Leeds Children’s Heart Surgery Unit

Tuesday 30th October 2012 Westminster Hall

[Mr Philip Hollobone in the Chair]

14:30

[Stuart Andrew (Pudsey) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to have a further opportunity—you might wonder why we are taking another chance to raise the issue—to discuss the Leeds children’s heart unit. Given that there is a new ministerial team at the Department of Health—I am delighted to welcome the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry) to her new post—and that the decision on the unit has been referred to the Independent Reconfiguration Panel, it is critical that the independent review gets this right. The issues that we have been raising need to be assessed in great detail by the independent panel.

It is important for us to remind ourselves of the key issues. I want to make it crystal clear at the outset that we have always supported the objective of the review. Of course, we all want the best services for our children, and having fewer specialist centres is a principle that we have never doubted. My grave concern is that the review will fail to meet the objectives, particularly in the north of England, subjecting my constituents and those in Yorkshire and Lincolnshire to a worse service than the one that they currently enjoy. That is why I want to outline our concerns.

First, the review has always made it clear that units need to perform 400 operations or more a year. If that is the agreed standard, we must accept that. However, a survey by PricewaterhouseCoopers showed that the majority of patients who live in east, west and south Yorkshire would not travel to Newcastle. Instead they would go to Liverpool, Birmingham, or, in some cases, even to London. Anyone who knows our area knows that that is instinctively the case. Since the decision was made, adverse weather over the past couple of months has caused huge problems on the A1. Would a parent go there or would they choose less problematic routes? The issue is made clear in the analysis. The independent review document states:

“There was more reluctance amongst members of the public to consider travelling to Newcastle as a centre. If the preference of the parents and the public were factored into assumptions of patient flows, they may have implications for projected levels of activity at – in particular – the Newcastle centre.”

What is the review’s answer to the problem? At the decision-making process meeting—a seven-hour meeting to rubber-stamp a decision that clearly had already been made—it was said that patients preferring centres other than Newcastle would be influenced by referring doctors, with the assumption made that they would be pointed to Newcastle. Frankly, the evidence points to the contrary: all 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, said that they would not refer patients there for treatment.

In addition, the review argued that if 25% of patients from Leeds, Sheffield, Doncaster and Wakefield chose to go to Newcastle, that unit would perform 403 operations a year, conveniently just over the target of 400. That also assumes that 100% of patients in the other remaining postcodes, including Hull and Harrogate, would go to Newcastle. Newcastle can only reach the 400 figure if all the assumptions—that 25% will go from south and west Yorkshire, that clinicians will refer, and that 100% in Harrogate, Hull and elsewhere would use the centre—are correct, but there is no evidence to support such assumptions.

Given the importance of the 400 figure, it is staggering that it has been reached on the basis of assumptions. I know my hon. Friend the Minister was a barrister before entering the House. I wonder how the court would have reacted if she had based her defence or her prosecution on assumptions. That is why I believe the review is flawed. If we are going to change, it must be for a much better service.

That brings me to the issue of co-location. The foundation of the review was the inquiry at Bristol, and ensuring that such events never happen again is crucial. A key recommendation of the inquiry was to have all paediatric services under one roof. The British Congenital Cardiac Association has stated:

“It is important that the centres designated to provide paediatric cardiac surgery must be equipped to deal with all of the needs of increasingly complex patients. For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

I completely agree with that statement. Indeed, Professor Sir Ian Kennedy, in his report following the Bristol inquiry, stated in recommendation 178:

“Children’s acute hospital services should ideally be located in a children’s hospital, which should be physically as close as possible to an acute general hospital. This should be the preferred model for the future.”

Yet despite Sir Ian’s assessment panel describing the location of key services on a single site as optimal, Sir Ian accepted a watered-down definition of co-location, which allowed Newcastle to be described as a co-located service, and that led to the decision to close Leeds, despite the Paediatric Intensive Care Society’s assertion that it

“would dismiss any suggestion that a service located on another hospital within the same city can be regarded as being equivalent to a service located on the same hospital site.”

What has caused Sir Ian Kennedy to change his mind? Anyone visiting the Leeds unit will know that it is a wonderful, integrated unit. It has all the services that are needed for children with complex and multiple needs. They need paediatricians there with other specialities. On my several visits to that unit, on each occasion I have seen paediatricians coming to help patients with complex needs.

[Philip Davies (Shipley) (Con)]

My hon. Friend has led this campaign in Parliament with his customary charm and tenacity. As ever, he is making an excellent case. The national health service is paid for by the public for the benefit of the public. Ultimately, the services that we provide should be the ones that the public want. MPs from our region, from across the parties, are here today, and it is clear that the people in Yorkshire have confidence in the unit, want it to continue and believe it will offer the best possible treatment. Should that not be one of the most important factors that the Government bear in mind?

[Stuart Andrew]

I am grateful for my hon. Friend’s kind words. It has been a tremendous cross-party campaign. People right across our region have been speaking in high praise of the unit. My hon. Friend is absolutely right that it should be about what patients want. Patient choice is a bedrock of the NHS. I hope that today’s debate will enable us further to put across our grave concerns about the review.

[Julian Smith (Skipton and Ripon) (Con)]

Another concern that people have raised is the initial consultation that took place, especially with regard to the language and translation for a large section of our community who suffer particularly from congenital heart disease. Will my hon. Friend comment on that? Does he think that that issue has been fully addressed thus far in the process?

[Stuart Andrew]

No, I do not. The projections of population growth, particularly in the south Asian community, are a huge issue that has not been fully addressed. I hope that that issue will be taken up by the independent panel when it considers the detail of the decision that was reached.

It would be a backward step for us to go to a unit that was separated from the rest of children’s services by three miles. We have a wonderful unit at Leeds general infirmary, where all the children’s services are under one roof. Staff there talk about the difference between now, and when the unit was at Killingbeck. There were great problems with getting doctors to travel there, even though it was only a couple of miles away. It is unacceptable for our constituents and poorly patients to receive a much lesser overall service, because the rest of the services will be three miles across the city of Newcastle.

A phrase that I have heard a lot in this campaign is, “Bring the doctors to where the patients are and not the other way around.” The review has been inconsistent regarding whether population density matters. The consultation document said that Birmingham gets a high number of referrals because of the large population in its catchment area, and it should therefore remain as a unit, but that simply does not seem to apply to Leeds. Leeds serves a population of some 5.5 million, double the 2.6 million in Newcastle, and projections show that that number will increase. The recent census showed that the population of the north-east had increased by 57,000, compared with an increase of 300,000 in Yorkshire, so surely we should put the services where the population is, and where it is growing.

The health impact assessment stated that options G and I were the only ones to induce few negative impacts—option G being the one that includes Leeds—and it admitted that option B would have a more negative impact than option G. That information was released only at the meeting on 4 July.

I want to talk about public opinion because, as my hon. Friend the Member for Shipley (Philip Davies) mentioned, support for the campaign has been phenomenal. Some 600,000 people have signed a petition, which shows the strength of feeling in our area, but those signatures were counted as just one response, while 22,000 separate text messages in support of Birmingham were counted as 22,000 separate responses. The NHS constitution states that the NHS is guided by several key principles, one of which is:

“NHS services must reflect the needs and preference of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.”

The fact that so many people felt compelled to sign the petition shows the strength of feeling that they have.

I have spent a great deal of time in the Leeds unit, speaking to families that use it. One of them is the family of one-month-old Lauren, who had problems with feeding and was referred to the Airedale hospital when she was approximately one week old. A heart problem was then suspected, and she was referred to Leeds general infirmary, which has strong links with Airedale. She was transferred to LGI through Embrace, the Yorkshire and Humber specialist ambulance service—a service that does not exist in Newcastle—and it took four hours to get the baby in a stable enough position to undergo the journey to Leeds. Imagine expecting that child to go all the way to Newcastle. Her mum, Sara, said that she could not understand why, given the size of the population in Leeds and the surrounding areas, as compared to the size of the population in Newcastle, it was contemplated making people travel further and separating them from their often crucial family support. I know from my time at Martin House children’s hospice how important it is to have family support close by. The patients are in incredibly stressful situations, and it is critical that others can share in the care and visit the children.

[Julian Smith]

What assurances has my hon. Friend had regarding ambulance services? He is right that Embrace, the Leeds service that looks after children in getting them from home to hospital, is second to none. How will Newcastle get anywhere near that quality of service in the time scale required?

[Stuart Andrew]

The answer is that I do not know. I have not been given any assurances that that will happen, which again highlights the crucial problem with the decision: we will be subjecting our constituents to a lesser service.

I spoke to another family at the unit. Libby was diagnosed at 20 weeks with complex heart problems, and her mum was referred for the rest of her antenatal care to LGI, where the baby was delivered; that again demonstrates the crucial co-location of services. It was clear that the daughter needed treatment immediately after birth, and at six days old she had her first of many operations. As she has complex medical needs, she has also needed support from the paediatric neurology and renal teams, and all those services are under one roof, which provides first-class care. My final example is of a child who had an operation in Leeds at 18 months. All the care was then delivered in Barnsley by doctors from Leeds. Leeds doctors have been out working in all the towns and cities across Yorkshire, at 17 different locations, over the past decade. We have a well-established network of services. Those are just a few examples of the kind of impact that the proposal could have on any of our families.

[Fabian Hamilton (Leeds North East) (Lab)]

I congratulate the hon. Gentleman on securing the debate, which, as he rightly points out, is extremely important. Does he agree that it is not just the children’s congenital heart problem services that serve us so well at Leeds general infirmary, but the post-16 services, which the review did not take into account? Does he also agree that Leeds is perhaps the leading centre in the country for training post-16 congenital heart problem surgeons in what is a valuable and important skill?

[Stuart Andrew]

The hon. Gentleman makes an absolutely first-class point. Indeed, I think we have all asked the question: why is the review into children’s services being held separately from that into adults’ services? It is bizarre. We know that the surgeons operating on adults are often the same people who operate on children. We have yet to get a sufficient explanation of why the reviews have not been run in tandem, and we expect, or at least hope, that the Independent Reconfiguration Panel will consider that issue.

That brings me on to my next point. I wholeheartedly welcome the fact that the Secretary of State has decided to refer the decision to the Independent Reconfiguration Panel—that is great news—but it is absolutely crucial that we get the decision right. There is no point in simply reviewing the decision; we want the panel to consider the whole process, right down to the information that was used at the very beginning regarding what the services were like at the different units. That must include the scoring.

[Hilary Benn (Leeds Central) (Lab)]

I echo other Members’ compliments about the force of the hon. Gentleman’s case. The review, if it is about anything, must be about the right clinical outcomes for children. That is why we are all here. We are all so passionate about the Leeds children’s heart surgery unit, which I have the privilege to represent. Will he confirm that despite the impression that is being given in some quarters, no assessment of the relative clinical effectiveness of the units considered in the review has been undertaken? Does he agree that the independent review must do that, as we all believe that it would lead to the decision being overturned?

[Stuart Andrew]

The right hon. Gentleman is absolutely right. He makes a clever and important point, because that is the foundation of the decision, and the information either does not exist or is incorrect. I want a root-and-branch review of the decision and all the information that was at the disposal of the Safe and Sustainable review team. I hope we can get an assurance today that the panel will do that.

There are further problems with the decision-making process. The joint committee of primary care trusts is still not disclosing information requested by the joint health and overview scrutiny committee in our area, including the agendas, minutes and reports of several meetings material to the JCPCT decision. There is also no evidence that the joint health and overview scrutiny committee’s report was even discussed by the JCPCT. The JCPCT has refused to disclose the breakdown of the Kennedy scores awarded to each children’s heart surgery unit by the panel. The value of the total scores, which are the supposed measure of quality, could neither be understood nor scrutinised.

I think we all believe that the JCPCT has misused the Kennedy scores. The JCPCT requested not to be shown the breakdown of the Kennedy scores, which raises many questions about the JCPCT’s ability to make an informed decision. The Kennedy scores were not prepared for the purposes of comparing one centre with another, yet a ranking of the units by total score was published. The scores were misused as indicators of quality, even though the scores did not assess units on what most of us would regard as measures of quality, such as clinical effectiveness, safety and patient experience.

The total unit score was given as 401 for Leeds and 425 for Newcastle. Those scores were published with the independent expert panel’s report in 2010. According to the first breakdown of the total scores, however, which was only released after the JCPCT made its decision, the Leeds unit gets 414 points and the Newcastle unit gets 421 points. Despite the enormity of the review, a basic mistake appears to have been made in the calculation. That matters because, in the eyes of the JCPCT, which saw only total scores, the advantage of the Newcastle unit was more than trebled from seven points to 24. When that was pointed out to the JCPCT, a second set of sub-scores was published that still did not add up to the original scores of 401 for Leeds and 425 for Newcastle; it stated that the Leeds unit outscored Newcastle on the core clinical standards used by Professor Kennedy by 347 points to 336. On care quality, Leeds is ahead; Newcastle outscores Leeds only because of the addition of leadership and vision standards, which are non-clinical standards covering IT and business strategy, working practices, and so on, that were developed by commissioners, not clinicians.

When the fact that Leeds outscores Newcastle on core clinical standards was pointed out to the JCPCT by the Yorkshire and Humber joint health and overview scrutiny committee, a third set of sub-scores was published, with the dubious claim that they were the raw Kennedy scores. The scores did add up to the original 401 for Leeds and 425 for Newcastle, but, mystifyingly, they now put Newcastle ahead of Leeds on core clinical standards. It is unclear which of those different sets of scores was used by the JCPCT because they give such different impressions.

The Kennedy scores were subject to a weighting system that disproportionately emphasised certain aspects of the assessment in a way that produced misleading results when used in a comparative process. No explanation was given for the way the weightings were worked out. I could address further issues, but I am aware that other hon. Members want to take part in this debate.

We suggested that the JCPCT’s decision be implemented elsewhere, but that in north-east England, both Leeds and Newcastle remain open and that the decision be delayed until April 2014. That would give an opportunity for patient choice and for parents to consider which centre they want to use, as is their constitutional right. By the end of that period, each centre would have to demonstrate that it is fully compliant with all the standards set by the Safe and Sustainable review. The judicial action brought against the JCPCT by Save Our Surgery might then cease; that would avoid the risk of sinking the review in its entirety. Leeds and Newcastle would have the opportunity to demonstrate their compliance with Safe and Sustainable standards. Less controversial decisions taken by the JCPCT could proceed elsewhere in the country, and the Government would be shown to be listening to the concerns of patients. That would give a clear message from the Department of Health that patient choice comes ahead of professional convenience. We made that suggestion, and it was rejected out of hand in no time at all. It is a sensible proposal for a solution that would allow us the very best services for our children and young people, as evidenced by where people go and what services they want.

Finally, I attended last week’s Westminster Hall debate on the Leicester unit. My hon. and learned Friend the Member for Harborough (Sir Edward Garnier) summed up the debate well. There is no point in my trying to come up with a fancier conclusion, so I will do him the honour of quoting what he said:

“The House does itself no great service if it shilly-shallies around process and avoids the question. As Members of Parliament, we must ensure that the question is put…The Secretary of State has the levers of power in this question and he must pull them—he must exercise them—and make a decision…I do not care who made the decision or how the dainty route was created to get to it. We all know that the current decision is wrong and needs to be dealt with.”—[Official Report, 22 October 2012; Vol. 551, c. 188WH.]

[Several hon. Members]

rose—

[Mr Philip Hollobone (in the Chair)]

I am just checking that the seven Members standing match the seven names in front of me, and they do tally. We have 45 minutes until I call the Opposition Front-Bench spokesman, which gives you about six minutes each. I cannot enforce that, but I urge Members to stick to six minutes so that everyone can get in. To be helpful, I will read out the batting order: Nic Dakin, Greg Mulholland, George Mudie, Martin Vickers, Julian Sturdy, David Ward and Andrew Jones.

14:58

[Nic Dakin (Scunthorpe) (Lab)]

Thank you, Mr Hollobone. That is very helpful, as your chairmanship always is. It is a pleasure to serve under your chairmanship.

I welcome the Minister to her post, and I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate. His cross-party and cross-regional leadership on this matter has been a credit to him and the region, and it is a pleasure to have worked with him. I hope we have a satisfactory outcome. He has spelled out in clinical detail the key issues in this case: the need to get the right clinical outcomes; the discrepancies in the clinical information issued throughout the process; the number of operations necessary to secure a unit; and the difficulties in securing that number of operations if Leeds closes and other centres are expected to receive its patients, given that if there is patient choice, it is clear that patients from the area that I represent, Scunthorpe, will probably go south, rather than north, to access services.

The hon. Gentleman has reminded us of the largest petition that I can remember in the region, which some 600,000 people signed at fairs and civic events in my constituency and, presumably, across the whole region. That was an active process in which people were engaged and supportive. Counting that as one response is not giving the public view the weight that it should have.

The villages and towns of the area that I represent will always be peripheral and on the edge. People from our area must travel to access services. It is interesting to note their concerns. I will refer to a couple of correspondents, because theirs are the voices of which we need to be reminded, and their observations echo the points made by the hon. Member for Pudsey. One correspondent said:

“All of us heart families, as you can imagine, are devastated…Please can you review this decision and hear our views?”

Behind the petition signed by 600,000 people are many people’s views. Another correspondent said:

“Our daughter is diagnosed with a rare condition, truncus arteriosus. She had major open heart surgery in July 2011 at Leeds general infirmary. Naturally, we were devastated with the diagnosis, coming to terms with it and going through her operation and hospital stay. The service they provide at Leeds is…at its best. I feel that our daughter is in extremely safe hands there. The staff on ward 4, ward 10 and HDU provide the best quality of care. The cardiologists and surgeons are truly amazing in the work they do. Whilst our daughter was in hospital, this was a terrifying time for us. Leeds is a good hour’s drive away, which is bearable in this situation”,

but

“it could endanger lives if people have to travel further, for example those babies born who need emergency heart surgery. I have read so many comments on the support group page that if Leeds surgery closed and they had had to travel further afield, their baby would not have survived the journey.

All the facilities are on site at Leeds general infirmary, i.e. X-rays and other investigations that need to be done prior to operation. Again, if Leeds was closed and we had to go to Newcastle, my understanding is the checks have to be done at other hospitals, again endangering lives in those more serious cases.”

Another constituent of mine says:

“I would now like to explain how the threatened closure affects my daughter. I have a 5 year old daughter who has 22q deletion…She has a number of complex, life-affecting and life-threatening health conditions, including serious congenital heart defects, as well as learning and communication problems. She is a pupil at St Luke’s school in Scunthorpe. Routine antenatal appointments at Scunthorpe failed to pick up her problems; an additional late scan there found a problem, and antenatal care was then transferred to Leeds.

Leeds general infirmary provides many services under one roof. During her stay on the cardiac ward, I required treatment due to birth complications and had access to the midwifery team and appropriate treatment. I was unable to walk following the birth for several days, and was able to stay on the heart ward with food provided and then in family accommodation.”

That emphasises the proximity of all services, and how that affects the well-being of not only heart patients, but mothers and other family members.

I take note of your instructions and encouragement, Mr Hollobone. I feel that I have reinforced the issues that were raised in the excellent speech made by the hon. Member for Pudsey, and I have added a couple of illustrations from my constituency that underline the point.

15:03

[Greg Mulholland (Leeds North West) (LD)]

I congratulate my neighbour, my hon. Friend the Member for Pudsey (Stuart Andrew), on everything that he has done and on securing this debate. It is also good to have four other parliamentary neighbours here, as well as many other colleagues from our region. That speaks for itself.

I put on record my regret that we have still not had a full and proper debate on the Floor of the House of Commons. Six minutes is not enough for me or other hon. Members to state our serious technical concerns about a deeply flawed process, and I do not believe that this debate should be seen as a substitute. However, I thank the Minister and her colleagues for doing the right thing in listening and correctly, considering the huge concerns, referring the decision to the Independent Configuration Panel. That is clearly essential. I am pleased that she and her colleagues did so, considering the outrageous protestations from the Joint Committee of Primary Care Trusts and, I am afraid, from other organisations trying to stop the process and prevent what is clearly essential democratic scrutiny. That in itself is a matter that should be taken further. It is a disgraceful thing for any body involved in the decision to seek to do.

Briefly, in the time that I have, I will raise with the Minister the slight concern also mentioned by the joint health overview and scrutiny committee for Yorkshire and the Humber. We want an assurance—today is a good opportunity—that the terms of reference for the Independent Reconfiguration Panel will not be restrictive. Otherwise, there is a danger that it could simply repeat the same deeply flawed assessment process that my hon. Friend the Member for Pudsey eloquently described. Will the Minister ensure that that is not the case, and that the IRP can properly and fully consider the decision?

We have all heard what a blow the decision has been to the wonderful staff who work at the unit and, most importantly, to the families and children involved, as well as to people in the region and beyond who rely on the unit or could do so in future. We must be clear on this point, which I want the Minister to take away. Of course we have all heard the stories of the awful situation in which families and children have found themselves. Each and every one is heart-rending, and they deserve to be listened to. However, we must also accept that the same stories would apply to any of the units in the review, so that is not the point. The point is a cold, hard one: by the review’s own criteria for bigger and smaller units, the JCPCT has made an absurd decision in favouring the closure of Leeds.

The JCPCT has demonstrated a clear bias all the way through. I am sorry to have to say it, but the JCPCT’s decision was clearly a stitch-up. If it had followed its criteria properly and gone through the process following the criteria set down by the previous Government, it could not have failed to argue, given the troubled times and all the other things that we have heard about, that Leeds must be a fully functioning bigger unit, yet it has not. I believe that investigations are still needed.

It is utterly disgraceful how the JCPCT and others have sought to avoid proper scrutiny. To back up what my hon. Friend the Member for Pudsey said, the JCPCT has continued to refuse to provide all the information requested of it by the body charged in the health service to scrutinise it. That is not only disgraceful but quite sinister, and I ask the Minister to look into it properly. If the JCPCT will not release its reports and minutes properly under the Freedom of Information Act, it must say why, but it simply has not done so. I pay tribute to Councillor Illingworth, his predecessor and the body of councillors for all the good work that they have done. They are being refused the information that they need to do their job. That is not acceptable, and I want it to be taken up properly with the JCPCT.

The other issue that has not been raised so far—none of us wants to repeat what has been said—and that I want to bring to the Minister’s attention is the absolute nonsense that despite the geography of the whole country, the Yorkhill unit was not included. There is already a flow of cross-border patients from the north of England to Scotland and the other way around. It is somewhat ironic that Sir Ian Kennedy, who chaired the Safe and Sustainable review panel in England and Wales, also separately commissioned a review by NHS Scotland of Yorkhill. He said:

“The panel had significant concerns about important aspects of the service in the surgical unit...Of most concern was a lack of leadership and coherent team working. Also of concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressed.”

He concluded:

“The panel was of the view that urgent remedial action is required in PICU to prevent care from becoming unsafe.”

I have to say to the Minister that it is nonsensical as well as dangerous for Yorkhill not to be included in the Safe and Sustainable review. If it had been, the only logical conclusion would have been to keep the Leeds unit open, and to allow the patients in the north of England and south of Scotland to choose between Leeds and Glasgow.

There is a concern about the whole review itself. The Scottish Government—we accept that there is devolution—have now decided that the Glasgow unit does not have to comply with the magical 400 cases per year, but that three surgeons performing 300 operations is enough to be safe.

I am sorry about the time, but as I have made clear, I object to the fact that we have not had a proper debate so far on this serious matter. I will be as brief as I can.

It is simply not acceptable to have one rule for children in Scotland—to say that it is safe to have 300 units—and to say to the people of Leeds that we have to close a perfectly safe unit on the basis of a number that has been dreamt up in Whitehall. That is inconsistent. Yes, there is devolution and we may even have independence, but even then we would still have people crossing the border to access surgery.

This simply does not make sense. It is dishonest. I am afraid to say that the Little Hearts Matter charity has been quite dishonest, on the one hand saying that Safe and Sustainable is the right way forward, and on the other saying that it is okay for Yorkhill to carry on performing only 300 operations per year. That simply does not make sense.

My final question to the Minister is one that has not been answered. If Leeds does close, will we be told how much it will cost to close it? It will cost an awful lot to close and to reconfigure the services. We have not had that figure yet. If we do get it, I think people will be even more angry about the decision to close a much-needed, perfectly safe and excellent children’s heart surgery unit.

15:12

[Mr George Mudie (Leeds East) (Lab)]

I join with hon. Members in congratulating the hon. Member for Pudsey (Stuart Andrew) on securing the debate and on the way that he has handled the campaign. He has been inclusive. He has handled it sympathetically and intelligently, and he has worked with a very good campaign in Leeds. I hope it is successful above all for the children’s unit, but it would also reflect on the hon. Gentleman. I echo his comments about the Minister. I am delighted to see an independent mind in the Department of Health. It makes such a difference, but I wonder how long it will be before those officials weigh down on her.

As a layman, it seems to me incredible to place such an important facility in Newcastle rather than West Yorkshire. Some 5.5 million people are served by the Leeds unit and 2.5 million served by Newcastle. By 2030, the population of Yorkshire and Humberside will increase by 16.5%, up to 6.2 million people. Newcastle’s will increase by only half of that—8.2%. If those figures are challenged as being only projections, in the last census Yorkshire and Humberside went up by 300,000 and the north-east by 57,000. If we are talking about placing a strategically important, sensitive service, Newcastle is not the place where the conurbations and numbers are.

When the subject was first debated, I argued in the House that we should look at Newcastle in a different light. I hate the idea of us and Yorkshire saying, “Our kids cannot go 100 miles because of this, that and the other,” but we are then put in this corner of arguing that Newcastle kids can come down and do the same thing and it is okay for them. The hon. Member for Leeds North West (Greg Mulholland) said that Scotland is content with the numbers. If the people of Newcastle wanted that unit and were prepared to have that unit, I think there is a case for leaving it, because the geographical distances cause a great problem.

In Leeds, 23% of the children are from an Asian ethnic background. In Yorkshire and Humberside, that figure is 6.2%, or 326,000. In the north-east, it is less than 70,000. I had to fight to close the South Shields immigration tribunal centre and open the Bradford centre, because I was aghast at the cost for people from ethnic minorities—the Bangladeshi community are among the poorest in the city—having to travel all that way. That is compounded when going to sit beside a child who has had surgery, and who is recovering or not recovering. The time and expense is a factor that does not seem to have been considered.

This is not the time—perhaps it is appropriate: more publicity and so on—to re-argue the case. The case has been argued. The case is stated. It is how this review body carries out the review. There are fears that the panel will not address the accuracy, objectivity and rigour in the assessment processes throughout the Safe and Sustainable review, and that impact assessments carried out by independent bodies were all ignored. The Minister said that it would be for the review body to decide the full extent of its review of all the decisions that have been made. That seems to suggest—we all agree with this—that the finding of the panel will be independent but the evidence it chooses to consider will be its own choice. I seek assurances from the Minister that she shares my view that all the facts that were part of the eventual decision—all the facts—should be investigated, and in particular, the specific facts raised in relation to Leeds and Leicester.

The hon. Member for Pudsey asked the Department of Health to ensure that the JCPCT released non-confidential information to the joint health and overview scrutiny committee. The Minister replied with the unsatisfactory,

“it is for the JCPCT to decide what information to release about the review and we are unable to comment further.”

Why did the Minister take this clearly unsatisfactory line? When she replies, I would like her to indicate whether she or her colleagues even asked the panel to release non-confidential evidence and, if they did not, why not.

15:18

[Martin Vickers (Cleethorpes) (Con)]

It is a pleasure to take part in a debate under your chairmanship again, Mr Hollobone. I, too, congratulate my hon. Friend the Member for Pudsey (Stuart Andrew). This is something of an action replay, not only for you, Mr Hollobone—you were in the Chair last week for the debate on Glenfield hospital in Leicester—but for the Minister. I apologise to her that some of the points that I am going to press her on now are identical to those that I raised last week. One is the point about distance.

It is noticeable that three out of the four representatives from northern Lincolnshire are here to take part in the debate. We are the remotest part of the area served by the hospital. That does not just present problems for people visiting. As we have heard in previous debates and meetings, getting babies to a unit has actually made the difference between life and death, and that cannot be ignored. In the Cleethorpes area, there are a large number of parents and grandparents whose children have received treatment here. We held a public meeting in July and the strength of opinion was evident.

In last week’s debate on the Leicester unit I was slightly disappointed by the Minister’s response. I appreciate that she is walking a tightrope, but she is noted for being an independent voice. She showed signs of being sucked into the departmental bureaucratic nonsense that we often hear, but I am sure she will rectify that in half an hour’s time. Commenting in her reply on something that I said, she made the perfectly valid point that in cases of the kind that we are considering we want

“fewer, but much bigger units.”—[Official Report, 22 October 2012; Vol. 551, c. 186WH.]

That is the opinion of some experts, but equally, of course, other experts disagree. If we are to be ruled by expert opinion, there are two possibilities. One is that we pack up and go home, because we are superfluous. The other is that because experts always disagree, someone democratically accountable is needed to arbitrate between them. My hon. Friend the Member for Brigg and Goole (Andrew Percy) wishes to intervene, as usual.

[Andrew Percy (Brigg and Goole) (Con)]

I want to intervene to defend the Minister. My hon. Friend is entirely right about the geographical problems in our area; but even if we accept the argument that we need bigger units, is not the core issue the fact that the population—the patient base—is in our region, not in the north-east? If we must go along this line—let us assume that we must—we should move the doctors to where the patients are, not the other way around.

[Martin Vickers]

As usual, my hon. Friend and neighbour is correct. Because of the remoteness and so on, the assumption that all patients in northern Lincolnshire will transfer to Newcastle will simply not be borne out. They will choose alternatives and I suggest that most will gravitate south. Therefore the Newcastle target of 403 will not be achieved.

There are expert opinions on both sides of the argument. The significant point is that the parents and grandparents of the children who receive the treatment are not convinced about the alternatives, because they have seen surgeons and other experts in Leeds performing miracles on their children with modern medical technology. That is their doubt: they do not have confidence in the alternatives when they have seen the Leeds centre of excellence in action.

My hon. Friend the Member for Pudsey stole a line from me because I too was going to quote the point that my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) made in last week’s debate. I will take another line from his speech:

“The Secretary of State has the levers of power in this question and he must pull them—he must exercise them”.—[Official Report, 22 October 2012; Vol. 551, c. 188WH.]

That is what we expect. We do not want the question shuffled off to a panel of experts, with automatic acceptance of what they say. Different experts come up with different decisions.

Time is pressing. In Leeds we have a centre of excellence. It deserves our support, and already has the support of those we represent. I am sure that the Minister and the Secretary of State would not want to be responsible for destroying it.

[Mr Philip Hollobone (in the Chair)]

If the final three hon. Members who want to speak in the debate take five minutes, they will all get in.

15:23

[Julian Sturdy (York Outer) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. He has been a champion of the children’s heart unit in Leeds, and I know that the staff, and, most importantly, the young patients, appreciate all that he does to lead the campaign in Westminster to save it from closure. It is a testament to the campaign that so many hon. Members from across the House are here to support it.

The debate over the Safe and Sustainable review has been going on for months. At each stage I have openly supported the need for the review. We must always strive to improve clinical standards in the health service. That is right; and it is right that the responsibility for treating children’s heart problems should be transferred to units that can offer the outstanding treatment that all affected children and their families deserve. The families of those children would not want anything else. I am a parent and understand it completely. Indeed, my support for the Leeds children’s heart unit is based not simply on close geographical links to my constituency or the wider region that it serves; it is based on the fact that the unit offers superb clinical outcomes for young patients. Indeed, as other hon. Members have mentioned, it scores higher on the JCPCT’s core clinical standards than the preferred option for the north-east. Core clinical standards should be combined with core statistics from the local area, too. More than 600,000 people have signed a local petition demanding that the Leeds unit should remain open. Leeds serves a population of 5.5 million, and 14 million are within two hours of the city. That is a catchment area far larger than those of other units.

Throughout the saga, I have been reluctant to compare the Leeds unit directly with others, particularly Newcastle.

15:25

Sitting suspended for a Division in the House.

15:40

On resuming—

[Mr Philip Hollobone (in the Chair)]

Order. Mr Sturdy has about three minutes remaining.

[Julian Sturdy]

Thank you, Mr Hollobone. As I was saying, throughout this saga I have been reluctant to compare the Leeds unit directly with others, in particular Newcastle’s. My intention is not to criticise the Newcastle unit, which has also carried out great work, saving many young lives over a number of years. Rather, my belief continues to be that the Leeds unit has always had the strengths to merit its survival without such comparisons. Put simply, its own case is strong enough. That is my message to the Minister today, and it was also put eloquently by my hon. Friend the Member for Pudsey.

The single biggest failing in the consultation has been the flawed decision-making process of the Joint Committee of Primary Care Trusts, from the lack of weight given to transport and travel times, and the population that centres such as Leeds serve, to the true co-location of services. There has also been a lack of clarity over the terms of the review, and the failure of the JCPCT to release the information and evidence behind its decision is only adding to the controversy and suspicion. Without being able to break down the scores awarded to each children’s heart surgery unit by Professor Sir Ian Kennedy’s assessment panel, the decision-making process lacks basic transparency and scrutiny.

Throughout York there exists huge public interest in this ongoing and disruptive issue. I am particularly concerned for the families of affected children in York who now face the problem of having to travel to other areas for treatment—I stress “other areas”. The Minister must be under no illusion that the families and children displaced to Newcastle if Leeds closes will not automatically head north. They will disperse to centres throughout the country, and we must not lose sight of that.

In conclusion, the Save our Surgery campaign has suggested a balanced solution to the current dispute, as set out by my hon. Friend the Member for Pudsey. It suggests that the decision should be implemented in full throughout the country, but delayed in the north-east until April 2014. That window of opportunity could then be used to clarify the figures and findings of the JCPCT, allowing both affected units to demonstrate their capacity and capability on a level playing field.

I am delighted that since the election, the Government have worked to make health services more representative and more responsive to local people. I urge the Minister to continue that fine work by listening to the concerns of patients and residents in Yorkshire and taking on board and responding positively to the Save our Surgery campaign to save the children’s heart surgery unit in Leeds from an unjust and ill-informed closure.

15:43

[Mr David Ward (Bradford East) (LD)]

I add my thanks and compliments to my hon. Friend the Member for Pudsey (Stuart Andrew) and all hon. Members who have engaged in this debate. The brevity of my thanks and congratulations in no way reflects my sincerity.

I want to make a brief point about where I believe responsibility for the decision lies. The Health and Social Care Act 2012 contains a contentious element concerning the Secretary of State. The contentious Bill was debated at length in the Lords, and in the Commons, but it remains within the legislation that the Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England. That is where I believe responsibility for the final decision should lie.

I turn to local circumstances. Most people will be aware that Bradford has the fastest-growing young population outside London. It has grown by 25% during the past 10 years. The issue is not simply the large number of young people in the area, but the incidence of the ailments that must be dealt with. As was said, 23% of Leeds cardiac surgery patients are south Asian, which is 6% of the population in the catchment area as a whole, but 23% are children on cardiac wards. Many come from Bradford and south Leeds—about 90 a year, and the number is increasing. Proportionately, those children have far more complex bowel deformities and facial deformities such as cleft lip and palate, and can be treated under one roof—that is the key—only at Leeds children’s hospital.

I am sorry that the hon. Member for Bradford West (George Galloway) is not here. That is not surprising but it is a shame because two of the constituencies in Bradford are in the top 3% in terms of deprivation and unemployment in the country. Bradford is generally a community that is less well off than average, and people would face particular difficulties in having to travel more than 100 miles further, not only because of the cost of travel and accommodation, but because of lost income from having to be away from work to be with their children. Bearing in mind what I said about incidence, it does not make sense to move the children’s heart surgery unit away from the community that is statistically more likely to need it.

Finally, much has been said about the flawed process in the analysis, but I want to talk about the flawed process of the consultation. The review did not have any translated documentation. Of the families attending the unit, 23% speak Urdu at home. Translated copies were requested, and a small number finally arrived, but they arrived three months after the consultation had started. The translation was largely unreadable in Urdu because italics were used for quotes. The Safe and Sustainable review tried to rectify that by holding separate events for black and minority ethnic participants, but they were told that that community would not travel to Newcastle. They were clearly given that strong message. The community indicated that to the review team, and it was shown clearly in the PricewaterhouseCoopers analysis and in a Mott MacDonald study, which stated that children from that community would be worse off and would not travel north.

The message has been consistently clear. Unfortunately, there has been an unwillingness to listen to that message, and I hope the Minister has taken it on board now. The community has largely been ignored in the process, and that shows that the process outlined by my hon. Friend the Member for Pudsey and others was flawed not only in its methodology, but in the consultation exercise.

15:47

[Andrew Jones (Harrogate and Knaresborough) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I add my congratulations to my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate and providing very effective team leadership that has crossed parties and brought us all together in support of this unit. Teams need leaders, and he has been a very effective one.

I am aware of the time, but I want to say a few words. I welcome the decision to have an independent review of the Safe and Sustainable process. I do not think it was wrong; it was right in principle, and none of us would want a repeat of the Bristol scandal, but the highly unexpected decision surprised and disappointed me. I did not expect the Leeds unit to be rejected in favour of Newcastle.

Colleagues have explored some of the arguments, and my hon. Friend the Member for Pudsey detailed the excellent clinical standards in Leeds, and compared them with those of Newcastle. This is not a Leeds versus Newcastle fight. We must focus on the process and recognise that both units have merit, and both have patients with heart-rending stories. We need to look at how we take this forward to deliver the best for patients. In Leeds, we have a unit that offers excellence. The question in the review is about location, and in my opinion, that is where the Leeds unit should have scored particularly highly. It is also where the independent review needs to focus.

Colleagues have mentioned the 5.5 million people in our area, and compared that number with the numbers in the north-east, but transport links are also an issue. Leeds has good transport links, not only from north to south, but from east to west, and the key point is that the review proposed that 100% of people in the Harrogate postcode should now travel north to Newcastle. It assumes that everybody will do that, but I want to share with colleagues that the feedback from those in the Harrogate and Knaresborough postcodes—I acknowledge that that area stretches beyond the Harrogate and Knaresborough constituency—is that that is nonsense. It is absolutely ridiculous; they simply will not do it. Bear in mind that the geography suggests that if anybody is going to do it, it should be those in the Harrogate and Knaresborough constituency, because we are already 15 to 20 miles north of Leeds, and therefore 15 to 20 miles nearer Newcastle.

The impact of population numbers, and travel times and patterns, simply needs far more weight in the review. I want to see the Leeds unit continue its excellent work, serving the people of Yorkshire and beyond, but as we take the review forward, correct weighting needs to be given to the important factors of travel time and population numbers. I hope that the Minister hears that point today, and that we do not start viewing this as a Leeds versus Newcastle contest. We should explore the opportunities for co-location and for a child-driven service.

15:51

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate, and on the way in which he and other Members across the House have put their case. The issues surrounding Leeds children’s heart surgery unit are important and certainly merit our debate. I also take the point made by the hon. Member for Leeds North West (Greg Mulholland) that a wider debate on the Floor of the House may be warranted.

I take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services, both in Leeds and across the country. We are all incredibly grateful for the tremendous job that they do, more often than not in complex, difficult circumstances.

Clinicians and professional bodies, including the Royal College of Nursing and the Royal College of Paediatrics and Child Health, have been clear that children’s heart services need to change. Surgeons are too thinly spread, and services have grown in an ad hoc manner in England, which, to be fair, the hon. Member for Pudsey recognised in his opening speech. Changing how we provide any hospital service is difficult, but when changes are necessary to improve patient care, as they may be for children’s heart services, politicians on both sides of the House should be prepared to listen to that argument and, if necessary, support it.

I know, however, that there have been real concerns and a great deal of protest in the communities surrounding the unit at Leeds general infirmary, particularly about the plans to close it. A motion of support from Leeds city council has been supported by people from across the political spectrum in the city. There has also been a large protest in Millennium square in Leeds, where, I am informed, over 3,000 protestors were joined by local MPs, parents and nurses to campaign to prevent the closure.

As we have heard today, there are similar concerns about plans to close the Glenfield hospital in Leicester, and the Royal Brompton in Chelsea, west London. That could mean that in future, children’s heart surgery would remain at the London children’s hospitals, and in Southampton, Birmingham, Bristol, Newcastle and Liverpool. Although the Opposition support the principle of fewer, more specialist centres, we have concerns about the location of the selected sites, which would leave a huge swathe of the east of England, from Newcastle right down to London, potentially without a centre.

As we have heard, the unit based at Leeds general infirmary serves the 5.5 million residents of Yorkshire and the Humber, and performs 360 operations a year, done by three surgeons. We have heard, too, that there are concerns that the closure of the unit will leave millions of people in the region without local access to the children’s heart surgery expertise that currently exists in Yorkshire and the Humber at Leeds. The local Save Our Surgery campaign group, under the Children’s Heart Surgery Fund, believes that families from Yorkshire, north Lincoln and the wider Humber region may have to travel up to 150 miles for treatment at the nearest unit in Newcastle or Liverpool, if the closure goes ahead.

As an aside, I was privileged to visit the hospital in Hull, at the invitation of my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), as part of my duties as a shadow Health Minister. It took me an hour and a half to get from Manchester to Hull to visit the hospital. However, because there was a slight flurry of snow on the way back, the M62 ground to a halt, and it took me over five hours to get back over the Pennines to Manchester. I have never seen so many Lancastrians trying to desert Yorkshire at the same time as me, but it shows that geography matters in such decisions. We cannot ignore the fact that the Pennines are there, and sometimes they are impenetrable.

Clearly, there is concern that families may be faced with having to travel further at what is undeniably a very stressful time for them. That case has been made eloquently by Members on both sides of the House in the debate. It is also worth remembering that it is not only the care of poorly children that needs to be taken into account; the care of the whole family is important.

I ask the Minister, for whom I have a great deal of respect, whether she was satisfied that the NHS joint committee of primary care trusts properly balanced clinical decisions with practical and transport issues for families. Furthermore, does she believe that the review was fair to families in the eastern half of England, which is now left with no centre between Newcastle and London? As we know, the JCPCT came to the decision in July to close the unit. The SOS campaign group launched legal proceedings against the NHS to stop the unit being closed, submitting an application to the High Court for permission for a judicial review. Last week, as we have heard, the Health Secretary asked the Independent Reconfiguration Panel to review the decision to close three centres.

We know that children’s heart surgery matters greatly to many people. However, as we also know, the issues surrounding children’s heart surgery have needed to be resolved for some time. The findings of the Bristol Royal infirmary inquiry into children’s heart surgery 10 years ago highlighted that between 1990 and 1995, a number of children died at the infirmary as a result of poor care. It is clear that children’s heart surgery has become an increasingly complex treatment. The aim must be for children’s heart services to deliver the very highest standard of care. The NHS should use its skills and resources collectively to gain the best outcomes for patients. The Government rightly want changes to children’s heart surgery services, so that they provide not only safe standards of care, but excellent, high quality standards for every child in every part of the country.

[Fabian Hamilton]

Does my hon. Friend agree that it is not only the continuum of children’s heart services and the care of parents and other family members that is important? The treatment should continue beyond 16, if it has to. There needs to be an overview of pre- and post-16 services; they should be taken together, because that is how we ensure that the young person, who becomes an adult, survives and lives the rest of their life.

[Andrew Gwynne]

I agree absolutely with my hon. Friend. He makes the point that I was about to come on to. We want that for children’s heart services. It cannot be good enough to say that it is possible to move a service; we want to know whether it is desirable to do so, in order to get the very best outcomes. He makes the point that if we are to have a specialist centre for adults, we should remember that it is often the same surgeons who deal with children, and rather than losing that, it is better to have one specialist centre for all.

It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and it follows that they will all be working at full capacity, so can the Minister ensure that in the event of a superbug outbreak like the one in the Belfast neonatal unit this year; a fire like the one in the Birmingham hospital in 2010, or the one in Leicester in 2011; or any other unforeseen incident occurring in one of the cardiac units, the other six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?

As I have previously said, I welcome the recent decision by the Health Secretary to have a review of the decision to close the children’s heart surgery unit at Leeds general infirmary. It is important that there be a full review, and that the right decision be made, with full consideration of all the facts. I echo the concerns raised by other hon. Members on that point. Many campaigners are concerned that the review by the Independent Reconfiguration Panel will simply repeat a process that was seen as flawed the first time round. What steps will the Minister take to reassure the campaigners in Leeds that it will be a full and comprehensive review? As I have said before, it is not good enough just to close one service and move it to a different part of the country. We must ensure that any potential decisions take full account of the facts, and that any moving of a service will result in a clear and demonstrable improvement in the outcomes for children’s cardiac services.

16:01

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Here we are again. It is a pleasure to speak under your chairmanship, Mr Hollobone. It is about a week since we had a very similar debate, also under your chairmanship. That has already been described by my right hon. Friend—sorry, I always call my hon. Friend the Member for Pudsey (Stuart Andrew) the right hon. Member for Pudsey. [Hon. Members: “Soon!”] Perhaps I am trying to elevate him too soon, but as he has explained, we had a similar debate only last week about the situation at Glenfield. I join everyone else in paying tribute to him for securing this debate.

I pay tribute to all hon. Members who have spoken, of whatever party. In many ways, this has not actually been a debate, because normally in a debate there is a degree of disagreement and people put forward their arguments for or against a particular motion or notion, but that has not been the case in this debate. Here, we have had an outbreak of complete unity, which I acknowledge, between all political parties. It is right and proper that, on this matter, people come together, are not divided by political party and are determined not to score any form of party political point in making their argument. All hon. Members have come to this debate for the right reasons. They have come to represent their constituents and to put forward all the arguments that they can on behalf of their constituents and with full force. That is absolutely right and as it should be, but I want to make this point as well, and not because I am any form of coward—after all, I spent 16 years defending, largely, the indefensible.

I have to say that the hon. Member for Denton and Reddish (Andrew Gwynne) was treading somewhat on my good humour with some of his remarks when he was asking me for my opinion because, as we all know, this whole review has taken great pride in the fact that it has been an independent review—independent of Government. It was set up, quite properly, by the last Government, on a cross-party basis, and it was on the basis that we needed fewer but larger and more specialised children’s heart services in England. It was accepted—I say this with great respect to my hon. Friend the Member for Cleethorpes (Martin Vickers)—that that was the basis of it all and that it was being done so that we could secure the best children’s heart services for babies and young children that we could possibly obtain, and so that we could ensure that those services were sustainable. We wanted to concentrate the specialist heart surgeons in a smaller number of centres to ensure that they had the best skills for dealing with babies and young children.

At the end of the day, we are talking about arguably some of the most specialised surgery that exists. There are instances in which surgeons are operating on a baby’s heart that is no bigger than a walnut. As I say, it is perhaps the most specialised and the most precarious of all types of surgery, so their skills have to be the best. It is also the case that if we have fewer, but larger, more specialised units, we can ensure that those surgeons, those doctors, those nurses and the other health professionals are training the future surgeons, doctors, nurses and other health professionals to do this very important and highly specialised work.

I pay tribute to my hon. Friend the Member for Pudsey. As we would all have expected, he advanced a thoughtful, well researched and sound set of arguments on behalf of his constituents. He gave the examples of Lauren, Libby and Abi. The hon. Member for Scunthorpe (Nic Dakin) also spoke with considerable feeling about what his constituents had told him. That is only right and proper. I am sure that all those constituents will welcome the comments of their Members of Parliament in advancing their arguments for keeping their children’s heart surgery unit open. It is quite clear from the various interventions that this has all-party support. We heard from my hon. Friend the Member for Shipley (Philip Davies), the right hon. Member for Leeds Central (Hilary Benn) and my hon. Friends the Members for Skipton and Ripon (Julian Smith) and for Brigg and Goole (Andrew Percy). As I said, people are coming together, whatever political differences they might otherwise have, in agreement and in support of children’s heart surgery at Leeds general infirmary.

A number of matters strike me from the speeches that have been made. In addressing some of the remarks made and arguments advanced by hon. Members on both sides of the Chamber, I shall try to give a response that perhaps allays some fears and certainly answers some questions.

[Fabian Hamilton]

I am sorry to intervene when the Minister is about to give those responses, but she said that the review, quite rightly, was independent; it was set up by the previous Government to be independent of Government. I think that the prevailing view this afternoon is that it was not impartial. Will she comment on that?

[Anna Soubry]

I will not comment on that, quite deliberately, because it is imperative that I am seen and, indeed, fellow Ministers are seen to be completely independent and impartial ourselves. Of course, that does not prevent hon. Members from making their own judgments and vocalising them, and there may be merit in them, but it is not for me to say whether there is, because, as hon. Members know, this has all been referred to the Independent Reconfiguration Panel—that is right and proper, in my view—and it will look at all aspects of how these decisions have been made. It will take evidence not just from the NHS, clinicians and local authorities, but from Members of Parliament. I am in no doubt that all hon. Members who are here today will make their own representations to the IRP on behalf of the children’s heart services at Leeds general infirmary and will make them with the force with which they have made them today and on the basis of as much information, sound evidence and argument as they have shown us here today.

[Julian Smith]

Will the Minister give way?

[Anna Soubry]

I was going to try to move on to some of the issues, but I will happily give way.

[Julian Smith]

I thank the Minister for giving way. Can she confirm that the panel will include some people who are actually living in the north? What is the make-up of the panel?

[Anna Soubry]

I shall be absolutely blunt: I cannot answer that question. I took a strong view some time ago that if I did not know the answer to a question, I would say so. However, I am more than happy to write to my hon. Friend and answer his question as much as I can.

Travelling times were mentioned by a number of hon. Members. I was going to go through all those who mentioned them, but I may not have time to do so. I shall just make this point. Of course, it is surgery that it is proposed will be lost from Leeds and will go to Newcastle. It is very important that all hon. Members, when they communicate to their constituents about this debate, make the point that the plan is that the surgery will take place in Newcastle, but all the follow-up, all the support and all the other things that we might imagine are involved when a baby or a small child has surgery will continue to be provided at Leeds. It is not the case that the whole thing will move up to Newcastle; it is simply the surgery. I just put that into the pot because the point was made about travelling times. Of course, it is for others to say, but it may be that they take the view that those were very good points that hon. Members advanced in the debate today.

The hon. Member for Leeds East (Mr Mudie) asked specifically about the JCPCT’s refusal, or otherwise, to disclose information. The hon. Member for Leeds North West (Greg Mulholland) spoke with passion, as ever, and commented on that, as did my hon. Friend the Member for Pudsey and other hon. Members. It is for the JCPCT to decide what information should be disclosed, in accordance with the requirements of the Freedom of Information Act. I am told that the Yorkshire overview and scrutiny committee has indicated its intention to refer the matter to the Information Commissioner, which is the established recourse laid down by legislation. I am afraid that it is not for Ministers to order the JCPCT to disclose information to the OSC in Yorkshire or any of the other local authorities involved. The various authorities are open to make applications under the Freedom of Information Act. I hope that answer deals with that point.

The powerful arguments the hon. Member for Leeds East put forward were largely based on population figures. I have already alluded to the contribution of my hon. Friend the Member for Cleethorpes. In large part, my hon. Friend and I disagree on the basis of the review. He said that different experts have different views, but I have to tell him that we have seen an outbreak of unity on this issue among many of the royal colleges, experts and leading clinicians in the field, who welcomed the decision of the JCPCT.

[Martin Vickers]

We heard from my hon. Friend the Member for Leeds North West that experts in Scotland disagree, so there is clearly some basis for doubt.

[Anna Soubry]

I am grateful for that contribution, but I know that when the JCPCT’s decision was announced, it was universally welcomed by many of the clinicians who have been involved in such specialised surgery, certainly throughout England, but I cannot comment on the views of those north of the border.

I have a short time left to speak. The Independent Reconfiguration Panel is just that—an independent reconfiguration panel. I can provide details to those who need to know its composition. It comprises independent experts, and Members can be assured that they will conduct a full and independent review. As I said, they will take evidence from NHS organisations, local authorities and local MPs. It is hoped that their deliberations will conclude at the end of February. It will then be for the Secretary of State to receive the findings and recommendations and to decide whether to act on them. There is a concern that there may be some delay due to a legal challenge.

In last Monday’s debate my hon. Friend the Member for Pudsey made a helpful intervention, to which I responded that if any local authorities in Yorkshire are minded through their OCSs to refer the matter to the IRP, they should get on and do it. I want to put that into the pot, because the one thing that nobody wants is any more delay.

This debate began back in the 1990s, and hon. Members talked about what happened in Bristol. It was determined then that we needed to ensure that our babies and young children had the finest specialised heart surgery services possible, which is why it has been a long process. It is difficult and painful, but the Safe and Sustainable review was set up on the basis that there would be a reduction in the number of units. No one wants to set one hospital against another, and I pay tribute to everyone who has avoided doing so, but unfortunately sometimes tough decisions have to be made. It is always important to remind ourselves that they are made for the very best reason, which is to ensure that our babies and young people are safe and get the very best service.