§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Goodlad.]12.55 am
§ Mr. Esmond Bulmer (Kidderminster)
In 1986 the consultant obstetric service that is currently operating at Bromsgrove general hospital will be transferred to Woodrow hospital at Redditch. This move has the most serious implications for my constituents. At present over 40 per cent. of mothers-to-be in my constituency go to Bromsgrove for the birth of their children. This entails a considerable journey and one which too often is undertaken after labour has begun. I shall return to these problems later.
The immediate concern that I wish to express is that no provision has been made in the planning of Woodrow for the continuation of an inpatient obstetric service for my constituents. Even if it had been, they would feel strongly that a journey of a further eight miles posed problems that should be avoided.
In an Adjournment debate two years ago I asked where mothers from the Kidderminster district would have their babies in 1986. I was given no answer then and I have received no answer up to this time. It is for this reason that I raise the matter again now.
I need hardly stress to my hon. Friend the Under-Secretary of State the crucial importance attached by the local community to the provision of comprehensive maternity services within the area of Wyre forest. A decision is required within the next six months if Kidderminster is to have a consultant maternity unit in time to replace that lost at Bromsgrove. This is not to say that some progress has not been made in the past two years.
The regional health authority has now accepted that Kidderminster general hospital should have a consultant maternity unit. Present planning, however, gives a completion date of 1992, six years beyond the date when the Bromsgrove general hospital consultant unit is to be transferred to Redditch.
Kidderminster has now been established as a district health authority and the strategy document prepared by the West Midlands regional health authority states unequivocally thatThe District General Hospital should provide for the whole population of this District a full range of specialist treatment including a maternity unit.I am concerned at the long delays that have been experienced in extracting from the region the decisions that are necessary. As long ago as 1974 the need for a consultant unit was identified, and this was not questioned until 1978. At this point the regional health authority, which had previously been committed to the development control plan, raised fundamental questions about the viability of a consultant obstetric unit because of the size of the catchment population. It asked the area health authority to produce a strategy for obstetric services. The area health authority set up a sub-committee to examine these problems in detail. The committee confirmed the original strategy of creating GP maternity facilities at the general hospital site and established that the Kidderminster district should have a consultant obstetric unit. These recommendations were unanimously accepted by the area health authority, but the region's response was to give the matter "unresolved issue" status.
1031 On 6 March 1980, after I had pressed the issue in the House, the then chairman of the regional health authority, Sir David Perris, wrote to me to say that the region had now agreed that the Kidderminster catchment area justified a consultant unit. He pointed out, however, that further problems remained to be resolved, such as the staffing of the unit and the provision of back-up facilities. He also pointed out that the unit did not feature in the region's strategic capital programme. Further exchanges around these issues have taken place in the past two years. It now appears that phase 6 of the Kidderminster hospital development plan, which includes the consultant unit, may start in 1988. That is clearly too late.
Early last year, Sir David Perris, in a meeting with Mr. Malcolm Cooper, the chairman of the Kidderminster and district health authority, undertook that discussions between region and district on the future of Kidderminster's obstetric service after 1986 would take place in the autumn of last year with a view to finding a mutually acceptable solution. Substantive discussions have yet to take place. It is perhaps unfortunate that the West Midlands region has 22 districts with which to deal. That inevitably makes for substantial slippage in timetables.
I understand that a meeting between Mr. Cooper and the new regional chairman will take place shortly. Mr. Cooper will press the case for bringing forward the building of the consultancy maternity unit so that when Bromsgrove closes its unit, Kidderminster can offer a full service. He will have the backing of the local community, especially that of the Kidderminster branch of the National Childbirth Trust, which has made a close study of the problems to which I refer. In the meantime, the Kidderminster and District health authority has produced an option paper that explores the various choices that may be open, should Kidderminster hospital not be able to accept those mothers-to-be who would have gone to Bromsgrove.
A recent survey of deliveries to residents of the Kidderminster district show that more than 40 per cent. went to Bromsgrove, 18 per cent. to Ronkswood, Worcester and a small number to other hospitals in Birmingham and Dudley. None of those hospitals has planned to provide for Kidderminster mothers after the Bromsgrove maternity service moves to Redditch.
The option paper explores the possibility of Kidderminster mothers going to Redditch and Wordsley hospital, Stourbridge. It also examines the possibility of adapting phase 5 of the development plan for Kidderminster hospital, which includes the provision of a GP maternity unit and retaining the Croft to provide the extra beds. It finds serious objections to each of those options.
The region will obviously wish to examine that paper in detail, but I believe that it will come to the same conclusions as the Kidderminster and District health authority, which is that there is a need to bring forward the starting date for phase 6 so that Kidderminster hospital will be able to offer a full range of services, including a special care baby unit and additional theatre capacity when Bromsgrove closes.
It does not seem to make any sense to involve neighbouring hospitals in unplanned and possibly expensive short-term measures to provide a service for Kidderminster mothers when the need for Kidderminster hospital to have a consultant unit is already accepted.
1032 The Shropshire health authority has recently issued a consultative document on the future of maternity services in south Shropshire, which states that the South Shropshire health authority will add its full support to the need for a consultant unit at Kidderminster hospital. Its proposal to close the Ludlow maternity unit permanently makes clear the need for Kidderminster to enlarge its catchment area so that many mothers in south Shropshire can attend Kidderminster hospital, which is much closer to their homes than Wolverhampton or Shrewsbury.
The chairman of the Kidderminster and District General Practitioners' Association has written to me, underlining the importance of bringing forward phase 6. He rightly points out that an obstetric emergency has no equal in its demand for immediate and expert intervention. Although all GPs have received basic obstetric training, with the trend of fewer deliveries being supervised by GPs it becomes even more essential that specialist facilities are available if a quite unacceptable number of women are not to be transferred in labour or run the risk that help will not arrive in time. He listed several recent serious incidents.
The first was a severe post partum haemorrhage at the Croft as a result of a torn cervix. A telephone call to Bromsgrove asking for expert help resulted in a doctor arriving 50 minutes later. The second case was a patient in labour who had a prolapsed cord. She had to be transferred to the general hospital where she underwent a caesarian section. The move resulted in considerable disruption of the operating list at the general hospital and exposed the patient to incalculable risk. The third case was of an ambulance that crashed when transferring a patient in labour. After being delivered by caesarian section at Bromsgrove, the unconscious patient was transferred to Smethwick neuro-surgical unit. The fourth case was a patient who suffered a post partum haemorrhage. Despite numerous telephone calls to Bromsgrove for assistance, it was not forthcoming. Eventually the doctor and his partner managed to stabilise the patient sufficiently for her to be transferred.
It is obviously highly undesirable for mothers to be transferred when in labour. Last year, 52 were transferred to Bromsgrove after labour had started. I have received letters from constituents describing their experience. I should like to quote two. The first wrote as followsAfter a long and, at times, very painful first stage of labour, lasting nearly twenty-four hours, the doctor found on examination that the baby's head needed turning and, therefore, decided that the special facilities at Bromsgrove were necessary.A transfer by ambulance, with a midwife in attendance was arranged.By this time, I was high on a mixture of 'pethidine' and 'gas and air'. Exhausted, frightened and unable to control the urge to push, the ten mile journey to Bromsgrove, which took half an hour, not only prolonged the agony, but caused added discomfort due to the motion of the vehicle. On arrival at Bromsgrove, I was on the verge of hysteria and had to be given a general anaesthetic to permit the doctor to deliver my baby with the assistance of Keillard Forceps. Christopher was born 1½ hours after the decision to transfer had been made.This unnecessary additional time in labour caused a great deal of extra internal bruising, which was so severe that I found it impossible to sit for the first two weeks or so. This frightening and painful experience is something I could not bear to repeat, and an obstetric unit in Kidderminster would prevent this.The second mother wrote:I was admitted to the Croft Maternity Hospital early evening of 3rd April 1971 expecting my first baby. My labour continued normally until early afternoon of the next day when I was taken into the delivery room. I was very tired and glad to think it was nearly all over. After a while my contractions were slowing and 1033 the baby was not moving down. The doctor was called, who attached a drip to try to speed up contractions. Nothing happened so he decided to move me to Bromsgrove. I was very upset at the prospect of the journey and very tired.The ambulance men arrived and with great difficulty carried me down 2 flights of steps on a stretcher complete with drip and labour pains. The midwife accompanied me in the ambulance while my distraught husband followed in the car. During the nightmare journey I was having contractions, trying to hold the gas and air mask, breathe correctly and hang on for dear life to stop me falling off the bed. Twice I very nearly fell off as the beds were so narrow, I was so big and the roads were so bad. The journey seemed to last a lifetime during which I became more worried, upset and frightened. Eventually we arrived at Bromsgrove and a suction machine was used to no avail after which my very distressed baby girl was delivered by caesarian section. She was kept in a special care baby unit for 10 days. The skill and medical care I received was first class but the journey not only prolonged a difficult birth but was emotionally so distressing that the thought of other women having to go through this experience is intolerable.I am sure that my hon. Friend the Minister wishes, as I do, to do everything possible to ensure that those experiences are not repeated. I am sure that he will also accept that serious problems occur for families who have to rely upon public transport to travel considerable distances, and that the costs involved may push some mothers-to-be into missing ante-natal visits. The cost of the return journey to Bromsgrove is £3.60 and to Redditch is £4.60. The journey to Bromsgrove takes four hours travelling and to Redditch five hours.
Serious problems can also, of course, arise if mothers are discharged before their babies. If daily visiting is as difficult as it would be if a mother had to travel from Kidderminster to Redditch, the possibility exists of a breakdown in a proper relationship between mother and child. I hope that my hon. Friend will visit the Kidderminster hospital and the Croft maternity home to learn at first hand of the problems that I have described. He will also, I am sure, be impressed as I have been, by the standard of care and the dedication of the staff that he will meet there.
I hope that, meanwhile, my hon. Friend will add his weight, in conversations with the regional chairman, to the case that I have made tonight and ensure that it is examined as a matter of urgency.
§ 1.8 am
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I congratulate my hon. Friend the Member for Kidderminster (Mr. Bulmer) on securing this debate. He has explained graphically why a consultant obstetric unit is needed at Kidderminster general hospital. He has also produced telling arguments for bringing forward the planned date for the new unit. I felt that his speech demonstrated the great care with which he has researched the facts and the genuine concern that he feels about this important subject.
The last time that the provision of maternity services in Kidderminster was debated in the House was in an Adjournment debate initiated by my hon. Friend on 14 January 1980. The difficulty then was that the West Midlands regional health authority, which was—and still is—responsible for all major National Health Service capital projects throughout the region, had not agreed to a consultant obstetric unit being built at Kidderminster.
The question then was not when the unit would be built or whether the proposed starting date could be brought 1034 forward,, but whether the population of Kidderminster was sufficient to warrant building a consultant obstetric unit there at all. Events have clearly moved on, for the question now is whether the planned starting date of 1988 can be brought forward.
I have taken the opportunity to re-read the forceful arguments put forward by my hon. Friend in that debate almost three years ago. He was as persuasive then as tonight in seeking to advance the interests of his constituents.
My hon. Friend has recalled the long history to this case. I will not repeat what he has said, save to say that at the meeting of the Kidderminster and district health authority on 2 December 1982 the authority considered the draft consultation document entitled "Maternity Services 1986–1990". The consultation document had been drafted following a planning seminar of health authority members and set out various options for providing consultant obstetric services for Kidderminster mothers between 1986 and 1990. When the document was introduced, the health authority chairman said that the issue had been the focus for public discussion for some time and that he saw the consultation process as a formal exploration of the options.
The intention was to consult all interested organisations and individuals as quickly as possible so as to have a clear strategy agreed in readiness for discussion with the regional health authority later this year. I understand that the document has been widely circulated and that recipients have been invited to submit comments by 4 February—a week on Friday. As I have said, it is a consultative document which explores a number of options.
However, such was the strength of opinion expressed by members at the health authority meeting on 2 December that a letter was dispatched straight away—on 7 December—to the regional health authority saying that the only viable option was to bring forward phase VI of the Kidderminster development. The letter also said that the issue would need to be discussed urgently. The regional health authority has not replied to the letter, but it has indicated that the consultative document will form the basis for discussion at the forthcoming district review meeting scheduled for June this year.
I have seen a copy of the consultative document and of the letter sent to the RHA. I have also seen copies of several letters, which have been sent both to the RHA and the Department, pressing for phase VI of the Kidderminster development to be brought forward. Everyone of those documents supports what my hon. Friend has just said. However, as he knows it is not for me or my ministerial colleagues based in London to attempt to determine the relative priority of building schemes in the west midlands region. That always has been the regional health authority's job and responsibility.
The region must weigh the needs of Kidderminster against those of the other 21 district health authorities in the region. In the west midlands that is no easy task, because the region as a whole is relatively deprived in terms of its capital building stock and it has a very full capital building programme. Phase VI of Kidderminster general hospital, I am told, could be brought forward only at the expense of some other project or projects which, up to now, have been accorded a higher priority.
I shall now deal with the maternity services that are available to Kidderminster mothers. The health authority's 1035 consultative document shows that in 1971, 430 of Kidderminster's 1,200 babies were born in the local general practitioner maternity unit and that 517 were born at Bromsgrove general hospital. However, the consultant obstetric unit at Bromsgrove general hospital is due to close in 1986, as my hon. Friend said when the new Bromsgrove and Redditch district general hospital opens. The new hospital is being built at Redditch, which is a further six miles away from Kidderminster, adding about 10 minutes to the journey.
As I understand it,—my hon. Friend stated this clearly—this is the nub of the problem. From 1986 until 1990 at the earliest, Kidderminster mothers will have to travel further for in-patient consultant obstetric services and, as yet, no firm arrangements have been made to ensure that they have ready access to such facilities. The consultative document points out that the new hospital being built at Redditch is intended to serve the population of Bromsgrove and Redditch, particularly those in the growing new town of Redditch. Nevertheless, the possibility of Kidderminster mothers using the new Bromsgrove and Redditch hospital from 1986 until Kidderminster's own consultant obstetric unit is built is one of the options explored in the consultative document.
The document also discusses other options, including the possibility of using the new 118-bed maternity unit at Wordsley hospital, Dudley which is expected to open in 1986–87 and is slightly closer to Kidderminster than Redditch is.
The difficulty facing Kidderminster mothers is not that they are losing a consultant obstetric unit. Far from it; they are due to get their own unit in about 1990. The problem is that the unit they have been using up to now is moving about six miles further away and for a period of about four years, while their own unit is being built, they will have to travel further.
Not all the mothers will be affected by this, as the general practitioner maternity unit in Kidderminster is being retained. However, a good many will be affected, and of course I am well aware, as my hon. Friend has so movingly and graphically illustrated, that these will be the less straightforward cases. However, as I have said, these patients have had to travel to Bromsgrove general hospital or elsewhere up to now, and the case for Kidderminster having its own consultant obstetric unit has only recently been accepted by the regional health authority.
No one wants to see patients, particularly maternity patients, travelling any further than they need for proper hospital care. I know that the regional health authority shares that view and that before the obstetric unit at Bromsgrove general hospital closes in 1986 everything possible will be done to find a solution to this problem, a solution that is acceptable to both the health authority and to the people of Kidderminster. I am sorry to repeat myself, but the task of finding that solution falls to the regional health authority and the district health authorities concerned, not to my Department.
They are far closer to these things than the Department could ever be and are in a much better position to 1036 determine local priorities. That is the job that we have appointed them to do, and I firmly believe that, wherever possible, they should be left to get on with it.
§ Mr. Bulmer
My hon. Friend has recently made some money available to the West Midlands regional health authority, which has defined some priorities, of which maternity is one. When granting this extra money, did my hon. Friend specify how it should be spent?
§ Mr. Finsberg
What we have said on this occasion—and I shall send a copy to my hon. Friend if he has not seen the press notice that set this out—is that one of the things for which the money should be used is to refurbish a poor stock of hospital building. The other part of the money was to be concentrated on the priority services. As my hon. Friend has rightly said, the West Midlands feel that maternity is one of the important services. I hope that my hon. Friend will find that the information will be of some help to him and that it will assist the regional health authority when it comes to consider the particular case.
Having said that, I must go on to say that Ministers are always prepared to examine the position if matters reach stalemate and seem incapable of resolution satisfactorily at local level, but this does not appear to be the case here, or at least not yet. If my hon. Friend feels, after he has made his representations, and perhaps seen the regional health authority, that he is not making progress, if he would like me to, I shall try to accept an invitation to come and look at the particular problems on site. It might be as well to wait until the regional review and the district review have taken place, because that is the next stage.
The regional health authority has agreed that the consultation document issued by Kidderminster and district health authority will be discussed at the forthcoming district review meeting. I cannot obviously predict the outcome of that meeting or of the other 21 district review meetings due to be held in the region in the next few months. It is fair to say that Kidderminster will not be alone in pressing for an important project to be protected or advanced in the region's capital programme. This is what makes the regional health authority's task so very difficult.
I cannot give my hon. Friend the assurance that he would really like. The only assurance I can give is that the chairman of the regional health authority would welcome the chance to talk to my hon. Friend. I know that when the region has its review with the district they will take careful note of the case that has been made out. I shall make certain that the chairman has a copy of this debate, so that he can read what my hon. Friend has said.
I also undertake to keep an eye on developments. I shall ask my officials to let me know what transpires at the forthcoming district review meeting between the region and Kidderminster and district health authority. I hope that, as a result of this activity, my hon. Friend will not find it necessary to raise this matter again on the Adjournment.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-one minutes past One o'clock.