§ Mr. Thomas McAvoy (Glasgow, Rutherglen)
My reason for requesting the debate is that Greater Glasgow health board has issued a consultation paper which proposes, among other things, the closure of Rutherglen maternity hospital. The debate is a direct response to that proposal. I have the support of my hon. Friends the Members for East Kilbride (Mr. Ingram), for Glasgow, Shettleston (Mr. Marshall), for Glasgow, Central (Mr. Watson), for Glasgow, Cathcart (Mr. Maxton) and for Hamilton (Mr. Robertson).
The hospital was officially opened in May 1979 and has clearly established a first-class record for providing service to the area. The proposal is to close the hospital and to direct the people in its catchment area to Southern general hospital. The catchment area consists basically of Cambuslang, Halfway, Rutherglen, Toryglen and East Kilbride, in which a third of the mothers attending the hospital live, and it includes a swathe of south Glasgow. That is a big area containing 250,000 people. In contrast to many areas and to proposals for hospital closures, this catchment area is expanding, especially in East Kilbride.
The board's only justification for the closure is the "stand-alone" principle, with which I shall deal later. I am bitterly disappointed that, in a 20-page document, the future of the hospital is dealt with in six lines, within which the hospital and its ethos and service are dismissed by the board. It is disgraceful that the hospital is felt to be so unimportant that it is dealt with in such a short space.
By the end of the year, the hospital will have delivered almost 50,000 babies. It has an excellent record not only for the service that it was started to provide but for the various services that the hospital has developed since it opened. It provides a day-care unit, a parenthood education department, a community midwifery base, physiotherapy and speech therapy units, and two pre and post-natal wards with 50 beds. The ground floors house an antenatal clinic, ultrasound facilities, an X-ray department, a dietician, social workers, a pharmacy, biochemistry and an in-service training department.
I do not intend any criticism of any hospital anywhere in the Greater Glasgow health board area when I say that I cannot think of a more modern and up-to-date maternity facility in that area. As befits a centre of excellence, it continues to expand its services. Recent developments include a pre-pregnancy clinic which provides consultant assessment and counselling on a one-to-one basis. The hospital has an Ultramark 9 scanner, which is one of the most up-to-date available. It has a day-care unit for the monitoring and assessment of maternal and foetal well-being and it provides a comfortable environment. I shall deal with that later in my speech. It has a host of special facilities which it has developed over the years, and that justifies my view that it is a first-class centre of excellence.
Over the years, two wards have been closed on the top floor. The board made a special case on that to the Minister, but they were closed as a result of the shorter time that women now stay in hospital after having their babies—it has dropped from over a week in some cases to just a couple of days. In the spirit and attitude of the Rutherglen maternity hospital, those wards have been put to positive use and now contain the X-ray service and 1004 physiotherapists and speech therapists. One indication of the work that has been put in by the hospital staff is community support. Fund-raising events have been held frequently to ensure that the hospital is one of the best equipped in the city of Glasgow or the surrounding area. There was such an input from people that it has become a vital care in the community asset in which most of the younger people have a firm stake. The hospital has an excellent record in clinical safety, and I shall expand on that when dealing with the stand-alone argument.
In addition to the services which I have mentioned, the hospital has a first-class training department. It is part of the Victoria infirmary NHS trust and is committed to the pursuit of excellence through clinical training, audit and research. It provides higher professional training for senior registrars, and participates in an extensive range of clinical audit and research projects, which include a leading UK role in fish oil trials in pregnancy. There has been a systematic review of clinical practice in labour suites and it has locally co-ordinated the Scottish joint breast feeding initiative. It uses the Cochrane database which provides information on clinical trials in obstetrics. Those and other continuing developments in clinical practice clearly show that it is not just a maternity hospital but a centre of excellence.
§ Mr. Adam Ingram (East Kilbride)
My hon. Friend's views are strongly expressed in my community. Some 900 births a year—two thirds of all the births in East Kilbride—occur in that hospital. Its closure will have a major impact on the delivery of hospital, maternity and obstetric services in that important part of Lanarkshire. I congratulate my hon. Friend on raising these issues and wish him well in his campaign, which has the full support of my constituents.
§ Mr. McAvoy
I am grateful to my hon. Friend for that intervention. East Kilbride is a key part of the area that is covered by Rutherglen maternity hospital. That is shown by the fact that the East Kilbride community, led by Joe Quigg, was the first of the communities served by the hospital to initiate a campaign of opposition to the proposed closure. That group was, of course, supported by my hon. Friend.
One of the key points which even the Government seem to accept in the provision of services in the NHS is women's choice. If Rutherglen maternity hospital is removed as a choice, the women in the population of 250,000 people in the catchment area will have their choice removed at a stroke. That is unacceptable and it will be challenged.
As I have said, the stand-alone principle was the reason given by the board for closing the hospital. It takes the view that a maternity hospital should not stand alone from acute hospital services in case anything happens to a mother or baby during birth. The fact that the board dealt with that in only six lines shows that it does not have a large base on which to justify the stand-alone theory. If throughout the medical world there were a proven and accepted clinical reason for stand-alone maternity hospitals being regarded as unsafe and bad practice, I would not argue against it. If the clinical world said that such a system was not good for pregnant mothers, I would accept it. But the board's reasoning is disputed not just by lay people but by medical people and by the Victoria infirmary NHS trust board. The proposal should be reconsidered.
1005 I would like to see the look on the faces of Scottish Office Ministers if the policy to abolish stand-alone maternity hospitals was implemented throughout Scotland, because they would then be responsible for trying to finance the building of replacement new hospitals. The policy has ramifications for Scotland, if not for the United Kingdom.
Let us consider the practical opposition to the stand-alone hospitals. Since Rutherglen was built, no mother has died either during or after transfer to the Victoria infirmary because of complications. The maternity hospital has a good track record. Greater Glasgow health board, to its credit, has not sought to cite any occasion when lives have been lost because of the stand-alone policy. I accept that the board must consider all aspects of health care, but it does not seek to fulfil the aim of providing optimum services in all health services. It does not station ambulances on motorways because of the bad risk of accidents taking place there. I do not see why we should accept its argument that, by abandoning the stand-alone maternity unit, it will provide optimum services to mothers in the catchment area.
The board's decision comes down to an unseen reason—cost. Mothers in the catchment area will be expected to travel to Southern general hospital in Govan, a journey which will take an extra 15 minutes. Who is say that that extra travelling time for those from Blantyre, East Kilbride or Halfway will not cause problems for mothers and babies and the people looking after them? The board has taken no account of the complications that could arise in that 15 minutes.
I make no criticism of any other hospital, but the board has tried to suggest that the acute and maternity services at Southern general are side by side. I have been reliably informed by people in the health service that should a mother develop complications in the maternity unit at that hospital, she would have to be transferred to the acute hospital services site by ambulance, because there is no direct route. That shoots down the argument that Rutherglen should be closed because of the delays experienced when mothers have to be transferred, because of complications, from that maternity hospital to the Victoria infirmary. The same argument applies to the Southern general, so where is the safety gain?
I pay tribute to a number of people who have campaigned for Rutherglen maternity hospital. They include members of the Victoria infirmary NHS trust board, who support the retention of Rutherglen. The campaign has received excellent support and backing from the chief executive of that trust, Barry Small, and one of the managers at Rutherglen maternity hospital, Jim Bretherton. One of the key people to challenge the stand-alone theory is Mrs. Kim Margey, of Rutherglen, who is a member of the National Childbirth Trust. Those people are part of the community campaign against the closure of Rutherglen.
The strength of local feeling was revealed when I organised a meeting of delegates from local community groups in the catchment area, when more than 400 people turned out. I remember the atmosphere in the hall when Dr. Neil McDougall illustrated the efforts of the staff to provide good services to the public. He came across extremely well and had the support of the audience. A host of other people and organisations are behind 1006 Rutherglen maternity hospital, for example, the Womens Royal Voluntary Service, which has supported the hospital for many years. That hospital and the services which it provides are valued in our community. I cannot vouch for those services, but my wife has certainly been a consumer of them. My younger son, Brian, is a true-born Ruglonian, because he was born at that maternity hospital, within the borders of Rutherglen town council and borough.
The hospital is rooted in the heart of the community. The chairman of Greater Glasgow health board, Sir Robert Calderwood, whom I respect, has said:In drawing up these proposals, the Board has sought to emphasise the importance of the involving of local communities in the provision of health care.The community served by the Rutherglen maternity hospital want it to remain open and it will continue to make that case. If Sir Robert is true to his word and the board listens to the community served by the hospital, the closure proposal will be withdrawn. The hospital and its staff will then be allowed to get on with providing their first-class service.
§ The Parliamentary Under-Secretary of State for Scotland (Lord James Douglas-Hamilton)
I congratulate the hon. Member for Glasgow, Rutherglen (Mr. McAvoy) warmly on securing a debate on this important subject, which I know is of great interest to him and to his constituents.
I should like to set out the current position on the future of Rutherglen hospital. Greater Glasgow health board has issued for public consultation a document setting out its purchasing intentions for acute and maternity services to the year 2001. That document sets out, among other matters, proposals for the reorganisation of maternity services for the Greater Glasgow health board area. The proposals suggest that Rutherglen hospital should close as part of the reorganisation and creation of new maternity services for the area.
Greater Glasgow health board is, of course, aware of the impact that its proposals will have outwith Glasgow. For example, over recent years the board has been in discussion with Lanarkshire health board. Its views have been sought as part of the current consultation exercise. The board will consider all responses lodged with it by the consultation deadline of 30 April. Any subsequent proposal by it to close the hospital would be subject to the consent of the Secretary of State for Scotland. He would have to he satisfied that better services would be put in place before he would agree to any such proposal.
May I reassure the hon. Member and the House that the current debate in Glasgow on how best to provide maternity care should not be taken to reflect on the staff and standard of care provided at Rutherglen hospital; but the board believes that continual improvement in care and services is vital. With that in mind, the board is merely seeking better ways of doing what it already does well.
The proposals in the Glasgow consultation document reflect a concern on the part of the board that, wherever practicable, maternity units should have the availability and back-up of the full range of clinical support services of a major acute hospital. As the hon. Member will know, the document sets out an argument against the Glasgow 1007 area retaining stand-alone maternity facilities. The health board aims to provide expert maternity services with full back-up facilities on site.
For the benefit of those present, Greater Glasgow has four NHS trusts which manage maternity services. Those services are currently organised from the Southern general hospital, the Queen Mother's hospital at Yorkhill, the Glasgow Royal maternity hospital and Rutherglen. In all, some 313 maternity beds are available. The consultation document, in proposing a reduction in bed numbers to 244, was arrived at following full discussions with local clinicians and general practitioners.
As its consultation document points out, 244 beds by the year 2001 is considered by the health board to be appropriate to estimated need and appropriate for the provision of a safe complement of beds for the city. That level of provision also takes account of the needs of women who may decide to come to Glasgow for their deliveries and maternity care in preference to their local health board services.
I have mentioned safety in terms of the board's views on future bed numbers. Safety is also a key consideration, of course, in the organisation of all health care—no less so for maternity services. Again, for the benefit of those hon. Members present, it is worth noting the consideration that lies behind the Greater Glasgow board's wish to have on-site full acute facilities to back up its maternity services.
In cases where mothers experience difficulties and complications after giving birth, it is obviously desirable and safer for all concerned that the full range of clinical support facilities of a major acute hospital be available on site. This is clearly set out in the board's consultation document.
There is another equally important consideration that has informed the Greater Glasgow board's thinking in this matter. As in most spheres of medicine, new techniques are also being developed by obstetricians, which allow the antenatal diagnosis of congenital disorders as part of the specialty of perinatal medicine. Where neonatal surgery and complex neonatal paediatric care are required, that can now be diagnosed before delivery. The board is of the view that there are clear safety benefits to be gained were babies in this category to be delivered and cared for on the site of the main neonatal surgical and medical paediatric unit—Yorkhill hospital, of course—and continuing services from the Queen Mother's hospital at the Yorkhill site is consistent with the board's view on back-up and the availability of specialist care.
§ Mr. Ingram
Although I take on board some of the Minister's arguments, I agree with the comments of my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy) about the views expressed by doctors at Rutherglen maternity hospital which, in a sense, tend to contradict some of the Minister's remarks. It is worth bearing in mind that there are about six maternal deaths per 1,000 in the United Kingdom but that there has not been one maternal death at Rutherglen maternity hospital since it was opened. The proportion of perinatal deaths throughout the United Kingdom is nine per 1,000 but only five per 1,000 at Rutherglen maternity. Those figures tend to cancel the safety worries about the hospital as a stand-alone facility.
§ Lord James Douglas-Hamilton
The hon. Gentleman's point will be taken into account in the 1008 consultation. The hoard is sympathetic to the views of those who support Rutherglen and will take those views into account before reaching a final decision. As I said, the Secretary of State's consent is required for any proposal to close Rutherglen.
As a dedicated sick children's hospital with associated academic units, Yorkhill is unique in the United Kingdom. As the board points out, this facility offers particular advantages in the care and treatment of sick newborn babies.
It is worth taking a step back for a moment and reminding ourselves of the great strides that have been made in developing maternity care in Scotland. Over the past few years, there have been steady improvements in maternal and infant health. Outcomes in childbirth in Scotland as a whole compare favourably with levels anywhere in the developed world. Since 1980, the rates of perinatal, neonatal and infant mortality have fallen by more than one third and the rates of maternal mortality are now so low that the fear of dying in childbirth has all but been eradicated. We should never take this achievement for granted, and it is worth reflecting how real a danger maternal mortality was until comparatively recently. We should never be complacent about these achievements—as ever, there is still further progress to be made.
Rutherglen does not have the advantage of being attached on site to the full range of back-up clinical support facilities—most critically, blood transfusion services—routinely found in a large acute hospital. That is why the board, having decided on the best course for the organisation and provision of modern services, is recommending the closure of Rutherglen.
As hon. Members will know, Rutherglen is a stand-alone maternity hospital. It has a proud history; it is held in high regard by the many mothers whose babies were delivered there and it is viewed with fondness, I am sure, by those born there. There will always be genuinely held strong feelings and attachments to local facilities, and the views offered in the consultation process and in this debate will further inform the health board's consideration of the proposals. Rutherglen hospital was opened in 1978 and currently has 56 beds, 15 special care cots and two intensive care cots. The hospital dealt with some 3,036 deliveries last year.
I mentioned that the Greater Glasgow board is in touch with neighbouring health boards on the proposals. Hon. Members may wish to know that, although it will be for individual mothers and their GPs to determine where individual births would occur, if Rutherglen were not available there would be sufficient capacity within existing facilities in Lanarkshire—principally at Bellshill hospital but also at Law hospital—to accommodate the current and anticipated levels of deliveries for Lanarkshire without any adverse effect on the quality of care.
§ Mr. McAvoy
I am grateful to the Minister, who has been very generous in giving way; that is much appreciated. I refer again to the heart of the problem, which is the stand-alone theory. Would he care to comment on the fact that the latest report states that only two patients in 3,000 in the past year were transferred from Rutherglen maternity hospital?
§ Lord James Douglas-Hamilton
That is a telling point, which will inevitably be considered in the consultation. I have no axe to grind. Clearly, the hon. 1009 Gentleman wants the very best services that he can get for his constituents. Were Rutherglen to be closed, current anticipated Lanarkshire birth levels could be accommodated at Bellshill and Law hospitals without quality being compromised. The key point is that the Secretary of State has to be satisfied that there will be an improvement in services before he consents to any proposal from the board.
In the board's view, the forecast number of deliveries for the year 2001 could be met satisfactorily in the three proposed maternity units. Local access will, of course, be given full consideration, and geographical circumstances, which have been mentioned, will also be taken into account by the Secretary of State in his consideration of all closure proposals.
The Secretary of State will need to study the proposals carefully in the light of Government policy on the provision of maternity services. I shall briefly spell out that policy. I have outlined already some of the significant improvements that have been made over the years in maternity care. In particular, there has, of course, been a move to develop more sensitive, flexible and safe systems of care.
The Scottish Office has been keen to promote those developments. Last year, its policy review on the provision of maternity services in Scotland set the framework for action by health boards. It affirmed the importance of delivering maternity care which is sensitive and effective and which offers the best value for money. It asked health boards to examine their existing services with a view to further improving choices in maternity care—a matter that the hon. Gentleman stressed—to promoting DOMINO and other community-based schemes and to achieving a shift from specialised to less specialised forms of care.
Meanwhile, the CRAG/SCOTMEG group—the Clinical Research and Audit Group and the Scottish Management Efficiency Group—on maternity services has been looking in more detail at particular aspects of maternity care, with a remit to develop strategies for raising standards and improving training. The Government attach the highest importance to making certain that while these improvements take place, we continue to maintain the high standards of safety that have been achieved.
1010 The benefits of easy access to services have to be considered alongside the need for sufficient concentration of staffing and resources to allow the delivery units to offer first-rate medical care, including the sophisticated technology of special baby care and neonatal intensive care units.
Delivery facilities need to handle enough births to ensure that clinical staff can keep up and improve their skills and experience in dealing with the more difficult cases and with emergencies. Proper arrangements need to be on hand to ensure 24-hour emergency medical cover and access to sophisticated clinical back-up. In short, the key is to work out for each local area, and in a way that is sensitive to local circumstances, the proper balance between the concentration and dispersal of resources for maternity services.
In reaching its planned configuration for bed numbers and locations, the Greater Glasgow health board has, quite properly at this stage, not announced what the final distribution of maternity beds will be between the three proposed sites. That remains a matter for discussion with clinicians. The location of neonatal intensive care cots will also be subject to clinical input before decisions are made. However, I know that, whatever the outcome, the board and NHS trusts will arrive at a flexible arrangement that can respond to future changes in need.
I am not in a position to anticipate the final outcome of the consultation exercise or the Secretary of State's decision, but the points made by the hon. Members for Rutherglen and for East Kilbride (Mr. Ingram) will be fully taken into account. There is no hidden agenda in the board's consideration of the organisation of maternity care provided for Glasgow. The current proposals have arisen from a genuine review of how best to match maternity care to need and how best to provide that care for the Greater Glasgow health board area. This strategy review is not driven by any artificial target on bed numbers. No target exists. The board's actions are confirmation of the board's continuing commitment to the policy of putting patients' needs first. We look forward to receiving its proposals following the conclusion of its consultations on 30 April.
I warmly congratulate the hon. Member for Rutherglen on raising the important matter. The fact that so many of his hon. Friends—the hon. Members for East Kilbride and for Clydesdale (Mr. Hood)—are—