HC Deb 14 November 1972 vol 846 cc381-90

11.14 p.m.

Mr. Robert Hicks (Bodmin)

I am grateful for this opportunity to draw to the attention of the House a subject which has been of considerable concern, irritation and frustration locally, namely the provision of maternity facilities in the Liskeard area of my constituency. It would be helpful if I briefly described the background to this problem and the events that have led to my raising this subject tonight.

Until 16th September, 1968, maternity services were provided at the Trebarras Nursing Home, Liskeard. The home was closed initially on a temporary basis on the ground that staffing was causing difficulties. In addition, it was generally agreed that the buildings were not suitable. Indeed, at the end of 1969 the South-West Regional Hospital Board consulted a number of interested bodies and persons in the area so that it might be aware of local opinion. This confirmed that there was little enthusiasm for the reopening of Trebarras.

The Minister made public his announcement that Trebarras should be permanently closed on 3rd August, 1971, in answer to a Parliamentary Question which I had put to him. During the period late 1969 to early 1970 that the South-West Regional Hospital Board was taking its soundings, it would be true to say that the board was left in no doubt by those authorities and bodies that it consulted that some form of alternative improved maternity facilities should be provided in Liskeard. In particular, there was the suggestion that a three to four-bed short- stay delivery unit should be established either within or as an extension to the local general practitioner Passmore Edwards Hospital in Liskeard. It is this latter proposal on which I wish to concentrate my remarks.

I was elected the Member for Bodmin in June, 1970, and this was one of the first major constituency problems to which my attention was drawn. The secretary of the South-West Regional Hospital Board wrote to me on 20th July, 1970, and stated quite categorically: We —that is, the board— would welcome an arrangement of this nature —namely, the short-stay extension project— but, as you will understand, this involves a major change of services about which our first step must be to consult the Department of Health and Social Security. In other words, the ball was passed back into my hon. Friend's court.

During the latter half of 1970 I received representations from the Liskeard Borough Council, the Liskeard Rural District Council, the Looe Urban District Council, the county councillor for Liskeard and the secretary of the Liskeard Hospitals Medical Staff Committee as well as from many private individuals informing me that they felt that some provision should be made at the Passmore Edwards Hospital and requesting that I continue to press the Department for a favourable decision. The Minister will be aware of those representations since he will recall that they were the subject of much correspondence between us and we talked about the matter informally.

On 7th May, 1971, my hon. Friend wrote to me indicating some of the problems which he believed would be inherent in any short-stay extension project at Passmore Edwards, and on 3rd August, when he confirmed the permanent closure of Trebarras, he informed me in answer to my supplementary question on that occasion that the three to four-bed short-stay maternity unit was not practicable because of staffing and the low number of projected deliveries per week. In a letter to me dated 7th September, 1971, the Minister elaborated on those details.

Needless to say, my hon. Friend's announcement was received with genuine disappointment in the Liskeard area. Many people approached me requesting that I make further inquiries to ascertain whether I could persuade my hon. Friend to change his mind. In addition, the Cornwall County Council protested strongly at the decision and agreed to investigate further the possibility of providing staff either on a joint basis with the regional hospital board or on a secondment basis, in the hope that the problem of staffing could be overcome.

I asked my right hon. Friend the Secretary of State a series of questions for Written Answer last December in order to obtain information and discover whether some variant scheme on a permanent footing might be feasible. Meanwhile the numerous branches of the women's institutes in the Liskeard—Looe areas organised a petition. In January a list of more than 1,500 names in support of the petition was handed to me urging that a birth unit be reinstated as an addition to the Passmore Edwards hospital.

It is because of those further representations and my own inquiries that I make the sincere request to the Minister to revise his decision, or at least to take another look at it. I make the submission on the following bases. The Liskeard—Looe population catchment area contains between 25,000 and 30,000 people. It is a growing area. It is expected that by 1981 the population of that catchment area will amount to almost 40,000. An increasing proportion will be young married couples.

On an earlier occasion the Minister stated that such a unit would serve only two to three deliveries per week. That depends upon the definition chosen for the Liskeard-Looe catchment area. It may well be that in its narrowest sense it would serve only two to three deliveries a week. But what of those villages which were formerly within the old Trebarras nursing home catchment area but which, upon reorganisation, have been placed in adjacent catchment areas?

There is also the question of staffing. I acknowledge the problems and I do not underestimate them. I have discussed them at length with the clerk of the Cornwall County Council. But surely it should be possible to reach a sensible and satisfactory arrangement between the hospital board and the local authority over the terms and the structural details of their employment. The equivalent of three full-time midwives is required. Liskeard is located within the South-West Development Area and is characterised by an above-average level of unemployment. Has a genuine effort been made either to employ or to train married women who are already resident in the area so that they can take up these positions?

The site at the Passmore Edwards hospital is certainly large enough to accommodate an annexe. It would have an administrative advantage in that it could be included within the existing hospital both from the point of view of staffing and the provision of essential services. The unit would serve a large rural area which at present is almost devoid of public transport and under present arrangements patients and relatives have to travel significant distances, often by narrow roads from remote parts in unpleasant weather conditions. Time as well as money is a relevant consideration.

Liskeard is a natural focal point, surrounded as it is by the rural hinterland. At present expectant mothers are asked to travel to Launceston which is 18 miles away, Plymouth 20 miles away, Tavistock 18 miles away and St. Austell 20 miles away.

My final point concerns the question of costs. My hon. Friend the Under-Secretary has told me that the capital cost based on January. 1972. figures would be about £100,000, comprising £40,000 for building and engineering for the three-four bed unit, £40,000 for the buildings and so on for ante-natal services, and £20,000 to cover the cost of fees and other equipment. In addition, he informed me that the annual running costs would be about £15,000.

In coming to his decision my hon. Friend placed much emphasis on those costs, suggesting that in relation to the probable demand the unit would be uneconomic. This may or may not be the case when the economics of the situation are viewed in isolation. But, important as the economic aspects are, surely there are other considerations, especially those based on social criteria? The purpose of the health and hospital services is to bring medical provision as near as possible to the general public, within the limits of reasonable and sensible economic bounds.

I believe that for the reasons I have outlined there is a very strong case for some form of short-stay maternity unit of, say, three beds being established at Liskeard in conjunction with the local Passmore Edwards Hospital. The regional hospital board has acknowledged the case in writing. Local authorities and local people certainly support the concept. Surely, if the will exists a way can be found to overcome the practical difficulties? It is in that spirit that I ask my hon. Friend to re-examine the position.

11.27 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

I must congratulate my hon. Friend the Member for Bodmin (Mr. Hicks) both on his good fortune in obtaining the debate and on his choice of subject. The care of mothers and babies is vital to any community, and he is right to raise the matter, which affects his own constituency.

I am particularly glad to be given this opportunity of explaining the position of maternity facilities in the Liskeard area, on which my hon. Friend asked several Questions last year, and on which we have exchanged a number of letters. No Member could have done more or expended more energy or zeal on behalf of his constituents' vital interests than my hon. Friend. I congratulate him on that.

First, I must make it clear that responsibility for planning hospital services, including maternity facilities, in the Liskeard area rests firmly with the South-Western Regional Hospital Board, which has the onerous task of deciding how hospital services in its region should be planned and operated. In spite of a little nuance in what my hon. Friend said about our joint responsibilities, it is only in very exceptional circumstances that my right hon. Friend the Secretary of State would expect to intervene.

In this case, however, because of both the requirement for the Secretary of State to approve the closure of the Trebarras Maternity Home and the issues raised by my hon. Friend, my Department looked into the maternity situation in the Liskeard area very carefully and asked the board to reconsider the practicability of providing facilities locally.

I hope my hon. Friend will forgive me for repeating some of what he has said, but I think it would help the House if at this stage I filled in some of the background of the present situation.

Up to four years ago there was a six-bed general practitioner unit, the Trebarras Maternity Home, in Liskeard. This was in a converted house in grounds adjacent to the Passmore Edwards Hospital, which has 20 medical beds for the use of family doctors. Not only was the Trebarras building unsatisfactory for modern maternity treatment but there were considerable difficulties in attracting qualified midwives to staff it, particularly during periods of leave. The regional hospital board found this a constant anxiety and it was for this reason that it was forced to close the unit in September, 1968.

It is important to note that when this maternity home was open, the average number of deliveries over a five-year period was only 2.1 per cent. per week and during the first three quarters of 1968 the average bed occupancy was only 40.5 per cent. The decision to close the home was taken because of the difficulty of providing qualified staff, but the under-use of the home over a long period cannot be ignored.

The board, however, fully appreciated that the distance from other maternity units at Launceston, Tavistock, St. Austell and Plymouth would mean a long journey for mothers, in some cases up to 20 miles, and considerable inconvenience for relatives wishing to visit them. The board, therefore, examined carefully a proposal to establish a new short-stay delivery unit attached to the Passmore Edwards Hospital. It was hoped that the main problem of finding qualified staff might be solved by using local authority domiciliary midwives, who could perhaps take their patients to the unit and deliver the babies there. The House will appreciate that my right hon. Friend before approving such a plan would need to be assured that this scheme could work without any risk of mothers being left unattended by qualified staff either in their own homes or at the delivery unit.

Further examination of the proposals indicated that the scheme was totally impracticable. Cornwall County Council has told the regional hospital board that it could not provide midwifery cover from its existing resources and that the additional commitment would demand the recruitment of three extra midwives. The House will remember that the recruitment of midwives is the fundamental problem and neither the county council nor the board felt confident that this could be resolved.

The county council also pointed out that there would be substantial difficulties due to the geography of the scattered rural area, with narrow roads making communications difficult in the holiday period. It thought there might be delays before a midwife working on the district would be able to reach a patient in labour in the Liskeard unit. It seemed, therefore, to the board that there was every likelihood that a scheme of this sort would break down, with the serious risk that a mother and baby might be left unattended at the crucial time. For these reasons, the proposal was rejected by my right hon. Friend who reluctantly agreed to the closure of the home, without replacing the facilities locally.

My hon. Friend has asked in the past about the costs of a short-stay unit of the kind proposed. At the time, the board estimated that the capital cost might be about £100,000, with running costs of about £15,000 a year. These were broad estimates which would, of course, need to be refined if it were decided to provide such a small unit. But even if considerable reduction in the estimates would be achieved and ambulance and other costs set against them, the provision of such a unit would clearly be uneconomic for only two or three deliveries a week.

I realise that the population of the Liskeard area may increase over the next few years. My hon. Friend has risked some projections on that. But I cannot accept that the increase would be such as to make a significant difference to the number of confinements which would take place in a maternity unit of this kind. As I said earlier, over a five-year period there were usually only two deliveries a week in the Trebarras home, which was adjacent to the site of the proposed new unit. We must also bear in mind that all cases in which any difficulty could be expected would continue to be booked for the consultant unit at Plymouth, as they were before the Trebarras home closed.

Although I have referred to the economic considerations, I assure the House that it was not these arguments which were dominant in our minds when we concluded that it would be impracticable to set up a new unit. Our chief concern was for the safety of the mothers and the babies who would be patients in such a unit.

As long ago as 1959, the Government of the day accepted the recommendation of the Maternity Services Committee, under the chairmanship of the Earl of Cranbrook, to the effect that so far as more lying-in beds were needed these should, where possible, be general practioner beds for normal cases under the overall supervision of a consultant obstetrician and within, or very close to, maternity or general hospitals where the maternity beds are under the care of obstetric consultants. This has been the policy of successive Ministers of Health and Secretaries of State.

In 1970 a sub-committee of the Standing Maternity and Midwifery Advisory Committee, under the distinguished chairmanship of Sir John Peel, went further than this in recommending that small isolated obstetric units should eventually be entirely replaced by larger combined consultant and general practitioner units in general hospitals and meanwhile should be closely linked with the consultant unit. But these recommendations are still being studied, and my right hon. Friend is not yet ready to say whether he accepts these latter recommendations in full.

The House will know that medical opinion on the place of delivery is by no means unanimous. But I think all would agree that no new isolated maternity unit should be established unless it can be shown with certainty that it would be properly staffed with fully qualified people. This is the crux of the issue. Neither the Cornwall County Council nor the South-Western Regional Hospital Board has been able to produce a plan which gives any assurance that this could be done. I regret that I cannot see any prospect in present circumstances of establishing hospital maternity facilities in the Liskeard area.

I know that the question of dealing with emergencies has been raised as a reason for providing a unit in the Liskeard area. But here again, in the interest of the safety of mother and baby—the key factor, which deeply concerns my hon. Friend—it must be remembered that cases likely to cause difficulty ought to be booked for the consultant unit in the first place, and, in the event of sudden emergency at home, it is more appropriate to rely on the services of the flying squad and subsequent admission to the consultant unit with full facilities than to admit to an isolated general practitioner unit without these facilities.

The situation, therefore, is that mothers have their babies at home, or, according to considerations of medical need, the relative geographical location of their homes, transport arrangements and the preferences of the individual mother and her doctor, are admitted to either the consultant unit at Plymouth or to the general practitioner beds in Devonport, Launceston, Tavistock or St. Austell. These arrangements have been in operation since the Trebarras Maternity Home was closed in September, 1968, and, as far as the regional hospital board is aware, have worked satisfactorily.

I fully understand that mothers may dislike the need to travel up to 20 miles to have their babies, and that this also causes husbands and relatives visiting them considerable inconvenience, to say the least. But I am sure that this is better than setting up a system with an inherent staffing weakness, thereby risking its breaking down, with the inevitable possibility of real tragedy as a result.

I think that people who live in rural areas, and enjoy the pleasure and peacefulness of the country and the absence of the pressures of urban living, accept the need to travel to centres of population for special amenities and important occasions.

The birth of a child to a family is one of the most important occasions in their lives. It may be in general that people are prepared to travel to where safe facilities can be provided rather than risk any harm coming to either mother or child

Question put and agreed to.

Adjourned accordingly at twenty-one minutes to Twelve o'clock.