§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorrell.]
2.30 pm§ Mr. David Evennett (Erith and Crayford)I am grateful for the opportunity to raise on the Adjournment a subject that is causing some concern to a significant number of my constituents—the provision of maternity services in the Bexley health district. Before I discuss the specific matter that has been raised by my constituents, I must make it clear that I have received no complaints about the standard of clinical care or treatment that my constituents have received, whether at antenatal clinics, in hospital during confinement, or from community midwives and health visitors at home following the birth of a child. Without doubt, the treatment that patients receive is extremely good and I wish to express my praise and support for the doctors, nurses, midwives and other National Health Service staff who provide such a high standard of care.
I know from my own visits to local hospitals of the dedication of the staff. As a National Health Service patient myself, I appreciate the tremendous work that is done throughout the Health Service. My constituents have raised only limited complaints about the facilities in the hospitals where they have been confined. In contrast, I have heard a great deal of praise for the conditions and facilities in our local hospitals and for the services that they provide. The National Health Service is a unique British institution, which is highly regarded by all patients. It is much valued and much loved.
However, nothing is perfect. The NHS has never been perfect and probably never will be. More and more money is spent, and more and more money is used to provide better services, but there will always be specific complaints and demands, such as the one that I raise this afternoon.
The complaint of a large number of my constituents who are expecting babies is that, although they receive good care, they do not receive it at the hospital of their choice. Although Erith and Crayford is within the Bexley health district, many expectant mothers in my constituency are denied access to the only maternity unit in the district, which is at Queen Mary's hospital in Sidcup. It is an excellent hospital, as my right hon. Friend the Minister for Health knows from his visit there a year or two ago.
I am concerned about the lack of maternity provision because Erith and Crayford are the main areas of population growth in the London borough of Bexley. Substantial house building is under way in my constituency, particularly of starter homes and homes for young families, in Thamesmead, Erith, Belvedere and Crayford. This influx of people is most welcome because it will not only rejuvenate the area but will ensure a balanced community in the north of the borough of Bexley.
A consequence of that is a high demand for the services that young families require, such as nursery and infant school places, child welfare services, playschools, recreation facilities and, of course, maternity care. In Crayford alone, the birth rate is on average 350 to 400 births a year. Women who live in Erith and Crayford expect and are entitled to receive good health care, including maternity provision, and that is what I wish to bring to the attention of the House this afternoon.
761 In part, the problem has been caused by local geography. The constituency of Erith and Crayford is long and narrow, bounded to the north by the river Thames, to the west by the London borough of Greenwich, and to the east by the county of Kent. As in many Greater London areas, local road and rail communications are part of the network radiating out from central London to the surrounding counties so that in the main they run from east to west. There have been considerable transport problems, particularly with bus services. There is no longer a direct bus route to the hospital at Sidcup, following major alterations to local services by London Regional Transport, without any proper consultation with the district health authority. I am amazed that there is no statutory obligation to consult health authorities when services to local hospitals are altered, but I realise that I cannot pursue that aspect in this debate.
The problems with the location of hospitals in the area are also partly historical. Erith and Crayford originally formed part of Greenwich and Bexley area health authority, which had three general hospitals strategically located throughout the area—Queen Mary's in Sidcup, the Brook hospital, and Greenwich district hospital—as well as a number of smaller hospitals, including maternity hospitals at Woolwich and Bexleyheath, which, sadly, no longer exist. Following reorganisation of the National Health Service, the area was divided into two districts and many of the smaller and older hospitals were closed, leaving Bexley with a very small complement of hospitals—the district general hospital at Sidcup and the small cottage hospital at Erith, which provided very few acute services.
Although Queen Mary's hospital is the only hospital in Bexley providing maternity services, the catchment area for those services does not include parts of Erith and Crayford—a situation that my constituents and I find unacceptable. Until recently, this did not present too great a problem. With easier east-west transport links, expectant mothers in western parts of the constituency such as Belvedere and Thamesmead received maternity care at Greenwich district hospital. Again, I have received very few complaints about the treatment provided at Greenwich, and many constituents—including my research assistant's wife, Mrs. Belinda Bracken, who gave birth to a baby girl there four weeks ago—have nothing but praise for the hospital. However, the fact that women living in Belvedere and Thamesmead have to go out of the district for maternity care presents some problems, especially with a deteriorating bus service.
Until recently, people in eastern parts of the constituency such as Crayford and Slade Green were in a similar position, finding it easier to travel to West Hill hospital in Dartford for their maternity care—another hospital about which I have a heard a great deal of praise for the quality of care and attention provided. This was largely a quid pro quo arrangement, with residents of Dartford and Crayford and the surrounding area making the easier journey to Dartford while Dartford and Gravesham residents in and around Swanley travelled to Sidcup.
A further problem has now arisen, affecting those who live in the area previously served by West Hill hospital, because Dartford and Gravesham health authority has 762 decided to end maternity services at West Hill and, in the jargon of the NHS bureaucrat, to "rationalise" maternity services at Gravesend hospital, many miles from my constituency. The change was strongly opposed by Bexley health authority, which foresaw the problems that would be created for my constituents, but I understand that the regional health authority—a body which rarely seems to understand the real needs of patients—has agreed to the ending of maternity services at West Hill despite the objections. I know that my right hon. Friend the Secretary of State for Social Services is concerned about the bureaucracy within the NHS and is considering how it can be improved so that the Health Service operates in the best interests of the patient as consumer. This is a case in point, and I hope that my right hon. Friend the Minister for Health will take note.
As a consequence of the change, expectant mothers in Crayford and surrounding areas will be expected to travel to Gravesend for maternity care—a journey of considerable difficulty for a pregnant woman, particularly if there are young children to be transported as well. The journey to Sidcup would be shorter and easier.
Obviously, maternity care is not just about confinement for delivery. Effective care must begin from the time that a woman finds that she is pregnant and continued for some time after the child is born. To be effective, at least part of that care should be provided by the hospital where the baby is to be born, if only to establish a link between the expectant mother and the hospital so that she is familiar with it and the surroundings, and so be more at ease when the time comes for admission for birth.
Given the need and reason for such an approach, it is a failure on the part of the Health Service to assign a patient to a hospital which is so far from where she lives that she may be deterred from attending clinics by travelling problems, the cost of travel, or the time involved. I have several constituency cases where that has been the case, and it worries me.
Such an arrangement is ludicrous when one realises that first-class facilities already exist at the general hospital in the district where the patient lives but to which access is denied because of the definition of the hospital's catchment area. The present position is so unsatisfactory that I raised it with the chairman of Bexley health authority, who assures me that the catchment areas are to be reviewed, but he is not sure that the results will be to the satisfaction of the patients in my part of the health authority. I am grateful to him for what he is doing, but I am concerned that a substantial change will not take place unless alternative facilities are provided at Queen Mary's hospital for out-district patients who at present receive maternity care at Queen Mary's.
The maternity unit at Queen Mary's was designed to deal with 3,000 births a year. I understand that it handles about 3,400, of which more than 1,000 are to out-district patients. At the same time, some 690 Bexley residents, mainly from Erith and Crayford, go out of district for maternity care. Obviously, the solution is not simply in the hands of the district health authority. It requires positive action by the regional health authority to adopt a strategic approach to resolve these problems.
The decision to make the boundaries of London boroughs and health districts conterminous was not just some chance happening or coincidence, but a logical and sensible way of linking health authorities with the local community. Bexley health authority, like other district 763 health authorities, has members who are local councillors and the connection between the authority and the community is strong and generally effective. As a consequence, decisions should be taken in the interests of that local community and with an awareness of its needs.
In deciding to end maternity services at West Hill, Gravesham and Dartford health authority was undoubtedly acting from similar motives. West Hill is on the edge of that disctrict and for people in the Dartford area the journey to Gravesend is not so difficult. However, given Bexley health authority's objections to the change, one can only assume that limited consideration was given to the effect that this change would have on out-district patients—my constituents.
The most sensible solution would be to ensure that, so far as possible, all in-district patients have the opportunity of being treated at hospitals within their district. That should not be assumed to imply any criticism of Gravesend hospital: the complaint is about transport and sheer distance. It is of an organisational nature.
All that is being asked of my right hon. Friend the Minister, his Department and the regional health authority is that expectant mothers in Bexley be given the option of confinement at their local hospital, which they are being denied at present. Understandably my constituents find it difficult to understand why they cannot be treated within their health district, particularly as one third of those receiving maternity care at Queen Mary's are from Bexley and other neighbouring districts. They object to being forced to seek treatment miles away while at the same time they are told that out-district patients treated at Queen Mary's cannot go elsewhere for treatment because the journey would be too difficult for them.
In common with so many other complaints about the National Health Service, this complaint is not about the standard of care or about financial and material resources. It is about administration—about which I feel particularly strongly. I believe that wherever possible we should aim for district self-sufficiency. A patient should have to go out of district only as a result of arrangements that are acceptable to him. Some of my constituents in Belvedere and Thamesmead may wish to go to Greenwich, but presently they have no choice. In the cases that I have taken up with Bexley health authority, patients have been positively refused treatment at Queen Mary's. Where the decision of a neighbouring health authority might mean that a patient receives care of a lesser quality—I emphasise "might" because I have no evidence that that is so—I believe that the health authority has a moral obligation to ensure that it acts to resolve the problem.
The answer to this problem is not complicated. Pregnant women in Crayford look to the local health authority to protect their interests. I believe that we have one administrative tier too many in the NHS. I would like the regional health authority to be removed and I do not believe that my constituents would shed many tears if that authority, located in its south coast haven, was no longer around.
I urge my right hon. Friend to consider carefully in-district care and to do all that he can to ensure that patients have a choice so that they can receive their maternity and other care at their nearest district hospital. Patients are under district care and receive treatment at Queen Mary's for all other health matters except for maternity care.
764 The patient is the most important person to be considered, and I cannot emphasise too strongly that in the bureaucratic discussions that take place the patient is sometimes forgotten. We are not asking for a great deal. The numbers involved could be catered for at Queen Mary's in Sidcup if the patients of Erith and Crayford so desired. I urge my right hon. Friend to consider this matter carefully.
§ The Minister for Health (Mr. Tony Newton)First, I congratulate my hon. Friend the Member for Erith and Crayford (Mr. Evennett) on securing, once again, an Adjournment debate to pursue the interests of his constituents. I know from being here on a similar occasion not so long ago that he is extremely assiduous in pursuing his constituency interest. I have a fat file of correspondence that will also testify to that.
I hope that my hon. Friend will forgive me if I do not attempt to follow him too far down some of the wider, albeit enticing, paths which he has sought to tempt me on the wider organisation of the Health Service. As a number of problems in this case cross district boundaries, I believe there is some role for the regional health authority, or as he implied in his remarks, some body above the district health authority, to attempt to resolve the problems
My hon. Friend spoke about maternity services, and I know that he has been in correspondence with the chairman of the Bexley health authority, Mr. Brian Hord. I am also aware, from the visit to which he referred, that Bexley's district general hospital, Queen Mary's in Sidcup, is very highly thought of. I know that that is part of the background to my hon. Friend's argument. Among other things, I know that the maternity and geriatric departments are held in high esteem. The maternity department at Queen Mary's was extended in 1984. It currently has 81 obstetric beds and 14 special care baby cots and, as my hon. Friend said, it is designed to cater for 3,000 births a year.
My hon. Friend will know from some recent questions that he has asked in the House that Bexley has a greater provision of maternity beds than the average rate for English health authorities. It has 1.7 beds per thousand women in the relevant age group, compared to the 1.6 average for England. I pay tribute to the authority for its excellent record and local reputation for good care, which is borne out by its place in some of the national statistics. Bexley's neonatal mortality rate—deaths within the first 28 days following birth—is well below average, and so too is its perinatal mortality rate—stillbirths or deaths within the first week. From our 1986 Health Service indicators we know that Bexley health authority has the lowest neonatal mortality rate in England, and its perinatal mortality rate is a long way below the England and Wales average.
I can well understand why mothers are so keen on having babies at that hospital, but, as my hon. Friend said, in 1987 there were 3,423 deliveries at Queen Mary's, which was above the design capacity of 3,000 births per annum. I hope that that use of statistics does not make the place sound more like a factory than a hospital, but for planning purposes one has to make an assumption about the amount of work that will be done. Queen Mary's is already well exceeding what was orginally expected.
My hon. Friend will agree that health athorities have to plan their maternity services to provide an efficient and 765 safe level of care. Assessing the number of beds required is a complex process, using estimates of the number of women aged from 15 to 44 in the catchment area, the local birth rate and the average length of stay following childbirth. That was part of the process leading to the extension in 1984. Where demand increases beyond the planned provision and an expectant mother from outside the hospital's usual catchment area asks for her confinement to be at the hospital, she may necessarily have to be referred to a neighbouring hospital, for reasons that I am sure my hon. Friend will understand.
My hon. Friend commented on catchment areas and patient flows in his locality and acknowledged that those flows are complex. As he said, many of his constituents in Crayford have traditionally been in the catchment area of West Hill hospital in Dartford and Gravesham health authority, which is thought to be more accessible for them. Approximately 200 Bexley mothers per year have been going there for their maternity care. A reciprocal arrangement has operated, with approximately 100 mothers from Swanley—situated in the south-west corner of Dartford and Gravesham health authority's boundaries—going to Queen Mary's because that is thought to be more accessible for them. There are a variety of other arrangements between Bexley and Greenwich health authorities, which my hon. Friend mentioned.
Those cross-boundary flows of mothers sound very complicated, but I think it is fair to say that they have been well understood by local GPs and hospital staff and help to ensure that expectant mothers can go to their most accessible hospital, which is perhaps the most important point, whether it is within their own health authority's boundaries or not. There are similar arrangements in all sorts of places across the country. There is an obvious need for such arrangements in a speciality where, by definition, the possibility of a waiting list does not arise.
My hon. Friend set out the implications for his constituents—I well understand the reasons why he raised the matter—of the move of obstetric and gynaecology services from West Hill hospital in Dartford to Gravesend and North Kent hospital. I do not have time to go over those arguments in full, but in September last year, after careful study, Ministers approved the proposal, which was one of several inter-related proposals by Dartford and Gravesham health authority, to rationalise—I realise that my hon. Friend would prefer me not to use that word, but I cannot think of another one—some of its acute in-patient services. I can testify that my hon. Friend wrote to Ministers, drawing attention to his views on the matter and what he believed to be the effect on his constituents. I can assure him—I hope that this is at least some comfort—that his representations were fully considered before the final decision was taken. My hon. Friend the Under-Secretary of State visited both West Hill and Gravesend and North Kent hospitals in September last year to make sure that we had done a full assessment of the proposals and to hear the objections at first hand.
There were several reasons for our deciding in the end to endorse the Dartford and Gravesham proposals, one of which, it is important to say in the context of what my hon. Friend has raised, was that the facilities at West Hill maternity department were old, cramped and inadequate. There is little doubt that if some change had not taken 766 place, there could have been serious midwifery recruitment problems, because the likelihood is that recognition by the professional body for training purposes would have been lost. In our judgment, it would have become increasingly difficult for Dartford and Gravesham to have continued to provide a safe obstetrics service at West Hill hospital if Ministers had rejected their proposal. It is important that that should be understood.
My hon. Friend referred to the fact that there is a study of catchment areas for maternity services under way involving Bexley, Dartford and Gravesham, Greenwich and Bromley health authorities, along with the South-East Thames regional health authority. This week the chairman of Bexley wrote to my hon. Friend in some detail on the review. It is clear that the possibility of changing the arrangements for his constituents in Crayford is among those that will be considered. I am sure that the review will be undertaken thoroughly, and I undertake to ensure that the chairman of the South-East Thames regional health authority is sent a copy of the Official Report of the debate. However, I might remove that part in which my hon. Friend suggested that his existence was no longer required. I shall draw his attention to the importance that my hon. Friend attaches to the matter so that my hon. Friend's worries can be taken into account. That does not prevent my hon. Friend from writing to the regional chairman, and, if he has not done so, I hope that he will.
There is not much more that I can say this afternoon, because the study is in hand, but I mention one point on which my hon. Friend may wish to reflect and on which I hope the health authorities involved will also reflect. When preparing for this debate, I noticed that our Health Service indicators showed that lengths of stay in obstetrics in both Bexley and Dartford and Gravesham are very long—among the highest 5 per cent. in the country. The district and regional health authorities should consider that point in their deliberations, because a reduction in the lengths of stay may ease some of the pressure on their maternity departments and perhaps allow additional flexibility in their consideration of catchment areas. It is also worth noting that an increase in the so-called domino system of maternity care—not a phrase for which I care much—where mothers are in hospital for only a short time, might contribute to resolving some of the difficulties.
I have been unable to go over all the ground as to why the changes took place in Dartford and Gravesham, but I hope that I have at least said enough to convince my hon. Friend that, although those changes have been inconvenient from his point of view and he regards the result as less than satisfactory, they were made with a view to ensuring the continued provision of good maternity services and, not least, to ensuring that a proper pattern of service could continue in Dartford and Gravesham.
I have undertaken to ensure that the views expressed by my hon. Friend this afternoon will be drawn to the attention of those conducting the review. I shall urge them to do everything possible to ensure that changes are made which will convince my hon. Friend that the interests of his constituents are being met to the maximum possible extent. I shall ask the regional authority to keep me informed of developments, and I hope that it will not be too long before it reaches conclusions that my hon. Friend will find more satisfactory than the present position.
I congratulate my hon. Friend on raising this matter. His constituents can be assured that, as long as he is their 767 Member of Parliament, thay will not want for an advocate in matters relating to the quality and location of their health services.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Three o'clock.