Maternity Units

– in the Scottish Parliament at 5:06 pm on 27th April 2000.

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Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament 5:06 pm, 27th April 2000

The final item of business today is a members' business debate on motion S1M-718, in the name of Irene Oldfather, on the relocation of maternity units. I appreciate that there has been great excitement, but another member is waiting to start a debate. Members who are not staying should please leave quietly and quickly.

In the meantime, members who wish to take part in the debate should press their request-to-speak buttons now. The debate will be concluded without any question being put after 30 minutes.

Motion debated, That the Parliament notes the proposed relocation of maternity wards throughout Scotland, including the Ayrshire Central Maternity Unit, Irvine; further notes the concerns of the communities affected; believes that any review of services should take into account all relevant factors, including the wishes of those communities and the effect of such closures on mothers and the local economy, and further believes that all health boards concerned should engage in full consultation with those affected, and take every factor into account when taking such decisions.

Photo of Irene Oldfather Irene Oldfather Labour 5:09 pm, 27th April 2000

I thank those who have supported this motion, enabling the debate to take place today, albeit it is somewhat overshadowed by the other events of the afternoon.

It is with some regret that I find myself, a member of the Health and Community Care Committee of this Parliament, speaking to a motion about lack of consultation by health boards. In particular, I am disappointed by lack of consultation by Ayrshire and Arran Health Board, which covers my area, in relation to a maternity hospital in which I had my own children. However, I welcome the opportunity that this debate provides to speak up for the women in the area I represent.

Most people see the creation of this Parliament as arising from a desire for a more democratic style of government for Scotland. Those who have been following the activities of the Health and Community Care Committee will appreciate that those expectations have not been matched in the activities of health boards. In the Stobhill and Stracathro reports, the Parliament has already sent out a clear message that railroading through predetermined outcomes is no longer acceptable.

The Stobhill report calls on the Executive to

"instruct Health Boards to prepare and discuss with interested bodies . . . a programme of informing, engaging and consulting with staff and the community on any change of use or closure."

I will outline for members what has happened in my constituency as an example of the difficulties that women face in having their views on maternity services expressed, even in the context of a Scottish Parliament pledged to bringing government and decision making closer to the people.

In February 1998, long before the setting up of a Parliament and even before the restructuring of trusts, Ayrshire and Arran Health Board published a maternity services strategy. In it was a recommendation to conduct an option appraisal of in-patient maternity services with a view to considering relocation. The report from that group was presented to the health board on 24 February this year—it is the rather weighty document that I have with me now. I received a copy of it in April. The recommendation was closure of the Ayrshire maternity unit in my constituency.

How did I find out about the health board's recommendations? As I had a three-hour meeting with the board on the Monday of the week in which the decision took place, one might think that I was made aware of the proposed closure then. I was not. Members will therefore understand that I and my colleagues in the area were astonished to receive routine health board papers two days before it made the decision to close the unit.

I have to ask whether the health board really believes that that constitutes consultation with communities in the new political structures. I ask the Parliament to send out a message today that health boards treating representatives of the people in that way is a disservice to our democracy in Scotland and a discourtesy to local communities and the women whom MSPs represent.

There is not enough time to consider the detail of the decision, but I would like to make some brief comments about Ayrshire central hospital's record of clinical effectiveness. The safety of women and their babies and offering women a choice are the most important factors in decisions to provide services. If one asks the women whom I represent—the service users—what they want from a maternity service, they will say, "A positive outcome; a healthy baby." They are likely to mention a personalised service with personal attention that is family friendly and helps them to deliver their baby. They will also ask for choice and control in the delivery process.

The excellence of Ayrshire central hospital's maternity unit in providing that choice and control is in no doubt, and suggesting otherwise is a great disservice to the staff. In 1998-99, Ayrshire central hospital registered the lowest stillbirth rate in Scotland, at 3.2 per 1,000 births against a Scottish total rate of 5.6 per 1,000. The figure for perinatal deaths is also the lowest in Scotland, at 6.1 per 1,000 as against 8.7 per 1,000.

The preventable stillbirth figures for 1998 are even more outstanding, with Ayrshire central boasting half the Scottish average. The percentage of normal deliveries with no complications was also well above the Scottish average. Ayrshire central holds the record for one of the youngest surviving premature births in Scotland. In common with almost 3,000 women who signed petitions about the closure, I remain to be persuaded that transferring essentially healthy women to a district general environment for sick people, where the possibilities of cross-infection and disease are prevalent, is in the best interest of reducing maternal death rates.

If the money is available, I urge the health board to invest in upgrading the present facilities. That would represent value for money for the taxpayer and build on the already first-class reputation of the hospital.

The figures that I have referred to illustrate what local people know: that the unit is first-class and provides some of the best health care in Scotland. I ask that Ayrshire and Arran Health Board engage in a proper consultation exercise in an open and transparent manner, and in the true spirit of partnership.

I welcome the opportunity to challenge the detail of the option appraisal paper. Frankly, as a researcher, I think that a coach and horses could be driven through it. This Parliament has demonstrated its worth today by providing the opportunity to remedy a wrong. It has allowed the views of my constituents to be heard. I ask the Parliament and the Minister for Health and Community Care to send out a clear message that health boards are accountable and have no right to disregard the democratic process.

Photo of Allan Wilson Allan Wilson Labour 5:17 pm, 27th April 2000

I thank Irene Oldfather for giving us the opportunity to discuss this issue and I associate myself with her comments.

Irene is the member for Cunninghame South, which encompasses the hospital in question, but its catchment area includes Ardrossan and Saltcoats, coastal areas from West Kilbride up to Skelmorlie, the Garnock valley—where I reside—and the islands of Arran and Cumbrae. I give that geography lesson partly to demonstrate my constituency interest, and to demonstrate that the catchment area is large.

My constituency is also served by the Royal Alexandra hospital in Paisley and the maternity hospital in Greenock. The latter is also under threat of relocation. If that happens, we will be left with no service west of Paisley. I drew the health board's attention to that point in a letter of 21 February, in which I asked it to defer a decision on a matter that affects thousands of my constituents until such time as duly elected representatives had had the opportunity to discuss with it a copy of its report, a synopsis of which—not the full report—I received only two days before the board took the decision in question. I did that on the basis that a large number of my constituents had expressed the view that the proposed relocation would disadvantage them because of the additional travel involved and inadequate public transport links.

Photo of Cathy Jamieson Cathy Jamieson Labour

I thank Allan Wilson for the geography lesson. Does he agree that some of the transport difficulties faced by my constituents who have to travel from as far south as Ballantrae and as far east as Muirkirk also have to be taken into account? My son was born in Ayrshire central hospital and I have every confidence in the people there, but the reality is that Ayrshire and Arran Health Board services a much wider catchment area than merely Irvine and the immediate surroundings. I hope that that will be taken into account.

Photo of Allan Wilson Allan Wilson Labour

I have no problem associating myself with those comments.

I speak as the constituency representative for Cunninghame North. My sons were born in Paisley, a detail which I provide to inform the debate. The National Childbirth Trust shares my concerns that small, more woman-centred maternity units are being closed in favour of large centralised units that involve more travel during pregnancy, when in labour and when visiting. Centralisation is being encouraged.

The NCT has three concerns: that greater travel will involve more stress after birth; that the care offered will not be as personal in centralised units; that the more institutional medical atmosphere reduces choice and creates more stress after birth. The health board simply ignored that. I learned two things: first, that the maternity services option group had been set up, which nobody knew about as it had not been referred to in any previous minutes; and secondly, that it had carried out a brief inspection of the relative distances involved. The group stated:

"These distances have been calculated on the basis of the main centre of population for each postcode area. For example Arran covers a whole postcode area, distances have been calculated on the basis of Brodick. Similarly, only 'crow-fly' distances have been estimated, with no additional water or difficult terrain weightings applied."

It ended by saying that it knew the geography and how ludicrous that proposition was.

The truth of the matter, substantiated by the board's comments, is that no consultation has taken place since the option appraisal recommended closure. No consultation is planned, despite the fact that since then this Parliament has been established and I have been elected to it.

Photo of Adam Ingram Adam Ingram Scottish National Party 5:21 pm, 27th April 2000

I thank Irene Oldfather for raising this subject for debate today. However, I believe that Ayrshire and Arran Health Board is to be congratulated on the comprehensive option appraisal exercise that it has undertaken and its review of maternity services. I support its conclusions, which are a logical and rational outcome of the process. They are to relocate the in-patient maternity services for Ayrshire in a purpose-built unit at Crosshouse hospital where all the services that could conceivably be needed in and around childbirth can be accessed readily.

The major and overriding consideration when making such a decision is to ensure that clinical effectiveness is maximised. A modern, purpose-built unit at Crosshouse will do that. It is also important to realise that all other antenatal and postnatal services will be provided at the level of local communities. A unit at Crosshouse hospital will be more accessible to more mothers than any alternative site, so it is the optimum outcome in that respect.

Although I sympathise with Irene Oldfather's remarks about consultation and the excellence of Ayrshire central hospital, I believe that the health board's proposals for upgrading and modernising the service—

Photo of Allan Wilson Allan Wilson Labour

If the member sympathises with Irene Oldfather's remarks about the lack of consultation, would he support an extended consultation based on the option appraisal report that has only now been published?

Photo of Adam Ingram Adam Ingram Scottish National Party

No, I would not. When elected a year ago, I raised the issue of maternity services in Ayrshire and was given a comprehensive briefing on the matter. I believe that the health board has consulted very comprehensively, although perhaps not as widely as it could. I do not agree with Allan Wilson's assertion that the health board has not consulted properly.

The health board's proposals for upgrading and modernising the service should be supported. As the father of four children, I consulted my wife on what she thought were the most important aspects of maternity services. She said that it is all about quality of care—how staff deal with mothers and how sensitive they are to their needs.

Photo of Irene Oldfather Irene Oldfather Labour

The statistics that I have outlined in relation to Ayrshire central hospital show that the quality of care there is the best in Scotland.

Photo of Adam Ingram Adam Ingram Scottish National Party

I agree that the service in Ayrshire has been very fine. However, we need to move on, to modernise and to progress.

Photo of Margaret Jamieson Margaret Jamieson Labour

I had my daughter some 18 years ago in Ayrshire central hospital. Does the member agree that the relocation of the service must be safe? I do not want my daughter or any other mother in Ayrshire to be sitting on a table waiting for the results of a test to find out her blood group to come from Crosshouse.

Photo of Adam Ingram Adam Ingram Scottish National Party

The fact that there will be a move to a district general hospital site means that there will be a 24-hour laboratory facility. There will also be an intensive care facility and all the rest of it.

I will stop to let someone else have a say.

Photo of George Reid George Reid Scottish National Party

My problem with timing is that the last speaker is dropping out.

Photo of Phil Gallie Phil Gallie Conservative 5:25 pm, 27th April 2000

There is a danger of getting into a Kilmarnock-Irvine-Ayrshire argument about localities.

Photo of Irene Oldfather Irene Oldfather Labour

On a point of order. If there is only one additional speaker, I wonder whether the Presiding Officer would consider extending the debate for a further few minutes.

Photo of George Reid George Reid Scottish National Party

I will be as generous as possible. As things stand, if Mr Russell takes about two minutes, we will just about manage.

Photo of Phil Gallie Phil Gallie Conservative

Irene Oldfather gave some figures that demonstrated that Ayrshire central hospital is offering an excellent service to people in Ayrshire. It is hard to see how those figures could be improved on.

I appreciate the trauma that Irene Oldfather faces with the prospect of maternity services moving away from her constituency to Kilmarnock. Just before I was elected as member of Parliament for Ayr, we had the same trauma in Ayr itself when Thornyflats hospital closed down and the facilities moved to Ayrshire central hospital.

I have some personal experience, although perhaps not quite as much as Margaret Jamieson and others. My granddaughter was born in Ayrshire central hospital. My daughter is a nurse, and she thought that the facilities were absolutely excellent. She had every confidence in the facilities offered. That counts for a lot. We are talking about something that is essential for the Ayrshire community.

There is another aspect that we must consider. If we are going to change the facilities and the location, the cost has to be examined. There will be additional costs in moving to Crosshouse hospital. It is claimed that there will be additional benefits. However, in the health service, every penny spent has to be carefully prioritised. Irene Oldfather referred to consultation, and I wonder whether that consultation has considered whether the additional costs of moving can be justified in relation to other health service facilities.

I sympathise with Cathy Jamieson and the points that she made about people in Ballantrae. I am sure that most of them are reasonably confident and happy with the services at Ayrshire central hospital.

Photo of Phil Gallie Phil Gallie Conservative

I cannot give way, because my time is up. My thanks to Irene Oldfather for letting me speak in her debate.

Photo of Duncan McNeil Duncan McNeil Labour 5:28 pm, 27th April 2000

I am aware of the time constraints, and I will rush through this. I feel as if I am intruding on an Ayrshire fight.

I appreciate the opportunity to speak in this debate, because I think it impinges on what is happening in the rest of Scotland. A review is taking place in my trust area, which includes the Vale of Leven hospital, Inverclyde royal hospital, and the Royal Alexandra hospital in Paisley. We are told that this review is driven by clinical considerations, that it needs to happen and that it will create bigger units that will be safer. That would be all very well if we lived neatly in units of 50,000. However, that is not what happens.

If reviews are to mean anything, they have to be open, inclusive and honest. A cloak and dagger situation, as exists in my trust area, only heightens the concerns about people having to travel distances, about whether safety or quality is—

Photo of Duncan McNeil Duncan McNeil Labour

No, I will not. Sorry, pal, but it is not on.

We cannot move people around while that type of cloak and dagger operation is going on.

I will cut to the chase. I am not asking for a boundary review because I appreciate that that might be difficult. However, we have artificial boundaries. One of the options for my side of the River Clyde is that Inverclyde royal hospital would move to the Paisley hospital, or vice versa. I do not believe that we would be considering that option if the artificial boundary were not there. Next door and up the road to Glasgow we have the situation where Queen Mother's and Yorkhill hospitals will be based only four miles from the unit at Paisley, and west of there is Crosshouse hospital. That is a piece of nonsense—it must be challenged.

It is understandable that constituency MSPs get excited about threats to local services. I am not saying that how things are organised is perfect and cannot be changed, but we must focus on the delivery of services and their quality rather than on imaginary boundaries. That is why health boards need to get together with the communities that they serve to deliver a service that can cover all Scotland.

Photo of George Reid George Reid Scottish National Party

If Michael Russell takes two minutes, that will leave one minute for Mary Scanlon and three bullet points.

Photo of Michael Russell Michael Russell Scottish National Party 5:30 pm, 27th April 2000

I congratulate Irene Oldfather on having the motion selected. The fact that I had a motion on the topic—she signed my motion and I signed her motion—and that her motion was selected for debate while mine was not shows how open and accountable the Parliamentary Bureau is.

I agree entirely with what Duncan McNeil just said—that is his career finished. The crux of the matter is a clinically driven argument that there has to be a drawing together of services. Duncan is right to say that people do not live in neat little units. It is not simply that the lines of division are wrong but that we must question that argument all the time. As Irene Oldfather said, the record of Ayrshire central hospital is second to none. Can it be made considerably better by the proposed change? I suspect not. In such circumstances the constant desire to amalgamate, to make units larger, to cut down the periphery, is an argument of despair. It will lead to one huge unit for everything—in health and education and elsewhere.

We must question that argument. I am sorry to see the Minister for Health and Community Care shaking her head. I am sure she will come up with her arguments but they are not infallible. Clinical judgments are not infallible, ministers are not infallible—the argument must be debated. Jackie Baillie indicates that ministers are infallible, so I will withdraw that remark.

Men are not infallible, women are not infallible. The moment we say that any clinical judgment is bound to be correct, that will lead to more services being withdrawn, affecting more localities and people. I support what Irene Oldfather said and Allan Wilson's view that there should be a longer consultation period. I think the behaviour of the health board in this case has been particularly poor and I would like to see the debate opened more widely so that we can return to it. I disagree with Mr Ingram, so there is a huge split in the SNP that the press can report and we will fight it out.

Photo of Mary Scanlon Mary Scanlon Conservative 5:33 pm, 27th April 2000

I am grateful for my one minute. As a Highlands and Islands MSP, I am not in a position to comment on where services should be situated in Ayrshire. Many of the women in the Highlands and Islands who have to take ferries and helicopters hundreds of miles when they are in labour would probably be grateful for the services enjoyed in Ayrshire.

I would like to know about Allan Wilson's woman-centred maternity units. I did not know there was any other kind.

My main concern is that Irene Oldfather, as the constituency MSP, sat down with the health board for a three-hour meeting two days before an announcement was made on the closure of the maternity unit and was told nothing about it.

Speaking as a member of the Health and Community Care Committee, the Stracathro and Stobhill petitions shocked me. We now know that those situations were not unique and that there is a general lack of consultation in a health service culture that is arrogant, bullying, secretive and high-handed. We know that health care is changing, but unless health boards and trusts engage with people, they will lose the confidence and trust we have in the health service, which should be cherished.

Photo of George Reid George Reid Scottish National Party

I should say to Irene Oldfather that I know the debate has been tight but I have no discretion. The Presiding Officer has made it clear that he will only exceptionally extend time for members' business debates.

Photo of Susan Deacon Susan Deacon Labour 5:35 pm, 27th April 2000

I am delighted to get the chance to talk about maternity services. I will attempt to focus on that, although it is tempting to respond to a number of the points that have been made about consultation in the NHS. However, that has previously been debated in this chamber, unlike maternity services.

The only comment that I will make on the consultation point is that I, as much as anyone, have stressed the importance of effective consultation and public engagement in the NHS. However, it must not become fashionable to say that what goes on in the NHS is bad in this respect. Good examples are currently being developed in certain parts of the country, particularly in relation to maternity services, which are examining new ways of involving people, including women and mothers. Occasionally, we should applaud those and be careful not to throw—dare I say—the baby out with the bath water. I apologise for that; it was not deliberate.

Today, I must focus on the Executive's position on the issue of maternity services. It is one that I regard as a personal priority and one on which we are making significant progress at a national level. It is important that I use my few minutes to tell members about that progress.

Why is this issue a priority? For some of us, it is the obvious, but often unstated, reasons that members have alluded to today. It is such a significant experience for women and those around them and it is so important that safety of mother and baby is maintained and protected as far as is practically possible. Let us not forget that childbirth was not always as safe as it is now. It is now much safer than it once was because the way in which we, as a society, view childbirth has changed; the way in which we support childbirth has changed; and maternity services have evolved and developed over the years. They will continue to evolve and develop, and rightly so.

However, what are maternity services? All too often, we talk as if they are synonymous with maternity units, maternity hospitals, labour wards and delivery suites; as if maternity services and pregnancy is about the day upon which someone gives birth. It is not about a day; it is about a year. It is about the whole antenatal and postnatal experience that goes around the birth. I want there to be the highest possible quality of service and support for women right the way through. We must continually balance two principles in this matter: safety and quality of care, and ensuring that where clinical intervention is required for the safety of the health of the mother, or baby, access to it is available, must be balanced with giving women informed choices.

Photo of Sylvia Jackson Sylvia Jackson Labour

I ask for the minister's advice about this matter. In the review that is going on in Forth Valley it is suggested in the proposal—and there is only one proposal rather than several—that surgical services will be concentrated at one end, in Stirling, and maternity services will be concentrated at the other end, in Falkirk. How does that fit in with the idea of safety?

Photo of Susan Deacon Susan Deacon Labour

It would be inappropriate and impractical in the time available to me tonight to delve into the details of local maternity strategies. I will be happy to meet any member to discuss those issues. It is important that I set out the principles on which the Executive wants to develop maternity services across the country. Those will be the guiding principles for local trusts and boards. I hope that in that way I will answer Sylvia Jackson's question.

As I said, two overriding issues require to be balanced. Quality of care and safety must be balanced with giving women informed choices. That means that, in future, maternity care must increase the choices available to women; it must increase the information that is available to them to enable them to exercise informed choice. We must also offer greater continuity of care, right through pregnancy. We must move further towards offering more midwife-led care, so that low-risk deliveries and low-risk pregnancies, which constitute the majority, can have that option available to them.

As I said earlier, we wish to ensure that throughout antenatal and postnatal care, in hospitals and in the community, the highest possible standards are maintained, and that services are available to women. I stress again that the reason we have been able so dramatically to reduce the levels of maternal and infant mortality over the decades is that we have embraced modern medicine and modern medical techniques.

That process continues to evolve and develop. I wish to ensure that when a woman wants access to the highest possible standard of care, in a hospital environment or wherever she may need it—bearing it in mind that at any stage during a pregnancy or a delivery, circumstances and needs can change—she has that access. That means being close to and having access to the full range of skills that might be necessary at some point during the delivery, including intensive care facilities and, if required, anaesthetists, blood transfusion services and blood itself.

We all, as politicians, as mothers and—I will be inclusive in my definition, as I am pleased to say that one of the big changes in maternity services over the years is that fathers have become increasingly involved in the process—as parents, know—

Photo of Susan Deacon Susan Deacon Labour

I will finish, if I may.

We all know, from our own experiences, that this area is different from any other area of health care, not least because pregnancy is not an illness. However, it can be a condition that requires medical support. That support must be there when it is needed.

On that—

Photo of Susan Deacon Susan Deacon Labour

I have to wind up at any second, so I must finish.

On that point—

Photo of Susan Deacon Susan Deacon Labour

Not only do services change, but attitudes change as well. We need a strategy, throughout the country, supported by local review processes that, based on the guiding principles I have noted already, translates into practical reality on the ground.

That is why we are developing, for the first time ever, a national framework for maternity services across Scotland. It is a very inclusive process, which has been widely welcomed. It involves general practitioners, midwives, health visitors, obstetricians, gynaecologists, paediatricians, others and, crucially, women themselves. We hope that that will be published late in the autumn. It will act as an important national framework within which the local development and delivery of maternity services will take place across the country.

Nationally and locally, we are moving absolutely in the right direction in this very important service area. Space must be given to local boards and trusts to continue to improve and to develop services and the methods by which decisions are taken. Within the Executive, I will be doing everything in my power to ensure that that happens.

Photo of Michael Russell Michael Russell Scottish National Party

On a point of order. Would you reflect, Presiding Officer, that during the minister's speech, she mentioned Ayrshire not once, Ayrshire central hospital not once, and Ayrshire and Arran Health Board not once? In members' debates, there should be some response to the subject of the debate. It was undoubtedly an important and interesting discourse on maternity services, but it did not address a word of the motion.

Photo of George Reid George Reid Scottish National Party

Your point is noted, Mr Russell, but it is not a point for the chair. The minister has indicated that she will write to a number of members on specific points.

Meeting closed at 17:44.