Premature Baby Care: Manchester (Hansard, 12 April 1988)

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)
My Lords, as I told the House on 23rd February, the beds in the premature baby unit were 972 reduced on the advice of the medical staff working in it. Since then arrangements have been made for two extra cots at a cost of £125,000 as a result of the £1.5 million allocated to the North-Western Regional Health Authority under the Government's special bridging fund initiative. They will open shortly.

§ Lord Dean of Beswick
My Lords, I welcome the restoration of two beds. However, is the Minister aware that, on the figures which I gave when I last put the Question, the average number of deaths before 12 months of age in Manchester was 100 per cent. higher than the national average? Those figures were obtained when 15 beds were still available.
Is it not a fact that, although there has been a restoration of two beds, the situation is that the Manchester area has suffered a cut of 20 per cent. rather than one of 33 per cent? In those circumstances, is it not realistic to assume that the percentage of deaths above the national average will again increase? Will the Minister keep that matter under review?

§ Lord Skelmersdale
Not necessarily, my Lords. I am advised by the neonatal unit of St. Mary's Hospital in Manchester that the percentage of low-weight babies surviving in 1976 was 5 per cent. and that in 1987 the figure was 50 per cent. Over and above that, central Manchester has a high concentration of regional specialities, including neonatal intensive care, and the regional health authority has undertaken to conduct a comprehensive review of regional specialities. In so doing, it has asked all health authorities to provide two cots each for neonatal intensive care. The noble Lord may well be right as regards the figures for central Manchester. However, I believe that the problem should be viewed region-wide rather than centralising inquiries on a specific hospital in a specific district.

§ Lord Molloy
My Lords, when a regional authority is deciding to close wards or abolish beds, does the ultimate approval have to come from the department? Does the department seek the views of the professional bodies within that regional organisation?

§ Lord Skelmersdale
My Lords, it is a long-established practice in those matters that the district in control of the situation has to consult the local community health council or councils. If they cannot reach an agreement between themselves, the matter goes up to regional level. If there is still no agreement, the matter comes to ministers in the department which I serve. At that point, when ministerial decisions are being made, there is no approach to unions or to anyone else. The matter is decided on the papers that are submitted.

Lord Winstanley
My Lords, does the Minister accept that by definition premature babies are patients who cannot be put on waiting lists? Is it not clear, from the figures which the Minister has given to the House, that there has been a net reduction in the number of beds for premature babies in the Manchester area? Added to the loss of such beds 973 from the Duchess of York's Hospital for babies in Manchester, does that not create a serious situation?

§ Lord Skelmersdale
My Lords, I must repeat what I said to the noble Lord, Lord Dean: not necessarily. Of course I accept that premature babies, or indeed any babies, cannot be put on a waiting list, for obvious reasons. The important point is that the service should be region-wide or within that part of the region where it is necessary and should not necessarily be concentrated in one particular hospital.

§ Lord Molloy
My Lords, the Minister gave an explanation of how the issue proceeds if there is disagreement. Can he say who would be involved from the initial disagreement right up to the regional level? Would it be the professional organisations or others as well? In other words, which parties would be disagreeing with government?

§ Lord Skelmersdale
My Lords, the disagreement initially would be between the community health council or councils depending on the area and the district health authority which wants to carry out the closure.

§ Lord Ennals
My Lords, in view of the very high figures which my noble friend has quoted of deaths of children in the first 12 months of life, is the Minister satisfied that replacing two out of five beds is satisfactory? Is it not right that there should be a total restoration of the number of beds which have been cut and which are desperately needed not only in Manchester but across the country?

§ Lord Skelmersdale
No, my Lords. I think that the noble Lord is using the word "cuts" in a slightly loose fashion. What has happened in this particular case is that the doctors and nurses involved decided to approach the general manager of the district so that they could concentrate on very very low weight babies for which fewer cots were needed. The more normal low weight deliveries—as one might call them—would then be treated at other hospitals in the immediate vicinity. That is what is happening.

§ Lord Ennals
My Lords, was it not originally a shortage of money which led to a shortage of staff? That is the point I was trying to make to the Minister.

§ Lord Skelmersdale
My Lords, no; emphatically not. There has been no cut in the funding or staffing of the unit. As I have said, the reduction was made on medical advice in order to use existing nursing staff more effectively.

§ Lord Dean of Beswick
My Lords, is the Minister aware that I accept his answer to my previous Question that there has to be a regional perspective to the problem? However, would he not agree in principle that premature babies born in the centre of Manchester have as much right to survival as babies born outside Manchester? If he concedes that principle, will he keep the matter under review in an urgent sense in order to prevent the tragedies which are occurring and which may well be preventable?

§ Lord Skelmersdale
My Lords, most certainly I agree with the noble Lord, Lord Dean, that premature babies born in the centre of Manchester have as much right to survive as those born in the surrounding areas. I shall certainly make it my business to keep myself informed as to whether this policy is failing. However, present indications are that it is not.

§ Lord Tordoff
My Lords, will the noble Lord not agree that while the babies may have the same right to survive they may not have the same chance to survive?

§ Lord Skelmersdale
My Lords, I would not agree. That is why I undertook to keep the matter under continuous review.