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Access to NHS Services

Geography is not convenient: the Horton general hospital in my constituency serves a large part of north and west Oxfordshire, south Warwickshire and south Northamptonshire. It has been a general hospital for more than 100 years, but it is now facing the prospect of a serious downgrading of hospital services, including the removal of 24/7 paediatric care. That level of paediatric care at Horton came about because of the death of a child. In 1974, Barbara Castle, then Secretary of State for Health, ordered an independent public inquiry, which ruled that there should be 24/7 paediatric care at the Horton. As a consequence of losing that care, we have the prospect of losing the special care baby unit and consultant-led obstetric and midwife maternity services. When the Oxford Radcliffe NHS trust made those proposals, 86 GPs made a joint statement saying that they were unsafe and inhumane. As a consequence, the trust took its proposals off the table and set up two clinical working groups, which—slightly bizarrely—met and worked in secret. Many of us thought that their purpose was to wear down GP opposition to the proposals. Indeed, several GPs now say that while they are very unhappy about what is proposed, they consider it to be—and we should take note of this sentence’s construction—the least worst option. I do not want an NHS in my constituency that is the least worst option. Nor do I believe that Ministers want that. The trust also set up a stakeholders’ group, with many members, including Labour councillors Surinder Dhesi, George Parish and Dr. Peter Fisher, who for many years was a consultant physician at the Horton and a Labour county councillor. The group has published a unanimous report, a bit like a Select Committee report, in which it expresses concerns. It says that"““health services must be designed in the best interests of patients and education and training should support that objective. Instead in Oxfordshire and other parts of England educational concerns are leading decisions about the pattern of healthcare with patient needs coming second. The position in maternity services is particularly acute as we understand that many more units across the country may be threatened by these changes to medical education and working hours.””" The group request that the trust"““raise this matter at a national level””." I am glad that I have the opportunity to do so in the House today. The group’s document also states that"““instead of being asked to consider a positive vision for the future we have found ourselves being asked to choose between the lesser of two evils—on the one hand there are the clinical risks inherent in the current service arrangements; on the other there are the proposals that by addressing the clinical risk will worsen access to services for local people. Both ‘evils’ are being driven by national policy changes which should be challenged…None of us believe that they””—" the changes—"““are desirable.””" I have two questions for Ministers. First, how are any of us to explain to people that a substantial downgrading of NHS services is an improvement? I would welcome any Minister who wished to come to Banbury for a rational debate—this is not a partisan issue. As I say, the chair of the ““Keep the Horton General”” campaign is a Labour district councillor and the campaign has broad support across the community. How can we explain that we are going back to pre-Barbara Castle days and that that is in some way an improvement? My second question is what will Ministers do to protect smaller general hospitals, or are they content to see them downgraded? The stakeholder group concluded:"““The proposals that the clinical working groups have put forward may be a ‘least worst’ scenario but they represent a significant downgrading of access to services and a worsening of choice for women and children in the Banbury area.””" I cannot imagine that Ministers or anyone want to see a downgrading of access to the NHS for women and children. Why Ministers should be concerned is because the Oxford Radcliffe trust seemed to suggest that the Royal College of Obstetricians and Gynaecologists suggested that a maternity unit is not viable unless it had 2,500 births a year. The group points out that the college’s document, ““Safer Childbirth: Minimum Standards for Service Provision and Care in Labour””, published in November 2006, actually says that units such as the Horton with fewer than 2,500 births should"““continually review staffing to ensure it is adequate based on local needs””." The group comments:"““This does not seem to be saying that 2,500 is the minimum figure for births in an obstetric-led unit. Rather it seems to suggest that fewer hours consultant support would be required for this number of babies and that staffing levels should be determined locally.””" I would hope that Ministers would feel able to try to work out how health care provision in smaller general hospitals can be protected. Sir Ian Kennedy, the chairman of the Healthcare Commission, in a recent speech, observed that"““it is terribly important that services and particularly maternity services, in the light of recent proposals from government and professional groups, keep their eye on the ball of safety as they go through the forthcoming period of change and development.””" I do not believe that making expectant mothers travel 26 miles, or more than an hour, to Oxford will necessarily enhance safety. So I hope that Ministers will hear what I have said and accept that it was not intended to be a partisan speech. Instead, I was making a genuine plea that they get a grip on what is happening in the NHS. They need to find ways to protect the services provided by smaller general hospitals, because people do not accept that the substantial downgrading of services in NHS hospitals is a way to improve the health service.