Perinatal Mortality Initiative (Hansard, 16 December 1986)

§ Mr. Nicholas Edwards

I am today publishing the final report submitted to me by the survey group set up under the perinatal mortality initiative which was announced in May 1983 by my hon. Friend the Parliamentary Under-Secretary of State. A copy of the report has been placed in the Library of the House. Copies are being made available to all hon. Members representing Welsh constituencies.

This is a very important report, containing what I believe to be one of the most detailed surveys ever undertaken of maternity and neo-natal services in the National Health Service as well as the results of the all Wales perinatal mortality survey based on a clinical review of all perinatal deaths in Wales during 1985. I congratulate the survey group and the catalyst team on their achievement. In addition, I would like to thank all those in the Health Service in Wales and across the border whose co-operation has, I know, proved invaluable to the group.

A large number of the recommendations in the report confirm and reinforce accepted good practice in maternity and neo-natal services and the group has acknowledged the work of the Maternity Services Advisory Committee which reported to me and to my right hon. Friend the Secretary of State for Social Services over the last four years. Most of the report's recommendations fall to health authorities and in some cases to family practitioner committees to implement, but I recognise that the Welsh Office also has an important role in carrying forward the work of the initiative. My officials will be reviewing progress regularly with health authorities to help overcome particular problems and to continue—albeit in a different form—the work of the catalyst team set up under the initiative to stimulate professional and administrative action in this area.

In addition, my officials will be taking urgent steps to initiate detailed consultations with the service on the report's proposals for a designated regional service of neonatal intensive care in Wales. I have noted the view of the group that a regional perinatal (intensive care) centre should be developed at the University Hospital of Wales, but do not consider that designation of such a centre should be made before this consultation has taken place. I recognise that considerable expertise has been developed at this hospital and that the necessary access to specialised support facilities is already in existence to a significant degree. I have therefore decided that in order to maintain and safeguard the existing neo-natal intensive care service in South Glamorgan, revenue funding should be made available on a recurrent basis pending the outcome of the consultation on a regional service, to enable the appointment of essential medical and nursing staff. It is my intention to make available central funding up to a limit of £0.25 million from 1 April next year.

The report also includes an analysis of the provision of equipment in special care baby units throughout Wales and identifies deficiencies in this provision. I believe it important that these special care baby units should be helped to continue to provide the level of care—in some cases quite advanced—which is already in existence and I also intend to make capital provision available in 1987–88 of £0.25 million to assist authorities to remedy deficiencies in this area. Health authorities are being invited to submit bids against this funding.

Finally, the report makes a number of important recommendations about the need to integrate all obstetric units on to district general hospital sites because of the 453W adverse effects physical separation has on efficiency and safety. In many cases such units are already integrated and remaining problems will be susceptible to straightforward remedies. In some authorities, however, significant capital investment will be required before integration can be achieved, and we will be discussing this with the authorities involved. In the meantime I am asking all authorities to review the existing disposition of their maternity services and to review proposals for integration, where necessary, in the light of their forward capital programmes.

Although it is clear from the report that there remains considerable scope for further improvement in the provision of this service, that must be judged against the progress that has already been made. The perinatal mortality rate in Wales has continued to fall and by 1985 had reduced to almost half of its 1975 level, to 10.2 per thousand total births. This reflects the considerable effort already put in by service providers and I would like to take this opportunity to express my appreciation to those involved. I look forward to seeing further improvements in the care of mothers and the newly born as the recommendations contained in this important report are implemented by the relevant components of the Health Service.