HC Deb 22 April 1980 vol 983 cc416-28

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

1.11 am
Mr. Robert Adley (Christchurch and Lymington)

I am sorry that some of my hon. Friends are leaving. I implore them to stay so that they may hear about this very important matter. Even if it does not concern their constituencies, it deeply concerns mine.

I thank my hon. Friend the Minister for being here. I also thank my hon. Friend the Minister for Health, who has taken a most helpful attitude throughout the many months during which the problem has been under discussion.

The debate tonight on the proposal by the Hampshire area health authority to close the maternity hospital at Barton-on-Sea has nothing whatever to do with the current debate on public expenditure. The Grove, as the hospital is known, has for many years been a target for the administrative machine in the part of the world that I represent. It would be out of order if I were to refer to constituents who were here to listen to the debate but I can assure the Minister that this is a matter of overriding importance to very many of my constituents.

I wish to deploy four points in my argument. First, there is dissatisfaction with the role and impartiality of the community health council. Secondly, we believe that there has been an unsatisfactory and an inadequate consultation process. Thirdly, we believe that we have been regaled with unsubstantiated facts of a financial and a medical nature. Fourthly, we believe that there is, or will shortly be, a need for a ministerial intervention at the appropriate stage if the community health council does not do its job, namely, to reflect the overwhelming balance of local opinion.

I want to look first at the role of community health councils. I have a number of circulars which have been issued by the Department over the years and from which I intend to quote briefly, but I shall not weary the Minister or the House by reading out the numbers and references to them. But in 1974 a document on community health services said that they will provide a new means of representing the local community's interests in the health services to those responsible for managing them. Thereafter, in another document listing the features which were considered to be relevant, one out of many was if there was a considerable seasonal fluctuation. This is one of the points that I wish to mention briefly in the debate. Living in and representing a constituency which has a large influx of people in the summer season, I can say that this is a very relevant factor and one of many which have been totally ignored by the community health council in its deliberations.

The community health council has a direct relationship to the area health authority. However, when the community health councils were being set up, my hon. Friend the Member for Barkston Ash (Mr. Alison), then a Minister in the DHSS, said on 15 May 1973: One advantage of the community health council is that it is totally free and independent of the managerial role."—[Official Report, 15 May 1973; Vol. 856, c. 694.] I do not know what has happened elsewhere, but that is nonsense in my constituency. The membership of the community health council was created by the regional health authority. The area health authority has made a proposal to close the Grove and the community health council either has to agree or disagree with the area health authority.

Any suggestion that the community health council is totally free and independent of the managerial role of the Health Service is little less than nonsense. That is widely believed in my constituency. At a recent public meeting in my constituency, which was attended by a very large number of people, Dr. Sandy Cattanach—a well-known and respected local doctor—stated: If you believe the decision has not already been made, you'll believe anything. There is a widespread belief in my constituency that the decision has been made. I hope that the Minister will disabuse my constituents and me of that belief. The administration of the area health authority wants to concentrate all the funds in the area on Southampton general hospital. That is the nub of this problem. The Lymington Times recently had the sub-headline: £80,000 'saving' to help pay for Southampton Unit". That sums up people's feelings.

My second point is that of the unsatisfactory consultation process. I pay tribute to Mrs. Carol Warne, leader of the protest group. She forced the need to have a public meeting on the community health council. The community health council now says that it had intended to hold a meeting, but it did not spend a penny on advertising. Mrs. Warne and her colleagues had to spend their money on advertising a public meeting that would attract the public's attention to the proposals of the area health authority.

Turning to the role of the community health council in the consultative process, I quote from another of the Department's documents: It will be for each CHC to decide how best to fulfil its role of representing to the relevant Area Authority the interests of users of health services in the district". We do not know what is meant by "district". We suspect that what we regard as our district and locality is not what the community health council has in mind. When it speaks of the district, it is speaking of the wider area. The name of the district is Southampton and south-west Hampshire. Southampton will always get its way because it is numerically more powerful.

I have received scores of letters on this subject. I shall not weary the House by reading long passages from them. However, in addition to the letters of protest that form part of the so-called consultation process, Drs. Cattanach, Ball, Tuddenham and Badham—all local doctors—came to that meeting and made their views known. Mrs. Warne and her colleagues have given me a petition that is signed by more than 5,000 people. The New Forest district council environmental services committee held a special emergency meeting last week and passed a unanimous resolution opposing the closure of the Grove. That local authority stretches from suburban Southampton to within a few miles of Salisbury.

My hon. Friend the Minister may think that I have received representations only from my constituents. I advise him that only tonight I have had a conversation with staff midwife May, who for five years has been at Southampton general hospital's maternity unit. Since last month she has been at Barton. This evening she spoke to me on the telephone and said that the Southampton unit is hard pressed, even with peripheral units such as Barton, to deal with patients. She said that the chief concern of the postnatal ward at Southampton was finding beds to send mothers to. She did not like to contemplate what it would be like if the Grove was closed. I understand that the staff at Southampton maternity unit are not in favour of the closure either.

Finally I shall quote Mr. Gillibrand, a consultant gynaecologist at Southampton general hospital who wrote to me on 3 March saying: I do wish there was more that I could do in return to save the Grove Maternity Hospital in Barton-on-Sea. In the course of the last few years, during which it has been under threat of closure, I have, firstly as Chairman of the Department of Obstetrics and Gynaecology, and later as Chairman of the Maternity Services Health Care Planning Team, helped to achieve a stay of execution. I do believe it serves a most useful purpose, particularly in that area, which is so far from the maternity departments at Bournemouth or Southampton. That is the nub of this problem. It is about 25 miles from Barton-on-Sea or New Milton to Southampton, and about 10 miles to Boscombe. While it is proposed to close the Grove, there is no proposal to close either the maternity unit at Romsey, or the Fenwick at Lyndhurst, both of which are many miles nearer to Southampton, and do not involve a long and arduous journey across the New Forest. That journey is fine in the middle of the night in the middle of winter, but at midday in mid-summer presents a most serious problem. It can take between an hour and an hour and a half.

I turn to the unsubstantiated financial and medical facts. Doctors locally have confirmed that if the Grove is closed there will be inevitable side effects. There will be a substantial increase in ambulance costs, and patient travel costs. Another DHSS circular recommends that one of the criteria which the CHCs should take account of is the hospital visiting arrangements for patients. The closure of the Grove will present very real problems for many people, particularly those who are not so well off, in getting from Barton or New Milton to Southampton.

Another by-product of the closure will be a substantial increase in the number of home confinements. I understand that this is contrary to DHSS policy. There will be more ambulance births, and this point was made abundantly clear by Dr. Ball at the recent meeting to which I have already referred.

Also, there will undoubtedly be an increase in the risk to the health of pregnant mothers, particularly those who may have complications immediately prior to the birth of their babies. One New Milton baby was born recently in the waiting room at Southampton general hospital. Even in the winter, the travelling time was insufficient to get from New Milton to Southampton and have the baby delivered safely. Even now, six babies a year are delivered in the ambulances in spite of the fact that the Grove is still open and many local mothers are still able to go there. I do not know whether my hon. Friend knows the journey through the New Forest, but if he does not, I can assure him that it is a real problem.

I shall quote two letters that I have received. One is from a lady in Banbury, a Mrs. Susan Morris, who says: Had it not been for the ready availability of that maternity facility and its most expert staff, I may have lost my five-week premature baby. I had approximately 30 minutes warning of the impending birth—30 minutes to call a doctor, (I was a visitor on holiday in the area) get an ambulance and be admitted to a maternity hospital. Had it not been for the existence of Barton, this would not have been possible because there is no other such facility in the close proximity of Milton, Barton or Highcliffe. That is undoubtedly true. If that lady had had to go to Southampton it is quite clear that she would never have made it. One of my constituents, Julia Villers, wrote to me from Hordle. She says: On the afternoon of 6 January I began to have strong contractions lasting 10 minutes. By 8 pm they were stronger, yet, still at 10-minute intervals. I decided to ring Southampton where a sister told me to hang on till the contractions were coming every five minutes. I was somewhat anxious to hear this advice, bearing in mind the 20-mile drive to the hospital. By 10 pm when I felt I could bear the pain no longer, I again rang the hospital, almost in desperation. A second sister answered my call. I explained the position again, and when I told her where we lived she did agree that I should make my way into Southampton. The drive was quite a nightmare and my husband and I were only thankful that it was late on Sunday evening, and therefore there was very little traffic on the roads. I will not weary the House with Mrs. Villiers' whole letter, but she says that her son was born 12 minutes after she was taken to the delivery room.

The area health authority says that £80,000 is the cost of running the Grove. The assumption it puts forward is that by closing the Grove the sum of £80,000 will be saved. This is nonsense. No account is taken of the extra ambulance costs. I am told that this is not a relevant factor. No account has been taken of the additional travel cost. No figures has been provided for me, the local press or anyone else.

The area health authority refuses to supply any individual costs for Southampton general maternity unit. Mr. Shaw, the district administrator of the Hampshire area health authority has, however, admitted that the cost of patient care at Southampton general hospital is double that of the hospital at Barton-on-Sea. If one is talking about an £80,000 so-called saving, where is anything mentioned about the cost of caring for the 450 women and babies presently looked after at Barton? So far as I can deduce, these women and babies have not been accounted for as an obvious offsetting cost that will have to be borne if the Grove is closed.

Those who are advocating closure are the same people who provide the figures. We know, from experience in this House, that officialdom can cook the books when it wants to prove something. British Rail has managed, over the years, to close innumerable branch lines by the old tactic of reducing the service, increasing the cost for a 12-month period and then, after 12 months, pointing to the increased cost of running the line and the fall in passenger revenues as reasons for deciding to close the line.

I have no confidence that the figures with which we have been presented are accurate. There has been no opportunity to challenge them. However, now that the matter comes to be challenged in the House of Commons, there is a fluttering in the dovecotes of the area health authority and the community health council. I understand that feelers hav already been put to the objectors suggesting that if the Grove is closed, a maternity unit might be built at Lymington hospital. That is a ridiculous suggestion. What will be the cost of building a whole new maternity unit when there is a perfectly good unit working and operating five miles away from Lymington hospital? Anyway, local residents are having to raise £150,000, by public appeal, to keep Lymington hospital in existence.

My last point concerns ministerial intervention. I realise that this is a matter of timing. I do not expect my hon. Friend to say tonight, in the middle of the consultation process, that he will agree immediately to call in the decision. There are some unusual factors that I must mention. Area health authorities are being abolished. The Bill is before Parliament. There is no doubt that, by the end of this Parliamentary Session, legislation will be on the statute book to wind up area health authorities. But the Hampshire area health authority, whose dastardly proposal is the subject of this discussion, seems determined to close the Grove as a final act of showing its power. The Community health council seems to support the area health authority. It is behaving in an unattractive manner contrary to the spirit by which community health councils and the whole Health Service administration was established.

I wish to refer to the timing of the closure. I am conscious of the fact that I do not want to take my hon. Friend's time. A document from his Department in October 1975 said: In general, responsibility for determining the closure or change of use of health buildings rests with the Area Health Authority, subject to the formal agreement of the Community Health Council. Where sufficient local agreement exists, it should be possible to move from a proposal to close (or change use) to actual closure or change of use within a period of six months. That happens where local agreement exists. It would be impossible to find a situation where there is less local agreement to a proposal than exists in the present situation. A closure is proposed to take place after the area health authority, which is making the proposal, will have had its death-knell pronounced by Parliament and when there is universal agreement that the administration of the Health Service is over-burdened. There is a clear case, in this instance, for my hon. Friend to recognise the peculiarity of the circumstances. Can there be intervention before consultation is complete? How much consultation is the community health council proposing to indulge in? So far as I know, it has not consulted the town council of New Milton and Barton, the biggest population centre in my constituency. It has not consulted formally local general practitioners, nor does it intend to. I do not suppose that it has consulted, or wants to consult, the staff of the Southampton maternity unit. If the council is to do any job, it is honour bound to have consultations. The White Paper states: The council's basic job will be to represent to the AHA the interests of the public in the health service in its district. That should be repeated. That job is not being done properly by the community health council. The Minister has powers to call in the proposal, even if the community health council disagrees with the area health authority.

Barton is a country area. It is not understood by the Southampton urban administrators who want to create a world of office hour births. That, frankly, is an unreal and unpleasant ambition.

The Grove is a superb, friendly, efficient, small, cost-effective part of the community. Sister Knott and her staff are highly respected. It is the type of small establishment which I understand the Government have come to believe is of value to local communities. We are not getting a fair or straight deal from the community health council.

The chairman of the CHC wrote to me about a different matter. She wants to keep her job and for the community health councils to remain. In a letter of 20 March she said that the community health councils are an important part of the democratic process and enable local communities to have a vigorous independent voice in the provision of health care. If that is true there can be no doubt about the conclusion that the council should come to if it pretends to do an honest job in putting the views of local people about the proposed closure to the area health authority.

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

I congratulate my hon. Friend the Member for Christchurch and Lymington (Mr. Adley) on securing the debate about the future of the Barton on Sea maternity home, otherwise known as "The Grove". He has been most assiduous in seeking to protect the interests of his constituents. He has delivered—if that is the right word—a well-researched and cogent case. I am grateful to him for giving me the opportunity to set out as a matter of record the background to the debate and to give an account of the procedures that must be followed when the closure of any hospital is proposed.

No decision has yet been taken to close the Barton on Sea maternity home, nor indeed is any final decision imminent. I shall refer later to the various stages that must be gone through before a hospital can be closed. If local agreement cannot be reached—in particular if the local community health council objects—the final stage in the process will involve a decision by Ministers in my Department. It would not be right for me to pre-empt tonight that decision or, indeed any decision of the relevant health authorities. My hon. Friend acknowledged that.

I should also stress that I am well aware of the dedicated work done by the staff of this hospital, both now and in the past. I am aware of the strength of their feelings in this issue. Any proposal to close this home of course in no way reflects adversely on the high standard of care that I know they have always given their patients.

My hon. Friend has rightly been concerned that any proposal to close The Grove—and I stress again that we are no more than dealing with a proposal-should not be rushed through by the Hampshire area health authority without adequate consultation and without due regard to the staff of this hospital and the interests of the local community. I can assure him that the proper procedures laid down by my Department must and will be followed.

Equally, I know that he is concerned that the interests of his constituents might not receive due consideration because of their proximity to Southampton and its preponderance of population. I have no doubt that his activity in this matter has ensured that there is little risk of this and that the voices of his constituents in Lymington, Milford-on-Sea, New Milton, Hordle, Barton-on-Sea and other areas are being loud and clear.

Any proposal to close Barton-on-Sea maternity home has to be considered in the context of the total maternity and gynaecology services provided in the Southampton and South-West Hampshire health district and surrounding localities. A major, but not the only, factor is the opening in 1981 of the new maternity and gynaecology unit at Southampton—20 miles from Barton-in-Sea. This unit cost £8 million and will I am told contain all the facilities to provide the highest possible standards of care both for obstetrics and gynaecology.

Once this new unit has opened the area health authority proposes a number of changes in bed distribution for maternity and gynaecology services in the Southampton and South-West Hampshire district. One of these consequences is the proposed closure of the 11 maternity beds and seven gynaecology beds at Barton-on-sea.

The consultative paper issued by the area health authority gives in part the following reasons for wanting to close the Barton on Sea maternity Home's maternity facilities. It says that the home is the least used of the maternity units peripheral to the central unit at the Southampon general hospital in terms of the number of births, the number of transferred cases, and the level of bed occupancy.

These factors, it claims, combine to render Barton the least economical of the peripheral units. I note what my hon. Friend said on that subject. The paper states that recruitment of staff to the home has proved difficult in the past and there is no reason to assume that this situation will improve. There is also said to be growing professional concern that the existing staff are unable to make full use of their midwifery skills in view of the low number of deliveries. In 1979 there was an average of about one delivery per week at the home and the total annual number of births in the hospital has fallen progressively from 104 in 1975 to about 50 last year.

The area health authority states that the desirability of retaining a facility in the western New Forest has been carefully considered, but it feels that there is no justification for retaining beds at the Grove simply to provide for mothers who give birth very quickly. Indeed, in the authority's view, it is questionable whether this type of isolated unit is appropriate for such cases. Additionally, the health authority draws attention to the wider and more comprehensive service that is already available at the Royal Victoria Hospital and the more than adequate spare capacity that exists there.

It would not be right for me to comment at this stage on the validity of these points other than to say that I am well aware of he strength of feeling that can be aroused among both mothers-to-be and professional staff by proposals to vary maternity services. Factors such as maximising safety, providing a friendly, homely and sympathetic environment, and the convenience of patients and visitors, do not always pull in the same direction and have to be balanced locally with tact and sensitivity.

I know that many authorities are now searching for ways to save money, and, as a last resort, closure may seem to be the only option. But my fellow Ministers and I have repeatedly made it clear that we will not agree to permanent closure as a way out of short-term difficulties.

As I have said before, permanent closures in some areas reduce the Health Services's precious stock of hospitals at a time when the country can ill afford to make good the loss and the cumulative effect of a number of small closures can be substantial. Thus we are quite firm that permanent closure should occur only as part of an agreed long-term plan for the development or rationalisation of health services in a particular area.

Mr. Adley

I am grateful to the Minister for giving way. Can he assure me that we can have access to the facts about the costs of Southampton general hospital maternity unit? I think that it is monstrous that these have been hidden from us. Can he make sure that we have the facts?

Sir G. Young

What I propose to do is make sure that the area health authority and the relevant officers in the district have copies of the report of the speech which my hon. Friend has just made so that they can read his criticisms of the statistics that have been put forward. I hope that they will respond to his hard-hitting speech and come up with the underlying facts which enabled them to put forward the statistics in their paper.

If I may revert to what I was saying, the health authorities in Wessex have a firm policy towards maternity services and their 1979–80 regional plan stated their intention to provide facilities to permit all mothers to have their babies in hospital, preferably in district general hospital based units.

To revert to the procedure that has to be adopted, the area health authority must issue a formal consultation document setting out its proposals to the relevant community health council and local authorities involved and to staff and professional interests. Three months are allowed for comment and all comments must then be passed to the CHC for any further observations it may wish to make. I understand that the CHC has not come to a decision on this proposal.

If the CHC does not object to closure, the AHA considers all the comments on its proposal and decides whether to close. If the CHC does object it has to submit a counter proposal to the area health authority. If the authority still wishes to proceed, it must then refer the matter to the regional health authority. If that authority supports the case for closure the case is submitted to Ministers for a final decision.

We have made it clear that, in cases where we are called on to intervene, Ministers will not support any case for closure unless it can be clearly demonstrated to be in the best interests of local health services and the community they serve.

But we are, of course, as yet a long way from that point in this case. The area health authority has asked for comments on its consultation paper by 19 May. The CHC has been asked to make its final recommendations by the end of June and the area health authority will consider the matter at its July meeting. The procedures are designed to be as scrupulously fair as possible and very careful consideration will be given to comments received at all points in the procedure.

I hope that I have allayed some of my hon. Friend's concern by setting out the procedures that have to be followed. I will draw to the attention of my hon. Friend the Minister of State to my hon. Friend's request that this matter should be called in.

Additionally I know that all concerned will give full consideration to the points that have been expressed here tonight, especially those that demonstrate the strength of local feeling on this issue. I say again how grateful I am to my hon. Friend for having raised this matter this evening.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to Two o'clock.