Maternity Provision (Greater Glasgow) (Hansard, 18 December 1985)

§ The Parliamentary Under-Secretary of State for Scotland (Mr. John MacKay)

I have a distinct feeling of déjà vu about this debate. The hon. Member for Cumbernauld and Kilsyth (Mr. Hogg) and I faced each other across the dispatch box in very similar circumstances and at the same hour of the night—or morning—in July of this year. On that occasion, the subject chosen by the hon. Gentleman related to the acute hospital services provided by the Greater Glasgow health board for residents of the towns of Cumbernauld and Kilsyth which the hon. Gentleman represents but which are situated within the area of Lanarkshire health board. If my memory serves me right, our previous debate rather concentrated on the service provided by the Glasgow royal infirmary.

Although the subject of today's debate is maternity services in Greater Glasgow, the hon. Gentleman's particular interest is the maternity service provided by Greater Glasgow health board to residents of Cumbernauld and Kilsyth. There are aspects of the debate which we had in July which are relevant to today's debate and to which I shall return later in my speech.

I would not, however, wish to draw too close a parallel with the debate in July since the subject of today's debate raises a number of separate and specific issues which, given the current widespread concern about the future provision of maternity services in Glasgow, it is only right that we should have the opportunity to debate and set out for the record.

To begin with, it might be helpful to describe briefly the current provision of maternity services in Greater Glasgow. Maternity services cover, of course, the primary care sector, the community care sector and the hospital service. While much of the current attention focuses on the 546 last of these, it is important to recognise the substantial contribution made to the health and welfare of expectant mothers and their babies by general practitioners and by the community nursing service. There have been significant improvements in the perinatal mortality rates in Glasgow during the last few years. Everybody can be rightly proud of those improved rates. For example, in 1975 the perinatal mortality rate was 22.5 per 1,000 births. By 1984, it had been reduced to 10.2 per 1,000 births. This is a considerable achievement for the Greater Glasgow health board, and credit for the successful implementation of these measures must go to the doctors and nurses working in and with the community as well as in the hospitals.

The hospital maternity service does not, of course, operate separately from the community maternity service and it is self-evident that there must be close co-operation between the two, and, indeed, as full an integration of them as possible. Here again I would mention the practice of the Greater Glasgow health board of setting up antenatal clinics in some of its more deprived peripheral housing estates staffed by hospital-based doctors and nurses. I think it is again worth our taking the time to recognise and applaud such service developments which have played their part in the reduction of perinatal mortality.

I turn to the hospital services in Greater Glasgow. There are five maternity units in the board's area—the Glasgow royal maternity hospital at Rottenrow in the east of the city; the Queen Mother's hospital at Yorkhill; Stobhill hospital to the north of the city; Rutherglen maternity hospital and the Southern general hospital, both serving the city's southern parts. Together, these units provide a total maternity bed complement of 557, and in 1984–85 the total average number of these beds, staffed and available for use, was 524. In the calendar year to 31 December 1984, there were 15,189 deliveries at these hospitals, with the largest number—4,000—being at the royal maternity hospital at Rottenrow and the smallest—2,100—at the Stobhill maternity unit. These figures reflect to some extent the relative sizes of the units.

Of the 15,189 births in the Greater Glasgow hospitals in 1984, some 1,650, or 11 per cent., were to mothers resident in Lanarkshire. This reflects the general pattern of health care in that part of Scotland to which we referred in our July debate and to which the hon. Gentleman referred earlier—the historical and continuing practice of hospitals in Glasgow providing a service to nearby centres of population in immediately adjacent health boards, notably in Lanarkshire. Of the 1,650 births in 1984 to Lanarkshire mothers in Glasgow hospitals, 656 were at the Rutherglen maternity hospital; 440 at the Stobhill unit; 430 at the royal maternity hospital; 94 at the Queen Mother's hospital; and 30 at the Southern general hospital.

This cross-boundary flow of patients is of course a common feature of the Health Service and the receiving health board is suitably reimbursed for the additional work load created. Here, however, I should like to pick up a theme from the debate earlier this year to which I have referred: the importance of close co-operation between health boards in such matters so that as full and complete a service as possible is provided to all patients, irrespective of their place of residence, and in the way most cost-effective to both boards. So far as I am aware, there has been very good co-operation and understanding between the Greater Glasgow and Lanarkshire health boards in the 547 provision of maternity services across their administrative boundary and it is most important that this should continue. I am sure the hon. Gentleman would wish to acknowledge in particular the important and positive role which the Greater Glasgow health board has played in the provision of maternity services for his constituents in Cumbernauld and Kilsyth.

It is of course the future provision of these services that concerns the hon. Gentleman. Indeed, in a wider context it concerns a number of Opposition Members who represent Glasgow constituencies, and also my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Hirst). They have indicated to me their concern about these services. It may be helpful at this point to explain some of the background to the current proposals by the Greater Glasgow health board to rationalise its hospital maternity services by the closure of the unit at Stobhill general hospital.

The Greater Glasgow health board's net revenue allocation for 1984–85 was £343.9 million and for 1985–86, £359.2 million. The board announced earlier this year that it was facing a £9 million budgetary deficit for the current financial year and a possible £13.5 million budgetary deficit for next year, 1986–87, although I have not yet announced the allocations to boards in 1986–87. It is most important to recognise that this arose not from any financial cuts imposed on the board but from the realisation by the board that if it continued its existing spending patterns it simply could not live within its means. Some hon. Members have commented that these budget deficits arose from the effect of the pay awards this year for doctors and nurses. This is not so because, as a result of the Government's deliberate staging of these awards, their net effect on Greater Glasgow's budget in each of the years in question is considerably less than the budget deficit figures that I have quoted.

The prospect of these budgetary deficits led Greater Glasgow to seek measures for generating savings through increased efficiency and through possible rationalisation of services. It was not simply this short-term crisis, however, that prompted the board to look at such measures. The board is well aware of the considerable improvements which are increasingly becoming necessary in its long-stay hospitals, for the elderly, whose numbers are as a proportion of the total population increasing, for the mentally ill, who for years have been accommodated in aging Victorian buildings which are more and more becoming substandard and for the mentally handicapped who, in Glasgow, are almost all accommodated in one single institution at Lennox castle.

To give credit to the board, it has in recent years been progressing a number of major projects in the psychiatric field—a 240-bed redevelopment at Lennox castle, a 120-bed development at Gartloch, a 120-bed development at Parkhead and most recently a prospective 240-bed development at Rutherglen. These are significant advances, but much remains to be done, particularly north of the river Clyde. All these developments require revenue resources to staff and operate them and the board is aware that while it can expect to continue to receive growth money in its annual allocations it will require to supplement this by finding resources from its existing allocations as a result of its very favourable funding position at present. Indeed, the board is the second best funded board in Scotland by reference to the objectively based assessment of relative need provided by the SHARE 548 formula, introduced by the Labour Government. For the present year the board is about £16 million better off than it would be were the resources allocated purely according to this assessment. In the years to come, however, the board is aware that it will gradually lose this advantage as funds are increasingly directed to the relatively under-funded boards. Ayrshire and Arran and Lanarkshire are but two of them in close proximity to Greater Glasgow.

At the same time, it is also well known that Greater Glasgow has some of the highest cost acute hospitals in the country, even comparing teaching hospital with teaching hospital. This results in part from the higher level of doctors and nurses which the board has maintained despite the constant fall in the size of population which it serves. The board recognises that it is time that the running of these hospitals was examined to find out why they should be so much more costly comparable hospitals elsewhere in Scotland.

All these factors have contributed to move the board towards a programme of efficiency savings and rationalisation within its acute services sector which, for this purpose, includes its obstetric service. The package of savings that it has devised amounts to a maximum of £13 million, though there may well be further potential savings available within the board's operations which the board will have to continue seeking, both to secure maximum efficiency in the resources it uses and to redirect such savings into the areas of patient care which I have outlined and where improvements are very much required. Of the present package, however, most of the savings proposed are in the main acute hospitals where an analysis of staff costs, supplies costs, and total costs per patient has revealed significantly higher figures than in comparable hospitals elsewhere in Scotland.

A further element of the package, however, and the one which concerns hon. Members is the proposed closure of the Stobhill maternity unit, with a possible overall expenditure saving of about £1 million per annum. I will explain why the board is considering this possibility.

I mentioned earlier that during the financial year 1984–85 there were on average 524 maternity beds staffed and available for use. On average, however, only 368 of these beds, or some 70 per cent., were occupied, and the maximum occupancy achieved in that year was only 440 beds, or 84 per cent. In other words, even on the day of maximum occupancy, there were 84 additional beds available and fully staffed but not in use. Compared with the official bed complement of 557, the discrepancy is even greater.

Against those figures and against the general background that I have described as to Greater Glasgow's budgetary position, it must be entirely understandable to all concerned that the board has some scope for efficiency savings here. It is simply a waste of resources to staff beds which are not required, and particularly when the resources so used are desperately needed elsewhere in the board's services.

The board's specific proposal, as I understand it—and I have yet to see it formally—is to close the inpatient accommodation at the Stobhill maternity unit. This unit has a notional bed complement of 83 beds. In 1984–85, it had an average of 65 available staffed beds with an average occupancy of 40 beds. This represents 61 per cent. of staffed beds, and less than 50 per cent. of the notional bed complement.

549 On the basis of the current bed usage figures for the area as a whole which I quoted earlier, the board should be able to withstand such a closure and provide alternative accommodation on the 84 unused beds at the four other maternity units in its area, presumably at the Royal Maternity hospital if at all possible, as that is closest to the population in the north of the city which the present Stobhill unit serves.

If this closure went ahead, it would, as the hon. Gentleman explained, have a major effect on the maternity service provided by Greater Glasgow health board for the residents of Cumbernauld and Kilsyth. Clearly, this is a case where my right hon. Friend and I would expect the Greater Glasgow health board to consult closely with the Lanarkshire health board to find the most acceptable alternative service which can be provided. Indeed, I understand that preliminary discussions have already been held between officers of the two boards.

But such discussions will be only part of the much wider consultation which Greater Glasgow is obliged to undertake in consequence of the well-established procedures where a closure or major change of use is envisaged. The great merit of these consultation procedures is that they give all parties or individuals who may be affected by the proposed closure or change of use the formal opportunity to express their views on the proposal in the light of the consultative document which the board must issue.

That consultation document will have to set out clearly the reasons for the proposed closure and the alternative services which the board proposes to provide in place, in this case, of the Stobhill maternity unit. The Greater Glasgow health board has yet to issue its consultative document, and in many ways it is premature to discuss the issue in detail until the board has set out its case fully. I urge hon. Members, therefore, to wait until they have seen the consultation document before coming to a final view on the merits of the case. I urge hon. Members, having read the document, to take the opportunity provided by the consultation exercise to make their observations directly to the Greater Glasgow health board. The same applies to anybody else who feels affected by the proposed changes that the board will make in the consultative document. When the board has received all the responses to that document, it will again consider the matter, and if the board decides to proceed it must come to my right hon. Friend, and that is the other purpose behind the consultation exercise.

Before any board may proceed, it has to come for approval to my right hon. Friend and I. In making a decision, my right hon. Friend and I take fully into account 550 the result of the board's consultation exercise so that the consultation process and the responses to it are not only useful for the board in coming to its decision but, if it decides to continue with its closure decision, the consultation exercise is useful to my right hon. Friend and I when we come to consider whether we should agree with the board.

The hon. Gentleman has raised a number of detailed points about the effect which possible closure of Stobhill would have on his constituents. I hope that he will accept, in the light of the formal position held on this matter by my right hon. Friend and I, that it would not be proper for me to comment on the merits of the board's proposals. In this speech I have sought to avoid comment on that for the very reason that eventually my right hon. Friend and I will have to decide. But I have tried to explain some of the factual background which has led up to the board's proposal.

Maternity provision throughout the country is facing the same sort of problem because with falling birth rates and improvements in maternity services leading to shorter stays in hospital by mothers after the birth we are seeing a lot of surplus capacity in maternity services in many health board areas. I do not think that there is one health board that does not have an imbalance in its maternity service, with more beds than its maternal population demands. There is spare capacity. It cannot be anything other than right for health boards to look at that spare capacity and to ask themselves whether they really need it because the resources which are going into those unused beds and facilities could be used for other patients who need services. I mentioned earlier the care of the elderly, the mentally handicapped and so on.

I should like to assure the hon. Gentleman and all other hon. Members concerned in the matter that my right hon. Friend and I will give close attention to their responses to the Greater Glasgow health board's formal consultation document before we reach any decision on the matter. In view of the considerable concern which the issue has aroused, I am grateful to the hon. Gentleman for giving me the opportunity to explain some of the background to the board's proposal even if, as I say, I cannot comment on the proposal at present and at this early stage in the board's consultation process. But I can assure him that I am more than mindful that it is not just the patients of the Greater Glasgow health board area who 1are affected by the proposals, but also the patients in Lanarkshire health board Area. All those matters will be taken into account by the board, in conjunction with Lanarkshire, and also by my right hon. Friend and I if the decision comes to us.