Health bosses grilled on efforts to staff Horton

Members of the Horton Health Overview and Scrutiny Committee (HHOSC) demanded that the Oxford University Hospitals Trust (OUH) examine how other small units have managed staffing when the OUH cannot.

Lay member Dr Keith Ruddle told the trust and Oxfordshire Clinical Commissioning Group (OCCG) at a meeting on Monday there were 35 units across the country delivering fewer than 2,000 deliveries.

The Horton delivered around 1,500 births before the downgrade in 2016 and at one point close to 2,000 before mums with certain conditions such as diabetes could no longer give birth in Banbury.

“I want some assurance OUH has looked at practice elsewhere and I would hope and expect a great teaching and research trust in Oxford is absolutely capable of matching those kinds of sustainable units,” he said.

Dr Veronica Miller, OUH Clinical Director of Women’s Services, said the trust was going to explore a number of models with the Royal College of Obstetrics and Gynaecologists.

Committee chair Cllr Arash Fatemian said: “We struggle to understand why a trust with the international brand of Oxford University struggles to recruit for obstetric services.

“We’re not convinced or satisfied that everything is been done. If you’re searching for nurses all over the world, why not obstetric doctors?” he said. “If the will is there I’m sure a way could be found.”

Mr Fatemian suggested even US doctors, disenchanted by their political situation, might be recruited.

He said given doctors were still being appointed to work at the Horton, in spite of the two year closure, it should be possible to engage sufficient staff – if there was genuine will and momentum to recruit.

Meghana Pandit, OUH medical director said: “There is a drop in training (for obstetrics and gynaecology) in excess of any other specialty.

“You’re right to seek flexible and creative solutions and we’re very hopeful and keen to go and look at the other units where this is possible and maintained.”

She said it had not been possible to recruit doctors needed so the campaign was ongoing.

She said it was being made very clear to those appointed and working at the JR that when there were enough doctors to staff the Horton they would be working in Banbury.

Dr Miller said: “We’re very clear (the advertising) is for the Horton. We absolutely want the trust grade doctors for the Horton. We can’t open the Horton for one or two doctors so they come and join the JR for the moment but we’re very clear it’s for obstetric support at the Horton.”

Kathy Hall, OUH Director of Strategy said the doctors would be doing ante-natal care at the Horton while the trust tries to recruit the other doctors needed to staff a full Banbury unit.

She described it as a ‘difficult balance’ attracting doctors before the unit was reopened.

Lou Patten, OCCG CEO, said salaries were on national payscales and money goes further outside the south east, making recruitment here difficult.

Mr Fatemian asked why the OUH could not split the number of births between the Horton and JR allowing doctors to work on both sites and to answer the recruitment problem.

Dr Miller said there were gaps in all JR rotas and in all trusts and it would be ‘challenging’.

She said some obstetric roles at the JR were different to the Horton’s ‘general’ obstetrics and skills had to be used where they were needed. It was not straightforward because of the different tiers of staff needed in two units with differing responsibilities.

Dr Miller said the questions about having two obstetric sites or one centralised site in Oxford would be explored during consideration of the ten options that had been drawn up for the Horton HOSC process.

Ms Pandit said: “We don’t have the numbers to cover both sites because the rotas would involve different demands at the two separate units. The numbers for that would be greater than we currently have.”

Cllr Barry Richards reignited a discussion about training accreditation. He said if the Horton could regain this it could help to train the doctors the trust needs.

Dr Ruddle referred to new estimates of the Horton delivering 2,000 babies within the next 12 years because of housing growth. He made a plea for flexibility, innovation and boldness.

“It’s a plea for looking at ‘how can we do this’. The ways in which this could be done need to be looked at the as best, most innovative way possible. If this really is in the interests of patients there should be a way of doing it,” he said.

Mr Fatemian said it had been a ‘glaring omission’ in previous plans not to include the pressure on the JR that housing growth in the south of the county would create.

Charlotte Bird, deputy chairman of Keep the Horton General, said after the meeting: “It was obvious councillors are less than convinced the OUH is making the effort it claims to.

“The trust said it was investigating other small units in England where consultant-led services have been maintained.

“This research was done several years ago by KTHG’s Dr Peter Fisher and passed to the OUH. It is a great pity that they didn’t give it the credibility it deserved at the time.”