HC Deb 15 May 1985 vol 79 cc465-72

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lennox-Boyd.]

1.38 am
Mr. Jack Dormand (Easington)

I make a plea for the retention of maternity services at Thorpe hospital knowing that there is an overwhelming case for it. Not least is the fact that the hospital enjoys the full confidence of the people of the area. That confidence is based on several factors that I shall develop, but I mention it first because we are often told by the Government that elected or appointed bodies must listen to the voice of the people. In the case of Thorpe, it appears that the responsible bodies are completely ignoring that voice.

In all my 15 years as the hon. Member for Easington, I have never known such concern and enthusiasm about a local issue. In letters, at meetings and on the streets I am constantly asked, "What on earth are they doing, talking about closing our hospital?" The action committee set up to campaign against the closure and with which I work closely, is a dedicated and knowledgeable group of local people who are doing magnificent work in defending the hospital. They are receiving the wholehearted support of the community.

The official documents relating to the hospital talk about it being "isolated". I never cease to wonder about the people who write such reports. The hospital could not be more central for the area that it serves. Many of the expectant mothers walk to it. Buses pass it. No car journey to it is longer than 10 minutes. I live half a mile from it, so I need no instruction from anyone about its location in relation to the people who use it.

It is proposed that the maternity services be transferred to Sunderland and Hartlepool. Those towns are 10 miles away from most of the population, and the bus services to them are not very convenient. Indeed, some are highly inconvenient. I need hardly add that there would be considerable extra expense in getting to both those towns and, of course, we are talking not just about expectant mothers, but about families and friends visiting them. Those distances and the inconvenience would also inevitably be a deterrent to attendance at ante-natal clinics. Surely that is of considerable importance, too.

Some of my constituents argue that the greater distances constitute an element of danger. That point cannot be denied. I hope that the Minister will agree with that. It may not be a major point to most people, but if there were to be any tragic happenings because pregnant women did not arrive at the hospital on time, it would be a major treagedy for the people concerned.

The Parliamentary Under-Secretary, the hon. Member for Oxford, West and Abingdon (Mr. Patten) ,

referred to geographic factors when replying to a debate raised by his hon. Friend the Member for Harborough (Sir J. Fan) in March this year, and drew support from the view shown by the Maternity Services Advisory Committee. Saying that the Government's view, by and large, is that women should be encouraged to have their babies in the larger and properly staffed consultant units of district general hospitals, the Minister went on to say However, the committee recognised that in some localities geographic factors will require the availability of what is 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."—[Official Report, 9 January 1985; Vol. 70, c. 881.] If the Minister and the Department believe that Thorpe hospital, for the reasons that I am now giving, epitomises the circumstances envisaged in that report.

I refer to the hospital itself. In my opening remarks I said that it enjoyed the full confidence of the people of the district. There are several reasons for that. One is the high standard of care and the happy family atmosphere that is a feature of it.

Anyone who visits the hospital cannot help being struck by that atmosphere. It arises from the dedication and the deep care continually displayed by the staff. Everything possible is done by them to provide the security that is so important at such times.

There was an interesting incident when I last visited the hospital. I spoke to a constituent who had just been delivered of her baby and asked if everything was satisfactory. She replied, "This is my seventh baby born here. I would not have been here if I did not think that everything would be all right." No words of mine can be more eloquent or convincing than those in seeking to justify the continuance of Thorpe hospital.

There is universal praise for the hospital. The campaign to retain it has now lasted for well over a year, and it is literally true to say that no person or organisation has spoken out in support of closure, in spite of claims by the health authorities and the consultants that the alternative proposals will provide a better service.

One of the most heartening and surprising letters of support came from the clergymen of the area. I wonder whether the Minister has ever received a letter from the clergymen of his area. This is an unusual step for them to take, and is a measure of the strength of feeling in the district. Perhaps more importantly, the doctors of the area support the retention of the hospital and are completely opposed to its closure.

The area served by the hospital is covered by parts of three health authorities. It must surely be of some significance that none of the three community health councils supports the proposed closure. When the Minister replies, will he say how much importance the Government place on the views of community health councils which. after all, are the patients' watchdogs?

There is a widespread view in my constituency that the closure is being pressed for the convenience of the consultants, who must travel to the hospital. No one appreciates more than I the splendid work done by the consultants over the years, but, having regard to the strength of the case for retaining maternity services at Thorpe, there may well be some substance in that view. I hope that the Minister will take due note of that point. At a meeting with the consultants which I organised some months ago, I told them of that view.

One consultant said that he would welcome an extension at his hospital, but went on to say: If Thorpe is to close it would be jolly hard luck on the residents of the area". That is an astonishing statement for a consultant to make. The quotation is taken from a local newspaper. It received widespread publicity, so I assume that it was a correct report of what he said.

Thorpe hospital has about 1,000 births a year. On 13 June last year, in a written answer to my question, the Minister listed the maternity hospitals and maternity wings which had been closed from 1979 to 1983, together with the average number of deliveries in each of them for the previous three years. Of the 46 hospitals named, only eight had more births than Thorpe, and from their location I suspect that the circumstances in most were very different from those in my own area. I can understand closures where the number of births were as few as 20, 47, 46, 73, 69, 98 or even more—I have quoted those figures from the Minister's answer — but those figures are very different from 1,000.

The Thorpe work load, if I can so describe it, allied to all the other factors I have mentioned, make the position very different from the closures mentioned in the written answer to me. The argument is that expectant mothers will be given a better and safer service at Sunderland and Hartlepool, and I expect the Minister to make that the main thrust of his reply. It will be necessary, however, to spend a considerable sum of money to bring the other two hospitals up to the required standard. The total capital and revenue costs at Sunderland will be £1,232,039 and at Hartlepool £498,250. Those are the official figures. If it is felt that there is a problem at Thorpe—and I do not accept that there is — a simple solution would be to spend the total of those two sums, £1,730,289, on Thorpe hospital. I assure the Minister that I am not being naive in suggesting that. In considering whether any hospital should close, it is essential to take all the factors into consideration, and I have described the merits of this hospital.

Had there been a high mortality rate at Thorpe, I would have been among the first to urge its closure. I understand that the mortality rate at Thorpe is 2.5 per 1,000 births. That cannot be regarded as a dangerous figure. I think I am correct in saying that it is below the average. I was informed yesterday that one of the most difficult births, a twin caesarean, was carried out recently without any problems. That is a tribute to both staff and facilities and is yet further evidence of the strength of the case for the retention of the hospital.

If there is any inadequacy or danger in regard to the medical aspects, we have yet to see the evidence of it. The confidence of expectant mothers in Thorpe and the difficulties associated with travelling to Sunderland or Hartlepool are giving rise to the very disturbing view, which has been expressed to me on several occasions, that expectant mothers will choose to have their babies at home. That would probably happen in some cases. I am sure the Government would deprecate such a development. I hope that the Minister will consider the seriousness of such a possibility.

When there is controversy about a proposal to close a hospital, the decision has to be taken by the Minister. I assure him that there is the utmost controversy in this case. I hope that he will listen to those who oppose the closure. By any objective standard, the case for retention could not be stronger. I would welcome the opportunity at an appropriate time to talk to the Minister in greater detail than is possible in a debate of this kind. I do not wish to praise a Tory Minister too much, but I have always found the Minister to be fair, if somewhat robust on occasion, and certainly open-minded. I know that he will give full consideration to the case that I have made tonight.

1.53 am
The Minister for Health (Mr. Kenneth Clarke)

I congratulate the hon. Member for Easington (Mr. Dormand) on his success in obtaining an Adjournment debate and on the way in which he has put the case for his constituents in raising the controversial proposal to close a hospital which serves his constituency. I listened with great interest to all that he said. Certainly if he would like to come to see me at a more formal meeting and expand his arguments, I shall await that with interest. I shall arrange such a meeting and suspend judgment on the matter until I have heard his full arguments.

The hon. Gentleman has made it clear that his principal concern is about the maternity services for his constituency. He is extremely assiduous in pursuing his constituency interests in matters of this kind. No doubt he shares the objective of everybody in the Health Service of making sure that in his constituency, as elsewhere, child birth is made both safe and a very rewarding time for mothers and mothers-to-be. Every health authority strives to ensure that, but every authority must at all times ensure that the care that it is providing at any given time is in line with the best modern practice. It has to review its maternity services to ensure that it is keeping up with the best and most up-to-date standards.

The proposal that the hon. Gentleman has raised is still subject to consultation. At this stage I am not sure that it will come to me for my decision. In many ways I prefer these matters to be determined locally.

I hope that the hon. Gentleman will forgive me if I begin by making some general remarks. Decisions must be based on the best kind of maternity care for a locality. The general issues between the wishes of the consultants and the obstetricians and the local population and mothers-to-be are frequently raised when proposals are made that involve small maternity hospitals. Anyone with any responsibility must ensure that, above all, the position of mothers-to-be and their babies is protected. Their safety and health must be ensured to the greatest possible degree.

There have been many inquiries into perinatal and neonatal mortality in recent years. It was the subject of a major inquiry that was undertaken first by the Expenditure Committee and subsequently continued by the Social Services Committee between 1978 and 1980. The Committee's report and the Government's reply were both published in 1980. They were the subject of a debate on 5 December 1980, when the Committee's Chairman, the hon. Member for Wolverhampton, North-East (Mrs. Short), highlighted the different questions that the Committee had attempted to resolve.

The Committee considered at length all the matters which might be linked with Britain's comparatively high natal mortality rates. It considered especially the importance of places of birth and the facilities available. After taking extensive evidence, both professional and from consumer groups, it came to the view that an increasing number of mothers should be delivered in large units; that selection of patients should be improved for smaller consultant units and isolated general practitioner units; that home delivery should be phased out further. That is to be found in the second report of the Social Services Committee 1979–80.

We set up the Maternity Services Advisory Committee, to which the hon. Gentleman referred. Its second report on care during child birth was published in January 1984. The committee came to basically the same view as the Social Services Committee, that by and large an increasing number of mothers should be delivered in large units. The committee recognised that in some localities geographical factors required the availability of so-called isolated maternity units. It recommended that these should be equipped to a standard to deal with the complications that may have to be dealt with on site. As a Government, we commended the reports of the advisory committee and distributed them widely within the NHS and to the appropriate professional and lay organisations.

In July 1984, the Select Committee on Social Services published its follow-up report and recommended that the DHSS should do more to encourage regions, in the light of the evidence available to them, to rationalise their maternity services in order to promote better standards of care as well as economy". In our reply to that in October 1984, the Government agreed that it was important for health authorities to look for rationalisation to improve maternity services and to redirect resources. A number of factors need to be taken into account when authorities consider doing this, including first, and most important of all, the view of users of the service, followed by the use made of different units, the need for units at particular locations because of social or geographical factors, the safety record of each maternity unit and the availability of medical cover and ambulance services for the transfer of emergencies.

There is no absolute prescription for all localities. It is not possible to lay down rules which all authorities should follow when reaching a decision either to concentrate maternity services on major sites or to retain the popular smaller, local units.

I mention these facts to demonstrate that local authorities have been encouraged to rationalise their services and to consider locating them in larger hospitals where all the emergency services are readily to hand not only by the Government but by the Select Committee on Social Services and by every advisory committee that has looked at maternity services.

Although there are no absolute rules, it is not surprising that authorities all over the country are looking at their services and trying, I hope, to strike a balance. They have to pursue the objective of reducing the perinatal mortality and handicap figures and improving the safety of the service that they provide. All considerations of that kind must lead them to consider the possibility of concentrating their maternity services on those sites where emergency facilities are most readily to hand. I hope that in doing so they will try to strike a balance, because authorities must keep constantly in the back of their minds how far the concentration of staff and resources in large hospital units matches the needs and wishes of the mothers who use those services.

In recent years emphasis has been placed upon improving the safety of maternity services. The effect has been dramatic. There has been a fall in perinatal mortality rates from 15.4 per cent. deaths per 1,000 births in 1978 to 10.3 per cent. in 1983. That is the result of the efforts of all the staff involved in maternity care in the National Health Service.

While great emphasis must be placed on safety, we must also remember the importance of providing a service that is satisfactory to the mothers. Therefore, I welcome the growing awareness among National Health Service professionals that, while the new technology and better clinical procedures which have led to safer maternity services must continue to be improved, they must not abandon the traditional, natural birth and all the basic human values that are implicit in childbirth. I believe that it is possible to develop the new general hospital units in such a way that they remain just as friendly and sympathetic places for mothers-to-be as the smaller units which, as we know, enjoy a great deal of local support.

I turn from those generalities to the specific proposal to change the use of Thorpe hospital. As the hon. Member for Easington knows, Thorpe hospital is about l 1 miles from Sunderland, just south of Easington. It draws its patients from an area covered by the Sunderland, Hartlepool and Durham health authorities and provides 49 beds on its three wards. In addition, eight clinics are held at the hospital each week. But the distance of the hospital from the main maternity unit at Sunderland general hospital causes difficulties. The consultant obstetricians working at Thorpe have their duties split between two units. I am sure that the hon. Gentleman appreciates that the difficulties which are caused are not just those relating to convenience for consultants but those connected with the best and most efficient use of their time, the ability to cater for the needs of all their patients and the need to be readily available at all times.

The hon. Gentleman does not agree that Thorpe hospital is isolated, but it is relatively distant from the remainder of the Health Service facilities and that presents a problem with the availability of anaesthetist cover. It means, for example, that epidural anaesthesia cannot be given. It also makes it difficult to provide proper paediatric back-up services.

As I understand it, most babies requiring special care facilities are transferred from Thorpe hospital to Sunderland general hospital. It is only there that such facilities can be provided. Those are the reasons that have caused the Sunderland health authority to propose the centralisation of its maternity inpatient services at Sunderland district general hospital. At the same time, Hartlepool district health authority proposes to extend its maternity inpatient facilities at Cameron hospital.

At Sunderland, by upgrading vacant wards at the district general hospital, the health authority aims to provide more obstetric beds on that site and at the same time to upgrade its delivery rooms. The plans would provide the inpatient facilities currently at Thorpe hospital in much improved accommodation, with experienced staff available full-time. Full anaesthetic and paediatric backup services would be on hand for all deliveries, together with the supporting pathology and radiology services, which are not available at Thorpe. For its part, Hartlepool health authority plans to accommodate patients from its area by making minor adaptions and improvements at Cameron hospital.

I accept that one reasonable reaction of people living in Easington is that travelling to hospitals in Sunderland and Hartlepool is inconvenient. I have no doubt that they will balance that inconvenience against the proposal that patients will receive better care, that fully trained, experienced staff will be continually on hand and that a fully equipped unit will be available.

As the hon. Member will know, it is intended that the outpatient clinics would continue to be provided in the Peterlee-Easington area. For most people attending these clinics there will be no change, as they would continue to be held at Thorpe. However, one gynaecological clinic would be transferred to Ryhope general hospital and the frequency of sessions held locally at Peterlee health centre increased from fortnightly to weekly. Discussions are taking place among the three health authorities on the future of services. The most important point is that they are consulting about their proposals. I must see what the public reaction to the consultation is. I have to see what the community health councils say about the proposals. I attach importance to their reactions. If they disagree, the proposals will come to me for a decision.

I assure the hon. Gentleman that I shall consider the proposals entirely on their merits. I shall agree to any contentious closure proposals only if I am satisfied that on balance the interests of the service and the patients are enhanced. I take on board his reaction. He has already reacted adversely. He plainly has his constituents' interests at heart. When I meet him next, whether he comes on his own or with a deputation, I shall listen with great care to his reservations. If the proposal comes to me as contentious I shall weigh up the matter carefully before any final approval is given.

Question put and agreed to.

Adjourned accordingly at eight minutes past Two o'clock.