Agenda item

10.45

At the November Oxfordshire Joint Health Overview & Scrutiny Committee (OJHOSC) meeting, members agreed the following:

‘The OJHOSC urges that discussions should continue with the Oxford Deanery aimed at achieving training accreditation for middle grade paediatric posts at the Horton General Hospital (HGH). The report from the Deanery visit to the HGH on 13 November should be made public as soon as possible.’

This referred to the Deanery visit, led by Mr Tony Jeferis, Acting Postgraduate Dean that evaluated the possibility of reinstating training accreditation for middle grade paediatricians.

The report has now been published and a copy is attached at JHO7. The outcome of the visit was that, due to insufficient workload, accreditation could not be given for training middle grade paediatricians. Mr Jeferis has agreed to attend the meeting in order to explain the reasons for that decision.

At the November meeting, the Committee had agreed the following:

‘The OJHOSC urges that discussions should continue with the Oxford Deanery aimed at achieving training accreditation for middle grade paediatric posts at the Horton General Hospital (HGH). He report from the Deanery visit to the HGH on 13 November should be made public as soon as possible’. This referred to the Deanery visit, led by Mr Tony Jefferis, Acting Postgraduate Dean, that evaluated the possibility of reinstating training accreditation for middle grade paediatricians.

The report had now been published and a copy was attached to the Agenda at JHO7. The outcome of the visit had been that, due to insufficient workload, accreditation could not be given for training middle grade paediatricians.

 Mr Jefferis had been invited, and had agreed, to attend this meeting in order to explain the reasons for that decision.

Mr Jefferis was invited by the Chairman to give a brief presentation of his report. Julia Cartwright, Chair, Community Partnership Forum and Andrew Stevens, ORH, were also invited up to the table with a view to forming a Panel, together with Mr Jefferis, to respond to questions from the Committee.

Members asked a number of questions, a selection of which are included below:

Q         How can the service be kept open?

R         (Mr Jefferis) There needs to be a radical rethink in the way in which the service is delivered. The world has changed since the European Working Directive was introduced in August 2009. Nobody wants their children to have a lesser service but nationally we are having  to adapt to a shrinking, not an expanding service. Training can be offered at the HGH during the working day but it is what is happening at night which is the problem. We would be able to pick up the little problems which occur, but we would not be in a position to solve them all.

We were asked if we could look at the Portland Hospital model and this we did. However, we had some misgivings about it as it is run as a fully serving procedure. Infrequent, emergency occurrences are dealt with on a case by case basis.

Q         Have you considered the implications for Maternity in relation to the distances for patient travel?

R         (Mr Jefferis) We did consider it, but in the report we focused on the training aspect of it.

(Julia Cartwright) In  the Portland model there is a 24/7 consultant delivered service in obstetrics and no middle grade tier. With regard to paediatrics in Banbury, we are continuing the dialogue with the Deanery. There is a need to be at the forefront with regard to training and a little creativity is needed on the part of the Deanery so that everybody can access the services.

Q         How can a hospital improve if there is not the appropriate training available?

R         (Andrew Stevens) There are a number of problems, one of the European Working Time Directive coupled with equality issues. A number of patients are seen at the HGH, but the way the rotas are, the junior doctors are not seeing enough patients to get the training recognised. An option put forward by the BHCP has been rather than focus on training, to explain how to get a clinically and financially stable model to sustain it.

Q         What are the range of consultant –led models within the country as a whole?

R         (Tony Jefferis) Most consultant-led models have not been sustainable and middle grade doctors have been brought in. Most of the models do not have 24 hour cover in their hospital. The Weston-Super-Mare model, for example, is a 16 hour service locally and then the team go to the Bristol Children’s Hospital to provide the service there. Where the models work well there is strong clinical leadership. The rota is developed to best fit the service and the community. We are working with consultants at the Royal Free Hospital, London, to see how their consultant –led model works there, but it is a different sized hospital to the Horton. We want to be creative with our ideas too.

(Andrew Stevens) We are looking at a number of other hospitals with consultants and other graded staff working on a rota basis.

Q         This is quite a critical report – there is no training for middle grade doctors, no appraisal structure, no study leave etc. What is your view on this?

R         (Andrew Stevens) This is legitimate criticism. We have to be creative. It is currently a balancing act with regard to the clinical service at the Horton. To date we have supported and maintained the service at the Horton using a series of short term locums, who, along with the consultants, have worked over and above their call of duty to keep the service going.

Q         Is there any reason why the Weston Super Mare model would not work for Oxfordshire?

R         (Andrew Stevens) This model is similar to the model originally proposed by the Trust, but which was turned down by the Independent Review Panel; ie an external, community based service, but with no in-patient facilities overnight.

Dr McWilliam commented that every part of the Oxfordshire population was in receipt of a high quality paediatric service, which enjoyed high investment and a significant amount of clinical ‘willingness’. Given this, it was his view that there could be a model found to provide a service for both sites using middle grade doctors. Andrew Stevens agreed adding that it was the role of the PCT to decide what was the best service which could be provided for all children across the county. Currently they were looking at where paediatrics was going as a profession and also working with GPs to keep as many robust community based services to enable children to be treated at home. Research indicated that children recovered better. This role needed to be married up with the objectives of the BHCP.

Q         Isn’t there more to it than whether the PCT can pay or not? If there is clinical willingness – shouldn’t that be explored?

R         (Andrew Stevens) Yes. The clinicians want to do what is best for the children of Oxfordshire. There is a national move towards community based services and, in the light of this, we need to think about what is the most appropriate service we can afford to get the best clinical outcomes for children and their families.

Julia Cartwright  pointed out that the Community Partnership Forum were an independent body who saw their role as bringing all the parties together and keeping the dialogue going. They encouraged ‘thinking outside the box’ and liaised on A nationa basis. She added that there were very different kinds of issues affecting the two strands of the profession(the acute and the community sector) in the future. For example, the clinicians needed to think about child protection issues in light of the two areas of deprivation in Banbury. The service was undergoing continuous change and there was a need to talk to the public, and to use the skills of the community services to ensure that Banbury was seen as a training of excellence.

Members of the Committee thanked Tony Jefferis, Andrew Stevens and Julia Cartwright for attending the meeting and for their valuable input.

It was AGREED to request Mr Edwards to write to the Deanery giving the views of the Committee as expressed in the meeting (a full note will be included in the  Minutes); in particular recommending that more clinical willingness and creative thinking be applied to any deliberations on a possible solution.