§ Motion made, and Question proposed, That this House do now adjourn.—[Jane Kennedy.]10.14 pm
§ Mr. Quentin Davies (Grantham and Stamford)
I am grateful for the opportunity to take up in the House a matter of vital importance to my constituents. Grantham hospital is a successful general hospital with a wide range of activities, including obstetrics and gynaecology, which are presided over by three consultants. The hospital has benefited a great deal from expansion and investment over the past 20 years of Conservative government—the last party political point I will make this evening.
Grantham hospital has depended for its maternity and obstetric service on paediatric support delivered, on contract, from Queens Medical Centre in Nottingham. That support includes the necessary neonatal cover to enable obstetricians to practise in the full confidence that they will be able to resuscitate when necessary and deal with difficult cases.
All that has now been put at risk. I have it at first hand from Queens Medical Centre that it would have been perfectly happy to continue with its contract, but that contract conflicted with the ambition of Lincolnshire Health to set up an ambulatory paediatric system throughout Lincolnshire, to be based at Lincoln county hospital. It was to be made answerable to consultants based in Lincoln and Boston, and the expectation was that in-patient paediatric cases would be referred to Lincoln county hospital; so Lincolnshire Health made it plain to Queens that it could no longer expect to supply in-patient and out-patient paediatric services. Queens Medical Centre therefore gave notice that it could not continue to provide the necessary neonatal cover. There is thus the prospect of an end to all maternity services and all deliveries in Grantham hospital.
I emphasise this history because it is important to appreciate that, if there is a crisis, it has been created by Lincolnshire Health. If we are seeking solutions, they are solutions to problems gratuitously caused by Lincolnshire Health.
At the end of last year, Lincolnshire Health produced a draft consultation document setting out one preferred option and three others that were dismissed in the same document. The community health council rightly objected to that method of proceeding; I am delighted to acknowledge that the Government shared the council's view. Lincolnshire Health was ordered to produce a genuinely open consultation document, to ensure that the options were considered dispassionately and professionally. Lincolnshire Health was also required to give a commitment to conduct a survey of opinion among women in the area covered by Grantham hospital.
It is my contention—I have no doubt that that contention will be 100 per cent. vindicated by the document discovery process that will be launched when we have a judicial review, which I trust we will now have, given that the community health council has requested one—that, first, the survey that was carried out has been blatantly ignored by Lincolnshire Health and simply thrown into the wastepaper basket; and, secondly, far from carrying out the genuine consultation exercise promised by Lincolnshire Health, the whole process has 1171 been made a mockery. On both commitments—to have a survey to take account of local opinion and to carry out a proper consultation process—Lincolnshire Health has acted in bad faith and has deceived both the Government and the public.
Since February, the survey has been undertaken, and 95 per cent. of respondents expressed their wish that the status quo should continue. The overwhelming majority of those who were asked what they would like to happen if the status quo could not continue chose option 3, which is the availability in Grantham hospital of maternity services under midwife supervision. However, Lincolnshire Health continues to be committed absolutely to option 2, which is the abolition of all maternity services in Grantham hospital, so that no deliveries could take place there.
Another event that has taken place since February is that, as a result of discussions between Grantham hospital and Leicester royal infirmary an agreement has been reached in principle under which Leicester royal infirmary would be prepared to supply the consultant cover that Queens Medical Centre is now reluctantly withdrawing. That would enable a proper consultant-led neonatal facility to be re-established in Grantham hospital and so enable a full range of obstetric and gynaecological services to continue there. I quote a letter, dated 21 April 1998, from the acting chief executive of Leicester royal infirmary, David Sissling, who writes:We would be very interested in working in partnership with Grantham and District hospital in respect of obstetric services.Notwithstanding the results of the survey, the commitment from Leicester royal infirmary, or the undertakings publicly given by Lincolnshire Health at the beginning of the year, a meeting of the health authority was held on 28 May in Sleaford—not in Grantham, whose population has a particular interest, although Sleaford people use Grantham's maternity services as well; incidentally, I am delighted to see my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) in the Chamber this evening. I was present in the audience throughout the period in which the public were admitted to the meeting, but I have never in my life seen such a mockery made of a meeting of a publicly accountable authority.
The executive of Lincolnshire Health who made the presentation focused entirely on option 2, which would remove all possibility of any deliveries taking place in Grantham hospital; she almost entirely ignored the other options, except to dismiss them, and said nothing whatever about the offer from Leicester royal infirmary.
§ Mr. John Hayes (South Holland and The Deepings)
It has to be said that holding a shambles of a public meeting was the pattern established throughout Lincolnshire and in every town in Lincolnshire during the consultation on the reorganisation.
§ Mr. Davies
I am grateful to my hon. Friend, whose comment reinforces the serious concern that we in Lincolnshire all feel about the conduct of our health authority in recent times.
To return to the meeting of 28 May, what was even more surprising than the fact that the executive charged with giving the board an objective assessment of the merits and demerits of each proposal should have 1172 concentrated on only one proposal was that, when the non-executive members of the board expressed their view that they were inclined to go for option 3—the midwife option—the Lincolnshire Health executive told them that it was too late, because the decision had already been taken and, even more scandalous, public money had already been expended on building and construction work at Lincoln county hospital on the assumption that option 2 would be selected. A complete mockery was made of the procedures. It is an extremely serious state of affairs, not merely for Lincolnshire, but for the country as a whole, that a public authority should conduct itself in such a fashion.
The closing of maternity facilities in Grantham hospital will be an unmitigated disaster for mothers, families and prospective mothers in Grantham and the surrounding villages, Sleaford, Newark and the other towns—about 100,000 people in all, who have been so well looked after by Grantham hospital over the years. It would mean an hour's travel on bad roads to get to a hospital where a delivery could take place.
It is all too easy to foresee the perils and tragedies that could ensue. There is the danger of babies being delivered in ambulances or passenger motor cars—as the Minister knows, most women are driven privately to hospital when they have babies, rather than transported in ambulances. There is the danger of mothers suffering haemorrhages and dying in a car or an ambulance on the way to one of the general hospitals an hour away. That is an appalling prospect, and a hideous responsibility would descend on the shoulders of anyone who connived at or accepted such a proposal.
There are other considerations of less enormous human significance, but nevertheless important ones. As we all know, mothers who are about to deliver often have premature symptoms. If the hospital is close to their home, they can be sent home and told to come back the next day if symptoms continue, or to return later. If they live an hour away on a bad road, they will presumably have to be kept in hospital overnight, and possibly for one or two nights before they deliver.
National health beds will thereby be occupied unnecessarily and expensively, and there will be considerable disruption to the families concerned. In its decision, Lincolnshire Health has taken no account of such incremental national health costs, or of the incremental ambulance costs that will be caused by the proposals.
A further consequence of the decision will be to weaken Grantham hospital, and perhaps fatally to emasculate it. If not only obstetrics but gynaecology are withdrawn, that may undermine the viability of the accident and emergency department, because no gynaecological facilities will be available as a back-up. If we lost accident and emergency, apart from the obvious danger to people's health and lives, it would be impossible for us to retain critical care beds in Grantham. If we had no critical care beds, I doubt whether surgeons would be prepared to undertake major or abdominal surgery in Grantham hospital.
By an inexorable clinical logic, that scenario leads to the closure of Grantham as a general hospital. There is a corresponding financial logic that leads in the same direction. We all know that hospitals have a high operational gearing and that fixed costs are a high 1173 proportion of total costs. If some facilities are withdrawn—Lincolnshire Health proposes to withdraw at a stroke paediatrics, gynaecology and obstetrics—that undermines the financial viability of what remains. Again, the path leads inexorably to the closure of Grantham as a general hospital.
The lives and health of mothers and potentially of babies are at stake. Also at stake is the confidence of the British people in the integrity of our institutions and the procedures that have been established for taking public decisions of this kind. The conduct of Lincolnshire Health over the past few weeks is an affront to every principle of sound administrative procedure, and to every principle on which a public authority should be based. It makes a mockery of the concept of fiduciary responsibility, on which health authorities were originally established.
§ Mr. Douglas Hogg (Sleaford and North Hykeham)
I know that the House wishes to hear the Government's response, so I shall be brief. I congratulate my hon. Friend the Member for Grantham and Stamford (Mr. Davies) on securing this Adjournment debate and I endorse everything that he said. My constituents who use Grantham hospital view the proposals of Lincolnshire Health with great concern. They believe—as do many hon. Members and I—that it is important that Grantham hospital retains a consultant-led paediatric and obstetric service. Lincolnshire Health's proposals do not make provision for that and, accordingly, they are objectionable.
I know that the community health council is making a formal legal objection, so the matter will come before the Secretary of State, who will be responsible for the ultimate decision. The hon. Member for Newark (Mrs. Jones) and I have met the Secretary of State to discuss the matter and we shall continue to press him. We believe that he should rule that Lincolnshire Health's proposals are unacceptable and should be rejected. He should insist on the retention of Grantham hospital as a fully fledged district general hospital, preserving, in particular, a consultant-led paediatric and obstetric service.
§ Mrs. Fiona Jones (Newark)
I do not think that there is any disagreement between the hon. Member for Grantham and Stamford (Mr. Davies), the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg) and myself. Many women in my constituency go to Grantham and District hospital to have their babies. A maternity unit at Newark closed in the 1980s, and the women of my constituency were assured that they could have their babies at Grantham hospital, which involves a journey of 15 minutes. The closure of Grantham hospital will distance the health service from my constituents and it will mean that women must travel for almost an hour to either the Lincoln county hospital or to hospitals in Nottingham to have their babies. I have had babies in recent years, and I believe that that is totally unacceptable. People should be able to access local hospitals that are situated within a reasonable distance.
I am unhappy about Lincolnshire Health's proposals. They assume that, if Grantham and District hospital cannot deliver babies utilising a consultant-led service, all 1174 women will go to the hospital at Lincoln. That logic is fundamentally flawed because many women will opt to go to hospitals in Nottingham. Therefore, Lincolnshire Health will lose many clients—if that is the current terminology.
I am also extremely unhappy about the position adopted by the royal college. The Lincolnshire Health review is about finance, but the closure of maternity services at Grantham hospital is more about the position of the Royal College of Paediatricians. I accept entirely that paediatrics is a shrinking service, but I do not accept that, because members of the Royal College of Paediatricians find it inconvenient to train at a smaller hospital such as Grantham, my constituents must distance themselves from a service that they need. The Government must consider that issue: the Royal College of Paediatricians has decided that it does not want to train its paediatricians at local hospitals, so we cannot have consultant-led units at smaller hospitals and women cannot have their babies at local hospitals in rural areas. That is totally unacceptable.
§ The Minister for Public Health (Ms Tessa Jowell)
I begin by congratulating the hon. Member for Grantham and Stamford (Mr. Davies) on securing an Adjournment debate on Grantham and District hospital. My ministerial colleagues and I are well aware of the concerns that exist locally about the current and future level of health services provided by the hospital.
The hon. Gentleman has made known his concerns about Lincolnshire Health's proposals for Grantham hospital through meetings and correspondence with Ministers, as he has said. I acknowledge his efforts and those of other hon. Members, including my hon. Friend the Member for Newark (Mrs. Jones), in bringing together key local people in a constructive attempt to resolve the concerns about the level of services provided at Grantham and District hospital.
I am aware that the key issue that has prompted the hon. Gentleman to call for this debate is the decision taken by Lincolnshire Health at the end of May, in line with its consultation document, that with effect from 1 August Grantham and District hospital should provide only antenatal and post-natal out-patient care and day-care gynaecology, with consultant and midwife care being provided by other hospitals.
I know that this has caused concern in the Grantham area, and that that concern has been expressed specifically by the South Lincolnshire community health council. I am also aware that the Royal College of Midwives has criticised the consultation process that Lincolnshire Health has followed. I shall return to the consultation process later. The health authority wishes to keep discussion open following this decision. The door is not closed. I reiterate, the door is not closed.
I shall say a little about Grantham and District hospital before moving on to the health authority's current proposals and maternity services in general.
§ Mr. Quentin Davies
The Minister says that the door is not closed, but Lincolnshire Health took a formal decision on 28 May. The community health council, equally formally, has objected to it. The door is indeed not closed; it is open to Ministers to reverse the decision taken by the health authority and to introduce some sanity 1175 into the provision of health care in south Lincolnshire. I hope that the hon. Lady and her colleagues will live up to those important responsibilities.
§ Ms Jowell
I am well aware of the stage that decisions have reached. I am aware also that further options are still being considered. I hope that the hon. Gentleman, in the spirit of his great concern about the issue, will make his contribution to the continuing discussions with the health authority.
I shall say a little about Grantham and District hospital before going on to the health authority's current proposals and maternity services in general. Sadly, for most people outside the local area, Grantham and District hospital will always be associated with the evil actions of Beverly Allitt during 1991. Locally, the hospital is held in high regard. It is a real testament to the comment, dedication and professionalism of the hospital's staff that that is the case. This is illustrated by the concern shown about Lincolnshire Health's proposals to change the services provided at the hospital, obstetrics and gynaecology being the matter of the debate. Concern has been shown locally in the press and in correspondence and representations to Ministers.
After the dreadful events of the Allitt case, paediatric services at Grantham were provided on a satellite basis by the Queens Medical Centre in Nottingham. Last year, the Queens Medical Centre made it known to Lincolnshire Health that it intended to withdraw from providing in-patient paediatric services because of concerns about clinical safety.
That decision was based on clinical isssues. Difficulties in recruiting consultant paediatricians to run the service were being experienced. That meant that standards of support for junior doctor training were not being met. The effectiveness of the service depends on the clinical skills of staff and on the trust's ability to recruit staff of the highest calibre. It also depends on a sufficient number of patients and variety of cases to allow staff to maintain and develop their skills. Those were all issues which could not be solved in relation to paediatric services at Grantham.
I understand, via public consultation, that the public and the CHC supported the health authority's decision to provide the majority of children's services from within Lincolnshire with an ambulatory service at Grantham hospital. The clinical implications of that development and its consequences for the obstetric and gynaecology 1176 services are clear. Without 24-hour paediatric cover seven days a week, the safe delivery of high-risk babies is unsustainable and clinically unsafe.
I fully understand that any proposal to change the services in a hospital causes concern. In this case, it is important to understand that the proposals are being made on grounds of clinical safety and, as my hon. Friend the Member for Newark made clear, not on grounds of finance.
§ Mrs. Fiona Jones
It is important to define a high-risk birth. A first birth is a high-risk birth. Therefore, any woman in my area who is having her first baby could not use a unit that is not consultant led.
§ Ms Jowell
A high-risk birth is determined clinically and defined within clinical guidelines. I agree with the point behind my hon. Friend's intervention. The circumstances of hospitals that serve rural communities are an important issue in relation to this set of decisions. It is important that hospitals in rural areas can meet tests of accessibility, clinical safety and the confidence of the communities that they serve. Scattered rural communities present different issues compared with densely populated urban centres.
As time is short, I reassure the hon. Member for Grantham and Stamford, and other hon. Members who have shown so much concern about the issue, that the decision-making process is continuing. The need for safe, clinically effective and efficient services throughout the county must underpin the review of services in Lincolnshire. Those factors will be of paramount importance in making decisions about obstetric and gynaecology services in Grantham.
Significant investment has been made by the health authority in paramedic obstetric training, with 36 staff receiving additional training in the last year to accommodate the needs of a service which is divided between two or more hospitals. That is an essential part of developing support for high-risk delivery.
As the hon. Gentleman made clear, the CHC is seeking judicial review. I hope that it will not pursue that course, and that it will be possible to resolve the matter locally. I reiterate that the decision-making process is still open. If the matter cannot be resolved locally, the decision will fall to Ministers.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes to Eleven o'clock.