HC Deb 05 November 1999 vol 337 cc663-70

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

2.30 pm
Mr. Alan Hurst (Braintree)

I am pleased to have the opportunity to draw the House's attention to the achievements of, and the threat to, the maternity services in the north Essex town of Halstead and the villages that run along the Colne river valley. That area is administered by the Essex Rivers health care trust.

I am supported in this matter by the right hon. Member for Saffron Walden (Sir A. Haselhurst), who represents the area with me and whose duties as Deputy Speaker prevent him from speaking in the debate. Nevertheless, both the right hon. Gentleman and I attended and addressed a demonstration rally in Halstead, which was supported by hundreds of local people, predominantly those who have given birth to children in the local birthing unit or under the care of the local maternity service.

I am pleased that the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), knows the area. I understand that her children were born in the W J Courtauld hospital, Braintree, which I also have the honour to represent.

It is worth reflecting on the principles behind maternity care as set out in Baroness Cumberlege's 1993 report, "Changing Childbirth". The principles and criteria contained therein were accepted by the then Government and have been accepted by the current Government as setting the standard that should appertain to maternity services. The principles are that: The woman must be the focus of maternity care. She should be able to feel that she is in control of what is happening to her and be able to make decisions about her care, based on her needs, having discussed matters fully with the professionals involved. Maternity services must be readily and easily accessible to all. They should be sensitive to the needs of the local population and based primarily in the community. Women should be involved in the monitoring and planning of services to ensure that they are responsive to the needs of a changing society. In addition care should be effective and resources used efficiently.

There is serious concern about proposals emerging from the health care trust to change the method of delivering maternity services to mothers in Halstead and the neighbouring villages. Halstead is a small market town in north Essex; it is somewhat distant from the main town that serves its health needs, Colchester, and it has its own small hospital, which would once have been called a cottage hospital and which is greatly supported by local people. The Friends of Halstead Hospital has raised £52,000 to establish a birthing unit at the hospital and that is the focus of the current midwife-led maternity service.

That service is known as the valley service, named after the Colne valley in Essex—not to be confused with the Yorkshire haunts of Victor Grayson. The service was set up three years ago to demonstrate that the principles of "Changing Childbirth" could be applied in small towns and rural areas. It has been a resounding success, but that success has, in some ways, laid a dangerous path for it.

It might help the House if I outline the maternity services process followed in Halstead and the valley villages. When a woman believes she is pregnant, she goes to see a local general practitioner; if the pregnancy is confirmed, the GP notifies Colchester general hospital. That hospital then sends the details of the expectant mother to the valley midwife team based at Halstead.

Completely following "Changing Childbirth" criteria, the valley team allocate a named midwife who acts with her partner midwife so that someone is always on call. The named midwife contacts the expectant mother at her home, not at a clinic. She takes the mother's history and gives appropriate advice about maternity services and what she can expect, and carries out ante-natal checks. The expectant mother is then given the choice that every expectant mother should have of where her baby is to be born: at home, in the birthing centre at Halstead hospital or in the general hospital in Colchester. The course of ante-natal care will be directed to suit that choice.

Ante-natal care is based on home visits, not clinic visits. The named midwife gives the expectant mother her telephone number, mobile phone number and pager number. Thus, the expectant mother can contact the named midwife or her partner any time, 24 hours a day.

On going into labour, the expectant mother contacts her named midwife, whom she knows well by that time. The midwife goes to the expectant mother's home and makes an assessment of whether labour has progressed to the point where delivery may be expected. The purpose of the home visit and the early check is to avoid premature or false admissions to hospital. That has two advantages: it avoids unnecessary anxiety for the expectant mother and the cost of travelling sometimes long distances to the birthing unit or the hospital in a predominantly rural area.

If labour has begun, the named midwife accompanies the expectant mother to Halstead or Colchester and is with her during birth and for the period afterwards. If the mother stays in the hospital, she passes into the care of the hospital staff; if she goes home, the named midwife goes with her and carries out the post-natal care for two or four weeks.

I shall compare the valley scheme with the traditional scheme that operates in the other part of the health trust area in Colchester and the villages on the Colchester side of the district. The mother will go to her doctor, who will send her to the clinic at the Colchester hospital, where she will see the duty midwife. The mother is seen by the community nurse probably twice during her pregnancy. When she goes into labour, she will ring the labour ward of the hospital and be told to come in. If she goes to the hospital too soon, she will be sent home. If she is ready, she will be admitted and seen by whoever is available. The mother stays in the post-natal ward for two to three days. After she is discharged from hospital, post-natal visits are made for the same period as under the valley scheme but from a team of three or four midwives. To be fair, the same midwife would probably visit the mother after the birth, but that is not guaranteed in the same way as it is under the valley scheme.

The local health trust have described the system as a two-tier service and claim that the service in Halstead and the valley villages is better than that in the rest of the district. The problem with the valley scheme is its initial set-up cost, which includes the provision of cars for the midwives, mobile phones and pagers. The health trust estimates the cost of applying the better scheme to the whole district as between £90,000 and £160,000, depending on the way in which the cost is calculated. After the initial costs, it appears that the midwife-led, valley scheme is more cost effective. Figures from 1998 show that a birth under the valley scheme cost £722, while a birth under the traditional scheme cost £1,200 in Colchester and £1,700 in Harwich.

I am told also that forceps delivery under the valley maternity scheme is half the rate of the traditional scheme and use of epidurals and pethidine is substantially lower. Some 20 per cent. of births take place at home or in the birthing unit, while the national figure for such births is nearer to 2 per cent. Locally, that figure has increased from 1 to 20 per cent. since the introduction of the valley scheme.

The scheme is acknowledged to be an outstanding success, even by the health trust itself. That is the problem, however, because the scheme is clearly better than the traditional scheme operating elsewhere and complies much more fully with the principles of "Changing Childbirth". However, on 4 October the local health trust board decided that the current two tier system was unsustainable", and went on to say that a new uniform service would be introduced at the end of March 2000.

Councillor John Kotz, who is the leading health spokesman on Braintree district council, wrote to Mike Pollard, the chief executive of the health trust, about his concerns. I shall quote a relevant section from the chief executive's reply. He said: As I observed, the Trust has been placed in a position of having two differing modes of service delivery—traditional and group practice. Without additional funding of between £90,000 and £160,000, depending on how costs are calculated, 'Changing Childbirth' cannot be 'rolled out'. The Trust therefore has a two tier service which is 'part fish and part fowl'. As the health services in North Essex are in serious financial deficit, I cannot foresee the circumstances when the 'Rolls Royce' service in the Valley can ever be extended across our entire catchment area".

The expression "Rolls-Royce service" gives cause for concern. Valley mothers obviously take the view that they are about to be offered a Skoda in part-exchange for the Rolls-Royce. The expression "Rolls-Royce service" was used about Essex during the debate on "Taking the initiative", issued by the neighbouring health trust, when I brought these matters before the House in 1998. The trust claimed that Braintree and Maldon had a better, Rolls-Royce service than Chelmsford or Colchester. The whole point of "Changing Childbirth" is that every expectant mother should have a Rolls-Royce service. Corners should not be cut to ensure that everyone receives a uniform, but lower, standard of service.

Mothers in Halstead and the valley villages are incensed by the plans. I mentioned a rally that the right hon. Member for Saffron Walden and I attended two or three weeks ago. Halstead is a very small town and the villages are even smaller. The rally was attended by hundreds of young mothers pushing prams. It was one of those autumn days when there is a deluge of rain, but I am pleased to say that, by the time that we reached the park and the petition was received, the sun had come out and feelings were much more hopeful than when we started out.

In the debate about town and country it is said that, in many ways, country areas receive fewer services, sometimes because of their very nature and their distance from towns. In this case, for once, a small town and small villages have a top-rate service. The mothers and children of Halstead and the valley villages would ask my hon. Friend the Minister to exert every possible influence to persuade the health trust that it has started well. It had high aspirations when it set up the scheme some three years ago. It must be congratulated on what it did then. It is a pity that, having marched us to the top of the hill, like the Duke of York, it has started to take us down again. I hope that it finds the necessary capital resources to ensure that everyone in the health district, including the constituents of the hon. Member for North Essex (Mr. Jenkin), enjoys the benefits that my constituents and those of the right hon. Member for Saffron Walden currently enjoy.

2.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate my hon. Friend the Member for Braintree (Mr. Hurst) on securing a debate on maternity services. He has championed the cause for many years. He was right to say that I am very familiar with Halstead and the maternity services in his constituency. I have used them not once, but twice.

I am particularly pleased to have an opportunity to reply to this debate because the maternity services in the national health service have been a success story. Huge advances have been made in the past few years in changing the experience of women during pregnancy and childbirth. It is now much safer to give birth, and women are more actively involved in making decisions about the maternity care that they receive. They no longer simply have to make do with what is decided for them by others.

The overriding expectation of pregnant women, their partners, their families and those who care for them is a safe pregnancy and delivery and a healthy mother and baby. Fifty years ago, at the birth of the NHS, the maternal mortality rate was 170 per 100,000 pregnancies. A unit delivering 3,000 babies a year could expect to see five maternal deaths annually. Thankfully, that figure has been greatly reduced. A unit delivering 3,000 babies a year today might have only one maternal death every five years or so.

There have been similar safety improvements for babies. The perinatal mortality rate, which is defined as stillbirth and death within seven days of birth, has dropped from 40 per 1,000 pregnancies in 1946 to 8.1 per 1,000 in 1998. The national health service, and particularly the maternity services, can take great pride in those figures.

However, childbirth is about more than just safety. Maternity services exist to support the mother, her baby, her partner and her family. They are about helping women enjoy pregnancy and childbirth as a positive, life-enhancing experience. No one has a greater interest in a healthy baby and a happy outcome than the pregnant woman. Care must be planned and provided for her and, more importantly, in partnership with her.

There has been a culture change in the national health service. The Government are determined to put the patient first. In maternity services, the ethos of putting the woman at the centre of service planning is now widely accepted.

The Government recognise the hard work, skill and commitment of all those involved in providing maternity services. There has been considerable progress in recent years in providing a more personal, woman-centred service that is tailored to meet the health needs of the local population. Maternity services have led the way in partnership working. Midwives have played a key role, working with women and other health professionals to ensure that the maternity service provided for women by the NHS is safe and satisfying.

Since 1994, 38 development projects have been centrally funded as part of the implementation of the "Changing Childbirth" initiative. The implementation phase has ended, but the central principles enshrined in the report have become embedded in mainstream NHS maternity provision. Those principles are that care should meet the needs of the individual, should be accessible and as close to the woman's home as possible, and should be woman-focused, user-friendly and predominantly led by midwives and the women themselves.

An Audit Commission report on maternity services was published in March 1997. It found that 90 per cent. of women surveyed were pleased or very pleased with the way that they were treated during pregnancy and childbirth. That is a very high satisfaction rate, which reflects the dedication and skill of all the professionals involved in maternity care.

There is, of course, no room for complacency, and we have been building on the Audit Commission's recommendations in our wider initiatives to modernise the NHS to improve still further maternity services for women and their babies.

In many respects, maternity services have led the way in the NHS. The principles of accessible, responsive, user-focused services, evidence-based care and user involvement, which were set out in "Changing Childbirth" some years ago, are all there in the White Paper, "The New NHS".

"The New NHS" is very specific in its intention of making the health service more responsive and accountable to users. Maternity services are already leading the way with the patient-centred care that is at the heart of our plans for the national health service. Groups, such as maternity services liaison committees, which enable users to work with health professionals in developing appropriate, local services will, we hope, have a much larger part to play in future. The Department has financially supported the strengthening of maternity services liaison committees by funding a training project for user representative committee chairs. Furthermore, the Department has supported the proposal of the national perinatal epidemiology unit to set up a website for maternity services liaison committees, so that an increased interchange of information can take place.

Another strand of our modernisation programme for the NHS is to improve the support and investment that we make in NHS staff. The recent pay increases, coupled with a new innovative recruitment campaign, provide a real demonstration that we care about the future of our nurses and midwives.

Last year, £42.6 million was invested in nursing and midwifery training, and, by the end of this year, we shall have spent £50.3 million. In addition, £50 million has been allocated to expand part-time nursing and midwifery training places.

We are also attracting more people into midwifery and encouraging qualified staff back into the NHS by broadening career structures and improving the working life of staff. A £5 million nursing and midwifery recruitment campaign took place, which attracted more than 50,000 responses. A further £5 million has been allocated to support local "return to practice" initiatives. We are especially encouraged that, as a result of these campaigns, applications for midwifery courses have increased by 61 per cent. this year.

I hope that what I have said has emphasised the Government's on-going commitment to the principles of good-quality, woman-centred maternity services. Of course things are still not perfect and, inevitably, in a climate of finite resources and competing demands, difficult decisions have to be taken. However, I firmly believe that we can build on the many examples of good practice that exist throughout the country. We will make further progress through the wider initiatives that we are taking to modernise the national health service and to improve public health.

I have listened carefully to my hon. Friend's concerns about the proposals from Essex Rivers Healthcare NHS trust, and I know that these concerns are shared by the right hon. Member for Saffron Walden (Sir A. Haselhurst) and the hon. Member for North Essex (Mr. Jenkin).

Mr. Hurst

I should have mentioned earlier that the hon. Member for Colchester (Mr. Russell) apologises for not being here today, but he has written to me and expressed his full support for the remarks that I was to make.

Ms Stuart

I am grateful for that comment. I know that the MPs for the area have been united in their concerns on previous occasions. I always welcome and appreciate cross-party co-operation, and this is an example of true cross-party co-operation.

I am sure that my hon. Friend the Member for Braintree will agree that we want to maintain high-quality maternity care not just for the women of Braintree, but throughout north Essex. We have a responsibility for all mothers in the area—the 80 per cent. who deliver in the large hospitals, which provide an excellent service, as well as those who deliver in smaller units or at home.

Midwives working in teams are only one way of providing good quality services. Pilots such as those described by my hon. Friend are a key way of developing maternity services for the future, not a way of setting up exclusive services for the few. Pilots are a way of learning and drawing conclusions from the experience gained, which must be adjusted to local needs and applied locally.

A further important step is local consultation, to feed in the views of everyone involved in using and providing local maternity services on the best way to spend the £3.9 million spent on the service in north-east Essex.

My hon. Friend will agree that it is vital that plans for service development are determined democratically and implemented sensitively and appropriately. I am aware that North East Essex community health council has previously expressed concern that North Essex health authority has not made progress in developing a strategy for maternity services.

A north Essex strategy group has been set up to tackle some of the issues involved in achieving better quality and greater consistency in maternity services. The group is producing guidelines and protocols to determine how maternity services should work. The strategy group consists of professionals from each of the north Essex NHS trusts and the lay chairs of the three local maternity service liaison committees—MSLCs—in north Essex. The MSLCs are mixed groups of professionals and local women.

The strategy group will not take decisions on future service delivery. Rather, it will be involved in developing protocols and standard frameworks for maternity services in north Essex. A draft strategy is expected from the group by the end of 1999 and consultation will begin in the new year.

This inclusive approach recognises the important role of the newly formed primary care groups. The health authority will consult widely on its proposals. It is determined to ensure equality of access to high-quality care for all the women in the area. We expect the consultation to include not only the views of the local community. I expect that the health authority will examine successful maternity service provision in other parts of the country. There are many excellent examples of good practice that should be studied during the strategic planning process.

If the community health council contests the proposals and agreement cannot be reached locally, the matter will be referred to Ministers, who will make a decision in the light of all the circumstances. I am sure that my hon. Friend will understand that it would therefore be inappropriate for me to express an opinion on the consultation process or the substantive issues at stake. I must and will keep an open mind.

Mr. Hurst

Does my hon. Friend agree that, if the health trusts concede that the Valleys scheme is the best, that should be the model for the rest of the district?

Ms Stuart

The purpose of the consultation process is to examine maternity services, the financial position of the trusts and the services to all the other users. The right balance must be struck.

I assure my hon. Friend that we remain fully committed to the provision of high-quality, up-to-date and responsive maternity services. We will uphold the health authority's proposals only if we are satisfied that they are in the best interests of local people.

I know that my hon. Friend has previously expressed concern about the future provision of maternity services in north Essex. He has been successful in ensuring that discussions on future service provision in his area are driving the development of the health authority's strategy for maternity services not just for his constituency, but for the whole of north Essex.

As a result of my hon. Friend's efforts, the lessons learned from the pilot schemes will be instrumental in developing options for consultation. That will ensure that services are developed equitably for all north Essex residents, recognising, as I am sure that my hon. Friend will agree, that plans for service development must be determined democratically to ensure sensitive and appropriate care of mothers, their babies and their families.

My hon. Friend can be assured that there will be no changes to existing services in north-east Essex unless and until—

The motion having been made at half-past Two 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 Three o'clock.