§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. MacArthur.]
§ 12.2 a.m.
§ Mr. Philip Holland (Acton)
In August 1963, the then Minister of Health asked the Metropolitan Regional Hospital Boards, in consultation with other bodies concerned, to define without delay the maternity catchment areas in the Greater London area and the group of maternity beds to serve them. I draw my hon. Friend's attention to the phrase used…in consultation with other bodies concerned…for that is really the root of the point at issue.
It might be said, in a curious sense, that the North West Metropolitan Regional Board consulted with the other bodies concerned. Certainly all the evidence points to the board's diligence in seeking to ascertain which solution to the problem would be most universally opposed by all the bodies concerned with its implementation. Having done so, the board then decided that this was the solution to be imposed, explaining to the Minister that it had reached this conclusion…in order to meet the comments of the other authorities which were consulted (local health authorities, executive councils and local medical committees).This last piece of information is contained in a letter written to me by my right hon. Friend on 27th January, but I believe it to have been perhaps a little more than the truth. I will return to that later. Now I will briefly trace the history of the consultation. At the beginning 966 of November the secretary of the Central Middlesex Hospital Management Committee wrote to the board:Central Middlesex Hospital has for nearly forty years been concerned with the maternity and gynaecological cases for the Borough of Acton, and I find it hard to imagine how the General Practitioners of Acton are going to react and cope with the prospect of having these problems disassociated as regards hospital treatment.Perhaps I should explain what the proposals were. All maternity cases in the borough of Acton which have previously been dealt with by Central Middlesex Hospital, that is, certainly all those from the northern half of the borough, will in future be sent to Queen Charlotte's Maternity Hosptial. Apart from anything else, this will mean a change in the facilities available for Acton from a general hospital to a specialist hospital. Central Middlesex Hospital has a long tradition of service to the borough of Acton and is situated approximately in the middle of our northern boundary, while Queen Charlotte's Hospital is situated well outside Acton to the east of the borough's south-easternmost tip.
Clearly, an obvious result of this move will be difficulties in transport, which will mean for many of my constituents two buses or a bus and a train. Difficulties in transport arising from the change to Queen Charlotte's will tend to dissuade Actonians from attending regularly the prenatal clinics which are so important. Further, Central Middlesex Hospital is a large general hospital fully equipped to deal with any complications which might at any time arise during or after pregnancy, whereas Queen Charlotte's would not deal with complications during the first eight weeks of pregnancy; nor has it any interest in pædiatrics. Further 967 difficulties would arise if the maternity case also happened to be a diabetic or heart case, neither of which complaints can be dealt with at Queen Charlotte's.
I am also advised that while the Central Middlesex Hospital operates a highly efficient flying squad service should difficulties occur before the patient leaves home to go to hospital, Queen Charlotte's, on the other hand, relies to a very great extent on the general practitioner having all the necessary facilities available in the patient's home to deal with any complications arising prior to admission.
Differences in facilities apart, the forty-year history of association and co-operation between the general practitioners of Acton and the Central Middlesex Hospital has established a close working understanding between the two which should not be under-rated in terms of benefit to the patient. So much for the outline of the proposal and the immediate reaction to it.
The first meeting of the Liaison Committee for Area D, in which stands the Central Middlesex Hospital, was called by the regional board on Friday, 6th November. Without any prior notice, it was announced at this first fleeting that the board had decided to combine Area D with Barnet, Finchley and Hendon and other surrounding areas instead of, as hoped for, with Acton, Ealing and Southall. At this meeting considerable concern was expressed by many of the representatives at the definition of the new catchment area for the Central Middlesex Hospital and a very strong plea was made for associating Area D with Acton, Ealing and Southall. The regional board rejected this out of hand and refused to accept the valid points put forward to support this practical scheme.
At this point let me explain that under the regional board scheme the Central Middlesex Hospital becomes situated at the very southernmost tip of its catchment area, whereas under the proposal put forward at the meeting by other interested parties the hospital would be plumb in the middle of its catchment area.
An attempt to move the reference hack of the board's proposal, moved by a general practitioner who was present and supported by a large section of the meeting, was vetoed by the board's representatives, who stated 968 bluntly that their proposals must be brought into operation. Is this consultation? I regard it as dictation and I think that the regional board has been getting away with figurative murder for far too long. I have the strongest objection to seeing my constituents pushed around by a little band of bureaucratic Hitlers. Only after I had made the strongest representations to my right hon. Friend the Minister and raised the matter on the Floor of the House at Question Time on 24th February did the board concede the point that it would consider whether the small residential part of Acton close to the hospital could be served by it.
According to my electoral register this area houses 630 electors. Since it is estimated that 46,000 electors in the borough require an allocation of 36 maternity beds, one can assume that one maternity bed is allocated to an area housing 1,280 electors. On paper, and in theory, the board is generously considering whether it might, as a sop, offer half a maternity bed to Acton. I am not trying to be funny. It would obviously offer one bed for half a year, but in practice it would not work out as half a bed because this is one of the oldest parts of the borough and has a higher than average proportion of older people living there. Is this a concession to be taken seriously? Of course it is not.
During the course of the interview that I had with my right hon. Friend at the end of December, and subsequently in his letter of 27th February, he advised me that there was considerable concern over the growing practice of admitting patients late in labour through the emergency bed service. I have a proposal to make, which I hope my hon. Friend will be able to act on, which I believe would not only reverse this trend, but would receive the cooperation of the local general practitioners and would be acceptable both to the staff of the Central Middlesex Hospital and to the group hospital management committee.
My proposal is simply this, that emergencies should be directed to a specified catchment area hospital, but that freedom of choice should be allowed for patients prepared to book 969 a bed well in advance of their requirement. If this practice were followed, I believe that throughout the catchment area demand and supply might find a natural level. For example, Wembley patients in Area D booking in at Perivale maternity hospital would leave vacancies for Acton patients at the Central Middlesex Hospital, who, in turn, would leave vacanices at Queen Charlotte's for residents of Chiswick who live practically next door to the hospital, but who, under the new scheme, will have to travel miles to Sunbury.
According to the information given to my right hon. Friend by the board, the North West Metropolitan Regional Hospital Board has reached its decision after consultation with all other interested bodies, including representatives of the local general practitioners. This information given by the board to my right hon. Friend is completely false, for no one can describe the issue of an ultimatum, coupled with a complete refusal to accept even the smallest compromise, as consultation.
I think that it is fair to assert that the only body in favour of the board's proposal is the board itself. The proposal appears to be opposed by the doctors, by the hospital, by the hospital management committee, by the local health authority, and, as I understand it, by the county council health committee, but on this last point, as also on the attitude of Ealing to the plan, my hon. Friend the Member for Ealing, North (Mr. Barter) hopes to say a few words in the short time available if he is fortunate to catch the eye of the Chair when I resume my seat.
I urge my hon. Friend and his right hon. Friend to have further consultation with the regional hospital board to see whether a new compromise solution can be worked out, perhaps along the lines that I have suggested this evening, to see whether more flexibility can be introduced into the plan so that a possible serious disruption in a most essential part of the Health Service in my constituency is avoided.
§ 12.14 a.m.
§ Mr. John Barter (Ealing, North)
My hon. Friend the Member for Acton (Mr. Holland) has set out the problem which 970 is the subject of this debate and has described the concern that has been aroused in Acton by the decision of the North West Regional Hospital Board with regard to the basis of allocation of maternity beds in that area. A similar situation exists in that part of Ealing which is affected by the proposal. My hon. Friend has requested that consideration be given to the allocation of maternity beds in consultation with the other bodies concerned. No sensible objection can be taken to this course of action. It appears, however, that the process of consultation which he described has been, in effect, less one of consultation than of information about the reaching of a virtually irrevocable decision.
This is the first basis of concern over the outcome of these proposals. The decision has been arrived at largely on the basis of the new borough boundaries, in so far as they can possibly be followed. Although one can appreciate that there may be many advantages in seeking to follow the new borough boundaries, which are possibly well designed for local government in the area, there is no doubt that these catchment areas would lead to areas which, for the purposes of hospital management, are much too large, and which are in no way related to the lines of communication between the proposed catchment area and the hospital.
Nor does the decision pay any regard to the traditional links established, in many cases over forty years, between the local public and the general practitioners and the hospital staffs. Our objections to the decision reached by the North-West Metropolitan Regional Hospital Board can be founded on two grounds; first, in respect of the actual decision reached, which can be proved to be unsatisfactory and inadequate for the purpose concerned and, secondly, in respect of the means by which the decision was reached—when the board sought to push forward its decision over people who were unwilling to accept it.
As my hon. Friend has said, it appears that the board is the only body of people that supports the proposed catchment areas. The area proposed has been opposed by all those who are expected to be responsible for administering the service in the future.
§ 12.17 a.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I am glad that my hon. Friend has raised this matter. It is obviously one of some concern to his constituents, and especially to young mothers, to doctors, and to the hospital and local authority staffs who serve them. He and my hon. Friend the Member for Ealing, North (Mr. Barter) have made their points very clearly, and I will do my best to answer them.
As I understand it, my lion. Friends complain about two things; first, the arrangements made by the North-West Metropolitan Regional Hospital Board for the admission to hospital maternity beds in the area embracing their constituencies and, secondly, the way in which those arrangements were made. It might be helpful if I first sketch in the background to this matter. It is true that all four Metropolitan Regional Hospital Boards and the London Teaching Hospitals with maternity departments were required by my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) in August last year, to define areas for which an adequate number of beds could be grouped to serve the needs of maternity patients, but the Minister did not set out the way in which these areas were to be defined. The responsibility for this, rightly, was left to the regional hospital boards and the teaching hospitals. Indeed, the way in which the areas have been defined differs from one board to another. It is our view that this is properly a matter for their judgment, subject to there being effective consultation with the various interests concerned.
Here I should say something about the reasons underlying my right hon. Friend's action and the arrangements which the boards subsequently made. The hospital confinement rate for London is over 80 per cent.—one of the highest in the country—and for Middlesex well over the 70 per cent. recommended in the Cranbrook Report. That is not unexpected. It arises from the special circumstances that attach to the capital city and its suburbs. The birth rate has been rising, and it may rise still further. Nevertheless, it has been possible for virtually all mothers who needed them on medical and social grounds to have hospital confinements.
972 Additional beds have been provided, and are still being provided where the provision is inadequate—for example, in the region with which my hon. Friends are concerned, at the City of London Maternity Hospital and in Perivale. In the main, however, the peculiar difficulties which some mothers in Greater London have been experiencing in recent years in finding a hospital stem, not from inadequacy of provision, but from a certain maldistribution of beds which has come about for historical reasons. With population expansion taking place on the periphery and a high proportion of maternity beds in inner London, increasing numbers of expectant mothers have been uncertain until a late stage of their pregnancy about where their babies would be born. In fact three in every 100 who are eventually admitted do not know where they are going until the emergency bed service has arranged at the last moment for them to be sent as so-called emergencies to any hospital which can take them.
That was not a satisfactory state of affairs. Many of these confinements were not emergencies of the sort which the emergency bed service had been designed to deal with. In 1961 for example, for just over half the emergency bed service maternity admissions it was known quite early in pregnancy that a hospital bed would be needed although no booking was obtained at the time. We made strenuous efforts to overcome these difficulties but without success and obviously fresh action was called for. Boards were therefore asked to make special arrangements on the lines I have described. In each of the areas they defined they were asked to take the initiative in setting up a body representative of the hospital authorities, local health authorities, executive councils and local medical committees concerned, to co-ordinate administrative action. It was arranged that each of these bodies should agree and keep under review the procedures needed to secure that the maternity beds serving the area met the needs both for antenatal treatment and for confinements.
Here I want to stress an important fact. These bodies are expected to keep the procedures under review. The situation will clearly be influenced as new beds become available. I think it is important for all concerned to realise what 973 the real object of all this is. It is quite simply that for all mothers who are known to need hospital confinement there should be an end of uncertainty so that every one of them receiving ante-natal care from a general practitioner, a hospital or a local authority clinic should know as early as possible in her pregnancy where her confinement will take place. We feel that the underlying clauses of the situation being what they are the scheme on the lines I have outlined is the best way to meet the need. But these newly defined areas are in no way intended to be rigid. I assure my hon. Friends of that. Adjustments which seem sensible when all the circumstances are considered can of course be recommended in the continuous process of review. At the same time, if a hospital is able to accept a mother from outside its defined area there is no objection to its doing so provided it meets obligations to the mothers in its own area. It is the responsibility of the hospital to which any expectant mother from the area served by its group applies, or is referred, first to satisify itself without delay whether or not the delivery is indicated on medical or social grounds and then, as the case may be, either to make a firm booking, or to arrange a booking for her at another hospital in the group or in another group, or to refer her to her family doctor or the local authority clinic.
Now I come to my hon. Friend's charge that the North West Metropolitan Regional Hospital Board in making its plan did not adequately consult all those concerned. As I have explained they were responsible for making the plan and not the Ministry of Health. The board could have listened to everyone first and then drawn up a plan. They chose to act differently. They drafted a plan based on the new boroughs to be established by the London Government Act, 1963. They then sent their proposals to each local health authority, executive council, local medical committee, teaching hospital with maternity beds and hospital management committee concerned.
The local medical committee for the area with which my hon. Friends are concerned was the Middlesex Local Medical Committee. This committee represents the general practitioner interests, and it nominated representatives 974 to each area liaison committee in any part of Middlesex. In the case of Area III the general practitioners were from Harrow, Willesden, Finchley and Whetstone and in the case of Area IV—which includes Acton and Ealing—they were from Southall, Greenford, Hounslow and Sunbury. The method by which these representatives were selected by the local medical committee is not, of course, known. The meeting with the representatives for Area IV was held on 31st December.
Following the completion of the series of meetings, one with each committee, the board received a report and considered objections received from the Central Middlesex Group Hospital Management Committee and the Health and Maternity Services Liaison Committee (Central Middlesex Group) to the exclusion of the borough of Acton from the area to be served by the Central Middlesex Hospital. The board considered these but felt that their grouping produced as even a distribution of resources over the whole of the Greater London area, including beds in teaching hospitals, as was consistent with reasonably defined areas, and they were satisfied that the needs of the area as a whole could be most fairly met if Acton and Ealing were included in Area IV.
In fact, only 30 per cent. of maternity discharges of Acton mothers have been from the Central Middlesex Hospital. From a catchment area survey made by the board for the period 1st March to 31st May, 1963, it was clear that only a small proportion of maternity discharges of Ealing mothers is from the Central Middlesex Hospital. In that period there were 38, representing 5.3 per cent.
To include Acton, which is equivalent to a 36-maternity-bed need, in Area III, as was suggested, would require a comparable transfer of responsibility to another area, and no such transfer appeared to be feasible. Without such a transfer there would be a serious deficiency to the north and west of the area. But the pattern is not intended to be rigid, and a part of Acton lying close to the Central Middlesex Hospital has in face been included, as a result of further consideration, in Area The board fees that there should be no difference in the quality of service to 975 patients in the arrangements which have been made and that such rearrangements as are necessary in regard to travelling to the hospitals concerned are a relatively small price to pay in achieving the general intention. To show my hon. Friends that this is not a rigid scheme imposed by the board, I would instance discussions which I understand are even now going on about the Southall area.
There is also an aspect of the situation which perhaps has been overlooked, and I know that my hon. Friends will forgive me if I mention it. There will undoubtedly be advantages to Acton patients if they go to Queen Charlotte's Hospital. I understand that it is about the biggest maternity hospital in the country. It has a very fine reputation. At the moment all the domiciliary midwifery in the Acton area is undertaken by Queen Charlotte's midwives. Thus there could well be a better integration of the hospital and domiciliary services. Patients who have been booked for home confinement and then have to change their booking will already be known to the hospital staff, and, similarly, patients who do not need to stay in the hospital for the full ten days can be looked after by the midwives from Queen Charlotte's in their own homes. The object of the Health Service, and the Hospital Service 976 in particular, is to serve the patient, and I do not think that in these arrangements the patient's interest is harmed in any respect.
My hon. Friend suggested that only emergencies should be dealt with on the basis of these newly defined areas and that all other cases should be free to book where they like. That can be looked at, but I doubt whether it could be made to work, attractive as it may sound. If, after a while, the hospitals serving Area III—Paddington, Central Middlesex, Edgware and so on—are certain that they can meet their obligations and have some spare beds, there would be no objection to the slack being taken up by patients from elsewhere.
I wish, finally, to emphasise again that there is no intention that this should be a rigid scheme following fixed and immutable boundaries. I hope, having said that, that it will be worked sympathetically and with understanding by all concerned so that the constant review under which it is to be kept will be dispassionate. I assure my hon. Friends that in all this we have only one object in mind—to serve in the best possible way the mothers of this great Metropolis.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Twelve o'clock.