I am grateful to Mr Speaker for allowing this debate on the future of services at the Horton general hospital in Banbury. This continues to be one of the most important constituency campaigns in which I have been involved during my time as a Member of Parliament. I am pleased to see in their places my constituency neighbours and hon. Friends the Members for South Northamptonshire (Andrea Leadsom) and for Stratford-on-Avon (Nadhim Zahawi). Their presence in the Chamber makes the point that the Horton general hospital's catchment area, which is home to some 190,000 people, reaches well into Northamptonshire and Warwickshire.
The Horton general hospital also provides services for a significant part of Oxfordshire, including a sizeable part of the constituency of my right hon. Friend the Prime Minister. I am also grateful for the support of my hon. Friends the Members for Henley (John Howell) and for Oxford West and Abingdon (Nicola Blackwood), who, as usual, show great Oxfordshire solidarity on such important issues.
I am also pleased to see the Minister of State, Department of Health, my hon. Friend Mr Burns, at the Dispatch Box, as he has taken particular trouble to ensure that he is briefed to respond to what I will say in this evening's debate.
On Monday, the board of the Oxford Radcliffe Hospitals NHS Trust met in public in Banbury. Its meeting had only one agenda item: the Horton general hospital, to agree a vision for the hospital and proposals for the enhancement of services at the Horton. The ORH Trust board agreed to implement proposals made by the Oxfordshire primary care trust that would ensure 24/7 consultant-delivered children's services, a 24/7 special care baby unit and a significant enhancement of consultant-led maternity and obstetric services at the Horton and the employment of further consultant anaesthetists for the hospital-all of which will also enhance the robustness of the accident and emergency service.
The chair of the ORH Trust, Dame Fiona Caldicott, and the trust board's paper made it very clear that
"the vast majority of care required by the people of Banbury and the neighbouring communities will be delivered from an innovative and modern local District General Hospital working closely with primary care and other health and social partners."
They made it clear that
"the strategy of the Horton General Hospital must exploit the very real strengths of the Horton to develop innovative ways of providing care in order to address the present challenges within a very difficult financial environment" and that
"the objective will be to advance the opportunity to use the Horton General Hospital as the basis of a newer model for providing care where there is greater integration between services provided in a hospital setting and community based services while maintaining the appropriate level of immediate/emergency service support needed by the population."
A strategy is needed that exploits the strengths of "Banburyshire", as there is a general recognition that the area served by the Horton benefits from some unique strengths that must be fully exploited. In its vision for the future of the Horton hospital, the Oxford Radcliffe Hospitals NHS Trust has noted that
"the Horton is in a similar position to many other small District General Hospitals across the country. It should be an objective of the strategy to articulate a vision that will position the Horton as a national exemplar of how the challenges faced by such hospitals can be addressed in a positive and effective manner."
Of course, as has been recognised by everyone involved with the Horton general hospital in recent years, if it is to aspire to be a national exemplar, its services will need continuously to change if they are to continue to meet in a clinically and financially sustainable manner the evolving health needs of the populations of Oxfordshire, Northamptonshire, Warwickshire and the surrounding areas that the hospital serves.
All this is very welcome news. I have no desire in this debate to dwell on the past, but it is important to explain how far we have all travelled in a campaign that has lasted for some seven years.
It was in July 2003 that the Banbury Guardian reported on its front page:
"The children's ward at Banbury's Horton Hospital is under serious threat and could be reduced to a daytime-only service...staff on the ward were gathered together by bosses this week and warned that current pressures could spell the end of the 24-hour acute paediatric services the Horton has enjoyed for the past 27 years.
A senior children's doctor said the end of children's services could mean the demise of other Horton Departments."
Without 24/7 consultant-covered children's services, it would not longer have been possible for the hospital to have a special care baby unit. Without a special care baby unit it would effectively have been impossible to have had a consultant-led maternity service, and the maternity unit at the Horton would have become a midwife-led unit with a very large number of mothers, many of them in labour, being obliged to go to Oxford to deliver their babies, and there would have been a cumulative knock-on effect on the effectiveness of the accident and emergency unit. In short, if those proposals had gone ahead seven years ago, the Horton would have ceased to be a general hospital and simply become a somewhat random collection of medical services.
This is not the opportunity and time does not permit me to give a full account of the exemplary way in which local people rose up to confront this challenge. The "Keep the Horton General" campaign, ably led by local Labour Councillor George Parish, now chair of the Cherwell district council, ensured that soon the whole community was involved in a campaign to "Keep the Horton General". In due course the then proposals for downgrading services at the Horton were referred to Oxfordshire county council health overview committee, which unanimously decided to refer the proposals to the then Secretary of State, Alan Johnson, with the recommendation that they be referred to the independent reconfiguration panel-the IRP.
The then Secretary of State did exactly that. The IRP took evidence and produced a report. The IRP's report was very clear. It concluded that
"our main focus is always the patient."
The report continued:
"The Horton General Hospital in Banbury must continue to serve the local community in North Oxfordshire and surrounding areas...we concluded that the local community's access to services would be seriously compromised if the Trust proposals were implemented. Panel members were particularly concerned about the difficult and costly journeys that local people would need to make to Oxford and felt this might even prevent or delay some people from seeking medical advice or treatment. The Trust's proposals are not in the best interests of patients, families and carers."
The IRP went on to state that
"local patient choice and access must also be a priority and that there are other possible solutions to the Horton Hospital".
Not surprisingly, the chair of the IRP, Dr. Peter Barrett, commented:
"During the course of this review we were left in no doubt that local people are passionate about the Horton Hospital. The hospital is well located for the population it serves, and the Trust's dedicated staff will play a vital role in the future success of the organisation. All parties should now work together to redevelop the proposals in response to our recommendations".
The IRP recommended that Oxfordshire primary care trust should develop a clear vision for children's and maternity services and a clear strategy for hospital services within north Oxfordshire as a whole.
It should be put on the record that I have no doubt that among the factors that caused the IRP to come to such robust conclusions were the very clear and unequivocal views put forward by my right hon. Friend the Prime Minister when he, as the local Member of Parliament for Witney, but also at the time Leader of the Opposition, gave evidence to the IRP, along with myself and my hon. Friends' predecessors, John Maples and Tim Boswell, both of whom I am delighted to see will shortly go to the other place, where I am sure they will continue to champion the interests of the Horton general hospital.
My right hon. Friend the Prime Minister made it very clear to the IRP that as far as he was concerned, the only things that mattered were the best interests and the health care of his constituents, a view supported without equivocation by the Horton's other Members of Parliament.
It is right that I should report to the House that in the just over two years since March 2008 when the IRP published its recommendations, the leadership and staff of the Oxfordshire primary care trust and the Oxford Radcliffe Hospitals NHS Trust have worked tirelessly and in an exemplary manner, on a process that sought to involve the whole community in finding a solution that works. Too many people have been involved in the process-the PCT, the Banbury better healthcare programme, and the community partnership forum, ably chaired by Julia Cartwright-for me to be able to name and thank them individually, but they all know who they are and they deserve our thanks.
During the time that this work was going on, we had visits to the Horton hospital from my right hon. Friend the Prime Minister, and several visits to Banbury by my right hon. Friend the Secretary of State for Health. Indeed, I do not think there was a single Opposition health spokesperson in the last Parliament who at some point did not come and visit the Horton hospital. The last Labour Secretary of State for Health, Andy Burnham, came and visited the staff and patients at the Horton and observed:
"I am very impressed. This is a much loved hospital which is crucially important to Banbury...there have been question marks over the hospital for too long and that will have had a destabilising effect on any hospital. I came to signal my commitment to the Horton. The time has come to take away the doubts. There comes a point where you have to take a decision".
We were grateful for the visit of the previous Secretary of State and are grateful that decisions to support the Horton hospital have been taken. I am now concerned to look to the future. I want, so far as is humanly possible, to ensure that we will never again have to pursue a seven-year-long campaign to keep Horton general hospital.
I very much welcome my right hon. Friend the Secretary of State to the Department of Health, together with an impressive ministerial team. He is probably better prepared than any of his predecessors, and his knowledge of the NHS is as impressive in private meetings as it is in his public speeches. I suspect that people have seriously underestimated the scale of the ambition of the new Government in their health policies. Health professionals are swiftly starting to recognise that the Government's proposed programme is intended fundamentally to change the health care system and has the intention of shifting power from the centre to patients and clinicians. The Secretary of State obviously has a clear vision of where he wants the NHS to get to over time.
There are several issues on which I would welcome the Minister's thoughts. There is going to be commissioning by GPs with funding going directly to them for such commissioning. When the Secretary of State visited the Horton, he made it clear that he believed that GP commissioning would potentially be a great support to the Horton that would enable the many GPs in Oxfordshire, Warwickshire and Northamptonshire who refer their patients to the Horton to collectively commission services at the hospital and help to develop new services. We will want actively to engage with local GPs in support of the Horton.
What is the timetable for the transition to GP commissioning? What will then be the role for primary care trusts? The Horton has only one potential weakness-it is a smaller general hospital. The cost of underpinning the new consultant appointments at the Horton will effectively be about £2.5 million over tariff. That is an annual cost that will be shared between the PCT and Oxford Radcliffe Hospitals NHS Trust. It is the price of maintaining services in a smaller general hospital serving a significant catchment area, where the distances to the next general hospital are such as to justify extra investment in maintaining services at the Horton. But who in the new system will make the value judgments and have the funds to ensure the continuity of care at the Horton? I understand that in due course there will be an independent board to set standards in the NHS, allocate resources and oversee the system. Can my hon. Friend provide more details?
My next concern relates to consultant provision. The effect of the European working time directive is that there has been a need for more doctors. I think I am correct that the previous Government were the only Government in the European Union who decided to interpret the directive in such a way that training counted as work. A few days ago, the British Medical Association issued a response to the review of the impact of the working time directive on training, concluding that
"the review defines and calls for a consultant-delivered service. The BMA has long advocated a service organised in this way-it will assure a high quality of care for patients as and when they are in the greatest need."
By developing consultant-delivered services at the Horton, we are in the vanguard of this trend, but the Government will of course need to ensure as time goes on that there are sufficient consultants to take up these places.
Medicine and medical training is one of the few disciplines where the numbers are almost entirely controlled by the state. I fully appreciate that medical manpower planning involves a whole number of difficulties in getting it right. However, all too often in the past, there has been a tendency to believe that if at any time we have insufficient doctors, we will always be able to busk it by recruiting doctors from overseas. For all sorts of reasons, that is now becoming much more difficult, and I think we all need to be confident that there will be sufficient training places today to ensure that there will be sufficient consultants tomorrow. Moreover, we should not in any way underestimate the changes in work practices that a consultant-delivered service will bring about. I would like to give particular thanks to Dr Janet Craze and the consultant paediatricians at the ORH Trust for the incredible work that they have done in devising consultants' rotas that will enable there to be effective 24/7 consultant-delivered paediatric services at both John Radcliffe and the Horton.
I have two brief final points. First, Horton general hospital is not the only small general hospital in the country. Such hospitals exist because the geography is not convenient, and they usually have a particular purpose in serving a significant community. Will my hon. Friend the Minister support any initiative that would bring those smaller general hospitals together in an alliance to see how they can maximise their contribution to the NHS and, in particular, how they can become, as we hope that Horton will become, an exemplar of how best to integrate community primary and hospital services? Secondly, I very much hope that my hon. Friend, given his ministerial responsibility for hospital services, will find time to visit Horton general hospital. I know that such a visit would be much appreciated by staff and patients, by me and my hon. Friends, and by our constituents.
There can be no conclusion to this debate because much of the story of Horton general hospital is yet to be written. I am simply glad that by our collective endeavours, we have managed to "Keep the Horton General". All the many thousands who have taken part in this campaign, in whatever way-by petitioning, writing letters, offering professional advice, or just being there-can take pride in what we have achieved. But let me be very clear: as far as I am concerned, the well-being and welfare of Horton general hospital will always be unfinished business.
I congratulate my hon. Friend Tony Baldry on securing this debate on the future of Horton general hospital. I know that he has campaigned vigorously in support of the hospital for several years, and I am sure that his constituents appreciate both his hard work and his dedication to protect good local health services in his constituency. I also pay tribute to the NHS staff across the whole of Oxfordshire, who provide such first-class care for his constituents.
As my hon. Friend will know, the Secretary of State has visited his constituency a number of times, and has seen for himself the excellent work carried out daily at Horton general hospital. I would be delighted to accept my hon. Friend's offer to visit Horton myself, so that I, too, can benefit from knowledge of the experience that his constituents enjoy.
I am grateful to my hon. Friend for drawing that to my attention. Given the constraints of time in this debate, if he were to be kind enough to write or to come and see me, I would be more than happy to discuss the situation with him.
My hon. Friend the Member for Banbury referred to the decision made by the board of Oxford Radcliffe Hospitals NHS Trust on Monday this week to maintain 24-hour paediatric services and a full obstetrics service at Horton general hospital. That is good news, and thanks in no small part to the strong opposition mounted by local GPs, clinicians and the public to the trust's original plans that were proposed in 2007. In addition, my hon. Friend and my right hon. Friend the Prime Minister-in his constituency role-my former hon. Friends Tim Boswell and John Maples, and my new hon. Friends the Members for Stratford-on-Avon (Nadhim Zahawi) and for South Northamptonshire (Andrea Leadsom), should be congratulated on the determined way in which they have fought for their constituents in seeking to stop the original proposals, which would have meant paediatric in-patient services moving from the Horton to the John Radcliffe hospital in Oxford, with the problems that that would cause for their constituents.
Following the rejection of the original plans in 2008 by the independent reconfiguration board, Oxfordshire PCT set up the better healthcare programme to develop proposals on how safe, long-term services at Horton might be delivered. It established a community partnership forum to ensure wide engagement with the local community, which included representation from local GPs, patients, the public, Horton general hospital staff, councillors and Members of the House. I am aware that my hon. Friend the Member for Banbury played a long and active role in those deliberations.
I am pleased to note that local engagement has been such a key part of the better healthcare programme. I understand that the community partnership forum has been involved throughout, and that frequent briefings were held with GPs and the practice-based commissioning consortia. Clinical staff at Horton general and John Radcliffe hospitals have also been involved, to ensure wide clinical engagement.
The model of care that emerged from the better healthcare programme was for consultant-delivered paediatrics and obstetrics services to remain at Horton general. That will mean less reliance on middle-grade doctors, and result in Horton continuing to provide local, high-quality paediatric and maternity services. The Oxfordshire health overview and scrutiny committee agreed with that model.
In March, the proposals developed to implement that model were presented to a clinical review panel. The panel consisted of local GPs, representatives from the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health, the Royal College of Anaesthetists, Cherwell district council and a PCT board member. Although I understand that the panel had some concerns, it concluded that the proposals were clinically safe and deliverable. Now that the PCT and trust boards have decided to go ahead with these proposals, the next step is for the trust to develop an implementation plan. That will involve recruiting the required number of additional consultants.
I am pleased that Oxfordshire PCT and South Central SHA have both assured me that the better healthcare programme has passed the four tests set out by the Secretary of State, which have been a strong feature of the way the programme has been organised. As my hon. Friend will appreciate, the four tests to which I refer are the new tests that the Secretary of State has laid down to ensure that when reconfiguration proposals are made, local GPs and clinicians-and local communities-are fully consulted before any decisions are made, so that they can have a say in the health care that they need.
My hon. Friend asked a number of questions that I will seek to answer now as far as I can. He asked about the timetable for the transition to GP commissioning and the future role of primary care trusts. As he knows, we have only been in government a matter of weeks and a tremendous amount of work needs to be done to begin to realise our vision for an NHS based on putting patients first so that quality of care is the priority in the service. In that context, we will set out our vision for the national health service shortly. Until we do, I am not in a position to respond in detail to those two specific questions.
My hon. Friend asked about the independent NHS Board. The board will set outcome objectives, allocate resources and provide commissioning guidelines free from political interference. Again, I beg my hon. Friend's patience as we will set out further details of the NHS Board shortly. I am sure that he appreciates that I cannot go into detail at this stage and while we are putting together our proposals to bring before the House and the nation.
My hon. Friend also raised the idea of an initiative to bring together an alliance of general hospitals to help provide the best integrated primary, community and hospital care. Like him, I believe that it is vital to have first-class integrated health and community services, and I assure him that we are looking at how we might best achieve that.
I applaud the determination that my hon. Friend, and my other hon. Friends-I am pleased to see them in their places tonight-have shown in their championing of local services in Banbury and in other areas affected by these proposals. His constituents, like those of all hon. Members, deserve good local health services that have the full support of local GPs, clinicians and the local community and provide the highest standards of quality and care. By seeking the support of GPs and local people for any changes made, by basing any changes on clear evidence, and by ensuring that all changes improve patient choice, the enhanced services in Oxfordshire will inevitably lead to better care for my hon. Friends' constituents, not only in that area but in those parts of south Northamptonshire and Warwickshire that form part of this hospital area.
In conclusion, I am pleased that the plans that have finally been devised through local involvement and commitment have solved a potential problem. It shows that, by consulting with local stakeholders and the local community, one can achieve the sort of configuration that meets the needs of local people as well as the needs of a local national health service. In particular, I congratulate my hon. Friend on his tremendous work and the leadership that he has provided in ensuring that the local community, working together, achieved the successful outcome determined last Monday. I wish him and the local health service in Banbury and the surrounding area every success in ensuring that these proposals work, and work well, for the benefit of the local community.
Question put and agreed to.