§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chichester Clark.]
§ 10.25 p.m.
§ Mr. Denis Howell (Birmingham, Small Heath)I rise to raise a matter of considerable importance—the question of the Birmingham Maternity Hospital and the decision that it has taken unilaterally. Hon. Members will know that I am opposed to all forms of unilateral action whether taken in the higher realm of politics or in the realms of the health services of Birmingham.
Recently Birmingham Maternity Hospital, which is one of the teaching group of hospitals in the city, decided that it would admit 300 cases fewer per year. I am referring—and I think the Minister who will reply will agree with me—to what are some of the most difficult maternity cases in the city. Notwithstanding that fact, there are in Birmingham, of course, other large hospitals which deal with difficult maternity cases, and I am associated with some of them. The pressure on the whole of the maternity services in Birmingham is very considerable and the pressure of difficult cases—and I say this in view of a reply which I received from the hon. Lady recently—does not fall entirely on the Birmingham Maternity Hospital.
It has been estimated that, at the Dudley Road Hospital, one of the large maternity hospitals in the city which is doing tremendous work, 70 per cent. of its intake of maternity cases are emergency and difficult ones. But this hospital does not have the resources or the nursing power to cope with a heavy additional burden, compared with that available in the nursing service attached to the United Teaching Hospital.
The decision to take 300 fewer cases a year raises great problems. These are cases that must go into hospital or must receive expert attention, and one must be concerned to ensure, especially in view of the extremely difficult time which these ladies go through, that they have medical attention. A regretful fact 1788 is that the decision to which I refer was taken entirely unilaterally. The hospital did not consult the Birmingham Regional Hospital Board, any of the other hospitals in the city or the City Maternity Hospital and it is, therefore, a disgraceful piece of social irresponsibility. I have said that before and I am sorry to have to repeat it now. Highly efficient though the medical attention at the Birmingham Maternity Hospital may be, I do not believe that it can divorce itself from the social consequences of the Health Service which face all the hospitals in Birmingham.
That is what has happened here. When I asked the Minister of Health a little time ago what communication had taken place between the teaching hospital group and the Regional Hospital Board I was told that it was not in the public interest to disclose communications between the teaching hospital group and the Birmingham Maternity Hospital. Why not? I ask the hon. Lady: have we reached the state of affairs in such an important field of social policy, the administration of our hospitals, that the relationship and liaison between the teaching groups and the regional hospital boards should be treated as if it were controlled by M.I.5, or that this is a question of such national importance that Members of Parliament cannot be given any information?
This is absolutely deplorable and I hope the hon. Lady will not rest on that line of defence tonight. It is deplorable that Members of Parliament concerned with the cohesion of all of the Health Service facilities, such as the practical after-effects of a decision such as I have mentioned, are not given the fullest possible information. This is treating the House of Commons with the greatest of contempt, and I hope that the hon. Lady will reflect on this. I can understand the desire of the Ministry, which I suppose was not consulted either, to bat on behalf of one of its departments, but I do not see how the hon. Lady, who represents the Birmingham constituency of Edgbaston, can defend a situation where Members of Parliament are not given vital information to enable them to arrive at decisions and conclusions.
The most important point which comes out of this whole affair, as far as I can 1789 see, is that there is a very serious deficiency indeed in the administrative setup of the Health Service when the teaching hospital group, which is not controlled by the Regional Hospital Board, can ac in this manner which is against the interests of the Health Service as a whole. Neither the Health Service nor the country can afford to put millions of pounds into the development of costly hospitals doing wonderful teaching work—I am the first to pay tribute to them—but in isolation from their responsibilities to the community as a whole.
Some of us have suspected for a long time—certainly I have—that the teaching hospitals in Birmingham, in carrying out their duties and following their legitimate interest in teaching in the medical world, have more and more tended to divorce 'themselves entirely from the social needs and realities of the community within which they work. I gather that this is not a criticism which applies in other areas, where there is the most effective liaison between teaching groups and the regional hospital board hospitals. In other areas, I gather, there is a tremendous desire on the part of the teaching groups to take their fair share of the social load. If the teaching hospitals divorce themselves entirely from the normal day-to-day work, they cannot perform their teaching functions properly.
Here we have a situation, as I say, which has caused tremendous concern. I ask the hon. Lady to deal with the general fundamental issue of the relationships in the National Health Service between the teaching group on the one hand and the regional hospital board on the other. If there is no proper liaison and co-operation, a very serious deficiency has been exposed.
The next point is: who is going to do the work left as a result of this decision of the Birmingham Maternity Hospital to take 300 fewer cases a year? In practice, most of these cases are now finding their way to Dudley Road Hospital and other hospitals of a similar nature, but most of them going to Dudley Road Hospital. This is a hospital which, in the last three years, has increased its intake into its maternity wards considerably beyond the point to which it is safe for such a hospital to go. The load on the Dudley Road Hospital is quite enormous, and the load on its nursing staff 1790 is more than any hospital administrator is entitled to place on young girls taking up nursing.
That was the position before this unilateral action of the Birmingham Maternity Hospital, and it has been materially worsened by the after-effects of that action. Not only is the load on the hospital itself great, but there is tremendous pressure now put on the hospital authorities to do all sorts of undesirable things as a result of the position in which the Birmingham Maternity Hospital has put the Regional Hospital Board. There is pressure, for instance, to cut down the number of days for which women stay in hospital after delivery of their babies. I hope that the hon. Lady will refer to some of these unsatisfactory trends.
It is not only the hospital service which must bear the heat and burden of the day. The city maternity services are feeling the pressure. If Dudley Road Hospital, Selly Oak Hospital and other hospitals said that they must have regard to the pressure on their nurses—which I believed to be much greater than the pressure in Birmingham Maternity Hospital, though that was the reason the Maternity Hospital gave for its decision —the result at the end of the day would be an enormous added burden on the city midwifery service's.
I had the privilege and pleasure of sitting under the chairmanship of the hon. Lady when she was chairman of the Birmingham maternity services committee. I know that she jealously guards the standards of the city's services and she would not in her present capacity wish to do anything to undermine them. I know very well that the contrary is true. But what would she say—perhaps she will think this an unfair question, although it really is not—if she were now the chairman of the maternity services committee of the Birmingham City Council faced with the situation which her present successor has? Knowing the facility with which the hon. Lady can express herself very forcefully and clearly, I can hazard a very good guess at the sort of line she would take in the Birmingham City Council today.
The city midwifery services are under very great strain. In another debate recenty, I mentioned that the increase in the birth rate in Birmingham in the past 1791 six years has been from 17,000 to over 21,000, a rise of over 20 per cent. There is tremendous pressure on all sections of the city midwifery services as well as on the maternity hospitals. In that general context, one cannot possibly justify the sort of unilateral action which the Birmingham Maternity Hospital has taken.
I hope that the hon. Lady will say honestly how the Ministry reacts to this deplorable situation. It is natural that the Ministry would not wish to become involved in pubic argument about different sections of the Health Service, but I sincerely believe that, where one is faced, as one is in this case, with irresponsible unilateral action which affects all the other hospitals and services in the city, one is not only entitled but one has a positive duty to make the strongest possible protest. That protest I make tonight in this Adjournment debate.
I make more than that protest. I am anxious to find out how those of us responsible for the administration of other hospitals in the city are supposed to get the united teaching hospitals out of their dilemma without imposing a further and intolerable burden upon our nursing staff.
§ 10.40 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)In order to set the scene to enable me to reply, I shall have to tell the hon. Gentleman something which I think that he knows perfectly well, and certainly I do, that in our City of Birmingham both domiciliary and institutional births have increased rapidly. In 1955 the domiciliary births were 6,237 and in 1960, 7,600. Births in hospitals in the same years have risen from 11,035 to 13,533. The maternity beds in Birmingham, as again the hon. Gentleman knows, are provided at the Queen Elizabeth Hospital and the Birmingham Maternity Hospital and by the hospitals in the Dudley Road and Selly Oak groups by the Birmingham Regional Hospital Board. I think that the hon. Gentleman may like to know that over the last eight years the total number of staffed maternity beds available has risen from 605 to 651, though I would add immediately that I know that there is room for further improvement.
1792 An indication of the rate of increase of confinements at the Birmingham Maternity Hospital is that the average number of births per month was 159 in 1955 and 206 in 1959 and had risen to 223 per month for the first ten months in 1960. At this average the pressure on the hospital and its staff was considered to be such that it could no longer be safely maintained. In October, 1960, the consultant paediatrician formally recommended that action needed to be taken to ease the burden on the paediatric staff. It had recently happened that no less than ten exchange transfusions had had to be performed in thirteen days. Early in November the matron reported the serious illness of one of her most senior midwifery staff and the pending resignation, on account of overwork, of others of that staff. The decision to limit the number of admissions to the hospital by a planned reduction in the number of forward bookings in the early period of pregnancy was not, however, taken only to relieve pressure on the staff of the hospital but also for the safety of patients.
Furthermore, the Birmingham Maternity Hospital has traditionally accepted the obligation to receive all obstetric emergencies which may be referred to it. This is not to suggest that this obligation is not also accepted by other hospitals in Birmingham, but the continued acceptance by the Birmingham Maternity Hospital of these emergencies previously booked elsewhere—including arranged home confinements—who by some change in medical or obstetric condition either in the latter period of pregnancy or in acute emergency, was in danger by October, 1960, of not being fulfilled. Many of these emergency cases originate from references from outside Birmingham City. Of the first 1,000 confinements in the Birmingham Maternity Hospital in 1961 55 per cent. were from the city and 45 per cent. from outside its boundaries, and the general pattern is that roughly an average of half come from outside the city.
The decision taken in November, 1960, to limit bookings to 1,894 per month, that is, 2,208 per annum, enabled the hospital to continue its working arrangements so that it could maintain fifty places 1793 for patients in obstetric or medical emergency which from experience was regarded as a necessary level, and one which it was considered had to continue to secure an essential service to the Birmingham region as a whole.
Restrictions on the number of forward bookings had been needed in the past in 1954–55 when the activities of the hospital were established at approximately 1,900 confinements and in 1957–58, at approximately 2,300 confinements. The limitation on booked confinements at the Birmingham Maternity Hospital since November has been achieved in two ways. First, by some intensification of the normal procedure, that is, consultation between the consultant and the general practitioner according to the individual circumstances of the case, with the result that, where it has been possible to make satisfactory arrangements with the general practitioner and the midwifery service, confinements have taken place at home. Secondly, a further proportion will have been admitted for hospital confinement both in the peripheral and in other Birmingham hospitals, probably especially at Dudley Road Hospital.
I have looked at the statistics of Dudley Road Hospital, knowing the hon. Member's personal connection, with it. For the first five months of 1961 they show an increase in the monthly maternity admission from an average of 360.5 per month in 1960 to 421.2 per month this year. Emergency admissions have risen from an average of 115.2 per month in 1960 to 162 per month in the first five months of 1961. Caesarian sections have increased from an average of 18.6 per month to 25.8 per month. Instrumental deliveries have increased from 14.4 per month to 26.8 per month. Total deliveries have increased from an average of 301.6 per month to an average of 336 per month. I should add that the increase in total confinements at that hospital is also partially due to the rising birthrate and other special local circumstances.
How big is the problem that has resulted from this decision at Birmingham Maternity Hospital? To have made it possible to revert to bookings at the same level and according to the same standards obtaining at the Birmingham Maternity Hospital before November, 1794 1960, involving an added 300 deliveries per year, would have required a minimum of twelve extra beds. That is the size of the problem. I should add that all cases which are potentially normal but which develop complications in labour at home are admitted to the hospital at the request of the general practitioner. Furthermore, the flying squad is available in the city as an ancillary help for difficulties arising in domiciliary confinements, but as far as the Regional Hospital Board is aware all cases with a medical indication in pregnancy are delivered in hospital. At present it is not possible to admit all cases with a medical indication for ante-natal treatment. Arising from this difficulty, which arises from the Loveday Street Hospital—as I prefer to call it—certain conclusions can be drawn.
The long-term solution to problems of pressure on admission for necessary confinements in hospitals is, in Birmingham as elsewhere, the provision of more fully-staffed beds. Provision of additional beds at the Birmingham Maternity Hospital on its present congested site, which is due for demolition, has not been practicable, but as is known, plans are being made for the building of a new maternity hospital near the Queen Elizabeth Hospital replacing the Birmingham Maternity Hospital and also providing additional beds. Six other major schemes providing new maternity units for the region have received approval in principle and the total needs of the region have been thoroughly surveyed in the ten-year development plans now submitted to my right hon. Friend. The particular problem was one requesting as far as possible short-term alleviation, and it is on these lines that it has been considered by all those concerned. Their proposals are essentially for local deliberation and arrangement. My Department will continue its interest and will give any help it can in the solution of these difficulties.
It is clear that the experience to be gained from these occurrences as to the interdependence of units in hospital service and the Health Service as a whole is already being put into effect and no doubt that will also stand to the general advantage for the future. The hon. 1795 Member referred to his earlier Parliamentary Question which began his discussions on this matter. He said that my reply then indicated that to disclose what consultations took place and to make these known was not in the public interest. That is not correct. What I said was that it would not be in the interests of the hospital service to disclose communications between boards, and that I must repeat tonight.
This is part of an integrated service, to Which the teaching hospitals have a contribution to make. We in the Ministry look for liaison. We expect it to be provided and maintained, and the request we have recently made to all regions to submit to us their ten-year development plans will help still further to increase the liaison available between all the hospitals in the area about the provision that they make to this service.
There are three parts, particularly in maternity work—the teaching hospitals, the hospitals of the regional board, and the local authority; and I cannot say too firmly how important it is to maintain good liaison in the interests of the people who are to receive that service.
§ 10.51 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)I do not think that even the hon. Lady can feel satisfied with the reply She has given to the main point raised by my hon. Friend the Member for Birmingham, Small Heath (Mr. Denis Howell), which was the apparent total failure in this case of communication between the teaching hospital and the regional board. There is a serious lack of liaison in the hospital service, and I speak with some feeling as a member of 1796 a regional hospital board within whose region there are no fewer than twelve teaching hospitals.
There are two views about the autonomy of the teaching hospital under its board of governors. If the boards of governors want to jeopardise that autonomy, they should continue to behave in the way that the governors of the United Birmingham Hospitals have done in this instance. It is quite unpardonable to take a decision of this kind, which thrusts an extra load on the regional board hospitals, without proper consultation. I am disappointed that the hon. Lady, duty bound as she is so far as possible to defend the board of governors, did not at least indicate that that was her view and the Ministry's view, too.
After all, the regional hospital board has a duty to plan hospital services within its region. It is probably its most important function, and it cannot carry out that function unless it has proper liaison and proper consultation with the boards of governors of the teaching hospitals in its midst.
The hon. Lady said that her Ministry looked for liaison and consultation. It is not good enough merely to look for them. She and her Ministry have a duty, and I hope that, by whatever means seem appropriate, she will convey to the United Birmingham Hospitals that they have not behaved very well on this occasion and that she and her Ministry will see that in future decisions of this kind are reached as the result of proper consultation between all branches of the hospital service.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes to Eleven o'clock.