HC Deb 22 April 1987 vol 114 cc766-72

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

10.16 pm
Mr. Jack Straw (Blackburn)

I am most grateful to you, Mr. Speaker, for choosing this debate this evening on the development of maternity and other health services in Blackburn. There is considerable need for investment in the Health Service in Blackburn. Waiting lists are too long. Typically, people may have to wait two years for a hip replacement. A case was brought to my notice the other day in my constituency advice bureau of a 13-month wait for an initial out-patient appointment for a medical condition. There is a problem with the renal unit at Accrington Victoria hospital.

I am glad to see the hon. Member for Hyndburn (Mr. Hargreaves) in his place. I am happy to allow him time at the conclusion of my speech to raise that matter, not least because he was good enough to allow me time in his Adjournment debate on the capital programme of Lancashire county council.

There are anxieties over the rundown of Calderstones and Brockhall hospitals and over the possible impact of the budgetary crisis in the Burnley district and the impact that that could have on emergency cover in Blackburn. I hope that the Minister will touch briefly on those issues in her reply.

Above all, there is an urgent need for investment in maternity services and for the building of a new maternity unit at Queen's Park hospital to be started as soon as humanly possible. The simple truth is that Blackburn women are getting a raw deal in maternity services.

I shall describe the facilities briefly. Maternity services in the Blackburn, Hyndburn and Ribble Valley districts are provided at present on four sites: at Queen's Park hospital, the main consultative unit has 67 beds; Accrington Victoria hospital has a general practitioner unit with 15 beds; Bramley Meade GP unit has 20 beds; and Bull Hill, which is another GP unit, has 19 beds. There are six delivery suites at Queen's Park hospital and two at each of the other three peripheral units.

Ten years ago, the three peripheral GP units catered for about a third, or 32 per cent., of all deliveries in the district. However, that has now dropped to 13 per cent. Therefore, Queen's Park hospital, with only half the delivery suites in the district, caters for 87 per cent. of the live births. There has always been a great deal of pressure on the facilities at Queen's Park hospital, but that pressure has become much greater in recent years, partly because of the increasing load that I have just described.

The work load is one of the highest in the country. Of 196 district health authorities, 121 had fewer than 40 births per bed, 34 had between 40 and 45 births per bed and at Queen's Park hospital there were 48.8 births per bed. The throughput of patients discharged is also one of the highest and the pressure on the midwives is staggering. The regional average is 26.8 births per midwife, whereas at Queen's Park it is 80 per cent. above that figure at 45.4.

Above all, the pressure shows in the conditions which patients must endure. Medical, midwifery, nursing and ancillary staff at Queen's Park and in the peripheral units are excellent and I cannot praise them greatly enough—without their dedication the service would have broken down many years ago—but the physical conditions are so poor that many women do not look back on their time there with pleasure, but regard it as a poor experience.

The ante-natal clinic is half the size needed for its load. On some mornings 100 patients wait to see doctors, but only four examination rooms are curtained off and there is one small waiting area, so some patients must wait in the corridors and some must stand. It is bad enough having to stand to wait for medical treatment when one is otherwise able-bodied, but for women in an advanced stage of pregnancy it is no joke. The number of ante-natal beds is inadequate and mothers must sometimes wait several hours for a bed to become vacant. Such is the pressure on beds that no mother stays after birth for more than 24 hours unless she or her baby is ill.

The special care unit is on the lower ground floor and away from the main area, only one lift serves the whole facility, sanitary accommodation is in a poor state and there is no anaesthetic or recovery room, no accommodation for parents and their babies and no facilities for privacy. The position is not only wholly unsatisfactory, but grossly wasteful and inefficient.

I know that the Minister will be aware of the campaigns to keep the GP units open at Bramley Meade, Bull Hill and Accrington Victoria hospital. Those three units are outside my constituency and I do not want to comment on the public pressure to keep them open, except to say that if adequate facilities existed at Queen's Park hospital the public demand for retaining Bull Hill and Bramley Meade as GP units would unquestionably evaporate. Different considerations apply in respect of Accrington Victoria hospital. If the facilities were adequate, GP beds at Queen's Park hospital could be made available for GPs and patients who wish them.

There is waste because, despite the fact that the peripheral units cater for only 13 per cent. of live births, they must be staffed 24 hours a clay with one midwife and one nurse each. That is a reason why the work load on midwives at Queen's Park and the central units is so great. On 32 occasions in the past year, the flying squad, involving at least one doctor and one midwife and often involving two doctors and two nursing staff, has had to leave Queen's Park hospital to deal with emergencies at the periphery. Twenty-five per cent. of the patients admitted to the peripheral units must be transported in labour to Queen's Park hospital and that, too, is extremely unsatisfactory. I understand that in some respects the peripheral units are not now meeting the regional health authority's guidelines.

The diseconomies and waste also mean that the development of low-cost services—for example the use of domiciliary midwives to deliver babies—cannot be utilised because there is such pressure on the midwives at Queen's Park hospital. The ones at the peripheral units must be there for legal reasons to provide cover.

The need for the new building at Queen's Park hospital has been recognised by word, but not by deed. I have a fistful of letters containing almost bankable promises that the new building would be erected by various dates.

I have a letter from the then Minister for Health, the hon. Member for Reading, East (Sir G. Vaughan), which says: This major scheme"— for a new maternity unit— is included in the RHA's capital programme for 1984/85. I have a letter from the then chairman of the regional health authority, Sir Sidney Hamburger, which is dated 9 December 1981. It says: The current timetable for pre-contract activities for this phase of development indicates that an approved budget cost estimate should be available early in 1983. I have a letter dated 26 April 1983 from the chairman of the regional health authority, Sir John Page, which says: The third phase will include a maternity department … and at the present time it is envisaged that the construction of this phase will commence in 1985/86. Something went wrong with the planning at the RHA, because in June 1985 we were told, like a bolt from the blue, that phase 3, the maternity unit, was to be taken out of the capital programme altogether. After a fight and a major local campaign, it was reinstated, and I have another letter from the chairman of the district health authority, Mr. Ian Woolley, which says that the maternity unit will commence in 1990–91 and will be available for use no later than 1993. I understand from conversations that I had over the weekend that the starting date is 1992–93, so the planned date of final use could be some years later.

I must say, and say advisedly, that the conditions at Queen's Park maternity unit for the staff, and above all the women of the Blackburn district, are intolerable. They should not be tolerated, and in my judgment they cannot be tolerated for very much longer.

I say to the Minister that I hope that there is no suggestion that the Blackburn district will be penalised for its success in making do with the facilities which exist. The paediatric consultants and other staff have worked hard to reduce the perinatal mortality rate, which is now below the regional average. Some cynics have suggested that the price that the consultants and other staff will pay for that is to see this maternity unit disappear into the mists of time. I hope that that will not be the case.

I hope that the Minister will say that she accepts that the situation is intolerable and that she will use her good offices and great powers of persuasion to twist the arm of the regional health authority so that this important and major project is brought forward much earlier than currently planned.

10.27 pm
Mr. Ken Hargreaves (Hyndburn)

I am grateful to the hon. Member for Blackburn ( Mr. Straw) for allowing me to briefly intervene in the debate.

The hon. Gentleman talked about misunderstanding and confusion, and I want to re-emphasise that. The threat to Accrington Victoria became apparent in 1978. It seemed to have been sorted out in 1985 when we were led to believe by the district health authority that we were to get a renal unit. Consequently, a ward closed at Accrington Victoria in July 1986. Staff were sent for training and suddenly in October 1986 it was announced that it had been postponed.

We now understand from Sir John Page—whom I went to see yesterday—that it was never intended that we would get a renal unit in the foreseeable future. He said that no date was fixed, yet the decision was taken to close the ward and send staff For training. Clearly, this considerable confusion has led to a dreadful lack of morale among the staff at Accrington. Victoria, who do not know what to believe. The public and staff are entitled to an explanation as to the truth. We need to know who made the decision. Were we entitled to a renal unit, and when will it come? The staff need to be reassured.

10.28 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

I observe the usual courtesies and congratulate the hon. Member for Blackburn (Mr Straw) on his success in the ballot.

The hon. Gentleman has generated a short but useful debate on maternity services in Blackburn. I should like to note the words of my hon. Friend the Member for Hyndburn (Mr. Hargreaves) and respond to him with particular regard to the renal services at Accrington Victoria. I understand that the regional health authority is committed to improving the facilities at Accrington Victoria with a new renal unit, but it has no firm date. I understand that it is considering the bid from the local health authority for funding for 1988–89.

I also understand that yesterday's meeting with the regional health authority chairman was not as satisfactory as one hopes that such meetings will be, but further discussions are always possible. My hon. Friend is aware that, whatever the morale of the staff, they should be congratulated on excellent treatment rates. Those for renal patients in that district are above the national average, which is clearly due to their hard work.

This debate gives me the opportunity to set the record straight on the proposed new maternity unit at Queen's Park and the related facilities at Bull Hill, and to put on record our investment in the health services of the hon. Gentleman's constituency, and the maternity services in particular. Before I do so, I will take up the point that he made about Burnley district health authority. It has sensibly done its sums and projected a £2 million overspend if it does not take some kind of remedial action. Constructive discussions on ways of remaining within the budget without affecting patient services are taking place between the regional health authority and Burnley. Therefore the overspend should have no effect on the constituents of the hon. Gentleman. We wait to see what the outcome of those discussions will be.

The district health authority that covers most of the hon. Gentleman's constituency is the Blackburn, Hyndburn and Ribble Valley district health authority. Spending in 1982–83 in this health authority was around £45.5 million. The cash allocation for the year just started is £59 million, which is a substantial increase. The district has improved from an estimation of around 10 per cent. below RAWP to an over-target figure, partly because of the technical element—it is managing a new hospital. There has been a substantial improvement in the health authority area by any appropriate standard of Health Service funding.

I note the points that the hon. Gentleman has made about the waiting lists. An extra £81,940 has been allocated this year for waiting lists, and should provide an extra 368 ear, nose and throat patient treatments and 33 additional hip replacements. We quote these statistics in the usual way, but that means 368 happier patients who are able to cope with ENT problems, and 33 people who are walking around not confined to wheelchairs. I am sure that they will be pleased to see that money.

A substantial amount of capital money is being spent in the district at the moment, all of which is coming on stream fairly shortly. About £4.5 million will be spent on the phase 1 redevelopment at Queen's Park hospital. It is due to be completed in July, and this will provide 56 acute beds and 40 children's beds, I know that my hon. Friend the Member for Hyndburn has been concerned about children's facilities for his constituents; those facilities will be available in a matter of weeks, and will be a great improvement on what has gone before.

Queen's Park hospital phase 2, which is costing nearly £9 million, will be starting later this year, and will provide 76 geriatric beds, 50 geriatric day places, a new kitchen and a dining room. The advice of the local health authority has been that these facilities should take priority and should replace what was nowhere near up to standard. In addition, between 1982–83 and 1985–86, over £11.5 million has been spent on other projects managed by this district health authority. For example, some £100,000 was spent on structural repairs to Brockhall hospital.

One of the results of all this activity is that the number of in-patients treated in 1982.85 has gone up from 37,000 to 41,000 — and we can add nearly 5,000 day cases to that. The number of out-patients is up to 175,000 in 1985, which is quite remarkable. The waiting list has dropped and waiting times have reduced, particularly some of the longer ones. However, as the hon. Gentleman sensibly said, they still have some way to go.

The hon. Member for Blackburn has accurately described what maternity services are available. Queen's Park hospital in Blackburn is the main district general hospital and provides the main maternity services—well over 3,200 deliveries a year, out of roughly 3,800. The number of births has been steady over the past five or six years. The GP unit that the hon. Gentleman has described at Bull hill in Darwen consists of 19 beds and the unit at Bramley Meade in Whalley has 20 beds. There are 15 beds at the Victoria hospital at Accrington and that hospital also provides a wide range of other acute services.

Mr. Straw

The Minister is correct to say that the number of births has remained fairly stable, but does she also accept that that figure is expected to rise from 3,850 in 1985 to 4,300 in 1993 and will only decline by 100 to 4,200 in 1996?

Mrs. Currie

I am aware that those predictions have been made. I was merely making the point that at this stage Queen's Park hospital covers by far the bulk of the births that take place in the neighbourhood.

The hon. Member for Blackburn will be aware that the maternity services advisory group, which has been in existence for some time and which has reported and advised the Department of Health and Social Security on how maternity services should be run said in 1984: Ideally GP maternity facilities should be integral or adjacent to consultant units. That is not possible at the existing GP units that are isolated from the main hospitals. Therefore, for several years there has been a feeling — not a concern, as standards are high — that perhaps, when possible, the way to deliver babies is on a main general district hospital site.

The beds in the two isolated GP units are seriously under-used — I am sure that the hon. Gentleman is aware of that. There is about a 46 per cent. occupancy of the beds at Bull Hill and less than 40 per cent occupancy at Bramley Meade. For example, in June and July 1986, a survey revealed that of the 57 mothers with a home address in Blackburn who had a baby in those two months only three went to Bull Hill. A number of them returned to Bull Hill for post-natal care. That raises the question of the quality of the community services that they might otherwise return to in their neighbourhoods. However. the figures reveal that by far the bulk of mothers go to Queen's.

Queen's Park hospital has about three times as many beds as the GP unit at Bull Hill but delivers 34 times the number of little patients. Even the GP unit at the Victoria hospital, Accrington, which is smaller with only 15 beds, is delivering three times as many babies. That information is based on the figures for 1985–86 and I understand that the figures have shifted even further since then.

Therefore, it makes sense to ask whether the appropriate funding is being given to the services that are presently provided. It is a wise and far-seeing district health authority that starts to consider that matter. The district health authority has said that the low usage and isolation of Bull Hill in particular makes the hospital expensive to run and calls into question its future. It forecasts that savings of around £68,000 net might be made and it would wish to use that money to improve community midwifery.

I accept the point the hon. Member for Blackburn made about ante-natal care. I take a dim view of large numbers of women being required to attend at hospital for ante-natal care all at the same time. Either that shows up some gap in the community service or it shows some gap in the management. In my judgment, those women could easily be asked to come at staggered times rather than the present system as described by the hon. Gentleman. I will undertake to draw that matter to the attention of the local management.

The community health council has said that it is concerned about some of the proposals, but the consultation process is still going on. If local agreement cannot be reached, Ministers are likely to be asked to take a decision. Therefore, my hon. Friend the Member for Hyndburn and the hon. Member for Blackburn will understand that I am in some difficulty in commenting on the merits or otherwise of the case. However, we will take into account all representations. In circumstances such as this it is much better for everyone concerned if local agreement can be reached that will benefit everyone. A consulation paper was issued in November and the DHA is now considering the proposals in the light of the representation made.

With regard to the proposed new maternity unit at Queen's Park hospital, I immediately reject the hon. Member for Blackburn's description of the existing facilities as "intolerable". The fact that a large number of healthy babies are born there, that a large number of GPs are happy to send their patients there and that the patients are willing to attend shows that the hon. Gentleman's description is a little over the top. The facilities are not as good as we would want them to be into the next century. That is why the regional health authority and the district health authority have more than once discussed improving and replacing them.

The possible new unit at Queen's Park hospital would be phase 3 of the district general hospital redevelopment. So far, no approval in principle has been applied for, so we have not been asked to go through any detailed proposals. But there are no proposals to drop the proposed new maternity unit from the capital programme. It has not been dropped from the capital programme at any stage. It did not appear in the draft programme, but was reinstated in the published programme last April.

In the past, North Western regional health authority's capital programme has been somewhat over-committed. All the regional health authorities used to do it on the basis of some scheme slippage. In other words, they would over commit on the assumption that something would not get done on time. With better management, particularly since the Griffiths changes, that does not happen any more. What goes in the plan must happen on time and usually within budget—in fact, nearly always within budget.

However, the new programme is not over-committed. It therefore gives start dates that can and will be delivered. The new date for Queen's Park maternity unit—phase 3 of the development—is firm. I checked it again today. Building will start in 1992–93 and completion is expected in 1995. The region is considering the district health authority's request to bring forward the start date of phase 3 because of the anticipated increase in the number of births in the district. The hon. Gentleman provided details, but I understand that the district has yet to do so. When they come in, the regional health authority will consider exactly what is proposed.

The new maternity unit in the phase 3 development is budgeted to cost over £5 million, including some 84 maternity beds and 22 special care baby unit cots. When built, that unit will answer many of the queries arid problems raised by the hon. Gentleman and my hon. Friend the Member for Hyndburn.

The current district provision is about 120 maternity beds, but the target will be slightly less than that in future —at least in part, because patterns of care are changing. When I was born, my mother was kept in hospital for a fortnight. When my younger daughter was born, I got out of hospital in 48 hours. Normal practice now is to keep the mother in hospital for as short a time as possible and to ensure that facilities at home are as they should be to enable mother and baby to return home satisfactorily.

I hope that I have answered most of the points that I am enabled to answer because of the consultation. I accept and I agree that the people of Blackburn and Hyndburn are entitled to the best possible service. I hope that I have shown that we are investing substantially in the Health Service in the neighbourhood to make sure that those people get the best service. No final decisions have been made either on the Bull Hill nursing home or on the exact pattern of future maternity provision, but we anticipate that there will be no delays in the proposed new maternity unit at Queen's Park hospital, apart from the dates that I mentioned.

We are building the health services not just for today but for our children and our grandchildren. The challenge is to meet the aspirations of all hon. Members' constituents with up-to-date services. I know that the local health authority at Blackburn, Hyndburn and Ribble Valley, the regional health authority and, indeed, Ministers are all determined to achieve that objective. We look forward with interest to the results of the current consultation

Question put and agreed to.

Adjourned accordingly at seventeen minutes to Eleven o'clock.