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Maternity and Paediatric Services (Teesside)

Volume 454: debated on Monday 11 December 2006

Motion made, and Question proposed, That this House do now adjourn.—[Huw Irranca-Davies.]

I am grateful to have the opportunity to raise the future of maternity and paediatric services in Hartlepool and Teesside, which also takes into account the future shape, sustainability and viability of the university hospital of Hartlepool.

I wish at the outset to pay tribute to the staff of the North Tees and Hartlepool NHS Trust. They have delivered a first class service to patients over the past few years, with ongoing uncertainty regarding services, their location and the finances of the trust. I know that only too well. In the past eight months, they have provided me and my family with a professional level of care following my grandmother’s death at the hospital on 20 April and eight days later, when my 12-year-old son suffered a stroke. All the health professionals working in the trust are a real credit to the NHS and the local area and must be supported as much as possible.

If my hon. Friend the Minister is expecting some sort of diatribe, as often happens in these circumstances, or me to argue that the hospital should not change but should deliver the same services, at the same site and in the same way as it always has, he will be disappointed. I fully recognise and accept the drivers that are pushing the Government towards the reconfiguration of hospital services. Thanks to rapidly accelerating medical technology, tests and procedures that in the past would have had to be done in a specialist centre can now be done in the local community. Professor Sir Ara Darzi illustrated that vividly in the presentation of his report on acute services in Teesside in July 2005. He said that 15 to 20 years ago cataract removals would have involved a lengthy stay at a specialist eye infirmary. Now, he claimed somewhat flippantly, the procedure can be done in a mobile unit in a Tesco car park. Operations that often meant a stay in hospital of several days or even weeks can now be treated as day cases.

I also understand that in order to receive the best specialist care available it is often necessary to be treated in bigger, more specialised hospitals. In such places, consultants are able to see larger numbers of patients, which in turn means that they can become cutting-edge specialists, working with the latest equipment and highly trained and experienced staff. I am also aware that people want to receive care as close to their home as possible. People, rightly, are more demanding in all aspects of life, including their health care, and want reduced waiting times and more choice about when, where and how they are treated. I am keen to see those trends develop and accelerate. I want to see continuing advances in medical technology provide a revolution in health care, so that treatments hitherto thought possible only in hospital, such as chemotherapy, can be provided in the community or in a patient’s home.

Professor Darzi, in his review of acute services in Teesside, was able to address those long-term challenges in a highly skilled way. He was extremely sensitive to local nuances—appreciative, for example, of strong and proud differences between the towns of Teesside. He was also aware of the “sucking-in” of specialist services over a number of years from north of the Tees to the James Cook university hospital in the south of the area. That has destabilised services provided at both university hospitals at North Tees and Hartlepool through the removal of some key clinical interdependencies that have contributed to the pressures on waiting time targets at James Cook.

The number of cancelled operations at James Cook over the past few years has been acknowledged by the hospital’s NHS trust—South Tees—as demonstrating

“the difficulties the Trust has in coping with the high level of activity on the James Cook Hospital site.”

Professor Darzi devised a service model that addressed those difficult challenges. He recommended that the university hospital of Hartlepool should continue to provide a consultant-led accident and emergency service and acute medicine. It should also host a new centre of excellence in women’s and children’s services, including consultant-led maternity and paediatric services, gynaecology and breast surgery. The hospital should increase its in-patient elective surgery portfolio, particularly in orthopaedics. Major trauma and emergency surgery out of hours should move to North Tees. For its part, the university hospital of North Tees should become the main centre north of the Tees for emergency surgery, with expanded intensive care facilities. The site should continue to provide a full accident and emergency service and acute medicine.

North Tees should develop as a centre for major complex surgery, including hosting a new North Tees complex surgical centre providing upper gastro-intestinal cancer services for the whole Teesside area. It was also recommended that vascular surgery should be developed at North Tees as part of a clinical network with the James Cook university hospital.

Under Darzi’s model, each hospital would become a regional centre of excellence, able to recruit and retain staff of the highest calibre, thereby providing the best possible standard of care.

Does my hon. Friend accept that if the Darzi report was implemented, as he is suggesting to the House, women and children from my constituency would face a journey four times longer than they face at present? In the main, they would have to go to Middlesbrough before they could go to Hartlepool, so in practice, they will stop in Middlesbrough and go to the James Cook hospital, thus not attending Hartlepool university hospital. The throughput of patients at Hartlepool will be significantly less, which will threaten a new department; indeed, it will close a department while North Tees has already lost an excellent gynaecology and paediatrics department.

I appreciate and respect my hon. Friend’s comments, but I disagree with them. I hope to speak about the element of choice, which is a central plank in the Government’s manifesto on health policy. The degree of choice for my constituents is somewhat different compared with that for my hon. Friend’s constituents.

Under Darzi’s recommendations, some services would migrate from the James Cook site to the university hospitals of North Tees and Hartlepool and to the Friarage hospital in Northallerton, thereby freeing up capacity at James Cook and enabling the hospital to achieve its waiting time targets. The model—crucially, in my opinion—provides the Hartlepool and North Tees hospitals with a sustainable future by offering distinct specialisms. With everybody giving a little, everybody in Teesside wins.

However, the recent referral of maternity and paediatric services in Teesside to the independent reconfiguration panel undermines the work of Darzi and a sustainable future for all the hospitals. His recommendations are interdependent and relate to one another. It would be difficult to unravel one piece without undermining the whole thing. If Hartlepool does not achieve status as a centre of excellence for women’s and children’s services, will my hon. Friend the Minister tell us whether, in terms of acute hospital services in the Teesside area, everything is now up for grabs? Does it mean that Hartlepool could become the site for complex surgery? Does it mean yet another review—the third or fourth in five years? Such questions and uncertainties make it clear to me that Darzi needs to be implemented as it stands, in full.

The specific configuration of services recommended by Darzi appears sensible, appropriate and responsive to local needs, both now and in the future. A significant increase in the number of older people in Hartlepool is forecast in the next few years: a rise of about 25 per cent. by 2021. People over the age of 60 will constitute more than 15 per cent. of the total population of Hartlepool. That demographic change will have a profound impact on the design and delivery of public services, particularly health and social care provision. The higher proportion of older people will mean a greater need for the co-ordinated configuration of planned and emergency surgery, with elective surgery a major part of Hartlepool hospital’s work, and it will still, rightly, have access to a full consultant-led A and E service and an emergency surgical option. That is why the full implementation of Darzi’s recommendations is so important.

I am most grateful to my hon. Friend. Darzi’s remit was specifically to do “whatever is necessary” to preserve the Hartlepool hospital and his suggestions were numerous and widespread. His report cannot be implemented fully, contrary to what my hon. Friend wants, because the James Cook university hospital in south Tees has said that it is not having it, that it is not going to happen and that it should go away. Full implementation simply cannot happen.

The maternity, gynaecology and obstetric department is a centre of excellence. It was opened by the Prime Minister, accompanied by his wife, in 1999. It has been very successful in North Tees and we want to keep it there. It has been successful for one reason—acute emergency surgery services are based there, which Hartlepool does not have. If we take one away from the other, neither is good. Yet we still have emergency surgery. I plead with my hon. Friend—I use the term “friend” advisedly of my Hartlepool comrade—to think in terms of primary care being based in health centres, secondary care in North Tees at the Hartlepool general and tertiary care in a brand new hospital in eight to 10 years’ time. I will attend when my hon. Friend opens it.

I am grateful for that suggestion, but my hon. Friend’s first comments were incorrect in some respects. Darzi was looking to provide the fullest range of services possible in Hartlepool and Teesside. I accept that, but his remit was extended in December 2004 to take into account the point that I made earlier about the sucking in of services at the James Cook hospital. That concerned me at the time, but it was entirely reasonable in retrospect. He needed to see that the whole of the health economy of Teesside area was sustainable—[Interruption.]

An answer to one of my recent parliamentary questions showed that births in Hartlepool have remained fairly static at about 1,100 a year, but the number of teenage pregnancies has increased as a proportion of the total number of births. It is widely recognised that very young and inexperienced mothers-to-be are reluctant to access health care until the last possible moment of their pregnancy, which increases the risk of a difficult delivery and means that they are disproportionately more likely to require assistance from a consultant. In my opinion, that supports Darzi’s view that the centre of excellence for women and children’s services should be based at Hartlepool—[Interruption.]

In direct response to—[Interruption.]

Order. As the hon. Member for Stockton, North (Frank Cook) knows, when an hon. Member secures an Adjournment debate, it is important for him to be able to say his piece to the Minister. That is the purpose of the Adjournment debate and it is bad manners to interrupt it.

I want to come on to the most compelling argument for Darzi, which directly relates to the comments of my hon. Friend the Member for Stockton, South (Ms Taylor). I am fully aware that some Stockton residents are concerned about a midwife-led unit being based at North Tees. I do not wish to undermine any access to health services for the people of Stockton, neither do I subscribe to the view that a midwife-led unit is inherently bad or unsafe. Equally, however, I would ask those residents not to compromise the choice and access that is available to the people of Hartlepool.

In a recent reply to my parliamentary question, the Minister outlined the Government’s policy on midwife-led units:

“In its manifesto, the Government made a commitment that, by 2009, all women will have choice over where and how they have their baby and this should include offering services in a range of settings, including hospitals, midwife-led units and at home. The choices offered to women should ensure access to an emergency network that is readily available, should the need arise. The Government have further demonstrated its commitment to choice in maternity in the White Paper ‘Our Health, Our Care, Our Say’, published on 30 January this year, which pledges to raise the profile of maternity services and encourages doctors to support birth choices. Ultimately, decisions about the patterns of maternity service delivery are matters for local NHS trusts to determine, taking into account local population needs, priorities and resources."—[Official Report, 30 October 2006; Vol. 451, c. 174W.]

The choice over how and where to give birth is very different for an expectant mother from Hartlepool and Horden than it is for a similar woman living in Norton. Even if Darzi were implemented, an expectant mother in the north Tees area would have the choice of a consultant-led service at the university hospital of Hartlepool, the James Cook university hospital or Darlington Memorial hospital, or a midwife-led service at the university hospital of North Tees or Bishop Auckland hospital. That wide variety of choice can suit her and her family’s needs and circumstances.

The similarly expectant mother in Hartlepool or Horden could choose between a consultant-led service at the university hospital of Hartlepool or the city hospitals in Sunderland, or a midwife-led service at the university hospital of North Tees. A failure to adopt Darzi’s recommendations on maternity services does not provide my constituent with an appropriate choice, as set out in the Government’s manifesto, and I hope that my hon. Friend the Minister will address that in his response.

With all this talk of hospital services, I readily concede that we as a town heavily rely on the hospital in Hartlepool, but that is largely a consequence of poor health and poor primary care infrastructure, both caused and exacerbated by deindustrialisation and mass unemployment from the 1970s onwards, poor diet and lifestyles and a woeful lack of investment in primary care over the past 40 to 50 years.

Hartlepool males live 2.8 years and females 2.4 years less than the English average. Life expectancy is significantly worse for residents living in neighbourhood renewal areas, where access to and the take-up of health facilities can be more difficult. The difference in life expectancy between wards in Hartlepool is about 10 years. Premature deaths from heart disease, stroke and cancer are significantly worse than the English average.

In a recent answer to a parliamentary question, the Minister stated that the number of accident and emergency admissions to the university hospital of Hartlepool had increased from just under 11,000 in 2000-01 to over 15,500 in 2004-05. That increase of more than 42 per cent. in four years demonstrates the inability of many people in my town to access primary care facilities. Above all else, that issue needs to be tackled before further reconfiguration of hospital services takes place.

Much that is extremely positive is happening in Hartlepool. The vision for care, signed by all partners in the town, expresses the wish that health services should be shaped by local people and based as close to the community and neighbourhood as possible. The primary care trust is leading the modernisation building programme of premises that is needed in the town. There is much improvement in the provision of primary care, with work taking place at the Headland surgery, the Owton Rossmere health centre and the planned GP complex in the centre of town. However, the closure of the urgent care service at Owton Rossmere last week, ostensibly on the grounds of clinical safety, shows that there is still some way to go before that vision can be realised and is fully operational, but it also shows how early that reversal in primary care actually is: the modernisation programme is in its very earliest stages and is trying to reverse nearly half a century of chronic underinvestment. Patience and further substantial investment will be needed before the reliance on acute services is halted and then reversed.

I am listening with great care to my hon. Friend’s statement about the investment in his hospital. I shall ask him once again. The investment in gynaecology and paediatrics at North Tees has been considerable. It is a department of excellence. He is suggesting to the House tonight that that department should close, and that a department open at Hartlepool’s hospital. I am suggesting that that department will close because the patient throughput will be inadequate. I would appreciate an answer.

No, I am not suggesting that; I am suggesting that to provide a sustainable and viable future for the university hospital of Hartlepool, which has been under threat for some time with the centralisation of services away from the town, we need a regional model of centres of excellence. Darzi has provided us with a model of a centre of excellence for women and children’s services. I should like to see a weaning off the hospital sector to community and primary care, and that is what I am trying to advance in my speech. We have relied far too much on the acute sector. We need substantial investment in the primary care and community sector, so that people do not need to go into the hospital sector.

The Government’s policy decision to move the emphasis of care from the hospital and towards primary care and community trusts is admirable and should continue to be encouraged in Hartlepool. However, I strongly reiterate that it would be an absurd decision, showing a complete lack of co-ordination in health policy, if services migrated from the university hospital of Hartlepool without having the community facilities operational and used throughout the town. Such a move would undermine completely the trust in the NHS of the people of the town.

Accessing health care, particularly in the hospital sector, is made more difficult by appalling transport links between the hospitals at Hartlepool and North Tees. The A19 seems to get blocked daily; only today, I nearly missed my train to London because an overturned lorry on the A19 had blocked a significant section of the road for six hours. That does not inspire public confidence in responsive and easily accessible services. The problem is made worse by the low level of car ownership—about half the English average—among Hartlepool people. A trend towards continuing centralisation of services away from Hartlepool would have a profound effect on my constituents’ ability and willingness to access health care.

I am conscious of the time, but I want to say that all that requires funding. Although the funding gap between Hartlepool and the English average has dramatically reduced in recent years, my town still receives a funding allocation that is below the English average. I am grateful to the Government for providing an 84 per cent. increase in funding to Hartlepool primary care trust in the past five years. No other Government have done or would do that. In 2001-02, Hartlepool PCT received 80 per cent. of the English average. Last year, that had increased to 94 per cent. That is going in the right direction, but, given the acute health problems of the town, and its inability to access primary care facilities, that remains a profound problem that should be addressed quickly.

Two weeks ago, I presented a petition on the Floor of the House. It was signed by 32,403 people and called on the Secretary of State for Health to implement Darzi’s recommendations in full. It is fairly evident that the people of Hartlepool and the surrounding area want to see their local hospital and its services safeguarded, while addressing the long-term challenges that I mentioned earlier. Darzi provides the best means of achieving that. My constituents require a health service that is responsive to their needs, that listens to their requirements and that is both easily accessible and proactive in addressing profound health inequalities. Investment in primary care over the past five years means that we are getting there and slowly turning round decades of neglect, although there is a need to do so much more. The Darzi review provides the best means available of securing modern, specialised and sustainable hospital services for the whole community of Teesside. I, and I am sure all my constituents, will be interested to hear the Minister’s response.

I congratulate my hon. Friend the Member for Hartlepool (Mr. Wright) on securing the debate and on the passionate and committed way in which he pursued the beliefs of many of his constituents about the best way forward for maternity and paediatric services. I congratulate him on the way in which he has continued to make that case at every opportunity, both publicly and privately.

It is somewhat amusing that the Opposition, who are not represented in the Chamber at the moment, claim that we are gerrymandering health reconfigurations in the interests of the Labour party, rather than the interests of the local population. Anybody listening to this evening’s debate would have to say that we are not making a very good job of it, if that is the case. My hon. Friends the Members for Stockton, South (Ms Taylor) and for Stockton, North (Frank Cook) made equally important contributions that gave a different view and showed their perception of the best interests of the local community and population in terms of maternity and paediatric services. If nothing else, that demonstrates that, at a local level at least, people are attempting to look at the reconfigurations from a clinical and service point of view, rather than being led by political reasons, from a political perspective—an accusation that is often made. If nothing else, that is a strength of the debate, and I would like to highlight that.

I want to echo the tribute that my hon. Friend the Member for Hartlepool paid to NHS staff in Hartlepool, and throughout the region, including in the constituencies represented by my other hon. Friends who have contributed to the debate. NHS staff daily save lives and improve the quality of lives in constituencies up and down the country. They are the people who make the health service the proud institution that it is and we should always use opportunities such as this to pay tribute to them.

A survey that we carried out last summer showed that 80 per cent. of women were satisfied with the maternity services that they received. That is an impressive response. However, I acknowledge that we still have a lot more to do, which is why we have to make some difficult decisions about local reconfiguration. The Government have invested £1.4 billion a year in maternity services. In 2001, we made a capital investment of £100 million to modernise facilities and to improve the environment in which maternity care is delivered. We have boosted the midwifery work force, with the result that there are 2,423 more midwives than there were in 1997, and the number of students entering the profession has risen by 44 per cent. in the same period. In the region of my hon. Friend the Member for Hartlepool, the number of midwives in the North East Strategic Health Authority has increased by 50 from 1,224 in 1997 to 1,274 in 2005. The number of midwives in North Tees and Hartlepool NHS Trust has increased by 48 from 95 in 1999 to 143 in 2005. Our clear vision for the future of maternity services is underpinned by three key drivers: the maternity standard of the national service framework for children, young people and maternity services; the 2005 manifesto commitment on choice; and the White Paper “Our health, our care, our say”.

How can the Minister reconcile the 90,000 choices from Hartlepool against the 186,700 choices from North Tees?

These matters must be decided by taking account of people’s local knowledge, local sensitivities and the local need, as defined by clinicians and managers, because Ministers sat in Westminster and Whitehall cannot possibly have a sensitive understanding of the situation facing every local community. I cannot respond directly to my hon. Friend’s point. However, it is important to stress that the definition of choice when we talk about maternity is centred on home births, births in midwife-led units, and births in units that have not only midwife input, but considerable consultant input. That is why the definition of choice that we use when we talk about access to maternity services is slightly more complex than the traditional, conventional definition that we use when considering other NHS services.

The promotion of normality during pregnancy and childbirth is key to the Government’s vision for maternity services. The national service framework for children, young people and maternity services is the single most important model for such service delivery that the Government have introduced. More importantly, it is the most important model for pregnant women and their partners because it specifically contains a maternity standard. The standard outlines the Government’s vision for the next 10 years, which is that women should have easy access to supportive, high-quality maternity services that are designed around their individual needs and those of their babies. That vision is reinforced in the Government’s manifesto commitment about choice and the White Paper “Our health, our care, our say” with a further commitment to three actions, which my hon. Friend the Member for Hartlepool mentioned in his speech: to raise the profile of maternity services in both the public and the commissioning agenda; to ensure that payment by results supports the choices that women make; and to work with primary care trusts to review the existing maternity work force and identify whether more staff are needed to deliver the commitments.

The White Paper outlined a vision of a truly personalised service that will give women as much control as possible during pregnancy and birth and post-birth. That will cover the ability to access information and to contact a midwife directly, in addition to services being made available at home, in a home-like setting, or in a hospital, and women being offered continuity of care before and after birth by a midwife whom they know. That will be in place by 2009.

We are working in the Department with stakeholders to develop a national maternity reform strategy that will focus on the key areas of delivering the choice policy, improving access to maternity services and providing continuity of care and safe maternity services for all women. The plan will set out a single vision for choice in maternity services, identify risks and management strategies, and set out a strategy for delivery, including performance management arrangements, governance structures nationally, stakeholder engagement and the communication plan to support delivery. It is essential that, at national level, we enshrine the principles that will underpin the concept of choice that was one of the major points in our manifesto.

The Darzi review was subject to a significant consultation exercise across the north-east. As a consequence, it became clear that there are competing, contrasting and conflicting views. My right hon. Friend the Secretary of State decided to refer the matter to the independent reconfiguration panel so that it could consider the relevant findings. I am sure that my hon. Friend understands that, as the panel is considering the matter, it would be entirely inappropriate for me to express an opinion on any aspect of the Darzi report or on the different views that have been expressed within the sub-region and the region affected.

The matter is best left now to the independent reconfiguration panel. I accept that hon. Members must always and at every opportunity do their best to reflect the strongly held views and passionate beliefs of their constituents on these extremely important subjects. There are few things more important than a family’s experience of antenatal, birth and postnatal care. Few experiences generate so much emotion and passion, and that is how it should be. I congratulate my hon. Friend on securing the debate, but the matter is with the independent reconfiguration panel and the decision is in its hands. We must await the panel’s verdict.

Question put and agreed to.

Adjourned accordingly at Eleven o’clock.