§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorrell.]
12.53 am§ Mr. Patrick McLoughlin (Derbyshire, West)In a previous Adjournment debate, I had the opportunity to talk about the future of two schools about which my hon. Friend the Minister and I felt strongly—Ecclesbourne school and the John Port school in my hon. Friend's constituency. We were successful in saving the sixth forms of those schools, and I hope that I am as successful tonight.
There has been much discussion of the maternity services of Ashbourne and Belper as provided by the Chevin unit at Babington hospital. I know that my hon. and learned Friend the Member for Burton (Mr. Lawrence) has told my hon. Friend the Minister of his wish to contribute to the debate, and I can say that I am speaking this morning with the full support of my hon. Friend the Member for Staffordshire, Moorlands (Mr. Knox), who shares the concern that is felt about the future of the Ashbourne maternity unit.
It would be wrong to assume that the unit serves only Ashbourne. Instead, it serves a wide area around Ashbourne, part of which extends across the border into Staffordshire. The unit is a highly valued part of the community, as is borne out by the massive public response against the health authority's proposals. The protests that I have received have been concerned mainly with geographical and practical considerations, for the unit is about 15 miles from Derby. That may not sound a great distance, but in the winter it would be difficult for many to travel to Derby. The health authority has referred to average journey times in some of the documentation which it has issued. It has accepted the times of 82 minutes from Mayfield and 74 minutes from Ashbourne to the city hospital at Derby.
I am concerned about the way in which the health authority's proposals have been introduced. It is intended temporarily to close the unit, or units, on 18 December. That is outrageous and disgraceful. It pre-empts any decision that my right hon. and learned Friend the Secretary of State for Health may make. I cannot see my right hon. and learned Friend overturning the authority's decisions following its decision to redeploy staff. The authority should wait until my right hon. and learned Friend has announced his decision on its proposals.
There is no doubt that the authority faces a financial problem, and part of it is set out in the consultation document. Part of the document states:
There are a number of possible risks facing the Authority which would make the position described above worse. First, it is possible that we shall have to provide funds to meet the cost of some pay awards.We know now that that is not the position.Second, it is already apparent that the increase in Local Authority rates for 1988/89 is greater than 4.5 per cent., which is the figure that the Authority has available to fund it, and this will increase the financial problems of the Authority by £234,000.As my hon. Friend the Minister is well aware, my constituents and I live in the highest rated shire county in Britain. There is no doubt that that rating has added to some of the problems that have confronted the health authority.148 I am speaking of a unit that is entirely separate from other hospitals. There is another hospital in Ashbourne—St. Oswald's—to which it was planned to move the unit early in the 1990s. I welcome that plan. It is right that the unit should be moved there. The move would make St. Oswald's more of a community hospital. At present, it cares mainly for the elderly and undertakes the tasks of a small minor casualty unit. If it were possible to take the maternity unit and put it on the site of St. Oswald's, I believe that would greatly help the area and greatly improve the local facilities. The health authority could then sell the land on which the Ashbourne maternity unit is situated, and thus raise a considerable capital asset.
I notice that in its consultation documents it talks about this unit along with a plan for the closure of other maternity units, and it says that it expects the sale of the units to raise some £200,000. I believe that it is erring on the gravest possible side of caution, as the Ashbourne site alone is likely to fetch more than £200,000. Therefore, the health authority will have capital available to improve some of the facilities at St. Oswald's, which I believe is vital.
A short while ago, I visited Derby city hospital and I would like to place on the record a few facts about that hospital. It has come in for some criticism from various sources, but I can only say that I was tremendously impressed with what the City hospital has to offer. Nobody can argue that it does other than hold all the facilities that a high-tech birth requires. I saw babies in the hospital who had been born at 24 weeks, and the care that can be given to those babies at that hospital is unbelievable. No one is saying, or has ever said, that that sort of facility can be offered at St. Oswald's. What the people in Ashbourne are saying is that, a week before Christmas, before the worst of the winter and before the Secretary of State's approval is the wrong time to close the unit.
Not so long ago my hon. Friend the Under-Secretary was kind enough to come to my constituency and participate in "Any Questions". My hon. Friend knows the sincere feelings of parents in that area. She has said that quite often we manage to get along with the procedure without going to Ministers, and that we usually carry people along when we talk about changes. If the health authority proposed a proposal to move the maternity unit up to St. Oswald's, my hon. Friend would have local agreement, my full support, and the health authority—as it obviously is not my hon. Friend's decision—would have my full support. That is what we are anxious to see happen.
A number of aspects worry us, such as the likelihood of an increase in home confinements, which is confirmed by the health authority's documents. One matter that especially worries me is that it does not say in its documents that it is closing the maternity unit and taking it to Derby to improve the maternity service, but the reason given is that the closure should take place on financial grounds. I find that difficult to accept, because, although the health authority has listed the savings that it believes will be made, it does not make any allowances for any increase in the ambulance service, and at present it is saying that all that would be needed is 1.32 full-time community midwives. At the end of the day, I do not believe that that will prove sufficient.
I should like Trent regional health authority to ask the district health authority to conduct a special review of 149 health care in the Ashbourne area in relation to the position of St. Oswald's in the community. St. Oswald's is a community hospital; let us see it used and become more a part of the community than it is at present. Let us see the leagues of friends from the maternity unit and St. Oswald's making a positive contribution to a community hospital in the Ashbourne area. I think that that would get a lot of support.
I plead with the Minister, and through her with the Southern Derbyshire district health authority, not to make the closures until adequate provision has been made or until the need for provision has been assessed and the Secretary of State is sure that the closures should go ahead.
The consultation paper about Ashbourne, which was published by the health authority, discusses selling off the unit, but it also says that, presently,
It is not intended to dispose of the site".I am particularly concerned by such words.In southern Derbyshire, we have a great deal of new hospital accommodation, but we also have a lot of old accommodation. That accommodation is a liability on the health authority and it is leading to many of the authority's present financial problems.
Babington hospital is based in Belper. It is a valued local facility and the Chevin maternity unit serves a number of surrounding districts, including Crich. The average journey time from Crich to the new city hospital will be 100 minutes.
§ Mr. McLoughlinMy hon. Friend disagrees, but that figure was derived from the Southern Derbyshire health authority's public transport access arrangements; it is not my figure. The return fare will be £4.68. The journey time would riot be as important if the journey was made once, but what about the husband who wants to visit his wife a number of times so that she does not feel isolated in the city hospital?
With the Ashbourne facility, the health authority knows that it has a unit to close, which it can sell to make a capital gain. That is not the case with the Chevin maternity unit, which is part of the Babington hospital, which mainly cares for the elderly. I want such hospitals to be part of the community rather than serving an isolated sector of it the—elderly. They should offer a range of patient care. That is why I wanted to bring this matter to my hon. Friend's attention.
Although the health authority may have the power within the rules to press ahead with the closures on 18 December, I do not think that that is right. I believe that that cuts short the political process that allows representations to be made at the highest level, and I believe that that is wrong.
I urge the health authority to reverse its action and not to go ahead with the closures until it has had the agreement of the Secretary of State. The health authority should go one step further and reach a consensus so that the Secretary of State does not have to make a decision. We should make a local decision about the hospitals rather than ask the Secretary to the State to make it.
§ 1.9 am
§ Mr. Ivan Lawrence (Burton)rose—
§ Mr. Deputy Speaker (Mr. Harold Walker)Does the hon. and learned Gentleman have the consent of both the Minister and the hon. Member for Derbyshire, West (Mr. McLoughlin)?
§ Mr. LawrenceYes. I am grateful for the opportunity to intervene in the debate.
Although Ashbourne maternity home is not in my constituency, I have to tell my hon. Friend the Minister that there is very strong feeling against the closure in east Staffordshire, for that home, with such an excellent reputation, serves many of my constituents. They have written to me from Ramsho rn, Mayfield, Uttoxeter, Leigh, Bramshall, Ellastone, M.archington, Denstone and Rocester. The South-East Staffordshire community health council has received over 100 letters from members of the general public in my constituency, all opposing the closure. It has received representations, as I have, from the women's institutes, local doctors and local midwives.
Of course the removal of a local facility always produces an adverse response, but the proposal is particularly galling and unnecessary. When Leek and Wirksworth maternity homes were closed in recent years, the argument for their closure was that Ashbourne maternity home would provide the services that had been closed down in those villages. When the snows pile up and the roads of south Derbyshire become treacherous in the winter, as they do almost year upon year, mothers and visitors will have to make a road trip of 35 to 40 miles because there are no maternity facilities in Uttoxeter.
Undoubtedly, new facilities at Derby city hospital will be of the highest standard, but what consolation will that be for mothers who have a rapid labour and have the risk and misery of worrying about the delivery while they make the long journey to Derby on winter roads? What about those of my constituents who have no access to private transport, when public transport is not always available just when a baby is about to be born or the mother is in distress?
My hon. Friend the Member for Derbyshire, West (Mr. McLoughlin) has made an excellent case. He is a great example of a caring Member of Parliament working at his best. He has my full support. He also deserves the support of my hon. Friend the Minister who is, as she well knows, my own Member of Parliament. I hope that she will be able to respond positively to our demands. Of course I appreciate that it may not be feasible to keep open Ashbourne maternity home in all the circumstances—my hon. Friend, and the district and regional health authorities, have analysed that. But if that is so, there is a sensible and practical alternative in transferring the facility to St. Oswald's hospital, which is nearby and is excellent.
I support the request of my hon. Friend the Member for Derbyshire, West for a full review of the hospital and the health facilities in his area. The Government have done wonders for the National Health Service. They are building up facilities all over the country which were run down under the previous Labour Government. They are spending more money than ever before. They are paying the nurses more than ever before. They are providing care and help undreamed of in years gone by.
Why is it necessary to spoil such an achievement and the appreciation for that achievement that is demonstrated 151 in election after election by my constituents, by over-centralisation, when the retention of village hospitals is perfectly feasible in some circumstances such as this and when that becomes socially desirable? It is a particularly cruel stroke if this maternity home is to be closed before that review takes place and before Christmas 1988. I ask my hon. Friend the Minister to think again.
§ The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie)I congratulate my hon. Friend the Member for Derbyshire, West (Mr. McLoughlin) on winning the ballot, and I noted with pleasure the intervention from my hon. and learned Friend the Member for Burton (Mr. Lawrence). They are my close neighbours in the midlands and no one could have better hon. Friends or neighbours. I am grateful for the help and support that they give me in my work here and the way in which we work together in the midlands.
I note that my hon. Friend the Member for Derbyshire, West takes a keen and active interest in the health and welfare of his constituents. He tells me that he took part in a delegation in July to discuss health matters affecting his constituency with the then Minister for Health. He has written 25 letters and tabled 20 questions on health-related matters since the general election, and he has certainly kept me busy.
I know the Southern Derbyshire district health authority very well, as it covers my constituency. It also serves the residents in the constituencies of Erewash, Derby, North and South and Amber Valley. It looks after the best part of 500,000 people and is one of the largest health authorities in the country. It is covered by the Trent regional health authority, which is also an enormous region. Its spending rose from £369 million 10 years ago to more than £1,000 million last year, an increase of about 14 per cent. in real terms. This year, Trent's initial cash allocation was increased by a further 6.3 per cent. to over £1,050 million, well above the national average increase of 5.7 per cent. As a result, Trent's poor funding in the past has now been corrected and it has moved from 92 per cent. of its target 10 years ago to 97 per cent. under the RAWP allocation.
We should not under-estimate the impact of the Trent regional health authority or of the National Health Service generally on local life. More than 660,000 in-patients were cared for in Trent hospitals last year and total employment in the regional health authority stands at about 75,000 whole-time equivalent staff. The amount of money contributed to the local economy by the health authority is considerable.
The South Derbyshire health authority has had a momentous year and we should not under-estimate how much it has achieved. It has opened three major new developments at Ilkeston community hospital, Derby city phase I—which includes a maternity unit—and the Derbyshire royal infirmary stage II which was opened in May. During 1988, 644 old beds have closed in the area and have been replaced by 585 new ones.
That has led to much improved occupancy rates, which were hovering around the 50 to 60 per cent. mark in some of the major specialties. It has also led to spectacular improvements in the waiting times and lists, improvements 152 which we hope will continue. The authority is in the middle of a painful and obviously very contentious process of rationalising hospital services. Since 1986, 10 hospitals have been replaced or closed. The health authority voted to close another six in September, including the four under discussion today.
My hon. Friends will be aware that most of the decisions were settled locally and did not come to Ministers. The closures are only partly due to finance. In a number of cases, the decisions were taken because the area was well endowed with small old Victorian hospitals whose economic lives would soon come to an end.
The district had an initial allocation this year of £100.7 million. That represents almost a 6 per cent. increase in cash limit over the previous year. When I became a Member of the House, the authority was spending £78 million. When my hon. Friend the Member for Derbyshire, West became a Member in 1985–86, it was spending £86 million. As I have said, this year the initial allocation is £100 million and the authority has access to other funds. That clearly shows that South Derbyshire health authority has received a great deal more money this year than last year and is much better endowed than before. Therefore, I do not think that the health authority has a strong case for arguing that it should have a lot more money. It has been allocated a much higher share from Trent's increased resources.
At the end of 1987–88, the district had an overspend of £2.2 million and at the beginning of this year it faced a deficit of £2.7 million. Most of that was due to overspending at the Derbyshire royal infirmary. Having opened new facilities at the DRI, the authority found that people liked them and activity levels jumped by about 8 per cent. in one year. That was part of a 23 per cent. increase in activity levels over the past five years.
The authority has considered its health indicators, the most recent of which relate to 1986–87. They show that the total proportion of acute patients dealt with as day cases in the Southern Derbyshire health authority was barely 9 per cent. and was as low as 2 per cent. in some specialties. However, in the health authority that covers most of the constituency of my hon. and learned Friend the Member for Burton—the South-East Staffordshire health authority—the overall figure for day cases was 22 per cent. and in some specialties it was heading for 50 per cent. As a result, the average cost per patient in the South-East Staffordshire health authority area was £514. In Southern Derbyshire, it was £738. Given the patient mix, that was 12 per cent. higher than expected. The health authority is well aware of these figures. They do not mean that, automatically, Southern Derbyshire is inefficient, but they raise questions that need to be examined, and I understand that the health authority is doing that.
The health authority has much success under its belt and should be proud of that. After a slow start under general management, the pace quickened in the last year or so, and major changes are now under way. While I and my constituents probably have fewer hospitals to visit, the standards in those hospitals are immeasurably higher, and modern facilities of the highest standard are now at last available to Derbyshire people after years of losing out somewhat to the south of England and, more recently perhaps, to Nottingham and Sheffield.
The district health authority is looking after more people better and faster and getting them home more quickly. With the arrival in Southern Derbyshire of 153 Trent's trend-setting personal services philosophy, which I saw for myself in Nottingham recently, I am sure that the health authority's public image will improve. Certainly, its presentation of some of its policies could improve: I am sure that we all agree on that.
My hon. Friend the Member for Derbyshire, West asked for a review of the services around Ashbourne. I know that the regional health authority has taken heed of his concerns. It tells me that it spent some time discussing with the Southern Derbyshire health authority the health needs of Ashbourne and its surrounding villages. It has agreed to look specifically at Ashbourne and the surrounding communities with representatives of the local community and to look at the broad shape of in-patient and out-patient services, as well as the wider network of community services. In so doing, the health authority will look specifically at the longer-term role of St. Oswald's hospital, and that will give it the opportunity to discuss the ideas that my hon. Friend has so eloquently put forward.
As I am sure my hon. Friends will realise, the closure of peripheral maternity units puts me in some legal difficulty. If the community health council persists in its opposition to closure, these matters will come for decision to my right hon. and learned Friend the Secretary of State. I take on board what was said about temporary closure. That is quite commonly done, and quite legal, although I realise that it can infuriate local people. It does not influence the judgment of my right hon. and learned Friend on these matters, and he will base his decisions entirely on what is needed for patients, mothers and babies in that area.
154 In the short time that is left, I should like to place on record one or two facts. The 1987 figures for perinatal mortality in our area are not as satisfactory as any of us would hope. Perinatal mortality, which is mortality within one week of birth, in England and Wales in 1987 was 8.9. In Trent, it was 9.3 and in Southern Derbyshire it was 9.6. Our new figures to be published nationally tomorrow will show that mortality among our babies has fallen again to a new all-time low. We all hope that that will happen in the Southern Derbyshire health authority area as well.
My hon. and learned Friend the Member for Burton spoke about the problems of travelling. I can tell him that people in labour are already travelling. I am advised that, of mothers admitted to local maternity units for births but later transferred to a district maternity hospital in 1987, Ashbourne had 20, Ilkeston had 13, Heanor had eight and Belper had 68. In the period April to December 1987, 27 of those women from the Babbington unit at Belper were transferred during labour. I do not know whether my hon. and learned Friend has ever tried travelling in an ambulance during labour. I can tell him that it is the most uncomfortable journey that one can have. When my right hon. and learned Friend takes his decision, it would be wise to take that sort of information into account.
§ Question put at and agreed to.
§ Adjourned accordingly at twenty-three minutes past One o'clock.