Maternity Services (Hastings)

Amber Rudd Excerpts

Thursday 24th March 2011 Commons Chamber

[Amber Rudd (Hastings and Rye) (Con)]

I am worried and my constituents are worried. There are many issues that Members of Parliament campaign on in their constituencies, but those to do with health provision must be the most important. We can all agree that maternity services deserve to be a high priority in health planning. This is about the safety of mothers and babies.

Our hospital in Hastings, the Conquest, has a full-service, consultant-led maternity unit. Within East Sussex Hospitals NHS Trust, which we are part of, Eastbourne also has a full-service maternity unit. Four years ago, it was proposed that one of those units should close, and that we should have one midwife-led service and only one full maternity service for the area. The community rose up in arms. We campaigned in our thousands. We marched with babies and with prams. Every local MP objected, and we did not let up until we won—and win we did. I would like to pay tribute to the able, determined and dedicated campaign leaders, Margaret Williams and Liz Walke.

In September 2008, the decision was made by the Independent Reconfiguration Panel, which advised the then Secretary of State for Health, that both units should stay open with their full service. The chair of the IRP said:

“The needs of local women and their families were at the heart of this review…we concluded that women’s access to and choice of services would be seriously compromised if the proposals were implemented.”

The campaigners already knew that, but we were reassured and, indeed, jubilant that the final decision makers also took that view. This was nearly three years ago. Some people might, ask “What’s the issue now?” or “Why are you campaigning when there is no formal proposal for closure of either units currently on the table?” They would not share my concern—my unease—about the latest information coming out of East Sussex Hospitals NHS Trust. It is being signalled that there may be change in the air. It is not change itself we are frightened of, but the possible outcomes for mothers and babies.

The Care Quality Commission visited both hospitals in February this year, and it has raised concerns about the maternity services. The hospital trust, to its credit, was swift to contact stakeholders and MPs to inform them of this and to reassure us that action was immediately being taken to ensure high standards of safety and to address the concerns that the CQC had raised. I would like to thank the chief executive of the trust, Darren Grayson, for his swift action in disclosing this important information. I must confess, however, that we are not entirely reassured. We, the campaigners—my constituents—are still worried. I am not reading any motive or plan into the trust’s response to the CQC; I am simply here to highlight, once more, that the outcome of these concerns must not lead us down the very road we have travelled before—namely, having to protect our full-service maternity units.

We do not want to stick our heads in the sand. If there are problems with the maternity units that might impact on safety in any way, we must address them. However, this must not be a shortcut back on to the damaging road of trying to shut one of our units. We will not accept that. I urge the trust not to present that as the answer to the current problems. I would like the Minister to consider that in her response.

There are other answers, and they are in the very problem that the trust is highlighting—namely, staffing. The original decision to maintain both units urged the trust to address the issue of staffing by getting the right and safe mix of experience and qualifications among the doctors and consultants. The report of three years ago accepted that staffing was a problem, but critically it urged the PCT to

“consider alternative staffing models which have not been explored so far”.

It stated:

“It is incumbent on the local NHS to explore the potential of these roles to develop midwifery careers and support doctors’ roles locally.”

It agreed that there was a problem, but urged the local NHS to develop a strategy to deal with it. But here we are. As was anticipated by the report three years ago, we have a staffing problem that may be impacting on the service, and in such a way that doubt is once more being cast on the viability of having two full-service units.

Each hospital handles about 2,000 births a year. I am pleased to say that the strategic health authority recently commissioned an external head of midwifery to review midwifery, leadership and staffing levels, and she confirmed that the trust was safe. The latest annual regional report also praised the trust for having the lowest caesarean section rates in the region, thereby supporting women to experience a normal birth.

Eleven consultants cover both sites, and we have our designated number of junior doctors. However, we are short of middle grade doctors. There should be eight at each site, but there are only seven at the Conquest hospital and six at the Eastbourne district general hospital. The gap is filled by locums, which is expensive. An agency locum costs approximately £79 per hour, which equates to £18,000 per agency doctor per month, as against a trust doctor, who costs approximately £9,000 per month. In these times of increased pressure on funds, even though NHS funding is ring-fenced the NHS is still being asked to make efficiency savings and to improve services. The locum costs are therefore an unpleasant and substantial addition to the hospital overheads.

Unfortunately, the staffing issue is exacerbated by the European working time directive. I know that the arguments against the directive for parts of the medical profession are being examined, but in the meantime the outcome of restricting working time to 48 hours per week simply puts yet more pressure on the staffing levels in these units.

I appreciate that some might say that I am panicking early. We have been reassured by the trust’s chief executive that there are currently no plans to close either unit, and a consultation is about to be launched on how to maintain a top service at both units. In this reassurance, there is a sting. It signals that the challenges of staffing may require a change. I fear that that could include the closure of one of the units. We must not let that happen.

The town of Hastings in my constituency has high levels of deprivation. Its teenage pregnancy rate is one of the highest in the country and, as we know, this country has the highest rate in Europe. Some 22% of its residents are in the bottom 10% according to assessments of deprivation. Local doctors, to whom I speak regularly, tell me that young women can be reluctant to attend antenatal classes and often miss their appointments. These are the women who may encounter unforeseen difficulties, and who may need a full-service maternity unit at their hospital. They are not the women who are likely to hop in their car to go to Eastbourne for their check-up. In fact, in many parts of Hastings car ownership is running at only 40%, so many would have to rely on the local bus services and the local roads. If the maternity service were closed, it would effectively put up barriers to safety for that group of young women.

I wish to say a word about the local roads, on which I hope to secure a separate debate. If we look on the map, we see that Hastings is just over 20 miles from Eastbourne, and the AA tells us that the journey can be done in approximately 20 to 30 minutes. It is quite wrong. It is in fact the equivalent of a 40 or 50-mile journey elsewhere, and in my experience it takes at least an hour. The Royal College of Obstetricians and Gynaecologists recognises the need for investment to support smaller units, such as ours, where there are significant distances involved. That is what we have in Hastings and Eastbourne—because of the nature of the roads, the towns are a significant distance apart.

Those of us who campaigned on the issue before know the arguments well, but we are up against what feels like the establishment. It is creating a tide that pushes us one way—to super-size maternity units, beloved of managers and some doctors but not particularly of mothers. Expectant women want choice, safety and accessibility. I can quite understand management’s preference for large units. It is easier to manage a larger group of people, more efficient for those delivering the service, more convenient for the consultants who are in overall charge and more flexible for training junior and middle-ranking doctors. However, we must not let the one-size-fits-all principle dominate our maternity services. We must remain aware of local issues that are relevant to any changes in configuration. In Hastings, I have mentioned geography, deprivation and the particular needs of some of the youngest, most vulnerable mothers in my constituency.

Although I speak up for the residents of my constituency, I urge the Minister to pay attention to the trend of addressing staffing issues in hospitals by moving towards super-sized units, particularly maternity units. “Bigger is not necessarily better”—that may sound like an extract from a nursery rhyme, but it is actually part of the name of a highly respected paper about the centralisation of hospital services. Even the well respected King’s Fund questions the assumption that outcomes are improved in bigger units.

Despite the conflicting views about smaller or larger maternity units, one thing is clear: the staffing issue is about preparing and planning. That was highlighted to the health trust more than three years ago in Hastings. We must demand more from our trust now, and we do not accept that closure should be considered for either of our full-service sites. We need the complete service. We need in our communities the delivery of a safe, efficient local service, for the continued delivery of safe and healthy babies.