Congenital Cardiac Services for Children
(13 years, 5 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Stuart Andrew (Pudsey) (Con)
I beg to move,
That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.
I thank the Backbench Business Committee for allowing us the opportunity to hold this valuable debate. I apologise to the Committee and the Clerks for taking so long to table the motion, but I feel passionate that it is right to get a motion that has the effect that we want. I have probably learned more this week than in the past year, and if I have not got it right, I am sorry. I also thank the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood), for Leeds North West (Greg Mulholland) and for Winchester (Mr Brine), who have helped me through the past week.
This debate is timely, as the consultation by the review of children’s heart surgery around the country will come to an end soon. I completely agree with and support the professionals and patients who say that the review of congenital cardiac services is needed. Of course, we all want what is best for our children, and we want the best centres in the world. It is absolutely right and necessary that we learn from past mistakes in other units, but serious concerns about the process have been raised with me by clinicians and parents. I believe that it is my duty and that of others to scrutinise the review if we feel that there are problems.
There have been accusations that this has been turned into a political campaign. I stress that I have been keen not to make this a political campaign, and I have been incredibly impressed by the cross-party support of the Members from across the country who have been helping us. We will hear from other Members from all over the country—the debate is not just about the unit in Leeds—but I want to highlight the fact that my concerns relate to the review and not just to one centre. Although I will naturally refer to Leeds to highlight examples, I am sure that other Members will highlight similar problems with the review and relate them to their units. I am keen that the campaign does not set one centre against another, but that they are all considered equally.
I want first to deal with what I perceive as the flaws in the review. That is my main concern. From speaking to patients and families, I know that that has made them lose confidence in the review. We would all agree that public confidence in the review is important. The review has stated that the objective is to have centres that perform 400 procedures a year. The first version of the pre-consultation business case showed that patients from Doncaster and Sheffield would travel to Birmingham. That is absolutely right and in line with advice from the Yorkshire and Humber specialised commissioners, but in version 2 and the consultation options, the flow had changed to Newcastle. I understand that that helps the Newcastle figures, but I and anyone else who knows the area would surely question the likelihood of that happening. Far more plausible is that people would go to Birmingham or Leicester. What happens to Newcastle then? In addition, one of the options—the 400 minimum procedures—is not even met. The JCPCT explains that that is due to new patient flows.
At a number of centres, activity has increased in the past year. For example, Leeds is now doing 370 procedures a year, but in the pre-consultation assessment it was not afforded the same consideration as other centres that carry out similar numbers of procedures. Furthermore, the health impact assessment had not been completed before the final options were presented for consultation. The independent company undertaking that work said that this was not the usual approach taken in large reconfiguration proposals. That means that the public will have no access to the findings during the consultation period.
An issue that affects the black and minority ethnic community is that until 24 May the consultation questionnaire was available only in English and Welsh. As a Welsh speaker, I approve of having a Welsh version, but it was not until 12 weeks after the consultation began that the questionnaire became available in other languages, leaving just five weeks for the community to respond. In Leeds, more than 20% of the patients come from the BME community, so this is an important issue that needs to be addressed.
Finally, on the flaws, yesterday when the Safe and Sustainable team were here, we heard them say that co-location of services, in their view, meant anything up to 10 minutes away, yet the British Congenital Cardiac Association issued a statement on 18 February 2011, two days after the release of the business case, to clarify its professional view of the importance of co-location. I believe this demonstrates the BCCA’s dissatisfaction with the review’s interpretation of co-location.
Julian Smith (Skipton and Ripon) (Con)
My hon. Friend refers to a meeting of the steering group with MPs yesterday. Does he agree that it was a slightly strange meeting and that there was a significant degree of defensiveness on the part of the steering group?
Stuart Andrew
That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.
On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds General infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.
How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel when there could be alternatives?
The Yorkshire and Humber congenital cardiac network board has a well-established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.
On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and it will have the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.
The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.
Greg Mulholland (Leeds North West) (LD)
I thank my hon. Friend and neighbour for giving way. Going slightly further on his last point, does he realise that if those surgeons are no longer there, they will not be able to perform operations on adults? Adult surgery would be very detrimentally affected.
Stuart Andrew
I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.
I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that will be made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.
I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.
Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well-organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.
Mr Deputy Speaker (Mr Nigel Evans)
Order. As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.
Mr Andrew Smith (Oxford East) (Lab)
I congratulate the hon. Member for Pudsey (Stuart Andrew) on introducing the motion and arguing his case so powerfully. The debate shows the value of Back Bench-initiated topics, which has enabled the House to speak out on an issue of enormous concern to the public, as demonstrated by the petition he referred to and by the Southern Daily Echo petition of nearly 250,000 signatures that was taken to Downing street earlier this week in support of the Southampton centre, which is mainly what I want to speak about. I will make just a few key points, as many Members wish to speak.
First, I want to praise the work done in the existing centres, including the John Radcliffe hospital in my constituency, which commands fantastic support from the parents of children who have been treated there. The Young Hearts organisation, which was set up to support parents of children with heart conditions in Oxfordshire, has been leading a great campaign, rightly paying moving tributes to the skill and dedication of surgeons, doctors, nurses and whole medical teams who have saved children’s lives and to whom we all owe a debt of thanks.
Secondly, as the hon. Gentleman noted, a key concern in the debate, and in considering the Safe and Sustainable review, must be to secure the best possible treatments and outcomes for children with congenital and other heart conditions. We must be guided by medical and research expertise, which few of us in this place are in a position to second-guess. I am therefore mindful of the joint statement by the Royal College of Surgeons and the Society for Cardiothoracic Surgery, in which they strongly support the concentration of treatment centres. They state:
“England has the right number of heart surgeons treating rare heart conditions in children, but we do know that they are thinly spread over too many units. A better service would be provided if this expertise were condensed in fewer units with the critical number of staff to support each other, disseminate new techniques and train the next generation of specialists.”
They believe that the proposals
“will result in rapid and significant improvement in treatment for some of the most vulnerable patients treated by the NHS.”
We should give great weight to that unequivocal statement.
The joint statement went on to suggest—this brings me to my third point—that:
“The benefits of undertaking this change, however, need to be balanced against longer journeys for some families”.
That, along with quality, is a matter of great concern on both sides of the House, and certainly in Oxfordshire. It was also stressed by the Oxfordshire joint health overview and scrutiny committee and the Young Hearts campaign in relation to the implications for patients in our area if any option other than option B, which is to retain the centre at the Southampton University Hospital NHS Trust, is chosen. As today’s Oxford Mail editorial states:
“If Southampton loses out in the Government shake up of children’s heart services, then so does Oxford.”
The benefits of this option, and in particular of retaining the Southampton centre, lie not only in the fact that the Kennedy review ranks Southampton highest in the country outside London for quality, but that the Oxford Radcliffe Hospitals NHS Trust has developed a joint network of care with Southampton, enabling local children who have surgery in Southampton to receive follow-up care and support services in the excellent facilities at the Oxford children’s hospital and to be able to progress as they grow older to the Oxford heart centre, thereby maintaining continuity of care, which the hon. Gentleman rightly said was so important in the relationship between children’s services and adult services. I very much hope that this south of England congenital heart network, with Southampton and Oxford working closely together, will be part of the option that is finally chosen.
That network does not figure in the present options, but I welcome the news in today’s briefing from Safe and Sustainable that a specialist team is examining it. The need for this flexibility is a key reason why I support the call in the motion for the joint committee not to restrict itself narrowly to the options set out in the original review. As Young Hearts has pointed out, it is important to consider the children needing paediatric cardiac services who were not born with a heart defect but who have suffered a virus or accident requiring cardiac treatment. The Oxford-Southampton partnership will retain ready access to the skills and facilities needed for that care.
That form of partnership network, with collaboration between a surgical centre and another cardiac care centre, offers a good model for other parts of the country. It enables us to ensure that children have the benefit of both the critical mass of surgery, which surgeons advise can significantly and rapidly improve treatment, and more convenient access to related services and continuing care nearer their homes. Surely that is the outcome that we all want. I very much hope that the review and the Government will take it forward, with the Southampton-Oxford partnership being the best way to retain high-quality and accessible services for central southern England.
Mr Stephen Dorrell (Charnwood) (Con)
Like the right hon. Member for Oxford East (Mr Smith), I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on introducing the motion, which is of huge importance to my constituents and to the national health service. In contributing to the debate, I wear two hats. First, I represent the village of Glenfield. Glenfield hospital is actually in the neighbouring constituency of the Opposition spokesman, the hon. Member for Leicester West (Liz Kendall), but it takes its name from the village in my constituency. Secondly, I am Chair of the Health Committee. The Committee has not approached the subject specifically, because we have been looking at a number of other matters, but we have so far published two reports on commissioning, which is precisely at the heart of today’s debate.
In a sense, I personify the conflict that every Member feels between the constituency interest and the national interest, and in this case I do so in a particularly dramatic form, as one of the surgical units involved is closely associated with my constituency. My first point is that that conflict exists for all Members. We are of course here to represent our constituents’ interests, but I argue that we are here first and foremost as Members of a national Parliament and should seek, as my hon. Friend the Member for Pudsey recognises, the right answer for all NHS patients, not simply for a particular local interest.
Chris Bryant (Rhondda) (Lab)
I wish to make a very small point because the right hon. Gentleman used the word “national”. Many of the services we are considering are also used by Welsh and Scottish constituents, so it is important to ensure that there is that communication between the different elements.
Mr Dorrell
I agree with the hon. Gentleman’s point.
My hon. Friend the Member for Pudsey said that this is not a political issue, by which he meant that it is not a party political issue. That is exactly right, but issues can be political without being party political. It is important that the House, in approaching the subject, makes it clear that the issue should ultimately be resolved according to clinical standards, not as a form of political bartering, whether party political or through the general representation of local interests.
I am in the happy situation, personifying, as I do, the conflict between local and national interests, that the specialist group has recommended a solution that accords with my constituents’ views, but I think that in approaching the subject it is important to be clear about the ladder of interest: we should approach this from the point of view of national standards for the service delivery. We of course should represent the views of our constituents, but we should be clear that the national view should come first.
Writing in The Times today, Sir Bruce Keogh, the medical director of the NHS, states:
“Intellectually, the case for change is compelling and widely accepted. Sadly, the realpolitik is that the closer we get to a solution, the more personal, professional and political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence…For too long this has been filed in the ‘too difficult’ box. Time is running out.”
Those words should ring loud in our ears as we debate the subject this afternoon.
We should recognise that the whole issue of child heart surgery has form in the history of the national health service. It is now over a decade since Sir Ian Kennedy published his review of circumstances that illustrate what can go tragically wrong when things are allowed to drift on and when real issues are not addressed. Although I am of course here as a Member representing my constituents’ interests, I think that the key priority for the House this afternoon is to support the principle that this issue must be decided in the interests of the children who are the patients and who will become the adult patients, and in a way that satisfies the key driver of the pursuit of excellence in clinical standards.
I welcome the fact that the previous Government set up the review to ensure that we addressed the issues that had been left to drift on for too long since the Bristol heart review a decade ago, and I wholeheartedly endorse the view, expressed by Sir Bruce in today’s Times, that the time to act is now.
As a local MP, I wonder what the effect is on Leicester of this drive to a decision. I have already referred to the fact that I am not in an uncomfortable position, because on page 93 the review states:
“Option 2”—
which became option A—
“is viable as it is consistently the highest scoring potential option.”
The review’s recommendation is that the process go ahead based on option A, and that is convenient from the point of view of the person arguing the case that I do, but I conclude that if anyone wants to argue for an alternative outcome, it behoves them, particularly in view of the history of this issue in the national health service, to present a coherent, whole argument for how their solution represents a better solution for the patients of those services, while reflecting, of course, the local interest of the people we are elected to represent.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) in debate, something that I have not done for 15 years in this place, and as ever I agree with the broad thrust of what he has said. I welcome the opportunity to take part in this debate about the Safe and Sustainable review. I want to make two points about the case for the review itself and the case for children’s cardiac care at the Freeman hospital in my constituency.
The review of paediatric cardiac services in England and Wales was instigated in 2008 under the previous Government. It was instigated not by them, not by the civil service but by the health care professionals themselves. There were two previous reviews, in 2000 and 2003, recommending the establishment of fewer, larger cardiac surgical centres; in 2006, a national workshop of experts concluded that the current configuration was unsustainable; in 2007, the Royal College of Surgeons called for the concentration of surgical expertise in fewer, larger surgical centres.
The 2008 exercise has been carried out on behalf of the 10 specialised commissioning groups in England and their primary care trusts. The clinical case for the exercise is pretty formidable: clinical outcomes are better at high-volume centres; it is undesirable that surgical expertise is spread too thinly, because apart from anything else it mitigates against the provision of 24-hour surgical cover; the increasing complexity of what can be achieved argues for fewer specialist centres; it is easier for fewer units with larger case loads to retain surgeons and to develop expertise; and strong leadership from surgical centres underpins non-surgical cardiology care in local hospitals.
Mr Nicholas Brown
If my hon. Friend will forgive me, I will not.
There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.
I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.
The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.
Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.
No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.
I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.
My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made. I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.
Greg Hands (Chelsea and Fulham) (Con)
I very much support the principle that lies behind the review—that we need larger, more sustainable centres with the same overall number of specialists throughout the country. That is why charity and campaign groups, such as the Children’s Heart Federation and Little Hearts Matter, back the change.
I recognise that people will have to travel further as a consequence, and that will sometimes be extremely difficult, for families in particular, but the choice is between people travelling further and getting the best outcome for their child, and people having a shorter distance to travel but perhaps compromising the outcomes that can be achieved. The clinical evidence is unambiguous: travelling further means that some children will live who would otherwise die. On that basis—the whole basis behind the review—we have to bite the bullet and make change.
I support the principle of fewer, larger units, but the experience of Royal Brompton hospital in my constituency has made me question the process that is being used to make individual decisions. As my hon. Friend the Member for Pudsey (Stuart Andrew) pointed out, the matter needs to be depoliticised from the outset. The review is taking place at arm’s length from the Government. Indeed, as the right hon. Member for Newcastle upon Tyne East (Mr Brown) said, it was set up under the previous Government and is being administered by a body called the joint committee of primary care trusts, which I assume is up for abolition.
Phase 1 of the assessment process involved ranking all the existing units on core standards, sustainability, facilities and so on. Great care was taken, and that makes the next phases all the more mystifying. Out of the 11 units ranked, the Royal Brompton came joint fourth, on 464 points. Of the 11 units assessed, only two had the maximum number of four surgeons—the Royal Brompton and Great Ormond Street. In terms of the number of procedures undertaken each year, the Royal Brompton came fourth highest of all. In each of the three objective criteria, the Royal Brompton was in the top four nationally. I therefore asked the joint committee of PCTs this question: why bother to rank all the units only then to stipulate that one of the top four has to close whatever else happens? That is the consequence of the decision arbitrarily to rule out keeping three centres open in London. One of the top four units in the country is to be axed, no matter its size and no matter its quality, due merely to its location. That flies in the face of the starting point of the review—that it was all about clinical outcomes, not geography.
The Royal Brompton has four specialist surgeons who perform 520 operations, including 453 children’s heart operations, per year. It has a fantastic safety record, with an aggregate mortality rate of 0.94 of 1%—less than half the national average of 2%. Why, then, when it is already a model example of what the review wants to create, does the consultation, in all the options available, decree that it must close? The joint committee of PCTs is claiming that it has an open mind, but in reality it is consulting on four options, all of which would shut the unit at the Royal Brompton.
The knock-on effects on services elsewhere in the trust would be considerable, especially on children with cystic fibrosis, of whom there are 300 in the country. The future of provision for those children would be extremely unclear. It is also unclear what capacity the remaining two hospitals in London would have to take on—
The Minister of State, Department of Health (Mr Simon Burns)
I will speak with great care because—my hon. Friend is as aware of this as I am—of the possible judicial review with regard to the Royal Brompton. I would like to say, though, as I think it may help him, that no decisions have yet been made. The consultation literature specifically asks consultees for their views on how many centres it is best to have in London—two or three. If they agree that two is optimal, they are asked to state which two they prefer, including the Royal Brompton. Even though it is not included in any of the pillars, people who are taking part in the consultation process can argue its case, and it will be considered because the JCPCT is taking a flexible approach to the consultation process.
Greg Hands
I welcome that intervention from the Minister. He is right that it is open to the consultation to consider it, as it says on the last page of the consultation document, but the document was contradictory on this point in the first place. On page 84, it says:
“London requires at least 2 centres due to the size of the population it covers”,
but in a footnote on page 93 it still imposes the arbitrary limit of two centres at most.
The joint committee has belatedly recognised a problem. Under pressure, it announced at the beginning of May that an expert panel would be established to review the wider impact on other services if cardiac paediatrics were to close. That was welcome, but it has continued to press ahead with the original consultation and names for the new panel were not proposed until this week. By the time the new panel reports in August, the consultation will have closed. What happens if its response reflects the serious concerns about a whole series of national services? Having consulted on options A, B, C and D, it can hardly go for an option E that no one was asked about. It would then probably have to re-consult.
I became the MP for the Royal Brompton in May last year, although, as the neighbouring MP previously, I have been very familiar with its work for many years. Its previous MP, my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind), also strongly supports its campaign to fight the proposal. I have visited the hospital three times in the past year. The proposal to end its cardiac paediatrics has been brought to the attention of parliamentary colleagues across all parties and across large parts of London, the south-east and East Anglia. A huge petition has been gathered, signed by more than 30,000 people, and tomorrow we are delivering it to No. 10. I have written at length and in detail to the Secretary of State on the matter, and he helpfully replied—I think this was confirmed by the Minister—that
“no decisions have yet been made”,
including on the number of units to be located in London. That is a cause for encouragement.
I repeat that I support the aims of the review, but the consultation has been badly flawed. Three units in London, perhaps restructured, should have been an option, and the knock-on effects of closing services should have been considered. The case must now be re-examined. The Royal Brompton is good enough, large enough and loved enough to survive.
Jon Ashworth (Leicester South) (Lab)
I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) and other members of the Backbench Business Committee on securing this timely debate.
When I delivered my maiden speech in the Chamber two weeks ago I mentioned my support for the campaign to maintain the children’s heart unit at Glenfield hospital, which, as the right hon. Member for Charnwood (Mr Dorrell), said, is in the constituency of my parliamentary neighbour, my hon. Friend the Member for Leicester West (Liz Kendall). The campaign is supported by my hon. Friend and by my right hon. Friend the Member for Leicester East (Keith Vaz), as well as by many Members from across the county, if not the east midlands as a whole. It is right that this does not become a party political matter.
Last week, my hon. Friend the Member for Leicester West and I attended the public consultation event on Glenfield at the Walkers stadium in my constituency attended by hundreds of concerned parents, dedicated staff and local people, not only from Leicester but beyond the east midlands. Many of those people have never used the unit at Glenfield and, one hopes, will never need to use it, but they were all convinced of the logic of maintaining it. We heard moving stories from parents telling us how outstanding was the quality of care provided to their children. We heard testimonies from many of the staff at Glenfield, who described in remarkable detail the quality of the care that they provide and how they intend to continue to improve it.
We also heard many people, particularly members of the Asian community, express frustration, if not anger, about the fact that Glenfield features in only one option—option A. Many Members will know that Leicester has a very diverse population. Evidence shows that there is a high prevalence of heart disease in Asian communities, and some of my constituents from those communities are particularly concerned that Leicester features in only one option. In the past few weeks, people from mosques, gurdwaras, Hindu temples and the Federation of Muslim Organisations have been very vocal about this.
I want to focus my remarks on something that is unique and specific to Glenfield: our world-class ECMO—extracorporeal membrane oxygenation—service. An ECMO machine—I have to concede that I am far from an expert on these things, so Members may want to correct me—rests the heart and/or lungs of a patient waiting for recovery. I have been told by many at Glenfield that this procedure was pioneered there 20 years ago. Today, Glenfield has more than 10 machines, and it is no exaggeration to describe it as a world-leading centre in this field. Glenfield is the only centre in the country that provides ECMO for patients of all ages, from newborns to adults. Its expertise has been recognised on many occasions. For example, last year 110 adults were treated during the swine flu outbreak at Glenfield’s ECMO centre.
How is that relevant to the future of the children’s heart unit? Quite simply, the ECMO service is provided by the same staff who work in the congenital heart centre. Therefore, if that centre closes, Glenfield will lose its ECMO service as well. Of course, the ECMO service could go to Birmingham, as is mooted in the consultation, but that rather misses the point. Many of the staff working at Leicester’s ECMO centre have done so for nearly 20 years. Their combined expertise has helped to make Glenfield’s ECMO unit the world-class facility it is today. Many of my constituents are concerned that it would be years before an ECMO unit could be re-established elsewhere with the same level of competence. Training new staff to have the level of expertise offered at Glenfield could take up to 10 years. That is why many people in my constituency feel that keeping this national service is vital. Giles Peek, a consultant paediatric heart surgeon, told the Leicester Mercury:
“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are almost always full and often take children from other hospitals… Our role at Glenfield as national reference centre for this treatment is important and underestimated.”
Although I understand that this is a consultation and that it is right that these decisions are made by clinicians and not politicians, I hope that the joint committee will consider further options because of the expertise at our ECMO centre. Many of my constituents would be grateful if the Minister reflected on the national implications of Glenfield losing its ECMO centre and, at an appropriate time, made some remarks about that.
Jason McCartney (Colne Valley) (Con)
I, too, thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his hard work, along with other colleagues, in securing this Back-Bench debate.
I will speak on behalf of the Leeds children’s heart surgery unit, which serves the whole of Yorkshire. I was fortunate enough to visit the unit in November. I met its wonderful staff and surgeons, and spoke to many parents and some of the patients. Over the next couple of hours, we will hear a lot of intricate detail, just as we have already. There will be many statistics, facts and figures. I want to give a few facts and figures of my own. Half a million names were on the petition to save the Leeds unit, which we delivered to No.10 Downing street on Tuesday. That is the biggest petition ever raised in Yorkshire, and we can be very proud about that. The two-hour radius around the Leeds heart surgery unit reaches 14.5 million people. Including check-up appointments, the unit sees 10,000 children annually, and it performs 340 operations.
Julian Smith
As well as the number of operations performed at Leeds, will my hon. Friend talk about the rurality of many of the areas it serves? Skipton and Ripon is the most rural part of North Yorkshire. I have received many representations from my constituents about the issue of distance that there will be if Leeds does not survive.
Jason McCartney
My hon. Friend makes an important point. Many of those 14.5 million people are in rural areas, such as his North Yorkshire constituency. I will touch on that issue in relation to my Colne Valley constituency shortly.
I want to say a few words about the inconsistencies in the options. The Safe and Sustainable review has said consistently that centres should perform a minimum of 400 operations a year, and ideally 500. However, under option B, Bristol and Southampton would fail to achieve that number. The review’s projected figures show that they would perform 360 and 382 operations respectively. During the meeting in Leeds, campaigners were told that it was not viable to have three centres in the north of England because the figures would be 347 for Leeds and 381 for Newcastle. If option B is viable, why is it not viable to have three centres in the north of England? Would not a solution be to keep Leeds and Newcastle open, and to give them two years in which to achieve all the standards set out by the review?
Mr Steve Brine (Winchester) (Con)
That is precisely why the motion calls on the JCPCT to show maximum flexibility and not to restrict itself to the four options. The answer could be, “Yes we can.”
Jason McCartney
I agree that that is what we are looking for. The idea behind the motion is to ask for more flexibility.
I have talked about statistics and about the 500,000 names on the petition, but there are three compelling reasons why I am speaking in this debate—or perhaps I should say three young reasons. Those three young reasons all happen to be at one school in my Colne Valley constituency. I met three pupils at Linthwaite Clough school near Huddersfield, who back the campaign to save Yorkshire’s only children’s heart surgery unit because they owe their lives to it. George Sutcliffe is a 12-year-old who uses a wheelchair six days a week and attends the heart surgery unit in Leeds about once a month. Ben Pogson, who is 10, and Joel Bearder, who is just four, both underwent major heart surgery at the unit. Ben and Joel’s mums, Sam and Gaynor, have played leading roles in the campaign to save the unit, along with many others, and I praise their contributions. As well as those three pupils, one of the teachers at the school owes his life to the skill of the medical staff in Leeds. Richard Quarmby, a learning mentor at the school who will start his teacher training in September, had major surgery for his congenital heart condition at the Leeds heart surgery unit.
Those people owe their lives to the unit. They cite its wonderful staff and its proximity to Huddersfield as crucial. It takes less than an hour to get there. The unit gives fantastic family support and there is accommodation for parents if needed. As a result of George, Ben and Joel’s treatment at the unit, the Linthwaite Clough school council has decided to support it as its annual chosen charity. Already, it has organised a series of fundraisers, including a colourful, cheerful day. For the reasons I have given, I think that the Safe and Sustainable review should be renamed the safe, sustainable and supporting families review.
Finally, on behalf of Ben, Joel, George and many others, I shall support the motion.
Mr George Mudie (Leeds East) (Lab)
I congratulate the hon. Member for Pudsey (Stuart Andrew) on the hard work he has put in to secure this debate. I compliment him on the sensitivity with which he phrased his contribution. I hope that that will allow the Government Whips to stay out of the decision and allow Members to get what we seek, which is not interference in clinical observations, but a review of how this is being carried out geographically.
The right hon. Member for Charnwood (Mr Dorrell) was more sanguine than I am about the involvement of Sir Bruce Keogh, the NHS medical director. I found his article in The Times this morning ill-timed, coming on the morning of a debate, when feelings are running high. I do not find it acceptable for him to say that anyone who opposes his view is “disingenuous” and that
“political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence.”
I find that offensive. Nobody in the Chamber argues with the clinical objectives. I find it unacceptable that some youngsters who are taken to centres for medical treatment get excellent treatment and that others get less than excellent treatment. I find it sensible and laudable that we should rationalise those centres to build up experience and techniques, and so that there are more people to share their experiences.
The right hon. Member for Charnwood said that we should not oppose the proposal because it is right clinically. He told us not to think of our own hospitals, but to think nationally. “Nationally”, however, also means “regionally”. The point that has not been made is that, while the Chamber should accept the clinical arguments, equality of access is also important. That is what is being said by most of the opponents of the proposals, and they are not being disingenuous. For instance, in the Newcastle versus Leeds argument, it would not be acceptable for me to argue in favour of the Leeds case on the basis that Leeds children should not have to travel 100 miles to Newcastle, because if we won our case, Newcastle children would have to travel 100 miles to Leeds. If it is wrong for us, it is wrong for them.
If the rationalisation, which we accept, takes place properly—and this is where the Minister comes in—there will be an underlay of fairness and equality of access. We have a National Theatre in London, but it is not a National Theatre for Yorkshire. It is nice for Hampstead, but it is not very good for Seacroft in Leeds.
Mr Dorrell
I think that the hon. Gentleman slightly misrepresented what I said. I did not say, “You must accept it”, or “Take it or leave it”. I said that those who wished to argue for a different approach must argue for the whole approach, and not for a sectional interest.
Mr Mudie
I entirely accept that, and I did not intend to suggest that the right hon. Gentleman had said anything different. My point is that, while the clinical case for a rationalisation is unarguable, equality of access is as important a consideration as any. Excellent treatment must not be available to only a certain number of people.
Greg Mulholland
We all accept the clinical premise of the review, but is it not incredibly arrogant for anyone to suggest that it cannot be fallible? There are obvious flaws in it. Many clinicians themselves say that it is flawed.
Mr Mudie
I hear what the hon. Gentleman says. I think that the same case was made by the right hon. Member for Charnwood. We may prevaricate for one reason or another, but sometimes it may be necessary to make a decision even when we think that it is not perfect, and I think that this is an instance of that. If the life of a child is involved, we must make a decision.
If we continue to challenge the clinical aspect of the review, we will fall into the trap of allowing a bad situation to continue. The case for change has been proved, and, while we may differ on how that change should be made, what is important is for us to express the view—and I should like to see it challenged—that there should be equality of access. Each region should ensure that every part of it has equality of access where possible, although that will involve some difficulty if Yorkshire is lumped together with the north-east.
In the last year I have had to move from my constituency office, which was in the centre of the constituency. I was offered cheaper, perhaps even better, accommodation in the outer part, but I felt that it would be unfair on the other wards for me to move away from the centre. If option 4 is either Leeds or Newcastle, I think that that is unfair on both. I do not want to close Newcastle, and Newcastle does not want to close Leeds. Locating provision sensibly in each region is important, but the House should also recognise, as it rarely does, that the country has some corners in which there is no equality of access in any respect. Those in Newcastle, in the top corner, and those in Cornwall, in the bottom corner, do not have access to many facilities that are accessible to people in the midlands, in Yorkshire and, above all, in London.
I believe that the House should accept the motion, and that the review team should forget about the clinical arguments and produce a template that proves to every Member that the excellent services that we should be demanding for children’s care will be shared equally around the country. The team should give some real, positive, out-of-the-box thought to how to deal with areas that generally lose out.
Greg Mulholland (Leeds North West) (LD)
It is a pleasure to follow my Leeds colleagues, and it is a pleasure to work with all the Leeds and Yorkshire and Humber Members of Parliament throughout the House in support of the inspiring campaign to save the Leeds unit. I too was proud to be there to help present that remarkable petition. Nearly half a million people in the region have spoken out in an attempt to save the unit. When I visited it, I had the same experience as other Members have had when visiting their local units. I found it incredibly moving to meet those babies and children and their families, while also being conscious that I was walking into a centre of excellence. It benefits from a genuine co-location of services, which is the gold standard that has been set, and 370 operations are already being performed there—very close to the 400 figure.
Mr Kevan Jones
I note the size of the petition, but as a former Defence Minister responsible for defence medical services I faced similar petitions when the Ministry of Defence was concentrating military health care at University Hospital Birmingham NHS Foundation Trust, which is now a centre of excellence not just in this country but internationally. Although petitions are valuable, clinical outcomes must be at the forefront of any decision, and the MOD’s decision to concentrate defence medical services at Birmingham was the right one.
Greg Mulholland
It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.
Stuart Andrew
My hon. Friend mentioned the co-location of services. As I said in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?
Greg Mulholland
I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.
There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.
That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.
I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:
“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”
Jonathan Darling, a consultant paediatrician at the Leeds General infirmary, states:
“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”
I am afraid that it simply has not done so, which is worrying and quite extraordinary.
The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.
Mr Mudie
The point I was making was that if we are to take the review’s point and place units strategically, the obvious place with a mass population is Leeds. However, I said that that would leave Newcastle out on a limb, and something has to be done about that. The case for Leeds is unchallengeable.
Greg Mulholland
Indeed, and we have to get the point across to colleagues in other areas that perhaps we have to challenge the premise of the review and some of its figures if we are to reach other recommendations.
The third matter that I wish to mention, as the hon. Gentleman did, is travel. In the meeting yesterday with the review team, I was frankly dismayed by how little consideration was being given to the reality of ordinary working families and the effect that having to travel would have on them. I shall give a couple of examples. Johanne Walters, the mother of Emma, states that to them the change
“would mean her…surgery will be undertaken miles away from home and nobody would be there to support me—no family no friends—and it is incredibly difficult being there 24/7 at your child’s bedside, even with this support”.
Joanne and David Binns, whose son Oliver has been treated, have said:
“Oliver is our only child, and I’m sure you can imagine how it turned our world upside down. But we knew that we had family and friends who could just pop in and make us some food at the end of a long day, bring us clean clothes, and just be there if we needed a chat. I can’t imagine how much extra pressure it would have been at this point to have to think about long distance travel and accommodation on top of everything else.”
Matthew and Karen are the parents of Liam Hey, a constituent of mine who has become something of a celebrity. He is a wonderful young man who is being treated at Leeds. Karen has said:
“My son would not be here if it wasn’t for the LGI. It would be too much of a trauma to transfer children to another place.”
Travel has simply not received adequate consideration. It comes out top of the criteria that people give when we ask them, but it is not anywhere near the top of the list of the review’s considerations. That is wrong.
We have to re-examine the situation. I am delighted that the House has had a chance to debate it today, and that Ministers have been so accommodating in enabling us to do so. I urge the House to support the motion. We should come back with some proposals that will really work for children and that we can all support.
Mr Deputy Speaker (Mr Nigel Evans)
Order. To accommodate more Members, I am reducing the time limit to five minutes. I hope that both Front Benchers will take into account the popularity of the debate and the need to get Back Benchers in when they make their contributions.
Pat Glass (North West Durham) (Lab)
I do not have a children’s heart unit in my constituency. I do not even have one close by. There are parents in my constituency who are 50 miles from the nearest unit, but they tell me that they do not care about that. They would travel to the ends of the earth to get access to the best provision. That is what matters to them, not having somewhere on their doorstep.
Stuart Andrew
I have to take issue with that. The parents I have spoken to are very concerned that they might have to travel. Of course they will travel as far as they have to, but if we can provide a service closer to their homes, should we not strive for that?
Pat Glass
They are saying that because they have a unit on their doorstep now. We do not all live in big cities, and some people have to travel a long way. Parents tell me that what they want is the best services, and even if they have to travel to get them, that is what comes first. Travel and access are issues to consider, but every parent who has contacted me has confirmed that the most important thing for them is that their child gets access to the best provision available, and to surgeons who carry out these complex operations a couple of times a week, not a couple of times a year. They tell me that they will go anywhere to ensure that their child gets the best chance of surviving and that their condition improves.
Mr Kevan Jones
Does my hon. Friend agree that in County Durham, the concentration of adult cardiac surgery and emergency care at the Freeman hospital and the James Cook university hospital, which was controversial when it happened, has improved not only care but the survival rates of individuals from County Durham? Even though there are hospitals in the county closer to some people, survival rates have gone up because of that concentration.
Pat Glass
Absolutely, and we need to appreciate why such moves are necessary. None of us wants another Bristol baby tragedy, and I think there is general agreement that we need changes in the organisation of services to drive up the quality of treatment and bring together specialist surgeons to work in larger teams.
Pat Glass
I am not going to give way, no matter how much the hon. Gentleman hassles me. I can see that that is what he plans to do.
Many local campaigns have been mounted, and they have been supported by local MPs fighting for their own units or fighting to delay decisions. I absolutely understand that, but the decisions have been put off before for many reasons, which I believe is to the detriment of patients.
The decision should not be made on a political basis. Few of us in the House are qualified to judge the quality, sustainability and deliverability of clinical outcomes in children’s heart provision. On 7 June, when I questioned the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), on the matter, he gave me a categorical assurance that decisions would be
“based on clinical outcomes, not political considerations.”—[Official Report, 7 June 2011; Vol. 529, c. 12.]
I hope that he will keep his nerve in the face of sustained political lobbying.
The Minister of State, Department of Health (Mr Simon Burns)
If it encourages or reassures the hon. Lady, I will give her that commitment again today.
Pat Glass
I thank the Minister.
The Children’s Heart Foundation has advised me that the closer we get to a decision, the more difficult the political battle will become. In a bid to save surgery facilities in their areas, some parents and clinicians are asking MPs to stall progress towards a decision. Parents have been told that some units will close, when in fact even if surgery is centred elsewhere, local units will continue to provide specialist medical treatment on a “hubs and spokes” model. I believe that parents have been misled on some matters.
These decisions are crucial to the future clinical outcomes and life chances of our children. The Minister has again today categorically assured me that they will be based on clinical outcomes only, and I thank him for that.
Mr Andrew Turner (Isle of Wight) (Con)
I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:
“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.
It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.
Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.
In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team
“based retrieval times between the island and the mainland on travel by air. This was an oversight”
because the policy is
“to retrieve children from the Isle of Wight by road and ferry”.
That is very odd, because the consultation document explicitly states:
“Air travel has not been considered because it cannot always be relied upon”.
The statement goes on to say that
“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.
The conclusion was that
“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”
On remote areas, the consultation document states:
“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—
meaning three hours or less from Southampton in my case.
On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognised that the island,
“by its very nature, is remote from the mainland”.
Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are
“unique factors around retrieval times by ferry”.
My Glyde was very helpful. He explained:
“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.
They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]
Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
That the children’s heart unit at Newcastle’s Freeman hospital is cherished across the north-east is undisputed. One has only to read the coverage of the Newcastle Evening Chronicle “Keep Our Children’s Heart Unit” campaign in recent months to appreciate just how the unit has changed the lives of countless young people and families over the past decades.
Indeed, because of the pioneering work of the children’s heart unit at the Freeman, it is recognised nationally and internationally as a centre of excellence, with particular strength in quality and outcomes. The unit has also had significant investment over recent years. It is the only unit in the country able to offer all forms of heart treatment, regardless of age, under one roof, and the Freeman is recognised as having led the way in the UK in providing end-stage heart failure treatment for children.
As my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) said, the Freeman famously and bravely performed the UK’s first successful baby heart transplant in 1987. It has performed more than 200 child heart transplants overall, and was recently the first hospital in the world to enable a young child to survive for four months with an artificial heart, while the baby’s own heart recovered.
The quality of the work carried out at the Freeman means that young patients and their families travel to Newcastle for treatment not just from the west of Cumbria or north Yorkshire, but from as far afield as Scotland, Northern Ireland and even the Republic of Ireland.
For those reasons, I believe that the children’s heart unit at the Freeman is well-placed to continue providing its excellent, world-leading cardiac surgery services for children. Three of the four options put forward by the Safe and Sustainable review propose that that should be the case. However, I have concerns about attempts to move the debate away from the key issue at hand: ensuring that congenital cardiac services provided to children in England and Wales continue to be high quality, and therefore safe, and sustainable and deliverable. That was the intention of the Safe and Sustainable review.
Andrew Percy
I do not think any hon. Members who are fighting to save their local units are trying to move the debate away from that. I shall quote what health professionals from the North Lincolnshire and Goole NHS Foundation Trust say:
“In summary, we believe the babies, children and families of northern Lincolnshire would be largely disadvantaged…knowingly relocating a well run and safe service without providing additional advantage to our families is questionable and unnecessary.”
We are not moving the debate away from the clinical issues at all.
Catherine McKinnell
The hon. Gentleman has put his thoughts and concerns issue on the record.
I mentioned the intentions of the Safe and Sustainable review, which was instigated by national parent groups, NHS clinicians and their professional associations. Those intentions must be the primary drivers in deciding the final outcome of the review.
I am equally concerned at suggestions that the decision and outcome of the review should be stalled, or that the remit should be altered. I am not alone in expressing such concerns. The Children’s Heart Foundation argues that that would leave
“the door wide open for another Bristol Baby tragedy”.
Meanwhile, the charity Little Hearts Matter believes that the Safe and Sustainable service reconfiguration offers—
Catherine McKinnell
No, I will not.
Little Hearts Matter says:
“The Safe and Sustainable Service reconfiguration offers a monumental opportunity to ensure that every child with a heart problem has access to the best heart surgery service that this country can offer—a gold standard service.”
I urge anyone in a position of influence, including hon. Members, to support that step forward, and not to halt the process because of personal bias.
A number of hon. Members are concerned about the co-location of children’s services. However, it is important to note that during the development of the £100 million new Great North Children’s hospital at the Freeman’s sister hospital, the Royal Victoria infirmary, a deliberate decision was made to retain children’s heart services at the Freeman, aligned with the world-renowned adult heart services there.
Services that simply did not exist 20 years ago have created a new generation of adults needing care, and the service at the Freeman allows for a seamless transition into adulthood. Of course, services at the Great North Children’s hospital are available to the Freeman in a matter of minutes—throughout the review process, they have been recognised as though they are on the same site.
In conclusion, I am not asking those who will make the final decision to give special treatment to the children’s heart unit at the Freeman, or indeed to the people of Newcastle and the north-east. I am all too aware how difficult this process has been for all children’s heart units under consideration. Each is valued and each has a great story to tell. However, I am asking that the decision is made on the grounds of clinical excellence and the quality of services that are currently provided, and on those grounds alone. I urge that a decision on the future of children’s congenital cardiac services is not put off or prolonged, because the safety of babies and children in need of heart surgery should be paramount in this debate.
Mr Robert Syms (Poole) (Con)
I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on the measured, sensible and sensitive way in which he moved his motion. There is clearly a lot of strong feeling in the Chamber today, which is understandable given the number of people potentially affected by these changes. We all know that geography in this country is an important consideration, and although a political argument can be made for having fewer centres—it might save some lives—it can also be argued that for some families, particularly those living further from theses hospitals, these proposals could cost lives, if people are unable to get to one of the hospitals.
My hon. Friend the Member for Isle of Wight (Mr Turner) made an extremely good point about the difficulties with moving the Southampton unit. Yes, parents will go wherever they can get the best treatment, but they prefer to go somewhere nearby. I have constituents who have moved to Poole simply because of its proximity to the Southampton unit, and I expect that families around the country with similar problems also sometimes vote with their feet by buying a home in close proximity to a unit. This point needs to be taken into account. A Mrs Owen made the point to me quite forcefully that it was one reason she and her family moved to Poole.
The chairman of Poole borough council’s health and social care overview and scrutiny committee has concerns, as do Councillor Charles Meachim and Antoinette McAaulay, who is a consultant paediatrician at Poole hospital. The latter raised concerns about the impact on the Southampton unit and pointed out that Southampton had the highest quality score for clinical care outside London and the second highest in the UK following the Kennedy review in 2010, suggesting that the children’s cardiac paediatrics service in Southampton is a safe service. She also points out that the numbers for Southampton might be wrong because since the suspension of services in Oxford, the numbers have gone up considerably from those quoted in the study.
Although I agree with the motion and think it silly to stick only with options A, B, C and D, people in my area of the country would prefer B because of the impact it would have on the Southampton centre. People in my constituency have pointed out that the option B proposal includes the centre with the highest quality score, the centre with the best surgery survival rates and the centre with the highest score for research. A strong argument can be made for retaining the Southampton unit. It has strong support from my constituents and people in Dorset, so I hope that the joint committee will consider it carefully.
Annette Brooke (Mid Dorset and North Poole) (LD)
Representing part of Poole, I am aware of the strong feelings there. Equally, however, I take on board the need for clinically driven decisions. Many Members are raising concerns about flaws in the proposals, so it makes a lot of sense to proceed with the motion, because whatever happens we want to be sure that the best decisions are being made. Does my hon. Friend feel that there is great uncertainty?
Mr Syms
I agree with the hon. Lady. It is important to get this right, rather than to rush. Clearly there are concerns. I know that the Minister is a sensible soul and will respond—[Laughter.] Well perhaps he was once a sensible soul. I am sure that he will respond to Members’ concerns. The important thing is that many people out there have concerns that we need to address if we are to deliver a first-rate service that our constituents feel is good for them.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. I have the privilege to have in my constituency the hugely impressive and world-class Alder Hey children’s hospital, which I am delighted is included in all four options in the motion. I would express some concern, however, were the motion to be agreed to and were we to go beyond those four options. I hope that Alder Hey would be included in any further options that the joint committee would consider and consult on.
Alder Hey’s cardiac unit treats children with all forms of heart disease, not only in Liverpool and the wider Merseyside area, but those travelling from the wider north-west of England, north and mid-Wales and the Isle of Man. The total catchment area for children using Alder Hey’s cardiac unit covers about 7 million people, so many people already travel very long distances to use the excellent services there. Since 2006, the hospital has treated more than 4,000 patients for cardiac conditions and performed surgery on more than half of them. I spoke to the hospital this week in anticipation of today’s debate, and it expects that the concentration of surgery at Alder Hey will further increase demand, and has built that into its current plans. Alder Hey is on track to have a brand-new hospital with a children’s park. The plans are very exciting and have got a strong commitment from the local community in my constituency in West Derby. The hospital is strengthening its services. For example, it is investing in the existing team to add a sixth cardiologist and an eighth intensivist, increasing its theatre capacity to enable the delivery of 637 cases per year, and it has already achieved the minimum required activity for this operational year of 447 cases.
Members have spoken about the balance between our responsibilities to consider the national picture and our constituency responsibilities. Happily I am in a position to argue that the proposals work both in terms of national policy and for my constituents. The Children’s Heart Federation has highlighted some of the benefits of the Safe and Sustainable review’s proposals, which have been mentioned by hon. Members today: minimal cancellations and short waiting times for surgery; better outcomes from surgery; and an end to high-risk rotas in which a surgeon in a small team covering for a colleague on leave can operate all day and be on call all night several days running. As has been pointed out, these changes have been put forward by clinicians, and I would urge the House to tread with great care in jeopardising the outcome of such a clinician-led review. We must remind ourselves that the review does not propose the closure of any centres, and would instead concentrate surgery in the centres where it can be performed safely.
I finish with a broader point that the Minister might like to reflect on. This review is a good example of evidence-based policy making in the NHS. Perhaps we can have more of that as the process of NHS reform moves forward.
Craig Whittaker (Calder Valley) (Con)
I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his incredible hard work on this issue, not just this week but over many months.
Yesterday many MPs received an e-mail from the chief executive of the Children’s Heart Federation, who is also a member of the Safe and Sustainable programme steering group. She wrote:
“'Clinicians have led these changes and we believe it is wrong that some politicians are now trying to block the process that will lead to the vital improvements in children’s care.”
I do not agree with that assessment because I agree absolutely with the aims of the review, as do many of my hon. Friends. However, I have an issue with the process of the review and what it has missed out. In the case of Leeds, there has been no formal opportunity to correct factual inaccuracies in Sir Ian Kennedy’s pre-consultation assessment report, and no impact assessment was undertaken before the four options were announced in the consultation
As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, Leeds delivers what is considered a gold standard of service, and is one of only two hospitals that offer this gold standard. However, the weighting in the criteria did not take account of that at all. It would be fair to say, therefore, that I, my fellow Yorkshire, Humber and Lincolnshire MPs and the more than 500,000 fellow Yorkshiremen who handed in a petition to the Prime Minister this week have little faith in an open and transparent process that is fair for the people in the current Leeds catchment area.
Greg Mulholland
Let me too say that it is a pleasure working with my hon. Friend, but can we debunk this myth that we are talking about a review without flaws that is based on clinical guidelines? Option B, which he mentioned, does not even get us to 400 operations for some centres. In too many places the review does not even follow its own logic.
Craig Whittaker
I agree with my hon. Friend, who is absolutely right. This comes back to my basic premise, because all we are asking for is an open, honest and transparent process that will produce the desired outcomes.
Last year, one of my constituents, Miss Libby Carstairs, spent many months in Leeds hospital and underwent heart surgery several times over several months. As we know, the aims of the consultation clearly show that parents would take their child anywhere to get the best treatment when they are as poorly as Libby is and was. Under the proposals, Libby would have gone backwards and forwards several times, probably between Newcastle for surgery and Leeds for her convalescence. Currently, her care and surgery all happen in one place. As with all families at such a stressful time, it was hugely beneficial that the family could visit regularly and help in the convalescence period. Libby’s mum spent her life in that unit with her, and her grandparents played a huge role with relief and support. Libby’s being in Leeds even allowed her head teacher, from Carr Green primary school, the opportunity to visit and take messages of support from her classmates and friends. I saw first hand not only how that cheered Libby up, but how it helped to fast-track the recovery of this poorly little girl. It also without question helped Libby eventually to go home, albeit with high levels of support. Such support from family and friends would not have been possible had Libby been up and down to, say, Newcastle or Liverpool, which are many miles away.
Although the main principle of parents taking their child wherever they need to go to get the best treatment is absolutely correct, it does not take into account the loss of income to the family through not being in work, the huge cost of travelling much further distances, and the incredibly important network of support from family and friends at what is an awfully frustrating and stressful time for everyone involved—the big society at its best, as it were. I cannot imagine what it is like not to know whether one’s child is going to live or die, so I cannot begin to comprehend the full extent of the support needed and appreciated by families.
Contrary to the e-mail received yesterday, MPs do understand the process, as do the 500,000 people who have signed the petition. However, it is scandalous that Leeds fits into only one of the four options, particularly as vital information has been missed out of Sir Ian Kennedy’s assessment. To sum up, if the Government are big enough to listen to the people and amend their proposals on issues such as the NHS and jail, surely clinicians at the JCPCT should be big enough to review their plans, by listening to what 500,000 people from Yorkshire, Humberside and Lincolnshire are telling them to do.
Dr Alan Whitehead (Southampton, Test) (Lab)
Southampton children’s services are located at Southampton General hospital, right in the middle of my constituency. The hard work undertaken by the large numbers of people who organised the petition presented at No. 10 yesterday—I and a number of fellow Members from across south-central England managed to get ourselves very wet helping to deliver it—showed not partisan fighting on behalf of a particular unit, regardless of its quality or the service that it represents, but genuine mystification that the process appears to have dealt so peripherally with Southampton’s role in the national roll-out of services. In 2010, Sir Ian Kennedy rated Southampton as provider of the highest quality service outside London, rating it particularly highly on paediatric intensive care and support for parents, and highly on training and innovation.
That mystification as to why such a unit should feature in just one of the options in the review was compounded by an examination of the background to that review. Indeed, perhaps the explanation for why Southampton appears to have been treated so peripherally can be found in the review itself. Of course it is important that the review should be completed, that changes should be made and that judgments be made on clinical grounds. However, I would suggest that it is not on clinical grounds that anyone should have forgotten that the Isle of Wight exists. That is the province of geographers rather than clinicians. If clinicians depend on the material in a review setting out the factors that will be taken into account in their final decision, much of their power in making that decision could be overthrown by what goes into that review in the first place.
It is not a clinical decision for the review to state that Southampton has two surgeons and undertakes 231 procedures, when in fact it will have four surgeons by this summer and undertake almost 400 procedures, as a result of, among other things, its excellent collaboration with Oxford, which my right hon. Friend the Member for Oxford East (Mr Smith) mentioned earlier, but which the review appears to neglect. If such a decision is made by the review, which appears to have got so many things wrong about the background to Southampton’s excellent services, the 250,000 petitioners who signed the petition that went to No. 10 yesterday will justifiably feel let down by the process, whoever conducts it. The national health service has a long and honourable record of stitching people up for the right reasons. If as a result of the review those 250,000 people end up feeling stitched up for the wrong reasons, they will have every right to feel very aggrieved indeed.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Just to inform the House of the procedure, I will now call the Minister. The recommendation from the Backbench Business Committee is that he speaks for about 15 minutes. However, I should remind the House that if he takes persistent interventions, that will extend the time that he spends on his feet, which will deny other Back Benchers the opportunity of speaking. The shadow Minister will be speaking towards the end of the debate.
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate on the review of children’s heart surgery services. He has a strong record of campaigning on this issue and of bringing the concerns of his constituents to the attention of the House. I also congratulate him and the other hon. Members on the motion they tabled. The Government and I wholeheartedly support its contents, and I urge other hon. Members to do so as well.
I should also like to take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in my hon. Friend’s constituency and across the country. They do a tremendous job, for which we are all incredibly grateful, more often than not in complex and difficult circumstances.
I should like to confirm that the review is totally independent of the Government, and that it is clinically led. It is not driven by me, by other Ministers or by the Department of Health. It is therefore not appropriate for me to comment on the specific hospitals consulted during process. I do not wish to act, or to be seen to act, in a way that could influence or prejudice the process that is going on. As many hon. Members have said, this is a highly emotive issue, particularly for those whose children’s lives have been saved by the services under review. It is worth reminding ourselves why the review was conceived and planned and is now being carried out.
This is not a new issue. The provision of children’s heart surgery has been a cause for concern since the Bristol Royal infirmary inquiry in the late 1990s. Understandably, there has been considerable pressure from national parents groups and professionals to ensure that children receive the best treatment, and the sole purpose of the Safe and Sustainable review is to ensure that children with congenital heart problems receive the best possible care now and long into the future. To do that, we must be certain that the centres in which surgery takes place are as good as they can be.
Mr David Davis (Haltemprice and Howden) (Con)
The Minister will not be surprised to hear that my constituents, like all the others in Yorkshire, are in favour of Leeds, but I do not want to draw him on that. I would like him to help us in our argument by telling us what the clinical outcomes for Leeds are and how they compare with other centres. In particular, will he confirm that they are all safe?
Mr Burns
I am grateful to my right hon. Friend for that intervention. With regard to Leeds teaching hospital, he will know that this is a complex issue. There are 36 different surgical procedures listed on the central cardiac audit database, but the three most relevant ones in the context of his question are those that deal with atrioventricular septal defect, arterial switch and Fallot’s tetralogy. Over the past six years, 304 operations have taken place involving those three specialties. Sadly, the number of patients who died within 30 days was 12, and 18 died within one year. The results of surgery in all units are good, with no significant divergence. The issue, however, is the future. We need to prepare for units that can deal with these highly complex procedures and the intense technology needed, and provide the qualified doctors and nurses involved, in order to keep up with professional and public expectations of the high quality of care required. This is not so much about today’s figures as about how we meet the challenges of the future to provide the finest and safest possible care in this deeply complex area of medical treatment.
The consensus among professional associations is that there should be no fewer than four congenital surgeons in a centre, each performing between 100 and 125 procedures every year, for a centre to be optimally staffed. Over the past few years, the outcomes for the services have remained good, as the figures that I have just given to my right hon. Friend illustrate, but there have been several warning signs that the current arrangements are fragile. For many years, professionals and national children’s charities, including the Children’s Heart Federation and the British Heart Foundation, have urged the NHS to review services for children with congenital heart disease. They have consistently raised serious concerns about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres.
Many of the 150 types of operation undertaken by these dedicated teams are among the most complex, challenging and technically demanding areas of surgery. Success requires intricate surgery on hearts often no bigger than a walnut, coupled with finely balanced judgments drawn from a combination of advancing science, personal experience and compassion. It involves a range of highly trained individual team members—before, during and after the operation.
The risks posed by the complex nature of heart surgery include not just possible death after surgery, but lifelong complications such as brain damage and other disabilities. The judgments of any expert medical team caring for a particular child therefore have a direct and long-lasting impact not only the future of each vulnerable child, but on that of their families.
There is also the issue of recruitment. The fact is that smaller centres have problems with recruiting and retaining the very best surgeons. There is a risk that those working in smaller centres will find themselves working in isolation and in units that are not as up-to-date with techniques and clinical practice as the larger ones are.
Greg Mulholland
We all understand the premise of the review about the need to move to larger centres, but does the Minister not understand—I am not trying to draw him—the real concern when Leeds is performing 370 procedures a year and Newcastle, a smaller unit, performed only 255 last year, yet Newcastle is in all four options and Leeds only in one?
Mr Burns
I fully appreciate the hon. Gentleman’s point, but I hope that he will appreciate that he is now trying to draw me into a discussion on the merits of Leeds as against Newcastle. As I said earlier, it is inappropriate for me as a Minister to do that. However, it is a point that the hon. Gentleman, my hon. Friend the Member for Pudsey and others can make more than adequately to the joint committee, which will be able to determine the merits of the argument prior to reaching a decision. I urge the hon. Gentleman to understand how inappropriate it would be for me to go down the route of arguing the merits or demerits of one area or another.
Smaller centres struggle to train and mentor junior surgeons, making these units less attractive to the senior surgeons of tomorrow and making it difficult to provide a safe 24-hour service. We must ensure that our surgeons and their teams are well supported. They need opportunities to develop their experience as they become increasingly expert in these intricate and complex procedures. We must ensure that all the hospitals that provide heart surgery for children can also provide care within safe medical rotas.
No parent would wish the care of their child to be entrusted to a surgeon who, though an excellent doctor, is overly tired because they have had to work around the clock without any peer support. This means that to reduce the risk of surgery in sick children and to improve their long-term outcomes, we must focus our surgical expertise in larger centres. The need has become ever more pressing with the increasing complexity of treatment.
As hon. Members will know, the national review is known as the Safe and Sustainable review. Its aim is to ensure that children’s heart services deliver the very highest standard of care. The NHS must use its skills and resources collectively to gain the best outcomes for patients. As I stated at the beginning of my speech, in line with the Government’s entire approach to the NHS, this review is both independent and clinically led. May I reassure hon. Members that the objective of the review is not to close children’s heart centres? Far from it. While surgery may cease in some centres, they will continue to provide specialist, non-interventional services for their local population.
Indeed, the review proposes to extend local care further, supported by the professional associations that support the increased clinical expertise across England. This wider support is crucial. Surgery is usually a single, short episode in what is often a lifelong relationship with specialist congenital heart services. The aim is to improve those services as a whole and to ensure that as much non-surgical care as possible is delivered as close to the child’s home as possible through the development of local congenital heart networks. These will enable children to be safely and expertly cared for nearer to home in the longer term.
Given the complexity of the issues for consideration, the NHS has held a four-month, rather than the usual three-month, consultation. Hon. Members should be reassured that the consultation process has been impressive in its scope, inclusiveness and transparency.
Julian Smith
I thank the Minister. Will he comment on the lack of translation of certain consultation documents, which has affected many communities, particularly in and around the Leeds area?
Mr Burns
I am grateful to my hon. Friend for raising that issue, and I will address it later in my speech.
No decision has yet been made about which centres should continue to undertake surgery. That decision will be made only after the responses to the consultation have been properly and fully considered. The chair of the joint committee of primary care trusts, Sir Neil McKay, has made it clear that it is a genuine consultation and that all viable proposals will be considered, and I agree with that. There has been no pre-determination of the number of centres that will be selected. Rather, the review remains flexible and open-minded as to the final number and is happy to listen to all options that would produce the excellent clinical outcomes for our children that we desire.
As I have said however, this review is being driven by a powerful clinical imperative. The trend in children’s heart care is towards increasingly complex surgery on ever-smaller babies. That requires surgical teams that are large enough to provide sufficient exposure to complex cases, so that surgeons and their teams can maintain and develop their specialist skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons. In recent years, other countries have recognised the clinical necessity of larger surgical units and have reconfigured their services along the lines proposed by the Safe and Sustainable proposals. Here in the United Kingdom, there are successful precedents for centralisation. In the past 15 years, the congenital cardiac services in Cardiff and Edinburgh have ceased heart surgery on children, as they recognised that their centres were just too small to be sustainable.
I also want to reassure Members about the integrity of the process that was followed in developing the options for consultation. In the past, concerns have been put to me in this House about mistakes in the assessment process, particularly relating to the Leeds service, and Members have referred to that again today. I understand that since our last debate in February or March of this year the chair of the joint committee, Sir Neil McKay, has written to the chief executive of the trust in Leeds to explain why mistakes have not been made in relation to the Leeds centre.
Members, including my hon. Friend the Member for Skipton and Ripon (Julian Smith) in his recent intervention, have also raised the issue of documents not being made available in a sufficiently wide range of languages, thereby excluding those who speak those languages from the consultation process. The relevant documents have for several weeks been available in 10 different languages, including Urdu, Arabic, Farsi and Punjabi. [Interruption.] The hon. Member for Leicester West (Liz Kendall) shakes her head, but I assure her that they have been available for several weeks, although I accept that they were not available from the first day of the review. That may be the point the hon. Lady was seeking to make, and I agree with her if she thinks they should have been from the first day. We cannot change the fact that they were not available from then, however, but they have been available from, I believe, 20 May, and the consultation process runs until 1 July, which gives sufficient time for people who need to access the documents in those languages to do so and to be able to input their views.
I hope to be able to reassure my hon. Friend the Member for Isle of Wight (Mr Turner) on retrieval times and access times from the Isle of Wight, given its unique geographical situation. It is my understanding that the joint committee of primary care trusts has agreed that Southampton University Hospitals NHS Trust has provided evidence on this issue that requires further consideration and has invited the trust to develop a detailed case regarding retrievals from the Isle of Wight, which the committee will consider as part of the evidence to determine the optimum reconfiguration.
Several Members raised the issue of the inclusion of black and minority ethnic communities in the consultation process. There have been a number of workshops and focus groups, many of which have been aimed specifically at the BME communities. Almost 2,000 community groups and organisations that have an interest in BME issues have been contacted and invited to take part in the proceedings. Public meetings have been arranged, particularly in Leeds, specifically for the Asian population of Yorkshire in partnership with representatives of local BME groups. The Leeds meeting is on 29 June, there is a meeting planned for Bradford on 30 June and a further meeting is planned for Kirklees. I hope that hon. Members who represent parts of Yorkshire and the surrounding catchment areas will be assured by that.
To abide by your rules, Mr Deputy Speaker, I will now conclude by saying that I am confident about the consultation. Everyone will accept that all consultations of this nature can be difficult, when tough decisions have to be taken. The decisions have to be taken for the right reasons, based on clinical evidence about the best way to improve and enhance care and the quality of care for patients. That is particularly true in this case because more often than not the patients are very young children with very complex needs—that is what makes this issue so difficult.
Let me reiterate that no decisions have been taken or will be taken until the joint committee has had an opportunity to consider the independent analysis of the consultation responses, reports from any local overview and scrutiny committees and a health impact assessment. Throughout, it will remain open-minded and flexible as to the number of centres. The only important consideration will be the sustainability of clinical excellence at the centres chosen. I doubt whether this is the case, but if any hon. Members have not taken part in the consultation I urge them to do so. I also urge them to ensure that their constituents and organisations in their constituencies with an interest in this matter take part in the consultation if they have not already done so, so that the committee can have the widest range of views, information and opinion before reaching what will, in any circumstances, be difficult decisions.
Nic Dakin (Scunthorpe) (Lab)
It is a pleasure to follow the Minister, who was very careful in setting out how he is attempting to ensure that this process proceeds in an appropriate way. I was pleased by his comments about the consultation being genuine and about the review being flexible, open-minded and not limited to a particular set or number of outcomes. His contribution was very reassuring and I thank him for that.
I would like to use as my reference point a lady who attended a meeting in Scunthorpe, at the Wortley House hotel, for people who have used the Leeds children’s heart unit’s services in recent years. Her use of the service goes back to when it was in Killingbeck hospital a long time ago before it moved to Leeds General infirmary in 1997. At that point, as has been pointed out, all children’s services were located in one area to great positive effect for the children of the Yorkshire and the Humber region. What she said to the people from Leeds at that consultation was that she really did not mind where the heart surgery locations were, but that she wanted the very best to be delivered for children in need so that they could access the best and most excellent services. She went on to say that her experience of the Leeds service was such as to give her assurance that it would meet those needs. She was particularly concerned that proper outreach services should remain in any future configuration. Her daughter was expecting another child and was already engaged, in relation to her pregnancy, with service support through Leeds, which was going to make it less likely that there would be significant cardiac problems that could not be dealt with at the appropriate time and with appropriate effectiveness.
In the Scunthorpe area, we tend to be on the periphery of things, so we always have to travel, in this case to Leeds. The weather conditions at the end of last year made it difficult to travel to and from Scunthorpe, and a two-hour journey with unwell youngsters would have led to great concern.
We need to make sure that there are proper outreach services to give support in future and, as my hon. Friend the Member for Leeds East (Mr Mudie) said earlier, we must recognise that people should have equality of access to excellence wherever they are in the country. That is important for my constituents.
Ian Mearns (Gateshead) (Lab)
Does my hon. Friend agree that it seems a little unfortunate that the options in the consultation would not include the continuation of services at both Leeds and the Freeman hospital in Newcastle? That was deeply upsetting for parents in the communities that both hospitals serve. There is real concern that the excellent heart and lung transplant service at the Freeman hospital could be jeopardised.
Mr David Ward (Bradford East) (LD)
It is good to be working with the hon. Gentleman on this issue, but does he agree that there is a fundamental problem? Newcastle performs only 255 procedures, so it needs the Leeds unit to close to reach the 400 figure specified in the review, whereas Leeds can stand on its own. Together, we have to challenge that premise, because the European regulations state that 250 procedures is perfectly safe. The Newcastle unit is safe and the Leeds unit is safe; they are both excellent. Together, we have to challenge the review.
Nic Dakin
I thank the hon. Gentleman for those comments. Leeds delivered 316 cardiac operations in 2009-10 and 372 in 2010-11, so the numbers meet the criteria fairly closely.
I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate. The Minister will have heard from his comments that there is still not total confidence in the integrity and transparency of the review. I feel that the Minister has helped to allay those fears and I am reassured by his saying that the review will be open, genuine and flexible. I thank him for putting that message across so strongly. The hon. Member for Pudsey clearly outlined the concerns, especially the need properly to engage with the ethnic minority community. Although it sounds as though steps have been taken latterly, they ought to have been taken at the beginning of the process, given the fact that young people in that community have a higher incidence of cardiac issues than the rest of the population.
I hope that the people conducting the review will hear the excellent comments that have been made by Members on both sides of the House, and from all regions of the country, during the debate, and that they will think outside the box, as the hon. Members for Pudsey and for Colne Valley (Jason McCartney) said earlier. We need to be flexible. We do not need to compromise on clinical excellence or clinical outcomes for children, but we should recognise the need for equality of access to excellence, as my hon. Friend the Member for Leeds East said. I hope that our debate will be part of the consultation process that the Minister assures us is genuine, listening and ongoing, and that it will assist us in reaching an outcome that we can all applaud.
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am sure that hon. Members will show time discipline, so that we can get as many of them in as we possibly can.
George Hollingbery (Meon Valley) (Con)
I should like briefly to place on the record my grateful thanks to the 18 highly qualified consultants from Portsmouth who recently wrote to me to express their support for the Southampton unit. As time is short, rather than repeating much of what has been already said, I should like to concentrate solely on one element of the review: retrieval times and their effect on the volume gateway.
The number of operations that a centre undertakes is clearly important to generate wide experience across a team and maximise the accumulated wisdom in any unit and, crucially, its support services. That seems entirely logical and sensible, and it is, of course, at the very centre of the entire review, but the available volume is crucially affected by one absolutely critical variable: the distances of emergency admissions, or retrieval, as it is known.
The paediatric heart unit closest to my constituency is in Southampton—thus, of course, it has been the focus of my attention. I absolutely agree with the point made by many hon. Members that we should not let our local sympathies cloud our judgment on what is a national matter, and I hope I have not done so. It is worth pointing out to hon. Members that for many constituents in Meon Valley, my constituency, the reality is that the loss of the Southampton unit would not be a huge disadvantage. The change would result in their becoming clients of the Evelina children’s hospital at Guy’s and St Thomas’s—hardly a poor alternative for them—but we should notice that the insistence that a three-hour, road-based retrieval time for emergency admissions should act as part of the gateway excludes certain parts of the south-west and south Wales from Southampton’s potential catchment. Initially and puzzlingly, as we have also heard, the Isle of Wight was also excluded, but that seems to have been sorted out, for which we are all grateful.
Why is this important? Simply because Southampton has the second highest score for quality in the country at 513 points, with the Evelina at the top of the list with 535 points. Although I genuinely do not believe that it is the place of elected politicians to wade in every time that the NHS wants to reconfigure local services, I am concerned that the review is likely to result in the loss of one of the very best heart units in the country.
We have been told that quality was presumed to be the overall driver of the review and that quality trumped geographical proximity and convenience. So the decision to include the Southampton unit, which is rated second in the country for quality, in only one option must be regarded as running counter to the core principles of the decision-making process. I fear that the panel may choose to lose one of the highest-quality options available in favour of a lower-quality alternative, for reasons that do not necessarily stand up when looked at closely.
I believe that those who are tasked with making the decision need to satisfy themselves that the overall three-hour road retrieval criterion is truly as crucial as it seems. Can it really be right that, in a review driven at its core by quality, the population-level risk of closing the second highest-rated paediatric cardiac surgical unit in the country is truly outweighed by a possibly longer-than-three-hour retrieval for a small number of potential patients? Only the joint committee of primary care trusts can make that judgment, and I leave it to do so. I simply ask that it considers that key variable and wish it the very best in making a decision that, although entirely necessary, is bound to upset many people.
Nicky Morgan (Loughborough) (Con)
I will try to keep my remarks as brief as possible to allow other hon. Members to have their say. I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew), who secured the debate, and all the other Members who have supported him. I thank the Backbench Business Committee for allowing the subject to be debated in the main Chamber.
I shall speak in favour of the motion. I was first contacted about the issue shortly after the election, and I should like to thank in particular the Russell family in Loughborough for bringing it to my attention. The review is called Safe and Sustainable for a good reason, and I entirely endorse the statement that all hon. Members probably received from the Little Hearts Matter campaign that the review offers a monumental opportunity to ensure that every child with a heart problem has access to the best heart surgery service that this country can offer. I am sure that that is what we all want.
I am, however, concerned by a few comments made by Opposition Members and in a recent article in The Times, which seemed to question why MPs felt the need to defend their local services whenever a reconfiguration is suggested. That is a misunderstanding of the role of 21st century Members of Parliament, however long ago they were elected. We are here to speak up on behalf of our constituents. I am sure that all hon. Members here today and those who cannot be here have been contacted by constituents who are concerned about their access or that of their children and grandchildren—those born and not yet born—to heart surgery should the need arise. It is absolutely our duty to stand up for that and to ask whether the review and the options are right. However, I am very pleased that, as a Member of Parliament, I am not the one making the final decisions.
As I said, I support option A, as do my right hon. Friend the Member for Charnwood (Mr Dorrell) and the hon. Member for Leicester South (Jon Ashworth). I am sure that, although the hon. Member for Leicester West (Liz Kendall) will focus on the national perspective, she will manage to get in a reference to Glenfield hospital somewhere in her concluding remarks. That hospital serves my constituents extremely well and I am in awe and admiration of those who work there—the surgeons, those who run intensive care units, all the nurses, and the many staff who packed the Walkers stadium for two consultation meetings last Thursday. Option A is the highest scoring option and the most cost-effective.
In the time available I want to talk about a topic that the hon. Member for Leicester South touched on—the ECMO services at Glenfield hospital. The hospital treated many of the patients who had swine flu over the winter, and the national leaders of the NHS said that the nation owed Leicester a debt of gratitude for the work that it had done with ECMO. My worry about the review—if option A were successful, I would not have this worry—is that we have a clinically excellent service in ECMO and I do not want to see that jeopardised in any way. As has been said, if the children’s ECMO service is moved, that will inevitably have an impact on the adult ECMO services. We should be very careful in this country about not respecting such clinically excellent services. We should allow them to continue in places where the staff are already well trained and well versed and offer a service of national importance.
My final point, which the Minister addressed—I am grateful to him—is about translation. There are a large number of ethnic minority people in Leicester and in my constituency of Loughborough. My right hon. Friend the Minister generously acknowledged the fact that it would have been helpful if the documents had been translated earlier. The question posed by hon. Members in the debate is whether that impacts on the fairness of the review and the way the process has been carried out. That is clearly for others to judge. It will be interesting to see how many people reply using documents that have been translated.
The timeline in the consultation document shows that the process has been going on for a long time, so it should not have been beyond the wit of man or of the review committee to realise that many of the services are located in areas where there are high ethnic minority populations, and that those documents should have been translated early enough to make sure that members of those populations could play their full part in making their views heard.
Mr Deputy Speaker (Mr Nigel Evans)
Order. If hon. Members speak for just under four minutes, everyone will get in.
Mr Steve Brine (Winchester) (Con)
I begin by congratulating my hon. Friend the Member for Pudsey (Stuart Andrew). There have been some interesting moments in the past week and I know he has enjoyed every minute of it.
I want to be clear from the outset that I have never called and am not calling for the Safe and Sustainable review to be stopped or even paused. The Children’s Heart Federation said to me this week, as it said to many Members:
“We urge MPs countrywide to support the need for change and fight for the highest quality national children’s heart service.”
I could not agree more and I could not have put it better myself. In the words of Sir Ian Kennedy, whom Members know well:
“Mediocrity must not be our benchmark for the future.”
Spot on, again.
On that point, let me take head-on the inevitable comments in some of today’s newspapers. Intellectually the case for change is compelling and, to be clear, I am not co-sponsoring today’s debate out of political or personal interest. For me, today is about getting us back to a point where the focus of the review is on quality. I recognise 100% that, since the recommendations from the Bristol inquiry were published a decade ago, professional bodies and patient groups involved in children’s heart care have been united in pressing for changes in the organisation of services to drive up the quality of treatment.
The Safe and Sustainable review states its main aim as providing
“excellent care for children with congenital heart disease”.
I have yet to meet one person who disagrees with that statement, but I have met many who take issue with how we are trying to get there. Each speaker this afternoon has in mind the children’s heart centre serving their constituents and many of us, myself included, will no doubt make points in support of the option containing their unit. That is fair enough. As my hon. Friend the Member for Loughborough (Nicky Morgan) said, we are MPs and would not be representing our constituents if we did anything less.
However, for me it is not all about my backyard. The points I have to make about Southampton have a wider purpose and illustrate the bigger picture. During the past few months, Members from across the House have listened to one another speak on the subject and heard the arguments ring one or two bells. For me, that moment came in the Adjournment debate that my hon. Friend the Member for Pudsey secured in March. That is what brought us together. As so often happens in this House, disparate parts come together to form something much bigger.
It is true that some campaigns in other parts of the country have been bigger and more muscular than others. It is also true that the campaign based around the so-called option B, which is to retain children’s heart surgery at Southampton, has been enormous by any measure. Its momentum flows directly from the fact that 17 weeks ago, when the options were published, the second-best children’s heart unit in the country was given only a one-in-four chance of survival. I want to be crystal clear that the team from Southampton supported the Safe and Sustainable review taking place and, on balance, still does, but it was shocked to the core to learn that a process that is about quality could put one of the world’s top centres on such a sticky wicket.
This week I received the final submission from the Hampshire health overview and scrutiny committee to the joint committee of primary care trusts. The opening paragraph does not pull any punches:
“Given that it has taken over a decade to reach this point, our observation is that the overarching objectives of this exercise—to improve the quality of these services for children—has been lost in an adversarial and divisive consultation exercise which has focused predominantly on defending the process and not on delivering the desired outcome.”
My fear is that Sir Ian Kennedy’s feared “mediocrity” is exactly the outcome that we are in danger of delivering unless those leading the process change their focus. The scrutiny committee also said:
“The responses to issues raised by clinicians, parents and other stakeholders seem to reflect a preoccupation by those driving ‘Safe and Sustainable’ with defending the process against legal challenge rather than securing the prize of better quality care for these patients. This is not acceptable or in the interests of the patients affected.”
That puts it very well.
The Isle of Wight factor is fast moving centre stage in the Southampton campaign. My hon. Friend the Member for Isle of Wight (Mr Turner) spoke with his usual force on the subject, so there is no need to say any more on it, other than to say that it is not too late in this regard and that the Safe and Sustainable team is listening carefully to the island’s arguments.
Finally, I will be supporting the motion because it clearly welcomes the aim of sustaining the provision of services based around quality. Above all—this is the key part that we worked so hard to include in the motion—I support the call for the joint committee not to restrict itself to the four options outlined in the review document. A case can be made for options A, B, C or D, but it can also be made for E and F. I ask it to bear that in mind as it goes forward to the end of the process on 1 July.
Nicola Blackwood (Oxford West and Abingdon) (Con)
I, too, congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on his leadership in securing the debate. I open my remarks by paying tribute to Oxford’s paediatric cardiac team, including Professor Steve Westaby. The team have saved countless lives and have the complete confidence of the patients and families who have asked me to speak up for them today. I also pay tribute to the Young Hearts charity, which has stood up for children with congenital heart disease and their families in Oxfordshire and presented a petition, which I am holding in my hands, with thousands of signatures to the Prime Minister in his constituency this month. They have done much to assure services in Oxfordshire.
Few would take issue with the basic aims of the Safe and Sustainable review; who does not want to improve outcomes for children with congenital heart disease? That is not where the concerns lie. The review works on a simple premise: more surgeons doing more surgeries will achieve better outcomes for more patients. That makes perfect sense, but in this instance, as the motion states, size is not everything. Although the simple centralisation of specialist services is backed by clinical evidence, some clinicians in Oxford, Southampton and elsewhere are of the opinion that it draws on too narrow an evidentiary base and that matters such as the co-location of services, assessed travel and population projections must also be considered.
On co-location, for example, a 2008 Department of Health report states that cardiac surgery requires the absolute co-location of paediatric cardiology, paediatric critical care, specialist paediatric anaesthetics, specialist paediatric surgery and specialist paediatric ear, nose and throat services. Even though Safe and Sustainable states that the co-location of those services should be mandatory, it is not clear how the four proposed options meet the standards of the framework of critical interdependencies or, for that matter, the standards of Safe and Sustainable itself. I hope that the Minister will note those grave concerns, which patient groups, families and clinicians have expressed, and will ensure that the joint committee of primary care trusts takes the process forward, clarifying the issue of the co-location of service and properly and transparently communicating that clarification to those groups.
A child with congenital heart disease does not exist in isolation. He or she is cared for tirelessly by family members who have to make terrifying treatment decisions, and by siblings who have to accept that home life is on hold while parents go to and from hospital and everyone concentrates only on keeping that child alive. That is what parents do for their children. It is what they sacrifice and do without hesitation, because nothing matters more than bringing that child home again, happy and healthy, so that everything can get back to normal. No matter how freely they give that care, however, caring for a child with congenital heart disease puts massive stresses on parents and siblings, and the outcome of the review should also try to relieve that pressure, if at all possible.
That is not just a moral argument; paediatric patient outcomes improve when carers cope better. I know that Ministers believe that the best possible surgical outcome is the best way to help families, but families who come to see me are worried that they will not be able to get to the hospital for the surgery in the first place; that there will be longer waiting lists; that they will not have continuous care under surgeons whom they can trust with their child’s life; that staff at units that close will not be able to move to those that scale up; that we will lose dedicated people from the NHS; and that there will be a shortfall in service while new staff are trained up. All those concerns are just as valid and significant as ensuring that the surgeon has the necessary skill once he gets the patient on to the operating table.
The irony is that, while the Safe and Sustainable options are causing that concern, Oxford and Southampton already have an option that is working as we speak. The south of England congenital heart network offers the quality guarantees of an increase in clinical team size and patient base that Safe and Sustainable seeks, while creating and retaining the continuity of care and patient access that local clinicians and patients fear losing. That network was developed and is led by clinical teams at Oxford and Southampton; it has five congenital heart surgeons and nine consultant paediatric cardiologists; and it is the first time that two teaching hospitals have collaborated to provide joint tertiary clinical service.
That is exactly the kind of networking arrangement that Safe and Sustainable aspires to create, but the network puts the patient first, not the surgeon. It makes the best use of existing services but does not require extensive restructuring of human or physical resources; it addresses the problems of waiting times, travel times and co-location which Safe and Sustainable has failed to address; and, most importantly, it has been tried and tested for more than a year.
There is a risk that Safe and Sustainable will be seen as a top-down, inherited review, so a locally innovative system such as that network, which is supported by local heart groups, supported by local clinicians and clinically driven, is something that the Government should seek to support.
John Glen (Salisbury) (Con)
In view of the time, I will be as brief as possible. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for initiating this debate, and I thank my hon. Friend the Member for Winchester (Mr Brine), who has provided much sound advice and support as we have brought this case to the House.
Two issues about the calculation of quality have come to my attention through my constituents Joanne Diaper and Richard Maguire. Southampton scored extremely well, but I am concerned about the differences between the various hospitals and how they have scored. If there is a range of difference of up to 20% on outcomes, I am concerned that the review could institutionalise mediocrity, not excellence.
There is consensus throughout the medical world that, as the Children’s Heart Foundation chief executive says,
“the majority of parents recognise that paediatric cardiac surgery is a specialist service,”
and that there will need to be some rationalisation nationally. She goes on to say that parents
“support the concept of larger but fewer centres of excellence”—
not of centres that are quite good but could become better over time. Given the complexity of the procedures that need to be undertaken, it behoves those reviewing the decision to note excellence and to embed it in future provision. We need to drive up standards in areas that do not have excellence.
Some clinical experts may move to the other side of the country, or perhaps to another country altogether. Most parents of chronically sick children with conditions that can be treated only by two or three specialists will travel any distance because they want to know that they have the best chance of having their children’s lives extended. The motion makes a sensible case in recognising the need for partnerships, and I welcome the partnership that exists between Southampton and Oxford.
It was announced in the Safe and Sustainable pre-consultation business case that 400 surgical procedures constituted a minimum threshold, but the mix could be extended to include surgery on adults as well as children. It is vital to look at what is clinically the right thing to do instead of imposing a threshold that seems convenient but does not do justice to the skills that exist in individual hospitals.
In the interests of time, I will now conclude my remarks to allow some of my colleagues to make, I hope, some different points.
Alec Shelbrooke (Elmet and Rothwell) (Con)
I will try to be brief to allow as many of my colleagues as possible to speak.
I do not want to take up too much time in defending the case for Leeds because that has been done exceptionally well by many others. Like me, a good number of the Leeds MPs who now occupy this place were city councillors there, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew) and the hon. Member for Leeds East (Mr Mudie)—a distinguished leader of Leeds council who was very much involved in achieving our aim of having the children’s hospital all in one place. As Leeds councillors, we had personal experience of this matter when one of our colleagues died of heart disease in his early thirties. He was from the black and minority ethnic community, which makes up 23% of the population of Leeds. Sadly, that community has inherent heart problems. That has been overlooked, and it needs to be given weight in the review.
We have heard about many of the flaws in the review. The Minister rightly says that he does not have any influence over the review, which is independent, and as individual MPs we probably do not have much influence over it either. What we do have, however, is this place. Twenty-four hours ago, we were knocking nine bells out of each other. It was raucous and it was fun; we made some serious points and we were having a go. Today, from across the Chamber, some very serious speeches have been made. No matter which side of the House we are on, politics does not come into it. This House is speaking with one voice, and that voice should be heard by the people carrying out the review.
When Members of a House such as ours, which can be so confrontational, all come together, that shows the real power of our parliamentary democracy. Although the Minister, and we as individuals, may not have any direct influence on this process, it would be extremely foolish for the people involved not to take note that we will almost certainly not divide on the motion and that we all support it, including the Minister himself and the Government. My constituents are always asking whether we can work together, and we can. Everyone has come together to say that the House of Commons says that the review needs to be looked at again and other options need to be developed. That is a powerful message that I want to go forth to the people who are carrying out the review.
Caroline Nokes (Romsey and Southampton North) (Con)
I add my congratulations to my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate. I thank the Minister for his important comments on, and support for, the motion.
I feel strongly that there should be a change in the configuration of children’s cardiac surgery, but it must create the right configuration. We want the correct answer to the question, and we want the review team to listen to all the arguments and make its decision based on the best possible evidence. I argue strongly, representing as I do part of the city of Southampton, that when we are looking at the important issue of children’s cardiac surgery, we must base our decision on quality.
I have been in regular contact with a constituent of mine, Mr Jim Monro, whose name will be familiar to all Members who have investigated this matter because he is one of the country’s most eminent cardiac surgeons. He is now retired. He first conducted a review into children’s cardiac surgery after the tragedies in Bristol in the 1990s. He feels strongly that he has seen this matter kicked into the long grass for too long. We must crack on and ensure that the review is completed. However, it must take into account the best available evidence and come up with the right outcome. None of us wishes to see a recurrence of the dreadful tragedies in Bristol. That is where the roots of the review lie.
Although I support the need for the review, I do not endorse the process, nor the recommendations in their entirety. I question three elements in particular. Fundamentally, the review must be about quality. We have to ensure that the best outcomes are achieved for the very sickest babies and children. However, the Southampton unit, which has a superb record of outcomes, finds itself in only one option—option B, the so-called quality option. I cannot believe that that is right for one of the highest performing units in the country. It carries out difficult procedures, does not cherry-pick cases where the best outcomes are likely, has proved that it can work collaboratively with Oxford, is widely acknowledged to be one of the best units in the country, and already has three surgeons, with a fourth starting shortly. I have heard colleagues describe it as a perverse outcome that one of the country’s top performing units is included in only one option, in which postcode matters more than the life chances of the sickest babies.
Secondly, and I will not rehearse this argument at great length, there is the additional complication of the Isle of Wight. My hon. Friend the Member for Isle of Wight (Mr Turner) has informed us of that issue clearly. People from Southampton want an answer to that question. Six weeks ago at a consultation meeting, they were promised that more information would be forthcoming from the review team about how significant the Isle of Wight factor was. We are still waiting.
Thirdly, the manner in which the consultation is being conducted has created an adversarial climate in which cardiac unit is put against cardiac unit and surgeon is put against surgeon. I feared that today we would see MP against MP, but we have not. As my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) said, this has been a collaborative debate that has picked up on the strengths of each case.
I welcome the spirit in which this House has responded to the motion.
Julian Sturdy (York Outer) (Con)
Like many Members, I have a local heart unit that I shall seek to defend. However, before discussing the merits of retaining the Leeds unit, it is important to acknowledge the wider context of the debate.
I strongly believe that the Safe and Sustainable review is a necessary and genuine exercise. Its aim is to ensure that the highest possible level of surgical care is provided to each and every affected child, regardless of where they live. There is no doubt that the case for change is medically accepted. Nevertheless, I believe that decisions over the potential closure of local health services cannot and should not be taken lightly. In the light of the huge amount of evidence behind the motion, I urge the review’s steering group to take as much time as possible in considering the performance, locality, capacity and strength of each unit, among other factors.
On the basis of those four criteria, I strongly believe that closing the Leeds unit would be a huge mistake. The first and most important factor is performance. Leeds General infirmary is at the forefront of work on cardiac conditions. All the relevant reviews and statistics highlight its record of excellence in providing safe and high-quality children’s heart surgery. An important contributing factor in that excellence is the centralisation of the whole children’s services operation at the site in Leeds. However, the review document contains discrepancies when it comes to the definition of co-location of services. To me, co-location means all children’s services operating on a single site, and Leeds is one of only two hospitals cited in the review that offer that gold standard.
The second principle is locality. The unit is within two hours’ travel time for nearly 14 million people, including 5.5 million in the Yorkshire and the Humber area. In such highly populated areas, surely the focus should be on delivering services to the people and delivering them to the greatest area of need, not vice versa. In my view, the location of the unit and the huge number of children whom it serves make its continued existence imperative.
The review document states that parents need not accompany their children. I have two young children myself. What parents would not want to accompany their children in such difficult circumstances? Sadly, however, that is not always possible. There are child care arrangements to be made, and work issues and transport links to be considered. The stress of all that is extremely disturbing for all families in such circumstances. I realise that that applies to all the centres, not just Leeds, but I believe that we must take account of the core principles: the need to deliver services to the people, and the need to provide easy access for as many as possible. That means locating services in highly populated areas with good transport links and travel times. Birmingham and Liverpool have been included in every option in the review, and rightly so, but why has Leeds not been identified in the same way on the basis of those core principles?
Damian Hinds (East Hampshire) (Con)
The review document is called “Safe and Sustainable”, and that is absolutely the right title for it. It is worth repeating what has been said by every speaker today, and by the clinical leadership of the review: this is about saving lives, not about saving money. We must bear in mind the link between scale and quality and between quality and safety. The “scale” factor applies to the number of procedures per surgeon per year and to the number of surgeons per unit. The challenge was summed up best by the statement from the Royal College of Surgeons, to which the right hon. Member for Oxford East (Mr Smith) referred, that although the country has the right number of surgeons carrying out these complex operations, they are too thinly spread. Change is clearly needed.
Coincidentally, in the last three weeks my family has had occasion to rely on the paediatric intensive care units and surgery at Southampton General hospital, in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), where we benefited from outstanding care. This was not heart surgery, but the experience gave me plenty of cause to reflect on the value of not just convenience and location but, above all, quality of care. In such circumstances, families will do what they have to do, although it may be very difficult, and they will find a way of securing care of the highest quality. The experience also taught me something about the interconnection between services.
All the criteria set out in the review document have a role to play, but in my view the most important criterion of all must be quality, and I do not think that that comes across as much as it should in the review. How can it, given that the centre that is ranked second out of the 11 in the country for quality appears in only one of the four options? The question also arises, in the context of Southampton General hospital, of whether—given the role of scale and quality—sufficient consideration has been given to the most recent trends since the suspension of paediatric cardiac surgery at the John Radcliffe hospital.
Other factors have also not been given sufficient weight. First, there is the requirement for co-location of paediatric surgery with other essential services for children. Secondly, there is the impact on paediatric intensive care units, paediatric intensive care retrieval, and the other networks mentioned by the right hon. Member for Oxford East. Thirdly, there are the implications for services that provide longer-lasting care for people with cardiac conditions from birth to adulthood.
Our objective must not be to stall or jam the process, because there is a need to reduce the number of centres. We must avoid the politician’s tendency to say that of course we agree with the general principles of the review, except in the particular circumstances that apply to our own constituency. I hope I have not done that, but I do think that Southampton has a particularly strong case based on the excellence of its clinical record. I strongly support the drive for us not to be restricted only to the four options in the review, considering the additional evidence that has come to light during its course.
Mr Deputy Speaker (Mr Nigel Evans)
To resume his seat at 3.32 pm, I call Mr Percy.
Andrew Percy (Brigg and Goole) (Con)
Outrageous, Mr Deputy Speaker! But obviously accepted.
I associate myself with many of the comments of my fellow Yorkshire and the Humber MPs, particularly my near neighbour the hon. Member for Scunthorpe (Nic Dakin). I want to mention a couple of issues raised by our local health trust, which is opposing anything other than option D very strongly. Indeed, North Lincolnshire council’s scrutiny committee met to discuss the matter on Tuesday and similarly supports that option, which would help to maintain the Leeds unit. That is not simply because it is our local centre. My constituents have to travel a considerable distance to get to Leeds, as it is not exactly next door. It is okay for some of us, but it is quite some distance for my constituents over in Brigg, in particular.
My constituents accept the regionalisation of health services when it is of proven benefit. That is so in the case of adult cardiac services, which are currently provided in Hull, and the same applies to children’s cardiac services. However, if we are to go down the route of regionalisation and big centres, it seems sensible to put services where the population is rather than try to move the population to where the clinicians are.
I wish to quote a couple of points that my local health trust has made. It has stated:
“Leeds has the largest population centre and therefore it is most sensible to ask fewer patients to travel the least distance”.
As I said earlier, the conclusion of the North Lincolnshire and Goole Hospitals NHS Foundation Trust was that it believed babies, children and families in North Lincolnshire would largely be disadvantaged in their access by the proposed changes.
I am aware of the very short time available, so I cannot say most of what I would have liked to say, but my final point is that under the proposals we could end up in the rather odd situation that some of my constituents could be served by one centre and others by another. Given that they are all in the same health trust area, that could mean different services being provided to different constituents.
Mr Deputy Speaker (Mr Nigel Evans)
To speak for 10 minutes, I call the shadow Minister, Liz Kendall.
Liz Kendall (Leicester West) (Lab)
It is a real privilege to take part in today’s debate, and to follow the thoughtful, moving and at times passionate speeches of Members of all parties. I thank the Backbench Business Committee, and I particularly thank the hon. Member for Pudsey (Stuart Andrew) for securing the debate.
Like the right hon. Member for Charnwood (Mr Dorrell), I wear two hats today. As the Member for Leicester West, home of Glenfield hospital’s superb congenital heart centre, I know how important the review of children’s heart surgery is for my constituents, as it is for those of each of the hon. Members who have spoken. As the Opposition spokesperson, however, I am also well aware of my national responsibility, and that of the House, to ensure that every child gets the very best quality of care.
I want to start by making the case for change, as did other Members including my hon. Friends the Members for Liverpool, West Derby (Stephen Twigg) and for North West Durham (Pat Glass), my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), who made brave and courageous speeches.
Following the devastating findings of the Bristol Royal infirmary inquiry almost 10 years ago, clinicians and professional bodies have been clear that children’s heart services need to change to ensure that every child gets the best standard of care now, and crucially also in the future. They include the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Society for Cardiothoracic Surgery, the British Congenital Cardiac Association, the Paediatric Intensive Care Society and many others.
The reason why services need to change is that children’s heart surgery is becoming ever more sophisticated. Technological advances mean that care is increasingly specialised and capable of saving more lives and improving outcomes for very sick children. However, services in England have grown up in an ad hoc manner. As my right hon. Friend the Member for Oxford East (Mr Smith) said, surgeons are too thinly spread. Care needs to be better planned to pool expertise in specialist centres so that all children get excellent quality care. I therefore welcome the Safe and Sustainable review, which was initiated by the previous Government. The challenge, as the House has rightly demonstrated today, is to ensure that the right aims, objectives and criteria drive the review, and, crucially, that they have the right weighting and that the right balance is struck.
Of course, improving the quality of care must be our primary concern. The review rightly calls for fewer, larger surgical centres to provide 24/7 consultant cover, and seeks to ensure that surgeons treat a sufficient number of patients with a sufficient variety of problems to ensure that they have the best possible skills.
The review also recommends the development of congenital heart networks, so that care is better co-ordinated at all stages of a child’s life, and that assessments and ongoing care can be provided closer to where patients live. However, as several hon. Members have said, the review cannot look at children’s heart surgery services in isolation; it must also fully consider the knock-on effect on other specialties at the hospitals in question.
As my hon. Friend the Member for Leicester South (Jon Ashworth) and the hon. Member for Loughborough (Nicky Morgan) rightly said, the work of Glenfield children’s heart surgery centre is closely linked with its extra corporeal membrane oxygenation service. ECMO helps patients with reduced heart or lung functions to have complex surgery that they might not otherwise survive. Glenfield is the country’s leading specialist ECMO centre, and trains and supports other services nationally and internationally. There is real concern at the possibility that that service will be moved to another hospital, because of the time that it would take to build up expertise elsewhere. Not only does it take up to 18 months to train new specialist nurses, but it takes many years to develop equivalent experience.
Ensuring high quality care is not just about surgery standards or links with other specialisms. The wider help and support that families get from doctors and nurses are vital. I was genuinely moved when hon. Members spoke of their conversations with parents and staff in their centres. Time and again, parents emphasise the communication skills of staff, and their ability to explain diagnoses and procedures simply and clearly, at what is often a frightening and worrying time.
Parents at Glenfield tell me that staff are like members of their families—they can ring day or night if they have any concerns. Such familiarity and trust is crucial, and it links to the issue of providing ongoing help and support, which many hon. Members mentioned. When children who have had heart surgery grow up, they have to deal with difficult issues such as whether they can have children. Many families are understandably concerned about having to build new relationships with a different team of doctors and nurses if their local centre closes. It is vital that the review look closely at the links between child and adult congenital heart services, but it has probably paid insufficient attention to that so far. I hope and believe that that will change before the review concludes.
As well as stressing the importance of the quality of clinical care, many hon. Members stressed the importance of ensuring fair access to services. We heard passionate speeches about that from my hon. Friends the Members for Leeds East (Mr Mudie) and for Scunthorpe (Nic Dakin). Accessibility matters, because time is of the essence when seriously ill children need to get to heart surgery centres in life-or-death situations, as the hon. Members for Meon Valley (George Hollingbery) and for Isle of Wight (Mr Turner) rightly said.
However, travel times also matter to families who need ongoing care and support. My hon. Friend the Member for North West Durham rightly said that many parents would travel to the ends of the earth for their children, but as the hon. Members for Leeds North West (Greg Mulholland) and for Oxford West and Abingdon (Nicola Blackwood) said, making families travel further than they already travel would make such a difficult time even harder for them, especially if they must also hold down a job or care for other children.
The difficult balance between specialising services in some areas but ensuring fair access is the crucial issue for the review.
Mr Dorrell
The hon. Lady is making an important point about access being one of the quality characteristics that need to be taken into account in making these decisions. However, does she agree that the Safe and Sustainable work programme has taken that into account? It was one of the key factors it took into account in making its recommendations and drawing its conclusions on the relative merits of these units.
Liz Kendall
The right hon. Gentleman makes an important point, but hon. Members have said that they feel the issue was given insufficient weighting. At the Leicester consultation, one parent said to me, “If we’d known that all the services were safe”, as the review has said, “we might have placed more importance on the issue.”
The affordability issue has not been mentioned. Hon. Members will, I am sure, be as one in saying that the review must be driven by the need to improve the quality of care, not by reducing costs. However, it is important to recognise, particularly in these financially constrained times, that significant costs are associated with all the current, and likely future, options in the review. That needs to be taken into account.
In conclusion, changing how we provide any hospital service is difficult, but when changes are necessary to improve patient care, as I believe they are for children’s congenital heart services, the House must have the courage to make them happen. Hon. Members have rightly raised a range of concerns on behalf of their constituents, but I am sure we would all agree that the final decision must be made by clinicians on the basis of evidence, not on political considerations. I hope that the joint committee will seriously consider the points raised in this debate and then make final recommendations in patients’ best interests.
Stuart Andrew
I thank everyone who has taken part in this debate, which I think all will agree has been very good and knowledgeable. Members have spoken passionately in favour of their units. The right hon. Member for Newcastle upon Tyne East (Mr Brown) and the hon. Members for North Durham (Mr Jones) and for North West Durham (Pat Glass) spoke passionately in favour of the Freeman hospital. The right hon. Member for Oxford East (Mr Smith), the hon. Member for Southampton, Test (Dr Whitehead) and my hon. Friends the Members for Isle of Wight (Mr Turner), for Poole (Mr Syms), for Meon Valley (George Hollingbery), for Winchester (Mr Brine), for Oxford West and Abingdon (Nicola Blackwood), for Salisbury (John Glen), for Romsey and Southampton North (Caroline Nokes) and for East Hampshire (Damian Hinds) spoke in favour of Southampton. My hon. Friend the Member for Chelsea and Fulham (Greg Hands) spoke for the Royal Brompton—I do not think I am going to get through all these.
The fact is that this debate has got to the heart of the matter. We have discussed the issues that parents and patients have been talking about, but also the concerns that clinicians have been talking about. It is important that we hear those. We heard concerns that if this review does not happen, there could be another Bristol baby tragedy. However, it was reassuring to hear that the units we have are safe. We just need to make them sustainable.
In conclusion, this has been a most excellent debate. I am sure that the Safe and Sustainable team have been listening to Members on both sides of the House. Above all, what has been brilliant about the debate has been the reassurance from the Minister that the Safe and Sustainable review is now flexible over the options and should be flexible over the number of units. That will mean a lot to the people who have been campaigning so hard on this issue, and it shows that a Backbench Business debate can work and make a real difference.
Resolved,
That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.