Skip to main content

NHS Maternity Services (East Sussex)

Volume 470: debated on Wednesday 23 January 2008

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

I am very pleased to have the opportunity to raise a subject of enormous importance to my constituents in Eastbourne, Willingdon and East Dean. This is far from the first time I have raised this topic in the House, as I have asked parliamentary questions about it, participated in debates and even had a meeting about it with the previous Prime Minister.

On 20 December last year, the local primary care trusts decided to remove consultant-led obstetrics and the special care baby unit from Eastbourne and to establish a single site at Hastings. Only last Wednesday, I raised that issue with the current Prime Minister at Prime Minister’s questions. In his reply, he claimed that those changes were recommended by local doctors and were in the interest of patient safety, but I have to tell the House that the Prime Minister was grossly misinformed. Prime Ministers are busy people, so I would not expect him to have all the local details readily at his fingertips, but someone misled him. Every single general practitioner in my area—more than 100—and many consultants are firmly against the proposals. Particular credit should go to Dr. Simon Eyre, a member of the local PCT, who broke ranks at the crucial meeting and set out in great detail why he now opposed the decision.

In recent years, two respected consultant gynaecologists—Vincent Argent and Kent Ayers—left the local hospital trust, in part because of the proposals; the consultant advisory committee at the Eastbourne district general hospital has come out publicly against the proposals; paediatricians who recently met the PCT were against them; and at least three of the eight current consultant obstetricians were against them, too. Remarkably, a previous high profile and early supporter of those proposals, Mr. Mark Malak, the leading gynaecologist, withdrew his support and asked that his comments in support be withdrawn from the official documents circulated to the public, although that did not happen. The East Sussex LMC—local medical committee—representing all GPs in the county opposed the proposals and as recently as 5 December my local PCT’s own professional executive committee voted for two sites for maternity services.

Only today, I heard from Mrs. Scarlett McNally, a consultant orthopaedic surgeon at Eastbourne DGH. She produced a letter yesterday objecting to the closure, which has already been signed by 34 consultants from across the range of specialties. Let us therefore put to bed once and for all the absurd spin suggesting that the proposals are somehow backed by, or even originated with, local clinicians. It is simply untrue. It seems to me that NHS bureaucrats, and possibly Ministers, are seeking to use local doctors as a human shield in this situation.

I want to pay tribute to the excellent campaigns running in parallel in my constituency and in Hastings—the Save the DGH campaign in Eastbourne and the Hands off the Conquest campaign in Hastings. I would particularly like to single out Liz Walke, one of my constituents, who has done a wonderful job in leading the campaign from the front, helping to organise marches, protests and petitions. Between them, the petitions have attracted some 80,000 to 90,000 signatures across Eastbourne and Hastings. The fundamental principle that has always driven our Hands off the Conquest campaign is not one of beggar my neighbour or competition with each other to be the one to end up with a full maternity unit. Rather, in meeting the health needs of our local populations, we believe that it is broadly right that we continue to have full maternity units in both Eastbourne and Hastings.

I also want to take the opportunity to thank neighbouring colleagues who have worked closely in support of our campaign: my hon. Friends the Members for Wealden (Charles Hendry) and for Bexhill and Battle (Gregory Barker) and the hon. Member for Lewes (Norman Baker). They have all been extremely supportive, while in one or two cases fighting their own border disputes in relation to facilities affecting other parts of their constituencies.

I remind the Minister that the biggest single issue is the 21 miles of poor roads between my local hospital and Conquest hospital in Hastings. National guidelines suggest that in the case of an emergency Caesarean, the ideal time from decision to incision—as the expression goes—is less than 30 minutes in the most urgent cases. Lord Darzi, I believe, suggested 10 to 15 minutes in his review “Healthcare for London”, and I understand that in a recent edition of “Woman’s Hour” the president of the Royal College of Obstetricians and Gynaecologists recommended a maximum time for transfer of 20 to 25 minutes. In a recent interview on BBC Radio 2, no less a person than the Secretary of State for Health said

“You shouldn't be going 20 miles. Twenty miles is a bit far.”

I entirely agree with him.

It is precisely because of the dangers posed by a journey that can take an hour or more—as long as an hour and a half, depending on the traffic and the time of day—that we have been so concerned about the proposals from the outset. It emerged at an early stage in the consultation that the projections for journey times issued by the NHS locally were based on off-peak travel, but, having made the journey myself, I can tell the Minister with total conviction that it can take much longer than that.

Last week I raised with the Prime Minister the case of little Hermione Bateman. Hermione was born in my constituency in the early hours of new year’s day, some 11 weeks prematurely. She was delivered in the family bathroom by her mother, while her father waited outside for the ambulance to arrive. Fortunately she was rushed to our local district general hospital and into the accident and emergency unit, where she received specialist care. She survived, and although she has had a rough time, she is still with us and doing well. I believe that if she had had to be taken all the way to Hastings in the middle of the night, she could not possibly have survived—and that is just an example of the sort of thing that may well be happening 15 months from now.

Nor are we simply talking about the health and well-being of newborn babies. In an e-mail, my constituent Mrs. Jane Booth-Clibborn wrote:

“In March 2006 my daughter suffered an abruption in the 30th week of her pregnancy. She was rushed to the DGH where I was told that it had not been possible to save the baby but that they would do all they could to save her. Thanks to the medical and nursing team’s prompt and skilful actions she survived but it was a close-run thing. Had she had to be taken to Hastings she would not be here today.”

I am sure that there are many other examples that I could quote.

Clearly the proposals must involve, if nothing else, a higher risk of deliveries en route to Hastings. Even according to the primary care trust’s own projections, there could be as many as 100 a year, which cannot be good news for patient safety. Buried in the decision made last month was a proposal for ambulance crews to receive intensive training in acute obstetrics. Could there be a clearer admission that more babies will be delivered in the back of ambulances?

As part of my routine on Christmas morning I visit the emergency services, and as always this year I visited the local ambulance station. The crews whom I met were less than impressed with the suggestion that they should be trained to deliver babies in the back of ambulances on the way to Hastings. As I see that the hon. Member for Hastings and Rye (Michael Jabez Foster) is present, let me stress that the objection would be exactly the same the other way around. It is not as though there is a problem with existing maternity arrangements in East Sussex, as the Healthcare Commission’s findings back in November show. The proportion of local women surveyed who said their care was excellent, very good or good was 90 per cent. during pregnancy, 88 per cent. during labour and birth, and 76 per cent. after birth.

At the recent joint meeting in December, the two PCTs made two crucial decisions: for the single siting of consultant obstetrics and the special care baby unit; and for that site to be in Hastings. I have explained how the first decision flies in the face of the evidence. I can only imagine the relentless pressure that was brought to bear, particularly on the non-executive members, to come to that decision. In fairness, it should be noted that one or two of them did speak up against the proposals. Had one more voted the other way, the proposals would have been sabotaged. The non-executive directors are meant to speak up for local people, but in this instance they failed to do their job.

However, the second decision—to single-site in Hastings—is even more inexplicable. The arguments about distance are, of course, precisely the same; that is why we have always argued to retain two sites. The deciding factor in favour of Hastings appeared to be social deprivation. The latest figures for deprivation in the whole county are depressing, and they are not simply a Hastings phenomenon. Those figures came out only a couple of days ago, and it seems that the national ranking for multiple deprivation has increased for every district in East Sussex; in other words, multiple deprivation has increased in all parts of East Sussex since 2004.

There is often an assumption, particularly by this Government, that East Sussex is a wealthy, well-to-do and fortunate county. No doubt that is why we are so badly funded for older people’s services, even though we have the highest proportion of over 85-year-olds in the country, and it might suggest why this blatant attempt to save money is directed at our facilities. However, I can tell the Minister that there are some significant areas of deprivation in our county—she is extremely welcome to come to the sunshine coast and see for herself. Some of them are in my constituency, and there are some in Hailsham, and other Members can talk about their constituencies. Almost 67,000 of the county’s residents are income-deprived, and just under 25,000 experience employment deprivation. Eastbourne has dropped in the national ranking by 13 places since the last figures for deprivation were produced, nearly twice as much as Hastings, which has dropped seven places. There are pockets of serious deprivation across the county, including in my constituency—in Devonshire ward, for example.

It is also significant that, despite the unfair image Eastbourne sometimes has in the outside world, there are more births per year in Eastbourne and they are set to rise, not least because of high rates of migration to the town, from Poland and elsewhere. The evidence is that there are more induced births, Caesarean operations and admissions to the SCBU in Eastbourne. I understand that that is largely owing to first-time mothers being on average older. The fact remains that both hospitals have high safety ratings.

The other argument deployed is that larger units are somehow safer, but a single siting at Hastings would not necessarily mean that that unit would benefit from dealing with the existing combined total of births delivered at the two units. It is clear that more women would opt to go to Brighton, Crowborough or Haywards Heath or to have home births, rather than travel to Hastings.

What would be the effect of the large new development at Pembury, which is bound to have a disproportionate effect on Hastings because of the geographical proximity? In another part of last week’s answer to me, the Prime Minister said:

“There are six new hospital developments in the whole of the region”.—[Official Report, 16 January 2008; Vol. 470, c. 922.]

Well I do not know where they are. The only one I know about that is in any way close to affecting us is Pembury, unless the Prime Minister is suggesting that pregnant women from Eastbourne go to Oxford, Milton Keynes or wherever else in the region is fortunate enough to be getting a new hospital. What we do know is that the Pembury development is going to happen, because that announcement has been made, and that it is likely to take flows of patients away from Hastings.

I do not wish to say much about the process involved in coming to this decision. I have called the consultation a sham before in this House, and nothing has happened in the interim to make me change my mind. It is worth reminding the House that as long ago as November 2006, the medical director of the hospitals trust, Dr. David Scott, was unwise enough to appear on TV to say that a decision to single-site had been taken six months previously. One therefore wonders why we wasted the time, effort and money in the interim having a public consultation that has not made a blind bit of difference to the outcome.

It is also worth making the point that the way in which the consultation has been conducted has been to downplay consistently the overwhelming view of the public and of local doctors, to rubbish to proposals set out in option 5, which had been produced carefully by a combination of local people and clinicians on behalf of our campaign, and in effect to argue that mass opinion as expressed at public meetings and in petitions was somehow less important.

In a masterpiece of drafting, the PCT produced an analysis of the consultation exercise in a document, which contrives to minimise almost entirely the overwhelming public and medical opinion in the area. In the latter stages of the consultation, as it became increasingly apparent which way the wind was blowing, the PCT was at pains to say that this process was not a vote as such and that it was just about asking people’s opinions. Call me old-fashioned, but if one is asking someone’s opinion on anything, one assumes that there is some purpose to doing so.

It is possible that there will be an application for judicial review. If there is, that will be the time to go into detail about the procedures that have been adopted in this case. I should perhaps tell the House that only last week, Eastbourne borough council voted unanimously, on a cross-party basis, to support the legal costs involved in a possible legal challenge. Incidentally, such a process might also be a good opportunity to investigate precisely how much ministerial interference there has been in the decision for a single siting and, in particular, in the decision for the site to be located in the marginal Labour-held seat of Hastings and Rye.

It is difficult to overstate the callous indifference to local opinion, the cynical manipulation of the consultation process and the ruthless determination to deliver a preset agenda that have all been exhibited by NHS bosses. Let me tell the Minister that it will take a long time to restore a sense of trust and confidence among my constituents in the people who are running our local NHS—indeed, there was a unanimous vote of no confidence in the PCT at our last march. I urge Ministers to re-examine this decision, taking into account all the aspects that I have mentioned and perhaps others besides. It may well be appropriate to refer this matter to the independent review panel.

Next Monday, East Sussex health overview and scrutiny committee will meet. I will be amazed if it does not vote to refer the matter back to the Secretary of State. I am a little unsure—perhaps the Minister can tell me—about the procedure to refer the matter onwards to the independent review panel, but that sounds like a good idea to me.

To conclude, the changes are not wanted by patients, doctors or local people. They are not based on patient safety or patient choice. They are based, I believe, on money and politics. A shameful decision has been made and, as a result, the lives of some babies and some mothers will be put at risk.

I congratulate my hon. Friend the Member for Eastbourne (Mr. Waterson) on securing this important debate. I am grateful that a number of us will have a chance to contribute.

I agree with every word that my hon. Friend said. He has expressed perfectly the views of local consultants, GPs, the public and the local media. They have all been simply appalled by the decision to downgrade the facilities at Eastbourne district general hospital. I join my hon. Friend in commending the campaigns that have been run by Liz Walke and Margaret Williams on behalf of both hospitals. They have made sure that this has been one united campaign to put the case for the hospitals along the East Sussex coast.

People in my constituency, which is right next door to Eastbourne, are mystified about how the decision has been reached. The area is fast growing. Hailsham is one of the biggest towns in inland East Sussex, and its residents would have a similar journey to the one outlined by my hon. Friend if they were required to go to Hastings or Brighton to have their babies. They are deeply concerned about that. In most cases, everything would be all right, but there would undoubtedly be anxiety at the time. A number of cases would be borderline, and some, we believe, would result in tragedy.

In Sussex, we have an outstanding ambulance service. Paul Sutton, who runs it, is one of the most outstanding public servants I know, as well as one of the most inspirational public figures in the health service. Those in the ambulance service tell us openly that they are good at dealing with a stroke, a cardiac arrest or a road traffic accident, but they do not have experience in dealing with pregnancy complications. The Minister might say that they will be trained in those areas, but the whole argument has been that maternity cases should be dealt with by people who have a specific expertise in the subject and who have sufficient throughput of cases to ensure that that expertise is enhanced daily. Relying on the ambulance service to deal with the most borderline and marginal cases is not the right way forward.

The decision also overlooks the fact that the part of the county affected will grow rapidly. We expect 10,000 new houses to be built in Wealden over the next 20 years, the bulk of which will be built in the area around Hailsham, Polegate and Willingdon. Further south are the south downs, while further north is the area of outstanding natural beauty—both areas are protected. We know that the population will grow. My constituents do not understand why, when we are experiencing such pressure from new housing and population growth, important public services, such as maternity services, are being reduced and downgraded.

Let me say a little about the process. When it started, I called on the East Sussex Downs and Weald primary care trust and the West Sussex primary care trust to carry out a joint analysis of the case. This point is particularly relevant to the hon. Member for Lewes (Norman Baker) and his constituents, as well as mine. Our constituencies are right on the border of East and West Sussex. We were told that that joint analysis was not necessary, that they could readily follow on from each other and that the two were significantly separate. However, we have ended up with a big question mark hanging over the Princess Royal hospital in Haywards Heath, which is where people from Uckfield and the surrounding area in my constituency go to have their babies delivered. If that hospital were downgraded, which is possible, those people would prefer to go to Eastbourne rather than anywhere else. However, the fact that the decision about Eastbourne was made first means that that option is not available. If we were to lose the Haywards Heath facility, the 20,000 people in Uckfield would have to rely on the hospitals in Hastings or Brighton.

I would love the Minister to join us in an attempt to drive into Brighton in the rush hour. It would not matter whether we started in Eastbourne, Hailsham or Uckfield, because she would quickly understand why the drive is simply not an option for a pregnant woman in an emergency. It is possible to reach the outskirts of Brighton quickly enough, but it can take another 30 or 40 minutes to get from there to the hospital in the city centre. The service is simply not good enough, and that is a source of profound concern to people expecting to give birth—a moment that is likely to be one of the most important in their lives.

A further concern has to do with the conduct of the meeting at which the decision was made. It took place in Uckfield, in my constituency. We were told at the outset that it was not a public meeting, but that it was a private meeting being held in public and that members of the public were therefore not allowed to speak. However, especially unattractive was the sight of a bouncer—6 ft 4 in tall, and 20 stone in weight—who had been hired to shut up members of the public who dared to speak.

The people who attended were predominantly elderly. They included midwives, nurses and GPs, and there were also a couple of Members of Parliament and a bishop in the hall. When my hon. Friend the Member for Eastbourne tried to address the meeting, the bouncer moved him to one side, but most despicable of all was having to see the Bishop of Lewes—a completely non-political figure, who speaks with passion about the community that he serves—also being moved aside when he attempted to speak at the end of the meeting.

I remonstrated with the bouncer afterwards. We expect such behaviour in Zimbabwe, where bishops are regularly beaten up on behalf of the Government, but what have we come to in this country when a public quango has to be defended from a bishop by a bouncer? I hope that the Minister will agree that it is not acceptable for decisions to be reached in the way that I have described. People were rightly angry at the decision that was made, but the way it happened was an appalling abuse of power.

I wrote to the PCT chief executive to remonstrate, and he responded by defending the right to have a bouncer present. For me, however, the fact that such a meeting could be conducted in that way will remain as one of the most horrific and abiding images of my time as a Member of Parliament.

My constituents feel a great sense of confusion about why we are having this debate at all. We are in the 21st century, and Britain is the sixth richest country in the world. The south-east contributes more to the country’s wealth than any other region outside London and, given our rapidly growing population, we should be investing in our health and maternity services and not allowing them to be run down.

We appeal to the Minister to say, even at this late stage, that she believes the decision that has been taken is wrong. If it is referred to her, we hope that she will overrule it, as it is categorically wrong for all constituents across east Sussex.

I am grateful to have this unexpected opportunity to contribute to this debate, and I apologise that I was not here when it began. Most especially, I apologise to the hon. Member for Eastbourne (Mr. Waterson) for not seeking his permission to speak, but I did not know that I would have the chance.

I sympathise with what the hon. Member for Eastbourne has said, and he is right to suggest that I would be jumping up and down, screaming and behaving in an antisocial manner if the decision had gone the other way. With respect to him, however, he is wrong to suggest that the decision was in any way political. When the matter came up for debate, I approached Ministers and said, “Will you make sure that we do not lose our maternity facilities in Hastings?” They replied, “No, this is a matter for the PCTs. We will get involved only if the matter is brought to our attention subsequently.”

I am convinced that the judgment was not a political one. Indeed, I suspect that most members of the PCTs involved are card-carrying Tories. I know for certain that the chairman of the Eastbourne Downs PCT and some of the executive directors are leading Conservative figures, so it is bizarre to suggest that this was a political judgment. It may or may not have been right, but the idea that it was a Labour Government fix is entirely wrong. I hope that my right hon. Friend the Minister will discount that view entirely; it is simply not the case.

It is important to know the history. Some time ago the hospital trust decided—the hon. Member for Eastbourne referred to this—that it would like to operate on one site. It decided that that site should be Eastbourne, because there was a business case for that. It took the view that if prospective parents lost the Eastbourne site, they would go to Brighton or somewhere else whereas parents from Hastings would have no choice. The business case was to have the site in Eastbourne, and I was outraged by the suggestion that finances should somehow affect the judgment of social need.

Many of us believe that the right answer was to try to see whether it was possible to have a double site—a continuation of the site in Eastbourne and a consultant-led service in Hastings. That would have been my preferred option if it had been possible. Much of the campaign was about that. However, with respect to the hon. Member for Wealden (Charles Hendry), his local council voted in favour of a single site in Eastbourne. There was no unanimity. I hope I am wrong, but I believe that the council in Lewes also voted for a single site in Eastbourne.

Perhaps I am wrong; I do not know. However, local authorities at one end of the county took one view while authorities at the other end took another. There was a bit of a turf war and not quite the unanimity that the House has been led to believe there was.

The real issue is whether the right decision was taken. Who should have received the benefit of the consultant-led service? There is no equality of value in the two claims. If it had been possible, I would have been happy to have had an Eastbourne consultant-led service and a Hastings consultant-led service, but I know that the Government are keen to improve maternity services and that they want greater coverage of consultants. We therefore asked the royal college a number of questions, and the answers that I heard were that there were no significant differences in the safety between small units of 1,500 and 3,000. That is an argument in favour of two sites, but the answers also said that there would be significant difficulties in recruiting and retaining consultants at very small sites. I do not know whether that is right or wrong, but that is what was said and it was a proper consideration for the PCT to take account of when deciding whether one or two sites would be feasible.

Of course we would like two sites but if that is not feasible, one has to make a judgment on where the site should be. If the trust came to the view that there should be single site, I unashamedly believed that that site should be in Hastings. Why? It is not simply a question of social needs. The hon. Member for Eastbourne referred to the social needs of Eastbourne, and I am sure that there are pockets of deprivation there. However, Hastings is the 29th poorest town in Britain. The social needs are so significant that it would be bizarre to suggest that Eastbourne should be preferred to Hastings on social grounds. That is nonsense.

I understand that Liz Walke and Margaret Williams, the leaders of the campaigns, did sterling work—Margaret Williams in the Hands off the Conquest campaign did exceptionally so—and I suspect that they reached an agreement that they would not give way on the two-site option. However, the PCT came to the view that there had to be a decision for one site. Once that was made, Hastings was clearly the right choice, and not just because of the social needs of the 29th poorest town in Britain

There is also the problem of the difficult geography. Getting 21 miles along the Marsh road is a challenge, although the word “challenge” might be a euphemism. It is almost impossible to do the journey at the wrong time of day. It is a problem and we need to consider how it can be resolved. However, the geography is also in Hastings’ favour. My constituents do not all live in Hastings; they live in Rye, Camber, Iden and to the east of Hastings, where they would have no option if they were required to go to Eastbourne in an emergency.

I understand that the decision to save the accident and emergency departments at Hastings and Eastbourne, which was made some time ago, is an important factor. If there is proper training, true childbirth emergencies at the Eastbourne end of the county can be dealt with in accident and emergency, although that is not the preferred option. No one would go past an accident and emergency entrance if a mother was in distress. That is what I am told, but I would like the Minister to comment further on that, and to confirm whether that is the case.

The hon. Gentleman is making an important point. Assuming that the loss of maternity services does not have a domino effect on accident and emergency and paediatric services in my local hospital, he is right to say that there is a real issue at stake: anaesthetists and those who are not gynaecologists or obstetricians may have to deal with difficult issues such as caesareans and related complications simply because there is not time to get the mother to Hastings. Does he agree?

Yes, I agree that it is important that an arrangement be in place, so that there are facilities for dealing with such emergencies in the accident and emergency departments, which will continue to exist. Of course, that is not the first choice, because although it may well save the mother’s life, the chance of saving the baby’s life is smaller, unless expertise is readily available. That is understood. However, such cases are exceptional, although I do not say that the issue is unimportant. It is wrong to suggest that they will be a regular occurrence; they are exceptional occurrences, but we have to consider them when designing the scheme. I am sure that the hon. Gentleman has already written to the PCTs and the hospital trust, as I have done, to ask them what arrangements they intend to put in place to ensure that such emergencies are covered, if and when there is a single site—and it appears that there will be a single site in Hastings.

Of course it is disappointing if it is decided that there must be a single site, but we must consider what will happen if that judgment has been made, and made properly. I believe that the consultation was very thorough. I am sorry to hear about the problems in the final meetings, and they need explanation, but the consultation was certainly long and thorough. The Government kept out of it completely. I have to say that I have a view about that: I would not leave the matter to the PCTs. I would have the judgment made by Government, but that is not how it is. That is not how things happen these days. We have to rely on the PCTs, and they came to that judgment.

If the Minister accepts the PCTs’ decision to have a single site, and if the Government’s ambitions to improve maternity services and ensure greater consultancy cover make that inevitable, the PCT was right to decide that it should be in Hastings, but that should not be the end of the debate. The debate should now be about finding a way to ensure that those at the other end of the county in Eastbourne receive the back-up that is necessary if we are to ensure that there is no loss of life or discomfort as a result of the changes.

I am pleased that the debate started early, as it gives me the opportunity to contribute. I apologise to the hon. Member for Eastbourne (Mr. Waterson), but I was caught slightly unawares and was two minutes late for the start. He and I do not agree on much, but we happen to agree on this subject, and I agree almost entirely with his comments this evening.

Let me deal with the point about politics that the hon. Member for Hastings and Rye (Michael Jabez Foster) made. I do not know whether politics has played a part or not, but he is most insistent that it did not. I have no evidence that it did, but I point out to him that the recommendations resulting from the consultations on health services in East Sussex and West Sussex mean that facilities in the very few Labour seats in the area will be left intact, while those in Conservative seats and those that my constituents use will be lost. It is therefore not surprising that on that evidence, some people have reached the conclusion that politics may be a factor. Of course, it may be a complete coincidence, but that is the conclusion that they have reached.

I am disappointed by the contribution of the hon. Member for Hastings and Rye. Of course he must stand up for his constituents; all of us in the House must do so. If we do not stand up for our area, who will? I thought the hon. Gentleman had recognised the value of the two-site option, but he seemed to be moving away from that in his contribution this evening.

The campaign was extremely effective and embraced all sections of the community, which was heartening for all of us who believe in democracy and people power. I do not believe that the campaigning by Liz Walke in Eastbourne and Margaret Williams in Hastings was tactical. I think the campaign was based on an analysis of the facts and a genuine belief that a two-site option was the best solution for those involved in the health service and particularly for expectant mothers. That is what has been driving the campaign, not some sort of back-room deal to try to keep two sites going.

The hon. Member for Hastings and Rye argued, rightly, that his constituents east of Hastings—his constituency stretches quite a long way east of Hastings—would have difficulty reaching Eastbourne. That is true, but there are constituencies west of Eastbourne—not least of all mine—which face a similar situation. I have constituents in Seaford, the biggest town in my constituency with 25,000 people, who are seeing maternity services at what they regard as a local hospital taken away from them. I have large numbers of people in Polegate who regard Eastbourne as their local hospital and who are seeing maternity services there taken away. I have in my constituency villages such as Alfriston, where people would take a similar view. They are to the west of Eastbourne.

What are the alternatives for my constituents? As the hon. Member for Wealden (Charles Hendry) correctly said, a parallel, but not connected, process is going on that is leading to consideration of the maternity services at the Princess Royal hospital in Haywards Heath. Many of my constituents will look to Eastbourne or to Haywards Heath, but not particularly to Brighton, and they may find out that both Eastbourne and Haywards Heath are losing maternity services. It is a disgrace that there has been no connection between those two processes. The case for a connection was made early on, but as the hon. Gentleman rightly said, a disconnect was put in place so that no proper consideration has been given to the impact of the closure at the Princess Royal, if it goes ahead, on constituents in my part of the world or, I am sure, in Eastbourne and Wealden.

The consequence if both go—it looks as though the Princess Royal at Haywards Heath may also lose its maternity services—will inevitably be to put more pressure on Brighton. As has been said, access to Brighton is extremely difficult. Nobody in their right minds would build the hospital where it is. They would build it on the outskirts, connected to the trunk road system. Instead, it has been built—some of it is pre-Nightingale—bang in the middle of town, on a very constrained site with little space for development other than upward. The site is difficult to access and already suffers extreme pressure. There are long delays at accident and emergency in Brighton, and sometimes at maternity services in Brighton. It not at all unknown for expectant mothers who turn up at Brighton to be referred elsewhere. It is not clear where they will be referred to in future if we have lost Eastbourne and Haywards Heath, and if we lose Worthing on the other side. Where will those expectant mothers go?

The capacity of Brighton is a serious issue which I do not think has been factored into the decision by the primary care trust. If it has, it has been factored in incorrectly. I hope the Minister will pay attention and have regard to the situation at Brighton, which is entirely relevant to the future of the Princess Royal’s maternity services and those at Eastbourne.

The hon. Member for Hastings and Rye spoke about the medical professional advice. Of course the primary care trust and Members of Parliament must have due regard for that advice, which is extremely relevant and pertinent. There is a belief that in some ways it is safer to have a single site than two sites. I understand that argument, but it is not overwhelmingly convincing. There are medical experts on the other side who believe that a two-site option is safer. The judgment is at least marginal.

What is not marginal, as the hon. Member for Hastings and Rye recognised, is that the travel distances across East Sussex to get from Eastbourne to Hastings or to get from Seaford to Hastings, to Haywards Heath or wherever it happens to be are extensive. I hesitate to say this as the hon. Gentleman might use it later, but the road from Eastbourne to Hastings is, as he says, not the most satisfactory road in the world for someone in an ambulance or for an expectant mother who has to get somewhere quickly. We all recognise that, yet people will have to rely on that road. It is no use the hon. Gentleman saying, “Well, we can sort it out in retrospect or bolt on something once we have decided to take away Eastbourne’s A and E.” That will not happen and he knows it. It is a county road and no way will the county council spend millions and millions of pounds to solve a problem on the A259 which has been exacerbated by the removal of a health service from Eastbourne. That simply will not occur.

It being Seven o’clock, the motion for the Adjournment of the House lapsed, without Question put.

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

If the maternity department at Eastbourne goes, the consequences will be clear. People will be taken in ambulances and there will be more births en route—I referred to that in an oral question to the Secretary of State for Health a couple of months ago. We will have to ask ambulance service staff to exercise and demonstrate skills in which they have not been trained and which we should not expect them to acquire. Ambulance staff are wonderful—the paramedics and their ambulances are first-rate—but they cannot do everything and deal with every single complication, and some of the situations that arise will be extremely complicated. We should not ask them to do so.

I turn briefly to the process. I agree with the thrust of the comments made by the hon. Members for Eastbourne and for Wealden. What has not been mentioned so far is that on the day of the meeting in Uckfield, the strategic health authority was meeting in Horley, expecting to ratify the local primary care trust’s decision. So secure were the SHA representatives in their knowledge of what the primary care trust was going to do that they had the recommendation, which had not even been discussed by the PCT, in front of them and were even prepared to meet early, before the PCT had reached its decision. The SHA representatives sat by the phone; as soon as it rang, they immediately ratified the PCT decision without much ado. If we want a definition of a rubber stamp, that is it.

I should also point out that in theory the SHA meeting was public, but even if the roads between Uckfield and Horley had been fantastic, people would not have been able to travel between both places in no time at all to be represented at both the PCT and the SHA meetings. Plenty of people wanted to be at both meetings, but they could not be. That is a travesty of democracy and an insult to the public. It is a way of saying, “The public consultation doesn’t matter. We’ve got our little deal behind the scenes and are going to push it through. If you can’t get there, that’s tough.” That is an insult to all those people who have marched through Eastbourne and elsewhere, attended public meetings and signed petitions. Frankly, the Government should tell the PCT and SHA to conduct themselves in a more seemly manner. The hon. Member for Wealden mentioned the bishop and the bouncer—the soundbite of the debate, and rightly so. It is appalling that a bishop and Members of Parliament can be shoved aside by a bouncer acting on behalf of an unelected quango that has made a decision that has no public support in the area that it is supposed to represent.

I hope that the Minister will not trot out the usual stuff about this debate being about a PCT decision that is taken in everybody’s best interests. That is not how it seems in East Sussex. I hope that she will listen to the voices coming not only from my constituency and those of the other Members here, but from many thousands of people in East Sussex who have participated in a consultation exercise in good faith, done their best to make their case and put together an extremely good case, but have been thrown aside in a process that has treated them with contempt.

I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing this debate about the future of national health service maternity services in East Sussex, a matter of great concern to him and his constituents. Like the other hon. Members who have spoken in this debate, he has raised the issue repeatedly. I appreciate the comments that the hon. Gentleman and others have made. It is a testament to the enduring popularity and success of the national health service that we have institutions that are held so dear by the people whom they serve. As I am sure that the hon. Gentleman has repeatedly acknowledged and would want to confirm today, that is a huge compliment to the NHS locally and to those who work within it to provide the best possible care for their patients.

That means, however, that talk about potential change often triggers huge public interest and debate, which is of course important. I recognise that change can be difficult and acknowledge that it provokes powerful reactions. Nevertheless, I would say to hon. Members that having decided to devolve the decision on these issues to a local level, the consultation process must be left to take place without interference from Westminster. I understood that principle of devolution to be supported by Members from both Opposition parties who have spoken in the debate.

When people talk about the reorganisation of services it is often suggested that it is about money, as has been asserted today. Let us therefore be clear about the position of East Sussex Downs and Weald primary care trust. In 2006-07 and 2007-08, its budget was increased by £70 million, it is 2.6 per cent. above its fair funding allocation, and in 2008-09 it is to receive an extra £25 million. It is not about money, nor is it about politics—that is, frankly, a ridiculous proposition. It is interesting how, when we respond to debates on different parts of the country, the allegation of political interference that Opposition parties make against the Government flexes in terms of whether they are in favour of or against the decision.

I know that my hon. Friend the Member for Hastings and Rye (Michael Jabez Foster) was disappointed by my reply when he and other Members from the area wrote to me asking to make representations to me before the local process has been completed. I have been clear that I am unable to meet to take those representations and express an opinion while the process continues.

It is not about politics—it is about saving more lives, providing better, safer services, and making care more convenient. That desire to see better outcomes for patients—increased safety and quality in care, allied with increased funding—is ultimately driving considerations of change.

I wonder whether I could make a little progress. It has been a long debate. I will gladly give way to the hon. Gentleman if he will first let me finish this point.

For example, some doctors have told us—it has been touched on in the debate—that specialist care needs to be concentrated in centres of excellence so that clinicians have the right expertise, experience and equipment and can treat those most in need quickly, safely and conveniently. Delivering the best possible services for all women and their babies will mean that changes will have to take place.

I am mystified by the Minister’s reference to convenience. Closing down a hospital or a service and requiring people to go an extra 20 miles can scarcely be more convenient. During the first Sunday in June last year, the maternity facility at Eastbourne was full and had to close, and by the end of that day the maternity facilities at Hastings, Haywards Heath, Crowborough, Brighton and Worthing had also closed to new mothers. How can she say that we have to centralise these things when, on occasion, we do not have enough capacity at the moment?

I am not saying, as the Minister, that we should centralise these services—I am advancing to the House the argument that is put to the Government by clinicians and those who are expert in this area, and setting the scene.

Pregnant women talk about the services that are most convenient to them, as they have always done. Those services might be home delivery or midwife-led services, and where necessary, they might involve the centres of excellence we are talking about. I also have to say that this is one of the safest countries in which to give birth; the quality of services and the changes being made have continued to build on that excellence and safety. I absolutely accept that the point of today’s debate is to consider the proposals being put forward relating to this change and whether it will deliver the best possible service for all women and their babies in that area.

That is precisely why the Government published “Maternity matters: choice, access and continuity of care in a safe service” last year. It is our strategy and our intention to modernise maternity services, placing safety, quality and the improvement of standards of care at the very heart of our vision. That is exactly what the Government have always said to this House. The process of improving services is continuous; it means that we have to look to the next stage review, which includes a specific maternity and newborn care pathway, in taking this forward.

I listened very carefully and with great interest to the points made by hon. Members on the consultation on maternity services in East Sussex, which I understand had been going on since 26 March, and ended on 27 July 2007. I also understand that, following consultation, East Sussex Downs and Weald PCT and Hastings and Rother PCT, referred to by my hon. Friend the Member for Hastings and Rye, announced on 20 December last year the decision to develop a single-site option for consultant-led services in East Sussex based at the Conquest hospital in Hastings. The special care baby unit and in-patient gynaecology services will also be based on the same site.

Under those proposals, Eastbourne hospital would continue to provide a midwife-led service—across the entire NHS, most women have an experience of giving birth safely and with support thanks to such services—and, in conjunction with the East Sussex Downs and Weald PCT, it intends to increase the provision of community midwifery services throughout East Sussex. It will do so to ensure that women do not end up going to hospital when they do not need to, and that they are supported in their homes. I am sure that the hon. Member for Eastbourne would support that.

We have always been clear that changes to service provision should be initiated only when there is a clear and strong clinical basis for doing so. I absolutely acknowledge that there might not be 100 per cent. agreement, and that doctors may have differing views, but in this instance the clinical case for change was based on the ability of a single, larger unit to provide safer, better-quality services, and on concerns about the sustainability of consultant-led services at the Conquest and Eastbourne sites. There was a recognition of the challenges, and the fact that they needed to be addressed.

Will the Minister say whether she believes that that clinical assessment took into account the objections raised by hon. Members in this debate, including the difficulty of travelling and the capacity problems at Brighton?

I shall come to the hon. Gentleman’s point when I deal with the point at which the decision becomes a matter for Ministers to consider, as opposed to when the process of decision making and consultation is dealt with locally. I know that he has been a great champion for the devolution of decision making in a whole range of policy areas, not just the health service, and that he accepts the principle in this case. I accept that he is totally dissatisfied with the outcome of this process. However, the principle must be, as the Government clearly set out, decisions and consultations undertaken locally and based on local opinion, need and advice to ascertain what is best for that area. I will deal with what the process will deliver next shortly.

As my hon. Friend the Member for Hastings and Rye said, in evidence to the East Sussex health overview and scrutiny committee the Royal College of Obstetricians and Gynaecologists said:

“It would be very hard for a unit delivering under 2,000 births a year to offer adequate training opportunities for junior doctors”.

Neither the Conquest nor the Eastbourne sites currently deliver 2,000 births a year.

Furthermore, the East Sussex PCTs established a new options panel in response to the points that were made locally in the consultation about different approaches. The hon. Member for Eastbourne mentioned that. The new options panel was independently chaired by Professor Stephen Field to appraise clinically all the emerging alternative options that were submitted during the consultation. They included an option submitted by local campaigners for a consultant-led service on both sites. I have been informed that it was given full consideration by the PCT boards but did not prove to be the preferred option.

I am aware that the hon. Members present in the Chamber played an active role in the consultation process and I appreciate that they are dissatisfied with the outcome. They have made their feelings clear. However, reconfiguring the service will enable the local NHS to maintain safety and allow a single, bigger unit to offer improved quality of service at the Conquest hospital in Hastings. The Eastbourne unit will continue to provide ante and post-natal clinics and midwife-led care.

As the hon. Member for Eastbourne knows—he referred to the matter—the decisions made by the PCT boards are subject to scrutiny by local authority overview and scrutiny committees. That has not happened yet. Those committees comprise locally elected councillors whose role is to consider issues that affect the health of local people. When the OSCs are unhappy with the consultation process, or do not believe that the proposed changes are in the interests of the local health service, they can refer the proposals to my right hon. Friend the Secretary of State for Health for final decision and, if necessary, to the independent review panel. Given that the meeting will take place on 28 January and that the outcome needs to go through a proper process of review and independent consideration, it would be incorrect for the Government—indeed, it would constitute the very political interference about which the hon. Member for Lewes (Norman Baker) complained—to express an opinion or make a decision while the democratic process is going on.

On that point of procedure, what criteria, based on recent experience, would make the Secretary of State unlikely to refer such a decision to the independent review panel? How many decisions get referred, proportionately?

I am happy to write to the hon. Gentleman specifically on that, but I understand that the Secretary of State has made it clear that decisions on reconfiguration that were not concluded would be referred to the independent review panel. I will ensure that that is correct and write to all hon. Members who have spoken in the debate. I know that, because of the expertise of the hon. Member for Eastbourne on such matters, he will understand that the process is independent, without political interference and based on revisiting all the issues, especially the clinical ones. The independent review panel is the final arbiter and the Secretary of State accepts its decisions. I think that covers the point that I was going to make.

What is obviously important, for every hon. Member who has spoken and for the health community in East Sussex, is, as the PCT has clearly said all along, to ensure strengthened antenatal and post-natal care across East Sussex, to develop more community outreach services and to ensure that pregnant women have access as quickly as possible to the high-quality intensive care that may be necessary. We are all required to ensure that maternity services remain a priority in East Sussex. I am sure that the hon. Gentleman will join me in welcoming the proposals regarding more support in the community for those parents who choose it, and access to the midwife-led units.

My final comment is about the various issues that the hon. Member for Wealden (Charles Hendry) raised with regard to a public meeting during a public consultation. He reported to the House that, in his opinion, the behaviour of some at that meeting would have been discourteous and inappropriate when directed towards any member of the public, let alone the person whom he cited. I have no knowledge of that, but it has now been raised. I certainly intend to take the issue away, because it is an entirely separate point, and to seek suitable explanations. Again, I will write to all hon. Members who have spoken on that, because if what the hon. Gentleman described turns out to be true, we would all want to be sure about how public consultations would be conducted in future by any public body, even in such difficult circumstances, where feelings are running high on both sides. Everybody—the PCT, Members of Parliament, the local community and the health community—is motivated to do what is best by those whom they serve. That is the principle that we must remember.

Question put and agreed to.

Adjourned accordingly at twenty-three minutes past Seven o’clock.