A lone voice stood out at yesterday's meeting where NHS bosses agreed to deny Banbury a full maternity service.
Prof Louise Wallace, the former chief executive officer of the Horton before it was merged with the John Radcliffe, was the only member of Oxfordshire Clinical Commissioning Group (CCG) Board to vote against continuing the midwife-only maternity unit.
Prof Wallace, who had a son at the Horton's consultant-led maternity hospital during her six-year stint at the Horton, was also the only Board member to vote against permanent closure of the obstetric unit when the CCG first made that intention official on August 2017, ten months after the service had been centralised by the Oxford University Hospitals NHS Trust (OUH) which said it could not recruit enough maternity doctors to keep it safe.
She said she had voted against the permanent withdrawal of obstetrics because there had been inadequate consultation, a view that concentrated on services being provided at Oxford and 'ignorance and dismissal of the particular issues' for the CCG, OUH and patients of the Horton's cross-county catchment of Banburyshire.
"There was a failure to examine the alternative models of staffing as highlighted by the Royal College of Obstetrics and Gynaecology in its report in 2016, the dangers of long transfer times and failure to consider the effects of population growth on the birth rate," she said.
Prof Wallace referred to the last year of review of the downgrade by the Horton Health Overview and Scrutiny Committee which acknowledged the overwhelming wish of Banburyshire mothers to give birth at the Horton, unacceptable travel times to the John Radcliffe hospital, difficulty getting onto the JR site by women in labour and lack of amenities for partners and husbands.
She said a third of mothers giving birth at the Horton's midwife-only unit had to be transferred to the JR because of complications and that statistics of harm to these babies were not being recorded for these Horton births.
The JR had benefitted since 2016 by taking on the Horton's doctors, midwives and special care baby unit nurses but still, the mother-midwife ratio at the JR was a 'struggle'.
And she described as 'disappointing' that the OUH had not taken the opportunity to investigate properly how other small units used recommended 'hybrid' models of staffing (where consultants help to fill rotas where there are doctor shortages), and how they retained training approval which made staffing much easier.
"Involvement of GPs in the consideration of the final decision in 2017 included a survey of GPs. This time no such formal process has been followed," said Prof Wallace.
And she suggested that the cost of an obstetric unit could be shared by the neighbouring counties that traditionally use the Horton's services.
The CCG Board accepted Chief Executive Louise Patten's long report on the HHOSC process and the recommendation that the Board accepted confirming that the midwife-only unit would continue, with its dedicated transfer ambulance, for the 'forseeable future'.
Prof Meghana Pandit, medical director for the OUH said the trust had left no stone unturned in its attempts to recruit doctors but had been unsuccessful. She said the trust had done research into other small obstetric units. Having two obstetric units in Oxfordshire had come top of a scoring exercise but this would only be possible if both could be staffed.
The meeting was told confirmation of the centralisation was 'not a permanent closure' and that the CCG would monitor housing and population growth which, if projected numbers grew sufficiently, would 'trigger' a review of the downgrade.
In addition a business plan for improvements on the Horton site would include 'flexible' accommodation to allow for an obstetric unit if one were deemed necessary in the future.
It is understood the decision will prompt a referral of the downgrade back to the Secretary of State for Health, as decided at the Horton HOSC last week. That committee felt the decision to confirm the downgrade was not in the interests of Banburyshire patients.