Maternity Services (East Lancashire) (Hansard, 14 April 1989)

§ Mr. Ken Hargreaves (Hyndburn)

I welcome the opportunity to draw the House's attention to the concern of right hon. and hon. Members representing east Lancashire constituencies about the inadequate maternity services in the area covered by the Blackburn, Hyndburn and Ribble Valley district health authority. The concern that I shall outline is shared by my right hon. Friend the Member for Ribble Valley (Mr. Waddington) and my hon. Friend the Member for Rossendale and Darwen (Mr. Trippier) but, because of their ministerial positions, they are unable to take part in the debate. The concern is also shared by the hon. Member for Blackburn (Mr. Straw) who is unable to be present because of a longstanding engagement in Cheshire. His interest in the need for improved maternity services is clearly shown by the fact that he raised the matter in an Adjournment debate two years ago.

I wish to make an urgent plea for reconsideration of the place in the North West region's capital programme of the new maternity unit for Blackburn, Hyndburn, and Ribble Valley district health authority. The provision of a centralised maternity unit has been considered urgent since the 1970s, and in 1979 was recognised as the highest priority of the former Lancashire health authority. The regional health authority incorporated the scheme as phase IIIA of a development programme for Queen's Park hospital. After much discussion, it was eventually included in the regional capital programme in 1985, with a start date of 1990–91, which was subsequently put back to 1992–93. As a result of the changes in the approval process, the current status of the scheme and its start date are not known. Current and future problems are so acute that urgent action is needed if a crisis is to be avoided.

At present, district maternity services are provided on three sites—the main consultant unit at Queen's Park hospital, which has 67 beds, the GP unit at Victoria Accrington hospital, which has 15 beds, and the GP unit at Bramley Meade, Whalley, which has 20 beds. The GP unit at Darwen was closed in 1988 because of a substantial fall in the number of births. The authority decided that staff and resources could be used more efficiently by providing a temporary GP unit with 10 beds at Queen's Park hospital.

The problem is accentuated by the fact that between 1978 and 1988 the proportion of births in GP units fell from 30 per cent. to 9 per cent. This change, together with a rise in birth rate, led to an increase in the number of births at Queen's Park hospital from 2,409 in 1978 to 3,591 in 1988—a rise of 49 per cent. Latest projections show that the number of births to residents of east Lancashire will continue to increase to more than 4,500 by 1993. If the current trend continues, most of the births will be at Queen's Park hospital.

The total number of beds and staffing levels in the district reflect the regional average, but unfortunately the combination of a rising birth rate, a three-site operation and a 20 per cent. deficiency in consultant beds has placed enormous pressure on staff and facilities at Queen's Park hospital. Clinicians and midwives are extremely concerned 1229 that the work load has increased to a point at which an effective and safe service can no longer be maintained. In 1985, while the number of births per midwife was 26.88 in the region as a whole and 29.6 in the district, it was a massive 49.4 at Queen's Park hospital—80 per cent. higher than the regional average.

The unit at Queen's Park hospital is clearly extremely busy and junior medical staff cover is inadequate. There is only one registrar for obstetrics and gynaecology. I believe that no other district which delivers 4,000 babies per year has only one registrar. The problem is further compounded by the fact that the registrar has commitments at other sites, particularly Blackburn royal infirmary.

I referred earlier to the debate initiated two years ago by the hon. Member for Blackburn. He reminded the House at that time that: 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 arc curtained off and there are only two small waiting areas 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 … Such is the pressure on beds that no mother stays after birth for more than 24 hours unless she or her baby is ill."—[Official Report, 22 April 1987; Vol. 114, c. 767.] In the two years since that debate, matters have not improved. The special care unit is on the lower ground floor, away from the main area. Only one lift serves the entire facility, sanitary accommodation is in a poor state, and there is no anaesthetic or recovery room. The position is not only wholly unsatisfactory, but grossly wasteful and inefficient.

The figures and examples cited give some idea of the unsatisfactory conditions that patients have to endure and under which the staff have to work. But for the dedication of the excellent medical, midwifery, nursing and ancillary staff at Queen's Park hospital, Accrington Victoria hospital and Bramley Meade hospital, the service would have broken down many years ago. It is sometimes difficult to escape the feeling that the district health authority is being penalised because it has made do with facilities that would not be acceptable elsewhere.

As the starting date of phase IIIA is unknown, the district health authority has had to consider interim measures. In February, the authority decided that bookings for deliveries could no longer be accepted from patients resident outside the district. There is a real danger that bookings for deliveries even from patients resident in the district will have to be refused and that mothers will be sent to hospitals miles away. The district health authority is well aware of that possibility and because it would be totally unacceptable if that happened it has recently agreed that improved delivery facilities and a temporary ward will have to be constructed at Queen's Park hospital in the near future. That is not only unsatisfactory and a poor use of the money available, but carries with it the risk that once we have a temporary ward, poor though it may be, we shall once again be seen to be making do, which may cause further delay in providing the much overdue unit at Queen's Park hospital.

The maternity service in Blackburn is already under pressure, with a high number of births, a high proportion of low weight births and a consequently heavy work load in the central unit. The service is already operating under 1230 conditions of considerable risk. The region's guidelines for the operation of general practitioner maternity units cannot be met, which has serious legal implications. The birth rate is forecast to rise significantly by 1993. If that happens and the decline in the number of births at the GP unit continues, the unit at Queen's Park hospital will be unable to cope. The new maternity unit will enable the district health authority to deal with its work load and will allow scarce resources in midwifery and medical staffing to be used more efficiently and with greater cost effectiveness. I ask the regional health authority to recognise the urgency of the situation and to support the view of Blackburn, Hyndburn and Ribble Valley district health authority that the only solution to the impending crisis—which could have serious legal implications—is to bring forward the new maternity unit in its capital programme. Building on the unit should be brought forward to start in 1989.

I hope that the Minister will feel able to say that he agrees with hon. Members representing constituencies in east Lancashire who say that the present situation is unacceptable. I hope, too, that he will do all that he can to encourage and persuade the regional health authority to find some way of ensuring that this important project is given urgent priority and that a date for the start of construction is decided as soon as possible, so that my constituents and those of other east Lancashire Members may benefit from a safe, efficient and effective service.

I assure my hon. Friend the Minister that we appreciate the enormous improvements in National Health Service provision in east Lancashire in the past 10 years. There has been a £4.5 million redevelopment at Queen's Park with 54 adult acute beds and 46 children's beds replacing wards that were appalling; £300,000 has been allocated for a renal unit at Accrington Victoria hospital and £200,000 has been provided to upgrade the theatres at Blackburn. Those are only three recent examples. Nevertheless, grateful as we are, we should be failing in our duty as Members for east Lancashire if we did not do everything in our power to ensure the urgent provision of the long-awaited maternity unit at Queen's Park hospital.

§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

Before dealing with the detail of this important subject, I should congratulate my hon. Friend the Member for Hyndburn (Mr. Hargreaves) on his success in the ballot. I am aware of the close interest that he has taken over many years in the provision of health care services for his constituents. This debate is yet another example of his continued presure on behalf of the people of east Lancashire. My hon. Friend is no doubt aware that the need for better maternity services in east Lancashire has been accepted by both the district and the regional health authorities. I, too, accept the need for improved maternity services and I hope that my hon. Friend is convinced that the Department of Health takes the matter seriously.

The maternity services for east Lancashire are provided' by the Blackburn, Hyndburn and Ribble Valley health authority. I hope that the House will allow me to comment briefly on the provision of patient services generally before responding to the points put to me about maternity services as it is important to set maternity provision in the context of hospital services generally.

1231 The Blackburn, Hyndburn and Ribble Valley health authority provides the full range of health care services for a local population of 268,000 people. The health authority's record on achieving improved patient services in recent years is good. Comparing the latest available figures for 1987–88 with those for 1982 we see that the in-patient annual treatment rate is up by 17.3 per cent. from 36,926 to 43,315, the outpatient rate is up by 18 per cent. from 158,000 to 187,000, and the number of persons treated by community nurses in the district is up by 33.2 per cent. from 65,000 to 86,000. Those figures, of course, do not show the increases in the quality of care which have also taken place.

Perhaps a more tangible sign to the local community of the improvement in services locally is the local building programme, which is well advanced, to modernise and upgrade buildings and equipment at Queen's Park hospital, Blackburn. The first phase has been completed and took the first patients in 1987. As my hon. Friend knows, this provided 46 paediatric medical beds and 56 acute medical beds and a range of other patient facilities, all at a cost of £4.6 million. Construction of phase II is due to start this year and will provide 76 geriatric beds and 50 day places and support services, including a new catering department. The total cost will be £8.3 million. Those new buildings and the facilities that they contain will ensure that the improvements in patient care achieved in recent years will continue well into the future, but the building programme must not end there.

With regard to the specific subject raised by my hon. Friend, it may be helpful to the House if I first give some of the background to the maternity services available in east Lancashire. Current district provision is located on three sites—Queen's Park hospital, Blackburn, whch has 67 consultant beds, 10 GP beds and seven delivery suites; Bramley Meade maternity home, Whalley, which has 20 GP beds and two delivery suites; and Accrington Victoria hospital, which has 15 GP beds and two delivery suites. The two smaller GP units are nine miles and six miles respectively from the main unit at Queen's Park hospital.

Taken overall, the district has about the right number of maternity beds, but changes in the pattern of work between the GP units and Queen's Park hospital have put the main unit at Queen's Park under considerable strain. I agree about the way in which the pattern of work has changed in the past few years and I agree with my hon. Friend's forecast of the number of births likely to occur in the next decade. The increased pressure at Queen's Park hospital, Blackburn is due not wholly but partly to the desire of general practitioners to refer expectant mothers to a large hospital with a full range of maternity facilites available, and the Department of Health understands that trend, which occurs throughout the country.

That brings me back to the building programme for the district. The solution to the problem is a further phase IIIA of building at Queen's Park hospital to provide extra 1232 maternity beds on the main district general hospital site to replace those presently located at the GP units. The health authority is aware however, that even if the phase IIIA capital development could be brought forward it would not be ready in time to solve the immediate problem.

I can reassure my hon. Friend that the Blackburn, Hyndburn and Ribble Valley Health Authority is aware of the need for immediate action to deal with the problem that I have outlined. The authority has given it the highest priority for action. I know that the full health authority has discussed it at both its last two meetings and that the district general manager has met regional health authority officers to discuss what action can be taken. At its meeting on 5 April, the district health authority made a decision on a further, more substantial measure to deal with the immediate effects of the problem. In conjunction with the regional health authority, it has agreed to erect a temporary building at the Queen's Park hospital as soon as possible. Final decisions have not been made about the extra facilities that this will allow, but it is hoped that it will contain 19 extra beds and two more delivery suites.

I am pleased to announce that, as an exceptional gesture, the North Western regional health authority has agreed to provide additional capital funding of £450,000 to the district to make that building possible, and I am advised that the building will be well founded and of an acceptable quality. It will not be temporary or makeshift but will, I hope, have a long-term use. It will not be a permanent solution to the problem, to which I shall now turn, but it will produce an immediate expansion in the facilities available in the short term.

Clearly the measures that I have outlined must be regarded as short term. I understand that both the district and regional health authorities regard the completion of phase IIIA as the permanent solution. The comments made by my hon. Friend add further weight to that view. When my predecessor spoke about phase IIIA in the Adjournment debate two years ago, she mentioned a start date for it in 1992–93. In the light of the points put to me today, I shall ask the regional health authority to advise me of the implications of achieving that. I mean the implications for the capital programme for the region, the revenue implications for the district and the potential closure decisions on the two smaller facilities to which GPs refer their patients for maternity care. I shall then discuss the details with the regional chairman when I am in the region next month.

In concluding my response to the points put to me during the debate on this important subject I pay tribute to the medical, midwifery and other support staff providing maternity services in east Lancashire. I know that my hon. Friend will join me in that tribute. We all value highly the extra efforts which I know that they have made to safeguard the standard of care that they give to mothers during the present period of difficulties which I hope will shortly be put right permanently.