§ Mr. Quentin Davies (Grantham and Stamford)
I am grateful to both you and Mr. Speaker for giving me this debate, Mr. Winterton. It is an opportunity— [Interruption.]
§ Mr. Nicholas Winterton (in the Chair)
Order. Will those leaving the Chamber please be quiet and leave quickly?
§ Mr. Davies
These new debates have provided an opportunity to bring to the attention of both the House and the Government a matter of the greatest concern to myself, my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg), my hon. Friend the Member for Newark (Patrick Mercer), who would be here but for his being away with a defence committee, and to all our constituents, including the mayor of Grantham.
The debate concerns the future of a general hospital, Grantham hospital, which has served the people of Grantham and its surrounding areas, including Newark, Sleaford and many villages, for generations. Until 1998, the hospital had a full range of services including paediatrics, gynaecology and obstetrics. With your knowledge of the health service, Mr. Winterton, you will be the first to agree that those are three important specialties in any general hospital.
The paediatric facility had been supplied for many years by a contract with the Queens medical centre in Nottingham. That worked perfectly well, providing a full range of paediatric services including neo-natal back-up to the obstetrics service. In the summer of 1998, Lincolnshire health authority decided to set up a new ambulatory paediatrics service in Lincolnshire. It announced to the Queens medical centre that in future all it would be required to deliver on its contract would be the neo-natal back-up for' emergency deliveries, which are, of course, exceedingly rare in the course of a year, requiring the immediate attention of a paediatrician. Lincolnshire health authority must have known that that would result in the Queens medical centre saying that it could no longer go on supplying paediatricians to be used once or twice a month. It was a ridiculous suggestion and the Queens medical centre was unable to renew the contract.
Lincolnshire health authority deliberately made no alternative provision. As a result, the viability of the obstetrics department was undermined, which provided the health authority with a wonderful excuse to withdraw gynaecology and obstetrics consultants from Grantham hospital. I use the word "excuse" advisedly. It was clear at the time that they knew the consequences of what they were doing. We found that out in the most dramatic fashion when, at a meeting of the health authority, which was supposedly going to take a decision on the future of the specialties in Grantham hospital, it was discovered that Lincolnshire health authority had already spent money on expanding the maternity facilities in Lincoln before the decision had been made. That was a clear breach of due process to which I drew attention at the time. Had we had the funds, we would certainly have pursued the matter 282WH under judicial review. What is more, the Government, who knew perfectly well what was going on, did not intervene, as they should have done, at this clear breach of due process. It is obvious that they were complicit in the manoeuvre whereby those vital specialists were removed from Grantham hospital. That caused great concern and agitation in Grantham and its surrounding towns and villages. In all, 100,000 people depended on the facilities in Grantham hospital.
Several proposals were made to save those services. I should like to pay tribute to Mr. Voght, one of the consultant gynaecologists and obstetricians in Grantham hospital, who produced several proposals under which it would have been possible for consultant gynaecologists and obstetricians to continue to operate in the hospital, but the Government rejected them all.
Of course, I immediately took the issue up with a series of Ministers. First, I contacted the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). I had meetings with him both privately and accompanied by my right hon. and learned Friend and by the then hon. Member for Newark. I took a deputation of local citizens, including many interested groups and local authority leaders of all three parties, to see the right hon. Member for Holborn and St. Pancras on 1 September 1998, when we received a promise that the royal colleges would be instructed to look at the matter and to make urgent proposals on the future of maternity services in Grantham hospital.
The right hon. Member for Holborn and St. Pancras was then replaced as Secretary of State by the right hon. Member for Darlington (Mr. Milburn), who continued to maintain that promise. I pursued him on several occasions—for example, in February and April 1999—and was always told that the report was about to appear. It never has, and it has now been revealed by the Minister for Public Health, who is not here today because she is on maternity leave, that the promise has been—to use her words, which I believe are in the new spin-doctor language—"overtaken by events". In other words, the promise has been breached.
From spring 1999, the right hon. Member for Darlington, who evidently had little taste for the issue and was perhaps deeply embarrassed by it, decided to pass the whole matter over to his deputy, the Minister for Public Health, who has displayed in her handling of the matter a lack of interest and commitment and a lackadaisical and disorganised approach to her work such as I have not previously witnessed in my dealings with Ministers in Governments of either party. On one occasion, she took a year to respond to one of my letters. I eventually received a grovelling written apology from the permanent secretary and chief executive of the national health service, Mr. Nigel Crisp, apologising for the behaviour of his Minister: a pretty extraordinary state of affairs. Her letter, which I am happy to make available to anyone who wishes it, is dated 16 May 2000. That gives a flavour of the way in which we have been treated by the Government.
Naturally, I continued to pursue the matter. I arranged a meeting with the Minister for Public Health on 1 March 2001, when I received her assurance that she would institute an inquiry into the future of maternity services in Grantham, apart and aside from any national investigations or inquiries relating to royal colleges about the future of maternity services in the national 283WH health service, because she accepted that the matter of Grantham was of sufficient urgency. I recorded that in a letter to her dated 9 April. I received no written confirmation from her of the promise or of any moves to set up the inquiry. My secretary and research assistant pursued her office and on 10 May received a promise that we would definitely hear something from her before the dissolution of Parliament. We did not. One may ask why the Government did not wish to give me a discouraging response on the eve of the election campaign, but I will leave that open to speculation.
I finally received a reply to my letter of 9 April on 20 September, which represented a considerable improvement in the hon. Lady's performance. The delay in her dealing with her correspondence has evidently come down from 12 months to six months, so I suppose that we should be grateful for that. The letter said that the original promise that I was given by the right hon. Member for Holborn and St. Pancras had been, to repeat her phrase, "overtaken by events" and that her own undertaking on 1 March no longer applied. The letter was full of gobbledegook saying that there would be all sorts of studies of all kinds of maternity and obstetric issues in the national health service and that over the long term the future of Grantham hospital would have to be considered in the light of those. I have no time to quote the letter, but I will make it available to the press and any other interested party. It makes depressing, but revealing, reading.
This is a history of avoidance and evasion of fundamental responsibility and of trying to fob off the people of Grantham. However, the really vital issue that we should be focusing on today is the actual consequence of removing those facilities from Grantham hospital.
I am afraid that the consequence has been what was predicted by myself and many others, including the general practitioners of Grantham to a man and to a woman, Mr. Voght and other doctors and specialists in Grantham hospital: a whole series of tragedies. We have lost lives. Babies have died. Children have died who quite evidently would not have done had the proper facilities, such as are usually expected to be present in a general hospital worthy of the name, still been in place.
The nearest obstetric, gynaecology and 24-hour paediatric facilities are now located in general hospitals all more than an hour away by road. One is on the other side of Nottingham, one on the other side of Lincoln and another on the other side of Boston. That is the position that we face. We now have a series of calls on the ambulance service to take emergency cases to those three hospitals. Imagine what it is like to have a haemorrhage and be on a bumpy road in an ambulance hoping to get to a general hospital in time.
It is always difficult to be certain in each individual case whether a fatality would have occurred had the facilities still been available in Grantham, but there are a number of cases in which there is little doubt. One is that of a poor little three-year-old called Tyler Foster. In March 2000 he was sent to three hospitals before he died. He was first admitted to Grantham, but because there was no paediatrician there he was shipped to Boston. Having gone 30 miles to the east he was then shipped 30 miles to the west, to Nottingham, where he 284WH died of meningitis. Usually, if that is diagnosed in time and treated with antibiotics, the prognosis is favourable. He was sent to three different departments in search of the paediatricians who should have been present in Grantham, and would have been before 1998.
Another case was that of Olivia Gonzales in October 2000. She was born with a blood incompatibility and rapidly developed jaundice. Again, the proper facilities were not there and she died from a condition the outcome of which, in the general medical view, is usually satisfactory as long as it is treated in time. By the time she got to Lincoln hospital, it was too late.
Just a week ago was the case of Georgia Adelle Sewards, which I will dwell on for a second, as it was so recent. I have been authorised by her grandmother to read from the tragic letter that I have received. It is dated 15 October 2001.Last Thursday, my daughter Keely had a stillborn baby after only being 22 weeks pregnant. She started bleeding on Monday and it took 4 doctors to see her before she was admitted to Lincoln Hospital where the baby was still born in the early hours of Thursday morning.She had been taken from Grantham to Lincoln.Had Grantham been open I am sure that she would have been referred there straight away or if she hadn't, I would have took her there myself…No words can express the heartache this has caused the whole family. The lack of facilities at Grantham could have made a difference I feel sure. Surely no amount of money is worth the cost of human life, even one so young.
§ Mr. Douglas Hogg (Sleaford and North Hykeham)
Will my hon. Friend accept my congratulations on having secured this Adjournment debate? My constituents who live in Sleaford and in the adjoining villages around Grantham and Sleaford would endorse the criticisms and anxieties that he has expressed on behalf of his own constituents in Grantham.
§ Mr. Davies
I am grateful to my right hon. and learned Friend, who has spoken well this morning. His constituents and mine look to us, above anything else that we do in this House at the present time in national or even international politics, to try to ensure that those essential facilities are restored to Grantham hospital.
There have been fatalities. I asked for a public inquiry into the case of Olivia Gonzales, but of course, the Government have not given it to me. Perhaps they would be embarrassed about what it would reveal. Many others have demanded public inquiries into fatalities. Even in cases where people have survived, the situation that has be m revealed is utterly unacceptable. One poor lady—I have been unable to contact her, so do not have consent to use her name, but the Government know about the case—had a haemorrhage in Bracebridge Heath, in my right hon. and learned Friend's constituency, in an ambulance rushing to Lincoln county hospital. She survived, but she could easily have not.
I shall read another account, from The Journal of 22 October 1999, which is just one of many that have been published in that Grantham paper:A pregnant woman's life was saved at Grantham Hospital when an ambulance crew decided she would not survive a 30-mile blue light trip to Lincoln.The unnamed woman was bleeding heavily when the ambulance heading for Lincoln County Hospital obstetrics unit turned round to go to Grantham accident and emergency.285WHFollowing a life-saving operation last Wednesday, the woman was detained overnight and then transferred to Lincoln…'A general surgeon agreed to perform a life-saving operation.'Normally, any emergency operation on a pregnant woman would be carried out by a consultant gynaecologist and obstetrician.We should pay tribute to that general surgeon, who was prepared to take the personal professional risk of intervening in a case that was beyond his specialty. Thank God he did—he saved somebody's life. However, he was put in that position by the decision to take away those consultants from Grantham hospital. Let no one be in any doubt about that.
I am authorised to quote from the following letter, which I received from a constituent of mine on 23 March:On 17 February this year, I gay,: birth to my third baby…Unfortunately, he was very poorly and grossly anaemic with a condition known as 'chronic foetal maternal transfusion'. So pale, cold and lifeless he could not support himself and would have collapsed without an immediate blood transfusion. Due to the lack of services at Grantham we had to be rushed to Lincoln county hospital. The journey to Lincoln was very stressful and upsetting—not to mention uncomfortable for a newly delivered mum. It was very bumpy in the ambulance for all of us. Also traumatic having the siren blue lights going with my new-born in such a lifeless state. More than once three of us had to hold the baby's incubator steady as it was jolted about inside the speeding vehicle.If that is not a graphic description of the situation in Grantham hospital, I do not know what is. I am authorised to mention the name of the lady concerned—it is Jayne Saunders.
I think that I have said enough to give a sense of the dramatic importance of this issue to the lives of people in Grantham now, and to the birth of future generations. Everyone in Grantham who expects to have a child at some time is extremely concerned about the absence of proper facilities. Every woman can legitimately be worried about the absence of gynaecological consultants. All manner of complications can emerge through the use of general surgery and accident and emergency facilities that have no gynaecological specialists or paediatricians. Women and children account for more than half the human race. How can a general hospital that is deprived of those essential facilities be called a general hospital?
This appalling situation has been made even worse by the Government's history of prevarication, equivocation and simple delay in even addressing the matter. They have tried every possible bureaucratic subterfuge to get rid of me, delay matters, find excuses and evade their responsibility. That cannot go on, which is why I have initiated today's debate. The Government must decide now whether they are going to bring back those consultants to Grantham hospital, or take the terrible responsibility for the consequences of not doing so.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I, too, congratulate the hon. Member for Grantham and Stamford (Mr. Davies) on securing today's extremely important debate on the future of Grantham and District hospital. My ministerial colleagues and I are aware of local concerns 286WH about the current and future level of services provided by the hospital. We are all aware of the passion and commitment of the hon. Gentleman and the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg) on their constituents' behalf. It is clear that these issues are of great concern to the entire community, and I understand how strongly the hon. Gentleman feels about the level of health services for his constituents.
Changes to those services have been the subject of considerable debate for a long time. The initial changes were introduced for reasons of clinical safety, and I intend to talk about them in a little more detail in order to set the future context for some of them.
§ Mr. Davies
The Government have made that contention—falsely—before. Before she falls into a trap of her own bureaucrats' making, I should tell the hon. Lady that there were no complaints whatever about the viability of services in Grantham hospital as they existed until summer 1998. There were no complaints from the royal colleges; nor did anyone else suggest that it was unsafe to continue with the existing structure. A decision was taken to change the structure and remove the consultants, and our problems derived from that.
§ Ms Blears
I understand that that is the hon. Gentleman's view of the situation. Rather than fall into a bureaucratic trap, I assure him that I am familiar with similar circumstances relating to accreditation, training, throughput and volume, the views of the royal colleges about those issues and how often they conflict with the perceived needs of communities. I understand the difficulties of drawing balances. Those are difficult issues for communities. Governments and clinicians to resolve.
As the hon. Gentleman stated, he has pursued this matter for a long time. I am aware that he had a meeting with the former Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), who said that the Grantham area needed a substantial hospital to meet the needs of local people and take advantage of technology changes and new services developing that may make it easier to provide higher quality services in future. That commitment existed then and exists now. There is no threat to the future of Grantham hospital as a district general hospital in that community.
The hon. Gentleman outlined the issue in depth and detail, and his intimate knowledge of it enables him to take us quickly through the history of the services. It is a long and complex history and, sadly for many people, the hospital will always be associated with the terrible events of the early 1990s relating to Beverly Allitt and the consequent review of paediatric services. At that time, a number of clinical concerns were expressed about the safety of paediatric services at the hospital—limited scope for clinical experience; low work load; professional isolation; and limited capacity to deal with complex problems. It is not true to say that those matters came out of thin air, they happened as a result of concerns about paediatric quality following the dreadful events related to Beverly Allitt.
§ Mr. Davies
This is getting worse. The hon. Lady is taking refuge in complete irrelevance. I already 287WH mentioned that the Beverly Allitt case resulted in a contract being placed with Queens medical centre to provide paediatric care and facilities. That worked extremely well and satisfactorily, there was no problem and the royal colleges were happy with it. The Government, or the health authority on the Government's instruction, pulled the rug from under that structure. Returning to what happened in the 1960s and 1970s is irrelevant. In the limited time that we have, we must focus on the central issue: will the Government bring back those consultants or not?
§ Ms Blears
It is important to explain that it was not a matter in which, in the hon. Gentleman's words, the Government were "complicit in the manoeuvre." The proposals arose from a set of circumstances that raised genuine clinical concerns about safety. After the service had been taken over by the Queens medical centre, concerns surfaced again about low volume and throughput that had significant implications for medical training and the safety of those services. The paediatric service was withdrawn in August 1998 and at that time the community health council did not object, so it was not a matter placed before Ministers. The ambulatory service was developed and the local community health council gave its full support to that model; there was therefore no need for any further decision to be made.
Those changes to paediatrics raised concerns about the sustainability of clinically safe obstetric and gynaecology services and it was considered that, without a 24-hour consultant-led paediatric service, the delivery of high-risk babies would be clinically unsafe. That was made clear in the original consultation on the changes in paediatrics.
In respect of the proposals on obstetrics and gynaecology, the community health council objected to them and there remains an outstanding reference to Ministers about the objection, which needs to be formally decided upon. A midwife delivery unit was then established that has now been formally evaluated by the NHS office and Nottingham university. It is important to reassure local women that delivery results at the midwife unit are extremely satisfactory: some 91 per cent. of people are satisfied with the service. There is no evidence of increased mortality at the midwife-led unit. It is important to have that on record because local people and their families would be concerned at the prospect of lower clinical standards. Standards in the midwifery unit are satisfactory and clinicians who thought that standards might deteriorate have publicly acknowledged that that is not so.
My ministerial colleagues have established a review to consider whether the midwifery unit can begin to expand its activities geographically and in terms of the sort of pregnant women it can take under its auspices. The unit has been recognised as doing excellent work and may be able to do more work for local people.
It is important to respond to the hon. Gentleman's point about the royal colleges' review. My ministerial colleague's letter to him stated that it had been overtaken by events, but that was not to avoid dealing with the issue. A number of national reviews of maternity services are taking place to try to ensure that we provide the best high-quality and consistent service 288WH throughout the country. There is to be huge investment, as the hon. Gentleman knows from the extra finance that was announced this week for maternity services. The national service framework for children, which will include maternity services, is trying to set top-quality standards. We want to examine Grantham in the context of that national review so that there is a prospect of providing high-quality services for local people.
I understand the hon. Gentleman's frustration that the national review, the work force review and the national service framework may sound like NHS gobbledegook, but we are making a genuine attempt to put in place, for the first time, a national entitlement for everyone, wherever they are in the country, to receive high standards of care. It would be easy to make decisions about Grantham now outside the context of that wider review. However, keeping the objection open, which the community health council has lodged, means that a decision will have to be made. Making a decision about Grantham in the wider context of the national review is harder in many ways than reaching an immediate decision on the basis of information that we have now. The re view may come up with further information that enables us to examine the situation in Grantham more closely in the future.
§ Mr. Davies
I do not underestimate the capacity of the review to provide further excuses for more delays by the Government. The hon. Lady now has three minutes in which to answer my questions. Will she make a decision? Will she deal with the formal objection? If she does not intend to do so today, when will she give us an answer? Will it be after the next election?
§ Ms Blears
I understand that the review group hopes to report by the end of the year and to send reports on its national consideration to Ministers by April 2002. That is the framework to which we are working.
It is right that I should refer to specific cases raised by the hon. Gentleman. I did not intend to do so, but as he has raised them, it is important to comment on them. The two cases of which I am aware—Tyler Foster and Olivia Gonzales—are tragic. It is important to say that Tyler Foster had meningitis and, as many people know, meningitis can deteriorate dramatically quickly. Tyler was transferred to Pilgrim hospital, Boston and then to the paediatric intensive care unit at Queen's medical centre, Nottingham. There have never been paediatric intensive care facilities at Grantham, so the transfer would have had to be made in any event. I also understand that the has been a full report on that case and that there is no evidence that, had he been transferred to the paediatric intensive care unit sooner, the outcome would have been any different.
§ Mr. Davies
May I point out the geography of Lincolnshire? Boston is 30 miles in one direction, Nottingham is 30 miles in another direction. The poor child was sent in one direction and then 60 miles in the opposite direction.
§ Ms Blears
In the case of Olivia Gonzales, the transfers took plate as they would have done in any event. There is no evidence that the unfortunate death of that child could have been avoided by the existence of a 289WH consultant-led service. The hon. Gentleman said that it is very difficult to decide in individual cases where the provision of services would be.
In relation to the current reviews, the national review and the decisions to be made in Grantham in that context, it would be inappropriate and wasteful now to hold a separate public inquiry. However, it is important that the objection from the community health council remains. Ministers will have to take a decision about Grantham, but it will be better informed, in relation to the work currently being done on maternity services. The hon. Gentleman has raised some important issues about the connection between paediatrics and obstetrics. Those issues need to be closely examined and I am grateful to him for bringing them to our attention.