At an Extraordinary Board Meeting held yesterday (31st August 2016), the Board of Directors of the Oxford University Hospitals NHS Foundation Trust have determined that for immediate and real patient safety reasons contingency plans must be put in place to temporarily suspend obstetric services at Horton General Hospital in Banbury from 1 October 2016.
The decision was made after it was revealed that insufficient numbers of middle grade obstetric doctors were available to safely staff the obstetric service from that date. The contingency plan will mean that maternity services will be offered temporarily by a Midwifery-led Unit (MLU), while efforts continue to fill vacant obstetric posts. Women requiring an obstetric-led birth will deliver their baby at the John Radcliffe Hospital. Other aspects of their care will continue to be provided at the Horton.
Oxford University Hospitals NHS Foundation Trust, which runs the Horton General Hospital, has been struggling to fill middle grade obstetric doctor posts at the hospital for several months. This difficulty is reflected nationwide, and the Trust currently has unfilled vacancies at both the John Radcliffe Hospital in Oxford in addition to the Horton General Hospital. The problem was compounded at the Horton due to the withdrawal in 2013 of recognised obstetric training programme status by the Royal College of Obstetricians and Gynaecologists, because of the low number of annual births.
The Trust will be consulting directly with expectant mothers about how this decision affects their individual options for giving birth. The Banbury Midwifery-led Unit (MLU) will provide the same environment of safety for mothers and babies as all MLUs across the country, including those operated by the Trust. MLUs are fully supported by national maternity policy. In addition, the Trust is enhancing arrangements for those occasions when a mother may need to be transferred to obstetric services.
Expectant mothers in the north of Oxfordshire, south Warwickshire and south Northamptonshire may still choose to give birth to their babies at the Horton General Hospital MLU, provided their pregnancy is deemed to be low-risk. Those assessed as high risk and in need of an obstetric service will be directed instead to hospitals in Warwick, Northampton or the John Radcliffe Hospital in Oxford.
Dr. Tony Berendt, Director of Medical Services said that the Trust would be adopting national guidelines in its decision to temporarily downgrade the Horton’s obstetric unit: “This decision is not based on our opinion or experience. We are following national guidance from NICE (National Institute of Health and Clinical Excellence), which is based on rigorous evidence“, Berendt told Radio Horton at a press conference in Oxford. Established in 1999, NICE guidance conducts research and provides evidence-based guidance to improve health and social care nationwide.
“The NICE expectation is that for low risk women, a conversation would be had with them to ensure they understood a Midwife led unit was a good option for them, with low intervention rates and equivalent rates of safety. If you’re a high risk woman, then you would be advised to deliver in an obstetric unit“.
More from the press conference:
The implementation of the contingency plan will result in the following.
- The temporary establishment of a midwifery-led birth unit at the Horton General Hospital
- The temporary cessation of obstetric care at the Horton General and its transfer to the John Radcliffe Hospital
- The temporary cessation of the Special Care Baby Unit at the Horton General and its transfer to the John Radcliffe Hospital
- The temporary cessation of the inpatient emergency gynaecology service and the establishment of a seven day ambulatory emergency gynaecology unit at the Horton General Hospital
The Trust alerted the public about potential problems in recruitment in July 2016, and from 25 July work started at the John Radcliffe Hospital to prepare for the possibility of additional beds being required at the hospital’s Women’s Centre. Further work on rooms for maternity and additional cots for the Special Care Baby Unit and work on theatres is ongoing.
Meanwhile Victoria Prentis MP expressed her disappointment of the decision, and shared the concerns of some of her constituents. “Personally, I am very worried about the contingency arrangements and will continue to put pressure on the Trust for answers. I will do all I can to offer assistance to worried constituents and expectant mothers during this time. I firmly believe the Trust could have done more to recruit enough consultants. I really hope this decision is short term and the recruitment process will continue so that a full service can resume as soon as possible.”
Dr Bruno Holthof, Chief Executive of Oxford University Hospitals stressed that the decision was temporary, based solely on safety concerns, adding that the Trust were committed to restoring obstetric services when suitable candidates had been employed. “This is a temporary decision. We will continue to recruit doctors with the right skills and experience to work independently in an obstetric led unit at the Horton. We will make it as attractive as possible to recruit those physicians. We have a lot of vacancies for these types of doctors, therefore we are also recruiting worldwide.”
The Oxford University Hospitals NHS Foundation Trust will continue to search for qualified doctors from across the globe that have the right skillset and experience to come to the UK and meet the personal specifications required for an obstetric consultant, though admitted there were no guarantees as to the duration such posts would be promoted worldwide.
The financial contracts offered have remained consistent and competitive to that of similar positions at other hospital trusts. If suitable consultants were found prior to the end of October 2016, the service may be able to resume from January 2017.
Holthof continued: “We are extremely disappointed to be in this position today. Having tried exceptionally hard to recruit to these posts, using every incentive available to us, we would prefer to be maintaining the obstetric service at the Horton and will keep on with our recruitment drives. However, we clearly cannot run a service without doctors to provide it.“