Chairman Sir William Stubbs said: “The need to consider changes at the Horton General Hospital reflects our growing concern that we could not continue to run some services safely or to the highest current standard.  We have a duty to our patients to do both.

“The decision of the Board to accept these changes is based on extensive evidence and advice from clinical experts, including staff running the services, and national clinical leaders in their fields. Changes in medical education, restrictions on the hours which doctors can work, and best practice guidance which indicates the need for fewer more specialist centres to provide services such as paediatric s and obstetrics, have all been factors which have been taken into account. 

“The matter has been referred to the Secretary of State for Health for his advice, and we await his decision.  In the meantime, I would like to thank all of the staff, members of the public, patient groups, primary care trust and local government colleagues and others, who have devoted so much time to considering the issues facing these services at the Horton General Hospital, and exploring options for the future. The Horton General Hospital matters greatly to people in North Oxfordshire, and to all of us in the Trust, and it is important that the right solutions are found.”

Chief Executive Trevor Campbell Davis added: “Following a decision by the Secretary of State, the implementation of any agreed changes will be monitored carefully by both the Board and Oxfordshire Primary Care Trust, to ensure that changes remain safe and to the highest clinical standards.

“I would like to thank the staff at the Horton General Hospital for the dedication and professionalism with which they have continued to provide excellent care for patients, during a time of great uncertainty.  Whatever the decision of the Secretary of State on these matters, this has been a learning process for all of us, and I hope we will continue to work together to ensure that the Horton has an important future within the health system in Oxfordshire.”

Non Executive Director Caroline Langridge said: “As a resident of North Oxfordshire, I want to ensure the best possible      services for local people at the Horton General Hospital.  Over the past two years, I have become convinced of the need for change in the paediatric, obstetric and gynaecology services. I have wanted to ensure that the changes were used as an opportunity to develop some first class services at the Horton, and were not simply a series of cuts. I am extremely pleased at the enhancements to the original proposals, as these allow for a number of important developments.

I am a keen supporter of birthing centres, and believe that the extra investment which we have agreed for the Horton will enable us to develop a first rate facility for women in North Oxfordshire.  I also believe that the new children’s service will quickly be established as a real asset to the area.  I have advocated the establishment of a women’s surgical ward at the Horton for some time, and am pleased that this is now possible.

I realise that people in Banbury feel passionately about the Horton General Hospital, and don’t like to see change.  I hope they now understand why changes are necessary, and feel reassured that we have done our best to ensure they will continue to receive the best care possible.”

Agreed Recommendations

The following summarises the changes which have been agreed: 

• The in-patient paediatric service will be replaced by a consultant-led paediatric service, which will operate 12 hours a day, five days a week, and a with an additional session on Sundays. Out of hours, the hospital will be supported by an on-call paediatrician and a 24-hour rota of paediatrically-skilled nurses linked to the Emergency (A&E) Department.
• Staffing in the Emergency Department will be strengthened, including the appointment of an additional consultant.
• Medium term solutions have been identified to sustain emergency general surgery and trauma services at the Horton General Hospital on a 24/7 basis, in order to support the Emergency Department.
• The obstetric inpatient maternity service will be replaced by a midwifery birthing centre.  A new birthing centre will be developed at the Horton General Hospital.  There will be a telemedicine link between Oxford and Banbury.  Women expecting high risk deliveries will be advised to give birth at the John Radcliffe Hospital in Oxford. Obstetric-led outpatient clinics and scanning facilities will remain at the Horton General Hospital.
• Babies requiring special care will be cared for within the John Radcliffe SCBU, alongside the neonatal intensive care unit.
• Children’s community nursing and community neonatal nursing will be strengthened in the area.
• A consultant-led emergency gynaecology service will be established during the day for five days a week.  Out of hours, women needing emergency gynaecology assessment or surgery will be transferred to Oxford, except in exceptional circumstances, when an on-call consultant will attend to them at the Horton General Hospital. 
• A new female surgical ward will be created at the Horton General Hospital, which will accommodate surgical inpatients.  The inpatient gynaecology ward will be converted to a gynaecology assessment and day case ward.
• All gynaecology outpatient clinics will continue at the Horton General Hospital.  The colposcopy clinic will be expanded, and the development of a new hysteroscopy clinic is being explored.
• New emergency transport arrangements will be put in place with South Central Ambulance Service.
• A new inter-hospital shuttle bus service for patients and staff will operate between the Horton General Hospital and the John Radcliffe Hospital on a daily basis.

The changes will lead to an increased annual running cost of £593,000.  In addition, a capital programme of £7 million for investments at the Horton General Hospital was agreed by the Board.  This will include the development of the new birthing centre, changes to the Emergency Department, and female surgical ward.

Background

Proposals to change services at the Horton General Hospital were initially developed in response to medical staffing difficulties in the children’s service, which were leading to serious concerns regarding its long term safety and sustainability. This led to the Oxfordshire Paediatric Taskforce, set up in 2003 to consider the problems affecting the service and to explore solutions. The ORH Strategic Review, launched in 2004, took forward this work.   Through the Review, a vision for the future of the Horton General Hospital was developed.  This vision, and further work on the problems affecting both the children’s and maternity services, were set out in the Emerging Themes document, published in 2005.

The Consultation and post-consultation process
Last year, the Trust carried out a four-month consultation on proposed changes to services at the Horton General Hospital.  The consultation was conducted across Oxfordshire, and in relevant neighbouring counties. The consultation resulted in an overwhelmingly negative response from people in the North Oxfordshire area, particularly in respect of proposals to change children’s services and maternity. Key concerns included why change was needed, the safety of the proposals, emergency transport, access to services and social and demographic issues.

Clinical staff remained concerned about the safety of these services in the future.  Two clinical groups, including GPs, consultants, midwives, nurses and other clinicians, the majority of whom are from the Banbury area, were set up to consider the issues further. The groups looked at the evidence relating to changes in medical training, and restrictions on the hours which doctors can work, and considered the risks to the safety of these services.  They received professional advice from Professor Sir Alan Craft, Professor of Child Health and a former President of the Royal College of Paediatrics and Child Health, Ms Suzanne Cunningham, a Consultant Midwife at Southampton University Hospitals, and Dr Nicholas Naftalin, Emeritus Consultant in Obstetrics and Gynaecology, and a member of the national Independent Reconfiguration Panel, and Dr Michael Bannon, Oxford Postgraduate Dean, who has responsibility for overseeing junior training programmes on behalf of PMETB.

A stakeholder panel, including representatives of patient, community and public bodies, was set up at the same time, to consider the recommendations of the clinical groups, and other issues arising from the public consultation.

The clinical groups came to the conclusion that the services could not continue safely in their current form. The groups set out recommendations which, they believe, provide the safest options for patients.  The clinical reports, including a list of those involved, are published on the Oxford Radcliffe Hospitals website.

The stakeholder group could not give full support to the proposals, a small majority continuing to feel that the case for change had not been made, and that the proposals represented a significant downgrading of access to services and a worsening of choice for women and children in the Banbury area. The group did however make a number of recommendations should the Trust decide to implement the proposals.

Oxfordshire Joint Health and Overview Scrutiny Committee

On 12 July, the Oxfordshire Joint Health Overview and Scrutiny Committee (OJHOSC) met to consider the reports of the stakeholder panel and clinical groups, and to hear evidence from witnesses.  The role of OJHOSC is to examine proposals for substantial changes to services that affect the health of the people of Oxfordshire, and to refer them to the Secretary of State for Health, if the Committee believes that they are not in the best interests of local people.

The meeting was an extremely thorough exploration of the complex issues involved.  Having heard the differing points of view, Committee members decided to refer the clinical proposals to the Secretary of State.  The Trust welcomed this decision, because these are complex issues of great concern to patients and the local population, and decisions about these matters should be based on the best possible evidence and advice available.

The Secretary of State may make a decision on the proposals, or may refer them to an Independent Reconfiguration Panel, the body set up to advise government on changes in hospital services.  The Trust expects a final decision to be made later in 2007.

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