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Mrs Helen Grant (Maidstone and The Weald) (Con)
In a few months’ time, if current plans proceed, there will be no consultant-led maternity services at Maidstone hospital. That means that each year, 2,000 women will be put at greater risk, with potentially lethal consequences. The community in Maidstone has spoken out loud and clear, and thousands of people have signed a petition to say no. Our borough and county councillors have said no, and members of the business community have said no. As a local resident and mother of two, I also say no. In a recent survey, 97% of respondents said no, and the response rate to that survey was 77%, which is high.
We are not resistant to change and we have no hidden agenda. We do not ask for anything new, and we do not seek something different. We simply want to retain our existing services, and maintain genuine, safe choices for our community. The NHS trust tells us that for the first time, choice will be available to Maidstone mothers. There will be a midwifery-led birthing unit with six beds in Maidstone, or people can travel to Pembury, Medway, Ashford or Dartford, which all require long journeys. However, I say that mums with complications or those who need an epidural will have no local choice; mums who need a Caesarean section, or those who simply want to know that they will have the best expertise and equipment available when their baby decides to come out, will have no local choice. The trust tells us that patients will vote with their feet, but it does not mention that many patients cannot vote to remain in Maidstone.
I have with me in the Chamber a bundle of letters addressed to the Secretary of State for Health. They have been signed by 100 GPs from the Maidstone area who claim that the new journey times over bad rural roads are unacceptable. They say that the extra risk and stress to mothers in labour is unacceptable and that, worryingly, it is a near certainty that some babies who are delivered in Maidstone will need immediate medical treatment and could die or suffer brain damage while en route to Pembury or elsewhere. Those are our GPs and future commissioners of services, and they are talking about our mums, children and babies.
I will not go on too long or go into too much detail, but I can speak from personal experience because my first child arrived a month early. I was in a full service NHS hospital and was cared for by a superb midwife called Sister Butler. Near the end, my baby became tired and his heart rate started to drop. Sister Butler looked worried and suddenly there was not one but four heads around the delivery table, including a consultant, and there was lots more equipment. That happened in moments, and it illustrates how quickly an apparently normal birth can change. Baby Benjamin Grant arrived safely, but I shudder to think of the consequences if he had had to take a 50-minute journey to Pembury—that is what it would have been.
Our campaign is about community, choice and safety. The evidence against downgrading our maternity services is powerful and profound. The reconfiguration plans are utterly wrong and dangerous and will lead to fatalities. On 21 May, the Secretary of State set out new, visionary criteria for hospital reconfigurations. Those criteria show his commitment to reforming the NHS and giving power back to our patients and—rightly—to our health professionals.
On 7 September, in reply to my oral question, the Secretary of State said:
“one of the four criteria that I set out on 21 May was that reconfigurations must have the support of local general practitioners as the future commissioners of services. To that extent, a reconfiguration that did not have the support of local general practices would not be able to meet that test.”—[Official Report, 7 September 2010; Vol. 515, c. 177.]
We have clearly demonstrated in my constituency that local GPs are strongly against the reconfiguration plan. In his recent White Paper, the Secretary of State said that there would be “No decision about me without me.” Maidstone GPs and patients have answered that call: they have said no, and they have said it loud and clear. When he considers the proposal in detail at the end of the month, I urge the Secretary of State to reject the reconfiguration plan that would move services for women and children from Maidstone. I am grateful to you, Mr Walker, for allowing me the opportunity to speak, and I believe that some of my colleagues have something to say.
Tracey Crouch (Chatham and Aylesford) (Con)
I congratulate my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) on securing this important debate, and I thank her for allowing me to take up some of her valuable time to make a few points. Although she has led on this issue, it significantly affects my constituents, too. For expectant mothers in Aylesford, Larkfield, Ditton, Snodland, and the three villages of Burham, Eccles and Wouldham, the town of Maidstone—and the closest hospital—is only a few miles away.
This is an emotive issue and it is fundamentally founded on concerns about practicalities. I do not know whether the Minister has been to Maidstone and made the journey from the current hospital site to the new unit in Pembury. My hon. Friend the Member for Maidstone and The Weald, the doctors, and the several hundred expectant mothers who have campaigned on this issue would, I am sure, be delighted to show her that even if someone is transferred by ambulance, it will take a significant amount of time to reach the unit. That could be critical in an emergency. Furthermore, mothers who have further to travel to a hospital tend to leave earlier, possibly at the first twinge. Instead of arriving at the appropriate time, they end up arriving too early and using valuable resources that would otherwise be available to others. Evidence suggests that the longer a mother stays at home before giving birth, the better the outcome. Therefore, moving the unit further away could have the opposite effect to that intended in the proposals, namely better maternity outcomes.
I promised my hon. Friend that I would take up only a few moments of time, so I conclude by saying that I fear the impact that the reconfiguration will have on the busy maternity ward at the Medway Maritime hospital. Earlier this year, the hospital reported a record month for childbirth, with a staggering 434 babies born in May. Midwives at the Medway Maritime hospital already deliver about 4,500 babies per year, and I believe that a further 8% increase on that is expected each year. The hospital is fortunate to have good facilities and it is recognised as the largest unit in Kent. However, it too is bracing itself for the fallout from the reconfiguration. We have already seen some worrying near-misses, with babies being born in ambulances that were diverted from Maidstone.
At present, about 50 women from Medway choose to have their babies in Maidstone, but I expect that figure to be revised, and I suspect that it will be much higher following the reconfiguration. Although I appreciate that funding will follow the mother from West Kent primary care trust to Medway, the pressure that will be put on resources could prove dangerous.
The Medway Messenger newspaper has recently covered incidents of babies sadly dying due to what mothers have described as stress in the service. Clearly, any complaint should go through the proper process, so I do not intend to say anything on individual cases, but even though the Maritime is well prepared for an increase in capacity, concerns remain that increased pressure on maternity units could lead to further cases of infant mortality.
I am in no doubt that the intention behind the proposals is to improve maternity services for my constituents and others, but it is not right to do so in a manner that could put mothers and babies at risk. I urge the Minister to listen to the excellent case made by my hon. Friend the Member for Maidstone and The Weald and to reconsider the proposals in order to ensure that expectant mothers in mid-Kent are given the best possible chance to deliver their babies safely and locally.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
Thank you, Mr Walker, for calling me to speak in the debate. My hon. Friends the Members for Maidstone and The Weald (Mrs Grant) and for Chatham and Aylesford (Tracey Crouch) have already made very significant points. I speak as someone who was, before entering the House, an obstetrician working in the London, Kent, Surrey and Sussex training rotation as a registrar. The points that have been made are valid; I just want to add another couple of issues to the debate.
First, it is true that throughout the London, Kent, Surrey and Sussex area, there has been a push to have more midwifery-led units, but generally speaking, if we consider the example of Crawley and East Surrey hospitals, examples that are being developed in Brighton, and the Bromley hospitals, we see that the push has been to have a low-risk, midwifery-led unit alongside a higher-risk unit. We in obstetrics know that a greater number of women—rising to about 30%—are giving birth by Caesarean section, and that number is going up year on year. Many births that we initially think uncomplicated end up being much more complicated.
I will concede that in Crowborough in Sussex, there is a midwifery-led unit that is run very well for a small number of mothers who are multiparous and have a very low risk of developing complications. Generally, however, accepted obstetric practice has been to put the high-risk unit close together with, or alongside, the low-risk unit.
The other issue that I want to raise is junior doctors’ training, because Maidstone hospital has very close links with the unit at Benenden hospital and shares gynaecology provision with Benenden hospital. If we take away the key driver of obstetric and gynaecology training, which is obstetrics, there is an issue about whether there will be a loss of gynaecology expertise at Benenden and, indeed, the whole of mid-Kent.
Having raised those few issues, which I am sure my hon. Friend the Minister will address, I shall conclude my comments.
Amber Rudd (Hastings and Rye) (Con)
I know my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) well, because he was the resident registrar at our local hospital, the Conquest. We had a major maternity campaign there two to three years ago to save our consultant-led service, and we stressed safety, which I know is a main issue for the Government. However, I would also like to stress, in support of my hon. Friend the Member for Maidstone and The Weald (Mrs Grant), that supporting the vulnerable is very important to the coalition Government and it is sometimes the vulnerable who are most left out of the sort of decisions that we are discussing. Vulnerable young women are sometimes not able to think ahead and plan their pregnancies. They find themselves in difficult circumstances and particularly need the support of consultants and obstetricians. I therefore support my hon. Friend in this debate, and place particular emphasis on the vulnerable; that is the issue that we led with in Hastings when we saved our service.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
It is an outstanding pleasure to speak under your chairmanship, Mr Walker. I congratulate my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) on securing this debate on the future of maternity services at Maidstone hospital and, in particular, the consultant-led maternity services there. I know that the future care of women and their babies in Maidstone is extremely important to her, her constituents and their families. No one could have done more to represent their views. She brought to the debate her own experience as a mother, as indeed do I. Interestingly, I had four children in four different hospitals, so I feel that I have quite wide experience on a personal level of maternity services. We also heard from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has professional experience in obstetrics. There is a wealth of experience in the Chamber on an issue that is clearly dear to many people’s hearts.
I want to take this opportunity to pay tribute to the NHS staff in Maidstone and, indeed, across the south-east region, who provide such wonderful care to all the people who use it. I pay tribute in particular to those who deliver babies, by the second, around us, bringing joy to many of us.
It may be helpful if I briefly describe the wider context of NHS reform, before turning to some of the more specific issues. All health care constantly needs to adapt to changes in demography, changing lifestyles, changes in disease patterns, innovation in health care and, indeed, rising health care costs. Change is always unsettling, however. Constituents rely on local health services and, naturally, any suggestion of those services being moved or reorganised always causes concern. However, as my hon. Friend the Member for Maidstone and The Weald stated, that does not always mean that people are resistant or see change as a negative thing. That assertion—people always hate change—is sometimes used unfairly to dismiss concerns, but what is clear about any change is that it must be managed openly and transparently. It should not be dictated by politicians from the Dispatch Box or in this Chamber. It must be a collective, informed and locally made decision, genuinely driven by clinical professionals, genuinely grounded in firm clinical evidence and genuinely recognising the views of the local community.
My right hon. Friend the Secretary of State has therefore been clear about the four crucial tests that any future change to the NHS service must pass. First, it must have the support of GP commissioners. Secondly, the public must be fully involved, with public and patient engagement duly strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals should take into account the need to develop and support patient choice. That will mean that patients, local GPs and clinicians, local people and local councils have a far greater say in how services are shaped in the future.
I understand that the proposals to centralise the consultant-led obstetrics and in-patient paediatric service in the Maidstone and Tunbridge Wells area to the new Pembury hospital were consulted on in 2004, and that the plans to consolidate consultant-led obstetrics and in-patient paediatric services at the new Pembury site have been agreed since 2005.
There are often strong arguments for centralisation. It is not, as is often believed, always about saving money, but is sometimes about delivering higher standards of care. There is no doubt that centres of excellence achieve that status by seeing critically high numbers of complex cases. I can cast my mind back to my own experience as a nurse and someone who worked in the NHS for 25 years. Even back in those dark days—it was a long time ago—we had centralisation of neurosurgical services and other specialties for exactly that reason. Critically high numbers of patients being seen produced centres of excellence that could deal with and make better people with rare and not commonly occurring conditions and diseases.
However, I am aware of the considerable public concerns about changes to services in Maidstone. I know that two petitions have been submitted—one to No. 10 Downing street and one to the Department of Health—and that my hon. Friend the Member for Maidstone and The Weald has written on numerous occasions to the Department to express concerns about the transfer of consultant-led obstetric services from Maidstone to the Pembury. Indeed, she has brought with her today a wodge of letters expressing those concerns.
In the light of the concerns, the council’s health overview and scrutiny committee referred the case to the previous Secretary of State in February this year. He asked the independent reconfiguration panel to provide advice, and in its response the panel concluded that due process had been followed. The current Secretary of State accepted those recommendations in July and therefore made it clear that plans for the centralisation of consultant-led obstetrics and in-patient paediatric services at the Pembury should continue.
As I have described, however, the new Government are determined that local voices should be properly heard and that any concerns are taken seriously. The Secretary of State has also asked the local NHS to work with clinicians, GPs, the local council and patient groups, to allay public concerns and demonstrate that those four tests are met. He has asked the strategic health authority to report to him at the end of September, and we would expect that report to set out clearly how the concerns mentioned by my hon. Friend the Member for Maidstone and The Weald—around accessibility, staffing, clinical quality and the huge concerns about transport—have been properly addressed.
I understand that the local NHS has to date conducted 26 one-to-one-interviews, 16 focus groups and addressed various other meetings and groups. Those included a focus group with nursing and midwifery staff, interviews with councils’ representatives and discussions with GPs across the area. Until the SHA report is submitted to the Secretary of State, it would, of course, be inappropriate—albeit, I am sure, disappointing to my hon. Friend the Member for Maidstone and The Weald—to speculate on what the report might say, but we must wait for that report to be published. The Secretary of State will look carefully at what the trust proposes to do, to allay those concerns and ensure that the voice of the whole community is heard in the implementation.
My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) raised some concerns about the funding for Medway PCT. I understand that the service changes will have no impact on that funding. I also understand that South East Coast SHA has advised my officials that Maidstone and Tunbridge Wells NHS trust has had detailed conversations with all the surrounding trusts about the impact of additional activity. She detailed the large number of births and concerns for a rising number of births. There is no doubt that, for anybody working in the field of maternity and anybody representing constituents who have had babies or are about to, the continuing safety of mothers and babies is absolutely paramount. I want to reassure her that these changes will provide some choice in a birthing setting for local women, who will perhaps have increased rather than decreased choice. However, what will be important is that the SHA takes full account of the impact.
My hon. Friend the Member for Hastings and Rye (Amber Rudd) also detailed some of the issues surrounding the reconfiguration for the Conquest hospital, on which I know she has campaigned. She also raised the issue of the impact on vulnerable people. At times like these, it is extremely important that we remember that there are people out there who do not necessarily get good representation and who rely on their local Members of Parliament to provide that for them. The needs of the vulnerable are critical. I fully understand that these issues arouse strong feelings.
I again congratulate my four hon. Friends who have spoken in this debate on representing their constituents so well. These decisions involve finely based judgments around how available resources should be used to achieve the best possible care for patients. I applaud the determination of my hon. Friend the Member for Maidstone and The Weald to campaign for the best maternity services, and indeed all hospital services, for her constituents. I reassure her that it is a commitment that I share.