§ 12.40 a.m.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Whitlock.]
§ Mr. Timothy Kitson (Richmond, Yorks)I welcome the opportunity to raise on the Adjournment the problem of the maternity facilities in the Northallerton area. For some time now, many of us have been deeply concerned about the present maternity arrangements connected to the Friarage Hospital at Northallerton.
1713 I think that to start with I should point out that the Friarage Hospital does an extremely good job and that there is a very good relationship between the local community and the hospital management committee and staff. It is a hospital which for many years has had a splendid reputation locally and the full confidence of the general practitioners in the area. However, the maternity facilities certainly are in no way comparable with the rest of the hospital.
Following the death of a patient at the maternity hospital in January last year, I asked the Minister to set up an inquiry, at regional hospital board level, to look into the cause and reasons for this death, and I am most grateful to the Minister for instigating this inquiry. As he will remember, Mrs. Stott died at the maternity hospital after losing her child and no post-mortem was held following her death.
At the full inquiry by the regional hospital board, the relatives of Mrs. Stott were legally represented, and although I have asked the Minister for the text of the report, neither the legal representatives of the relatives nor the Northallerton Hospital Management Committee, nor I, have been given the text of the report. Only the findings of the inquiry have been sent to the hospital management committee and to the relatives, and it is very difficult to understand this procedure.
There were many points that could have been cleared if only we had been informed of all the circumstances. I will read to the House the findings which were sent which will demonstrate the inadequacy in the minds of the relatives on this occasion. In August the regional hospital board wrote the following letter to the relatives—and this was also all that the hospital management committee received:
The Report of the Committee of Inquiry which met at Northallerton on the 7th July, 1966, has now been received and, as the Board is in recess, has been submitted to the Chairman of the Board. The Chairman, acting under the authority of the Board, has accepted the findings and recommendations of the Committee, which will be reported to the full Board at its next meeting in October. I should, however, inform you that the Committee of Inquiry has expressed the following opinions:—That was the only letter received by the hospital management committee. I have no wish in any way to exaggerate the deficiencies of the maternity hospital. I feel, however, that I should point them out in full. The maternity hospital of 28 beds is provided in an old converted country house. The surroundings are very pleasant but the building is a mile from the main hospital and is separated from the town by a busy railway crossing. No buses pass the hospital, which is also approximately one mile from the nearest bus station.
- 1. On the evidence the Committee is satisfied that there was no neglect or incompetence on the part of any member of the medical or nursing staff.
1714 - 2. The Committee is further satisfied that there was nothing in this patient's condition during the months of pregnancy, during her earlier admission to hospital and during her treatment in hospital on her last admission, which indicated that there was any possibility of the emergency which in fact arose. Once the emergency arose the patient was given the correct treatment as expeditiously as the facilities available allowed.
- 3. So far as the facilitiese available are concerned, the Committee is satisfied that they were adequate for the size and type of the unit."
The important deficiencies and defects are as follows. There is no separate admission suite. The admission bathroom is shared by in-patients and the adjacent toilet accommodation is shared by ante-natal patients and in-patients. The labour rooms, two in number, are substandard. There is no single-bedded accommodation for the nursing of infected or seriously ill patients.
There are no facilities for the isolation nursing of infectious babies. There is no obstetric theatre. Cases of Caesarian section must be transferred to the Borough-bridge hospital. Occasionally this can happen after an anaesthetic has been started. There is no special baby care unit. No day room accommodation is available. This results in patients having to spend much of their day sitting about in the wards. If they wish to smoke, they can do so only by going into small selected areas of the hospital corridors which have been set aside for the purpose.
Because of shortage of space, roomingin—that is, the practice of babies being nursed in the main wards—cannot be practised. The nursery is on the first floor and the babies must be carried up and down stairs at feeding time. There is no lift in the hospital. Patients on admission, often in labour, must be carried 1715 upstairs on a stretcher. On many occasions, the stretcher is carried up by one ambulance driver and one nurse.
The facilities in the ante-natal clinic are spartan, inadequate and undignified for patients. The hospital is one mile distant from the main general hospital and is beyond a busy level crossing. Facilities for pathology, X-ray, pharmacy and physiotherapy are not immediately available. No buses pass the maternity hospital, and the nearest bus station is one mile distanct. This means that the ante-natal patients attending the clinic and travelling by bus must walk one mile from the town to the hospital irrespective of weather conditions.
There is only one resident doctor, a senior house officer. The two consultants live some distance away, one in Darlington, 16 miles away, and one in Croft, 13 miles away. This tends to isolate the resident and places too much responsibility on them. General practitioners have lost confidence in the maternity facilities and in the standard of service offered. This has been stated by the general practitioners in the area to the hospital management committee. Some general practitioners are now looking to the maternity hospital in Catterick for help in dealing with maternity cases.
May I mention briefly the benefits of amalgamating the maternity and general hospitals. All the facilities of the general hospital would become immediately available to maternity patients. Not only would this include pathology, X-ray and physiotherapy, but it would also mean that the full support of the other specialties would be available to advise on any complications. General practitioners would place much more reliance on a modern unit with proper standards of facilities and proper levels of staffing. There is great difficulty in staffing this hospital because it is so far out of town and is so isolated.
Some things have, however, been done since the Stott inquiry. A refrigerator has been provided for rhesus negative blood, which is now immediately available at the maternity hospital. We all welcome this. The resident senior house officer, although he is a single man, now lives adjacent to the maternity hospital and, accordingly, he is immediately 1716 available for all night emergencies. He owns his own car, so that he can go to the maternity hospital very quickly in daytime.
Finally, I fully recognise and appreciate the very happy relationship that has existed between the Northallerton Hospital Management Committee and the Newcastle Regional Hospital Board. In no way do I wish to interfere or upset this fortunate relationship. I find on consultation with my friends in the hospital management committee, however, that they have for many years past pressed for a major hospital development scheme in the Northallerton area, and, more particularly, they have shown great concern for many years about the state of the maternity service.
In no way do I wish by my intervention to upset the happy relationship between the hospital management committee and the regional board, but I feel very strongly that unless the regional board recognises the pressing need for a completely new look at the future hospital needs of the Northallerton and Catterick areas this happy relationship may well be broken. It is for this reason that I request that the Minister should initiate an inquiry into the provision of a more satisfactory maternity service in Northallerton, and that this should be considered in conjunction with a reappraisal of the total hospital requirements designed to cover the very rapid expansion of population and industry expected and likely to take place in the Northallerton area in the next few years.
Northallerton, which is in a development area, is expanding very quickly, and there is a very pressing need to do something very quickly. I know that the Minister recognises the need and the problem that we have in the area, and I hope that he will be able to take some very speedy action and help us in getting an amalgamation of the maternity home with the general hospital there.
§ 12.52 a.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)I have listened with much interest to the speech of the hon. Member for Richmond, Yorks (Mr. Kitson). I know from the correspondence that he has had with my right hon. Friend that the subject of maternity services in Northallerton is one that has been a particular concern of his 1717 for some time past. I appreciate very much indeed the moderate way in which he expressed himself. In addition to what else I have to say in my speech, I shall see that his observations are brought to the attention of the regional hospital board. Indeed, his observations will be read most carefully by my Department.
The maternity services in the Northallerton Hospital Management Committee area are provided in the Northallerton Maternity Hospital, which is about one mile distant, as the hon. Member said, from the main general hospital, the Friarage Hospital. The Friarage Hospital provides a good service for the area and is not thought at present to have serious deficiencies such as to give it a high priority for redevelopment in the building programme of the Newcastle Regional Hospital Board.
The maternity hospital is also providing a good service within its limitations. In 1965, the latest year for which complete figures are available, there were no maternal deaths in the Northallerton area, and the peri-natal rate was the same as the national average; there was a 76 per cent. hospital confinement rate, which is above the nationally accepted figure of 70 per cent.; and the average length of stay was 12½ days, which is above the nationally recommended period.
The maternity hospital is not, however, a modern unit, and it is not a part of a general hospital where full and comprehensive services are available to patients. The regional hospital board, as the hon. Member knows, has confirmed its intention to redevelop the Friarage Hospital and to include in that redevelopment a new maternity unit to replace the present maternity hospital. There is, therefore, no difference between the hon. Member and myself on the policy to be followed.
In the recent review of its building programme, which was published by my right hon. Friend in Cmnd. 3000, the regional hospital board specifically stated that the Friarage Hospital is to be redeveloped. The problem is one of priorities, and the regional hospital board has not found it possible to accord a high priority to this redevelopment. I am sure that the hon. Gentleman is familiar with the procedure which my right hon. Friend and his predecessors have followed in relation to capital allocations to 1718 regional hospital boards. These are made each year by the Minister, but it is for the board and not the Minister to determine the relative priority of the different schemes to be undertaken in the region. In due course, therefore, the regional hospital board will be putting proposals to my Department for a major redevelopment in Northallerton.
Here I might say that it is the Government's intention to replace numerous small and out-dated hospitals by a network of large modern district general hospitals, each having a wide range of facilities for diagnosis and treatment. Four such hospitals have already been completed, and major parts of 60 others are currently under construction. There are, in addition, 50 more where substantial work is now being undertaken.
I am deliberately portraying the national picture but I shall have something more specific to say about Northallerton later. Work to the value of £99 million was started nationally in the last financial year. This year capital expenditure is expected to be more than £75 million, compared with the average of about £18 million a year for the period from 1948 to 1966, which is the most recent accountable period we can give figures for during the lifetime of the National Health Service. In short, it is the Government's earnest intention to provide a network of first-class hospitals, but the process will, of course, take time.
As to what can be done in Northallerton itself, as the hon. Gentleman probably knows, some small improvements have been made in the maternity hospital recently. The hon. Gentleman listed a certain number of items, and I would like to check his list. The improvements which have been made include emergency lighting in wards and corridors, provision of a refrigerator for blood storage, and arrangements for rooming babies with their mothers. I understand that during the next financial year a side ward for the isolation of infected babies will be provided, and there will be improvements in the milk kitchen arrangements.
I know that the regional hospital board has the question of further improvements in the present maternity unit very much in mind, but I would not wish on this occasion to anticipate the conclusions it may reach, and, as I said earlier, the 1719 board has to examine the priorities of its programme as a whole to provide for further improvement at the maternity hospital if this should be its conclusion.
My right hon. Friend in correspondence at the end of last year with the hon. Gentleman made it clear, I believe, that the regional hospital board had specifically decided to re-examine conditions at the maternity hospital. This examination is currently in progress, and I would like to respond to the hon. Gentleman's plea for an examination by my Department direct, and I am happy to fall into line with his suggestion about a visit from a member of the Minister's medical staff. I shall be glad to arrange for one to make an early visit to the hospital with officers of the regional hospital board.
I am aware that a number of patients in the Richmond area are admitted to Catterick Hospital, and this arrangement is mutually acceptable to the hospital and the service authorities. I should point out that the bed occupancy for the maternity hospital was 88 per cent. in 1965, and 87 per cent. in 1966, and it was news to me that there had been any evidence of lack of confidence, or any occasion on which a lack of confidence had been expressed about this maternity unit. I shall look into this.
So far as I am aware, there have been only two complaints or occasions brought to my right hon. Friend's attention concerning this hospital during the past year or so. The first was the tragic case, a very sad case, of the mother who died after childbirth early in 1966, to which the hon. Gentleman referred. This case was examined very thoroughly by a special sub-committee of the hospital management committee itself and later by a completely independent committee of inquiry under a barrister as chairman, set up by the regional hospital board. The report of this inquiry was sent to the hospital management committee so that it might take such immediate action as it thought necessary pending any conclusion reached by the board. The report, following the normal practice in such cases, was not sent to the patient's relatives. Only the conclusions reached by this independent inquiry were forwarded. I assure the hon. Gentleman that there are very good reasons for this practice in general, and in this case in particular.
1720 This independent inquiry concluded that there was no negligence or incompetence on the part of the medical or nursing staff in this case. I am advised that there exist no grounds for ascribing this patient's death to the facilities, or lack of them, in the maternity hospital. Plasma was kept in the hospital and this was administered to the patient. This was the accepted treatment, as opposed to blood, for this type of case. I am informed that the consultant was satisfied as to the cause of death and did not consider a post-mortem examination necessary. The hospital is a consultant unit, the duties being shared by two consultants, a perfectly normal arrangement.
The figures I quoted earlier relating to his hospital were for 1965. The hon. Gentleman has stated in correspondence, I think, that there was another maternal death. In fact, I know of two other cases. There have been two other maternal deaths since the beginning of 1966 and in both cases post-mortem examinations were carried out. As far as I am aware, there has been no suggestion of inadequate care and attention being accorded to these patients.
As for domiciliary midwifery, I am informed that the local health authority, Yorkshire North Riding County Council, has no difficulty in recruiting sufficient midwives to meet all needs. The domiciliary confinement rate in the county is slightly lower than the average for the country as a whole and staffing is such that the midwives are not unduly burdened. I understand that the service has given satisfaction in all areas of the county.
As I have said, the other points mention by the hon. Gentleman will be considered very carefully indeed. Naturally, some are more important than others. As for his complaint about a lack of transport facilities, I am not sure that my Department can do much about that, but we shall look into the matter.
I share the hon. Gentleman's desire to see the hospital services in this area, including the maternity services, brought to the highest possible standard, but I am equally anxious that it should not be thought, because we have discussed this matter tonight, that the services at present being provided fall short of acceptable standards. 1721 I hope that, with these remarks, the hon. Gentleman will feel that we are aware of the general complaints which he has made. We understand his anxieties, which he so adequately presented, and we look forward to seeing any report which the Department may receive as a result of sending one of its officers to the area, 1722 in collaboration with the regional hospital board, and I have no doubt that, in due course, I shall be in further communication with the hon. Gentleman.
§ Question put and agreed to.
§ Adjourned accordingly at three minutes past One o'clock.