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31 Oct 2006 : Column 72WH—continued
I am not a clinician, so I have to listen to what clinicians are saying, but part of the clinical issue is that the number of births required to sustain 24-hour
consultant cover depends on local circumstances. Decisions about the size of a maternity unit are most definitely a local matter, and neither the Department nor the royal colleges have issued guidance on specific unit sizes. However, there is general recognition that services in a particular location need a critical mass of deliveries so that staff remain clinically skilled. That is as important in this area of health provision as it is in others. About 12 whole-time equivalents are required to ensure a consultant presence on maternity units24 hours a day, seven days a week. At that staffing level, about 4,000 births per year can be safely managed. That will obviously provide the trustwith income and enable it to afford not only the12 consultants, but the associated levels of junior staff and midwives. Hospitals that manage that level of deliveries can, for example, also support a co-located, midwife-led unit. Certain antenatal and postnatal care features can also be provided in different settings, in addition to a hospital service for particularly complicated births that might need consultant intervention.
Last year, there were 1,589 deliveries at the Conquest hospital and 1,767 at Eastbourne district general hospital. Of those, 443 were moved to a special care baby unit for additional care following birth. There were also 341 births at the birthing centre at Crowborough and 140 deliveries at home. In looking at services, we must take account of the current figures, although the hon. Gentleman mentioned population changes, and it is important that those are also fed into any deliberations. However, it is important that low-volume units are considered in terms of what is necessary to produce good outcomes. The problem is that such units tend to have poorer outcomes. Even if they could afford 12 consultants, who would do, say, 2,000 births, they would be covering fewer than four births per week. The argument from those who skill up consultants is that that is insufficient to maintain consultants’ skills. Therefore, it is a question not only of funding more consultants, but of ensuring that the throughput—to use the jargon—of women who give birth is sufficient to keep the skill base and clinical and patient safety at the optimum level.
All those issues need to be discussed locally. They need to be discussed alongside issues such as introducing midwife-led birthing units that can operate
in different locations and catering for the wishes and choices of women who might want more assisted births in their own homes. We must also take into account the number of multiple births that we are now seeing, partly as a result of in vitro fertilisation treatment. Furthermore, the average age of women who give birth for the first time has increased in the past years, and although that is not a problem in itself, there are risks connected with having children in one’s late 30s, rather than one’s late 20s. All such issues must inform our discussion of maternity services, and any views expressed by the ambulance service should also be considered.
On NHS funding, the hon. Gentleman will be only too aware that the NHS as a whole is in receipt of record resources. I do not think that the current financial situation in East Sussex can be attributed to the lack of funding; in fact, the primary care trusts there collectively received allocations of £669.5 million for this financial year, and the funding for East Sussex Downs and Weald PCT will increase by 18 per cent., or £70 million, in the two years between 2006 and 2008.
NHS organisations have, however, always been expected to plan for and achieve financial balance in each and every year, and it is only right that we have exposed cases in which they have not been operating as transparently as they should. We are only too well aware that there are different deficits in different organisations, and organisations that have managed their finances well and kept them in balance contribute to dealing with imbalances in wider health economy. However, as a Member of Parliament and a Health Minister, I think that we will get through this only by bringing some rigour and accountability into the system to help us plan better for the future. It is not good for any service to be under the shadow of unresolved financial problems.
I am assured by NHS South East Coast that any proposals that come out of the current process will meet three vital criteria: clinical safety and quality, improved access for patients and financial stability. Financial stability is important. When people are planning services, it is important to know that those services will not be knocked off balance by unresolved financial problems elsewhere in the health system.
It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.
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