Orsett Hospital (Hansard, 5 March 1986)

§ Dr. Oonagh McDonald (Thurrock)
I make no apology for talking about the plight of Orsett hospital, which serves the majority of my constituents.
The hospital's future has been under discussion in the Basildon and Thurrock district health authority area for the past few months. Because so many doubts have been raised about some of the services offered there, my constituents made their views felt by a petition, which 55,000 of them signed. That constitutes almost the whole electorate.
A poll of 500 residents showed unanimous opposition to the removal of any services from Orsett hospital. On 27 February, the district health authority again considered the future of services in the area and proposed this time that all maternity, gynaecological and children's surgery should go to Basildon hospital, subject to a three-month consultation period.
Before I continue, I want to say that I am deeply concerned about the possibility of any cuts in hospital provision in the Basildon and Thurrock district health authority area. Nevertheless, at the moment it is the future of Orsett hospital which is causing me and my constituents great concern.
Although Orsett hospital is situated in the east end of the borough and is in fact in the Billericay constituency, it largely serves my constituency from the west end of the borough. Although Orsett and Basildon hospitals might appear to be not too far apart geographically, the journey from Basildon, from the west end of my constituenly, is very difficult. Constituents—mothers-to-be—travelling from Grays, Purfleet, Tilbury, West Thurrock, Aveley and South Ockendon, find the journey to Basildon hospital even more difficult than the journey to Orsett hospital. If an ambulance had to bring an emergency patient to the hospital, the additional few miles could cause tremendous problems. Traffic in the area is very bad and it would be possible for an ambulance to be held up, perhaps a little too long, to the detriment, even death, of a patient.
The hospital has been described as an excellent hospital in which the maternity unit and antenatal care form a good service for my constituents. About 40 percent. of births in the area take place at Orsett hospital, and it has about 1,700 births per year. I asked the Department of Health and Social Security for figures and found that the number of births at Orsett hospital per year is about average when compared with other maternity units in England and Wales.
The maternity unit at Orsett hospital does not have a special care baby unit, which wouuld be desirable. However, there are about 60 other hospitals with maternity units which do not have special care baby units. If my constituents are to be provided with a full and proper service, not only should the maternity unit remain, but the hospital should be provided with a special care baby unit so that the needs of my constituents can be fully met.
The district health authority has problems of staffing, but it is difficult to be sure what form those problems take. For example, the district health authority suggests that it wishes to phase out a particular grade of specialist in the maternity and gynaecological unit, but when I questioned the Department on that matter, I found that it was not 422 Department policy for that particular grade to be phased out. Staffing problems are indicative of financial problems. Since 1982, the district health authority has had its budget reduced by £2.5 million—5 per cent. Some of that is due to the resource allocation working party formula and some is due to a reduction in efficiency.
Over the period 1984 to 1993 there is a planned reduction for the regional health authority in the long-term resource allocation. All of those cuts will mean not only the disappearance of the maternity unit at Orsett hospital, but the ear, nose and throat, children's services, pre-convalescent geriatric services, cuts in the family planning service and other general cuts. Those cuts are being made in an area which is growing. At present the need for maternity units at Basildon and Orsett hospitals is based on population figures that are somewhat out of date. In fact, the area is developing pretty rapidly. In Thurrock, my constituency, the number of houses has already increased substantially, and most of them are occupied by young families, many of whom will have children in future years. That feature of the area has been picked up by the local press. For example, the Basildon Evening Echo reported on 28 February: Essex, already one of the largest shire counties in the country, will be the centre of another massive population explosion between now and the year 2001. The paper goes on to comment that the prospective baby boom is one of the main Problems.worrying county hall officials, and that possibility should be worrying the district health authority more than it appears to be at the moment.
I also wish to refer to the accident and emergency unit. I have, of course, discussed the matter with the district health authority, including the district manager, Mr. Taylor. He has given me assurances that the district health authority has committed itself to two-centre planning for accident and emergency units—one at Basildon and one at Orsett. In my view, those two units are essential not only because of the population, but because of the serious risks from the industry in the area. Thurrock, in particular, is noted for oil refineries, power stations, petrochemicals and the docks, and the M25 and the dualled A13 are extremely busy roads. As I fear we know all too well, traffic on such roads can mean serious injuries in accidents.
Although I have been given assurances, I am extremely concerned about the future of the two units in view of the cuts in the resources of the district health authority. Some of the savings that the district health authority expects to make will come from competitive tendering for cleaning services and so on. Other savings are supposed to come from increased efficiency. I am sure the Minister knows that, as few services in the Basildon and Thurrock district health authority area have been put out to competitive tendering, the prospective savings from that can be only guessed at, and cannot be regarded as certainties. I do not expect the Minister to admit that, but, on the other hand, the efficiency savings are to be found more on paper than in actuality.
Therefore, I am concerned about the future of those services, in spite of the fact that I believe that the district health authority does not want to see the two accident and emergency units disappear. That point was also covered in the Basildon Evening Echo in some detail on 3 March, just this week.
I referred to the maternity unit, and that of course is my prime concern. It is an efficient and attractive unit. 423 Patients readily turn to it. They value the services provided by Orsett hospital very much, and many of the older residents in Thurrock regard Orsett as their hospital. Let me give the Minister a little history. The original hospital for Thurrock was in Tilbury, in the docks area. It was brought into being by public subscription. Eventually that hospital became out of date and was transferred to a new building at Orsett. The hospital is very much the result of past community effort. Any cuts in services, particularly in maternity services, would be bitterly resented by the whole community.
The Minister and other hon. Members have had experience of dealing with petitions. They will know that the obtaining of 55,000 signatures on a petition in a very short time, without any real effort by the organisers, shows the depth of feeling in the constituency about any threat to the maternity services and the accident and emergency units at Orsett.
The number of live births, 1,771 in 1984, means that the maternity unit is about the same size as other maternity units throughout the country. In regard to the views of the medical profession, Professor Sorors, professor of paediatrics at University College hospital, commenting on a suitable and viable size for a maternity unit, said: Not less than 2,000 deliveries a year would be ideal … but it is not practicable, I do not suppose, for every woman in this country to be delivered in a unit of that size. The West Midlands regional health authority has said that a minimal work load of 1,500 deliveries per year is acceptable for a maternity unit. The professor suggested that a large unit was ideal, but he recognised that other considerations were important besides the mere number of deliveries per year. The maternity unit must be acceptable and accessible. Patients must be able to reach it easily, should they find that the birth is more imminent than expected, or is risky. If a patient has to be rushed to hospital, the accessibility of the maternity unit is important.
Because of the antenatal care provided at Orsett, a mother has her baby in familiar and friendly surroundings. I have visited the maternity unit more than once for constituency, not personal, reasons. I have also visited the prenatal unit. I was most impressed by the care and concern shown by the staff, by the brightness and friendliness of the surroundings and by the way in which people are treated in the maternity unit.
The maternity unit is a valued part of the community to which the residents feel they have contributed in the past. They are determined that it should remain. If the petition is anything to go by, my constituents will not accept the closure of the maternity unit. They find the journey to Basildon long, difficult and expensive by public transport. They want their familiar and friendly hospital. The medical and financial reasons are not adequate justification for refusing to let the residents of Thurrock have the service that they need and desire.
The present population want the services. Mothers who are moving into my constituency in large numbers want a convenient maternity unit. If the number of births is to be a consideration, the growth of the population will remove that as a justification for closing the maternity unit. To close the maternity unit only to find that the growth in population necessitated its reopening would be a grave error that would cause unnecessary anxiety and suffering. It would simply be a financial mistake.
424 I hope that the Minister will take account of what I have said and begin the consultation period, which will be completed in May. I know that my constituents are relying on me to present their views tonight, and they will no doubt present their views very forcibly indeed during the consultation period.
We expect the Government to ensure that a good maternity service will remain at Orsett hospital to serve my constituency. We hope that the Basildon and Thurrock district health authority area will not experience cuts and loss of services.

§ Mr. K. Harvey Proctor (Billericay)
rose—

§ Mr. Deputy Speaker (Sir Paul Dean)
Do I understand that the hon. Gentleman has the agreement of the hon. Lady and the Minister to intervene?

§ Mr. Proctor
Yes, Mr. Deputy Speaker.
This is the third in a series of Adjournment debates on the reorganisation of health services by the Basildon and Thurrock health authority, and the hospital to which the hon. Member for Thurrock (Dr. McDonald) has referred is in my constituency. I ask the Minister to assure my constituents that Orsett hospital is quite safe. Such an assurance is needed for morale and recruitment reasons which my hon. Friend will readily understand.
Orsett hospital is a larger hospital than Basildon district hospital. It is providing substantially more general surgery and medicine than Basildon. It is the only ENT in-patient service in the Basildon and Thurrock district area. It is less than 15 years old, and in investment terms it is today worth between £30 million and £35 million. There is bound to be at least 60 years of life left in it, and it is needed to provide a substantial part of the acute services for my constituents.
I should be grateful for an assurance from my hon. Friend about the safety and the future of Orsett hospital, and I look forward to his response to the comments of the hon. Lady on the maternity and accident and emergency units.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I recognise that the subject that the hon. Member for Thurrock (Dr. McDonald) has chosen is of great importance and concern to her constituents and to the constituents of my hon. Friends the Members for Billericay (Mr. Proctor) and for Basildon (Mr. Amess), whose presence I also welcome.
As my hon. Friend the Member for Billericay said, this is the third debate in as many months on the organisation of NHS facilities within the Basildon and Thurrock health authority. The views of the constituents of my hon. Friends were represented in the debates in January and December. Following the earlier consultation— as the hon. Lady recognised—the district health authority decided not to proceed with its earlier proposals, but on reconsideration it has issued a further set of proposals relating solely to the provision of maternity services.
As in the previous debates, at the centre is the proposal that has been put out for public consultation by the health authority. I must emphasise that it is only for consultation. The proposal is for the centralisation of maternity, gynaecology and paediatric in-patient services on one site 425 in the district. If the community health council, which represents the views of the community, objects to the proposal, and if the regional health authority then supports the plans, it will come to Ministers for final decision.
The hon. Lady will well understand that it would not be appropriate for me to pronounce at this stage on the validity of the arguments either for or against the proposals that the district health authority put out only on 27 February for consultation. Therefore, as I hope the hon. Lady will understand, I cannot respond in favour or against her points. I achnowledge that she has properly used the procedures of the House to make clear her constituents' anxiety, which is shared by those of my hon. Friends, but I may not respond in a way that might prejudice the well established procedures for dealing with such important matters.
Comments on the consultation are required by 30 May 1986. All that is said in this debate, and all other relevant factors, will then be weighed carefully by the health authority to see what is best for the overall interests of all its patients. Therefore, the time for Ministers to play their part has not yet arrived, and there is no certainty that it will.
One issue is central to the proposal to relocate Basildon and Thurrock's in-patient maternity services upon which I can comment. It is not unique to this proposal, and it keeps cropping up wherever Health Service reorganisa-tions Are discussed. It is the question where best to locate services in a district with several large population centres. I reiterate the points made by my right hon. Friend the Minister for Health in the Adjournment debate in the House on 3 December, when my hon. Friend the Member for Basildon spoke so eloquently and movingly to express his great concern about the proposal at that time to withdraw in-patient maternity provision from Basildon hospital, and to concentrate maternity services at Orsett. Although the proposal now is to centralise these services at Basildon and not now at Orsett hospital, the points made then remain valid.
First, it would not make sense to provide all facilities come what may in every large town in a district. I hope that the House will accept that. It must be recognised that where it makes no medical or economic sense to preserve the status quo, change is essential and extremely difficult decisions must often be taken. That proposition finds wide agreement in principle, but in practice real and strongly held objections will arise when a town is chosen for a closure or major change of provision. But the health authority has a duty to make those difficult decisions, and to seek to get the balance and distribution of services right for the majority of its patients.
Secondly, I understand that the district health authority continues to believe that mothers and babies in the district will receive better and safer in-patient care, if they are cared for in a central unit where there is adequate 426 paediatric cover. I understand that it is proposed that outpatient ante-natal and post-natal clinics will continue at both Orsett and Basildon, as will accident and emergency services. The authority has also said that it is committed to maintaining the integrity of both hospitals as acute hospitals. I hope that my hon. Friend the Member for Billericay will accept that undertaking, which is not challenged.
I understand that there is also a genuine staffing resource problem over providing obstetric services at more than one hospital. The district reports an unstable and unsatisfactory medical staffing structure that would be brought up to standard by centralisation.
Those reasons together suggest to the district health authority that a safer, enhanced standard of service will be provided only if in-patient services for maternity, gynaecology and paediatrics are concentrated on one site. The future organisation of those services are now being considered on their own, and not, as previously, as part of a package covering other services. As a result, the district believes that the services should be centralised, not, as the hon. Member for Thurrock has argued, at Orsett, but at Basildon. I stress that that proposal is service-led and revenue-neutral and does not stem from a desire to save money.
In response to the hon. Lady's point about funding, I hope that she accepts that the issue here is how best to provide maternity cover of the highest quality for her constituents and those of my hon. Friends. It is not a matter of finances. Inevitably, there are financial problems, of which we are all aware, but I repeat—as I have done many times during debates on changes in health provision—that it is important to recognise that the proportion of resources, in real terms, devoted to our health services is steadily increasing. Next year, there will be an increase of no less than 6.7 per cent., with forecast inflation of 4.7 per cent. Of course, RAWP also has an impact here, but North-East Thames regional health authority will receive an increase of 5.7 per cent. —significantly above the forecast rate of inflation.
The district health authority has problems, but here, too, I hope that hon. Members will recognise and acknowledge the achievements of the district authority in treating more patients. For example, between 1982 and 1984, in-patient treatment increased by no less than 12 per cent., and the number of day cases treated increased by 24 per cent.
The district health authority is managing its resources well and is extremely sensitive to the needs of the community. It is seeking better provision, and I hope that the consultation exercise will achieve that. I assure the hon. Lady and my hon. Friend that their contributions to the debate will be taken carefully into account as part of the consultation exercise which an issue of this seriousness and importance merits.