§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury.]
11.42 pm§ Mr. Jonathan Aitken (Thanet, South)I am grateful for this opportunity to raise the subject of the maternity services in Thanet—an important aspect of the NHS in the constituencies of my hon. Friend the Member for Thanet, North (Mr. Gale) and myself.
Before coming to the specific topic of maternity services, I want to make the general point that in the allocation of today's NHS resources, my hon. Friend and I are anxious that Thanet may be in danger of becoming the poor relation— the Cinderella—of the Canterbury and Thanet health district.
During the last 10 years in the House, I have often voiced my longstanding misgivings about the administrative wisdom of the 1974 shotgun wedding between Canterbury and Thanet as an outsized health district. As my hon. Friend the Member for Canterbury (Mr. Crouch), who is carefully listening to the debate, will confirm, both areas have such demographically different populations that conflicting priorities and other difficulties are bound to arise from time to time.
We are discussing one such difficulty tonight — a specific problem within the maternity services. But before dealing with the details of that problem, it is right to put the matter in its true perspective by emphasising that Thanet is fortunate in the fundamentally high quality of its maternity services.
These are based at the Margate hospital in the Edith Greaves maternity unit, which contains 56 beds and which last year successfully and happily delivered 1,496 newborn Thanet babies into the world. It is a modern, well-equipped and efficient ground floor unit, complete with its own operating theatre and ante-natal clinic.
It is staffed by a team of dedicated professionals—doctors, consultants, midwives and nurses—to whom I am glad to pay a warm and well-deserved tribute. Nothing that I say should cause any expectant mother to fear that this team will ever let her down, or that there is any foreseeable slide away from the high standards of excellence which the unit extols.
It is, of course, essential in the world of obstetrics—a world in which babies often arrive at inconvenient nocturnal moments—that a maternity unit is adequately covered by a fully trained medical staff at all times.
This adequate medical cover is provided in Thanet at present only by operating a schedule which is exhausting, which is unworkable in the long term and which would be unlawful according to the DHSS's own regulations if it were not for a device known as a variation order. Under this order, one registrar at the Edith Greaves unit, who of course works there every day, is, in addition, on duty for no fewer than nine out of every 14 nights. That is an intolerable burden for anyone to carry. The Department recognises this, for after negotiations with junior doctors a year or so ago, the DHSS introduced new regulations making it unlawful for a doctor to work more than seven out of 14 nights in addition to normal day working in a hospital. The situation in Thanet therefore is unacceptable, other than as a short-term and temporary expedient.
Yet already, the variation order has been renewed once, and although it is due to expire for the second time on 379 31 March, there are rumours that the regional administrators may seek to renew it again. Will the Minister give an assurance that this round-the-clock working by a hospital registrar for nine out of 14 nights should not continue at the Edith Greaves maternity unit beyond the end of March. The present registrar, Mr. Panch, for all the excellent work that he has done, cannot and should not be allowed to continue on this present schedule.
The trainee GPs who are attached to the maternity unit are not professionally trained to take charge of the unit, and it is right that they should not do so. A new solution must, therefore, be found, and it should be a new appointment of a senior house officer who can divide the night duty with the registrar. At present, this appointment of a senior house officer is being stalled and held up at the region, and I do not know why this should be the case. It should not be for financial reasons, because, extraordinary though it sounds, the appointment of a new senior house officer would actually save the NHS money, provided that the appointee's contract ensured that he would provide cross cover between obstetrics and gynaecology on a regular basis.
This cross cover is at present being provided on a complicated, technical and expensive pay formula for junior doctors, and it should be replaced by a new arrangement in which the new senior house officer's contract would be an important and money-saving element. I am, therefore, in the surprising position of arguing tonight for an improvement in the NHS which would also save money.
The hour is late and my hon. Friend the Member for Thanet, North hopes to make a brief contribution to the debate. I conclude with the thought that although this short debate may be helpful in ending an unacceptable situation in Thanet's maternity services, it would not have been necessary if an alert administration team at the region had been a little more actively sympathetic to the obvious needs and requirements of Thanet.
My hon. Friend the Member for Thanet, North—and, no doubt, the Minister—sincerely hope that it will not be necessary to have to ballot for an Adjournment debate every time a Thanet NHS problem gets stalled by administrators. Alas, we have several problems — in orthopaedics, in geriatric care, and now over the future plans for Thanet's hospitals. But our constituents will not lack vigorous parliamentary advocacy if the NHS administrators move as sluggishly as they seem to have done over the maternity services problem, which I hope will now be solved quickly.
§ Mr. Roger Gale (Thanet, North)rose—
§ Mr. Deputy Speaker (Mr. Harold Walker)Does the hon. Gentleman have the consent of the Minister as well as that of the hon. Member for Thanet, South (Mr. Aitken) to intervene in the debate?
§ Mr. GaleYes, Sir. I am extremely grateful to you, Mr. Deputy Speaker, to my hon. Friend the Member for Thanet, South (Mr. Aitken) and to my hon. Friend the Under-Secretary of State for allowing me to intervene in the debate. Given the lateness of the hour, I shall be as brief as possible.
380 I endorse everything that my hon. Friend the Member for Thanet, South has said about the excellence of the maternity unit at Margate hospital. I took the opportunity —I was privileged to do so shortly before Christmas—of visiting the unit. It was patently apparent—there was a wealth of new-born babies on Christmas Eve—that babies do not arrive to order. It might be possible in an ordered world to schedule the staff who are attendant on the unit, but in a disordered world, which properly it is, that is not possible. On Christmas Eve, the young man to whom my hon. Friend has referred, was worked extremely hard. I add my compliment to that of my hon. Friend on the work of the unit.
The problem that my hon. Friend has raised will, we hope, be solved by the medical manpower board in the only manner that seems to us reasonable under the regulations that now apply. There is the suggestion that a post may be transferred from medicine to obstetrics and gynecology. We hope that in that way the board will be able to overcome the problem.
This issue highlights the special problems of a district that has two hospitals, two centre bases, with the senior staff, particularly, travelling between the two bases and endeavouring to serve both hospitals at the same time. My hon. Friend and I believe that the RAWP system does not take that fully into account in the allocation of staff, especially in the reallocation of the balance between senior and junior staff.
In addressing our remarks to my hon. Friend the Under-Secretary, both my hon. Friend the Member for Thanet, South and I hope that the Department will recognise the need for a fair degree of flexibility in the formula if it is to meet our specific needs.
I endorse what my hon. Friend said about the other problems that face medical needs in Thanet. We look forward to the rationalisation of the Thanet hospitals and the rebuilding programme, which we both believe is essential to the provision of services in the area. We have, as is generally recognised, an age imbalance in the area. If we are to redress that balance and provide the services that will attract young people and the industry that we hope to bring there, it is vital that the medical services that the area needs are provided. We both regard the rationalisation of the hospital services as an essential ingredient in the growth of the area.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)I am glad that my hon. Friend the Member for Thanet, South (Mr. Aitken) has raised this important issue, for a number of reasons apart from the specific and important case to which he referred. It has caused me to consider the problems facing the Canterbury and Thanet district health authority, a district with which I am not hitherto familiar. It will not surprise my hon. Friend to hear me say that when I remind him that there are 192 districts throughout the land.
It was interesting to ascertain the average level of provision in the district's area, which I understand is more or less on target in terms of resource allocation. My inquiries about the nature of medical politics in the district demonstrated to me that there is a certain amount of tension between the Canterbury end and the Thanet end. I hope that that is constructive rather than conflicting tension. It is a feature with which I am familiar in the Oxford district health authority in my constituency, where 381 the people of Banbury, who are 18 to 20 miles to the north of Oxford, sometimes feel in a similar position to that of the people of Margate when they consider provision in Canterbury. Overall average levels of provision should demonstrate that all is well in a district health authority such as the Canterbury and Thanet district health authority, but the overall picture can mask considerable variations within the authority.
I was interested to hear what my hon. Friend the Member for Thanet, South said about the Edith Greaves maternity unit. I was delighted by the warmth with which he described the level of care that is provided by the medical and nursing staff. I was equally pleased to hear his sentiments echoed by my hon. Friend the Member for Thanet, North (Mr. Gale).
I seem to have done little else today except listen to my hon. Friend the Member for Thanet, South. I woke up at 7.15 am to his dulcet tones on the "Today" programme, and this afternoon he was speaking on a ten-minute Bill on another issue of great importance to his constituents — straw and stubble burning. In the dying moments of the day he is raising another issue of great interest to his constituents, who certainly cannot criticise him for not being as assiduous today as he is every day.
The point raised by my hon. Friends the Members for Thanet, North and for Thanet, South is important. I should be the first to agree that the rota currently being worked in obstetrics and gynaecology is not satisfactory, and I hope that that will not last much longer. I hope that my hon. Friend the Member for Thanet, South will understand that I shall not offer any detailed comments on this matter. It would not be appropriate for me to do so, as this is primarily a local service matter within the broad framework laid down by my right hon. and learned Friend the Minister for Health. It is better that detailed service arrangements are worked out within the local framework.
Local people would be the first to criticise central Government if the man from Whitehall appeared to know best. In this case it would not be the man from Whitehall —oh, that we were in such elegant surroundings—but the man from the Elephant and Castle. None the less, there is cause for concern and I should like to offer my hon. Friends some reassurance. I shall draw this debate to the attention of the chairman of the district health authority and make sure that he is aware of the views of my two hon. Friends. I am glad that my hon. Friend the Member for Canterbury (Mr. Crouch) is listening to this debate as well.
My hon. Friend the Member for Thanet, South is right in saying that, in general, rotas more onerous than one in two are prohibited for all junior medical staff. A little over a year ago my right hon. and learned Friend the Minister for Health announced a programme aimed at reducing the hours of duty worked by some junior doctors. That programme was agreed with the profession and welcomed by health authorities and the Select Committee on Social Services. Regular rotas more onerous than one in two have been prohibited since last July.
As my hon. Friend the Member for Thanet, South said, provision exists to vary the terms and conditions of service of junior doctors where necessary. It was agreed with the professions and the health authorities that variation orders might be granted by the Department if ending a particular rota would cause particular difficulty in providing or maintaining a service. I assure my hon. Friend that we are fully committed to seeing that rotas more onerous than one in two are ended as soon as possible.
382 We recognised that it might not be possible to achieve that objective everywhere immediately—Thanet hospital is one such example. We agreed with the professions and health authorities that where ending existing rotas would cause serious difficulties for services they would be reviewed by a special professional panel at regional level. That panel and the regional health authority would then make recommendations to the DHSS.
I am glad that most authorities have succeeded in ending those rotas, but some still remain. The particular rota to which my hon. Friend the Member for Thanet, South referred has been reviewed by the regional panel, and on its advice a temporary variation order is outstanding until 31 March to give the regional and district health authority the time and opportunity to ascertain how the present unsatisfactory position can be brought to an end.
I understand that the district is examining this matter closely and will shortly be submitting proposals to the South-East Thames regional health authority for consideration. It is a matter for decision within the region, and I hope my hon. Friend understands that it would not be right for me to comment in greater detail on deliberations which are continuing between the district and the regional health authority. I think that he may be assured, however, that his concern has been or will be noted by the district health authority.
Both my hon. Friends spoke of the creation of a new senior house officer post at the hospital. That is an interesting idea, but I hope that they were not suggesting that an additional post should be created in the district health authority area, as that would fly in the face of the way in which we are trying to develop the hospital services. It would not be open to a district in this kind of difficulty simply to create an additional junior post to try to get out of the difficulty. The reason is that the Government — and, I believe, the profession and the Select Committee—want a much greater proportion of patient care to be provided by fully trained doctors as soon as possible. I know that that view is shared by my hon. Friend the Minister with responsibility for the disabled, who, with characteristic courtesy, has come to the Chamber at this late hour to support me in my comments. That new policy drift simply could not be achieved if we experienced once again an uncontrolled expansion in the junior grades, especially the senior house officer grade, such as occurred in the 1970s, which I and, I believe, the profession regarded as a very bad development, leading merely to an imbalance between senior and junior staff in the medical staffing structure.
We are very conscious that health authorities would have faced an impossible task if their existing junior posts had simply been frozen. Instead, therefore, we announced that regions would be expected to agree with the Department a ceiling on the total number of SHO posts that could be filled at any one time. My hon. Friend the Member for Thanet, North referred to the need for flexibility. We have provided flexibility by allowing regional health authorities scope to redeploy posts between districts or, where service or planning needs dictate, between specialties—a matter to which both my hon. Friends referred. Our broad objective is to secure a better balance in hospital medical staffing structure, which we believe is absolutely correct in the interests of patient care. Nevertheless, we have given health authorities that additional flexibility.
383 I end on this positive note. Although I share my hon. Friends' desire that the rota problem be ended as soon as possible, other developments affecting maternity services in the Thanet area are extremely positive. I refer especially to recent developments in midwifery and midwifery recruitment, which is of critical importance in that maternity unit. I understand that although there have been difficulties in the past in this context they are now almost over and the situation is extremely healthy. The excellent Canterbury and Thanet midwifery training school has a waiting list for places, which is a very good sign, and the small number of existing vacancies for staff midwives is expected to be filled very soon following a carefully planned recruiting exercise. Happily, too, more and more 384 midwives trained in the Thanet area are choosing to remain in that area and thus to be involved in the delivery of all those Thanet babies to whom my hon. Friend the Member for Thanet, South referred.
With the continuing development of midwifery services and the close attention of the district health authority to sorting out the specific problems that my hon. Friends have raised, I hope that in the not-too-distant future those problems will be solved and I heartily hope that it will not be necessary for my hon. Friend the Member for Thanet, South to ballot for a further Adjournment debate on this issue.
§ Question put and agreed to.
§ Adjourned accordingly at four minutes past Twelve o'clock.