On Tuesday 17 October, Victoria Prentis and a number of other Oxfordshire MPs joined together in a Westminster Hall debate called by Witney MP, Robert Courts, to discuss the future of healthcare in Oxfordshire.
Opening the session, Robert Courts raised concerns about GP and maternity services, stroke care and the Oxfordshire Clinical Commissioning Group’s recent consultation. His points were echoed by neighbouring MPs, including Ed Vaizey (Wantage), Layla Moran (Oxford West and Abingdon), John Howell (Henley) and Nadhim Zahawi (Stratford on Avon) . Victoria highlighted issues relating to population growth, safety and communication. Within this, she emphasised problems with the processes followed by health chiefs in the County, particularly in relation to the split nature of the consultation and a lack of real engagement with local people. Towards the end of her speech, Victoria outlined the need for “reasoned and evidence based conversations about the future”, expressing the determination felt locally to protect vital acute services in North Oxfordshire.
After the debate, Victoria commented: “I am very pleased that my neighbour and fellow local MP, Rob Courts, secured such an important debate in Westminster this morning. It is clear that we are united in our frustration with local health providers.The Clinical Commissioning Group must engage and consult local people properly, and across county boundaries, to enable us to move forward safely. The fight for acute services and local health care continues.”
The below account is taken from the Official Report from Tuesday 17 October 2017
Victoria Prentis (Banbury, Con): It is a pleasure to serve under your chairmanship, Sir Roger. I made my first speech about the Horton General Hospital when I was seven. I apologise that many people in this Chamber will have heard it before, but I do not know that you have had that pleasure, so with your permission, I will carry on.
Let us remember what we are talking about. The Horton is not a community hospital. It has been a pleasure to listen to colleagues talk about their community hospitals; we have heard about Wantage and Abingdon, and one rarely meets my hon. Friend the Member for Henley (John Howell) without hearing him mention the Townlands, of which he is very proud. I love community hospitals too; my mother helped run Brackley Cottage Hospital for most of my childhood and until recently, and I think that the marvellous hospital in Bicester still has untapped potential. However, the Horton General Hospital, which I will talk about, is quite different.
The Horton has hundreds of beds and treats about 39,000 people in accident and emergency every year—nearly one third of Oxfordshire’s A&E attendances. What happens at the Horton affects all my colleagues, due to the knock-on effects of closure. Our surgeons are among the top five in the UK for neck and femur operations. It is not a community hospital; it is a fully functioning, very busy district general.
We feel beleaguered. For more than 40 years, the John Radcliffe Hospital has viewed us as a smaller and less academic sibling that can be treated with contempt when staffing is short. In 2008—this is not ancient history; it is nine years ago—the Independent Reconfiguration Panel was asked to consider the last proposed downgrade of paediatrics, obstetrics and gynaecology and the special care baby unit. It conducted, as I hope it will again, a full five-month review and made five excellent recommendations, which I will read once more.
The first recommendation was:
“The IRP considers that the Horton Hospital has an important role for the future in providing local hospital-based care to people in the north of Oxfordshire and surrounding areas. However, it will need to change to ensure its services remain appropriate, safe and sustainable.”
On the proposed downgrades, it said:
“The IRP does not consider that they will provide an accessible or improved service to the people of north Oxfordshire and surrounding areas.”
Other recommendations were:
“The PCT should carry out further work with the Oxford Radcliffe Hospitals NHS Trust to set out the arrangements and investment necessary to retain and develop services at the Horton Hospital. Patients, the public and other stakeholders should be fully involved in this work… The PCT must develop a clear vision for children’s and maternity services within an explicit strategy for services for north Oxfordshire as a whole… The ORH must do more to develop clinically integrated practice across the Horton, John Radcliffe and Churchill sites as well as developing wider clinical networks with other hospitals, primary care and the independent sector.”
I am afraid that none of that happened. The recommendations were made nine years ago, but none of them were followed. The only things that changed were that the traffic got worse and the population of the area grew. Our district council, I am proud to say, tops the leader board for house building.
Less than 10 years later, we now have no obstetrics or SCBU. They went in the blink of an eye, without any real attempt to address recruitment issues or work with us to do so, although we offered and offered. Locally, we remain deeply unhappy and frightened. Patients in the later stages of labour are travelling for up to two hours, and emergency gynaecological operations take place in a portakabin in the Radcliffe car park. We have heard stories locally—in fact, they are all people talk about—of babies born in lay-bys and in the back of ambulances. The data that show statistics of complete births—defined by when the placenta has been delivered—tell a different story; they do not register the reality of people’s experience.
I pay tribute to what my hon. Friend the Member for Witney (Robert Courts) said about Google Maps. Locally, the impression is that the CCG and the trust massage the figures and use them when it suits their argument. I conducted a travel survey of nearly 400 people on their real-life experiences of how long it takes to get from our area to the John Radcliffe Hospital in Oxford. Sadly, those data were not taken on board in any of the CCG’s reports, although the data set was bigger and better than the CCG’s. The CCG provided real data only when we had harangued, pestered and begged it to do so.
I will not go on about how worried I am; I will focus on what we can do to put the situation right. It is true, as all hon. Members have said, that local health providers do not talk to one another. Health Education England’s decision to remove training accreditation for middle-grade obstetricians was the straw that broke the camel’s back for recruitment, yet it remains aloof and makes decisions in a vacuum. Its recent decision to remove accreditation from certain grades of anaesthetists puts all the acute services provided by the Horton at risk. The dean did not communicate that decision to decision makers at the trust or the CCG; I had to tell them at a meeting in August. I do not think that that is an acceptable way to run a healthcare system.
The trust usually tells the CCG what to do. When it does not agree, there is stalemate. The trust, the clinicians and everyone else locally know that the A&E at the Horton cannot possibly be shut, because the knock-on effects on the rest of Oxfordshire and the surrounding counties would be catastrophic. The CCG, however, is determined to press ahead with its consultation that suggests otherwise. Owing to this impasse, we have ended up with a split consultation that means nothing to any of us. Patients’ needs appear to be an afterthought. South Central Ambulance Service, which bears the brunt of the transfers, is carried along as a consultee with no voice at the table when decisions are taken.
One of the main complaints is that local health decision makers do not listen to us. Our latest consultation report described the “universal concerns” of more than 10,000 people from my area who responded to our consultation. I cannot overemphasise the strength of local feeling. We all feel the same: all the elected representatives, of whatever party; a great campaigning group, Keep the Horton General; and even the local churches, which are praying for sense in the clinical commissioning group’s decision making. [Interruption.] My right hon. Friend the Member for Wantage (Mr Vaizey) laughs, but I am afraid it is impossible to overstate how essential our local hospital is to people in our area. He may think it is funny, but we do not.
Mr Vaizey (Wantage, Con): 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.
Victoria Prentis (Banbury, Con): Quite.
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.