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Mr. David Chaytor (Bury, North) (Lab): I am pleased to have the opportunity to bring to the attention of the House the situation in respect of the current public consultation being promoted by the Greater Manchester strategic health authority, "Making it Better", which concerns proposed changes to health care services for children and young people, parents and babies in Greater Manchester. My interest is particularly and understandably in the hospital that serves my constituents, Fairfield hospital in Bury, but I want to make some remarks that spread a little more widely.
In the north Manchester area at present we are going through a considerable period of change within the NHS. For example, the chief executive of the Bury primary care trust will retire this weekend and a new chief executive will be appointed in due course. The chairman of the Pennine Acute Hospitals NHS Trust resigned some weeks ago. We have a temporary chairman, and a permanent chairman will be appointed in due course. The chief executive of the Pennine trust will be leaving his position in a few weeks' time. The merger of primary care trusts is moving forward and a number of neighbouring PCTs will be amalgamated in the near future.
The Greater Manchester strategic health authority, which has driven the process of consultation, will be abolished in the near future. The current chief executive and chairman will be moving to new positions or to pastures new and the Greater Manchester SHA will be absorbed into a new regional strategic health authority. Given the scale and pace of change in structural organisation in Greater Manchester, and of changes of leadership in the primary care trust and north-east sector and in many neighbouring primary care trusts, is this the right moment to embark on an additional, radical phase of reform, some elements of which have not been thought through in sufficient detail?
Fairfield hospital is the hospital in which the vast majority of my constituents were born. Most families in Bury will have seen relatives die in that hospital. I was born there. Many of my relatives were born there and have worked there, and most of my relatives have died there. My hon. Friend the Member for Bolton, North-East (Mr. Crausby) was also born in Fairfield general hospital, as were his children and the children of the constituency assistant of my hon. Friend the Member for Heywood and Middleton (Jim Dobbin).
You understand, Mr. Benton, the close personal interest that my colleagues and I have in the future of the maternity services at Fairfield. Our interest is enhanced by many distinguished people having being born there, not least the Prime Minister's wife. She was born in Fairfield a number of years after me. We were delighted that Mrs. Blair was able to reopen the new, refurbished and enhanced maternity unit just five years ago. To most members of the public and to most of my colleagues, suggesting that a unit that was reopened merely five years ago should now be closed and transferred to another hospital makes little sense.
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The current consultation process is the third attempt in six years to consider the future of maternity and paediatrics. The first attempt was stifled at birth, because it took the form of an internal report by the former regional health authority, before the Greater Manchester SHA was established. That came to the conclusion that the Fairfield hospital should maintain its maternity and paediatric service.
That report did not see the light of day, but the debate continued until mid-2004, when a public consultation was launched with a different set of recommendations. In particular, it was suggested that Fairfield should lose its maternity and paediatric services but that Rochdale infirmary, the second of the four hospitals in the Pennine acute trust, should maintain its services. That public consultation was withdrawn following criticism by me and my hon. Friends the Members for Bury, South (Mr. Lewis), for Heywood and Middleton and for Rossendale and Darwen (Janet Anderson) concerning the lack of detailed information supporting those conclusions.
Following the withdrawal of that consultation, there was a further period of informal consultation from early to mid-2005, which culminated in the publication of the current consultation document in January 2006it was launched on 12 January. Fortunately, it has been extended for an additional month, to mid-May, so today's debate is very timely, as we are moving towards the final weeks of consultation.
The thrust of the proposals in the document are in many respects welcome and entirely in line with the views of most Greater Manchester Members and large sections of the general public. We are talking about a major expansion in primary care, and we welcome hugely the proposal to build 35 new primary care centres throughout Greater Manchester, seven of which will be in the borough of Bury and four of which will be in my constituency of Bury, North. The general drift of the proposals for primary care and the improvement of services outside hospitals is completely to be welcomed.
We recognise the need for rationalisation in maternity and paediatric services and units. Most people accept the need to reduce the number of separate units. We are not arguing against the principles underlying the consultation. We are arguing against the specific choice of Fairfield hospital as one of the hospitals that will lose its maternity and paediatrics in-patient services.
When the first consultation was launched in 2004, there was considerable public reaction in Bury: a major petition was launched and a march was held. The best part of 5,000 people marched through the centre of the town to express their opposition to the proposal. That was in early 2005. Next Saturday, another march will be held in the centre of Bury, and I imagine that several thousand people will march against the proposal to close the maternity unit at Fairfield. In addition, at least 30,000 people have signed a petition supporting the retention of maternity services at Fairfield.
I stress again that the general direction of the proposed reforms has considerable public support. We are all in favour of the expansion of primary care, and we recognise the need for rationalisation following the closure of two of the older children's hospitals and the formation of the new tertiary children's hospital in the centre of Manchester. Change has to take place.
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We recognise the imperative of the working time directive and the pressure on doctors' rotas. We recognise the problems that will be caused by a shortage of midwivesor problems with their age profile, as a considerable number will be retiring in the not too distant future. We understand all the pressures on maintaining a well-staffed and safe service across a large number of sites, and Greater Manchester is fortunate in having a larger number than many regional cities. Nevertheless, we argue that it is wrong to choose to close Fairfield.
I shall outline some of the reasons for our opposition. The process through which the consultation has developed was questionable in one key respect: it started with the designation of sites. Once the sites that should continue had been designated, criteria were established to test the validity of that choice. That puts the process the wrong way around; it puts the cart before the horse. In a normal decision-making process, one would reasonably expect to establish criteria before making a decision about the options. In this case, the SHA has chosen the options before agreeing the criteria. Subsequent to the options being chosen, they were tested against the criteria, but certain options that were excluded from the start might also have satisfied the criteria that were agreed. It is important to stress that there is a serious flaw in the process that was established earlier. Owing to that, our hospital has not been given the full opportunity to demonstrate its case against the agreed criteria.
The consultation document published this year is detailed. One could not criticise the SHA for not attempting to provide a substantial amount of information. The document is not completely accessible, and aspects of the layout and the presentation of the information could have been done better, but by and large we have no criticisms.
In addition, a considerable amount of information has been published on the website. The information is relevant to the process, the choice of options, the establishment of the criteria and the pre-consultation carried out, and it contains details of clinicians' internal meetings and the arguments made. The SHA has gone out of its way to offer considerable information to the general public to help formulate their decision.
However, certain key areas of information are neither included in the consultation document nor properly presented on the website. For example, one element of the website deals with staffing. It identifies for all hospitals in Greater Manchester the numbers of whole-time equivalent staff in paediatrics, for example, so that we can find out how many paediatricians or whole-time equivalent paediatricians work at each hospital. However, we do not get the same information for midwifery and nursing staff, so there is a significant gap in the information on staffing. There is also no information about how the proposals for the new reduced number of maternity units would be staffed. Again, that is a significant gap, and it limits the extent to which people can form a reasoned judgment about whether the series of proposed options is workable and justifiable.
As I recall, one item on the website says that the work force strategy and action plan, which will presumably determine how the proposed new units are staffed, will be presented to the task force in April. If the
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consultation has been under way for the best part of two years, and the current phase was launched in early January, but the decisions about the work force strategy are not to be taken until April, there seems to be something wrong with the time frame of the process.
Another gap in the background information on the website is the revenue and capital cost implications of the proposals. It is not just a gap; it is a hole. There is no information about those implications. Evaluating whether it would be better to maintain services at Fairfield general or another hospital
Mr. Chaytor : I shall attempt to continue seamlessly from the point at which I left off. I was discussing the question of revenue and capital costs in the consultation document, or, more accurately, their absence from it.
If we consider the papers on the website relevant to paediatrics and maternity for the Pennine acute trust, there is literally a gap when we come to the proposals for maternity. There are no financial costings, just a simple comment that the
To many of my constituents, one of the biggest contradictions in the proposals seems to be on the question of choice. My hon. Friend the Minister knows what great emphasis the Government have placed in recent years on patient choice in developing their policy. That featured prominently in our general election manifesto and, more recently, in the document "Creating a Patient-led NHS". It will be appreciated that for thousands of people in my constituency who were born in Fairfield, and who continue to expect that their children and grandchildren will be born there, the idea of patient choice rings a little hollow if the overwhelming choice expressed about the hospital in which they wish to give birth is taken away from them.
I stress the point that if we, as a Government, are serious about patient choice then it makes no sense whatsoever to take away what is an enormously popular choice for many people in my constituency, Bury North, and its neighbouring districts, especially in significant parts of Rochdale, Heywood, Middleton and Rossendale.
In the district that Fairfield supports, everyone would accept that Fairfield and Rochdale infirmary are both smaller hospitals. We also accept that Bury and Rochdale are two of the smaller towns within the Greater Manchester conurbation. However, to deprive both hospitals of their maternity and in-patient paediatric services would leave a gaping hole in the north of that conurbation, unique when every other part
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of it would remain well served in maternity and paediatrics by local hospitals. We find that gaping hole unacceptable; for local people, it would result in severe deterioration of both services in and accessibility to the NHS.
We also know that while Bury and Rochdale are two of the smaller towns, their combined populationwith the neighbouring district of Rossendaleis greater than that of the city of Manchester, which brings me to my final point. The consultation document offers four options for the future, none of which include Bury or Rochdale. I believe that to consider an amalgamation of Bury and Rochdale's in-patient paediatric and maternity service on the Fairfield site would be an ideal fifth option, and one which is increasingly supported by wide numbers of local people, and particularly by clinicians, nursing staff and doctors working in the Pennine acute trust.
That amalgamation would have several advantages. First, it would create an in-patient service and maternity unit large enough to deliver the economies of scale and critical mass of patient through-put to ensure that staff working in the unit were faced with the full range of clinical problems that they would need in order to maintain the quality of their clinical practice. Were we to amalgamate Bury and Rochdale it would, by dealing with the necessary critical mass of patients, mean that we would be talking broadly of 13 births per day compared, for example, to 12 in the neighbouring hospital at Bolton or seven at North Manchester. If talking of maternity out-patients we would be talking of over 400 compared, for example, to 100 at North Manchester or 310 at Oldham. I could go through a long list of figures to demonstrate that merging the two units would create a more than viable single site.
A second point is that in terms of choosing between the two locations, given that Fairfield hospital is the last building in my constituency and immediately adjacent to the border with Rochdaleif it were moved 50 yards further to the east it would be in the borough of Rochdaleit is ideally suited to serve the population of my constituency and other parts of the constituency of my hon. Friend the Member for Bury, South, and also most parts of Rochdale and the district of Rossendale to the north. The central geographical location of Fairfield hospital is also a powerful case for my fifth option.
We welcome the consultation document published by the strategic health authority and the considerable amount of work that has gone into it. We recognise the serious attempt to hold an open and transparent consultation; we value the information that has been provided; we support the general direction of policy in the rationalisation of the total number of units and the concentration on centres of excellence and the massive expansion of primary care. However, we think that the SHA has made the wrong decision in the choice of site and therefore I, and a considerable number of my constituentsI mentioned the 30,000 who have already signed the petition, and several thousand will demonstrate on the streets of Bury on Saturdaywill support the fifth option, the amalgamation of in-patient paediatric and maternity services in Fairfield hospital in Bury.
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The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate my hon. Friend the Member for Bury, North (Mr. Chaytor) on securing this debate on maternity services. He advanced a powerful argument. I thank him for bringing the debate to the Floor of the House and for his consistent argument with Ministers on behalf of his constituents off the Floor of the House. I want to put on record my thanks to my hon. Friend the Member for Bury, South (Mr. Lewis), the Economic Secretary to the Treasury, for his contribution to the debate. My final words of thanks are to the Bury Times and to the Manchester Evening News, which have consistently kept the debate, and the facts, in front of the local community. Their approach to the subject showed again that they are effective voices for local people.
The starting point of the debate is the extraordinary changes that have happened in the national health service in the constituency of my hon. Friend the Member for Bury, North since 1997. They have happened not by accident, but because we doubled, and are on our way to tripling, health service investment, which has meant more than 360 extra consultants, 2,500 extra nurses and 3,700 more health care assistants for Greater Manchester since 1997. As a result, waiting times for the health service in his part of the country and in the rest of England have fallen dramatically. In 1997, about 18,000 people had to wait more than six months for in-patient treatment in Greater Manchester, but today that figure has come down to noneno one waits longer than six months.
The improvements in the NHS generally are also true for maternity services. Last year, we achieved our target of recruiting an extra 2,000 midwives. The vacancy rate for midwives throughout the country has come down from about 3.3 per cent. in 2000 to 1.8 per cent. My hon. Friend mentioned some concerns about the number of midwives who are coming up to retirement age. I am pleased that there has been a 44 per cent. increase in the number of students entering training to become midwives, which is great news.
It is no surprise, therefore, that the vast number of women80 per cent.who use the NHS when they have a baby are overwhelmingly satisfied with maternity services. The satisfaction rate for men is not equivalent, but it is not far off. As someone who has three children aged five and under, I have spent some time in maternity wards in the not-too-distant past, and the service is first class.
The most important figure is that of infant mortality. We now have the lowest ever rate of infant mortality in England5.1 deaths per 1,000 live birthsbecause of the big investment we have made. As my hon. Friend said, reform has to go alongside that new investment over the months and years ahead. I am grateful for his measured presentation of the arguments in his part of the country.
Fairfield hospital is part of the Pennine Acute Hospitals NHS Trust, which is involved in two of the biggest health improvement programmes in the country. The geography of my hon. Friend's area is unique. The pattern of mill towns that developed there over the 19th century has meant that many of the hospital services are
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small and unique in their configuration. My argument is that, although those services worked extremely well in the past, in the 21st century, they have to change.
Part of the change must be to the organisation of maternity and obstetric services. The reorganisation is not proposed for the sake of reform; it reflects three important principles. I am referring to principles that we set out in the White Paper on health and social care, to which my hon. Friend alluded. That is important because, in the 21st century, people want an NHS that is available not only around the clock, but around the corner. We therefore have far more to do on moving in-patient services out of hospitalstheir traditional locationinto the community. Quite significant services can be moved into the community, where they are far more convenient, particularly for people from more deprived communities, who often lack access to public services in general and to services such as transport in particular.
The position that I have described has an important bearing on how maternity services will be organised in my hon. Friend's constituency. In particular, we will ask PCTs to go about developing and implementing the national service framework for maternity services quickly. At the last election, we knocked four or five years off the deadline for implementing that framework. We now have plans in place for its implementation and we hope to see a big expansion of community-based midwifery services. They are particularly important to ensure that people from all corners of the community have access to early antenatal care, which is vital to the baby's future health and to the mother's health. Dr. Foster estimates that about 40 per cent of births are unassisted and could be safely delivered in a midwife-led unit or at home. That is the first issue.
The second issue is the pattern of 24-hour in-patient services, which are spread quite thinly across the hospital sites in Greater Manchester. That results in pressures on staffing. I understand that maternity units across the review area were closed on 90 separate occasions over a 12-month period to March 2006. Those closures ranged from a few hours to an entire day.
Thirdly, it is important to create strong 24-hour in-patient services, because they allow a critical mass of patients to come together and they allow clinicians to develop particular types of expertise. Why is that important? The infant mortality rate in central Manchester is eight per 1,000 babiesI am referring to babies who die before their first birthdaycompared with a rate of only two per 1,000 in mid-Surrey. There are great inequalities in the infant mortality rate, and we must reflect that in the services that we organise.
Those are all big questions, and that is exactly why the consultation is so important. I am especially grateful to my hon. Friend for highlighting fresh and innovative proposals that were not put on the table in the consultation. I will personally write to the chief executive of the strategic health authority to make sure that those proposals are taken into account as the consultation unfolds.
My hon. Friend made a central point about criteria being developed after the configurations were proposed. I will look into that and write back to him on it. He also
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made some important points about gaps in information. I am grateful for his thanks for the way in which a lot of detail was presented but, if there are gaps in information, I will see what we can do to remedy that. He mentioned that there is an ongoing debate that has captured the attention of the entire community, and I understand that there are marches this Saturday. I want
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to make it clear that, where there are petitions and where there is a public response of that kind, we will absolutely make sure that those voices are heard as the consultation draws to a close.