§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ioan L. Evans.]
§ 1.28 a.m.
§ Mr. Arthur Davidson (Accrington)
I am grateful for the opportunity to raise at this hour a matter which is of considerable concern to my constituents, and which has been for many years past. When the divisional medical officer of health describes the shortage of maternity beds in my constituency as being desperate, then I think that it is not out of place for me to ask my right hon. Friend the Minister of Health to take a further, and I hope, sympathetic look at the whole position of the maternity unit in Accrington.
Medical officers of health are not given to exaggerated talk or verbal flights of fancy, and the Medical Officer of Health for Accrington is no exception to this rule. So, if there were no other facts than the rather extreme language which he has used about the shortage of beds, I suggest that that alone would be sufficient for me to raise this subject tonight.
But, I shall try to show that there are other pressing facts of which I hope the Minister will take notice; and may I say here that I am extremely grateful to my right hon. Friend for coming here in person to answer this debate, and for the fact that he has given considerable attention to this matter previously. I am grateful, too, for the assurance from him that the views of my constituents will receive full consideration when future hospital developments are being considered.
The Minister, as we have heard earlier tonight, is a kindly man. I do not doubt that, but what my constituents want are more maternity beds, more up-to-date equipment, and the building of a new maternity unit. This, to compress the matter, is what my constituents are asking for. It is what they need and are entitled to if they are to receive the proper care and attention which an up-to-date Health Service should provide in this modern society.
What is the position in Accrington today? In the whole of my constituency 1358 there is only one maternity unit. That is at Rough Lee. Rough Lee has given admirable service over many years, but it is now out-dated and the building itself shows the signs of antiquity. For example, it does not even contain a lift to transport stretcher cases up and down. In this modern age I should have thought a lift was not exactly a technological wonder. Rough Lee has an even bigger imperfection, for it contains only 12 or 13 beds, a number totally incapable of meeting the requirements of those of my constituents who wish to have delivery in hospital.
To be fair, in addition to Rough Lee my constituents can use the maternity home at Bramley Mead, near Whalley, which has 25 or 26 beds, but Whalley is some distance from my constituency. Cases can be admitted to Queen's Park Hospital, in Blackburn, but many of my constituents would have to make three bus journeys to go there, thus causing delay, and adding to the expense.
The Minister will be aware of the Cranbrook Committee's findings that 70 per cent. of women should have their babies in hospital. Applying this to my constituency, the full gravity of the situation is brought home. In 1965, I am assured, there was a total number of 1,401 live and still births. On the Cranbrook figures, 980 of them should have been delivered in hospital. On the assumption that one bed can take 22 cases a year, there should be 48 beds, plus 10 per cent. more for emergencies and anti-natal cases. This would make a total requirement of 53 beds. This is a conservative estimate, for medical opinion inclines to the view that in North East Lancashire 80 per cent. of the cases in the area are proper hospital cases. Instead, we have the few beds at Rough Lee and such proportion of the Bramley Mead beds as are not required by patients from other districts. To make up for this deficiency, the practice of early discharge from hospital has become a habit. I am aware that there is medical opinion which says that on a scientific basis early discharge is a good thing, but the high percentage of early discharges in my constituency is not for scientific reasons but purely because of shortage of beds. During 1965, I am assured, 38 per cent. of women who were admitted to hospitals were subject to early discharge. I do 1359 not suggest that all were from my constituency, but they came from the surrounding area. This is a disturbing figure, the more so when it is realised that a high percentage of these early discharges were from Queen's Park Hospital, a unit which is supposed to be for cases with special factors requiring admission to hospital. The Minister will realise that these are the very cases where early discharge is undesirable on general principles.
Another disturbing fact which I hope—indeed, I am sure—that my right hon. Friend will take into consideration is the difficulty that can arise when, as sometimes happens, a case of infection occurs in one of the existing small units. In Rough Lee or Bramley Mead it is impossible to isolate a patient infected or suspected to be infected. In the past, to some degree by luck, the medical officer of health assures me, serious consequences have not ensued but this is an unsatisfactory situation and I hope that it is one that my right hon. Friend will bear in mind when he replies to the debate.
What, therefore, is the alternative? I think that my right hon. Friend is well aware of what we in Accrington want. We want a new unit, and I urge him to use such influence as he has to speed up the building of the new maternity unit which has been suggested for opposite Victoria Hospital. Only a new unit in Accrington would satisfy the very heavy demands on bed space, and the sense of urgency and of fear and alarm that my constituents have about the position. They will not be satisfied by the suggestion of a new hospital in Blackburn.
Lest it should be thought that I am overstating the case, perhaps I can read a telegram I have received:1,520 Mothers Union members of the Accrington Deanery support your request for maternity unit.I also have with me a petition signed by many hundreds of people in Accrington. Doubtless, had there been more time, many more signatures could have been added. I hope the points I have made have impressed upon my right hon. Friend just how urgent the problem is in Accrington and that he will be able to give some words of comfort to my constituents and institute some course of action as well.
§ 1.37 a.m.
§ The Minister of Health (Mr. Kenneth Robinson)
I have listened with great interest to my hon. Friend and from correspondence I have had with him and with others I know that there is considerable local feeling about this whole matter. I think that this was made clear from the way in which he spoke, and in the circumstances I am grateful for the moderation with which he put his case. I am glad to have this opportunity to explain the situation in some detail.
My Department and the Regional Hospital Board acknowledge the inadequacies of the existing Rough Lee Maternity Home in Accrington but, as is explained in the Hospital Building Programme, Command Paper No. 3,000, the planning and building of the proposed new maternity unit at Accrington Victoria Hospital has had to be deferred pending a thorough re-examination of the scheme.
I should first of all say that the hospital service for Accrington cannot be considered in isolation. Accrington falls within the catchment area of the Blackburn and District Hospital Management Committee and the whole of the hospital services, including maternity services, must be planned on a group basis so that an efficient service can be offered to the entire catchment area in the most economical way, both as regards capital provision and consequential maintenance costs. I hope, therefore, that my hon. Friend will bear with me if my remarks range somewhat wider than the specific points he has made.
Similarly, maternity services cannot be planned in isolation from other hospital services, as will be evident from a study of Command Paper No. 3,000, the new building programme published earlier this summer, and of Command Paper No. 1,604, the original Hospital Plan.
The whole concept of the district general hospital is based on the provision of comprehensive hospital facilities, including maternity facilities, on one site, so that everything needed to treat a patient for any contingency is immediately to hand. This is the basis on which the facilities for the Blackburn and Accrington district will be planned, taking into account particular local circumstances.
1361 For planning purposes, we are working on a 1981 population for the whole area of 260,000, of whom at least 40,000 will live in Accrington Borough. My estimate—and here my figures differ somewhat from one figure given by my hon. Friend—is that to serve the whole catchment area some 140 to 150 maternity beds will be needed by 1981, of which Accrington Borough will require some 20 to 25. At the moment there are only 107 beds for the whole of the Blackburn and district group of hospitals, 58 at Queens Park Hospital, 16 at Bull Hill Maternity Home, 22 at Bramley Mead Maternity Home and my figure is 11 at Rough Lee—my hon. Friend said that that figure was 12 to 13.
§ Mr. Arthur Davidson
The figure for beds needed which I was given related to the Accrington constituency which contains four urban districts in addition to the borough itself.
§ Mr. Robinson
That accounts for the discrepancy.
Rough Lee, as my hon. Friend said, is the only unit in the Accrington area and we acknowledge that Rough Lee is the least satisfactory of these units. Not that the accommodation is poor; I understand that the mothers of Accrington appreciate the homely atmosphere. The main objection to Rough Lee is that it is too small, is isolated from hospital and full consultant facilities in the area, and that there is little scope for improvements, even if it were thought worth while to embark on them. To some extent, this also applies to the rest of the maternity accommodation of the group and there, too, improvements are desirable.
Bramley Mead and Bull Hill suffer from the same isolation from other hospital facilities and the substantial improvements at the Queen's Park unit have never been regarded as providing more than an interim solution pending the planning and building of permanent maternity accommodation incorporating all the facilities which we now consider essential.
The shortage of maternity beds and the defects of existing accommodation in the Blackburn area were recognised in the original Hospital Plan. This proposed the building of a new maternity unit at Accrington Victoria Hospital, starting in the first five-year period, and a new 1362 maternity unit at Queens Park Hospital, Blackburn, starting in the second five-year period. These developments when completed would have provided better facilities than those available in the existing units. Planning of the Accrington unit accordingly proceeded on the basis of a 42-bedded unit, with both consultant and general practitioner beds, to be built on a site across the road from Accrington Victoria Hospital.
As planning progressed, it became clear that the cost of building would be excessive—more than £500,000 for 42 beds—partly because of the need to tunnel underneath the main road separating the unit from the main hospital and partly from the need to expand the services in the old hospital to meet the demands of the new unit. In addition, when it became clear that the assessments in the original Hospital Plan were far too optimistic and the timing of the schemes consequently unrealistic, the Accrington maternity scheme was one of the many schemes in the Manchester region, as in the rest of the country, which had to be deferred.
In view of the unavoidable deferment of the scheme for the reasons which I have given, the Manchester Regional Hospital Board considered it prudent to take the opportunity to review not only the scheme, but also the whole pattern of hospital provision in the Blackburn-Accrington area. The basis of this reexamination is mentioned in Command Paper No. 3,000; first, the planning and content of the Accrington maternity scheme is to be reviewed and, secondly, the possibility will be explored of abandoning in the long term the re-building of Queens Park Hospital in favour of an entirely new hospital on a virgin site.
These two questions are inevitably related, since the maternity facilities to serve the Blackburn area must be associated with this new distrist general hospital. Its precise siting in relation to the catchment area as a whole, and to the Accrington Victoria Hospital in particular, will obviously affect the division of facilities between it and the Accrington Victoria.
At the moment the Board has not formulated any firm proposals which it can put to me, and I understand that it will be some time before it will be in a position to do so. However, I am assured by the Board that in formulating 1363 its proposals there will be full consultation with all of the local authorities concerned, and that it will hold a public meeting at which the views of any interested party can be heard. Full information on the outcome of these consultations will be supplied to me when the proposals are eventually put forward for my consideration. Very careful attention will be given to any unresolved differences of opinion, and if necessary, I will consult my hon. Friend about them.
The Regional Hospital Board is conscious that it is planning the hospitals to serve the Blackburn-Accrington area for many years to come. It is right that it should try to ensure that its plan is sound and is one which will stand the test of time. Clearly it would have been wrong to proceed with the building of the Accrington unit as originally planned, when more detailed consideration had led it to the conclusion that the validity of its original proposals was open to question.
My hon. Friend mentioned the question of early discharge. I understand 1364 that in the divisional area, which includes Accrington Borough—Division Five of the Lancashire County Council area—the domiciliary confinement rate is less than 20 per cent. of all births, compared with a national average of 27 per cent. There is in addition a good staff of domiciliary midwives and district nurse midwives. The local health authority is satisfied that these staff provide an adequate domiciliary service for the needs of the area and that the planned scheme for early discharge of maternity cases from hospital is operating well. As far as I am aware, there have been no recent complaints received from patients in the area about the domiciliary services provided. Early discharge is something which needs to be planned in conjunction with the domiciliary services, but according to my information the necessary requirements for it are present in this case. If my hon. Friends has any information to the contrary, which he would send me. I will gladly consider it.
§ Question put and agreed to.
§ Adjourned accordingly at twelve minutes to Two o'clock.