Children’s Cardiac Surgery (Glenfield)

Anna Soubry Excerpts

Monday 22nd October 2012 Westminster Hall

[Jonathan Ashworth (Leicester South) (Lab)]

It is a pleasure to speak in this debate under your chairmanship, Mr Hollobone.

I pay tribute to the hon. and learned Member for Harborough (Sir Edward Garnier) for securing this debate, and I am grateful to the Backbench Business Committee for allowing us to hold it this afternoon.

The hon. and learned Gentleman, who is one of my parliamentary neighbours, spoke with typical eloquence, as is his wont, and I for one am disappointed that he no longer graces the Government Front Bench. The Front Bench’s loss is the Back Bench’s gain, and I thought that he spoke extremely well. I apologise in advance if I echo many of his points, but that indicates the cross-party support for the campaign. Although we are perhaps blessed in not having any Liberal Members in the east midlands, I am sure that, if we did, they, too, would support the campaign.

As I am sure that the Minister, who represents an east midlands seat, is aware, this issue has caused considerable concern, not only in my Leicester South constituency, but across the east midlands region. It is no surprise to those of us who have been involved in the campaign that the e-petition has hit 100,000 signatures, and I pay tribute to Adam Tansey, the father of Albert Tansey, who set up the e-petition.

There has been widespread opposition to the proposals from the Safe and Sustainable review and how they affect Leicester. The review recommended the closing of the children’s heart unit and the associated moving of Leicester’s world-class extracorporeal membrane oxygenation service to Birmingham. Local people have campaigned vigorously against the proposal, and I pay particular tribute to Ms Robyn Lotto—a constituent of mine who has magnificently led much of the local campaigning in recent weeks. We should also pay tribute to Glenfield’s staff, who are very concerned, as the hon. and learned Gentleman indicated when he read out the circular that we were all sent.

Many organisations in Leicester and beyond have spoken out. The vice-chancellor of Leicester university, Sir Bob Burgess, said:

“Glenfield is a leading international heart hospital where excellent clinical care takes place within a context of internationally significant research. I would therefore ask that the proposal to move the Glenfield services be reconsidered and this valuable facility retained for people of our region.”

The Bishop of Leicester, who I see observing us, said:

“It is not…clear that the movement to Birmingham will be straight forward… In fact I fear that the movement of these services will be harmful to the nation as a whole”.

As I have mentioned, politicians from all parties have come together on this campaign. Politicians on the Labour-dominated Leicester city council are working alongside politicians on the Conservative-dominated Leicestershire county council and on what I assume is the Conservative-dominated Lincolnshire county council, and they have all expressed their concern.

MPs on both sides of the Chamber are speaking up, and, as the hon. and learned Gentleman did, I pay tribute to my hon. Friend the Member for Leicester West (Liz Kendall), who in many ways has spearheaded the campaign from our side with her usual pizzazz, and to the hon. Member for Loughborough (Nicky Morgan), who cannot speak in this debate because she is a Government Whip—fortunately for me, Opposition Whips can speak—but who I am sure would speak if parliamentary convention allowed.

I am, of course, pleased that the Secretary of State for Health has today announced that the independent committee will conduct a full review and report back at the end of February next year. Notwithstanding that welcome announcement, I want to make a number of points on which I hope the Minister can provide clarification.

On demand and capacity—I appreciate some of these points might be for the review committee, but it is important to get them on the record—genuine questions have been raised about the assumptions on demand and the capacity on offer at Birmingham that the joint committee of primary care trusts used. As I understand it, the national projections used by the review assume that demand will be flat, yet the most up-to-date data show demand increasing, because birth rates in the east midlands and west midlands are well above national averages. The projections of population trends used by the review team were based on data from 2006-07. Using those data would suggest a relatively stable work load rising to 3,990 cases in 2025, but, if the latest data on population expectations from the Office for National Statistics are used, the projected rise in surgical case loads hits 5,422 in 2025. Questions have also been raised about the likely patient flows, with clinicians suggesting that Sheffield and Doncaster have indicated a preference for Birmingham rather than Newcastle.

Given that extra surgery work, the movement of the ECMO provision, the increased population projections for the midlands and the worries about increased patient flows from south Yorkshire, I would be grateful to the Minister if she let us know whether the Department is confident that Birmingham has the capacity to meet what is clearly set to be considerably increased demand.

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

The hon. Gentleman knows, of course, that the Independent Reconfiguration Panel will no doubt consider all his points. As he knows, from the outset, this has been an independent process decided by clinicians. In those circumstances, I am sure that he will make it clear that I am in no position to answer any of his points, which must be addressed by the IRP. Does he agree with me on that?

[Jonathan Ashworth]

The Minister makes an important point. None the less, I still think that, even if it is not appropriate for her to respond, as I suggested might be the case, this is an appropriate forum to put some of those points on the record, and I will continue to do so. I entirely understand her position.

I have a couple of points to make on Leicester’s paediatric cardiac intensive care unit, which the hon. and learned Member for Harborough mentioned. There is concern about how the decision will affect the wider paediatric cardiac intensive care on offer in Leicester, with the potential closure of the unit at Glenfield increasing pressure on the other Leicester hospitals and, more generally, reducing the supply of paediatric intensive care across the east midlands and placing more demand on Birmingham. Again, that is an important point. If the Minister cannot respond, I hope that the committee at least will take it into account.

I want to focus on the ECMO service, as the hon. and learned Gentleman did, and as I suspect many other hon. Members will, too. As I said at the outset, I entirely welcome the Secretary of State’s announcement this morning, but—I will quote from the letter, as the hon. and learned Gentleman did—I am disappointed that he said:

“The decision of the SoS taken regarding the removal of the ECMO equipment”—

he uses the rather bland word “equipment,” but the decision is quite controversial, so describing it in that way is unfortunate—

“from Glenfield to Birmingham should not form part of the review as the decision was not taken by the Joint Committee of Primary Care Trusts.”

That is right, but as has been said, the two things go hand in hand.

I shall repeat some of the points that have already been made. The ECMO service at Glenfield is the longest-established and provides 80% of ECMO capacity nationally. Many of its staff have more than 20 years’ experience. Glenfield’s ECMO service has some of the very best mortality rates. The mortality rate for ECMO at Glenfield is 20%, but the national mortality rate is 50% higher. Will the Minister address the decision not to include ECMO in the review? Does she expect to be able to pick up an ECMO unit in one hospital, plonk it into another and find that the same expertise and mortality rates will transfer with it? As has been said, many international experts do not think so—certainly not in the short run. We have already heard about Kenneth Palmer, the expert ECMO adviser, who told BBC Radio Leicester:

“They could never have the same survival rate in another unit if you move it like this.”

He also said—I think that the hon. and learned Member for Harborough quoted this, and I will repeat it:

“Moving one unit to another place is the same as totally closing down and rebuilding from zero in the new place... I have been very clear…that you cannot move a unit; you can just destroy it and rebuild with many years of decreasing survival rate and increasing morbidity.”

In other words, he is concerned that lives will be lost.

Another international ECMO expert, Dr Thomas Müller, says that

“in the interest of best patient care the decision to close down the most experienced centre in the UK is difficult to comprehend.”

Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, has already been quoted in the debate. He said on BBC Radio Leicester that the ECMO unit is

“considered one of the finest ECMO units”

and described it as a “real jewel”. When he was asked on the radio whether he thought lives would be lost he said:

“I do agree with that unfortunately, I think the risk is great”.

International experts are therefore deeply concerned about moving ECMO from Leicester to Birmingham. One of their concerns is that the institutional memory, built up over a generation by the team, will be lost. That is one reason why I find it slightly disappointing when the Secretary of State presents the matter as just moving equipment from Glenfield to Birmingham. We have already heard that many of the staff feel that they will not be able to move. I shall repeat the quotation from the letter that they sent us all, because it is worth focusing on:

“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.”

As I understand it, 13 nurses are required for one ECMO bed, so there are concerns about Birmingham’s ability in the short run to build and develop a dedicated team of expert staff similar that at Leicester.

Given that the review panel will not consider the ECMO decision, I should be grateful to the Minister if she shared her analysis, or the Department’s analysis, of the risk assessment of moving the ECMO facility. It has been suggested in past debates—indeed, if my memory serves me correctly, it was suggested in a useful meeting that we had with the previous Minister, now the Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns)—that different experts had advised the Department and that they did not share the analysis of Mr Palmer and others. I apologise if my memory of that is slightly wrong, but if that is the case, perhaps the Department will agree to publish the evidence.

We have a campaign including an e-petition signed by 100,000 people—clinicians, staff and members of the public—who are deeply concerned about the proposal to move the ECMO unit. They accept the argument made by Mr Palmer and others. If the Department thinks that there is a different analysis to be considered, perhaps it will finally publish it, so that both sets of analysis can be properly scrutinised, and we can come to a considered opinion. That would reassure us on the point about mortality rates.

I would be interested in hearing the Minister justify the decision not to allow the IRP to consider the ECMO decision. Was not the decision to move ECMO taken and presented as a necessary consequence of the decision taken by the JCPCT in relation to the Safe and Sustainable review? Given that that was the context in which the ECMO decision was made, does it not seem odd that the review committee will not now consider the decision to move ECMO? If the justification is that there is a procedural argument that the various local authorities have asked the committee to consider the outcome of the Safe and Sustainable review and that ECMO was not part of that, fair enough, but it would leave a rather sour taste in the mouth of many campaigners who signed the petition. If that is the case, is there any way in which the ECMO decision can be reviewed? Can the Secretary of State consider reversing the decision of the previous Secretary of State? Many of us who are involved in this cross-party campaign would be grateful for guidance on that from the Minister. I am not sure whether the campaigners would feel pleased if, despite their winning the review, the ECMO unit were still to be shifted.

Many hon. Members want to speak, and because of the cross-party nature of the campaign, we are probably all making similar points, so I will conclude my remarks, but I encourage the Minister to focus on the point about ECMO. There is deep concern about it. People will be pleased about the review, but concerned that ECMO seems to have been excluded from it, and I hope that she can give us some reassurance.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) on securing the debate and other Members on all the contributions that we have heard. I pay tribute to all Members who have attended today, as well as those who have spoken. My hon. Friend the Member for Pudsey (Stuart Andrew) attended the debate but, unusually perhaps, has not made a speech, although we have not been discussing the hospital for which he has campaigned so hard.

I pay tribute to all Members who have spoken in numerous debates in the House, written letters to Ministers, met and conferred with local groups and experts and spoken at length to their ordinary constituents. As a result, we have heard a moving story from the hon. Member for Leicester West (Liz Kendall) about the services offered at Glenfield, and there are many more stories to be told about children’s heart services centres throughout England. All such Members have campaigned locally to have decisions overturned or reviewed in some way, or to ensure that the right decisions have been made on the right basis. They have brought such arguments and their campaigns to the House, as they should do, because each of them is doing their job as a first-class, local constituency MP by bringing important issues to this place.

I also pay tribute to great cross-party work, which my hon. and learned Friend the Member for Harborough mentioned, both in Parliament and locally. Forgive me for speaking not only as a Minister but with my other cap on as the Member of Parliament for Broxtowe. On my local television service, I have seen and witnessed such cross-party work, which is to be commended; such issues are not party political and certainly nothing to do with any alleged cuts. This is about how we ensure that our children and babies get the very best heart surgery services that we can give them.

I must pick out my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West, who together have spearheaded the campaign, but I also pay tribute to all the work and effort of the hon. Member for Leicester South (Jonathan Ashworth), who joined them at the meetings. Everyone involved in the process up to the decision of the joint committee of primary care trusts has been motivated by the very highest of intentions to ensure that our children and babies receive the very finest heart surgery services that we can provide, and that those services are sustainable.

I will deal with as many of the points that have been raised today as I can. As I said at the outset, hon. Members should make and have made their points so that they can be recorded—not just so that their constituents can see how they have advanced the argument, but so that those who, in turn, must look at the decisions that have been made and consider the arguments can see how important these matters are, because they have been raised in Parliament by local Members.

I turn to what has happened today and what is, in some respects, the nub of the debate, which has been very good. As many hon. Members know, councils have a right to challenge the JCPCT’s decision, and today the Secretary of State has agreed that the Independent Reconfiguration Panel should conduct a full review. I will come to what that means in a moment. He has asked the panel to report back by the end of February—my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) was worried about the time factor—or, and this may concern my hon. Friend, after conclusion of the legal proceedings brought by a Leeds-based charity, which may delay things, although I hope not.

The review will consider whether the proposals for change under the Safe and Sustainable review of children’s congenital heart services will enable the provision of safe, sustainable and accessible services, and if not, why not. The panel’s review will also be able to consider how the JCPCT made its decisions and—hon. Members may think that this is the most important point—the implications of those decisions for other services.

The Independent Reconfiguration Panel today received instruction from the Secretary of State and will now begin to consider how to constitute its review. It is, of course, a matter for the panel to decide how to conduct that review. It is an independent body, but I make it clear that it will look at all the decisions and—for many hon. Members this is most important—at the implications of those decisions, which includes the implications for the unit at Glenfield.

[Stuart Andrew]

rose—

[Liz Kendall]

rose—

[Anna Soubry]

I shall give way to my right hon. Friend the Member for Pudsey, then to the hon. Member for Leicester West.

[Stuart Andrew]

I thank my hon. Friend for the promotion. I am grateful that there has also been cross-party support in the campaign to keep the unit in Leeds open. I want absolute clarification on the IRP. Will she assure me that it will consider the whole decision-making process, including the initial assessments and all the data that were submitted? That is where many of us believe there to be inaccuracies, which have brought about the wrong decision.

[Anna Soubry]

I am grateful to my hon. Friend. It will be for the IRP to decide the full extent of its review of all the decisions that have been made, but the points that he has made here and in various letters will no doubt be put to it for consideration. I am told that, so far, it has not had a formal request from Leeds city council’s overview and scrutiny committee, and perhaps he can prevail on the committee to make that submission as a matter of urgency, so that we can all be absolutely sure that the review will be concluded by the end of February, and that there will be as few delays as possible.

[Liz Kendall]

The Secretary of State’s letter today says that his decision regarding removal of ECMO from Glenfield to Birmingham should not form part of the review. Is the Minister saying that the IRP will not look at the Secretary of State’s decision, but that it can look at ECMO services, although not at what he said? I am afraid that that is still unclear.

[Anna Soubry]

I am grateful for that intervention. I will explain why the Secretary of State has not been able to review the previous Secretary of State’s decision in this way. However, I am making it clear that the IRP will look at the implications of the decisions, and I will shortly turn to why the previous Secretary of State’s decision is not part of the process. I will then answer some of the specific points that have been raised by the hon. Member for Leicester South, but I want to finish dealing with the IRP.

More generally, in undertaking its review—this may assist my hon. Friend the Member for Pudsey—the IRP will interview and take evidence from a number of parties, including, but not limited to, NHS organisations, local authorities and local Members of Parliament. That will normally include evidence used in developing recommendations and proposals, taking decisions and national guidance.

I turn to the specific point about why the decision to move the children’s ECMO services over to Birmingham from Glenfield is not part of the review, or at least part of today’s decisions. Decisions about ECMO for children at Leicester being moved to Birmingham follow from the decision to transfer heart surgery to Birmingham. In other words, it was a consequence of the JCPCT’s decision. Children’s ECMO services are a nationally commissioned service, so the decision was taken by the Secretary of State, not the JCPCT. The Secretary of State made his decision based on the Advisory Group for National Specialised Services. To be clear, the JCPCT having made the decision, AGNSS then looked at the children’s ECMO services at Leicester and recommended to the Secretary of State that, in light of the JCPCT’s decision, those services should also be transferred to Birmingham.

I want to make it clear that it is unfortunate that the word “equipment” has been used. I am more than aware that the matter involves considerably more than pieces of equipment at Glenfield, and I pay full tribute to the team who work there, and indeed to the children’s heart surgery team there and to every team throughout the country. It is important to make it clear that no one is saying that a good service is not being provided, or that a service is bad or poor. The issue is all about ensuring that we get the very best service in fewer but bigger centres.

[David Tredinnick]

The Minister said that the issue is all about patients getting the best service, but I take her back to the point about the mobile service, which has been the subject of the thoughts of various hon. Members. Is there any way we can ensure that that aspect of the service is fully considered? If Birmingham will not commit to providing a mobile service, it is crystal clear that a number of patients will suffer.

[Anna Soubry]

I am grateful for that intervention. It may be argued that that is one of the implications of the JCPCT’s decisions. The children’s ECMO services at Leicester are being been moved over to Birmingham. That is an implication of that decision. Another implication is that there are concerns about the mobile unit for children’s ECMO as well.

The previous Secretary of State accepted the recommendations of AGNSS—the advisory group for national specialist services—and it is that information to which the hon. Member for Leicester South referred when he told us about his meetings with the then Minister, now the Minister of State, Department for Transport, my right hon. Friend the Member for Chelmsford (Mr Burns). The recommendations of AGNSS are made to the Secretary of State, on, as I understand it, a confidential basis. It is not normal for them to be disclosed, but the previous Secretary of State made his decision based on the advice of that service.

The question, as it has been rightly put today, is whether there is any challenge now to that decision. I am told that that is for the Secretary of State; he can, in exceptional circumstances, revisit that decision if those exceptional circumstances are made out. If the IRP wants another full review of all that has happened—it effectively calls into question the whole process, and so on—it obviously flows from that that the ECMO children’s service at Leicester must be retained in that event, because it flows from the JCPCT’s decision about where to have the specialist children’s heart services. In any case, if there is some other new or exceptional evidence that can be placed before the Secretary of State, or that he is aware of, he may be able to look again at the decision that was made by the previous Secretary of State. I hope that that is of some help. I can go no further and give no more detail, except, safe to say, that I am told that that is a rare and unusual event.

I remind everyone, as I conclude my remarks, what led to the review, the recommendations and the decisions. Concern about children’s heart services began a long time ago as a result of serious incidents in Bristol back in the 1990s. For some 15 years, therefore, it has been accepted, almost by everyone, that children’s heart surgeries were of great concern. National patient groups all agreed that what was needed was to ensure that we had surgeons, nurses and other health professionals based in larger, but fewer, specialised centres. That is why, as the hon. Member for Leicester West has identified, the previous Government set up the review. In many ways, it took courage to do so, because there had been a lot of talk about the issue but not much action. Everyone agreed absolutely that reducing the number of centres was necessary, so that we would have bigger numbers of surgeons, nurses and other specialists, and that the service could be better, but in fewer units. Therefore, to put it crudely, somebody was always going to lose out.

Although I have listened with great care to the remarks made by my hon. Friend the Member for Cleethorpes (Martin Vickers), this is an example in which we do not want a greater number of smaller units; it is a good example of where we want fewer, but much bigger units. It is perhaps worth remembering that children’s heart surgery has advanced considerably over the years, so that surgeons now operate on children who are often only two days old, with hearts the size of walnuts. It is argued that that is the most specialist, delicate and difficult of all surgery.

It is not surprising, given the service’s nature—the fact that it is for children and babies—that so many people who have experienced what Glenfield provides speak with such passion about it, and why they are so concerned about its future. That, too, goes for other places that have been told their facilities will be moved away—for example, from Leeds up to Newcastle. I pay tribute to all who have gone to the trouble of signing the e-petition in support of Glenfield. I can speak about the great campaign that was organised, having attended a Leicester Tigers rugby match some time last year; every seat had a leaflet on it and an event was organised in support of Glenfield. Other places, too, have organised campaigns, and rightly so. It is an indication of the passion and loyalty that such services engender in people.

There has, however, been a long process. There has been an independent review, aimed at ensuring that our children are operated on safely and given the very best services. As a result, tough decisions have been taken by the JCPCT. It has done that independently, and with considerable support from clinicians, royal colleges and many eminent bodies, as well as others who have spoken out in favour the proposals. However, today’s decision by the Secretary of State is to be welcomed. Everybody can now be assured that there will be an independent review of the decision—I stress the word “independent”. I have also made my observations about the possibility, if there is new evidence in exceptional circumstances, that the previous Secretary of State’s decision about the future of children’s ECMO at Glenfield may also be considered.

I hope that that will give some reassurance to hon. Members who have attended the debate. All their comments are listened to by both the Department and me. It is to be hoped that the review will be thorough, as I am sure that it will be, and swift; it will be concluded by the end of February.