Maternity Services, Edinburgh

Part of the debate – in the House of Commons at 9:36 pm on 24th November 1994.

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Photo of Malcolm Chisholm Malcolm Chisholm , Edinburgh Leith 9:36 pm, 24th November 1994

I applied for the Adjournment debate a couple of weeks ago because of the clear intention of Lothian health board to centralise all Edinburgh maternity services at one hospital, the proposed new Edinburgh royal infirmary at the southern edge of the city, and also because it planned to break its clear promise to reopen a maternity unit at the Western general hospital, which serves large areas of my constituency.

There were several reasons why that caused anger in my constituency and beyond. First, and most important, it was a denial of the fundamental principle of choice. Choice for women means not just choosing the kind of unit in which to give birth, but the location of that unit.

Secondly, there would have been very long travel times for women in my constituency when they had to go into hospital to have their children, for antenatal visits and for visits from their relatives when they were in hospital. That would have involved great expense and many people in the catchment area of the Western general hospital are poor and deprived.

The third reason was that the health board had overlooked the high density of population and the high birth density in north Edinburgh. It seemed an ideal solution to have a maternity unit at the Western general hospital, which serves an area where there is much poverty and deprivation. It seemed a good idea to have a maternity unit near such an area rather than miles away on the other side of the city.

The fourth reason was that there seemed to be no evidence for the proposition that one centralised maternity unit was safer. That argument was being advanced by many health professionals. Yet that opinion is not shared by other health professionals. There does not seem to be any evidence to back up such a proposition.

I received a copy of a letter from a professor of paediatrics in Canada who previously worked at the Western general hospital but now works in the university of British Columbia. He said: We were, until recently, the only tertiary perinatal centre for a birth population of 45,000, with 8,000 births, heavily high risk oriented, in house. In my experience 8,000 deliveries is about twice too many. People were particularly angry because the original acute services strategy put out for consultation earlier this year contained a proposal for a maternity unit at the Western general hospital. That was overwhelmingly approved by people during the consultation process. Therefore, people were angry when that proposal was rejected and it was decided to work up another proposal in which all the births would be centralised at one mega-unit in the south of Edinburgh.

Since then, there has been a strong and vociferous campaign against that proposal. It was spearheaded by a group called the Women's Health Lobby. They did a great deal of research which showed that women simply did not want such a proposal. The group was also supported by both councils in Lothian—Lothian regional council and Edinburgh district council. It was supported by many general practitioners and by the local newspaper, the Edinburgh Evening News.

That campaign was so strong and the opposition was so overwhelming that Lothian Health was forced late in the day to come up with a compromise proposal. That became clear only at the health board meeting on Tuesday. In that compromise, the board has come up with the smallest concession that it could get away with. It is a proposal for 1,000 deliveries a year in a midwife-led unit at the Western general hospital in Edinburgh.

I am not opposed in principle to a midwife-led unit, but there are several problems with the proposal. I should like to mention at least three of them. First, there is no guarantee that it will go ahead. The health board stated in the proposal that it would evaluate other midwife-led units currently in operation in Scotland and then come to a decision. We do not know what the result of the evaluation will be. Beyond that, the proposal has to obtain the approval of the Scottish Office. We know that Lord Fraser, the Scottish Office Minister with responsibility for health, did not accept Fife health board's proposal for a midwife-led unit at Dunfermline. That is an analogous proposal to the proposal for the Western general. Both are stand-alone units without obstetric back-up on site. It is by no means clear that the proposal will be implemented.

Secondly, even if the proposal is implemented, we are talking about a single unit of 18 beds and about 1,000 deliveries a year. That will not meet the demand for that type of delivery. If Lothian Health is now saying that such a unit is acceptable at the Western general, why not have one in other places in the city? If the principle of midwife-led units is accepted, why not have more? It is clear that there will be far more demand not only from the local population but from all over the area because many women are attracted to such small units rather than the large mega-unit on the outskirts of the city.

Thirdly, many women will not be allowed to go into such a unit. In the proposal that was worked up by Western general hospital, it was stated that only 40 per cent. of local women would be eligible for such care. So the majority of women in the area which I represent would not even be allowed to have their babies in such a unit. I shall listen carefully to what women in my constituency say about the proposal for a midwife-led unit. If they accept it, I will certainly accept it, but the message that I am getting now is that such a proposal simply is not enough.

I should like to know why Lothian Health did not adopt the proposal made my me and many other people that there should be two units with perhaps the larger at the new royal infirmary. It could even have a unit of 4,000-plus deliveries, and there could still be one of 2,500-plus deliveries at the Western general. Within those large units, there could be midwife-led units. An innovation in maternity practice is to have midwife-led units in a hospital setting alongside obstetrician-led units. That proposal was not even discussed seriously at the health board meeting on Tuesday. In fact, many attempts have been made to rubbish such a proposal.

In correspondence in the past few weeks, the chairman of Lothian Health said that there would not be enough people to use such a unit at the Western general and that the catchment area would mean that only about 1,700 deliveries a year would take place there. I cannot for the life of me understand how he comes to that conclusion, because more than half of Edinburgh is nearer to the Western general than to the new royal infirmary proposed at Little France. Therefore, I do not see how he arrives at a figure of 1,700 or fewer deliveries at the Western general and, presumably, 4,500 or nearly 5,000 deliveries at the new royal infirmary.

One of the mysteries of the process has been how many deliveries we are talking about. When the proposal was first put forward, we were talking about 7,500 deliveries at the new royal infirmary, which would provide the largest maternity unit in the United Kingdom. But as the debate went on, it suddenly became clear that we were talking about 6,500 deliveries. There may be a good explanation for that. It has not been given to me. Some people are slightly sceptical about this, because the lower number of deliveries may have made it slightly easier to sell the case for a large unit.

I would like the proposal for the two units to be seriously considered. Most of all, I would like there to be a full consultation process on the new proposal. What we have before us is not the same proposal as went out to consultation earlier this year. It is for a small midwife-led unit. The indications that I am getting are that it is not accepted as adequate by the women whom I represent, so I would like an assurance from the Minister that he will ask Lothian Health to carry out a full and proper consultation. There was a slight ambiguity at the end of the meeting on Tuesday. The chairman began to talk about marketing the proposal and fortunately somebody else on the board objected and said that we needed consultation, but it was not clear if we would get it.

The most important principle in all this is that women should decide what kind of maternity care they want. Therefore, it is essential that we have full consultation on the proposal. I suspect that, if that takes place, women will say that they want a larger unit at the Western general; that they want something more in line with the original proposal that was thrown out earlier this year. That is what I am arguing for this evening and shall continue to argue for as long as the women of my constituency want it.