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Today’s debate provides an opportunity not only to reiterate our commitment to the quality of care that we want to achieve, but to call on the Government to stop and think about what is happening to maternity services across the country at the moment. Let me take the House back to 8 December, shortly before the recess. On that day, two regional announcements were made—
affecting the Greater Manchester area and the east of England—that highlighted the serious consequences of the closure of maternity units across the country. On that one day, nine maternity units were identified for possible closure as a consequence of reconfigurations.
We undertook our own consultation to find out what people on the front line of the NHS feel about the future configuration of maternity services—something that the Government need to do and that the motion calls on them to do. The national picture shows that while we talk about and value birth centres and midwife-led units, 19 of them are at risk of closure. While we talk about accessible services, a number of smaller consultant-led maternity units—by our reckoning, 24 of them across the country—are at risk of closure. As I said, nine were identified in one day.
Andrew Gwynne (Denton and Reddish) (Lab): The hon. Gentleman mentioned the Greater Manchester reconfiguration, but is he seriously saying that, setting aside which hospitals are identified in it, there is no need for a change to services there? That is absolutely crazy.
Mr. Lansley: I shall come on to say what I think about the Greater Manchester consultation in a few moments.
Gregory Barker (Bexhill and Battle) (Con): My hon. Friend is making a powerful speech. May I tell him that it is not just Greater Manchester or the east of England trusts that face drastic cuts and closures, because the East Sussex trust is faced with the closure of the maternity unit in either Eastbourne or Hastings. My constituents may face a journey of up to 50 minutes to get to a maternity unit. In that case, a poorly resourced midwife service or home births may become not just an option, but a necessity.
Mr. Lansley: My hon. Friend anticipates a general point that I wanted to make, so I shall make it now in response to him. Changes in the configuration of maternity services are occurring across the country, and they are driven by financial deficits, as in the case of East Sussex, or by the working time directive and staff shortages, as is predominantly the case in Greater Manchester. Those changes are not justified by evidence about clinical safety, yet we should be concerned primarily about quality and safety.
Mr. Lansley: I will give way again in a few moments.
As for Eastbourne and Hastings—Labour Members may recall the same thing in respect of Calderdale and Huddersfield—we are presented with the question whether maternity units with fewer than 3,000 live births can be maintained in this country any more. My contention is that we should retain such units, because we need to maintain access and extend to women the sort of choices that we want them to have, but NHS organisations across the country are planning to shut them down. They are doing so because of deficits and the working time directive and not because of issues of clinical safety.
Mr. Lansley: I shall give way first to my hon. Friend the Member for Welwyn Hatfield (Grant Shapps).
Grant Shapps (Welwyn Hatfield) (Con): Has my hon. Friend taken into consideration one widespread issue? At my local hospital, the Queen Elizabeth II in Welwyn Garden City, the maternity unit is under threat, yet the review into the closure that is about to take place does not take into account the fact that over the next 15 years its catchment area is due for a population increase of 70,000.
Mr. Lansley: Yes, I understand that and I will move on to deal with the East of England trust later.
Mr. Lansley: I shall give way to the hon. Member for Colne Valley (Kali Mountford), as I have referred to her area.
Kali Mountford (Colne Valley) (Lab): I am grateful to the hon. Gentleman for giving way on the issue of the Calderdale and Huddersfield NHS trust. He made a point about the number of births required in order to maintain standards of safety, but may I tell him that it is obstetricians who say that at least 5,000 births are necessary for viable units and it is politicians like him and me who want to maintain services as close to home as possible. Midwife-led units may be the right answer when assessments of patients’ needs have been made. It would then be possible to say that fewer births were necessary to maintain services in a particular area. That could be a way of maintaining services closer to home. We need to find a compromise so that—
Madam Deputy Speaker: Order. The hon. Lady has made her point.
Mr. Lansley: I understand the hon. Lady’s point, but I do not know what world she lives in when she says that maternity units need 5,000 live births in order to be viable. [Interruption.] Has the hon. Lady ever talked to people working in France or Germany? If we go to Germany —[Interruption.] If Labour Members would listen, they might learn something. In Germany, the largest maternity unit is the Humboldt in Berlin with just more than 3,000 live births and the largest maternity unit at Lille in France has 4,000 live births. Let me tell the hon. Lady why that is the case. It is because those countries have put far more effort into the identification and management of low-risk births in the community and in smaller units so that the number of births concentrated in specialist centres can be kept down. That is not what is happening in this country at the moment.
Mr. Lansley: I want to make some progress, as many Members want to speak and I have a lot to say about Manchester before giving way again.
The hon. Member for Colne Valley made a point about midwife-led units and I agree that it is perfectly possible for them to be one of the best ways of
providing services and that it may be appropriate for them to replace existing consultant-led units in some cases. However, midwife-led units are being shut down across the country, not opened on the required scale. Midwives are not taking responsibility for those services.
As far as Calderdale and Huddersfield was concerned, the independent reconfiguration panel reached the conclusion that, because of the working time directive, it was unable to staff paediatric services, so it accepted the loss of maternity services at the Huddersfield royal infirmary. Let us consider the position in Manchester. The consultation document, “Making It Better, Making It Real” was presumably supplied by the department for ironic titles within the Department of Health— [Interruption.] I hear the Under-Secretary, the hon. Member for Bury, South (Mr. Lewis), saying, from a sedentary position, that it is all local. I suspect we will hear a lot from him about how this is not his responsibility. Here he is, the Minister with responsibility for maternity services, who says that everything that has happened in Manchester over the past two years is absolutely nothing to do with the Government.
The local primary care trust says in the consultation document:
“There is evidence that sick children, young people and babies do better in larger units than in smaller units.”
Reference is made to a study undertaken in southern California in 1991, which demonstrated that low-weight babies born where there was no regional neonatal intensive care unit did not do well. We all know that, but that does not support the general proposition that babies do better in larger units. There is no evidence for that. The Government have told us that there is no evidence for that: last year, they published a call for evidence and research, which we now know is to be undertaken by the National Perinatal Epidemiology Unit, which will not report until 2009. The Government’s call for tenders states that
“there are concerns about the lack of evidence of this shift in service provision on the outcomes for both mother and child”
and that what is required is that
“empirical research is urgently undertaken to evaluate the outcomes and costs of home births and all types of midwife-led birth centres.”
Ministers do not know what the outcomes are and they do not believe that there is any evidence for the proposition that births in larger units are safer than births in smaller ones.
In those circumstances, how can it be that on 8 December, the primary care trust in Manchester published a press release that stated that it had decided—not that it was thinking or consulting further, but that the trust had decided—that five units in Manchester were to close? At the time, I was astonished that the Labour party chairman—I told the right hon. Lady that I might refer to her, but she has chosen not to be here—and the Under-Secretary said, “Ah, well, this is a consultation—nothing has been decided,” when the PCT had issued a press release saying that it had decided that the units were to close. The Under-Secretary’s local maternity unit, at Fairfield hospital, is to close, as are maternity units in Pendlebury, Trafford, Macclesfield and Rochdale. The Under-Secretary argues about the geography, but
says that he accepts the case for change. How can he accept the case for change when there is no evidence to support the proposition? The “Making It Better, Making It Real” document even states, on page 18,
“The birth rate nationally is falling so there will be fewer children and young people in the future.”
That is the basis on which the decisions were made, but that statement is not true.
What actually underlies the Greater Manchester strategic health authority’s decisions? To quote page 18 of the document again,
“Staffing pressures on the 13 units providing in-patient care are getting worse. Already children’s wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work.”
That is what is behind the events in Manchester—the working time directive, not quality and safety. In April 2004, the right hon. Member for Barrow and Furness (Mr. Hutton), who was a Health Minister at that time, said that the UK would have to comply with the working time directive but that the Government would not allow it to impact on local services. But it is having an impact on local services. The Under-Secretary cannot get away with saying that the changes are the result of local decisions; they are driven by national policies and the failure to reform the working time directive.
Mr. David Chaytor (Bury, North) (Lab): Is the hon. Gentleman’s position that the existing number of maternity units and neonatal units in Greater Manchester should continue indefinitely?
Mr. Lansley: No, because I do not contend that what ought to happen in Greater Manchester is my decision to make. However, I do contend that the Members of Parliament who represent Greater Manchester and the population of that area are ill served by a Government who imposed the working time directive that has forced the changes and by a local NHS bureaucracy that is so transparently unaccountable and unprofessional in carrying out its job.
Mr. Lansley: I will not give way, because I wish to make progress.
The Labour party chairman can do one of two things: either she can represent her constituents and say that the consultation is neither evidence based nor justified, or she can leave the Government and argue that the Government’s implementation of the working time directive and imposition of certain policies is having a detrimental impact on her constituents and is clearly unjustified at national level—but she cannot do both. She cannot represent her constituents in one way and then, at national level, support a Government who are working in precisely the opposite direction.
Mr. Lansley: I will not give way now. I want to turn my attention to the east of England.
Madam Deputy Speaker: Order. The hon. Gentleman has said that he is not prepared to give way at this point.
Mr. Lansley: Thank you, Madam Deputy Speaker. Hon. Members will thank me later for not giving way now, because they will have a chance to make their own speeches.
I have one more point to make before I leave the subject of the right hon. Member for Salford (Hazel Blears)—I wonder where she is. Today, she has received a letter from a former chief executive of the Salford and Trafford health authority, in which he says:
“We in Salford are now in a position where, instead of having a local hospital with a full range of secondary hospital services for our people, we face under your government the loss of a significant element of local health care, with probable further consequences for hospital services here in Salford. Your unprincipled intervention in 1998 helped to bring about the unfortunate situation in which we now find ourselves.”
He is referring to the loss of paediatric services from the Hope hospital in 1998. There is a lesson there for Labour Members: the loss of paediatric services leads to the loss of maternity services. Hon. Members representing Huddersfield—none is present—know that. That is what is happening in Manchester and elsewhere.
The position in the east of England is astonishing. A document has been released stating that units dealing with fewer than 3,000 live births a year are not supportable. As a consequence Hinchingbrooke hospital, which covers part of my constituency, the Queen Elizabeth hospital in King’s Lynn, the James Paget hospital and West Suffolk hospital may all lose services. In essence, the document states that a maternity unit cannot be maintained with less than 40 hours a week consultant cover on the labour wards, which now requires no fewer than six consultants. It is the working time directive problem all over again. It is astonishing that six obstetric consultants are required to maintain 40 hours a week consultant cover on labour wards. That is not true and it should not be the basis on which the strategic health authority makes its judgments.
The East of England strategic health authority has the effrontery to say that the lack of consultant cover on the labour wards caused the problems at Northwick Park hospital and that that is the reason why small maternity units have to be closed. When the chief executive of the East of England strategic health authority came here in December, I asked him how many live births there were at Northwick Park hospital in the period after 2002 when 10 tragic maternal deaths occurred. He did not know. The answer is 5,000. What is important is that the unit is well run, that the consultants are on the labour ward and work as a team with the midwives, and that the unit does not have to deal with an unsustainable number of births. Northwick Park hospital was affected by, among other things, the fact that the Central Middlesex hospital had shut and births were transferred to Northwick Park. What will happen in the east of England if the Hinchingbrooke unit or the West Suffolk hospital unit is shut and all the births are sent to Peterborough and Cambridge, or if the facilities at the Queen Elizabeth hospital are closed and patients are sent to the Norfolk and Norwich hospital? The consultant-led maternity units will be subjected to unsustainable pressures, resulting
in all the problems that were seen at Northwick Park, yet the East of England strategic health authority is trying to use lack of consultant cover as the reason for shutting maternity units down. I know why the strategic health authority is doing what it is doing: there is a £240 million deficit and budgets must be cut. The authority believes that economies of scale are automatic, but in practice they are not.
There is not any evidence. That is the point that I am trying to make to the Government. That is the point in the motion. The motion is not an aggressive attempt to expose the Government’s failures; it is an attempt to get the Government to ensure that the NHS across the country takes time to think. The Government have started a research programme, to be completed in 2009, to discover the evidence on the scale of maternity units that are safe and on outcomes in different types of maternity setting. How can we secure the number of midwives that we need to meet the Government’s commitment to achieving one-to-one care by 2009? All those things are necessary and there should be a timetable through to 2009, but there is none. What is happening in Manchester, the east of England, Redditch and other places is that financial deficits and the pressures of the European working time directive are causing maternity units to be shut down.
Restrictions are being put on the choice, access and opportunities that mothers should have to receive the maternity service that is in their best interests. Today, in our motion, we call on the Government to stop and think—not to stop change everywhere but to stop and think—and then to proceed on the basis of the evidence, not of the financial pressures. I urge the House to support our motion.
2 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
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