NHS: Leeds General Infirmary

Earl Howe Excerpts

Tuesday 23rd April 2013 Lords Chamber

[Baroness Eaton]

To ask Her Majesty’s Government what was the extent of their involvement in the decision to suspend surgery at the Leeds General Infirmary Children’s Heart Unit.

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

My Lords, the Government did not play any role in the decision to suspend children’s heart surgery at Leeds. By agreement, this was a local decision taken by the trust, in agreement with Sir Bruce Keogh, NHS England’s medical director, and the Care Quality Commission. The Government strongly believe that it was the right thing to do. It is absolutely right that the NHS should act quickly and decisively if there is any evidence that patient safety may be at risk.

[Baroness Eaton]

I thank the Minister for his Answer and for the concern that I know he shares for those who have been affected by the decision. We all wish to see the safest surgery possible for our children. The Minister quite rightly understands that specialist doctors and experts, not politicians, should be responsible for asking and answering questions of safety. In the particular circumstances of Leeds, however, a number of the experts—

[Baroness Eaton]

My question is coming. The experts in Leeds have been causing understandable concern because of their partiality and apparent vested interest. In Bristol and Birmingham, children’s heart units have recently had mortality alerts and 14 NHS trusts are under investigation. Will the Minister explain why surgery has not been suspended at any of those trusts? Will he also explain why NHS England has chosen to spend resources appealing the decision of the High Court judge, who called the Safe and Sustainable review of children’s heart units flawed, when the decision for the Independent Reconfiguration Panel and the Secretary of State is imminent?

[Earl Howe]

My Lords, my noble friend raises quite a large number of points. I simply say to her that in regard to Leeds, which is the matter on which I have been briefed, the decision to suspend surgery was taken because concerns had been raised from a variety of sources about the safety of surgery at the unit. Mortality data were supplied to the National Institute for Cardiovascular Outcomes Research with significant flaws, and until those flaws had been rectified, it was impossible to be sure that the trust was operating within acceptable mortality thresholds. Those mortality concerns have, I understand, been resolved, which is why low-risk children’s cardiac surgery has been resumed at the hospital. However, NHS England’s appeal on the Safe and Sustainable review—which, I emphasise, is quite separate from the events of late March and early April—has to be a matter for NHS England. The review of children’s heart services was an NHS review, independent of government, and if NHS England wants to appeal the decision and thinks that there are good grounds for doing so, that is a matter for it.

[Baroness Howarth of Breckland]

My Lords, does the Minister agree that the people most affected by this are the children and many of the families who do not understand and cannot comprehend what is going on at the moment across these services? I declare an interest as the patron and trustee of Little Hearts Matter, which deals with hundreds of children who have half a heart and therefore all have surgery across the country. The Government may not have a direct interest in dealing with this matter but what are they going to do to make sure that the health services reassure these families that wherever they get surgery it will be safe for their children?

[Earl Howe]

My Lords, children’s heart surgery has been the subject of concern for more than 15 years. Clinical experts and parent groups have repeatedly called for change, and there is an overwhelming feeling in the NHS that the time for change is long overdue. The review that has taken place was about making sure that children’s heart services are as good as they possibly can be, and that has to be the message to the parents involved. It is of course an extremely complex issue but it is generally accepted that concentrating surgical expertise will deliver better outcomes for the children concerned. In view of the legal proceedings, it is very difficult for me to go any further than that at the moment.

[Lord Warner]

My Lords, if NHS England decides, under its new responsibilities, to undertake and control the specialised commissioning functions within the NHS, and if it chooses to implement the McKay panel’s recommendations on paediatric surgery, can the Minister say whether they would accept that judgment by NHS England or whether they would seek to overturn it?

[Earl Howe]

I take the noble Lord’s question to mean: would the Government accept that decision? Yes. This is a matter for the health service to determine. As I mentioned earlier, the Safe and Sustainable review was an NHS review. The Government and Ministers were not in any way involved in it, and that is appropriate. Therefore, the answer to the noble Lord’s question is that the Government would stand back from any such decision.

[Lord Shutt of Greetland]

My Lords, it is clear that murky internal health politicking has been going on here. However, the underlying question is: why are the Government determined to deny the people of Yorkshire a children’s heart unit when Yorkshire’s population of 5.3 million is similar to that of Scotland, Denmark and Finland, and is larger than Norway and Ireland? Yorkshire is double the size of the north-east of England, and the Government are happy to see that region locally served.

[Earl Howe]

I say to my noble friend with great respect that the premise of his question is incorrect. The Government have not taken a role in this matter. As I said to the noble Baroness, Lady Howarth, and to the noble Lord, Lord Warner, this is a matter that the NHS itself has led. There is no agenda by the Government at all, apart from our desire to see the best possible children’s cardiac services provided in this country.

[Lord Hunt of Kings Heath]

My Lords, I refer noble Lords to my health interests. Would the noble Earl accept that Sir Bruce Keogh has an outstanding record in the health service in improving outcomes from heart surgery, and therefore he has to be listened to with a great deal of respect?

On the more general issue of the reconfiguration of services, on which NHS England has promised to become much more assertive—which, I am sure, is welcome—is the noble Earl concerned that the Office of Fair Trading and the Co-operation and Competition Panel seem to be intervening in sensible reconfiguration decisions on the spurious basis that they impact on competition? Will he tell these bodies to desist?

[Earl Howe]

My Lords, if the noble Lord can supply me with some examples, of course I will look into them. I remind him that tomorrow we are debating a set of regulations that bear on this very question and I shall have plenty to say on that occasion, which I hope will assuage his concerns.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that it has been really splendid to witness the Members of Parliament from all over Yorkshire supporting their constituents? Will the Government listen to them?

[Earl Howe]

My Lords, I have made clear that it is not for the Government to take a decision on this question. It is for the NHS to decide what the best configuration of services should be, and I think most noble Lords agree with that.