§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Conway.]2.35 pm
§ Mr. Greg Pope (Hyndburn)
I start by saying how pleased I am to have secured this debate on an issue of such importance to so many of my constituents. My one deep regret in securing the debate today is that it prevents me from attending the funeral in Edinburgh of the former leader of the Labour party, John Smith. I know that the Minister has been sympathetic to my dilemma on that; I thank him for the concern that he has shown and for being present on the Government Front Bench to reply to the debate. I am sure that he understands—as I hope you do, Mr. Deputy Speaker—that I felt that it was important that I put the interests of my constituents first.
I am sure that the Minister will be pleased to hear that I have not come here to score cheap debating points or, indeed, to criticise the Government's health service reforms. Indeed, I hope to be able to show that keeping Accrington Victoria hospital's maternity unit open is consistent with the Department of Health's recommendations on mother and baby-centred care. I am optimistic that the Minister can give me positive assurances today.
The maternity unit at Accrington was recommended for closure by the Blackburn, Hyndburn and Ribble Valley district health authority on 16 March this year, following a three-month consultation period. During that time, representations were received from the community health council, myself as the local Member of Parliament, Hyndburn borough council and the Lancashire county council, to name but a few. All but one of the representations—the one exception being the National Childbirth Trust—recommended that the maternity unit should stay open.
The highly controversial decision to recommend closure of the unit was taken at a district health authority meeting attended by only five people, all of them men. Five men proceeded to take a decision affecting the future not only of hundreds of Hyndburn women but of women across the whole area of east Lancashire. Five men made a recommendation which will mean that women from my constituency will have to travel to Blackburn to have their babies.
Many of my constituents contributed by making representations to the district health authority. One would have expected that their views, together with the other responses, would be examined, discussed and taken into account, but they were ignored by the district health authority, which spent less than five minutes discussing the options for maternity care across a large area. How could the five men on the district health authority possibly have taken all the responses into consideration in less than five minutes? Indeed, why did they bother to accept the responses at all if their intention was merely to ride roughshod over the majority of people's views and to pay only lip service to the consultation process?
The House will appreciate my anger at the arrogance with which not only my view but that of hundreds of my constituents was swept aside by the district health authority. It has made a complete sham of the consultation process. What is worse, my constituents cannot even write 1104 to the district health authority about the decision because it was made at the authority's last ever meeting prior to its abolition on 31 March. The district health authority was replaced by a trust on 1 April last year. Clearly, the trust did not take the decision. It cannot be held responsible or to account for that decision, but nor can the district health authority, given that it no longer exists. I deplore that cynical exercise in evading responsibility. The decision was rushed through before the abolition of the district health authority by a small number of people against all advice and at the expense of the interests of women in my constituency.
Following the closure in the late 1980s of the Bramley Meade and Bull Hill maternity units, the maternity unit at Accrington is the last in the area outside the unit at Queen's Park hospital in Blackburn. The closure of the Bramley Meade maternity unit in Warley and the Bull Hill maternity unit in Darwen met with massive public opposition. Thousands of people signed petitions, but the district health authority ignored them.
Nobody can deny that the planned modernisation of Queen's Park hospital and the maternity unit is desperately needed and will be beneficial. I do not seek to oppose that, and I warmly welcome the improvements at Queen's Park hospital, but I cannot accept that the maternity unit in my constituency at the Victoria hospital in Accrington—an integral and much-loved part of the community—should be sacrificed to make way for those plans.
I am sure that the Minister will accept that expectant mums should have the right to decide where to have their babies. Women who experience complications in pregnancy will require consultant care, but the women who are in desperate need are those in low-risk categories who do not need a high-tech approach and who very much value a much more low-tech approach. Some of those women will want to give birth at home, which is fine. My constituency secretary, Pamela Gedzielewski, had her three babies at home and I strongly support her right to do so. If the maternity unit in my constituency is closed, women will be denied a major option—having a local, low-tech and friendly unit available to them. The Victoria hospital is a friendly and excellent establishment. I was there only a couple of weeks ago to meet the new trust managers and staff. If it is kept open, it will provide an invaluable service not only for people in my constituency, but for people across east Lancashire who want to choose a small, friendly unit.
One of the reasons given for the closure of Accrington Victoria is that it is under-used. That argument, however, does not stand up and has become a self-fulfilling prophecy. GPs do not send women to Accrington Victoria because it is threatened with closure. Therefore, the unit is under-used and is threatened with closure. It is a circular argument. In some instances—I stress not in all instances—general practitioners have sent women to Queen's Park without discussion with the patient.
The Blackburn, Hyndburn and Ribble Valley community health council commissioned a survey, some of the findings of which are interesting. It showed that 44.7 per cent. of women assumed that Queen's Park hospital was the only place available. Almost 41 per cent. said that the choice of venue for birth had not been discussed with them. A little under 70 per cent. were not aware of the GP unit delivery service and 62.2 per cent. were not aware that they could have had midwife-only care. When they were made 1105 aware of that, more than 14 per cent. said that they would have opted for midwifery-led care and more than 10 per cent. said that they would have opted for the GP unit.
If one takes into account those figures and the fact that some women will need consultant care whatever their preference, in the last year there could have been 380 births in midwifery units and 273 births in GP units. As 47 per cent. of Hyndburn women who responded said that, given the choice, they would opt for Accrington Victoria hospital, I suggest that they have not been given that choice. One woman told the community health council that she had had her baby at Queen's Park, but later found out that she could have had it at the Victoria hospital in Accrington. She was furious with her doctor because she had not been informed of that possibility. Women are having to fight to have their babies locally. General practitioners are the first point of contact for pregnant women, many of whom do not feel able to challenge their GPs' decisions on the alternatives in pregnancy. If women were properly informed of their choices, many more would use the Victoria hospital.
Accrington's Victoria hospital is obviously the local choice for people in my constituency. It is worth bearing in mind that 36 per cent. of households—significantly above the national average—do not have a car. Queen's Park hospital is quite a distance for new dads, grandparents and other relatives to travel. Some women have also voiced the concern that the distance to Queen's Park hospital increases the likelihood of their giving birth in an ambulance in peak times, which I am sure that all hon. Members would agree should be avoided.Queen's Park hospital is two, or even three, bus rides from where many of my constituents live. I do not see why they should be forced to use maternity services in a very large, impersonal and high-tech facility so far from their homes. Queen's Park desperately needs the proposed new facilities. One step that would help and would relieve the pressure on that hospital would be to keep Accrington Victoria open and to promote it properly.
Closing the maternity unit in my constituency would be a major step backwards. The people of Hyndburn want to keep their maternity unit open—I use the word "their" advisedly, as the Accrington Victoria hospital was built using public subscriptions and not by the state and my constituents strongly believe that it belongs to them. The least that they can expect is to have a say in what happens to it. Whenever possible, my constituents have voiced their objections to the proposed closure of the maternity unit. They have written to the Secretary of State for Health and the community health council, queued up to sign petitions, and attended public meetings and even candle-lit vigils.
I appreciate that the Government Front Bench are not very keen on referendums, but if we had one tomorrow I am convinced that the overwhelming majority of my constituents would vote to keep the maternity unit open, but they have not been given the choice—it has been made for them by the unelected and now abolished district health authority.
This is not just a case of a Labour Member carping at Government policy. The campaign to keep the unit open has cross-party support. As one would expect, Labour party members have been in the forefront of the campaign, such as Councillor Sheelagh Delaney, who has worked tirelessly on its behalf. The Conservative mayor of Hyndburn, Councillor Bramley-Haworth, has also expressed his personal support for the unit. We have also had 1106 support from Liberal Democrats and, what is more, from thousands of people who live in Accrington. Only this morning the Accrington Observer, which I can assure the Minister is no Labour rag but a fiercely independent newspaper, wrote in its opinion column:Not many issues make people genuinely angry—but the health authority's decision to close the baby unit is definitely one of them.It's a complete disgrace that the wishes of an overwhelming majority of the people of Hyndburn … can be blatantly ignored.And it's even more scandalous that the totally undemocratic decision was taken by a rump of five unelected people in just five minutes.Accrington Victoria was put at risk so that funds could be released to develop Queen's Park. It seems clear now that the hospital trust that runs the maternity unit in Accrington does not want to operate it. A cynical person might suggest that that has something to do with the fact that the people who run it are the self-same people who ran the district health authority when it was originally proposed that the unit should close some years ago.
Although the hospital trust operates the maternity unit, it does not own it—it is owned by another trust. I hope that the Minister will take this on board, as it is the key to the argument. I am trying to suggest that because of the diversity of provision in the health marketplace, if I may so describe it, more than one trust can run the maternity unit. It does not have to be the hospital trust. I understand that if the decision is referred back to the purchasing consortium, another trust will be very interested in bidding to run the maternity unit. I put it to the Minister that the Government have nothing to lose by referring it back. It would be a sign of immense good will and it would be widely welcomed in my constituency. If, at the end of the day, another trust does run the unit and there are not enough referrals to that maternity unit and it closes, fair enough—at least we shall be able to say that we have had every opportunity.
I know that the Minister cannot give me that direct categorical assurance today. I know that he cannot possibly pre-empt the decision of the regional health authority next week, but I implore him to give an assurance to me, to the House and, most of all, to my constituents that when the decision lands on his or the Secretary of State's desk it will not simply be rubber-stamped but that the issues that I have mentioned today will be taken seriously and that strong consideration will be given to referring the decision back.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
I start by congratulating the hon. Gentleman on his good fortune in securing the opportunity for the debate and acknowledging the dilemma that he faced in speaking today, of all days, to which he referred at the opening of his speech.
The hon. Gentleman believes, as I do, that comprehensive, high-quality maternity services, responsive to women's needs and offering real choice, should be available to all women, regardless of where in the country they happen to live. That is Government policy and has been adopted throughout the national health service. Guidelines were issued in January and health authorities have been asked to set target dates for the implementation of their own local strategies. Most important of all, the policy reflects the views of women themselves.
It is not surprising that close bonds develop, as the hon. Gentleman said, between local communities and their 1107 hospitals. Those are often buildings with a long history, which hold cherished memories for people. In the case of baby units, perhaps there is a heightened sense of nostalgia and family history. Times and health needs change, however, as do patterns of care. We must not allow feelings of nostalgia to subvert the need to develop the best possible health services for the future. In other words, modern health care delivery must learn from the practices of the past, but not be restricted by them.
For some years, until its dissolution on 31 March this year, the Blackburn, Hyndburn and Ribble Valley health authority had worked on a strategy of centralising its maternity services at Queen's Park hospital in Blackburn. To that end, one of the last actions of the authority, at its March meeting, was to decide in favour of closing the last remaining peripheral maternity unit at Accrington Victoria hospital, about which the hon. Gentleman spoke.
The former authority had issued a consultation document on 27 October 1993, setting out its proposals to complete the strategy. It explained that that could be successfully achieved only by shutting Accrington Victoria maternity unit and redistributing the resources released by the closure. Those resources could then be invested in an integrated hospital and community midwifery service based at Queen's Park hospital, where the £13 million centralisation of gynaecology and obstetric services is nearing completion.
The consultation document emphasised the authority's intention to introduce woman-centred maternity services in line with the recommendations of the Government's expert maternity group. There is no disputing the fact that that approach offers women a greater choice and more say in the care that they receive. It also means continuity of care throughout pregnancy and child birth and beyond.
What we are speaking about here is the type of maternity care that women are choosing for themselves. Last summer's report of the Government's expert maternity group, called "Changing Childbirth", recommended placing additional emphasis on involving women in planning their ante-natal and post-natal care. The report concluded that maternity services should be as responsive as possible to the needs and wishes of women throughout pregnancy and during and after childbirth. We formally accepted its recommendations in January this year.
The consultation on Blackburn's proposal to close the Accrington unit ran for three months, ending on 4 February. The responses received were then considered by members of the health authority in line with procedural requirements, culminating in the March decision.
The community health council opposed the district health authority's plans, which means that the matter has now been referred to North Western regional health authority, which will consider the evidence at its meeting on 26 May. I remind the hon. Member that, if the RHA were to support the district but the CHC were to maintain its opposition, Ministers would then be called upon to decide the issue. He will appreciate, as he said, that I cannot pre-empt any final decision, which would be made only after taking into account all relevant factors, including the responses to the consultation exercise and, of course, the points that he made today.
The new East Lancashire health district has a residential population of 495,000. Most women's maternity needs are 1108 met at Queen's Park, with 87 beds and Burnley general hospital, with 64 beds. Victoria hospital has a total of 74 beds, of which 14 on one ward form the maternity unit. There is no other peripheral unit in east Lancashire.
As the hon. Member said, the number of women using the Accrington unit has declined in recent years. In plain figures, 120 babies were delivered there last year against a potential maximum of some 400. That compares with a current total of 1,000 deliveries each year at Queen's Park hospital. At full capacity, the Queen's Park maternity unit is designed to provide midwifery-led care for up to 1,500 births per year.
The new development at Queen's Park, six miles from Accrington, opens later in the year. It brings together, for the first time in Blackburn, maternity and gynaecology services on one site. It will provide the whole district with a modern, purpose-built centre that will serve the population for many years to come.
The district health authority confidently believes that the new Queen's Park maternity unit represents a major advance in terms of medical facilities and will offer a much-improved environment for mothers, babies and their families. The hon. Member acknowledged that.
The new unit will be the centrepiece of an integrated community and hospital midwifery network serving women throughout Blackburn, Hyndburn and Ribble Valley. Strengthening the midwifery service is seen as a vital part of the DHA's strategy. This integrated network will enable women to be offered five levels of maternity care depending on individual choice and clinical need.
As the hon. Member stressed, the Accrington unit has served the town well for many years. Although numerous people have expressed support for its continued existence, the hon. Member also acknowledged that that has not been reflected in GP referral rates, which have shown a long-term decline, more than halving in a 10-year period. One reason is the trend towards short stays in hospital, followed by post-natal care by community services at the mother's home. The number of women transferred from Queen's Park to Accrington after the birth of their babies has fallen and there has been a corresponding rise in demand for community midwifery services—those services are struggling, under the present arrangements, to meet that demand.
The DHA argues that the full benefits of its integrated hospital and community midwifery services can only be realised by closing Accrington's maternity unit and redistributing the resources. Consultant ante-natal clinics would continue to be held in Accrington twice a week.
Comments arising from the consultation were considered by the authority at its March meeting. Those who responded to the consultation generally supported the planned developments in community midwifery, but, at the same time, there remained opposition to the closure of the Accrington unit.
As I understand it, the new East Lancashire health authority maintains the view that the maternity strategy set in train by its predecessor is the appropriate one, but is unable fully to implement it while a significant slice of its resources is still committed to the Accrington unit. It believes that women throughout the district are being denied the freedom of choice that they have every right to expect. The health authority is responsible for ensuring that the best services are available to all its resident population.
I note that, in formulating its plans, the DHA also drew on the findings of a survey of 620 local mothers who had 1109 given birth during the preceding 12 months, the views of 11 GP practice-based focus groups and those expressed at two open public meetings. Those results bear out both the underlying themes running through "Changing Childbirth" and the long-term strategy adopted by the DHA.
I recognise of course that the hon. Member's main concern, and that of his constituents, is for the effect on a community that has grown accustomed to the presence of a maternity unit in the town. That concern is understandable. On the other side of the coin, the health authority is rightly concerned that all women in the district should have access to a comprehensive range of high-quality maternity services, offering as much scope for individual choice as possible. The arguments are complex and sensitivities run deep.
Under the statutory consultation procedures, the next step is for the RHA to consider the matter. If it decides in favour of the district health authority and the community health council maintains its opposition, the matter will be referred to Ministers for a final decision.
1110 I assure the hon. Gentleman that, in reaching a decision, Ministers will carefully consider all the arguments, and that we would not countenance a reduction in services. Rather, we expect to see maternity services throughout the district brought up to the standard of the very best. It is vital that maternity services respond to the needs and wishes of mothers, and we are determined—as is the hon. Gentleman—to ensure that that is valid for the people of Hyndburn, as it is becoming true for women throughout the country.
For the last half hour, the thoughts of the House have centred on Accrington. Today, as the hon. Gentleman said, our thoughts are also in Scotland, with John Smith's family. Perhaps it is appropriate that the final prayer of the House this week—from the hon. Gentleman, myself and the whole House—is for John Smith. May he rest in peace.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.