HC Deb 23 May 1980 vol 985 cc995-1004

2.1 pm

Mr. Robert Rhodes James (Cambridge)

One of the most interesting and important aspects of public life for someone who endeavours to be a conscientious constituency Member of Parliament is that he is constantly confronted by the totally unexpected. Cambridge has not only a world-famous university and industry. It also—this is not at all coincidental—has one of the finest hospitals in the country—Addenbrooke's. This hospital serves not only the city of Cambridge but a large area of East Anglia. New Addenbrooke's is a place of light, human warmth, great capacity and practical efficiency. No hospital service is without its problems, but Addenbrooke's is rightly regarded as a magnificent and vital asset not only to Cambridge and Cambridgeshire but to a wider area.

Shortly after my election to this House in December 1976, I visited Mill Road maternity hospital, in the middle of my constituency. The contrast with Addenbrooke's was total. I was shocked by the condition of the buildings, while at the same time I was deeply impressed and moved by the dedication and skill of everyone who worked there.

It is customary to pay tribute to the work of doctors and nurses. As my eldest daughter is a nurse, I am somewhat heavily biased in favour of them. But no one whom I have ever met who has been a patient at Mill Road, or has had friends or relatives who have been patients, has anything but praise and gratitude for all its staff. Under physical conditions that were described in a report by a health district official to the area health authority in April 1977 as "disgraceful ", the staff daily achieve miracles of skill and devotion.

A senior consultant at Mill Road has recently written: The building is an outdated, inefficient structure, incapable of further expansion to accommodate an ever-increasing number of patients, or housing equipment to implement new techniques. Accommodation for both patients and those working in the hospital is very sub-standard. A clinical medical school has recently been established in Cambridge, and the maternity hospital is the main obstetric centre. Despite this, there is not even one square inch in which to build a seminar room to teach students, let alone providing proper lecturing and library facilities. There are occasions in this House when one wishes that one could inform hon. Members and Ministers by means of photographs or other visual methods. If I could do that, I am sure that they would be as astonished and dismayed as I was on the first of my visits to Mill Road maternity hospital. I shall have to confine myself to the stark facts.

The main building was built as a poor-house in 1838, shortly after the accession of Queen Victoria. During the last war, it was developed as a maternity hospital and in 1948 was named the Cambridge maternity hospital. Since then, it has developed into the main obstetric centre for the region and for the new clinical medical school.

In a well-argued special issue of the Cambridge Evening News, compiled by my constituent Mr. Fulton Gillespie, the overall situation is accurately described. Mill Road is short of beds, short of filing space for records, short of space for ante-natal clinics, short of examination rooms, short of residential accommodation for those midwives who stay … and short of storage space for anything from dirty laundry to urine bottles. In [his situation it handles twice the national average throughput of patients, yet, miraculously loses less babies than any other hospital in the country. I disagree with only one point. It is not a miracle; it is the result of intense devotion, skill and hard work under well-nigh impossible conditions.

It is important to emphasise that the demand on the hospital is steadily increasing. For example, delivery numbers of babies, which is obviously only one part of its work, which had been relatively stable for the past three years, are rising again. There were 3,903 in 1978 and 4,133 in 1979, of which 884 were from outside Cambridgeshire, emphasising the fact that I am not making just a constituency or even a Cambridgeshire point, but an East Anglia point.

The county of Cambridge has 18 per cent, more women of child-bearing age than in 1971. It is one of the most significantly expanding population areas in the country. Bitter complaints about the antediluvian conditions of the main building, which is surrounded by a dismal and ragged collection of huts, mainly of war-time vintage, one of which contains the operating theatre, have been incessant and are wholly justified. A study team on hospital services in Cambridge reported in 1975: These problems can only be satisfactorily solved by providing a new obstetic unit at New Addenbrooke's. Twenty years ago, the then matron of Mill Road told the board of governors that matters had reached a crisis point. That is even truer in 1980.

There is no disagreement on the facts. The buildings are dreadful, the facilities are inadequate, and the staff is magnificent, though sorely pressed. What is at issue are the priorities for the East Anglia region and the attitude of the regional health authority.

Since my election to the House three years ago, I have raised the question of Mill Road constantly at private meetings with members of the regional health authority and the area health authority and with former and present Ministers, hopeful that private persistence and the sheer force of the argument would get things moving. I am a great believer in private persuasion and argument. I am not interested in personal publicity or in making headline-catching speeches. Usually, I am successful for my constituents, through the process of private persuasion, but in this case I have been wholly unsuccessful, which is why I am taking the time of the House to raise the matter publicly.

I am told by the regional health authority that 1998 is the earliest possible starting date. We have had so many postponements in the past that if we go on at the present rate, 1988 might be a more reasonable estimate. The consultants, nurses, midwives, staff, present and future patients are not prepared to wait patiently until a starting date of 1988, and neither am I.

I shall not weary the House with an account of the interminable and complex discussions, non-decisions and postponements that have dogged the matter for so long and totally exasperated everyone involved, including me. I blame no one in particular. What I say is that someone, or some authority, must get the hospital priorities of East Anglia right, and the dominant priority today is a new obstetrics unit at New Addenbrooke's.

Yesterday, my hon. Friend the Minister for Health issued a consultation paper on hospital services, "The Future Pattern of Hospital Provision in England ". On page 1 he rightly says: There are … a number of arguments against building very large hospitals: their remoteness, complexity and impersonality, and the effect these have on the morale of staff. I entirely agree. He adds: In the past Government has tended to prescribe a single basic pattern for the whole country. This is both unrealistic and undesirable. Different circumstances demand different solutions. So I have no intention of producing a blueprint to be applied everywhere. With that second point I particularly agree.

I fully understand the difficulties that face a regional health authority in reviewing its capital programme without a clear notification of the capital resources that it can expect over the next few years. That brings me to my hon. Friend the Minister and his officials. When they consider the regional strategic plan and its funding programme I urge them to consider this project as an absolute priority for East Anglia.

The Mill Road hospital site has many advantages, being centrally located and more convenient for many of my constituents than New Addenbrooke's, but the conditions in the area are such that I see no realistic alternative to a new obstetric unit at New Addenbrooke's, with the present site in Mill Road, which is very valuable, being made available for other purposes.

I fully accept that this is a difficult period for Ministers and the Health Service. There are many competing claims for public expenditure. However, what I am asking for is not more public expenditure but a shift in priorities for the East Anglian area—a shift that would be of long-term value to the area as a whole. I am not simply making a constituency point, although clearly a hospital that is situated in my constituency and that serves my constituency has a particular relevance to me. Through this hospital service we cover a wide area in East Anglia, as emphasised by some of the figures that I have given.

Throughout this protracted business I have had very warm, strong support from my right hon. Friend the Member for Cambridgeshire (Mr. Pym), my hon. Friend the Member for Saffron Walden (Mr. Haselhurst), whose child was born at Mill Road, and the Cambridge area health authority. I have also been supported particularly by my constituent, Mrs. Maskell, who, in her shop in Victoria Road, Cambridge, organised a public petition that was an immense encouragement to me in my campaign on the issue.

I feel that I am in good company and that I have a case. I hope that my hon. Friend the Under-Secretary will respond to the strong emotions in Cambridgeshire.

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

I should like to reply to the strong case made by my hon. Friend the Member for Cambridge (Mr. Rhodes lames). I hope that he will not take it amiss if I say that I was born at the Radcliffe Infirmary in Oxford.

I am grateful to my hon. Friend for the opportunity to speak about the future of the maternity hospital in Mill Road, Cambridge. As those who know him would expect, my hon. Friend made a forceful, well-informed, compassionate speech on behalf of the institution, those who work there and his constituents.

I assure my hon. Friend that the East Anglia regional health authority and the Cambridgeshire area health authority, which are responsible for the provision of health services in Cambridge, are fully aware of the need for a new maternity hospital in Cambridge. I propose to draw my hon. Friend's forceful speech to the attention of both authorities. They share my hon. Friend's concern, which he expressed on behalf of his constituents when he wrote to my hon. Friend the Minister for Health about the matter in January this year, and which he has enlarged upon today. No one can be in any doubt about the strong local feeling on the matter.

I am aware that parts of Mill Road maternity hospital were built as long ago as 1838 and that it started its life as a workhouse. I have equipped myself with photographs and cuttings from the local paper to get the full background. It was an institution for the poor, the aged and the homeless for almost 100 years, administered by the guardians of the poor of the Cambridge Union. It should perhaps come as no surprise that 142 years after it was built the people of Cambridge feel that it can no longer meet the demands being made on it. It was built for another purpose in another age, and there is genuine and wide concern locally about the pressure on the hospital and the serious shortcomings in the standard of accommodation available there.

As my hon. Friend indicated there is no room for expansion on the site and the shortage of space and facilities, the shortage of beds and of midwives, of examination rooms and residential accommodation, place tremendous pressures on the staff who work there. The staff are faced also with a constantly increasing number of births, and bed occupancy figures are well above the national average. Re-siting of the hospital was first agreed in 1961, but has been deferred on several occasions since then because of pressing demands on available resources.

My hon. Friend has already praised the effort of those staff who are called upon to work in such difficult conditions. I cannot allow the opportunity to pass without adding my own very full appreciation of their efforts. I cannot speak too highly of the results which they have achieved and are continuing to achieve. One measure of their performance can be seen from the fact that the hospital has one of the highest rates of live births among the newborn in the country. This alone would be commendable even if only the normal obstetric cases were treated, but Mill Road maternity hospital is a centre of excellence to which general practitioners and local maternity hospitals also send their more difficult cases.

The tremendous sense of purpose and dedication shown by the staff has enabled them to overcome the difficult conditions in which they are required to work. Their commitment and skill is renowned locally and it is not difficult to understand why, despite the conditions at the hospital, prospective mothers choose to have their babies there. I am aware of the concern that the growing population and the increased demands on Mill Road are causing. The health authorities, too, are very aware of this and, as I have already indicated, are agreed that there is a need for the replacement of the hospital at the earliest opportunity.

The East Anglian regional health authority's current plans, as my hon. Friend mentioned, do not provide for a start on replacing Mill Road until 1988. However, the Cambridgeshire area health authority regards the relocation of the hospital to the New Addenbrooke's site as its top priority. I should perhaps explain that the responsibility for determining the priority to be given to any capital building scheme in the East Anglia region rests with the East Anglia regional health authority, although, of course, hospital provision in Cambridge would require detailed consultation with the Cambridgeshire area health authority. The area health authority has forcefully pressed the regional health authority for the immediate replacement of Mill Road, and I know that my hon. Friend shares its view that a serious review of the region's capital building priorities is now called for.

The inclusion of the Mill Road scheme in the capital programme will be considered in detail by the regional health authority as part of its strategic plan as soon as revised capital resource assumptions are known.

The regional health authority will be given details shortly of the capital resources that it can expect over the next few years. It will re-examine its priorities in the light of its revised financial expectations. I cannot anticipate what decisions will be reached, as the regional health authority is best placed to ensure that its available resources are allocated equitably over the whole region. It is not our policy to intervene when decision on priorities can best be made at a local, albeit regional, level. It is basically the regional health authority's job to plan. We want it to try to get on with that job. The perennial problem is one of resources, of which there never seem to be enough.

As a Government, we are very conscious of the need for more resources in the NHS and are anxious to do more, but to do this we must first restore the prosperity of the country. We are committed to improving the national prosperity. As the economy improves, more resources can be devoted to the NHS. Some small growth in the volume of resources has been made available to health authorities in the current year and growth prospects beyond 1980–81 are a little more hopeful. Our aim is to build on this when our own policies come to fruition.

In a letter, my hon. Friend has expressed the view that a public appeal for funds should be launched in the city of Cambridge, and in Cambridgeshire as a whole, to help with the resiting of Mill Road. He has expressed his willingness to head such a campaign. I am grateful to him for this offer and have asked him to explore the idea initially with the health authorities. Such an appeal, if properly harnessed, meets the Government's wish to encourage local initiative and enterprise.

The health authorities have not been solely concerned with the question of the relocation of Mill Road. Whilst this will solve their long-term needs, in the shorter term, ways have to be found of relieving some of the heaviest strain on the existing services. For some time the health authorities have been examining ways of improving the situation and reducing the pressure on the staff. I understand, for example, that terminations of pregnancy will no longer be carried out at Mill Road. As a result of this a ward can now be re-commissioned for the use of obstetric patients as and when the necessary money becomes available. This will provide nine extra maternity beds, and I hope that the health authorities will soon be able to find the necessary resources.

The health authorities also feel that the recent closure of the much underused Grange maternity unit at Ely may provide a small measure of relief to Mill Road. Most mothers who would normally have had their babies in the Grange are now expected to use the nearby Royal Air Force hospital in Ely, and the small number of midwives who were formerly based at the Grange, have returned to community midwifery. This will improve the quality of care in the community, and it is thought that some mothers who may have intended having their babies in Mill Road will now choose to have them at home.

I have already mentioned the ever-increasing demands on Mill Road. One of the problems facing the hospital is the number of patients being referred from outside the health district, and even from outside the East Anglia region. These numbers are known to be increasing, such is the reputation of Mill Road as a centre of excellence. Discussions are taking place to consider whether such patients can be referred elsewhere, where alternative facilities exist and are less stretched. Many patients, however, go to Mill Road because of their special needs and the hospital's particular expertise, and patients' interests will need to be protected in any arrangements which may be agreed.

A greater measure of relief to the staff at Mill Road, and to the population of Cambridgeshire generally, should result from the development of the Hinching-brook hospital at Huntingdon. Proposals for this hospital include the provision of a 40-bed consultant obstetric unit, which the regional health authority hopes will come into use in 1982. Patients from the Huntingdon area who would at present look to Mill Road for their maternity services would then be able to have their babies locally. This will further reduce the pressure on the overstretched facilities at Mill Road. I hope that my hon. Friend is somewhat reassured by my comments. I repeat that I am grateful to him for having raised this matter today, giving me an opportunity to acknowedge the splendid work done at Mill Road maternity hospital.

Mr. Rhodes James

By leave of the House, perhaps I may speak briefly again. I am most grateful to the Minister for what he said, but I hope that when he says that he hopes that the capital resources will be made available shortly, he really means shortly. I emphasise that although I stand ready and willing to launch a public appeal I am not prepared to do so until the RHA is prepared to amend the starting date. The date of 1988 is far too distant.

However, I am most grateful for the care and thought that my hon. Friend has given to this matter and for the evident sympathy and knowledge that he has in terms of the problems that we face, not only in Cambridge but in East Anglia as a whole.