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Mr. Mark Field (Cities of London and Westminster) (Con): I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this important debate. He highlighted some of the specific problems in London but, as a predominantly loyal member of the governing party, he downplayed some of those concerns. However, the Minister has plenty of food for thought.
I have direct experience of maternity services. Six weeks ago, my first son was born. It is with some regret that my wife and I decided to go private, partly because of the acute problems with midwifery and maternity services in London. We went to the Lindo wing at St. Marys hospital, Paddington where we received tremendous service throughout from Dr. Raj Rai.
I was born in the health service, albeit at a British military hospital in Germany, and I was educated in the state sector, so I did not take lightly the decision to use a private hospital; it was a reflection of the problems in the national health service. Those problems predate 1997 so I am not trying to make a narrow political point. Although we rejoice at some of the great successes of our national health service, there are some real problems, which platitudes from politicians on both sides of the House do little to resolve.
My wife had a caesarean and she had to stay in hospital for four days after the birth of our son, Frederick. I reflected that the service we received, which was tremendous, was unlikely to be received by mothers who had given birth a few hundred yards away in the main St. Marys hospital. I know that from a number of constituents. There have been too many horror stories from friends in central London who have gone through the national health service, not just at St. Marys, Paddington, but at the Chelsea and Westminster hospital. I shall refer to one or two examples from a letter that I received only this week.
There are problems because women are passed from pillar to post, from trainee midwife to locum midwife during the pregnancy, and there are problems after the birth. Such problems are particularly acute in the capital for a number of reasons. As I have often said, the trade unions may like national pay bargaining, but in a nationalised health service it does no great service for people living in London. That also applies to the education system. There are acute problems with our public services in London, and in the south-east, because the cost of living is so enormous.
There has been an explosion in the birth rate, to which the hon. Member for Leyton and Wanstead rightly referred, largely due to immigration. There is no doubt that a vibrant, young work force have come to work in the UK, particularly in London but also in other parts of the country and in other large cities. Young people in their 20s and 30s are at the fertile age and they are likely to have children. Since enlargement of the European Union three and a half years ago, we have known that there would be an explosion in the number of young people coming to live and work in the UK, yet there has been insufficient planning. The hon. Gentleman was too polite to make the point as blatantly as I have.
The problem applies not just in London, but outside. There is little doubt that in central London there are specific problems of hypermobility and hyperdiversity; many people are moving around and living in our cities, and 90 languages are spoken in the diverse population in my constituency. Regrettably, that puts undue pressure on inner-city health care.
I shall refer to a constituency case. A letter from Mrs. Sarah Meier of St. Georges square, Pimlico arrived in my office only last week. Her experience is not typical, but it is not unusual, and on a personal level it was one reason why I decided that the national health service was not fit for purpose in my constituency. I regret that, but I have seen the problems as a Member of Parliament, and as someone who has friends who have used central London hospitals for childbirth in recent years.
I am writing to bring your attention to how dissatisfied I am with the treatment my baby son and I received after giving birth at the Chelsea and Westminster Hospital on 9 November 2007. I am writing so that you can take action to prevent others having to suffer what we endured...the treatment we received afterwards on the...Ward was a disgrace. I had an epidural during labour and also an
an episiotomy with extensive associated bleeding. So I had to stay in hospital overnight and was moved to the...Ward. The conditions of hygiene and care in that ward were appalling. During my 24 hour stay my bedding was never changed. I had to sit in my own blood and nobody came to check me. Later that week, after I had gone home, it was found that I had an infection. I, and the GP who several days later saw me as an emergency, are both sure that this was due to the conditions in the ward and the lack of interest taken in my wellbeing. I thought the prevention of infection was supposed to be
The GP also diagnosed me as having anaemia. Again this could and should have been picked up on by someone on the ward, but nobody had bothered to come and check on me...This is my first child and I was attempting to breastfeed him. This was particularly challenging as my milk had not yet come in properly. The midwife on duty shouted at me for not doing it the correct way. My son and I were discharged from hospital on Saturday 10th November. My son was checked by the paediatrician prior to discharge.
It transpired that the baby had suffered from post-birth jaundice, so within 24 hours of leaving hospital he had to be rushed back into hospital at the behest of a GP. The whole episode was very traumatic, but it could have been avoided if the paediatrician had picked up the problem before discharge. That is by no means an untypical experience. I am sorry to have to bring it up on the Floor of the House, but it is appropriate to do that in this place, rather than going through a lot of platitudes about various targets and figures and saying how marvellous the health service is.
In many areas, such as central London, the health service is not fit for purpose. Mrs. Meier said her experience was a contrast to the excellent care and attention that her sister-in-law received only last year when she gave birth in Harrogate district hospital. She said:
It is difficult to believe that both hospitals are part of the same health service.
That goes to the heart of the issue about a national health service. Mrs. Meier said that in no circumstances would she have another child at the Chelsea and Westminster hospital. She advises all her friends to avoid the place.
As I said, I am sorry that I have had to bring up the matter on the Floor of the House. However, such distressing episodes are increasingly common in central London, and not only in relation to maternity services; there are difficult problems in respect of hypermobility and hyperdiversity, to which I have referred. Problems stem from the explosion in the number of young people who come to the UK and give birth in this country. There are specific problems in London, to which the hon. Member for Leyton and Wanstead rightly drew attention. The Minister, who is also a London MP, will be aware of some of the issues that have been raised, although that is not to say that there are not some very positive stories.
There are positive stories about some of our hospitals, even though they are under great strain in central London. None the less, I hope that the Minister will consider some of my specific concerns, which are not just about money, although the hon. Member for Leyton and Wanstead got it right when he said that we face a financial crisis in London in relation to maternity care. I hope that the Minister will give maternity services proper investment and attention in the months and years to come.
Mr. David Drew (Stroud) (Lab/Co-op):
I am aware that other hon. Members wish to speak, so I will keep my remarks as brief as possible. I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on raising such an important and topical matter.
We could not have a better backdrop than the current Healthcare Commission report. I have some direct experience of the impact of the restructuring of the health service. A year ago, as a result of the proposals to reorganise health services in Gloucestershire, the maternity unit in Strouda small but invaluable unitwas under threat of closure. There was a massive campaign to keep it open. The authorities finally saw sense, and it is now flourishing, which shows that small units have a part to play. I pay tribute to Michelle Poole, who is in charge of that unit. Her stewardship is excellent, and she has always kept me apprised of the different maternity issues.
The Governments direction is absolutely right. Despite some of the recent criticism, maternity services is an area of which the Government should feel proud. I shall not go over the same ground as my hon. Friend. Clearly, he has made the case very strongly. We are looking at the issues of recruitment, training and retention of staff. From my experience, this, like many other public professions, is an ageing profession, so we have to ensure that we recruit more people into it. I am interested to hear how my hon. Friend the Minister responds to my hon. Friend with regard to getting the numbers right. I would like to put on record my welcome for maternity care assistants. Again, they do not necessarily get much publicity. After some initial worries in the midwifery profession, the role of the care assistants now seems to be both established and welcome.
I raised the issue of insurance in a debate secured by the hon. Member for St. Ives (Andrew George) last May. I am particularly concerned about independent midwives, who are an important part of the service. Have the Government made any progress in their talks with insurers to ensure that such a matter does not militate against smaller units and those who work as independents?
As my hon. Friend said, the numbers are up, and not just in the urban centres but also in areas such as Stroud. That is helpful because one of the accusations was that our numbers were going to decline and that such units would not be viable. That was the prediction in 2006. In fact, in 2006-07, the numbers born at Stroud maternity unit were up by 7 per cent. Again, it is manifest that a lot of that increase is due to migration. We now have a little Polish unit under the leadership of midwife Helen Conway. It is good to see that people can get the best of care even in a rural setting. I am referring here to the translation services. I do not mean midwifery care, but care in the wider social provision. That is very impressive.
I want to discuss the issue of maternal mental health, which was quite rightly raised by my hon. Friend. The problem is highlighted by the Healthcare Commission and the National Institute for Health and Clinical Excellence clinical guideline 45. One of the advantages of smaller units is that they can provide specialist care. Stroud has always prided itself on the fact that it has recruited midwives who, while not suffering medical problems, have learning difficulties, and who may not have English as their first language. That is helpful. There is a question mark over how the midwifery-led units work with the Gloucestershire Partnership NHS Foundation Trust. Mental health is not an area that is well resourced or an area in which one can easily cross
boundaries. What does my hon. Friend the Minister aim to do to ensure that there are more resources going into this area, that there is more co-ordination between the different trusts and that post-natal depression is given due attention?
The report Saving Mothers Lives that was published last year stated that the number of suicides associated with childbirth was down. Will the Minister say how we can further reduce those figures, which reflect a very sad aspect of giving birth? How can we ensure that there is better overall care in this field? It would be good to hear what the Governments strategy is.
Finally, I want to congratulate the Government on their clear-sighted approach to childbirth and the very early years of childhood. I have been a great supporter of our nursery provision and the drive towards children centres. It makes sense that we have now linked health visitors with children centres. In Stroud, the health visitors are now based in the maternity unit. Okay there was space there, but it also made eminent sense to have health visitors working with midwives in the children centres.
The difficulty is, of course, resources. Childrens centres are not always well resourced. I will not say that there is snobbery, but there is some questioning in the medical profession about the role of health visitors. The Minister smiles, but there is still some prejudice in the medical profession about what health visitors do. As we have moved them increasingly away from purely medical intervention, that has led to some questioning among GPs in particular, so I would welcome what my hon. Friend has to say about how we can reassure the GP community that health visitors are doing vital work, if in a slightly different way, and about joining them up much more with midwives and childrens centres.
It would be remiss of me not to mention that linked to that are organisations such as Home-Start. In rural areas, we accept that because of the lack of concentration of facilities, we will never be able to provide Sure Start or childrens centres in every rural location, much as that is a dream of mine. However, we have excellent organisations such as Home-Start, which fill in the gaps and provide support in the early years for both mother and child. It would be good to know how the Department of Health envisages the role of such organisations, which are very much supported by health visitors. If the Minister will say some nice things about that, I can at least go back to my Home-Start organisation and say that it is well loved even if it is not always as well resourced as we would like it to be.
This is a good story. I know that there has been criticism and that there is a lot of pressure in this area, but I hope that we continue to do what we have been doing and that we provide some more resources to ensure that we can do it properly.
Tony Baldry (Banbury) (Con):
For me, this is a timely debate because tomorrow my right hon. Friend the Member for Witney (Mr. Cameron), my hon. Friend the Member for Daventry (Mr. Boswell) and I will be giving evidence to the independent reconfiguration panel, seeking to persuade it that proposals to downgrade the
consultant-led maternity unit at Horton general hospital in Banbury to a midwife-led unit, causing large numbers of women to have to travel some 26 miles to Oxford, is a bad and dangerous idea. I am sure that the House will note that, given the concept of collective government that we have in this country, my right hon. Friend the Member for Witney, part of whose constituency is covered by Horton hospital, speaks not only as the Member of Parliament for Witney but as Leader of the Opposition, and his views therefore reflect those of the official Opposition and the Conservative party. [Interruption.] The hon. Member for Stroud (Mr. Drew) titters, but many communities in this country are desperately concerned at the downgrading of maternity services.
The Keep the Horton General campaign, which is ably led by a Labour district councillor, George Parish, evidenced the ambulance transfer times between Banbury and Oxford. These figures represent what actually happens at present. In only 5 per cent. of cases did an ambulance manage to get to Horton hospital in 10 minutes. Only in just under a quarter of cases could an ambulance get there in 30 minutes. In most instances, it took more than half an hour to get an ambulance to Horton hospital. That is before the transfer of a mother has even taken place.
At the moment, the Horton General Hospital is classified by the Ambulance Service as a place of safety. This means that the Ambulance Service treats calls from the Horton as urgent but not as emergencies, which require a very rapid response, and they have a very long timeframe in which they can respond.
If the proposals are accepted by the Secretary of State, this will change. The Ambulance Service will treat any calls from the Horton General Hospital for women or children who need ambulance transfers as Category A (999) emergencies.
Sandra Gidley (Romsey) (LD): I have another concern. Many women choose to attend midwife-led units, and another battle being fought throughout the country is to prevent the closure of such units. Is the hon. Gentleman concerned that in the longer term, if he loses this battle, which I hope he does not, he may be fighting yet another battle?
Tony Baldry: It is clear that even on the Oxford Radcliffe trusts own best figures, a large number of women who elect to go to Horton hospital in future will have to have their babies somewhere in transit, because even the most prospectively normal deliveries can go wrong. Indeed, an e-mail from one of my constituents the other day stated:
My newest cousin Ewan was born at the Horton at 3.19 am on Monday 14 January. It had been decided only half an hour before, that a Caesarean, unplanned and unexpected, was essential as baby, and mother, were becoming dangerously stressed. The consultant-led team of 8 delivered him safely. A 24-mile dash to the JR in such circumstances is unimaginable.
Time is short and I am conscious that the hon. Member for St. Ives (Andrew George) wants to speak, but I have two other points. We hear from the Government continuous rhetoric about choice and patient power. On 9 January, the Prime Minister made a speech on the NHS. Obviously it must have been cleared by the Cabinet and the Department of Health. He said that
the NHS of the future will be one of patient power, patients engaged and taking greater control over their own health and their healthcare too.
frustrations with access to services, with a service too often centred on the needs of the providers rather than those of patients,
That is why giving patients choices through reforms to encourage plurality of provision, create a genuine level playing field between competing local providers and allow money to follow the patient are so important.
Frankly, my constituents and those of my right hon. Friend the Member for Witney and my hon. Friend the Member for Daventry think that that is complete tosh. When they are being denied choicewhen choice is being taken away from them and existing services are being taken awayfor the Prime Minister to have the impertinence to talk about patient power is just insulting.
We are seeing locally a health service that is in danger of going backwards. That a general hospital is told that it will no longer be a place of safety in the 21st century is insulting to large numbers of people living in north Oxfordshire, south Warwickshire and south Northamptonshire. It is a disgrace. I hope that tomorrow, and sooner or later, the independent reconfiguration panel will have the courage to say to the Secretary of State, Enough is enough. A line has to be drawn on the downgrading of maternity services in the UK, which is putting at risk the lives of mothers and babies. It is simply not good enough.
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