Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 29th October 2019 Commons Chamber

[Caroline Dinenage]

There have been NHS prescription charges in England for decades, and successive Governments have concluded that patients who can afford it should pay prescription charges in order to contribute to the running of the NHS, but a huge number of exemptions are in place and mean that, in England, 89% of NHS prescription items dispensed in the community are currently provided free of charge. People on low incomes who do not qualify for an exemption will be eligible through the NHS low-income scheme.

[Mr Edward Vaizey (Wantage) (Ind)]

Prescriptions not only include pharmaceuticals, so I congratulate the Secretary of State on the launch of a national academy for social prescribing, which he pushed through with his own energy and enthusiasm. Prescribing alternative treatments such as art therapy and speech and language therapy can have a massive impact on people’s mental health and on many other ailments. This Department has undertaken a revolutionary step, and I wholeheartedly congratulate him and all his Ministers.

[Caroline Dinenage]

The right hon. Gentleman plays down his role in this agenda; he has been a great champion for social prescribing. All of us in the Department’s Front-Bench team have met people for whom social prescribing has been life changing; it has totally changed the way they are able to deal with their symptoms and illnesses. It really is a massive game changer.

[Mr Speaker]

But of course modesty is the right hon. Gentleman’s middle name.

[Mr Vaizey]

And humility.

[Mr Speaker]

Indeed.

Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

As I have said to the hon. Lady, we do not consider it to be a valid referral. What I would say is that NHS England remains committed to ensuring that the public are involved in decision making. Part of the extensive public engagement included completing a 30-day engagement about the phase 2 procurement proposals in 2016. I understand the strong passions that this has raised on both sides of the House and I urge all parties to continue working together.

[Mr Edward Vaizey (Wantage) (Con)]

I have made it clear to my constituents that, in principle, I have no objection to private companies providing NHS services, but totally legitimate concerns have been raised about the consultation involved in awarding this contract. May I simply thank the Minister for agreeing to meet Oxfordshire MPs this afternoon? I know that she is very much engaged in this issue and, although it may not technically be overseen by the Department of Health and Social Care, I know that she will do all she can to help us to reach a solution.

[Seema Kennedy]

I thank my right hon. Friend for his question. I am looking forward to the meeting this afternoon. As I have said, I am assured that the decision will maintain services in Oxford and that there will be improved patient access, with new scanners in Milton Keynes and Swindon for people living there as well.

Diabetes

Lord Vaizey of Didcot Excerpts

Wednesday 9th January 2019 Westminster Hall

[Sir John Hayes]

I hope that the Minister, in respect of that excellent intervention and my earlier remarks, will say how he will ensure that that kind of vital education is provided in a format and at a point that works for everyone. This is about getting to people by a means and at a place that will penetrate, have effect and be comprehensible. The objectives in the long-term plan are right, but how we deliver those objectives has become the vital next step.

We have already spoken in this debate about technology. A flexible approach to the provision of technology, as well as education and support, is critical. Once equipped with information and skills, people must have access to, and the choice from, a range of technologies to help them to manage their condition in everyday life, as my right hon. Friend the Member for Ludlow (Mr Dunne) mentioned a few minutes ago. For people with type 2 diabetes, that is about ensuring access to the required number of glucose test strips. In the rapidly developing world of type 1 technology, insulin pumps and continuous glucose monitors can radically transform lives.

Decisions on which technologies are available should be made with reference to advice from clinicians, patients and, perhaps most importantly, health economists, who will help to determine value to the NHS.

[Mr Edward Vaizey (Wantage) (Con)]

Will my right hon. Friend give way?

[Sir John Hayes]

I will give way, but I want to make my point before I do so, and it might well inform and inspire my right hon. Friend’s intervention: it concerns me that, in contrast to medicines, medical devices and now digital solutions do not have clear processes for appraisal and subsequent funding once approved.

[Mr Vaizey]

My right hon. Friend has indeed inspired me. I do not have diabetes, but I tried a FreeStyle Libre sensor because a constituent of mine is involved in the company. Given my right hon. Friend’s remarks, he seems to agree with me that a robust process of cost-benefit analysis would show that the more people who were issued with that device, the more the health service would save in the long term from people being able to avoid catastrophic incidents because they could monitor their glucose levels much more effectively.

[Sir John Hayes]

I agree entirely with my right hon. Friend. In the modern idiom, we need to be technology-neutral about that, because the field is changing rapidly. As new technology comes on stream and improves, we need to be sufficiently responsive to and flexible about those changes to ensure that people get the very best, latest technology available to them, for the reasons he gave.

The limits on self-management by the restrictions on technology inhibit people’s wellbeing, confidence and, thereby, opportunities. I want to ensure that the provision of technology is consistent throughout the country. There are suggestions that such provision is patchy, that some places are better than others and that some of our constituencies are not getting all that they deserve. The Minister will not want that, because he is an extremely diligent and resourceful Minister—I know that from previous experience—and I want him to tell us how he will ensure that the technology is appraised properly, is delivered consistently and, accordingly, will change lives beneficially.

--- Later in debate ---

[Sir John Hayes]

Entirely; in fact, I call on the Minister to do just that: will he introduce a mandatory front-of-pack traffic light labelling system, which is supported not only by my hon. Friend but by 83% of the population when asked whether that should happen? The Minister will be in tune with popular opinion; he will become something of a popular hero by responding to my hon. Friend’s request, which I amplify.

[Mr Vaizey]

We have Belisha beacons—could this not be the moment for Brine indicators?

[Sir John Hayes]

It could indeed. Not only that—I wonder whether we might consider a watershed on the advertising of junk food. Wherever children go, they face adverts suggesting that they eat all kinds of foods. As children, we never ate those things, did we? We were not exposed to the same kind of seductive, alluring advertising suggesting that children should consume that kind of food. There is an argument for cracking down, and Government have a role to play. Again, that kind of watershed on junk food advertising is supported by 76% of the population. The Minister would be a double hero if he did that.

Fitness matters, too. There must be a focus on exercise, given that studies illustrate that regular exercise pays dividends in respect of health and wellbeing, including diabetes. That is why we should not build on playing fields, close down sports halls and concrete over green spaces where people walk, play, run and enjoy all the opportunities to get healthy.

There is a link between poverty and ill health, as Members in the Chamber know very well. Although 6.6% of Britons have diabetes, that percentage falls markedly in wealthy areas. In Richmond upon Thames, 3.6% of residents have diabetes; in Bradford, the number rises to 10.4%. In south Lincolnshire, where my constituency is located, 7.3% of people have been diagnosed as diabetic. Such health inequalities must be addressed. It is with that in mind that I have campaigned so hard for the protection and maintenance of our parks and green spaces, which are often the only places that communities in less advantaged areas have to exercise, play sport and get healthy. In the case of diabetes prevention, do we perhaps take too puritanical an approach by rigidly pursuing individual outcomes? As I said, contrast that with what I described as the democratisation of the debate and the wider view that I have begun to outline today.

I commend, finally, the work of Government and the NHS on moving towards a fresh approach to diabetes in the NHS long-term plan, with a commitment to double the number of diabetes prevention programmes to 200,000 places. None the less, hon. Members will agree that that is a fraction of the 12.9 million people who are at high risk. Will my hon. Friend the Minister say how he plans to take a measured approach and appraise the evidence for all available solutions that might reach the wider population, beyond those targeted special programmes for that relatively small number—well, 200,000 is not a tiny number, but it is a relatively small proportion of the total number of people at risk of contracting diabetes?

Much commendable progress has been made, but it is now time for the Government to do several things. First, they must intensify their public information campaign and encourage everyone to speak about their own type 2 diabetes with their healthcare professional. Secondly, they should ensure that healthcare professionals offer a range of proven solutions, be that education or technology to enable self-management, or the resource to facilitate prevention at scale. Thirdly, they should continually review a rapidly changing environment and update the House on the tough political decisions being made to tackle this crisis of immense proportions. Politicians can no longer afford to abnegate their responsibility to a so-called expert class driven by bureaucracy. Too much is at stake. I know that the Minister will not be able to respond now to all my points, but I invite him to meet me and other concerned colleagues once he has had a chance to reflect on some of the issues, so that we can take the debate forward.

I began with C. S. Lewis, and I will end with him as well:

“We all want progress…If you are on the wrong road progress means doing an about-turn and walking back to the right road and in that case the man who turns back soonest is the most progressive man.”

I do not think we are entirely on the wrong road, but we must be honest about what more we can do. That is not for our own interests or sake, and it is not even for the Minister’s heroic reputation, which I championed earlier. It is for all those who are suffering, or who might suffer, from the crippling illness that is diabetes.

Oral Answers to Questions

Lord Vaizey of Didcot Excerpts

Tuesday 27th November 2018 Commons Chamber

[Caroline Dinenage]

I am happy to work with our colleagues in Scotland to push forward best practice in helping to support community facilities and to ensure that they are investing in facilities at the heart of people’s local areas, which is where they are needed.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage Community Hospital was built and opened by the local community in 1927, but it has been closed for two years. Moves are afoot to improve both our local health centre and health facilities in Didcot, but all that must be joined up and the community needs an answer. Will the Minister use her power to convene a meeting of local stakeholders and her officials to find a way through the maze and a future for our hospital?

[Caroline Dinenage]

I am always happy to speak to my right hon. Friend about such things. I understand that the intention is now to move to a more place-based approach to health and care planning in his local area, but all such changes are subject to consultation.

Lung Cancer

Lord Vaizey of Didcot Excerpts

Thursday 26th April 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a real privilege to respond to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) because he genuinely is a friend and has been a great friend to me. The public see this bear pit where we rip each other apart on a regular basis, but I am sure you will agree, Mr Deputy Speaker, that this is also a very special place.

The House takes a judgment of people and views us all as honourable Members, and my right hon. Friend is known for being one of the most decent men in this place. The genuine outpouring of concern and love when he was forced to make his announcement was tangible. I am not surprised that he was surprised to hear where some of the good messages came from, but he should take that as well deserved. He has talked today about a very personal and traumatic experience, and he did so with real purpose and dignity. In doing so, he has shown the best parts of being a Member of this House, and I warmly congratulate him. It has made it very difficult for me to answer, but there we are.

I congratulate my right hon. Friend on securing this debate. He suggested he was lucky to get an early diagnosis and the outcome that he has. There is an element of luck in it, but I will come back to that. The most important point he made was the fact that he followed up with his doctors and did not let it go. The most important thing in getting a good outcome from cancer is being vigilant and taking that early action.

In my right hon. Friend’s speech, he has humanised his story. We all recognise the behaviours that he outlined. It must have been a very painful decision for him to make—at the top of his game, having entered the Cabinet as Secretary of State and done really good stuff, he was suddenly faced with physical health issues but knew it was the right thing to do and took comfort from his family. The rightness of that is here for all to see.

Luck forms part of it, but we also need to properly engage with health professionals. Some people are dogged, others do not want to face up to it, but we all need to have a much more open conversation. The days when cancer was a death sentence are gone. Cancer survival rates in this country have never been higher. As my right hon. Friend pointed out, that is down to early diagnosis and good treatment. The latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS treatment than three years ago, and that is testament to the hard work of our dedicated NHS staff, but we must do better. Our aim is to save an additional 30,000 lives by 2020. Some 130,000 people die from cancer every year, so there is much to do, which is why the Government have accepted all 96 recommendations in the cancer strategy and backed up this commitment with £600 million of additional funding up to 2021.

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) on a superb speech. It sounds a provocative thing to say perhaps, but it is becoming increasingly apparent that we have cured cancer, in the sense that if diagnosed early enough survival rates shoot up. This might also sound provocative, but it pays for itself. If we can screen people and catch it early, treatment is cheaper than when it is caught later, so although screening would entail a big upfront cost, it would not only save many lives but pay for itself.

Surgical Mesh

Lord Vaizey of Didcot Excerpts

Thursday 19th April 2018 Commons Chamber

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate the hon. Lady on this important debate. She is right to call this a scandal. A constituent of mine now has a colostomy bag and severe internal pain and probably cannot give birth safely in future. She is 24. She makes the point that ventral rectopexy mesh procedures are not included in the audit, apparently because there is no code for surgeons to enter. May I join the hon. Lady in pressing the Minister to go back and include that in the audit so that my constituent’s suffering can be recorded?

[Emma Hardy]

I absolutely agree, and I hope that will be included in future.

Analysis conducted by Carl Heneghan, professor of evidence-based medicine at the University of Oxford and clinical adviser to the APPG on surgical mesh implants, reveals that the 100,516 women who have undergone mesh surgery in England since 2008 have required follow-up treatment in 993,035 out-patient appointments. He has calculated the total cost to the NHS for all incontinence and out-patient appointments to be £245 million. His analysis of the trend in out-patient appointments also shows that more are required by women as each year passes after their surgery, which is completely the opposite of what you would expect after a successful surgery.

The data shows that the number of operations using mesh has halved over the last decade, which shows that doctors and patients are voting with their feet and telling the world that they do not want to use mesh.

NHS Staff: Oxfordshire

Lord Vaizey of Didcot Excerpts

Tuesday 20th February 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing this debate, and I echo her praise for NHS staff who do a fantastic job—indeed, only the other day I was approached in the street by a constituent who told me just how fantastic his NHS treatment had been.

The issue under discussion is not a new problem or something that started only in the past year. I have chaired a group of Oxfordshire MPs and the clinical commissioning group for a number of years, and this issue has been there from the beginning. If I can segment the NHS market a bit, perhaps we can consider how different elements of the NHS can play their part. First, however, let me say that the release of information to The Times by Churchill Hospital must be opposed. It created much stress among patients, and it bore no resemblance to the policies of that hospital. We should send a firm message to Churchill Hospital that the way it behaved was unacceptable.

Perhaps my constituency is very fortunate, but on several occasions I have been told by constituents that a surgery is full and can take no more people, and that that is all down to new housing. Each time I rang the GP surgery, however, I was assured that that is not the case and it still had a tremendous amount of room to take more people. Nevertheless, that does not reflect the current problem with the GP practice system which, however we look at it, we must admit is in need of considerable reform. There are at least two reasons for that. First, we have the problem of young doctors who are unable or unwilling to take on the stress burden created by taking out the loans necessary to buy into the surgery. Secondly, there is a limitation on the ability of GP practices to do some of the minor operations that they have done in the past, and which allowed them to carry on the excellent work that they do for their communities. I urge the Minister to look at that, and perhaps to remove some of the restrictions that apply to the ability to operate in GP surgeries.

Of course GPs need to adapt to new ways of working, and they need to use the internet in a much better way. My own results from what is, I hasten to say, a minor health issue are dealt with by the internet. I email the information in on a regular basis, and the results come back on the internet—fortunately they come back clear each time. [Interruption.]

[Mr Edward Vaizey (Wantage) (Con)]

We are all speculating now.

[John Howell]

I know, and I will leave that issue there.

Social care has been mentioned in terms of its competition with the retail sector in Oxford, which I think is a very real threat. Another issue goes back to one of the more substantial points in the Care Quality Commission report, which is that the joining up and interlinking of different aspects of social care in Oxfordshire leaves a lot to be desired. For example, the amount that was paid by the NHS health trust was different to the sum paid by the county council for the same number of people doing the same amount of work. Evening up that difference must be something to concentrate on, and I wish people success in doing that.

The income of the clinical commissioning group amounts to about £880 million. Staff costs are about 70% of that, at just over £600 million. A 1% pay increase means at least £6 million to £7 million as an unfunded pressure on the health care system, and that is not a very productive way forward. There is no getting away from the fact that the biggest problem with recruitment and retention is living costs in Oxfordshire. There are a number of ways that we can tackle that problem, such as by building more houses—the Oxford-Milton Keynes-Cambridge express way is a good joined-up process for dealing with that, and I hope it comes to fruition.

The second thing we can do, I am afraid to say, is change the housing policies in Oxford city. That goes back to conversations that I had ad nauseam with the predecessor of the hon. Member for Oxford East (Anneliese Dodds). We were known for our fighting over the green belt, and I am glad to infer from what the hon. Lady has said that Oxford is changing the way it deals with issues of planning and housing.

We are talking about a marginal increase across the board, and the uplift that that will bring will not have a big impact on retention and recruitment. It would be much better for us to focus any increase in funds on the issue itself. I ask the Minister, formally, to agree to a weighting for Oxfordshire that gives it some of the strength that London has. As we have already heard, housing costs in Oxfordshire are at least as great as those in London, and that must be tackled. We need a specific weighting, not a marginal increase in pay, and since there will be only a limited pot of resources for increasing pay, it makes a lot of sense to concentrate the impact of that in those places with more intractable problems, such as the housing market and living costs in the city.

[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—

[Anneliese Dodds]

I agree that it is a marvellous speech, and I thank the right hon. Gentleman for that. On the point he was making, we must be sanguine, of course, and I am sure that colleagues will be. There is a tension that I have discussed many times with the trust, and with others; it wants a green and pleasant environment for patients and staff, but intensifying car parking, as many want, might go against that. There could also be planning implications. To be fair, the trust is actively looking at the issues.

As to innovation, the new district heating system that has just been put in is pretty unique. We should give credit where it is due, sometimes: it will ultimately save the trust hundreds of thousands of pounds.

[Mr Vaizey]

I thank the hon. Lady for a course correction in my so-called brilliant speech. I have perhaps been too hard on the NHS management locally to make that point. I am sure that there are hundreds of examples of great innovations that they have introduced. I want to re-emphasise what I said at the beginning of my speech about my huge admiration for nurses, doctors, consultants, surgeons and indeed NHS managers, who do a difficult job. However, I hope that there is appreciation of the frustration that I feel as Wantage Community Hospital’s closure comes up to its second anniversary and there appears to have been no movement.

I do not have time to discuss pay but I noted what my hon. Friend the Member for Henley said. He is a bold and brave advocate for pay locally, and if he thinks that an Oxfordshire weighting is a good idea I am happy to support that, because of his venerable experience in the area. I would be delighted for us to get together as all the MPs of Oxfordshire and with key stakeholders. Personally, I would leave the Minister out of it, because the key message for me in this debate is that Oxfordshire has its issues, but a lot of them can be solved locally.

Healthcare in Oxfordshire

Lord Vaizey of Didcot Excerpts

Tuesday 17th October 2017 Westminster Hall

[Mr Edward Vaizey (Wantage) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger, and I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing this important debate. He spoke with verve and passion; in fact, throughout his speech I was grateful that I was never prosecuted by him when he was at the Bar, because I would not have stood a chance. He made his points cogently and those were ably supported by my hon. Friend the Member for Henley (John Howell). I, too, am a trade envoy—I missed a trick in not informing you of that before the debate, Sir Roger—but I wish my hon. Friend luck with his forthcoming meeting, and I quite understand why he cannot stay for the entire debate.

Let me speak briefly, because I know that my hon. Friend the Member for Banbury (Victoria Prentis) also wants to speak and she is particularly passionate about this subject. I fully support the comments that my hon. Friend the Member for Witney made about the consultation process, which has been, not to put too fine a point on it, pretty tortuous. That has not been helped by the fact that the chief executive and the chairman of the clinical commissioning group both left in the summer, although this gives me an opportunity to congratulate the new chairman, Kiren Collison, who has just been elected on a 97% turnout of GPs in Oxfordshire.

There is clearly great passion for health services in our county—an affluent county that is capable of providing very good services to the people here. But we are getting older, and over the next few years, the population of people aged over 85 will rise by almost 100% and the population of those aged over 60 will increase by 58,000. We are also getting more houses, which are much needed, but that also means that the population as a whole will rise from its current 700,000 to almost 900,000 in the next decade or so. There are great pressures on our local health service, and it has not been helped by this consultation period.

Let me highlight three issues in my constituency, starting with Wantage Community Hospital, a much loved local amenity, which previously had maternity services, with about 60 births a year. I regularly bump into people in Wantage who were born there—many of my constituents were. The hospital was closed in April 2016 because legionella kept being found in the pipe system. Some 4,000 people signed a petition asking simply for the physiotherapy and maternity services to remain open. As I said, there is huge support and there have been great demonstrations in favour of it.

The process that has followed has been appalling. The consultation was due to start in October 2016, but as my hon. Friends know, the clinical commissioning group split the consultation into two phases, with the first covering acute hospitals and the second covering community hospitals. My hon. Friend the Member for Banbury might comment on that strange way of going about a consultation. In any event, the first consultation did not take place until January 2017, three months late. As the hon. Member for Oxford West and Abingdon (Layla Moran) pointed out, community hospitals are not covered in that phase.

In addition, we have now lost our physiotherapy services. They were retendered, and Healthshare won the tender, but it informed my local newspaper that it would not provide physiotherapy services in Wantage as it otherwise would have done, because it was not offered the opportunity. The only service that the hospital can offer is limited maternity care; it has effectively been closed for more than a year, and will have been closed for two years when we get to the phase 2 consultation that might decide its future. That is a completely unacceptable position. I have said again and again to my constituents that I will support anything that provides good healthcare services in Wantage, whether in the community hospital or elsewhere, but at the very least I would like the consultation to start so that my constituents can participate in the discussion.

That leads me to my next point about the pressure on some of my local GP surgeries. For example, Wantage health centre, which could provide some of the services formerly offered by the community hospital—not maternity care, clearly—is home to two practices and is located in a relatively new building on a large site, purpose-built with a view to expansion in future. Its current capacity is 29,000 patients, but over the next 10 years it is likely to reach 45,000.

The landlords, Assura, made a bid to EFTA in March 2016, offering to meet the capital provision and proposing to ask Oxfordshire CCG to meet the additional rent reimbursement. That bid was not successful. I am told that Assura is still committed to investing in the building and that any capital provided by the NHS will be offset by reduced rent, but it needs reassurance that the NHS wants to progress the project; otherwise, it will have to consider alternative uses for the land. The current rent reimbursement is around £350,000, and would rise to around £550,000 with the increase in capacity.

The trouble is that Oxfordshire CCG has not engaged in any imaginative approach to the conundrum that the building is owned by a private landlord—albeit one that is a specialist healthcare provider—meaning that it would incur a revenue cost to the NHS rather than a capital cost. However, at least some sense that a creative discussion is taking place is needed, and I am afraid that there is none.

The White Horse medical practice in Faringdon also has problems. It is two practices merged in one large building, but the internal configuration is far from ideal: for example, it has two waiting rooms. The practice put in a bid for £375,000 to enable internal alterations that would provide five much-needed extra consulting rooms. It received funding for the plans to be drawn up and costed, but was unsuccessful in the final bid, and the CCG has no funding for this project. I do not necessarily lay the blame at the CCG’s door, but it is intensely depressing that relatively small sums of capital that would make a tremendous difference seem to be completely unavailable.

Finally, the Elm Tree surgery in Shrivenham faces issues as well. It is managed by a different CCG in Swindon. The trouble is that because Swindon is mainly an urban area, the CCG has drawn up plans that are perfectly sensible for urban areas, whereas the Elm Tree surgery is a rural practice with completely different needs. Inappropriate decisions have been taken, such as about payments and the surgery’s relationship with care homes. I have met GPs from the Elm Tree surgery and written to Swindon CCG to highlight the problem, but although I have requested a meeting, Swindon CCG has refused, which I find slightly disheartening.

I conclude by echoing the comments of my hon. Friend the Member for Witney, who opened this excellent debate. The whole consultation process has been completely unacceptable. All of us recognise the pressures on the local health authorities and the pressures from a changing population; all that my constituents ask for is a reasonable, open and transparent conversation about the services that they need in their towns and communities.

[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 ---

[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.

[Mr Vaizey]

I hate to interrupt the Minister’s flow as he is getting stuck into the STP, but as time is running out, will he prevail on his officials to write to me after this debate and answer two questions? First, when will the next tranche of capital funding be available for GP surgeries in Oxfordshire? Secondly, what engagements could his Department facilitate between Assura, myself and the clinical commissioning group to try to break the logjam at the Wantage surgery? I do not want to waste any more of his time, and I feel reluctant to prevail upon his officials’ time, but that would be very helpful.

[Mr Dunne]

I can do better than that; I can answer my right hon. Friend’s first question directly. The bids for STP capital funding have been made by all 44 STP areas. They are being assessed at the moment, and we will be making submissions to the Chancellor for the Budget to see whether there will be a capital release for phase 2 of STPs. It is a competitive process. I can confirm that the STP area covering Oxfordshire has made a bid, but I cannot confirm whether it will be successful, because we will not know until we know how much the Chancellor is prepared to release in the Budget. I will happily write to him on his second question and his concerns about Wantage.

Members have said much about some of their concerns about their community hospitals. In his absence, I thank my hon. Friend the Member for Henley (John Howell) for his invitation to visit his hospital and look at the rapid access care unit. I am pleased that he supports the impact it is having in ensuring that elderly and frail people are seen quickly and can return to their homes without needing to be admitted. As he pointed out, and I think we all agree, care at home is how we should be seeking to treat as many people as possible, because that allows people to lead longer independent lives instead of having a prolonged stay in hospital.

The second phase of the Oxfordshire transformation programme is continuing. As has been pointed out in the debate, the CCG leadership is going through a transition period. We have a process under way to recruit a new chief executive, who is expected to be in post in the coming weeks. I am sure that the chairman will read this debate and take note of the comments that have been made on the challenges in engaging in recent years, as will the new clinical lead, who was appointed only yesterday. It is important that Oxfordshire CCG undertakes full public engagement for the second phase of the transformation, and I am aware that that is what it is intending to do. It is likely to begin early in the new year, and I strongly encourage all Members to engage with that consultation in as forceful and impressive a way as they have with this debate, led by my hon. Friend the Member for Witney. I pay tribute to the passion with which everyone has spoken about their commitment to their local residents in providing high-quality healthcare in Oxfordshire.