Rt Hon Lord Lilley

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    Children‘s Services (Hertfordshire)
    12.30 pm
    Mr. Peter Lilley (Hitchin and Harpenden): I called this debate for three reasons. I wanted to make Ministers aware of the intense local feeling about the intended closure of maternity services at Hemel Hempstead and their move to Watford, to place on record our reasoned concerns on the subject, and to spell out our short, medium and long-term aims.

    On 26 September, the local health trust announced that the special care baby unit at Hemel Hempstead was no longer considered safe. It was therefore to be closed and moved to Watford, along with all maternity, women‘s and related children‘s services. The move is set to be completed by 4 February 2002. Although there had been some consultation with the primary care trust since July about the safety of the SCBU, as the unit is known, no discussion had taken place with it about the simultaneous closure of maternity and women‘s units at the hospital. However, we have now been told that the problem had been apparent at Hemel for up to 18 months. Why was it not discussed publicly earlier? Why was it not known about at the general election?

    The first explanation of the changes was given at a hastily arranged meeting at Watford general hospital on Monday 8 October. I attended it, along with representatives of the primary care trust and local councillors. The chairman, chief executive and medical director responsible for clinical governance in the West Herts community health NHS trust gave us several reasons for the planned closure and transfer. The main ones were the difficulty in recruitment and retention of skilled nursing staff at the Hemel unit, the difficulty in maintaining duplicate cover as required following the inquiry into the Bristol Royal infirmary, and the case of the nurse who suffered from Munchausen‘s syndrome by proxy. There had been instances of misprescription and misdiagnoses, and a higher than average proportion of nursing staff at the Hemel unit are nursery nurses. They are dedicated staff, but are not trained to fulfil some roles.

    The decision comes on top of other issues that have undermined confidence in the West Herts community health NHS trust, and especially in Hemel hospital. The reputation of the hospital was affected by figures that showed that it had one of the highest mortality rates for neck of the femur operations–hip transplants–with one in six patients dying within 30 days of an operation. Action has been taken to respond to that. More relevant to the closure of the maternity unit is that two of the four consultants in the gynaecology and obstetrics team are suspended and under investigation following complaints from hundreds of local women. An inquiry is due to be published soon, and I do not want to pre-empt its findings. Suffice it to say that, even though they have been replaced, the events have hit public confidence and are probably a much more important factor in putting the skids under maternity and women‘s services in Hemel than anyone publicly admits. Hemel was already at a disadvantage compared to Luton and Dunstable, which has twice as many consultants in the relevant specialties but handles only 40 per cent. more births. I would like to know the reason for that disadvantage.

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    Following the announcement of the proposed changes, all three parties on St. Albans district council unanimously passed a motion of no confidence in the management of West Herts community health NHS trust. However, my constituents are overwhelmingly grateful to and confident in the doctors and nurses at Hemel for the care and treatment that they have provided over the years.

    Mr. Tony McWalter (Hemel Hempstead): Is the right hon. Gentleman aware that no fewer than 51,281 local people have signed a petition opposing the disposition made by the local health authority? That clearly demonstrates the general fantastic local confidence in the service.

    Mr. Lilley : I am grateful to the hon. Gentleman for that point. Similar petitions have been signed in my constituency and in St. Albans to express opposition to the proposed change, and determination that the services should be restored as rapidly as possible.

    I accept that safety must be paramount. If there is a clinical risk to mothers and babies, action must be taken to remedy that. If the only option is a temporary move to Watford–that remains to be proved–it will be painful and difficult for mothers during that period, but so be it. My main worry is that the move will not be temporary, but permanent. That is unacceptable. The chairman of the local hospital trust admitted that even outside rush hour, it takes 27 minutes to get from Hemel Hempstead to Watford. For my constituents in Harpenden, Redbourn, Sandridge and Wheathampstead, journey times can be considerably longer.

    Watford rush-hour traffic is notorious. It took me longer to get from the junction of the M1 to the hospital in Watford than it did took to get from the House to that junction. On top of that, the hospital is next door to the football stadium. Mothers who must go to the hospital during a home match face intolerable delays.

    Ultimately, distance undermines safety and I cannot accept the idea that those services should be so far from my constituents. My constituents in Sandridge and Wheathampstead, who currently have the option of going to the Queen Elizabeth II hospital in Welwyn Garden City instead, are worried that there are rumours of those services moving up north to the Lister hospital. Will the Minister tell us whether that is likely?

    The fear that the closure of Hemel Hempstead general hospital will be permanent is exacerbated by the Government‘s plans for maternity spending, which were announced on 16 October. They show that there are plans to spend more on maternity services in virtually every other hospital in Hertfordshire, but no money is set aside for Hemel Hempstead general hospital. If the Government planned to improve that hospital and ensure that we could return maternity services there, surely the hospital would receive a large chunk of the spending. The fact that that will not happen clearly suggests that there are long-term plans to close Hemel Hempstead general hospital‘s maternity services permanently.

    Mr. McWalter : What the right hon. Gentleman says is absolutely correct. The result of that is that ?750,000

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    of the ?1 million given by the Government for maternity services is going to West Hertfordshire. If these plans go ahead, the result of that investment will be a decrease in maternity beds jointly held in Watford and Hemel Hempstead from 63 to 45. That investment would mean a massive slashing of services.

    Mr. Lilley : I am grateful to the hon. Gentleman for spelling out how the word “investment” in new Labour speak is a substitute for spending, and often means spending less than under the Conservative Government.

    The announcement by the Under-Secretary of State for Health, Lord Hunt of Kings Heath, in November of an independent review of the decision gave local people some hope that the move to Watford could be averted. Plans were made for meetings with the review panel at the beginning of December and the end of November. However, the meetings were cancelled. It emerged that the team would not start work until 7 January. It will publish its report on 18 January, but that will be only a fortnight before the movement is to be completed. The planning will certainly be under way by then, so effectively, there is a fait accompli and the review has the appearance of a cosmetic job to endorse that.

    The name of the chairman of the review team has been released, but the rest of the panel remain anonymous. We are told that that is because the panel is independent. However, how can we know that if we do not know who is on it? Will the Minister tell us who the people are, why the review will start so late, and its terms of reference? I sincerely hope that my scepticism about the review will be unfounded and that it will serve a useful purpose. If it too late to stop the transfer, the panel could set down a programme to restore accessible services to Hemel Hempstead or St. Albans within a firm timetable.

    There is even more serious concern in my constituency that the move of the women‘s and children‘s services may not only prove permanent, but may be a prelude to the downgrading of Hemel Hempstead General hospital and the loss of its accident and emergency services. We fear that because we have been here before; in the mid-1980s, the maternity unit at St. Albans City hospital was merged with, and moved to, Hemel Hempstead because, we were told, it had a high risk of perinatal mortality. The subsequently published figures did not demonstrate that, but by then it was too late.

    We were told that the move was a one-off. Not so: it was a precursor to the merging of the accident and emergency units and acute services, which also moved to Hemel Hempstead from St. Albans. I strongly opposed the merger, as did most local people and all parties, but it was unanimously supported by the consultants, who argued that the merger would lead to an improved service.

    The merger went ahead. Ever since then, I have challenged the health authority to publish figures showing whether the service has improved. It has refused. I have asked Ministers to carry out a study of similar mergers across the country to demonstrate whether they have raised clinical standards. They, too, have refused.

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    We fear remorseless centralisation in the national health service. We could accept it more readily if it were based on evidence, but if that evidence exists, it has not been published. The real reasons for the merger are the supposed cost savings, which rarely materialise, and bureaucratic empire-building, which materialises all too often. We fear that the change will be permanent, not temporary. It will lead ultimately to the loss of all major acute and accident and emergency services at Hemel Hempstead, and their transfer to Watford General hospital.

    Let us consider the short, medium and long-term. In the short term, we must be sure that the move is truly necessary. We must be assured that all options have been properly considered, including transferring qualified staff, increasing the unit‘s budget and staff complement, and making more strenuous efforts to recruit staff. We have little faith in the proposed review, which purports to be independent although it was set up by a Minister. The review is mostly anonymous and started work too late. It looks more like a whitewash than an objective inquiry. None the less, we hope that the review will be of some use, but if it is not, we must look to the medium term.

    Our medium-term objective is to receive a firm commitment to restoring maternity and related services accessible to people in Harpenden, Redbourn, Sandridge, Wheathampstead and St. Albans. That means bringing those services back either to Hemel Hempstead or to St. Albans. That is the least that we will accept from the review.

    If there is a proven case for specialisation and larger hospitals, the only satisfactory long-term solution is a super hospital accessible from Harpenden, St. Albans, Hemel Hempstead, Watford, and the area between those four places. None of the existing hospital sites are large enough or accessible enough to fulfil that role and house a first-class specialist hospital covering West Hertfordshire.

    We must not let services implode into one of the existing sites, like a black hole absorbing stars into a minute space of infinite density. It is all the more essential to avoid that, given the current review of hospital services in Hertfordshire. At present, there are no hospitals with specialist standing in Hertfordshire that serve the whole region, so a new super hospital in Hertfordshire would help us to prevent the county from being downgraded to an auxiliary of London and Cambridge.

    I wait to hear the Minister‘s response, and ask her to give me assurances about the short, medium and long term. That would be the best Christmas present that my constituents, particularly future mothers, could receive, and I hope that they do.
    12.44 pm
    The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : I am grateful to the right hon. Member for Hitchin and Harpenden (Mr. Lilley) for raising such an important issue and for the way in which he has approached the matter on behalf of his constituents. Clearly, almost nothing is more important to people than the future of their hospital services, in particular those that relate to maternity, obstetrics, gynaecology and other services for women and their

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    families. I understand the local worry that will have been caused by the speed with which such decisions have been taken.

    I am also aware that the right hon. Gentleman has raised the issue previously. He has asked a parliamentary question of a ministerial colleague about the urgent transfer of the service. I know that the way in which the decision became known has caused great worry to hon. Members, health service staff, community health councils in the area and local action groups. The residents of St. Albans and Harpenden became aware of the information by way of their local press. I emphasise that the decision to transfer the special care baby unit from Hemel Hempstead to Watford General hospital is clinical. It is not financially driven, but is a response to several adverse clinical incidents combined with acute difficulties in recruiting specialist paediatric nurses to the special care baby unit. That position led Hertfordshire Partnership NHS trust to declare the special care baby unit service at Hemel Hempstead hospital unsafe.

    As the right hon. Gentleman said, clinical safety must be of the utmost importance when providing services to families in his area.The decision was made in the best interests of patient care and safety. Given the circumstances, the option to transfer the service to Watford general hospital was felt to be the most appropriate.

    Mr. McWalter : My hon. Friend‘s briefing may be a little out of date in that the Hunt inquiry was established to find out whether such claims–some of which may be founded on misinformation–are true. The Hunt inquiry was due to meet in January but, as the right hon. Member for Hitchin and Harpenden (Mr. Lilley) said, there has now been a fourth postponement until March of the movement of the special care baby unit. Perhaps those developments have not reached my hon. Friend‘s office, but she must not talk as if that action is a fait accompli–as the right hon. Member for Hitchin and Harpenden described it. On the contrary, the decision is still very much under investigation.

    Ms Blears : I understand my hon. Friend‘s point, but it is important to say that the decision came about as a result of clinical safety issues and concern about adverse incidents, together with difficulties in recruiting paediatric nurses. Those difficulties are a matter of fact. The trust has set up several recruitment drives, but has been unable to recruit nurses to the unit. I understand that the cover required is about 16 whole-time equivalent paediatric nurses to sustain the number of beds that were in the special care baby unit, but at the moment it has about 6.45 equivalents. Clearly, there is a real problem. It is a fact that recruiting paediatric nurses to a place such as Hemel Hempstead is difficult, given housing costs and the salaries that are paid. Most people in the area would recognise that that has been a problem for a considerable time. Whether or not that issue is sufficient in respect of the decision to relocate the special care baby unit will be examined by the review. Recruitment problems have been an issue for the trust for some time.

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    Mr. McWalter : My hon. Friend may be aware of the plan to have a 135-unit nurses home on site, so there will be no problem in the medium and long term.

    Ms Blears : I am aware of that. Negotiations are continuing with English Partnerships to look into setting up a multi-storey residential development of 135 single cluster units to attract young nurses to the area. However, such developments will occur in 2003 and, as my hon. Friend said, we are talking about the medium term. I am explaining the reasons for the immediate decision that was taken, which will be the subject of review. I wish again to put it on the record that the decision was not financially driven. It is about safety, clinical issues and ensuring that, in the interim, the situation is managed safely so that we can reassure the people in the area that their families and babies are not at risk, and that the situation will continue to be managed as safely as possible.

    I also want to set the issue in the context of the various reviews that are taking place. The right hon. Member for Hitchin and Harpenden talked about the need to ensure that the decision is temporary and not a fait accompli or a permanent decision. It is important that the matter is considered in the context of the review of services generally. Too often–I have personal experience of this–decisions have been taken that, as a result of subsequent events, almost inevitably become permanent. It is important, therefore, that the temporary decision is based on clinical safety and is not embedded by subsequent actions, from which it is extremely difficult to retreat. I am acutely conscious of the need to do that.

    In Hertfordshire and south Bedfordshire, the need for strategic change in relation to acute services is recognised. The right hon. Gentleman‘s suggestion about the possibility of a new super hospital is not on my agenda. We recognise the need for a review of services, but it is important that all such reviews are linked together. For example, any proposed permanent changes to acute children‘s services must be subject to formal public consultation with all its implications. People must be involved in the consultation and their views must be taken properly into account. It is important that decisions are made at local level to ensure that maternity provisions, in particular, and provisions for new-born babies are the most effective in terms of local needs. The proposals for maternity services in Hertfordshire also need to be considered in the context of two important developments in the national health service as a whole.

    I am not sure whether the right hon. Gentleman is aware of the current national review of links between maternity, gynaecology and other related services. The long-accepted view has been that, once a special care baby unit is moved, the maternity provision has to move. The obstetrics and gynaecology units also then have to move. I understand the right hon. Gentleman‘s concern that it is a salami-slicing process and that an initial decision can have many knock-on effects. A substantial number of services could be dramatically changed. It is important to mention that the national review is looking at the links between those various services. It aims to establish whether the accepted view that such services are inextricably linked–and cannot

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    under any circumstances be considered differently–is the right approach. In the context of that range of services, that would be a significant change.

    The right hon. Gentleman talked about the move toward centralisation and bigger services. Within the NHS generally, there is a view that some of those issues should now be reconsidered, that they are not automatically given and there may be different ways of organising services. As a result, more services could be provided safely, closer to people‘s homes and communities. It is difficult to strike a balance between safety and excellence, clinical quality and local access. However, it is important that we examine those issues and not accept the idea that because they have been carried out in a certain way in the past, they must continue in that way indefinitely. We must therefore look at the long term and the national picture as well as the local picture.

    We must also be aware that there is a large commitment from the Government to increase the number of midwives in maternity services in many local areas. Midwife-led units are extremely popular. They have had excellent outcomes, especially with low-risk births without complications. Local women certainly appreciate midwife services. We are on target to recruit a further 500 midwives by the end of next year, and an extra 2,000 midwives by the end of 2005. It is important to ensure that we not only recruit new midwives, but retain the existing midwives.

    I want to deal with the issues raised by the right hon. Member for Hitchin and Harpenden and my hon. Friend the Member for Hemel Hempstead (Mr. McWalter) about funding for maternity care. The funding was recently announced as a result of the ?100 million of capital investment nationally, but Hemel Hempstead did not receive its allocation. I understand how my hon. Friend could feel that that reinforced the permanent nature of the removal of maternity care services from Hemel Hempstead.

    I firmly refute that position and say that West Herts community health NHS trust received ?622,000 for Watford General hospital. There was an allocation of ?240,000 for Hemel Hempstead general hospital. That allocation still exists; it has been deferred until 2002. That decision was made immediately before the decision to relocate the special care baby unit, so it would have been inappropriate to allocate the money to Hemel Hempstead. However, I am assured that that allocation has not been set aside. The money is still available, and has not been used elsewhere. Hemel Hempstead has not lost out with regard to those allocations–but any capital allocation will need to be supported by a robust revenue situation in the broader health economy.

    As a period of change is under way, the allocation has been deferred until 2002-03.

    Mr. Lilley : Will the Minister elaborate on that? One of her colleagues published a list of all of the sums, hospital by hospital. Hemel Hempstead received nothing, so it is interesting to learn of that ?750,000. Has it been plucked out of thin air? If the hon. Lady possesses the power to magic money out of thin air, we would like her to exercise it more frequently.

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    Ms Blears : I do not have a magic wand, and I do not cast spells.

    I am assured that the eastern region has had its allocation, and the figures are as I have stated–?622,000 for Watford, and ?240,000 for Hemel Hempstead. However, because the decisions to institute the changes were made at the same time, the allocation of those sums has been deferred to 2002. This morning, I sought an assurance that that money is still provided for, and I received it. However, I understand that hon. Members might have seen that their hospital had no allocation, and that they might therefore have assumed that that was confirmation that the decision to move services was permanent, rather than temporary. The situation is still fluid; there is still an allocation for Hemel Hempstead general hospital.

    The right hon. Gentleman also referred to his constituents‘ concerns that there might be a proposal to move the maternity service from the QE2 to the Lister hospital. There are no plans to do that, at present–although a general strategic review of acute services is being conducted. I wish to reassure people who live in the area that there will be sufficient capacity for mothers-to-be and families to have access to high quality maternity services in the future.

    The hon. Gentleman mentioned transport problems such as congestion, and the time that it takes for patients to travel to the site of the alternative provision. I am aware of those problems. Discussions have taken place with the ambulance services in the area, and the midwifery service, to try to ensure that patients are informed of the preparations that they will have to make, should they need to travel those distances. They should be told how long the journey is likely to take, so that undue distress is not caused to people who are going into labour, who need swift access to a hospital.

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    There have been other discussions, in particular with the ambulance services, about what to do about the possibility of increased 999 calls from women who are going into labour, to ensure that the best possible service is provided.

    The Dacoram primary care trust, and Harpenden and St. Albans primary care trust, are undertaking a feasibility study of the possibility of establishing low-risk maternity services provision in north-west Hertfordshire. That study is separate from the acute review that is also being conducted, and if it finds that it is possible to provide a midwife-led service in the area, that would benefit local people.

    Concerns have been raised in the local media about the cost of the proposed transfer, and about whether resources might be wasted if the independent review panel were to change its decision after improvements had been made at Watford. I assure local people–and hon. Members–that the vast majority of those improvements would have been carried out in any event. We are not in the business of spending money unnecessarily: we are focussing on certain necessary safety improvements. If there are to be any permanent changes that affect maternity services and services for families in this area, they will be the subject of proper public consultation, so that all the people in the community who have raised proper concerns about those issues will have a full chance to get involved and make sure that they have their say on shaping services for the future. I hope that the independent review will be able to look at the proposals that have been made, and ensure that they are robust and properly reflect the clinical and safety concerns in that community. Those concerns must be given the highest priority, but must always be balanced with trying to ensure that services are as close to home and as accessible for local people as possible.

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