§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Ainsworth.]
§ 10.2 pm
§ Mrs. Helen Liddell (Monklands, East)I am grateful for the opportunity to bring before Parliament an issue of great concern to my constituents. I am grateful to have this opportunity so soon after the House has returned from the summer recess, because the issue has exercised my hon. Friends and myself during the recess. I sought this debate urgently because of a developing problem that could deprive mothers in my constituency of local maternity services. That is bad enough in itself, but the impact of removing localised services could also have a bad effect on paediatric care in the local district general hospital, putting children, some of whom have life-threatening conditions, at considerable risk.
The problem has arisen because of Lanarkshire health board's desire to close the local Bellshill maternity hospital, which is part of the Monklands and Bellshill hospital trust. It wants to locate maternity provision at a new hospital to be built at Netherton in Wishaw to replace the existing Law hospital. Let me make it abundantly clear at the beginning of my contribution: I do not oppose the establishment of maternity facilities at Netherton. Rather, I believe that the needs of Lanarkshire mothers and children would be best met, if Bellshill should close, by two-site provision at general hospitals in both Netherton and Monklands. It is ludicrous to suggest at the end of the 20th century that expectant mothers should face increased inconvenience, not to mention risk, when one of the main achievements of the first part of the century in Lanarkshire was the provision of more appropriate localised care in that county.
Time is of the essence in this matter as the local health board is currently involved in a consultation exercise that I believe is based on a totally false premise. If the wrong decision is arrived at as a consequence of that exercise, it could have an adverse effect on health care in the northern part of Lanarkshire for a long time. I cannot overstress the importance of those issues. My hon. Friend the Member for Monklands, West (Mr. Clarke) and I represent an area that has the dubious record as one of the unhealthiest places in Europe. I know that the Minister recognises that fact and I urge him to consider my remarks not just in the light of maternity provision, but in the face of the generally recognised need to concentrate on improving health care in Monklands generally. That is particularly true in relation to children.
In seeking to effect the closure of Bellshill maternity, the health board has made an unwarranted attack on the safety of the service that is provided. It is a stand-alone specialist facility that provides top-class care from a committed staff. Both past and present mothers in my constituency have much to thank Bellshill maternity hospital for. Notwithstanding that fact, the health board has suggested that the facility is unsafe, based upon a misreading of the "Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom 1991ߝ1993", which states on page 193 that units on sites away from acute hospitals "should be regarded as unsafe".
Based on that sentence, the health board has taken an insensitive line that is insulting to the staff at Bellshill and has caused alarm among mothers in my constituency who 564 expected to be delivered there in the near future. That statement is not true. The quotation upon which the health board is relying refers to very small units that do not have blood transfusion and anaesthetic services and are sited more than 20 miles from an intensive care unit. That is not the case with Bellshill—indeed, only a few units in England are affected. I contend that the health board is using the safety argument to avoid the economic arguments.
Bellshill is the largest maternity hospital in Lanarkshire. It has obstetric, midwifery, anaesthetic and paediatric staff who care for between 3,700 and 4,000 women and their babies each year. They are experienced in dealing with normal and abnormal pregnancies. There is a neonatal intensive care unit, which has a successful record in treating very ill premature babies as young as 24 weeks gestation and 500 g birth weight.
Neonatal care in Lanarkshire matches the best provided at the large teaching hospitals, resulting in Bellshill being used as a back-up by hospitals in the north of England and elsewhere in Scotland when their units are full. The staff are recognised widely within their profession, but were they included in the strategic analysis by the health board or invited to comment on the completed review? No, they were not. The board claimed that the working party comprised a sound body of local expertise, yet no identities were revealed. Why were local experts kept in the dark? Is that the way to devise an accurate and unbiased strategy?
Furthermore, the board claims that it has based its conclusions on projected births to Lanarkshire women by 2005. How did it come to those conclusions? Where is the evidence that it has taken account of the significant inward investment in Lanarkshire from both Chunghwa and Lite on, which will inevitably cause an increase—we are very glad of it—in the number of people moving to Lanarkshire? The board assumes that 30 per cent. of mothers will want to give birth in Glasgow. On what does it base that conclusion? The geographic difficulties associated with travelling from the northern part of my constituency to Wishaw could leave mothers with no choice but to make the longer journey to Glasgow, as trans-county transport in Lanarkshire is extremely bad. If the birth rate in Lanarkshire falls to between 52 to 55 per cent., which is what the projections could lead to, the viability of the new unit at Netherton could be in question and mothers in my constituency would be further disadvantaged.
In the past week, obstetricians and midwives in Lanarkshire have conducted a mini-survey of 100 mothers in antenatal units throughout the county. If Netherton were the sole Lanarkshire site, 91 per cent. of mothers in Coatbridge say that they would have to travel to Glasgow. In Airdrie, the largest town in my constituency, 69 per cent. would have to travel to Glasgow and, from Viewpark, 57 per cent. So it continues. Geography does matter and that is why I do not make an exclusive case for maternity facilities to be provided only at Monklands general hospital.
Lanarkshire health board has a duty to provide health care for all the mothers of Lanarkshire, not to offload some of that responsibility to Glasgow to make its accounts look neater. Its approach will remove true choice from mothers and it looks suspiciously like an accounting exercise to reach the economically attractive figure of 4,000 deliveries. Any deliveries over that number would 565 make the proposed Netherton unit unsafe. I urge the Minister to challenge the health board on why it is discounting the needs of one third of Lanarkshire mothers.
The health board survey that was conducted among mothers was also seriously flawed. The mothers consulted were those who had, thankfully, normal births and therefore did not require follow-on care. It is precisely the mothers who do not have normal births, or who have babies in need of neonatal intensive care, who should be taken into account. The sampling was not done by a professional polling organisation, as it was in Edinburgh when a similar case arose, and serious questions must be asked about how truly significant the analysis has been.
The survey defies common sense, quite apart from random sampling techniques. If a mother is in a maternity hospital for more than two days, it is usually for a significant reason—either she or her child is poorly. If we site maternity provision at Netherton, mothers who are not physically or emotionally at their best will have to undertake a difficult journey. My constituency is not a wealthy area and we do not have high ownership of private cars as people do in other parts of Scotland. It is difficult to envisage how some of those mothers and their families could cope with the journey across the county to a facility at Netherton. It would be equally difficult for mothers from the south of Lanarkshire to travel to a unique facility in Monklands district general hospital.
If Bellshill is to be closed, the costs of submerging a stand-alone facility into two general hospitals, with the economies of scale that that would involve—together with the clinical arguments—seem to make a self-evident case for a two-site facility. Why has that idea been given the brush-off by Lanarkshire health board?
The local people, whenever I talk to them about the facility, say that they believe that the consultation has nothing to do with their needs and everything to do with cobbling together an attractive private finance initiative deal for the new hospital. If that rumour is true, it is a scandal that outweighs any that we have seen so far.
I spoke earlier about general health in Monklands. An analysis of maternal morbidity in north Lanarkshire in the past three years shows that Hamilton, Airdrie, Coatbridge and Motherwell have the highest levels of morbidity requiring in-patient stay. Neonatal morbidity shows a similar pattern, and Hamilton, Airdrie, Coatbridge and Bellshill have the highest incidence of low birth weight babies. Even among so-called normal births, there is a shift towards the north of the county in relation to admissions to high-dependency neonatal care. Those figures show that there must be easy access to a unit close to those areas of high morbidity if the situation is to be contained and reversed.
Paediatric care pops up almost as an afterthought in the health board's deliberations. That afterthought could completely destroy the advances of the past 20 years in ensuring that sick children in Monklands have the best care when they most need it. The issue of paediatric services did not form any part of the remit of the original strategic review. It has now sneaked in and could have the most serious repercussions for Monklands hospital and the patients it serves.
I received a letter from Dr Marie Brookes, who is an accident and emergency consultant at Monklands district hospital. I urge the Minister to listen closely to what she 566 has to say. Dr. Brookes points out that 22,000 children under 15 years of age are treated in A and E at Monklands hospital. They comprise one third of the work load of her department. Two thousand of those children are ill enough to be admitted to hospital, yet under the health board's proposals, there will be no beds at Monklands. Four hundred children are currently admitted to the infectious diseases unit through A and E. That unit is to be taken away as well.
Monklands provides the acute head injury service for children in north Lanarkshire; that will cease, too.Dr. Brookes says that her anaesthetist colleagues join A and E in the intensive care of critically ill or injured children who may require to be admitted to Monklands hospital or transferred to Yorkhill. If the paediatric A and E emergency service at Monklands is lost, children will face a journey without prior resuscitation. Is that acceptable?
With her colleagues, Dr. Ian McLaren and Dr. Martin Watt, Dr. Brookes states that in line with national recommendations they would not be willing to provide an A and E service for children at Monklands without the on-site support of senior paediatric colleagues. She states:
'The scenario of the transfer of up to 2,000 children by ambulance to other units is one which we would not wish to face and which will deplete the Department of Medical and Nursing Staff and increase the demands on the Scottish Ambulance Service.Dr. Brookes continues:Your constituents and their children will be forced to take their sick and injured children either to Netherton or Glasgow. At best, this may be inconvenient, economically (for them) unacceptable, and for a minority of children, a life-threatening scenario. Our recent experience with meningitis confirms that time is of the essence and that the delays inherent in these plans are medically and ethically unacceptable.She concludes:That these matters have not even featured in the discussion documents, must be a measure of ignorance or ineptitude of those who have formulated and promulgated these proposals.That is a warning that I find chilling.Dr. Brookes' remarks are backed up by Dr. John White, a consultant obstetrician and gynaecologist, by Dr. John Grant, also a consultant obstetrician and gynaecologist and the editor of the obstetric and gynaecology journal. Consultant haematologists, anaesthetists, midwives and general hospital staff have already contacted me with their grave concerns. The entire community, including Churches and voluntary organisations, is unanimous in its opposition to what is proposed.
I urge the Minister to use his powers to insist that the consultation process starts again, with full involvement this time with those directly involved and with a more rigorous analysis of maternal preference and projected births. The survey of recently delivered mothers is not acceptable. There is potential for a greater number of births in Lanarkshire than that which has been taken into account. A wrong decision now could lead to a significant problem for my constituents and their children, probably for the next generation. I urge the Minister to use his good offices to ensure that it is not visited upon my constituents.
§ Dr. John Reid (Motherwell, North)I am grateful to the Minister for his courtesy in allowing me to make a brief contribution to the debate. I declare three interests:I 567 am the Member who represents the constituency in which Bellshill maternity hospital is situated; I was born at Bellshill maternity; and I predicted as soon as the Lanarkshire health board became a trust that it would close the maternity hospital within 10 years. I was five years out because the decision has been made five years earlier than my prediction.
I am grateful for the opportunity to participate in the debate. I thank my hon. Friend the Member for Monklands, East (Mrs. Liddell) for initiating it. I wish to see the Bellshill maternity hospital remain. It has been a stalwart in the provision of medical services for the people of Lanarkshire for many years. I have never been convinced by the arguments for its closure and I remain unconvinced.
The central argument is that there will be less risk to expectant mothers in pre-natal and maternity care if the unit is placed within the context of a general hospital. I know that we are talking of the very margins of risk. I know also that the emphasis that has been placed on that argument has been challenged by obstetricians, midwives and others. Even if I accepted that the argument was a logical reason for closing the maternity hospital at Bellshill, it would be offset if the facility were to be placed in a general hospital servicing a huge area, with the consequent inconvenience, cost and risk to health given the huge distances that would have to be travelled.
I urge the Minister to consider sympathetically the case made by my hon. Friend. If Bellshill maternity hospital ultimately has to close after a proud record of service, it should be replaced by maternity services at Netherton and Monklands general hospitals—two general hospitals at either end of a vast area.
§ The Minister of State, Scottish Office (Lord James Douglas-Hamilton)I congratulate the hon. Member for Monklands, East (Mrs. Liddell) on her speech. There is also strong representation from Lanarkshire through the hon. Members for Motherwell, North (Dr. Reid) and for Motherwell, South (Dr. Bray), as well as from the hon. Member for Monklands, West (Mr. Clarke), the right hon. Member for Glasgow, Garscadden (Mr. Dewar) and the hon. Member for East Kilbride (Mr. Ingram), not to mention the hon. Member for Dunfermline, West (Ms Squire).
The board proposes that paediatric services should be centralised at the site of in-patient services at the New Law hospital. They will be underpinned by appropriate out-patient and day care facilities at Monklands and Hairmyres hospitals and elsewhere, the purpose being to improve care available to the children of Lanarkshire.
The hon. Lady can be assured that the board is not saying that care at Bellshill is currently substandard, but in reaching its decision it had regard to the publication earlier this year by the Department of Health of the report on confidential inquiries into maternal deaths in the United Kingdom between 1991 and 1993. That report contained the key message that consultant units on sites away from acute hospitals—Bellshill, for example—and without appropriate and adequate facilities are now in a significant minority, and should be regarded as substandard. It recommended that there should be renewed efforts by health authorities to correct those deficiencies. The board took that recommendation into account.
568 I must make it clear that no decisions have been made on this matter. Last month, Lanarkshire health board published its consultation paper on the future of maternity and related services. It was the product of a two-year review aimed at renewing maternity services in Lanarkshire to provide the best care possible for mothers and their babies into the next century. The future shape of maternity services for the residents of Monklands is a key element of the board's proposals. The board will consult widely on those proposals between now and early December.
The issues that we are discussing this evening are at the heart of that programme of reinvestment for the future. No final decisions have been made. I can give hon. Members an assurance that no hospital closure can or will take place until new and better facilities are in place. I understand that the time scale in the proposal relates approximately to the year 2000.
I welcome this debate as an opportunity to air views that can be fed into the consultation process—and they certainly will be. I am grateful to the hon. Lady for highlighting the concerns of her constituents: it is important that they are heard.
In-patient facilities are a key aspect of the health board's service review. A key outcome is that the existing pattern of service provision in Lanarkshire will not be sustainable in the future in the context of the new, localised approach to maternity care in which the health board is investing. The review considered the position of Bellshill. Bellshill is a stand-alone maternity hospital, and currently provides care for around 3,300 births each year. Having consulted widely, the board rejected the option of centralising future in-patient services at Bellshill. Clear advice from national and local bodies is that such stand-alone maternity units, lacking the back-up facilities for more specialised care, should be phased out. Wherever possible, maternity units should have available the full range of clinical support services of a major acute hospital, especially for mothers who experience difficulties and complications giving birth. Both proposals for the site of a new in-patient unit, which I shall discuss shortly, envisage the closure of Bellshill maternity hospital once alternative accommodation becomes available. I would, however, like to take this opportunity to state clearly that the re-provision of in-patient services at another site is in no way a reflection of the dedication of the staff and the quality of care that they provide at Bellshill hospital. The hospital is much respected and admired in the community, and I am grateful to all who work hard there to provide care for mothers in Lanarkshire.
The health board's review has recommended that in-patient maternity services should be centralised in a new unit on a district general hospital site. Two local acute trusts have submitted proposals for the location of the new unit. In considering the proposals, the board has weighed the need to provide the best quality of care possible alongside the need to offer accessible services. Although finely balanced, the health board has expressed a preference to locate the new in-patient unit at the new Law hospital to be built at Netherton, beside Wishaw.
Importantly, in a patient-centred NHS, the board also took into account extensive consultations with mothers in making their decision. The key message from these discussions was that mothers attach greater importance to quality of care during pregnancy and to the facilities 569 available in the maternity unit than to the location of the in-patient unit itself. Of those who expressed a preference as to its location, 38 per cent. preferred Netherton and 33 per cent. preferred Monklands.
For the residents of Monklands, this decision would enable an increased quality of service to be provided. New locally based day care facilities in the Monklands district general hospital care will be available for mothers in the Monklands area, with immediate access to on-site specialists. With in-patient accommodation in the new Law hospital, intensive neonatal and other specialist care would, for the first time, be available on-site for all mothers, with no need to transfer to another site should complications arise.
The hon Lady raised an alternative option of providing in-patient facilities at two sites in Lanarkshire the new Law hospital at Netherton and Monklands district general hospital. This was a fundamental question addressed by the review. The size of future demand for services is an important consideration. The number of births per year to Lanarkshire mothers is expected to fall by almost 15 per cent. by 2005 to just over 6,600. Of these, around 4,400 will take place in Lanarkshire, reducing the need for local in-patient accommodation to around 80 beds. A single in-patient maternity unit remains the health board's preferred option for strong clinical reasons. There are five reasons, which I shall go through.
First, with two sites, a neonatal intensive care unit for critically ill babies could be provided at only one location, resulting in around 50 per cent. of babies who need that level of care having to be transferred to the hospital with the unit. The advice that I have received is that transference is dangerous if a baby is critically ill. Secondly, with two sites, peaks in demand would result in some women being transferred at short notice to unfamiliar surroundings when their "local" unit was already full. That is unsettling to prospective mothers. Thirdly, two sites would reduce the availability of expert anaesthetic and paediatric staff, since the range of work at each site would be insufficient to attract top specialists. Obviously, anaesthetists and paediatricians of top quality are needed.
Fourthly, the lower activity levels at two sites would not equip staff with sufficient expertise to deal with the range of potential birth complications as effectively. Only with higher activity levels at a single site could that be achieved. That might affect safety and would be a concern in securing continued accreditation from royal colleges and other national bodies. Fifthly, the consequences of having two smaller sites rather than one large one would also impact on recruitment and retention of staff. To develop their professional skills, many staff would be seeking experience in a unit with a greater volume of activity and offering a wider range of experience than could be offered in the two smaller units. For those reasons, the single-site option is preferred by the health board.
570 I should make it clear that the review of maternity services in Lanarkshire goes much wider than just in-patient care. The board wished to respond to the expressed wishes of mothers for increased community-based antenatal and post-natal care, which we think is extremely important. The board considering whether the 24 antenatal and post-natal clinics sited around Lanarkshire, including six in Monklands, should be increased in number, whether the range of services available at each clinic should be increased, and whether the opening times of clinics should be revised or extended.
In addition, the board intended to build on the concept of day assessment centre services already provided in Bellshill and Law hospitals. It will provide four such centres, including a new centre in Monklands hospital. These centres will be staffed by midwives and will provide a wide range of services locally to avoid the need for women to travel to the in-patient unit if at all possible. The centres will be linked to the hospital day-bed facilities for conditions which do not need the full support of the in-patient unit.
Finally, the board also intends to develop the concept of integrated care. With a unified clinical and organisational structure, each woman will have a named midwife and consultant with a midwifery team to ensure continuity of care from the first contact until after the birth. Importantly, the service will be both personal and local.
I have been impressed by the extent to which local consultations have formed the bedrock of the service review and development of proposals. It is right to acknowledge the efforts of the board to consult as widely as possible and the response from so many interested parties. That has been of assistance. Consultations on the board's proposals are and will be actively pursued, with over 20 public meetings and meetings with professional and other bodies arranged in Lanarkshire. Several of these are being held in Monklands, and I know that the health board will shortly wish to invite the hon. Member for Monklands, East in particular, along with other hon. Members from Lanarkshire, to discuss the proposals.
I am not in a position to anticipate the final outcome of the consultation exercise, or the Secretary of State's decision in relation to the possible closure of Bellshill hospital. [Interruption.] Opposition Members have put a number of arguments and they will be considered. That is right. Before the papers come to the Secretary of State, every conceivable contingency and possibility should have been properly considered. We are interested only in the provision of better care in the future than in the past.
We are aiming for enhanced antenatal and post-natal clinics and day-care maternity facilities and we want to make certain that a new unit should have intensive care back-up and access to other specialities.
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-eight minutes to Eleven o 'clock.