Basildon Hospital (Perinatal Services) (Hansard, 3 December 1985)

§ Mr. David Amess (Basildon)

For many people there is no experience quite so marvellous as witnessing the miracle of life. It is a fairly modern practice to allow dads to see the birth of their children—something that I was privileged to see some 18 months ago when my first son, David James, was born and four months ago when my daughter, Katherine Louise, was born. I well remember how excited I was and how glad that I was not in my wife's position as in every respect was aptly called hard labour.

My wife and I could not speak more highly of the excellent care at every level administered to our children and to her during their stay at Basildon hospital. We found a high degree of professionalism combined with a warm and friendly atmosphere—a view shared by the overwhelming majority of my constituents—and the hospital therefore has a special place in our hearts. Indeed, it is never really out of our vision as our house backs on to its grounds. My horror can be imagined when, some weeks ago, I was informed by Basildon and Thurrock health authority that it was proposing that Basildon hospital should lose its obstetrics, gynaecological, paediatric and special baby-care services.

These proposals were greeted by a storm of protests and anger by many of my constituents—a reaction which I share. At a time when so much good was happening in Basildon—unemployment over the past 12 months has fallen by 5.8 per cent.—the announcement was shattering. The authority's report recommends the centralising of services, which I am fundamentally against. In an ideal world I should like the status quo to be maintained, with two units and Orsett hospital brought up to the same standard as Basildon hospital in the provisions of services. Strong arguments have been advanced which show that that is not possible.

A special baby-care unit cannot be supported at Orsett because there are not enough deliveries to justify its existence. Babies are delivered at Basildon and Orsett hospitals and the paediatric department is based at Basildon hospital with minimum input to Orsett hospital. If a baby that is delivered at Orsett hospital gets into unexpected difficulties, there is unlikely to be a paediatrician nearby to give immediate help. High-risk babies are delivered at Basildon, but it is not always possible to predict problems.

The situation could be overcome by the provision of a 24-hour paediatric service at Orsett. That would require the appointment of at least two more paediatricians at Orsett hospital to provide cover. That is not possible because for a considerable time, there has been a complete embargo on new posts of this kind. The work load for two doctors at Orsett would amount to about one hour a day. They would have nothing to do for most of the time. No self-respecting doctor would apply for such a job. The Royal College of Physicians would not recognise such a post for professional training purposes, which would make it even less attractive.

Obstetric staffing is in a parlous state because of the lack of junior staff. The Short report, in chapter III. section 84, states: We regard the creation of a universally high standard of intrapartum care throughout the country as one of the major 275 contributions to lowering perinatal and neonatal mortality. We agree with the planning guidelines proposed by the West Midlands RHA for improving their perinatal services, which are particularly relevant to the maintenance of good intrapartum care. We recommend, in accordance with these proposals, that as soon as possible every delivery suite should be provided with a minimum of 24-hour cover in obstetrics, anaesthetics and paediatrics, immediate access to a suitable operating theatre and proper facilities for the care of sick babies on site. The Minister may wonder why I am detaining him to respond to the debate. The health authority has given us until 21 December to respond to its proposals. It will meet in January to reconsider its proposals in the light of comments that it has receieved. If it decides to go ahead with its proposals, we shall have to appeal to the Minister. I fully accept that there is little that my hon. Friend can do now, but I want clearly to establish in his mind and that of the Department the case for Basildon. It is both irresistible and overpowering.

Basildon hospital was built strategically in the centre of the district health authority and it is not yet 10 years old. It stands on an excellent picturesque site and is well placed. The hospital is especially accessible to all modes of transport. Basildon is the main centre of concentration of population in the district. Being a new town, there are many women of child-bearing age. In 1986, there will be 39,150 women in Basildon in the 15 to 44 age group. In Thurrock the number is much lower—27,200. By 1986, the population of Basildon will be 165,950; in Thurrock it will be only 125,600. Over 60 per cent. of the babies born in the area are to mothers who live in my constituency. Basildon's population is still increasing, but that is not the position in other parts of the district.

As a special baby-care unit has always been at Basildon, people from throughout the district have accepted that fact and are used to travelling to it. Any suggestion that the child development centre at Basildon should be moved will meet strong opposition. It is only two years old, and it was built with private money. Over £55,000 was raised, and half of that was raised by the Basildon Hospital League of Friends, to which I pay tribute.

The recruitment of special baby-care nurses and midwives is far easier in Basildon than elsewhere. I have it on good authority that few of the present staff at Basildon would be prepared to move to Orsett. The recruitment of professional staff at Orsett is known to be quite difficult.

The building of a skilled team to care for sick babies takes many years, and we would have to start virtually from scratch. The intensive care services for premature infants would virtually cease in the district and new-born babies with other than minor problems would have to be transferred to centres in London.

There can be little argument with the view that it is far easier to build at Basildon than elsewhere. We could build on top of the existing site or on the land to the south, which would easily provide scope for the expansion which would be needed in any reorganisation.

Any move must involve a building of some sort and at Basildon, from the point of view of hospital layout, there is less risk of any architectural damage. Money would be saved because of the extra theatres that are available at Basildon rather than at Orsett. The balance is six to four in Basildon's favour. We all appreciate how expensive it 276 is to build and staff any new hospital theatre. When considering these matters it would be as well to remember that all antenatal facilities would continue at Orsett, apart from the inpatient service.

The only travelling involved would be on the few occasions in any woman's life when she delivers her baby. I take issue immediately with the suggestion in the health authority's report that hospital services should be sited on the basis of car ownership. That is no way to run a hospital. If transport is the problem, public transport will have to be improved. Buses could be run quite easily to help overcome the difficulty.

It is important to add that reorganisation would not prejudice the status of Orsett hospital in any respect as an acute hospital. It would be nonsense for anyone to suggest otherwise. The report advances a curious argument about the number of severely deprived in Orsett and the surrounding areas. That is an extraordinary statement. I represent the area with the greatest number of single-parent families in the south of England. Until the success that we have enjoyed over the past 12 months, I represented also the constituency with the highest number of people wishing to work who did not have jobs in the south.

The report talks about difficult access for the severely deprived, which is just not true. What is true is that my constituents would have a more difficult and longer journey to Orsett hospital. Is it right that the overwhelmingly majority of patients must travel from Basildon to Orsett because the people of Orsett are deprived?

In spite of Orsett's deprivation, 84 per cent. of people from Orsett get to the hospital by motor car and only 16 per cent. rely on public transport. In Basildon, 80 per cent. use cars and 20 per cent. use public transport. The people who are visiting will usually be husbands, after their wives have had their babies. If it is not the first child, the stay in hospital will be a short one.

A further point in the report that is worth mentioning is that part of the equation of centralisation at Orsett would be the sale of St. Andrew's. I have good reason to believe that the figure of £2.7 million that has been mooted is wildly optimistic. I apologise if I have given the impression that it is a "them and us" situation—Basildon versus Orsett. It is not like that. Basildon and Orsett are fine hospitals. I hope that I have demonstrated how completely unacceptable it would be to remove from Basildon the services that I have mentioned. It would be wrong to involve it in the jigsaw that the health authority presents.

The problems of the burns unit at Basildon are regrettable. I have had several letters on that subject from colleagues in neighbouring constituencies in Essex. The burns unit is a regional service supplying a facility to a wide area. Its site is not of the same significance as that of the maternity services. I hope that none of my constituents has to have treatment for burns, whereas I hope, and know, that mums in Basildon will continue to have babies.

I have been inundated with letters, telephone calls, petitions and lobbying from my constituents. If I had the time I would read out a selection of the letters, but suffice it to say that many have been deeply moving. Many mothers have said that they had their first baby in Basildon—we all know the anxiety that a first delivery can bring—and wish to have future babies at the same hospital. 277 My constituents have responded to the proposals with controlled anger and in a responsible fashion. I have tabled early-day motion 100, and I hope that many hon. Members will sign it.

I pay tribute to the committee of KOMPASS which has worked with great dedication to keep the services at Basildon hospital. At 11 am on Monday 9 December a human chain of mums, babies and children—the children and babies will all have been born at Basildon hospital—will be formed from the town centre to link arms up to the hospital. A model of a baby will be passed from the town centre to the hospital as a symbol of our intent for the hospital to continue delivering babies. In just six weeks 25,000 signatures have been gathered for our petition—and Queen Victoria's name did not appear once. Next week I shall present a small sample of the petition to the House.

My final words to the Minister are, for humanity's sake, for pity's sake and for Basildon's sake, if intervention is necessary, please keep the services at Basildon maternity hospital.

§ The Minister for Health (Mr. Barney Hayhoe)

I congratulate my hon. Friend the Member for Basildon (Mr. Amess) on choosing this subject for his Adjournment debate and on the personal as well as constituency interest that he spoke of in such moving and powerful terms. Clearly, the issue is of great concern to him and his constituents. I readily acknowledge the care and diligence with which my hon. Friend represents the views of his constituents on the matter, which is of considerable local importance.

I shall try to explain to my hon. Friend the present position in my brief reply, but if I find when I read the full text of his speech in Hansard that there are some further points with which I can deal, I shall write to him about them.

My hon. Friend made it clear that he understood very well that the proposal that has been put out for consultation—one emphasises that it is for consultation—to centralise maternity in-patient services on to one site in Basildon and Thurrock is part of a package of measures. If the community health council, which formally represents the views of the community, objects to the proposal, and if the regional health authority then supports the plans, it will come to me for a final decision.

My hon. Friend was kind enough to acknowledge this as well, because he well understands the procedures that have been established by the House for dealing with such important matters that arouse so much local interest and concern. It would not be appropriate for me to pronounce at this stage on the validity of the arguments either for or against the proposal that has been put out for consultation by the district health authority.

My hon. Friend concentrated on maternity services provision, but it should also be borne in mind that that is only one facet of the proposed reorganisation, which also involves gynaecology, paediatrics, plastic surgery, burns and geriatric services. My hon. Friend referred to the burns unit, to which I shall refer. The reorganisation also involves several hospitals and the closure of one hospital in Billericay. Therefore, the proposals are a wide-ranging package. My hon. Friend was entitled to concentrate on the elements of the package that are of particular interest and concern to his constituents. I take no exception to this. However, he will also recognise that the proposals 278 intermesh and are largely interdependent one upon the other. In considering them, therefore, I hope that all concerned will look at the overall interests and needs of the many different patients, which must be kept in mind in trying to reach a balanced and sensible judgment on the package as a whole.

Central to my hon. Friend's remarks is one issue that is not unique to Basildon and Thurrock or indeed to the North East Thames regional health authority. It is recognised by people who follow debates on the subject and arguments across the country—the familiar question of where best to locate services in a district with several large population centres. All facilities cannot be provided willy-nilly in all the towns. That proposition is widely recognised in principle, although I fully understand that in practice objections will arise when a town is chosen for a closure or change in provision, which is seen to be disadvantageous. All facilities cannot be provided in all towns. That would not make economic or medical sense. Difficult decisions have to be taken and the proper balance struck.

The maternity services proposal was the main thrust of my hon. Friend's concern. He knows, and I hope understands, my position on the proposed changes. The proposal is out for consultation. Comments are required by 21 December. My hon. Friend has indicated that he will be presenting a petition to the House. The comments, the petition and all the other relevant factors will have to be considered by the district health authority. It will have to take account of all the points and the representations of my hon. Friend, of the committee which has been organising support for the hospital's maternity services and of the many others who will wish their point of view to be considered.

If the community health council objects but the district health authority and the regional health authority decide to proceed with the proposals, they will come to Ministers. As I said a moment ago, until that happens it is not appropriate for me to comment. I am left in the difficult position, which my hon. Friend fully understands, that cannot respond in favour of or against the proposition that he has put to me. I rather suspect that he did not think the miracle would occur that I would agree with him tonight, but that he was using very properly the procedures of the House through an Adjournment debate to make clear his deep interest in the matter.

I understand that the district health authority believes that mothers in the district will receive a better inpatient service if they and their babies are looked after in a hospital where there is adequate paediatric cover. My hon. Friend argues that it would be better if that were done at Basildon rather than at the alternative site of Orsett, if a choice has to be made between the two. I took my hon. Friend's point that he would much prefer no choice but the maintenance of the present facilities. The proposals keep outpatient clinics at both Orsett and Basildon for ante and post natal services. I am advised that there are genuinely problems for the district in providing sufficient obstetric and gynaecological staff at more than one hospital. That is a basic resource problem. A difficult and careful judgment must be made. It would not be right for me to preempt at this stage the decision which will have to be: made by Ministers.

Perhaps I should add that centralisation of facilities and staff is not necessarily due to any lack of money. All services cannot be provided at every hospital; waste of 279 resources dilutes the experience needed to develop good expertise. No doubt my hon. Friend and I are totally at one in wanting a proper balanced judgment which will ensure efficient use of resources to the benefit of everyone concerned.

When the results of consultation are received, the health authority will weigh up all the factors to see what is best for the overall interests of all the patients. My hon. Friend referred to travel, an important factor which must be taken into account when one is trying to decide upon the location of any centralised inpatient maternity unit. The consultation process is taking place. The time for ministerial decision is not yet here and there is no absolute certainty that it will arrive. My hon. Friend has deployed his constituency case with the skill, passion and concern that I would expect from him. I can assure him that full account will be taken of that matter. He also spoke about the proposal to relocate the regional plastic surgery and burns unit at Basildon hospital. That is another proposal that has aroused considerable local anxiety and one upon which it would not be appropriate for me to comment in 280 detail at this stage. My hon. Friend the Member for Billericay (Mr. Proctor) is also interested in that aspect of the matter.

I understand that the health authority plans to phase out old and inefficient hospital accommodation. It believes that the move to Basildon will improve facilities for burns and plastic surgery patients by rehousing them in modern buildings more suitable for the practice of modern medicine.

The health authority recognises that some patients will have to travel slightly further to attend the regional unit. It also appreciates that local people, who recently contributed towards improving facilities to make the unit what it is today, may have great difficulty in accepting an overall strategy which proposes a move.

I have no doubt that the health authority will consider the weight and strength of local opinion when reaching a decision on all those matters.

I can only repeat that my hon. Friend has deployed his case with force and skill. I assure him that full account will be taken of what he has said.