Healthcare in Oxfordshire Debate

17th October 2017

Philip Dunne responds to a debate on Oxfordshire CCG engagement on the future of health services in Oxfordshire.

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

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

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

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

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

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

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

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

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

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

 

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

 

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.

 

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.

 

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.

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