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NHS Staff: Oxfordshire

Volume 636: debated on Tuesday 20 February 2018

I beg to move,

That this House has considered recruitment and retention of NHS staff in Oxfordshire.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am delighted to have secured this important debate on the retention and recruitment of NHS staff in Oxfordshire. It is a pleasure to see fellow Oxfordshire MPs in the Chamber.

Since my election last summer, the state of the NHS in our county has been one of the issues that my constituents have raised with me most frequently. I pay tribute to all those who work in the NHS in Oxfordshire at every level for their outstanding dedication and commitment to delivering first-class care. We owe it to them, and to patients and their families, to ensure we are providing the best possible service across Oxfordshire and, indeed, the country. I am sure all hon. Members will agree that the staff do an incredible job, but they are under increasing pressure. Some have described the situation as a crisis. Although politicians are prone to hyperbole, I fear that that word is increasingly apt.

Last month, our local NHS hit the headlines nationally, as a leaked memo suggested that Oxford University Hospitals NHS Foundation Trust is considering rationing rounds of chemotherapy at the Churchill Hospital for terminally ill cancer patients because of a 40% shortfall in the number of specialist nurses needed to deliver care. I spoke with the trust bosses, as I am sure many other hon. Members did, and they assured me that the leaked suggestion is not their policy—it is important to reaffirm that point—but they confirmed that it is one option among many being considered by senior staff in the privacy of internal conversations. It is alarming that they are having such conversations at all. That points to a wider issue that needs to be addressed urgently.

The problem, of course, goes beyond cancer services at the Churchill. I am sure Oxfordshire colleagues have their own experiences. In my advice surgery, junior doctors, who prefer to remain nameless, have told me in confidence that staff shortages at the John Radcliffe Hospital and high workloads are leaving some departments dependent on less experienced doctors. They tell me that that would not have happened in years past, and that they are now anxious about patient safety. They work far more than their allocated hours to catch up with paperwork, and they are especially concerned about the night shift, when the problem is most prevalent.

In recent years, the NHS in our area has been propped up by the good will of staff at all levels—doctors, nurses and ambulance workers alike—who put patients first, but the stress of the job is affecting them and their families, and I am afraid that some are voting with their feet. In nursing, the shortage is most acute. In Oxford, we had 560 unfilled vacancies at the end of last June. The vacancy rate increased from 6% to 10% at OUH trust between October 2016 and October 2017.

Mental health is another area of concern. The child and adolescent mental health services in Abingdon provide outstanding care and support to young people with mental health issues and their families, but I have been contacted by residents who are worried that experienced staff are leaving the profession and the NHS altogether due to the pressure on the service and their workloads. According to the Royal College of Psychiatrists, in the Thames valley area, we have a below average number of consultant psychiatrists per 100,000 people, below average numbers of junior doctor psychiatrists, and below average numbers of psychiatric nurses.

The Department of Health’s pledge to expand the mental health workforce to the tune of 570 extra consultant psychiatrists by 2021 is welcome, but the number of medical students specialising in psychiatry has flatlined. The Government must do more to ensure Oxfordshire has sufficient mental health specialists to make parity of esteem between mental and physical health a reality. I am interested to hear from the Minister what they are doing about that.

On the mental health of NHS workers themselves, there is a huge if perhaps unsurprising problem relating to stress and sick leave. A freedom of information request by the Liberal Democrats found that nurses took 5,869 days off for stress and mental health-related illnesses in Oxfordshire in 2016-17—up 11% on the previous year.

Why are we having all these issues? There are several strands to the problem, some of which are specific to Oxfordshire and some of which are represented more widely in the country. I will take each in turn. My Oxfordshire colleagues on the Conservative Benches, in particular, would be disappointed if I did not take the opportunity to speak about Brexit, so let me do that first. To put it bluntly, the Government need to do more to reassure the EU citizens working in the NHS that they are not just welcome in the UK but valued. They face uncertainty about their future status, whether they will be settled and the cost and bureaucracy of it all, and they do not have faith in the Home Office to manage the gargantuan administrative burden. More than 2,700 EU nurses left the NHS in 2016—a 68% increase since two years ago. Separate figures from the Royal College of Nursing show that the number of EU nationals registering as nurses in England has dropped by 92%. I am told by local EU nurses that one of the main sticking points is uncertainty about whether their time spent in the UK will count towards career progression in their country when they go back home, so people are making the decision not to come to the UK lest they risk being at a disadvantage in their career. Is the Minister aware of that problem? If so, what is the Department doing to tackle it? I would also like to see the introduction of an NHS passport, or an equivalent with a different name, to secure the rights of EU citizens who have made their home here and to encourage others to come now, because we cannot wait to address this crisis.

Coming back to our home-grown population, the Royal College of Nursing suggests that the next generation of British nurses is deterred by pressure, a lack of funding and poor pay. It also says that the cuts to training places are exacerbating the problem. Just a fortnight ago, we learned of a 13% reduction in the number of UCAS applications for nursing, compared with the year before. This is the second year in a row that applications for nursing courses have fallen, and 700 fewer nurses are even starting. NHS Digital figures show that one in 10 nurses is leaving the NHS every year, and that those leaving now outnumber those joining.

I recently visited Abingdon Community Hospital, and the staff there told me that the shortages mean that they are increasingly using agency staff to fill the gap. Although those staff are well trained, there is strain associated with bringing them up to speed while managing everything else. It is not a sustainable situation.

The RCN is clear that the Government’s attempts to increase the number of trainee nurses are not working, and that care failings are becoming more likely. The Government must address this situation urgently so the public can have confidence in safe staffing levels in our NHS. The Department has pledged an extra 5,000 places for student nurses in 2017. Again, that is welcome, but how does it square with the collapse in applications? I would like to hear what the Minister and the Department are doing about that.

I think we can lift the 1% pay cap for NHS staff, who deserve a decent, fair and long overdue pay rise. The Minister must be aware of what the cap is doing to morale across the NHS—especially in areas such as Oxfordshire, where the cost of living is high.

I congratulate the hon. Lady on securing this important debate. She may be about to address this point—I apologise if I am foreshadowing her speech—but she mentioned the cost of living, and of course the cost of housing is a big issue for all of us in Oxfordshire, no matter where we live. Does she agree that one of the most helpful things we can do is to follow the example of schemes such as the partnership in my constituency between Blenheim Estates and West Oxfordshire District Council, which is looking at providing substantially reduced market-rent housing for all key workers—not just those in the health sector? There is a great deal to be done there. Furthermore, institutions such as hospitals may be able to look at similar practices. The clinical commissioning group might take up the long-standing invitation for it to attend growth board meetings, in which it will be able to have some input into the housing provided for key workers, what it costs and where it is located. I am sorry that there are so many points there, but perhaps the hon. Lady can consider them.

Not at all; I thank the hon. Gentleman for his helpful intervention. He is right to foreshadow what is coming later. The more times we make the point, the better, because it is the crux of the issue in Oxfordshire. On the pay cap, when will we see the timetable for the pay review? We need to ensure that the basic cost of living at least is covered. I will come on to housing later.

I am glad about the renewed focus on social care in the Department since the reshuffle, but I sincerely hope that it extends beyond just a name change. Staffing levels for the sector are even worse than in nursing in Oxfordshire. One of the more surprising facts I have learned in recent months has been about how many social care staff are leaving the service locally to fill positions in the retail sector created by the opening of the shiny new Westgate centre in Oxford. Pay is at a similar level, but the work is less stressful, so the people doing those vital social care jobs are deciding that they would rather do something else and take the easier path.

It is not just pay that we are talking about; Oxfordshire pays well for such jobs in comparison with other parts of the country. Our area still struggles to recruit and keep people. The recently published Care Quality Commission report for Oxfordshire found that

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades”,

and that “countless” concerns had been expressed about recruitment and retention, and their impact on developing a skilled and sustainable workforce.

The report goes on to highlight the need to do more to increase professional development. We must ensure that budgets are available for continuous professional development within the NHS, allowing existing staff to train, develop and build their career over time. Without such opportunities, it is little wonder that they move on. That has been raised vociferously by nursing leads as another key factor in the retention crisis. I will be interested to hear what the Minister has to say about CPD and whether the budget for that will be increased.

Then there is overall funding. At the election, all political parties pledged more, but it was not enough. Rather than just talking about how much, I want to talk about how we can be honest with the public about how to pay for more funding, if we are all agreed that that is needed. In the short term, my party would like to see a ring-fenced penny in the pound on income tax, providing a £6 billion cash injection. In the longer term, and as a replacement for national insurance, on the basis of wide consultation, we advocate a dedicated health and social care tax. The advantage of that would be that people could see in their pay packets exactly what we were paying for.

We also want an NHS and care convention to bring together all political parties and stakeholders, so we stop using the NHS and social care as the political football it was during the election. Recently a letter on the issue backed by nearly 100 MPs was sent to the Prime Minister, but I was saddened to see that it was not taken up. I therefore urge the Minister not only to continue to ask the Prime Minister and the Treasury for more money for the NHS but, critically, to back something along the lines of a cross-party NHS and care convention, so that we can take the NHS out of the hands of political pundits and put it back into the hands of patients, where it belongs.

I have talked about what I would like to see from the Government: an open and generous offer to EU citizens; a decent pay rise; better funding, which is not kicked about as much; improved working conditions; and action on bursaries and training for nurses. But, to come to the point made so eloquently earlier, that will not cut the mustard for Oxfordshire, because our biggest issue by far is the prohibitive cost of housing in the county.

I will share an email I received from one of my constituents in Kidlington who works for the NHS. She contacted me to say that she feels as though she will never be able to afford a house of her own:

“I work for the NHS and although it comes with fantastic benefits and, I hope, great security it doesn’t pay like those who would be doing the same job as me as an office manager, in the private sector.

My situation is that I have been working for NHS nearly 9 years now. I want to move out and I live in Kidlington. To have a slight chance I would have to do shared ownership. Although not ideal it is a great stepping stone, and you have to start somewhere. However, if I was to look outside Kidlington, the Bicester area where there is up and coming new builds, the prices are still out of my range. It is disheartening to be rejected, especially when you are literally outside the affordability, yet you have worked, paid taxes and generally contributed to society.”

That is a damning indictment, and the despair is shared by so many public sector workers across Oxfordshire. A 2017 study by Lloyds bank listed Oxford as the most expensive city in which to live in the UK, with the average house price now 11 times average earnings. The recent CQC report on Oxfordshire found that staff at every level cited cost of living and housing as barriers to staff recruitment and retention.

There have been some steps in the right direction. As the Minster will know, in March 2016 the OUH trust launched a scheme in which new nursing recruits were offered a cash incentive equivalent to their first month’s rent and a deposit. I have no doubt that the council, the NHS and other organisations in other parts of the county, as we have heard, are doing everything they can—I am not here to bash them—but the fact is that the new houses to be built will not fix the problem. At best, the models show that house prices may flatline over time, but the definition of affordable as 80% of the value of incredibly expensive houses is still nowhere near enough to tackle the problem for public sector workers.

I can propose a solution. I would like to see some kind of Oxfordshire housing allowance for public sector workers given to local NHS staff to help them meet the extremely high cost of living and to tackle our recruitment crisis. Unison’s Oxfordshire health branch has called for the reintroduction of an Oxford weighting to help staff with living costs in the area, in line with the NHS weighting already paid to staff in London. I prefer not to do that, simply because “more pay” can be seen as “more valued”, which is not what that is meant to be. I would prefer to see the introduction of a specific payment for housing—a specific payment for a specific problem.

I am open to exploring all options, and I am very keen to hear what fellow Oxfordshire MPs and others think. Without an Oxfordshire housing allowance in some form, we will always struggle to recruit the NHS staff we require. Moreover, we need to start doing something now.

To conclude, the Government can and must take a role collaboratively with stakeholders to recognise the unique situations and challenges that we face in Oxfordshire. If we do nothing, we risk the rationing of care and treatments and, rightly, a backlash from our constituents. God forbid that anything should happen to a single patient as a result of any of the issues I have described today. It is our duty to tackle the problems head on and to ensure that we recruit and retain the staff whom patients deserve and our local NHS desperately needs.

The debate can last until 1 o’clock. I will call the Front-Bench spokespeople at 12.30 pm, so other Members have 10 or so minutes each. I call Victoria Prentis.

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

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

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

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

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

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

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

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

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

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

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

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

It is a real pleasure to see you in the Chair, Mr Hollobone, and to be among my fellow Oxfordshire MPs. I wish that we could always take the same friendly approach as this county group to different policy issues. It is a pleasure to participate in this debate and to follow the hon. Member for Banbury (Victoria Prentis) and the hon. Member for Oxford West and Abingdon (Layla Moran), to whom I am very grateful for calling it.

In common with my colleagues, I receive a huge amount of case work from patients, members of the public and NHS staff who are concerned about the local NHS. I want to share one very recent example that offers some very telling lessons. A local nurse who came to one of my surgeries had talked to other nurses in her department and put a notice on the staffroom noticeboard asking for people to add their comments about issues that they wanted raised with their local MP. Low pay and understaffing came right at the top of that list. She was absolutely dedicated to helping her patients, but she felt under extreme pressure. She said to me that the recent negligence claim that was brought against a doctor, which many of us will have seen, could have happened anywhere in the NHS, and that she was enormously concerned. I was very impressed by her dedication and concern to make sure that these issues were dealt with at political level. She did not believe that they were being dealt with and I do not believe that they have been either.

The Library briefing rightly indicates that recruitment and retention are largely the responsibility of individual trusts, yet they are undertaken within a framework of national policy. This is a particular problem for the local NHS—colleagues have already mentioned that. The pay cap in particular is a big issue in Oxford—we have no uplift compared with London, which is a competitor in staffing terms—as is the large number of EU staff in the local NHS. I will briefly run through each of those three matters before turning to some of the positive moves that are ameliorating the situation but are being countered by those strong headwinds from national-level factors.

The seven-year pay cap has been a particular problem for NHS staff in Oxford because of the gap between wages and our high living costs. It is the No. 1 issue whenever I talk to NHS staff. Yes, there will be local concerns too, but so many staff say to me that they feel they are being forced either to leave the profession or to work as an agency or bank member of staff, because the pay is not keeping pace with the costs that they face. That is a much more expensive way of staffing the healthcare system, because it is much more expensive to fill those gaps through bank or agency staff than by using the permanent workforce. The hon. Member for Oxford West and Abingdon mentioned that the Government have maintained that they will lift the pay cap, but that is contingent upon an “Agenda for Change” process. A lot of the NHS staff I have talked to have said they are worried that that could be used as an excuse to screw down terms and conditions.

More than one nurse has said to me on the doorstep that they are concerned about the impact of the removal of the nurse training bursary and pointed out that nurses who are in training cannot do other jobs to keep themselves afloat. They are expected, in effect, to live on thin air. That might be possible at times in some low-cost areas, but it is just not possible in Oxford, and it leads to a lot of potential recruits abandoning their dream of entering nursing. That really is a dream for a lot of people, and they are very motivated to do it, but it is becoming very hard to achieve.

Colleagues have already referred to Oxfordshire’s particular problems with mental healthcare. Mental healthcare funding generally is low in Oxfordshire compared with other clinical commissioning group areas, but that is compounded by the issues with recruitment. Again, there have been positive developments, such as the reinvigoration of the child and adolescent mental health service, but we still have many issues with recruitment.

That is of course compounded by the lack of Oxford weighting, which is a particular problem for us because we are so close to London. If we were not, we might be in a different situation, but there is a natural process whereby staff look to London and see what they would be able to afford there, where their housing costs would be the same, if not lower. Colleagues will know that local NHS staff began a petition calling for some kind of Oxford weighting to be introduced. That petition now has more than 7,000 signatures.

Such a weighting must not be used as an excuse to move away from collective bargaining. I am a bit disappointed that some Government Members have said to me, “Yes, this is why we need to abandon collective bargaining.” That is not what NHS staff have told me they want. A weighting introduced specifically to cover housing costs—we could call it a levy, a special payment or whatever—could be part of a system that recognised the abnormally high costs in Oxford, which is the most expensive place in the UK to buy a home and one of the most expensive in which to rent.

We need to ensure that outsourced staff are covered by any uplift. I was appalled to hear that some outsourced staff have been living in a corridor in a shared house because they cannot afford a room. This is not about people being able to afford their own flat or house; it is much worse. I recently came across a couple living with their children in Blackbird Leys, which is a relatively low-cost area of Oxford, who both work in the NHS. They were unable to afford their rent and thought they would have to move out of the city. That is not uncommon.

I do not want to stress the point too much, but I do not think the answer is to stop Oxford’s economy growing. Instead, we must ensure that we pay NHS staff properly. My party set out in our grey book how we would do that by removing the pay cap, which, given the issues with recruitment and retention, may end up saving the NHS money in the long run. NHS staff have told me that they believe it would save the NHS in particular on filling gaps with agency staff that are not filled by permanent staff.

The hon. Member for Oxford West and Abingdon mentioned the reliance of our local NHS on EU staff. Oxfordshire has about double the national average of EU staff. It does not give me any joy to say that—although I expressed concerns just before the referendum and afterwards about the danger that a new immigration system for EU staff similar to that for non-EU staff would end up costing the NHS money and result in it losing staff—all those chickens seem to be coming home to roost. I have experienced the same kinds of issues as the hon. Member for Banbury, who mentioned NHS trusts’ problems with recruiting staff from outside the EU, and particularly with getting them on to their books. It will be an enormous problem if we end up taking the same approach to staff from the EU, because the system is already very costly, bureaucratic and unclear.

Given those circumstances and all the problems, local measures can have only limited impact, but I will mention a few of them, because they demonstrate that solving the current problems with recruitment and retention requires national commitment. First, Members have already mentioned that one of the major problems for our local NHS is social care, which is under enormous pressure in Oxfordshire. Social care is the responsibility of Oxfordshire County Council, which has struggled to deliver adequate services since its budget was cut by about one third due to reductions in central Government grant. However, there are positive developments in Oxfordshire. The home assessment reablement team—HART—has brought together social care and NHS staff and delivered a big acceleration in the provision of the social care that people need when they are able to go home. That ultimately has not been enough, but it has helped.

Secondly, it has been good to see Oxford Brookes University develop its own nursing and midwifery school in an innovative attempt to bring together research, education and training, which does not happen anywhere else in the country, and to persuade local people that nursing and midwifery may be for them. Again, though, that is a big challenge, because people still have to be able to afford to live in Oxford while they undertake that world-class training.

Thirdly, we have spoken quite a bit about housing. Oxford’s housing plans include a commitment from the city council to enable the NHS to meet employee needs by exempting staff housing schemes on land owned by the NHS from social rent requirements. However, it is important that we ensure that any housing that results from that exemption is permanently provided on a favourable basis, for affordable rent, to those who need it. If it is only later going to be sold and returned to the free market, it is not going to deal with the problems. Applying a 50% affordable housing requirement to new developments in Oxford will also help the situation. Constituents I speak to, including people who work in the NHS, say that schemes such as Help to Buy and the stamp duty holiday are not having an impact, because even contemplating buying a house is far too much of a jump. Genuinely affordable housing would help.

The removal of restrictions on land acquisition, new rules on viability and enabling local authorities to borrow to build would help improve the situation further, especially when it comes to the provision of key worker housing. In Oxford, that has to involve co-operation with neighbouring councils. I am pleased that we have had such co-operation on the Oxford to Cambridge corridor, but that needs to come to fruition. Independent assessments indicate that Oxford needs about 30,000 new homes, but there would be space for only about 8,000 within Oxford’s boundaries even if occupancy levels in the city were intensified. The Oxford to Cambridge corridor plan has to focus on delivering housing for key workers and people on low incomes; otherwise it will not deliver the change that we need.

The leader of the city council and I wrote to the Housing Minister last week to detail some of the areas where we desperately need change. Oxford probably has the biggest housing crisis of just about any city. Unfortunately, we see that right in front of us every day from the number of people on the streets, but there is also a hidden problem of people struggling in overcrowded or unsuitable accommodation.

The local NHS trust is working hard on recruitment and retention, and it has done some innovative things. The hon. Member for Oxford West and Abingdon mentioned the golden handshake people get when they start, which is obviously necessary. A lot of work has been done on advertising, recruitment fairs and so on, and there is an attractive on-the-job training offer, although we always need more funding for that. However, all that has been done in the context of the almost perfect storm of factors that affect us in Oxford—particularly the pay cap and uncertainty for EU staff.

There is an enormous amount that we, as Members who represent Oxfordshire constituencies, should be proud of, and I am sure that we all are. We have world-class services and incredible opportunities because of the proximity of Oxford University, Oxford Brookes University and other research centres, and the incredible diversity of innovative companies and others in our area. However, those world-class services are under pressure like never before. If we want to continue providing the kind of excellent care that I am grateful to have received when I gave birth to both my children in the John Radcliffe Hospital, we need to deal with these issues very quickly.

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

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

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

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

I know, and I will leave that issue there.

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

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

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

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

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

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

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

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

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

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

[Mr Nigel Evans in the Chair]

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

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

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

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

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

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

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

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

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

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate and on the powerful arguments she made about the recruitment and retention crisis affecting NHS services in her area and across the country.

As the hon. Lady said, the NHS has been a frequently raised issue in recent times, certainly since her election. I join her and the other right hon. and hon. Members who have spoken today in praise of the dedication and commitment of the staff who work in our health service. She said that we are close to a crisis in the NHS. I believe that only the dedication and commitment of staff prevent a crisis from turning into a complete catastrophe. She was also right to say that the good will of staff is propping up services at the moment. That is something that, I am sad to say, I have to keep repeating every time we have a debate: it is the good will of staff that keeps the show on the road.

I was concerned to hear that some staff had approached the hon. Lady to say that some of the levels of experience in particular wards were raising concerns about patient safety. She highlighted in particular the shortage of mental health specialists. She is right to say that the good intention to try to achieve parity of esteem will be extremely difficult to meet when there are so many shortages.

The hon. Lady diagnosed a number of issues that have contributed to causing the crisis. Uncertainty around Brexit has certainly accelerated some of the staffing challenges already in place. The abolition of the nursing bursary has also created issues, and I will come back to that later on. I agree with her that reliance on agency staff is unsustainable, and we can talk about that in a little more detail later. She mentioned the pay cap, as I think every hon. Member did; that is something else I will come back to later, but I remind her that when her party was in government it enacted that policy for a full five years.

The hon. Lady also mentioned staffing shortages in social care. It is sad to hear that those doing one of the most valuable jobs in society feel that they have a better prospect of earning a decent living in retail. That brings home the challenge we face. The issues she raised about training and professional development are also particularly relevant.

The hon. Lady was right to mention that behind all of that is the funding challenge we currently face. We are in the longest and most sustained financial squeeze in the history of the NHS, and it is inevitable that those kinds of issues will come up until we reach a sustainable funding settlement. She also raised the question of housing and the cost of living in Oxfordshire. I think most hon. Members touched on that point. She said she was concerned that unless the issues are tackled in a comprehensive way, services will be rationed. I am afraid to say that services up and down the country are already being rationed, as we have discussed here on a number of occasions.

It was a pleasure, as always, to hear from the hon. Member for Banbury (Victoria Prentis). She always speaks strongly and passionately about NHS services in her area. She said that staffing issues were a major factor in the proposals to downgrade the maternity unit at Horton. It is a sad fact that half of all maternity units up and down the country have had to turn expectant mothers away at some point in the last year, often due to staffing shortages. We currently have a national shortage of about 3,500 midwives. It was interesting to hear some of the possible initiatives to attract new obstetricians in particular. Certainly, the prospect of free beer is something that works for me, but I do not know whether the hon. Lady can wait quite as long as it will take for me to train in that profession. I think we will have to do without my particular skills in that area.

The hon. Lady raised the issue of transparency and openness. It is disappointing to hear the difficulties she has had with her local trust on that issue, but it is clear from what she has said today that she has a lot to contribute to the wider health economy in her area. She is not alone on that issue. The Government have been pushing through policies on sustainability and transformation plans, accountable care organisations and the capital expenditure processes, which are all done under a veil of secrecy. There are wider issues in play there.

My hon. Friend the Member for Oxford East (Anneliese Dodds) described the current situation as a perfect storm—an apt description. I am impressed at the way in which she has engaged with staff in the health service in her constituency to get to the real meat and bones of the issues. It was sad to hear that staff feel they are forced to leave the profession and go to work for an agency; she was absolutely right to say that forcing staff to go and work for an agency to make ends meet costs us more in the long term. There are ways in which that could be a saving for us if the pay cap was lifted.

The problems with the nursing bursary were again highlighted, particularly how they are exacerbated in the Oxfordshire area by the cost of living. Has the Minister done any analysis of the cost of living in different parts of the country and the income streams available to those undertaking nursing degrees, who, because of the way the degree is structured, do not have the option of supplemental employment?

My hon. Friend explained very well how the proximity to London creates recruitment difficulties. The stark image of staff living in a corridor highlighted to me the impact of eight years of pay restraint. She also highlighted the bureaucratic nature of recruiting overseas staff. I know immigration policy is outside the Minister’s remit, but I hope he is making representations to the Home Office about how we tackle those issues in future. My hon. Friend highlighted how, despite the Government’s various initiatives for getting people on to the housing ladder, it is still too big a leap for many. We need much more genuinely affordable housing to be built.

We also heard from the hon. Member for Henley (John Howell). I agree with him that the problem did not start in the last year. He raised the question of challenges in GP practices, particularly younger GPs not feeling able to make the financial commitments to buy into practices, but also the restrictions on operations. He was right to mention that GPs need to move with the times on technology. A number of interesting initiatives are doing that up and down the country, although we have concerns about some of them and how they may exclude patients.

Finally, we heard from the right hon. Member for Wantage (Mr Vaizey). He painted an impressive picture of how healthy the Oxfordshire area is, but a report by the Oxfordshire clinical commissioning group shows a gap in life expectancy of nine years between different parts of the county—something about which the Opposition feel passionately.

It is fair to say, from the right hon. Gentleman’s comments, that the local NHS leadership are not on his Christmas card list. He gave a pretty damning assessment of their ability to engage, but of course the structures we are currently working under were brought in under the Health and Social Care Act 2012, which led to the removal of the Secretary of State’s responsibility for much of the system and to the fragmentation with which we are all grappling. I applaud the right hon. Gentleman for his efforts to try to bring everyone together, but he should consider whether the legislative framework we currently work under is fit for purpose. The way in which he has brought people in the NHS together is important and we should be doing more of that. In this particular area, that should be not just on the health economy, but on the wider issues, particularly those relating to cost of living and housing.

As we have heard, the potential impact of the recruitment and retention crisis was brought into stark focus by the issue that sparked the debate: the leaked email from the head of chemotherapy at the Oxford University Hospital’s NHS Foundation Trust that found its way on to the front page of The Times. That memo confirmed to staff that the trust was down on nurses at the day treatment unit by approximately 40%, and as a consequence that the hospital was having to delay chemotherapy patients’ starting times to four weeks. It also stated that there was no prospect of an improvement in the situation for 18 months to two years.

More worrying was a proposal to reduce the number of chemotherapy cycles available to dying patients, which is totally contrary to National Institute for Health and Care Excellence guidelines, as well as the national cancer strategy. We were therefore relieved to hear that the trust has now backed down from those suggestions.

To be clear, as other Members have mentioned, those were not live proposals. The problem was that the trust had to scope out the full range of potential action, given the challenge it was facing. However, the proposals were not something that it wanted to do—quite the opposite. I just wanted to underline that.

I thank my hon. Friend for that point. I was not trying to imply that the proposals were live, but the fact they were being considered is of huge concern, which Members have rightly raised. It will be helpful if the Minister could look at what caused the proposals to even be discussed, because they are contrary to so many of the principles and guidelines that we want in our NHS. I hope he will be able to assure us that those kinds of dramatic measures are not being considered in other areas.

The impact of recruitment and retention issues at the trust extends far beyond chemotherapy. In January, 2,159 patients waited for longer than four hours to be seen in A&E, falling well below the 95% target—a measure that the Health Secretary described as “critical for patient safety”. Even more worryingly, since December eight cancer operations and 26 heart operations were cancelled either the day before or on the day itself. Although that is at the upper end of operation cancellations, it is sadly a story that we now hear up and down the country. Cancelling an appointment at short notice causes immense frustration. It is sometimes unavoidable, but we know that it can have devastating consequences and put patients at unnecessary risk, not to mention the emotional impact. On the practical side, cover has to be arranged, spouses and family members have to arrange their own time off, and sometimes even national or international travel is required.

Staffing shortages are not behind every cancellation, but they will be a factor in many, and the vacancy rate at the trust tells us that it is an increasing problem. As we heard, vacancies at the trust for nurses, midwives and nursing support workers have almost doubled in the past year, from 5.99% in October 2016 to 10.8% in October last year, leaving about 400 whole-time equivalent vacancies. As we have heard from hon. Members, local factors have undoubtedly contributed to that. A 2017 study by Lloyds bank listed Oxford as the most expensive city in the UK, with average house prices 10.7 times average annual earnings. As we have heard, there is some support for the introduction of an Oxford weighting-type arrangement.

There is also a national context to look at, with housing costs being exacerbated by the pay cap. It is clear that, although that is probably at the sharper end of the pressures, Oxford’s issues are being repeated up and down the country. We now know that, after eight years of this Government, more nurses are leaving the NHS than joining. That position is particularly sharp in the Thames valley area, where there were 39% more leavers than joiners between September 2016 and September 2017.

While almost all trusts up and down the country have been unable to fill vacancies, Oxford’s is probably one of the more acute situations. However, much of it was completely predictable. One of the first decisions the Government took in 2010 was to cut the number of nurse training places by 3,000, which has led to about 8,000 fewer nurses nationally. We then had the Health Secretary’s farcical decision to take on the junior doctors, which has led to a demoralised workforce.

Then, to cap it all, as Members have said, came the decision to scrap nurse bursaries, which is possibly the most ill-conceived decision the Government have made—and there is plenty of competition for that particular award. We warned at the time that, far from providing more nursing places, the move would lead to a drop in the number of applications, with the biggest impact being on mature students, who bring a huge amount of experience from outside the profession.

As we have heard, statistics show that there was not only an 18% drop in applications in 2017, but a 2.6% decline in England in the number of students accepted on to courses. Among mature students, 13% fewer of those aged between 21 and 25 were accepted. That decision is discriminatory and stands in stark contrast to the Government’s aims on social mobility. Those are not just my words—they are in the equality assessment undertaken by the Department for Education. However, instead of learning from that lesson, Ministers have decided to scrap NHS bursaries for postgraduate students as well.

Alongside that disastrous decision, we have had the counterproductive capping of pay, which has led to hard-working NHS staff losing money in real terms at the same time as their workload has increased. We have heard encouraging noises from the Government recently, but we have seen no firm action. Perhaps the Minister can provide some clarity when he responds. The Nursing Times reported this week that the Treasury apparently still needs convincing that a rise in wages should be “meaningful”. Will the Minister send his Treasury colleagues a transcript of the debate, to persuade them that a strong case is being made for an increase?

Across Oxfordshire and the whole of our NHS, a recruitment and retention crisis is exacerbating a situation that has already reached crisis point. The Government need to act, realise their mistakes and urgently give hard-working NHS staff the belief that their work is valued and the confidence that their concerns are being listened to.

It is a pleasure to see you in the Chair, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate. We have met a number of times and I have responded to a number of her written questions, so I know that she is working hard on this subject.

It is always great to hear Members speak personally about their experiences—maybe none more so that my hon. Friend the Member for Banbury (Victoria Prentis)—and how passionately they speak about the national health service. Members from the county of Oxfordshire have spoken well; I do not know how they play in private, but in public they seem like a very good team. That may not be the case in Hampshire; maybe there are too many of us on the Front Bench. We are only a two-party state in Hampshire; perhaps that is why.

The debate is not only important but timely. I had the pleasure of visiting the Churchill Hospital, which is part of the Oxford University Hospitals NHS Foundation Trust, last Tuesday during our half-term recess. I saw the superb and innovative cancer care provided by the dedicated staff—I obviously echo all the praise for the staff—and had the opportunity to discuss workforce issues for a little time with the chief executive, Dr Bruno Holthof, who is a very nice man, and his senior team. I therefore hope I can provide some well-informed replies to the hon. Member for Oxford West and Abingdon and Members from across the county. The NHS in Oxford is working hard to ensure it has the doctors and nurses to continue to provide excellent care to Members’ constituents.

We met in Maggie’s Oxford cancer centre. As Members will know, I am the cancer Minister—it is the thing that gets me out of bed in the morning—and I was blown away by Maggie’s cancer centre. I know there are a lot of them across the country, but this was in a beautiful building, was brilliantly designed and had incredible, passionate staff. I met a number of patients who described Maggie’s as a haven for them while they are going through their cancer treatment. It was great, as always, to talk to patients.

My hon. Friend the Member for Banbury spoke about the recent story in The Times—the front-page splash on changes to patient cancer treatment plans at the Churchill—which a number of hon. Members mentioned and which I suppose was the spur for the debate, although it seems to have broadened out into everything, covering about four different Government Departments. I, too, was obviously concerned when I saw the story. I called the chief executive of the trust, and he was very clear that, although it would have been a great story, there was only one small problem: it was not true.

The leaked emails—whoever leaked them can examine their own conscience and motives—set out hypothetical challenges and invited suggestions from clinical staff, ahead of a meeting taking place this month. There has been no change to formal policy on chemotherapy treatment at the trust, and any such decision would be a matter requiring clearance at board level anyway. As we discussed, the chief executive’s first consideration was, rightly, the obvious and needless worry caused to cancer patients across Oxford and the wider area. I am pleased, although obviously disappointed it was necessary, that he quickly put in place plans to communicate to his patients that there were absolutely no changes, as the hon. Member for Oxford East (Anneliese Dodds) said, to chemotherapy treatment.

The trust continues to meet two of the three main cancer waiting time standards and is working hard to meet the third. We discussed that last week, too, and the trust should be very proud of it. I was able to congratulate some of the team personally last week. The trust is considering how best to deliver chemotherapy services going forward, and I am confident that it will do that in the correct way, through the correct channels, and of course in compliance with NICE guidance.

When I was on site at the Churchill, I was able to pop in to the ACE wave 2 pilot. ACE stands for accelerate, co-ordinate and evaluate—I know that my right hon. Friend the Member for Wantage (Mr Vaizey) enjoys these acronyms. I met Fergus Gleeson, Sara Bainbridge, Shelley Hayles, a local GP in Oxford who leads on cancer, and Julie-Ann Phillips, who is the navigator—a great title—and seems to make it all happen there. I, as a cancer Minister, and we as a Government are very excited about ACE. It is about taking patients with suspected cancer from the GP and into the accelerated diagnostic centre and getting them a diagnosis or clearance quickly. I met patients and saw how much it means to them.

I asked patients about stories on the front pages of national newspapers, which of course are trying to sell national newspapers. I noted, in relation to the story, which was gleefully run by the BBC that morning once it had read The Times, that by the end of the day the coverage had slightly changed as it realised that it had been reporting fake news all day. I asked patients what they thought about seeing that sort of thing on the front page of The Times while they were receiving world-class cancer treatment in Oxford, and I will not repeat the exact words that they used, but they were very clear about how disappointed they were to see that, and that they did not feel that it represented the professionalism that constituents of hon. Members across this Chamber see. I think that hon. Members can get a sense of what I thought about that story, and I do not take The Times anyway.

Let me start with the global picture, and then I will localise. The dedicated men and women who work in our NHS are of course its greatest asset. The Government have backed the NHS. We have made significant investments in frontline services and are now taking bold steps to plan for future generations. We do, however, recognise the workforce challenges that the NHS faces in its 70th year. That is why the entire system embarked on a national conversation, with the publication by Health Education England in December of “Facing the Facts, Shaping the Future: A draft health and care workforce strategy for England to 2027”, which is designed to stimulate debates such as the one that we are having today. I know that HEE will read the record of this debate.

The strategy sets out the current workforce supply and retention, and the challenges that we face, but also the significant achievements made from work already under way. It is the first step towards a proper plan that stretches beyond any electoral cycle—we must get away from working in that way—and secures the supply of staff for future generations in our health service. The strategy posed a number of questions that will inform a comprehensive strategy for the workforce over the next decade, to be published in July this year. We need to think innovatively about how we can make the NHS workforce fit for the future, and as always in debates about our NHS, we have heard a number of excellent suggestions today. I encourage hon. Members to engage with the consultation, and from what I have heard today, I do not doubt that they will.

We have heard a lot today about recruitment. Of course, that is not the only way to ensure that the NHS has the workforce that it needs to deliver the safe and high-quality care in which I, the Secretary of State and all hon. Members are so interested. We need to ensure that our excellent doctors and nurses want, and are supported, to stay in the national health service, and we have a clear plan to ensure that the NHS remains a rewarding and attractive place to work.

Let me list a few of the things that the plan covers. It includes arrangements for more flexible working—we know that many health professionals are married to other health professionals, and quality of life matters as much as quality of pay—and a system of staff banks for flexible workers across the NHS, increasing opportunities for staff to work on NHS terms and to reduce agency costs for employers. Something else that we discussed last week is a scheme to offer the right of first refusal to NHS employees on any affordable housing built on NHS land, to increase NHS workers’ access to affordable housing, with an ambition of benefiting up to 3,000 families. When I got lost while trying to find Maggie’s cancer centre on the Churchill site, I noticed that there is a lot of surplus NHS land on that site, and I know that it is looking at that. In addition, since September 2014, more than 2,700 nurses have successfully completed the nursing return to practice programme and are ready for employment.

Let me localise to the recruitment and retention of NHS staff in Oxford, which I also discussed last week. It is important to note from the outset that although there are workforce challenges, Oxford University Hospitals NHS Foundation Trust has 388 more hospital doctors and 591 more nurses than it did eight years ago. It is also successfully seeing 11,500 more patients—a 120% increase—with suspected cancers than it was in 2010. One of the key challenges that we discussed is that Oxford, much like London, is a very expensive area to live and work in, as hon. Members have mentioned, and unemployment is very low. Those conditions present a recruitment challenge that other, less affluent areas do not have.

The hon. Member for Oxford West and Abingdon mentioned continuous professional development, and I promised to mention that. It is a matter for employers; any agreements, such as for protected study time, would need to be negotiated between employer and employees. However, it is always in the best interests of employers to encourage and support the learning and development of their employees. HEE provides national funding to support development of the NHS workforce and invests up to £300 million every year in supporting NHS employees to achieve registered qualifications, and that will continue.

We are increasing the number of nurse training places by 25%. That means 5,000 additional nurse training places every year from September 2018. It is one of the biggest increases in NHS history, and I was glad that the hon. Lady welcomed that in her opening remarks. She also mentioned Brexit, as my right hon. Friend the Member for Wantage did. The Secretary of State and the Prime Minister could not have been clearer: the Government hugely value the contribution of EU staff working in our NHS and understand the need to give them certainty. The Secretary of State has made it clear that after Brexit, we will have an immigration system that means that the NHS is able to get the staff that it needs, not just from the EU but from all over the world.

The hon. Lady asked about career progression; I think that she was referring to scale points earned in the NHS and whether they would transfer. I will get back to her on that; I will get a note to her and copy it to other hon Members in the debate, as I know they will be interested.

Pretty much everyone mentioned the idea of pay weighting for Oxford, as with London, given the proximity of the county. There are a number of mechanisms in the NHS funding and pay system to compensate for higher costs in particular areas. It is open to the independent NHS Pay Review Body to make recommendations on the future geographical coverage and value of such supplements. Additionally, there is flexibility for local NHS employers to award recruitment and retention premiums where recruitment is difficult at standard rates of pay, so when they are having their team get-together—

I will not, because I need to give a minute to the hon. Member for Oxford West and Abingdon, who introduced the debate.

Pretty much everyone asked about the public sector pay cap. I am glad that everyone recognises and welcomes the fact that we have said that that will be lifted. The shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), and the hon. Lady leading the debate asked about the timetable. I cannot give an exclusive in this Westminster Hall debate today, but I can say that talks between NHS Employers and the trade unions continue, and I know from my hon. Friend the Minister for Health that they are constructive.

So many other points were raised. They included the future of the Horton. I am told that the decision has been considered by the Independent Reconfiguration Panel and the Secretary of State will consider its advice and recommendations in the next few days. I have a funny feeling that when we have a vote tonight, my hon. Friend the Member for Banbury will seek out the Secretary of State.

My hon. Friend the Member for Henley (John Howell) left us hanging as to what he is transmitting via the internet with his GP. [Laughter.] Perhaps that is the wrong expression, but his point about primary care at scale and truly integrated services that can take pressure off the NHS was so well made and is exactly what we mean: sustainability and transformation partnerships are about one NHS and bringing NHS services together.

If I have not covered any of the points, I will write to hon. Members. The pressures on the health system are significant. I have talked about the sheer increase in the number of people coming forward needing cancer treatment in the area of the hon. Member for Oxford West and Abingdon, and that is true across the NHS. The demands are intense, but the workforce are responding brilliantly. We understand that there is a workforce challenge. That is why we launched the workforce consultation, with which I know hon. Members will want to engage. We look forward to the responses to the consultation exercise, so that collectively we can ensure that the NHS remains the best health system in the world, and the envy of the world, as it celebrates its birthday in June.

I end the debate by thanking all my fellow Oxfordshire MPs for their fantastic contributions. I am pleased to see that we are in violent agreement on most of the issues that we face. We also agree that the staff, above all, must be thanked for the work that they do; we cannot say that enough. I thank the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), for his remarks, and the Minister. I hope that he can see how passionate we all are about this matter and that we hunt as a pack, so this will not be the last time that he is contacted by us. I look forward to his note and to any answered questions that come back to us on this issue.