health

Greg Mulholland Excerpts

Tuesday 18th September 2012 Commons Chamber

[Greg Mulholland (Leeds North West) (LD)]

I rise to make a further contribution in this House on the deeply flawed decision by the Joint Committee of Primary Care Trusts, with regard to the Safe and Sustainable review of children’s heart services, to close the excellent Leeds children’s heart unit. I know that other colleagues will also speak about that today and that many across the House feel strongly about it. I welcome the new ministerial team to their posts and hope that they will now look at the matter.

To be absolutely clear, neither we nor the campaigners in Leeds challenge the premise of the national review, but the decision to close the Leeds unit is very questionable. One of the questions that has not been adequately scrutinised is whether the decision even concurs with the premise of the review, and I believe that it clearly does not. That is most patently a matter for ministerial interest, because a flawed and wrong decision is indeed the business of Ministers, so I hope that the Minister will take that away and reflect upon it.

I will just update the Minister and the House on the current situation. A referral is being prepared by the joint health overview and scrutiny committee for Yorkshire and the Humber, and that is part of the democratic process of scrutiny of our NHS, but it is being held up by the obstructionism of the JCPCT, which has made the decision. The JCPCT is refusing to hand over all the information requested, which is absolutely disgraceful. At the same time, implementation is being forced through as if there is an attempt to avoid the scrutiny that is essential in any major decision on the health service, and especially in so sensitive a case. Professor Deirdre Kelly, who chairs the implementation advisory group, has said:

“Implementing the decision on the future of children’s heart services is a top priority and we need the work to start now so that children can benefit during 2014.”

Sir Neil McKay, who chairs the JCPCT, has said—rather outrageously, considering the strength of feeling among children and families in Yorkshire and the Humber—that:

“Children and their families have waited far too long for these vital services to be changed”.

That is patently absurd when we consider that 600,000 people from the region have said that they do not wish the service to be closed and changed in the way that he and his committee propose.

Let me go further and say that the JCPCT secretariat is denying access to key documents needed to challenge the decision while at the same time releasing reams of largely irrelevant material. We do not yet have enough information on the weighting methodology used or detailed scoring information and assessment forms for each surgical centre, something that is crucial for determining whether the decision is as robust as Sir Neil McKay seems so desperate to tell us it is while trying to force it through. Councillor John Illingworth, who chairs the joint health overview and scrutiny committee, has said:

“This is completely unacceptable. JHOSC is the statutory body that should scrutinise the JCPCT decisions, but we cannot complete this process without a full disclosure by JCPCT. The reluctance of the JCPCT to release this non-confidential material is delaying the entire scrutiny process.”

The simple and outrageous reality that I want the Minister to take away—he is conferring with the former Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), but I hope that he will listen to this point—is that the JCPCT is deliberately denying the joint health overview and scrutiny committee access to the documents in an effort to block any real scrutiny of this flawed process. That is disgraceful, because that is the proper process. We need full disclosure, because this is a democratically referred renewal, as Ministers have explained from the Dispatch Box previously.

I must also bring into focus the rather unsavoury role being played by the Children’s Heart Federation. As a charity, it is being used to try to force the pace of implementation of a decision that has not yet been formally approved and ratified. Its chief executive, Anne Keatley-Clarke, has said:

“Further possible delays in implementing the planned improvements to children’s heart services across England would be extremely worrying and would also cause a great deal of further uncertainty and distress for parents right across the country.”

That is a dishonest suggestion, frankly, considering the distress that those parents and families across the country, and in our case in Yorkshire and the Humber, are already feeling as a result of the decision. To try to force it through and undermine the Leeds unit before the decision has been finalised is something that a charity should simply not be doing. It is an arrogant and insensitive thing to say and, in my opinion, brings the charity into disrepute. The reality is, to quote my constituent Steph Ward, the mother of Lyall Cookward, who has relied on the Leeds unit:

“The Children’s Heart Federation have acted in a disgraceful manner. Anne Keatley-Clarke and her organisation think it is perfectly acceptable to completely ignore the views of 600,000 people, so how dare they call themselves a national organisation when they are prepared to ignore such a large section of the country?”

Will the Minister give us a clear assurance today that implementation will not be forced through until the proper process has been followed and there has been full, proper and honest disclosure of all the material necessary to scrutinise the decision? We do not have that. I hope that he can at least give us that assurance today. In the end, we all accept that the review was commissioned. We can have an argument about the number of operations that should be carried out—incidentally, we still have the ludicrous situation in which Glasgow will be permitted to carry out only 300 operations a year but will be deemed safe and sustainable, yet Leeds, which can carry out many more operations, will not be. We have still had no word about that, but organisations, particularly the JCPCT, are trying to force through the decision as if it is finalised. It is not finalised, and the democratic body that is there to scrutinise the decision on behalf of us all has so far been denied the very documents it needs. If that is not sinister, I do not know what is. We must have full disclosure, we must have an open and transparent process, and we must have that now.

[Stuart Andrew (Pudsey) (Con)]

I cannot resist the opportunity in the time available to raise the same issue as that which my hon. Friend the Member for Leeds North West (Greg Mulholland) has just addressed, particularly given the fact that we now have a new ministerial team. I am delighted to see the new Minister on the Front Bench.

I realise that the Safe and Sustainable review is independent of Government, as the former Health Minister, my right hon. Friend the Member for Chelmsford (Mr Burns), told me on many occasions. It is clear, however, that there is a problem with the decision, particularly in the north-east of England, and I hope that we can try to find a solution today.

It is worth restating the issue. Despite claims by some, right hon. and hon. Members on both sides of the House, parents, the charity and clinicians are fully supportive of the review’s objectives. It has never been in doubt that safer and more sustainable units are the way ahead, but we are concerned that the outcome does not meet the review’s objectives. It goes against logical health planning, patient choice and clinical preferences. The fact is that patients in Yorkshire, Humberside and north Lincolnshire will simply be offered a poorer service.

Patient choice has been totally disregarded. A survey of patients showed that those in the major postcode areas would go not to Newcastle, but to Liverpool, Birmingham or, indeed, London instead. At the decision-making meeting, it was said that those patients would be influenced by referring doctors. The assumption was made that they would be pointed towards Newcastle, but no justification has been given for that assumption. Indeed, all of the 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, have said that they would not refer patients there for surgical treatment.

[Greg Mulholland]

It is a pleasure to carry on campaigning with my hon. Friend on this issue and we will continue to do so. Does he still agree with what we have said before, namely that the reason the Leeds unit is to be closed is the flawed assumption that that will allow Newcastle to reach the target of 400 operations, even though it will not? The unit is being sacrificed for something that will not even happen.

[Stuart Andrew]

I am grateful for that intervention, which brings me on to exactly that point. The review’s decision said that 25% of Leeds, Wakefield, Doncaster and Sheffield patients would go to Newcastle, when its own evidence said that they simply would not. Funnily enough, if 25% of those patients go to Newcastle, guess what? Suddenly, 403 patients a year will have surgical operations in Newcastle, which is just three more than the magic figure of 400. I do not believe that that 25% will exist, so Newcastle will miss the target of 400 operations, which is a key plank of the whole review.

We have heard about how public opinion has been discounted. A petition signed by more than 600,000 people was brought down to Downing street. That is an enormous number for one region, yet the review counted it as just one response. On the other hand, 22,000 text messages received in support of Birmingham were counted as 22,000 separate responses, which is blatantly unfair.

One of the most important issues is the co-location of services. What has impressed me about the Leeds unit is that it is part of the Leeds children’s hospital. All other surgeons get there within minutes, if needed. We are asking our patients in our constituencies to go to Newcastle, where all other services are some 3 miles away from the heart surgery unit. That is simply not acceptable and goes against the advice of the key recommendation of the Bristol inquiry, which was backed by the British Congenital Cardiac Association. The inquiry said:

“For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

It is important that we do not forget that.

The fact is that, allowing for patient choice and without the flow of patients from the populous areas of Yorkshire, as evidenced by the PricewaterhouseCoopers research, Newcastle will not reach the target of 400 surgical procedures. In 2010-11, Leeds delivered 336 procedures against Newcastle’s 271.

The impact assessment also showed that the options that included Leeds would have fewer negative impacts and that option B, which included Newcastle, would be particularly damaging for paediatric intensive care in Yorkshire and Humber.

It is also important to ask why Birmingham was chosen because of its density of population and Leeds was not, given the fact that we have a high south Asian population who, statistically, are more likely to need the service. As we have said time and again, doctors should go where the patients are, not the other way around.

Sheffield parents whom I have met at the unit travel three times a day to visit their children in hospital, because they have other children at home. We have to think about the impact this has on families.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I thank hon. Members for their kind comments. A lot of ground has been covered in this debate and many good points have been raised about local NHS services. I hope that hon. Members will forgive me if I cannot give comprehensive answers about everything that has been raised, but I will do my best in the time that is available.

It was clear from all the points that were made in the debate that every hon. Member sees the NHS through the prism of the patient. That is the right way to regard how NHS services are delivered. Patients are the priority for our NHS services and for the Government, and they were the priority for the former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his decision to push ahead with the NHS reforms. The basis of the “No decision about me without me” policy is that patients are the most important thing. They are why doctors and nurses do their work and why all Governments endeavour to fight for a better NHS.

I turn now to the concerns of individual Members. I believe that I am right to wish my hon. Friend the Member for Milton Keynes South (Iain Stewart) a happy birthday. A number of hon. Members have concerns about the competitive procurement processes for community health services in Milton Keynes. He mentioned the concerns of my hon. Friend the Member for Milton Keynes North (Mark Lancaster). Our policy is clear that it is for the local NHS, and the primary care trust in particular, to look at the options for different procurement procedures and to decide what is best for local people. The local strategic health authority has played an important role in assuring the PCT’s decisions. Whichever option is chosen, it must be possible to put it in place before 31 March 2013, to avoid the continuing and damaging uncertainty for staff. I am happy to meet my hon. Friend the Member for Milton Keynes South and other hon. Friends to discuss the matter further.

My right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith) talked about maternity services, which is a matter close to my heart. This morning, I visited Newham university hospital, which faces different challenges in maternity care. I looked at the fantastic new unit that has been opened at Newham, which will meet those challenges and provide high-quality maternity care to that part of London.

My right hon. Friend was right to point out that the challenges for maternity services—indeed, for all health care services—in more rural areas such as Berwick-upon-Tweed are different from those in more urban parts of the country, such as London. Women and families in Berwick, like women and families everywhere, deserve maternity services that focus on improving the delivering of high-quality health care for women and babies, and on improving women’s experience of care.

The decision temporarily to close the midwifery-led maternity unit and in-patient post-natal services at the Berwick infirmary, to which my right hon. Friend alluded, was difficult for the local trust to make. He is right to say that in making such decisions there should be regard to the rurality of the area. He made good suggestions about the potential for rotating staff to support rural maternity units. I understand that the decision was made to protect the quality and safety of maternity services in the area and, in particular, to protect the quality of care and safety of women in labour.

I have been assured that the trust is working closely with commissioners to look at the future of maternity services in Berwick. The review will be completed in the coming months. My right hon. Friend may be aware of the recent birthplace study, which discusses good and bad practice in supporting smaller maternity units. I am sure that the commissioners will have regard to that study in making decisions about the future of the unit in his area. He should be assured that I will take a close interest in the matter and support his advocacy on behalf of his constituents.

My hon. Friend the Member for Ealing Central and Acton (Angie Bray) made some points about the service reconfiguration of health care services in London. The hon. Member for Mitcham and Morden (Siobhain McDonagh) also mentioned that issue, and I am sure she would like to pay tribute—as I do—to my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), for their work over the years campaigning for services at St Helier hospital.

Key tests must be passed to ensure that clinical services are suitable for reconfiguration. First, there must be support from local clinicians, and, secondly, arrangements for public and patient engagement and consultation—including with local authorities—must be strengthened and put in place. Thirdly, we need greater clarity on the clinical evidence bases underpinning proposals, and, finally, any proposals should take into account the need to develop and support patient choice.

The reconfiguration of front-line health services is up to the local NHS, and no decisions will be taken until there has been a full public consultation. St Helier hospital is part of the south-west London reconfiguration scheme “Better Services, Better Value”, which is in its pre-consultation stage and is led by local GPs, nurses, acute clinicians, other health care professionals and patient representatives. Under “Better Services, Better Value”, the number of accident and emergency and maternity units will be reduced from four to three, and the likely recommendation is for St Helier to become a local hospital with an urgent care centre.

Ealing hospital is part of the “Shaping a healthier future” scheme in north-west London. Proposals for that scheme include centralising A and E units, and having maternity facilities on fewer sites. However, I reassure my hon. Friend the Member for Ealing Central and Acton that there are no plans to close any hospitals, and certainly not Ealing hospital. As she said, a full public consultation began on 2 July this year and will finish no earlier than 8 October, and I encourage my hon. Friend and her constituents to continue engaging with that process. She outlined the good campaign that she has been running to encourage local engagement, and I am sure she will continue with that so that local voices can be heard when health care decisions are made in the area.

The issue of children’s congenital heart surgery was raised by a number of hon. Members, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew). My hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) spoke passionately about Jacob, the son of one of his constituents.

A number of hon. Members are concerned about the “Safe and Sustainable” review of specialist paediatric services, and particularly its focus on the reconfiguration of heart surgery services. However, as was made clear in a number of contributions, its findings were based on Professor Kennedy’s review of paediatric heart services at Bristol after the heart scandal there, and the “Safe and Sustainable” review is independent of the Government, as it should be. In those circumstances, and given the notice of legal proceedings and referrals to the Secretary of State, it is not appropriate for me to comment further on that review or its outcome, and that stands for my statement on the Floor of the House as well as for my correspondence with constituents. I know that my hon. Friend the Member for Leeds North West has written to the Department on this matter, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied with details of how anyone who wishes to raise concerns about the review can get their voices heard.

[Greg Mulholland]

I commend the Minister for his professionalism in both his previous career and his current role. Although I accept what he says, does he agree that our statutory process must be allowed to look at whether this review is, as we believe, a dodgy decision, or, as the Joint Committee of Primary Care Trusts contends, a fair one? Does the Minister at least agree that such scrutiny should take place, and that the fact that it is being prevented because documents have not been released is wrong and must be rectified? That is all I ask him to say today.

[Dr Poulter]

As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.