Agenda item

12:00

As requested by the Committee, representatives from the Oxfordshire Clinical Commissioning Group (OCCG) and the Oxfordshire University Hospitals NHS Foundation Trust (OUH) will attend the meeting to give an update on the situation with the Obstetrics Unit at the Horton Hospital. This includes records of engagement with key stakeholders, including patients and staff at the Unit (JHO8).

Background information is also attached at JHO8 including a letter from Victoria Prentis MP to the OUH and the response; and a job description for a Trust Doctor in Obstetrics and Gynaecology.

LUNCH  - 13:30

Prior to consideration of this item, the Committee was addressed by the following speakers:

Catharine Gammie – speaking in behalf of Victoria Prentis MP

Firstly the decision to suspend obstetric services at the Horton Hospital was made with no consultation at all. Victoria Prentis’s staff were made aware of the OUH’s plans at a meeting of the Horton on 20 July. It was thought that the object of the meeting was to discuss the Transformation Plan proposals affecting maternity provision at the Hospital and Victoria could not attend the meeting. At no point did anybody forewarn her of the imminent announcement relating to the temporary closure of obstetrician provision. The Trust’s decision affects not only her constituents in North Oxfordshire, but those beyond her own Parliamentary constituency boundary, for example, the Cotswold Birthing Centre in David Cameron’s former constituency transfers 50% of emergency closures to the Horton. Yet at no point did the Trust inform them of their plans.

Secondly, no effort has been made to engage with clinicians or the public. There is considerable bad faith locally and this is exacerbated by a total lack of engagement. The consultants feel excluded and do the Banbury GPs, many of whose patients would now have to decide whether to give birth in the midwife-led unit or to make the 90 minute journey to the JR Hospital. Together the GPs wrote to the Trust in advance of the Extraordinary Board Meeting to express their opposition to the proposals. Their letter expressed many of the concerns they expressed to the Independent Reconfiguration Panel in 2008 ie. safety, sustainability and the reduction in access to base health care and choice for their patients.

Thirdly, the decision to suspend obstetric services is not evidence based. Despite asking to see the risk assessments on many occasions, it was not until this Committee’s Agenda was published was there one in the public domain. She has grave concerns, that without controls and contingency plans, there were a number of ‘high risks’ on the register, including the timeliness of the transfer of patients; the impact on the JR Hospital’s maternity service and the retention of staff. Whilst she recognised that without sufficient obstetricians the service was not safe, the transference of mothers who had encountered complications during or post-labour when that transfer would take at least 45 minutes in an ambulance, not taking account of loading and de-loading the patient was extremely worrying.

In conclusion she expressed her fear that lives would be lost and urged this Committee to do everything in its power to intervene and hold the Trust to account. He understood that when there was an emergency, there could not be a statutory consultation process, but the decision needed real scrutiny. She asked the Committee to refer the Trust’s actions to the Independent Referral Panel as a matter of urgency and at the same time to ensure that the Trust remained under pressure to recruit, either by being more creative with the advert and job offer, or by outsourcing responsibility to dedicated recruitment consultants. Despite being told consistently that this is will be a temporary suspension, she stated that it would be and there would be a domino effect which would be a fatal blow to the future provision of acute services at the Horton General Hospital. She called for the Committee to ensure that a full obstetric service resumed in the New Year.

Keith Strangwood

Keith Strangwood referred to a third option that he had put forward to the Trust on behalf of ‘Keep the Horton General’ which was that instead of transferring the obstetric service to the JR Hospital, to keep the theatre open at the Horton so that elective caesarean operations could be carried out by senior gynaecologists. He expressed his concern that unlike the Horton there were no beds at the JR Hospital and to transfer patients from the Horton would cause an overflow.  Mr Strangwood commented that the efforts of the OUH to recruit and employ obstetricians was ‘ridiculous’.  He expressed his belief that the OUH had manipulated the situation and urged the OCCG to utilise the facilities offered by the Horton to take the pressure off the JR. He also expressed his concern that patients could suffer and a life could be lost.

Cllr Lawrie Stratford

Cllr Lawrie Stratford, a former member of HOSC and a resident of Bicester North where many of his constituents resided, were, or had been Horton patients, including himself. He stated that during the past number of years, the Horton had been a recurring item for this Committee. Back in 2008, following a very substantial review of NHS proposals for the Horton by the Committee, the Independent Reconfiguration Panel was asked to examine the proposals and report back to the Secretary of State. One of the key proposals at that time was, and he quoted:

‘Obstetrics, gynaecology, and the special care baby unit.

·         Replace consultant-led obstetrics and gynaecology services with a midwifery-led maternity unit;

·         Transfer obstetric-led services and the special care baby unit to Oxfor Women’s Centre;

·         Transfer emergency and inpatient gynaecology services and care to Oxford Women’s Centre.

Cllr Stratford asked if there was some familiarity with the above proposals and stated that the detail IRP report response , made in 2008, made several references to ‘could put mothers and babies at risk’ whilst transferring them to Banbury from the Oxford area. It was summarised as follows:

‘The IRP does not support the Trust’s proposals to reconfigure services in paediatrics, obstetrics, gynaecology and the Special Care Baby Unit at the Horton Hospital. The IRP does not consider that they will provide an accessible or improved service to the people of North Oxfordshire and the surrounding areas.’

Cllr Stratford also stated that to help demonstrate this point a ‘test run’ was organised where two HOSC members were ‘rushed from Banbury to Oxford’ to ascertain the ‘safety’ issue. The test was undertaken in a blue light car as an ambulance was not readily available and it took place on a Wednesday afternoon. The outcome demonstrated that it was not a viable or safe option. Since 2008, there was an estimated 20% more traffic and considerably more roadworks especially around the City. He concluded that if it was not safe then, how could it be safe today? He therefore urged Health to ‘think again’, adding that it was his view that people had lost faith in NHS management. He added that Health had to greatly improve its engagement with residents and patients in the north of Oxfordshire if it was ever going to regain their trust going forward.

Cllr John Christie

Cllr John Christie addressed the meeting in his capacity as a County Councillor for Banbury Ruscote and also as Chair of the Banbury Locality Group of County Councillor who were united in support of the Horton. He stated his view that residents were concerned that the underfunding of the NHS was putting at risk vital acute and maternity services at the Hospital, as outlined in the earlier presentation on the STP. He added that it also made clear that the projected 2% annual growth in the NHS budget was insufficient, and implied cuts to services as well as efficiency gains. He reported that what residents did not understand was how cuts to the Horton were even being considered when it had existed for over 140 years, and in light of the population growth in demand for services in Oxfordshire. In addition to this, they could not understand it in the face of the ‘atrocious’ nature of current access to Oxford from North Oxfordshire, and when the JR site itself was being restricted. He concluded by stating that residents saw the emergency cessation of maternity consultant provision at the Horton as ‘the thin end of the wedge’ which could lead to permanent cuts under the STP. They were concerned that the current staff training and recruitment exercise would fail without some innovative approaches to staff redeployment across both sites which may include incentives. He ended by stating that there must be more ways of ensuring the continuation of such vital services.

The Chairman welcomed Paul Brennan and Andrew Stevens to the meeting to explain why the temporary removal of the consultant-led service would be implemented at the end of October.

Mr Brennan recognised the value north Oxfordshire residents placed on the Horton, but the Trust did not want to be put in a situation where it would be held responsible for patient safety. The Obstetrics service carried out very complex work and emergency work and a senior doctor was required to be in situ 7 days a week, otherwise it was deemed unsafe.

With regard to the recruitment and employment situation, Mr Brennan explained that on 3 October there would be 3 doctors in post. One had resigned and was leaving in November. The number of doctors required to maintain a safe rota for individuals who would have the opportunity for exposure for training at the JR also was 9. Furthermore, due to the low number births since March 2015 (1,466) it had been found that there was insufficient exposure for doctors who needed to keep up their exposure to complex births. Given these numbers, this service was suitable for a midwife-led service, of which there were 3 across the County. Thus a decision had been made at a meeting of the Trust to temporarily close the Obstetrics Unit on 1 October, and to open as a Midwife-led Unit. In the meantime, the Trust had been continuing with their efforts to recruit doctors and had recently offered 4 doctors a consultant post. All had indicated their wish to take up their offer but not all resided in the UK and 2 were not registered with the UK Medical Council. The Trust was trying to support then, but there were limitations with what they could do. Any new doctors would require a 6-8 week induction and would need to be overseen by senior clinicians at the Horton. He added that there was currently a new advert out and then a further one would go out following its expiry.

Mr Brennan reported also that the Trust had responded to public comment that the salary was too low and, for new advertisements, it was set at £62-76k and incorporated banding and premium rate payments. Also in response to public comment, the advertisement had been altered to include the possibility of the appointment being extended after one year. He explained that doctors needed to attain equilibrium of exposure and that, after that period, they would be moved onto larger centres. The recruitment cycle would be continued and if in the event that more doctors were recruited, the Trust would make their decision on 30 October to re-open the Unit on 9 January 2017 as an Obstetric Unit. In the event that this did not happen, then the Trust would continue to run a series of advertisements and if the correct contingent of doctors could be found, the Trust would re-open the Unit on 1 March 2017.

The Chairman thanked Mr Brennan for his report, commenting that the question of maternity services remaining open in the longer context were to be incorporated into a set of clinical options for the Horton to be considered by the Trust. This was not yet in the public domain and would feature as part of the Transformation Plan. She reminded members that today the Committee were only considering the immediate decision to close the consultant-led Unit on the grounds of urgency.

A member asked if the Trust had considered any other options to make the post more attractive. Mr Brennan responded that the Trust was paying more for the entry level of a consultant and was also helping to support doctors who required a visa. The Trust was also receiving help and support from local MPs on the latter. He pointed out, however, that obstetricians, were very specialised in terms of training and there was a general shortage of doctors. Currently there was a vacancy rate in trainees of 24%. There was no designated assisted training by the Deanery available at the Horton. He stated that he believed the Trust was doing everything possible to recruit obstetricians, although there had been recruitment challenges such as some not attending their interviews, or changing their minds after being offered the post in favour of going to larger Units.

Mr Brennan was asked about the alternative option as presented by the Keep the Horton General group. He responded that this would be costly (at a cost of £1.2m) and was not practical as many doctors at the JR could not be moved to the Horton because the training designation by the Deanery had been removed in 2013.

A Committee member expressed concern that one thousand new maternity cases would be relocated into the JR. Andrew Stevens responded that it was impossible to ‘grow’ birth numbers and there was a need to decide the safest course of action for women in north Oxfordshire. He added that part of the risk assessment was to look at additional capacity at the JR, as outlined in the paper. The risk assessment showed that the JR would be able to accept additional births. He also pointed out that the Trust had worked very closely with the planning authority and with statisticians and it had been ascertained that even with the level of population expansion, the birth rate would only rise by 10%.

In response to a question, Mr Brennan stated that the Trust would pay staff transferring from the Horton any excess travelling expenses incurred and provide designated parking permits for the period end of October to January, when it was anticipated that the Unit would re-open. Also, when asked about the knock on effect of the new arrangements on the gynaecological services, Mr Brennan explained that there would be an additional theatre to be staffed by a sufficient number of midwives.

A member asked if this emerging situation had been created in order to support long term plans for the Horton. Mr Brennan stated that this was not so, explaining that a difficult position had emerged in 2013 when training had been taken away, as outlined in the paper. He added that the Trust came up with an innovative solution to keep it running, via a Clinical Research Fellowship, but it needed to be recognised that its continued success had been due to EU doctors and nurses coming into the EU. Unfortunately, this pipeline had dried up.

Mr Brennan confirmed that there would be no change to the Special Baby Unit and screening would remain.

Mr Stevens, in responding to a question about whether a viable consultant-led maternity service at the Horton would be viable in the future, stated that there were concerns as to whether it is clinically sustainable for a variety of reasons. He added that if a viable option emerged, then there would have to be a trade-off.

Mr Stevens was asked if there was a hospital, consultant-led Unit closer to the Horton which would compare more favourably to the travel time to the JR. He responded that the Trust had undertaken some detailed modelling and, as part of this, had conducted discussions with hospitals in Warwickshire and South Northamptonshire. Mr Stevens commented that there was a need for the Committee to look at those options, adding that he had spoken to Northampton Hospital and midwives were speaking to all women giving birth, giving them the choice of where they wished to have their baby. He added that the Trust was currently working out the maximum number of women who may choose to give birth at the JR.

The Committee AGREED to request Mr Brennan and Mr Stevens to attend the special meeting of the Committee on 30 September in order to discuss further the following issues:

·         timing issues of travel between the Horton and the JR in relation to safety;

·         other options open to the Trust with regard to the successful recruitment of obstetricians; and

·         why the number of births at the Horton had decreased in number from 1,700 to 1,466.