§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. R. Thompson.]
§ 6.30 p.m.
§ Mr. James Dance (Bromsgrove)
I am extremely grateful for the opportunity to put forward some of the views of Redditch on the very important matters of providing maternity facilities, and I am also grateful to the Minister for the consideration which she has already given to this matter.
Redditch is a rapidly growing town. Its pre-war population was about 22,000, whereas last year the figure was about 31,000. That rapid increase in population is likely to continue at a more accelerated pace due to the fact that Redditch has agreed to assist Birmingham in its overspill problem. At present, there exists a feeling of frustration among Redditch people that they are being prevented from developing along progressive lines. We are here dealing with a community which is not prepared just to sit down and expect someone else to do everything for it. It is prepared to act, and has acted, on its own initiative.
After the war, private enterprise and private money set up a maternity home known as "The Gables" which was run for years successfully except, unfortunately, from the financial point of view, as there was no Government assistance. Recently, this progressive council acquired a hostel from the Ministry of Labour known as the Abbey Hostel. We are not, therefore, dealing with a council which is not prepared to endeavour to help itself.
Owing to the lack of these maternity facilities, there is a great deal of inconvenience in the town. First, there is the question of husbands visiting their wives and children. In a large number of cases they have to go many miles. The nearest accommodation at present is at Bromsgrove, which is about 6½ to 10 miles from parts of the Redditch urban district. Bromsgrove itself cannot deal with the whole problem so that many of these mothers are sent about 15 miles to Evesham, and there is an extremely bad bus service. I am informed that there are certain occasions when fathers have made 432 this journey and found that they had only a few minutes to spend with their wives before they must return home. There is another question—that of the ambulance service. Sending these mothers to the surrounding towns at 2s. a mile amounts to quite a considerable sum at the end of the year.
I wish to discuss for a moment the trade and industry of this progressive town. Because a diversity of goods are manufactured there, Redditch has the extraordinary record of exporting something like 80 per cent. of its products, which must be among the highest figures in the land. Another factor which should be considered is that, because of the actual articles they make, such as hypodermic needles, springs and the like, the amount of valuable steel which in many cases has to be imported into this country does, in effect, earn a large number of dollars and foreign currency, a great deal more than the heavier industries whose consumption of steel is far greater compared with the output.
The work done in Redditch is in many ways complicated and requires great skill. For years we have been told that to get on well in the Redditch industry one needs "Redditch fingers." I wish to see those "Redditch fingers" employed in making these goods for export, and not idle. I understand that it is the policy of the Government, and also the recommendation of doctors throughout the country, that as many mothers as possible should have their babies at home, and we would all agree with that. But I think that it has been proved that in Redditch there exists a problem by the mere fact that the council found it necessary to buy the hostel.
There are many people in transit who have no homes of their own and people who live in lodgings. While I agree that most of the people who live in hostels are single, there are very many married families who live in lodgings, so that it would be impossible for those mothers to have their babies at home, because they have no home of their own. The Redditch Council recently offered a sick bay in the Abbey Hostel to be used as a maternity ward. I have received local medical advice about the suitability of using this ward. I am told that with virtually no expense we could produce there one labour ward, one isolation ward 433 and at least nine beds which would be quite adequate to meet the present needs of Redditch. Like an expanding bookcase, this hostel, being fairly large, would allow the maternity hospital to be always complete but never finished—it could expand and go on expanding. I am also informed that it may be possible for this maternity home, if we secure it, to be run in conjunction with the general hospital known as "Smallwood," which is 500 yards away from the proposed new home. It may easily be that that idea would work very well and, in some cases, might avoid the duplication of nursing staff.
I believe that the psychological effect on this town and the feeling of frustration is very marked. Were the people given some encouragement, which I sincerely hope the Minister will be able to offer, it would have a profound effect on them. It is a hard-working community, earning valuable foreign currency. I consider that here the people of Redditch are asking only for reasonable facilities in requesting this maternity accommodation. I can assure the House that if this request is granted, the Redditch community will play its part in good faith. It will not let the Minister down if this assistance is granted.
§ 6.38 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to my hon. Friend for the manner in which he has raised this question. It is a matter which is common to many communities; they all wish to have their own small local maternity unit.
It is true that in August, 1954,"The Gables," a privately run maternity hospital, was closed because of financial difficulties. It is a measure of the sympathy displayed by my right hon. Friend the former Minister regarding this problem that he met a deputation and referred the matter to the regional board. It was found quite impossible to take over this very small unit of ten beds. It would have required considerable adaptation to bring it up to the standard required for a maternity unit under the Health Service and it would have been very uneconomic to run.
There are many questions which every regional hospital board has to consider in relation to these small maternity units.
434 We all appreciate the desire of every community to have one on the doorstep, but it is not a practical proposition in the overall programme of regional hospital boards, provided that they are able to offer available beds to meet the demand in reasonably near units. The board has looked most carefully into this question and has also considered, at our request, the suggestion which my hon. Friend made in regard to the Abbey Hostel. When any unit of this kind—and"The Gables" was such a unit—is closed, the board has to ask itself whether there are alternative beds. In this case there are, and they are linked with general hospitals, where greater and wider facilities are available.
It is true that some of those beds are at Evesham, which is about 16 miles away, and the others at Bromsgrove. I understand that some mothers from Redditch have had to go to Evesham. I should like to make it quite clear that of those mothers who, in the first half of last year, had to be confined at either Redditch or Evesham, more than half were confined at Bromsgrove, which is nearer. Thirty-five were confined at Evesham, and 20 at six other hospitals within the area. I want to make it plain to my hon. Friend that the Government appreciate the disadvantage of Redditch mothers having to travel so far as Evesham. It is the board's ultimate intention to increase the maternity accommodation at Bromsgrove Hospital in order that Redditch mothers can go there rather than to Evesham. Seven additional beds were made available in Bromsgrove last year, and the additional award of 17 beds should be completed by the end of this month.
The main trouble, which applies not only to general hospitals but to any new unit such as that suggested by my hon. Friend, is the great difficulty of staffing. We cannot open these 17 beds at Bromsgrove Hospital until we are able to obtain additional staff, and it would make things even more difficult if the board set about opening a new unit of 10 or 12 beds within the locality, because that would make an even greater demand upon the available maternity ward staff.
I can assure the hon. Member that the board is advertising; it is also endeavouring to see whether it is possible to transfer any staff from other centres within the 435 region, in a very real effort to get the 17 beds at Bromsgrove opened as soon as possible. As soon as they are opened mothers will no longer have to go to Evesham from Redditch; except for the odd exceptional case they will automatically go to Bromsgrove Hospital, which is about six miles from Redditch. That is not an undue distance when one considers the many calls upon the regional hospital board, and its duty, if it has available beds, to see that those beds in general hospitals, which have far greater facilities than the 10 or 12 bed unit, are properly used in the interests of the efficient running of the service.
I understand that the local authority has put forward a suggestion in relation to the taking over and use of Abbey Hostel. Our report is not as favourable as that of my hon. Friend. First, it is a prefabricated building. Secondly, its layout is not suitable for a maternity unit; the interior would have to be completely demolished and rebuilt and the layout re-designed in order to conform to the standards upon which the service now insists in regard to maternity units. To adapt a unit of this very small size—at present it would take only 10 or 12 beds—would cost many thousands of pounds. There is no provision for anything that could be turned into a labour ward, and one would have to be built. This would probably take up the space of two of those 12 beds. It is true that there are some sterilising facilities there, but it is not suitable for a maternity unit.
The capital expenditure on this unit would be very high, and, even if we could get over the staffing problem—which I very much doubt, in the light of our difficulty in finding staff for 17 beds at Bromsgrove—it would be a unit of only about 10 beds, which we have found from experience to be an extraordinarily costly unit to run, and one which carries costs in staffing and equipment far and away above those of a general hospital or, in many cases, even a teaching hospital. It would be a small unit, isolated from the general hospital services which, as I have said, can provide overall a better and wider service for mothers than can such a very small unit.
Taking the region as a whole, the board is very satisfied that Worcester is well provided with maternity beds. The 436 problem is not that a mother cannot get hospital attention; there has been no question of mothers in Redditch not being able to get hospital accommodation when it is required—and I know my hon. Friend did not raise the point. In fact, accommodation can be so provided, and it is our hope and intention, as soon as staff are available, that the 17 additional beds at Bromsgrove will be put at the disposal of those mothers.
With that assurance I think my hon. Friend can fairly say to the mothers of Bromsgrove that adequate accommodation is being provided for confinement in hospital, and is being provided in a general hospital with all the facilities and equipment that we require under the Health Service. While it does entail a journey of about six miles, it provides a more efficient service and it is a practical and efficient solution to the problem.
I do not believe that the unit which it has been suggested should be turned into a maternity hospital would be as satisfactory. Further, it would not be fair to ask the board—when it has available beds which are within a reasonable distance and are attached to a general hospital—to expend considerable capital moneys, which are needed for other priorities within the region, to turn an old, prefabricated building into what, at most, would be a second-best maternity unit.
I hope that my hon. Friend will feel that this matter has been given very deep consideration. We considered the question of the closing of the former unit with great sympathy. We have gone into this matter in great detail, and I believe that when we are able to get the staff—and the board is seriously endeavouring to get that staff, by advertising—the 17 beds at Bromsgrove will be made available, thereby cutting down the journey for those who previously had to go to Evesham, and providing an efficient and sound service for the mothers of Redditch who are housed in Bromsgrove Hospital.
§ 6.50 p.m.
§ Sir Frederick Messer (Tottenham)
The House should be indebted to the hon. Member for Bromsgrove (Mr. Dance) for raising this question. While it is true that it has local interest, the whole problem is one of national importance.
When the National Health Service came in, one of the chief functions of the regional boards was to plan the service, 437 allocate money and deal with specialist services, etc. When the boards started on this job it was evident that they would have to take cognisance of the work that was being done by hospitals and similar institutions which were outside the service. In the main, the standards of the service improved as the result of planning, but not necessarily so with the standards of hopsitals that were outside.
There were many reasons for that. In the case which has been cited of a hospital which is no longer continuing because it was unable to provide the necessary finance, during the period towards the end of the time the standards of service must have got lower and lower because of the limited means at its disposal for maintaining the hospital and keeping the doors open, but the hon. Gentleman need not be alarmed at the prospect of maternity cases going six miles away. It is usually in rural areas that that applies. There are many cases where a mother has had to go six miles.
One important factor, as those who have read the Reports of the Central Health Service Council will know, and who pay attention to the proper use of beds, is that the normal place for a confinement is at home. Confinement is not a pathological condition but a normal condition. Admission to a maternity hospital is mainly decided according to surgical necessity. If the case needs Caesarean section or an operation, or calls for the attention of a surgeon, it must have first priority. The next priority is for a first child or bad social conditions. Far too many homes are congested and it would be strictly against the interests of the mother and child, and of the health of the rest of the family, for the confinement to take place there. Cases that are not likely to be difficult cases are admitted if there is a vacant bed, because that is an advantage to the mother.
We have to regard maternity in the light of a normal case. In the case we have been discussing there is a prefabricated, hospital. I do not know its conditions or whether there is a nursery. Up-to-date opinion is that the child should be in a cot in the same ward as the mother, but that must be related to the type of ward. I do not know what conditions are in a ten-bed hospital and whether it has a milk kitchen. One child may go down with gastro-enteritis and then we 438 have to shut the hospital because that is an infection that is easily caught. It would be wrong to consider convenience as against health. I know that small maternity units are run privately where we get none of these dramatic happenings. but it is the risk which is important.
I shall not argue the case about hospitals which are a long way from the patient. That cannot be avoided. In some parts of the country, even under National Health Service planning, the position is serious, and not only in relation to maternity. In East Anglia, for example, Cambridge may be 50 miles in one direction from a patient and Norwich 50 miles in another direction and between those places there may be no hospital of any sort. For a patient to have to travel six miles for a confinement cannot be regarded as real hardship compared with what may happen to other types of patient. Every regional board has its planning committee, which is not a body which sits, plans and goes away, leaving the plan to be carried out. It is continually in session because of the need for constant change. The regional board has to take cognisance of the pressure on ordinary days.
We wonder whether the best use for a place like this hospital is maternity. Could it not be better used for a different type of patient? Already, in almost every region, pressure is being applied for the accommodation of old people. The suggestion is that the chronic case ought not to be in the high-standard hospital where it probably costs £15 or £20 per week to keep a patient. Old people ought to be in an annex to a district hospital. That would be a better use for the type of hospital about which we have been hearing.
The hon. Member for Bromsgrove ought to press for ease of transport. I have in mind one hospital in North London. Delivery of the child takes place in the hospital, and the mother is afterwards taken a few miles away TO what, in effect, is a maternity nursing home. That system has operated quite well. At Isleworth, in West Middlesex, mothers are delivered of their children, and then taken 15 miles away. As the result of that turnover in the hospital, the mothers no longer needed that proportion of the labour ward, of the milk kitchen or of the nursery, so many more 439 patients can be accommodated. For those reasons we ought to aim at a plan for adequate maternity accommodation in a district hospital for the catchment area in which that hospital happens to be.
While I praise the hon. Member for raising this subject—I think he has done the right thing—what is wanted is fresh planning, so that when we can get the capital we can adjust our existing accommodation——
§ It being Seven o'Clock, and there being Private Business set down by direction of The CHAIRMAN OF WAYS AND MEANS, under Standing Order No.7 (Time for taking Private Business), further Proceeding stood postponed.