On Tuesday 25 October, North Oxfordshire MP Victoria Prentis, presented her first Ten Minute Rule Motion to the House on the subject of the Horton General Hospital. The National Health Service Provision (Local Consultation) Bill was a direct response to events over the summer at the hospital, which saw the downgrade of the maternity unit to a midwife-only service with no public consultation.
During her speech, Victoria voiced her concerns about the way in which the decision was taken and emphasised the need for public consultation whenever there is a change to NHS services, even when it is in response to an emergency situation. Presenting her Bill to the Commons, Victoria said in the Chamber:
“Madam Deputy Speaker, I was a civil servant for 17 years, and on the whole I believe the best of our public servants. I feel let down by the way we have been treated this summer, by the lack of good management, transparency or evidence-based decision-making. I am concerned that without change to the law, other areas may also suffer as we have…..
“…This Bill would increase accountability of local Trusts and commissioning authorities. Where major changes to service provision are proposed, clinical groups and medical consortiums are not a replacement for public consultation. Doctor may know best, but only when he has listened to the patient. Local decision making can work, but only with democratic accountability.”
Speaking after presenting her Bill, Victoria said: “I was really pleased to be able to speak at some length about the suspension of our consultant-delivered maternity service at the Horton. It provided an opportunity for me to voice the concerns of my constituents. I feel strongly that the public must be consulted whenever a service change is proposed, regardless of the circumstances surrounding any decision. My Bill called for exactly that; I was particularly grateful for the cross-party support from colleagues, including former Leader of the Opposition the Rt Hon Harriet Harman QC MP”.
You can read the full text of Victoria’s speech below:
Mr Speaker, I beg to move that leave be given for me to bring in a Bill to make provision about mandatory local consultation in relation to changes in services proposed by NHS Trusts and healthcare commissioning authorities; and for connected purposes.
This Bill is the result of our experience in Oxfordshire this summer; during which the Oxford University Hospitals NHS Foundation Trust suspended consultant-led maternity services at our local general hospital with no warning and no consultation.
The Horton General Hospital was a gift to the people of Banbury in 1872. It serves a community of around 150,000 people, though this number is growing by the day as a large number of new houses are being built. The Horton General’s patients are spread across six Parliamentary constituencies covering a large rural hinterland and some of the most deprived areas in Oxfordshire. I was born at the Horton and four generations of my family have been treated there. Like my constituents, I am proud of my local hospital, and feel passionately about keeping it.
Our unit was fairly small by national standards, with about 1,500 births a year. It was well regarded, both medically and by the families who chose it, but despite this fine reputation, it has been under threat for as long as I can remember. The first speech I made in primary school was about saving maternity at the Horton. The last major threat we faced was in 2008 when my predecessor, and the former Prime Minister and the former member for Daventry, and the passionate Keep the Horton General group fought tooth and nail to save the hospital.
At that time, the matter was referred to the Independent Reconfiguration Panel, who looked at the evidence in considerable detail and concluded that:
“There are major concerns over whether such a large unit as that being proposed [at the John Radcliffe] would be (a) safe and (b) sustainable. There are sufficient concerns about ambulance provision and the transfer of very sick babies from Banbury to Oxford to call into question the safety of what is being proposed by the Trust.”
After this, we thought the fight was over for some time. How wrong we were.
On 20th July, I was invited to what seemed a routine meeting with the Trust. I asked a member of staff to go on my behalf. No other Members of Parliament were asked to attend, nor of course could they have done so on a sitting Wednesday. I was horrified to hear the report: the Trust had failed to recruit sufficient obstetricians, and as a result The Horton would be downgraded as an emergency. There would be no consultation; on 31 August the Trust Board approved this. Three weeks ago obstetricians left, and we became a midwife led unit, or MLU.
Colleagues know that I am, with good reason, passionate about both maternal and peri-natal safety. Nevertheless, I accept that for most deliveries, MLUs are the best place to be, particularly as most are located alongside or very near an obstetric unit.
And that is the nub of our problem: if an emergency arises, or a woman simply changes her mind about having an epidural, our labouring mothers will have to be transferred by ambulance to Oxford. It is around 23 miles. The average time taken in a blue light ambulance from door to door will be between 30 and 45 mins. The traffic is dreadful and unpredictable; many of my constituents, myself included, go to some lengths to avoid driving into Oxford. NICE guidelines make clear that when an emergency caesarean needs to take place, it must be done within 30 minutes. Once you factor in transfer time, and moving a labouring mother into and out of an ambulance, that will be quite impossible from the Horton. The worry is of course, that some won’t make it in time.
Clearly most women will no longer be permitted to deliver in Banbury. In fact, there have been 12 births since the unit became midwife led. Ordinarily there would have been around 90.
Many of the women who will now deliver in Oxford live an hour and a half’s drive from the JR. I worry about these women; about the babies that will be born at the side of the road and about everyone’s experiences of labour. I can barely begin to imagine the situation of women who do not own a car. The journey to Oxford by public transport from many of the villages is virtually impossible.
I have repeatedly asked the Trust to see risk assessments, and have been sent nothing. My office eventually tracked down some risk assessments on-line, which showed an alarming number of “high risk” factors including transfer time, ambulance provision and the ability of the John Radcliffe to cope with the additional births. I asked for an explanation and have received nothing.
I struggle, without evidence, to accept that patient safety has been fully assessed; the unit should have been staffed by locums and professionals from the Trust’s other sites, while this was done thoroughly. I must also question how it all became an emergency, when I have since been told that the Clinical Research Fellows programme had become increasingly unsustainable over the past eighteen months. Serious concerns have also been raised about whether sufficient and timely efforts were made to recruit. As a new MP, meeting the new Chief Executive, I would have expected this problem to have been flagged. I would have welcomed the chance to try to help solve the problem, as my constituents are now doing; offering discounted housing, school fees, and even free Hook Norton beer to those who apply to be obstetricians.
My constituents are fearful and angry. We have had a summer of protests. Many local consultants and GPs are against the suspension, and have complained furiously that such an important decision was taken over six weeks during the school holidays. I have considerable sympathy for those who believe this is part of a wider conspiracy to downgrade our local hospital. For many years a vociferous contingent at the Trust have wanted to centralise services in Oxford, and use our site for more outpatient services. One of the options proposed in the forthcoming Sustainability and Transformation Plan is for exactly that, with maternity services at the Horton becoming midwife-led. We fear the situation this summer has been engineered in order to make this a fait accompli.
Madam Deputy Speaker, I was a civil servant for 17 years, and on the whole I believe the best of our public servants. I feel let down by the way we have been treated this summer, by the lack of good management, transparency or evidence-based decision-making. I am concerned that without change to the law, other areas may also suffer as we have.
The Trust holds all the cards. Only it has the ability to manipulate the number of births each centre receives. We have no control over recruitment; only they have the power to make the posts attractive. They have all the evidence, and carry out all risk assessments. The Clinical Commissioning Group has been notable by their silence.
This Bill would increase accountability of local Trusts and commissioning authorities. Where major changes to service provision are proposed, clinical groups and medical consortiums are not a replacement for public consultation. Doctor may know best, but only when he has listened to the patient. Local decision making can work, but only with democratic accountability.
We in North Oxfordshire and the surrounding area remain hopeful that our unit will reopen next year, when sufficient obstetricians have been recruited. In the meantime, our mothers and babies suffer.”
Victoria Prentis MP (25 October 2016)