§ Baroness SUMMERSKILLMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government why the maternity services have been selected for financial cuts, in view of the perinatal mortality figures which are higher than those of our European neighbours.
§ Lord WELLS-PESTELLMy Lords, reduced expenditure on the maternity services is planned to take account of the under-utilisation of existing beds brought about by the fall in the birthrate. At the same time, we are determined to improve the standard of care provided. Closures will be concentrated on inefficient and ill-equipped units, so allowing a greater proportion of births to take place in district general hospitals where the full range of modern obstetric and paediatric facilities is available, and this should itself contribute to reducing the perinatal mortality figures.
§ Baroness SUMMERSKILLMy Lords, I thank my noble friend for that Answer. Is it not a fact that perinatal mortality is linked with the incidence of children born with a physical or mental abnormality? Therefore, is it not a short-sighted policy to cut down the obstetrical services even in a small degree, and thereby increase this condition?
§ Lord WELLS-PESTELLMy Lords, my noble friend will know better than I the recommendations of the Peel Report, which encouraged the use of hospitals for the very reason which I should have thought my noble friend had in mind, that great care can be exercised in the obstetric field at the time of confine- 2142 ment. It is with this in view that I gave the Government's reply a moment or two ago.
Lord WALLACE of COSLANYMy Lords, is my noble friend aware that closure of many of these hospitals will mean that a pregnant mother has to travel a considerable distance under great difficulty for pre-natal treatment, which will not be to the advantage of the mother or the unborn child? How would my noble friend like to be a pregnant mother in such circumstances?
§ Lord WELLS-PESTELLMy Lords, in reply to my noble friend's last point, I really do not know. But in reply to his first point, we shall never have a system that provides complete ante-natal care either in the home or on a person's doorstep. It is absolutely essential that we provide the best possible facilities that we think can be provided in district general hospitals where there is expert staff, modern equipment and everything that is required. Of necessity, some people—whether for ante-natal purposes, confinement or ordinary illness—will have to travel a certain distance. That cannot be avoided.
§ The Earl of CRANBROOKMy Lords, is the noble Lord aware of the great difficulty people in rural districts experience in obtaining ante-natal care of the kind to which he has referred? Is he also aware that some years ago a Committee reported that the smaller local hospitals in rural areas were probably perfectly adequate for dealing with second and third confinements, and that what was essential was to get first and multiple confinements into the larger hospitals? But the smaller maternity hospitals in smaller towns and rural areas are absolutely essential if we are to give proper ante-natal care and treatment, in cases where it is not likely that complications will arise.
§ Lord WELLS-PESTELLMy Lords, I am aware of the problems in rural areas. For some years I was, in the wilds of East Anglia, a near neighbour of the noble Earl who has just spoken and I know the situation well. These factors have been taken into account. This matter was considered by the Peel Committee and the recommendation was to provide—and I 2143 do not want to cover the ground again—these facilities in district general hospitals as the best way of meeting this problem.
§ The Earl of CRANBROOKMy Lords, perhaps the noble Lord will read the Report of the Cranbrook Committee.
§ Lord SEGALMy Lords, can my noble friend say how, when these maternity facilities are cut, the services of the redundant personnel will be utilised?
§ Lord WELLS-PESTELLMy Lords, I cannot answer precisely, but where inefficient and ill-equipped units are closed down the personnel will presumably be used in the district hospitals and in the other facilities provided in the area.
§ Lord GAINFORDMy Lords, if any clinic or establishment is judged to be inefficient, would it not be easier to improve its efficiency and keep it remaining as a valuable unit?
§ Lord WELLS-PESTELLNo, my Lords. I have on more than one occasion had to say to your Lordships that the money available within the National Health Service, and the work it has to undertake in the United Kingdom, must be put to the best possible use. Therefore, it is necessary to close these inefficient and ill-equipped units. It is necessary, and will remain necessary, to close certain hospitals. But in the long run we shall be providing a far better, more effective and more efficient service.
§ Lord PLATTMy Lords, is not this a case where the best is the enemy of the good? Was not the Peel Committee thinking of all the wonderful facilities that can be provided and perhaps forgetting that the onset of labour can be a very sudden emergency and that in those circumstances the idea that the nearest help is 20 miles away is not very comforting to a pregnant woman? Are Her Majesty's Government further aware that in New Zealand where all this is organised they say that 98 per cent. of births now take place in hospital and the other 2 per cent in the ambulance on the way to hospital?
§ Lord WELLS-PESTELLMy Lords, the noble Lord will know that the Cardiff study which was reported in the British Medical Journal on 27th March last dis- 2144 covered that delivery in hospital had become almost universal. I am not going to say that there will not be areas which may give cause for concern for a while, but these will not be overlooked.
§ Lord CARRINGTONMy Lords, if the clock were working I wonder whether the noble Lord the Leader of the House would think that we had spent long enough on this Question?
§ Baroness SUMMERSKILLMy Lords, with the approval of my noble friend I wonder whether I may put another question on perinatal mortality—about which, I am sure, he knows nothing. May I ask my noble friend to make more investigations with regard to perinatal mortality? Is he aware that St. Mary's Hospital, which is situated right in the heart of the congested area of Paddington, has applied the methods which I should like to see applied throughout the country, but which, as a result of my noble friend's answer, will not be applied? Is my noble friend aware that, as a result, St. Mary's Hospital have reduced perinatal mortality from 30 per 1,000 to 12 per 1,000, and is he further aware that this is the kind of thing some of us would like to see throughout the country?
§ Lord WELLS-PESTELLMy Lords, I will take note of what my noble friend has said. We know that many factors are involved, but I understand that there is no simple answer. However, I will look at what my noble friend has said and pass it on to my right honourable friend.