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10 Oct 2007 : Column 101WH—continued

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 Government’s proposals for downgrading general hospitals in London and replacing them with polyclinics have been
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attacked by the British Medical Association. Dr. Hamish Meldrum, the BMA council chairman, recently observed that costly, unproven polyclinics could lead to

Ministers would do well to reread Lord Darzi’s 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:

Lord Darzi clearly has not considered the Oxford Radcliffe Hospitals NHS Trust’s proposals for the Horton.

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 possible—like 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 Government’s 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
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general practitioners therefore feel that they are being marginalised in the Government’s 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 establishment’s 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 trust’s own figures—putting its own best case—it 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 baby’s 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 baby’s head from being delivered.

In future, such a mother in those circumstances would have to be put in an ambulance and sent on an hour’s 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:

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
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(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 Banbury—we must bear it in mind that the Government set up such forums to be the voice for patients and the public—he could not be bothered to reply. Instead, a letter from an official in the Department’s events and visits unit wrote saying:

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:

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
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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 opinion—and 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 Minister—was on the Bill Heine show on BBC Radio Oxford describing the Horton as “a small cottage hospital”. The Government’s 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 children’s 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 boy’s 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 children’s 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 weekends—bar about three hours on Sundays—there will no longer be any consultant-led children’s 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 wards—Ruscote, 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.

An indication of the trust’s desperation is that in its most recent proposed service reconfiguration, it announced:

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?
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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 trust’s 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:

On paediatrics, the GPs observed that much of their discussions

The GPs described the proposals for maternity services as inhumane, and said:

The GPs continued:

There would be no accident and emergency department. The GPs concluded:

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 Horton’s 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
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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 means—how 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:

Senior local GPs are still making it clear that they believe that local mortality rates will rise and that delays in treatment will result in death and disability as a consequence of the changes.

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 hour’s 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:

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 Government’s 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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The Minister wrote a letter to me in anticipation of this debate. It states that

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