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The GPs conclude that the current proposals of the Oxford Radcliffe NHS Trust

In the face of 85 GPs collectively saying that the proposals are “unsafe” and “inhumane”, there is no way in which the trust can pretend that it is making the changes on grounds of safety. Not surprisingly, it has taken all the changes off the table and is sensibly going back to consult GPs again, properly, over a period to establish whether consensus is possible. However, the people of north Oxfordshire and south Northamptonshire are determined to retain all the general services at the Horton, and for it to remain a general hospital. They are not prepared to see services salami-sliced and cut away bit by bit, while the Horton is undermined and turned into little more than a supra-community hospital. It has been made very clear to me that if local GPs do not consider proposals from the Oxford Radcliffe NHS Trust to be safe, they will continue to argue, publicly and vocally, that the proposed services are unsafe and unacceptable.

I hope the Government will heed—because it has not been made sufficiently clear in the debate today—the advice of the Royal College of Midwives, which I suspect was sent to every Member before the debate. The RCM says

There are two pressures on maternity-led services. First, trusts such as the Oxford Radcliffe NHS Trust are trying to save money to tackle deficits. Secondly, there seems to be a centralising tendency throughout the country that is supported by the Government, whether it is in Manchester or in Oxfordshire. Little attention seems to be paid to the views of local people or to those of GPs.

I ask the Minister to give one simple undertaking. Ministers are always saying that they are willing to listen. I very much hope that the Minister replying today will give an undertaking to listen, and to heed the collective views of GPs. If Ministers are not willing to heed the views of GPs, what confidence can GPs’ patients have in the Government’s decisions? They will have no such confidence unless Ministers make it clear that they are willing to take advice and listen to GPs,
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rather than just listening to the views of managers in the NHS who, for their own convenience and for financial reasons, wish to centralise services, particularly maternity services.

We are determined to ensure that mothers and babies in north Oxfordshire and south Northamptonshire continue to receive the service that they have expected for generations—a decent, consultant-led local service, not one that requires them to travel for miles to obtain the maternity service that they deserve.

3.34 pm

Mr. John Baron (Billericay) (Con): Our debate on maternity services has been good, albeit brief, and I congratulate Members on their contributions, in which they expressed concern about the future of those services. The debate is timely, as many maternity units throughout the country face closure.

The hon. Member for North Norfolk (Norman Lamb) raised the issue of deficits and the link to closures, as highlighted by the Health Committee; he was right to do so. The hon. Member for Worsley (Barbara Keeley) made a thoughtful contribution. She said that although she does not support the option recommended locally, which will result in the loss of services at Salford royal hospital, she will stand by the decision. However, she also rightly stated that services should be based near to where need is greatest, and she made the point that Salford has one of the highest—the third highest, I think—birth rate in the country.

My hon. Friend the Member for Hertsmere (Mr. Clappison) made a good speech. He mentioned the effect of staff shortages and cuts in his part of Hertfordshire. He revealed that his local trust is making cuts and closing services because of financial deficits. He also commented on the lack of choice in how and where women can give birth.

The hon. Member for Eccles (Ian Stewart) talked about the implications of paediatric services in his area being moved away. He confirmed the powerful case made by Dr. Greatorex in his letter of many years ago; he stated that, under what he called the Dobson settlement, he felt he had been given an assurance that the remaining services at Hope hospital in Salford would be protected—an assurance given to him by a former Secretary of State. However, with option A now being chosen, that appears unlikely.

My hon. Friend the Member for Banbury (Tony Baldry) referred powerfully to a survey of 85 local GPs who used the word “inhumane” in describing proposed changes to maternity services in his area. He raised the important issue of the distance to the nearest services in considering the well-being of patients, and he reminded Members that there is often—not only in his constituency, but in constituencies throughout the country—a contradiction between the views of local people and GPs and the decisions made by primary care trusts, which are in many cases under financial pressure and therefore wish to centralise services.

Our brief debate has, at heart, been about three key issues: first, the inability of the NHS to offer genuine choice, where clinically appropriate, to women about how and where they give birth; secondly, the loss of much-loved local services as part of reconfigurations taking place in the absence of any evidence-based
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model for safe and accessible care, which is a point that the hon. Member for Worsley made; and, thirdly and overarching the other issues, the shortage of midwives in the NHS at a time of financial difficulty and deficits.

The Government often accuse the Conservative party of scaremongering—which is somewhat predictable, but never mind. However, for evidence of the impending crisis in the maternity work force we need look no further than the survey of the heads of midwifery published this week by the Royal College of Midwives, which has been referred to. Two thirds reported that their unit was understaffed, while one in five claimed that midwifery staffing establishment had been cut. I ask the Minister to say in his summation whether that is scaremongering.

In the past year alone, the overall head count of midwives working in the NHS fell, while the number of whole-time equivalent midwives—the best measure for the availability of a midwife at any single point in time—increased by a mere 5 per cent. between 1997 and 2005. That has been happening during a period when the birth rate has been rising rapidly, and the maternity case mix is becoming more complex as women choose to give birth both earlier and later in life.

The jobs crisis in maternity leads to existing midwives being overworked and, sometimes, unable to cope. Indeed, the RCM has said publicly that midwives are struggling to provide good care. Does the Minister believe that to be scaremongering?

There is little doubt that jobs and training posts are being cut for short-term financial reasons, due to deficits. An analysis of the financial outturn figures published in Hansard on 9 October 2006 clearly shows that three quarters of the midwife-led maternity units under threat are operated by trusts with financial deficits. But this short-term fix is highly irresponsible given the ageing profile of the midwifery work force and the impact on newly qualified midwives unable to get that all-important first job in the health service.

With the RCM now claiming that NHS trusts are increasingly reliant on maternity care assistants and employing fewer newly qualified midwives, what a betrayal is that of midwives who were encouraged to join the profession to address long-term shortages and have been trained at a cost to the taxpayer of £45,000 but now cannot find that first post. Again, does the Minister believe that to be scaremongering?

Paul Rowen: I want to make the House aware of some figures. I asked the Government whether they had figures for the numbers of student midwives getting jobs. They did not, but I can tell the House that of the 36 students who finished last year at Salford university, only three have got a job, and one of those has had to emigrate. That reinforces the hon. Gentleman’s point that these difficulties with training have a financial cause. The midwives are there, but they are not being given the jobs.

Mr. Baron: I totally concur with those figures. The University of West of England figures show that about two thirds of those leaving training posts were unable to find jobs in the NHS. That contradicts what has been suggested by Ministers up to now.


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While I am on the subject, I point quickly to something that the Secretary of State said about the European working time directive. She certainly seemed to downplay the effect that it has had on decisions about services. I refer her to the independent reconfiguration panel’s comments regarding the Calderdale and Huddersfield trust. It says that proposals for a paediatric rota to support consultant-led maternity services at Huddersfield royal infirmary were explored, but were not considered viable in the light of the implementation of the European working time directive. It is clearly wrong for Ministers to go round the country suggesting that the directive has had little or no effect on decisions about reconfiguration and closure.

As for the effect on patients, one thing is certain. The Government’s 2005 manifesto commitment to offer every woman one-to-one midwifery support cannot be met unless swift action is taken to improve our midwife numbers. One-to-one care is the gold standard in maternity and places women at the centre of the NHS. It has our support. Will the Minister explain how that promise will be implemented when there is such a shortage of midwives?

Further to that, will the Minister make a brief statement, either now or in writing, about the viability of the community midwifery model developed by the Independent Midwives Association? The IMA has been invited to apply for a pathfinder grant to roll out the model in a trial PCT, but so far its proposal has not been given ministerial backing.

Of course, one-to-one-midwifery support is only one piece in the maternity jigsaw; another is the provision of choice about where a woman gives birth, whether at home, in a midwife-led environment or in a consultant-led unit, and about the methods of pain relief being used. The provision of such choice is clearly important for the promotion of well-being in childbirth. The principle is enshrined in the 2005 Labour party manifesto, in the maternity standard of the national service framework and in the draft NICE guidance on intrapartum care. It is a vital feature of the patient-centred NHS, yet the Government are still complicit in the closure of midwife-led units and birth centres for short-term financial reasons, insisting that it is a matter for the local NHS while doing nothing to promote alternatives. Before Christmas, we were able to identify approximately 20 midwife-led units that were either being closed or facing closure, each of which was a much-loved local institution.

The threat of closure hangs over not just midwife-led units and community birth centres, because major reconfigurations are threatening consultant-led units and specialised services and there are proposals of centralisation around maternity super-centres. Communities throughout the country face the loss of much-loved local hospitals. Before Christmas, we identified a further 20 consultant-led units that were facing the threat of closure or being downgraded. That figure was challenged before Christmas, so it was interesting that Secretary of State did not bother to challenge any of the figures on proposed closures during today’s debate.

There is little doubt that the closures in some places are occurring for short-term financial reasons in order to save the Secretary of State’s political skin. In others, however, service redesign is being guided by a confused and often conflicting idea about the best size and style
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of maternity services for the promotion of safety and accessibility. On the continent, large maternity units are the exception. The largest unit in Germany has just more than 3,000 live births a year. However, in this country, we seem hellbent on channelling women into ever larger maternity units. The number of maternity units delivering fewer than 3,000 births a year has halved since 1996, yet there is no evidence-based model of care for maternity services to suggest that that is the right course of action—it is fundamentally wrong. Will the Minister take this opportunity to express his commitment to a consultation and national debate on the topic, or is this another area in which the official Opposition must take the lead and engage professionals and women to develop policy?

To illustrate, or indeed to emphasise, the confusion at the heart of the Government over these issues, one need look no further than the extraordinary spectacle of Ministers endorsing the Prime Minister’s call for service reconfiguration in principle at a national level, yet shamelessly opposing the implication of such a policy when it affects their constituencies. The right hon. Member for Salford (Hazel Blears) is a case in point. She sees it fit to stand up for the people of Salford when there is a television crew in her constituency, but not here in the House of Commons. She has said:

well, she did not put them forward today.

Ian Stewart: Will the hon. Gentleman give way?

Mr. Baron: I will not because I am short of time and must wind up.

Ian Stewart: I am the Member for Eccles.

Mr. Baron: I apologise to the hon. Gentleman, but I was citing a quote.

The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who is responsible for maternity services, is happy to tell constituents of ours that they must lose local services as part of necessary reconfigurations and to accuse us of scaremongering when we talk about maternity closures, but he is quick to oppose closures when they happen in his own back yard. Ministers are trying to have it both ways. On the one hand they support the principle of a national service redesign yet, on the other hand, they oppose closures when they affect their constituencies. It is a blatant case of “do as I say, not as I do”, if ever there was one. If these Ministers carry on in that way, they will be beating a path to the Liberals’ door very shortly. The reason for that embarrassing inconsistency is that the reconfigurations are not guided by an evidence-based model of maternity care.

In short, the Government are all over the shop on this issue. Meanwhile, in the words of Louise Silverton, the deputy general secretary of the Royal College of Midwives, just before Christmas,


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I put it to the House that the Government should stop hiding behind accusations of scaremongering and instead face up to reality and get on with the job of putting things right.

3.48 pm

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Conservative party still has no shame. As we sit here at the beginning of 2007, let us never forget the realities of 1997: a national health service on its knees; crumbling hospitals; underpaid staff; outdated technology; disgraceful waiting lists and waiting times; a shortage of doctors and nurses; and policies that were silent on the scandal of health inequality. What of the past 10 years? Conservative Members have championed policies to encourage people to opt out of the national health service. They have proposed a funding system that would take no account of health inequality, and they have systematically set about rubbishing the NHS and its continued progress at every turn.

We should remember the Opposition’s big claim of last year. Apparently, my right hon. Friend the Secretary of State for Health and my right hon. Friend the Member for Salford (Hazel Blears), who is Minister without Portfolio, were involved in a conspiracy to protect Labour MPs from changes in services that would be unpopular in their constituencies. I hope that my right hon. Friend the Secretary of State will forgive me when I say that, if the claim was true, that would have been one of the most inept conspiracies in history! However, the reality is that the reconfiguration recommendations were made by local professionals who are not politically motivated.

The Opposition have now changed tack, and claim that we are hypocrites. For my part, that is apparently because I continue to oppose the closure of maternity services at Fairfield hospital in Bury. I am content for the facts to speak for themselves. Contrary to what has been said, Fairfield hospital is not in my constituency—so much for Opposition Members’ research.

Moreover, the majority of my constituents use hospitals that will gain from the proposed changes. The total additional investment in North Manchester, Central Manchester and Bolton amounts to £24.1 million, £900,000 and £12.5 million, respectively. Those figures do not include extra resources for community services, but the Tories describe the changes that have led to that extra investment of £37.5 million as cuts.

Since the Greater Manchester consultation began more than two years ago, I have believed in and supported the view of professionals that there needs to be change, that the status quo is not viable and that there has to be a reduction in maternity units across the area. Equally, I have opposed a solution that would leave the Bury, Rochdale, Rossendale and Heywood communities without one consolidated maternity service, and I have done so for the very good reasons frequently articulated by my hon. Friend the Member for Bury, North (Mr. Chaytor) who, along with other hon. Members, has campaigned tirelessly on the issue.


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