HC Deb 09 December 1970 vol 808 cc627-38

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

1.58 a.m.

Mr. Jeffrey Thomas (Abertillery)

I am grateful for this opportunity of bringing to the attention of the House the decision of the Welsh Regional Hospital Board, a decision somewhat surprisingly concurred in at present by the Secretary of State for Wales, to close the maternity unit at Nantyglo and Blaina Hospital in my constituency. I raise this matter in the real hope that common sense will yet prevail and that this piece of planning tomfoolery will be set aside.

It would be difficult to spell out adequately the bitter resentment that this decision has caused in all sections of the community, a community which this excellent unit has served so admirably since it was opened in 1932 by the Queen Mother when she was the Duchess of York. This sense of grievance is not confined to one part of the community but is deeply and keenly felt by general practitioners, nurses, midwives and the officers and members of the three urban district councils in the constituency, and not least, and in many respects the most important, by prospective patients. One of the grounds for complaint is that almost total lack of consultation in arriving at the decision and the cursory and perfunctory way in which the matter has been dealt with thereafter.

It is proposed that the facilities of the general practitioner unit at this hospital be transferred to St. James's Hospital, Tredegar, when work on that unit has been completed. I understand that that is a hospital with a comparatively short lease of life. Many of us consider St. James's Hospital—and I cast no reflection upon its staff—to be wholly unsuitable for its purpose as a hospital, let alone as a maternity unit. St. James's is a converted workhouse situated in an extremely inaccessible position on the outskirts of Tredegar. The proposed catchment area is virtually the same as for Nantyglo Hospital. It stretches from Crumlin in the South to Brynmawr in the North. We are dealing with a population of about 38,000, and I do not include in that the populations of Ebbw Vale, Tredegar or Beaufort. The return bus fare from Abertillery to Tredegar is now 10s. I hope that I have fairly selected Abertillery, as it is in the centre of the catchment area.

To reach the hospital it is necessary to use three different buses, and at the end of that journey a pregnant woman, unless she has the good fortune to have travelled in one of the very few buses which travel to the hospital gates, a facility not afforded her on her return journey, must then walk 250 yards up a one-in-five hill to reach the hospital.

That this is seriously proposed in 1970 is a public scandal. It is quite impossible for pregnant mothers to cope with such a situation. Many will simply not be able to tolerate the journey and will consequently not receive the consultant attention they need during pregnancy. How it is suggested that patients with young children will be able to manage, defeats my imagination.

The position is much worse in winter. On no fewer than 16 days last winter there was total disruption of traffic due to snow and ice in the area, and this is by no means unusual.

In contradistinction, Nantyglo Hospital is in the centre of the area and within a stone's throw of the main road. The Report of the Cranbrook Committee in 1959, which went into close detail on maternity care, made it quite clear that local maternity provision should be utilised to best advantage wherever possible. Such provisions are available locally in Nantyglo. What is completely beyond our comprehension is that whilst it is proposed to close Nantyglo it has been decided to keep open the Victoria Cottage Hospital at Abergavenny, one of the reasons being that the provision of beds at St. James's Hospital will be inadequate. This hospital, at the extreme end of the catchment area, 12 miles from Abertillery, has dealt in the past year with about a third of the number of births that Nantyglo has dealt with. It has no operating theatre, unlike Nantyglo, which has a purpose-built unit on which money has been spent in the past 12 months. Indeed, no operation of any kind has been carried out at Victoria Cottage Hospital for some five years. What was once the operating theatre has been converted to a nurses' sitting room.

It has been estimated from official sources that it will cost at least £20,000 to put Victoria Cottage Hospital into the same league as Nantyglo. The distance from Nantyglo to the consultant unit at St. James's is seven miles and from Abergavenny to St. James's 16½ miles. To retain this hospital is, therefore, completely at odds with the recommendations of the Peel Committee. I invite the Minister's attention to paragraph 204 of that Report which says: Each general practitioner maternity unit should be linked with the nearest and most conveniently situated specialist unit. Paragraph 120 refers to the evidence of this and recommends the need for detailed surveillance throughout the antenatal period. This will not be achieved, in fact, either at St. James's or at Victoria Cottage Hospital. But accepting that one G.P. unit has to close, in every respect all the evidence points overwhelmingly to the retention of Nantyglo as opposed to Victoria Cottage Hospital. The facts speak for themselves.

I now deal with some of the matters raised in the letter dated 4th December, 1970, from the Welsh Regional Hospital Board to the Clerk of the Nantyglo and Blaina Urban District Council. I will turn first to the arguments advanced on page 3 of the letter for the retention of Victoria Cottage Hospital. These are, firstly, that that hospital has to serve a wide rural area; secondly, that should complications arise, a blood bank and pathology services are available at Nevill Hall Hospital. I am delighted to see the Minister here, and I know that he will deal with the replies to these arguments with great care.

Firstly, the population served by Victoria Cottage Hospital is merely 19,000. Many people in the area referred to can and do use the maternity facilities at Brecon and Hereford Hospitals, but this is not the only point. In paragraph 252, the Peel Report specifically envisaged this kind of problem in rural areas and recommended the provision of beds in hostels set up especially for this purpose until the time came when it was possible to maintain a fully viable maternity unit. This is the answer to the first argument put forward by the Welsh Regional Hospital Board in favour of retaining Victoria Cottage Hospital. It is simply not good enough for the Board to say that this is a hospital in a rural area serving a wide area and to leave it at that without going more into detail.

Secondly—and this is of cardinal importance—if complications should arise at Victoria Cottage Hospital, the patient would be sent to the consultant unit at St. James's and not to Nevill Hall. It is widely known in the medical profession that maternity cases are not sent to district general hospitals. Apart from the danger of sepsis, a mother in labour cannot have the services of a midwife at such a hospital, and, of course, there are no midwives at Nevill Hall Hospital.

I want now to deal with the question of blood banks and pathology services. Blood banks and pathology services are so rarely used as to be completely irrelevant to the argument. In Nantyglo, blood bank and pathology services have not been required for 12 years. The arguments in favour of the Victoria Cottage Hospital are at best flimsy and at the most misleading.

The letter from the regional board goes on to state that 22 out of 29 general practitioners have agreed to use the facilities at St. James's. I need say only that they took that view because it was felt that they had no choice in the matter except that of Hobson. But I draw the Minister's attention in particular to the figures presented by the Board on page 2 of the letter.

I say at once that those figures dealing with admissions and emergency admissions to St. James's Hospital give a totally false and misleading impression. As they stand, they cast a disgraceful and unwarranted slur on the hospital, its staff and its midwives which I for one am not prepared to tolerate. I can only assume that the chairman's advisers have misled the chairman about these figures. I will give my reasons for saying so.

Because of the hour, I will deal only with the position in Nantyglo Hospital. The figure of 23 out of 77 emergency admissions to St. James's is the relevant figure and the 23 emergency admissions out of 77 are the figures for 1968 and 1969, up to October, 1969. What on earth is the point of choosing 77 as the relevant figure? The total number of maternity cases during the period mentioned by the chairman of the Board was 189, that is, 189 admissions to the Nantyglo Hospital, and it is right to say that 23 of these patients were referred to St. James's Hospital. That is 7 per cent. of total admissions. The only relevant figure is the total number of admissions and any other figure is frankly misleading and will give rise to a totally distorted picture.

Fifty-four of the 77 patterns were booked for St. James's as special cases in the ordinary course of events. This rate of emergencies is well below the national average, as is the rate of still births at the Nantyglo maternity unit. I assure the Minister that the same pattern emerges in 1970, again only 7 per cent. emergency admissions. When one looks at these figures anew, they give a very different picture from that painted by the Board.

We hope that this folly will not be allowed to prevail. It is high time that the wishes of ordinary people—the people most affected by these decisions—were taken into account by the planners. The Times on 20th July, 1970, commenting on the Peel Report, had this to say: Efficient maternity care involves much more than the provision of expert facilities for the mother in labour. If there is to be adequate ante-natal and post-natal supervision, more attention has to be paid to community needs. Only last week, and not for the first time, an ambulance on its way to St. James' had to stop at Nantyglo, because it could not reach St. James's Hospital in time. There was another such case only a few months ago. We have no doubt that these proposals, as they stand, will result in grevious reduction in the overall care of mothers and mothers-to-be. I believe that they should be put under the spotlight of a public inquiry at the very least, and I earnestly ask the Minister to scrutinise them again, both in the interests of prospective patients and in the interests of modern medicine.

2.17 a.m.

The Minister of State, Welsh Office (Mr. David Gibson-Watt)

I should like to thank the hon. Member for Abertillery (Mr. Jeffrey Thomas) for raising this matter tonight, as it gives me an opportunity to discuss a matter which I know is the subject of great local anxiety—anxiety, indeed, which he himself has voiced in his very persuasive speech. With regard to the maternity unit at Blaina Hospital, I think I should make it clear to the House that the Welsh Hospital Board initiated consultations on the closure of these beds in February, 1969, and made final recommendations on their closure to the former Secretary of State in July of that year. The Board's proposals were approved by the then Secretary of State and a formal decision was sent out in August of that year.

Mr. Thomas

The situation then was different. In the first instance, there were only eight beds in the Nantyglo maternity unit, as opposed to fourteen now; and in the second place, it was not then envisaged by the then Secretary of State that there would have to be a second maternity unit opened in order to provide the extra beds required because St. James's could not provide an adequate number.

Mr. Gibson-Watt

With great respect to the hon. Gentleman, I am coming to that in my speech. He has not left me as much as half the time. I am therefore going out of my way to be rather quick, and I hope he will forgive me if I deal with the point as I go along in my speech.

We are discussing a matter which has been fully examined, and it was because of the representations which have been made from the area that my right hon. and learned Friend the Secretary of State asked me to look again at this matter. I have done this, and for reasons which I shall give I am afraid—and I must say this early in my speech—that I cannot see grounds for coming to a different decision.

The reorganisation of maternity services in the area is bound up with the reorganisation of hospital services consequent upon the opening of the first phase of Nevill Hall Hospital, Abergavenny. There has for some time been concern about the maternity services in this part of Monmouthshire. The perinatal mortality rate in North Monmouth is high, as the hon. Gentleman knows, and the Hospital Board therefore considered whether the opening of Nevill Hall might afford an opportunity of reorganising maternity services.

At this time, too, there was a debate which is still continuing about the best way of providing maternity care. As the House knows, a sub-committee of the Standing Maternity and Midwifery Committee, under Sir John Peel's chairmanship, produced a Report recommending that every mother should have her baby in hospital and that the facilities of the maternity service should be concentrated. The Report recommends that general practitioner maternity units should not be isolated, but should be near to consultant maternity units so that the full resources of such units will be available.

In line with this thinking, therefore, the Welsh Hospital Board's proposals were to concentrate maternity services at St. James's Hospital, Tredegar, where there was already a consultant maternity unit which would be expanded and which would have, in addition, general practitioner maternity beds associated with it. Extra G.P. maternity beds would be provided at Victoria Cottage Hospital, Abergavenny, to replace those at Blaina. The consequence of these proposals would be that the G.P. maternity beds at the Rookery, Ebbw Vale and Blaina Hospital would be closed.

This was the proposal upon which consultation took place and this was the recommendation made to the Secretary of State after this consultation. It was approved, as I have said.

In view of the criticisms that have been levelled at the Board, it is perhaps the right time to make two important points. First the result of the proposals which were accepted by the former Secretary of State will be to increase the number of maternity beds in the area. In 1969 there were some 69 consultant and G.P. maternity beds there. On the completion of the work at St. James's, Tredegar, there will be 78. Second, I hope I have made it clear from what I said earlier that the concentration of facilities is in line with modern thinking and the Board hopes the result will be a better level of service to the patients. This must always be our prime objective.

The Hospital Board has been criticised on the grounds that its present plans cannot in effect be reconciled with the proposals upon which it went out to consultation. The hon. Gentleman has touched on this. It is urged that the current plans differ so markedly from its original proposals that there should be fresh consultation.

Let us consider this aspect. First it has been pointed out quite correctly that the Board's original plans envisaged the closure of maternity beds at Blaina and their transfer to Victoria Cottage Hospital. However, the Board is now saying that the great majority of Blaina patients will go to St. James's, Tredegar.

The reason for this is that the Board has offered G.P.s using the beds at Blaina the alternative of facilities at St. James's, Tredegar, as well as Victoria Cottage as originally proposed. In fact, I understand that the great majority of G.P.s prefer St. James's, Tredegar. I see no reason to reopen consultations on these grounds. The original option of Victoria Cottage is still open to G.P.s who want it, but in addition they were offered beds at Tredegar. This it seems to me is an improvement on the Hospital Board's original proposals and is something for which it should receive credit

Second, it has been pointed out that the Hospital Board proposed to increase the number of beds at Victoria Cottage Hospital to 19 but now it proposes to keep the number at 14.

The reason for this is that so few G.P.s wished to make use of facilities at Victoria Cottage that the Board considered it would be unjustified in increasing the number of beds allocated to G.P. maternity services there.

I appreciate that some anxiety has been expressed about the number of G.P. maternity beds in the area now, but I would point out that there will be an overall increase in the number of maternity beds from 69 to 78 when the Tredegar unit opens in the New Year.

I understand, too, from the Hospital Board that should the demand for G.P. maternity beds be greater than expected there will be considerable flexibility in the use of the consultant beds at Tredegar so that, if available, G.P.s can make use of them.

I would now like to say a few words about the hospitals involved in the reorganisation as there seems to be some misunderstanding about them. First, I have been asked why, if Blaina is to close, the number of G.P. maternity beds there have been increased from eight to 13. It is argued that in view of the money spent on this and the increase in bed numbers, Blaina is now a viable unit.

I do not think this is so. The bed numbers were increased as a temporary measure to provide facilities for G.P.s who formerly used beds at the Rookery, Ebbw Vale.

This does not alter the fact that Blaina is a small unit isolated from a consultant unit. In addition, I understand from the Board that very little money has been spent on providing the increased accommodation—only some £180 for the conversion of a room into a stand-by second delivery room.

Second, I have been asked what Victoria Cottage has that Blaina does not have. It has been pointed out, quite rightly, that there is no consultant maternity unit at Abergavenny. The answer is that Victoria Cottage is very close to Nevill Hall and, although there are no maternity facilities there, Victoria Cottage will have the benefit—and the hon. Gentleman referred to the letter from the Welsh Hospital Board chairman—of the blood bank and specialised diagnostic services which are available at Nevill Hall.

I would agree that this is not ideal but it seems to me better than the position at Blaina. The ultimate reorganisation of maternity services will have to await the next phase of Nevill Hall which will include, maternity beds. I should also perhaps add that I am assured by the Board that no money has been spent at Victoria Cottage. I say this because the hon. Gentleman has alleged that £20,000 has been spent at Victoria Cottage.

My information is that no money has been spent and I hope that it is correct.

Third, I can, perhaps, reassure local opinion about the staff situation in the area. There are tour midwives at Blaina, and I understand that there has been some local anxiety about the question of transfer to Tredegar. I am, however, told by the Hospital Board that three of the four have now agreed to transfer.

There is one point the validity of which I fully accept. This is that the removal of facilities to Tredegar and Victoria Cottage will mean that expectant mothers will have a longer journey to make. The hon. Gentleman made this point. St. James' Tredegar is seven miles from Blaina and Victoria Cottage is 11 miles. I appreciate that there will be some inconvenience and expense involved for those in Blaina. However, I think that the following points are relevant.

First, ante-natal care would be provided locally, and it would usually be necessary for an expectant mother to be seen only twice at consultant clinics at St. James's Tredegar. I think it important to put the matter into perspective.

Second, I understand that the Hospital Management Committee is at present in negotiation with the local bus company to improve bus services. I am told that five services will now stop at the St. James's Hospital gates and that further talks are being held about return services. I think that this demonstrates an anxiety on the part of the hospital authorities to do everything possible in this connection, and I pay tribute to their efforts.

Third, I repeat that our prime objective must be, and is, to consider the needs of the patient and the provision of the best service. The Hospital Board believes that the proposed reorganisation will bring about a better service and this must take precedence over everything else in the interests of mother and child.

To sum up, I have looked carefully at all the arguments advanced both in the speech of the hon. Gentleman, who put his case persuasively and with great feeling—and rightly so—and in the other representations which the Secretary of State and I have received from the locality. I have looked at the matter most carefully, but I must tell the hon. Gentleman that, in spite of his pleas and his arguments, for the reasons which I have put to the House tonight I can find nothing which leads me to think that there is need to review the decision made by the former Secretary of State.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes past Two o'clock.