Healthcare in Oxfordshire

Robert Courts Excerpts

Tuesday 17th October 2017 Westminster Hall

[Robert Courts (Witney) (Con)]

I beg to move,

That this House has considered the future of healthcare in Oxfordshire.

It is an honour to serve under your chairmanship, Sir Roger. May I, at the outset, thank colleagues from both sides of the House for attending and the Minister for replying? I have deliberately left the wording of the motion quite open, because I want all colleagues to have the chance to set on the record any of their thoughts about the future of healthcare in Oxfordshire.

This is a multifaceted, complex topic. I will of course concentrate on west Oxfordshire and hope I will be forgiven for doing so. We all have particular concerns, and this topic perhaps matters to our constituents more than any other. I would like to broadly separate the debate into the following sections. I will review what was done within the first phase of the sustainability and transformation plan process, how it was handled, the split of the consultation into two phases, how the public were involved in the matter and the outcomes. I will then look forward to phase 2, the proposed changes that have been included and how the clinical commissioning group can work better with the public and all stakeholders throughout the process. I will explore ways in which we can move forward and give Members the chance to raise specific concerns from their constituencies. I will review the past, but for the sake of learning for the future.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

Horton General Hospital is unique in that it serves not only Oxfordshire but Warwickshire, Northamptonshire and even Gloucestershire. I was very concerned about the lack of engagement by Oxfordshire CCG with relevant stakeholders in Warwickshire in phase 1 of its consultation. There was very little communication between the Oxfordshire and South Warwickshire CCGs, despite the fact that there is obviously a knock-on effect on Warwick Hospital. Why was there not greater communication? Colleagues have raised that repeatedly, but with few outcomes.

[Robert Courts]

That intervention precisely illustrates the point I will make in the course of this small speech about a lack of public consultation. That is most marked in the areas we will be talking about—in my case, Witney in west Oxfordshire, and in the case of my hon. Friend the Member for Banbury (Victoria Prentis), Banbury and the Horton. The point is that the issues surrounding the Horton go far further than Banbury; they relate to Warwickshire, Northamptonshire and the north of west Oxfordshire. The lack of engagement is perhaps the main theme of my speech, so I am grateful for that intervention.

I will start by talking about Deer Park surgery. I was elected just under a year ago today, when I faced an unfolding local press crisis. There was a lot of press attention and, understandably, an extremely distressed patient group centred around the closure of its much-loved practice, Deer Park medical centre. To give a short history, the practice was run by Virgin Care. The contract ended and was retendered, and Oxfordshire CCG health bosses received a bid from Virgin that, in their view, did not meet the requirements they were looking for, so they decided to close this small but very well-performing and popular surgery that provided an outstanding and much-needed service for Witney and its immediate surroundings.

The real kicker was that there was no real or meaningful consultation with the people of Witney before that took place. There was little discussion with the district or county councils as to how they may be able move things forward or help or to discuss the building that was coming down the line, nor with patient groups, who might have been able to suggest a way forward. The patients and elected representatives were simply told that it was happening. I met the CCG, Virgin and the patient groups many times, including here in Parliament, but the CCG was resolute: it had decided that the practice would close. Its view was that the lower level of service offered in the tender was not sufficient and that it could not justify spending that money on the surgery, even though the significant growth, to the tune of thousands of houses that we know Witney will have in the years to come, means that the need for the practice is not only present now but will remain so in the future.

The decision to close the practice led to legal action by a patient, funded by legal aid, to keep it open. After sustained campaigning by myself, the patient group and local councillors, the Oxfordshire joint health overview and scrutiny committee voted that making that change without consulting was a substantial change in service, which—I hope I am not going beyond my remit in saying this—it clearly was.

The matter was referred to the Secretary of State for Health, who referred it to the Independent Reconfiguration Panel. That was the first time a primary care decision had been referred to that level—the highest possible level. Ultimately, the IRP ruled that the CCG did not have to reopen the practice, but it did provide specific strictures about the way the decision had been handled and about consultation. It specified that the CCG needed to improve the way that it engaged and further to consider Witney’s healthcare needs.

I hope everybody will forgive me if I quote a short chunk of the IRP report that is pertinent to my point:

“The CCG should immediately commission a time limited project to develop a comprehensive plan for primary care and related services in Witney and its surrounds. At the heart of this must be the engagement of the public and patients in assessing current and future health needs, understanding what the options are for meeting their needs and co-producing the solutions. This work should seek to produce a strategic vision for future primary care provision in line with national and regional aims and should not preclude the possibility of providing services from the Deer Park Medical Centre in the future.”

It is quite clear from that report that the CCG requires a separate project to assess the primary healthcare needs of Witney. Its immediate surrounding areas are included, but that wider reading should not include the entirety of west Oxfordshire, which would enable the CCG to—as it seems to wish—simply wrap this piece of work into the wider STP work it is carrying out in any event.

The IRP is clear that the CCG is required to produce a specific, specially focused piece of work on Witney and its primary care needs. That is what the people of Witney should have. That should include a consideration of the impact upon projected housing growth in and around the town and a roadmap for primary care, covering what will be provided, by whom and at what place. Above all, the people of Witney should be presented with a range of options and scenarios, because if there is only one, there is no consultation. The CCG’s approach is a little bit like Henry Ford saying to the customer, “You can have whatever colour car you like, provided it’s a black one.”

I opened with that story and took some time over it because it is a microcosm of the problems that west Oxfordshire is facing with its CCG, and I suspect—we will hear from them in due course—that other Members in Oxfordshire feel the same. Oxfordshire has been facing a systemic issue with its CCG. The public have not been fully consulted and engaged in a dialogue about the overall picture of the future of healthcare in Oxfordshire any more than they were over the future of Deer Park medical centre.

The CCG is embarking on a consultation regarding primary care in Oxfordshire over the next month, and I am sure all colleagues will join me in engaging with that process, but there are lessons to be learned from Deer Park. I focus on it today because I want those lessons to be learned, and I am keen that we look at how we can avoid this happening again, rather than simply look back and dwell on the mistakes of the past.

Let me be quite clear: I am not a doctor. I do not presume to tell doctors, healthcare professionals or those who commission them how to do their job. I am one of those who feel that, by and large, the profession should be left in peace to do what they do best and to practise their job. However, I expect the people of Witney to be consulted at all times. I expect their voice to be heard and listened to, and for their needs to be met.

The impression should not be gained that I am against any change. I accept that healthcare professionals must allocate their resources in the most efficient way to ensure the best treatment for patients. I might not disagree with changes being made per se, if there was a clinical need, they worked well with other healthcare provision in the area and they were in the interests of the people of Witney and west Oxfordshire, including when we consider the challenges of the future, particularly in respect of housing. I might not be against what is suggested, but if there is to be change, the public and local stakeholders must be fully informed and involved in decision making at the earliest opportunity. The local community must not be surprised by changes being sprung on them. They must be aware of how any proposed changes will affect them and why those changes, in the CCG’s view, need to be made. If the changes are indeed for the better, the sensible, reasonable people of Witney and west Oxfordshire will support them, provided that they are properly explained.

I shall move on to the far wider issue of the STP process across west Oxfordshire. As I said, I do not necessarily disagree with decisions that are made from a clinical perspective. I might or might not agree with decisions, although let me be clear that I do disagree with some of the decisions that have been made. However, what always concerns me in every case is the way in which they are handled.

I have made my response to phase 1 of the STP publicly available—it is on my website—and it clearly outlines my concerns. I will not go through it all in detail now, but I will go through the headlines. The first is “Process”. I do not feel that the STP should ever have been split into two phases, and I made that abundantly clear to the CCG at the time. It is a simple headline point. How can we assess Oxfordshire’s healthcare needs when we hive off the decisions for the Horton, which have an impact on Chipping Norton, Warwickshire and Northamptonshire, and then say that there are some other decisions that are linked inextricably to the first section that we will look at at some future point—a date that keeps going further back into next year? The whole point of the STP process is to look at healthcare needs in the round, not piecemeal, with penny-packet decisions made earlier, making that process impossible. As I have said, the CCG has a duty to the public to provide multiple viable solutions to enable true choice and real consultation.

I shall give an example of how local communities have not been involved. The projected ambulance times from the Horton or Chipping Norton to the John Radcliffe Hospital are simply improbable. Indeed, the journey times are wildly optimistic. There is an over-reliance on Google Maps. Anyone who lives locally in Chipping Norton or Banbury can tell us how long it actually takes to get from either of those towns to the John Radcliffe in traffic, because they do that journey all the time. There is a serious lack of indication of any involvement with South Central Ambulance Service, and they are the people who will be taking heavily pregnant mothers in the late stages of labour from north Oxfordshire or the north of west Oxfordshire to the John Radcliffe. The decision permanently to downgrade maternity services at the Horton, which was made by the CCG board in August, has been unanimously referred by the health overview and scrutiny committee to the Secretary of State, alongside the judicial review appeal that we know about. I go no further at this stage than to say that that indicates a seriously flawed decision-making process.

I make it clear at this stage that for those who live in the north of my constituency, around Chipping Norton, the downgrade of the Horton is greeted with utter dismay. It is important to understand why. Chipping Norton is rural. It is one of the highest places in Oxfordshire; it is one of the few places that still gets snow in winter—people do not get it anywhere else, but they do in Chipping Norton. A journey to Oxford takes, with traffic, the best part of an hour, or more if someone is in one of the outlying villages. I made it clear in the baby loss debate last week that I fear the consequences of an absence of proper obstetric services in the north of Oxfordshire, even more so if the Horton midwife-led unit does not have a standby ambulance. Those proposals are simply not safe, and the deeply moving baby loss debate reminded us last week, if we ever needed reminding, of the consequences of getting this wrong.

For the same reasons, the services at Chipping Norton hospital itself must be safeguarded. Chipping Norton is seeing significant development and needs its own NHS services, which are based in a new building alongside a superb GP medical centre. Perhaps the best example of the mess caused by the split consultation is the confusing reference to the possible closure of the Chipping Norton MLU in phase 1, which purports to deal only with the Horton. How on earth can we say, “We’ll have as a possible solution in phase 1 the possible closure of Chipping Norton; oh, but we won’t make any decisions about Chipping Norton until we come to phase 2”—which will be at some stage in the future—when that clearly impacts on the Horton? How can we decide what is right at the Horton unless we know what there will be at Chipping Norton? It is the same point again. We cannot decide on the future of Oxfordshire’s services unless we look at them as a whole. They ought not to be hived off piecemeal.

Let us look ahead to phase 2. I hope that it is clear from the points I have made that the consultation around phase 1 was inadequate. I stress again that I am not a doctor. If the decisions are in the interest of public safety, I of course appreciate their importance.

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

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

[Robert Courts]

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

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

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

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

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

[Layla Moran]

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

[Robert Courts]

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

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

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

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

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

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

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

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

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

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

[Sir Roger Gale (in the Chair)]

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

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[Julie Cooper]

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

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

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

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

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

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

[Robert Courts]

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

[Julie Cooper]

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

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

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[Robert Courts]

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

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

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

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

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

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

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

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

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