Children’s Heart Surgery

David Tredinnick Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

The answer is this needs to be a mix of both; this needs to be about clinical excellence and issues such as accessibility and travel. A wide range of factors are involved. I accept, and this is widely accepted, that it is particularly difficult with specialist services to interpret mortality rates in a meaningful way, but that does not mean we should not look at them and seek to learn what we can.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement will have given great hope to all those in and around Leicestershire who campaigned to keep Glenfield hospital, and we welcome the acceptance that the original site selection was flawed and the implicit acceptance of bias against the east midlands and against the east of the country in general. On a positive note, if we are going to have the clinical case for change accepted and consolidation in the future, what is his understanding of the number of lives that would be saved if we have to go through this painful process?

[Mr Hunt]

I do not want to pluck a number out of the air; I want to listen to the clinical evidence on that. However, it is important to say that as a result of the excess mortality identified at Bristol the Kennedy report said that up to 170 lives could have been saved over a 10-year period in just one location. That is why it is so important that we get this decision right.

A and E Departments

David Tredinnick Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.

[David Tredinnick (Bosworth) (Con)]

Does my right hon. Friend agree that we could make better use of the ambulance service and that if we had more fully trained ambulance men who could assess whether a patient needed to go to hospital, we could reduce A and E admissions that way?

[Mr Hunt]

My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.

Health and Social Care

David Tredinnick Excerpts

Monday 13th May 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.

The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.

If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?

[David Tredinnick (Bosworth) (Con)]

The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?

[Mr Hunt]

My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.

The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.

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[David Tredinnick (Bosworth) (Con)]

It is a pleasure to follow the hon. Member for Vale of Clwyd (Chris Ruane). I entirely agree with what he said about mindfulness and the need for NICE to ensure that it is available for the treatment of stress in particular. That is all the more important now that we have a Government who have put patient choice at the heart of the health service, a fact that will become more and more evident as health and wellbeing boards and Healthwatch start to make an impression through the Health and Social Care Act 2012.

Like the hon. Gentleman, I intend to focus exclusively on health issues. I shall concentrate not on what is in the Queen’s Speech but on what is missing from it, particularly the expected statutory regulation of herbal therapies. If we are to ensure that the range of treatments that people demand, including mindfulness, are safely regulated in the health service, we must tackle the issue of herbal medicine, which is a crucial tool in our cupboard.

At this point, I must declare an interest. I was involved in the legislation applying to the last two groups that were made subject to statutory regulation, the Osteopaths Act 1993 and the Chiropractors Act 1994, as a member of the Standing Committees that considered those Bills. Let me emphasise to Ministers how important it is to take that route. It makes practitioners focus on a disciplined structure and operate a robust complaints procedure, it makes it easier for doctors to refer, and it makes treatments more widely available.

When it comes to herbs, we need an interface with European legislation. We must deal with regulation 3(6) of the Human Medicines Regulations 2012, which grants “a person”, not a therapist, the right to practise. What worries me is that Ministers may regulate not therapists but specific herbs. There are thousands of them out there, and that cannot be satisfactory. We must give therapists the right to prescribe. In the case of traditional Chinese medicine, for example, most practitioners will prescribe three herbs to work in conjunction. As I have said in the House before, it works like the Whips Office: there is a chief, a deputy and a messenger. The messenger takes the chief and the deputy to cure the problem. My hon. Friend the Member for Rochford and Southend East (James Duddridge) laughs; of course, that does not always apply to Whips.

My greatest worry is this: I believe that the statutory regulation has been blocked by vested interests in the orthodox medical community who have said to the Secretary of State “We do not want this, because it will enhance the status of herbal therapists.” If that is true, it is selfish and stupid.

A sub-set of the problems lies in the fact that there are two types of herbal therapies. There is the phyto therapy provided by Hydes Herbal Clinic in Leicester, which I believe is in the constituency of the hon. Member for Leicester West (Liz Kendall), and there is traditional Chinese medicine, which involves the use of different types of herb. We need separate registers to make sure that these therapies are prescribed safely.

It is interesting to see the headlines that are appearing now. The hon. Member for Vale of Clwyd talked about doctors using mindfulness. One headline states, “GPs prefer herbal remedies to Prozac, says survey”, and one such cited remedy is St John’s wort, which in fact has side-effects if used with other, conventional, medicines. One reason why I want statutory legislation is to make sure that people who are taking herbal medicines can go to their doctors and say, “Yes, I am taking it, and doing so under the prescription of a statutorily regulated practitioner.”

I should say in passing that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has been dealing with this issue, has graciously offered me a meeting to discuss it further, and I look forward to taking him up on that.

Provision was made in the Health and Social Care Act 2012 for the Professional Standards Authority, which should regulate all complementary therapies other than those provided by individual practitioners, who are regulated under individual legislation. The Society of Homeopaths, which I have supported for years, should be regulated too. Here, we are completely out of line not just with Europe but with Asia and America. We have not used enough of such resources. It is patently absurd to say it is all placebo, given that in Europe 40,000 physicians practise homeopathy, in Asia, 250,000 physicians practise it, and it is practised in Brazil, Nigeria and America. It is not a placebo, because people are using it. One can fool some of the people all of the time and vice versa, but not all the people all of the time.

The other reason why those who oppose such therapies make some headway is they refer only to homeopaphy randomised control trials. Sixty-four of 156 have been positive, and only 11 negative. We should also consider meta-analyses and patient-reported outcomes. Where double-blind placebo-controlled trials are conducted, they are ignored.

Just a few centuries ago, scientists were saying that the sun went round the earth; now, we know that the earth goes round the sun. Science changes. Here, we should bear in mind what is known as the Semmelweis reflex. When a doctor in Germany discovered that child mortality rates could be reduced if doctors washed their hands, conventional practitioners pooh-poohed the idea, but eventually it became the norm. We have to be progressive, and so it is with some homeopathic remedies, which are so dilute that they cannot be seen through conventional analysis. However, the fact is that those very dilute substances work effectively. The future lies in a wider range of health provision across the health service.

I want to finish with an e-mail I received today:

“Dear David,

From browsing the web I hear you are cynically referred to as the honourable member for Holland and Barrett.”

Yes, a Labour Minister many years ago called me that. The e-mail continues:

“If those who jeer had survived a life debilitating illness like Parkinson’s for twenty years, I would have more time for them.

I have done this while trying to escape the unsolicited attentions of a family populated with several consultants and even more GPs… Alternative therapies like homeopathy, acupuncture, herbs and now helminths are the reason I am alive today.”

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

We are always open to discuss anything that can improve outcomes for anybody suffering from cancer, and certainly we are alert to all new research. As I said, if that involves talking to devolved Administrations, my officials do that in order to improve outcomes for people in England.

[David Tredinnick (Bosworth) (Con)]

Is my hon. Friend aware that one of the most effective treatments in reducing the impact of prostate cancer is traditional Chinese herbal medicine and acupuncture, and does she agree that it is crucial that we get the regulation of herbal practitioners in place as soon as we can?

[Anna Soubry]

All these things have to be evidence-based. I am reminded of the evidence that the chief medical officer gave recently on this subject.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 26th February 2013 Commons Chamber

[Anna Soubry]

Those are good points well made, if I may say so. I am more than happy to discuss that further with the hon. Lady, because I take the firm view that everyone involved in making, manufacturing, supplying and selling food has a responsibility to make sure that all of us have longer, healthier, happier lives. I am all for ratcheting up the responsibility deal.

[David Tredinnick (Bosworth) (Con)]

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

[Dr Poulter]

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Speaker]

I thank the Minister for her answers, including her very generous and gracious remarks. I wish her a full and speedy recovery.

[David Tredinnick (Bosworth) (Con)]

Does my hon. Friend the Minister agree that Penny Brohn Cancer Care, based near Bristol, which offers a unique combination of physical, emotional and spiritual support designed to help patients live well with the impact of cancer, is an organisation that should be supported? Can she confirm that such organisations are eligible for funds from the cancer drugs fund?

[Anna Soubry]

It is important that we consider all aspects of how we can treat cancers. We also need to bear in mind the people who care for those with cancer, as we sometimes forget them. Any organisation—especially in the charitable sector—that offers treatments that help people and their families and carers is to be welcomed.

NHS Commissioning Board (Mandate)

David Tredinnick Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

We will publish a sexual health strategy at the end of this year that will look at variation in services across the country and at the kind of problems the hon. Lady raises. It will be led by the public health Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), who will be happy to meet the hon. Lady to discuss the issue further.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement will be widely welcomed, especially his emphasis on an integrated system based on the needs of people. Does he not agree, however, that there is far too little use of complementary medicine outside private health care, and that greater use of herbal medicine, acupuncture and the much under-utilised resource in this country of homeopathic medicine, homeopathic doctors and the Society of Homeopaths, would be a good thing? Seventy per cent. of pregnant women in France use homeopathic medicine.

[Mr Hunt]

There are parts of the country where acupuncture is available on the NHS. This will be clinically led. It needs to be driven by the science, but where there is evidence, and where local doctors think that it would be the best clinical outcome for their patients, that is what they are able to do.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Jeremy Hunt]

We have a clearly set out programme for all those trusts, to make sure that they get back to the proper financial controls and proper governance structures that they need. We do not want to get into the business of bailing them out; we want them to stand on their own two feet. That is the vision of the Health and Social Care (Community Health and Standards) Act 2003, passed by the hon. Gentleman’s party when it was in government.

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend extend the scope of personal budgets? They help not only patients, giving them wider choice, but carers, allowing them to leave their post.

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend makes an extremely good point. This is all about giving power to patients. Personal budgets have already been very successful in social care, and there are pilots under way in health care; the indications are that they are proving very successful.

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[Mr Speaker]

I am sorry to disappoint colleagues, but we must move on.

[David Tredinnick]

On a point of order, Mr Speaker.

[Mr Speaker]

The hon. Gentleman has been in the House since 1987; he knows perfectly well that points of order come after statements, not before them. I feel certain that he was just teasing the House and me.

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.

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[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.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

As I am sure the hon. Gentleman knows, we will publish the allocations for 2013-14 later this year. However, we are ensuring, I think rightly, that the allocations to clinical commissioning groups for NHS services reflect the population, because they have a responsibility for the whole population. Some parts of the country, particularly London, have substantial unregistered populations, which often include the groups who are most at risk.

[David Tredinnick (Bosworth) (Con)]

Does my right hon. Friend agree that one of his important initiatives that could reduce health inequalities is the development of personal care budgets, which give real power and choices to patients, and also have the potential to reduce hospital admissions and costs?

[Mr Lansley]

Yes, since the election we have pushed forward with offering access to a personal care budget to those who are in receipt of care and support. At the time of the last election, about 168,000 people were exercising that right. The figure now is over 432,000, and we are extending the scheme so that, for example, people in receipt of continuing health care through the NHS will not lose the opportunity for personal care when the NHS takes over that responsibility; instead, that will continue as a personal budget under the NHS.