Children’s Cardiac Surgery (Glenfield)

Baroness Burt of Solihull Excerpts

Monday 22nd October 2012 Westminster Hall

[Sir Edward Garnier]

I am grateful to my hon. Friend for that intervention. His support demonstrates that the issue is not only for Leicestershire, but one that affects patients from right across the east midlands and, I would suggest, from well beyond the east midlands.

Before my hon. Friend the Minister feels a little surrounded, may I thank her for being here to respond to the debate? I also congratulate her, although she must be bored of hearing congratulations, on this first step in what will be a long and successful ministerial career; I say that not as a question but as a statement of fact, and on that basis I am sure that we have won the case. I have no doubt that her response to this debate will act as an accelerant to her progress and provide great hope to those of us who want to see the Glenfield hospital’s ability to save lives continue.

Let me read out part of a letter from some members of staff at the Glenfield hospital:

“As members of the East Midlands Congenital Heart Centre team, we feel that we have a responsibility to our patients to ensure that we make clear our intentions with regards to the implementation of the recommendation of the safe and sustainable review. We are not in a position to leave our homes and families, to move to Birmingham to work. As a team of (predominantly) women, we are (predominantly) second wage earners, with husbands, children and homes. The toll of this review on both our work and home lives has been immense. It has created uncertainty and confusion, as well as intense anxiety. The repeated mantra of the review team that it will all be ok ‘with the help of the EMCHC team’ is meaningless in that we have not even been consulted. Unfortunately, we have been placed in a position where to refuse to relocate is openly criticized as being obstructive by the review. This is not the case. Our patients remain our priority within our working life, yet we have a responsibility to our families which, when push comes to shove, will over ride this.”

They go on:

“This letter is in no way representing a threat. It is an open expression of our concerns, over another assumption made by the review team, and which places us in a position where we are forced to choose between our patients and our families. We are a group of dedicated professionals, who have worked hard to achieve the excellence that we have done. Our patients deserve the best, and we fear that the recommendations will not give them that, and we will be unable to be there to support them.”

In my view, that letter speaks for them all—from doctors through to cleaners—and I hope that the Secretary of State will not forget the work that employees of the national health service do at the Glenfield unit when he comes to decide how best to proceed.

It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and thus they will all be working at full capacity. Can the Minister ensure that in the event of a superbug outbreak, for example, as happened at the Belfast neonatal unit this year, or of a fire, as happened at Birmingham hospital in 2010 and in Leicester in 2011, or of any other catastrophic event in one of the cardiac units under consideration, that the remaining six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?

Glenfield already takes patients not just from Leicestershire, but from across the east midlands, as my hon. Friend the Member for Newark (Patrick Mercer) said. It also receives patients from Birmingham, Southampton, Northern Ireland and elsewhere in the United Kingdom—and even from Scandinavia and mainland Europe.

The Safe and Sustainable cardiac review for children in England has been under way for more than three and a half years. It proposes that the Glenfield unit be closed and its patients and neonatal and paediatric ECMO services be transferred to Birmingham. The Minister and the Secretary of State are, we now know, to revisit the medical and economic evidence that the review board has considered, but I look to them to make a different, better and more logical decision, based on the evidence that is there for all to see.

Four available options emerged from the review, and they were predicated not so much on the cost of providing children’s cardiac services—albeit that cost must play a significant part—as on their sustainability. I will not, for reasons of time, list the options or their components, but option A suggested that there should be seven surgical centres: at Glenfield, at Freeman hospital in Newcastle, at Alder Hey children’s hospital in Liverpool, at Birmingham children’s hospital, at Bristol royal hospital and at the two centres in London, each with four surgeons looking after a minimum of 400 children every year.

Following the public consultation between 1 March and 1 July this year, option A received the greatest support. The consultation was the largest ever public consultation within the national health service, with more than 75,000 respondents; nevertheless, that number is much smaller than the number of people who signed the e-petition that provoked this debate. Option A was supported by six of the 10 health regions in England. It is, at £22 million, the least expensive option—the next cheapest costs £44 million—and it has the added advantage of ensuring shorter travelling distances for families.

None of the four options is perfect or ideal, but the option that includes Glenfield satisfies many of the objective criteria that one would expect of a good solution—not least in respect of Glenfield’s nationally commissioned ECMO services. Given today’s letter from the Secretary of State, it is in that regard that our attention now needs to focus. Glenfield provides both cardiac and respiratory ECMO. Its national ECMO centre has been in operation since 1991, and it treats babies, children and adults from across the country and abroad.

ECMO is an invasive life-support system, which can be used on patients with severe respiratory or cardiac failure. It consists of removing blood from a patient, taking steps to prevent clots from forming in the blood, adding oxygen to the blood and pumping it artificially to support the lungs. There is an increased chance of survival of half as much again when a patient is treated in an ECMO centre rather than in a conventional intensive care unit. The Glenfield ECMO unit has the best results in the world, has more expertise and success than any other ECMO unit in the country and is the only such unit in the country to provide mobile ECMO. We have four national centres for ECMO, and the ideal scenario would be to maintain ECMO services in their current locations.

There is the fact that Glenfield’s ECMO unit was applauded by the national health service during the H1N1 crisis and that Glenfield’s ECMO survival rates are 20% higher than the United Kingdom average. Kenneth Palmer, director of the ECMO unit of the Karolinska university hospital in Stockholm and an international expert on ECMO treatment, wrote to my right hon. Friend the Member for South Cambridgeshire, the former Health Secretary, on 7 July, on learning about the proposal to shut the Glenfield unit:

“You will take over 20 years of experience from one of the world’s...best ECMO units and throw it away...to rebuild it in another place...You cannot move a unit, you can just destroy it and rebuild it with many years of decreasing survival rates and increasing morbidity”.

Mr Jim Fortenberry, paediatrician-in-chief of children’s health care in Atlanta, Georgia, also wrote to my right hon. Friend on 6 July:

“Glenfield has one of the finest ECMO programmes in the world and was the source of the recent CESAR trial, a landmark study that helped sort out the benefits of adult ECMO...The impact on care of attempting to move out this program in toto to another location would be devastating. ECMO is not merely the equipment, but the incredible collective expertise and institutional memory of its entire team”.

Glenfield has, over the years, built up a team of more than 80 ECMO specialists.

Dr Thomas Müller, ECMO co-ordinator at the university medical centre in Regensburg, Germany, wrote to my right hon. Friend on 9 July:

“Glenfield Hospital has won an excellent reputation for their expertise in paediatric and adult ECMO treatment and is deemed to be one of the world’s leading centres. The knowledge and experience of the staff in Glenfield probably is unmirrored in Europe and the US. To my knowledge, Glenfield treats the largest number of patients with severe cardiac and respiratory failure with ECMO worldwide...centres with less expertise certainly will experience a higher mortality. Therefore, in the interest of best patient care the decision to close down the most experienced centre of the UK is difficult to comprehend for somebody from abroad.”

Dr Leslie Hamilton, a cardiothoracic surgeon at the Freeman hospital in Newcastle, has also acknowledged that there is a risk in moving ECMO services from Glenfield.

Glenfield performs about 100 ECMO procedures a year, which accounts for 80% of the neonatal and paediatric activity in England and Wales. As I have mentioned, Glenfield also takes patients from other countries, including Scotland, Sweden, Finland and Ireland. The mortality rate at Glenfield is 20%, compared with 34% in the rest of the United Kingdom. Two additional surgeons have expressed an interest in going to work there. The centre is a popular place to work and can be made more “sustainable”—to use the jargon—with more surgeons and space.

In advancing the case for Glenfield, I do not need to denigrate the facilities and expertise of other hospitals. I see the right hon. Member for Newcastle upon Tyne East (Mr Brown) in the Chamber along with my hon. Friend the Member for Solihull (Lorely Burt), who no doubt represents the interests of the Birmingham children’s hospital. In advancing the case for the retention of the internationally acclaimed ECMO centre in Glenfield, I do not need to undermine the good work and dedication of cardiac and thoracic specialists elsewhere. I do not want to do that, and I would not have the time, even if I thought it a proper or sensible thing to do. It just so happens that Birmingham children’s hospital regularly refers patients to Glenfield. Why? Because unlike Birmingham, which conducts only cardiac ECMO, Glenfield does both cardiac and respiratory ECMO.

[Lorely Burt (Solihull) (LD)]

I fully endorse my hon. and learned Friend’s comments about Glenfield. Indeed, one of my youngest constituents, Yvie Beards, would probably not be here today were it not for Glenfield. However, does my hon. and learned Friend not agree that the type of expertise that we have in Leicester should be replicated in other parts of the United Kingdom? Although the Birmingham children’s hospital has one of the best child treatment centres, it could also contribute to that same level of care for children and others in the west midlands.

[Sir Edward Garnier]

I am sure that my hon. Friend is right, but we do not replicate what goes on in Glenfield by closing down Glenfield. If she and I are right about this, we need more Glenfields, not one fewer. We certainly do not need Glenfield itself to be closed.

Glenfield has this year opened a paediatric intensive care unit—a PICU—which will also become unviable as a result of losing paediatric cardiac surgery. Currently, 71% of those in the PICU are cardiac patients, so closing it down will no doubt affect the non-cardiac patients whom the unit treats. The loss of the ECMO service would also make the adult ECMO unit unviable. As of 18 October, option A is supported, on the e-petition, by about 103,000 signatories.

The Guardian, not necessarily a newspaper that a Conservative Member of Parliament leaps to quote from, pointed out on 28 April 2010:

“There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres… Survival and recovery rates would improve markedly with many lives saved.”

The ECMO unit at Glenfield works: it helps children survive and, as we just learned from the Prestatyn case, it helps adults survive. The medical evidence shows that the ECMO unit works, and now it is up to the Secretary of State to understand that and let both the unit and the children it treats survive.