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Essex Rivers Health Care Trust
Motion made, and Question proposed, That this House do now adjourn.--[Mr. McNulty.]
2.30 pm
Mr. Alan Hurst (Braintree): I am pleased to have the opportunity to draw the House's attention to the achievements of, and the threat to, the maternity services in the north Essex town of Halstead and the villages that run along the Colne river valley. That area is administered by the Essex Rivers health care trust.
I am supported in this matter by the right hon. Member for Saffron Walden (Sir A. Haselhurst), who represents the area with me and whose duties as Deputy Speaker prevent him from speaking in the debate. Nevertheless, both the right hon. Gentleman and I attended and addressed a demonstration rally in Halstead, which was supported by hundreds of local people, predominantly those who have given birth to children in the local birthing unit or under the care of the local maternity service.
I am pleased that the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), knows the area. I understand that her children were born in the W J Courtauld hospital, Braintree, which I also have the honour to represent.
It is worth reflecting on the principles behind maternity care as set out in Baroness Cumberlege's 1993 report, "Changing Childbirth". The principles and criteria contained therein were accepted by the then Government and have been accepted by the current Government as setting the standard that should appertain to maternity services. The principles are that:
That service is known as the valley service, named after the Colne valley in Essex--not to be confused with the Yorkshire haunts of Victor Grayson. The service was set up three years ago to demonstrate that the principles of "Changing Childbirth" could be applied in small towns and rural areas. It has been a resounding success, but that success has, in some ways, laid a dangerous path for it.
It might help the House if I outline the maternity services process followed in Halstead and the valley villages. When a woman believes she is pregnant, she
goes to see a local general practitioner; if the pregnancy is confirmed, the GP notifies Colchester general hospital. That hospital then sends the details of the expectant mother to the valley midwife team based at Halstead.
Completely following "Changing Childbirth" criteria, the valley team allocate a named midwife who acts with her partner midwife so that someone is always on call. The named midwife contacts the expectant mother at her home, not at a clinic. She takes the mother's history and gives appropriate advice about maternity services and what she can expect, and carries out ante-natal checks. The expectant mother is then given the choice that every expectant mother should have of where her baby is to be born: at home, in the birthing centre at Halstead hospital or in the general hospital in Colchester. The course of ante-natal care will be directed to suit that choice.
Ante-natal care is based on home visits, not clinic visits. The named midwife gives the expectant mother her telephone number, mobile phone number and pager number. Thus, the expectant mother can contact the named midwife or her partner any time, 24 hours a day.
On going into labour, the expectant mother contacts her named midwife, whom she knows well by that time. The midwife goes to the expectant mother's home and makes an assessment of whether labour has progressed to the point where delivery may be expected. The purpose of the home visit and the early check is to avoid premature or false admissions to hospital. That has two advantages: it avoids unnecessary anxiety for the expectant mother and the cost of travelling sometimes long distances to the birthing unit or the hospital in a predominantly rural area.
If labour has begun, the named midwife accompanies the expectant mother to Halstead or Colchester and is with her during birth and for the period afterwards. If the mother stays in the hospital, she passes into the care of the hospital staff; if she goes home, the named midwife goes with her and carries out the post-natal care for two or four weeks.
I shall compare the valley scheme with the traditional scheme that operates in the other part of the health trust area in Colchester and the villages on the Colchester side of the district. The mother will go to her doctor, who will send her to the clinic at the Colchester hospital, where she will see the duty midwife. The mother is seen by the community nurse probably twice during her pregnancy. When she goes into labour, she will ring the labour ward of the hospital and be told to come in. If she goes to the hospital too soon, she will be sent home. If she is ready, she will be admitted and seen by whoever is available. The mother stays in the post-natal ward for two to three days. After she is discharged from hospital, post-natal visits are made for the same period as under the valley scheme but from a team of three or four midwives. To be fair, the same midwife would probably visit the mother after the birth, but that is not guaranteed in the same way as it is under the valley scheme.
The local health trust have described the system as a two-tier service and claim that the service in Halstead and the valley villages is better than that in the rest of the district. The problem with the valley scheme is its initial set-up cost, which includes the provision of cars for the midwives, mobile phones and pagers. The health trust estimates the cost of applying the better scheme tothe whole district as between £90,000 and £160,000, depending on the way in which the cost is calculated.
After the initial costs, it appears that the midwife-led, valley scheme is more cost effective. Figures from 1998 show that a birth under the valley scheme cost £722, while a birth under the traditional scheme cost £1,200 in Colchester and £1,700 in Harwich.
I am told also that forceps delivery under the valley maternity scheme is half the rate of the traditional scheme and use of epidurals and pethidine is substantially lower. Some 20 per cent. of births take place at home or in the birthing unit, while the national figure for such births is nearer to 2 per cent. Locally, that figure has increased from 1 to 20 per cent. since the introduction of the valley scheme.
The scheme is acknowledged to be an outstanding success, even by the health trust itself. That is the problem, however, because the scheme is clearly better than the traditional scheme operating elsewhere and complies much more fully with the principles of "Changing Childbirth". However, on 4 October the local health trust board decided that
Councillor John Kotz, who is the leading health spokesman on Braintree district council, wrote to Mike Pollard, the chief executive of the health trust, about his concerns. I shall quote a relevant section from the chief executive's reply. He said:
Mothers in Halstead and the valley villages are incensed by the plans. I mentioned a rally that the right hon. Member for Saffron Walden and I attended two or three weeks ago. Halstead is a very small town and the villages are even smaller. The rally was attended by hundreds of young mothers pushing prams. It was one of those autumn days when there is a deluge of rain, but I am pleased to say that, by the time that we reached the park and the petition was received, the sun had come out and feelings were much more hopeful than when we started out.
"The woman must be the focus of maternity care. She should be able to feel that she is in control of what is happening to her and be able to make decisions about her care, based on her needs, having discussed matters fully with the professionals involved.
There is serious concern about proposals emerging from the health care trust to change the method of delivering maternity services to mothers in Halstead and the neighbouring villages. Halstead is a small market town in north Essex; it is somewhat distant from the main town that serves its health needs, Colchester, and it has its own small hospital, which would once have been called a cottage hospital and which is greatly supported by local people. The Friends of Halstead Hospital has raised £52,000 to establish a birthing unit at the hospital and that is the focus of the current midwife-led maternity service.
Maternity services must be readily and easily accessible to all. They should be sensitive to the needs of the local population and based primarily in the community.
Women should be involved in the monitoring and planning of services to ensure that they are responsive to the needs of a changing society. In addition care should be effective and resources used efficiently."
"the current two tier system was unsustainable",
and went on to say that a new uniform service would be introduced at the end of March 2000.
"As I observed, the Trust has been placed in a position of having two differing modes of service delivery--traditional and group practice. Without additional funding of between £90,000 and £160,000, depending on how costs are calculated, 'Changing Childbirth' cannot be 'rolled out'.
The expression "Rolls-Royce service" gives cause for concern. Valley mothers obviously take the view that they are about to be offered a Skoda in part-exchange for the Rolls-Royce. The expression "Rolls-Royce service" was used about Essex during the debate on "Taking the initiative", issued by the neighbouring health trust, when I brought these matters before the House in 1998. The trust claimed that Braintree and Maldon had a better, Rolls-Royce service than Chelmsford or Colchester. The whole point of "Changing Childbirth" is that every expectant mother should have a Rolls-Royce service. Corners should not be cut to ensure that everyone receives a uniform, but lower, standard of service.
The Trust therefore has a two tier service which is 'part fish and part fowl'. As the health services in North Essex are in serious financial deficit, I cannot foresee the circumstances when the 'Rolls Royce' service in the Valley can ever be extended across our entire catchment area".
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