Children’s Cardiac Surgery (Glenfield)

David Tredinnick Excerpts

Monday 22nd October 2012 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I offer many congratulations to my hon. and learned Friend the Member for Harborough (Sir Edward Garnier), who very deservedly received a knighthood recently. I remind him that that is of course a tradition in his constituency, as his predecessor was also knighted. I served with Sir John Farr in my first Parliament, and he did so much for hosiery and knitwear in his constituency. I welcome my hon. Friend the Minister to the Front Bench. It is very nice to see her there.

It is clear from remarks that hon. Members have made that there is universal and cross-party support for retaining children’s services at Glenfield. One of the first decisions of the new Secretary of State for Health was to call the matter that we are debating in for review. That bodes well, because my right hon. Friend did so well with the Olympics that I believe he will do just as well as Secretary of State for Health. His decision shows his light touch. The fact that we now have a second chance to consider the issues, and the welcome arrival of a letter today, saying that the Independent Reconfiguration Panel will commence a full review and report not later than 28 February, is a huge relief for the county. My hon. Friend the Minister has already intervened to point out that she cannot second-guess what it will say, but the point of today’s debate is to give Leicestershire Members on both sides of the House an opportunity to show how concerned we are about the decision and to make some points about it.

I shall not repeat the points made by my hon. Friend the Member for Harborough or the hon. Member for Leicester South (Jonathan Ashworth), who engagingly described my hon. Friend as learned; I think, Mr Hollobone, that we are not allowed to do that any more. Did not the reforms of the House say that we could not call—

[Sir Edward Garnier]

You can make an exception.

[David Tredinnick]

My hon. and learned Friend says I can make an exception for him, and I am delighted to do that.

The first point I want to make is that there is real concern that we are working on faulty statistics. The data used to make the decision were based on 2006-07. We need only consider the recent publication of the census in London to see the huge increase that there has been in population. There are shifting populations, and there is concern that the analysis is fundamentally flawed. It is not only my right hon. Friend the Secretary of State for Health who has had to consider flawed data recently. What about the west coast main line, whereby we found we were operating with completely inaccurate information? The right hon. Member for Newcastle upon Tyne East (Mr Brown) nods his head. This can happen in Departments, and we must take note of it.

My hon. and learned Friend the Member for Harborough and the hon. Member for Leicester South have addressed the issue of the ECMO link. To most reasonable people, it seems absurd that the two decisions will not be linked. I am sure that there are legal arguments, but somehow we must get a sensible decision so that both issues can be considered together.

The next point concerns the site of Glenfield. Glenfield is a hugely popular hospital not just with patients, but with surgeons. From, one might say, a feng shui point of view, it is on top of a hill outside the city, and it has a good, clean, clear energy. That is why everybody likes working there: it is nicer for everybody than the Birmingham site, as is proven, I would suggest, by a survey showing that only 2% of the staff in Glenfield want to move to Birmingham. It is not just BBC current affairs programmes that are jumpy about moving out of their current locations, as there is a real problem with the decision to move from Glenfield to Birmingham, as the hon. Member for Leicester South said. The body of knowledge built up over 20 years will dissipate, because many of the people who work at Glenfield simply will not move.

My next point involves the increased pressure on Birmingham, which has been referred to. Can Birmingham deal with it? Somewhere in the briefing papers is a point about Bristol. What happens if something goes wrong at Bristol and patients are moved around? My hon. and learned Friend the Member for Harborough made the point about the terrible tragedy in Wales, during which patients have been brought to Glenfield. Is it wise to concentrate all the resources in the midlands in one centre? I wonder whether it is.

[Pauline Latham (Mid Derbyshire) (Con)]

Birmingham is already having to send patients to Glenfield because it cannot cope with the numbers. Does my hon. Friend not agree that it seems silly to close such a popular centre? As he said, there will be a knock-on effect if other centres close, but patients are already being sent from Birmingham to Glenfield, and children are being sent to different hospitals because there is no room at Birmingham. It seems absolutely crazy that my constituents cannot continue to use the Glenfield hospital, where so much expertise has been created over a number of years.

[David Tredinnick]

I agree absolutely with my hon. Friend, who makes another valid point.

I will not detain the House for long, as other hon. Members want to speak, but I want to make two more points. I have had letters from all over my constituency from people who have benefited from Glenfield. Let us think for a moment. Who put the money into the unit in the first place? Was it all Government money? No, it was not. A lot of charities in Leicestershire have raised money to support the unit. What about their efforts? How will they feel, having struggled over the years to provide a superb local service? It will be a great injustice if that money is dissipated in a reorganisation.

I am delighted to see my hon. Friend the Minister in her place, and I congratulate my hon. and learned Friend the Member for Harborough and all the other Leicestershire Members, including my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall), across the Floor, who has worked on the issue. I say to my hon. Friend the Minister that this is a critical problem. Please help us.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to follow such excellent speeches from hon. Members on both sides of the Chamber. I rise to speak both as the shadow Health Minister and as the Member of Parliament for Leicester West. My constituency is extremely fortunate to include Glenfield hospital. I welcome the members of staff who have taken time out from their busy jobs and travelled a great distance to attend the debate, and I thank them for doing so.

The future of children’s heart surgery matters greatly to the thousands of people who signed the e-petition that has made today’s debate possible. I thank the Backbench Business Committee and the hon. and learned Member for Harborough (Sir Edward Garnier) for securing the debate. The issue also matters to thousands of families right across the country, which is why my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and the hon. Member for Solihull (Lorely Burt) have attended this afternoon.

The issue of children’s heart surgery has needed to be resolved for many years. Following the findings of the Bristol royal infirmary inquiry 10 years ago, clinicians and professional bodies, including the Royal College of Nursing and the Royal College of Paediatrics and Child Health, have been very clear that children’s heart services need to change.

The problem is that services in England have grown up ad hoc and are too thinly spread across the country for every child to get the best possible standards of care. That is why the previous Government initiated the Safe and Sustainable review and why we continue to support the principle of fewer, more specialist centres for children’s heart surgery.

The issue is whether the Safe and Sustainable review has fully considered all the relevant clinical evidence in making its recommendations. The review has failed fully to consider the clinical implications of moving services from Glenfield, particularly the children’s ECMO service. I fear that that mistake is about to be repeated, because the new review being conducted by the Independent Reconfiguration Panel, which we learned about earlier today, will not include discussion of the former Secretary of State’s decision to sign off moving children’s ECMO services from Glenfield to Birmingham.

The two things cannot be separated and are inextricably linked: what happens to the children’s heart surgery happens to ECMO services. It is important to remember that any decisions about nationally commissioned specialist services, such as ECMO, must be signed off by the Secretary of State. I assume that the former Secretary of State made that decision only because of the recommendations of the Safe and Sustainable review, so we need to ensure that any review of those recommendations looks at both ECMO and children’s surgery.

At the risk of repeating the many eloquent speeches that we have heard, Leicester has one of the largest ECMO units in the world and it has long experience, having started in 1989. Glenfield has built up a team of more than 80 ECMO specialists. It is the only unit in the UK that can treat all age groups, which was critical during the H1N1 flu pandemic, because Leicester was able to flex its service to treat up to 10 adults simultaneously while training people working in other adult centres and co-ordinating the national service, triaging all the patients and providing the majority of the patient transport.

[David Tredinnick]

Will the hon. Lady dwell on the mobile service, because that is often a last-hope service for patients? I am informed that, without the mobile service, some patients would not survive.

[Liz Kendall]

The hon. Gentleman has predicted my next sentence. Leicester is also the only unit in England and Wales to provide a mobile ECMO service for babies and children. Once again, it is difficult, if not impossible, to separate the adult ECMO service from the children’s ECMO services. The two are linked. It is not just about equipment; it is about staff and teams working and learning together.

I do not want to denigrate any hospital’s work, but I understand that Birmingham has neither the capacity to continue the mobile ECMO service nor any plans to develop a mobile ECMO service for children. That is a serious cause for concern and something that the Independent Reconfiguration Panel must consider.

Hon. Members have already talked about the outcomes for ECMO patients at Glenfield being significantly better than elsewhere. This is not anecdotal opinion, but clinically audited, peer-reviewed evidence that has come from the very best clinical databases available in this country and internationally. Independently validated data from the UK paediatric intensive care unit database, or PICANet, show that survival rates are at least 50% higher in Leicester. That difference in mortality is maintained even when the severity of illness treated by Glenfield is taken into account.

Data from the best available international register, provided by the Extracorporeal Life Support Organisation, support the evidence of good outcomes in Leicester and show that crude mortality rates in Leicester are 19%, but nearly twice as high in other centres, at 35%. Both those independent, validated data sources show the high quality of ECMO care provided at Leicester and bring into sharp focus the risks of closing Glenfield’s children’s ECMO service.

A service cannot simply be picked up and moved to another city without losing vital skills and expertise. It takes years to build up the quality of care to the same level. Interestingly, the Safe and Sustainable review explicitly addresses the time it takes to build up the quality of care in relation to children’s heart surgery. It says that

“clinical outcomes improve with experience”,

due to factors such as team working, as well as the experience of individual clinicians. The review says that this is a

“statistically significant observation in keeping with analysis which demonstrates historically, an 8 - 10 year period of time before such a service matures to produce excellent clinical outcomes”.

If that is so in relation to children’s heart surgery services, it also pertains to children’s ECMO services.

It was unfortunate that, in his letter to the chair of the Independent Reconfiguration Panel, the Secretary of State referred simply to moving the equipment of the ECMO service. It is not just equipment; it is about staff. It is clear that the majority of staff at Glenfield will be unable to move due to family commitments. Many of the nurses there have homes, families and children, and they may be second earners. A family cannot simply be uprooted and moved. Indeed, an anonymised survey of all staff at the unit found that 80% are “not at all likely” to move to Birmingham. Significantly, none of the ECMO specialists who replied to the survey were able to consider working in Birmingham.

I am concerned that the Safe and Sustainable review has not considered the evidence about ECMO in sufficient detail. The review panel took advice about the future of ECMO services from the Advisory Group for National Specialised Services. There was no representative from any UK or international professional ECMO body on the advisory group, so it commissioned a report from ECMO experts, including Dr Kenneth Palmer, director of the ECMO unit at Karolinska university, whom several hon. Members have mentioned.

Following that report, the advisory group said that it would be “possible” to move Glenfield’s children’s ECMO service. However, the question is not whether it is possible, but whether it is desirable and whether it makes sense to move one of the best-performing services—if not the best, not just in this country but in Europe and internationally. That would not be considered in respect of children’s heart surgery services, so why consider that for ECMO?

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[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.