Horton maternity downgrade decision referred to Secretary of State
The ‘Hands of our Horton’ campaign has today received a huge boost as Oxfordshire County Councilors have voted unanimously (vote of 12 in favour) to refer the decision to downgrade Banbury’s Horton maternity to the Secretary of State.
The Oxfordshire Joint Health Overview and Scrutiny Committee (OJHOSC) looks at the health services provided by the NHS and other providers in Oxfordshire.
The last time the Horton downgrading was referred to the Secretary of State in 2008, it was then referred to the Independent Reconfiguration Panel (IRP) who found that Oxford was too far for women in labour to be transferred to Oxford.
With travel times increasing between Banbury and Oxford and the problems with parking, it is hoped the Secretary of State and IRP will make the same decision.
Yesterday, Councillor Barry Wood, Leader of Cherwell District Council and Councillor Kieron Mallon, Leader of Banbury Town Council sent an open letter to the OJHOSC ahead of the meeting:
An open letter to the members of Oxfordshire County Council’s Joint Health Overview & Scrutiny Committee.
We write to you in advance of your meeting tomorrow, Thursday 2 February. While we appreciate, your agenda does not set aside time for consideration of the ongoing suspension of obstetric services at the Horton General Hospital, we would be grateful if you could consider this letter as part of your wider discussion on the Oxfordshire Transformation Programme.
As you will all know, the consultant-led maternity service at the Horton General Hospital has been suspended since the beginning of October 2016. At your September meeting, the Committee agreed not to refer the matter to the Independent Reconfiguration Panel (IRP) on the basis that the action plan in place by the Trust meant that by the beginning of March, maternity services at the Horton would once again be consultant led.
Since then, however, it has become clear that there are no plans in the immediate future for the maternity unit to return to a full obstetric service. We believe it is imperative for this Committee to revisit the issue of the Horton’s maternity service. A move to a permanent MLU in Banbury is a significant service change and one which must be considered by the IRP.
In 2008, the IRP concluded that transferring obstetric maternity and paediatric provision (including special care and emergency gynaecology services) from the Horton did not provide an accessible or improved service to the people of north Oxfordshire. Since that time, the geography of Oxfordshire has not changed but the population has increased, and travel and accessibility to the JR has significantly worsened. We fail to see how the current proposals offer an improved service to patients in the Horton catchment (including those patients from across the county border) or, and perhaps more crucially, a safe service.
Currently, the Trust has met public concern over transfer time from Banbury to Oxford by stationing one ambulance outside the maternity unit to deal with births which suddenly, in the late stages of labour, require consultant intervention. A proposed permanent downgrade does not offer these assurances. Even if it did, we know the transfer time during labour to be critical and fear for the safety of north Oxfordshire’s mothers and babies in transit.
Following the downgrading of the maternity unit, several other acute services at the Horton may be at risk, including A&E, Gynaecology, Paediatrics and Anaesthetists. As you will all be aware, the first phase of the Oxfordshire Transformation Programme (OTP) is currently out for public consultation. We are very disappointed that the OCCG made the decision to split the consultation into two parts and are concerned about the effects this may have on services at the Horton. There is a direct link between all healthcare services and it is simply wrong that Oxfordshire residents are not being given the full picture. It is impossible to ask residents to express their views on what is being proposed in Phase 1 when we have no idea what impact our responses in the first part will have on the second part.
Both in Phase 1 of the consultation and at the consultation events, the Trust and the OCCG have expressed their commitment to invest in the Horton Hospital through the creation of a new diagnostics centre. This sounds promising. However, while we support Banbury patients being treated in Banbury, this should not be at the expense of vital acute service provision being centralised at the JR.
The Health & Overview Scrutiny Committee faces an unenviable task but one which is vitally important. We all want to act in the best interests of the people of Oxfordshire. We do not believe that the CCG or Trust are taking decisions lightly but we must ensure that the healthcare needs of patients across Oxfordshire are properly served, including for those residents who rely on the services at the Horton Hospital. It is clear there is a real lack of trust between the decision-makers at the CCG and Trust, and the public.
Please do take our concerns into consideration in your deliberations and communications with the OCCG and the Trust.
Councillor Barry Wood, Leader of Cherwell District Council
Councillor Kieron Mallon, Leader of Banbury Town Council
Councillor Sean Woodcock, Leader of the Labour group and Leader of the Opposition on Cherwell District Council and Councillor Steve Kilsby, Leader of the Labour group on Banbury Town Council also sent the following letter to the Oxfordshire County Council’s Joint Health Overview & Scrutiny Committee:
Already you will have been inundated with correspondence on the Sustainability & Transformation Plan and in particular the consultation launched by the Oxfordshire Clinical Commissioning Group on proposed changes to NHS services in the county. We felt it important to set out what we feel the committee needs to know and the questions it needs to ask as it considers this issue.
To start with we should record that we both have absolute faith in the honest intentions of the NHS staff, commissioners and the management involved. We do not believe that anyone gets into medicine with the intention of doing harm to patients. Suggestions that the CCG or Trust have “blood on their hands” or are making decisions with callous disregard to the welfare of patients could not be further from the truth.
We understand the severe pressure that the CCG and the Trust are under.
The demand for treatment is increasing year upon year. Unprecedented cuts to the money given to councils by central government, which members of HOSC will be familiar with, has had the effect of virtually condemning the social care sector to failure.
The knock-on effect of this is that more and more people are turning up to NHS hospitals because of the absence of adequate social care. The measures that have been proposed for allowing increases in council tax, are completely inadequate sticking plasters applied to gaping wounds which need major surgery. They are symptomatic of a government that is not leading on the issue and is instead passing the buck on to local councils.
Government funding is not increasing anywhere near in line with this increased demand. Meanwhile, demands from Whitehall to deliver a 7 day NHS are not being matched by the money to make it either deliverable or sustainable.
Finally there are the underlying problems caused by the Health & Social Care Act of 2013, which had the disastrous effect of creating duplication in some areas and lack of coverage in others.
The £200m funding gap as anticipated for Oxfordshire in 2020-21 is also stark.
With Britain set to leave the European Union, the opportunity for recruiting trained staff into the NHS from abroad, is hampered by any impression that is given of a UK that is not welcoming to foreigners.
Commissioners and Health chiefs face awful and tough choices which we do not take lightly. It is very easy to point the finger at civil servants and bureaucrats who cannot answer back when many of the problems are the work of politicians.
Yet even in this context it is absolutely imperative that the people making these decisions are honest with the public and that their decisions are open to scrutiny. A number of events have been held with this in mind and yet, despite this, there remain very serious questions which have not been answered. This has led to a real issue of trust between the decision-makers and the public. We ask that members of HOSC put party politics aside, as they are meant to, and ensure that these questions are answered.
1. The Trust has explained the closure of the Consultant led maternity unit by an inability to recruit obstetricians to take up these posts. The Trust has met public concerns over transfer time by having, in the interim, an ambulance stationed outside of the maternity building to deal with those low-risk pregnancies which suddenly, in the latter stages of labour, require escalating to a consultant-led unit. The proposed permanent change to a midwife-led unit (MLU) is a concern, however, as none of the other MLUs in the county have anything like this in place. The issue of transfer times remains a concern and so what is the Trust’s plan long-term for dealing with the small number of cases that require escalation from the Horton to the John Radcliffe?
2. At the consultation events and in the literature sent out to go with them, mention has been made of a brand new, state-of-the-art diagnostics centre being built at the Horton. This sounds promising. But no costings have been provided and it is unclear where the capital and investment for this is likely to come from. Whilst this may not be in the remit of HOSC, residents are being sold this diagnostics centre as a way of trying to engender support for the proposals. Can you try to clarify the issues of capital and costs for this centre?
3. Numerous examples have been provided at every public meeting of appalling care provided to users. What scrutiny has the Trust been put under for the quality of service it provides in some areas by the CCG? The impression is given that there is a lack of robust challenge from commissioner to provider.
4. What contact has the CCG had with neighbouring CCGs in Warwickshire and Northamptonshire given the large number of people from these areas for whom the Horton is their nearest hospital? What arrangements are in place or are proposed for dealing with these cross-border users as the consultation is not clear on the issue?
5. What representation has the CCG made, if any, to central government regarding staffing and the importance of any post-Brexit arrangements allowing NHS providers to recruit the best staff from around the world for a variety of positions?
The Health & Overview Scrutiny Committee faces an unenviable task yet it is an important one. We are all aware of the pressures that have been put on them by increasing publicity of this issue. What we have sought to do here is not to add to their work, but actually give them greater confidence in doing their job. By pushing for answers to these questions, they will ensure that the people who rely on the Horton Hospital and who care about its future are properly served.
Councillor Sean Woodcock, Leader of the Labour group and Leader of the Opposition on Cherwell District Council.
Councillor Steve Kilsby, Leader of the Labour group on Banbury Town Council