§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boscawen.]10.27 pm
§ Sir John Farr (Harborough)
The purpose of my debate is to raise the subject of the small peripheral maternity units in some of the smaller hospitals in Britain. Very often in our major debates on the Health Service in England and Wales the smaller unit, which often gives better value to the public than the larger, more impersonal unit, is overlooked. I am compelled to raise this matter with my hon. Friend because I am concerned about what is proposed for Market Harborough general hospital maternity unit, which has 11 beds.
The value of this unit is recognised not only by the more than 5,000 people who have signed a petition to save it but by Leicester area health authority, which in February 1984 produced an admirable document entitledStrategic Intentions 1984 to 1994".In this the authority saw the need to keep until 1994 the 11 maternity beds in Market Harborough. The document was entitled, "For consultation". Naturally, this met with total local support. Therefore, it was with considerable dismay and surprise that I learnt that a further document had been produced by Leicester health authority in October 1984, this time calledA Strategic Plan for the NHS in Leicestershire 1984–94and described as a "draft for consultation". The proposal is to reduce by almost half the maternity provision for Market Harborough—from 11 beds to six. Eleven beds provide a professional unit; six provide emergency treatment only.
The House might ask what happened between February and October to change the area health authority's proposals. Was it a sudden surge of public opinion expressing itself instinctively, to which the health authority reacted? As the representative of Market Harborough and the surrounding villages, I assure the House that that was not what happened. Between February and October last year one of the most remarkable expressions of public opinion that I have known took place. Out of about 15,000 persons in the general hospital's catchment area, over 5,000 signed the SOBBs petition — that is the petition to "Save Our Babies Beds". I was overwhelmed by letters protesting about the rundown of beds. Between March and October I received only one letter in favour of the rundown. It was from the community health council.
The Leicestershire community health council does an excellent job, but in this case it is out of touch. For example, it has recently conducted a mass canvas of local people about organ donors. The Minister is a pioneer in this respect. He may recall my modest endeavour when I introduced a Bill designed to secure the anonimity of organ donors.
As my hon. Friend knows, the supply of organs is insufficient. The community health council has an excellent public consultation scheme. Nearly 3,000 people have been approached to find out what they think of the organ donor scheme and how it can be improved. The results, which have been sent to the Minister's office, show that the majority do not want a change in the scheme.
I have told the secretary of the Leicestershire community health council, Brian Marshall, that I support 879 what he is doing to promote the availability of organs but that the council should conduct the same public relations exercise for the Market Harborough maternity unit.
The community health council is the only supporter of the area health authority's sudden change of view. Public opinion did not cause the sudden change by the health authority. What did change it? In 1982 I was concerned about possible threats to the future of that highly successful unit. I wrote to the excellent lady chairman of Leicestershire health authority in May 1982, and Mrs. Margaret Galsworthy replied on 24 May 1982 to the effect that the authority had no plans for any closure of maternity beds in Market Harborough hospital, so far as could be foreseen.
The House will be interested to know that in the Leicester area alone it is the intention to slash the peripheral general practitioner maternity bed provision from 94 beds at the moment to 37 in 1994, a reduction of over 60 per cent. The figures include a reduction from 11 to six in Market Harborough.
I am convinced that behind the change of heart by the Leicester health authority is pressure from Trent region to centralise births. It has declined to provide new replacement GP units in the Trent region and is apparently determined to extinguish the peripheral GP maternity units altogether. In a recent leaflet it gives that as the policy of what it called its regional medical committee and backs that up by saying that it means a lower mortality rate for babies. The House accepts that priority must be given to securing the lowest possible mortality rate of babies. It is a most important factor; in fact, it is the most important factor that can be taken into consideration.
Trent region goes on to say that in the region in 1970, for instance, there were 23 baby deaths per 1,000, and that that figure had been improved to 13 per 1,000 by 1980. However, the single staggering fact, to which I call the attention of the House tonight, is that in the Market Harborough maternity unit, where it is proposed to halve the number of beds, compared with the 13 mortalities per 1,000 nationally, and 6.1 mortalities per 1,000 in comparable units, the figure is 0.67 per 1,000 deliveries. That is a remarkable statistic. It shows that the mortality level in that excellent unit is 20 times lower than the national average, yet Trent says that the unit is too small, does not work and should be closed because it is not wanted.
In the past 10 years, the unit in Market Harborough, in co-operation with consultants, has provided facilities for no fewer than 2,972 patients, of which 1,650 were delivered. During that time only two infants have died in the ward. One of them, delivered in a consultant unit, died unexpectedly of severe cardiac abnormalities, and the other was stillborn — no foetal heart was audible on admission in labour. The perinatal mortality rate of 0.67 per 1,000 deliveries compares with an average of 6.1 per 1,000 in comparable units and 13.3 per 1,000 in all maternity units. Any major change in the facilities available will lead to a deterioration in that record.
My hon. Friend is a busy, well-respected and much-admired Minister, but he should make time to rush to Market Harborough to see what is there. He should come and admire the unit. He would find a part of the National Health Service that is universally loved, admired and respected. He, like me, believes in the NHS. We want to 880 make it successful. In Market Harborough we have a small maternity unit which is an example of how we would all like the NHS to be.
We must remember that it is the mothers' opinions that count. It may be of interest to my hon. Friend to know that there is a practice at Bowden house, Market Harborough, conducted by eight doctors who work at the Market Harborough general hospital. In a recent letter they said to me that over 90 per cent. of their patients request delivery in Market Harborough hospital and that that is a conservative estimate. They said that:we would be unable to guarantee a bed should these cuts be made. We believe that a significant number of women would not accept delivery in Leicester, and this would result in an increase in the number of home confinements and of deliveries on the way to hospital, thereby increasing the demands on the Flying Squad and already over-stretched Ambulance Services.My hon. Friend is aware that I have been writing to him regularly on this subject since August, and I have been approaching you, Mr. Speaker, regularly for an Adjournment debate. I have come out top of the ballot this year, for which I am grateful. That I did not introduce the debate earlier was not due to lack of interest or urgency. The matter is important to local people.
My hon. Friend wrote a courteous letter to me on 25 October. He said thatshould any closure proposals emerging from these current discussions be opposed by the CHC, these will come to the Secretary of State for final decision.These proposals are flying in the face of public opinion, the wishes of the mothers and of expert medical opinion. The CHC is completely alone in supporting the proposals and I invite my hon. Friend to investigate the CHC's attitude, which makes it unique.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I have listened with great care to my hon. Friend the Member for Harborough (Sir J. Fan), who has been pursuing his constituents' interests in this matter with considerable assiduity over recent months. We have had a correspondence. I am well aware of my hon. Friend's views and no one could have represented the interests of his constituents more powerfully in advance of any plans for closure or partial closure.
I hope that my hon. Friend will accept an apology at the beginning of my speech. I cannot tonight answer a number of the interesting and detailed local points that he has raised, because my right hon. and learned Friend the Minister for Health and I have to play a quasi-judicial role from time to time in cases referred to us where closure has been suggested by a district health authority. I have to reserve my position and that of my right hon. and learned Friend in case that should happen with regard to the hospital that my hon. Friend has talked about. I hope that my hon. Friend appreciates that. I am grateful for the assent that he has just indicated.
That will not stop me from expressing my opinions on the important national points that my hon. Friend has mentioned, and trying to be as helpful as I can when referring to as many of his local points as I reasonably can, subject to the proviso that I have just given.
Should any proposal such as my hon. Friend and some 5,000 of his constituents fear come forward and be accepted by the district health authority, and should that decision be endorsed by the regional health authority, my 881 door and that of my right hon. and learned Friend will be open for my hon. Friend to bring representatives of his constituents to see me or my right hon. and learned Friend at the earliest opportunity. I am happy to give my hon. Friend that pledge.
In the time available to me I should like to pick up at substantial length a number of the national points that arise from the remarks of my hon. Friend and then to deal, in slightly less time, with some of the Leicestershire points. Perinatal and neonatal mortality is a subject that has concerned the House over a substantial period. The Social Services Committee has reported on a number of occasions on the problems of perinatal and neonatal mortality, the safety of mothers and the consumer interest of mothers. The Committee first looked at length in the last Parliament at the factors which may be linked with comparatively high perinatal mortality rates and considered in particular the importance of the place of birth and the facilities available at the place of birth. The all-party view to which the Committee came after taking extensive evidence, not just from professional interests but from consumer groups, was thatan increasing numberof mothers shouldbe delivered in large units; that selection of patientsshouldbe improved for smaller consultant units and isolated general practitioner units; and that home deliveryshould bephased out further".Those were the conclusions of the Social Services Committee in its second report of 1979–80.
In its reply to that report the Government welcomed the importance that the Committee gave to an increase in the number of deliveries in large units. Clearly my hon. Friend feels that the Government are unfriendly towards small units and are in favour only of large units. That is not the case and I shall seek to illustrate why. By and large, it is the Government's view, and it remains their view, that women should be encouraged to have their babies in the larger and properly staffed consultant units of district general hospitals, which can offer the whole range of obstetric, paediatric and supporting services necessary to cope with any emergencies at the time when the life of the infant is most frail and when the life of the mother may be threatened.
This view was also shared by the maternity services advisory committee, whose second report—a fascinating report — on care during childbirth was published in January 1984. However, the committee recognised that in some localities geographic factors will require the availability of what it termed "isolated" maternity units and recommended that such units, where geographic factors were a powerful influence on the provision of health care, should be equipped to a standard to cope with any of the complications that might have to be dealt with on site.
In July 1984 the Social Services Committee published its follow-up report and again recommended that theDHSS should do more to encourage regions, in the light of evidence available to them, to rationalise their maternity services in order to promote better standards of care as well as economy".Again the Government concurred with that view. However, while it is our overall view that the larger unit, with the acute medical care that is available there, is likely 882 to be a factor promoting the health and welfare of mother and child, or of mother and children in the case of multiple births, it is not for the Government to make an absolute prescription for all places at all times in England.
In recent years there has been a considerable increase in the proportion of maternity beds provided in units on hospital sites — either in consultant or general practitioner units — but we must have an element of flexibility and planning. Therefore, I agree with some of the remarks made by my hon. Friend. Health authorities must strike a balance between the interests of rationalisation and centralisation in order to try to provide the most cost efficient forms of care while at the same time—which is the most important point—helping mothers and their children and, on the other hand, providing the services that are necessary for more isolated communities. They must pursue the objectives of further reducing perinatal mortality and handicap and improving the safety of their services. They must also keep under review—I am sure that the Trent region is enjoining health authorities to do this—how far policies of concentrating staff and resources in large general hospitals match the needs and wishes of mothers who use the services.
In some communities, social and geographic factors—distances, difficulties of travel, particularly in winter, and so on — strongly favour the retention of smaller maternity units for low-risk cases. It is not true that my right hon. and learned Friend the Minister for Health and I have always approved health authorities' proposals to close smaller maternity units. I can think of at least two cases in the past six months in which units were kept open after careful consideration by my right hon. and learned Friend.
If the best use is to be made of the facilities of both smaller and larger units, we need an agreed booking policy that takes into account the needs of mothers, the nature of local GP obstetric care and the availability of essential medical staff. We need an integrated booking system between the smaller and larger hospitals, so that mothers who need more acute care, as well as those who prefer to go to larger units, can go to those larger units, while mothers perhaps on their second, third or subsequent births can go into smaller units closer to home. The best decisions must be made about where mothers are to go to get the best care at the time of birth.
It is because of the care that most district hospitals and doctors devote to the system that it may appear that smaller hospitals are "safer" than larger hospitals. Perinatal mortality rates appear to be higher in large acute general hospitals. As the right hon. Member for South Down (Mr. Powell) would say, it is something of a conundrum. The reason is that generally only the mothers least at risk are put into the smaller hospitals. Reports do not usually take into account instances where the mother or baby has had to be transferred to a larger hospital because complications have arisen.
Generally, only mothers whose medical history and the progress of whose pregnancies have suggested that complications are unlikely are booked into smaller units. That is a matter of clinical practice which goes some way to explaining the apparently surprising figures quoted by my hon. Friend.
§ Sir John Farr
I accept what my hon. Friend says, but it does not hide the fact that the Market Harborough unit is still 12 times better than the national average for comparable establishments.
§ Mr. Patten
I assure my hon. Friend that such matters will be considered carefully if a decision on the hospital comes to Ministers.
Although the emphasis in recent years has been on improving the safety of maternity services by centralising — and there has been a dramatic fall in perinatal mortality rates—we must always remember the welfare and interests of the mothers. I welcome the growing awareness among health professionals that the new technology and clinical procedures that have been introduced to make labour and delivery safer for mother and baby, primarily in the larger units, should not displace the traditional concept of a healthy natural birth and the fundamental human values implicit in childbirth.
It is now widely recognised that the onus is on those practising the most up-to-date techniques of ante-natal and obstetric care to ensure that such techniques are just as acceptable to mothers as the traditional practices that they replace. However, it is critically important to realise that large units can very often provide just as homely and caring an atmosphere as the smaller hospitals. Many mothers who have been cared for in large maternity units in large hospitals speak highly of the homely and intimate quality of the care that they received there. Certainly, by 884 and large, bigger should mean safer, but bigger should certainly not, in terms of the care offered to mothers, mean more impersonal.
I was most interested to hear of the consultations in which my hon. Friend the Member for Harborough has engaged in Leicestershire. I was also grateful for the information that he gave me, in the margins, about the organ donor scheme. I agree that the health authority has published a document setting out its proposals for health care services until 1994. As my hon. Friend will be aware, any plans for closures or significant changes in use which are opposed by the local community health council must be referred to my Department for ministerial decision. However, Ministers may also call in decisions for scrutiny on their own account, even if they are not opposed by the local community health council. That has frequently happened in the past.
If at the end of the consultation process the matter is referred to the Department, we shall certainly approach with an open mind the complicated issue that my hon. Friend has raised and give full weight to the views expressed by all interested parties. I repeat my pledge that after—not before—decisions have been taken locally, my right hon. and learned Friend and I would welcome the opportunity to discuss the issues further with my hon. Friend and with constituents, doctors, mothers and representatives of interest groups in his constituency.
Question put and agreed to.
Adjourned accordingly at four minutes to Eleven o'clock.