HOSPITAL MATERNITY FACILITIES, BLAENAU FFESTINIOG (Hansard, 27 April 1964)

§ Mr. T. W. Jones (Merioneth)

As is so true of other voluntary institutions in the Blaenau Ffestiniog area, the Ffestiniog Hospital was built by funds raised by the quarry workers at the respective slate quarries. It was definitely intended that it should be a maternity hospital in addition to a hospital for general purposes and that the surplus funds after the creation of the hospital should be used expressly for that purpose.

In 1948, we had the introduction of the National Health Service, and not only the hospital, but the accumulated funds, were taken over by the State. It was naturally expected that the funds would be utilised for the purpose for which they had been collected, namely, to provide a maternity unit. In spite of repeated representations, the maternity unit has not been established, and the Minister's letter to me on 17th April last year and the one received by the local council from the Welsh Hospital Board, Cardiff, made it abundantly clear that it was not intended to establish a maternity unit.

It is unfortunate that both the former Minister of Health and the Welsh Hospital Board, according to their respective letters, have compiled their statistics exclusively on the population figures of the area of the Ffestiniog Urban District Council. I wish to emphasise tonight, however, that when we argue on behalf of a maternity unit connected with the hospital at Blaenau Ffestiniog we mean it to serve the needs not only of the Ffestiniog Urban Council area but also the major parts of the Deudraeth Rural Council area, with the outlying districts of Trawsfynydd, Gellilydan, Harlech, Maintwrog, Penrhyndeudraeth and Dolwyddelan—that is a mouthful. In this connection the resulting total number would then more than double that which is referred to in the letter I received from the Minister of Health.

166 Let me quote him to see what he said: In the Ffestiniog Urban District there were 146 births in 1961 and 130 in 1962. Of these 17 were home confinements in 1961 and 12 in 1962. Those are the statistics given to me by the former Minister, and I do not dispute them. I am most anxious to point out to the present Minister, however, that in the extended area which we envisage and propose that the maternity unit should serve, the medical officer's report for 1962 shows an average of 250 live births and of these only 30 were domiciliary.

The matter raised tonight has a human aspect which cannot be overlooked. The Minister will agree, I am sure, that in the case of a pregnant woman there should be a close and personal relationship between the doctor and his patient up to the actual birth of the child. The mothers of the Blaenau Ffestiniog area are today denied that human right. When the pregnant woman has signs of impending birth she is suddenly transported a distance of 35 miles, in most cases, to be placed in the charge of an utterly strange medical practitioner. It is most certainly psychologically wrong to have such strains and fears imposed at the very time when happy and relaxed atmospheres could and should be provided to the expectant mother.

What terrible roads she has to travel also, to get to her destination. I have handed to the Minister an Ordnance Survey map which gives some indication of the terrain which has to be negotiated with such heights as that of the Crimea Press, 1,263 ft., and the Capel Curig to Ogwen, 1,030 ft. The road conditions at their best are poor, and at their worst, in winter, impossible.

It is disquieting to note that, from time time, a number of births have taken place in ambulances on the road to the hospital at Bangor. There was one as recently as last January. Only last month I received a letter from a constituent which I am anxious to quote: I am a 25 years' old native of Blaenau Ffestiniog with a 19 years' old wife who had the misfortune of losing her second born child on Friday 13th March. Hence this letter to you, Sir, as my Member of Parliament, in order to express my most profound disgust at the deplorable lack of maternity facilities in this area. I feel sure in my own mind that had my wife had access to the treatment and 167 assistance that all pregnant women have the right to expect she would not have to suffer the loss of her second child. I feel sure I speak for a large number of people in this town when I say we should have a Maternity Hospital in Blaenau Ffestiniog, for it seems to me that 35 miles to Bangor is too far to expect an expectant mother to travel, especially when haemorrhage starts, as was the case of my wife. So, Sir, I appeal to you. Can something be done to stop this suffering and wanton waste of life? I would hope so most fervently, and if you were successful in having a Maternity Hospital for here we should all owe you a deep debt of gratitude. That is a letter which cannot fail to touch our hearts. I would use the last sentence again in applying it to the Minister on my own behalf. I would say to him that if he would provide a maternity hospital at Blaenau Ffestiniog we would all owe him a deep debt of gratitude.

It should not be overlooked that it is also a very costly business for relatives to visit a woman sent to Bangor, and I am certain that if anyone should be visited it is the daughter and wife who has just given birth to a child. We have heard a great deal from time to time about the supposed two beds which are available for obstetric emergencies at Ffestiniog Hospital, but we are told that no use has been made of this accommodation by the local general practitioners.

Let me say at once that, for all practical purposes, these two beds are nonexistent. I make that claim on the strength of a letter received by the local council clerk from Dr. Owen Glyn Jones, a highly respected medical practitioner at Blaenau Ffestiniog. He wrote: I was told quite definitely by Mr. G. L. Williams, Group Secretary, and Dr. Alban Jones, Welsh Board of Health, that Blaenau Hospital had no maternity beds. The Welsh Hospital Board and the Welsh Board of Health have permitted our hospital to accept emergency maternity cases only. This means that I as a General Practitioner in Blaenau cannot admit a case to Blaenau Hospital if, for example, home conditions are unsuitable, or the expectant mother has no one to attend her after the confinement. I asked Dr. Macfarlane to send cases that were being discharged from St. David's Hospital, Bangor, on the 2nd–4th days after confinement and sent to Bryn Beryl, Pwllheli, to come here to Blaenau Hospital to our supposed two maternity beds but even this is against the rules and cannot be done. I think it is high time that this 'red herring' of two maternity emergency beds in the local 168 hospital should be fully understood and that the local General Practitioners shall not in future be blamed for not using them. It will therefore be seen that for practical purposes the so-called two-bed unit is non-existent.

I will say in conclusion that with an estimated population of 15,000 in the area I have mentioned and with the nearest general hospital 35 miles away, the provision of a maternity unit of six to eight beds could be made viable. Perhaps I should add that the town of Blaenau Ffestiniog has a brighter industrial prospect than it has had for a number of years. Depopulation has been stemmed and a new factory is to built there this year. Nearby is the new large nuclear power station at Trawsfynydd. There is every indication that population in the area will grow steadily.

In the light of all that I have said, I hope that my plea will not again be in vain. Before the Parliamentary Secretary turns down my plea, I invite him to visit Blaenau Ffestiniog to discuss the whole question with the local council and general practitioners. I will gladly convene such a meeting. I should prefer him to declare tonight that he has views on this subject different from those of his predecessors. I ask him not to come to any conclusions until he has seen for himself the situation in this town, and I invite him to come there at any time he chooses.

§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

The hon. Member for Merioneth (Mr. T. W. Jones) has argued his case with great eloquence. I have listened to him very carefully and of course I know the interest which he has shown in the subject of the provision of hospital facilities in Merioneth over a good many years. In an Adjournment debate on 10th February, 1960, he complained about the facilities for outpatients attending the Dolgellau Hospital. At that time, the Welsh Hospital Board's other commitments did not permit any improvements being effected. These were promised for 1962–63 and, I am glad to say, have now been provided at the Llwyn View Hospital, across the road from the Dolgellau Hospital, and include a waiting room, reception room, consulting rooms, changing cubicles, 169 plaster room and X-ray facilities, at a cost of about £18,000.

In the same Adjournment debate, the hon. Gentleman made a very strong plea for the establishment of a maternity unit at Blaenau Ffestiniog and on 27th March, last year, he saw my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) on the same subject.

While one has a great deal of sympathy for the hon. Member, or for any hon. Member who wants to improve facilities for his constituents, the Welsh Hospital Board has the responsibility for looking at the needs of Wales as a whole and ensuring a fair distribution of available resources. It may be helpful, therefore, if I say something about the nature of the problem with a view to seeing whether the hon. Gentleman's complaint is justified.

As I know from personal experience, Merioneth is a beautiful county; it is also very mountainous and sparsely populated. Of its total population of about 38,000, more than one third lives in the north-west in Ffestiniog and neighbourhood where the main industrial activity is slate mining. Otherwise, it is essentially a rural community. Dolgellau is the county town. Barmouth and Towyn are attractive seaside resorts. Communications are difficult, especially during the winter months. There are three cottage hospitals—at Ffestiniog, Dolgellau and Towyn, where the work is done by local practitioners with regular sessions from visiting consultant staff. For the more important treatments, medical and surgical, patients are referred to the major hospitals within the respective group—Caernarvon and Anglesey Hospital, Bangor, in the north; the Wrexham hospitals to the east; and Aberystwyth General Hospital to the south.

Maternity beds in the county are found at Barmouth Maternity Home, Towyn Hospital, and Dolgellau Maternity Home. The main obstetric unit for the area is at St. David's Hospital, Bangor, which of course is outside the county. It is natural that the hon. Gentleman should want to see that his constituents have a proper share of the available resources. On the other hand, the Welsh Hospital Board has a responsibility for the Principality as a 170 whole. What we have to be sure about is that the hon. Gentleman's area is not ill served compared with the rest of the country.

I hope that hon. Members will forgive me if I quote some statistics, but this is the only fair way of setting out the position. The live birth rate per thousand population in the county is 16.8 compared with 17.1 for Wales and 18.0 for England and Wales. The stillbirth rate was 20 compared with 22 for Wales and 18 for England and Wales. The infant mortality rate, that is deaths under one year per thousand live births, was 25 compared with 25 for Wales as a whole and 22 for England and Wales. The perinatal death rate, that is deaths under one week plus stillbirths per thousand live and stillbirths, was 29 compared with 36 for Wales and 31 for England and Wales. Unfortunately, there were two maternal deaths in 1962, giving a death rate of 3.0 compared with 0.41 for Wales and 0.35 for England and Wales, but there were no maternal deaths in 1960 or 1961 and only one in 1959.

In 1962 there were 650 babies born to mothers living in Merioneth, and of these 591, that is 90.9 per cent., were born in hospitals or maternity homes. I am bound to tell the hon. Gentleman that this compares with national figures of 66.2 per cent. for England and Wales, and 70.1 per cent. for Wales alone in the same year. In 1963 institutional confinements amounted to 581 out of 632, a rate of 92.1 per cent. compared with 73 per cent. for Wales as a whole.

I have quoted those figures because they show that hospital confinements for Merioneth are well above the Cranbrook recommendation of 70 per cent. They also establish that hospital facilities in the area are not only adequate, but that about 90 per cent. of mothers go to hospital. They clearly prefer to do so rather than have their babies at home, notwithstanding the difficulties that some may encounter in travelling. I am not making light of the point about travelling made by the hon. Gentleman. In this connection, it is worth noting that the percentage of births in hospital to Blaenau Ffestiniog mothers is marginally higher than for the County of Merioneth as a whole.

171 It is true that the hon. Gentleman is complaining not about the number of hospital beds available in the area, but that none is provided in Blaenau Ffestiniog itself. What the hon. Gentleman would like to see established is a small general practitioner unit.

I fully understand that the overriding consideration in all this is what really serves the interests of the mothers and babies of this part of Wales. I know that that is what has motivated him, and that that is why he has raised this matter tonight. I am sure that he knows his constituency pretty well. He will know that there are very good relations between the general practitioners, hospitals, and local authority services in his constituency. The standard of those services is reflected in the statistics that I have quoted. The standard is high.

What really seems to be in the best interests of the hon. Gentleman's constituents is the availability of first-rate maternity units strategically placed to ensure the proper deployment of highly trained staff. Admittedly we could put a small unit at Blaenau Ffestiniog, but that would be at the expense of providing one really effective unit covering the whole area. I know that the hon. Gentleman's argument sounds superficially attractive, but I am advised that medically speaking it would not provide the best possible care for mothers and their babies.

I regret that the hon. Gentleman mentioned the case of the baby born on the way to Bangor Hospital, because it seemed that the inference he was drawing was that when mothers have to travel any distance an occurrence of that kind is frequent. I assure him that nature sometimes defeats the best man-made arrangements, and it also happens from time to time in heavily built up areas where the mother's home is on the doorstep of the hospital. It happens in London and it happens in the great city of Cardiff.

As regards the second distressing case to which he referred, I deeply sympathise with the writer of the letter, but I do not feel that I can comment on it because it is clear from what was said that there was a medical complication.

I can assure the hon. Member that there is nothing unusual in what is being 172 planned by the Welsh Hospital Board for Merioneth as a whole. What we are seeking to do, not only in North Wales but throughout the country, is to provide a comprehensive hospital service which takes into account the changes occurring all the time in concepts of medical care—a service which will ensure that patients everywhere will get the best treatment that modern medicine can provide.

In recent years there has been a trend towards greater interdependence between the various branches of medicine. Most patients needing in-patient hospital care nowadays require the attention not only of a physician or surgeon but also of other specialists such as radiologists, pathologists and anaesthetists in support. Essentially, the patient's treatment is provided by a team, and the team needs to have at its disposal complicated and expensive equipment. To work efficiently in the service of the patient, the team must spend the major part of its time at a large district general hospital; and it is at these hospitals where the necessarily wide range of diagnostic and treatment facilities can be provided.

This is clearly the best method of employing to the full the resources, in terms of staff as well as money, avaliable to the hospital service. It is not possible to spread the most up-to-date facilities over a larger number of smaller hospitals and, at the same time, ensure for the patient the best that modern medicine can provide. I stress this because our first consideration in these matters must always be the patient.

The Welsh Hospital Board envisages the development of four district general hospitals—at Bangor, Aberystwyth, Rhyl and Wrexham. These hospitals will all have maternity units with full and continuous consultant cover and every facility available. In addition, the Board proposes to provide at Llwyn View, Dolgellau, a new unit of about 15 beds to cover the needs of Merioneth. This will be a sizeable unit.

In his letter of 17th April, 1963, to the hon. Member, my right hon. Friend the Member for Wolverhampton, South-West pointed out that the total number of births in a year in the Blaenau Ffestiniog area could be set at a maximum of 150. Allowing for at least half of these to be at a consultant obstetric unit would leave 173 no more than 70 to 80 to be confined either at home or in a general practitioner maternity unit. My right hon. Friend's letter concluded that the number of births at the general practitioner unit would justify only two beds, which would be quite impracticable. To provide a round-the-clock maternity service, at least four qualified midwives would be required, and for a unit of two beds they would be employed for only a small part of their time. Experienced midwives would be reluctant to serve in such a unit and, in any event, it would be a wasteful use of midwifery resources. If we enlarged the catchment area, as the hon. Member suggests, and provided for, say, a maximum of 250 live births, I am advised that this would still not provide a viable unit.

I note what the hon. Member said about the two beds at Blaenau Ffestiniog Hospital, a general practitioner hospital of 16 beds. These, of course, are not regarded as maternity beds but are available, as all the general practitioners know, for exceptional circumstances. The matron and one member of the staff at the hospital are qualified in midwifery. It has been necessary to take advantage of these beds only once in recent years—there was one emergency birth at the hospital last year. I hope that that disposes of the "red herring" which the hon. Member mentioned. We do not regard these as normal maternity beds.

I agree with the hon. Member that travelling in rural areas, especially in winter conditions, can be extremely 174 difficult. But this is not a problem peculiar to Blaenau Ffestiniog. It is one that could be multiplied time and again in rural areas throughout the country, particularly in Wales. If resources, both manpower and material, were unlimited, claims such as this one could be met but, with limited resources, concentration on the broad pattern outlined in the Hospital Plan is the only sensible way to proceed. This is a matter of striking the right balance between the claims of particular districts and the need to deploy our available resources, especially of trained midwives and nurses, so that we provide the best possible medical care for the country as a whole.

We are anxious to put to the best possible use the available nursing and midwifery skills and to encourage non-practising midwives to resume practice either full time or part time. I can hardly think that they would be encouraged by a wasteful deployment of skill which—despite the great eloquence with which he advanced his case and the great skill with which he deployed his argument—the hon. Member is asking us to do. It would be a wasteful deployment of skilled resources. I feel sure that on reflection he will see that what we are seeking to do is to serve the best interests of the mothers and babies in this very beautiful part of Wales.