HC Deb 24 November 1994 vol 250 cc829-34

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

9.36 pm
Mr. Malcolm Chisholm (Edinburgh, Leith)

I applied for the Adjournment debate a couple of weeks ago because of the clear intention of Lothian health board to centralise all Edinburgh maternity services at one hospital, the proposed new Edinburgh royal infirmary at the southern edge of the city, and also because it planned to break its clear promise to reopen a maternity unit at the Western general hospital, which serves large areas of my constituency.

There were several reasons why that caused anger in my constituency and beyond. First, and most important, it was a denial of the fundamental principle of choice. Choice for women means not just choosing the kind of unit in which to give birth, but the location of that unit.

Secondly, there would have been very long travel times for women in my constituency when they had to go into hospital to have their children, for antenatal visits and for visits from their relatives when they were in hospital. That would have involved great expense and many people in the catchment area of the Western general hospital are poor and deprived.

The third reason was that the health board had overlooked the high density of population and the high birth density in north Edinburgh. It seemed an ideal solution to have a maternity unit at the Western general hospital, which serves an area where there is much poverty and deprivation. It seemed a good idea to have a maternity unit near such an area rather than miles away on the other side of the city.

The fourth reason was that there seemed to be no evidence for the proposition that one centralised maternity unit was safer. That argument was being advanced by many health professionals. Yet that opinion is not shared by other health professionals. There does not seem to be any evidence to back up such a proposition.

I received a copy of a letter from a professor of paediatrics in Canada who previously worked at the Western general hospital but now works in the university of British Columbia. He said: We were, until recently, the only tertiary perinatal centre for a birth population of 45,000, with 8,000 births, heavily high risk oriented, in house. In my experience 8,000 deliveries is about twice too many. People were particularly angry because the original acute services strategy put out for consultation earlier this year contained a proposal for a maternity unit at the Western general hospital. That was overwhelmingly approved by people during the consultation process. Therefore, people were angry when that proposal was rejected and it was decided to work up another proposal in which all the births would be centralised at one mega-unit in the south of Edinburgh.

Since then, there has been a strong and vociferous campaign against that proposal. It was spearheaded by a group called the Women's Health Lobby. They did a great deal of research which showed that women simply did not want such a proposal. The group was also supported by both councils in Lothian—Lothian regional council and Edinburgh district council. It was supported by many general practitioners and by the local newspaper, the Edinburgh Evening News.

That campaign was so strong and the opposition was so overwhelming that Lothian Health was forced late in the day to come up with a compromise proposal. That became clear only at the health board meeting on Tuesday. In that compromise, the board has come up with the smallest concession that it could get away with. It is a proposal for 1,000 deliveries a year in a midwife-led unit at the Western general hospital in Edinburgh.

I am not opposed in principle to a midwife-led unit, but there are several problems with the proposal. I should like to mention at least three of them. First, there is no guarantee that it will go ahead. The health board stated in the proposal that it would evaluate other midwife-led units currently in operation in Scotland and then come to a decision. We do not know what the result of the evaluation will be. Beyond that, the proposal has to obtain the approval of the Scottish Office. We know that Lord Fraser, the Scottish Office Minister with responsibility for health, did not accept Fife health board's proposal for a midwife-led unit at Dunfermline. That is an analogous proposal to the proposal for the Western general. Both are stand-alone units without obstetric back-up on site. It is by no means clear that the proposal will be implemented.

Secondly, even if the proposal is implemented, we are talking about a single unit of 18 beds and about 1,000 deliveries a year. That will not meet the demand for that type of delivery. If Lothian Health is now saying that such a unit is acceptable at the Western general, why not have one in other places in the city? If the principle of midwife-led units is accepted, why not have more? It is clear that there will be far more demand not only from the local population but from all over the area because many women are attracted to such small units rather than the large mega-unit on the outskirts of the city.

Thirdly, many women will not be allowed to go into such a unit. In the proposal that was worked up by Western general hospital, it was stated that only 40 per cent. of local women would be eligible for such care. So the majority of women in the area which I represent would not even be allowed to have their babies in such a unit. I shall listen carefully to what women in my constituency say about the proposal for a midwife-led unit. If they accept it, I will certainly accept it, but the message that I am getting now is that such a proposal simply is not enough.

I should like to know why Lothian Health did not adopt the proposal made my me and many other people that there should be two units with perhaps the larger at the new royal infirmary. It could even have a unit of 4,000-plus deliveries, and there could still be one of 2,500-plus deliveries at the Western general. Within those large units, there could be midwife-led units. An innovation in maternity practice is to have midwife-led units in a hospital setting alongside obstetrician-led units. That proposal was not even discussed seriously at the health board meeting on Tuesday. In fact, many attempts have been made to rubbish such a proposal.

In correspondence in the past few weeks, the chairman of Lothian Health said that there would not be enough people to use such a unit at the Western general and that the catchment area would mean that only about 1,700 deliveries a year would take place there. I cannot for the life of me understand how he comes to that conclusion, because more than half of Edinburgh is nearer to the Western general than to the new royal infirmary proposed at Little France. Therefore, I do not see how he arrives at a figure of 1,700 or fewer deliveries at the Western general and, presumably, 4,500 or nearly 5,000 deliveries at the new royal infirmary.

One of the mysteries of the process has been how many deliveries we are talking about. When the proposal was first put forward, we were talking about 7,500 deliveries at the new royal infirmary, which would provide the largest maternity unit in the United Kingdom. But as the debate went on, it suddenly became clear that we were talking about 6,500 deliveries. There may be a good explanation for that. It has not been given to me. Some people are slightly sceptical about this, because the lower number of deliveries may have made it slightly easier to sell the case for a large unit.

I would like the proposal for the two units to be seriously considered. Most of all, I would like there to be a full consultation process on the new proposal. What we have before us is not the same proposal as went out to consultation earlier this year. It is for a small midwife-led unit. The indications that I am getting are that it is not accepted as adequate by the women whom I represent, so I would like an assurance from the Minister that he will ask Lothian Health to carry out a full and proper consultation. There was a slight ambiguity at the end of the meeting on Tuesday. The chairman began to talk about marketing the proposal and fortunately somebody else on the board objected and said that we needed consultation, but it was not clear if we would get it.

The most important principle in all this is that women should decide what kind of maternity care they want. Therefore, it is essential that we have full consultation on the proposal. I suspect that, if that takes place, women will say that they want a larger unit at the Western general; that they want something more in line with the original proposal that was thrown out earlier this year. That is what I am arguing for this evening and shall continue to argue for as long as the women of my constituency want it.

9.47 pm
The Parliamentary Under-Secretary of State for.Scotland (Mr. Allan Stewart)

I congratulate the hon. Member for Edinburgh, Leith (Mr. Chisholm) on his success in the ballot and on initiating this debate on an issue which we all accept is of great interest and concern to the people of Edinburgh and to his constituents in particular. He has put his case in his customary well-researched and forthright way.

The hon. Gentleman referred to the timing of the debate and, as he rightly pointed out, it was only 10 days ago, after he had applied for the debate, that my noble and learned Friend the Minister of State announced ministerial endorsement for Lothian Health's acute services strategy. At that time, proposals for the future of maternity services in Lothian were still to be finalised.

The hon. Gentleman has rightly pointed out that the board has taken a decision in the past two days on how it wishes maternity services to be provided from now until the 21st century. I hope that the hon. Gentleman will understand that my noble and learned Friend the Minister of State will need to take time to consider the proposals carefully. Therefore, I am not in a position tonight to confirm the Government's endorsement or otherwise of the proposals. However, I assure the hon. Gentleman that what he has said tonight will be read carefully by my noble and learned Friend and all the points that he has reasonably made to the House will be taken fully into account.

I am sure that the hon. Gentleman agrees that we have made great strides in developing maternity care in Scotland. I agree with his point about meeting in principle the wishes of mothers, who have been saying loud and clear that they want services that are accessible, flexible and treat them with dignity. That shift in attitudes had led to positive changes in maternity care throughout Scotland, and we are actively encouraging those developments.

This debate is specific to Edinburgh, which has long been at the forefront of innovations in maternity care. It had the first professor of midwifery in the world in 1726—Professor Joseph Gibson. The hon. Gentleman will be aware of the pioneering work later of Professor James Simpson.

To respond to the hon. Gentleman's question about the number of births in the city, there are currently 7,000 a year, and mothers have access to a full range of antenatal and post-natal services. Most women experience shared care between GPs, obstetricians and midwives. Both the Simpson Memorial maternity hospital and the Eastern general hospital offer home births, domino deliveries, midwife care and shared midwife and obstetrician care. Lothian Health is committed to building on that range of choices.

I know that the hon. Gentleman joins me in paying tribute to the major contribution that the Simpson and the Eastern general have provided to mothers over the years. Tribute should be paid also to the excellent delivery services formerly provided by the Elsie Inglis maternity hospital and the Western general hospital.

There have been major changes in the pattern of maternity care in Edinburgh over the years and growing recognition of the need for proper community-based maternity care. Lothian Health would freely admit that there is considerably further to go in developing community-based services and ensuring that delivery services are fully sensitive to the needs of mothers. It is addressing those issues in its review of maternity services.

The immediate spur to action for Lothian Health has been the need to reconfigure maternity services in the light of its acute services strategy. In future, adult acute in-patient hospital services will be provided from three modern hospitals in Lothian. For Edinburgh, that means a new state-of-the-art royal infirmary, which will be built in Little France in south-east Edinburgh, and a substantial redevelopment and upgrading of the Western general. That is excellent news for Edinburgh, which for too long has had to make do with aging and increasingly outdated hospital buildings.

The proposals were, of course, strongly supported in Lothian Health's public consultation, and they promise substantial improvements in acute in-patient care. The hon. Gentleman raised the specific issue of further consultation. That matter is for Lothian, which will no doubt carefully read the hon. Gentleman's remarks.

To deliver that 21st century pattern of hospital services, it is necessary to close outdated and old buildings. More specifically, when Lothian consulted the public on its acute strategy, it proposed three maternity units in Lothian, with one each at the new royal infirmary and at the Western general hospital—the third being at St John's hospital in Livingston. That proposal was, of course, widely welcomed.

Subsequently, the board accepted that it should take account of concerns expressed that the highest standards of care might not be possible unless deliveries were kept to just two sites in Lothian. The health board was mindful of the need to consider both the importance of local accessibility, to which the hon. Gentleman rightly referred, and the requirement to secure a pattern of service that offers the greatest possible scope for successful outcomes. The board therefore commissioned its maternity services liaison committee to conduct a full appraisal comparing the two-site and three-site options. As the hon. Gentleman told the House, the committee's report came down in favour of two sites—one at St John's and one in Edinburgh—and the board undertook to consider that report at its meeting on 22 November. Ministers were happy to announce their approval of the acute services strategy last week on the understanding that the maternity issue could remain unresolved for a little longer, but Ministers would need to approve the board's final proposals.

As the hon. Member knows, the board has now decided to accept its maternity services liaison committee's recommendations. It is committed to the principles that primary care should be the main focus of maternity services; community-based midwifery teams are needed to ensure greater continuity of care; and consultant-led obstetric outreach facilities should be further developed to provide local community care for more complex pregnancies. The board also intends further to develop neonatal services, enhance the range of anaesthetic services and look into furthqr developing maternal intensive care services for those with the greatest need for medical care.

Mr. Chisholm

Does the Minister realise that, in some ways, the centralisation plan was sold under the cover of having community services for antenatal care, yet in the original acute services strategy, it was proposed that antenatal care should be given in the community, so the issue of antenatal care is separate from that of a mega-unit?

Mr. Stewart

Yes, but in the context of the strategy as a whole, antenatal care is a key issue. The hon. Gentleman and I do not disagree about that. If those principles are taken together, they represent an impressive list of commitments and the key principle of the strategy is a major move towards community-based ante and post-natal maternity services. I am not pre-empting anything that my noble Friend the Minister of State may decide by saying that those principles are to be welcomed.

The hon. Gentleman concentrated on the key issue of whether facilities should be supplied in addition to those already proposed by the board. The Government welcome the evaluation of the midwife-led model of care for deliveries. In proposing the unit to which he referred for the Western general hospital, the health board has been mindful of the experimental midwife units that have been set up in Glasgow, Aberdeen and Kirkcaldy, as well as south of the border. We are now starting to learn about the key conditions that need to be met to ensure that such units can work effectively and safely, especially if they are not alongside an obstetric delivery unit. The support of all participating professionals is needed. Midwives running the units need the necessary skills and confidence. That is common ground.

To sum up, I congratulate the health board on coming up with proposals for maternity services which clearly demonstrate its commitment to delivering the highest possible quality of service. I welcome its concern to deliver greater choice in delivery, to ensure the highest standards of safety and further promote the availability of accessible and flexible services based in the community.

I congratulate the hon. Member on raising this debate, in such timely fashion, on these important matters and assure him that my right hon. and noble Friend the Minister of State will take his comments fully into account before final decisions are made.

Question put and agreed to.

Adjourned accordingly at one minute to Ten o'clock.