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LOCAL MP SAYS TRUST PROPOSALS MAY GO TO RECONFIGURATION PANEL

Tony Baldry (Banbury) (Con): I congratulate the hon. Member for St. Ives (Andrew George) on introducing the debate, and my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) on the birth of his child—although I hope that someone has explained to him that babies grow into teenagers. That has been my experience.

As the hon. Member for Stroud (Mr. Drew) said, what is important in the debate is choice. The Secretary of State says that as a consequence of “Maternity Matters”, every mother will have the choice of a home delivery or delivery in a midwife-led unit or a consultant-led unit. Although that sounds very good, behind it there will be the potential for considerable downgrading of services in various parts of the country.

The Horton general hospital in Banbury has served for more than a century a significant area of the United Kingdom—north Oxfordshire, south Northamptonshire and south Warwickshire. We have for a long time—decades, centuries, generations—had a consultant-led unit at the Horton, but that is now threatened with being downgraded to a midwife-led unit. We already have an excellent midwife-led unit at Chipping Norton hospital. Any mother who wants a midwife-led birth can go there.

When the proposals were made, local GPs responded as part of the consultation to the Oxford Radcliffe Hospitals NHS Trust. I think that what they said is worth repeating:

“We remain opposed to the proposals on the grounds of safety, sustainability and the reduction in access to basic health care and choice for our patients, which will affect especially the most vulnerable.”

They continued by discussing maternity services specifically:
“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.”

That is a strong word. Their submission continues:

“There would be an increase in the burden of responsibility on midwives and ambulance crews. Legal claims”— the comments of the hon. Member for Stroud are relevant here— “following incidents where there was harm to the mother or baby might be very costly to settle. 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.”

The submission states:

“We submit the opinion of Professor James Drife who wrote in the BMJ...about the shortfalls of midwife led units...It accords with recent publications by NICE on the safety of such units”

and adds:

“We are not reassured and maintain that a midwife led unit with a delivery rate of 450+ per annum, which is 25 miles away from the nearest obstetrician and paediatrician, is not safe. Through no fault of the midwives working in such a unit, GPs would have to consider the wisdom of recommending mothers to this service, numbers would drop further and the service soon become non viable”.

It continues:

“A midwife led maternity unit, possibly lacking the confidence of local GPs, may well wither. Kidderminster had to close its unit due to excessive neonatal mortality (6 avoidable deaths in under 2 years). Increasing concern about such units is being expressed by RCOG and NICE.”

RCOG is the Royal College of Obstetricians and Gynaecologists. The GPs’ submission continues:

The existing serious congestion at peak times and lack of parking facilities at the JRH site will be worsened by 1,000 to 1,600 extra deliveries per year. All emergency surgery and major gynaecology currently managed in North Oxfordshire will need to be absorbed by the JRH as will all paediatric cases requiring overnight assessment or admission.”

The GPs said:

“We conclude that the current proposals...will result in services which are unsafe and unsustainable into the future” and “are not in the best interest of our patients who will be faced with serious obstacles in both accessing services and visiting sick children or relatives. The most vulnerable will be hardest hit.”

They believe that the proposals “will increase demands on the ambulance services and its crews and on already overstretched departments at the JRH...will have onsequences both in medico-legal and human terms that are far reaching and expensive... adhere to an outmoded model of centralisation that ignores more modern trends to bring services closer to patients...ignore the clear recommendations of the Davidson Inquiry and the prerequisites of the agreement to merge into a single trust”and that they “are overly influenced by a small group of medical specialists in Oxford who have plans for centralisation that ignore the expressed and documented needs of this community.”

The GPs end their submission:

“These proposals offer neither a better deal for children nor security for a range of other services vital to our local community”.

Those views were in a document signed by 85 local family GPs from north Oxfordshire, south Northamptonshire and south Warwickshire. As a consequence, not surprisingly, the trust took its proposals off the table and set up two clinically led working parties on paediatrics and children’s services to see whether they could find an approach that GPs would find acceptable. They are still deliberating.

I have one concern and one question to put to the Minister in that respect. I can see no justification for keeping the membership of the working parties confidential. I understand why they might want to deliberate in private; however, I walk into the Court of Appeal every day, where the lords justices of appeal deliberate in private, but I know who they are and they are accountable. It cannot be right, as a matter of public policy, that clinicians should decide whether their participation in the working parties should be made a matter of public record. It undermines confidence in the system and the process if my constituents are told that they cannot know the membership of the bodies that will determine the future of services at their general hospital.

At the end of the process the working parties will, I imagine, make proposals, which will vary to some extent from those that were originally on the table. GPs will have to decide whether they think the amendments make the changes safe. They consider the existing proposals unsafe and inhumane. Unless there is overwhelming support from GPs for the changes, given their total opposition to the changes to date and given that the Horton will no longer have consultant-led midwifery services, I want to ask that, if in those circumstances the matter is referred to the Department, the Secretary of State look favourably on the idea of the proposals being considered by the independent reconfiguration panel.

I share the concern that was put to me by a GP, who said that he and his colleagues felt constantly worn down by academic professional pressure to accept as the least worst option something that they were not happy with but thought they would end up with. GPs have been put in an intolerable position in all of this, and I still have a very unhappy impression of the situation. We want to continue to have a general hospital in Banbury that provides the full range of services of a general hospital, including consultant-led midwifery.

Taking away the consultant-led unit from the huge catchment area that has had such a unit for as long as anyone can remember because there is a midwife-led unit down the road, or another consultant-led unit an hour away, does not enhance choice, but undermines it. It means that there is a worse service, and nothing that the Minister or anyone else does will persuade my constituents that a service that they see as worse than the present one is an improvement to the NHS. If the Minister believes otherwise, he is welcome to come to Banbury at any time and meet people from the “Keep the Horton General” campaign, which has been ably led by George Parish, a local Labour councillor. I do not believe that it is possible to get that message across because people realise when their services are being downgraded, and services are being downgraded in Banbury.