HC Deb 22 March 1985 vol 75 cc1158-66

Motion made and Question proposed, That this House do now adjourn.—[Mr. Archie Hamilton.]

2.31 pm
Mr. Roger Moate (Faversham)

Last year, in June, I presented to Parliament a petition from the people of Sheppey in the name of Mrs. Rita Barton and some 7,000 petitioners calling for the retention of the Sheppey maternity unit. On 12 July last year we received a welcome assurance from the Secretary of State on the retention of the maternity unit. My right hon. Friend said: I am assured by the Authority that there has been no decision to run down the maternity facilities at Sheppey General Hospital … The Authority does not envisage any change to present maternity facilities before the completion of the major development, expected in 1990. Just six months later, in January, the Medway health authority produced a plan for the early closure of that unit.

I am sure that my hon. Friend the Under-Secretary of State for Health and Social Security, whom I am glad to see here, will understand the anger of local people at this sudden change. He may even feel that my right hon. Friend the Secretary of State was somewhat misled last July when he gave that assurance. If he feels that he was misled, I am sure that the misleading was inadvertent, but it is no less disturbing for all that.

I am sure my hon. Friend will agree that if it was right last July to say that the authority could plan for some years ahead to keep the maternity unit, it cannot be argued now, a few months later, that there is some overriding medical or financial reason why that unit should be closed.

Let me stress to my hon. Friend and the House an important fact. The Sheppey maternity unit is a modern, purpose-built unit built in about 1963, which currently has 25 beds. It is part of the Sheppey general hospital, which has 110 beds. It is located on the Isle of Sheppey, which, for those who are not familiar with the island, is a real island with a substantial population. It has just one road contact, with a lifting bridge. That is an important factor in considering the strong feelings of local people, who wish to defend their local hospital facilities. Most people throughout the country wish to protect their local hospital facilities, but there are arguments for Sheppey and I hope that my hon. Friend the Under-Secretary understands that fact and will bear it in mind when he comes, if it comes to him, to consider this proposition.

It is because the maternity unit has offered such a high standard of service in both medical and personal terms to the people of the island, because it is held in such high esteem and affection by everyone — by the whole population, those who have experience of it and the medical profession—and because it has such a good medical record that there is such an overwhelming reaction against the proposal.

I stress again the nature of the opposition. There has been a massive reaction against the proposal, by general practitioners, health visitors, midwives, politicians of all parties, the press, the hospital watch committee, which has been a notable opponent, and the many other groups which have been formed. It should be understood that all these people are not irresponsible. They are not clamouring to keep a facility which is in some way inferior in its medical service. These people understand the need for the highest standards of medical service. They are saying that this maternity unit is a high-quality, modern facility which should be retained.

In this brief debate I shall not try to set out the full case against closure. There will be further opportunities for that to be developed. My main object is to seek some assurances from my hon. Friend, and I hope that he will be able to help me, the people of Sheppey and the people of the whole borough of Swale, where Sheppey is located.

The proposal is still at an early stage. The Medway health authority has asked for comments by 24 April. I have every hope that the authority will rethink the proposal and that it will never reach my hon. Friend's desk. But it may well end up on his desk. If it does, I hope that he will listen carefully to all the arguments that will be deployed by my constituents.

My main reason for raising the matter today is one which I am sure my hon. Friend will understand. There is widespread cynicism among many members of the public about these processes of consultation and appeal. I mean that as a generalisation, and not specifically in this connection, although it arises in this case. There is a widespread and understandable feeling that once proposals of this kind are made they are cast in tablets of stone and are very hard to change.

I repeat that the Medway health authority has told me and many other people that it means it sincerely when it says that this is a genuine process of consultation. Having said that, I fear that it is very hard to get such proposals altered.

I should like from my hon. Friend a categorical assurance that in the event of an appeal to him it will genuinely be considered at ministerial level. I hope he can assure us that if it gets to that point he will be willing to receive further representations.

We also want an assurance that this is not a rubber-stamp procedure. When Ministers receive applications of this kind which are so close to the hearts of the people, we want to know that they give them personal attention and do not simply rubber-stamp them because they have had a weight of bureaucratic or medical advice which tends to disregard the other side of the argument. It would be most encouraging if my hon. Friend could tell us of any cases where the Secretary of State has overturned applications by health authorities and upheld the objections of community health councils against health authorities' proposals.

I am arranging with my hon. Friend's office for the presentation of a petition on behalf of thousands of islanders, and I hope that my hon. Friend will receive it in person.

It would also be helpful if, not necessarily today but at an early stage, my hon. Friend could stress again our belief as a party in the value of local community hospitals wherever they can be maintained with high medical standards against this continuing centralisation on district general hospitals. It would be encouraging to everyone to be reminded that the Conservative party's heart is still in the right place and that these matters still receive sympathetic support from a Conservative Government.

May I deal with a number of key points. First, and crucially, I have here a letter from the community health council which states: A working group of the community health council has met to discuss this issue and they are recommending that the community health council should formally oppose the closure". That is an important step and we very much welcome the support and involvement of the CHC. May I also put on record its latest statistics, which are different from other statistics which have recently been presented. They reveal a slightly better position than that reflected in the health authority's strategic plan. The bed occupancy is 40 per cent. whereas the strategic plan showed a bed occupancy of only 35 per cent. The number of births was 690, a slight increase on the figures in the strategic plan. However, this does not reflect the amount of activity in the unit. Well over 1,000 patients are treated in the maternity unit—a very important statistic to be placed on record.

As for numbers, it has been suggested on previous occasions that units of this kind are not viable unless the figures are higher than those to which I have just referred. My hon. Friend was kind enough to give me a list showing the total number of births at maternity units. There are 75 maternity units on the list but at one third of those units —25 — there were fewer births than at the Sheppey maternity unit, which proves, I believe, that the unit is viable.

There is no dispute about the need to maximise the use of resources and about the under-use of the unit. Equally, there is no shortage of proposals to make better use of the unit, together with a much higher bed occupancy.

I have received a large number of letters from knowledgeable and concerned people who live in the area, and I should like to quote just a few. First, may I refer to the excellent and constructive response of the Sheppey hospital watch committee, which has done so much valuable work over the years. It emphasises, first, that it is concerned about the way in which this procedure has evolved and says, for example: It has also transpired that the gynaecological department at Sheppey was not consulted, nor were the local general practitioners. It would seem to us that it should be axiomatic that those who would be expected to operate such a plan should be consulted before what the authority called the draft plan was published rather than afterwards. I very much sympathise with that point of view.

In a long report, the committee suggests: the plan takes no account of the projected population growth on Sheppey and in particular in the Kemsley area of Sittingbourne which is a natural catchment area for the Sheppey maternity unit. It sets out proposals for the improvement of the maternity unit and ways in which to maximise the use of the beds in the unit.

I received a letter just this morning from a Mr. Peter Cooper. I mentioned earlier how limited is the access to the island, Mr. Cooper says: it will interest you to know that due to the 'annual'"— I think he meant that sarcastically— roadworks on the A249, it took me 45 minutes this morning to travel the two miles from the roundabout at the northern end of the Sheppey Way to just past the bridge. For most people it is a journey of 20 or 30 miles to get to the Medway district hospital or to All Saints hospital, whose maternity facilities would replace those at Sheppey. If it took Mr. Cooper 40 minutes to travel two miles, one can understand the great concern of those who know how long it will take them to get all the way to the Medway district hospital if there is a hold-up at the bridge.

I have also received letters from VOICE, one of the most effective industrial organisations in the country, which stresses its support for the campaign to keep the maternity unit open, and from Mrs. Rapley, a health visitor who works on the Isle of Sheppey. She makes plain her opposition to the planned closure and says: When I moved to the island 5½ years ago, local people still referred to the Unit as 'Our lovely new Maternity Unit'—How can it become obsolete in so short a time? I could develop the theme at much greater length, but I shall not do so.

The National Childbirth Trust emphasises how ideally equipped is the Sheppey maternity unit to provide maternity care for women whose pregnancies and deliveries are straightforward. It is modern and was purpose-built, and has the added bonus of an intimate and friendly atmosphere, almost impossible to create in a larger hospital. I have a letter from Mrs. Tompsett, who sets out an excellent proposition for a combined gynaecological and maternity unit. I shall not elaborate on that except to say that I hope the health authority will consider such a proposal, and that if it rejects it the Minister will recognise it as being a valid alternative.

I wish to emphasise that there is an overwhelming case for retaining this outstandingly good maternity unit. I could quote at length, but I shall not do so.

Having stressed how strongly I and local people feel, it is right to put the proposal into perspective. I do not doubt the sincerity and genuineness of the health authority in putting forward proposals in its 10-year plan to maximise the use of resources. It has to do that, and we respect its efforts, but I regret this proposal and think that it is a misjudgment. It is wrong to suggest that such a proposal arises from cuts in Government spending. That is not the case. It is a genuine and continuing effort to realise and use resources to the best.

During the next decade the Medway health authority will have one of the biggest projects in the south-east. Some £35 million will be spent on Medway phase 3, plus another £11 million for other capital projects. We have always been one of the poorest districts in the south-east. We have been the poor relation, the Cinderella, of the south-east. That programme will bring us up to nearly 95 per cent. of our RAWP target. It is not quite enough, but it is real progress. Year on year, the Medway health district has managed to secure real growth.

The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

I hope my hon. Friend will accept that we in the Government are doing all that we can to raise quickly the standard of health provision and investment in the Medway. That is important. We recognise that it has been a problem for a number of years. The area has been allowed to lag a long way behind, and it is due to the efforts of my hon. Friend and some of his hon. Friends that we have had this substantial increase in expenditure.

Mr. Moate

I am grateful to my hon. Friend for making that point. It is close to our hearts, and we welcome it. Inflation has played tricks with figures, but 10 years ago Medway's income was just £10 million. Next year it will be £37 million. There has been real growth and that is welcomed.

It would be much more welcome to the people of Sheppey and Swale if we could keep the maternity unit on the Isle of Sheppey and move forward to what we really want, which is a Swale district general hospital. That is not in this programme. but it has been long planned and long awaited. We want all those improvements, but we want to ensure that the local hospital services on Sheppey and in Swale are retained and improved.

2.48 pm
Mr. John Patten

I am grateful to my hon. Friend the Member for Faversham (Mr. Moate) for raising this matter. I know that the proposal has caused strong feelings in Sheppey. I have never visited the hospital, but I have visited the island. I have been across the bridge, although I did not suffer from the annual traffic works on the road. My hon. Friend the Minister of State, Department of Transport, needs to have that drawn to her attention.

My hon. Friend's concern for the unit is well known in my Department and was demonstrated in June 1984 when he presented to my right hon. Friend the Secretary of State a petition containing some 7,000 signatures. That is one of the more substantial petitions that we have received recently, but although 7,000 signatures are impressive the figure is nothing like as impressive as the size of my hon. Friend's majority over his alliance opponent which, at 15,252, was more than double the number of signatures on the petition.

I look forward to receiving the next petition that my hon. Friend has promised, and I shall certainly make myself available to receive it from him at the House, or at the DHSS at the Elephant and Castle, whichever is more convenient. But the petition that we have had, combined with my hon. Friend's speech, put the case most eloquently for the maintenance and improvement of maternity services at Sheppey general hospital. Local interest in the Sheppey unit certainly has not abated since last June, and was caused, of course, by the change of regional strategic plan.

I understand that there have been two well attended meetings: at Sheerness on 14 February, and at Sittingbourne on 20 February. Indeed, before the Adjournment debate, my hon. Friend let me know of the strength of feeling that resulted from those two meetings, which has been reflected by local residents and by the activities of the community health council. At those meetings, the district health authority tried to explain the thinking behind its draft strategic plan.

One feature is the proposal for the hospital's change of use. No such change was foreseen when the petition was presented last year, and my right hon. Friend the Secretary of State, my right hon. and learned Friend the Minister for Health and I were not aware at that stage that any such proposals were coming forward.

However, since last year the authority has made a thorough review of its resources in the light. of commitments over the 10-year period of its strategic plan. The plan has now been prepared in draft, and is presently subject to the consultation process. I shall say more about that later, as I know that my hon. Friend is rightly concerned, on behalf of his constituents, that that consultation process is genuine and not a sham. I am intent on demonstrating to him that it is certainly not a sham.

I am sure that my hon. Friend will appreciate that it is not for the Government to make absolute prescriptions for what the pattern of services should be in different localities. It would be absolutely absurd for the Government to attempt to prejudge, judge and second-guess decisions taken all over England when expenditure is about £14 billion, or about double what it was in 1979. The DHSS is a huge and integrated organisation, but decisions are best taken, and feelings about them are best expressed, at the local level, subject always to the overriding decision of my right hon. Friend the Secretary of State and his ministerial colleagues.

There is a continuing debate about maternity services which can be summed up briefly in the big versus small argument. Many people say that we need big hospitals with substantial maternity units, as they will make an even greater contribution to the rapid fall in perinatal mortality rates in this country. Indeed, the fall in perinatal mortality rates since 1979 represents one of the most significant social trends in this Government's lifetime.

Those who say that small hospitals and small maternity units are better argue that only those who perhaps need a consultant's care need go to the big units or big district general hospitals, and that those mothers who do not need that level of care, and who have been advised by their general practitioners or consultants that their births are likely to be safe with no complications—particularly those with second or subsequent children—benefit from going to smaller units. They argue that it is there that they will get the intimate care for which I understand from my hon. Friend his hospital is renowned.

I think that that is a fair, though brisk, summing up of the arguments. However, I.also think that it is possible to create a good homely atmosphere on wards in our large hospitals, provided that the staff get on and do it, and provided that the consultants and senior staff involved make the personnel perform that difficult task of making a large unit seem homely and not too much like some sort of baby factory. I can think of examples where that sort of good practice goes on. However, that is just a footnote.

Health authorities must strike a balance between the big and the small theories and the big and small practice in maternity provision. They must pursue the objective of further reducing perinatal mortality and the incidence of handicap in young babies, which gives such a tragic start to life to so many. However, I am happy to say that the incidence of handicap is declining. They must also pursue the objective of improving the safety of the service that they provide.

The essence of good maternity care is that there should be close communication and mutual support between the mother and all those looking after her. Sensitivity to the anxieties and wishes of mothers is an essential part of the professional expertise of all staff involved in maternity care.

I assure my hon. Friend that we shall bear in mind the importance, in general Government policy, of close connections between the mother and those looking after her as being the essence of good community care when we are involved in any decisions over this or any other maternity hospital. That may seem like a set of generalities, but it is not; it is the background to what I shall now say about the specific hospital.

I cannot say much about the hospital because it is not on Ministers' desks and has not been referred to us. No decisions have been taken. If I were to give as much as one slight opinion to one or the other side it might be read as some kind of prejudgment or pre-emption of a later ministerial decision, showing some sort of prejudice in favour of the plan or in favour of the protesters against the plan. I do not intend to put myself and my right hon. and learned Friend in that position this afternoon.

What I can say is that the structure plan—of which the change of use of the Sheppey maternity unit is but one proposal among many — is at present the subject of consultation with local interests, ending on 24 April. The district chairman of Medway health authority has gone on record as saying that no proposal in the strategic plan is a forgone conclusion, and that no proposal in the strategic plan—if I may lapse into French, which is generally, quite properly, forbidden in this Chamber—is a fait accompli. I am simply quoting his words.

The overriding aim of the plan is to ensure that the greatest number of people in the district have as fair a share as possible of the growing health resources available in the district, to which I am glad that my hon. Friend drew the attention of the whole House. The chairman of the district health authority is making staff resources available to examine carefully any plans that are put forward and to develop any viable alternative proposals that might emerge from the consultation process.

Even if, following the consultation procedure, the change of use proposals remain part of the strategic plan, there will still be ample opportunity for local people and representative interests to express their views and put their proposals to the health authority as the consultation process rolls on. It may not come to that; we shall have to wait and see.

We have made it clear in earlier debates—and here in my concluding remarks I shall try to answer my hon. Friend's questions—that when proposals are made to us we shall not agree to closure or change of use unless it can be clearly demonstrated—I emphasise those words—that the closure or change of use is in the best interests of local health services and the local community, or that savings will result to finance necessary developments elsewhere.

I was asked to give some examples to show that the consultation process and procedure was not some sort of formality, with rubber-stamping by Ministers. I will mention a couple of cases drawn from the South-East Thames regional health authority in which the Medway district health authority is located. In 1983 there was a proposal that the Brook hospital cardiac unit shold be closed. That was rejected because we felt that the regional health authority had not demonstrated real benefits or clinical advantages from a concentration of services.

Perhaps closer to home—if not geographically, then at least in regard to the subject of the debate, a maternity unit—at Crowborough hospital there was a proposed transfer of six maternity beds to Pembury hospital by the Tunbridge Wells health authority. We rejected that in April 1984 again because the service arguments of the district health authority were not seen as compelling. It was felt that the authority had not made out a clear case to persuade my right hon. and learned Friend and myself that the closure should go ahead.

We constantly tell district health authorities that it is up to them to demonstrate clearly to us that proposals should go ahead. If they do not, the closures do not go ahead. We take the concentration exercise seriously. My right hon. and learned Friend and I see delegations and would be happy—should it come to it—to see any delegation led by my hon. Friend at any stage to discuss the unit, after all the due processes of consultation within the district health authority and the regional health authority have been gone through.

Finally, because of what my hon. Friend has said and because of the strength of feeling that he has expressed, I undertake that, should any closure recommendation be forwarded to us by the South-East Thames regional health authority, we shall ourselves take the final decision. I give my hon. Friend that clear undertaking this afternoon. I hope that that satisfies my hon. Friend and, through him, his constituents that the whole consultation process will be gone through very carefully indeed, and that that process will end with a decision — should it ever reach Ministers' desks—taken with the greatest care and the fullest consideration.

Question put and agreed to.

Adjourned accordingly at Three o'clock.