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23 April 2003

In the twenty years that I have been at Westminster, I have learned certain truths.

So, for example, when the Prime Minister describes a Cabinet Minister's position as being "unassailable" you can guarantee that that Cabinet Minister will be sacked within the next six months.

Similarly, when Ministers say that they "have no plans" immediately to do something, you can rest assured that it is going to happen within a very short time-frame.

So when officials write saying " ... there is no hidden agenda" I have long since recognised that that is because there is a very obvious agenda. So what I have learned over the last twenty years, is that when the John Radcliffe gets into financial difficulties, cuts are made of the budget at the Horton Hospital.

So I suppose I should not be surprised, given the parlous state of the finances of the Oxford Radcliffe NHS Trust, that as certainly as Tuesday follows Monday, the Oxford Radcliffe NHS Trust is intending to initiate yet a further "Discussion Paper" over the future of the Horton.

I think I have probably lost count of the number of Discussion Papers, Reviews and Task Forces that there have been over the last couple of decades into the future of the Horton. I, like I imagine most people locally, had hoped that the last Review six years ago which resulted in the Horton merging with the John Radcliffe as part of the Oxford Radcliffe NHS Trust would have been the last of these Reviews. It is also perhaps worth noting that the public reasons given for this new Review � Working Time Directive, Difficulties with Junior Doctors Hours, Problems with the Royal Colleges � were actually all part of the background as against the last Review some six years ago. There is nothing new here except the total inability of those in Oxford to sensibly sort out the finances of the John Radcliffe and sort out what of the central Oxford medical complex is serving the medical needs of the local community and what is part of the academic element of the teaching of medicine at the University of Oxford.

Obviously we shall all have to wait and see what the actual discussion paper has to say. There will, I think, however, be a very simple test. If the proposals it contains are implemented, will they enhance the medical services that are delivered at the Horton, or will they reduce them? And given that in the past there has been a certain amount of "double-speak" by administrators in Oxford with regard to the Horton, I am sure that you will understand that people locally will want to test rather thoroughly whatever proposals are put forward.

There is, however, one matter that already causes me some concern when reading the press release put out by the Oxford Radcliffe NHS Trust. I won't take the rather boorish point that the press release refers to medical services in "North Oxford" rather than "North Oxfordshire" although I suspect that for many of us the suspicion is that the horizons of all too many in Oxford are limited by the ring road. There is, however, a much more substantial point.

The press release refers to the Horton simply as the Horton Hospital. This is a fundamental point.

Oxfordshire is not a tidy county. Having its only city and largest concentration of population roughly in its centre is very tidy. Having its second largest and perhaps one of its fastest growing towns on the northern edge of the county is not particularly tidy, particularly when that town serves a catchment area that stretches deep into at least two neighbouring counties. For years there has been a recognition that there could be only one district general hospital within a district and that for Oxfordshire was clearly the john Radcliffe, but, and this is an important but, it has always been accepted, including in the last Review, that there needed to be a "general hospital" in Banbury. In other words, a hospital that delivered the basic range of key medical services that constitute a general hospital � accident and emergency, maternity, paediatrics, etc.

I sense that what, however, is happening now, is the suggestion that incrementally the Horton should be downgraded from being a "general hospital" into being effectively a satellite of the John Radcliffe simply delivering certain Oxford-based services locally in Banbury. The proposed moving of the pathology services from the Horton to Oxford is but one further indication of this intention.

That is not what I think local people understood was intended with the merger of the Horton into the Oxford Radcliffe NHS Trust and the difficulty of such an incremental approach is that once it starts it is all too easy for administrators to continue to move services to Oxford, leaving the Horton with a rump of local provision and becoming little more than a cottage hospital.

I hope that I am mistaken, but I have a horrible feeling that it is not going to be long before again we see posters all over Banbury and the surrounding area saying "Hands off the Horton".

Tony Baldry