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9 May 2006 : Column 7WH—continued

She went on to say that the only reason why women did not receive one-to-one care was because there were not

The Government are aware of some of the problems facing maternity and midwifery, but inertia on their part has also contributed to a lack of progress in implementing the manifesto and other policies affecting maternity care. The national service framework was published more than 18 months ago, yet there is still no sign of an action plan for the implementation of its maternity standard element, nor is there any evidence that the Government have properly and fully costed it. While the Government could have taken forward the implementation of their own manifesto commitment, they have instead—I regret to say—indulged their obsession with tinkering with structures, while services are being cut. That is proving to be a very expensive distraction.

It is as yet unclear whether payment by results will ensure a fair and consistent basis for funding maternity care. When the crunch point comes for maternity services, will the result be a fair, accurate and fully funded tariff, or will commissioners conclude that there are insufficient funds for maternity care, and so opt to pay for a reduced quality service? I hope that that will not be the case. The wider question is: how can anyone be sure that payment by results will result in

rather than in perpetuating existing inadequacies in the system for funding maternity care? When asked by my hon. Friend the Member for Guildford (Anne Milton)
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what assessment had been made of the likely impact of payment by results on the number of home births and caesarean sections, the then Under-Secretary of State for Health, the hon. Member for Birmingham, Hodge Hill, replied that no such assessment had been made and gave no date or time frame for when this work was likely to take place.

It is not clear whether the tariff used for applying payment by results will reflect social as well as medical costs. Coming from Macclesfield, I am well aware that there are not only medical costs but in some areas also social costs. Pregnant women and new mothers from socially disadvantaged groups tend to require greater support in respect of advocacy. In some areas, translation and interpreting services are required, as well as closer liaison between midwives and other health and social care professionals. Will the Government guarantee that the tariff will reflect the different costs incurred by women with different medical and social needs?

When will the Government be able to say how maternity services will be commissioned in the future? While practice-based commissioning is central to the Government’s reforms, it does not follow that this will be the most appropriate level at which maternity services will be commissioned. Clearly, different commissioning functions will need to be delivered at different levels, according to factors such as population size, purpose and strategic significance, and the interrelationship between these factors will vary between services in the same locality. Thus, the integrated nature of maternity services implies that commissioning will need to take place at a different level than, for example, the commissioning of elective hospital services. Furthermore, midwifery services have increasingly engaged with the wider public health agenda and have played a significant role in working collaboratively with commissioners—a bigger-picture role that must not be lost as a result of the new commissioning proposals.

Finally, let me explain the way ahead as I see it. The Government have a major job to do in order to get maternity services back on track and to rebuild trust with women who use maternity services and all those clinicians and others who work in the services, particularly the midwives who care for women. Current NHS deficits should not be addressed by cutting maternity services budgets or cutting the number of training places for student midwives; they should be increased because there is a proven need for them. Increasing the number of student midwives would also help to address the growing age profile imbalance in the midwifery service work force. The NHS cannot afford to lose any midwifery posts through redundancy. To help stabilise the situation facing maternity units in England, the Government should give trusts a more realistic time scale in which to address their deficits. They must address them, but they must be given time to do so. In addition, the Government must fully fund pay modernisation, as there is evidence that trusts are using the funding crisis to try to avoid their obligations under the “Agenda for Change” agreement. Moreover, three Secretaries of State are on record as stating that “Agenda for Change” is fully costed. Is it fully costed? To reduce the excessive demands on an already overstretched work force, the Department of Health must urgently address continuing midwife staff shortages. If the Government do not attract and retain significantly greater numbers of midwives, they will sadly fail to meet their manifesto commitments.


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The Department of Health should publish without delay the plan of how it will implement not only the maternity standard of the national service framework for children, young people and maternity services, but all other relevant commitments made in this important area, including the manifesto commitments. It is unacceptable that 18 months after the publication of the national service framework so little has been achieved.

The national tariffs relating to maternity services must be developed in a way that reflects all the costs associated in providing care to women and babies with diverse clinical and social needs. Commissioners should explore the potential for contracting midwifery group practices to provide antenatal and post-natal care services in deprived areas. I am not just concerned about my own area, where the need is great; there are many more deprived areas of the country where such services are important. The midwifery group practices must provide antenatal and post-natal care services in deprived areas in the event of a GP opting out of providing such services. The midwifery group practices are important.

I pay tribute to those who played such a major role in the Health Committee when I chaired it and when it produced the report on maternity services to which I have referred. That was during the period 1990 to 1992, which is a long time ago. I still greatly respect the help given to me by the late Mrs. Audrey Wise, who was as emotionally involved and committed to the report as I was, Mrs. Alice Mahon, who stepped down from Parliament recently, David Hinchliffe, the Labour Member who chaired the Health Committee with such distinction until the end of the previous Parliament, Rev. Martin Smyth from Northern Ireland and the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke). This House remains concerned about these important services.

I have tackled both the national and local aspects of the issue. I hope that the Minister will appreciate that I am committed to saving the in-patient paediatric, maternity and obstetric services at Macclesfield district general hospital, and that I am strongly supported by Dr. Ian Spillman, the leading paediatric clinician, Dr. Val Lether, the lead obstetrician in Macclesfield, and all the other clinicians and consultants, who unanimously believe that it would be wrong to remove the in-patient services. The situation facing maternity services and the midwifery profession nationally also requires Government attention.

10.8 am

Paul Rowen (Rochdale) (LD): I congratulate the hon. Member for Macclesfield (Sir Nicholas Winterton) on securing the debate and on his excellent tour de force. One of my predecessors, Sir Cyril Smith, speaks highly of his work, which has taken place over 35 years, andI am privileged to follow his remarks. The hon. Gentleman spoke about maternity services in general and how NHS policy can impact on those services in his local hospital in Macclesfield. I echo and support his general remarks. He is far more knowledgeable than I am on the issue.

I wish to concentrate on the “Making it Better, Making it Real” consultation, which, as the hon. Gentleman said, covers not only the Cheshire PCTs, but much of Greater Manchester, and which has an
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effect on my constituency. The proposals are currently out for consultation, and the consultation period ends this Friday. The recommendation in the report is to cut the number of maternity units and child care services from 13 to eight or nine.

I am not opposed to change—indeed, I accept that some reconfiguration is needed—but like the hon. Gentleman I am very concerned about the proposals. Not one of the options given includes providing maternity, child care or obstetric services at Rochdale infirmary. With Bury excluded and Burnley general hospital also set to lose its maternity services, a large part of Greater Manchester and Lancashire will be left without easy access to child care and maternity services. Not only that, but for many reasons—whether lack of transport, poor public transport or high levels of deprivation—those areas need such services.

The proposals do not make economic sense. The unit at Rochdale infirmary is purpose-built and was opened in January 2001. By contrast to at least one of the strategic health authority’s preferred options, no new investment will be needed to keep the unit open. It is very popular. The number of deliveries at the unit has risen since it opened from 1,776 to 2,270 last year. It is the only one of the four hospitals in the Pennine Acute Hospitals NHS trust to have admissions rising year on year. The background against which that is happening is one in which the population of Rochdale is set to rise by 6.7 per cent. by 2028, whereas that of the other towns in the area, such as Oldham and Bury, is set to fall.

There are some specific facilities and practices at Rochdale infirmary that are worthy of special mention and should be retained. The hon. Gentleman mentioned the importance of antenatal services in deprived areas, and the antenatal ward is open 24 hours a day, seven days a week. Referrals are made by professionals, but also by the women themselves, and since opening the number who attend for antenatal services has risen from just over 3,000 in 2002 to nearly 6,000 last year. If the strategic health authority proposes to close Rochdale’s maternity and antenatal services, which are unique in the Pennine Acute Hospitals NHS trust in that they are the only ones to be open 24 hours a day, thought needs to be given to how that facility will be provided.

There are many examples in the post-natal ward at Rochdale infirmary of care being given to babies that is only provided in other areas by special care baby units. That includes the care of pre-term babies as young as 34 weeks’ gestation, and low-weight babies, weighing as little as 1.8 kg. The staff have real expertise that is not recognised in the title they are given. It is incorrect and controversial to say that staff become deskilled insmall units because they do not care often enough for the more unusual cases. The example of Rochdale infirmary shows that that is not so.

As I said, the Rochdale infirmary unit is the only one in the trust with a rising admission rate, and it has a large number of admissions from outside the Rochdale area. Last year’s figures, for example, included 45 babies from Bacup, nine from Rossendale, 61 from Whitworth, 26 from Todmorden and 87 from Oldham. More than half of the 87 women from Oldham made a definite choice of Rochdale rather than Oldham. The other half went there because the unit at Oldham was closed. In fact, the unit at Rochdale was closed 16 times last year, not because of lack of staff—the hon. Gentleman referred
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to that—but because it was full and could take no more people. As he said, the national service framework states clearly that it should be a priority

Given the popularity of the Rochdale infirmary unit, I believe that it could and should be maintained.

The consultation document gives four criteria for choosing the options, none of which includes Rochdale. The main criterion is safety. The document states:

No figure is given, but it has been stated that 4,000 deliveries could be a safe figure. I dispute that.

A report by Reform, an independent, non-party organisation, gives evidence that larger units do not automatically provide better quality care or a safer environment for maternity and neonatal care. The report states that larger units are less likely to be able to provide high-quality care because they are more difficult to manage efficiently. It states:

I believe that the report describes what is happening in Rochdale, and it would be a travesty if the unit were to close.

The second criterion is equity. The consultation document states that disadvantaged and vulnerable groups will be able to access health services easily. It adds that the services will need to reflect the geographical spread of the population, reasonable travelling times, choice and type of service, and choice of location for service users. However, that is not addressed in the current options. If we look at a mapof the review area and include Rossendale and Todmorden, we see that a huge geographical area will be left without maternity and paediatric in-patient services if the proposals are accepted.

Rochdale experiences a higher level of ill health than the national average. In September 2004, it had more than 400 families living in accommodation supported by the National Asylum Support Service. The teenage pregnancy rate in Rochdale is greater than the national average. It is one of the areas worst affected by deprivation. All those factors point to the need to retain a locally based service.

The hon. Gentleman referred to recruitment and retention of midwives—a key point. I said that the closures in Rochdale were because the unit was full, not because of a lack of staff. The number of midwives leaving Rochdale has remained low for many years, and the usual reason for leaving is retirement. There are no problems with recruiting staff to Rochdale infirmary’s maternity suite, in contrast with the situation in both Bury and Oldham, where there have been problems with recruiting and retaining staff. In my view, if something works well, we should not change it.


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On patient satisfaction, there has been a huge campaign in Rochdale, similar to the one described by the hon. Gentleman, by people supporting the efforts to keep the maternity and paediatric unit open. More than 37,000 signatures were collected for a petition saying that the unit should be maintained, and during the Easter recess more than 80 people travelled from Rochdale to Westminster to present the petition to the Prime Minister.

I shall quote some of the comments from the customer satisfaction questionnaire that were given to me by the midwives. They include:

Those are examples of people’s satisfaction with the unit.

Before the Pennine Acute Hospitals NHS trust was created, Rochdale infirmary had a three-star rating. It was the first hospital in the country to be awarded magnet accreditation. It is already a centre of excellence in the fields of midwifery, obstetrics and paediatrics. The care given is exemplary and second to none, and the population of Rochdale are speaking out strongly against closure. When the consultation finishes on Friday, I hope that there will be another look at the proposals, that some sense will be applied and that there will be a move to ensure that a maternity service is retained in that part of the conurbation of Greater Manchester.

Mr. David Drew (Stroud) (Lab/Co-op) rose—

Mr. Martin Caton (in the Chair): Order. Exceptionally, I shall call you, Mr. Drew, even though you missed almost the whole of the initiator’s speech. However, I ask that you complete your remarks by 10.30 so that the Front-Bench spokesmen have adequate time.

Martin Horwood (Cheltenham) (LD): Mr. Caton, I wish to speak as well, and I was here for many of the opening remarks.

Mr. Martin Caton (in the Chair): I apologise,Mr. Horwood. I did not see you standing.

10.21 am

Martin Horwood: I congratulate the hon. Member for Macclesfield (Sir Nicholas Winterton) on securing this important debate, and I apologise for missing some of his opening remarks. It is a shame that we are discussing this subject in the context of such a dire financial crisis in the NHS. By way of background, I should tell hon. Members that the financial crisis in the Cheltenham and Tewkesbury primary care trusthas produced a deficit of precisely zero. In fact, that PCT has never been in deficit. What is more, the Gloucestershire Hospitals NHS foundation trust has been an efficient and relatively low-cost provider of health care services, and our mental health care trust is a three-star trust and about to be in the first wave of foundation trust status applicants among mental health service trusts. Our local managers have done absolutely everything right in financial terms, yet we are suffering.


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A review of the maternity strategy in Gloucestershire was already under way. In the words of the consultation document, the strategy

Those are fine words.

Mr. David Drew (Stroud) (Lab/Co-op): I apologise for arriving late, Mr. Caton. I was stuck on a train. I know that the hon. Gentleman will clearly make the points that I would have made. Does he recognise, as I do, that this is the third review? For the Stroud maternity unit, it is the third review in 10 years. Can we stop the reviewing and actually deliver services? It is about time someone listened to what the people want, which is not another review or closure of services. Does he agree with that?

Martin Horwood: I agree entirely. The hon. Gentleman, who represents a neighbouring constituency, faces a direct threat to the maternity services in his constituency, as I do in mine, where the context is a financialcrisis caused not by financial deficits in Cheltenham and Tewkesbury but by deficits elsewhere in Avon, Gloucestershire and Wiltshire, particularly in the neighbouring Cotswold and Vale PCT. Those deficits are leading to a huge range of closures and cuts in services, from health visitors to adult mental health services, from community nursing to overnight care for children in Cheltenham, from cuts in access to acute care to the closure of the Delancy rehabilitation hospital in Cheltenham.

Of course, added to that list is the euphemistically named “rationalisation”, which, over time, will put obstetrics and gynaecology services on one site. My neighbour in Stroud and I are under no illusions as to what that means. The inevitable site for the rationalisation is Gloucestershire Royal hospital in Gloucester, which means that there is a direct threat to the Stroud maternity services and to St. Paul’s maternity unit in Cheltenham, despite the fact that it is an excellent purpose-built facility like the one in the constituency of my hon. Friend the Member for Rochdale (Paul Rowen). My children were born at St. Paul’s, and my family can bear personal witness to the excellent care and first-class facilities that it offers.

The closure of the maternity unit would strike at the heart of our town. Without it, there will be no more Cheltonians, in the old-fashioned sense of the word, because almost no one will be born in the town. Only about 1 per cent. of Cheltenham people are born at home so almost no one will be a Cheltonian ever again if this unit closes. Instead, people will have to face a dangerous extension in drive time, during a very stressful period, through an unfamiliar urban landscape in Gloucester city, which could add dangerous minutes.


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