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Healthcare in Oxfordshire

Volume 629: debated on Tuesday 17 October 2017

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.

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.

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.

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?

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.

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.

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.

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.

Thank you, Sir Roger. I do apologise that I have to go to meet the Minister of Agriculture from Nigeria. He is here at my own invitation, so I can hardly be absent from the meeting.

Let me say straightaway that I chair a group of Oxfordshire MPs who meet approximately every six weeks to discuss their relationship with the CCG. The meetings were started in order to discuss delayed discharges of care, and I have to say, from the last meeting that we had, they are going very well. Oxfordshire had the difficulty that it was one of the worst performers in delayed discharges, but is now coming back to being one of the best. I have been outside the STP process because my area was handled separately in advance. Townlands Hospital in Henley needed a multi-million pound investment before the STP process started, but I agree with my hon. Friend the Member for Witney (Robert Courts) that the process of consultation that was started by the CCG left a lot to be desired. As a former professional in the area of consultation, I looked with some disdain at what was taking place, but I appreciate that the CCG had a particular difficulty in seeing the hospital as Henley’s or south Oxfordshire’s, which they deliberately intended it to become. In the villages outside Henley that make up the largest proportion of people in south Oxfordshire, there was enormous support for the proposals. It was only in Henley that people took the opportunity to complain about the lack of beds.

Let me turn to the lack of beds. My hon. Friend the Member for Witney spoke about treating people in hospitals close to them. I fully agree with that, but a better model would be to treat them in their own homes. That healthcare system is called ambulatory care. I have spoken about that in this Chamber at length, so I will not repeat all of what I have said before. Ambulatory care requires a full integration of social care activities and medical activities in an area, because it turns the hospital into an extremely efficient medical campus-type facility, with very few people needing to stay in overnight.

In fact, if people stay in overnight, the effects on them are quite horrendous. Anyone over the age of 60 who stays in for four or five days is immediately incontinent. Without wishing to comment on people’s ages, some of us in the Chamber would look at that with great horror. If people stay in for a lot longer than that, other bad effects come from that.

When the consultation took place, there was a tremendous amount of antagonism about the beds being put—

I am sure that my hon. Friend, who is making a powerful, constructive contribution to the debate, would not want to give colleagues the impression that of necessity, someone over the age of 60 would become incontinent if they spent four nights in a hospital. I think he is trying to suggest that there is a greater risk of adverse effects the longer one stays in hospital.

I thank the Minister for that point; I was not suggesting that it was an inevitability. However, at this stage let me extend an invitation to him to visit the hospital so he can see how it works and how it has integrated social care with the medical activities there. It is based around a RACU—a rapid access care unit—which is similar to the EMU—emergency multidisciplinary unit—in Abingdon that is being proposed elsewhere. As I said, it turns the hospital into a diagnostics hospital, similar to a hospital developed in Welwyn Garden City that I went to see.

I saw the difficulty for the CCG with regard to its consultation when I went to a SELF—a South East Locality Forum—meeting. People from Henley were sitting around the table with big beaming smiles on their faces saying how wonderful the hospital was, and a member of the CCG had to stop them and say, “Well, it is a pity you didn’t say that when we were developing the hospital. Right to the end of the consultation you were attacking us on this and on taking the beds out and putting them in a care home at the side of the hospital. That is working very well and now you say that it is absolutely wonderful.” The fact is that, apart from some minor snags with the new hospital, it is a fantastic new investment by the Department of Health. It shows the way a community hospital should be developed not just in Oxfordshire but across the country. I repeat my invitation to the Minister to come and visit.

The great thing about the hospital was not the consultation initiated by the CCG but the support that I got from the Royal College of Physicians, which came out very strongly in favour of an ambulatory healthcare model and very favourably in support of the hospital. That is an interesting point, which goes back to my comments in support of my hon. Friend the Member for Witney about the lack of consultation experience on the part of the CCG. That organisation is willing to learn, and I hope that it will. I also hope that we, as MPs who meet it from time to time, will be able to keep up our pressure on it to deliver the sort of services that we feel our constituents want.

On the point about learning, the Oxfordshire clinical commissioning group has only one district council from Warwickshire—Stratford-on-Avon District Council—on its board. In phase 1 of the consultation, which began in January, it only met the council in March; the council’s overview and scrutiny committee had requested a much earlier meeting. Should that not be part of the learning process?

I fully agree that it should be. As I said, I am not here to defend how the CCG does its consultation. If I had the chance, I would make many changes to the consultation, and including others on the list of people who will be consulted as part of the decision-making process would be an important part of that.

I think I have probably said enough both to support my hon. Friend the Member for Witney and to make the point that it is possible to get through even a bad consultation by a CCG and get a fantastic hospital—ours is doing a brilliant job for all the constituents of south Oxfordshire, not just for one town.

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.

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.

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.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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.

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.

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)).