§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bryan.]
§ 9.47 p.m.
§ Mr. Eric Johnson (Manchester, Blackley)
May I begin by congratulating my hon. Friend the Parliamentary Secretary to the Ministry of Health on her new appointment which, I think, will give her scope for showing that sympathetic understanding of human problems which was so marked in her previous post. She will have that opportunity tonight because you, Mr. Speaker, have been kind enough to give me this early opportunity of drawing attention to the unsatisfactory state of the maternity services in Manchester.
This is causing grave anxiety to doctors in the city and I think that the tolerance of Manchester mothers and their husbands over this state of affairs is just about exhausted. The main trouble, of course, is the shortage of beds for confinements. That in itself is serious enough, but it has the further ill effect of leading to a diversion of beds in the gynæcological section of St. Mary's hospital for use for purposes of ordinary confinement on the maternity side. That is happening throughout the city.
The tragedy of this situation in human terms was brought home to me at the beginning of September when I was told by a doctor that he was unable to book a bed for a patient who was to have her first baby as far ahead as next March—six months ahead. Last week another doctor told me that he could get no room for a mother who was to have her first baby next May. Those are far from being isolated instances. Over and over again women who want to have their first babies in hospital have to be turned down. They go away in tears feeling bitterly resentful.
The position is so serious that if a woman wants to have her first baby in one of the three main Manchester hospitals she must be seen during the first ten weeks of her pregnancy or it will be too late for her to get in, unless the case is quite abnormal. 530 Statistics show that I am in no way exaggerating the position. The report of the Committee on Maternity Services, the Cranbrook Committee, shows that the percentage of institutional confinements of mothers normally resident in Manchester compares unfavourably with the national figure. In 1957, the last figures available in the Report, this was 59.1 per cent. in Manchester, against the national figure of 64.5 per cent. Manchester is, in fact, in a worse position in this respect than most of the large industrial counties and county boroughs. By comparison with the Manchester rate of 59.1 per cent., the figure in the London County Council area is 80.9 per cent., in Leeds it is 68.7 per cent., in Liverpool it is 68.7 per cent., and in Birmingham it is 66.4 per cent. The Manchester figures are even further below the Cranbrook Committee's figure of 70 per cent., which it recommends for future planning.
There are at present 345 lying-in beds available in Manchester, and in 1958 there were 8,675 confinements in this accommodation. That gives a figure of 25.14 per bed per year. I think that my hon. Friend will agree that that is far too large, and it leads to a number of undesirable and, in fact, dangerous expedients. For example, there is a tendency to misuse ante-natal beds which, of course, should be kept for those who are ill during the ante-natal period but which are being used for ordinary lying-in patients. In addition, there is a further difficulty of keeping beds solely for isolation purposes. There is sometimes serious overcrowding. In fact, patients have literally to remain in the labour room for a very long time after their delivery while they are waiting for a bed from which a lying-in patient has just been discharged. That, in turn, leads to the undesirably early discharge of lying-in patients, and it also leads to some restriction of ward cleaning and decorating programmes in order to avoid taking beds out of use.
I said that Manchester's confinement rate was 25.14 per bed per year, and that is very high indeed, especially when it is compared with the rate of 20 which was recommended by the Royal College of Obstetricians and Gynaecologists in their 1944 Report. Perhaps their figure of 20 is an ideal recommendation. We 531 might say that perhaps a figure of 23 is reasonable and more realistic. Even if the figure of 23 were accepted for Manchester, instead of 20, it would mean that the number of lying-in beds must be increased by 98 immediately in order to achieve the figure of 70 per cent. institutional confinements recommended by the Cranbrook Report. On that basis of 70 per cent., the number of births for which provision would have been necessary in Manchester would have been 10,183. On the basis of 23 confinements per bed, it would mean that 443 beds would be required against the present number of 345. That gives the deficiency of 98 which I just mentioned.
It has been suggested that a more rapid through-put of patients is the solution of Manchester's problem, but they are already being discharged in as little as five days from the regional board hospitals and three days from the teaching hospitals. Five days is far too short and three days is quite outrageous. I know my hon. Friend too well to believe that she would for one moment countenance a suggestion which would increase the risk to the mother, and still more to the newly born child. That is precisely what this more rapid through-put, if I may use that rather unpleasant word again, would do.
The figure of 98 beds which I mentioned does not give a true picture, because the present total of 345 beds includes 32 beds at the gynaecological section of St. Mary's Hospital. There is an urgent need for them to return to their original function. In addition, there will be a loss of six maternity beds through the new developments at the Withington Hospital, so the total deficit will be 136 and not 98. It will be 98, plus the 32 to be returned to the gynaecological section and the six lost.
There is something on the other side. There is the prospect of the new maternity unit at Wythenshawe which will provide 56 beds, four isolation beds and 20 ante-natal beds. There is also the much less definite proposal to build a new maternity section for the teaching hospital, St. Mary's, so as to replace its present out-moded and ill-sited hospital in Whitworth Street.
I do not know if my hon. Friend knows Manchester, but I hope that she will take 532 an early opportunity of going to see that hospital. I think that she will agree that that is long overdue. It would be very hard to imagine a worse site than the present one for a maternity hospital. It is situated on a very busy and noisy crossroads. Immediately opposite on one side of the street is a theatre. Opposite on the other side is a railway station. Next door is a dance hall. Behind it is a canal. There is such a continuous noise going on that I should have thought that it would have been very difficult indeed to examine a patient properly and virtually impossible when this involves listening, as I believe that it does, to an unborn baby's heart. In addition, the accommodation for the staff is very poor. It is not surprising that that makes recruiting of nursing staff extra difficult, because they naturally want to work under better conditions.
I understand that the Minister accepted the proposal to build a new hospital three years ago. I believe that it has been suggested that it should contain 135 beds. If my hon. Friend will look through the figures I have given she will agree that 135 beds are inadequate. It will not make up the deficiency now. Even if building the new hospital started right away, there is still an urgent need to do something at once before the new hospital can possibly be completed. There is a need for some action to meet this urgent need for beds and to increase the number available.
By far the best way—I am supported in this by all medical opinion in the city—is the provision of additional general practitioner beds. That would require perhaps three or four units similar to one which we have now at Beech Mount Maternity Home in North Manchester. That home does a very good job. There is plenty of room at Beech Mount for expansion. The need for expansion is shown by the fact that there are 245 general practitioners anxious to use its 21 beds. However, the provision of more general practitioner beds is only a stop-gap. Manchester's urgent and imperative need is for a new maternity hospital. I hope also that when that hospital is built, which I hope will be soon, a general practitioner annexe will be provided. 533 Further, this is not only confined to Manchester—
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sharples.]
I believe that it is a national need, and I hope that when a new maternity hospital is built anywhere in the country a general practitioner annexe will be provided alongside.
§ 10.1 p.m.
§ Mr. Francis Noel-Baker (Swindon)
I intervene only very briefly to reinforce the closing words of the hon. Member for Manchester, Blackley (Mr. E. Johnson), and to remind the hon. Lady that I have from time to time bombarded her predecessors in the Ministry of Health with complaints and suggestions about the situation in my constituency of Swindon. I should be failing in my duty if I did not now remind her that in my town we have a very serious situation that is preoccupying not only expectant mothers but also the medical profession in the division.
This situation has led to a number of cases being sent out of the town to a Royal Air Force hospital. That, when it was first mooted, caused a good deal of alarm in Swindon, but I understand that the arrangements have worked out better than some expected. Nevertheless, it is an anomaly that a Service hospital should be used for this purely civilian and, indeed, very unmilitary purpose.
I should like to ask the Minister to look carefully, after this debate, at the situation in Swindon—I would have raised the matter at Question Time, in any case—and, in particular, let us know when the maternity ward at the new Princess Margaret Hospital in the town, which had its formal opening ceremony only a very few days ago, will be available for mothers of the town.
The hon. Lady, when she has had time to settle in her new Department, will see that from time to time I also questioned her predecessors about the implementation of the Cranbrook Committee's Report. I must say that very many of my constituents feel extremely impatient 534 over the whole question, and would be most grateful if some action should now follow.
§ 10.3 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
First, I should like to thank my hon. Friend the Member for Manchester, Blackley (Mr. E. Johnson) for his kind congratulations. When I have finished speaking I hope that he will feel that I bring to my new job the sympathy with which he so generously credited me in my previous position.
I say at once that I know that there is a shortage of maternity beds in Manchester, but I would add that the problem that undoubtedly exists in Manchester is being seriously attacked. Before I sit down, I hope to satisfy him that this is so. The House is grateful to my hon. Friend—as the present attendance at an Adjournment debate should prove—and Manchester should be particularly grateful to him for raising this matter, which is of such great importance to that city and, indeed, to its neighbouring areas. I can assure the hon. Member for Swindon (Mr. F. Noel-Baker) that I will certainly look into the matters that he has put to me tonight about Swindon.
I myself am grateful for the opportunity to take part in this debate because, to begin with, my first speech in the new Ministry enables me now to deal with a subject of which I have some experience, as I was chairman, in Birmingham, of the maternity and child welfare committee; and also because it provides a chance to examine the problem of maternity accommodation in Manchester in the wider setting of the Cranbrook Committee's Report on the Maternity Services, to which my hon. Friend frequently referred in his speech; and to say something of the action being taken.
I have already stated that my right hon. Friend the Minister is fully aware of the deficiencies in maternity accommodation in Manchester, both in quality and quantity. My hon. Friend referred particularly to St. Mary's Hospital, which is the maternity hospital of the teaching group in Manchester. I agree that, however excellent may be the work which is done there, the maternity accommodation is out of date and needs replacement. Similarly, I agree that the statistical evidence suggests that the total 535 amount of accommodation available for Manchester mothers is insufficient. I think I can give my hon. Friend figures later than those he was able to quote.
In 1958, just over 58 per cent. of the births in Manchester took place in hospitals or maternity homes, and this is a smaller proportion than the national average for England and Wales which, in the same year, was about 64 per cent. The figure for Manchester, of course, relates to an area where it might reasonably be expected that the need, owing to housing conditions and other local circumstances, would be for a higher proportion of the births to take place in hospitals or maternity homes than in the country as a whole.
In the simplest terms, the problem is that there is a known deficiency in quality and quantity. The question then is: how should it be attacked? In answering that, we are fortunate in having at our disposal the guidance of the Cranbrook Committee. The Committee has emphasised the need for careful selection of patients in deciding the need for hospital confinement. It suggested, also, the criteria which should apply in deciding whether confinement in hospital or at a maternity home is needed. It has drawn attention to the priority need for a proper proportion of antenatal beds as well as lying-in beds.
Further, the Committee has emphasised the desirability of providing any necessary additional lying-in beds as far as possible in the form of general practitioner beds. My hon. Friend referred particularly to this. Moreover, the Committee urged the need for hospital authorities, in consultation with the other health authorities, to conduct local reviews in the light of these principles to find out how much accommodation is actually needed in each area, according to local circumstances.
All these points were brought to the attention of hospital authorities by my right hon. and learned Friend in July last, and he then asked them to undertake an immediate review. Thinking in terms of Manchester, this means that the regional hospital board, which is responsible for planning the maternity hospital services in the city, as in the rest of the area, and for determining priorities in providing them, is now charged 536 with the task of reviewing the need for maternity beds. This it will do in consultation with the board of governors of the teaching hospital, the corporation, the executive council and the local medical committee, to decide what needs to be done and how and when it can best be done.
The review is not confined to the City of Manchester—this is an important point—for this reason: about 15 per cent. of the lying-in beds in Manchester are used for mothers resident outside the city. If all those mothers could reasonably be confined nearer their homes, the accommodation available to Manchester mothers would be substantially increased. Of course, it is neither possible nor desirable that all the non-residents should be excluded from Manchester maternity beds. As a teaching and research centre, Manchester must continue to meet the special needs of cases from a wide area. But the fact remains that development outside the city—for example, the provision of a new maternity unit of 108 beds in Salford, which is already being planned—may well help in meeting the city's needs. A review on a basis wider than the city alone is needed to solve the city's problems.
Further, the review must take other factors into account before conclusions can be reached. It must, for example, overhaul arrangements for the selection of patients, to which I have already referred, to ensure priority in the available accommodation for those who need it most. It must be considered whether, by better organisation, more effective use can be made of the present accommodation and whether existing hospital beds can be reallocated to provide more for maternity purposes. Only when the facts on all these points have been fully sifted can conclusions be reached by the regional hospital board about the size of the problem in Manchester and how to tackle it. My right hon. Friend relies, and must rely, on the board to advise him of what action is required when it has completed its review, but, in reaching its conclusions, the board, no less than my right hon. Friend, will, I am sure, certainly bear in mind what my hon. Friend has said tonight.
My hon. Friend mentioned the maternity home at Beech Mount and asked whether it was possible to consider 537 extensions there. That is one of the points which the board must have in mind when it conducts its review. I found out for him—perhaps this is a small crumb of comfort to my hon. Friend—that the board proposes to spend £3,500 in 1960–61 on that maternity home in improving the ante-natal clinic, kitchen and dining room.
In connection with the general picture, my hon. Friend referred to the short periods which some mothers spend in hospital when confined. That is not the information which I have. It was a point on which I particularly asked for information when I knew that I was to answer the Adjournment debate, because it is the first thing that I personally would wish to know. I am advised that the average length of stay of a mother in a Manchester hospital, taking the overall accommodation available, is just over eleven days—11.3. However, I promise my hon. Friend that I will check the figures which he quoted.
I have already said that the final conclusions about the needs of Manchester for maternity accommodation must await the result of the review by the regional hospital board, but it would be misleading to leave the matter there or to give the House the impression that no action is possible at present. It is possible to take action, and, in fact, action is being taken. In the first place, a new maternity unit is being provided at Withington Hospital to replace the present unsatisfactory accommodation there. Secondly, the first phase of a new 538 hospital now being planned for building at Baguley will include another new maternity unit. Taken together, these two projects will increase the number of available maternity beds by about 70.
Thirdly there is the question of St. Mary's Maternity Hospital. My hon. Friend has particularly emphasised the need for new building to replace present outworn units. I am happy to be able to tell him that within the next few days my right hon. Friend will invite the board of governors to begin the planning of the first phase of a new hospital so that the building may begin as soon as planning is completed. In the main, the new hospital will be a replacement of the old, but it is anticipated that about 20 additional ante-natal beds will become available as a result.
This means that in Manchester there are already projects at different stages which will increase the present total of maternity beds of all kinds under the National Health Service from about 370 to 460, or by nearly 25 per cent. When the board's review has been made, further steps may be needed, but I am sure that my hon. Friend will agree that Manchester's problem has been fully recognised and is being seriously tackled. I am sure that he will welcome the progress which is being made and the information that I have been able to give him tonight.
§ Question put and agreed to.
§ Adjourned accordingly at fourteen minutes past Ten o'clock.