It is, perhaps, appropriate that at the end of an extensive debate that touched on so many issues affecting women's health, we should move on to specific issues affecting the well-being of the women in my constituency.
I wish to start with a few personal remarks. Yesterday I attended the funeral of Dr. Allan Matheson, who was a key figure in all our efforts in Moray not only to improve maternity services but to enhance all of Moray's medical facilities. Like me, the community of Keith has been devastated by his tragic and untimely death at the age of 39. All of us remember his unstinting work in his community—his selfless, sincere and abiding concern for all the patients in the local practice. His commitment to those with special needs was reflected in his work for the Sunshine playgroup, his involvement with the Keith patients participation group, the local parent teachers' association and the Keith caring service. Keith has lost a great friend. As was said at his funeral yesterday, it is a fitting memorial to his life and his work that his activities helped to persuade Grampian health board to retain a maternity unit in the Turner memorial hospital. I am sure that the Minister, who met Allan Matheson during that campaign, will join me in recording our deepest sympathy to his wife Hazel and his children Kirsty, Rhona and Duncan.
To return to the issue of the debate, I understand that the Scottish Office has received a full submission from the Grampian health board recommending that five general practitioner maternity units should be closed. I note the Minister indicating dissent, but must tell him that I was given that advice last week when I spoke to a representative of the board. I apologise if the Minister has not yet received it, but it is certainly on its way. The submission is to close the five GP maternity units in the area, with no further consideration being given to the possible establishment of a specialist obstetric and gynaecological unit in Elgin.
My first key questions, therefore, are can the Minister say when the Scottish Office will give a response, how will the announcement be made, and what provision will be made in the coming weeks for representatives of the Scottish Office to meet local interested groups representing both the medical profession and the public? Such meetings would be desirable before any final decision is reached.
As the Minister well knows, the Grampian health board's proposals met with universal antagonism throughout the region. While this debate relates specifically to Moray, I wish to emphasise the general principles underpinning that reaction. Together with the right hon. Member for Kincardine and Deeside (Mr. Buchanan-Smith) and the hon. Member for Gordon (Mr. Bruce), I have argued that women in rural areas have the right to give birth in local hospitals. All three of us, irrespective of party politics, feel most strongly that choice and safety are being ignored, and we resent the centralising philosophy that denies our mothers the right to have access to local facilities that, over the years, have been marked by the highest standards of care and practice.
Our mothers are to be asked to undertake hazardous and lengthy journeys. They will be removed from the familiar surroundings of their local units and distanced from family and friends at a time when they wish to be in their local communities. All three of us believe that that is against the interests of our constituents and communities. We are certain that no good reason has been put forward for doing that.
There are two key issues in Moray. First, Leanchoil hospital in Forres is to lose its maternity unit and all mothers are to be transferred to Raigmore hospital in Inverness, which is in a different health board area. It appears that complex negotiations—though not public negotiations—have taken place between Grampian and Highland health boards, and the former will pay the latter for such obstetric facilities. Will the Minister give me some guidance? First, what costing of that deal has Grampian health board given? Secondly, are the obstetricians based in Inverness prepared to accept full responsibility for all aspects of pregnancy, labour, delivery, neonatal and paediatric care that were previously dealt with by general practitioners in Forres?
Thirdly, is the Minister satisfied that Raigmore hospital will be able to cope with increased numbers, including the provision of lying-in facilities for new mothers? Fourthly, has any costing been made or will a costing be made of accepting the suggestion from Leanchoil general practitioners that the current 12-bed unit be reduced to six beds, with the other beds being given to orthopaedic facilities? Fifthly, has any account been taken of the importance attached to Leanchoil by young RAF families based at RAF Kinloss? Sixthly, what safety net is to be left for emergencies for Forres mothers who, for whatever reason, cannot travel to Raigmore?
Dr. Russell Lees, a consultant obstetrician and gynaecologist at Raigmore, commented:
We, the Consultants in the Department of Obstetrics in Raigmore view with anxiety the prospect of an increased demand for home confinements which could conceivably arise as a result of the closure of the maternity unit at Leanchoil and it is for that reason that we would support the retention of a six bedded unit at Forres for uncomplicated deliveries with the additional benefit of "lying in" facilities for those mothers who deliver their babies in Raigmore but whose medical condition is such that they can be looked after in the early days … in a hospital nearer home.
That issue directly affects Forres and the western side of my constituency.
The next main issue for Moray is the need to establish a full-scale specialist obstetric unit in Elgin, which is regarded as the centre of the district. Perhaps the fate of the Turner memorial and Leanchoil hospitals would not have met such antagonism had Grampian health board offered us a locally based specialist facility. However, the long-held hope that Elgin would have such a unit has apparently been ditched for good by the board. Instead, Aberdeen and Inverness are to be the central points for such services. The suggestion is that all women east of the Spey will be asked to attend Aberdeen maternity hospital and that all women west of the Spey will be asked to attend Raigmore and Inverness hospitals.
On my latter point relating to the geographical area west of the river Spey, I again refer to comments made by Russell Lees, the consultant obstetrician at Raigrnore hospital in Inverness. He stated:
I feel I should add that the Consultants in the Department of Obstetrics at Raigmore view with some concern the prospect of transfer of maternity care patients in
the Elgin area from Grampian Health Board to Highland Health Board, and we are uniformly of the opinion that without additional facilities in terms of beds and staff at all levels we could not provide a similar quality of care to that which is already provided by this Department for mothers from the Highland Region.
Dr. Lees said that against the background of an increase in the bed complement at Raigmore from 56 to 72. It is not enough to say that facilities at Raigmore have already been increased.
In whatever direction the mums in my constituency are pointed, they face lengthy and hazardous journeys along the A96—a road that is notorious for delays and accidents at all times of the year. Obviously, that road is most dangerous in winter. Recently, it was branded by the Inverness chamber of commerce as a goat track, and by the Royal Automobile Club as a death trap. In conjunction with all the district councils near that road, Highland and Grampian regional councils are mounting a major campaign to improve the A96. It seems unlikely that that will be within the immediate future, although piecemeal opportunities have been given for slight improvements on the road.
We must think of women who are in distress—perhaps already aware that the life of their baby is at risk—being driven over a road that they know is in poor condition. Often, they are already in labour, strapped to a drip, and in severe pain. No one could harden his or her heart to the psychological and physical stress that such an experience must create. We must remember that such women may not have their husbands with them, and may have left behind young children.
There is, of course, the flying squad. On page 10 of unit II's strategic plan for maternity and neonatal services in Grampian, it says:
Once the Flying Squad call is received it takes an average 30 minutes to assemble medical staff, equipment and taxi and if the call is to Elgin, for example, then a further one hour 45 minutes transport time ensues to reach the destination. This delay may be crucial to patient management. Often, because of the time factor involved, the patient is sent by ambulance to Aberdeen and may deliver en route.
So now it is being suggested that a helicopter could form part of the normal service to mums in my area. The same report says that it should be part of the normal service to have a helicopter as a standby to transport mums in labour from my constituency.
I have never travelled by helicopter, but many who have—including my husband who is a member of a mountain rescue team—tell me that it is without doubt the most unpleasant and uncomfortable form of transport imaginable. The idea that women in labour and in stress should be asked to regard a helicopter as a mainstay is unpalatable.
We should consider Grampian health board's reasons for opposing the establishment of a specialist unit such as we want in Moray. The board says:
There is no definitive guidance on the optimum population to be served by a full specialist obstetric facility".
It seems that, in the absence of definitive guidance, the board is prepared to reach its own definition. By using the Gavin Shaw report, which recommends a minimum of three consultant obstetricians, Grampian health board concludes that 1,100 births per year do not justify the establishment of such a unit.
My argument, like that of my fellow campaigners in Moray, challenges that assertion. I shall use the facts and fugures provided by MUM—theMaternity Unit for Moray campaign—which says:
In a centre of population such as Moray, with 26,361 females aged 16–64 and 6,880 females aged 65–89, is it appropriate to provide obstetric and gynaecological services for the majority of these women, either 68 miles away in Aberdeen or 37 miles away in Inverness? Miss Hines, the Director of Midwifery Services in Grampian stated on 11 February 1988 at the public meeting in Elgin, that she could not justify or defend the decision of Grampian Health Board to continue to send mothers such distances for obstetric care.
On page 2 of its strategic plan, unit II says:
The total number of births in Grampian will fall to approximately 6,500 by 1991: of these 1,300 babies will be born to women living in Moray. The numbers for 1996 are approximately 6,300 and 1,400 respectively.
In other words, we are anticipating an increased birth rate in the Moray district. We know that obstetric units which cater for smaller numbers have been established elsewhere in Scotland and I believe that, south of Perth, the norm for such facilities is a travelling distance of something less than 30 miles.
Grampian health board also believes that the number of cases that it predicts would not attract consultants of the quality that it desires. That must be one of the most spurious arguments that has been advanced. Elgin has never experienced any difficulty attracting consultants of the highest calibre on other specialties, and nobody but Grampian health board anticipates any difficulty in attracting obstetricians.
If population were used as the sole criterion for the establishment of specialist centres in rural communities, we could fully expect all specialist centres in Scotland to be based in cities. It is therefore an argument to which we cannot give any credence and I hope that the Minister, who also represents a rural constituency, will reject it.
I trust that the Minister will give us hope in Moray that the maternity services that we already have and appreciate will not be taken from us. Our GP units are of the highest standard and the public has shown its confidence in them by the demand for their retention. The files that I have on the Bench beside me represent the strength of feeling from my constituency. Those files contain letters of support and argument, not just from the GPs or from the medical practitioners within my constituency, but from hundreds of ordinary men and women who are deeply concerned about their community. This argument is not about statistics and, according to the Grampian health board, nor is it completely about costs. The argument is about life. It is about safety and proper medical care. In Moray we are refusing to be regarded as second-class citizens.
I was sad indeed to hear the news about Dr. Allan Matheson. I well recall the hon. Lady bringing a delegation to see me about the Keith maternity unit. The clear commitment that Dr. Matheson had to the community was evident from our discussions. I join the hon. Lady in expressing my condolences to his wife and family on such a tragic loss.
The hon. Lady expressed some surprise when I said from a sedentary position that I had not received the final submission from the Grampian health board. I received in April some preliminary material regarding its proposals for closure. Additional infomation was forwarded to my Department on 2 June, and the remainder is expected within the next fortnight. Therefore, I have to dissappoint the hon. Lady because I am unable to say very much today—in fact nothing—about the substance of the board's case or to reply to her arguments. However, I have had a large number of representations on this matter from a wide variety of opinions and from every section of the community in Moray. In fact, a few weeks ago I had a lengthy discussion with the chairman of the health council, Mrs. Rona Hossack. I have given an undertaking to the officers of the health council that before coming to any conclusions on the matter I will meet them to discuss the arguments. I hope that the hon. Lady will accept that as going some way towards meeting her request that I should take account of local opinion on this matter before reaching a conclusion.
It clearly would not be appropriate for the Scottish Office to embark upon a whole new consultation process, because these matters are for the board. I am sure that the hon. Lady will forgive me if I make one rather pertinent observation. In this debate the hon. Lady is asking me and my right hon. and learned Friend to overturn the decisions of the Grampian health board and direct it to do something else. It was only a few weeks ago that she was strongly chiding me and criticising me in public for directing the health board on competitive tendering. She was then arguing that it was no part of the Secretary of State's duty to undermine the local autonomy of health boards. Having said that, the breadth of feeling on this matter is clear.
I am grateful to the Minister for allowing me to intervene. I am conscious of the time constraint. Some of his latter comments have been mischievious but I shall not respond to them. On the issue of consultation within the community, and over and above meeting the representatives of the full health council, will it be possible for representations to be received from general practitioners in Forres, and will there be discussions with the obstetricians in Raigmore, which is within the Highlands health board.
I shall consider all the arguments, but it is the job of the health board to carry out the consultation process and reach conclusions, and it requires the consent of the Secretary of State. The hon. Lady is asking my right hon. and learned Friend to overturn its conclusions following its consultation, and it would not be appropriate for my right hon. and learned Friend to be involved in consultation. Having received strong representations from Mrs. Hossack, I agreed to meet officers of the health council before reaching any conclusion. I have agreed to meet a delegation that my right hon. Friend the Member for Kincardine and Deeside (Mr. Buchanan-Smith) is bringing to deal with the issue of Torphins prior to reaching any conclusions.
I have received representations from the Maternity Unit for Moray campaign and I shall examine carefully the specialist unit proposal. I have also received representations from regional and district councillors and others through the political network from the Moray Conservatives. I accept that it is an issue of concern to every sector of the community.
There was the hint in the hon. Lady's speech that resources have had a part to play—she referred to the overall level of funding available to the Grampian health board—but I do not believe that they have. Conclusions should have been reached on the basis of what will provide the best quality of patient care for the people of Moray. The Grampian health board has seen a substantial increase in the resources granted to it since the Government came to power. Since 1979, the amount of money available to the health board to meet running costs has increased by one third over and above inflation. The increase in capital resources that has been made available to the board to fund new developments and new hospital projects has been spectacular. That level of funding has almost doubled in real terms, there having been an increase of 96 per cent. since 1979.
I know that the hon. Lady will be aware of the difference between the resources that are available to the health boards now and those which were available when the Labour Government were in office, whom she and her party were keen to support.
When that Government were in office we saw a 28 per cent. cut in the capital expenditure made available to health boards in Scotland. These figures are sometimes dismissed as mere statistics or just numbers, but they are not. The increased funding that we have provided for Grampian is seen in new developments. Phase 1 of the new royal Cornhill hospital will begin construction in October and will improve the services that are available to the mentally ill. When I visited Foresterhill I announced that £3 million would be made available for the new blood transfusion centre that will open in 1991. More central to the hon. Lady's constituency interest is the redevelopment at Dr. Gray's hospital to replace the Maryhill maternity unit, which will cost more than £1 million. I recently announced the extension of cardiac surgery in Grampian that will result in a capital investment of about £1·2 million over a period. As we are now taking centrally the funding of cardiac surgery operations there, the result will he a windfall running cost benefit to the health board of about £250,000.
The board has benefited from some substantial extra money. I urge the hon. Lady to recognise that and to recognise also that any decisions should be based on what represents value for money. The review of maternity services is designed to ensure that the needs of the people are met as well as to ensure efficiency.
Lest these discussions seem to be limited to Grampian, let me say that other health boards are having to consider these matters. Lothian has had to consider the problem of the underutilisation of maternity beds. Clearly, it is in no one's interest to have beds which are staffed but which are not needed, because that constitutes a waste of resources. Today my right hon. and learned Friend has approved a restructuring of obstetric services in Lothian which will involve the closure of the Elsie Inglis maternity hospital in Edinburgh. He was prepared to give consent on the basis that for years there had been an oversupply and underuse of obstetric beds and that the position would be made worse because of the opening of new obstetric services in the Borders. He also took account of the facts that the proposals have the support of Lothian health board's professional advisory committees and that the savings will be fully available to the board to promote development and improvement in the services in other areas.
The hon. Lady asked about the A96. Fortunately, roads are not within my area of responsibility, but the importance of the A96 is fully recognised. Works worth some £6 million are under construction; £44 million worth of work is planned and a major feasibility study is under way. Progress on future schemes will be determined by the satisfactory completion of statutory procedures, the availability of finance and the priority of particular schemes within the context of competing claims from the entire trunk road network in Scotland.
The hon. Lady will forgive me for pointing out that in Scotland we enjoy a Health Service that is funded to the extent of rather more than a quarter more per head t n the Health Service in England. Our roads programme is also considerably better funded. Were it not for the fact that I would be called to order, I would be intrigued to hear from her how she imagines that continued support would be available if we were to follow the prescriptions of her party.
I shall listen carefully to all the arguments and study with the greatest possible care the papers, submissions and letters we receive in the Department. I am happy to hear from the hon. Lady of any additional arguments, other than those which she put in the debate and in correspondence with me. I will make arrangements to meet the officers of the health council. The personal remark which she addressed to me about my constituency interest and recognition of the problems of rural areas strikes home. I need no convincing because when my wife was expecting our latest child, the central thought in her mind was the 25 miles which were involved from Aberfoyle to Stirling, so I am aware of the anxieties and feelings. I shall ensure that the arguments are considered carefully before we reach a conclusion.
The hon. Lady asked when we would reach a conclusion. In the time-honoured phrase which trips off the tongue so easily after a mere year at this job, we would expect to reach a conclusion as soon as possible and shortly.