Horton maternity review became a forum for ‘evasion’

Cllr Arash Fatemian who has published his report on the Horton HOSC maternity downgrade review  NNL-170908-093838001
Cllr Arash Fatemian who has published his report on the Horton HOSC maternity downgrade review NNL-170908-093838001

Oxford University Hospitals NHS Trust (OUH) managers and clinical commissioning group (CCG) staff saw the review into downgrading of the Horton’s consultant-led maternity as a ‘tick-box’ exercise to stall further action to reinstate a full service, it has been claimed.

The accusation has been made by Horton Health Overview and Scrutiny (HHOSC) chairman Cllr Arash Fatemian in a damning report at the end of a year-long examination of the evidence used to centralise maternity in Oxford.

The Horton General Hospital campaigners, councillors and general public. L - r Charlotte Bird, Julian Procter and Horton the Hobby Horse, Keith Strangwood and Jan Bennett. NNL-160726-164445009

The Horton General Hospital campaigners, councillors and general public. L - r Charlotte Bird, Julian Procter and Horton the Hobby Horse, Keith Strangwood and Jan Bennett. NNL-160726-164445009

It was published on Monday, hours after the CCG announced a recommendation that its board makes permanent the midwife-only service at the Horton.

Mr Fatemian will today (Thursday) ask his committee to refer the entire matter back to the health secretary, who asked for the review to be carried out last year following intense criticism of the downgrade.

In the document Mr Fatemian reported numerous evasions and refusals to provide vital information and some responses ‘tested the limit of believability’, he said.

One example was a claim by head of women’s services, Veronica Miller, the trust would need more doctors to work ‘trust-wide’ over the JR and Horton sites than to run two entirely separate units.

Keep the Horton General chairman Keith Strangwood

Keep the Horton General chairman Keith Strangwood

“Another example of evasiveness... is the eight months it took to provide financial data. The committee’s request for additional information remains unfulfilled,” he said.

“The actions... give the impression of an evasive and ‘blocking’ approach. I interpret this lack of a fully inclusive process as the CCG and OUH having pre-determined the outcome.

“Similarly when a topic has become ‘too difficult’ to deal with the CCG and trust have just dropped this from our discussions.”

Unfulfilled requests included providing a clinical view on the acceptability of transfer times of 30 to 120 minutes from the Horton to the JR and data on mothers who chose to give birth outside the trust after downgrade because of the Horton situation.

A protest in August 2016 before the downgrade of the maternity unit to a midwife-only service

A protest in August 2016 before the downgrade of the maternity unit to a midwife-only service

Other unanswered questions were for information on how house-building would put increased pressure on the JR birth unit and what the impact would be on transfer times if there were no 24-hour emergency ambulance outside the Horton unit.

The committee asked for details of staffing needed for running two sites separately and two integrated sites but did not get them.

And information that had been promised to the HHOSC and county council by the OUH CEO, Bruno Holthof on how ‘weighting’ had been used in a scoring exercise to determine the best option for maternity in Oxfordshire, was not forthcoming until after the review was complete.

Mr Fatemian said a unilateral decision to close obstetrics at the Horton had been made on ‘safety’ grounds because of lack of staff. He described as ‘incredulous’ the trust was now saying it was an issue of money. He said: “The trust appears not to have sufficiently and aggressively tackled the recruitment and retention of staff at this world-leading institution.”

The Horton General Hospital where the CCG wishes to make downgrade permanent

The Horton General Hospital where the CCG wishes to make downgrade permanent

Mr Fatemian criticised the trust for suggesting other trusts operating small consultant-led maternity units might lie in their responses if asked for information by HHOSC.

In the event, Keep the Horton General (KTHG) researched a full picture of small obstetric units with detail of how these were staffed.

“The committee heard during its meeting of December 19, 2018, several cases where women had harrowing experiences because obstetric services were not available at the HGH. At no point has the trust responded effectively to these experiences,” he said.

Confirming a midwife-only unit was not in the interests of Banburyshire patients, Mr Fatemian said: “Whilst the CCG and OUH have heard from expectant mothers, contrary to the IRP advice, they have not ‘learnt from the experience of mothers, families...’

“A telephone call for priority parking is a disgraceful response as a solution and only serves to illustrate the trivial perspective of the CCG and trust on the experiences of the population of the Horton catchment. The needs of the poulation have not changed and the arguments set out in the 2008 IRP judgement still apply. The population of north Oxfordshire is set to grow.”

The Horton HOSC meets this evening (Thursday) at Banbury Town Hall at 6.15pm and is expected to reject the recommendation for permanent closure of obstetrics and to refer the matter back to the Secretary of State for Health for further consideration in the light of the list of issues in Mr Fatemian’s report.
o - The CCG’s paper says it recommends its board, meeting on September 26, to confirm the permanent closure of the Horton obstetric unit and to confirm the midwife-led unit at the Horton into the forseeable future.

The CCG says it will put in place a dedicated hotline for women in labour and their families to navigate the JR site and use priority parking in an emergency.

It will expand services available at the Horton MLU or provide them ‘virtually’ to enable women to receive most of their maternity care closer to home and increase facilities for birth partners to stay overnight in Oxford.

It will also strengthen links with Warwick Hospital to ensure it is an attractive option.

The recommendation appears conditional. It says: “The decision is for the ‘foreseeable future’ rather than a statement of

permanency.

“This is because we now have a framework, agreed by the Oxfordshire Health and Wellbeing Board, that states an ongoing commitment by the CCG and all health and care partners to regularly review population health and care needs and change services as appropriate to meet that need, all co-produced with local stakeholders. “This approach will ensure that if population or other factors change significantly then the need for obstetric services can be reviewed.”

It says acceptance of the recommendation will allow it to plan for Horton’s future and actively pursue the opportunity of capital investment.
o - Keep the Horton General (KTHG) said it was ‘utterly dismayed’ by the clinical commissioning group’s recommendation for permanent removal of obstetrics from the Horton.

Deputy chair Charlotte Bird said: “Committee members have given up numerous hours to attend meetings in public and in private with OCCG and Oxford University Trust (OUT) representatives.

“We believed a corner had been turned and that the past history was exactly that. We were told bridges were being built and we would be part of the way forward.

“It seems this outcome bears no resemblance to that promise. The OCCG/OUH told Horton HOSC members, in a public meeting, that our group would definitely be part of communications with other small obstetric units up and down the country whether by phone or physical visits.

“The first we realised we had been duped was when a senior member of the OUH team told us they had contacted the hospitals by phone using an internal system and ‘hoped we understood’.

“We didn’t then and we certainly don’t now. It is a particularely hard blow,” she said.

Chairman Keith Strangwood said: “This should have gone to the Independent Reconfiguration Panel to decide. The IRP looks at the facts. OCCG has just looked at itself. It must be referred back to the health secretary. “