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“mothers who wish to bottle feed their babies to supply their own Ready to Feed Baby Milk or Baby Milk Powder and bottles whilst in hospital.”
In fairness to the trust, I must add that it states that this change is in line with guidance and a wish to educate mothers in the best way possible, and that it has been introduced for educational rather than financial reasons. However, against the background of the loss of the antenatal classes the week before and all the other problems affecting the health service in Hertfordshire, this change has perhaps not been greeted with as much confidence as might have been hoped by local parents and mothers-to-be. One mother-to-be, who is 11 weeks pregnant, was distinctly unimpressed by the change. She said:
“Many women do not know when they go into the hospital whether they will be able to breastfeed. If they don’t think they will breastfeed, they will have to take in a huge bag of equipment when, previously, the hospital would have trays of ready-sterilised milk available.”
My constituents see all this as part and parcel of the financial pressure that the health service is under. I accept the health service’s argument about this change being made for educational reasons, but my constituents see their maternity services as being under the same pressures that other parts of the health service in Hertfordshire are facing. They will not have been altogether convinced by the response of the Secretary of State when these problems were put to her today by my hon. Friend the Member for South Cambridgeshire. She said—I hope that I am paraphrasing her fairly—that Hertfordshire was spending too much and that it might need to make economies for the sake of other parts of the country.
The fact is that the share of health service spending going to Hertfordshire has been reduced as a result of decisions taken by this Government. I appreciate the interest that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) is taking in what I am saying, and I am sure that he will be able to confirm that the share of health service spending per head in Hertfordshire is substantially lower than in many other parts of the country, including London, which is just next door to Hertfordshire. I would welcome it if the Minister could check that; I think that he will find that it is the case.
The Secretary of State also mentioned the value of antenatal classes to parents from disadvantaged backgrounds. I would say gently to the Minister that, although Hertfordshire is generally prosperous, it is not, and never has been, universally prosperous. There are mothers-to-be there who would have received the antenatal classes who come from disadvantaged backgrounds, and I ask the Minister to reflect on that matter when he responds to the debate. The Secretary of State said that she would write to my hon. Friend the Member for South Cambridgeshire about this, but I
would be grateful if the Minister too would reflect on the fact that disadvantaged mothers-to-be will lose out as a result of this across-the-board loss of antenatal classes at Watford hospital. The antenatal classes have been suspended. I hope that there will be a rethink on that and that the Minister will encourage the Secretary of State to contribute to that rethink, so that we can have those antenatal classes restored.
There is a wider question as to the health service in Hertfordshire and the Government’s answer to all those serious problems, which are reflected in deficits that put Hertfordshire health authorities and primary care trusts among those with the gravest financial difficulties and leave them needing to make changes in and cuts to services to respond to those deficits. Are the Government prepared to see health services in Hertfordshire fall substantially below the level and quality of those provided in the rest of the country if that is what it will take to solve the problem of deficits? That is the question that the Government must face.
How far down will Hertfordshire health services go? How far will maternity and other services be reduced? Is there any safety net or does there have to be a mechanical accounting procedure to reduce the deficits, even if Hertfordshire residents receive a service that is substantially inferior to that provided elsewhere in the country?
3.11 pm
Ian Stewart (Eccles) (Lab): I am grateful for the opportunity to speak on this important issue. I concur with most of the comments made by the hon. Member for Worsley (Barbara Keeley), so I will try not to cover the same ground. I will put an historical perspective and then give a rationale for this matter to be referred by the Secretary of State to the appropriate committee.
By 1996 there was a proposal to close the Royal Manchester children’s hospital, also known as Pendlebury children’s hospital, in my constituency of Eccles. The three Salford MPs at that time, and others, campaigned for a solution—a new children’s hospital to be built adjacent to Hope hospital on the Stott lane site in Salford. The other proposal was that it should go to St. Mary’s hospital in Manchester. We lost that battle and the Secretary of State indeed decided that children’s services should be transferred to St. Mary’s.
At that time, Salford and Trafford health authority considered whether a new paediatric unit should be set up at Hope. There was sense in that, because Hope hospital—also referred to earlier as the Salford Royal trust—was very close to Pendlebury children’s hospital, which provided the specialist services. Hope therefore had no paediatrics, but it had excellent, well-developed neonatal and other services, including maternity.
When we realised that the children’s services would move to St. Mary’s, it was sensible for us to consider putting a paediatric unit at Hope. As we moved to the situation in which the Secretary of State had made that decision, there was clearly concern in Salford about putting children’s services at St. Mary’s—so much so that the local council went for judicial review. I might add that Manchester city council had similar concerns about the proposal to put neurosciences at Salford and also, I understand, pursued judicial review.
My right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), then the Secretary of State for Health, had to deal with all this, as is the norm with any serious decision of that nature. The outcome was that children’s services were indeed transferred to St. Mary’s in Manchester, but that Salford Hope hospital children’s and maternity services would be protected. I call this the Dobson settlement.
The basis of that protection meant that beds at other Greater Manchester hospitals had to be closed. Indeed, there was talk of some of those other hospitals having beds that were clinically unviable. If those beds went, Hope’s provision would be protected. I distinctly remember similar conversations being held in relation to Booth Hall and North Manchester general hospital.
The point here is that we have been clear that we had agreement from the Secretary of State that Salford Hope hospital services would be protected. I was informed that it would take several years for the whole reconfiguration plan to be implemented, but by 1998 it became clear that the Salford and Trafford health authority consultation process, which was designed to create a new paediatric unit at Hope hospital, had been stopped by the Department of Health.
The then Member of Parliament for Worsley, Terry Lewis, and I complained vigorously about that decision to stop a paediatrics facility being set up at Hope. I was aware that the then chief executive of Salford and Trafford health authority, Dr. Ian Greatorex, had offered his resignation as a matter of principle over the decision to stop the process to establish paediatrics at Hope and other matters.
Terry Lewis MP and I were sympathetic to the situation that Dr. Greatorex found himself in, and we both supported his stand. From that point, I believe that the Dobson settlement, as I refer to it, was in jeopardy. Consequently, whenever I met with anyone to discuss health issues, I would ad nauseam state that the Dobson settlement must be implemented in full.
In 2000, I attended a meeting of Greater Manchester MPs where I set out my views about the fact that the medically unviable beds at other hospitals not being closed was stopping the implementation of the Dobson settlement and his commitment that Hope’s service would be protected. I continue to promote the Dobson settlement at every opportunity.
In autumn 2005, I received a letter from the strategic health authority saying that a new consultation process was intended to look at the provision of women’s and children’s services in Greater Manchester and beyond. I believe it was called “Making It Better, Making It Real”. I was astounded that there was no proposal that would maintain maternity provision at Hope in Salford.
I therefore wrote immediately to the strategic health authority, saying that the proposed consultation would break the Dobson settlement, that it must include a Salford Hope hospital option and that the proposed financial model was flawed. I asked for a review of that financial model.
The decision was to be made by a joint committee of primary care trusts. I alerted everyone else to that, as I copied my letter to Salford Hope’s trust, Salford city
council, the PCT and my colleague MPs. Subsequently, a broad-based “Save Hope” community campaign was established, which I and others supported. I continue to work with political colleagues and others on that campaign.
In addition to meeting with the council, Hope’s trust, community groups and others, I attended meetings of the joint PCTs to lobby for and press home the Salford case. The strategic health authority was forced to add an option C to the consultation, and indeed to review the financial model. In December 2006, it phoned me to say that the joint PCTs had decided to adopt option A, which meant that the Salford Hope facility would be closed.
I hear hon. Members mutter, “What about Dr. Ian Greatorex, then?” He has made certain allegations regarding the period in 1998 that I described, which are in the public domain. I make no comment on that, as it is for the Member of Parliament for Salford, not for Eccles, to answer.
Today, I ask the Secretary of State to refer the case back to the independent reconfiguration panel, but not only on the basis that the original process was flawed. I am told, although I have no written evidence yet, that the financial review shows clearly that option C would be a money saver to the tune of up to £2 million year on year.
In addition, it is important to realise that the figures on viability quoted by the Conservative spokesman are contested. My understanding is that the maximum that any facility should offer is 6,000 births a year, and the minimum 3,000. I would argue with the way in which the joint PCTs addressed those questions, because, if the order had been changed, and those issues had been addressed first, in the Greater Manchester area Salford Hope hospital would have been found to meet both those criteria. Other hospitals within the plan under option A exceed the 6,000 births by as many as 800, and some have as few as 2,500 births a year. In my view, that would have been enough, had it been considered earlier, to rule out option A. On that basis, I must ask the Secretary of State to review the situation and to refer the decision to the independent reconfiguration panel.
Finally, the local decision-making process was flawed—
Mr. Deputy Speaker (Sir Michael Lord): Order. The hon. Member has had his final word.
3.21 pm
Tony Baldry (Banbury) (Con): I fully appreciate the concerns of the hon. Members for Eccles (Ian Stewart) and for Worsley (Barbara Keeley).
Having heard the right hon. Member for Salford (Hazel Blears) on the radio on 28 December, I wrote to her. I would like to share what I wrote to her with the House:
“I write, having heard you speak on ‘The World at One’ today on, amongst other things, explaining your decision in campaigning on the ‘picket lines’ last week in Salford protesting about the withdrawal of maternity care in your constituency under an NHS reorganisation.
I think any Member of Parliament would understand your desire to represent the strong feelings of your constituents, notwithstanding your position as a member of the Cabinet and Chair of the Labour Party.
As I am sure you will understand, there are sizeable numbers of communities across England who are feeling equally strongly about proposed reorganisation of hospital services.
In my constituency, the Oxford Radcliffe NHS Trust have been consulting on proposals which would lead to the serious downgrading of, amongst other things, what is now a consultant-led maternity service, to what would be the largest midwife-led maternity unit in the UK.
Furthermore, whereas I would imagine that in Manchester the distances between the various maternity services that are being reorganised in the city are comparatively short, downgrading of the maternity services at the Horton Hospital in Banbury would mean expectant mothers and others having to travel at least 26 miles, and depending on where exactly they live, potentially considerably further, to get to the maternity unit at the JR in Oxford.
You are, of course, fortunate that as a Cabinet Minister you can raise your concerns directly with Patricia Hewitt, the Secretary of State for Health—indeed, I see that you are quoted in today's ‘Guardian’ as saying ‘I have raised the issue ... with the Health Secretary several times.’
Obviously it is much more difficult for Opposition MPs such as myself, to be heard by the Secretary of State.
On the 16 January, the All Party Local Hospital Group is organising a rally at Westminster involving campaigners from hospitals across England and hopefully there will be a team there from Salford.
I appreciate that Ministers have extremely busy diaries, but I very much hope, given the stance you have taken on NHS reorganisation in your own patch, that you might be willing to come and meet campaigners from the ‘Keep the Horton General’ campaign. This is a broadly based, community campaign, reflecting views of all political parties locally, and is ably led by George Parish, a longstanding local Labour councillor.
If you were able to spare time to talk to campaigners from Banbury, it would be much appreciated and I think you would then be in a position to make it clear to Patricia Hewitt that there is widespread opposition in England to downgrading and closure of key services at General Hospitals throughout England.”
I have no complaint about a Cabinet Minister breaching collective responsibility, but there should be evenness in this matter. I hope that, on 16 January, Health Ministers and others will come to hear the concerns of many hospitals throughout the country.
At the Horton hospital in Banbury, there is a proposal to downgrade a perfectly good consultant-led service to what will be the largest midwife-led unit in the country. Members of the House might think, “Well, we as Members of Parliament would say these things, wouldn’t we?” However, I would just like to share with Ministers the united submission made by 85 GPs to the Oxford Radcliffe Hospitals NHS Trust:
“We remain opposed to the proposals on the grounds of safety, sustainability and the reduction in access to basic health care and choice for our patients, which will affect especially the most vulnerable. We have little confidence in the process of ‘consultation’ and the spirit in which it has been conducted.
These proposals are unsafe....Under the proposed model mothers who may fail to progress or show signs of foetal distress in the second stage of labour, or who have prolapsed cord or haemorrhage, would require very rapid transfer to Oxford. Given the numbers involved this would carry significant risk and would be inhumane.”
It is pretty telling that those 85 GPs use the words “unsafe” and “inhumane” to describe the proposals.
“There would be an increase in the burden of responsibility on midwives and ambulance crews. Legal claims following incidents where there was harm to the mother or baby might be very costly to settle.
Babies born in need of immediate resuscitation would incur a transit time of approximately one hour. The idea that paediatric cover could be provided safely from Oxford in these circumstances is false and dangerous.”
Mr. Lansley: My hon. Friend makes an important point about distances, which is one of the issues being considered in our consultation launched last month. When I was making comparisons with other countries, I should have referred to the point made effectively in a document published by the think tank Reform in December 2005: one of the reasons that countries on the continent do not have to engage in this kind of centralisation of maternity services is that they have put in place a strong neonatal transport network. We should consider that option, which would allow us not to have to centralise to the extent proposed.
Tony Baldry: My hon. Friend makes a good point. The danger in the Government’s proposals, and in the way in which the Government and certain trusts are driving them, is that we will have centralisation without the previous infrastructure. Mothers in labour will often have to travel considerable distances without new infrastructure having been put in place.
As the 85 GPs from Oxfordshire and Northamptonshire say:
“We submit the opinion of Professor James Drife who wrote in the BMJ...about the shortfalls of midwife led units.... It accords with recent publications by NICE on the safety of such units...We are not reassured and maintain that a midwife led unit with a delivery rate of 450”—
“per annum, which is 25 miles away from the nearest obstetrician and paediatrician, is not safe. Through no fault of the midwives working in such a unit, GPs would have to consider the wisdom of recommending mothers to this service, numbers would drop further and the service would soon become non viable ... A midwife led maternity unit, possibly lacking the confidence of local GPs, may well wither. Kidderminster had to close its unit due to excessive neonatal mortality (6 avoidable deaths in under 2 years). Increasing concern about such units is being expressed by the Royal College of Obstetricians and Gynaecologists and NICE.”
Dr. Richard Taylor (Wyre Forest) (Ind): I am grateful to the hon. Gentleman for giving way, as I am unlikely to be called and I need to correct that impression. Unfortunately, when Kidderminster hospital was downgraded the correct measures were not taken to keep the birth centre safe. If that had been done, the deaths would probably not have occurred. Maternity-led birth centres with the right escalation and admission protocols are entirely safe for selected, otherwise fit mothers.
Tony Baldry: As we know from NICE, from BLISS and from the experience at Kidderminster, there is a greater risk in such circumstances. The risk to the largest midwife-led unit in the country, when there is a perfectly good obstetrician and consultant-led unit, is a risk that the people of north Oxfordshire and south Northamptonshire are not prepared to take.
In their submission, the GPs say that “increasing concern” about such units is being expressed by the Royal College of Gynaecologists and by NICE. They say
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