NHS Staff: Oxfordshire

Victoria Prentis Excerpts

Tuesday 20th February 2018 Westminster Hall

[Victoria Prentis (Banbury) (Con)]

Thank you, Mr Hollobone, and it is a pleasure to take part in the debate. I thank the hon. Member for Oxford West and Abingdon (Layla Moran) for securing it.

It is great to see all my fellow Oxfordshire colleagues present today. If I may say so, they have all been great allies in my fight to save acute services at the Horton General Hospital. Talking about recruitment in some detail is particularly useful, because that is our greatest local challenge with regard to good healthcare.

It is also good to see the Minister in his place. Since he took up his role, he and I have spoken many times about the issues faced at the Horton. We in Banbury are waiting patiently to hear the outcome of the Independent Reconfiguration Panel’s initial assessment of the permanent downgrade of our maternity services. Our hopes are pinned on a full review, and we were due to find out 10 days ago whether that would take place. We have heard nothing yet, but I am watching the post with interest.

The Independent Reconfiguration Panel is familiar with our situation, having looked at similar proposals to downgrade maternity at the Horton back in 2008. Just as recruitment was the contributing factor almost 10 years ago, the failure to fill middle-grade vacancies at the Horton’s obstetric unit was the straw that broke the camel’s back in 2016. However, failures in recruitment are not, as we have heard, unique to maternity services at the Horton. We have spoken briefly about chemotherapy services at the Churchill, and at a meeting in January with local GPs, many expressed concerns about the sustainability of their practices in the current recruitment climate. Last week, the Care Quality Commission observed the following in its full and, if I may say so, quite critical review of the local system, which the hon. Member for Oxford West and Abingdon has quoted and which I will carry on a little:

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades, especially acute hospital staff…and in the domiciliary…market. This resulted in staff shortages, heavy workloads and impacted upon seamless care delivery and integration of services.”

I am reassured that the Department takes recruitment seriously and has invested significant time and resources in addressing current workforce challenges across the nation. Attracting more people to the profession and training them takes many years. The cost of living in our area is high and London weighting is a significant pull factor out of our area, particularly given our very reliable transport links to the capital. We may be a wealthy county but we must think creatively to overcome the current challenges. The future of our services depends on that.

When I called for help, I was overwhelmed by the generosity of local schools and businesses in my area, which offered discounted school fees, free shirts from Charles Tyrwhitt, and free beer from Hook Norton—that made the headlines—to any prospective obstetricians who wanted to apply for a job at the Horton General. As a leading house building authority, Cherwell District Council has been exemplary in its support for the Horton, exploring the possibility of golden handshakes and providing key worker housing. A local developer came forward to offer one of its new build properties to any obstetrician looking to relocate to our area. Yet all of these offers remain completely unexplored by the local hospital trust, which has refused repeatedly to engage with me on this issue.

Last September, the Secretary of State announced plans to offer salary supplements to GPs in rural and coastal regions, which was a really welcome development. Market towns such as Banbury, Bicester, Abingdon and the many others represented in this Chamber desperately need similar incentives to attract newly trained professionals, whether through an Oxfordshire weighting or a ring-fenced housing allowance. I have no particular view about which would be the more effective incentive—I am happy to explore both. More money is always welcome, but it does not have to be the only answer. Just yesterday, I heard from a Banbury GP who has not been able to recruit a fully qualified international GP who is a resident outside the EU, because of problems with the tier 2 visa requirements. The person is an Australian who trained in Banbury and is very familiar with the local system, and we would really value having her back.

It is important that we consider specialties such as general practice and obstetrics when looking at the shortage occupation list that needs to be filled, because there are gaps in those areas too. We must think outside the box and talk across Departments to find the solutions that we desperately need. We must also have some clarity. When obstetric services at the Horton were suspended in August 2016, we were told that the rota needed six obstetricians to operate safely. But the goalposts were moved; the trust now tells us that nine are needed before the unit can reopen. Those decisions have real consequences. We must know the potential domino effect that shortages can have on other medical rotas. Since maternity services at the Horton were downgraded, the hospital has, in turn, lost one of its anaesthetic rotas. Difficulties attracting professionals to CT1 and CT2 posts pose a very real risk to the future sustainability of the one remaining rota. Until that can be full resolved, the threat to all acute services at the Horton cannot be fully ruled out.

Finally, we must learn, as I say repeatedly, to communicate openly and transparently. Extracting recruitment information from the trust is painfully slow. Rather than offer updates, it leaves us to ask for meetings. We are still waiting for the meeting that my hon. Friend the Member for Witney (Robert Courts) requested for us to discuss recruitment at the Churchill. Yet when I made remarks on local radio about a perceived culture of secrecy, the trust chairman was very quick to summon me to meet her. I was told by the trust that all Oxfordshire MPs would be sent a detailed briefing on recruitment and retention challenges by 1 February. I have not had such a briefing and I do not know whether other hon. Members have.

Time and again I have offered assistance with tackling recruitment. Schools and businesses made generous offers to attract obstetricians, and I am furious that the trust continues to fail to engage. I am hopeful that the CQC report provides a long overdue reality check and that we start to see a real step change in its approach. I have made clear numerous times that we MPs are ready and waiting to help. I am really hopeful that under the new excellent interim head of the clinical commissioning group, we will start to develop a vision for our future healthcare, which we have so desperately lacked for so long.

This year we mark 70 years of the NHS. I am hopeful that many of the hard-working staff in Oxfordshire will be recognised at the upcoming parliamentary awards. I am particularly grateful to the dedicated Horton midwives who now face an almost three-hour round commute to and from the John Radcliffe, following the downgrade of our unit. Experience has taught us that we need to keep up the pressure.

--- Later in debate ---

[Mr Edward Vaizey (Wantage) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I thank you for saving the best till last. I congratulate my Oxfordshire colleague, the hon. Member for Oxford West and Abingdon (Layla Moran), on securing this important debate and on her extremely eloquent speech. I echo the way that she opened the debate by paying tribute to our colleagues who work in the NHS. When talking about the problems faced by our NHS locally, we should not lose sight of the fact that we are supremely well served by some extraordinary men and women in our hospitals and GP surgeries, who go well beyond what is required of them to provide first-class care. As Oxfordshire MPs we are also lucky to represent a population that, on the whole, is pretty healthy—indeed, the greatest health care challenge we face is the fact that a lot of our constituents, thankfully, live to a serious old age.

I also want to pay tribute to the hon. Member for Oxford East (Anneliese Dodds) and my two hon. Friends the Members for Henley (John Howell) and for Banbury (Victoria Prentis), for their fantastic speeches. It may be frustrating for the Front Bench that, although potentially there were plenty of goals to be scored, the debate was conducted as all Oxfordshire debates have been since I became a Member in 2005, in the spirit of doing the best for the county.

I want to mention particularly the work of my hon. Friend the Member for Banbury on the Horton General Hospital, which relates to the problem I want to focus on. She has worked tirelessly to maintain services there, and has made it clear to me that although the Horton is geographically well away from my constituency the services that it provides mean that my constituents benefit from choices. The pressures on the local NHS are spread further, enabling a better service to be provided for all. My hon. Friend has come up time and again, as she pointed out, against a culture of secrecy. There have even been court proceedings in which she has been involved. The mind boggles at how the local NHS goes about its business.

Perhaps when the Front Benchers speak we shall go back to playing the traditional national blame game. However, I want to play a bit of a blame game myself—but placing the blame squarely on local NHS management. I do not want to put words into my colleagues’ mouths, but whenever I go to meetings with local NHS management—ably convened by my hon. Friend the Member for Henley—I find that they are passive, unimaginative and deeply bureaucratic. I find the local NHS system completely opaque, and mired in jargon, endless consultation—or non-consultation—and a woeful lack of action.

The CQC report well illustrates the inability of silos to come together for conversations for the greater good of healthcare in Oxfordshire. An example of that is provided by the biggest local issue for me and my constituency: the closure, coming up for two years ago, of Wantage Community Hospital. It closed in April 2016, apparently for justifiable reasons. It is a very old building and its pipes are ageing. There were continual outbreaks of Legionnaire’s disease, so it was closed for safety reasons; but one would have expected some rapid developments to solve that problem. We were promised a consultation that was going to happen in October 2016; that never happened. Then we got a consultation in January 2017, but because of the opaque bureaucracy that my local NHS enjoys that was a phase 1 consultation. Apparently the community hospital was going to be in phase 2, which of course—like the gold at the end of the rainbow—has not materialised.

I took it upon myself at the end of last year to convene a meeting—ultra vires, you might say—of local stakeholders, my local GPs and health managers. It was the first time they had all met together, convened by me, the local MP, not by the health authority. Again, there was complete passivity. I shall not bore my colleagues with the complexities of the attempts to untie the Gordian knot, but clearly one of the solutions for local healthcare in Wantage is the expansion of the local GP surgery. It is owned by a private landlord, Assura, but it seems to me a benign landlord that wants to do the best thing; it would be happy to expand the building. Of course it would receive increased rent as a result. We need, potentially, some financing from the Department of Health and Social Care, but at the very least we need some engagement from health management. I am the one who has effectively brought Assura to the table to discuss how we can develop the GP surgery, to put some proposals on the table and to search for a funding solution. That could involve all sorts of imaginative solutions. I think there will be a meeting at the end of the month to take things forward, but I find it deeply frustrating that I am the one having to drive the process, and not my local NHS management—not that I am complaining, as it is the only way we shall get results.

[Mr Nigel Evans in the Chair]

As to the quasi-national issues that have been raised, I echo much of what has been said. As a convinced remainer—although, sadly, the horse has bolted—may I get well behind the hon. Member for Oxford West and Abingdon and point out that we have, proportionately, twice as many EU citizens working in our local NHS as elsewhere? As the hon. Lady said, it is absolutely reasonable to say that the Government must do more to reassure our European colleagues who live and work here, who contribute their taxes and want nothing more than to be good citizens of our communities, that they are welcome here and that we have nothing against them. I am sure that now that we have Mr Nigel Evans in the Chair that sentiment will be echoed by him at the earliest opportunity.

Housing is clearly an issue, and although I am sure that all our postbags are full of letters from people who do not want an increase in the amount of housing, we need to speak up for all the people for whom it is essential. They include the very people charged with keeping us healthy. I had not appreciated the issue of visas—that is why the debate is so important. I am driven mad by the lack of imagination on the part of the people running our local health service. That came up in what my hon. Friend the Member for Banbury said about the imaginative solutions that her community came up with to secure a senior obstetrician. Shift patterns are an example of what I mean. Nurses leaving the John Radcliffe after 9 o’clock in the evening is something that needs to be looked at.

Parking at the JR is appalling. Surely it is possible for representatives of the local council and the JR to sit down and find a parking solution. An imaginative health authority and imaginative health leaders would look holistically, if I may put it in that way, at the entire working environment for nurses and doctors, particularly in hospitals: how do they get there, how much does that cost, how can parking arrangements be improved and how can permits be given to people who need them for their shift working pattern? That could make such a difference, above and beyond pay. It needs everyone to come to the table. It sounds incredibly boring to keep talking about getting people together for discussions; however, in my time as a Minister—and as a Back-Bench MP—I have often discovered, on bringing together people who I thought probably had regular conversations, that they never sit down to discuss the issues.

[Victoria Prentis]

My right hon. Friend is making the most marvellous speech I have ever heard him make, on a number of issues. I regret interrupting him, but I want to echo what he said and suggest that, as we despair slightly of anyone else taking the action in question, perhaps we as a group—with the Minister if he is willing to be involved—could take the baton and go forward. When I was in charge of fundraising as a volunteer at my local hospital, as I was for many years, I offered charitable funds to look at car parking. That was ridiculous, really, but it was an attempt to break through the bureaucratic impasse that we so often came up against. Let us take matters forward together.

[Mr Vaizey]

I am happy to work with my hon. Friend, particularly considering her back-handed compliment. She has heard hundreds of speeches from me, so for this to be the best she has heard—