§ Mr. Tim Collins (Westmorland and Lonsdale)I thank the Under-Secretary, the hon. Member for Birmingham, Edgbaston (Ms Stuart) for attending the debate. I should like to give her a couple of assurances: I do not intend to make any partisan remarks; and I have no criticism of Government policy in respect of Helme Chase. Although I fully recognise that the matter will not be decided by Ministers anyway and that that might be the case indefinitely, there are points that are relevant to them.
The story of the maternity unit is not one of failure or problems in the national health service, but one of a genuine NHS success that had strong cross-party and cross-community support in my constituency. I hope to demonstrate that there is almost complete unanimity among my constituents about the issue, but also that they have some medium and long-term anxieties.
I should like to start with the history and geography of Helme Chase. Until 1993, the Helme Chase maternity unit was located outside Westmorland general hospital. It was originally situated close to where the hospital is now based, in Kendal in my constituency. For many decades—indeed, for most of the 20th century—it was separate from the area's hospitals: Kendal hospital and then Westmorland general hospital. Generations of Westmerians, as those who live in Westmorland like to call themselves, have been born there.
I shall not disguise from the Minister the fact that some of the public feeling about the unit is based on sentiment, but sentiment is not unimportant in such matters. Westmerians would like to know that future generations can be born in Westmorland and not in the slightly more alien territory of Lancashire, to our south.
The geography of the Morecambe Bay health authority area is slightly complicated, as it crosses county boundaries and encompasses a large chunk of southern Cumbria. It includes both the southern lakeland area in my constituency and the Barrow district, which is situated in the constituency of the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton). It also embraces large chunks of north Lancashire. The Morecambe Bay Hospitals NHS trust is now coterminous with the authority area, in which it has three hospital sites. It has one hospital at Barrow, Westmorland general at Kendal and the Royal Lancaster infirmary at Lancaster.
One of the key issues at stake is the concern among people in and around Kendal about whether decisions about their hospital—they take pride in Westmorland general hospital—are taken locally and in the interests of people in south Cumbria. Obviously, the health authority and the trust must consider the wider perspective and community, but that should not be at the expense of the residents of south Cumbria.
As I said, the Helme Chase maternity unit moved only in 1993 into what was then the spanking new Westmorland general. The unit is now within the hospital, but it has maintained its great tradition of being a friendly place to which mothers are happy to go. In contrast with some of the more clinical, less friendly 231WH and more antiseptic environments of maternity units elsewhere within the health authority area, Helme Chase has the reputation of being a place where there is love, tenderness and care. Given the geography of our part of the world, its accessibility to husbands, grandparents and partners, who can visit the mother before, during and after the birth, is a significant advantage.
If a large number of births are transferred from Westmorland general hospital to Lancaster, the possibility of such visits will greatly diminish. Mothers who live in outlying areas and who might already be some distance from Kendal will be anxious about getting to Lancaster when their time comes. The community health council public meeting held in Kendal 10 days ago was attended by a mother who lives in Windermere, which is in my constituency and is a good 20 to 25-minute journey from Kendal. She was worried about having to travel yet another 30 minutes or so to Lancaster. She said that she was expecting her fourth child and that the previous two had arrived after a labour of only 25 minutes. Her concern about being faced with a 50-minute journey to the local maternity unit is readily understandable, as such loss of time could cause grave difficulties.
As the Under-Secretary knows, the Morecambe Bay health authority is currently in the throes of a consultation exercise. I appreciate that she is not in a position to prejudge the results of that exercise and I would not expect her to do so. Indeed, I make no complaint about the way in which the health authority is conducting the process, as it has done so perfectly properly. It has released a multiplicity of options for public consultation, which will conclude next month. There are three basic options: retention of the status quo; outright closure of the unit; or establishment of a midwife-led unit.
The Under-Secretary may have been briefed on the local anxiety about whether the consultation initiated by the authority includes all the viable options for the unit's future. The answer to that question largely depends on what the definition of a midwife-led unit turns; out to be. The midwives at Helme Chase have a clear view about such a unit: they want it to carry out the same sort of deliveries that are conducted now. Those that are currently dealt with by the unit cover a pretty wide range. Difficult, dangerous and potentially risky deliveries are transferred to Lancaster under present procedures, but deliveries at the unit currently include elective caesareans and induced births. There is some anxiety that those slightly more complicated births might not occur in Kendal under the health authority's preferred option of a midwife-led unit and would instead be transferred to Lancaster.
The concerns are twofold. First, such an option might transfer from Kendal to Lancaster nearly 50 per cent. of births. Currently, about 600 babies a year are delivered in Kendal, but, under the health authority plans, that number could conceivably drop to about 350, meaning the transfer of 250 births out of the area. Secondly, even though it is recognised as unlikely that the health authority will recommend outright closure this year, there is a longer-term concern about the other options in that respect. The introduction of an option that causes the number of deliveries dealt with this year to drop could mean that people come back in five or 10 years' 232WH time and say, "As most babies in the area are not delivered at Westmorland general hospital, there is now a case for closure."
Sister Anne Carruthers works in the gynaecology ward at Westmorland general hospital. I should be happy to provide the Under-Secretary with a copy of the letter that she sent me, in which Sister Carruthers makes an important point that is relevant to the future of Helme Chase. As I am sure the hon. Lady recognises, many people share the concern expressed in the letter. Sister Carruthers writes about the role of the royal colleges, with whose recommendations I am sure the hon. Lady will be very familiar.
The colleges' recommendations are usually produced for the best possible motives and often result in the raising of standards. That, of course, is not the problem. The difficulty lies in the implication that, in respect of the responsibilities of the various royal colleges, fewer and fewer units throughout the country are acceptable. Time after time, services are moved steadily away from outlying areas and towards central points. I have caricatured the matter, but the caricature has a grain of truth. Ultimately, I think that the royal colleges will be happy only when there is a single hospital somewhere near Birmingham to which all patients in the country are shipped. [Interruption.] I see that the Minister recognises the truth in that assertion.
A balance must be struck. The point made by Sister Carruthers is valid and should be considered not only in the context of Helme Chase, but more widely. She says that there are two sides to the matter. Her letter states:
The consultants tell us that RCOG guidelines stipulate that they should be within half an hour of reaching their patients. That appears to be illogical when looked at from the opposite perspective, because it apparently does not matter how long it takes for patients to reach them—patients who may be travelling from outlying districts.She puts her finger on the issue, which is that the royal college guidelines are often constructed for perfectly logical and sensible reasons, but are organised from a producer rather than a patient perspective. I shall be interested to hear anything that the Under-Secretary has to say about that issue, as it is relevant not only to south Cumbria, but to the whole of the NHS.I applaud many of the steps that the Government have taken, not least through NHS Direct, to expand access to the NHS. However, it is important that, whenever possible, we are seen to be following public wishes for an accessible health service. We should not use safety, which is vital, especially in maternity services, as an excuse to provide one giant hospital in the midlands. I appreciate that if it were in the midlands, the Under-Secretary would not suffer as much as some others.
The health authority has categorically stated that its decisions are not prompted by a resource problem. However, I wish to put on record for the Undersecretary and her civil servants that the health authority has occasionally been tempted to cite statistics to show that the delivery costs of Helme Chase and the Morecambe Bay trust in general are among the highest in the country. Such statistics are slightly misleading because they do not take account of the significant number of deliveries to mothers who are not resident in the Morecambe Bay health authority area, but come from further afield, partly because of Helme Chase's 233WH reputation. I am sure that the Under-Secretary can reassure us that resources will not drive the provision of maternity services in south Cumbria. I should be grateful for such a reassurance.
The Under-Secretary will know that, under the current arrangements, the community health council, which has been considering the issue diligently and carefully, has what could be described as a nuclear option. If it is not happy with the health authority's solution, it can reject it. The matter would then be referred to the Secretary of State. I profoundly hope that that will not happen because it will delay matters and cause greater uncertainty. A solution that attracted strong local support would be far preferable.
If the nuclear option is taken, it will be helpful for Ministers to be aware of some of the background and the strength of local popular support for the unit. I should also be interested to hear the Under-Secretary's comments on the position after the community health councils are replaced. I appreciate that Ministers intend to replace them with an alternative mechanism for assessing local wishes, but I should like to know precisely how it might apply in the case that we are considering.
I promised that I would comment on the cross-party nature of the anxiety about Helme Chase. A march of approximately 3,000 people took place 10 days ago through the small town of Kendal. It was attended not only by me as the local Member of Parliament, but by John Bateson, the Labour prospective parliamentary candidate and Tim Farron, the Liberal Democrat prospective parliamentary candidate. There is genuine support for Helme Chase throughout the community—from farmers, businesses, mothers and midwives, who feel very strongly. Nicola Kaye, a Kendal mother, has started a huge petition, which some 6,000 people have signed to date. More signatures are expected.
Helme Chase constitutes a genuine NHS success story. All hon. Members—the Under-Secretary more than most—receive letters that relate instances of public services that do not always provide exactly what people want. Helme Chase is not an example of that. My constituents regard the maternity unit with huge affection; it would not be putting it too strongly to say that it is loved. That is underlined by the fact that 3,000 people came out to march at short notice on a cold January morning.
I acknowledge that the decision is not currently up to the Government. However, they may have to consider the matter. Perhaps the Under-Secretary can suggest how the Government would hope to respond to the clear public outpouring of support for Helme Chase. I hope that she will say that it is possible for such a much-loved, successful and appreciated service to continue for many years.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)I congratulate the hon. Member for Westmorland and Lonsdale (Mr. Collins) on securing the debate on the future of Helme Chase maternity unit. I appreciate that the subject is important to his constituents, and I commend him for making it 234WH clear at the outset that the issue is not party political but is about meeting the needs of his constituents. I am grateful for the hon. Gentleman's public statements; he has gone on record long before today to say that he wants the matter to be resolved locally, and not adversarially.
The hon. Gentleman mentioned the restructuring of community health councils. The nuclear option, which allows for the decision to be referred to Ministers, is undesirable, especially when the issue can be resolved locally. However, that provision will continue to exist under the new structure. A new element is that the matter will be referred to independent reconfiguration panels. We always want such matters to be resolved locally if possible.
The hon. Gentleman rightly said that a debate, at a time when consultation is taking place about the future of a unit, does not allow Ministers to make firm statements; it is an opportunity for us to listen. Debates on maternity have an additional element: women do not wish pregnancy and childbirth to be perceived as an illness. They want childbirth to happen as naturally as possible. The royal colleges sometimes give the impression that the primary function of hospitals is training doctors, not serving patients. We must tackle that.
It is important to ensure that the environment in maternity units is not only clinically safe, but friendly and that relatives have access. Birth should be treated not as an illness but as a family event. It should therefore take place as locally as possible. However, mechanisms must be in place to provide good clinical care quickly. I speak with some passion because I gave birth to both my children in a small unit, which carried out 300 deliveries a year, so I am a great advocate of such units. I reassure the hon. Gentleman that such considerations are taken into account.
As the hon. Gentleman clearly outlined, consultation started on 1 December and concludes on 28 February. A report must then be prepared. It may be ready for the March meeting or the April meeting, and the next steps will depend on the preferred option. Surrounding health authorities have also been consulted and I hope that those areas and their Members of Parliament will contribute to the debate. The hon. Gentleman also rightly said that community health councils could object to the decision. However, we hope that the final decision will be made locally.
Over the past 50 years, childbirth has become much safer for mothers and babies. We must not lose sight of that in our discussions. There has been a continued drive to attract more qualified midwives to the NHS by, for example, persuading them to return to the service by offering free refresher courses, mentoring schemes, flexible working and improved pay structures. The hon. Gentleman is fortunate that his constituency is in such a desirable area that recruitment is not a problem there.
Our success is shown by the fact that figures for infant mortality, perinatal mortality and maternal deaths all show a continuing downward trend. We must not lose that gain. It is safer than ever to have a baby. However, we cannot be complacent. We need to support families and promote the health and well-being of disadvantaged children to give them the best start in life.
235WH As a Government, we remain fully committed to the principles of women-centred maternity services that offer greater choice, continuity of care and give control to women. The ethos of putting women at the centre of maternity service planning is now firmly embedded in mainstream practice. We believe that further improvements in maternity services can and are being made through wider Government initiatives to modernise the NHS, improve public health and strengthen family life.
Clearly, our policy of putting women at the centre of maternity service planning and offering women informed choices about the type of care that they receive has to run alongside the need for local trusts and health authorities to provide care that is cost effective and clinically appropriate.
It is for local health authorities and trusts to develop effective maternity service provision that takes account of the needs of local people, the evidence of effectiveness and the need for clinical safety. Decisions regarding service provision are best made locally because it is at local level that people's needs and circumstances are known and that services can be tailored to meet those needs.
I was interested to hear the hon. Gentleman refer to having to be born in alien Lancashire. There is undoubtedly some significance in what is written on a child's birth certificate. We should not underestimate that. The word "Essex" appears on both my children's birth certificates. I am not quite sure what they will make of that, as I am now a midlands Member of Parliament. Perhaps they will wonder why they were born in Essex.
Individual trusts and maternity units operate a variety of methods for organising midwives to deliver maternity care, including one-to-one midwifery practice and case load midwifery schemes. It is important to recognise local cultures in terms of what women want. For example, the demand for home births might be higher in some areas than in others. We need to be very sensitive about such issues.
We recognise that, in many cases, women prefer to give birth at small, local, midwife-led units. Indeed, a number of such units throughout the country offer a very effective service to women with low-risk pregnancies. However, the Government would not wish to support one model of maternity service provision in preference to all others.
The report from the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, "Towards Safer Childbirth", published in 1999, seeks to establish benchmarks for the provision of a standard of care that will offer women a safe and pleasant childbirth experience.
I smiled when the hon. Gentleman rightly acknowledged his slightly exaggerated version of what some royal colleges would like to happen, because he chose Birmingham as his hypothetical location. As a Birmingham Member of Parliament, I could not possibly object to such a proposal. However, I accept the point that he made.
Difficulties can sometimes arise, even when midwife-led units may be the preferred option, if, for whatever reason, local midwives do not wish to take on responsibility for leading the unit. It is, therefore, 236WH important that midwives, local GPs and other professionals work together. It is never easy to make universal comments on this issue.
§ Mr. CollinsI want to make it clear that the midwives at Helme Chase are enthusiastic about the idea of taking ownership and control of the unit. They would, however, like to do so across a range of services. I am delighted that the Minister said that there is no preferred model. May I take it that the Government—as a general principle; I accept that the Minister cannot be specific—take the view that having a maternity unit in which the midwives are happy with the range of services provided is a good thing?
§ Ms StuartIt will not come as a great surprise that I think that any service in which the key professionals who deliver it are comfortable with the framework within which they operate will have better clinical outcomes.
The report acknowledges the need for expert medical advice in the care of women with high-risk or complicated pregnancies. In cases involving difficult pregnancies or pre-term babies, highly sophisticated medical equipment needs to be in place. Sometimes, the appropriate equipment and skills may be available only in certain centres. Tensions naturally arise in such circumstances.
The report also highlights the importance of good working relationships between the multidisciplinary team midwives, obstetricians, anaesthetists—we should not forget them—and paediatricians, so that women receive optimal care and the best outcomes.
The recommendations and audit standards contained in the report will provide health care planners, unit managers and clinical directors with the means to improve standards of care for women in labour. That sits well with the Government's programme to promote high-quality health care and clinical excellence throughout the NHS, setting clear standards for services and delivering them locally through the framework of clinical governance.
I shall now turn to the detailed position in south Cumbria and the history of the proposed changes. In response to one of the hon. Gentleman's questions, the changes are not about money or a lack of staff. Nor are they driven by financial or managerial considerations. The hon. Gentleman will be aware that Morecambe Bay health authority has been allocated £242 million for 2001–02, an increase of 5.8 per cent. in real terms on this financial year. Furthermore, the income of Morecambe Bay Hospitals NHS trust rose from £111.3 million in 1998–99 to £123.9 million in 1999–2000. I am told that there have been no problems in recruiting midwives at Helme Chase, and that the unit's charter mark has recently been renewed for the second time. I should like to take this opportunity to congratulate the staff on that renewal, because it represents official recognition of their good work from beyond the local community.
Regarding the proposed changes, it is important to remember that there are maternity units at Furness general hospital in Barrow and at the Royal Lancaster infirmary, as well as at Helme Chase. All three are managed by Morecambe Bay Hospitals NHS trust.
Last summer, Morecambe Bay Hospitals NHS trust advised the local health authority of the findings of a report by an independent steering group on the 237WH maternity services presently based at Helme Chase. It is generally referred to as the Turnbull report. The trust board had accepted the recommendations of that review, which supported the development of a midwife-led service for the Kendal area. The hon. Gentleman will be aware that the Turnbull report was centred on Kendal. The health authority, in acknowledging its requirement to ensure the provision of safe and effective services for its entire population, decided to extend the scope of the review to take in maternity services across south Cumbria and Lancaster, with particular emphasis on the changing childbirth criteria of improving flexibility and continuity of care, which I outlined earlier.
The health authority's report sets out three options: the first would be to do nothing; the second would be to cease providing in-patient maternity services in Kendal; and the third would be to introduce an integrated, midwife-led service. Without outlining each option in detail, I shall briefly touch on each one. I am mindful of the hon. Gentleman's concerns about the precise definition of a midwife-led unit. That may need to be taken on board in further discussions, so that all the parties involved talk about the same thing and we do not end up with a consultation in which one group suddenly says, "That is not what we meant by a midwife-led unit."
The first option was to do nothing. However, we would have to take care with such an option as safety and professional standards may not be able to be met. The second option, closing in-patient maternity services in Kendal, would mean that services would be provided at Furness general hospital and the Royal Lancaster infirmary, which would meet the safety and professional standards but limit the degree of choice that local women would receive.
238WH The hon. Gentleman will be aware that the health authority's preferred option is to introduce an integrated, midwife-led service, which is the third option. That would involve Helme Chase continuing to serve the local community as a birth centre. It is argued that the more flexible deployment of midwives envisaged by that plan would bring potential benefits in terms of continuity of care. Whenever possible, a woman would see the same professional throughout her pregnancy, delivery and immediate post-natal recovery.
If that final option were to be approved, I understand that a team of community-based midwives, working closely with GPs, would provide ante-natal, confinement and post-natal care from several centres in the Morecambe Bay area, including Kendal.
The hon. Gentleman mentioned travelling distances. Consultations have taken place with the ambulance trusts, which would provide the relevant services. They are confident that, if any unforeseen difficulties were to arise, there would be no problems with patient transport. They are also confident that any increase in patient numbers could be accommodated, because the hospitals in Lancaster and Barrow would continue to offer the full range of maternity services. The arrangements for home deliveries will remain as at present, but the continued existence of a dedicated in-patient unit nearby would be a reassuring sign for mothers-to-be.
I would like the hon. Gentleman to take away from this debate my reassurance that we have not yet made any decisions. We support his view that the matter should be resolved locally. The option of closing Helme Chase maternity unit does not form part of any option put forward in the consultation. I assure the hon. Gentleman that the record of this debate will be read widely by those people who need to hear what has been said today.