We now come to the first debate on the Opposition motions. I must inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister, and that he has imposed a 10-minute limit on Back-Bench speeches.
I beg to move,
That this House supports the provision of high quality maternity services designed around the needs and wishes of expectant mothers and reconciling choice, access and safety; values the hard work of health professionals working in maternity care; endorses the need for every woman to be supported by the same midwife throughout her pregnancy; is deeply concerned at the closure or prospective closure of birth centres and maternity units and the consequent impact upon choice and access to services; regrets that the impacts of financial deficits and the Working Time Directive are forcing closures; welcomes and congratulates the cross-party opposition to such closures; and calls on the Government to respond positively to the demands for a national debate about the future configuration of maternity services.
Thirteen years ago, in a report entitled “Changing Childbirth”, the previous Conservative Government set out principles for the improvement of maternity care. They stated that the woman must be the focus of maternity care, that she should be able to exercise control over her care, that maternity services should be readily accessible, that they should be planned with the involvement of women, and that resources must be used efficiently.
Since then, Ministers have added to those principles. At the time of the last general election, the Labour manifesto stated:
“We want every woman to be supported by the same midwife throughout her pregnancy”.
Subsequently, a date of 2009 was set for the achievement of that commitment.
The Opposition motion effectively reiterates the commitments that I have set out, which I think are shared by hon. Members of all parties. They are based on the following principles: that, wherever possible, childbirth should be normal and governed by the exercise of choice by the mother and her partner; that the services that provide maternity care must be accessible, with continuity of care wherever that is possible; and that that maternity care must be safe and effective.
However, good intentions are not enough. We have to deliver. The motion recognises the NHS staff involved in that delivery—the midwives, maternity assistants, obstetricians, neonatologists and others—and thanks them for their hard work, the support that they give to mothers and the quality of service that they provide. But they know—as do we—that there is a long way to go. This week, the Royal College of Midwives expressed its concern about maternity services when it said:
“Maternity services are being pared back…unless midwifery services are expanded there is no hope of these manifesto commitments being achieved”.
The RCM this week published a survey of heads of midwifery that paints a very worrying picture. It found that two thirds of midwifery units are understaffed, that qualified midwifery posts are being left unfilled or replaced by maternity care assistants, and that training budgets are being cut.
The Government have responded to that with complacency. They say that maternal and infant mortality rates are continuing to fall, and that is true—to the continuing credit of those who work in our maternity services. The Government say that that demonstrates the underlying safety of care, but mortality rates are not a sufficient measure of outcomes for the vast majority of mothers. Achieving a reduction in mortality rates is not the same as achieving quality.
The hon. Gentleman said that outcomes had improved in terms of mortality rates, and of course that is due in part to the dedication displayed by staff. However, does he agree that that is also due to increased funding? Why did his party oppose that increase?
The long-term reductions in maternal and infant mortality rates are due to more than increased funding. There is a long-term trend across the range of mortality rates, and the Prime Minister said as much earlier today when he talked about cancer mortality rates. The matter is much more complex: it involves funding, the organisation and quality of the care that is provided, the technology that is applied and the skills of the staff. I do not accept that the problem is simply one of resources.
However, resources—that is, inputs—matter, as do outputs. The availability of midwives is an important factor. The Government amendment says that there are 2,400 more midwives than there were in 1997. That is on a head-count basis, but a calculation based on full-time equivalent staff shows that there are only 896 more midwives than there were in 1997. Full-time midwives now work 37.5 hours as opposed to 40 hours, which means that there are fewer midwife hours available now than was the case in 1997.
Moreover, the number of midwives is significantly smaller in relation to the number of live births. To begin with, the increase in the number of midwives under this Government was in the context of a falling birth rate nationally, but what has happened in the past five years? In that time, the number of live births in England has risen from 563,644 in 2001 to 613,028 in 2005. That is a 9 per cent. increase, so it is little wonder that midwives are hard pressed.
Has the number of midwives risen or fallen in the past year? The answer is that 36 fewer midwives are employed in the NHS, according to the most recent work force census.
I shall give way first to the hon. Member for North-West Leicestershire (David Taylor), and then to the hon. Member for Ealing, North (Stephen Pound).
I am grateful to the hon. Gentleman for giving way, but is he not distorting the statistics to a certain extent? It is true that the live birth figures have risen since 2001, but they are subject to cyclical trends and remain roughly what they were in 1996. The hon. Gentleman is right that the number of live births oscillates around a slightly rising trend, but he exaggerates the position.
I am sorry but I do not accept that at all. If the hon. Gentleman reads the record, he will find that I said that there was a falling birth rate when the Government took office, but that it has risen substantially since—a 9 per cent. increase.
Did we not see in the past couple of weeks just how good—or I should say how bad—Government work force planning is? The departmental internal documents showed how poor it had been. The equivalent documents produced in 2004 were junked within two years, before most of their predictions ever came to pass. The Government are not enabling the service to match the number of midwives to the task in hand. Increasing the supply of midwives is absolutely central to delivering the objectives on which we all agree—for example, one-to-one care and continuity of care from midwives to mothers and the availability of midwives to enable women to exercise choice and have either home births or named midwife-led care. The supply of midwives is instrumental if those options are to be available.
No one would disagree with the points that the hon. Gentleman has just made. No one would disagree with him in respect of valuing the work of midwives and paying tribute to them. No one would disagree with the words in the motion to the effect that the House
“values the hard work of health professionals”.
However, it is one thing to value that work, but quite another to show admiration and respect for it by providing the highest ever rate of increase in resources in the history of the NHS. The one thing that has increased massively since 1997 is the rate of salary paid to midwives and other health professionals. Surely, the hon. Gentleman cannot argue with that.
I have to tell the hon. Gentleman that his point would have been a lot stronger before the publication of the internal Department of Health document two weeks ago, which made it clear that the Department was planning how to reduce the real-terms wages of NHS professionals on account of the embarrassment of financial deficits into which it has plunged the NHS. So I will not take the hon. Gentleman’s point.
Today’s debate provides an opportunity not only to reiterate our commitment to the quality of care that we want to achieve, but to call on the Government to stop and think about what is happening to maternity services across the country at the moment. Let me take the House back to 8 December, shortly before the recess. On that day, two regional announcements were made— affecting the Greater Manchester area and the east of England—that highlighted the serious consequences of the closure of maternity units across the country. On that one day, nine maternity units were identified for possible closure as a consequence of reconfigurations.
We undertook our own consultation to find out what people on the front line of the NHS feel about the future configuration of maternity services—something that the Government need to do and that the motion calls on them to do. The national picture shows that while we talk about and value birth centres and midwife-led units, 19 of them are at risk of closure. While we talk about accessible services, a number of smaller consultant-led maternity units—by our reckoning, 24 of them across the country—are at risk of closure. As I said, nine were identified in one day.
The hon. Gentleman mentioned the Greater Manchester reconfiguration, but is he seriously saying that, setting aside which hospitals are identified in it, there is no need for a change to services there? That is absolutely crazy.
I shall come on to say what I think about the Greater Manchester consultation in a few moments.
My hon. Friend is making a powerful speech. May I tell him that it is not just Greater Manchester or the east of England trusts that face drastic cuts and closures, because the East Sussex trust is faced with the closure of the maternity unit in either Eastbourne or Hastings. My constituents may face a journey of up to 50 minutes to get to a maternity unit. In that case, a poorly resourced midwife service or home births may become not just an option, but a necessity.
My hon. Friend anticipates a general point that I wanted to make, so I shall make it now in response to him. Changes in the configuration of maternity services are occurring across the country, and they are driven by financial deficits, as in the case of East Sussex, or by the working time directive and staff shortages, as is predominantly the case in Greater Manchester. Those changes are not justified by evidence about clinical safety, yet we should be concerned primarily about quality and safety.
I will give way again in a few moments.
As for Eastbourne and Hastings—Labour Members may recall the same thing in respect of Calderdale and Huddersfield—we are presented with the question whether maternity units with fewer than 3,000 live births can be maintained in this country any more. My contention is that we should retain such units, because we need to maintain access and extend to women the sort of choices that we want them to have, but NHS organisations across the country are planning to shut them down. They are doing so because of deficits and the working time directive and not because of issues of clinical safety.
I shall give way first to my hon. Friend the Member for Welwyn Hatfield (Grant Shapps).
Has my hon. Friend taken into consideration one widespread issue? At my local hospital, the Queen Elizabeth II in Welwyn Garden City, the maternity unit is under threat, yet the review into the closure that is about to take place does not take into account the fact that over the next 15 years its catchment area is due for a population increase of 70,000.
Yes, I understand that and I will move on to deal with the East of England trust later.
I shall give way to the hon. Member for Colne Valley (Kali Mountford), as I have referred to her area.
I am grateful to the hon. Gentleman for giving way on the issue of the Calderdale and Huddersfield NHS trust. He made a point about the number of births required in order to maintain standards of safety, but may I tell him that it is obstetricians who say that at least 5,000 births are necessary for viable units and it is politicians like him and me who want to maintain services as close to home as possible. Midwife-led units may be the right answer when assessments of patients’ needs have been made. It would then be possible to say that fewer births were necessary to maintain services in a particular area. That could be a way of maintaining services closer to home. We need to find a compromise so that—
Order. The hon. Lady has made her point.
I understand the hon. Lady’s point, but I do not know what world she lives in when she says that maternity units need 5,000 live births in order to be viable. [Interruption.] Has the hon. Lady ever talked to people working in France or Germany? If we go to Germany—[Interruption.] If Labour Members would listen, they might learn something. In Germany, the largest maternity unit is the Humboldt in Berlin with just more than 3,000 live births and the largest maternity unit at Lille in France has 4,000 live births. Let me tell the hon. Lady why that is the case. It is because those countries have put far more effort into the identification and management of low-risk births in the community and in smaller units so that the number of births concentrated in specialist centres can be kept down. That is not what is happening in this country at the moment.
I want to make some progress, as many Members want to speak and I have a lot to say about Manchester before giving way again.
The hon. Member for Colne Valley made a point about midwife-led units and I agree that it is perfectly possible for them to be one of the best ways of providing services and that it may be appropriate for them to replace existing consultant-led units in some cases. However, midwife-led units are being shut down across the country, not opened on the required scale. Midwives are not taking responsibility for those services.
As far as Calderdale and Huddersfield was concerned, the independent reconfiguration panel reached the conclusion that, because of the working time directive, it was unable to staff paediatric services, so it accepted the loss of maternity services at the Huddersfield royal infirmary. Let us consider the position in Manchester. The consultation document, “Making It Better, Making It Real” was presumably supplied by the department for ironic titles within the Department of Health—[Interruption.] I hear the Under-Secretary, the hon. Member for Bury, South (Mr. Lewis), saying, from a sedentary position, that it is all local. I suspect we will hear a lot from him about how this is not his responsibility. Here he is, the Minister with responsibility for maternity services, who says that everything that has happened in Manchester over the past two years is absolutely nothing to do with the Government.
The local primary care trust says in the consultation document:
“There is evidence that sick children, young people and babies do better in larger units than in smaller units.”
Reference is made to a study undertaken in southern California in 1991, which demonstrated that low-weight babies born where there was no regional neonatal intensive care unit did not do well. We all know that, but that does not support the general proposition that babies do better in larger units. There is no evidence for that. The Government have told us that there is no evidence for that: last year, they published a call for evidence and research, which we now know is to be undertaken by the National Perinatal Epidemiology Unit, which will not report until 2009. The Government’s call for tenders states that
“there are concerns about the lack of evidence of this shift in service provision on the outcomes for both mother and child”
and that what is required is that
“empirical research is urgently undertaken to evaluate the outcomes and costs of home births and all types of midwife-led birth centres.”
Ministers do not know what the outcomes are and they do not believe that there is any evidence for the proposition that births in larger units are safer than births in smaller ones.
In those circumstances, how can it be that on 8 December, the primary care trust in Manchester published a press release that stated that it had decided—not that it was thinking or consulting further, but that the trust had decided—that five units in Manchester were to close? At the time, I was astonished that the Labour party chairman—I told the right hon. Lady that I might refer to her, but she has chosen not to be here—and the Under-Secretary said, “Ah, well, this is a consultation—nothing has been decided,” when the PCT had issued a press release saying that it had decided that the units were to close. The Under-Secretary’s local maternity unit, at Fairfield hospital, is to close, as are maternity units in Pendlebury, Trafford, Macclesfield and Rochdale. The Under-Secretary argues about the geography, but says that he accepts the case for change. How can he accept the case for change when there is no evidence to support the proposition? The “Making It Better, Making It Real” document even states, on page 18,
“The birth rate nationally is falling so there will be fewer children and young people in the future.”
That is the basis on which the decisions were made, but that statement is not true.
What actually underlies the Greater Manchester strategic health authority’s decisions? To quote page 18 of the document again,
“Staffing pressures on the 13 units providing in-patient care are getting worse. Already children’s wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work.”
That is what is behind the events in Manchester—the working time directive, not quality and safety. In April 2004, the right hon. Member for Barrow and Furness (Mr. Hutton), who was a Health Minister at that time, said that the UK would have to comply with the working time directive but that the Government would not allow it to impact on local services. But it is having an impact on local services. The Under-Secretary cannot get away with saying that the changes are the result of local decisions; they are driven by national policies and the failure to reform the working time directive.
Is the hon. Gentleman’s position that the existing number of maternity units and neonatal units in Greater Manchester should continue indefinitely?
No, because I do not contend that what ought to happen in Greater Manchester is my decision to make. However, I do contend that the Members of Parliament who represent Greater Manchester and the population of that area are ill served by a Government who imposed the working time directive that has forced the changes and by a local NHS bureaucracy that is so transparently unaccountable and unprofessional in carrying out its job.
I will not give way, because I wish to make progress.
The Labour party chairman can do one of two things: either she can represent her constituents and say that the consultation is neither evidence based nor justified, or she can leave the Government and argue that the Government’s implementation of the working time directive and imposition of certain policies is having a detrimental impact on her constituents and is clearly unjustified at national level—but she cannot do both. She cannot represent her constituents in one way and then, at national level, support a Government who are working in precisely the opposite direction.
I will not give way now. I want to turn my attention to the east of England.
Order. The hon. Gentleman has said that he is not prepared to give way at this point.
Thank you, Madam Deputy Speaker. Hon. Members will thank me later for not giving way now, because they will have a chance to make their own speeches.
I have one more point to make before I leave the subject of the right hon. Member for Salford (Hazel Blears)—I wonder where she is. Today, she has received a letter from a former chief executive of the Salford and Trafford health authority, in which he says:
“We in Salford are now in a position where, instead of having a local hospital with a full range of secondary hospital services for our people, we face under your government the loss of a significant element of local health care, with probable further consequences for hospital services here in Salford. Your unprincipled intervention in 1998 helped to bring about the unfortunate situation in which we now find ourselves.”
He is referring to the loss of paediatric services from the Hope hospital in 1998. There is a lesson there for Labour Members: the loss of paediatric services leads to the loss of maternity services. Hon. Members representing Huddersfield—none is present—know that. That is what is happening in Manchester and elsewhere.
The position in the east of England is astonishing. A document has been released stating that units dealing with fewer than 3,000 live births a year are not supportable. As a consequence Hinchingbrooke hospital, which covers part of my constituency, the Queen Elizabeth hospital in King’s Lynn, the James Paget hospital and West Suffolk hospital may all lose services. In essence, the document states that a maternity unit cannot be maintained with less than 40 hours a week consultant cover on the labour wards, which now requires no fewer than six consultants. It is the working time directive problem all over again. It is astonishing that six obstetric consultants are required to maintain 40 hours a week consultant cover on labour wards. That is not true and it should not be the basis on which the strategic health authority makes its judgments.
The East of England strategic health authority has the effrontery to say that the lack of consultant cover on the labour wards caused the problems at Northwick Park hospital and that that is the reason why small maternity units have to be closed. When the chief executive of the East of England strategic health authority came here in December, I asked him how many live births there were at Northwick Park hospital in the period after 2002 when 10 tragic maternal deaths occurred. He did not know. The answer is 5,000. What is important is that the unit is well run, that the consultants are on the labour ward and work as a team with the midwives, and that the unit does not have to deal with an unsustainable number of births. Northwick Park hospital was affected by, among other things, the fact that the Central Middlesex hospital had shut and births were transferred to Northwick Park. What will happen in the east of England if the Hinchingbrooke unit or the West Suffolk hospital unit is shut and all the births are sent to Peterborough and Cambridge, or if the facilities at the Queen Elizabeth hospital are closed and patients are sent to the Norfolk and Norwich hospital? The consultant-led maternity units will be subjected to unsustainable pressures, resulting in all the problems that were seen at Northwick Park, yet the East of England strategic health authority is trying to use lack of consultant cover as the reason for shutting maternity units down. I know why the strategic health authority is doing what it is doing: there is a £240 million deficit and budgets must be cut. The authority believes that economies of scale are automatic, but in practice they are not.
There is not any evidence. That is the point that I am trying to make to the Government. That is the point in the motion. The motion is not an aggressive attempt to expose the Government’s failures; it is an attempt to get the Government to ensure that the NHS across the country takes time to think. The Government have started a research programme, to be completed in 2009, to discover the evidence on the scale of maternity units that are safe and on outcomes in different types of maternity setting. How can we secure the number of midwives that we need to meet the Government’s commitment to achieving one-to-one care by 2009? All those things are necessary and there should be a timetable through to 2009, but there is none. What is happening in Manchester, the east of England, Redditch and other places is that financial deficits and the pressures of the European working time directive are causing maternity units to be shut down.
Restrictions are being put on the choice, access and opportunities that mothers should have to receive the maternity service that is in their best interests. Today, in our motion, we call on the Government to stop and think—not to stop change everywhere but to stop and think—and then to proceed on the basis of the evidence, not of the financial pressures. I urge the House to support our motion.
I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“welcomes the extra investment in NHS maternity services under this Government; further welcomes the endorsement by the Royal College of Midwives of the ambitious vision for maternity services; notes that this investment has funded 2,400 more midwives than in 1997 and supported a 44 per cent. increase in students entering the midwifery profession, and that the latest surveys show that 8 out of 10 women say they are satisfied with their maternity care; recognises the preparatory work underway to deliver the Government’s manifesto commitment that by 2009 all women will have the choice over where and how they have their baby and what pain relief to use, and that every woman will be supported by the same midwife throughout her pregnancy, with this support linked to other services provided in children’s centres; supports the focus of services to tackle inequalities; and recognises that maternity services will need to continue to change in order to deliver this commitment and to ensure that the NHS provides the safest and most effective maternity care for babies, parents and families and the best possible value for money for taxpayers.”.
I recently had the opportunity to attend the annual awards ceremony of the Royal College of Midwives, where I was able to meet many of the midwives who provide such outstanding care to women, their partners and babies all around the country: professionals such as Jackie Christer and George Brook at Northumbria Healthcare NHS Trust, who have led the creation of midwife and nurse-led neonatal care. Their team is providing round-the-clock cover to the special care baby unit, the delivery suite and post-natal wards.
As I like, when possible, to find a point of agreement with the hon. Member for South Cambridgeshire (Mr. Lansley), I note that at the Alnwick midwife-led centre in the Northumbria Healthcare NHS Trust, a small midwife and nurse-led unit is providing superb quality care to mothers and their babies, with fewer than 200 births a year. I want to return to that point a little later, but it serves to illustrate the fact that depending on the way in which the local NHS chooses to organise care, and the investment it makes in the training and support of its staff, it is quite possible for a small midwife-led unit to provide high quality, safe care to mothers—in that case, in an isolated, rural area.
Research from southern California, to which my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) referred in his speech, has been cited by the PCT and the hospital trust as a reason for closing one of the maternity units at Eastbourne or Hastings. Does the Secretary of State accept that that research from the early 1990s is valid for regular, UK maternity closures of, for example, of units handling 2,000 deliveries?
I prefer to take my advice about consultant cover for hospital births from the—British—Royal College of Obstetricians and Gynaecologists. I shall have a little more to say about that in a moment when I turn in more detail to the issue of clinical standards.
Like most Members on both sides of the House, I still remember the midwives and the consultant obstetrician who helped my husband and me with our two children. That was about 20 years ago, but millions of families around the country have every reason to be grateful to NHS staff for the superb quality of care they give at a critical point in people’s lives.
All of us should be proud of NHS maternity services. Women are generally happy with them; according to my Department’s latest maternity survey, eight in 10 women tell us that they are happy with the care they received during birth. That is down to the superb hard work and dedication of thousands of NHS midwives and other clinicians and professionals. It is down to the increased investment—more than £1.5 billion a year—that we are making in NHS maternity services. It is down to the fact that the number of midwives has increased by about 2,500 over the past 10 years, which is of course reflected in the fact that childbirth is probably safer now, for both mothers and their babies, than at any time in the past.
As many of us know, in some parts of the country services are not only good, not only safe, but outstanding: they match the best in the world.
Unlike Opposition Members, I have a long memory. I was a member of a health authority for many years. During that time, an independent report about my constituency of Carlisle stated that babies were dying because there was a split site; the consultants were on one site and the maternity unit was 2 miles away across a crowded city. In 18 years, the Conservative Government did nothing to assist us, yet within three years of a Labour Government it was put right. We have a brand new hospital. The maternity unit was moved to the same site as the consultants and we now have an excellent service. Those people across the road should remember what it was like when they were in charge of the NHS.
My hon. Friend speaks with great experience in the matter. He is absolutely right and has given us a vivid illustration of how in many parts of the country maternity services need to change to provide even better and even safer care for mothers and their babies.
The Secretary of State says that maternity services need to change, and that in many places there is satisfaction with the quality of maternity services. What would she say to expectant mothers in my constituency whose antenatal classes, provided by West Hertfordshire Hospitals NHS Trust, have been withdrawn with little notice? First-time mothers in particular feel nervous about giving birth, for understandable reasons, and they were relying on those classes to provide them with the education and preparation that is so useful, yet it has been withdrawn. The reason? Financial deficits.
I should be happy to write to the hon. Gentleman about the details of that point but, as he knows, there are real financial difficulties in some parts of the country, including his. In a minority of places, there has been overspending at the expense of NHS patients and staff in other parts of the country. That is simply not fair. It is particularly unacceptable at a time when more money is going into the NHS than ever before and, in case the hon. Gentleman has forgotten, his party voted against that extra investment. The local NHS in his area needs to make sure that it gets the best value for the increased money we are putting in, and that it delivers, within that budget, the best possible services.
I want to make some more progress.
The hon. Member for South-West Hertfordshire (Mr. Gauke) and I agree that we need to do more. In parts of the country, there are more births, more births to older women, more complex births, more assisted conceptions and more babies born prematurely—thanks to the advances in medical technology more premature babies and babies with profound disabilities survive. That is a great advance for human progress, but all those changes in society and in medicine mean that maternity services need to change, too.
As we stressed in our national service framework, we know well that giving birth does not need medical intervention for a high proportion of women. Many of those women would much rather give birth at home or in a community setting, supported by a midwife.
The shadow Health Secretary tried to depict the Manchester reconfiguration as the basis for cuts in provision. Is my right hon. Friend aware that when Manchester reconfigures its services significantly more money will be spent on maternity and children’s services and there will be a significant emphasis on services to mothers and babies and young children in their homes rather than in a hospital setting?
My hon. Friend is absolutely right. I shall talk about Manchester in a little more detail in a moment.
First, I want to make the point that only about 3 per cent. of women have their babies at home and only about 4 per cent. in community facilities such as a midwife-led birthing centre, although in some parts of the country, such as Torbay, where I had the opportunity to meet the midwifery team last year, maternity services have been organised differently. More women are being supported so that they have a real choice about where to have their babies, and more than 10 per cent. already give birth at home.
On the Secretary of State’s response to her hon. Friend the Member for Bolton, South-East (Dr. Iddon), if everything is so fine why is the Minister without Portfolio, her right hon. Friend the Member for Salford (Hazel Blears), campaigning and demonstrating against the plans?
Let me turn to the issue of—
Answer the question.
Let me turn to the reorganisation of services in Greater Manchester, which has been under consideration for many, many years and has been subject to more than two and a half years of formal consultation. As my hon. Friend the Member for Bolton, South-East (Dr. Iddon) indicated, it will involve increased investment in maternity services in Greater Manchester.
Will the Secretary of State give way?
No, I will not give way at the moment. The reorganisation has nothing whatever to do with the financial difficulties that recently emerged, or with the overspending in a minority of NHS organisations over the past year. The reorganisation of services has been proposed and led by clinicians. It is disgraceful that the hon. Member for South Cambridgeshire spent so much of his speech attacking and denigrating outstanding NHS clinicians in Greater Manchester—clinicians such as Dr. Anthony Emmerson, consultant neonatologist, who says that across the review area, which is Greater Manchester,
“There are too many hospitals each seeing too few patients”—
so the issue is not the working time directive—
“to maintain the skills and expertise of those who provide obstetric or paediatric care.”
I will make progress before I give way again. Let me continue to quote a professional on the issue of the Manchester reconfiguration:
“Doctors treating babies so small that they fit into the palm of the hand can do so with far more confidence and skill if they see those cases every week”
than if they see such babies on only a handful of occasions a year. Changes to intensive care will save the lives of approximately 20 babies every year. It is the assessment of the clinicians and the NHS professionals who are leading that reconfiguration that if services are changed in the way that they propose, between 20 and 30 babies a year will live, who previously would have died.
I was a premature baby—I was born at St. Mary’s hospital in Manchester some 32 years ago—so I support what the Secretary of State says. Is not the good news story of the reconfiguration the fact that central Manchester will have a state-of-the-art facility for the whole county of Greater Manchester, which we do not have at present?
My hon. Friend is absolutely right, but let me stress that a final decision on the reorganisation of services has not yet been made.
I will not give way, because I want to respond to the points already made, particularly about the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears). It is absurd for Opposition Members to attack my right hon. Friend for making representations about NHS changes in her constituency, and yet to spend months, as they did last year, accusing us of gerrymandering NHS changes to protect Labour constituencies. They simply cannot have it both ways. Opposition Members seem to be saying that a Member of the House should not make representations to his or her local primary care trust and strategic health authority, or put forward the case for nine, rather than eight, specialist maternity centres. Are they really claiming—this is what the hon. Member for South Cambridgeshire says—that the people of one constituency should have less representation in the House of Commons simply because their Member of Parliament sits on the Front Bench? That would be completely unacceptable. I do not know—[Interruption.]
Order. I call the Secretary of State.
I do not know whether that is the policy that the Opposition propose to adopt, should they ever form a Government again, but it would be entirely wrong to do so.
I want to take the Secretary of State back slightly. The hon. Member for South Cambridgeshire (Mr. Lansley), who opened the debate for the Opposition, said that the working time directive was driving matters. Clearly that is not the case—the issue is improving the quality of service—but does my right hon. Friend, particularly as a former Secretary of State for Trade and Industry, share my dismay that the Conservatives, who broke European Union law by not implementing the working time directive are, 10 years later, apparently still against it? It is a safety measure for staff.
My hon. Friend is absolutely right. The Opposition negotiated the working time directive when they were in government—and a pretty poor job they made of it, too. As my right hon. Friend the Leader of the House has explained on many occasions, they ignored the advice that they were given at the time and failed to negotiate the directive effectively, and thus opened the way to judgments in the European Court that have made life genuinely difficult for parts of the national health service.
That is precisely the point: we had a new deal for junior doctors, which would have reduced their hours, and it would have been consistent with the working time directive, but the SiMAP and Jaeger judgments completely changed all that. They made it impossible for doctors to be asleep when on call in hospital, and for that time not to be treated as working time. Back in 2004, the Secretary of State’s predecessor said that that would all be changed, but that has not happened. That is what is driving the proposals.
The hon. Gentleman is simply wrong to say that the proposals are driven by the SiMAP and Jaeger judgment, although it is causing additional problems and we disagree with it, as do most other European Union countries. We have spent several years reaching an agreement within the European Union to change the SiMAP and Jaeger judgments, but unfortunately we have not been able to reach agreement with some of our European colleagues about the individual opt-out.
Just do it!
Opposition Members keep saying, “Just do it”, but they may not have noticed, given their extraordinary hostility to the European Union, that an individual country cannot simply overturn the judgment of the European Court on such matters. We will therefore continue to make services safer, and to bring down doctors’ working hours. As my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) said, that is better for doctors and safer for the patients for whom they care. As we bring working hours down, initially to 56 hours from 2009 onwards, and then to 48 hours, there will be an impact on maternity services. Of course, the NHS has to take that issue into account, but working hours are not the only factor, as the Manchester clinician whom I quoted made crystal clear.
I want to make it crystal clear that when the final decision is made in Greater Manchester on the reconfiguration of services, it will be made on clinical grounds, and on the basis of what is best for patients—for women and their babies. It will not be made on political grounds, either there or elsewhere.
There has been a lot of discussion about Manchester and other cities, but does the Secretary of State agree that some of the reconfigurations will have a far more significant impact on rural areas, such as Shropshire? The hospital trust in my area covers more than 1,300 square miles, and it deals with mothers from mid-Wales, too. There is a significant impact on the Royal Shrewsbury hospital, because 16 beds are being cut in maternity.
I entirely agree with the hon. Gentleman that such decisions need to be made locally, in light of local circumstances, because what is right in a large city will not be right in a rural area; different issues will need to be taken into account. That is why, wherever possible, such decisions should be made locally.
I will not give way; I will make some more progress. Earlier, the hon. Member for South Cambridgeshire referred to the reorganisation in Calderdale and Huddersfield. In that case, there was consensus across the local NHS that two consultant-led units should be replaced by one consultant-led unit and one midwife-led unit. There was considerable consternation among local people, particularly in Huddersfield, about whether the midwife-led unit proposed for the area would provide good quality, safe care. That issue was referred to me by the overview and scrutiny committee, which plays a critical part in the statutory consultation that we have insisted should take place locally when there is to be any substantial change in services.
The panel made it absolutely clear that the standards to which local clinicians worked were set by the royal colleges themselves, including the Royal College of Obstetricians and Gynaecologists, which says that dedicated consultant cover should be available for a minimum of 40 hours during the working week. It wants that to be increased—rightly, in my view—to 60 hours by the end of 2008.
Much has been made of the situation in Manchester, but the Pennine Acute Hospitals NHS Trust provides alternative arrangements, as consultants work across four hospitals to provide the necessary cover. The Government’s decision to concentrate everything in one or two large facilities need not always apply, and alternative arrangements would prevent Bury and Rochdale from losing maternity and obstetric services.
That is a matter for local decision making; local clinicians should take the lead on it.
Although the perception was that it was a done deal, it is important to acknowledge that there are opportunities to make even more improvements in assessments, and to provide new transport arrangements, community services and maternity services, as well as initiatives to tackle teenage pregnancies and help young mothers. Now that the decision has been made, more can be done with the local hospital to provide better services for local people. It is not a done deal.
My hon. Friend makes an extremely important point. The independent review panel did an admirable job when it went to Calderdale and Huddersfield, as it listened to local people, clinicians and other professional staff. It thought that the decision to centralise services in one consultant-led unit was right, but it made it clear that the local NHS needed to do more to provide community-based maternity support, particularly for women in disadvantaged areas of my hon. Friend’s constituency. It pointed to the need, too, for closer working between the NHS and the local council to ensure good transport facilities. That is exactly the kind of decision that needs to be taken locally, and not dictated by the Department of Health or a one-size-fits-all approach, if services are to be tailored to the needs of particular areas.
What would the Secretary of State say to one of my constituents, who is desperately worried about the possible closure of Royal Surrey county hospital’s maternity unit? Her child was born within five minutes of her arrival in the unit. The baby was several weeks premature, and needed immediate access to life-saving equipment. If the unit had not been in operation, the child would have been born in an ambulance, with potentially life-threatening consequences.
The hon. Gentleman underlines the need to ensure that services are properly organised so that they are safe, particularly for women who are at high risk of a difficult labour. That should be the case not just for women who live within five minutes of that hospital but for women across the region, and it is exactly the kind of issue that will be taken into account when proposals on that part of the country are considered in the consultation.
I am conscious of the number of Members who wish to contribute to our debate, and I wish to make progress.
I said earlier that we need to do considerably more. In our 2005 manifesto, we pledged to give women more choice by 2009 about where and how they have their babies, and about which pain relief to use. We want women to be supported by the same midwife throughout their pregnancy. We must do far more to address the deep-seated inequalities that persist both in maternity services and in the outcomes for women and their children. Despite the fact that maternal and neonatal deaths have fallen for several decades, there are still deep inequalities, as women from highly disadvantaged groups are up to 20 times more likely to die in childbirth. We need more services, particularly antenatal services, in local communities to support women during pregnancy and to allow them to choose where they will give birth. We therefore created Sure Start programmes in the most disadvantaged communities to give women, their partners and their babies the most effective support. I have seen that initiative working superbly in the disadvantaged communities in my constituency. In Portsmouth, the maternity outreach programme is caring for the most vulnerable women in the city, including pregnant teenagers. We now have 1,000 Sure Start children’s centres, and we are working to create a centre in every community. Such investment in public services would be put at risk by Tory cuts.
The Secretary of State has rightly flagged up the successes of our nine-and-a-half years in power, as well as the need for more qualified midwives in the years to come. Early last year, I presented a petition of 2,947 signatures that was co-ordinated by a student midwife in North-West Leicestershire who wished to highlight the very high attrition rate on midwifery training courses. Of every 10 students who begin a course, two do not complete it. Of the remaining eight who graduate, only five find jobs. Is my right hon. Friend satisfied that attrition and employment rates can be tackled so that there will be enough qualified midwives in the years to come to deal with the trends that she identified?
My hon. Friend makes an extremely important point. As I said, there are about 2,500 more midwives employed in the NHS than in 1997. Vacancy rates in most parts of the country are low, although in London some trusts find it difficult to recruit and retain midwives. There are more midwives in training than there have ever been, with an increase of about a third since 1997. As my hon. Friend said, however, many of those midwives have experienced difficulties finding a job this year, and we are working closely with hospital trusts to ensure that everything possible is done to help midwives secure employment.
That issue emphasises the need for the NHS to continue to change to secure even better value for money. A recent report by the Institute for Public Policy Research confirmed that if every hospital did what the best are already doing, and ensured patients went home as soon as they were medically ready to do so, the NHS would save nearly £1 billion a year. That is more than enough not only to deal with last year’s overspending but to continue to improve maternity services and pay for new drugs and improvements that are needed.
The Secretary of State has been generous in accepting interventions. She knows that in south-west Hertfordshire, the trust is in dire financial straits and, worryingly for the community, devastating cuts have been proposed. The debate on midwife-led units was conducted four or five years ago, when a huge investment was made in a state-of-the-art, award-winning birthing unit that was opened under the Government. It has now closed, because there is no money to pay the midwives. If there is a surplus of midwives elsewhere in the country, will she enable them to work in Hertfordshire and guarantee that it will reopen?
I have discussed that issue with the hon. Gentleman on several occasions, and he knows that the NHS in Hertfordshire has overspent for many years, despite record increases—far greater than under his party—in its budgets. It needs to reorganise its services to use those record budgets far more efficiently. By doing so, particularly by reorganising its acute services, it will release the money that it needs to continue to improve maternity services.
My right hon. Friend has discussed disadvantage. Does she agree that disadvantage is reflected in different breastfeeding rates around the country? May I thank her for the support that she and her Department have given over the past few months to the breastfeeding manifesto, which I drew up with a wide group of interested parties? I urge her to continue to support that manifesto so that we can achieve internationally comparable standards of best practice.
I congratulate my hon. Friend on his leadership on the breastfeeding manifesto, which deals with an extremely important issue. We will provide both antenatal and postnatal support in the children’s centres that we are building in every community, consolidating the success of Sure Start children’s centres and helping all women to give their children the best start in life.
The Royal College of Midwives congratulated the Government on their ambitious vision for safe maternity services of the highest quality that give women in every part of the country more choice. But it is an ambitious vision, and we know very well that much more needs to be done to achieve it. That is why we are working closely with the Royal College of Midwives, with others and with the NHS around the country on the changes that will be needed. We will publish further plans on that shortly.
We will go on supporting the NHS to change maternity and other services because people’s needs are changing and medicine is changing. We will go on supporting investment and making record investment in the NHS, and we will go on exposing the absurdity of a Conservative party that says it wants more money for the NHS but votes against the record investment, and which has adopted an economic policy that would mean cuts of £17 billion this year in public service funding. We will support our local clinicians and our front-line staff, unlike the Opposition, who attack staff pay rises and have said that they would overturn the recent agreement on public sector pensions.
We know very well that maternity services in England are good. They are getting better and they need to get better still. With the vision and ambition that we have set out, I am confident that we will indeed deliver on that vision.
I welcome the debate on an issue of central importance to so many people. The issue has inevitably been brought into sharp focus by the extraordinary decision of the chairwoman of the Labour party to campaign directly against Government policy by fighting to retain maternity services in Salford. Of course, she was not the only member of the Cabinet to do that. The Home Secretary and the Chief Whip have also been indulging in double standards, campaigning to retain health services in their constituencies. Perhaps we should applaud these Labour Ministers. Perhaps they are belatedly embracing the concept of localism.
Will the hon. Gentleman give way?
Just give me a few more moments. I have been speaking for about 30 seconds so far, but I would love—[Interruption.]
I shall come back to my good friend and previous neighbour from Norman Shaw North, the hon. Member for Ealing, North (Stephen Pound).
Labour’s hypocrisy is matched on the Conservative side. The motion rightly calls for high quality maternity services and resists the closure of birth centres and maternity units, and that comes from a party which voted against the increased investment in our health service. They cannot have it both ways. If the Tories had had their way, £35.5 billion less would have been spent on the health service since 2003. The Liberal Democrats believe that that money could have been spent much more wisely, but imagine the state that our maternity services, let alone the rest of the health service, would be in, if the Conservatives had had their way. The public need to understand that. In government, the Tories presided over chronic underfunding of the NHS.
I acknowledge that there are many examples around the country of good practice. It is clear from the evidence that childbirth is safer than it ever has been—
I apologise for intervening prematurely, but it was on the point that the hon. Gentleman made about the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears). There is a particular situation in respect of the Manchester configuration, especially as regards the location of the Royal Bolton, St. Mary’s and Salford Hope hospitals, and my right hon. Friend was surely acting in the best interests of her constituents. Is the hon. Gentleman seriously suggesting that her constituents should be disfranchised at the moment that she takes her seat at the Cabinet table? If he is saying that, he is not the man I thought I knew and admired—
The hon. Gentleman ought to calm down. He is getting very excited. His intervention needs no further response.
The context of the debate is the desperate state of NHS finances in many parts of the country. It is particularly desperate in the east of England, my own region. It is important to debate in an objective way the best framework for maternity services, but decisions are being taken now, at least in part, because of intense pressure to clear often historic deficits. In many areas the situation is so bleak that it is inevitable that patient services, including maternity services, will suffer.
Yesterday I raised with the Secretary of State the situation of trusts which have massive historic debts and little hope of being able to clear those deficits without severe damage to patient care. Nigel Edwards, the policy director of the NHS Confederation, has said that there are a number of trusts where
“recovery looks extremely difficult, if not impossible”,
yet the Secretary of State gave little reassurance that those trusts will be able to escape from that nightmare.
What is happening in the parts of the country where the health economy is in serious financial trouble? The Health Committee reported before Christmas on NHS deficits. It found evidence that reconfiguration was in some cases being driven by financial crisis, rather than being the result of rational planning.
I cannot allow the debate to go much further without making it clear that in my area, Calderdale and Huddersfield, it was made clear from the outset that the reconfiguration was not based on any financial consideration whatever and that the trust is not in deficit. That may not be the case in other areas—I do not speak for them—but I do not want the debate to continue on the basis that reconfiguration is the result only of financial considerations.
I acknowledge the hon. Lady’s point about her own area. I will go on to speak about reconfiguration and the fact that we do not oppose it in all circumstances. The position varies around the country.
The Health Committee found evidence that in some cases reconfiguration was being driven by financial crisis rather than rational planning. The Committee referred to Worcestershire, where all hospital births, neonatal care and the special baby care unit have been moved to a single site at the Worcester Royal hospital. Evidence from the acute trust referred specifically to the massive financial challenge that it faces, and stated that
“service reconfiguration is essential”,
“the Trust Board has recognised that it will not be able to take the final steps to achieve recurrent financial balance without even more radical action”—
an example of reconfiguration being driven by financial crisis.
On that point, is my hon. Friend aware that in my constituency, Montgomeryshire, once again financial pressures are being used as a reason for the possible closure of one of the local hospitals, Llanidloes hospital? I am sure he would agree that closing services does not save money. Often it simply shifts the cost into other silos, so it is utterly counterproductive, especially when the local community overwhelmingly opposes the closure.
I am grateful to my hon. Friend for that intervention. He makes some good points.
Does the hon. Gentleman accept also that in Greater Manchester, even though some aspects of the restructuring are controversial, the cost will be greater than the current cost of running the service because of the massive expansion in primary care? Is his party committed to matching our investment in primary care, and is he committing himself to funding the deficits of trusts which currently have deficits and which he is criticising?
I accept the hon. Gentleman’s point about Manchester. It is clearly important that the services be adequately funded. Examples from overseas, which I will discuss later, show that it does not always have to cost more for the service to provide more choice for women and high quality maternity care.
On the Greater Manchester reconfiguration, especially the Pennine Acute Hospitals NHS Trust, my hon. Friend may be aware that the Government have invested considerable sums at the Rochdale infirmary— £25 million seven years ago—and a similar figure at Fairfield hospital, yet those units are to be closed and a brand new unit, which I am told will cost over £40 million, will have to be built in north Manchester. That is meant to satisfy a pledge made by the Prime Minister when Booth Hall was shut. It has nothing to do with planning properly—it is more about keeping past promises.
I am grateful for that intervention. We see examples all over the country of investment being overtaken by decisions to move in a different direction, thereby wasting money. Clearly, not all the money that has been invested in the health service has been spent wisely.
We do not oppose reconfiguration per se—it is sometimes necessary—but because so much of the NHS is mired in debt it is inevitable that judgments will often be driven by the requirement to clear it. These decisions should be taken locally, based on objective judgments on how to improve the service—and with genuine local accountability, doing more than merely paying lip service to involving local communities in the sometimes tough choices that have to be made.
In its report before Christmas, the Select Committee found that in a desperate attempt to recover financial balance soft targets are often disproportionately affected. It referred particularly to mental health services, to support for voluntary organisations and, crucially, to staff training. There is no doubt that cuts in staff training are affecting maternity services. A recent survey by the Royal College of Midwives found that trusts were cutting training budgets, with one in five reporting that entire budgets had gone and the same proportion saying that three quarters of the budget had gone.
It is not only training budgets that are suffering. The RCM survey found that two thirds of units surveyed were under-staffed; that one in five had lost staff in the past year; that trusts were increasingly relying on maternity support workers, not qualified midwives, to fill the gaps; and that trusts are employing fewer newly qualified midwives than a year ago. Those are the midwives recruited to training programmes three years ago because of staff shortages; every one of them who does not become employed in the health service effectively costs the taxpayer £45,000 in wasted training costs, apart from the cost to the future of the student who fails to get a job. The survey also found that fewer students are starting training courses because places have been cut. As a result, there will be insufficient newly qualified midwives to replace those retiring, let alone the need to tackle the growing pressures on the service.
Midwife numbers are down in the past year. The Government tell us that in the period of their office numbers have increased, and I accept that, but worryingly, the trend is now in the opposite direction. Significant numbers of midwife-led services have closed or are threatened with closure. The RCM highlights the fact that we have an ageing work force with increasing numbers planning to retire in the next few years.
My hon. Friend mentions the closure of a significant number of midwife-led units; indeed, that has happened in my own area. Does he share my concern that the fact that many of the units that are closing are midwife led removes choice for women who may decide that they do not want to go to the nearby consultant-led unit, however safe and good it may be?
I entirely accept my hon. Friend’s point. It cuts against the Government’s commitment to increase choice, since if units disappear, choice self-evidently disappears as well.
All those trends that are moving in the wrong direction are factors that affect the prospects of tackling the inequalities that the Secretary of State rightly mentioned. They are happening at a time when pressures on the service are increasing. The number of births has started to rise. In 2003-04, there were 5 per cent. more births than in the previous year. There is an increased level of intervention. Birth is an increasingly medicalised practice. Post-natal hospital stays can be longer when intervention is necessary, which inevitably places extra demands on midwives. The percentage of spontaneous births fell from 76.5 per cent. in 1980 to 66.5 per cent. in 2003-04. Meanwhile, the number of caesarean deliveries has increased from 9 per cent. in 1980 to 22.7 per cent. in 2003-04, and the trend is continuing in that direction. It is worth noting that back in the 1980s the World Health Organisation found that there were no additional health benefits associated with caesarean deliveries when they reach more than 10 to 15 per cent. of births. If that is correct—I do not know whether there is any new evidence to counteract it—there are resources to saved by finding ways of reversing the trend.
The main Opposition made great play of the lack of research evidence in this area, although investigations are being undertaken by the King’s Fund as well as by the national perinatal epidemiology unit. There is an international dearth of evidence in the whole area of maternity. Does the hon. Gentleman agree that it is important to get that research, even if it takes years, so that we can get some of these questions answered?
Yes—it is important to get the research so that we can make judgments on an objective basis. It is also worth considering practice elsewhere, as I will explain later.
The other pressure that is developing is that increasing numbers of women over the age of 40 are becoming pregnant. Between 1991 and 2003, the number of women conceiving over the age of 40 almost doubled. Midwifery for those women is more demanding. More teenage pregnancies also have an impact on the service.
Now we come to the Government’s manifesto commitments. The manifesto said that by 2009
“all women will have choice over where and how they have their baby and what pain relief to use.”
It also stated:
“we want every woman to be supported by the same midwife throughout her pregnancy”.
The brutal truth is that choice, far from being enhanced, is being compromised by the cuts that we have witnessed over the past 12 months.
I should also mention the national service framework for children, young people and maternity services, which appears to be increasingly marginalised. It was published two years ago, and yet there is still no delivery plan for implementation of its maternity standard element. The Government’s ambition is worthy, but it is undermined by financial crisis, delay and a determination to drive everything from the centre. Last September, the NHS chief executive, David Nicholson, declared that there would be up to 60 reconfigurations of NHS services, determined not locally but nationally, affecting every strategic health authority in the land. He specifically identified accident and emergency, paediatrics and maternity services as areas ripe for reform.
Let me deal briefly with the case for reconfiguring services. I accept that difficult choices sometimes have to be made. Women with high risk pregnancies must have access to the expertise necessary. Women falling into that category include those having twins, those with a past obstetric history, those with premature deliveries, those suffering high blood pressure and those with other clinical problems such as diabetes. They need the care provided in specialist units, and we will fail them if we do not ensure that they have access to them. That does not mean, however, that we should back away from giving women a real, informed choice.
In developing maternity services we should be willing to learn lessons from other countries. Holland’s maternity health statistics consistently rank among the best in the world. It has a national policy—just like the policy in the Labour manifesto—that guarantees every woman a midwife from the beginning of pregnancy through the first year after birth. Thirty to 40 per cent. of births there take place in the home under the care of a midwife. That option is proven to be safe and cost effective, and women choose it. Let us compare the figure with the tiny percentage of women who have home births in this country. Other methods of doing things appear to work and be cost-effective, and the choice should be made available in a positive way to women in the UK.
It is remarkable that, in Holland, caesarean births have been kept below 10 per cent.—compared with our 23 per cent.—leading to massive cost savings and a better outcome for women. That shows that we can reconfigure without necessarily imposing an additional burden on the NHS budget.
We should learn lessons from elsewhere and be willing to confront difficult decisions to ensure the best care and to empower women. Decisions should not be driven by crisis management because of the legal obligation to clear unsustainable debt.
Our vision is of offering genuine, informed choices to women—home care, midwife-led services, hospital delivery—about where and how they give birth; making decisions locally, thus involving local communities in delivering the best framework of care; and ensuring that we have the work force necessary to realise that vision.
I remind hon. Members that Mr. Speaker has imposed a 10-minute limit on Back Benchers’ speeches. In view of the time left for the debate, hon. Members may wish to restrict their contributions even further.
As a Salford Member of Parliament, whose constituency is served by Salford royal hospital—also known as Hope hospital locally—I know that the maternity and neonatal services that it provides are vital to the local community and that they are world class.
The Government have already doubled investment in the NHS in the past 10 years, and that has helped hospitals such as Salford royal to achieve excellent results. Millions of pounds have been invested in our local acute services and that has led to extra doctors and nurses, shorter waiting times for operations and better cancer survival rates.
I accept the need for the reconfiguration of paediatric, neonatal intensive care and maternity services so that they can continue to deliver the most effective care for patients. However, in the case of the reconfiguration of maternity, children’s and neonatal services across Greater Manchester, I do not believe that the locally recommended option is the right decision. The outcry from my constituents and people across Salford shows that public opinion is strongly against the option that clinicians recommend.
On 8 December 2006, the outcome of the “Making it Better” consultation into the future of services for women, babies and children was announced. The Joint Committee of Primary Care Trusts recommended that the future configuration of services across Greater Manchester should not involve Salford Royal NHS Foundation Trust retaining its maternity and neonatal services.
It is important to note that the Salford Royal NHS Foundation Trust supports the principle of fewer, larger maternity and children’s units and developing three major neonatal intensive care units. I, too, support that. However, I believe that Greater Manchester would benefit more by retaining and developing the existing services at Salford royal.
Salford already has one of only three large neonatal intensive care units in the north-west that are accredited by the Royal College of Paediatrics and Child Health. It is led by a dedicated team of neonatologists and nurses with specialist, advanced roles, and, unlike other hospitals, it has no recruitment difficulties. It takes many years to build such a successful team. It therefore makes sense to retain the hospital’s excellent staff, who are such an integral part of the high quality of service that the hospital’s maternity and neonatal units provide, rather than dispersing the expertise and trying to rebuild it elsewhere.
Salford royal’s unique range of specialist services enables it to support high risk maternity cases, thus benefiting approximately 120 women a year. Those services are not found in any other general hospital. Salford women would therefore have to travel elsewhere should the proposals go ahead. Similarly, Salford’s neurosciences centre is the only unit that specialises in care for pregnant women. Continuing to provide neonatal services at Salford royal would be as safe and effective as providing them elsewhere, but—crucially—they would be delivered at lower cost, lower risk and with greater potential for the future.
The option in the consultation document that involves Salford continuing to provide maternity and neonatal in-patient care is also the best value option. It can be in place in 14 months and it costs £1 million less than the other options. Choosing the cheapest and quickest option appears to be common sense as it frees up money that can be spent on other improvements to the health service.
Furthermore, Salford already has existing plans for developing children’s services. It planned to establish an observation and assessment unit to support emergency care, which would be staffed by six consultant paediatricians and specialists in paediatric anaesthesia and radiology. Plans also exist to develop paediatric day surgery and community services for children. All those plans would be enormously valuable in a community that contains some of the most deprived neighbourhoods in the country.
It has been suggested that future neonatal units should be located only next to paediatric units. As Salford royal planned to open the new observation and assessment unit that I have just mentioned in 2008, babies born at the hospital would have access to the best neonatal and paediatric expertise. Retaining maternity services in Salford would be the safest option for Salfordians, as there would be better distribution of maternity units, with each one able to operate above the recommended minimum number of births for safe service.
I firmly believe that health services should be situated where there is most need for them and that neonatal units need to be based where there are the highest number of low birth weight babies rather than where the biggest maternity units are. Salford has the fifth highest birth rate in Greater Manchester and the highest incidence of very low birth weight babies, so moving the unit away would deprive local people of a service that they desperately need. It is only right that those babies—and their parents—have easy access to the care that they require.
Easy access is a vital matter, especially in Salford, which has the lowest car ownership in Greater Manchester. Travelling to the other proposed locations by public transport is not easy and, for a heavily pregnant woman or one with a small baby, it could be unpleasant and difficult. The length of the journeys would be unacceptable for some women. If the services were moved, some of my constituents simply could not access them as they should.
The neonatal intensive care unit at Hope is groundbreaking in the research that it has carried out on tiny babies. Doctors and nurses led an international study to improve the care of very low birth weight babies. That research has been shared with the medical community and will have a bearing on the future care of very low birth weight babies throughout the world. The fact that Hope was the ideal unit to host the study, and the resulting improvements in care that will take place worldwide, prove that it is important for the unit to be able to continue its work and its research, hopefully leading to similar successes in the future.
Hope hospital is much loved and appreciated by the people of Salford. The trust has been rated as the most successful of all trusts in the north-west by the Healthcare Commission. Attention has been given to maternity and neonatal services at Hope hospital in the past few weeks, but Salford Members of Parliament have campaigned to keep our excellent services for many months. I visited the neonatal unit at Hope hospital with the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears), on 20 January last year. We saw at first hand the world class standard of care that the staff in that unit provide.
Our local paper, the Salford Advertiser, ran a campaign, Hands Off Hope, which attracted the support of 26,000 people. I spoke in support of retaining our services alongside my hon. Friend the Member for Eccles (Ian Stewart) at a rally on 25 March last year, organised by the Salford Advertiser and the city council. Those local campaigns for Hope and the massive support that they attracted are a powerful indication of the strength of local feeling about retaining the maternity and neonatal services that people value so highly.
My hon. Friend makes a powerful case for Salford, especially on access to services. Are not the implications that she describes for Salford exactly the same as for the other highly deprived area of north Manchester, which is served by North Manchester general hospital? If Salford royal hospital stayed open, North Manchester general hospital would probably lose its maternity unit under the plans. I emphasise that I do not accept the basis for the consultation. Would not it make sense to keep open Salford royal and North Manchester general hospitals, which are in the middle of some of the most deprived areas in the country?
I thank my hon. Friend for that intervention. One of the issues that needs to be considered in the final stage of the consultation is the need to keep services as proximate as possible to the most deprived communities. As I have made clear, the need for the services in Salford is caused by the high birth rate and the high incidence of very low birth weight babies, and it makes absolute sense, given the difficulties of public transport in our conurbations, to keep these services as local as possible.
In summary, Salford MPs have argued consistently over many months to keep the local maternity and neonatal services at Hope hospital, and we have argued this on clinical grounds. I have supported the Government’s policies on the NHS and on the need to reconfigure services, but I also support the view that the best option will be to retain services at Hope, because that is the quickest and cheapest way of achieving the aims set out in the consultation, which we endorsed.
Salford city council’s community health and social care scrutiny committee has been asked to scrutinise the proposal for change made by the joint committee of PCTs locally. The decision may then be referred to the Secretary of State, who can refer the matter to the independent configuration panel. This is an example of the process working as it should when there is disagreement during a consultation. Given that I support the need to reconfigure services, I will support the decision made at the end of the process, but I believe that it is right, while the process is going on, for me as an MP and for other Salford MPs to continue to press the views of local people.
I shall certainly do my best to follow your injunction to be brief, Madam Deputy Speaker, although I should like to mention one particular matter that affects my constituency. Before I do that, however, I want to congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and his Front-Bench colleagues on choosing this important subject for debate today. I also want to join him in paying tribute to all the professionals involved in the maternity services—the doctors, nurses and midwives, including those who serve my constituents in Hertfordshire.
My hon. Friend referred to the Royal College of Midwives’ survey, which is an important piece of evidence in this context, and to the problems being experienced up and down the country. Of the 102 maternity departments questioned, 74 per cent. reported that they were facing staff shortages. It is important, from my constituents’ point of view, to add that the survey also found that the problems were most acute in London and the south-east. My constituency in Hertfordshire is certainly no exception, in that it is experiencing similar problems to those found elsewhere in the south-east.
The House has already heard about some of the other problems being experienced in Hertfordshire. My hon. Friend the Member for Welwyn Hatfield (Grant Shapps) mentioned the threat hanging over the hospital that serves his constituency. My hon. Friend the Member for Hemel Hempstead (Mike Penning) mentioned a unit that was standing unused in his constituency, and my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke) talked about the loss of antenatal classes at Watford general hospital. That is the subject to which I want to turn, because it affects my constituents most directly.
It was announced just before Christmas that first-time mothers—except those who are teenagers or who are expecting twins—will no longer receive antenatal classes. The trust put out a statement on 12 December saying:
“The Trust has agreed to a temporary suspension in antenatal parentcraft classes provided for first time mothers. Tours of the maternity unit will continue to be offered.”
The statement makes it absolutely clear that the decision is being taken on financial grounds. It goes on:
“The Trust faces difficult choices in terms of how to use its available resources to serve all patients.”
This is a trust with a substantial deficit. According to the national surveys, it is among those with the most serious deficits, and I understand that it faces a projected deficit of £100 million by 2012.
This is part and parcel of the general crisis affecting NHS services throughout Hertfordshire. The crisis has manifested itself in a number of ways, including the apparent loss of the new hospital that was to have been built at Hatfield. The proposals for the hospital were announced just before the last general election, and it was to have provided cancer services and other services in Hertfordshire. However, the project has been undermined and will apparently no longer take place.
We have also seen the loss of hospital beds at Potters Bar hospital, the loss of beds and services at other district hospitals, and the threat of the loss of a variety of services affecting my constituents, including mental health services and genito-urinary medicine services. The general picture is one of financial crisis in the health service throughout Hertfordshire, and it would appear that this problem is also affecting the antenatal classes and other maternity services at Watford hospital.
Hard on the heels of the announcement about the loss of antenatal classes came another announcement. I note that it was made just before Christmas. A statement was issued to the media on 20 December by the trust, giving very short notice that, from 8 January this year, the trust intended to ask
“mothers who wish to bottle feed their babies to supply their own Ready to Feed Baby Milk or Baby Milk Powder and bottles whilst in hospital.”
In fairness to the trust, I must add that it states that this change is in line with guidance and a wish to educate mothers in the best way possible, and that it has been introduced for educational rather than financial reasons. However, against the background of the loss of the antenatal classes the week before and all the other problems affecting the health service in Hertfordshire, this change has perhaps not been greeted with as much confidence as might have been hoped by local parents and mothers-to-be. One mother-to-be, who is 11 weeks pregnant, was distinctly unimpressed by the change. She said:
“Many women do not know when they go into the hospital whether they will be able to breastfeed. If they don’t think they will breastfeed, they will have to take in a huge bag of equipment when, previously, the hospital would have trays of ready-sterilised milk available.”
My constituents see all this as part and parcel of the financial pressure that the health service is under. I accept the health service’s argument about this change being made for educational reasons, but my constituents see their maternity services as being under the same pressures that other parts of the health service in Hertfordshire are facing. They will not have been altogether convinced by the response of the Secretary of State when these problems were put to her today by my hon. Friend the Member for South Cambridgeshire. She said—I hope that I am paraphrasing her fairly—that Hertfordshire was spending too much and that it might need to make economies for the sake of other parts of the country.
The fact is that the share of health service spending going to Hertfordshire has been reduced as a result of decisions taken by this Government. I appreciate the interest that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) is taking in what I am saying, and I am sure that he will be able to confirm that the share of health service spending per head in Hertfordshire is substantially lower than in many other parts of the country, including London, which is just next door to Hertfordshire. I would welcome it if the Minister could check that; I think that he will find that it is the case.
The Secretary of State also mentioned the value of antenatal classes to parents from disadvantaged backgrounds. I would say gently to the Minister that, although Hertfordshire is generally prosperous, it is not, and never has been, universally prosperous. There are mothers-to-be there who would have received the antenatal classes who come from disadvantaged backgrounds, and I ask the Minister to reflect on that matter when he responds to the debate. The Secretary of State said that she would write to my hon. Friend the Member for South Cambridgeshire about this, but I would be grateful if the Minister too would reflect on the fact that disadvantaged mothers-to-be will lose out as a result of this across-the-board loss of antenatal classes at Watford hospital. The antenatal classes have been suspended. I hope that there will be a rethink on that and that the Minister will encourage the Secretary of State to contribute to that rethink, so that we can have those antenatal classes restored.
There is a wider question as to the health service in Hertfordshire and the Government’s answer to all those serious problems, which are reflected in deficits that put Hertfordshire health authorities and primary care trusts among those with the gravest financial difficulties and leave them needing to make changes in and cuts to services to respond to those deficits. Are the Government prepared to see health services in Hertfordshire fall substantially below the level and quality of those provided in the rest of the country if that is what it will take to solve the problem of deficits? That is the question that the Government must face.
How far down will Hertfordshire health services go? How far will maternity and other services be reduced? Is there any safety net or does there have to be a mechanical accounting procedure to reduce the deficits, even if Hertfordshire residents receive a service that is substantially inferior to that provided elsewhere in the country?
I am grateful for the opportunity to speak on this important issue. I concur with most of the comments made by the hon. Member for Worsley (Barbara Keeley), so I will try not to cover the same ground. I will put an historical perspective and then give a rationale for this matter to be referred by the Secretary of State to the appropriate committee.
By 1996 there was a proposal to close the Royal Manchester children’s hospital, also known as Pendlebury children’s hospital, in my constituency of Eccles. The three Salford MPs at that time, and others, campaigned for a solution—a new children’s hospital to be built adjacent to Hope hospital on the Stott lane site in Salford. The other proposal was that it should go to St. Mary’s hospital in Manchester. We lost that battle and the Secretary of State indeed decided that children’s services should be transferred to St. Mary’s.
At that time, Salford and Trafford health authority considered whether a new paediatric unit should be set up at Hope. There was sense in that, because Hope hospital—also referred to earlier as the Salford Royal trust—was very close to Pendlebury children’s hospital, which provided the specialist services. Hope therefore had no paediatrics, but it had excellent, well-developed neonatal and other services, including maternity.
When we realised that the children’s services would move to St. Mary’s, it was sensible for us to consider putting a paediatric unit at Hope. As we moved to the situation in which the Secretary of State had made that decision, there was clearly concern in Salford about putting children’s services at St. Mary’s—so much so that the local council went for judicial review. I might add that Manchester city council had similar concerns about the proposal to put neurosciences at Salford and also, I understand, pursued judicial review.
My right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), then the Secretary of State for Health, had to deal with all this, as is the norm with any serious decision of that nature. The outcome was that children’s services were indeed transferred to St. Mary’s in Manchester, but that Salford Hope hospital children’s and maternity services would be protected. I call this the Dobson settlement.
The basis of that protection meant that beds at other Greater Manchester hospitals had to be closed. Indeed, there was talk of some of those other hospitals having beds that were clinically unviable. If those beds went, Hope’s provision would be protected. I distinctly remember similar conversations being held in relation to Booth Hall and North Manchester general hospital.
The point here is that we have been clear that we had agreement from the Secretary of State that Salford Hope hospital services would be protected. I was informed that it would take several years for the whole reconfiguration plan to be implemented, but by 1998 it became clear that the Salford and Trafford health authority consultation process, which was designed to create a new paediatric unit at Hope hospital, had been stopped by the Department of Health.
The then Member of Parliament for Worsley, Terry Lewis, and I complained vigorously about that decision to stop a paediatrics facility being set up at Hope. I was aware that the then chief executive of Salford and Trafford health authority, Dr. Ian Greatorex, had offered his resignation as a matter of principle over the decision to stop the process to establish paediatrics at Hope and other matters.
Terry Lewis MP and I were sympathetic to the situation that Dr. Greatorex found himself in, and we both supported his stand. From that point, I believe that the Dobson settlement, as I refer to it, was in jeopardy. Consequently, whenever I met with anyone to discuss health issues, I would ad nauseam state that the Dobson settlement must be implemented in full.
In 2000, I attended a meeting of Greater Manchester MPs where I set out my views about the fact that the medically unviable beds at other hospitals not being closed was stopping the implementation of the Dobson settlement and his commitment that Hope’s service would be protected. I continue to promote the Dobson settlement at every opportunity.
In autumn 2005, I received a letter from the strategic health authority saying that a new consultation process was intended to look at the provision of women’s and children’s services in Greater Manchester and beyond. I believe it was called “Making It Better, Making It Real”. I was astounded that there was no proposal that would maintain maternity provision at Hope in Salford.
I therefore wrote immediately to the strategic health authority, saying that the proposed consultation would break the Dobson settlement, that it must include a Salford Hope hospital option and that the proposed financial model was flawed. I asked for a review of that financial model.
The decision was to be made by a joint committee of primary care trusts. I alerted everyone else to that, as I copied my letter to Salford Hope’s trust, Salford city council, the PCT and my colleague MPs. Subsequently, a broad-based “Save Hope” community campaign was established, which I and others supported. I continue to work with political colleagues and others on that campaign.
In addition to meeting with the council, Hope’s trust, community groups and others, I attended meetings of the joint PCTs to lobby for and press home the Salford case. The strategic health authority was forced to add an option C to the consultation, and indeed to review the financial model. In December 2006, it phoned me to say that the joint PCTs had decided to adopt option A, which meant that the Salford Hope facility would be closed.
I hear hon. Members mutter, “What about Dr. Ian Greatorex, then?” He has made certain allegations regarding the period in 1998 that I described, which are in the public domain. I make no comment on that, as it is for the Member of Parliament for Salford, not for Eccles, to answer.
Today, I ask the Secretary of State to refer the case back to the independent reconfiguration panel, but not only on the basis that the original process was flawed. I am told, although I have no written evidence yet, that the financial review shows clearly that option C would be a money saver to the tune of up to £2 million year on year.
In addition, it is important to realise that the figures on viability quoted by the Conservative spokesman are contested. My understanding is that the maximum that any facility should offer is 6,000 births a year, and the minimum 3,000. I would argue with the way in which the joint PCTs addressed those questions, because, if the order had been changed, and those issues had been addressed first, in the Greater Manchester area Salford Hope hospital would have been found to meet both those criteria. Other hospitals within the plan under option A exceed the 6,000 births by as many as 800, and some have as few as 2,500 births a year. In my view, that would have been enough, had it been considered earlier, to rule out option A. On that basis, I must ask the Secretary of State to review the situation and to refer the decision to the independent reconfiguration panel.
Finally, the local decision-making process was flawed—
Order. The hon. Member has had his final word.
I fully appreciate the concerns of the hon. Members for Eccles (Ian Stewart) and for Worsley (Barbara Keeley).
Having heard the right hon. Member for Salford (Hazel Blears) on the radio on 28 December, I wrote to her. I would like to share what I wrote to her with the House:
“I write, having heard you speak on ‘The World at One’ today on, amongst other things, explaining your decision in campaigning on the ‘picket lines’ last week in Salford protesting about the withdrawal of maternity care in your constituency under an NHS reorganisation.
I think any Member of Parliament would understand your desire to represent the strong feelings of your constituents, notwithstanding your position as a member of the Cabinet and Chair of the Labour Party.
As I am sure you will understand, there are sizeable numbers of communities across England who are feeling equally strongly about proposed reorganisation of hospital services.
In my constituency, the Oxford Radcliffe NHS Trust have been consulting on proposals which would lead to the serious downgrading of, amongst other things, what is now a consultant-led maternity service, to what would be the largest midwife-led maternity unit in the UK.
Furthermore, whereas I would imagine that in Manchester the distances between the various maternity services that are being reorganised in the city are comparatively short, downgrading of the maternity services at the Horton Hospital in Banbury would mean expectant mothers and others having to travel at least 26 miles, and depending on where exactly they live, potentially considerably further, to get to the maternity unit at the JR in Oxford.
You are, of course, fortunate that as a Cabinet Minister you can raise your concerns directly with Patricia Hewitt, the Secretary of State for Health—indeed, I see that you are quoted in today's ‘Guardian’ as saying ‘I have raised the issue … with the Health Secretary several times.’
Obviously it is much more difficult for Opposition MPs such as myself, to be heard by the Secretary of State.
On the 16 January, the All Party Local Hospital Group is organising a rally at Westminster involving campaigners from hospitals across England and hopefully there will be a team there from Salford.
I appreciate that Ministers have extremely busy diaries, but I very much hope, given the stance you have taken on NHS reorganisation in your own patch, that you might be willing to come and meet campaigners from the ‘Keep the Horton General’ campaign. This is a broadly based, community campaign, reflecting views of all political parties locally, and is ably led by George Parish, a longstanding local Labour councillor.
If you were able to spare time to talk to campaigners from Banbury, it would be much appreciated and I think you would then be in a position to make it clear to Patricia Hewitt that there is widespread opposition in England to downgrading and closure of key services at General Hospitals throughout England.”
I have no complaint about a Cabinet Minister breaching collective responsibility, but there should be evenness in this matter. I hope that, on 16 January, Health Ministers and others will come to hear the concerns of many hospitals throughout the country.
At the Horton hospital in Banbury, there is a proposal to downgrade a perfectly good consultant-led service to what will be the largest midwife-led unit in the country. Members of the House might think, “Well, we as Members of Parliament would say these things, wouldn’t we?” However, I would just like to share with Ministers the united submission made by 85 GPs to the Oxford Radcliffe Hospitals NHS Trust:
“We remain opposed to the proposals on the grounds of safety, sustainability and the reduction in access to basic health care and choice for our patients, which will affect especially the most vulnerable. We have little confidence in the process of ‘consultation’ and the spirit in which it has been conducted.
These proposals are unsafe….Under the proposed model mothers who may fail to progress or show signs of foetal distress in the second stage of labour, or who have prolapsed cord or haemorrhage, would require very rapid transfer to Oxford. Given the numbers involved this would carry significant risk and would be inhumane.”
It is pretty telling that those 85 GPs use the words “unsafe” and “inhumane” to describe the proposals.
The submission continues:
“There would be an increase in the burden of responsibility on midwives and ambulance crews. Legal claims following incidents where there was harm to the mother or baby might be very costly to settle.
Babies born in need of immediate resuscitation would incur a transit time of approximately one hour. The idea that paediatric cover could be provided safely from Oxford in these circumstances is false and dangerous.”
My hon. Friend makes an important point about distances, which is one of the issues being considered in our consultation launched last month. When I was making comparisons with other countries, I should have referred to the point made effectively in a document published by the think tank Reform in December 2005: one of the reasons that countries on the continent do not have to engage in this kind of centralisation of maternity services is that they have put in place a strong neonatal transport network. We should consider that option, which would allow us not to have to centralise to the extent proposed.
My hon. Friend makes a good point. The danger in the Government’s proposals, and in the way in which the Government and certain trusts are driving them, is that we will have centralisation without the previous infrastructure. Mothers in labour will often have to travel considerable distances without new infrastructure having been put in place.
As the 85 GPs from Oxfordshire and Northamptonshire say:
“We submit the opinion of Professor James Drife who wrote in the BMJ…about the shortfalls of midwife led units…. It accords with recent publications by NICE on the safety of such units…We are not reassured and maintain that a midwife led unit with a delivery rate of 450”—
“per annum, which is 25 miles away from the nearest obstetrician and paediatrician, is not safe. Through no fault of the midwives working in such a unit, GPs would have to consider the wisdom of recommending mothers to this service, numbers would drop further and the service would soon become non viable … A midwife led maternity unit, possibly lacking the confidence of local GPs, may well wither. Kidderminster had to close its unit due to excessive neonatal mortality (6 avoidable deaths in under 2 years). Increasing concern about such units is being expressed by the Royal College of Obstetricians and Gynaecologists and NICE.”
I am grateful to the hon. Gentleman for giving way, as I am unlikely to be called and I need to correct that impression. Unfortunately, when Kidderminster hospital was downgraded the correct measures were not taken to keep the birth centre safe. If that had been done, the deaths would probably not have occurred. Maternity-led birth centres with the right escalation and admission protocols are entirely safe for selected, otherwise fit mothers.
As we know from NICE, from BLISS and from the experience at Kidderminster, there is a greater risk in such circumstances. The risk to the largest midwife-led unit in the country, when there is a perfectly good obstetrician and consultant-led unit, is a risk that the people of north Oxfordshire and south Northamptonshire are not prepared to take.
In their submission, the GPs say that “increasing concern” about such units is being expressed by the Royal College of Gynaecologists and by NICE. They say
“The existing serious congestion at peak times and lack of parking facilities at the JRH site will be worsened by 1,000 to 1,600 extra deliveries per year. All emergency surgery and major gynaecology currently managed in North Oxfordshire will need to be absorbed by the JRH as will all paediatric cases requiring overnight assessment or admission.”
The GPs conclude that the current proposals of the Oxford Radcliffe NHS Trust
“will result in services which are unsafe and unsustainable into the future… These proposals offer neither a better deal for children nor security for a range of other services vital to our local community.”
In the face of 85 GPs collectively saying that the proposals are “unsafe” and “inhumane”, there is no way in which the trust can pretend that it is making the changes on grounds of safety. Not surprisingly, it has taken all the changes off the table and is sensibly going back to consult GPs again, properly, over a period to establish whether consensus is possible. However, the people of north Oxfordshire and south Northamptonshire are determined to retain all the general services at the Horton, and for it to remain a general hospital. They are not prepared to see services salami-sliced and cut away bit by bit, while the Horton is undermined and turned into little more than a supra-community hospital. It has been made very clear to me that if local GPs do not consider proposals from the Oxford Radcliffe NHS Trust to be safe, they will continue to argue, publicly and vocally, that the proposed services are unsafe and unacceptable.
I hope the Government will heed—because it has not been made sufficiently clear in the debate today—the advice of the Royal College of Midwives, which I suspect was sent to every Member before the debate. The RCM says
“There must be a moratorium on unit closures during the current short-sighted deficit-driven cost-cutting. Short-term decisions are being made to close units and thereby save money that can be used to pay down deficits. That makes immediate financial sense, but little long-term sense. What choice will women have over their pregnancy if everything but a consultant-led maternity unit has been shut down? Reconfigurations should be properly planned in consultation with both service users and providers.”
There are two pressures on maternity-led services. First, trusts such as the Oxford Radcliffe NHS Trust are trying to save money to tackle deficits. Secondly, there seems to be a centralising tendency throughout the country that is supported by the Government, whether it is in Manchester or in Oxfordshire. Little attention seems to be paid to the views of local people or to those of GPs.
I ask the Minister to give one simple undertaking. Ministers are always saying that they are willing to listen. I very much hope that the Minister replying today will give an undertaking to listen, and to heed the collective views of GPs. If Ministers are not willing to heed the views of GPs, what confidence can GPs’ patients have in the Government’s decisions? They will have no such confidence unless Ministers make it clear that they are willing to take advice and listen to GPs, rather than just listening to the views of managers in the NHS who, for their own convenience and for financial reasons, wish to centralise services, particularly maternity services.
We are determined to ensure that mothers and babies in north Oxfordshire and south Northamptonshire continue to receive the service that they have expected for generations—a decent, consultant-led local service, not one that requires them to travel for miles to obtain the maternity service that they deserve.
Our debate on maternity services has been good, albeit brief, and I congratulate Members on their contributions, in which they expressed concern about the future of those services. The debate is timely, as many maternity units throughout the country face closure.
The hon. Member for North Norfolk (Norman Lamb) raised the issue of deficits and the link to closures, as highlighted by the Health Committee; he was right to do so. The hon. Member for Worsley (Barbara Keeley) made a thoughtful contribution. She said that although she does not support the option recommended locally, which will result in the loss of services at Salford royal hospital, she will stand by the decision. However, she also rightly stated that services should be based near to where need is greatest, and she made the point that Salford has one of the highest—the third highest, I think—birth rate in the country.
My hon. Friend the Member for Hertsmere (Mr. Clappison) made a good speech. He mentioned the effect of staff shortages and cuts in his part of Hertfordshire. He revealed that his local trust is making cuts and closing services because of financial deficits. He also commented on the lack of choice in how and where women can give birth.
The hon. Member for Eccles (Ian Stewart) talked about the implications of paediatric services in his area being moved away. He confirmed the powerful case made by Dr. Greatorex in his letter of many years ago; he stated that, under what he called the Dobson settlement, he felt he had been given an assurance that the remaining services at Hope hospital in Salford would be protected—an assurance given to him by a former Secretary of State. However, with option A now being chosen, that appears unlikely.
My hon. Friend the Member for Banbury (Tony Baldry) referred powerfully to a survey of 85 local GPs who used the word “inhumane” in describing proposed changes to maternity services in his area. He raised the important issue of the distance to the nearest services in considering the well-being of patients, and he reminded Members that there is often—not only in his constituency, but in constituencies throughout the country—a contradiction between the views of local people and GPs and the decisions made by primary care trusts, which are in many cases under financial pressure and therefore wish to centralise services.
Our brief debate has, at heart, been about three key issues: first, the inability of the NHS to offer genuine choice, where clinically appropriate, to women about how and where they give birth; secondly, the loss of much-loved local services as part of reconfigurations taking place in the absence of any evidence-based model for safe and accessible care, which is a point that the hon. Member for Worsley made; and, thirdly and overarching the other issues, the shortage of midwives in the NHS at a time of financial difficulty and deficits.
The Government often accuse the Conservative party of scaremongering—which is somewhat predictable, but never mind. However, for evidence of the impending crisis in the maternity work force we need look no further than the survey of the heads of midwifery published this week by the Royal College of Midwives, which has been referred to. Two thirds reported that their unit was understaffed, while one in five claimed that midwifery staffing establishment had been cut. I ask the Minister to say in his summation whether that is scaremongering.
In the past year alone, the overall head count of midwives working in the NHS fell, while the number of whole-time equivalent midwives—the best measure for the availability of a midwife at any single point in time—increased by a mere 5 per cent. between 1997 and 2005. That has been happening during a period when the birth rate has been rising rapidly, and the maternity case mix is becoming more complex as women choose to give birth both earlier and later in life.
The jobs crisis in maternity leads to existing midwives being overworked and, sometimes, unable to cope. Indeed, the RCM has said publicly that midwives are struggling to provide good care. Does the Minister believe that to be scaremongering?
There is little doubt that jobs and training posts are being cut for short-term financial reasons, due to deficits. An analysis of the financial outturn figures published in Hansard on 9 October 2006 clearly shows that three quarters of the midwife-led maternity units under threat are operated by trusts with financial deficits. But this short-term fix is highly irresponsible given the ageing profile of the midwifery work force and the impact on newly qualified midwives unable to get that all-important first job in the health service.
With the RCM now claiming that NHS trusts are increasingly reliant on maternity care assistants and employing fewer newly qualified midwives, what a betrayal is that of midwives who were encouraged to join the profession to address long-term shortages and have been trained at a cost to the taxpayer of £45,000 but now cannot find that first post. Again, does the Minister believe that to be scaremongering?
I want to make the House aware of some figures. I asked the Government whether they had figures for the numbers of student midwives getting jobs. They did not, but I can tell the House that of the 36 students who finished last year at Salford university, only three have got a job, and one of those has had to emigrate. That reinforces the hon. Gentleman’s point that these difficulties with training have a financial cause. The midwives are there, but they are not being given the jobs.
I totally concur with those figures. The University of West of England figures show that about two thirds of those leaving training posts were unable to find jobs in the NHS. That contradicts what has been suggested by Ministers up to now.
While I am on the subject, I point quickly to something that the Secretary of State said about the European working time directive. She certainly seemed to downplay the effect that it has had on decisions about services. I refer her to the independent reconfiguration panel’s comments regarding the Calderdale and Huddersfield trust. It says that proposals for a paediatric rota to support consultant-led maternity services at Huddersfield royal infirmary were explored, but were not considered viable in the light of the implementation of the European working time directive. It is clearly wrong for Ministers to go round the country suggesting that the directive has had little or no effect on decisions about reconfiguration and closure.
As for the effect on patients, one thing is certain. The Government’s 2005 manifesto commitment to offer every woman one-to-one midwifery support cannot be met unless swift action is taken to improve our midwife numbers. One-to-one care is the gold standard in maternity and places women at the centre of the NHS. It has our support. Will the Minister explain how that promise will be implemented when there is such a shortage of midwives?
Further to that, will the Minister make a brief statement, either now or in writing, about the viability of the community midwifery model developed by the Independent Midwives Association? The IMA has been invited to apply for a pathfinder grant to roll out the model in a trial PCT, but so far its proposal has not been given ministerial backing.
Of course, one-to-one-midwifery support is only one piece in the maternity jigsaw; another is the provision of choice about where a woman gives birth, whether at home, in a midwife-led environment or in a consultant-led unit, and about the methods of pain relief being used. The provision of such choice is clearly important for the promotion of well-being in childbirth. The principle is enshrined in the 2005 Labour party manifesto, in the maternity standard of the national service framework and in the draft NICE guidance on intrapartum care. It is a vital feature of the patient-centred NHS, yet the Government are still complicit in the closure of midwife-led units and birth centres for short-term financial reasons, insisting that it is a matter for the local NHS while doing nothing to promote alternatives. Before Christmas, we were able to identify approximately 20 midwife-led units that were either being closed or facing closure, each of which was a much-loved local institution.
The threat of closure hangs over not just midwife-led units and community birth centres, because major reconfigurations are threatening consultant-led units and specialised services and there are proposals of centralisation around maternity super-centres. Communities throughout the country face the loss of much-loved local hospitals. Before Christmas, we identified a further 20 consultant-led units that were facing the threat of closure or being downgraded. That figure was challenged before Christmas, so it was interesting that Secretary of State did not bother to challenge any of the figures on proposed closures during today’s debate.
There is little doubt that the closures in some places are occurring for short-term financial reasons in order to save the Secretary of State’s political skin. In others, however, service redesign is being guided by a confused and often conflicting idea about the best size and style of maternity services for the promotion of safety and accessibility. On the continent, large maternity units are the exception. The largest unit in Germany has just more than 3,000 live births a year. However, in this country, we seem hellbent on channelling women into ever larger maternity units. The number of maternity units delivering fewer than 3,000 births a year has halved since 1996, yet there is no evidence-based model of care for maternity services to suggest that that is the right course of action—it is fundamentally wrong. Will the Minister take this opportunity to express his commitment to a consultation and national debate on the topic, or is this another area in which the official Opposition must take the lead and engage professionals and women to develop policy?
To illustrate, or indeed to emphasise, the confusion at the heart of the Government over these issues, one need look no further than the extraordinary spectacle of Ministers endorsing the Prime Minister’s call for service reconfiguration in principle at a national level, yet shamelessly opposing the implication of such a policy when it affects their constituencies. The right hon. Member for Salford (Hazel Blears) is a case in point. She sees it fit to stand up for the people of Salford when there is a television crew in her constituency, but not here in the House of Commons. She has said:
“I have been putting forward the views of the people of Eccles and Salford”—
well, she did not put them forward today.
Will the hon. Gentleman give way?
I will not because I am short of time and must wind up.
I am the Member for Eccles.
I apologise to the hon. Gentleman, but I was citing a quote.
The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who is responsible for maternity services, is happy to tell constituents of ours that they must lose local services as part of necessary reconfigurations and to accuse us of scaremongering when we talk about maternity closures, but he is quick to oppose closures when they happen in his own back yard. Ministers are trying to have it both ways. On the one hand they support the principle of a national service redesign yet, on the other hand, they oppose closures when they affect their constituencies. It is a blatant case of “do as I say, not as I do”, if ever there was one. If these Ministers carry on in that way, they will be beating a path to the Liberals’ door very shortly. The reason for that embarrassing inconsistency is that the reconfigurations are not guided by an evidence-based model of maternity care.
In short, the Government are all over the shop on this issue. Meanwhile, in the words of Louise Silverton, the deputy general secretary of the Royal College of Midwives, just before Christmas,
“women are not getting the service they want, and midwives cannot do the things they want.”
I put it to the House that the Government should stop hiding behind accusations of scaremongering and instead face up to reality and get on with the job of putting things right.
The Conservative party still has no shame. As we sit here at the beginning of 2007, let us never forget the realities of 1997: a national health service on its knees; crumbling hospitals; underpaid staff; outdated technology; disgraceful waiting lists and waiting times; a shortage of doctors and nurses; and policies that were silent on the scandal of health inequality. What of the past 10 years? Conservative Members have championed policies to encourage people to opt out of the national health service. They have proposed a funding system that would take no account of health inequality, and they have systematically set about rubbishing the NHS and its continued progress at every turn.
We should remember the Opposition’s big claim of last year. Apparently, my right hon. Friend the Secretary of State for Health and my right hon. Friend the Member for Salford (Hazel Blears), who is Minister without Portfolio, were involved in a conspiracy to protect Labour MPs from changes in services that would be unpopular in their constituencies. I hope that my right hon. Friend the Secretary of State will forgive me when I say that, if the claim was true, that would have been one of the most inept conspiracies in history! However, the reality is that the reconfiguration recommendations were made by local professionals who are not politically motivated.
The Opposition have now changed tack, and claim that we are hypocrites. For my part, that is apparently because I continue to oppose the closure of maternity services at Fairfield hospital in Bury. I am content for the facts to speak for themselves. Contrary to what has been said, Fairfield hospital is not in my constituency—so much for Opposition Members’ research.
Moreover, the majority of my constituents use hospitals that will gain from the proposed changes. The total additional investment in North Manchester, Central Manchester and Bolton amounts to £24.1 million, £900,000 and £12.5 million, respectively. Those figures do not include extra resources for community services, but the Tories describe the changes that have led to that extra investment of £37.5 million as cuts.
Since the Greater Manchester consultation began more than two years ago, I have believed in and supported the view of professionals that there needs to be change, that the status quo is not viable and that there has to be a reduction in maternity units across the area. Equally, I have opposed a solution that would leave the Bury, Rochdale, Rossendale and Heywood communities without one consolidated maternity service, and I have done so for the very good reasons frequently articulated by my hon. Friend the Member for Bury, North (Mr. Chaytor) who, along with other hon. Members, has campaigned tirelessly on the issue.
If I had ditched that view on the day that I became a health Minister—if I had abandoned the local campaigners whom I had supported and turned my back on parliamentary colleagues—that would have been true hypocrisy. In addition, it would be hypocritical if Bury’s hosting of a unit to serve four distinct communities were in any way contrary to Government policy, but it is not. It would also be hypocritical of me if I were to argue for the status quo in Manchester when I knew that it was unsafe and against the public interest, but I am not doing so.
Our wonderful system of democracy, which means that Ministers have to deal with the daily realities faced by their constituents, should be celebrated and not undermined. Yes, Ministers sometimes face tensions and dilemmas but, if they do not agree with decisions at a local level, they have a right to make that clear in a way that is consistent and in accordance with the process enshrined in legislation.
The Minister contends that the reconfiguration of services in Greater Manchester is needed but that Fairfield hospital should be maintained for geographical reasons. Is it therefore his view that maternity services at North Manchester and Rochdale should still be shut down?
The hon. Gentleman is entirely wrong. Services at North Manchester will be newly created and state of the art, so his intervention is nonsensical. The inconsistency is his: he always claims to believe in local decisions made by professionals, yet in this afternoon’s debate he has rubbished the judgment of those same professionals. I am sure that professionals in Greater Manchester will read his contributions to the debate with great interest.
I turn now to maternity services. There is no more important period in a family’s life than the birth of a child. For the mother, the experience is intensely emotional and personal, and the same is true for the father and the extended family. Our responsibility is to ensure that the birth is safe, secure and, if at all possible—notwithstanding the physical pain for the mother—a truly special and unique experience. For this Government, “every baby matters” is the foundation of “Every Child Matters”—whether it be ensuring that parents do not smoke or drink during pregnancy, good nutrition, the nature of the birth experience, or positive parenting support, including the encouragement of breastfeeding in post-natal care.
On a point of order, Mr. Deputy Speaker. I am sure that you would want me to raise a point of order to ask the Minister to correct the record. The Minister said that there were no maternity services at the North Manchester hospital, but the consultation document of Manchester PCTs says that over the latest 12-month period of 2004-05, there were 2,587 births at North Manchester general hospital.
I suspect that that is more a matter of debate than a point of order for the Chair.
The hon. Member for South Cambridgeshire (Mr. Lansley) referred to the closure of the unit at North Manchester general hospital, which I know to be absolute nonsense.
For some parents, the level of professional and community intervention should be and will be minimal. For others, it will be more intensive to ensure that every child gets the best possible start in life and every parent has the chance to be the best they can. Our 10 health-led parenting project sites will test out a new approach, which has the potential to make a radical difference to a child’s development and thus their lifelong opportunities.
The Secretary of State and I will shortly make proposals to support the NHS to deliver our historic promise of real maternity choice for all parents by 2009. Professionals and managers should seek to reorganise services in a way that is consistent with the aims of safety, quality and choice, based on local knowledge and follows proper and authentic engagement with the local community.
I want to deal with specific contributions to the debate. The hon. Member for North Norfolk (Norman Lamb) described reconfigurations driven by finance. The requirement for the NHS to get its books into balance is one for which we make no apology, and the reconfiguration that I know best began in Manchester about two and a half or three years ago. It has absolutely nothing to do with any financial challenges that the NHS faces at the moment. The Liberal Democrats say that we should not oppose reconfiguration per se—there is a first for the Liberal Democrats: not opposing things for the sake of it, whatever the best interests of the wider population.
My hon. Friend the Member for Worsley (Barbara Keeley) made a good case for Hope hospital and the hon. Member for Hertsmere (Mr. Clappison) talked about the temporary suspension of antenatal classes for first-time mums. I certainly cannot intervene in that, but I will write to him to find out further details about why that happened. The hon. Gentleman might be interested to know that, under the funding formula advocated by his Front Benchers, his constituents would be 9.2 per cent. a head worse off than under the current NHS funding formula.
My hon. Friend the Member for Eccles (Ian Stewart) has a longstanding and impressive track record of campaigning for the development of paediatric and maternity services and their maintenance at Hope hospital. He has been a passionate and powerful advocate in that context both publicly and privately. My hon. Friend’s call for it to be referred to the Secretary of State depends on the decisions taken by the overview and scrutiny committees of the individual local authorities affected by the decisions. I know that he has had discussions with his own overview and scrutiny committee in Salford.
The hon. Member for Banbury (Tony Baldry) is concerned about reconfiguration. There is a process and professionals will make their views known locally. The overview and scrutiny committee will have an opportunity to make its judgment; if it is unhappy, it has the option under the legislation to refer the matter to the Secretary of State.
In conclusion, real hypocrisy in the NHS is claiming support for it at every opportunity, while voting against extra investment. It is championing local decision making and operational independence, while portraying every change to local services as a cut. It is promising to match NHS spending, while having an economic policy that will require millions of pounds of NHS cuts. Real hypocrisy is criticising the Government’s work force strategy when there are 33,000 more doctors and 85,000 more nurses since 1997. Opposition Members have no shame.
We should contrast that with the present Government’s policies on the NHS. By 2009, every woman will have choice over where and how they have their babies and what pain relief to use. We want every woman to be supported throughout her pregnancy by a named midwife. By 2008, no one will have to wait for an operation more than 18 weeks from the date of their first GP visit to the door of the operating theatre. By 2008, there will be 2,500 children centres; and there will be 3,500 by 2010.
It was the Labour party that created the NHS, it was the Labour party that was asked by the people to save it in 1997, and it is the Labour Government who, fittingly, are charged with its transformation. The NHS is the glue that binds the values of the Labour party and the British people. We have no need to prove that the NHS is safe in our hands, only the awesome responsibility of ensuring that the NHS completes the journey from a third-world health service in 1997 to a world-class health service in time for its 60th anniversary in 2008.
Question put, That the original words stand part of the Question:—
10 January 2007
The House divided:
Question accordingly negatived.View Details
Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
Mr Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the extra investment in NHS maternity services under this Government; further welcomes the endorsement by the Royal College of Midwives of the ambitious vision for maternity services; notes that this investment has funded 2,400 more midwives than in 1997 and supported a 44 per cent. increase in students entering the midwifery profession, and that the latest surveys show that 8 out of 10 women say they are satisfied with their maternity care; recognises the preparatory work underway to deliver the Government’s manifesto commitment that by 2009 all women will have the choice over where and how they have their baby and what pain relief to use, and that every woman will be supported by the same midwife throughout her pregnancy, with this support linked to other services provided in children’s centres; supports the focus of services to tackle inequalities; and recognises that maternity services will need to continue to change in order to deliver this commitment and to ensure that the NHS provides the safest and most effective maternity care for babies, parents and families and the best possible value for money for taxpayers.