The long-awaited initial assessment on the removal of consultant-led maternity from the Horton to Oxford has posed as many questions as it has offered opinions.
The Independent Reconfiguration (IRP) panel says unexplored options should be investigated now, although it also urges the Oxfordshire Clinical Commissioning Group (OCCG) to continue with its cost-cutting changes programme without delay.
These could include loss of the Horton’s 24-hour children’s ward, closure of half the county’s community hospitals and review of the county’s midwife-led birth centres.
The report says a ‘super-HOSC’, including Northamptonshire and Warwickshire county councils, should have been formed to deliberate on the Horton’s downgrading.
A scrutiny body including representatives of all counties will be formed but hospital bosses said this week while they are still recruiting doctors for the Horton, there is no special care baby unit provision to return.
The report says: “The panel’s view is... that action to consider alternative options is needed because the problems with sustaining the obstetric service at the Horton that led to its temporary closure in 2016 are real and the prospects for returning to the earlier status quo are poor given a national shortage of obstetricians, exacerbated by the local workforce recruitment challenges.
“Secondly, this consideration must be driven by what is desirable for the future of maternity... and all those who need them across... Oxfordshire and beyond, rather than a search for any possible way to retain an obstetric service at the Horton.
“This necessarily brings into play potential trade-offs between meeting the needs of higher risk mothers in specialised services, access to more local services, sustainability of staffing and the best use of finite NHS resources.”
The panel says it is important consultation on future services ‘takes account of patient flows and is not constrained by administrative boundaries’.
However some cross-county consultation did not take place. For example south Northants and south Warks GPs were not included in a vote of Banbury area GPs that the OCCG claimed determined a ‘majority’ in favour of removal of obstetrics from Banbury.
The report said it considered ‘an alternative perspective’ to that of OCCG and a high court judge who dismissed a Judicial Review claim (of unlawfulness of the first phase public consultation), that closing the Horton’s obstetrics did not undermine decisions still to be made about other services provided at the Horton.
“In the panel’s experience obstetrics and paediatrics in district general hospital settings are services that ‘travel together’. A decision about the future of one necessarily influences the future of the other.
“If the effect can be said to flow through into A&E, then what the Horton will look like in the future remains unclear, at least to the residents of Banbury and surrounding area, who continue to be concerned that population growth and access to services have not been fully taken into account.”
The report said separating obstetrics from paediatrics, related Horton services and maternity services elsewhere in the county highlighted the interdependencies that must be tackled together to move forward successfully.
Further detailed work on obstetric options at the Horton is required, the report said and the findings externally reviewed by a clinical senate, an independent, strategic advisor to NHS commissioners.
The IRP report gives no firm instructions but says OCCG and its partners should decide how to link ‘further work’ with a final decision about Horton maternity, the hospital’s other services and the Oxfordshire Transformation Plan (OTP) which is tasked with saving £200m in the next three to four years as part of a much larger, regional Sustainability and Transformation Plan.
Phase Two of the OTP consultation was originally planned to start in December 2017 but has been put back.
The IRP panel said the challenges facing Oxfordshire’s health and care services must be ‘confronted honestly by all parties’. And it says it is in everyone’s interest that the ‘next phase is commenced as soon as practicable’.
OCCG refused to answer a list of questions from the Banbury Guardian.
Instead it directed us to a statement on its website that said: “We have been asked to undertake a joint piece of work with Oxfordshire Health Overview and Scrutiny Committee (HOSC) and we have contacted the HOSC chairman to ensure an early discussion about how we will do this together.”
Louise Patten, chief executive of OCCG said: “As the new CEO I will personally ensure the CCG and wider health system approach the IRP recommendations in a way that ensures all stakeholders feel involved and informed.
“I have written to the chair of the Oxfordshire HOSC and offered my commitment to move forward in a transparent and inclusive manner.”
The paper’s questions asked when the CCG had first seen the report, whether it nullified last August’s decision to permanently close Horton obstetrics, whether patients from outside OX postcodes would now be allowed to deliver their babies in Oxford and whether the CCG would now ensure consultation on interdependent Horton services.
To read more about the reaction to the report click here.