HC Deb 28 April 2004 vol 420 cc312-20WH 3.44 pm
Mr. Paul Goodman (Wycombe) (Con)

I am pleased to have secured this important debate on maternity services at Wycombe hospital. Perhaps you, Mr. Benton, can indicate whether the debate will get its full half hour if we are interrupted by the Division bell. You are nodding, so that is the case.

I am pleased to have secured the debate, but I must add that I am extremely sorry that I had to ballot for it at all and that it has to take place. Let me explain why. The reason behind the debate is the proposal in the consultation document "Shaping Health Services" to transfer key maternity services—the maternity department, the children's ward and the special baby care unit—from Wycombe hospital to Stoke Mandeville.

As the Minister may know, the plan has met overwhelming opposition, not only in the High Wycombe and Marlow area in my constituency, but in neighbouring constituencies, including that of my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan), who is present. The major political parties in my constituency oppose the proposal, and so do Wycombe district council, the local race equality council and local midwives, who protested against it at a consultation meeting last Monday. Local people in general and mothers in particular oppose the proposal; already, a petition organised by Janet Milne, chairman of the Wycombe special care baby unit club, has gathered more than 14,000 signatures, and other petitions are circulating. For example, a petition organised by the Wycombe Conservative association gathered more than 1,000 signatures in a single morning. Signatures to petitions currently total more than 20,000, and there is an all-party campaign against the proposal, chaired by Steve Cohen, editor of the Bucks Free Press.

I pay tribute to Janet Milne, whose club has raised more than £70,000 for the special care baby unit since it was set up in the late 1970s, to Dr. Kim Cheetham, who has helped sick babies at the hospital for a quarter of a century, and to all the staff who help to provide maternity services at Wycombe hospital. The department has a good reputation; its results are excellent; its integration between hospital and home is outstanding, and it is larger than many other departments that are not being closed. The staff are a dedicated team and are mostly local, with personal local connections. The service may move, but there is no guarantee that the staff would move, too.

My concern, and that of all who oppose the plans, is not based simply on the underfunding of health services in Bucks, although they are underfunded. As my hon. Friend the Member for Chesham and Amersham made clear in a debate that she instigated on the subject recently, every resident of Bucks receives 18 per cent. less per head in health care spending than the national average. Nor is our concern based simply on the consequent deficits that arise from that underfunding, which is expected to run at some £14 million next year, and on the closures that have arisen at least in part from that underfunding—the closure of the respite facility at Riversdale and the day-care facility at Marlow day hospital and the threat to the Haleacre unit in my hon. Friend's constituency in Amersham and other mental health facilities in the south of the county.

Mrs. Cheryl Gillan (Chesham and Amersham) (Con)

I am grateful to my hon. Friend for allowing me to intervene in his short debate, and for his references to me. Does he agree that there is concern among all Members of Parliament in Buckinghamshire that our health services continue to be seriously underfunded? There is no hope of the Government putting into the health system what the county and its residents deserve. It is not just isolated examples that are under threat; there is also a threat to Chesham hospital and to the Misbourne ward at Amersham hospital. Many issues are not being addressed because of the lack of funds.

Mr. Goodman

I agree wholeheartedly with my hon. Friend, who has an excellent record of campaigning on these issues. I was going on to say that our concern is not based on the belief of the people of south Bucks that they have paid their fair share in taxes, a phrase my hon. Friend has used, and that they are not getting their fair share in health service spending, nor is our concern about the proposals based simply on the anxiety, difficulty and stress that journeys from the south of the county to Stoke Mandeville would cause. To put it starkly, our concern is based on the fear that babies may die if maternity services go to Stoke Mandeville, and I shall explain why.

The local hospital trust assures us that no babies and mothers will be in danger if they have to make the journey by ambulance or other transport from south Bucks to Stoke Mandeville. It was said in a letter to me that the plan will not put women or their babies at more risk". However, I must tell the Minister that that flies in the face of my constituents' experience. I have time to quote only one of many letters that draw on that experience, which states: My sister's first child developed an irregular heart beat six months into my sister's pregnancy … it was basically a 30 minute survival window for this to take place … Thankfully, we were incredibly fortunate and my niece got the care she needed and is now a healthy little girl. But if a 45-minute journey, not to mention the time waiting for an ambulance to arrive was needed, she would not have survived. I could quote from many more letters on the subject, but the main point is clear: the journey from south Bucks to Stoke Mandeville is long and potentially dangerous for many babies and mothers.

The hospital trust estimates that a non-blue light ambulance journey from Wycombe to Stoke Mandeville takes 36 minutes 47 seconds and that a blue-light journey takes 32 minutes four seconds. That estimate has been met with incredulity by south Buckinghamshire residents and at least one expert. Peter Cox, a former paramedic with 20 years' experience of negotiating the road, has said: Maybe on a computer that journey can take 30 minutes, but in practice it can often be up to an hour or more. I have driven patients in ambulances both in south Buckinghamshire and abroad and the High Wycombe to Aylesbury road is one of the worst I have ever come across. The time it will take ambulance crews to make that journey will put the lives of sick and dying babies at risk.

In the light of that expert assessment, I want to put the first of a series of questions to the Minister. I do not expect complete answers from her today, although I expect them in due course in writing. I hope that she will assure me that I shall receive them and that she will respond to the full text of my speech, which I shall send her if the debate is interrupted by the Division bell.

What are the actual times for ambulance journeys in peak hours, with and without sirens and lights, at various times of day? What route would be used, and what assessment has been made of the propensity for severe disruption on those routes? Can we infer that Buckinghamshire Hospitals NHS trust is no longer willing to provide maternity services to Marlow and other parts of south Bucks and that people in those areas should travel to Wexham park instead?

There may be disagreement between the hospital trust and others about ambulance journeys, but I hope that there is complete agreement about other aspects of transport. We all agree, surely, that transport is vital. Without adequate transport, my constituents—particularly my poor and ethnic minority constituents who live in the deprived centre of Wycombe; they often do not have a car and may not speak English as a first language, or even speak it at all—will not be able to get from the middle of High Wycombe to Stoke Mandeville easily, conveniently and safely.

The consultation document states that the health authorities concerned are working on detailed transport proposals. It must follow, surely, that if detailed and adequate proposals are not in place by 25 June, when the consultation period is due to end, the strategic health authority will have to reject the proposals.

I understand that with less than eight weeks to go, little progress has been made in discussions between the relevant health authorities and the county council. No wonder that the county council feels, quite reasonably, that it is disgracefully underfunded by the Government, and it fears, also quite reasonably, that it will be forced, with no additional resources, to pick up part of the bill for the NHS and for the plans in question, in particular those relating to transport.

What consultations have taken place to date between the local health bodies and the county council? Who was there? What was decided? When are further meetings planned, and does the Minister agree that if a clear and coherent transport strategy is not in place by 25 June, the strategic health authority will surely have no option but to reject the proposals?

The proposals as a whole have been advanced by the mid and south Bucks health community. The Minister confirms to me in a written answer that The body does not exist in law but that the term "mid and south Bucks health community" refers to both the providers of health services and the people who use or have access to the health services in the mid and south Bucks area". The people of south Buckinghamshire will not be pleased to learn that the proposals have apparently been issued in their name. Their response will be, to quote a phrase that has been current recently, "Not in my name."

A question obviously follows. Who will take the final decision if the local overview and scrutiny committee, under the chairmanship of Councillor Mike Appleyard, does not refer the decision to the Secretary of State? I understand that the strategic health authority wants a special committee, made up of members of local health service bodies, to make a recommendation to it. Can the Minister confirm that?

Will the Minister tell us how such a committee will be constituted, and what will happen if there is dispute or disagreement about its constitution? Can she confirm that if the overview and scrutiny committee refers the proposals to the Secretary of State, he will refer them automatically to the independent reconfiguration panel?

My constituents and others will give due regard to the main argument advanced by the hospital trust, namely that the proposals are in part driven by the severe national shortage of paediatric staff. I want to press the Minister on that point. According to the financial framework document that accompanies the main document: There are currently 18.8 WTE vacancies for consultant and junior medical staff within the acute trust compared to a funded establishment of 471 staff. At four per cent of the workforce this is a good position compared to other parts of the NHS. Can the Minister tell me into which medical categories those vacancies fall? In particular, how many of those vacancies are paediatric vacancies? Can she confirm the rumour that only three of the doctor vacancies are paediatric vacancies? Is this risk to mothers and babies and the potential disruption of successful teams taking place for the want of only three doctors?

I have already asked the Minister what efforts the hospital trust has made in recent years to recruit paediatric staff, and I have received only the most general of answers. I do not think that it was good enough, so I would like to put the questions again. How has the trust attempted to recruit? When, where and how often has it advertised? Has it advertised abroad and if so, when, where and how often?

More questions arise about the proposals. Another answer that I have received, which really is not good enough either, relates to risk assessment. Will the Minister guarantee that the clinical risk assessment that has been carried out—I have received details from her about how it has been carried out—will be published in full before the consultation closes? If acute surgery and orthopaedics were to be concentrated at Wycombe and children's services at Stoke Mandeville, that would mean that children who needed surgery or acute accident and emergency treatment would not be nursed in a children's ward or be tended to by children's doctors and nurses. Can she say whether the proposal would be compatible with the national service framework for children issued by her Department last year? Is she in a position to confirm or deny the rumour that the strategic health authority—I heard this only yesterday—plans to move the two intensive care beds in the Wycombe special care baby unit not merely to Stoke Mandeville but to the John Radcliffe hospital in Oxford in 2006?

Finally, there is the whole question of costs. The strategic health authority argues that the proposals are not driven by the need to reduce the deficits. The consultation document argues that the net effect of option one on income and expenditure would be minus £160,000 and that the net effect of option two would be minus £230,000. Did those calculations cover costs other than income and expenditure? What about each element of capital costs, recruitment and retention costs, travel costs, the cost to the ambulance service and, most important, transport costs? Has a full assessment been made and if so, what is it and where is it?

Of course, costs are not the primary issue at stake for my constituents and people in south Bucks. It is rather the fear that our local health care ecology and the lives of babies and mothers are being put at risk because of a rushed plan that has not been properly thought through and has been made under the shadow of the chronic underfunding of the NHS in Bucks. However, the case against the proposals does not ultimately rest on emotion alone. It also rests on reason and good health service practice.

To date, these proposals offer no cost information, no transport strategy, no publicly available clinical risk assessment and no clear decision-making criteria. The Minister must surely agree that until or unless they do, it is not proper to consider or reach a conclusion on the proposals because they are incomplete. Neither is it proper to consider alternatives, because not all the information needed to draw them up is available. I hope that the Minister will agree that, on the basis of the evidence we have, it would be impossible for the proposals to proceed properly. I look forward to her response.

Mrs. Gillan

rose—

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I received no request to speak from the hon. Lady.

Mr. Benton (in the Chair)

I am sorry, but unless a specific request was made to the Minister, the hon. Lady cannot speak in the debate.

Mrs. Gillan

I made the request to my hon. Friend the Member for Wycombe (Mr. Goodman). Briefly, I wish to associate myself with the remarks that he made and to say that they reflect the views of my constituents. I think that the Minister has been most ungracious.

Miss Johnson

I will defer to the hon. Lady and allow her to speak. I merely point out that the House rules suggest that she should approach me as well as her hon. Friend.

Mrs. Gillan

I have made my contribution.

4 pm

Miss Johnson

I congratulate the hon. Member for Wycombe (Mr. Goodman) on securing this debate on maternity services at Wycombe hospital. Before I deal with some of the specific issues that he raised, I should like to take this opportunity to recognise the work done across Buckinghamshire to deliver good quality services and to pay tribute to all the staff who are dedicated to the process. All hon. Members rightly attach the highest importance to developments in the NHS in their constituencies, because local people should have local access to high quality health services, including maternity services. Local staff play a key role in ensuring that that is possible for local people.

National maternity services perform a core function in the NHS. More than 600,000 babies and their mothers in the UK each year benefit from our maternity services, which the NHS provides free, at a cost of £1 billion a year. The Department of Health is committed to improving maternity services by modernising all maternity units, increasing the number of midwives, giving women greater choice over childbirth and ensuring that they receive the highest quality maternity care.

Huge advances have been made in the past few years in improving the experience of women during pregnancy and childbirth. It is now much safer to give birth, and women are much more actively involved in decisions about the maternity care that they receive. The main driver for future change will be the publication of a children's national service framework later this year. Extending access and choice will be key themes of the maternity module, in order to make services more flexible, accessible and appropriate, and to give improved choice to all women and their families.

We have also made available £100 million of additional capital funding over the past two years, to refurbish and modernise more than 200 maternity units in England—including that at Wycombe hospital—to improve the environment in which care is provided and better meet the needs of women and their families. That is the largest investment to improve maternity care that any Government have made and it will help to ensure that women in every area of the country have high quality maternity services, as they should.

In order to achieve the goal of providing high quality maternity services, and as part of the modernisation programme that has been set out in the NHS, many NHS economies and organisations are considering changes to the organisation of their services with their local stakeholders. I am sure that Opposition Members will agree that we should recognise that hospital services need to change if they are to continue to fulfil patients' needs and improve access. Services should not remain static for ever, but should be responsive to local needs. That approach informs part of the work that underlies "Keeping the NHS Local—A New Direction of Travel", which was published in February 2003.

I deal now in more detail with the local services in Buckinghamshire. I beg greatly to differ with the assessment that the hon. Member for Wycombe gave of the underfunding of the Bucks health care system. The health services have received record sums of investment that were partly funded through the increase in national insurance, which Conservative Members opposed. I shall therefore take no lectures from the Conservative party about funding the NHS. The service would have been much more poorly funded, with many cuts, had that party's programme of patients passports been implemented. The underfunding that we inherited would also have persisted for a long time.

The funding that the Government have put into the NHS can be seen in the improvement in all the delivery information that we have about the Buckinghamshire health care economy. All waiters over nine months have now been seen. There are now no in-patient waiters over nine months and no out-patient waiters over 17 weeks. Buckinghamshire is ahead of profile on in-patient waiters for the end of March and is on profile for out-patient waiters. There is access to primary care, with 100 per cent. meeting the target of seeing a nurse within 24 hours and 99 per cent. meeting the target of seeing a GP within 48 hours. In the past weeks, the rolling average of people seen in accident and emergency is 96.7 per cent. hitting the target of being seen in under four hours. The ambulance response rates are above performance targets, too.

The overall picture is extremely encouraging, with a much better deal in terms of funding and performance for all of the Buckinghamshire health care economy. I am sure that Opposition Members, whatever their views about the level of funding, which I appreciate are different from the Government's support for more generous funding of the health care system, will welcome the improvements that that extra funding has brought for their health economy.

The hon. Member for Wycombe talked about a wide-ranging public consultation exercise that is being held by the mid and south Buckinghamshire health community into how best to improve the quality and range of health care services. It is considering services for patients with long-term conditions, planned surgical and emergency care, rehabilitation and mental health care. I have been assured by the Thames Valley strategic health authority that none of it, including the maternity review, is about cutting services and that no savings are expected from implementing the service changes. The proposals are about improving the quality of care for patients—we must remember that the patient in some circumstances will be a newborn baby or a would-be newborn baby—improving the use of existing skills and resources and providing sustainable, fully staffed services.

Mr. Goodman

I raised the issue of costs and finance, and the Minister has now alluded to it. I want to respond by simply asking her to answer one question. Will she guarantee in writing to answer all the points that I raised in my speech? I do not expect her to answer them all today.

Miss Johnson

I will endeavour to secure the hon. Gentleman an answer from the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), who has regional responsibility. I am sure that she will take a keen interest in what has been said today and will want to respond in detail to his points.

To reiterate, the consultation exercise is not about cutting funding, and it has the full support of the Thames Valley strategic health authority. I am sure that hon. Members will be in contact with their strategic health authority, and although we will endeavour to answer as many of the hon. Gentleman's points as possible, the truth is that the authority is often the best body to ask. It is responsible for what is happening within its area and for working with the local commissioners of health care.

The current consultation is the result of months of joint working within the local health community to come up with proposals to modernise the local NHS, both to improve the quality and range of services and to meet the challenges. Those challenges mean that no change to maternity services is not an option. I understand that there are already difficulties in providing children's in-patient services, and it has been decided that women and children's services cannot continue in their existing configuration because it is neither safe nor practicable in the long term.

I also understand that the mid and south Buckinghamshire health community has looked at ways of finding an option that offers a safe and sustainable 24-hour service at both Stoke Mandeville and Wycombe hospitals. However, no comprehensive option offers the safety needed at both sites. The proposal—I should stress that what we are discussing is only a proposal—is that in order to provide a service that can be safely staffed, a single women and children's in-patient unit would be developed at Stoke Mandeville hospital. It would include in-patient children's services, a special care baby unit, maternity deliveries, and emergency and in-patient gynaecology. The proposal would also mean that the special care baby unit at Wycombe hospital would close, but were that to happen the unit at Stoke Mandeville would be increased commensurately. I am sure that hon. Members are as painfully conscious as I am of the fact that the principal concern of any parent of a baby in a SCBU is that it is the safest possible place.

The maternity unit at Wycombe hospital would still have an important role to play. All day-time services such as antenatal and paediatric services will continue to be provided at the site. The possibility of establishing a midwifery-led delivery unit at either Wycombe hospital or Stoke Mandeville is being considered. That option would provide local services for women expected to have an uncomplicated birth. The preferred option in shaping the health service is to develop the single women and children's in-patient unit at Stoke Mandeville, but it is only a proposal. No decisions have been made. As the hon. Gentleman acknowledged, there is a considerable period of consultation still to run.

A detailed programme is now under way to engage with the local community. The hon. Gentleman reflected many of its views about the future provision of the service. This is the biggest and most wide-ranging consultation ever undertaken in Buckinghamshire. It provides local people with a real opportunity to make their views known about the future proposals and to shape future local health services. People are making their views known in a variety of different ways such as public meetings and focus groups or in response to the patient questionnaires that have been distributed. In addition, a web-based virtual health panel has been developed to encourage discussion and debate. It sounds as though there may not be much need to encourage debate. There have also been local radio phone-ins and a public question time event.

As the hon. Gentleman remarked, the Buckinghamshire health overview and scrutiny committee will be fully involved and consulted to ensure that the due process is followed. The scrutiny committee can refer a decision to the Secretary of State if there is any dispute or difference of opinion. That is obviously a matter for the future because the outcome of the consultation has not yet been determined. Were such a decision referred to the Secretary of State, he could refer to an independent reconfiguration panel if he so decided. The hon. Gentleman was interested in that and so I have taken the time to explain the process to him.

The hon. Gentleman also raised concerns about the distance patients will have to travel to receive maternity care if they are transferred to Stoke Mandeville. These issues have been given careful consideration and are addressed in the consultation document. The county council is working closely with the trust on transport issues and exploring possible solutions. The local ambulance trust would ensure that early transfer and admission for pregnant women were a priority in any event.

In conclusion, I have listened to the hon. Gentleman's concerns. Our policy is that primary care trusts, in partnership with the other local NHS trusts and the strategic health authority, decide the priorities for the NHS locally. They are closest to the provision and that is where the specific local knowledge and expertise lie. It is not appropriate for Ministers to decide.