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Parental Contact
6.55 pm
Mr. Ian Liddell-Grainger (Bridgwater) (Con): I wish to present a petition signed by 100 residents of the Bridgwater constituency. It declares:
- That parents, after they separate, should enjoy a legal presumption of frequent and continuing contact with their children, unless a child's safety would be put at risk.
The petitioners therefore request that the House of Commons amend the Children Act 1989 to replace the term "contact order" with "parenting time order", to provide for the making and enforcement of parenting time orders, and to ensure that parents and, where appropriate, grandparents enjoy a presumption of contact with their children and grandchildren.
And the Petitioners remain, etc.
Paediatric Doctors
Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]
6.56 pm
Tony Baldry (Banbury) (Con): Paediatrics is often in the media. No doubt the Minister's officials expected me to want to talk about the cases of Sally Clark, Trupti Patel and Angela Cannings, but I do not. To avoid confusion about the matters that I want to raise in the debate, I have given the Minister notice of what I intend to say. I want to raise the less familiar cases of three-year old Ian Luckett, a Bloxham boy who tragically died at Oxford's Radcliffe infirmary, and of the late Dr. Ian Watkins.
I shall begin with the tragic case of Ian Luckett. He is the reason why, a number of years ago, the Horton general hospital recruited paediatricians of the calibre of Dr. Bob Bell, who retired recently after many years of outstanding service to the community.
Ian Luckett died in 1974, after accidentally receiving a drug overdose. His father, Donald Luckett, told of how his son said, "Daddy, I want to sleep. My eyes won't stay open." That was just before he was discharged from the Houghton general hospital. The next day, Ian's father was unable to wake him: sadly, he never regained consciousness, and he died three days later at the Radcliffe infirmary.
There followed three inquiries into the tragic death of Ian Luckett. Two were private, internal inquires held by the then Oxford area health authority and the then district hospital management committee. After considerable lobbying by the boy's family and my predecessor as Member of Parliament for Banbury, Sir Neil Marten, a full public inquiry was held. It is that public inquiry, held some 30 years ago, that is relevant to the pressures facing paediatric services at the Horton hospital today.
The public inquiry was ordered by the then Secretary of State for Health and Social Security, Barbara Castle. Opening the inquiry, the chairman said:
- "The reason there has been this third enquiry is because it is recognised by the Department . . . that there should be the fullest enquiry to ensure such a thing does not happen again."
The evidence that the Luckett inquiry heard reinforced the need for an enhanced paediatric department, and for more trained paediatric staff at the Horton general hospital. Dr. Douglas Pickering, the consultant paediatrician at the Radcliffe infirmary, was reported by the Banbury Guardian of 6 June 1974 to have explained to the inquiry that he
- "would like to see doctors at the Horton rotate at the Radcliffe for paediatric experience".
When I read the evidence to the Luckett inquiry, some 30 years after it was held, I was struck by how strong was the message that the Horton general hospital needed experienced paediatricians and comprehensive paediatric care, not least because of the distance to other hospitals in Oxford.
What did the inquiry find? The Luckett report began by observing that
- "nursing and medical staff are devoted, but severely stretched",
- "junior medical staff might be rotated",
- "only severely ill children, fit to travel, should be admitted directly to Oxford hospitals."
It being Seven o'clock, the motion for the Adjournment lapsed, without Question put.
Motion made and Question proposed, That this House do now adjourn—[Mr. Jim Murphy.]
Tony Baldry: My predecessor, Sir Neil Marten, rightly concluded that the Luckett inquiry
- "highlights a number of matters that must be put right immediately. Nothing like this must be ever allowed to happen again".
Shortly afterwards, a number of paediatric consultants, including Dr. Bob Bell, were appointed at Horton general hospital, and no sick children had to travel to Oxford hospitals. In future, sick children will almost certainly have to travel to Oxford hospitals by night, when, by definition, it will be an emergency, if 24 hours a day, seven days a week paediatric care is withdrawn from the Horton.
The situation for paediatrics is grim even at the John Radcliffe hospital. My recent correspondence with the chairman and chief executive of the Oxford Radcliffe hospitals and the president of the Royal College of Paediatrics and Child Health has produced the same point time and again: there is a national shortage of paediatricians—simple as that. A parliamentary answer to my question about the matter states that just 15 new paediatricians are being trained over the coming year in England and Wales, although it goes on to say—using words very carefully—that
- "an extra 155 National Training Numbers have been proposed for paediatrics through other initiatives."—[Official Report, 4 March 2004; Vol. 418, c. 1117W.]
Why are so few paediatricians—just 15—being trained? The Minister should not underestimate the impact that downgrading local paediatric services will have on the people of north Oxfordshire and south Northamptonshire. The public inquiry of 1974 resulted in 24 hours a day, seven days a week paediatric services for north Oxfordshire and south Northamptonshire, which has been the situation for 30 years. Local people have become used to the high calibre of consultants such as Dr. Bob Bell and Dr. Harvey Marcovitch, who is now at the Royal College of Paediatrics and Child Health.
When Dr. Bob Bell retired in July last year, he expressed in public his concerns over the future of the children's ward at the Horton general hospital. There is now just one of the necessary five middle grade doctors in paediatric posts at Horton general hospital. Why have five advertisements led to no appointment? It
seems that the number of trained doctors in the country is simply insufficient, and not enough of them are being trained.Only Ministers can give us the complete answer, but surely part of the explanation is illustrated by the tragic death of Dr. Sid Watkins. The 44-year-old Dr. Watkins committed suicide last year and was a consultant paediatrician who had worked more than 100 hours in that week. The British Medical Association does not believe that his working week was unusual and calculates that almost 80 per cent. of consultants work more than 50 hours every week. The Independent, the only broadsheet to cover Dr. Watkins's death, quoted Harvey Marcovitch, by now working at the Royal College of Paediatrics and Child Health, who commented:
- "there isn't anyone around anymore among the juniors who really knows what's going on with individual children day by day. They each see snippets and the consultants are left as the people responsible for keeping an eye on the whole of the child's hospital admission."
I know that the Royal College of Paediatrics and Child Health has conducted a survey and given the results to Ministers. I asked a parliamentary question about those results and—again, rather selectively—the answer was that Ministers were "considering" them. It would be interesting to know exactly what the Royal College of Paediatrics and Child Health said.
The parliamentary answer that I received on 4 March states:
- "In 2004–05, a further 15 locally funded NTNs will be allocated." —[Official Report, 4 March 2004; Vol. 418, c. 1117W.]
Not only is there clearly a shortage of paediatricians but the working time directive is exacerbating existing difficulties. The Royal College of Paediatrics and Child Health, the British Medical Association, and the NHS Confederation in evidence to the Select Committee on Health have all made clear their concerns over the time left to implement the working time directive, which has hit paediatrics particularly hard. It has hit smaller general hospitals hardest, and I understand that Ministers have made funds available for rural areas such as Cornwall and Lincolnshire. I am under the impression that almost £46 million has been made
available to implement the working time directive over the next three years. The Minister will be aware that I have asked his Department whether any additional funding might be made available to help the Horton general hospital. The Minister of State responded on 6 January:
- "Turning specifically to the Horton, the recently announced strategic review explicitly sees a continuing and important role for the Horton in providing a range of hospital services. A paediatric task force is meeting to develop proposals for quality sustainable paediatric services at the Horton in response to difficulties in recruiting junior doctors."
There is a further problem. The Oxford Radcliffe trust is under the misapprehension that the Horton general hospital is no longer accredited to train registrar paediatricians. That is a serious concern. It is also seriously surprising because the president of the Royal College of Paediatricians tells me that the Horton is accredited; that there is no problem; and that, moreover, he would welcome more paediatricians working at the Horton general hospital.
Why does the trust say that it cannot train paediatricians at the Horton? There can be no doubt that that assumption was formed on the basis of poor advice given to the trust by others in the NHS. By way of example, a regional adviser in the NHS wrote on 9 January 2004:
- "with . . . junior doctors hours being reduced progressively, it has been felt that the middle-grade posts currently available at the Horton Hospital are not of sufficiently high intensity for Specialist Registrar Training. My apologies to the Horton Hospital but, at present, we do not feel it is appropriate to allocate Specialist Registrar training there."
On 1 March the chief executive of the Oxford Radcliffe hospitals NHS trust wrote to me. He said that
- "the workload is not considered to be enough to provide appropriate experience to meet training requirement".
As Dr. Harvey Marcovitch explained by letter to me on 19 January:
- "the Royal College has not made any recent pronouncement re: Banbury . . . they will not be raised again formally until the next inspection, whenever that will be."
- "are enormous pressures on all hospitals at the moment because of the forthcoming Working Time Directive".
- "the decision on the level of services is one that must be taken by the Trust in the light of demand and resources available."
I understand that the Horton general hospital had its status accredited at the last inspection. That status has not changed and will not change until another inspection, whenever that may be. I had that point confirmed by the chief executive of the Royal College of Paediatricians yesterday. He said:
- "Training approval for paediatric Registrar posts at Horton General Hospital has never been sought by the relevant trust. There is, in principle, no reason why the Oxford Radcliffe Trust should not submit a training programme to the College that includes some time at the Horton. We must stress however that the current plan to reduce the level of paediatric services in Banbury is not a direct or indirect result of any ruling on the part of the College."
The chief executive of the Oxford Radcliffe hospitals NHS trust raises further concerns over the Horton general hospital not being accredited by the Royal College to take registrars. But the Oxford Radcliffe hospitals NHS trust has never asked the Royal College for such accreditation. It has not been told that it cannot train registrars, because no one has ever asked the question. There is no reason why registrars employed by the Oxford Radcliffe hospitals NHS trust should not undertake work in rotation in Oxford and Banbury at the Horton general hospital. Yet the trust tells me that it cannot even recruit paediatric doctors for the John Radcliffe, let alone for a smaller general hospital. Why? I hope that the Minister can give us an answer.
In a letter of 29 January, the president of the Royal College told me:
- "I am not too sure what the problem is at the Radcliffe hospital in terms of attracting registrars. Paediatrics is still very popular, and for regular registrars . . . there is no shortage."
However, NHS advisers are not even giving the trust the opportunity to take on paediatricians and accrediting them to the trust but rotating them to its hospitals, including Horton—something recommended by a public inquiry set up by the then Secretary of State
about 30 years ago. That opportunity has unfairly been removed from the table for no good reason. The Minister must look into what his officials are saying to one another as there is evidently a serious communication problem. If he does not do so and his officials continue to base their work on somewhat false foundations, it will seriously impede the inquiry of the taskforce into which model of paediatric services would work best for Horton hospital. It is unacceptable for NHS officials to tell NHS trusts that they are not allowed paediatricians because they do not have the relevant status when in fact they do.Not only is that manifestly unfair, but it will also put Horton general hospital at a severe disadvantage in respect of the findings of the paediatric taskforce, which will report shortly. The Minister will be aware that the taskforce is considering two ways forward for the Horton and paediatric services across Oxfordshire. The first is known as an ambulatory service, whereby I understand that Horton general hospital would provide a paediatric service from 9 am until 6 pm for five days a week. There would no longer be any paediatric beds at the Horton; patients would be seen, assessed and either treated there or sent to the John Radcliffe for more specialist treatment. In effect, there would no longer be 24-hour paediatric cover—no cover at nights and no cover at weekends.
There would inevitably be a detrimental impact on obstetrics at the Horton general hospital. At present, there is a special care baby unit and it is not clear whether it would be able to continue. There would most certainly be knock-on consequences for the accident and emergency department. It is unclear whether the A and E department would be happy to continue to give general 24-hour, seven-day-a-week cover if there were no longer any paediatric services at the Horton in the evenings, at night and at weekends. It is thus clear that the John Radcliffe would have to take on further cases from Banbury at a time when there is an acknowledged problem across Oxfordshire in recruiting trained paediatricians.
There is an alternative: more registrars. Paediatric registrars undertake a five-year training; the last three years are fairly specialist but the first two years are reasonably general. When the Horton general hospital merged with the John Radcliffe to form the Oxford Radcliffe hospitals NHS trust my understanding was that appointment would always be made to the trust, not to an individual hospital, so I see no reason why registrars based at the John Radcliffe should not also give cover and work at Horton general hospital.
However, the chief executive of the NHS trust has been advised to say that that is not possible because
- "registrars are appointed to training posts that have been allocated to a trust by the Regional Training Advisory committee"—
- "cannot include any Horton based activity because the paediatric work available at the Horton is not considered by the committee to provide adequate training".
The taskforce's terms of reference are ill balanced before it has even reported. It is receiving bad advice from the Minster's Department and has started off on false foundations. Clearly, the Minister needs to sort out the communication problems over the employment of registrars. There are two immediate problems that he must address. The first is that his Department's officials are telling the NHS trust that its registrars cannot work at Horton general hospital. But they could; the royal college says that the hospital is accredited. The Luckett report made that recommendation more than 30 years ago.
The second problem is that the Government have invested in too few new paediatricians for the whole of England and Wales. Neither Horton general hospital nor the John Radcliffe can fill their paediatric vacancies, so if paediatric services are not being provided at the Horton and they cannot be found at the John Radcliffe, where on earth in Oxfordshire will they be provided?
The answer lies in increasing the number of registrars accredited to the Oxford Radcliffe hospitals NHS trust; furthermore, the Minister's Department must stop telling the NHS trust that registrars cannot rotate between the Horton and the John Radcliffe; and, in any event, more funding must be found so that more paediatricians can be trained than the absurdly low number that the Department is funding.
The chairman and chief executive of the NHS trust and my hon. Friend the Member for Daventry (Mr. Boswell) and I will shortly meet the president of the Royal College, so I should welcome a response from the Minister on those two crucial issues. The crisis in paediatric services at Horton general hospital needs to be set against the background of other services at the hospital. If the taskforce makes a recommendation on paediatric services that is based both on inaccurate information from the Minister's Department and on inadequate funding for paediatric numbers, the loss of 24-hour, seven-day-a-week paediatric services could undermine the A and E department at the Horton.I am not confident that sufficient time has been taken to assess the likely domino effect caused by the downgrading of paediatric services. It remains, however, a real possibility, to which every GP who responded to my letter on the future of services at Horton general hospital referred. It leaves the real possibility of Ministers overseeing a situation whereby 30 years later the lessons of the Luckett tragedy are ignored.
Ministers must surely understand that local people hear that billions of pounds are being pumped into the NHS, and are somewhat confused by that when they realise that their local general hospital's children's ward is under threat. People in north Oxfordshire and south Northamptonshire want the comprehensive paediatric services that they have enjoyed for the past 30 years to continue. That is a 24-hour, seven-day a week paediatric service at Horton general hospital.
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