Baroness Morgan of Huyton
Main Page: Baroness Morgan of Huyton (Labour - Life peer)Health: Congenital Heart Disease
Baroness Morgan of Huyton Excerpts
Baroness Morgan of Huyton (Lab)
My Lords, I am proud to declare my interest in this debate as chairman of the Royal Brompton and Harefield NHS Trust. I am also immensely grateful to the noble Baroness, Lady Boothroyd, for obtaining this debate and introducing it so brilliantly. I hope that the Minister realises what a formidable force she is and, importantly, that she understands that she stands at the head of a large, articulate, informed and angry group of patients, parents of patients, charities, local politicians and MPs of all parties—and that is before we talk about clinicians, academics and educators connected to our trust but also around the UK and globally. As you would expect, there is a lot of emotion, but crucially there is also a great deal of expert opinion and experience. I hope that the Minister has not just been supplied with a file that says, “The standards have been carefully drawn up and the consultation results will be reviewed diligently”. We need more than that.
The trust board would not stand in the way of change backed by strong clinical evidence, nor do we resist all change. We focus hard on patient outcomes and experience. Our opposition is neither nimbyism nor the result of closed minds. We are aware of the need to reconfigure and strengthen a range of services nationally in the medium and longer term. However, any such decisions at any point must be transparently discussed, clinically led and must put patient outcomes and care at the centre. So let us use these benchmarks in relation to CHD.
The services at the Brompton are world-renowned. Babies born with CHD live with often very complicated medical conditions all their lives. The Brompton manages the transition from child to adult care flexibly and brilliantly. The transition age can meet the needs of the individual patient rather than the patient being fitted into the structure. Remember that these patients often have complex special needs. The Brompton treats 12,500 patients, including 4,500 children. We performed almost 1,300 clinical procedures in 2015-6. Crucially, our 30-day patient outcomes are among the very best in the country and our “family and friends” recommendation rate is over 98%. I fully understand the history of the Bristol scandal but completely fail to understand the relevance of that history for services today at the Brompton.
The hospital is situated in Chelsea but truly is a national specialist hospital. For example, the main foetal referrals are from Queen Charlotte’s, St George’s and Chelsea and Westminster Hospitals, but there are formal outreach relationships with 23 trusts where over 8,000 babies are reviewed, with many babies coming to the Brompton for further investigation and/or treatment. Over a quarter of hospital admissions are from north-west London, a quarter are from other parts of London, a quarter are from the wider south-east, and the rest are from anywhere else in the country. There are dynamic relationships with a wide range of clinicians at a significant number of hospital trusts, which is as it should be for a specialist tertiary provider.
The Royal Brompton and Harefield Trust is internationally known for its education and training as well as its research, as we have already heard today. This is evidenced by the letter sent to the Secretary of State recently by 198 leading professionals from around the world, including Gary Webb from Cincinnati Children’s Hospital; Professor Khairy from Montreal Heart Institute; Professor Ju Le Tan from the National Heart Centre Singapore; Professor Diller from Münster, Germany; Professor Shah, cardiac director at the Geneva University Hospitals: Professor Geva from Boston Children’s Hospital and Harvard; and many other eminent professors from Brazil, Israel, France, Italy, Greece, India, Spain, Belgium, the Netherlands, Egypt, China, Sweden, Japan, Australia and Denmark. I could go on. In their letter they say that,
“by any measure the Royal Brompton’s CHD service is the largest in the UK with excellent outcomes. The Trust’s research team is the most influential in the world”.
They say that the plan will have “devastating consequences”. Similarly, the Joint Royal Colleges of Physicians Training Board has written to NHS England to express its deep concern about the future training of paediatric cardiologists.
Of course, bizarrely, none of this is disputed by the NHS England board. The trust meets 469 of its 470 care standards. Until a recent addition to the standards—a very specific designation of collocation—safe and sustainable specialised paediatric services were governed by the Baker review. This was detailed and thorough work led by a clinical advisory group. It was produced in collaboration with, among others, the Royal College of Paediatricians and Child Health and the Royal College of Surgeons.
Prof Mike Richards commented on Baker:
“This framework is a unique piece of work with clinical credibility and I commend it to commissioners”.
It gave clear advice on collocation of services as being either on the same hospital site or in neighbouring hospitals if specialist opinion and intervention were available in the same parameters, as though the services were on the same site. I shall tell the House what that means for the Brompton, which, as we have heard, delivers in partnership with Chelsea and Westminster Hospital, which is round the corner. It means service level agreements 24/7, 365 days a year; joint ward rounds; multidisciplinary meetings; integrated patient pathways; senior and junior staff rotation; shared imaging and digital systems; joint teaching programmes; and a gastro and general surgery portal.
However, suddenly there was a new heart disease review and a new definition of collocation, which meant more instability. No scientific or clinical evidence is given for this change. There is no suggestion that the current model provided by the Brompton does not and will not provide excellent care. Only 1% of children with CHD have needed non-cardiac emergency care, which has been delivered 100% of the time within 30 minutes.
Frankly, the consultative meetings have been insulting. I attended the one with staff at the Brompton where highly trained practitioners were treated to a parroting of the consultation documents. There was no serious engagement. No medical professional was sent to face the detailed, knowledgeable, evidenced questions of our staff. I was livid on their behalf, and frankly I was embarrassed on behalf of those sent to do the parroting.
What would the knock-on effects be? It would be a devastating blow, first, to the viability of the trust—that is, to two leading hospitals, the Brompton and Harefield—and, secondly, to paediatric intensive care; our intensive care unit would be non-viable. Thirdly, closure of the ICU would have a damaging effect on the intense treatment of cystic fibrosis and asthma, and a number of charities have talked about the many other services that would go. The body of highly skilled UK and international staff would be split, and people here know far better than I do the importance of that. Our staff have stayed but they are clearly anxious. The assumption in the consultation document is that people are like widgets that can be moved around.
Finally, I ask the Minister, first, whether she can produce the clinical and scientific evidence on which the proposals are based, not the minutes of the committee meeting that produced them. Secondly, will she commit to publish the submissions that have been received and the independent review of those submissions? Thirdly, will she explain to us what consideration has been given to the knock-on effects of this proposal?
Baroness Chisholm of Owlpen
I understand, but this is a time-limited debate. I have only 12 minutes to speak and if interrupted, I cannot. I am very sorry. I shall continue the quote:
“In … one year, a formal transfer of care was required to 18 different specialties … These specialties included urology, renal medicine, metabolic medicine, general surgery, respiratory medicine, plastics, neurosurgery, neurology and haematology”
Having those all in one location obviously makes a huge difference. This way of working brings paediatric cardiac care into line with expectations in other specialist children’s services. Collocation of specialist children’s services is the accepted international norm, and this is why the standard requires collocation on the same hospital site.
Baroness Morgan of Huyton
The way the Minister is replying suggests that the decision has already been taken. I thought we were having a consultation and there is then going to be a decision.
Baroness Chisholm of Owlpen
The decision has not been taken. I am explaining why collocation is the accepted international norm. I am not saying the decision has been made. I am just putting forward the reasons why we hope we will be able to do this, but the consultation will come out later in the year, we hope.
The noble Baroness, Lady Masham, asked about continuity of care. Collocation would encourage that. It not just about the ability to get to the bedside within 30 minutes of the call. The aim is to have immediate access to a full range of specialists, operating theatres and intensive care for the sickest children. Experience shows that once families have used a collocated service, they do not go back.
No final decisions have been made yet, and we need to wait to see what comes out of the next stage of the process. Responses to the consultation will now be carefully considered, and NHS England expects its board to reach a decision by the end of this calendar year. Any change to CHD services would be implemented at the correct pace. I want to be quite clear: this is not a cost-cutting exercise and funding is not the issue. The recent protest march, which featured the noble Baroness, shows how passionately people feel about these issues and their strong desire to defend their local services. I would gently suggest that in celebrating and cherishing the incredible achievements of our current services, we do not lose sight of the obligation we owe to future patients and their families.
This is about ensuring that all patients receive the best care from providers that meet agreed national standards, now in and the future, regardless of where those patients live. I hope that providers and other stakeholders will support these aims and work with NHS England going forward to ensure that sound decisions for the future are taken and, once taken, are implemented effectively and efficiently.
I will just respond to a few issues that were raised during the various speeches. My noble friend Lady Pidding talked about the effect on respiratory services. NHS England’s impact assessments acknowledged that there would be an impact on paediatric respiratory services at the Royal Brompton. A panel that includes respiratory clinicians from outside of London and representatives from other patient and public groups has been set up to assess the potential impact on these services. The panel’s findings will be taken into account by the NHS England board before it takes any decisions concerning these proposals.
The noble Baronesses, Lady Watkins and Lady Finlay, both mentioned the impact on patients and beds. We acknowledge this concern. One of the main reasons for carrying out the consultation is to better understand the impact the proposals might have on the paediatric patients from the Royal Brompton who will go the Great Ormond Street Hospital or the Evelina. The hospitals that will be taking on additional patients have confirmed that they will be able to manage the increase in activity.
The noble Baronesses, Lady Masham and Lady Watkins, mentioned Brexit and immigration. The Government continue to want the brightest and best from the EU and around the world to work on research in the NHS. Government and charities invest £4 billion a year to support world-class research in the UK and will invest more in the coming years.
The noble Baroness, Lady Morgan, talked about the publication of consultation responses. NHS England will publish the independent report on the consultation responses and the relevant NHS England board papers.
Finally, let us remember that the strength of the NHS does not reside within any individual institution. NHS England has a responsibility to ensure that these services deliver the very highest standard of care, regardless of where patients live or which hospital provides that care. We must strive for an objective focus on the actual needs of sick children and their families in this debate. I thank all your Lordships for attending this debate. I realise that people have very strong feelings about what is going to happen to their hospital.