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The days of the district general hospital...are over.
Indeed, he went on to say in that interview that in the not too distant future there will be far fewer general hospitals in London, and that many of them would be replaced by what he described as polyclinics. Ministers have doubtless seen that the Governments proposals for downgrading general hospitals in London and replacing them with polyclinics have been
attacked by the British Medical Association. Dr. Hamish Meldrum, the BMA council chairman, recently observed that costly, unproven polyclinics could lead to
a damaging fragmentation of care.
Ministers would do well to reread Lord Darzis report, Health care for London. On page 26, he compares productivity in various types of hospital. He concludes that the best results outside London are achieved by small general hospitals. On page 49, in discussing the proposals for more midwife-led care, Lord Darzi states:
Prompt transfers are vitalthe Royal College of Obstetricians and Gynaecologists recommends that such transfers should ideally take fifteen to twenty minutes.
It is not just in London that the Government are presiding over a damaging fragmentation of care of hospital NHS services, but in the rest of the country. Some 25 to 30 general hospitals in England are threatened by substantial downgrading, through which maternity services and accident and emergency services could close, or combinations of various services could be downgraded or closed. If such changes go ahead, hospitals will no longer be general hospitals but simply a collection of medical services.
Mr. Tim Boswell (Daventry) (Con): On maternity services, does my hon. Friend and constituency neighbour agree that there is little chance indeed of making the journey with a complicated obstetric case from Banbury to the John Radcliffe in less than 40 minutes, even with the bells down and no traffic? Does he also agree that there is a wide rural hinterland in both our constituencies, from which transfers would be even farther and even more critically dangerous?
Tony Baldry: I entirely agree with my hon. Friend. We know the geography of north Oxfordshire. I was amazed today to discover that the Oxford Radcliffe trust had told Radio Oxford that it thought that a journey could be made in 30 minutes. I challenge the trust to organise a trial any time that it wants; I would happily take part. It is inconceivable that it could demonstrate to the local newspapers that it is possible to get from Banbury to Oxford in 30 minutes, even with a blue light. Everyone who lives in north Oxfordshire knows that that is just not possiblelike so many other things, it is just totally aspirational.
As the Minister will doubtless observe, some changes have the support of some parts of the medical establishment, but that is very much a consequence of the Governments substantially reducing the amount of time that junior doctors will spend in training. We are rapidly moving to a training-led NHS, rather than a patient-led NHS.
Dr. Andrew Murrison (Westbury) (Con):
Does my hon. Friend share my dismay regarding the advisers whom the Government have chosen to take forward their proposals on the NHS? It is hardly surprising that the review is going in the direction that it is, with a focus on tertiary centres, as the advisers are Lord Darzi, Roger Boyle and George Alberti. Excellent though they are, they have no experience of primary or intermediate health care, and it is hardly surprising that
general practitioners therefore feel that they are being marginalised in the Governments plans, almost exclusively in the interests of highly specialist and tertiary centres.
Tony Baldry: I entirely agree with my hon. Friend. As I shall show the House, GPs feel that they are being not only marginalised but patronised as a result of the way in which the changes are taking place.
The medical establishments attitude, to which my hon. Friend the Member for Westbury (Dr. Murrison) just referred, was effectively demonstrated by the dean for medical training in the Thames valley, who gave evidence to the health overview and scrutiny committee on the proposed downgrading at the Horton hospital. The dean was asked by the committee why it would not be possible to send doctors who are in training on rotation from the John Radcliffe in Oxford to the Horton in Banbury. After all, both hospitals are in the same NHS hospital trust. The dean responded to the effect that it would be unreasonable to expect junior doctors to travel the 26 miles from Oxford to Banbury. I believe that the dean was somewhat surprised by the wry laughter around the council chamber in which the meeting took place. Everyone said, Hang on a moment, the Oxford Radcliffe NHS trust is expecting huge numbers of patients and their families, sick children, concerned parents and mothers in labour to make the 26-mile journey from Banbury to Oxford.
Indeed, on the trusts own figuresputting its own best caseit is expecting as a consequence of its changes that hundreds of mothers in labour will have to be transferred from the Horton to the John Radcliffe. I am thinking of mothers such as my constituent Alison Bentley, who enjoyed a trouble-free pregnancy, but whose babys cord dropped beneath the neck during delivery. To prevent brain damage to the baby or death by oxygen starvation, Mrs. Bentley had to be placed on all fours while a midwife physically prevented the babys head from being delivered.
In future, such a mother in those circumstances would have to be put in an ambulance and sent on an hours journey to Oxford, so it is not surprising that the Royal College of Midwives is vigorously opposing the removal of consultant-led obstetric services at the Horton. It is not surprising that Judy Slessar, the regional organiser of the RCM, recently observed:
The RCM does not consider the Oxford Radcliffe Hospitals Trust has provided a strong enough argument to transfer services to Oxford.
What the Government are presiding over is a fragmentation of NHS hospital services. My straightforward question to the Minister is, how do the Government explain to my constituents and the constituents of many parliamentary colleagues how a comprehensive downgrading of services at the Horton in Banbury is in any way an improvement in NHS services for the hundreds of thousands of people from Oxfordshire, Warwickshire and Northamptonshire who look to it as their local general hospital? Of course, perhaps it would help Ministers to answer that question if they could be bothered to come to Banbury, or at least to understand that the Horton is a general hospital. I am glad to say that my hon. Friend the Member for South Cambridgeshire
(Mr. Lansley), the shadow Secretary of State for Health, has taken the time and trouble to come to Banbury to talk to those who are concerned about the future of the Horton, as have my hon. Friends the Members for Eddisbury (Mr. O'Brien), and for Guildford (Anne Milton), who has recently joined the Conservative shadow health team.
When the chair of the Oxford Radcliffe patient and public involvement forum wrote to the Secretary of State specifically inviting him to Banburywe must bear it in mind that the Government set up such forums to be the voice for patients and the publiche could not be bothered to reply. Instead, a letter from an official in the Departments events and visits unit wrote saying:
Regrettably due to heavy diary and Ministerial commitments the Secretary of State is unable to accept your invitation.
That is civil service-speak for saying that the Secretary of State could not be bothered to come to Banbury. Perhaps he did not want to face up to the local PPIF, which expressed on the record considerable concern at the lack of proper consultation by the trust. Jacqueline Pearce-Jervis, the chair of the forum, observed in a letter to me:
The truth is, as we all know, consultation has been minimal...the public are telling us that no attempt whatsoever has been made to talk to young mothers or, older people.
Peter Bottomley (Worthing, West) (Con): The Minister might like to invite the ambulance services to a party for all paramedics who have delivered babies before they could get the mothers to hospital, and then consider how many more would have to be invited if every maternity unit led by consultants in England were closed down.
Tony Baldry: I entirely agree with my hon. Friend, and with his early-day motion about births on the road. We are getting into a crazy situation in which our constituents must contemplate whether they will have their babies in a hospital or in an ambulance somewhere between their home and a hospital.
Mr. Andrew Turner (Isle of Wight) (Con): We on the Isle of Wight are lucky that we kept one district general hospital open. Low levels of maternity were observed following the threat to the island, yet we kept the hospital open. On the mainland, smaller hospitals have closed or are threatened, at least partly by the EU working directive. Does my hon. Friend agree that it is an unnecessary directive that adds to the problems faced by general hospitals?
Tony Baldry: Yes, but the Government must explain how, when every other country in the European Union is covered by the same directive, France, Germany, Belgium and Holland still manage to have consultant-led maternity units substantially smaller than those here, and are not setting an arbitrary figure for a minimum size for consultant-led midwife units.
Mr. Nigel Waterson (Eastbourne) (Con):
Is my hon. Friend aware that in my area, despite overwhelming opposition from local people and all GPs bar one, who happens to work for the primary care trust, to proposals to downgrade maternity, those proposals are being proceeded with and the EU working time
directive is often being quoted? Is my hon. Friend aware that, as I understand it, the Government would be well within their rights to apply for a derogation from that directive, at least until 2012, but have not lifted a finger to do so?
Tony Baldry: My hon. Friend makes two good points. First, the Government have made absolutely no attempt to obtain a derogation from the European working time directive. Secondly, Ministers say that reconfiguration of local services is a matter for local medical opinionand then completely ignore the views of local general practitioners as though they simply do not exist.
Against that background of ministerial indifference and poor consultation, it is perhaps not surprising that as recently as a couple of weeks ago, during the Labour party conference, the hon. Member for Exeter (Mr. Bradshaw)another Health Ministerwas on the Bill Heine show on BBC Radio Oxford describing the Horton as a small cottage hospital. The Governments intention may be that it becomes a small cottage hospital, but it has for many years been a general hospital, and everyone locally is determined to do everything possible to keep the Horton general.
I am conscious that a number of colleagues understandably wish to contribute to this debate, and I suspect that one and half hours is far too short to do justice to the importance of the issues. I want to focus briefly on the proposed changes to services at the Horton.
At the moment, the Horton has a 24/7 consultant-led childrens service to look after sick children. That came about following the tragic death of a little boy in the 1970s because, at the time, the Horton did not have the necessary facilities. That little boys death demonstrated that for a sick child, Oxford is often simply and tragically just too far away. Following his death, Barbara Castle set up a statutory public inquiry, which directed that there should be 24/7 childrens services at the Horton. What is now being proposed will take us back 40 years. What is now being proposed is that no sick child will be admitted as a patient to the Horton, and during evenings and weekendsbar about three hours on Sundaysthere will no longer be any consultant-led childrens services at the Horton.
That will present every GP and every parent with a considerable conundrum: if they have a sick child, do they take their child to the Horton, which is nearby but might not be able to treat the sick child, or do they start the journey to Oxford? Ministers who are too busy to visit Banbury will probably not know that it contains three wardsRuscote, Grimsbury and Neithrop with some of the highest social needs in south-east England, and many people who simply do not have access to a car, so for them, getting a sick child to Oxford will be something of a nightmare.
Transition arrangements should include an education programme to advise parents and the public about the new service and what to do with a sick child out of hours.
Will my constituents and those of neighbouring Members of Parliament be expected to recognise illnesses such as meningitis? How do the Government explain to local parents that the removal of those services is in some way an improvement in the NHS?
Without 24/7 consultant-led paediatrics, there can no longer be a special care baby unit, and the trust is also proposing that the Horton will no longer have a consultant-led maternity unit, but that it will become the largest midwife-led maternity unit in the country.
Ministers make much play of the fact that the reconfiguration of medical services should be informed by local medical opinion. When the trusts proposals were first promulgated, they were met with an excoriating response from the north Oxfordshire and south Northamptonshire general practitioner forum, with some 86 GPs supporting a joint submission in which they said:
We remain opposed to the proposals on the grounds of safety, sustainability and the reduction of access to basic health care and choice for our patients, which will affect especially the most vulnerable. We have little confidence in the process of consultation and the spirit in which it was conducted.
with the Oxford Consultants are centred around our genuine concerns about safetywe have highlighted these areas to them in a detailed and specific way. Their response has been a reactive and a rather inadequate sticking plaster approach which would seem to confirm the fundamentally flawed nature of the proposed model in the first place. It would seem quite inappropriate to take forward such a flawed proposal.
Under the proposed model mothers who may fail to progress, or show signs of foetal distress in the second stage of labour, or who have prolapsed cord or haemorrhage would require very rapid transfer to Oxford. Given the numbers involved this would carry significant risk and would be inhumane...babies born in need of immediate resuscitation would incur a transit time of approximately one hour. The idea that paediatric cover could be provided safely from Oxford in these circumstances is false and dangerous.
Without 24 hour paediatric cover locally, the A&E Department could not continue to accept paediatric emergencies. If proposals to remove local emergency surgical services are carried through, it will also lack surgical cover for acutely ill surgical patients. The domino effect would lead to the result of downgrading to a minor injuries unit in the mid to longer term.
We believe that these proposals and the tenor of discussions relating to them pose a risk to the overall integrity and sustainability of the Horton as a General Hospital. They undermine the morale of its staff and impact adversely on recruitment and retention of high quality personnel. Far from creating excellence in health care...they betray a lack of will, vision and imagination and consequently degrade it.
Clearly, it was impossible for the trust to assert that it was introducing service changes at the Horton hospital on the grounds of safety, when every GP whose patients were within the Hortons catchment area described the proposals as unsafe and inhumane. The trust took the original proposals off the table, ceased the consultation and established two clinical working parties. Somewhat bizarrely, it refused to disclose the names and professional qualifications of any of the members of the two working parties, which somewhat undermined any confidence in the integrity of their work. The changes consequent on the work done by the clinical working parties were fairly cosmetic, and if the clinical working parties were an
exercise intended to persuade local GPs of the need for downgrading services, they failed.
Giving evidence to the health overview and scrutiny committee, Dr. Richard Lehman and Dr. Emma Haskew, representing the local GP forum, reported that they had carried out a further survey of the original 86 GPs. Some 56 remained clearly opposed to changes and they could find only three who supported them, and that was on the basis that they were the least worst option. I am not sure what that phrase meanshow does the least worst option differ from the worst option? I do not want NHS hospital services for my constituents to be provided on the basis that they are the least worst option. The present views of local GPs on the changes were well summarised in a recent letter from Charles Perrott, the lead partner of the health centre in Brackley, which is in the constituency of my hon. Friend the Member for Daventry (Mr. Boswell). It states:
Many of us have seen cases where delays in treatment would have resulted in death or disability had the Horton hospital not been available...It is true that for specialised conditions the outcomes in the specialist centres are better, but one has to be able to get to the hospital first. The overall population-based mortality rates (as opposed to hospital mortality rates) will rise if frontier hospitals such as the Horton General are not able to provide the full range of general services such as paediatrics and obstetrics.
Another group that the trust must persuade about the wisdom of the changes is the midwives at the Horton. After all, they will go from working in a consultant-led unit to working in the largest midwife-led unit in the country. That unit will be 26 miles and approximately one hours ambulance journey away from the nearest consultant obstetrician. The midwives at the Horton have made their views clear. The Banbury branch of the Royal College of Midwives, in a letter to the Banbury Guardian, stated:
The branch wishes to make it clear that the majority of its midwife members have expressed their support for maintaining the full range of maternity and paediatric services at the Horton. The current service provides true choice for the benefit of women, their babies and families...The branch notes an article of August 30 which quotes comments made by the clinical working group that the proposals were the safest option...The branch does not consider the changes to be the safest option when compared with the present service. Over the past few weeks, it has been made clear through the Banbury Guardian by local women of the wide variety of situations that have been dealt with successfully by the Horton and that they wish the full coverage of the current service to continue.
Since then, articles such as that by Professor James Drife in the British Medical Journal have been published. He is a specialist in obstetrics and gynaecology at Leeds university, and he has made it clear that the lives of women and babies will be put at risk under the Governments plans to encourage births at midwife-led units. I am sure that the Minister has noted that Professor Drife observed in his article that thousands of women may need to be rushed to hospitals from such units if complications arise that put the lives of mother and child at risk.
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