Congenital Cardiac Services for Children

Baroness Blackwood of North Oxford Excerpts

Thursday 23rd June 2011 Commons Chamber

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

I, too, congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on his leadership in securing the debate. I open my remarks by paying tribute to Oxford’s paediatric cardiac team, including Professor Steve Westaby. The team have saved countless lives and have the complete confidence of the patients and families who have asked me to speak up for them today. I also pay tribute to the Young Hearts charity, which has stood up for children with congenital heart disease and their families in Oxfordshire and presented a petition, which I am holding in my hands, with thousands of signatures to the Prime Minister in his constituency this month. They have done much to assure services in Oxfordshire.

Few would take issue with the basic aims of the Safe and Sustainable review; who does not want to improve outcomes for children with congenital heart disease? That is not where the concerns lie. The review works on a simple premise: more surgeons doing more surgeries will achieve better outcomes for more patients. That makes perfect sense, but in this instance, as the motion states, size is not everything. Although the simple centralisation of specialist services is backed by clinical evidence, some clinicians in Oxford, Southampton and elsewhere are of the opinion that it draws on too narrow an evidentiary base and that matters such as the co-location of services, assessed travel and population projections must also be considered.

On co-location, for example, a 2008 Department of Health report states that cardiac surgery requires the absolute co-location of paediatric cardiology, paediatric critical care, specialist paediatric anaesthetics, specialist paediatric surgery and specialist paediatric ear, nose and throat services. Even though Safe and Sustainable states that the co-location of those services should be mandatory, it is not clear how the four proposed options meet the standards of the framework of critical interdependencies or, for that matter, the standards of Safe and Sustainable itself. I hope that the Minister will note those grave concerns, which patient groups, families and clinicians have expressed, and will ensure that the joint committee of primary care trusts takes the process forward, clarifying the issue of the co-location of service and properly and transparently communicating that clarification to those groups.

A child with congenital heart disease does not exist in isolation. He or she is cared for tirelessly by family members who have to make terrifying treatment decisions, and by siblings who have to accept that home life is on hold while parents go to and from hospital and everyone concentrates only on keeping that child alive. That is what parents do for their children. It is what they sacrifice and do without hesitation, because nothing matters more than bringing that child home again, happy and healthy, so that everything can get back to normal. No matter how freely they give that care, however, caring for a child with congenital heart disease puts massive stresses on parents and siblings, and the outcome of the review should also try to relieve that pressure, if at all possible.

That is not just a moral argument; paediatric patient outcomes improve when carers cope better. I know that Ministers believe that the best possible surgical outcome is the best way to help families, but families who come to see me are worried that they will not be able to get to the hospital for the surgery in the first place; that there will be longer waiting lists; that they will not have continuous care under surgeons whom they can trust with their child’s life; that staff at units that close will not be able to move to those that scale up; that we will lose dedicated people from the NHS; and that there will be a shortfall in service while new staff are trained up. All those concerns are just as valid and significant as ensuring that the surgeon has the necessary skill once he gets the patient on to the operating table.

The irony is that, while the Safe and Sustainable options are causing that concern, Oxford and Southampton already have an option that is working as we speak. The south of England congenital heart network offers the quality guarantees of an increase in clinical team size and patient base that Safe and Sustainable seeks, while creating and retaining the continuity of care and patient access that local clinicians and patients fear losing. That network was developed and is led by clinical teams at Oxford and Southampton; it has five congenital heart surgeons and nine consultant paediatric cardiologists; and it is the first time that two teaching hospitals have collaborated to provide joint tertiary clinical service.

That is exactly the kind of networking arrangement that Safe and Sustainable aspires to create, but the network puts the patient first, not the surgeon. It makes the best use of existing services but does not require extensive restructuring of human or physical resources; it addresses the problems of waiting times, travel times and co-location which Safe and Sustainable has failed to address; and, most importantly, it has been tried and tested for more than a year.

There is a risk that Safe and Sustainable will be seen as a top-down, inherited review, so a locally innovative system such as that network, which is supported by local heart groups, supported by local clinicians and clinically driven, is something that the Government should seek to support.