Health and Care Bill

Baroness Morgan of Cotes Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

Moved by

[Baroness Morgan of Cotes]

17: After Clause 5, insert the following new Clause—
“Duty to consider residents of other parts of UK
For section 13O of the National Health Service Act 2006 substitute—“13O Duty to consider residents of other parts of UK(1) In making a decision about the exercise of its functions, NHS England must have regard to any likely impact of the decision on—(a) the provision of health services to people who reside in Wales, Scotland or Northern Ireland, or(b) services provided in England for the purposes of—(i) the health service in Wales,(ii) the system of health care mentioned in section 2(1)(a) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (c. 1 (N.I.)), or(iii) the health service established under section 1 of the National Health Service (Scotland) Act 1978. (2) The Secretary of State must publish guidance for NHS England on the discharge of the duty under subsection (1).(3) NHS England must have regard to guidance published under subsection (2).””Member’s explanatory statement
This new Clause places a duty on NHS England to consider the likely impact of their decisions on the residents of Wales, Scotland and Northern Ireland, and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.

[Baroness Morgan of Cotes (Con)]

My Lords, in moving my amendment I will speak also to Amendments 205 and 301. I thank my noble friends Lord Moylan and Lady Fraser of Craigmaddie for their support for these amendments.

It is a pleasure to follow two excellent debates. I suspect—although, as the noble Baroness, Lady Hayman, said, we are never quite sure how feisty the debates on these groups will get—that we may spend an even shorter time on this group to enable the Committee to make progress. These amendments are relatively simple, designed to improve transparency, quality and access to healthcare for residents in all parts of the United Kingdom. I thank Ministers for their engagement so far on the amendments. In particular, Amendments 205 and 301 were tabled in the House of Commons by Robin Millar MP and others.

The NHS is a UK institution. It could not have been developed without the combined economic strength of our United Kingdom and has developed from unifying United Kingdom values—you might even say that the NHS embodies them. It includes a promise that, wherever in the United Kingdom you are from and whatever your situation, you are entitled to the same protection and treatment. That is why the first two amendments, Amendments 17 and 205, are about access by patients to a consistent national standard of healthcare.

The unfortunate reality, of course, is that many UK residents do not have equal access to healthcare. Referral-to-treatment waiting times for England, Scotland and Wales are, respectively, 11 days, 32 or 42 days—depending on whether you are talking about in-patients or out-patients in Scotland—and 21.5 days. These headline figures are concerning enough. However, they obscure even more stark differences when treatments are considered separately.

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[Earl Howe (Con)]

Rather than give a wrong answer to the Committee, I had better take advice on that and write to the noble Lord, if he will allow it.

I say to the noble Baroness, Lady Walmsley, that if we look at this area in general, we are clear that we must and will continue to work closely with the devolved Administrations to ensure a fully interoperable, UK-wide approach to healthcare, including in relation to the provisions in this Bill.

It is worth adding that the devolved Administrations already have powers in legislation under Section 255 of the Health and Social Care Act 2012 to request NHS Digital to collect and analyse data, so they have that ability if they wish to exercise it. I am very grateful for my noble friend’s interest in this important area. I assure her that we will continue to keep listening to ways in which we can make the NHS work for all four nations of our union. It is vital that we do so and implicit in the collaborative processes we are engaged in. However, for the reasons I have set out, I ask my noble friend to understand why I am unable to accept this amendment.

[Baroness Morgan of Cotes (Con)]

I thank my noble friend very much for his response. Although this has been a short debate, it has been a very good one. It has certainly been very helpful in noble Lords on all sides sharing their experiences and thoughts. It has raised some important issues and some comments on drafting. I am grateful to noble Lords for them. It has also enabled your Lordships to share some practical experiences, not least about the NHS Covid app. It sounds as if it is moving towards a resolution.

I was slightly amused that some of those who said that these issues do not need to be addressed in the Bill are often those who say that other issues need to be addressed in primary legislation so, when we are talking about consistency, we all need to think about that.

I am very grateful to my noble friend for saying that he agrees that more needs to be done and is being done to align healthcare across the United Kingdom and for stressing the importance of collaboration. I will, of course, withdraw this amendment, but the amendments in this group raise important issues and I hope that discussions can continue. As the noble Baroness, Lady Walmsley, I think, said, this is about practical, positive treatment and outcomes for patients, which is what we all want to see regardless of where they live.

Amendment 17 withdrawn.

Health and Care Bill

Baroness Morgan of Cotes Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Morgan of Cotes (Con)]

My Lords, it is a pleasure to follow the two previous speakers. I particularly congratulate the noble Lord, Lord Stevens of Birmingham, on an assured, entertaining at times, but also extremely interesting speech. It is good to have him in the House, particularly as we come to consider the Health and Care Bill. I know that he will make an enormous contribution through his membership.

I declare my interest as a trustee of the Loughborough Wellbeing Centre charity, which offers mental health support to those facing mental health challenges. As we have heard, this is clearly a Bill that those outside this House and Westminster, but also inside, feel strongly about, given the quantity of briefing that we have received so far. I am sure that that will only continue.

In the time available, I want to cover two points that I shall return to later. First, I alert the Minister that I and others will be picking up on two amendments tabled but not voted on in the House of Commons that recognise that the NHS is an institution that covers the whole of our United Kingdom. As we know, there are huge disparities in service quality and delivery between different parts of the United Kingdom. That is unfair on patients and, I suspect, extremely wearying for staff and those caring for those seeking treatment.

The first amendment raised in the Commons would place a duty on NHS England to consider the likely impact of its decisions on the residents of Wales, Scotland and Northern Ireland and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.

The second proposal

“would enable the Secretary of State to specify binding data interoperability standards”

across the whole of the United Kingdom. It would

“require the collection and publication of comparable information about healthcare performance and outcomes across the United Kingdom and would require Ministers in the devolved institutions to provide information on a comparable basis.”

Surely, the lesson of the last 18 months of facing the Covid pandemic is that more data and more transparency are better at putting more power in the hands of patients and those seeking care.

My other point relates to mental health provision. I was delighted to hear the noble Lord, Lord Stevens, mention this and I know that it will come up elsewhere in the debate today. I am very grateful to those who have worked in this field for a very long time for pointing out that this Bill is not ambitious enough on preventing mental health issues or on the need to provide earlier support to those experiencing mental health distress. I am also deeply concerned, given the declaration that I have already given, that there seems to be no role for the voluntary and community sector in the new structure of integrated care partnerships—yet we know that the voluntary and community sectors do a huge amount to support people with health needs, particularly in mental health but with other conditions as well. They take the burden off our National Health Service and often provide that support for a much more efficient cost or price than the statutory services ever could.

We have already heard about the NHS triple aim. I would argue that the Bill should mention parity of esteem and mental health specifically in that triple aim. My understanding is that Ministers agree with this, so I hope that they might agree to say so clearly in the Bill. It sounds to me as though the triple aim may become slightly more than triple, given all the requests that my noble friend the Minister will get to expand it. So I wish my noble friend well as he takes the Bill through the House. I look forward to future proceedings and to covering the issues that I have mentioned today.

Brain Tumour Research

Baroness Morgan of Cotes Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right that precision medicine offers an enormous and powerful opportunity for us to tackle cancers. Brain cancers are particularly difficult to tackle, especially in adults, and we are daunted by the struggle to make further progress in this area. Since April 2018, we have spent £5.7 million on directly funded brain tumour research, but that is not enough and we would like to spend more. I am open to recommendations on how the money could be spent.

[Baroness Morgan of Cotes (Con) [V]]

My Lords, brain tumours kill more children and adults under the age of 40 than any other cancer, and I am grateful to hear my noble friend’s acknowledgement that research funding is not yet enough. Does he agree with the proposal to change the system so that if a site-specific brain tumour grant is deemed fundable by a panel, it will automatically be funded during a highlighted brain tumour funding round such as the one announced last month?

[Lord Bethell (Con)]

My Lords, I am extremely grateful for a briefing given by Professor Richard Gilbertson earlier today on the specific question raised by my noble friend, which is grants for brain tumours in children. The NIHR system is a gold standard that is envied by the world and does not necessarily need to be broken and restarted. However, the point made by my noble friend is a good one and we are looking at ways of ensuring that more and better recommendations for grants go into the system in the first place so that, basically, we can spend the money more quickly.

Covid-19: Test and Trace App

Baroness Morgan of Cotes Excerpts

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, from the beginning we have worked closely with other countries, including in Asia, Europe and America. We have worked closely with companies including Apple and started our dialogue with it the moment it launched its app. There are a number of challenges. A most profound one is our need to use technology to tackle local outbreaks. Without local information on where new cases have originated, it is difficult for the Government to achieve that task. We look forward to working with Apple to try to define a use case around that.

[Baroness Morgan of Cotes (Con) [V]]

Has this experience prompted broader reflection in government about the influence of big tech companies in so many spheres of our lives? Has it prompted a need and desire for proper regulation of those companies now to be brought to bear?

[Lord Bethell]

My Lords, it has been my experience that working with some of the biggest companies in the world in pharmaceuticals, in diagnostics and in tech has brought to the fore the paramount importance of partnership with big industry. We have benefited enormously from such partnerships and I thank some of the major companies that we have worked with. However, it is undoubtedly the case that government has its own agenda and it is important that we work to champion the needs of the British public, which is where our biggest interests lie.

Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.

[Nicky Morgan (Loughborough) (Con)]

ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?

[Jackie Doyle-Price]

I have corresponded with my right hon. Friend and the hon. Member for Leicester South (Jonathan Ashworth), but I am more than happy to meet them to discuss that issue. From my perspective, services for people with ADHD are a bit of a Cinderella and I would like to do my best to address that, working with colleagues across the House.

Appropriate ME Treatment

Baroness Morgan of Cotes Excerpts

Thursday 24th January 2019 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

It was a pleasure to apply for this debate with the hon. Members for Glasgow North West (Carol Monaghan) and for Ceredigion (Ben Lake) and others. [Interruption.] How could I possibly forget the hon. Member for Ealing North (Stephen Pound)?

Like other Members, I will speak about my own constituents’ experiences. As we have already heard, so many Members are here on a Thursday afternoon to talk on behalf of their constituents. We held out for a debate on the Floor of the House, and we are debating not a “take note” motion but a substantive motion. This House debates many contentious issues, passions can run high and there can be many points of order, but hopefully we will see the House of Commons at its finest this afternoon as we do our job of bringing to the attention both of Ministers and of the wider public an issue of real importance that devastates the lives of our constituents and their families.

We have already heard about the issues of funding for biomedical research, and it is clear that, given the prevalence of the condition, there must now be an increase in funding not only to help advance our understanding of its underlying biology but to develop new diagnostic tests and better, more targeted treatments. The problems and dangers of graded exercise therapy and CBT have already been powerfully set out. My constituents have also called for NICE to take their concerns into account and to remove those treatments from its guidelines. We have heard the call for NICE to issue an immediate public statement on the harm that may be caused by the current guidelines for the period they remain active.

It is right that we want GPs and health professionals to know more.

[Paula Sherriff]

My constituent has to travel 40-odd miles to Manchester for treatment. With a condition such as ME, that is particularly distressing. Does the right hon. Lady agree that we need many more specialists throughout the country?

--- Later in debate ---

[Nicky Morgan]

I agree with the hon. Lady. We all know that resources may be constrained, but we want our constituents to be able to see specialists who really know about a condition. One of the most powerful things that we have heard is that not only are sufferers fighting a condition that makes them feel terrible, but they are not believed when they say what they are going through. That must compound the difficulties of the condition. Having a GP who not only believes them, but wants to help and understand, would make a huge difference. The same is true of other health professionals.

We have talked about children being affected. One of my constituents wrote to me to say that she had had ME since 2013, and had been left housebound. She added:

“As if having this illness wasn’t devastating enough, in 2016, my then 10 year old son became unwell and never got better, he has also been diagnosed with ME.”

We have heard today about the potential involvement of child protection services. In addition, some schools can deal with the condition, but some schools will struggle. I was contacted only this week, as the debate was being advertised, by another constituent. She talked about her daughter, Elisha, who is now 11 years old and has had ME for four years. Elisha has been discharged from the community paediatrician, physiotherapist and occupational therapist and left with no support or medical help, because there is no funding for paediatric ME care in Leicester or Leicestershire. She has missed most of her schooling in the last four years. Clearly, with children as well as with adults, people must be believed and the condition must be investigated. It is a considerable source of stress for parents and carers, but of course it has a negative effect on the child’s personal development and future life chances.

I have family experience of ME, but I want to pay tribute to the constituent who first brought the matter to my attention, Sarah Reed. Some Members, particularly Opposition Members, will know her as the wife of the former Labour MP, Andy Reed, who was my predecessor in Loughborough. Sarah has been a tireless campaigner for ME Action and for sufferers.

There are 250,000—a quarter of a million—sufferers of ME, or chronic fatigue syndrome, in the UK. With any other condition, we would not allow a situation in which people continue to struggle to have their voice heard, and the NICE guidance takes so long to be delivered. There are many examples, and it is time for the Government to respond.

Budget Resolutions

Baroness Morgan of Cotes Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

No. The £84 billion is the cash figure. The £20.5 billion is the real-terms increase by the end of the five years. If we add up all the extra money, we get £84 billion. It is there on page 36 of the Budget, if the hon. Lady wants to look. The biggest single cash increase comes next year, in 2019-20. It is all there in the Red Book.

[Nicky Morgan (Loughborough) (Con)]

I thank the Secretary of State for more good news for the midlands in the form of £70 million for the Defence and National Rehabilitation Centre just outside my constituency to help civilian rehabilitation. Can he share further details of that with us?

Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 24th July 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Clearly, the sequence of events that the hon. Lady has outlined is completely unacceptable. We have obviously set out clear expectations on NHS England to commission sufficient beds to enable local placements where possible and specialist care where a more acute service is required. It is up to NHS England to ensure that sufficient services are commissioned and I will readily take up that case with NHS England.

[Nicky Morgan (Loughborough) (Con)]

I welcome my right hon. Friend to his new position.

On Friday, a retired NHS consultant visited my surgery to talk about carpal tunnel syndrome. It appears that some of the operations are not going to happen now, and he said that they can happen at general practice level for about a third of the cost that they happen at hospital level. Is there an opportunity, yes, to save money but also to do things better by moving surgery out to community facilities? Can we explore such opportunities before these decisions are taken?

[The Minister for Health (Stephen Barclay)]

My right hon. Friend raises an important point about ensuring that procedures are done in the right place at the right cost, but primarily in a way that is best for the patient. I am happy to meet her to discuss the specifics of that and to see whether a change can be made.

PACE Trial: People with ME

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Tuesday 20th February 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Mr Hollobone. I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing today’s debate. As she has articulated so beautifully, the situation is clearly very concerning. I know that she has done an enormous amount of work in this area, and has met people, both in her constituency and more widely, affected by the condition, and with expertise on the condition, to hear about its impact on individuals’ lives. As MPs, we all know people in our constituencies who are affected by the condition.

As we have heard, chronic fatigue syndrome, also known as myalgic encephalomyelitis or encephalopathy, is a debilitating and very poorly understood condition, which is estimated to affect more than 200,000 people in England. We do not understand the underlying causes of it, there is no one diagnostic test to identify it, and although patients can improve and recover, there is no cure for it. The condition, which for brevity and to avoid covering you in a thin layer of spittle, Mr Hollobone, I shall refer to in the abbreviated form CFS/ME, can stop a life in its tracks, leaving sufferers unable to carry out the most basic tasks. In the most serious cases, people can be bedbound for weeks at a time. It has a complex range of symptoms, including a very disabling, flu-like fatigue and malaise, and neurological problems. Of course, the impact on friends, families and carers can be significant as well.

It is also true that the difficulties in diagnosis mean that patients with CFS/ME often experience delays in getting the treatment and support that they need. In recognising the need for GPs to be aware of the condition, the Royal College of General Practitioners identified CFS/ME as a key area of technical knowledge that GPs should have as part of their qualifying exams, which answers a question raised by the hon. Lady.

The recommended treatments for CFS/ME, namely cognitive behavioural therapy, or CBT, and graded exercise therapy, or GET, and the evidence for them are the subject of today’s debate. Those treatments were first recommended for patients with mild or moderate CFS/ME in 2007 in the NICE guidance, in line with the best available evidence, which showed that the treatments offered benefits. The guidance sets out that there is no one form of treatment to suit every patient and that the personal needs and preferences of patients should be taken into account. Doctors should explain that no single strategy will be successful for all patients; that in common with all people receiving NHS care, CFS/ME patients have the right to refuse or withdraw from any part of their treatment; and that those with severe symptoms may require access to a wider range of support, managed by a CFS/ME specialist.

The results of the PACE trail, which examined pacing therapy, cognitive behavioural therapy, graded exercise and specialist medical care for chronic fatigue syndrome, were published four years after the NICE guidance. The trial ran from 2005 to 2011 and, contrary to what the hon. Lady said, was primarily funded by the Medical Research Council, not the DWP. Total funding was £5 million and the MRC contributed almost £3 million.

The study was undertaken by the Queen Mary University of London. It was the largest ever trial for CFS/ME, including more than 600 participants in England and Scotland. It sought to assess and compare the effectiveness of the four main treatments for CFS/ME—adaptive pacing therapy, CBT, GET and standardised specialist medical care.

The peer-reviewed trial results published in The Lancet in 2011 found, as the hon. Lady said, that 60% of patients with CFS/ME benefited from CBT and GET when provided alongside specialist medical care. CBT and GET were found to be better than pacing therapy or specialist medical care alone in improving both symptoms and disability, and a follow-up study looking at recovery after one year further supported the benefits of interventions. The trial had ethical approval from the NHS research ethics committee and had ongoing oversight from an independent trial steering committee, which included patient representatives. Trial reports were regularly provided to a data monitoring and ethics committee that had the power to halt the trial if harm was indicated. NICE considered the PACE results in 2011 and concluded that they supported its existing recommendations on both CBT and GET.

The Government are aware that the use of CBT and GET in treating CFS/ME has long been a controversial issue for patient groups, charities and some clinicians. That began with the publication of the NICE guidance 10 years ago and continued with the PACE trial. Since 2011, PACE trial data has been shared with many independent scientists as part of normal research collaboration, including the internationally respected research organisation Cochrane, which independently validated the findings. However, in the last 18 months, the attention on the trial has increased substantially, following a tribunal ruling in August 2016 ordering the release of the trial data to a member of the public, which the hon. Lady referred to. The data has since been examined more widely and critics, including some clinical academics, have suggested that it shows that CBT and GET are not as effective as the trial results suggested.

[Nicky Morgan (Loughborough) (Con)]

This is clearly a very important debate. I think both the hon. Member for Glasgow North West and the Minister would agree that it is not possible to do justice to the concerns raised by all our constituents, and the 200,000 sufferers that the Minister has identified, in half an hour. Does the Minister agree that this is a subject worthy of wider debate in the House of Commons? Constituents such as Sarah Reed, who have written to me, say that because of the belief in CBT and GET, and because academics believe in the results, many other treatments have not been pursued. Does the Minister feel angry about that?

[Caroline Dinenage]

I thank my right hon. Friend for her intervention. As has already been said, it is important that we listen to patients. As I will go on to explain, NICE is now looking at reviewing its guidance on this and, in the light of that, it may well be worth discussing the issue more fully.

Health

Baroness Morgan of Cotes Excerpts

Tuesday 17th July 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

It is a pleasure to speak in this debate and particularly to follow the remarks of the hon. Member for Leicester South (Jonathan Ashworth) about children’s heart surgery at Glenfield hospital in Leicester. In view of the time limit, I will not repeat the issues to do with the Safe and Sustainable review, because those have been well rehearsed by other Members.

It is no great surprise that all Members, as well as all patients, all staff, all parents and all families, want the best services when dealing with children’s heart surgery. We are talking about very sick young babies and children, and there is no doubt that high-quality services are wanted across the country. At the same time, we have to recognise that in the 21st-century national health service there are bound to be reconfigurations. The reconfiguration that has been worked on by the Safe and Sustainable review arises out of what happened in Bristol, and there is a very good reason for what it proposes. As we have heard, there are some serious questions still to be answered about the process and the way in which decisions have been made.

In the debate in this Chamber in June 2011, I talked about the ECMO—extracorporeal membrane oxygenation —service offered in Leicester, which the hon. Member for Leicester South discussed. It is a world-class, excellent service, and the question is what will happen to it if the children’s heart surgery unit is moved from Leicester to Birmingham. Like the hon. Gentleman, I thank the Minister very much for meeting a delegation of east midlands MPs this afternoon to talk about this. ECMO is a nationally commissioned service and the Secretary of State is therefore required to sign off the move. I understand that he accepted the recommendations of the panel last Friday.

Those of us who are most interested in this and have been listening to constituents and to consultants and staff at the Glenfield unit have a number of questions to raise with the Minister. I would like to be sure of three things before I can be happy with how the decision has been taken. First, before the Secretary of State signed off the move, was he aware of the misgivings of experts that have been described by the hon. Member for Leicester South? Letters are still arriving from international experts. Indeed, since I have been sitting in the debate I have seen a letter that has arrived from the medical director of the Children’s Hospital of Philadelphia. I should like to read out a couple of quotes. The first is from Stephen Conrad, who is chairman of the steering committee of the Extracorporeal Life Support Organisation and who says that

“moving an ECMO program is non-trivial and amounts to much more than moving equipment and some key personnel. Excellent outcomes that are now characteristic of the Leicester group, whose work was instrumental in the worldwide adoption of pediatric and adult ECMO, would not be maintained following such a move.”

[Liz Kendall]

I am grateful to the hon. Lady for her work on, and support for, this important issue. Does she agree that this is not simply a matter of moving the machines but also about the expertise and skills of the staff, which would not be easy to move? Leading international experts on ECMO say that it could take between five and 20 years for the excellent level of service that is available in Glenfield to be made available anywhere else in the country.

[Nicky Morgan]

I am grateful to the hon. Lady; she is absolutely right. The hon. Member for Leicester South referred to Kenneth Palmer, who was retained to give his expert advice to the Joint Committee of Primary Care Trusts on the move. Since the decision was made on 4 July, he has said:

“You will take over 20 years of experience from one of the world’s absolute best ECMO units and throw it away and then to rebuild it in another place and probably it will take at least 5 years to have some kind of quality and probably 20 years to come back to top quality, if it’s ever possible.”

As the hon. Lady said, it is about the staff. Of course the machinery is important, but what has been built up in Leicester, and what it is most renowned for, is the expertise of its consultants, nursing staff, and all the other staff. That is what people particularly rely on. In addition, Leicester has the only paediatric mobile ECMO unit, which is often called out to fly by helicopter to other parts of the country to retrieve patients and take them back to Leicester. I hope that the Secretary of State and the JCPCT were aware of that when they made their decision.

My constituent, Mrs Edith Felstead, who wrote to me and talked about the risk of moving the service, says that survival rates at Glenfield are 20% better than in the rest of the world. The point that I made last year and still want to make is that we have an excellent, internationally renowned service, and if we move it, we must be sure that we are doing so to obtain better outcomes. Will the Minister tell me what advice was given to the JCPCT about the likely outcomes if the move were made?

The rather hefty tome that was published to help the JCPCT to make its decision on 4 July, refers to the secretariat being able to provide “reasonable assurance” that paediatric respiratory ECMO could be transferred safely to Birmingham. I am concerned about that phrase. What assurances have been given? In particular, if the move goes ahead and has to be implemented, what will happen if it then becomes clear in the course of preparing for the move that the service cannot be safely moved and we need to undo some of what has happened as a result of the review?

As the hon. Member for Leicester South said, two narrow questions could be independently reviewed in relation to the Leicester move. I very much hope that following the meeting that we have just had and this debate, the Minister will agree to such a review. I would like to know what advice was available to the Secretary of State and to the JCPCT and the Advisory Group for National Specialised Services before they made their decision.