Health Services (Huddersfield)

– in Westminster Hall at 12:41 pm on 10th January 2006.

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Photo of Roger Gale Roger Gale Conservative, North Thanet 12:41 pm, 10th January 2006

I understand that Mary Creagh has arranged for other Members to participate in this debate. As she knows, this debate is strictly limited to 30 minutes, so it is up to her to manage the time.

Photo of Mary Creagh Mary Creagh Labour, Wakefield 1:00 pm, 10th January 2006

Thank you, Mr. Gale, for your flexibility in allowing colleagues from neighbouring constituencies to speak in this debate.

Hon. Members may be asking why, as the Member for Wakefield, I am discussing Huddersfield health services. The reason is that my constituency contains two wards, Denby Dale and Kirkburton, that fall under the local authority area of Kirklees. The wards are large rural areas covering some 80 square miles with poor roads, and my constituents will be deeply affected by the proposed changes. I am grateful to my hon. Friend Kali Mountford, in whose constituency the Huddersfield royal infirmary lies, and my hon. Friend Mr. Sheerman for attending today, and I look forward to hearing their views on how the proposals will impact on their constituents.

In October 2005, the Calderdale and Huddersfield NHS trust and the local primary care trusts published proposals in the "Looking to the Future" consultation on the future of health provision in the area. The laudable aims are to move services closer to people and to provide safe high-quality hospital care. However, maternity care and gynaecology and obstetrics are to be transferred from Huddersfield royal infirmary to Calderdale royal infirmary five miles away in Halifax. The document states that the changes are being made because local people said that they wanted as much care as possible to be provided closer to their homes. The trust wants to provide local services, and local people want local services, but the changes in maternity services will have exactly the opposite effect. Obstetricians and anaesthetists who are on call for childbirth at Huddersfield royal infirmary will no longer be available, and women who need specialist treatment during childbirth will have to travel to Halifax. Fewer services will be available locally and specialist care will be provided further from my constituents' homes.

At present, women from Denby Dale or Kirkburton can give birth at Huddersfield royal infirmary, which offers the full range of back-up should the birth prove more difficult than expected. Under the new proposals, that option would no longer be available to any woman at risk of complications. The trust proposes a new midwife-led unit at the hospital for low-risk women, but the criteria by which women are judged to be high or low risk are fairly wide. I can understand the reason for that, as birth is a risky time for mother and baby. Women who are considered at risk include those who are having their first baby, those who are aged under 18 or over 35, and those who have a medical condition such as diabetes or high blood pressure. They also include women who need epidurals and caesarean sections, women with infections, users of class A drugs, those who have received in vitro fertilisation treatment, and women with a high or low body mass index. In short, a large percentage of pregnant women would be unable to give birth in the new midwife-led unit.

Women from Denby Dale and Kirkburton and their partners would have to travel 25 miles to the Pontefract general infirmary in the Wakefield district, 15 miles to the Calderdale royal infirmary in Halifax, or 12 miles to Barnsley. At present, 2,700 women give birth at Huddersfield royal infirmary. It is expected that a maximum of 400 or 500 women will give birth at the midwife-led unit, so the remaining 2,200 will have to travel to the Calderdale royal in Halifax.

There is a birth centre in Wakefield in the heart of my constituency. I wish to discuss some of the issues that have arisen there. Despite the excellent care provided by midwives, the number of women choosing to give birth in the birth centre has been much lower than expected. One of the consequences of that is that staff sometimes spend entire shifts without helping a woman give birth, so the centre has been downgraded from a 24-hour service to a 9-to-5 operation.

A woman at the proposed midwife-led unit at Huddersfield royal infirmary would be transferred if she developed unexpected complications during her labour to Calderdale royal infirmary. She would be moved out of the room that she was giving birth in, taken out of the building, put in an ambulance and transferred to a new hospital with a new set of carers. We must ask ourselves whether that will prepare the woman mentally to welcome her new baby.

Carolyn Saville, a Royal College of Midwives steward, has written a consultation response, in which she highlights the concerns of midwives and ambulance services working in this area. The ambulance crews are concerned because they do not feel that they have a great deal of specialist maternity training to support midwives who are transferring labouring women. Both sets of professionals feel that they have not been properly consulted. She also talks about the figures from the Halifax midwife-led unit—the Calderdale midwife-led unit—where between one third and half of the women were transferred to the consultant-led unit during labour. That is just a transfer down a corridor, but women labouring in the Huddersfield royal infirmary would be transferred 5 miles.

Women rightly have high expectations for a positive, safe and comfortable delivery of their child. The stresses that that type of transfer brings will not help their sense of being in control and of being in a positive frame of mind. Women with a retained placenta or extensive tearing after the birth will also be transferred. What will happen to the partner and the baby? Will they travel with them in the ambulance? How will the partner choose between caring for their new baby and supporting their sick partner?

My hon. Friends the Members for Huddersfield and for Colne Valley and I have collected a petition and postcards as part of our campaign against the changes. We have spoken to our constituents, who want to keep a fully supported maternity service in Huddersfield. My hon. Friend the Member for Colne Valley and I met Diane Whittingham, the chief executive of Calderdale and Huddersfield NHS trust, and her officers and colleagues last Friday to convey our constituents' concerns. It is clear that the changes are driven not by a lack of funding but by the need to maintain specialist training of doctors and provide consultants with sufficient cases to ensure professional development. We want well trained specialists, but if it is necessary for them to undergo training, surely transport could be provided for the doctors to travel between the hospitals, rather than forcing labouring women to make the journey in an ambulance when they are giving birth?

A woman who suffers the tragedy of her baby dying in the womb would have to leave the midwife who supported her during her pregnancy, travel to Calderdale and have a different midwife caring for her if she wished to have an induced labour or a caesarean. A woman who presented at accident and emergency in Huddersfield with an ectopic pregnancy would have to make the same journey or, if she was in extreme danger, would be operated on by a general surgeon in Huddersfield. All of those things happen, albeit rarely—we might be talking about only 10 cases a year—and they all matter.

We believe that the trust should re-examine the proposals. We are grateful to the Minister for taking part in this debate. We want mothers to have confidence in the service and to know that they will be fully supported should anything go wrong. I look forward to hearing what my hon. Friends have to say.

Photo of Kali Mountford Kali Mountford PPS (Rt Hon Des Browne, Chief Secretary), HM Treasury 1:08 pm, 10th January 2006

I am grateful to my hon. Friend Mary Creagh for securing this important debate. It is important for three MPs present, because it affects our constituents so profoundly.

The changes date back to before I became an MP. Changes to local services were considered as long ago as 1996. Indeed, in 1999 a consultation took place in our constituencies whose findings were profoundly rejected by the local community. That set of proposals would have resulted in all the maternity services and many other services being transferred to Halifax. The health authority at that time rejected the proposals because the campaign against them in our communities was so strong.

It is important to mention that, because the current consultation has to be real and has to be listened to. Local people have developed a certain cynicism about what lies behind it. They do not hear doctors' concerns for their patients and for their own long-term development as clinicians; instead, they hear little more than, "We have something that you want to take away." Some people were consulted before the so-called official phase of consultation took place, and I applaud the hospital trust for attempting to find out what women of birthing age who had recently had babies or were about to have them thought. What they thought was very interesting and must be considered. The key thing they wanted was to have midwife support throughout the pregnancy and up to the birth; they did not want to have a break in care at any point in between. They needed that confidence.

It is not that local women do not want a midwife-led centre, but that they want one in which they can have trust and faith. If the midwife-led centre is set up as proposed, there will be dangers and worries. The key worry for me is whether it would have the public confidence it needs to be set up successfully.

I wish to discuss one or two issues other than the maternity services, so I shall try to make sure that I have time to mention them, but maternity services are the ones in the consultation that draw the most concern. Most other conditions mentioned in the report are special cases, for which people would travel anywhere to get the best treatment, but giving birth is seen as an ordinary, everyday event. It is not an illness, but an ordinary part of every family's life. People expect to have their babies at home or near home, and certainly in their home town. The idea that they may not be able to have their babies in Huddersfield causes the people I have mentioned great concern. Indeed, our local paper's last campaign was called the "born in Huddersfield" campaign.

This is a serious issue for people. Some clinicians have turned their noses up at it, but it matters, not only because of the real concerns outlined by my hon. Friend the Member for Wakefield about whether we can clinically support women during transfer, but because of questions about whether the women would have the confidence to use the midwife-led unit.

I would like to see a successful midwife-led unit. The evidence is that if a midwife-led unit has a home-like setting, it produces a better birth experience and fewer clinical interventions—certainly fewer unnecessary ones. We have seen a rise in unnecessary Caesarean sections and in all sorts of other procedures that some of us might have experienced but that the gentlemen here will certainly not have. For the sake of your stomach, Mr. Gale, and that of my hon. Friend Mr. Sheerman, I shall not go into a description of them, but a lot of them are now demanded by women when they are really not necessary. In a more home-like setting, such births and procedures would not be necessary. The proposals could, if handled properly, give women the confidence to give birth in a more natural way, and I applaud that idea.

The problem is that even in the most natural and normal of settings, even if there is only a one in a thousand chance of something going wrong, people want to know that the moment it does, the person who can best help them will be there on site. The real dispute is about whether there are people on site who can help. On Friday, my hon. Friend the Member for Wakefield outlined to our colleagues in the health service the particular case of an ectopic pregnancy. They said immediately, "Yes, of course we would have general surgeons on site. We would be willing to come immediately ourselves; we would be good Samaritans. In such circumstances, we would obviously not transfer a woman, but help her there and then in the hospital where she had presented herself."

If we can be good Samaritans, can we not build into the protocols a means by which women can be confident that when something that has not been sorted out by the sifting process goes tragically and unexpectedly wrong, they will be assured of giving birth with some surety that they will be safe? That is paramount. Otherwise, a midwife-led centre will not be successful because people will automatically choose the place where clinical interventions can be made immediately and where all the obstetricians, gynaecologists and paediatricians that women feel they need are already on site.

I do not want a centre to be set up to fail. We need to be careful about how it is set up in the initial stages so that we can have the confidence and build up the number of births in that centre before making any other changes. I cannot see how removing services when the number of births is still about 200 a year can be a viable proposition. I want to see as many babies who can properly be born in Huddersfield to be born there; it is the right place for them to be.

I should like briefly to mention breast cancer services. Public subscriptions were used to buy equipment and local people feel that they paid for it, but they fear that it will now be taken to Halifax. I want people to know that on Friday we received an assurance that the equipment will stay in Huddersfield and will be there for local people, who have paid for it. That part of the breast cancer service will stay there. It is important that that is known.

It is important that the consultation takes account of all the public concerns and that the postcards and petitions that have been sent in do matter. The Socialist party petition, which unfortunately does not even mention these particular services has been signed by 1,700 people, who do not realise that they are not being counted. In my view, they believed that they were signing something that said that they did not want maternity services removed. Unfortunately, the petition refers to having no Government cuts to health services, so those people are not being counted. I want to put on record that those 1,700 people, with those who signed the petitions run by my hon. Friends and myself, want maternity services to stay in Huddersfield.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee 1:15 pm, 10th January 2006

I shall be brief. Given the considerable expertise on these issues of my hon. Friends the Members for Wakefield (Mary Creagh) and for Colne Valley (Kali Mountford), who am I, a mere mortal man, to contribute to the debate? However, I have four children and a family history of using the excellent facilities of the excellent Huddersfield royal infirmary over many years. The service is great. We all know how much we appreciate a first-class service from a local hospital when our children are ill. A good general hospital is founded on two pillars: a good accident and emergency department and a good maternity department. If one of those pillars is taken away, it undermines the whole notion of a good, comprehensive general hospital.

Let me give some background. Huddersfield is a much larger town than Halifax. The healthy Huddersfield trust—it was financially healthy and well run—merged with the Calderdale trust, which had been less well managed and faced an expensive overrun on a private finance initiative hospital. Huddersfield residents, taxpayers and council tax payers have a right to believe that they got the short end of the deal not only in terms of having rescued the other trust, but because, further down the line, it seems that some of the services to Huddersfield are threatened.

There is an important issue at stake in the sense that we have been scrutinising midwife-led units throughout the country. There is no doubt that it will be some time before the National Institute for Health and Clinical Excellence inquiry reports. It seems strange to make a big decision before there has been a full evaluation of how midwife-led units work. Some of the evidence that has come to the attention of my office and those of my colleagues suggests that there is a question mark over some of the units. They may be appropriate: certain women, usually those from more affluent backgrounds, consider that to be the sort of unit in which they want to deliver their children. That is perfectly all right, but most of the units are small, dealing with an estimated 400 or 500 births a year each. As my colleagues have said, there are 2,500 births a year in Huddersfield, so 2,000 women would have to go elsewhere.

Many people who look at the topography of our part of the world do not understand that the 5 or 6 miles between Huddersfield and Halifax is a hell of a long way, given the hills, valleys and traffic. If we build into that the experience that my constituents have had trying to park at the new Halifax PFI hospital, it is a daunting prospect indeed. It does no one any good if people estimate that it will take only 12 minutes to travel between Huddersfield and Halifax, when most of us who have travelled that way know that one would be a lucky man or woman to do it in that time. It is much more likely to take at least half an hour. There are real difficulties.

Do not let us dismiss—I know that my colleagues have not—a town that produced Harold Wilson, who was born in the local hospital. People feel that they should be able to be born in the hospital in their town—born in Huddersfield. If you had seen the valiant display Huddersfield Town put on against Chelsea on Saturday, Mr. Gale, your heart would have swelled with pride in Huddersfield and you would know what we are talking about. Unfortunately, we were robbed of a draw, but the fact of the matter is that pride in one's local area and local town, especially when it is the larger town, is important.

I must make one party political point and I hope that it will not upset you, Mr. Gale. We ran a wonderful democratic campaign on the issue. In 1999, my hon. Friend the Member for Colne Valley and I fought and won the campaign. We were proud of that success and we have worked constantly for the hospital. It is a fine hospital that has delivered excellent care and usually obtains all the stars that are available to it. No one can take away my pride in its public servants, whether porters, consultants, administrators and so on. All are first class and I do not want to downgrade or do any disservice to them. However, the Liberal Democrats, without a majority, have overall control of Kirklees metropolitan council. They went on the attack and made the issue a party political one. That destroyed my faith in local democratic politics because it should not be a party political issue. It is about local people who want a local resource that is accessible. That is the strong message from Huddersfield and I hope that the Minister is listening.

Photo of Rosie Winterton Rosie Winterton The Minister of State, Department of Health 1:21 pm, 10th January 2006

I congratulate my hon. Friend Mary Creagh on securing this debate on an important local issue. I also congratulate my hon. Friends the Members for Colne Valley (Kali Mountford) and for Huddersfield (Mr. Sheerman) on the way in which all contributions have reflected their constituents' needs. Their constituents will be extremely reassured to know that their views are being so eloquently voiced in this place.

I concur with much of what has been said about Calderdale and Huddersfield NHS trust being well resourced and well managed. I congratulate it on being awarded three stars this year by the Healthcare Commission, thanks to the hard work and dedication of local NHS staff. I am sure that they are pleased to have Members of Parliament who take up issues in the House and thank them for their hard work. Too often, we do not thank our NHS staff. However, the trust and local PCTs clearly feel that despite the stars awarded more changes need to be made to build on the improvements and to ensure that high-quality services continue to be offered.

I reiterate that we are discussing proposals which are out for consultation. It is absolutely right that that consultation process should take account of all views expressed. I remind my hon. Friends that Kirklees metropolitan council will be able to refer any changes to the Secretary of State if it contests a substantial change to health services and feels that there has been inadequate consultation or that the proposals do not have merit. We are in the middle of a consultation process and it is right that local decisions are taken in that way. Local people know their priorities and the services that are available and it is important that they have the right to make their views known.

I know that a number of the proposals are controversial and I shall explain the information that I have been given on why the PCTs and the trust feel that they need to make changes. I have been given an assurance that after the proposed changes the majority of women who currently give birth at Huddersfield will continue to do so. Most births will take place at the two new midwife-led units based at hospitals in Huddersfield and Halifax. The trust has planned for 500 births a year at the unit in Huddersfield initially, and hopes that this will rise over time.

The trust proposes that neonatal intensive care, paediatric in-patients and obstetric care all be centralised at the Calderdale royal site in Halifax. Let me be clear about this: I have been informed that there is real concern that without those changes the trust will lose its intensive care accreditation awarded by the Yorkshire Neonatal Network, because the trust is unable to provide senior medical staff cover on the labour ward from Monday to Friday. Withdrawal of intensive care accreditation would result in all local babies who require intensive care having to travel to Leeds. That is one of the clinical reasons the trust has given to explain why it does not believe that children's and maternity services can be maintained at both sites.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee

Will my hon. Friend address the arithmetic? If there are 2,000 or 2,200 live births in Huddersfield per year and only 500 will be accommodated by the new unit, 1,700 mothers will have to go to Halifax. It is not just the more difficult cases, but most women who will have to travel. I think that she has been misinformed.

Photo of Rosie Winterton Rosie Winterton The Minister of State, Department of Health

That is certainly one of the issues I would expect the trust to take into account. However, the concern is that the trust cannot provide the level of round-the-clock cover on children's wards it believes is needed. By centralising in-patient services, Calderdale will be able to have two consultant paediatricians available in an emergency at all times. It is also struggling to meet national clinical standards for obstetric services which state that an obstetrician should be present on labour wards for at least 40 hours a week. The trust is the only one in Yorkshire and Humberside that is unable to provide readily accessible senior medical cover to the labour wards from 9 am to 5 pm, Monday to Friday.

I know that some people have expressed concern that patients will not be able to receive the best care from the midwife-led unit in Huddersfield, but I hope that I can give some reassurance following the comments of my hon. Friend the Member for Colne Valley. Research shows that for a healthy woman with a normal pregnancy, delivery at home or in a midwife-led unit is as safe as a hospital birth. There are already 100 such units across the country and the vast majority of women in a midwife-led unit have a problem-free labour.

I return to a point that my hon. Friend the Member for Wakefield raised with me before, which is the capacity of the ambulance service to deal with increased transfers between Huddersfield and Halifax. I have followed her question up and I have been assured that the trust is already discussing the matter with the West Yorkshire metropolitan ambulance service to ensure that a robust service is in place. I hope that that reassures her.

My hon. Friend the Member for Colne Valley suggests that the changes should not go ahead until the midwife-led unit at Huddersfield is up and running. She has mentioned that to me before and I have some sympathy with that view. I have made inquiries and I am assured that the midwife-led unit will be up and running before consultant-led services are transferred to Calderdale.

Final decisions about the reorganisation of these services have not yet been made. The purpose of any consultation exercise is to seek out and listen to the views of the public on proposed changes. However, I felt it important to give some of the important reasons relating to the need for emergency services and so on for the proposed changes. It is important to have that intensive care accreditation, because there would be bigger problems without it—

Photo of Roger Gale Roger Gale Conservative, North Thanet

Order. We must move on to the next debate.