Those concerned about the future of services at the Horton General Hospital are in for several nail-biting months.

It is just over two years since the then Secretary of State for Health, Alan Johnson, accepted the recommendations of the Independent Reconfiguration Panel (IRP) that the NHS in Oxfordshire should look for a county-wide solution to retaining 24/7 Children’s Services at the Horton General Hospital and consultant-led Maternity services.

Alan Johnson gave the responsibility for this work to the Oxfordshire Primary Care Trust – increasingly now known simply as “Oxfordshire NHS”.

The Primary Care Trust (PT) in response to Alan Johnson’s mandate, established the Banbury Better Healthcare Programme as the process by which they sought a solution to the need to provide 24/7 consultant-led children’s services at the Horton General Hospital and a consultant-led maternity service.

In addition to parents having the confidence that sick children will be well cared for at the Horton, the further importance of having consultant-led, 24/7 children’s services at the Horton is that without this cover, it is impossible for the Horton General Hospital to have a Special Care Baby Unit and without a Special Care Baby Unit it is not possible to have a consultant-led maternity service.

As in any General Hospital, a number of medical services depend on each other.

The Better Healthcare Programme has had a Programme Board, made up of key administrators and managers from both the PCT and the Oxford Radcliffe NHS Trust (ORH) but the Programme Board has also included clinicians, local GPs, and community representatives, such as Mary Harpley, the Chief Executive of Cherwell District Council, and Julia Cartwright, who chairs the Community Partnership Forum (CPF) which in turn was set up to try to bring together local MPs, elected representatives of the relevant local Councils, and representatives of the “Keep the Horton General” campaign and others.

Over the last two years, the Banbury Better Healthcare Programme Board has been considering a range of different options, has been looking at what happens in other countries in Europe, particularly in relation to the implementation of the EU Working Time Directive, have been considering what is done in other hospitals and areas of the UK, and at the end of this work, the Programme Board has concluded that what is needed is a consultant-delivered 24/7 Children’s service at the Horton.

Subsequent work has been done to work out how many consultants would be required to manage the appropriate rotas at the Horton.

Whether it would be possible to recruit sufficient consultants, and to make such posts sufficiently attractive for recruitment, and what would be the additional cost of providing an increased number of consultant paediatricians at the Horton Hospital.

These conclusions have then been tested in public by an expert panel representing the various Royal Colleges, concerned with these particular areas of medical speciality.

Originally the ORH said that they estimated that the increased cost of providing such services would be an addition £2 million a year.

This is a total annual budget of the ORH of £650 million.

Subsequently, as I understand it, they have increased their estimate of the increased costs to £2.6 million a year.

On the 19th May, there is a meeting of the Better Healthcare Programme Board which is expected to come to some conclusions and make a collective recommendation to the Oxfordshire PCT – as I say, now known as “Oxfordshire NHS”.

I would expect the Programme Board, on the basis of work done so far, to conclude and recommend that the way forward is to have a consultant-delivered paediatric service at the Horton, to specify the number of consultants that they believe will need to be recruited to operate such a service and to note the ORH’s estimates of how much such a service would cost.

The conclusions and recommendations of the Banbury Better Healthcare Programme Board are then going to be put to a meeting of “Oxfordshire NHS” at one of their regular Board Meetings, which is being held in public at Wantage on Thursday, 27th May.

At that meeting “Oxfordshire NHS” will have to decide whether or not these are services that they wish to seek to commission from the Oxford Radcliffe NHS Trust.

It is to “Oxfordshire NHS” that the Government and Department of Health give money, on behalf of the residents of Oxfordshire as a whole, to procure NHS medical services throughout the county, for both GP and Hospital services.

This decision and these discussions have to be seen as against a background of various growing tensions within the NHS.

Although the Conservative Party made a clear election pledge that we would seek to protect spending on the NHS in any programme to reduce the overall public deficit, it is clear that spending on the NHS is not going to be able to grow at the rate that it has done over recent years.

This is going to mean that both the “Oxfordshire NHS” as a commissioner and the Oxford Radcliffe NHS Trust as the provider of medical services, are going to be having to look for not insignificant efficiencies and savings over the coming years.

Also, discussions and decisions about the Horton retaining essential services at the Horton General Hospital are also going to be taking place as against a background of broader discussions and negotiations between “Oxfordshire NHS” and the Oxford Radcliffe NHS Trust as to how large a proportion of the money that the Oxfordshire NHS has available to spend, they spend with the Oxford Radcliffe NHS Trust.

It is obviously to be hoped that the “Oxfordshire NHS”, at its Board Meeting on 27th May, having regard to the conclusions and recommendations of the Better Healthcare Programme Board, will decide that they do wish to procure services from the Oxford Radcliffe NHS Trust which will ensure that the Horton remains a General Hospital with 24/7 children’s and consultant-led maternity services.

It is possible that, given the comments of some of the Non-Executive Directors of the “Oxfordshire NHS” at a public meeting that they held in Banbury a little while ago, they may choose not simply to accept the Oxford Radcliffe NHS Trust’s estimates of the costs of providing these services and decide that in the interests of ensuring best value, that they go out to tender, to see whether there are others who might provide services at the Horton General Hospital more cost effectively.

It is unclear to me who other such providers might be, and how they would work in a hospital where all the other services and staff are run, managed and funded by the Oxford Radcliffe NHS Trust.

It is one thing having an Independent Treatment Centre for certain types of surgery operating alongside the Horton General Hospital, but it would look more difficult to have another provider providing medical services within the Horton, alongside and integrated into the Oxford Radcliffe NHS Trust.

Then, on a date in June, which has not yet been finalised, the Oxford Radcliffe NHS Trust will meet to decide whether they wish to deliver and provide the services at the Horton which the “Oxfordshire NHS” wish to procure.

The position of the Oxford Radcliffe NHS Trust on all this is unclear.

The Oxford Radcliffe NHS Trust has recently appointed a new Chief Executive .

One of the reasons why the Oxford Radcliffe NHS Trust said they needed more time was because they wanted to consult existing consultants within the Oxford Radcliffe NHS Trust on the Better Healthcare Programme’s proposals.

It is unclear and not yet know what reaction they have had from existing consultants, particularly paediatricians.

Obviously, it is very much to be hoped that the leadership and management of the Oxford Radcliffe NHS Trust will want to ensure that they retain a General Hospital at the Horton, and that they are able to provide the services for the local community that the “Oxfordshire NHS” wish to commission at an agreed cost.

If it were to happen that for whatever reason the Oxford Radcliffe NHS Trust were unwilling to provide consultant-delivered children’s services and consultant-led maternity services at the Horton, then I strongly suspect that those 140,000 or so people living within the immediate catchment area of the Horton General Hospital, would want the Government to consider whether there is any reason not simply to move the Horton General Hospital out of the Oxford Radcliffe NHS Trust and see whether another neighbouring Hospital Trust would be interested in taking on and delivering General Hospital services at the Horton.

Clearly I don’t think any of us would hope that we would ever find ourselves in this position, but I think everyone needs to clearly understand that so far as those living within the catchment area of the Horton General Hospital are concerned, for them one of the greatest priorities is retaining the Horton as a General Hospital, and not simply as a collection of ad hoc medical services.

Now that the General Election is behind us, once parliament resumes, I will be writing to the Speaker to request an early opportunity to raise “The Future of the Horton General Hospital” by way of a Debate in the House of Commons to give Ministers an early opportunity to comment on some of the above issues and wheresoever helpful to give a Ministerial steer, and to make it clear that so far as Ministers are concerned, they wish to see the Horton remain a General Hospital, retaining all the services, including children’s and maternity services, and an Accident and Emergency Department that one would expect at a General Hospital.