Health: Cardiology

Earl Howe Excerpts

Monday 24th October 2011 Lords Chamber

[The Lord Bishop of Ripon and Leeds]

To ask Her Majesty’s Government what progress they are making in the development of paediatric cardiac services in England.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the review of children’s congenital heart services is a clinically led NHS review, independent of government. The consultation ended on 1 July and an independent analysis of the responses and interim health impact assessment was published in August. The joint committee of primary care trusts expects to make a decision later this year. This will be based on an independent analysis of the consultation, reports from overview and scrutiny committees, a health impact assessment and other evidence from the consultation.

[The Lord Bishop of Ripon and Leeds]

My Lords, I am very grateful to the Minister for that Answer. Does he agree with me that, especially where children from deprived backgrounds are concerned, it is crucial that social and personal issues are considered alongside the clinical? Will he ensure that geographical proximity of services to children’s homes is taken into account when the time comes to make final decisions in this matter?

[Earl Howe]

I am grateful to the right reverend Prelate. All that he says is very pertinent. I am confident that the review will take those matters into account.

[Lord Alderdice]

My Lords, given that the review of paediatric cardiac surgery services presented earlier this year suggested a requirement for 400 or 500 cases per year, which is a level that cannot be provided in Northern Ireland so the service there would not be allowed to continue, can my noble friend reassure me that the Department of Health has been in discussion with the Department of Health, Social Services and Public Safety in Northern Ireland to see what the Department of Health here can do to ensure that paediatric cardiac surgery services are available to the children and young people of Northern Ireland?

[Earl Howe]

As my noble friend knows, the children’s heart surgery unit in Belfast is not part of the Safe and Sustainable review as it is the responsibility of the healthcare systems in the devolved Administration. It is for the Northern Irish health service to take a view on the safety and sustainability of those services and to consider the recommendations that flow out of the review in this country. We will, of course, share the learning from our experience in England, but I emphasise again that this is a matter for the NHS, and not Ministers, to resolve.

[Baroness Masham of Ilton]

My Lords, is the noble Earl aware that the north of England is a special case because of deprivation, long distances and cultural problems around the Bradford area? Does he agree that both Leeds and Newcastle need their children’s heart surgery units, and that deprivation is an important factor as far as travelling is concerned?

[Earl Howe]

My Lords, I agree that deprivation is an important consideration. The population density of the West Midlands conurbation and the very high case load of Birmingham Children’s Hospital suggested that the Birmingham service should be, as it were, a fixed point. However, I am afraid that the same cannot be applied to Leeds because although the Leeds catchment area has a high population it has a much lower case load than that of Birmingham. The analysis of the expert group suggested that there needed to be two centres in the north of England because of the population density; that was either Liverpool and Leeds or Liverpool and Newcastle. It was not possible to have a Leeds and Newcastle combination since Newcastle could not achieve a credible network.

[Baroness Thornton]

My Lords, as a Bradfordian I have to say that that is a very great shame because I cannot see how the people in Bradford will find it easy to go to Newcastle to visit their children in hospital. When you add up the number of surgical cases performed on adults as well as children in England each year, you reach a figure which would require nine or 10 centres across England, not the six or seven proposed by the Safe and Sustainable review. Therefore, does the Minister share my concern that, by deciding the future of children’s heart services without reference to adult congenital heart services, the review is not looking at the full picture? Indeed, why are adult and children’s services subject to two reviews?

[Earl Howe]

My Lords, surgery for children with congenital heart disease is much more complex than surgery for adults with congenital heart disease. The focus of the review has been on paediatric services up to now. As the most immediate concerns were around the sustainability of the children’s services, the paediatric cardiac services standards include the need for links with adult services and for good transition services between the two.

[Lord Woolmer of Leeds]

Will the Minister confirm that in Yorkshire and Humber, there are 5.5 million people—more than in Scotland—and that there are nearly 14 million people in the catchment area of the Leeds children’s heart unit? Does the Minister imply by his remarks that he rules out Leeds as continuing to have a heart surgery unit? Will the Minister play any role at all in bringing good sense to the need for a major unit in one of the largest regions in this country?

[Earl Howe]

My Lords, I cannot rule anything out, because, as I emphasised, this is a matter for the NHS. In the final analysis, however, this could be a decision that falls on to the desk of the Secretary of State, so it would be unwise of me to be drawn into commenting in too much detail on particular centres of surgery. All I can say about the service at Leeds is that it received a very low score as an outcome of the assessment by the independent expert panel. It was ranked 10th out of 11 centres; that is one above the service at the John Radcliffe Hospital which, as noble Lords will know, was suspended over safety fears in February 2010.

[Baroness Finlay of Llandaff]

Does the Minister accept that the lessons to be learned from Bristol represent an important critical mass for highly specialised services, and that a hub-and-spokes model allows families to access really high-quality, high-tech services, leaving the lower-tech services to be delivered nearer to home? That requires integration at all levels across providers, but the concern with the NHS reforms is that that integration will be threatened.

[Earl Howe]

I hope to persuade the noble Baroness in our debates on the Health and Social Care Bill that her fears on the Bill and its provisions in regard to integration are not well founded. However, I agree with her remarks in the first part of her question. It is very important that surgeons have sufficient clinical work to maintain and develop their skills and to train the next generation of surgeons. The need for change in this area is widely supported, and it is only by taking a national perspective that the optimum configuration of services can be effectively assessed.

[Lord Newton of Braintree]

Am I not right in thinking that this process of review is currently the subject of judicial review initiated by the Royal Brompton? What will the Minister do if the process is found to be flawed?

[Earl Howe]

My Lords, my noble friend is quite right. A judicial review has been launched by the Royal Brompton into the fairness of the process being followed. I am not in a position to comment on that. We expect a decision well before the end of the year and if that decision is not one that allows the process to continue, then clearly those in charge of it will have to look again at how to set about it.