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Norman Lamb: I entirely accept my hon. Friend’s point. It cuts against the Government’s commitment to increase choice, since if units disappear, choice self-evidently disappears as well.
All those trends that are moving in the wrong direction are factors that affect the prospects of tackling the inequalities that the Secretary of State rightly mentioned. They are happening at a time when pressures on the service are increasing. The number of births has started to rise. In 2003-04, there were 5 per cent. more births than in the previous year. There is an increased level of intervention. Birth is an increasingly medicalised practice. Post-natal hospital stays can be longer when intervention is necessary, which inevitably places extra demands on midwives. The percentage of spontaneous births fell from 76.5 per cent. in 1980 to 66.5 per cent. in 2003-04. Meanwhile, the number of caesarean deliveries has increased from 9 per cent. in 1980 to 22.7 per cent. in 2003-04, and the trend is continuing in that direction. It is worth noting that back in the 1980s the World Health Organisation found that there were no additional health benefits associated with caesarean deliveries when they reach more than 10 to 15 per cent. of births. If that is correct—I do not know whether there is any new evidence to counteract it—there are resources to saved by finding ways of reversing the trend.
Mr. David Drew (Stroud) (Lab/Co-op): The main Opposition made great play of the lack of research evidence in this area, although investigations are being undertaken by the King’s Fund as well as by the national perinatal epidemiology unit. There is an international dearth of evidence in the whole area of maternity. Does the hon. Gentleman agree that it is important to get that research, even if it takes years, so that we can get some of these questions answered?
Norman Lamb: Yes—it is important to get the research so that we can make judgments on an objective basis. It is also worth considering practice elsewhere, as I will explain later.
The other pressure that is developing is that increasing numbers of women over the age of 40 are becoming pregnant. Between 1991 and 2003, the number of women conceiving over the age of 40 almost doubled. Midwifery for those women is more demanding. More teenage pregnancies also have an impact on the service.
Now we come to the Government’s manifesto commitments. The manifesto said that by 2009
“all women will have choice over where and how they have their baby and what pain relief to use.”
“we want every woman to be supported by the same midwife throughout her pregnancy”.
The brutal truth is that choice, far from being enhanced, is being compromised by the cuts that we have witnessed over the past 12 months.
I should also mention the national service framework for children, young people and maternity services, which appears to be increasingly marginalised. It was published two years ago, and yet there is still no delivery plan for implementation of its maternity standard element. The Government’s ambition is worthy, but it is undermined by financial crisis, delay and a determination to drive
everything from the centre. Last September, the NHS chief executive, David Nicholson, declared that there would be up to 60 reconfigurations of NHS services, determined not locally but nationally, affecting every strategic health authority in the land. He specifically identified accident and emergency, paediatrics and maternity services as areas ripe for reform.
Let me deal briefly with the case for reconfiguring services. I accept that difficult choices sometimes have to be made. Women with high risk pregnancies must have access to the expertise necessary. Women falling into that category include those having twins, those with a past obstetric history, those with premature deliveries, those suffering high blood pressure and those with other clinical problems such as diabetes. They need the care provided in specialist units, and we will fail them if we do not ensure that they have access to them. That does not mean, however, that we should back away from giving women a real, informed choice.
In developing maternity services we should be willing to learn lessons from other countries. Holland’s maternity health statistics consistently rank among the best in the world. It has a national policy—just like the policy in the Labour manifesto—that guarantees every woman a midwife from the beginning of pregnancy through the first year after birth. Thirty to 40 per cent. of births there take place in the home under the care of a midwife. That option is proven to be safe and cost effective, and women choose it. Let us compare the figure with the tiny percentage of women who have home births in this country. Other methods of doing things appear to work and be cost-effective, and the choice should be made available in a positive way to women in the UK.
It is remarkable that, in Holland, caesarean births have been kept below 10 per cent.—compared with our 23 per cent.—leading to massive cost savings and a better outcome for women. That shows that we can reconfigure without necessarily imposing an additional burden on the NHS budget.
We should learn lessons from elsewhere and be willing to confront difficult decisions to ensure the best care and to empower women. Decisions should not be driven by crisis management because of the legal obligation to clear unsustainable debt.
Our vision is of offering genuine, informed choices to women—home care, midwife-led services, hospital delivery—about where and how they give birth; making decisions locally, thus involving local communities in delivering the best framework of care; and ensuring that we have the work force necessary to realise that vision.
Madam Deputy Speaker: I remind hon. Members that Mr. Speaker has imposed a 10-minute limit on Back Benchers’ speeches. In view of the time left for the debate, hon. Members may wish to restrict their contributions even further.
2.51 pm
Barbara Keeley (Worsley) (Lab):
As a Salford Member of Parliament, whose constituency is served by Salford royal hospital—also known as Hope hospital locally—I
know that the maternity and neonatal services that it provides are vital to the local community and that they are world class.
The Government have already doubled investment in the NHS in the past 10 years, and that has helped hospitals such as Salford royal to achieve excellent results. Millions of pounds have been invested in our local acute services and that has led to extra doctors and nurses, shorter waiting times for operations and better cancer survival rates.
I accept the need for the reconfiguration of paediatric, neonatal intensive care and maternity services so that they can continue to deliver the most effective care for patients. However, in the case of the reconfiguration of maternity, children’s and neonatal services across Greater Manchester, I do not believe that the locally recommended option is the right decision. The outcry from my constituents and people across Salford shows that public opinion is strongly against the option that clinicians recommend.
On 8 December 2006, the outcome of the “Making it Better” consultation into the future of services for women, babies and children was announced. The Joint Committee of Primary Care Trusts recommended that the future configuration of services across Greater Manchester should not involve Salford Royal NHS Foundation Trust retaining its maternity and neonatal services.
It is important to note that the Salford Royal NHS Foundation Trust supports the principle of fewer, larger maternity and children’s units and developing three major neonatal intensive care units. I, too, support that. However, I believe that Greater Manchester would benefit more by retaining and developing the existing services at Salford royal.
Salford already has one of only three large neonatal intensive care units in the north-west that are accredited by the Royal College of Paediatrics and Child Health. It is led by a dedicated team of neonatologists and nurses with specialist, advanced roles, and, unlike other hospitals, it has no recruitment difficulties. It takes many years to build such a successful team. It therefore makes sense to retain the hospital’s excellent staff, who are such an integral part of the high quality of service that the hospital’s maternity and neonatal units provide, rather than dispersing the expertise and trying to rebuild it elsewhere.
Salford royal’s unique range of specialist services enables it to support high risk maternity cases, thus benefiting approximately 120 women a year. Those services are not found in any other general hospital. Salford women would therefore have to travel elsewhere should the proposals go ahead. Similarly, Salford’s neurosciences centre is the only unit that specialises in care for pregnant women. Continuing to provide neonatal services at Salford royal would be as safe and effective as providing them elsewhere, but—crucially—they would be delivered at lower cost, lower risk and with greater potential for the future.
The option in the consultation document that involves Salford continuing to provide maternity and neonatal in-patient care is also the best value option. It can be in place in 14 months and it costs £1 million less than the other options. Choosing the cheapest and
quickest option appears to be common sense as it frees up money that can be spent on other improvements to the health service.
Furthermore, Salford already has existing plans for developing children’s services. It planned to establish an observation and assessment unit to support emergency care, which would be staffed by six consultant paediatricians and specialists in paediatric anaesthesia and radiology. Plans also exist to develop paediatric day surgery and community services for children. All those plans would be enormously valuable in a community that contains some of the most deprived neighbourhoods in the country.
It has been suggested that future neonatal units should be located only next to paediatric units. As Salford royal planned to open the new observation and assessment unit that I have just mentioned in 2008, babies born at the hospital would have access to the best neonatal and paediatric expertise. Retaining maternity services in Salford would be the safest option for Salfordians, as there would be better distribution of maternity units, with each one able to operate above the recommended minimum number of births for safe service.
I firmly believe that health services should be situated where there is most need for them and that neonatal units need to be based where there are the highest number of low birth weight babies rather than where the biggest maternity units are. Salford has the fifth highest birth rate in Greater Manchester and the highest incidence of very low birth weight babies, so moving the unit away would deprive local people of a service that they desperately need. It is only right that those babies—and their parents—have easy access to the care that they require.
Easy access is a vital matter, especially in Salford, which has the lowest car ownership in Greater Manchester. Travelling to the other proposed locations by public transport is not easy and, for a heavily pregnant woman or one with a small baby, it could be unpleasant and difficult. The length of the journeys would be unacceptable for some women. If the services were moved, some of my constituents simply could not access them as they should.
The neonatal intensive care unit at Hope is groundbreaking in the research that it has carried out on tiny babies. Doctors and nurses led an international study to improve the care of very low birth weight babies. That research has been shared with the medical community and will have a bearing on the future care of very low birth weight babies throughout the world. The fact that Hope was the ideal unit to host the study, and the resulting improvements in care that will take place worldwide, prove that it is important for the unit to be able to continue its work and its research, hopefully leading to similar successes in the future.
Hope hospital is much loved and appreciated by the people of Salford. The trust has been rated as the most successful of all trusts in the north-west by the Healthcare Commission. Attention has been given to maternity and neonatal services at Hope hospital in the past few weeks, but Salford Members of Parliament have campaigned to keep our excellent services for many months. I visited the neonatal unit at Hope
hospital with the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears), on 20 January last year. We saw at first hand the world class standard of care that the staff in that unit provide.
Our local paper, the Salford Advertiser, ran a campaign, Hands Off Hope, which attracted the support of 26,000 people. I spoke in support of retaining our services alongside my hon. Friend the Member for Eccles (Ian Stewart) at a rally on 25 March last year, organised by the Salford Advertiser and the city council. Those local campaigns for Hope and the massive support that they attracted are a powerful indication of the strength of local feeling about retaining the maternity and neonatal services that people value so highly.
Graham Stringer (Manchester, Blackley) (Lab): My hon. Friend makes a powerful case for Salford, especially on access to services. Are not the implications that she describes for Salford exactly the same as for the other highly deprived area of north Manchester, which is served by North Manchester general hospital? If Salford royal hospital stayed open, North Manchester general hospital would probably lose its maternity unit under the plans. I emphasise that I do not accept the basis for the consultation. Would not it make sense to keep open Salford royal and North Manchester general hospitals, which are in the middle of some of the most deprived areas in the country?
Barbara Keeley: I thank my hon. Friend for that intervention. One of the issues that needs to be considered in the final stage of the consultation is the need to keep services as proximate as possible to the most deprived communities. As I have made clear, the need for the services in Salford is caused by the high birth rate and the high incidence of very low birth weight babies, and it makes absolute sense, given the difficulties of public transport in our conurbations, to keep these services as local as possible.
In summary, Salford MPs have argued consistently over many months to keep the local maternity and neonatal services at Hope hospital, and we have argued this on clinical grounds. I have supported the Government’s policies on the NHS and on the need to reconfigure services, but I also support the view that the best option will be to retain services at Hope, because that is the quickest and cheapest way of achieving the aims set out in the consultation, which we endorsed.
Salford city council’s community health and social care scrutiny committee has been asked to scrutinise the proposal for change made by the joint committee of PCTs locally. The decision may then be referred to the Secretary of State, who can refer the matter to the independent configuration panel. This is an example of the process working as it should when there is disagreement during a consultation. Given that I support the need to reconfigure services, I will support the decision made at the end of the process, but I believe that it is right, while the process is going on, for me as an MP and for other Salford MPs to continue to press the views of local people.
3.1 pm
Mr. James Clappison (Hertsmere) (Con):
I shall certainly do my best to follow your injunction to be brief, Madam Deputy Speaker, although I should like
to mention one particular matter that affects my constituency. Before I do that, however, I want to congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and his Front-Bench colleagues on choosing this important subject for debate today. I also want to join him in paying tribute to all the professionals involved in the maternity services—the doctors, nurses and midwives, including those who serve my constituents in Hertfordshire.
My hon. Friend referred to the Royal College of Midwives’ survey, which is an important piece of evidence in this context, and to the problems being experienced up and down the country. Of the 102 maternity departments questioned, 74 per cent. reported that they were facing staff shortages. It is important, from my constituents’ point of view, to add that the survey also found that the problems were most acute in London and the south-east. My constituency in Hertfordshire is certainly no exception, in that it is experiencing similar problems to those found elsewhere in the south-east.
The House has already heard about some of the other problems being experienced in Hertfordshire. My hon. Friend the Member for Welwyn Hatfield (Grant Shapps) mentioned the threat hanging over the hospital that serves his constituency. My hon. Friend the Member for Hemel Hempstead (Mike Penning) mentioned a unit that was standing unused in his constituency, and my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) talked about the loss of antenatal classes at Watford general hospital. That is the subject to which I want to turn, because it affects my constituents most directly.
It was announced just before Christmas that first-time mothers—except those who are teenagers or who are expecting twins—will no longer receive antenatal classes. The trust put out a statement on 12 December saying:
“The Trust has agreed to a temporary suspension in antenatal parentcraft classes provided for first time mothers. Tours of the maternity unit will continue to be offered.”
The statement makes it absolutely clear that the decision is being taken on financial grounds. It goes on:
“The Trust faces difficult choices in terms of how to use its available resources to serve all patients.”
This is a trust with a substantial deficit. According to the national surveys, it is among those with the most serious deficits, and I understand that it faces a projected deficit of £100 million by 2012.
This is part and parcel of the general crisis affecting NHS services throughout Hertfordshire. The crisis has manifested itself in a number of ways, including the apparent loss of the new hospital that was to have been built at Hatfield. The proposals for the hospital were announced just before the last general election, and it was to have provided cancer services and other services in Hertfordshire. However, the project has been undermined and will apparently no longer take place.
We have also seen the loss of hospital beds at Potters Bar hospital, the loss of beds and services at other district hospitals, and the threat of the loss of a variety of services affecting my constituents, including mental health services and genito-urinary medicine services. The general picture is one of financial crisis in the
health service throughout Hertfordshire, and it would appear that this problem is also affecting the antenatal classes and other maternity services at Watford hospital.
Hard on the heels of the announcement about the loss of antenatal classes came another announcement. I note that it was made just before Christmas. A statement was issued to the media on 20 December by the trust, giving very short notice that, from 8 January this year, the trust intended to ask
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