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questions and answers

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Please send your question to feedback@ouh.nhs.uk with the subject line Question on the Horton.

Horton General Hospital

What are the future plans for the Horton General Hospital? I've heard that it's closing.

There are no plans to close the Horton but there are plans to extend services at the Horton. The Trust has talked to local people about its plans to extend outpatient services at the Horton General Hospital by increasing them by about 80,000 appointments a year. The Trust's aim is to provide more day cases, outpatient services and diagnostics closer to home for people from the Banburyshire area, so that they do not have to travel to the Trust's Oxford hospitals.

As part of the work that the Trust has done with Oxfordshire Clinical Commissioning Group on future plans for health services in Oxfordshire, the Trust has looked at what services should look like in the 21st century and how they can best be provided at the Horton.

The Trust's intention is to rebuild the Horton as a hospital fit for the future. The Trust has already invested millions of pounds in new buildings and equipment (endoscopy, radiology, CT Scanner etc.).

The Trust has raised its concerns about the long-term future of obstetric maternity services at the Horton, because of difficulties recruiting staff.

On 31 August 2016 the Trust Board took the decision to relocate obstetric services on a temporary basis to Oxford, because there were insufficient doctors to run the service. This decision was taken on the grounds of safety.

You can see our news release about this meeting and a video of it at the link below.

Maternity services at the Horton

I understand a different proposal has been put forward that will allow obstetrics to stay at the Horton after 1 October by providing an elective caesarean section service there. Is this true and will this happen?

The Trust was sent a suggestion by the Keep the Horton General Campaign to provide an elective caesarean section service for women in Oxfordshire at the Horton.

The proposal and the Trust's response are here.

I've heard that the Horton Midwifery-led Unit has only one midwife on duty to handle the births. If more than one pregnant woman comes in at the same time how can one midwife be enough?

At the Trust's other midwifery-led units the duty midwives are always called in as needed. At the Horton there are midwives on duty at all times with additional on-call as needed. The maternity service is by its nature a responsive one and so staffing is very flexible.

Banbury is a growing area. Even if there are only four births a day at the Horton, won't there be lots more in the future?

This has been looked at by the Trust. The modelling of maternity services suggests that in the Horton catchment area the increase in births is likely to be relatively small. Even a 10 percent increase, which is significantly above current predictions from the planning authorities, would equate to just an additional 150 births i.e. less than an additional three births per week.

Still, wouldn't this be enough to get training recognised at the Horton again and therefore make the posts easier to recruit to?

Even this projection, which, as we say, is considerably above what local authority planners are forecasting would only take the overall number of births from the Banburyshire area up to around 1,600 to 1,700 which is still not enough to meet the requirements of the Royal College of Obstetricians and Gynaecologists for there to be around 3,500-5,000 for training to be recognised at a unit. And unfortunately, even where training is recognised, there is such a national shortage of doctors in this speciality that 24 percent of the training posts across the Thames Valley area are vacant.

What is the catchment area for maternity patients of the John Radcliffe in Oxford?

Women come to the John Radcliffe Hospital to give birth from all over Oxfordshire, but also from Berkshire and Buckinghamshire and even Hampshire if they require specialist maternity or neonatal care.

Pregnant women in Banburyshire

What should pregnant women do to find information they need about where to give birth, now that the unit is being made into a Midwifery-led Unit?

All pregnant women should discuss their options with their GP and midwife, or consultant obstetrician if they have been referred to one. Everyone's birthing plan and circumstances are unique to their individual pregnancy, so it is important that they discuss it with the people providing their antenatal care.

They will be able to go through the options (home birth, midwifery-led unit at the Horton or Chipping Norton, obstetric units at the John Radcliffe Hospital in Oxford or at Warwick or Northampton, or finally, the Spires Midwifery-led Unit alongside the obstetric unit at the John Radcliffe Hospital). The options for each woman will depend on their risk assessment which is based on a thorough assessment of any prior medical conditions and the pregnancy.

There are also many authorised websites which give information on the choices pregnant women have to give birth.

OUH publishes this guide:

This national guide is available on NHS Choices:

As a pregnant woman in Banbury, how do I know if I am high-risk or low-risk?

The discussions that women have with their midwife and doctors are part of the process of risk assessment.

High-risk women are identified at various stages during pregnancy. There are some women who are easily identified as high-risk early in the pregnancy (for example women with pre-existing medical conditions, with high BMI, multiple pregnancies, mothers who have already had more than four children), but for other women risks may not become apparent until later on (for instance, gestational diabetes or pre-eclampsia). Women whose pregnancies are deemed to be higher risk will then be able to plan their birth at a suitable obstetric-led unit.

I am a pregnant mum who is worried about my safety. I have read that the Horton MLU is not safe for me or my baby. Is this true?

National research shows that for women who have been assessed as having low-risk pregnancies the safest place for them to give birth is a midwifery-led unit. The outcomes for their babies are the same whether it is an obstetric-unit or a midwifery-led unit.

For women who are assessed as having a higher-risk pregnancy, then an obstetric-led unit is the safest place to give birth, and they will be advised accordingly.

The Trust already runs three stand-alone midwifery-led units at Chipping Norton, Wantage and Wallingford:

I have an appointment with a consultant at the Horton; is this correct?

Antenatal and postnatal appointments at the Horton are continuing. Unless you have specifically been told that your appointment is elsewhere, you should expect to go to the Horton if that is what it says on your appointment letter.

Recruitment process to try and recruit obstetric doctors

Can you let us know regularly where you are at with recruitment for these jobs?

The Trust will publish updates on our website at www.ouh.nhs.uk/hospitals/horton/news/recruitment.aspx

We understand how anxious people are to learn what progress has been made, and are keen to keep local people up-to-date on the situation.

Why can't you just get doctors from overseas?

These jobs are advertised internationally and we recruit many of our doctors and nurses from overseas. We welcome applicants from all over the world and the vast majority of applicants and successful candidates come from overseas.

However, overseas applicants may take longer to get into post if they are successful, as there are a number of issues including visa requirements, language tests and registration with the GMC that may delay starts.

Why don't the ads give a longer period of time than a one year contract? Is this off-putting to potential doctors?

The nature of these roles is that they are jobs that people will do for a short period of time for career development, before moving on to new jobs.

However, following feedback, the Trust now offers a contract extendable to two years in case this makes a difference.

I've heard that the jobs are not that attractive, and that is why there have not been applicants. Is this true?

It is not true. Unfortunately there is a national shortage of doctors in this field at this level, so we have tried to make our jobs as attractive as possible. Since July 2016, which is when we have been particularly short of staff, we have been offering a higher rate of pay than normal for these roles, other financial enhancements including help with visa costs, and time for the post-holders at the John Radcliffe Hospital, with therefore greater exposure to more complex births. This is of interest to doctors in terms of career development.

Why can't you just employ locums to cover the shifts? They are used everywhere else in the Trust.

The Trust has used locums to provide cover when there were just one or two posts missing from the rota, but they have proved unreliable (sometimes not turning up for shifts) and the Trust has had real concerns about the quality. We have tried to recruit longer-term locums alongside the permanent posts, but there is a shortage of obstetric locums as well as applicants for permanent jobs.

Special Care Baby Unit (SCBU)

Why was the Special Care Baby Unit closed at the Horton, just because the obstetric service is suspended?

The Special Care Baby Unit at the Horton provided care for babies born prematurely, or who needed extra care after birth.

Now that the maternity unit is midwife-led there will not be any more high-risk births at the Horton.

The Trust explored the idea of keeping the unit open so that babies could be brought back from other units after birth to be nearer to home. We sought advice from the Neonatal Clinical Network for the Thames Valley, and they clearly stated that we should not do this, as it would be against national guidelines and was not considered to be a safe model of care.

The letter can be found on page 35 of the Board papers here:

Transport and the John Radcliffe Hospital

What happens if a woman who has been categorised as low risk and who has chosen to give birth at the Horton Midwifery Led Unit requires obstetric assistance?

The Trust currently operates three other stand-alone midwifery led units. Women at those units are regularly transferred to the John Radcliffe Hospital. The transfer rate is between 20 and 25 percent of women who have chosen a stand-alone midwifery unit. The reasons for transfer are varied and include: change of mind about pain relief options; labour not progressing as hoped; complications that develop in labour. A number of women will transfer themselves and others will go via ambulance.

The Trust is aware of the anxieties raised by women in the Banburyshire area about journey times between Banbury and Oxford and so has made an agreement with South Central Ambulance Service to have an ambulance on standby 24/7 to transfer women to Oxford as required. This means that if the ambulance transfers a patient then it will then be replaced with another ambulance.

What about the time it takes to travel to Oxford, particularly with the roadworks and congestion in the city?

Travelling by road in Oxfordshire is undoubtedly a challenge that will need to be discussed with a woman as part of her informed decision making about where to give birth. This is no different from the discussions community midwives already have with women wanting to give birth at Wallingford Midwifery-led Unit and in particular at Wantage Midwifery-led Unit which is a similar distance from the John Radcliffe Hospital. More than three quarters of women who start labour in a midwifery-led unit deliver there safely and do not need to transfer.

What about parking at the John Radcliffe Hospital? I hear it is very difficult to park there.

Parking at all of our hospitals is a challenge. The number of spaces on our sites for staff and visitors are determined by our local councils. This is why the Trust encourages staff, patients and visitors, where possible, to come via public transport. Parking is at its busiest during the day when people are coming in for outpatient appointments. Family and friends visiting in the evening or at weekends do not generally have a problem travelling to our hospitals or parking when they get there. There are also short term drop-off points at the main entrances, including our maternity entrance. The Trust has been working hard to improve the parking situation and it has improved recently.

Does it really take 38 minutes in an ambulance to get from the Horton to the JR? Where did this time come from?

Yes. The figure of 38 minutes is supplied by South Central Ambulance Service and is the time they have given us for the current average journey time in a blue light ambulance.

Staff issues during the suspension of the obstetric service at the Horton

What happened to all the midwives who worked at the Horton Maternity Unit?

Now the Horton is a Midwifery-led Unit, fewer midwives are needed to work there than before. Midwives who worked at the Horton now work elsewhere in the Trust.

Will there be enough SCBU nurses left to restart the service? I’ve heard some nurses have left.

If the Trust were to re-open the obstetric service at the Horton, the Special Care Baby Unit will need to be fully staffed.

We are advertising a number of vacancies for SCBU nurses, and do not yet have enough nurses to re-open the unit.

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