HC Deb 19 June 1964 vol 696 cc1800-12

Motion made, and Question proposed, That this House do now adjourn.—[Mr. MacArthur.]

4.2 p.m.

Mrs. Joyce Butler (Wood Green)

I begin with a quotation: Midwives frequently have to conduct deliveries in small single rented rooms where bathrooms and kitchens are shared by several other tenants and where other children of the family have to be taken into a neighbour's house temporarily while the delivery takes place. This is not a quotation from a Victorian document. It comes from the annual report of the Medical Officer of Health for Tottenham. The situation which it discloses is entirely due to the shortage of maternity beds in the London area.

This month, in Tottenham, there are eight expectant mothers in priority categories who will not be able to have beds in hospitals, and four of these mothers are living in only one room. There are 10 such mothers whose confinements are expected in July, and three of these are living in only one room. For August, there are five such mothers and, again, three are living in only one room. These figures from Tottenham are typical of the whole London region. It is no wonder that about 25,000 babies die each year in Britain when a large number could have been saved had hospital provision been available for their mothers.

When I have raised this matter in the House, as I have done over a number of years, I have always been informed by the Minister of Health that London is a special case. Of course it is. It is the capital city, and large numbers of people come into London from outside. But is this a good reason why London mothers should continue to put up with inadequate maternity services and why London midwives, general practitioners and hospitals should have to do a superhuman job in coping with these inadequacies?

The Minister who is to reply proudly proclaimed in answer to a series of Questions from me that 83 per cent. of the births in London took place in hospitals. This compares unfavourably with the 96 per cent. of births in hospitals in Sweden where there is a much lower infant mortality rate. And the figure does not give any indication at all of how many mothers in this category were rushed to hospital while in labour, and probably were driven round in ambulances trying to find a hospital bed; or those who were suddenly obliged to go to hospital because of some abnormality occurring while labour was proceeding. This happened in a quarter of the first confinements booked to stay at home and which ought to have been booked to go to hospital, had beds been available. Each year hundreds of mothers apply to the North Middlesex Hospital alone and have to be turned away. What is true of that hospital must be true of other hospitals in the London area.

On 27th April, in reply to a Question from me, the Minister of Health said that 167 additional beds would be provided in London as a result of projects started this year. That is a pitifully small number for the whole of the London area. I wish to ask the Parliamentary Secretary when it is expected that these beds will actually be in use. Many of them are only at the planning stage now. What account has been taken of the special needs in special areas? I should like to ask him how the programme will expand to meet the additional 1 million population expected to come in or to be born in the London area as indicated in the South-East Study? This will considerably affect the provision of maternity beds. What arrangements are to be made for staffing these additional maternity beds now that there is already a serious staff shortage?

I wish to refer to the special area with which I am particularly familiar covered by the new London Borough of Haringey with a population of about 250,000. In the whole of that area, which covers the Boroughs of Tottenham, Wood Green and Hornsey the only maternity bed provision is in the small Alexandra annexe to the Whittington Hospital which has some 15 maternity beds for the whole of the new borough. Bearing in mind that in 1962 in Tottenham alone there were 2,233 births compared with 1961 when the figure was 1,919—there is a steadily increasing number over the years—this is completely inadequate for this northern part of London.

At the present time mothers have to go to hospitals outside the area in which they live. Last year from Tottenham 600 went to the North Middlesex hospital, 345 to the Mothers Hospital at Clapton, 108 to Bearsted Hospital, Stoke Newington and 57 to the City of London, 49 to Bethnal Green and so on. All these mothers had to travel long distances not only for their confinement but for ante-natal check-ups and were involved in considerable trouble, expense and difficulty. One would have thought that in such an area, with this shortage of beds and with the very difficult situation regarding housing accommodation over a large part of the area, now that a new hospital is being planned on the site of the present St. Anne's Hospital, there would be adequate provision for maternity beds.

It is incredible that this new hospital is to have no maternity beds at all. The Minister will know that the local authority feels so strongly about this that it has asked him to urge that maternity bed provision should be made in this new hospital. The most that the local authority has been able to achieve so far has been that the Hospital Board has promised to bear the matter in mind in its annual review. This completely overlooks the fact that this is a serious and urgent question.

The North Middlesex Hospital is planning to extend its maternity bed provision from 101 to 142 beds—a very small number—and the Bearsted Hospital, a hospital providing specially for the Jewish community, from 38 to 100 beds. That is all. I remind the Minister that temporary huts built to house soldiers during the First World War are still being used at North Middlesex Hospital for delivering babies.

I have also been asked to say something about the position in Romford, which is not in my constituency but is within the London region and where no account appears to have been taken of the vast housing development at Harold Hill and its effects or the maternity bed provision there and where a transfer bookings scheme is to be introduced to try to relieve the shortage.

Faced with this situation of too many babies dying unnecessarily, the shortage of hospital beds and the conditions which appertain in the emergency bed service, an increase of planned early discharges has been resorted to by a number of hospitals. Put quite crudely, the phrase "planned early discharge" means that mothers will be discharged from hospital within 24 hours of their confinement. This is an appalling situation, because what was put forward as a temporary expedient to meet a shortage seems to be settling into a regular procedure which, unless action is taken quickly, will become accepted practice. General practitioners are very concerned about this and nobody seems to know whether adequate arrangements for home care to follow these early discharges can be provided. I have today a brochure from the Royal College of Midwives which refers to the importance of expanding the home help service, the domiciliary midwife service, and so on, to meet the needs of these early discharges from hospital and the home services which must be provided in consequence. At the moment, however, it is completely impossible to do this.

Not only are there medical risks to consider, but with all the improved medical care which is available today, with the relaxation exercises and the emphasis on natural childbirth, the birth of a child is still a tremendous event. After such an experience, there is need on the part of the mother for rest, relaxation and adustment as well as for medical care. This is all the more necessary when the mother is in one of the special categories which are the only ones now admitted to hospital and where the mother is likely to be anxious and tense right un to the last moment.

These special categories are the mother with obstetrical complications, which she may only half understand, the mother with medical or surgical complications, a mother having her first baby and entering a unknown, lonely and rather unnerving experience, the mother with three or four more children already, who is without a moment to herself right up to the last minute of the confinement, and the mother who is coping with unsatisfactory social conditions and is often exhausted by so doing. All these categories need a full period of at least eight days in hospital. They should not be treated like broiler hens and pushed out quickly to make room for the next batch, which is what will happen unless action is taken. Many of those mothers have to return to homes where the strains and stresses are acute because of financial worries, and in a home where there is not much money and where there are many children the fact that the mother is out of action inevitably produces strains and stresses at home.

I therefore ask the Minister whether he or any of his advisers—or any hon. Member—would tolerate such a swift confinement in hospital for his own wife if it could possibly be avoided. When the mother gets home, because of financial stringency she may well not be able to afford the home help service which she needs and she is deprived of the home confinement grant, which in these circumstances is a meanness on the part of the Ministry of National Insurance which is aggravated by these planned early discharges.

This is an increasing problem and it will continue to grow. The new provision is completely inadequate. The Minister ought not to use these planned early discharges as an excuse for a cheeseparing approach to the provision of more beds or allow it to become accepted practice, particularly as, apparently, it is not producing any obvious relief of the bed shortage.

This morning, I was talking to a doctor with great experience in this field. This is what he said: "The position is quite fantastic. We simply cannot put the requirements of the Ministry into operation because of the lack of staff. We are being asked to put a quart into a pint pot and it cannot be done. The problem is insoluble under present conditions."

The two factors which would solve the problem—more beds and more staff—both lie in the Minister's hands. He must stop relying on medical devotion, on public apathy and on the patient acceptance by women of impossible conditions, and take immediate and effective action to provide a solution.

4.15 p.m.

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

I am sure that we are all glad that the hon. Lady the Member for Wood Green (Mrs. Butler) has raised this matter. This is clearly an important question and one of particular importance to a great many people. We must, therefore, see it in its right perspective, identify the problem and try as far as we can to look at it dispassionately.

There is nothing more calculated to stir the emotions than to picture the mothers of London seeking, but unable to find, a place in which to have their babies. I know the keen interest over a long period that the hon. Lady has taken in this subject, but this, of course, is not a correct picture, and I know that she is aware of that. Perhaps, therefore, I might start by telling the House what is the present position.

When we talk about London in this context, we generally think in terms of Greater London rather than of the precise London County Council area or the area of Middlesex, a part of which the hon. Lady represents. She has expressed her concern about particular areas, and I shall make some reference to them. I should like first—I am sure that this is what she wants me to do—to look at the position in the London County Council and the Middlesex County Council areas.

In 1963, no fewer than 82 per cent. of confinements in the London County Council area were institutional—it is an awkward word, but I mean by that confinements which took place in the National Health Service hospitals and in private hospitals—while in Middlesex the figure was slightly lower, 76 per cent. These figures are in both cases slightly higher than in the previous year when they were 81 per cent. and 74 per cent. respectively.

This increase in institutional confinement is significant, and I suggest that it does not indicate a bed shortage or, as the hon. Lady has said, an insoluble problem—at least, it does not indicate any serious shortage. It is a fact—and I am glad to be able to reassure the House—that practically every mother needing hospital confinement on medical or social grounds is eventually admitted. In line with the general position is the further fact that in the Grsater London area 90 per cent. of mothers of first children are delivered of their babies in hospital, compared with 85 per cent. clsewhere.

I am, of course, aware of the special factors which contribute to the high level of institutional confinements in London and its suburbs. Even so, I think that the figures are impressive looked at against the national background, and, again. I suggest that they do not indicate a serious shortage, but there is—I concede this to the hon. Lady—a somewhat uneven distribution of maternity beds in the London area. There are, of course, historical reasons for this.

There is a relative concentration of beds in certain parts of London, particularly in the centre, and a relatively light provision in some of the peripheral areas. Our efforts, and those of the regional hospital boards, whose duty it is to plan the hospital services in their regions in consultation where necessary with the teaching hospitals, are, therefore, aimed at better geographical distribution by increasing the provision where there is local shortage.

One hundred and sixty-seven additional maternity beds will be provided in the Greater London area as the result of the schemes to be started this year. In 1963, 64 additional beds were provided, and 108 have been or will be provided this year. The hon. Lady asked me how many beds will actually become available for use this year. The answer is 108.

The hon. Lady specifically mentioned two areas—Tottenham and Romford. It is true that these are, unfortunately, areas where there is at present a local shortage of maternity beds. Measures are being taken in these areas and others, and they illustrate precisely what I have just been saying. It is true that Tottenham has only the Bearsted Memorial Hospital, with its 32 beds—

Mrs. Butler

The Bearsted Hospital is in Stoke Newington.

Mr. Braine

The area of which Tottenham is a part, is served by 200 maternity beds located at Chase Farm, and at South Lodge—which recently opened 24 beds—and which are in Enfield; at the North Middlesex, and at Tower Annexe, which are in Edmonton; and at the Bearsted Memorial Hospital. The Hospital Plan is expected to add another 188 to this total of 200.

On the other hand, there is, for the reasons that I have already indicated, an existing surplus provision in the adjacent area, and arrangements have recently been made for hospitals in that area to help out the neighbouring area of shortage. In order still further to help, 21 additional beds have been provided at the Bethnal Green Hospital because it is possible to provide them quickly there.

To turn to the Romford area, which, like Tottenham, Edmonton and Enfield, is on the periphery of the new Greater London area, there is also a shortage. Ten additional beds will result from the building taking place during this year. Short cuts have been introduced into the planning of a completely new unit at Rush Green Hospital, which is going ahead as fast as possible; and major developments are taking place at Barking and Orsett Hospitals which, in the longer term, will provide most of the beds required by the area.

I turn now to one of the difficulties which has been faced in recent years, on account of the uneven distribution of beds rather than of an absolute shortage. In recent years there was a steady rise, beginning in about 1955, in the number of mothers admitted to hospital in the Greater London area for their confinement through the emergency bed service. Many of these were not emergencies of the sort for which the emergency bed service is designed to deal. In 1961, for example, for just over half of those mothers it was known quite early in pregnancy that hospital beds would be needed, but no booking was obtained at the time. This clearly, was not a satisfactory state of affairs.

I know that when I first went to the Ministry of Health as Parliamentary Secretary this was worrying the then Minister of Health very much, and after trying hard to find other solutions the four Metropolitan Regional Hospital Boards and London teaching hospitals with maternity departments were asked in August last year to define areas for which an adequate number of beds could be grouped to meet the needs of maternity patients. In each of the areas they defined they were asked to take the initiative in setting up a body representative of the hospital authorities, the local health authorities, executive councils, and the local medical committees concerned to co-ordinate administrative action. These bodies exist and they are functioning well. They are expected to keep the arrangements under review, and, clearly, the situation with which they have to grapple will be influenced favourably as new beds become available. I am sure that the hon. Lady—indeed, everyone—will be glad to know that the emergency bed service is now being called on much less for finding beds for maternity cases, and these, of course, include many real unexpected emergencies. In the first five months of this year there were only 1,359 such cases compared with 1,941 in the corresponding period of last year. This is a most welcome improvement, and the number is 8 per cent. lower than in the same period in 1961. This is despite the fact that there has been an increase in the number of births.

The hon. Lady has from time to time expressed some concern—and it is quite right to probe into these matters in the way she has done—about the length of stay in hospital. I agree that this may be a factor in the improvement in the admission situation which I have described. One aspect of this which we should not overlook is that the effective use of beds has been increased throughout the country. We must recognise, however, that what is a satisfactory period of stay obviously depends on the circumstances of the mother and the child and on the opinion of her own doctor.

The Cranbrook Committee recommended a normal stay of 10 days after confinement and our planning of new hospitals is on this basis. If a shorter stay comes to be accepted by the profession—and I think the House must recognise that this is essentially a matter of professional judgment—a higher hospital confinement rate may result. In those areas where there are for the time being not enough beds, a planned shorter stay may seem to the profession the best means of securing that confinement in hospital is possible for all who need it.

Perhaps I may quote from the Report of the Cranbrook Committee which on this subject said this: …in areas where this level"— that is, 10 days after confinement— cannot be achieved for the time being we can see no over-riding objection to earlier discharge in carefully selected cases. I would, of course, emphasise that the cases need to be carefully selected, and we at the Ministry have always made this absolutely clear.

Again, the Gillie Committee on the Field of Work of the Family Doctor said: Early discharge, whether forty-eight hours after delivery or a few days earlier than is traditional, is acceptable if the mother has been prepared for it before delivery, if the family doctor and local authority are consulted in advance and if home conditions are satisfactory. I entirely agree with the hon. Lady that the key to this is the existence of satisfactory domiciliary arrangements.

I understand that pending the additional beds to be provided for the area in which she is particularly interested a scheme of early discharge for selected patients has been introduced. The lying-in beds at North Middlesex Hospital are used to capacity, but experience within the hospital has shown that the labour rooms and staff are capable of undertaking some additional deliveries each month. Discussions took place between the Middlesex County Council's Medical Officers for Enfield, Edmonton, Wood Green and Southgate areas, the staff of the North Middlesex Hospital, and the general practitioners. These are obviously the people who should have been brought together. Following their consultations a scheme was started for discharging patients whose home circumstances are suitable as soon as they are medically fit. I can assure the hon. Lady that this scheme has been in operation for several months and I am told that it is working well.

I do not for one moment want to leave the impression that I or the Ministry of Health for that matter, are in any way complacent about this, indeed, the action which was taken by my right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell) last year is an indication of our determination to do all that is possible.

Mr. Eric Fletcher (Islington, East)

There is a good deal of concern about this matter. I know that the Minister does not want to appear to be complacent, but there is concern because many mothers are now being discharged within 48 hours after delivery. Can the Minister give us an assurance that in no case, either in the London area or elsewhere, will a mother be discharged within 48 hours after confinement, unless he is completely assured that the home conditions are satisfactory for looking after the future of the children?

Mr. Braine

Of course, that is an essential part of the scheme. Indeed, in this context I have here a letter from the Edmonton Group Hospital Management Committee addressed to all general practitioners in Edmonton, Enfield, Wood Green and Southgate. It points out that one of the main features of the scheme is that obstetricians will pick out at ante-natal clinics certain patients who might be suitable for early discharge. The key to the whole thing is that no risk must be taken with the patient and that there must be effective co-ordination between the local authorities, the hospitals, the mothers and the general practitioners.

The best yardstick of the quality of the maternity services is found in the maternal and infant mortality rates. The peri-natal mortality rate is the most sensitive index we have of the performance of these services. It is influenced by the age of the mother, the number of babies she has had, social factors like housing conditions, illegitimacy, and previous medical and obstetric history.

In 1963, the peri-natal mortality rate reached the lowest level ever both in England and Wales as a whole and in London. I can reassure the hon. Lady that it is, in fact, lowest in London and the South-East generally. That is a tribute to all who play a part—the family doctors, the hospitals and their staffs and the local authorities. I know that the hon. Lady joins me in saying that.

I know that one aspect of the maternity services has caused concern in some areas, and this is the availability of practising midwives. Over the country as a whole, their number has been rising in recent years. Indeed, the present number in practice is the highest on record. There are, however, difficulties in some areas, and we have been making efforts to stimulate recruitment. My right hon. Friend recently sent a personal letter to every midwife who is no longer practising asking her to consider returning to whole-time or part-time work if she possibly could. Hospitals and local authorities are also co-operating by seeking to establish more direct local contact with midwives to whom my right hon. Friend has written. The hon. Lady may be aware that my right hon. Friend broadcast recently on this subject both on sound radio and on B.B.C. television. These special Ministerial appeals have been supported by various other publicity measures, including national Press advertising.

The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-eight minutes to Five o'clock.