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Dr. Ladyman: Had I recommended to the Secretary of State that we follow the advice of the working party to which the hon. Gentleman refers and close down all the paediatric cardiology units that performed less than a certain number of operations, we would, among other things, have closed down one of the only two facilities that can provide heart transplants for children, and we would probably have closed down half of the units that have the lowest mortality rate. There was no expert evidence to support that figure. It was an arbitrary figure produced by the working party on the basis of their judgment. Far from not looking to the future, we said that that advice should be set as a direction of travel for all future reconfigurations to take into account. So I would not be surprised if, over a period of time, all units were configured in accordance with the numbers mentioned. We are just not going to do it immediately and close down half of the best units in the country at a stroke.
Mr. Lansley:
The Minister and I have had this exchange before, so I shall not detain the House by repeating it, although my recollection of the working party report was that it did not recommend that those steps should be taken now and that it contained a staged programme. One can argue about the design and the timetable for implementing the recommendations. If the Minister disagreed with the review, it would have been better for him to ask the working party to re-examine the process, rather than to put the review back on the shelf.
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In the context of this part of Sir Ian Kennedy's report, one of the central issues was the lack of throughput of activity to justify the maintenance of specialist services on which there could be sufficient peer review and validation. The Government put those elements of his recommendations to one side and said they would be reconsidered in the context of the national service framework. There is nothing in the national service framework that says how those recommendations can be picked up for the future. To my surprise, the hon. Member for Bury, North raised the point that the NSF provides no guidance.
The configuration of children's services has caused serious concern in areas such as Manchester, an issue that the hon. Member for Manchester, Blackley (Mr. Stringer) has raised before, but it is better in other places. In areas such as Yorkshire and my area, East Anglia, a powerful case exists for the reconfiguration of children's services and for the establishment of a children's hospital. Such a children's hospital could become the base for expanded activity within the region promoted from within the acute sector, and it could reach out into community paediatrics, like the Queen's medical centre, Nottingham. The national service framework contains no guidance, not even in the form of alternative service models, on how one might go about that. Although it contains guidance on good practice, in that respect it does not follow up the reports from which it was derived.
I had a much better speech, but my daughter, who is only 18 months old, wrote all over it this morning. In years to come, she will appreciate that we have debated children's services, which is something that we should do regularly. I hope that we return to the matter in five years' time, halfway through the life of the national service framework, and on other occasions.
An incoming Conservative Government will point to the actions that flow from the NSF. I hope that it will be our responsibility and privilege to turn the NSF into standards that make it clear what the NHS should provide and when it should provide it. By 2014, I hope that not only will those standards have been met, but we will have gone beyond them to look to a new and constantly improving quality of service for children, who are indeed our future.
5.17 pm
Mr. Alan Hurst (Braintree) (Lab): I am pleased to have the opportunity to speak in this important debate. I fully endorse the standards that have been set out, but I want to detain the House for a few moments on maternity services, which the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned earlier.
"Women have easy access to supportive, high quality maternity services designed around their individual needs and those of their babies",
and the accompanying narrative mentions:
"Informed choices . . . Women able to choose the most appropriate place to give birth . . . range of local options including home birth and delivery in midwife led units".
I want to discuss choice. I have raised the matter before on the Floor of the House—I make no apology for that—in the context of maternity-led services in my parliamentary division, Braintree, at the William Julian Courtauld hospital.
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The concept of choice in maternity services is not new and has been an issue for the past 15 years. A Select Committee report—the Committee is chaired by the hon. Member for Macclesfield (Sir Nicholas Winterton)—dwelled upon choice and not disadvantaging those who live in small towns or rural areas, and Baroness Cumberlege also chaired a report. The chain of events has led to a situation in which women should choose where their children are born and should not be disadvantaged in making that choice if they live in country areas. Politicians and members of all political parties have happily endorsed that concept for many years, but it does not always come to pass. The William Julian Courtauld hospital was founded by a member of the Courtauld family after the first world war and has continued to be held in great affection by the people of Braintree and the surrounding districts ever since. It was threatened with complete closure in 1997, but enormous public protests secured it a longer lifetime.
Then, as in the film "Jaws"—"Just when you thought it was safe to relax"—along came another threat to the hospital. Last autumn, the local health trust advised me that the maternity unit was closing—but only temporarily, because so many of the midwives were either unwell or giving birth themselves that there were not enough staff. I may have been a little naive, but I took that at face value. However, when the unit reopened—as it did; I was not completely misled—its opening hours were somewhat different. It now opens from 9 in the morning to 5 at night and not at weekends. However, as those who have had children will be aware, they do not always arrive between those prescribed hours.
The trust made arrangements to address that problem. A woman who thought she was going to give birth outside those hours could telephone the midwife, who would go and get the key to let her in and attend upon her. I have not made this up, although it sounds like it. As one might imagine, the system has not always worked successfully, with the result that at least one baby has been born in the car park of the William Julian Courtauld hospital because the key, the midwife and the mother did not come together at the same time.
If we are to make real the concept behind the standard on maternity—standard 11—people must have real choices, not the sort offered by Henry Ford. They must have a choice other than that of a large general maternity unit. I fully understand that if a mother has complications, as she may do for a range of reasons—it is much better that she goes to a fully equipped major maternity centre to give birth, but where it is presumed that the birth will be relatively straightforward—that may be the conceit of a man; I am sure that it is never straightforward, but in so far as it can be—she should have the choice of having her baby delivered locally.
I am fortunate that the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), is present to hear me, because previously I had to make do with an Adjournment debate. I am speaking on behalf of the mothers of Braintree, who are very worried about the situation. The
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trust is now saying that if the number of babies reaches a certain level it will think about opening the unit seven days a week, 24 hours a day.
Dr. John Pugh (Southport) (LD): Does the hon. Gentleman agree that the success of maternity-led units very much depends on GPs promoting them, believing in them and selling them to young mums in uncomplicated circumstances?
Mr. Hurst: The hon. Gentleman is absolutely right. The standards say that mothers must have information made available to them on an even-handed basis so that they can choose between home delivery, a maternity-led unit or a general maternity centre. In my experience, and perhaps that of the hon. Gentleman, GPs do not always promote the midwife-led maternity unit. Indeed, the unit that I mentioned was formerly GP-led, but became midwife-led—very successfully—because an increasing lack of enthusiasm among GPs meant that there were too few of them to staff it. GPs need some propaganda to encourage them to offer mothers a real choice. I am pleased that the standards promote that; we need to aim to achieve it.
I hope that my hon. Friend the Minister will take on board what I have said about my local hospital with a view to some advice being given to those who presently have power over it.
5.24 pm
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