Health

Debate between Baroness Morgan of Cotes and Liz Kendall

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.

NHS Reorganisation

Debate between Baroness Morgan of Cotes and Liz Kendall

Wednesday 16th March 2011 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

This debate is about one of the most important issues facing this House and this country: the future of our NHS. It has been an excellent and at times lively discussion, with important contributions from all parts of the House.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke with great passion about his recent experience of using the NHS and the importance of the NHS for his constituents. My hon. Friends the Members for West Lancashire (Rosie Cooper), for Oldham East and Saddleworth (Debbie Abrahams) and for Kingston upon Hull East (Karl Turner) gave compelling speeches about their concerns over what is really in the Health and Social Care Bill, including the implications of removing certain duties from the Secretary of State and of introducing competition law explicitly in the NHS for the first time. The hon. Members for Southport (John Pugh) and for St Ives (Andrew George) raised important and serious issues with regard to the Bill, including the implications of centralising services such as dentistry, pharmacy and primary care. It is far from clear how a national body will know what primary care services need to be commissioned in my constituency. They also expressed concerns about the dangers in the Bill. My hon. Friend the Member for Warrington North (Helen Jones), whom I am proud to be following, raised the importance of the threats to the “national” in the national health service and concerns about patients with long-term and chronic conditions, of whom we know there are an increasing number in the NHS.

The debate has shown that, as on so many occasions with this Government, it is not their rhetoric but the reality that counts. They promised in their manifesto an end to top-down reorganisations, but instead they are forcing the NHS through the biggest reorganisation of its life. As the right hon. Member for Charnwood (Mr Dorrell) has said many times, although unfortunately not in the House today, they are doing that at a time when the NHS faces its toughest ever period of funding, when jobs are already being cut and when, far from what the Secretary of State told the House earlier, waiting times are starting to rise.

The Government also say that they want clinicians to lead changes in the NHS, but their Health and Social Care Bill fails to guarantee even that GPs will be running consortia, let alone that hospital doctors, nurses or other NHS staff, who are so crucial to improving the quality of care, will be involved. As eight of the country’s leading patient charities said in a letter to The Times last month:

“The reforms will place £80 billion of the NHS budget into the hands of GPs, but plans to make GP consortia accountable to the public are far too weak.”

There is no requirement to have elected representatives on GP consortia, as the coalition agreement promised for primary care trusts. The new health and well-being boards will have no power to require GP consortia to do anything, and local councils’ scrutiny committees will actually lose some of their powers to refer decisions to the independent reconfiguration panel in the case of services not on the safe list of designated services.

At the heart of the Bill are proposals to change the NHS fundamentally that the Secretary of State simply does not want to talk about: his plans to run the NHS along the same lines as the gas and electricity companies.

[Nicky Morgan]

I know that the hon. Lady is a hard-working fellow Leicestershire MP, but I disagree with her. Is not the fundamental principle of the Bill, as we have discussed in the Public Bill Committee, that what constituents want is an NHS free at the point of need and the delivery of services, and funded by taxpayers? Which part of the Bill changes that fundamental principle?

[Liz Kendall]

What patients want is their views and voices to be heard. As the hon. Lady well knows, eight of the country’s leading patient charities, including the Alzheimer’s Society, Asthma UK and Diabetes UK, have said that the patient and public voice is not strong enough under the Bill, and they have demanded changes. I respectfully ask that she look at their comments and act on their views.

The fundamental issues at the heart of the Bill are turning Monitor, which is currently responsible for foundation trusts, into a powerful new economic regulator to promote competition across the NHS, and enshrining UK and EU competition law into primary legislation on the NHS for the first time. That is not my view but the view of David Bennett, the new chairman of Monitor, expressed in his evidence to the Public Bill Committee. The Government are explicitly modelling the NHS on the gas, electricity, railway and telecoms industries. Government Members who are shaking their heads or looking blank should read the explanatory notes to the Bill, which make that absolutely clear.

Paediatric Cardiac Surgery

Debate between Baroness Morgan of Cotes and Liz Kendall

Wednesday 7th July 2010 Westminster Hall

[Liz Kendall]

I agree absolutely with my right hon. Friend. Many parents and staff are rightly concerned about the implications of travelling longer distances, particularly in emergencies.

I am a former director of the Ambulance Service Network, and I know that paramedics are highly trained professionals—increasingly to degree level—who can provide lifesaving treatment for patients while taking them to specialist centres further away, but that is not always possible, and the review must thoroughly consider the implications of further travel for the lives that could and will be saved.

High-quality care is not just about standards of surgery, the links with other specialisms or the ability to access planned and emergency care. A recent event organised to discuss children’s heart surgery in Leicester was attended by more than 800 parents and former patients, and those present felt that many more people would have attended if the event had not been held mid-week and during working hours.

The families said that the help and support that they get from the nurses, doctors and other staff at Glenfield are outstanding, and the key point that came up time and again was the excellent communication and support provided by the centre. Parents spoke about how staff go the extra mile to explain diagnoses and procedures simply and clearly, often at a frightening and worrying time. Every child gets a diary that explains in a way the whole family can understand what care they have received. It provides something for the children to look back at when they are older.

Parents said that the staff were like members of their own family; they could ring them day or night if they had any concerns. That familiarity with individual patients and families is crucial. All the studies by groups such as the Picker Institute of patients’ experience of care prove that individual, personalised care and communication are vital. One young man said that the staff knew him as a person, not as just another case, and that he was worried that that would be lost in a larger unit or if his care were split between outreach clinics and other centres.

Families also spoke about the fantastic help they get from the Heartlink charity at Glenfield, which has raised money to provide accommodation so that parents can stay overnight with their children, a play area so that brothers and sisters can play while families are visiting the child, and day trips for the patients as they get older. Those wider aspects of care are vital to parents and patients, but are barely mentioned in “The Need for Change”. I urge the Minister to ensure that the review has fully considered those issues when it makes its recommendations.

The final factor that the review of children’s heart surgery needs to take into account is affordability. It must be driven by the need to improve quality, not to cut costs, and, in these financially constrained times, it must acknowledge that there will be costs associated with changing children’s heart surgery in England.

[Nicky Morgan (Loughborough) (Con)]

Like the hon. Lady, I have visited the Glenfield centre, which is close to my constituency. As the parent of a healthy child, I felt humbled by the care that I saw there. The point that she is making about cost is important, because we appear to be achieving neither safer care—there has always been safe care—nor more efficient care. I understand that the reconfiguration would be very expensive, and she speaks rightly about straitened economic circumstances at this time.

[Liz Kendall]

I agree absolutely with the hon. Lady. The costs associated with changing children’s heart surgery centres include not just physically expanding a centre’s buildings, beds and equipment, but retraining staff. When I went to Glenfield, I was told that many of the staff would not move if the centre were changed. It takes time and money to train new staff, particularly in such a specialised area, and the review must take that into account when it makes its recommendations.