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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 been talking to local people about its plans over the last few months 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 is doing with the Oxfordshire Clinical Commissioning Group on future plans for health services in Oxfordshire, the Trust is looking at what services should look like in the 21st century and how they can best be provided at the Horton. This work is at an early stage and plans are still being worked on. When they are ready, there will be a public consultation (probably at the end of this calendar year).
Following the result of the consultation 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 over the last few years (endoscopy, radiology, CT Scanner etc.).
As part of the initial engagement work on this, the Trust has raised its concerns about the long-term future of obstetric maternity services at the Horton, because of the issue of recruitment which has got more and more difficult over the last few years.
The service has unfortunately been overtaken by circumstances and the crisis has become more immediate, resulting in the Trust Board on 31 August 2016 having to take the decision to relocate obstetric services on a temporary basis to Oxford, because there will be insufficient doctors to run the service from 3 October.
You can see our news release about this meeting and a video of it at the link below.
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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 has been sent a suggestion from Val Ingram of 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
The Trust was sent this proposal on 6 September. Senior managers then discussed it with clinical, and most importantly obstetric, specialists to assess its feasibility. Patient safety was the Trust’s over-riding concern in examining the proposal, as it has been throughout this process.
I’ve heard that when the Horton becomes a midwifery-led unit in October there is only going to be 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. The proposal for the Horton is that there will be 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 currently, won’t there be lots more in the future?
This is something that the modelling for future services is looking at. However, 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% 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% of the training posts across the Thames Valley area are currently 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.
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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:
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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 new 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; how do I know if it is still happening there?
Antenatal and postnatal appointments at the Horton will continue even after the unit becomes midwifery-led after 3 October.
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.
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Recruitment process to try and recruit obstetric junior doctors
Where and when did these jobs get advertised?
Job ads were placed in April, May, July, August, September, October, November and December 2016.
The job was advertised, as is normal practice for this grade of job, on NHS Jobs, which is the main employment website for all NHS employment.
Because of the lack of success in recruiting from this, the Trust, unusually, took a decision to also place an advert in the British Medical Journal, which would normally only be used for some consultant level posts. The ads were also shared on social media.
I searched on NHS Jobs and couldn't find a single job for these doctors advertised. Where are the jobs? Can you give us a link to the adverts?
These two adverts are currently live:
There are short periods when adverts are unavailable, while they are rewritten in order to make sure that we reflect useful feedback and revise the closing dates.
There always needs to be a cut-off date as part of any recruitment process, so that candidates know when to submit their applications, and so that interviews can be set up and arranged.
We will update the recruitment grid at the beginning of every month to let everyone know the outcome of the latest recruitment.
If insufficient doctors have been recruited to restart the service, then we will re-advertise with a new closing date until such time as we are able to fill the rota.
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Can you let us know regularly where you are at with recruitment for these jobs?
The Trust will publish a monthly update on progress in terms of recruitment on this page on our website at the beginning of each month. 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.
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.
I've heard that there are doctors ready with their bags packed to start tomorrow. Why aren't they being employed?
We have had a number of applications from doctors from overseas. Not all of them were qualified to work doing this particular role, as they were insufficiently experienced to work on their own. Those who met the criteria have been interviewed. It was never the case that doctors had their bags packed.
Why don't the doctors from the JR come to the Horton to 'cover' during this temporary period?
There are currently approximately 6,000 births a year at the John Radcliffe Hospital compared to 1,500 at the Horton. The John Radcliffe Hospital has training recognition, making the posts attractive to doctors in training, but even there, the national shortage of these middle grade obstetric doctors mean that there are some vacant posts.
This means that it is not possible for doctors to be spared from the John Radcliffe, the much busier site, to support the relatively small number of births at the Horton (four a day).
Overall, across the Thames Valley up to 25 percent of training posts in the area are vacant, with trusts unable to appoint to them because of the national shortage of doctors in this field.
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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. The one year period was therefore chosen deliberately, as it was considered to be an advantage rather than a disadvantage to make the jobs more attractive.
However, following feedback, in the new job advert the Trust has offered 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.
In the latest job ad we have tried to spell this out even more, giving the total pay package including the enhancements.
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.
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Special Care Baby Unit (SCBU)
Why does the Special Care Baby Unit need to be closed at the Horton, just because the obstetric service is suspended?
The Special Care Baby Unit at the Horton provides care for babies who are born prematurely or who need some extra care after birth.
When the maternity unit becomes midwife-led on 3 October 2016 there will not be any 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:
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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 (or until 1 October, women have been transferred to the Horton from Chipping Norton). The transfer rate is between 20 and 25% of women who have chosen a stand-alone midwifery unit. The reasons for transfer are varied and include: change their mind about pain relief option; women whose labour is 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.
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Staff issues during the suspension of the obstetric service at the Horton
Will the midwives at the Horton be given their jobs back if obstetrics is put back to how it was before? Will they have to apply for them?
When the Horton becomes a Midwifery-led Unit on 3 October 2016, fewer midwives will be needed to work there than at present. However, once we are able to reinstate the obstetric service at the Horton, which is our goal, midwives and SCBU staff who have been temporarily relocated to one of our other units, and who wish to go back to their former roles, will be enabled to do so.
Will there be enough SCBU nurses left to restart the service? I’ve heard some nurses have left.
We are currently advertising for SCBU nurses for the Horton to ensure that there will be no gaps in the rota when we are ready to return to the Horton. The timetable as set out in the board papers here reflects the need for the time to move services back, including re-establishing all the rotas.
I’ve heard that staff at the Horton feel that they are not being properly informed. What is the Trust doing to keep its staff involved and informed?
Managers in maternity and other services affected such as the Special Care Baby Unit have held a number of meetings for staff as well as offering one to one interviews for those who want them. In addition the Chief Executive and executive and non-executive directors have all held a number of open meetings for staff to discuss the situation and allow staff to ask questions.
This situation has been very fast moving and at times the Trust has found it difficult to keep staff up to date with the latest developments. That is one of the reasons we have developed this Q&A.
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