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Maternity Units (Grampian Region)

Volume 983: debated on Thursday 24 April 1980

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. Boscawen.]

10.10 pm

I am pleased to have obtained this Adjournment debate, as I believe that there are many things concerning the Grampian health board's policies in this functional area which require airing. I want mainly to speak on the closing of the maternity unit at Dufftown. I understand very well the rather awkward position in which my hon. Friend the Minister finds himself, because he is obliged to rule in a dispute in which those submitting the proposal comprise a body appointed by his right hon. Friend. On the other hand, many of those objecting to the proposal are the elected representatives of the people living in the area. In fact, the objectors comprise virtually all the people living in the Dufftown area.

The strength of feeling on the subject can be measured by the fact that three local people from Dufftown, representing public opinion—a local doctor, a local regional councillor, who is also the chairman of the social work department of Grampian regional council, and the secretary of the Speyside and district council of social service—felt it proper to travel from Dufftown at their own expense in order to support this objection to the board's proposals.

In order to reinforce my argument, I should like to list those who have banded together to oppose the proposals. I understand that my hon. Friend the Member for Moray and Nairn (Mr. Pollock) wishes to intervene later, also in support. In addition, support has come from the Moray district council, the local regional councillor, who is present for the debate, the Speyside and district council of social service, the secretary of which is present, Moray local health council, Moray trades council, all the community associations, the local national farmers union as well as young mothers and others who organised a petition which was signed by no fewer than 2,589 people in the area. It is worth noting that in Dufftown itself the signatories totalled 98 per cent. of the adult population. Therefore, we have an awkward situation in which my hon. Friend must make up his mind whether to back the decision of his appointees or to pay heed to the overwhelming desires of local people in the Dufftown area.

In those circumstances, any Government who ignore such weight of public opinion do so at their peril. These are reasonable people. I should like to quote from a letter that I have received from the Speyside and district council of social service:
" It has never been disputed that the maternity unit of six beds at the Stephen Hospital is underutilised, but still considered that a unit on even a reduced scale should be maintained in order to retain this important service for the local expectant mothers.
This view is taken for a number of reasons that have been adequately expressed, but particularly in consideration of the climatic conditions to which Speyside is exposed during the winter period."
Nearly everyone in Scotland has heard of the Dufftown area and the roads between Dufftown and Huntly, between Tomintoul and Dufftown, and between Tomintoul and the Lecht road all being blocked. They are not only blocked. It is far more common for them to be extremely treacherous. One can imagine a young, fairly harassed expectant father, if I may use the phrase, rushing his wife off to a maternity hospital in the middle of the night and going off the road.

Speyside is situated on the extreme western side of the Grampian region. The single journey from Tominoul to Aberdeen involves a distance of nearly 80 miles. Even the journey to Elgin from Tomintoul constitutes a distance of 35 miles.

Notwithstanding the foregoing points, the objectors have continually tried to gain acceptance of certain alternatives that it was felt would provide minimal safeguards for this exposed rural area. They are the establishment of a full consultant obstetric unit with back-up facilities to be provided at Elgin. This would obviate the frequent necessity of pregnant women being transported on the long and often difficult journey to Aberdeen. An alternative is to maintain an emergency maternity unit of one of two beds at the Stephen hospital, Dufftown, to cater for emergencies that could so easily occur due to climatic conditions.

It is surely significant that on the day that the Minister visited Dufftown to hear objections a baby was born in the hospital in just such an emergency. The roads on that day were so bad that I did not even take the road myself—I did not have an expectant mother with me—over the hill from Dufftown to Huntly. I took the roundabout way through Keith. It is strongly felt that those suggested alternatives are reasonable and constructive, bearing in mind the Speyside situation.

I am sure that my hon. Friend will say that one of the main reasons for the closure is to provide more geriatric beds. There is no dispute about the need to increase geriatric care. The Grampian regional social work department is doing just that in the area. The trouble is that the board's full proposals, which are understood to include the closure of the county hospital, would reduce the number of geriatric beds available for old people. If that is not so, there is need for the board to make its proposals clear—much clearer than in the two consultative booklets. Much of the acrimony that has arisen could have been prevented if the board had been more open and frank and genuinely used the consultative procedures.

It may be said that the shortage of midwives is the compelling reason for the closure. In the area, seven hospital staff, four community staff and one newcomer are already looking for work. All have had necessary refresher courses. This proposal would put them out of work as midwives.

There are many more compelling arguments which it is impossible for me to deploy in the time allowed, but I sincerely request my hon. Friend the Under-Secretary and my right hon. Friend the Secretary of State for Scotland to meet a small delegation to hear those arguments fully so that they may understand the serious nature of the situation.

10.20 pm

I am pleased to have the chance of adding my weight to the voice of my hon. Friend the Member for Banff (Mr. Myles) in the arguments that he has put forward this evening. It is essential that the House be left in no doubt whatsover about the strength of local feeling in Grampian about the proposed cutback in maternity services in that region. I realise that this is not the place or time to go into detailed arguments about the pros and cons, but a debate such as this can provide an opportunity for the main arguments to be laid before the House.

I should emphasise that I also have a direct constituency interest. Many mothers in my constituency would look to the maternity facilities based in Banff for help in a crisis. Therefore, this debate has wider ramifications than those restricted purely to the Banff part of the Grampian region. I trust that, in his reply, my hon. Friend the Under-Secretary of State will take that into account.

This debate has wide ramifications for those in rural areas. The decision to which the Secretary of State has given his consent highlights the worries faced by rural areas which are desperate to keep a strong infrastructure but feel that somehow the centralist, bureaucratic mentality is conducting a war of attrition in which, year by year, the facilities available to allow them to survive are made more and more difficult.

I am grateful to the right hon. Member for Rutherglen (Mr. MacKenzie)—a man with a distinguished ministerial record—for having seen fit to come and listen to the argument. I think that he recognises the implications of this debate for the whole of Scotland.

What worries us is that we are facing a problem about which the centralist, bureaucratic approach, on paper, is that it is clear that we must concentrate services in the large centres of population. However, the House will realise that, if the rural community is to survive, that philosophy can have little relevance. If we are to maintain a strong rural community, we must equally rely on the Government to provide those necessary services to allow the rural areas to exist. That necessarily involves the provision of adequate maternity, geriatric and other services.

What worries us is that if those who live in the more remote communities are faced with bureaucratic decisions, with only limited consultation among those who are in the front line, the response will increasingly be to say " The Government do not care about us, and the health board does not care about us. There is only one choice left, and that is to leave the countryside and go into the city ". If that is the option, that is a very dangerous path for the Government to follow.

My hon. Friends, and I suspect some Opposition Members, recognise that there is a place for the rural community. But that rural community can be strong only provided it is confident that there is adequate recognition on the part of the Government of the necessary facilities to allow it to survive. Therefore, I plead with the Government to recognise that when they argue about a cutback in expenditure they must not take that argument so far as to say that that will lead to an irreversible cutback in public provision in the rural areas.

There is increasing unease on the part of those in the upper Speyside area that appointees of the Government have decided on a plan of reconstruction of health service facilities without any proper procedure of consultation with those who are most directly affected by the cuts. I am on common ground with my hon. Friend the Member for Banff when I say that there is something close to amazement among the local medical practitioners, the regional councillors and the local spokesmen for the social services, who cannot understand why the health board has to be so secretive about the reasons that compel it to accept a programme which will make life in the rural communities ever more difficult.

That leads me to the main thrust of my contribution to the debate, which is to plead with the Minister to allow the responsible spokesmen from that community an opportunity to have a meeting at ministerial level to put the fears of that community to the Government, and to have a direct dialogue with the Scottish Office about the reasons that have compelled them to reach this point of view. Unless there is an open discussion between those who are in charge of the Government and those who have a chance to elect the Government, we shall not operate the open democracy in which I so fervently believe.

10.29 pm

In the time that is left, I shall endeavour to respond to the points that have been made.

I congratulate my hon. Friend the Member for Banff (Mr. Myles) on being successful in what I think is the first Adjournment debate in this Parliament initiated by a Scottish Tory Back Bencher. I am grateful to my hon. Friend the Member for Moray and Nairn (Mr. Pollock) who supported my hon. Friend the Member for Banff, and to the right hon. Member for Rutherglen (Mr. MacKenzie), who has stayed with us.

I have listened with great interest and care to what my hon. Friends have had to say on this important question of the Grampian health board's proposals relating to maternity units in peripheral areas and geriatric services within its field of responsibility.

The House may be surprised to learn that I agree with much of what has been said during the debate. The issue is of importance and deep concern to the people of the area. I know this very well both in my capacity as the Minister responsible and as Member for Aberdeenshire, West. It was in recognition of the strength of the opposition to the board's proposals that I personally visited Dufftown on 14 December 1979 to listen to the case presented by various bodies and individuals who were objecting to the board's proposals, in particular those relating to Stephen cottage hospital, Duff-town and also Turriff cottage hospital.

While, as I thought proper, the health board was not invited to be directly represented at this meeting, it had made available premises at the Dufftown health centre. It had been arranged that a baby was delivered at the Dufftown maternity unit a few days before my arrival, and the objectors also ensured that snow fell during the meeting, thus emphasising the points that they wished to make. As my hon. Friend the Member for Banff pointed out—he took another route—I was lucky enough, and no more, to make Grampian Television that evening. I can therefore claim that I have experienced at as near first hand as possible all the factors which as Minister it was proper for me to take into account in advising the Secretary of State on what decision he should reach.

My hon. Friend the Member for Banff was present at that meeting. My hon. Friend the Member for Moray and Nairn was also to be present but unfortunately he had a previous arrangement to take his wife to hospital—not to Dufftown hospital, not to Forres, nor to Elgin, but to Raigmore hospital, Inverness, where she was delivered of her second child, a bonny, bouncing boy.

To clarify one point, I should emphasise that the Secretary of State's decision relates only to the board's proposals regarding the two specific hospitals at Duff-town and Turriff. Nevertheless, the objectors quite properly referred to the board's proposals for the future of maternity services and the development of geriatric services throughout the area.

Reference has been made in this debate to two booklets—" Future of the Peripheral Maternity Units " and " Future Provision of Hospital Services for the Elderly in the Grampian Area ". These were two very substantial documents, published in 1978, sent out to 70 bodies, from 60 of which replies were received. That is consultation, but consultation does not necessarily mean acquiescence.

In these green and blue books the board has outlined in some detail its proposals and has explained the reasoning behind them. I have to say at the outset that these propasais are in line with Government policy generally. " The Way Ahead " was published by the last Administration, but in the emphasis which it lays on the need for increasing geriatric provision throughout Scotland I am at one with Labour Members in accepting that this is a pressing need in the Health Service.

I may also add with regard to the hospitals about which we are talking tonight, that there have been no deliveries at Dufftown since this great delivery of which I was a witness—that is, July of last year—and that at Turiff there have been no deliveries since August of last year, because, of course, there is not the necessary incentive for midwives to be present at these small maternity units.

The board has also argued that there is an over-provision of maternity beds. This aspect of its proposals is the more controversial but it is one that is difficult to dispute, on the basis of throughput of maternity patients, where the percentages are very low indeed.

Indeed, not even the objectors have argued that the maternity beds, in particular at Dufftown and Turriff, have been fully utilised. Rather, they have contended that the provision should continue to be made even if there has been marked under-utilisation in recent years.

This is an argument which, frankly, I cannot accept. It would be valid only if satisfactory alternative services could not be made available elsewhere. But the offering of a satisfactory alternative is precisely what the board has done. Of course, my hon. Friends and others who object to he proposals will find this difficult to accept, but I have looked at this point very carefully indeed and I cannot see that the board could have reached any other sensible decision.

All first confinements and any other cases thought likely to be difficult are already referred to specialist units elsewhere and will, of course, continue to be so referred under the new proposals. What we are really arguing about is the question of maintaining small maternity units equipped on a fully comprehensive basis. I cannot believe that the attempt to maintain such a provision represents the best use of the board's resources and the Secretary of State and I have therefore accepted the board's proposal for a change of use in these services per se. By that I mean that, even if the question of geriatric provision did not arise, we would still consider the board's case proved for the closure of these maternity beds.

I stress that because it has been argued that the board, desperate for more geriatric provision, has found a makeshift solution by proposing withdrawal of maternity beds. I do not accept that argument. Of course, the two things are inter-related and it is no more than prudent planning on the part of the board to have proposed that a provision which in its view was no longer required for maternity services should be used for geriatric services. It had first to prove the case for closure of these maternity beds. It would not have been a convincing argument that it wished to use the premises for geriatric provision. If we should have kept the maternity provision, we would have done so and found some other solution to the geriatric question.

In short, therefore, the board's case has related to the rationalisation of services and to making the best use of the resources of the Health Service. That is its job as the Secretary of State's agent for the Health Service in the Grampian area. I am glad that it has carried it out efficiently and, while I fully apprecate all the heartache that inevitably results from a decision of this kind, I remain in no doubt that the proper proposals have been put to the Secretary of State on this issue and that a correct decision has been taken.

I am pleased that three local people have made the long journey from the north of Scotland to listen to the debate because that shows the concern of the people in the area.

My hon. Friend the Member for Banff mentioned the necessity of keeping at least some emergency provision. Clinical emergency facilities are always available. My hon. Friend also asked whether the Secretary of State for Scotland would consider meeting a delegation, including himself, from the north of Scotland. I am glad to say that my right hon. Friend will certainly meet such a delegation.

On behalf of hon. Members on both sides of the House, I express our gratitude to the Under-Secretary of State for the generous offer that he has made to meet a delegation from the north of Scotland. We appreciate it.

I thank the right hon. Member for that kind intervention. I shall pass on what he has said to the Secretary of State.

I accept that my hon. Friend the Member for Moray and Nairn has a direct constituency interest and that there are wider implications, and I accept what they mean to rural areas.

Your clemency is well known, Mr. Deputy Speaker, but you will not want me to diversify and to talk about what could be done in rural areas—in other words, to go far beyond maternity homes. If I started to talk about agriculture, forestry and other subjects in which I am interested, I know, Mr. Deputy Speaker, that you would rule me out of" order.

I thank my hon. Friends for contributing to this important Adjournment debate. My right hon. Friend the Secretary of State for Scotland will be delighted to meet the delegation. He and I and the Grampian board will do everything that we can in the interests of those in the Grampian area.

Question put and agreed to.

Adjourned accordingly at twenty minutes to Eleven o'clock.