Healthcare in Oxfordshire

Victoria Prentis Excerpts

Tuesday 17th October 2017 Westminster Hall

[Victoria Prentis (Banbury) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I made my first speech about the Horton General Hospital when I was seven. I apologise that many people in this Chamber will have heard it before, but I do not know that you have had that pleasure, so with your permission, I will carry on.

Let us remember what we are talking about. The Horton is not a community hospital. It has been a pleasure to listen to colleagues talk about their community hospitals; we have heard about Wantage and Abingdon, and one rarely meets my hon. Friend the Member for Henley (John Howell) without hearing him mention the Townlands, of which he is very proud. I love community hospitals too; my mother helped run Brackley Cottage Hospital for most of my childhood and until recently, and I think that the marvellous hospital in Bicester still has untapped potential. However, the Horton General Hospital, which I will talk about, is quite different.

The Horton has hundreds of beds and treats about 39,000 people in accident and emergency every year—nearly one third of Oxfordshire’s A&E attendances. What happens at the Horton affects all my colleagues, due to the knock-on effects of closure. Our surgeons are among the top five in the UK for neck and femur operations. It is not a community hospital; it is a fully functioning, very busy district general.

We feel beleaguered. For more than 40 years, the John Radcliffe Hospital has viewed us as a smaller and less academic sibling that can be treated with contempt when staffing is short. In 2008—this is not ancient history; it is nine years ago—the Independent Reconfiguration Panel was asked to consider the last proposed downgrade of paediatrics, obstetrics and gynaecology and the special care baby unit. It conducted, as I hope it will again, a full five-month review and made five excellent recommendations, which I will read once more.

The first recommendation was:

“The IRP considers that the Horton Hospital has an important role for the future in providing local hospital-based care to people in the north of Oxfordshire and surrounding areas. However, it will need to change to ensure its services remain appropriate, safe and sustainable.”

On the proposed downgrades, it said:

“The IRP does not consider that they will provide an accessible or improved service to the people of north Oxfordshire and surrounding areas.”

Other recommendations were:

“The PCT should carry out further work with the Oxford Radcliffe Hospitals NHS Trust to set out the arrangements and investment necessary to retain and develop services at the Horton Hospital. Patients, the public and other stakeholders should be fully involved in this work… The PCT must develop a clear vision for children’s and maternity services within an explicit strategy for services for north Oxfordshire as a whole… The ORH must do more to develop clinically integrated practice across the Horton, John Radcliffe and Churchill sites as well as developing wider clinical networks with other hospitals, primary care and the independent sector.”

I am afraid that none of that happened. The recommendations were made nine years ago, but none of them were followed. The only things that changed were that the traffic got worse and the population of the area grew. Our district council, I am proud to say, tops the leader board for house building.

Less than 10 years later, we now have no obstetrics or SCBU. They went in the blink of an eye, without any real attempt to address recruitment issues or work with us to do so, although we offered and offered. Locally, we remain deeply unhappy and frightened. Patients in the later stages of labour are travelling for up to two hours, and emergency gynaecological operations take place in a portakabin in the Radcliffe car park. We have heard stories locally—in fact, they are all people talk about—of babies born in lay-bys and in the back of ambulances. The data that show statistics of complete births—defined by when the placenta has been delivered—tell a different story; they do not register the reality of people’s experience.

I pay tribute to what my hon. Friend the Member for Witney (Robert Courts) said about Google Maps. Locally, the impression is that the CCG and the trust massage the figures and use them when it suits their argument. I conducted a travel survey of nearly 400 people on their real-life experiences of how long it takes to get from our area to the John Radcliffe Hospital in Oxford. Sadly, those data were not taken on board in any of the CCG’s reports, although the data set was bigger and better than the CCG’s. The CCG provided real data only when we had harangued, pestered and begged it to do so.

I will not go on about how worried I am; I will focus on what we can do to put the situation right. It is true, as all hon. Members have said, that local health providers do not talk to one another. Health Education England’s decision to remove training accreditation for middle-grade obstetricians was the straw that broke the camel’s back for recruitment, yet it remains aloof and makes decisions in a vacuum. Its recent decision to remove accreditation from certain grades of anaesthetists puts all the acute services provided by the Horton at risk. The dean did not communicate that decision to decision makers at the trust or the CCG; I had to tell them at a meeting in August. I do not think that that is an acceptable way to run a healthcare system.

The trust usually tells the CCG what to do. When it does not agree, there is stalemate. The trust, the clinicians and everyone else locally know that the A&E at the Horton cannot possibly be shut, because the knock-on effects on the rest of Oxfordshire and the surrounding counties would be catastrophic. The CCG, however, is determined to press ahead with its consultation that suggests otherwise. Owing to this impasse, we have ended up with a split consultation that means nothing to any of us. Patients’ needs appear to be an afterthought. South Central Ambulance Service, which bears the brunt of the transfers, is carried along as a consultee with no voice at the table when decisions are taken.

One of the main complaints is that local health decision makers do not listen to us. Our latest consultation report described the “universal concerns” of more than 10,000 people from my area who responded to our consultation. I cannot overemphasise the strength of local feeling. We all feel the same: all the elected representatives, of whatever party; a great campaigning group, Keep the Horton General; and even the local churches, which are praying for sense in the clinical commissioning group’s decision making. [Interruption.] My right hon. Friend the Member for Wantage (Mr Vaizey) laughs, but I am afraid it is impossible to overstate how essential our local hospital is to people in our area. He may think it is funny, but we do not.

[Mr Vaizey]

For the record, I am laughing because I have never heard of a church praying for sense from a clinical commissioning group. That highlights the parlous state that we find ourselves in.

--- Later in debate ---

[Victoria Prentis]

Quite.

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

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

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

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

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

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

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

[Julie Cooper (Burnley) (Lab)]

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

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

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

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

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

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

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

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

[Victoria Prentis]

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

[Julie Cooper]

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

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

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

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

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

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

--- Later in debate ---

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

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

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

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

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

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

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

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

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

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

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

[Victoria Prentis]

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

[Mr Dunne]

Indeed, I recognise that. If we are moving to an obstetric-led service at the John Radcliffe, any mother who is high-risk or is expected to give birth will have time to travel in good order, rather than in an emergency. I accept that emergency transfers do take place from midwife-led units during the course of labour.

I have heard the criticism about the overall transformation programme for Oxfordshire being divided into two phases. At this point, we are where we are. The first phase has come to a conclusion, and we are entering the second phase. I recognise some of the criticisms that it is hard to comprehend a coherent system without seeing it all laid out together.