, which has existed for so long, is a classically British compromise. It has created a benign environment under which community transport can operate. It is essential that we continue to go through the regulation and the law with a fine-toothed comb. Simply put, we cannot allow a situation to arise in which community transport providers are not able to operate.

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

Will the hon. Gentleman join me in thanking all the groups across our county that do this, and especially Christopher Gowers from Wolvercote? Many of them cross our constituency boundaries, because our communities are interwoven.

[Robert Courts]

The hon. Lady is absolutely right. I mentioned Our Bus Bartons, which from my constituency runs a service to not only the Banbury constituency but Oxford Parkway railway station. It provides vital links, not just to stations but to doctors’ surgeries, for people to go shopping or for young people to go to work. The impact and essential value of the services simply cannot be overstated. She made that point very clear.

I, too, thank all the volunteers, without whom the services would not run. They put an incredible amount of effort into ensuring that when commercial services were withdrawn, communities could step in and fill the breach. We must make sure that that can continue to happen.

Rural isolation is a real challenge for any of us who represent a rural area, and I know that the Government are combating it and worried about it. That is another essential reason for community transport to continue.

I gave a full response to the consultation, in which I made some of the more technical points that I do not have time to make now. I urge the Minister to engage with the all-party parliamentary group and all of us, because we want to help. We must find a way through to ensure that community transport can continue to thrive, as it has done so far.

NHS Staff: Oxfordshire

Debate between Robert Courts and Layla Moran

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.

Healthcare in Oxfordshire

Debate between Robert Courts and Layla Moran

Tuesday 17th October 2017 Westminster Hall

[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.