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04 June 2003

Thank you for your letter of 30 May.

I take as my starting point last year�s substantial deficit in the budget of the Oxford Radcliffe NHS Trust and the predicted substantial deficit in the Trust for the coming year.

The Trust has acknowledged a deficit last year, I understand, of some  20 million and indicated a predicted deficit this coming year, if action were not taken to change matters, of some  40 million, which would seem to indicate that matters, unless reversed, are getting substantially worse rather than better.

However, I have been told, "off the record", that the deficit last year was itself nearer the  40 million than the  20 million figure.

These are large amounts of money.

So far, all that we as local Members of Parliament have been told is that there is, as one would expect ... "a recovery plan". I understand from Mike Williams that the Oxford Radcliffe NHS Trust has identified some of the areas of overspend. It is unclear as yet where these areas of overspend might be.

What is certain is that over at least the last two decades the experience of the Horton has been that whenever the John Radcliffe and consequently the Oxfordshire health system get into financial difficulties, the Horton takes a disproportionate "hit" because even if one applies a straightforward percentage reduction across the system, an "x" per cent cut on the Horton�s budget has a much greater impact than an "x" per cent cut on the budget of the JR.

Moreover, I think there is a feeling that these difficulties are endemic at the JR, and in the central Oxford medical complex; they have been ongoing for many years and there appears to be an inability to dis-aggregate out spending on the JR as a large District General Hospital and spending on the JR as a teaching hospital and part of the Oxford University complex.

Other large general hospitals do not appear to have the same problem and other university teaching hospitals do not appear to have the same problem.

It will have to be seen whether Sir William Stubbs and the new Chief Executive can start to sort these matters out.

In the meantime, I of course acknowledge your observation that the Cherwell Vale Primary Care Trust will seek to ensure that the Horton is not unfairly disadvantaged as a consequence of the cuts that are inevitably going to have to take place in the budget of the Oxford Radcliffe NHS Trust to enable it to get back into budget.

I am not entirely, however, as to the mechanics whereby the Cherwell Vale Trust can undertake this protection as I have been told that there is not a separate budge for the Horton Hospital as such and it is unclear to me as to who is now driving forward and overseeing the process of the so-called "Recovery Plan"; whether that is the ORH or various PCTs.

Presumably the Oxford City PCT is having to take responsibility for the JR along with other PCTs in the County who send patients to the JR, including Cherwell Vale and North East Oxfordshire. Is that an exercise that is going on separately and in parallel to any consideration that is taking place of the budget of the Horton?

Also, I think it is now unclear as to what is the shape of the relationship between the Horton and the JR. At the time of merger, I think it was very much two general hospitals, albeit of different sizes, coming together in one Trust, not least for the administrative convenience of satisfying the Royal Colleges in relation to the training provisions of Registrars and Housemen which it was clearly becoming increasingly difficult for the Horton to do on their own.

I now increasingly get the impression that what we are now seeing emerge is effectively the concept of one hospital on two sites, with the more acute high-tech and complex services increasingly being based at Oxford and moving to Oxford, and with the Horton increasingly delivering and operating important, but nonetheless second tier services. This over time manifests itself in a whole number of different ways, increasingly with consultant appointments being made primarily at the JR, and with consultants undertaking clinics at the Horton, rather than being mainstream consultant appointments at the Horton.

As an indication of this I should be extremely interested to see the shape of paediatrics at the Horton, once Bob Bell retires later this year.

Of course, I take your general point that the delivery of services within the NHS, or indeed public services anywhere, will always be evolving. There is no quarrel about that and obviously people in North Oxfordshire locally will be delighted if there is delivery of an enhanced range of services at the Horton. However, I am sure that you will appreciate that as a workaday Member of Parliament, my experience of the machinery of government is that it is almost, if not entirely, impossible for public services simultaneously to deliver substantially enhanced services, simultaneously to making substantial cuts and however one seeks to dress up the issue, what the ORH at the present moment is having to deliver is a reduction in the combined budgets of the JR and the Horton, of some  40 million of spending which, if last year�s budgets and activities had continued, they would have cost  40 million more than the hospitals are being allowed to spend and so I hope you will understand that people locally will need a fair deal of persuading that concepts such as a Diagnostic and Treatment Centre are not an exercise in "smoke and mirrors"; to on the one hand suggesting that services are being enhanced whilst simultaneously the ORH is having to make a substantial reduction in their budget.

Turning to consultation, clearly the Horton Users Group is a well-established, "ad hoc" group over many years doing valuable work. As to the other groups that you mention, the two CHCs as you know, are in the process of being abolished. I think locally that has been much regretted, as certainly I think the Oxfordshire CHC over the years did much useful work. As to the other groups that you mention, it is an indication of the increasing complexity of the NHS that I have absolutely no idea as to how they are appointed, who is on them, what are their terms of reference, or their ability effectively to scrutinise and monitor. If I, as a local and I hope reasonably conscientious Member of Parliament, have difficulty keeping up to speed with the ever-changing machinery of the NHS, then I think it is probably even more difficult for others, and again it all tends to give the impression of some sort of NHS "secret garden" where the impression is given of consultation and participation, but in reality no-one is particularly clear as to who is being consulted over what, just as I think people are no longer clear as to which bits of the NHS machine are now driving what processes, and so whilst of course you I am sure will continue to consult, and we would expect you to consult all those bodies that you are under a statutory duty to consult, the only virtue of the ad hoc group that has been set up in Banbury, is that it is made up primarily of people who have been elected to public office of one sort or another, and are therefore at least "accountable" to electors.

I look forward to discussing these issues further with you on 13 June.

Tony Baldry