HC Deb 13 June 1979 vol 968 cc579-90

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

10 p.m.

Mr. Walter Johnson (Derby, South)

I draw attention to the proposed closure of the Nightingale maternity home in Derby, in my constituency. The area health authority has a special responsibility for such matters. It has decided that a financial cutback is necessary because of overspending to the tune of about £300,000. It has proposed that the most renowned and efficient of the maternity homes in Derby and Derbyshire should be closed.

In support of that recommendation a number of statistics are quoted. The statistics are used to try to prove that the home is under-utilised and that patients could be accommodated in the Queen Mary home. The health authority believes that such a plan would be adequate for the local people.

The health authority believes that such a proposal will result in a considerable saving. However, it neither spells out what in real terms the proposal will mean to expectant mothers nor how it will lead to depleted services.

Before I come to the real issues, I urge the Minister to give an assurance that fresh consideration will be given to the consultative procedures. The present procedures on such matters are a disgrace. If that means that I criticise the Government who have just left office, I do not alter my words. Clearly, the consultative procedures have been so slanted that they have been grossly unfair, to the staff in particular.

The area health authority has been told that it is overspending. It must then examine the situation in its area. In this case the authority decided to set up a working party to examine the Nightingale maternity home. The working party proposed that the home, which has been in operation for between 50 and 60 years, should be closed.

That is not proper consultation. The plan refers to the "proposed" closure of the home. Those who have made that proposal have already made up their minds. They are not prepared to look at the issue objectively. Whatever the weight of the argument, it will be difficult to change the minds of those who have made the proposal. This consultative machinery should be re-examined by the Government.

As the Minister will know, I am a national officer of a trade union. He may take it from me that if we had this type of consultation in industry, all hell would be let loose. It is time that the Government—any Government—looked at the consultative procedure, particularly when it comes to the closure of hospitals.

It seems that the AHA has made up its mind to go ahead regardless. Therefore, it makes a mockery of the consultative procedure with which we are familiar in industry. I ask the Government, not only on this issue but on the wider issue of the closure of hospitals, or whatever it may be, to look at the consultative machinery.

I turn now to some of the real reasons for the proposed closure. First, I do not consider this to be a wise move. There has been a 10 per cent. increase in the birth rate nationally. In Derbyshire that figure is likely to be exceeded because of changes in housing arrangements. New housing estates are going up in the South Derbyshire districts of Sinfin, Shardlow Road and Chellaston. Therefore, there is bound to be a higher birth rate in those areas.

The Nightingale maternity home average bed occupancy of 40 per cent. for 1978, which is often quoted by the area health authority, seems on the low side until one appreciates that at one stage during the year 82 per cent. of the beds were occupied. At the same time, the City hospital was regularly having to discharge patients. Its average bed occupancy was about 63.5 per cent. I am advised that post-natal depression is at its worst in the four days following birth, but women who had just had babies were being discharged during that period. I understand that that was because there was not enough bed occupancy in some of the homes in Derby.

Factors which influence the increase in the birth rate are the decrease in popularity of male sterilisation—vasectomy—due to side effects, the abandonment of the use of the pill by women in the 30-plus age group, again because of side effects, and the use of the pill by an increasing number of women as a family planning aid. Women who, prior to the introduction of the pill, would have started families in their late teens or early twenties, more by accident than design, have been able to defer confinement until a degree of financial stability has been achieved—such as part of the house and furnishings being paid off—usually by the late twenties. Therefore, an increase in the birth rate now means that there will be a substantial increase in years to come.

On the financial side, as the Nightingale maternity home staff has already been run down to suit the somewhat lower work load, there will be little or no saving from transferring patients and staff to a different location. The area health authority must be aware of this fact. So why does it propose to close the Nightingale maternity home, which is a famous home, in Derby? It is particularly famous because my wife was born there.

There appear to be two possibilities. In the short term the Derby health authority, as I have already mentioned, is currently some £300,000 overspent. It is looking for scapegoats to sacrifice in order to appear to be making savings. The Nightingale maternity home could be one of those scapegoats.

This must be in preference to grasping the nettle, which the Derby health authority must surely do if the National Health Service is to survive, by tackling the expensive mere called "Administration". There is the penchant for centralising everything and it is possible to employ more administrators in that way.

That approach has already gone sour in the case of the new Nottingham hospital adjacent to the university, which is an expensive white elephant which the authorities are desperately trying to justify by attempting to take over Derby's radiotherapy and neurosurgical units. A similar situation could arise in the longer term with the proposed City hospital extensions—in other words the Nightingale and Queen Mary maternity homes.

This whole exercise is opposed right the way through by everyone concerned. I could go on giving all sorts of examples but my hon. Friend the Member for Derby, North (Mr. Whitehead) would like to say a word in this matter and I shall give way to him in a moment. This is a shameful exercise by the area health authority. As I have said, it has to try to find savings somewhere. In my view, it has made a ghastly mistake in trying to close this maternity home.

The Nightingale maternity home is run by people who are devoted to the service. There is a prenatal clinic there where mothers can go to gain the confidence that is necessary during this difficult time, in particular for mothers having their first child. As a result, there is a new atmosphere and spirit. When the expectant mother goes into hospital, she is among friends and knows that she will be well looked after and given proper consideration. I believe that that is very important.

The doctors are against the closure. The regular doctors who attend their patients in the maternity home—there are about 50 of them—are unanimously against the closure, as are the midwives. The midwives are concerned that if the closure takes place facilities will not be available there for people to be looked after properly. More than anything, the midwives are worried about mothers being sent home too early because of the lack of facilities. They are very worried about this.

The people of Derby have shown overwhelmingly that they are against the closure. My hon. Friend the Member for Derby, North attended a meeting in Derby last Saturday, and he will be able to tell the House the measure of feeling against this closure. The city council took a decision at its last council meeting completely opposing the closure. Therefore the doctors, the midwives, the city council and the people of Derby are completely opposed to this closure. In the light of that, surely the Minister will give proper advice to the area health authority and tell it to think again.

The staff are against the closure and, most important of all, the patients are unanimously opposed to the closure. The patients realise that they will be better looked after in this home. In the area that I represent, it requires one bus journey to bring patients into the Nightingale maternity home. If it closes they will have to change buses, and there will be two bus journeys. Apart from the cost, I cannot imagine that it is a pleasant exercise for a woman who is seven or eight months pregnant to have to jump on and off buses. That is another important factor.

As I have said, the people of Derby are opposed to the closure. I ask the Minister, when replying, to take note of what I have said of the very strong feelings of the people of Derby, and not to look at this matter from the financial or statistical point of view but to take into account what this means to those women who are about to have a child—particularly a first child—and who are concerned and worried. If proper consideration is given, there will be no question at all but that this home should remain open for the benefit of the people of Derby and of the Health Service generally.

10.14 p.m.

Mr. Phillip Whitehead (Derby, North)

By leave of my hon. Friend the Member for Derby, South (Mr. Johnson), and of the Minister, who is a friend in another capacity of many years' standing, I should like to say a word. I congratulate the Minister on his new eminence, to which I am sure he will bring the compassion that has always been part of his approach to politics. That was never more needed than in this case. I hope that the Minister will find it possible to look at the facts and figures set out by my hon. Friend, and perhaps to visit the city of Derby to see for himself. He will see the kind of public indignation to which my hon. Friend referred when he spoke of the great rally that took place in Derby on Saturday.

I should like to say in one sentence what the nub of the case appears to be to me. I wish to make it clear that this is the unanimous voice of the people of Derby, including those who live in the constituency that I represent. The nub of the case is that the Nightingale maternity home serves an area which in itself is already underprivileged. It is an area in which people find it less easy, because of lower incomes and because many are immigrants and so on, to travel to those rather distant places to which patients would have to be transferred if they could no longer go to the Nightingale home. The home is part of the fabric of the community in Derby. It is a false economy to suggest that it should be closed.

On behalf of all the constituents in both the Derby constituencies, I earnestly recommend that the Minister and his civil servants should look at this matter again, talk to the area health authority and make sure that after genuine consultation—not phoney consultation—the home is kept open.

10.16 p.m.

The Under-Secretary of State for Health and Social Security (Sir George Young)

The hon. Members for Derby, South (Mr. Johnson) and Derby, North (Mr. Whitehead) have made a forceful case about a popular local institution. I am grateful to the hon. Member for Derby, South for giving me the opportunity to speak about the future of the Nightingale maternity home, in Derby.

I should like to make it quite clear at the outset that neither my right hon. Friend the Secretary of State nor my hon. Friend the Minister for Health has been formally asked to act as arbiter on the future of this maternity home. Indeed, I understand that the Derbyshire area health authority, which is responsible for its administration, has not yet decided whether it wishes to adopt the proposal to close the home. I understand that the matter is to be fully considered at the area health authority's next meeting on 9 July.

It would, therefore, be quite wrong to make any assumptions at this stage about the future of the Nightingale maternity home. Nothing that I say today should be construed as prejudging the issue. I think I should also stress that a closure proposal of this nature is by no means unique to Derbyshire. In a number of parts of the country, homes similar to the Nightingale have been closed after consultation, or are being proposed for closure, because of the need to gear maternity services to the interests of patients and to make the most effective use of the available resources.

The area health authority is concerned, as we all are, that infant and perinatal mortality should be reduced, and to this end a working party has been set up by the authority to consider studies carried out in the central and south health districts and to make recommendations to the area health authority on what further new measures are needed.

In view of what the hon. Member for Derby, South said at the outset of his remarks, it might be helpful if I now describe the procedures for the closure or change of use of any National Health Service building. Following the reorganisation of the National Health Service in 1974 and the introduction of new planning procedures, the procedures for the closure or change of use of health buildings were reviewed, and the Department issued revised guidance in 1975. The aim of these procedures is to enable scarce resources to be redeployed with the maximum speed and simplicity consistent with adequate local and, where necessary, national consultation. This approach seems especially relevant at a time when it is absolutely essential that no unnecessary barriers should stand in the way of the cost-effective use of resources.

Both hon. Members criticised the procedure outlined and asked me to have a look at it. I shall make inquiries to see to what extent this view is shared generally, and shall write to the hon. Members. In general, responsibility for determining the closure or change of use of health buildings rests with the appropriate area health authority, which in the case of the Nightingale maternity home is the Derbyshire area health authority, provided that the community health council is in agreement. Where there is general local agreement, it should be possible to effect a closure or change of use within a period of six months.

If, having discussed informally a particular closure or change of use with the interested organisations, an area health authority considered that such a measure would be beneficial, it would have to initiate formal consultations. In this event, the procedures require the authority to prepare a consultative document covering such matters as the reasons for its proposal; an evaluation of the possibilities of using the facilities for other purposes, or the disposal of the site; implications for the staff; the relationship between the closure or change of use and other developments and plans; and the transport facilities for those patients who might be affected by the proposals.

The area health authority would invite comments on the proposals contained in the document, within a period of three months, from such bodies as the community health councils, local authorities, joint staff organisations, family practitioner committees and local advisory committees, including the local medical committees. Hon. Members whose constituents were affected would also be informed.

I have been told that this consultation procedure has been carried out in respect of the Nightingale home closure proposal. The area health authority would then seek the community health council's views on the comments it received and the authority's own observations on those comments. The authority would then review its original proposals in the light of these comments, and, unless there was strong local opposition, it could then implement its original proposals provided that the community health council agreed. The regional health authority and the Department would be informed of the decision.

However, if the community health council objects, it is required to submit to the authority a constructive and detailed counter-proposal, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. The matter must then be referred to the regional health authority.

If the regional health authority is unable to accept the views of the council and wishes to proceed with the closure or change of use, it falls to my right hon. Friend the Secretary of State to act as arbiter. The decision whether to proceed with the closure will, under the arrangements introduced by the previous Administration, rest with Derbyshire area health authority after taking into account all the representations made in response to the consultation document.

I must add here that at a meeting of the South Derbyshire community health council on 9 May—called specially to consider Derbyshire area health authority's consultation document—the council passed a resolution accepting the area health authority's case for the closure of the Nightingale maternity home and supporting it in its proposal for the closure of the home. I also understand that some other local bodies have supported the proposal—in particular, the Derbyshire family practitioner committee and the British Medical Association—and I understand that the county council took a broadly neutral view.

Mr. Walter Johnson

The hon. Gentleman has gone through the procedure quite precisely and correctly. However, what I am saying about the procedure is that right from the word "go", a working party having been set up and having reported to the AHA and recommended the proposed closure, one finds people whose minds have been made up. It is very difficult to get people at that level—the AHA, or whatever the level may be—once they have made up their minds, to change them. Once people have made up their minds, they do not like to be proved wrong. In my book, consultation means not making a recommendation until all the facts are known and have been considered properly. That is consultation. This is not consultation. It is absolute rubbish.

Sir G. Young

I understand what the hon. Gentleman is saying, but surely the community health council does not approach the matter with the closed mind with which the hon. Gentleman implies the AHA approaches it. As I have just said, the CHC supported the recommendation for closure, as have a number of other local bodies.

Having outlined the procedure for consultation, I should like to make a few comments about the particular proposals contained in the consultation document about the home.

In February this year the area health authority issued its consultation document proposing that the Nightingale maternity home, a general practitioner unit of 34 beds, should be closed and that consideration should be given to the possible alternative use of the buildings for health purposes. The underlying reasons for the proposal were, firstly, the need to make financial savings wherever possible, so that scarce resources could be employed more effectively elsewhere—I shall say a little more about this later—and, secondly, the need to rationalise the maternity services in the Central and South Derbyshire health districts, to ensure that the best and most appropriate maternity care is available to expectant mothers in those health districts.

In addition to the Nightingale maternity home, which provides facilities for general practitioners based in and around the periphery of Derby who look after their own patients, maternity patients are also taken at Derby City hospital and the Queen Mary maternity home, which, like the Nightingale home, is in the South Derbyshire health district. At the City hospital there is a main obstetric unit of 76 beds, which serves both Central and South Derbyshire health districts. Expectant mothers there are under the care of consultant obstetricians. I understand that some are referred by their general practitioner at an early stage in their pregnancy. Others intended for other maternity units or for home confinements are referred for consultant opinion at a later date in their pregnancy and in some cases the mothers' bookings are transferred to Derby city hospital.

The Queen Mary maternity home, also in the South Derbyshire health district, has 41 beds. The medical staff there come from the main obstetric unit which is at Derby City hospital. That home serves a similar catchment area to that of the Nightingale home. It is used usually to deal with normal pregnancies in cases where the general practitioners do not wish to look after their own patients or where the patient expresses a specific wish to go into the Queen Mary maternity home.

At present both the Nightingale and Queen Mary homes are considerably under-used. I am sure that hon. Members will appreciate that the cost of maintaining two separate maternity homes serving, in effect, the same catchment area and with low levels of occupancy is high. I am advised that the same number of patients as are presently cared for in both homes could be placed in one home at a much reduced cost.

I have been assured that the area health authority has considered carefully what provision should be made in Derby to meet likely future demand for maternity beds. The view expressed in the consultation document is that it would be quite uneconomic to retain both homes, currently providing a total of 75 beds, which, as I mentioned earlier, are considerably under-used. The AHA has therefore decided to retain the Queen Mary home, with its 41 beds, which in the longer term could be progressively increased to 50 to meet future demands on the maternity services and to release the Nightingale maternity home for other Health Service purposes.

I understand that whilst the Queen Mary home can cope with the present work load of both homes and with the estimated future demand, which assumes an increase in the birth rate in Derby of some 40 per cent., the Nightingale maternity home could not do so and that the structure of the Queen Mary home—in which a new lift has just been installed—is superior to that of the Nightingale maternity home and less expensive to maintain.

As I mentioned earlier, one of the principal reasons is to make financial savings. The consultation documents estimate that the savings resulting from the closure of the Nightingale maternity home would be of the order of £80,000. While I must be careful not to express any judgment on an issue that still has to be considered finally by the responsible authority, there must be few health authorities who could not make very good use of £80,000 to provide health services for the community.

Hospital staff are concerned about preservation of existing facilities. I have said that there will be no reduction in the number of beds in use and that the authority intends to increase provision in the future. The staff are concerned about their jobs. I have been assured that midwives presently employed at the Nightingale maternity home will be offered employment at the Queen Mary home and that other staff will be offered posts in other appropriate units within the district. That should therefore mean no diminution in staffing levels.

I would like to add here a word of praise for the good work done by the staff at Nightingale maternity home, and to emphasise that the proposed closure in no way reflects on the care and devotion they have given to their patients. But, as I have said, the local community health council supports the closure. According to the closure procedures, the CHC's decision is an important one. It came to its decision after careful consideration of the proposal and all the implications for the local community and the Health Service. I know that in reaching its decision—and the matter next comes before it on 9 July—the area health authority will take full account of the views expressed by all those who have commented on its consultative document and what both hon. Members have said this evening.

There is concern in Derbyshire about the level of financing health services. There is no doubt that Trent region is a deprived region. In recent years the allocations that it received have made a significant reduction in the level of deprivation, but there is still some way to go. This Government will seek to improve the financial lot of the deprived localities in this country, but I cannot offer instant equality any more than our predecessors could.

Some people locally are worried about the additional travelling time for patients. I understand that at present doctors and, indeed, many patients do not always choose the maternity unit nearest their homes. As regards emergencies, I am also told that the travelling time between the two homes and the City hospital is broadly the same—of the order of 12 to 15 minutes.

In his address this evening the hon. Member has presented cogently on behalf of his constituents arguments which I think it important that the area health authority should be aware of and give full consideration to when it makes its decision. I shall therefore draw to its attention what he and his hon. Friend have said in the House tonight.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.