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Maternity Services

Volume 958: debated on Tuesday 14 November 1978

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed, That this House do now adjourn. [ Mr. Tinn.]

10.47 p.m.

I wish to raise tonight the question of the provision of maternity services in the South Buckinghamshire and East Berkshire areas. Although the name of my constituency suggests an entirely Buckinghamshire interest, in fact, owing to the unfortunate change of local government boundaries which occurred some time ago, the southern parishes of my constituency are in Berkshire and, in the case of two districts, in the borough of Slough.

The matter which I raise has a fairly long history, in the sense that it began in July 1975, when the East Berkshire area health authority was directed by the Oxford regional health authority to discuss rationalisation of maternity services. Two months later the community health council announced a proposal to close the Cliveden maternity unit and to concentrate services for Maidenhead, and the whole area with which I am concerned, upon Upton hospital in Slough and Heatherwood hospital in Ascot.

Needless to say, intense opposition was aroused in my own constituency at the suggestion to close Cliveden. There was much controversy about it. It had been agreed to by a majority of only nine votes to seven. As a result of the public agitation, the area health authority reversed its decision and decided to close Upton and retain Cliveden. What it was proposing to do when it reached that decision—and, indeed, when it reached the earlier decision—was to provide the maternity services in my area, as I will call it, although the hon. Member for Eton and Slough (Miss Lestor) is sitting here and it is also her area. We are equally interested in this from different sides.

The authority proposed to provide the maternity services from two centres instead of three. Whereas in the past the services had been provided from the Cliveden hospital at Taplow, the Upton hospital in the middle of Slough and Heatherwood hospital at Ascot, giving a total of 170 maternity beds, the proposal was, and currently is, that the service should be provided from two hospitals only, namely, Cliveden and Heatherwood, giving between them a total of 119 beds. The justification offered was the decline in the birth rate, and economy. I need not go beyond those two reasons, which often seem enough.

At the moment, Upton has been closed and Cliveden and Heatherwood are taking the load. That was done in the teeth of opposition from the obstetric consultants in the area, who disagreed entirely. I do not know precisely upon what grounds they disagreed. I suspect that it was upon such grounds as that any temporary solution was probably not very good—this was a temporary solution—and that Cliveden, Heatherwood and Wexham Park, which is the ultimate solution, are not easily accessible for patients, nurses or medical staff.

The present arrangement agreed upon by the area health authority is that Cliveden and Heatherwood should provide the services. The intention is to close Cliveden in the early 1980s and its place being taken by a new maternity wing, centre of provision at Wexham Park which, it is hoped, will be opened in 1983. Of course, dates always slip, and it might be 1984 or 1985.

Cliveden is being treated as a temporary provision ostensibly for five years, or it might be a little more. That is not a satisfactory arrangement, because its temporary nature tends to dominate any decisions about the provision of equipment or anything else.

Of course, the birth rate has not continued to decline. It was always a slightly improbable assumption in my area, because it includes the borough of Slough, which has a large immigrant population, and the immigrant birth rate has not gone down in the way that the indigenous birth rate has. But the indigenous and, I dare say, the immigrant birth rates have recovered, and the solid fact which accounts for this debate is that the 119 beds available are not carrying the load.

The result has been that a number of pregnant women have had to be told that they cannot book in advance at either Cliveden or Heatherwood. They will not be told until they go into labour where they will be able to go. When a woman goes into labour, either she or someone on her behalf has to ring the hospital and ask where she is to go. It could be anywhere from Reading in the west to Hillingdon in the east. That remarkable situation is further complicated by the fact that Reading and Hillingdon are objecting to the arrangement because they, too, have stresses. Therefore, no pregnant woman any longer knows, even with that degree of vagueness, where she will have to go.

As far as I can see, this situation could continue almost indefinitely, because the Wexham unit, if it is ever continued with —I rather think that it should not be continued with—is at least five years away. The question therefore arises: what will happen in the meantime? There has been a tremendous lot of feeling about this matter. The consult- ants say one thing and the health authorities say another. The consultants have objected that they are being asked to take, in their 119 beds, a number of patients who will inevitably get a lower standard of attention than they should get. Under great pressure and with reluctance, the consultants at Cliveden have yielded to the insistence of the area health authority and said that they will take more in order to try to help. The consultants at Heatherwood have dug their toes in and said that they will not take more because they consider that it would reduce the level of services below what is acceptable.

That is an attitude which I do not feel competent to judge. I shall merely read to the Minister a couple of extracts from a letter which I received yesterday morning, which will show him the unlikelihood of this matter being solved without assistance from his Department. The letter is from the chairman of the East Berkshire community health council. He describes the attitude of the consultants at Heatherwood as "bloody-minded nonsense". He sets out as follows the reasons why this problem of inadequate services has arisen:
"1. the failure to get the planning off the ground at the beginning because the consultant obstetricians refused to join in."
That is true. They said that they did not approve of the plan and that they would not plan it. The chairman continues:
"2. the resulting 'collision' in the capital programme with other projects requiring the attention of the planners.
3. staffing problems at Oxford regional health authority because of the management costs reduction "—
not enough bureaucrats; great trouble there.
"4. the subsequent decision to expand pathology services at Wexham. This added to the problems of establishing back-up requirements like boiler capacity and drains."
I thought that we had got rid of the drains at the end of the previous debate, but obviously we have not. Then the chairman says:
"The district has also run into trouble with the supply of midwives. This is primarily attributable to the suspension of pupil midwifery training."
I think that he must mean that the suspension might have been shortened had the decision on closure been taken very much earlier. I do not quite know exactly what that means, but the fact is that Upton hospital was closed in implementation of this plan. Therefore, the Upton midwife training course was discontinued, and now there is a shortage of midwives.

We are told that a course at Cliveden will be ending soon and that this may mitigate the problem. Indeed, when I wrote to the Minister of State, he suggested that it would do so. However, I am told that there are only 10 on that course. Half of them are expected to go back to their own countries when they are trained. That leaves only five, and I am told that two of those five are expected to take employment elsewhere. Therefore, I cannot see the situation being transformed by the emergence of midwives at the end of this course.

I have read extracts from that letter because the Minister will see from it that this problem will not be solved locally—I think—unless some assistance is given. The real trouble, of course, is shortage of money. I manage to have a bit of sympathy with both sides here, because the fact is that the AHA must try to save money somewhere. It is trying to do that here. The consultants have their standards and they do not want to lower them.

As to whether those standards would be unacceptably lowered at Heatherwood, I should like to read a few extracts from a letter which reached me from a constituent—whom I shall not name—which was totally unsolicited and obviously connected with neither side. She is a pregnant mother. She says that she went to Heatherwood hospital for prenatal examination. She had an appointment at 9.30 a.m. and left at 12.30 p.m.
"I had managed to see a very rushed Doctor for about two minutes. The staff I realise are rushed off their feet. Over one hundred pregnant mums in one morning. I was also told that as the local maternity hospitals are so full, when I go into labour I must ring the hospital to find out if I am to go to Heatherwood, Ascot; Cliveden, Maidenhead or the Reading Hospital. What worries me most are the following. 1. I am an SRN"—
she has had children already, so she is not a new mother—
"so hospitals do not frighten me and I have given birth before. I am English".
That is getting to be a little unusual in that area. She has a car. She and her husband both drive. She is educated and articulate. They are on the telephone.

As that lady rightly asks, what is going to be the situation of those who lack any of those things? Perhaps they do not have a telephone or a motor car of their own. Perhaps they are first-time mothers, who are a little frightened by the whole business. Someone will have to go out to a telephone kiosk, which has probably been destroyed by a vandal, and find out in some way or other which hospital they must get to in the middle of the night. These are the problems. I am concerned not to allocate blame but to hope that there can be a solution. That is where I want the Minister to help.

Heatherwood says that it will take more patients if it can have 25 more beds. I have read about the treatment at Heather-wood and I put these points to the consultant at Heatherwood today. He said that all these complaints are justified and that what that lady says is true. That is how pregnant mothers are treated. The consultant said that it cannot be helped because, as my constituent said, the staff are rushed off their feet. As a result, that is the kind of treatment they have to give. Heatherwood has 57 beds. If it is asked to take even more in those beds, what kind of conditions will pregnant mothers encounter? That is the question. A practical answer must be found for the next 12 or 24 months.

I must leave a couple of minutes for the hon. Member for Eton and Slough, but it seems to me that access to hospitals is terribly important. It is all very well having green-field hospitals, but we cannot get the nurses to stay in them, the patients and their relatives cannot get there and the medical staff itself even has problems.

Wexham has always had problems. It is in my constituency. It is a beautiful, new district general hospital, but it is always having staff problems and it has never had a maternity unit. To shut down Upton in the centre of Slough and build a brand new maternity unit at Wexham seems to me to be crazy. I do not see the saving in money and I certainly see great inconvenience to all those who in 1983 will have to use that facility.

11.3 p.m.

I am grateful to the hon. and learned Member for Beaconsfield (Mr. Bell) for allowing me a couple of moments. I really want to underline what he has said about the facilities in the area which we both share. I should also like to remind my hon. Friend the Minister that two years ago I raised this very problem and foresaw some of the difficulties which we are now encountering.

I know that my hon. Friend then said that this was something that was only being considered and that he could not comment on the plan. The fact remains that the potential problems that the hon. and learned Gentleman outlined have developed, so much so that I have already arranged for a deputation of both sides politically, as it were, to come and see the Minister's right hon. Friend later this month.

The situation in Slough and the surrounding area is now reaching one of panic among young mothers. The links and plans which were supposed to cover and accompany the closure of the facilities at Upton hospital in Slough just have not taken place. Even if they had, we would still be in difficulties. I urge the Minister to take this matter very seriously. He looked surprised and shocked when the hon. and learned Member for Beaconsfield said that mothers had to telephone when they were in labour to inquire where their child would be born. That is not an exaggeration. That is the advice that they are being given. I am worried about women who may have a quick labour and give birth before knowing which hospital they have to go to.

Unless there is a rapid improvement in East Berkshire generally, I can foresee many tragedies and a deterioration in the present situation.

11.5 p.m.

I am grateful to the hon. and learned Member for Beaconsfield (Mr. Bell) for providing me with this opportunity to speak about the maternity services in East Berkshire and South Buckinghamshire, and I am pleased to see my hon. Friend the Member for Eton and Slough (Miss Lestor) here. I know that many people in that part of the country have recently been expressing concern about the problems associated with these services, and this concern has recently been reflected both in local newspapers, which I have read with interest, and correspondence with the Department.

Concern was first expressed about the level of hospital maternity services in this area when the Berkshire area health authority's plans for the rationalisation and development of East Berkshire's hospital services were widely circulated for comment in June 1976. At that time, the district had an excess of acute beds and a deficiency of beds in particular for the elderly, mentally ill and elderly severely mentally infirm. The House will be aware that the Government have asked health authorities to give priority on the development of these services. The way in which we wish to see the health and personal social services developed has been set out in our consultative document "Priorities for Health and Personal Social Services", which was published in 1976, and the follow-up document "The Way Forward", which was published in September 1977. The objectives of the area health authorities' rationalisation and development programme were, thus, broadly in line with national policy.

As for the maternity services, prior to the implementation of the rationalisation programme hospital facilities were provided at the Canadian Red Cross memorial hospital at Taplow, the Upton hospital at Slough, and the Heatherwood hospital, Ascot. The proposal finally adopted by the area health authority in April 1977, after a great deal of discussion and consultation, was that in the short and medium term maternity facilities would be provided at the Canadian Red Cross memorial hospital, Taplow, for mothers living in the north of the district, including South Buckinghamshire, and the Heatherwood hospital, Ascot for the southern part of the district. Most of the accommodation becoming vacant at the Upton hospital would be developed to provide additional geriatric in-patient beds and a day hospital for geriatric patients, but specialist out-patient maternity clinics providing modern antenatal care were nevertheless to be retained at Upton hospital. In the longer term, the area health authority planned to transfer the maternity work from the Canadian Red Cross memorial hospital, which is eventually to close, to a new purpose-built maternity unit at Wexham Park hospital, Slough.

The plans, which are now being implemented by the Berkshire area health authority, were accepted by the East Berkshire community health council, whose function it is to represent to the health authorities the views of the general public in East Berkshire and South Bucks. If the council had opposed the AHA's plans, and the AHA and Oxford regional health authority had wished to proceed with their implementation, my right hon. Friend the Secretary of State for Social Services, under procedures laid down by my Department for the closure and change of use of Health Service buildings, would have had to take the final decision.

However, my right hon. Friend was not called upon to act as arbiter and, as I have said, the plans are now being implemented. The in-patient maternity facilities formerly at the Upton hospital were transferred to the Canadian Red Cross memorial hospital and Heather-wood hospital about 16 months ago. Work on adapting the vacated space at Upton for the provision of geriatric facilities has now been in progress for more than a year. The AHA has informed me that two of the adapted wards are now in use, one since October 1977 and the other from September of this year. Extensive alterations to convert accommodation to provide the clay hospital facilities for geriatric patients are still in progress.

Perhaps I can now deal with the suggestion that there is a shortage of maternity facilities and that this has been exacerbated by the change of use of the Upton maternity unit.

The services at the Canadian Red Cross memorial hospital and Heatherwood hospital are undoubtedly under pressure at present, but not because there is a shortage of beds. The pressure has arisen because of a shortage of trained midwives. A couple of years ago the Central Midwives Board introduced revised midwifery training courses and advised the Berkshire area health authority that it would be unable in future to recognise the midwife training programme in East Berk- shire because it was spread over three units—Canadian Red Cross, Heather-wood and Upton. This decision by the board served to reinforce the area health authority's decision to reduce the number of maternity units in the district from three to two by changing the use of the Upton unit, but in the meantime it also unfortunately led to the temporary closure of the midwife training programme, the final group of pupils qualifying in March 1977.

Following the change of use of Upton and the concentration of maternity services in two centres at Canadian Red Cross and Heatherwood, the Central Midwives Board has, I am glad to say, accorded recognition to the district's revised midwife training programme, which restarted at Canadian Red Cross and Heatherwood in January this year with an intake of 11 pupils to be trained over a period of one year. The first midwives to qualify since the reorganisation should therefore start taking up posts in February 1979 and this should ease the pressure on the two hospitals, even if not all the output take up posts, as the hon. and learned Gentleman suggested. The future output cannot be guaranteed in advance, but four intakes per annum are authorised, with up to 12 pupils per set.

In the meantime, however—and this is what has indirectly given rise to the public concern and possibly to some confusion and misunderstanding—because of the shortage of trained midwives, the consultant obstetrician at Canadian Red Cross and Heatherwood imposed a booking limit in October on each hospital of 170 admissions each month. This effectively reduced the number of women who could be admitted, and general practitioners had to make arrangements for some of their expectant mothers to be confined in hospitals outside the health district. Some mothers from the district were booked at the Royal Berkshire in Reading, others at Frimley Park in Camberley, and a few at the Hillingdon hospital, Uxbridge.

This has undoubtedly been a difficult time, but I am pleased to be able to say that the position has now changed considerably for the better, even in advance of the pending qualification of the first set of pupil midwives currently in the reorganised midwives' training programme. On 31st October—just over two weeks ago—the district community physician, Dr. Jeremy Cobb, wrote to every general practitioner in East Berkshire to announce that arrangements have now been made to enable the Canadian Red Cross hospital to try to accommodate all the deliveries within its catchment area, both in East Berkshire and South Buckinghamshire. This is being achieved by the co-operation of the present consultants and midwives and by the area health authority's making available additional supporting staff, equipment and appropriate administrative assistance. General practitioners have been told that the limit of 170 bookings per month at Canadian Red Cross has been lifted, and it should be possible now for all new bookings within the usual catchment area of this hospital to be accepted. Credit is due to all concerned.

The position in the south at Heather-wood is more complex. The district community physician has advised general practitioners that when Heatherwood is overloaded the Royal Berkshire hospital at Reading will provide as much support as possible. On the whole, general practitioners who are not able to obtain bookings at Heatherwood will be able to book patients into the Royal Berkshire, whilst an alternative is available in the extreme south of the district in the form of Frimley hospital. Furthermore, I am able to say that the regional health authority has assured me that enough additional cover can be made available at the John Radcliffe hospital, Oxford—with the co-operation of the Oxfordshire health authority—to prevent the Royal Berkshire hospital at Reading being over-pressed.

Hon. Members will no doubt be glad to know that the area health authority has informed me that, as a result of these measures, so far as is known appropriate bookings have in fact been arranged—or can now be arranged—for every patient in the district up to March and April 1979. As the newly trained midwives take up their posts next year, I hope that all the problems will be resolved, although it may be some little while before Heatherwood unaided can cope with the entire work load of the south of the district. There may be a need for some continuing reliance for some time to come on the Royal Berkshire in the case of patients living in the Bracknell area. Such a reliance is, of course, no new development. A number of general practitioners in this area have traditionally referred their obstetric patients to the Royal Berkshire hospital at Reading.

The health authorities and I are acutely aware of the misunderstandings and confusion which have arisen in consequence of this complex pattern of events and necessary changes. We very much regret any distress which may have been caused to individual families who have feared—even though the fear was unfounded—that appropriate facilties might not have been available for their confinement. I assure the hon. and learned Gentleman and my hon. Friend that I have taken careful note of the points they made about transport, telephone bookings and so on. I shall draw them to the attention of the area health authority concerned.

I am sure that the hon. and learned Gentleman is relieved to hear of the progress that has been made. I pay tribute to the good will and patience of those who have evolved satisfactory interim solutions.

Looking now to the future, I turn to the much-debated decision of the area health authority and regional health authority to build a new maternity unit at Wexham Park hospital. The plan is to transfer the maternity unit from the Canadian Red Cross memorial hospital. When the new maternity unit opens, maternity services will be provided at Wexham Park, Slough, for mothers living in the northern part of the East Berkshire health district, including South Buckinghamshire, and at Heatherwood for the southern part of the district. It has been suggested and widely canvassed by the obstetricians in the district that a better solution would have been for a single unit to be built at the King Edward VII hospital, Windsor, for the whole district, and it is argued by some that a single unit for the whole district would make better use of staffing and financial resources. Furthermore, it is argued that a single unit at Windsor would be both central and readily accessible to all mothers in the district.

These matters are debatable, and indeed have been vigorously debated, not least in the local press. The essential fact is, however, that the area health authority and regional health authority have calculated that the additional capital cost of siting one single maternity unit for the whole district at Windsor could be as much as£2 million more than that for building the second unit at Wexham Park. This is not, I understand, because of the size of the proposed single unit—the "conveyor-belt baby-factory" as it was dubbed by local reporters—but because the site at Windsor is extremely restricted both in extent and in terms of planning constraints. There would also be consequential changes if a single maternity department were created at Windsor in that certain departments, notably paediatrics, are normally considered necessarily to be associated with obstetrics and at present these departments are all currently established not at Windsor Park, at Wexham Park or Heatherwood. To establish a large, new isolated maternity unit at Windsor would run counter not only to departmental policy but to current medical thinking.

Moreover, there will be considerable pressure on the RHA's capital funds in the foreseeable future because further major developments are planned elsewhere in the Oxford region, notably for Milton Keynes, Northampton and Oxford. Their urgency will be appreciated when I explain that the Oxford health region, comprising the counties of Berkshire, Buckinghamshire, Oxfordshire and Northamptonshire, is one of the most rapidly expanding health regions in the country and the towns of Milton Keynes and Northampton are likewise two of the most rapidly growing urban areas. Priorities in other parts of the region have to be balanced against the needs of East Berkshire, and they simply do not allow for making available an additional£2 million to develop the Windsor site even if this were desirable. In fact, I am told that even if there were no financial constraints whatsoever, the RHA and the AHA are convinced that to centralise maternity services in Windsor would not be the correct solution when the overall needs and probable pattern of future services for the district as a whole are taken into account.

So there are overwhelming financial disincentives and major service planning objections to locating a single maternity unit for the whole district at Windsor. Nor should it be forgotten that preparatory planning work on the new Wexham Park maternity unit is well under way, with the present programme envisaging work starting on site in either 1980 or 1981 and being completed in either 1984 or 1985. Any change from Wexham Park at this relatively late stage—even if the very heavy additional costs could be justified and the service planning objections could be ignored—would entail significant delays and would impede rather than advance the development of the comprehensive maternity service which the hon. and learned Member, my hon. Friend and I earnestly wish to see provided for the whole of the East Berkshire and South Buckinghamshire health district as soon as is reasonably practicable.

To summarise, I have reviewed the general strategy and background to the rationalisation of health services as a whole in East Berkshire so far as they have a bearing on the maternity services in particular. I have set in context the admitted recent difficulties caused by a shortage not of beds but of midwives, which has arisen in consequence—

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at seventeen minutes past Eleven o'clock