Banbury's Horton General Hospital is facing a double assault -
- management determined to centralise as many services as possible in Oxford, no matter the cost to Banburyshire residents
- and the government's Sustainability and Transformation Plans / Accountable Care Organisations, which are about to decimate the NHS across the country.
The Sustainability and Transformation Plans (known as STP) deserve a page all to themselves - please read it, get angry and do something about it - quickly. You'll find instructions on our dedicated STP page here.
As for the onslaught the trust continues to deliver - here's what we know.
The Oxfordshire Clinical Commissioning Group has released a paper for discussion at its Board Meeting on Thursday 29th March 2018.
The paper asks the OCCG Board/Governing Body to agree that the following services should remain, "in line with the views from OCCG Clinicians and the OUH":
The paper also asks the board to:
At face value it paints a picture of a secure future for Paediatrics and A&E at the Horton. However, Keith Strangwood, Chairman of KTHG, remarks, "The devil is in the detail. What we don't know is the extent of the commitment. How long is it for? Exclusions are hinted at - what are they?"
Retired HGH consultant Peter Fisher, interviewed today by BBC South TV and Radio Oxford, commented "We welcome (the OCCG report) as far as it goes but before we claim total victory we want to see (the proposals) accepted by the Board. In particular how they intend to proceed in terms of Obstetrics and how they will accommodate the views of the public".
Keith Strangwood emphasised "KTHG is very keen to be part of any consultation process moving forward. We represent the people of Banburyshire and all we seek is the best possible outcome for them".
The long-overdue results of the initial assessment of the Independent Reconfiguration Panel (IRP) have been announced on the downgrade of the consultant-led maternity unit at the Horton. The following is an initial response by the Keep the Horton General Committee, pending full examination of the IRP's long report.
"The Keep the Horton General Campaign Group is concerned that this falls short of key recommendations the campaign group was hoping would be made. We are examining the long IRP report and expect to be able to update supporters with an official report shortly."
Following the release of Mr Justice Mostyn's judgment, members of Keep the Horton General have been in close contact with their legal team at Leigh Day. Grateful for their advice we would like to issue the following summary:-
Mr Justice Mostyn's judgment may be found here.
A judicial review challenge to Oxfordshire CCG's decision to reconfigure services at the Horton General Hospital was heard by Mr Justice Mostyn on 6 and 7 December 2017. The challenge was brought by a group of District Councils and campaign group Keep the Horton General.
The proposed reconfiguration included the removal of obstetric services, 46 bed closures and the removal of level 3 critical care.
It was argued that the consultation was unlawful for numerous reasons, including the fact it was split into two phases where many issues dealt with in Phase 2 were interlinked with Phase 1 issues. In addition, the CCG failed to consult on the new bed closure test which was announced by Simon Stevens, Chief Executive of NHS England, on 3 March 2017.
Judgment was reserved, and Mostyn J ordered that the CCG do not take further steps in relation to the consultation or decision until judgment is handed down.
Samantha Broadfoot QC and Leon Glenister acted for Keep the Horton General.
In September 2017, a deputy High Court judge ruled that opponents of the hospital's downgrading should be allowed a full hearing into the lawfulness of the public consultation held before last month's decision to permanently close 45 beds and remove consultant-led maternity.
Campaigners (represented by Leigh Day and Landmark chambers, thanks to Banbury fundraising) hope that the hearing - part of a Judicial Review of the lawfulness of public consultation - might ultimately lead to the reinstatement of some acute services in Banbury.
Keith Strangwood, chairman of Keep the Horton General (KTHG) said Tuesday's decision was testament to team working between Cherwell, Stratford and South Northants councils, Banbury Town Council and KTHG."We hope, if the full hearing goes in our favour, the Oxfordshire Clinical Commissioning Group (OCCG) will be asked to go back to square one and consult on these horrendous downgrading plans in a single exercise. That will be a mirror image of the fight in 2007-8 and they lost that because taking acute services to Oxford is too far for patient safety."
Mr Justice Fraser, at the Royal Courts of Justice on Tuesday, said the hearing should be given priority for an early date, before the end of the year, because of the seriousness of the case. It would also take place before the OCCG presents its controversial second phase of the Oxfordshire Transformation Plan which involves planned changes to A&E and the 24-hour children's ward.
The councils' and KTHG's legal teams expressed serious concerns about the consultation. The judge agreed it was arguable that the consultation process was flawed and it must go forward to a full hearing quickly. The move allows the councils and KTHG to make a formal challenge to the consultation.
The councils and KTHG argued that the consultation was unlawful and unfair because it split phase one, dealing with maternity and bed closures from others, dealing with A&E and paediatrics - that the split timing is illogical and would heavily influence the outcome of phase two which has not started.
If it is found the consultation in phase one was defective and should be run again, it makes sense to be done before phase two.
Having the case expedited moves the Horton case up the queue, allowing it to be heard within months rather than up to a year in the busy administrative courts.
It is with sadness, but no great surprise, that we confirm the result of the Oxfordshire Clinical Commissioning Group's meeting, held 10 August 2017, in Oxford.
During the meeting, the OCCG board members voted to support the following proposals from the consultation:
What happens now?
As voted on Monday, the Joint Health Overview and Scrutiny Committee will refer the maternity decision to the Secretary of State for Health, but this position being held by Jeremy Hunt, we caution against too much optimism.
Five local councils and the Keep the Horton General campaign continue to consult with legal representatives regarding the possibility of further action.
Campaigners, politicians and clergy were united in a last-ditch plea to Oxfordshire's Health Overview and Scrutiny Committee (HOSC) at their meeting on 7 August 2017.
Almost 20 people, including KTHG campaigners and Banbury MP Victoria Prentis, spoke of their concerns over phase one of the Oxfordshire plans, which includes the permanent downgrading of the Maternity services at the Horton General Hospital, the reduction in the Critical Care level at the Horton from 3 to 2 and acceptance of the closure of 146 acute beds which have already been removed across the county.
Had HOSC voted to refer the entire plan, the Secretary of State for Health might have been able to step in and stop the permanent downgrade at the Horton. However HOSC committee members voted unanimously to approve the reduction in bed numbers and the reduction in Critical Care to level 2, subject to certain conditions and caveats. HOSC committee members said they would refer the Maternity decision to the Secretary of State if the Oxfordshire Clinical Commissioning Group decide to approve the permanent downgrade plans at their meeting this Thursday when the First Consultation will be finalised.
Disappointed campaigners from Keep the Horton General and Keep Our NHS Public said HOSC's decision was a 'watered-down threat' and they had hoped for them to refer the whole of the STP to the Secretary of State for Health.
On 21 February 2017, members of Oxfordshire County Council's cabinet accepted recommendations to reject the Oxfordshire Transformation Plan - which feeds into the controversial regional Sustainability and Transformation Plan (STP) - in its current form.
They said it was impossible to consider proposals to permanently end consultant-led maternity and close scores of hospital beds because the splitting of the consultation meant the knock-on effects would not be highlighted until the second phase in the autumn. This information would be necessary for the county council to gauge what the impact would be on council services.
On 2 February 2017, the influential Health Overview & Scrutiny Committee voted to refer the temporary closure of Consultant Led Maternity at the Horton to the Secretary of State for Health, Jeremy Hunt.
Hunt has previously confirmed on BBC South Today that he would pass the case to the Independent Reconfiguration Panel (IRP) if HOSC referred it to him. HOSC's decision should therefore ensure that the case is reviewed the same body of independent experts who saved services at the Horton General Hospital back in 2008.
In 2008, the Independent Reconfiguration Panel ruled that the journey from Banbury to Oxford was too far for a woman in labour, and extremely unwell adults and children to undertake.
Originally expected to begin in May, public consultation on the loss of the Horton's consultant-led maternity unit, medical beds, trauma, paediatrics and A&E will now begin on Monday 16th January. A Banbury public meeting is to be held on Thursday, January 26 but the Oxfordshire Clinical Commissioning Group has not yet confirmed a venue. Sign up to our mailing list to receive details when we know more, by emailing firstname.lastname@example.org
This is because they continue to fail to recruit enough doctors.
Oak Ward closed on 7 October 2016. Oak Ward delivered acute general medicine services to mainly elderly patients. The Health Overview & Scrutiny Committee was highly critical of the decision which the trust had sought to slip through claiming it wasn't a big enough change to warrant consultation. HOSC disagreed, and a consultation will now be started by January 2017.
Consultant-led maternity closed its doors on 3 October 2016, replaced by a midwife-led unit staffed by just one midwife, one care assistant and an ambulance stationed outside. The trust say the closure is temporary, although the resignations of staff, removal of equipment and conversion of rooms into offices suggest otherwise, as does the trust's continued lacklustre attempts at recruitment. HOSC and KTHG are watching closely.
At a board meeting on 31 August 2016, the board of the Oxford University Hospitals NHS Foundation Trust (OUHFT) decided to temporarily suspend Consultant led Maternity Services at Horton General Hospital in Banbury from 3 October 2016. A midwife-led service will operate instead. Campaigners have vowed to keep up the fight.
A meeting was held at the Horton General Hospital on the morning of Friday 3rd June 2016 to inform staff about the Trust's future plans for Banbury's consultant-led maternity unit.
The Trust claims the existing situation is unviable, and is proposing alternative solutions that would reduce the service to a midwife-led unit (i.e. no consultant support available on-site), with the loss of the Special Care Baby Unit and in all probability loss of the 24/7 Children's Ward.
It's only eight years since the Independent Reconfiguration Panel decreed that 28 miles / 1.5 hours in traffic was too far to travel, and that all these services must stay in Banbury in order to provide 150,000 people (and growing) with a safe, fair and accessible service.
On 20 July, Trust representatives informed a meeting that due to 'three clinical fellows resigning' the Horton General Hospital's obstetric service (doctor-led maternity) would not be safe from the first week of September onwards. They are now drawing up a contingency plan. Allegedly a recruitment drive has been unsuccessful, although the Trust representative when questioned, could not remember where the posts had been advertised.
Desperate interim measures include converting offices to maternity wards at the JR.
Meanwhile, local GPs from Bloxham Surgery and Hook Norton Surgery, Chipping Norton Surgery, Cropredy Surgery, Deddington Surgery, Fenny Compton & Shenington Surgery, Hightown Surgery, Horsefair and Middleton Cheney Surgery, Shipston Medical Centre, Sibford Surgery, West Bar Surgery, Windrush Surgery, Woodlands Surgery and Wychwood Surgery joined together in writing a letter of strong opposition to the trust's proposals. In their letter they state that they are "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."
Further condemnation came from Banbury MP Victoria Prentis and in a joint statement by all the political parties in the Banbury constituency. This is of course in addition to the widespread anger within the local community that has seen membership of our facebook group grow from 4,000 to 14,000 supporters, and was evidenced at Banbury's biggest ever public protest, 2016's "Hands Around the Horton" in which 5,000 people joined hands in a symbolic circle of protection around the Horton General Hospital.
Shortly after the maternity meeting on 3 June 2016, the OUHFT presented their "emerging options" for the Horton General Hospital at the public session of the Community Partnership Network (CPN).The OUHFT said all options will need to be assessed for activity, workforce, finance and estates and there will be a full consultation in October 2016.
The options were as follows:
Option 1 is what we currently have at the Horton General Hospital. It was initially presented to the CPN, and to the midwives on 3 June, as the "status quo" but more recently (perhaps as a result of unwanted publicity?) it has been honoured as an Option. Option 1, the status quo, is what the experts in the form of the IRP decreed we must have, at the end of the last campaign in 2007/8.
Andrew Stevens, OUHFT Director of Planning & Information, said "Option 1 is the status quo but if we thought that was adequate..... we would not be doing this exercise".
So let's look at Options 2 and 3, which the OUHFT believe to be the only real options.
Under Option 2, Banbury's Horton General Hospital would:
Lose A&E - downgraded to GP urgent care and Minor Injuries Unit
Lose Acute Stroke and Rehab - downgraded to Rehab and Early Supported Discharge
Surgery (elective day cases) - would be limited to 8am to 3pm
Lose Surgery - elective inpatients
Lose elective orthopaedic inpatients
Medicine - elective day cases - would be limited to 8am - 3pm
Lose Medicine - elective inpatients
Medicine - non-elective inpatients - inpatient ward would be downgraded to frail assessment unit
Lose Critical adult care (C