Royal Maternity Hospital, Belfast

HC Deb 09 May 1996 vol 277 cc522-30

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

9.59 pm

Dr. Joe Hendron (Belfast, West)

I am grateful for this opportunity to draw to the attention of the House a proposal that threatens one of Northern Ireland's most respected and renowned hospitals with an international reputation for innovation and research. It is the Royal maternity hospital, Belfast, which is an integral part of the Royal hospitals trust and is facing possible closure. Access to and from the four hospitals is simplicity itself and they are only about 150 m from each other. That is the geography, and when that is understood one can appreciate why over 85 per cent. of Northern Ireland's population can reach the Royal hospitals inside an hour.

In a typical year, one family in three in Northern Ireland is seen in some department of the Royal hospitals. I emphasise that I speak not just as a politician but as a medical practitioner who has spent all his medical life in west Belfast where these great hospitals are situated.

I shall explain why I have asked for the debate. The Northern Ireland Department of Health and Social Services, acting on behalf of the Minister, established a committee, the acute hospitals reorganisation project, under the chairmanship of Dr. James McKenna, a former chief medical officer for Northern Ireland. The committee is considering ways to eliminate unnecessary duplication of services by the Royal hospitals trust and Belfast City hospital, Northern Ireland's two largest hospitals.

The committee, which includes representatives from both hospitals, was asked to make proposals as to how services could best be redeployed between the two to make the best possible use of resources in terms of specialist staff, accommodation and, presumably, finance because, inevitably, it was hoped that these proposals would bring about some savings in the Northern Ireland health service.

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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

Dr. Hendron

On the face of it, the establishment of the committee with its representation from the Eastern health board and various other interested parties seemed a good idea. However, many people, myself included, ask why the committee's remit should have been restricted to the services of these two great hospitals in isolation from other hospitals, particularly those within the Greater Belfast area which also duplicate services that are provided by the two hospitals in the centre.

In terms of fairness, let alone economies of scale, it seems odd in the extreme that not one but three other acute hospitals within 10 miles of Belfast city centre are not included in the current review. I am grateful to the Minister for being present for this debate. First, he should immediately announce a further review of hospital services not just for Greater Belfast but for the whole of Northern Ireland. Until such a review has been completed, no hospital should be considered for closure.

Of course I must deal with reality. Today a proposal, which will shortly be presented to the Minister, suggests that the maternity services of the Jubilee hospital, which is part of the Belfast City hospital trust and the Royal hospitals trust, should be brought together in one unit in three yet-to-be-refurbished floors of the multi-storey tower block of the City hospital. That proposal has attracted almost universal opposition.

I shall make some important facts clear before proceeding further. Both the Royal hospitals trust and the Belfast City hospital trust are committed in principle to the work of James McKenna's committee, but that does not mean blind acceptance of all the proposals, especially those in the most recent document called "Seeking Balance" which has been issued by the committee.

The Royal, for example, with some reluctance, agrees with the proposal to move its renowned breast care clinic, the first in the United Kingdom to receive a charter mark, to a new location in Belfast City hospital. That is because the Royal trust believes that, if Belfast City hospital is to be the cancer centre for Northern Ireland, as appears to be the case, it is better for women to have the breast clinic located there. The Royal trust, however, is unanimous in opposing the proposal, which would close its maternity hospital and move it to the city hospital site.

The Government are on record as having the best interests of the national health service at heart. Understandably, they advocate change, but surely only where change is for the better. They advocate change when clear economies are to be made. Those are worthy ideals, to which we would all subscribe. If the Minister agrees, however, with the proposal from the "Seeking Balance" document about maternity services, he will bring about changes in Belfast which, far from protecting or even enhancing the service, will weaken it and, almost unbelievably, will cost more to provide.

I said earlier that I speak both as a politician and as a family doctor, but let me assure hon. Members that my views are not simply those of a concerned doctor. The opposition to the proposal is echoed by astonished clinicians throughout Northern Ireland and by medical experts throughout the UK. Let me quote some of the things that those learned people have been saying.

The Provincial Paediatric Specialty Group, representing doctors throughout Northern Ireland, said about the proposal: It was uniformly agreed that the proposed move would give rise to considerable difficulties in the care of the sick newborn. These babies may require the urgent attention of a range of specialist services and specialised laboratory services. On the site of the Royal Hospitals Trust there is easy access to the specialists and associated facilities. A move of the maternity services in isolation would compromise the care of the sick baby. The chairman of the division of paediatrics from the Homefirst community unit in Ballymena said: Members were amazed and concerned at such a proposal as it was felt there could be no medical justification for it. Movement to Belfast City Hospital would isolate the neonate from the Royal Belfast Hospital for Sick Children. This cannot be in the best interests of the sick baby. The paediatricians in the Northern Health and Social Services Board feel that the proposed move would be a retrograde step moving from a unified to a split service. The Craigavon area hospital group trust said: Our concern as referring doctors, to the neo-natal services is that they should have cardiac, surgical, neurosurgical, nephrology or ophthalmology requirements and that there is no unnecessary delay in obtaining those for the neonates. All those services are available only within the Royal hospitals trust.

Erne hospital in Enniskillen said: In any redeployment of facilities for caring for small acutely ill babies, it is most important to so arrange affairs that all necessary facilities are available within one unit". As I said, in Northern Ireland, those facilities are available only in the Royal hospitals trust.

The paediatric sub-committee of the area medical advisory committee of the Eastern Health and Social Services Board said: The Sub-committee is of the view that there are clear disadvantages to this proposal for the management of babies requiring multiple specialist input. The Sub-committee can see no advantage to babies being treated on the Belfast City Hospital site. The proposal is in conflict with guidance from the British Paediatric Association and the British Association of Perinatal Medicine. There is no support for this move by any body of paediatrician in Belfast or anywhere in Northern Ireland. The committee unanimously recommend that the Regional Neonatal Service remains at the Royal site in close proximity to all specialist paediatric services available only at the Royal Belfast Hospital for Sick Children. The National Board for Nursing, Midwifery and Health Visiting for Northern Ireland said: The National Board is strongly of the view that maternity, neonatology and children's services should be on the same site, as a significant number of neonates require the services of the Sick Children's Hospital within the first days of life. The paediatricians at the Ulster, North Down and Ards hospitals trust said: We are concerned at the proposal that the Regional Neo-natal Services should now move to the Tower Block at the Belfast City Hospital. It has been our understanding over the years as clinicians that to provide the best such service it has been important and will remain important to have our regional neo-natal and paediatric system specialists on the same site to most efficiently meet the complex needs of these babies. To separate the neo-natal service to the Belfast City Hospital would clearly be a clinically poorer service than the present excellent one. The Royal Belfast Hospital for Sick Children is in close proximity to the neo-natal unit and the Royal maternity hospital. Its staff said: The proposals to dislocate the relationship between the tertiary maternity and neo-natal services from the paediatric specialties and the regional cardiac and neurosurgical services on the Royal Hospitals site receives no support. To rearrange these services so that they are separated not only by physical distance, but also by the busiest dual carriageway in the province is almost certainly going to reduce the quality of the service available to newborn babies and will result in delayed diagnosis and treatment and consequent increases in morbidity and mortality. The staff of the Royal maternity hospital said: It is envisaged that all the facilities for a regional service can be provided within the present Royal Maternity Hospital. 'Seeking Balance' proposes the removal of obstetrics, gynaecology and neonatology from the Royal site. We submit that firstly the quality of care to the women and the babies of Belfast and Northern Ireland cannot but deteriorate as a result of this move and secondly, facilities can be provided on the Royal site to enable the highest quality of effective care to be maintained. The Western Health and Social Services board in Londonderry said: We consider it clinically inappropriate given the regional nature of some of the maternity/neonatal provision that this should be separated from related back-up facilities such as the paediatric surgical component. We find the proposal surprising given the recent significant refurbishments which there have been at the Royal Maternity Hospital. Amalgamation on the Royal Maternity site could be achieved more quickly and at significantly less cost. One clinical difficulty related to the use of the tower block option is that there would inevitably be greater time delays for mothers arriving in advanced labour or with emergency difficulties and who need emergency clinical assessment. That is currently coped with easily in the layout that exists at the Royal maternity hospital, but it is likely to be much more difficult to achieve where a maternity unit is placed on three floors of the tower block.

I want to make a few important points, to which I know that the Minister will pay particular attention. There are about 50 calls per month by paediatric specialists to sick babies in the neonatal unit of the Royal maternity hospital. The Jubilee maternity hospital refers 15 babies per year to the neonatal unit of the Royal and, in addition to that, there are about 70 to 80 babies a year from throughout Northern Ireland. It does not take minutes, which is what it says in the McKenna report, to transfer a baby from the Jubilee to the Royal—it takes three quarters of an hour from the moment a decision is taken to transfer a baby until it arrives at the Royal.

Targeting social need is an important part of Government policy. The Secretary of State refers to the policy of targeting social need being implemented in areas such as north and west Belfast—areas of great deprivation. The Royal group of hospitals is the biggest employer in west Belfast. Therefore, to threaten its future is gross and rank hypocrisy.

Opposition to the proposal to close or transfer the Royal maternity hospital comes from all staff levels in the Royal, including midwives, nurses and consultants as well as from trade unions and the West Belfast health monitoring committee. The people of the Protestant Shankill road and of the Catholic Falls road, as well as the hon. Member for Belfast, North (Mr. Walker), are totally against the closure of the Royal maternity hospital.

I could add many more quotations, Mr. Deputy Speaker, and I could tell you about the tens of thousands of people throughout the city and the rest of Northern Ireland who have signed petitions against the proposal. I could tell you about communities united as never before in the joint aim of protecting and maintaining the best possible clinical service for mothers and babies.

In the national health service beyond Northern Ireland, health authorities throughout the United Kingdom have been unanimous in saying that where possible they would wish to provide paediatric and maternity services side by side on one site. In Belfast, within the Royal hospitals trust, that sought-after arrangement already exists, yet it is under threat from a committee set up by the Minister and the Department of Health and Social Services.

There is another aspect to the ludicrous and ill-conceived proposal to move maternity services from the Royal into the Belfast city hospital tower block—that of finance. The Belfast city hospital is a modern building less than 10 years old, yet because of its design, if all the maternity services from the Jubilee maternity hospital and the Royal maternity hospital had to be accommodated within its floors, as the McKenna committee proposes, alterations costing £5 million to £6 million, which could not be completed until the year 2000 at the earliest, would have to be made. It is claimed that the relocated services would then have a 25-year life span.

However, the Royal maternity hospital, although admittedly the building is 60 years old, was designed to handle up to 7,000 deliveries a year, and already houses Northern Ireland's superb regional neonatal unit, which is known not only the length and breadth of Ireland but far beyond. The unit was opened recently at a cost of about £2 million, has more theatres than are envisaged in the relocation to the city hospital, and could easily and swiftly be adapted to take all the services currently at the Jubilee, at much lower cost.

Indeed, to give the Royal maternity hospital the same 25-year life span believed possible at the Belfast city hospital would cost about £4 million—£2 million less than the current proposal at the city hospital will cost. That does not include the savings that could be made almost immediately because the Royal maternity option would quickly be brought into operation, whereas the proposal involving the city hospital tower could not be implemented until the year 2000 at the earliest.

I admit that I am no economist, but it seems to me that to reject the idea of spending £4 million to enhance a service that is already of high quality, with high standards and a unique and comprehensive range of services, in favour of spending £6 million on a proposal that will offer services that are less accessible and of a lower standard, simply does not make sense. So why is the proposal before the Minister?

The answer is now clear. The object of the acute hospitals project in this case is to utilise fully Belfast city hospital's tower block. I have no hang-up about that; indeed, as a young doctor I worked in the city hospital myself. The Royal hospitals trust has no hang-up about it either, but it has offered Dr. McKenna other more sensible options, which so far all seem to have been rejected. The document "Seeking Balance" does not seem to have sought far enough.

There are strongly held views that the three floors thought necessary to accommodate the maternity services will not be available in the tower from the year 2000. But even if they were likely to be available, no Government and no department of the civil service, no one faced with possible appearances before the Public Accounts Committee, could accept a proposal to commit millions of pounds to what is clearly a contentious recommendation, without serious in-depth investment appraisals being carried out by independent experts.

That would mean that all the options would have to be fully considered, not simply the one proposal about to be put before the Minister. There are at least three other options, which must be fully financially explored.

The first option is to concentrate all the Royal maternity hospital and Jubilee hospital services in the tower of the Belfast city hospital. The second is to leave the services as they are. The third is to look at the maternity services provided by all the hospitals in the Belfast area before making a decision. The final option—the most obvious and sensible one in the circumstances—is to relocate the services from the Jubilee hospital to the Royal maternity hospital site. Without such an appraisal, no Government could possibly approve action that, in the long run, could result in millions of pounds being spent unwisely.

History is often strange. In the case of the maternity services in Belfast area, it is not just strange but bizarre. Just before the trusts were launched in Northern Ireland, the Eastern health and social services board was trying to find ways of saving money. The board produced a number of reports that offered various options as to how services should best be provided within the tight finances that the board expected to be available in the coming years.

One plan produced by the board was to centralise maternity services in the Greater Belfast area. Bearing in mind the then regional strategy, the proximity of the children's hospital to the Royal maternity hospital and various other factors, which hospital found itself faced with a closure plan? It was the Jubilee, and of course there was a massive campaign to keep that hospital open. But that was the recommendation that was made to the Government. Barely three years later, the same board—having failed to bring about the closure of the Jubilee hospital in pre-trust days—is one of the key players in the McKenna committee that produced the proposal to move all maternity services into the Belfast city hospital. Isn't that amazing?

Let me sum up. The document "Seeking Balance", produced by the acute hospitals reorganisation project, wants to move maternity services from the Jubilee maternity hospital and the Royal maternity hospital and relocate them in the upper three storeys of a multi-storey tower block. This proposal is against all the best clinical opinion, which supports the provision of maternity and paediatric services on the same site as is currently provided on the Royal hospital site. The proposal to relocate at the Belfast city hospital will cost a minimum of £6 million, whereas centralisation at the Royal maternity hospital will cost at most £4 million—a saving of £2 million. No financial appraisals have been made of this contentious proposal, and clearly there must be a thorough investigation of all possible options.

The Minister should reject this illogical, ill-conceived and insensitive proposal concerning maternity services. The Department of Health should carry out a thorough review of all hospital services throughout Northern Ireland and, in addition, obtain proper investment appraisals of all other possible options for maternity services other than those currently outlined in the document "Seeking Balance". These will conclude that the only sensible way to provide and to protect these most necessary services is to have them located within the Royal maternity hospital, which is only a few minutes walk from the internationally acclaimed services of the other three hospitals within the Royal trust.

Were the Government to do anything less, they would be ignoring the best options for women and babies. Surely no Minister and no Government would want to compromise these essential services.

10.22 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Malcolm Moss)

I congratulate the hon. Member for Belfast, West (Dr. Hendron) on his good fortune in securing the debate. I commend him for his choice of subject and for the clear manner in which he has set out his concerns and those of his constituents about the current proposals by the acute hospitals reorganisation project for the rationalisation of maternity services between the Belfast City Hospital trust and the Royal Group of Hospitals trust.

I want to make it clear at the outset that the proposal for maternity services has not been made in isolation. It is one of a large number of proposals for 28 specialties that have been put forward by the reorganisation project and not, I wish to make it clear, by my Department. Because those proposals are so closely interrelated, they can be considered properly only as a complete package.

The proposal on maternity services was one of 16 contained in the third project paper, "Seeking Balance", on which consultation finished on 5 April. The project's steering group is at present considering the responses that it received and, in the light of those, will put a final set of recommendations before me for consideration. At that stage, I shall wait to consult further, as I did in relation to the second paper, "A Singular Service". At the end of that process, it will be my responsibility to make the final decisions.

I assure the hon. Gentleman that I shall do so as quickly as possible, to remove the uncertainty at both trusts, but not before I have had time to hear and consider fully all the arguments from both sides of this important and emotive issue. I want to emphasise that, whatever my final decisions, the future of the two trusts will not be put in any doubt by the absence of a maternity unit, either in clinical terms or in terms of income.

The Belfast city hospital tower is one of the most modern hospitals in the United Kingdom, and will continue to be a key asset for many years to come. The Government have recently agreed an investment of approximately £65 million for the reconstruction of the Royal Victoria hospital. That is in addition to expenditure of more than £20 million in the Royal Group in the past five years. There could hardly be clearer evidence of our commitment to both those much admired and loved hospitals.

As a prerequisite to discussion of any of the proposals, it is necessary to understand how and why they came about in the first place. We started back in November 1993 when, after extensive consultation over almost two years, the Eastern health and social services board produced its "Strategy for General (Acute) Hospital Services". In the section of the document that focused on maternity services, the board set down its view that one maternity unit in central Belfast could provide the required services both for the local population, and, in terms of specialist services, for the wider board area and Northern Ireland as a whole. The board also commented on the significant support for the concept of one maternity unit in central Belfast that it found during the consultation process.

The board's strategy was then considered by my predecessor, Baroness Denton, and in announcing her decisions in March 1994, she welcomed the fact that not only the board but both Trusts recognise the need for rationalisation and are willing to play their part in achieving this". She then asked Dr. James McKenna, then the chief medical officer, to move from that post and lead a steering group on rationalisation.

For the record, the remit of the acute hospitals reorganisation project, as it came to be known, is to develop and oversee the implementation of a coherent strategy for the reorganisation of services at the RGH Trust and the BCH Trust to provide a sound basis for their future development"— this is a key point— having regard to services presently located at other hospitals in the Greater Belfast Area where relevant". To take up the hon. Gentleman's point about the wider remit, I think that there is still within the original remit for the reorganisation project the wherewithal to move beyond the two hospitals, where that is relevant. It is important to note that the chief executive and clinical director of the RGH and the BCH trusts are members of the steering group.

I want to deal with some of the hon. Gentleman's more specific points in the very limited time that he has left me to respond. If I do not cover all his points, I shall write to him and I shall be issuing a press release to the Andersonstown News.

The group's second paper, "A Singular Service", was issued for consultation in mid-1995 and contained proposals for 12 specialties. That paper, too, gained public and professional support and, following further consultation on my part, I endorsed the recommendations at the beginning of this year.

Simultaneously with my announcement on "A Singular Service", the steering group issued for consultation the "Seeking Balance" document, which contains proposals not only for maternity services but for 15 other specialties. It sets out the majority view of the steering group, that maternity services, including gynaecology and neonatology, should be provided in the Belfast city hospital tower rather than the Royal Group of Hospitals site. I do not intend to comment this evening on the pros or cons of that recommendation. It would be wrong for me to do so at this time, as I expect to be asked by the group to consider its final recommendation, whatever it may be, and to make a decision on the issue. I can, however, make some general comments on the matter.

The view that only one consultant-led maternity unit is required in central Belfast was, as I said, first expressed by the Eastern board in its acute hospital strategy, and was subsequently endorsed by my predecessor, Baroness Denton. There was clear evidence of strong support for the concept during the consultation on the board's strategy. The physical inadequacies of both the present units, the Royal maternity hospital and the Jubilee, were pointed out by the hon. Gentleman.

The hon. Gentleman also asked me about the need for an option appraisal. I agree that the financial aspect of the proposal is important, and I would not pretend otherwise. The demand for health services outstrips the supply of money available and there must be a continuous search for greater efficiency, to ensure that the maximum benefit is derived from existing resources. I give him an undertaking that there will be a need for an option—

The motion having been made at Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.