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.

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[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.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Burns]

I am very grateful to my hon. Friend; this is the hors d’oeuvre before the main meal later today. Ultimately, if any overview and scrutiny committees of relevant local authorities do not agree with the final decisions, they have a right to write to my right hon. Friend the Secretary of State asking him to refer the matter, with their concerns, to the Independent Reconfiguration Panel. If it is asked to look into the matter, it will then come to a conclusion, of which it will inform my right hon. Friend and he will then take a decision.

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

The Scottish Government have decided that although the Yorkhill unit is currently unsafe, it can be made safe in the context of three surgeons doing 300 operations, whereas the “Safe and Sustainable” review, which is increasingly discredited, is demanding 400 to 500 operations. Why is it one rule for children in Scotland and another for children in Yorkshire?

[Mr Burns]

I have to tell the hon. Gentleman that the decisions that the Scottish Government and the Scottish Health Department might take with regard to Glasgow is a matter for them. The fact is that we recognise what is commonly accepted among the international community: that the safest way of providing that surgery is by carrying out about 400 operations a year.

Health

Greg Mulholland Excerpts

Tuesday 17th July 2012 Commons Chamber

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

I rise to take the opportunity to discuss the Safe and Sustainable review into children’s heart surgery in England and Wales and the concerns about the process that led to the closure of the excellent Leeds unit. The decision was taken on 4 July. Families from up and down the country were asked to be present to give their views and the joint committee of primary care trusts—the JCPCT—deliberated in public all day. The decision was due, but it was delayed, delayed and delayed again, until it was finally announced that Leeds would close. What left a particularly nasty taste in the mouth was that it was abundantly clear when documentation was produced that the decision had already been taken and that that day, including asking the families of children who had needed to use the surgery unit, was a charade. I am afraid that that was all too typical of the way in which this process has been handled.

There are serious questions about how the JCPCT reached that decision. It ignored clear evidence and, I am afraid to say, there has been a clear and obvious bias all along towards Newcastle. Leslie Hamilton was on the committee despite being based at Newcastle, but there was no one from Leeds. No one in Leeds or, I am sure, up and down the country was at all surprised at the decision, because we expected it. We could see that the JCPCT was simply not considering the evidence.

In the brief time I have available I shall raise a few points and I know that my hon. Friend the Member for Pudsey (Stuart Andrew) will raise a few more. I am sure that other hon. Members will also seek to do so and I shall look forward to having a full debate in the autumn, when we can place on the record the myriad serious concerns on this point.

First, 600,000 people signed a petition in support of the retention of the unit at Leeds, yet that was counted as only one response by the committee. At the same time, 22,000 text messages from unknown sources supporting Birmingham were counted as 22,000 submissions. So, how can the JCPCT say that it does not “count heads” when it is ignoring 600,000 people, counting them as one submission, yet counting 22,000 text messages as 22,000 separate responses?

Why has the JCPCT watered down expert advice on the gold standard of collocation? It has adopted a watered-down version on the advice of fewer than 10 clinicians in the steering group and on the recommendation of Sir Ian Kennedy, who is not a clinician. How can the panel justify following that advice rather than that of the country’s most respected gatherings of experts in this field? How can it be right, if this closure happens in Leeds, for the Yorkshire and Humber region to go from enjoying the highest standards of collocation in the country to having the lowest?

The Safe and Sustainable model of children’s heart surgery is also dependent on networks of care, but whereas the Leeds network was recognised as “excellent”, Newcastle’s was regarded as “poor”. Why is the Yorkshire and Humber moving from a centre that delivers an excellent network to one with a record of delivering a poor one?

The JCPCT accepted the advice that 90% of doctors in the relevant areas of option B would be happy to refer to Newcastle, yet the referring doctors in Yorkshire and Humber have never been asked about that. That is simply outrageous.

I am aware that there has been a referral from the joint overview and scrutiny committee in Yorkshire, which we fully support and insist is properly investigated. We must also consider the very worrying situation in Glasgow. The Yorkhill unit is currently failing and a separate report by Sir Ian Kennedy stated:

“The panel had significant concerns about important aspects of the service in the surgical unit and in the broader congenital heart network. Of most concern was a lack of leadership and coherent team working. Also of concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressed.”

That has not been part of the review, however, and extraordinarily the Scottish Government have now decided that three surgeons performing 300 operations is safe in Scotland. However, that is not considered to be safe in Yorkshire. That is simply unacceptable. Today we are saying that we have no confidence in the review and that we want the whole process to be reconsidered.

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[Jason McCartney]

I thank the Minister. I said earlier that the decision would go to the Secretary of State via the independent panel. I look forward to its going through that process.

The first test for redesigning services is that there should be clear clinical benefit. The health impact assessment was that option G—to keep Leeds open—had fewer negative impacts than the chosen option. The second test is clinician support. There is no evidence that the decision has the support of clinicians; in fact, most have given their support to the Leeds unit.

The third test involves the views of the public. Surely nothing can be clearer than the views of the 600,000 people who signed the petition to keep the Leeds unit open, and the admirable cross-party support for the campaign. The fourth and final test is that there should be support for patient choice. A survey in west and south Yorkshire clearly shows that patients would not travel up to Newcastle.

Many constituents with experience of the Leeds unit have been in touch since the announcement on 4 July.

[Greg Mulholland]

The evidence clearly shows that Newcastle will not hit the magic number of 400, making the point of the process farcical. As we now know that Glasgow will continue, but will perform only 300 operations a year, there will be two underperforming units, and we will have lost Leeds, which could easily reach those numbers. Does that not make the whole thing a farce?

[Jason McCartney]

My hon. Friend makes a good point. There is an assumption that all the patients who have been going to the Leeds unit will automatically migrate to Newcastle. That is a big flaw in the assessment, and I look forward to further exploration of that matter.

Constituents who have been in touch with me include teenager Seb, who recently did work experience with me. He had three heart operations and a pacemaker fitted at Leeds. He wants the Yorkshire unit to stay open; he stresses the fact that there are good transport links to the Leeds unit.

Paul told me about his 10-year-old stepson who suffered a cardiac arrest last August. His stepson had a defibrillator fitted internally, which he will have for the rest of his life. Paul said the Leeds location was key for their family.

Ruth told me about her six-month-old daughter Eleanor who was born with a heart defect caused by Down’s syndrome. Ruth fears for the emotional and financial stress families will be put under by the longer travelling distances, as parents try to hold down their jobs, care for other children and fulfil other responsibilities.

I was also contacted by the grandparents and, separately, the parents and siblings of four-year-old Lily Rose, who had surgery in the Yorkshire unit. They asked how a four-year-old was expected to cope at such a traumatic time without being able to see her mummy each day. The emotional impact on the rest of the family would be enormous. They stressed that distance from the centre is extremely important. They reiterated the population figures: 14.5 million people are within two hours of Leeds, whereas only 3 million are within two hours of Newcastle.

Those cases are real; the families were in touch with me over the past two weeks. In the past year, I have spoken in the Chamber about George Sutcliffe, Ben Pogson and Joel Bearder who, with their families, have been campaigning locally for the Leeds unit to stay open. I compliment them and all the families who have worked so hard on the campaign, and will continue to do so.

It is clear that the plans do not meet the four tests, which are factual; they are not about emotion. I look forward to the flawed decision eventually being referred by the independent panel to the Secretary of State so that the tests can be looked at again. I firmly believe the JCPCT decision clearly fails all the four tests for redesigning services, and I look forward to its being reconsidered.

[Mr Andy Slaughter (Hammersmith) (Lab)]

On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.

Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.

The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond Street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.

Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:

“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”

Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.

Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.

[Greg Mulholland]

The hon. Gentleman makes a passionate case for the Royal Brompton unit. The chief executive of Little Hearts Matter says that, in the Glasgow case, a unit that does 300 operations can be made perfectly safe by other means, without closing units. Does the hon. Gentleman share my frustration at the fact that in the Royal Brompton, Leeds and other places, those involved are not prepared to do that? It does not make sense.

[Mr Slaughter]

I am grateful for that intervention, because, in case my comments are seen as special pleading from the hospital, I was just coming on to mention some independent recommendations and sources that support the argument that, if there is no opportunity for research, and if experts—in Leeds, as well as the Royal Brompton—are prevented from working to the level of their abilities, many are likely to seek work elsewhere, possibly outside the UK.

Dr Neil Gibson, a consultant in paediatric respiratory medicine at Glasgow’s royal hospital for sick children, wrote to the chair of the review as follows:

“The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record…There is a significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.”

Professor J. Stuart Elborn, president of the European Cystic Fibrosis Society, wrote that

“high quality research is a key determinant of the ability of a centre such as the Royal Brompton to retain and recruit the world leading clinical and academic staff on whom its respiratory services depend. Adverse impact upon the ability of the clinical staff to carry out cutting-edge research will undermine the sustainability of the clinical services, to the detriment of its patients.”

Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign, and the Primary Ciliary Dyskinesia Family Support Group wrote a joint letter to the chair of the committee, saying:

“We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future.”

Patients and staff at Royal Brompton are understandably deeply distressed at the prospect of losing their high-performing children’s heart unit, soon to be followed by their specialist respiratory services. They do not understand how such a decision can be made by bureaucrats who have never visited the hospital and have no specialist knowledge of the care provided there. They have written to their MPs and to the Secretary of State. Indeed, one resourceful mother brought the matter to the attention of the Prime Minister in Downing street last Thursday.

The Secretary of State for Health assures the parents of these seriously poorly children, and the dedicated teams that treat them, that this is a matter not for him, but for the NHS. For the sake of the thousands of children whose care will be damaged by the decision of Sir Neil McKay’s committee, the sake of the research programmes that will be destroyed, and the sake of common sense, I hope that the Minister of State will realise that the time has come for him to meet clinicians from the Royal Brompton and at least hear what they have to say. Perhaps he will be able to persuade them that destroying NHS services and research programmes that are viewed by international peers as among the best in the world is a good idea. I wish him luck in doing so.

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[Stuart Andrew]

My hon. Friend is right. I am sure that that is the case for constituents across Yorkshire and the Humber.

[Greg Mulholland]

I am happy to be working so closely with my hon. Friend on this matter. When all the evidence is considered, is not the reality that Leeds is being sacrificed simply to allow Newcastle to achieve a level of operations that it might not even achieve? That is no reason to close a good unit.

[Stuart Andrew]

I could not agree with my hon. Friend more.

The decision flies in the face of a fundamental aspect of the NHS constitution: patient choice. The JCPCT asserts that Newcastle could reach the minimum number of procedures if parents are “properly managed” to go to there. That is simply unacceptable. The whole point of patient choice is that people decide where they want to go.

As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, the review ignored a petition of 600,000 people, counting it as only one response, when 22,000 text messages in support of the Birmingham unit were counted as 22,000 separate responses. Why was that?

The scores in the review were allocated to four bands. Each of the points from one to four were multiplied by the weighting. That gave 286 points to Newcastle and 239 points to Leeds. However, there was no clarification of how the figures had been arrived at. Also the figures were not definite, but were rounded up or down, which may have made a huge difference to the outcome.

As has been mentioned, clinical experts at the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists all say that surgical centres should be chosen on the basis of their having paediatric services all on one site. That is something that we enjoy in Leeds, which has a wonderful children’s hospital with all the services that are needed. On meeting such children, it is clear that they need the support not just of heart surgeons, but of other experts. In Newcastle, the extra support will be some 3 miles away. There will therefore be a worse service for people who live in and around Yorkshire, not the world-class service that we all want.

There is much more detail that I would like to go into. I sincerely hope that we will have a Back-Bench debate on this issue when we come back in the autumn, because it is of grave concern to hundreds of thousands of people in the Yorkshire region. We will not give up our fight to save our unit.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 12th June 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

If the hon. Gentleman would like to supply me with the details of regions that are having to do that, I will certainly write to him on the matter. What we are doing is making an extra £750 million available to the NHS during this spending period to support the investment in radiotherapy services. I will certainly come back to the hon. Gentleman on his particular point.

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

In an Adjournment debate last year on the safe and sustainable review, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) confirmed the minimum number of operations at 400 a year, saying that it was based on the level of activity needed to provide good quality care around the clock. Does he share my astonishment that the chairman of the joint committee of PCTs has said that he can give no assurance that that will be included in the final review? Does that not undermine this unhappy process?

[Mr Lansley]

My hon. Friend will be aware, as other Members are, that this is an independent review conducted by the joint committee of primary care trusts. On that basis, I will not comment directly on anything said in that context. I simply reiterate what was made clear in last year’s debate that the joint committee will not conduct its review solely on the basis of the options set out in its original consultation.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

I pay tribute to the work my hon. Friend does and to the work the Raynaud’s and Scleroderma Association has done over many years in raising funds, raising awareness and making sure there is a greater focus on these issues. I can assure my hon. Friend that the work we have done in establishing the NHS Commissioning Board will mean that in future, for the first time, there will be one organisation that will be able to look at issues involving specialised and complex needs that require a national focus.

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

14. What recent progress he has made on the review of adult congenital cardiac services.

[The Secretary of State for Health (Mr Andrew Lansley)]

The review of adult congenital heart services is a clinically-led NHS review, independent of Government. I understand that an expert advisory group has been established and its first task will be to develop designation standards and a model of care that commissioners can use to help determine the future pattern of services.

[Greg Mulholland]

I thank the Secretary of State for that answer, but adult cardiac patients in Yorkshire are both disfranchised and extremely worried because of the review of the children’s heart unit, as if it is closed, they, too, would lose access to surgeons. Does the Secretary of State agree that it does not make sense to have two separate reviews, and that they should instead be brought together?

[Mr Lansley]

My hon. Friend will know that no decision has yet been taken on the location of children’s or adult congenital heart surgery centres in England. Neither the draft adult clinical standards nor the proposed standards for children’s services require services for children and adults to be collocated.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

As I have said, the review is clinically led and independent of Government, and I am afraid that it would not be appropriate for me, or my colleagues, to intervene. Moreover, the review is the subject of legal proceedings. It will be for the Joint Committee of Primary Care Trusts, on behalf of local commissioners, to decide the future pattern of children’s heart services on the basis of the best available evidence.

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

It seems nonsensical to deal with the provision of surgical services for adult and child congenital cardiac patients in separate reviews. Given the delay in the review of children’s services, does the Minister not agree that it is time to consider including them in the forthcoming review of adult services?

[Mr Burns]

I am grateful to the hon. Gentleman for his suggestion, but I am afraid that I do not share his view. As he knows, there will be a review of adult services, but it has always been considered most appropriate to deal with paediatric cardiac services before adult care, and that is what we will continue to do.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 22nd November 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful for that question, and I assure the hon. Gentleman that the Government are determined to root out ageism wherever it might be within the NHS. That is why we have made it clear that there will be no exemptions from age discrimination legislation—and that will have to be taken into account by clinicians when they make decisions.

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

The recent judicial review concerning the unit at the Royal Brompton hospital said that the Safe and Sustainable consultation was unlawful and the review should be quashed. Considering the concern about this matter and the flaws in the review, is it not time for the Minister to indicate when the Government might intervene? Otherwise, there could be further threats of judicial review.

[Mr Simon Burns]

The straightforward answer is no, because the Joint Committee of Primary Care Trusts has said that it intends to appeal. This is an independent review. It would be inappropriate for me or any other Minister to interfere in such a review, because we could be accused of compromising its independence.

Southern Cross Care Homes

Greg Mulholland Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman is absolutely right; this is about people’s homes and their futures. That is why the Government have been working to make it abundantly clear to all those involved in the process what their responsibilities are, and what the local authorities’ responsibilities are. We have also made it abundantly clear that in no circumstances will the Government do anything other than ensure the future continuity of care for people. No one will be made homeless, and no one will wind up without the care and support they need.

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

Considering the real concern in areas around the country, including Leeds, and the clear duty of local authorities in this role, does the Minister agree that it is inappropriate and irresponsible for councils such as Leeds city council to pursue a raft of closures in their own care homes while this problem clearly exists?

[Paul Burstow]

My hon. Friend tempts me to comment on an individual local authority’s decisions, the details of which I do not have. It seems to me that that is an area that the council in question will have to look at carefully. The key thing has to be that local authorities are responsible for looking at the availability of good- quality care home placements in their area and to supply individuals who are funded by the local authority and who need a decent care home with just that.

Oral Answers to Questions

Greg Mulholland Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Burns]

Yes, I can give the hon. Gentleman a categorical assurance on that.

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

Further to the previous question, if there are further options in addition to the four already presented, I ask that the Government do not rule out looking at the matter again if it is shown that it is possible for Leeds and Newcastle to serve the north of England.

[Mr Burns]

As the hon. Gentleman will appreciate, I do not want to be drawn into that too far because this is an independent assessment by the joint committee of primary care trusts and I do not want to be seen to be interfering, but I can say that neither we nor the JCPCT have ever said categorically exactly how many centres there should be. It will be up to the JCPCT, as it considers the representations it receives, to decide how many there should be. If it decides to have more than four, it would not need the processes that he is suggesting because it has the power within its remit to increase the number if it thinks circumstances warrant it.

Congenital Cardiac Services for Children

Greg Mulholland Excerpts

Thursday 23rd June 2011 Commons Chamber

[Stuart Andrew]

That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.

On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds General infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.

How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel when there could be alternatives?

The Yorkshire and Humber congenital cardiac network board has a well-established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.

On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and it will have the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.

The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.

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

I thank my hon. Friend and neighbour for giving way. Going slightly further on his last point, does he realise that if those surgeons are no longer there, they will not be able to perform operations on adults? Adult surgery would be very detrimentally affected.

[Stuart Andrew]

I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.

I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that will be made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.

I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.

Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well-organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.

--- Later in debate ---

[Mr Mudie]

I entirely accept that, and I did not intend to suggest that the right hon. Gentleman had said anything different. My point is that, while the clinical case for a rationalisation is unarguable, equality of access is as important a consideration as any. Excellent treatment must not be available to only a certain number of people.

[Greg Mulholland]

We all accept the clinical premise of the review, but is it not incredibly arrogant for anyone to suggest that it cannot be fallible? There are obvious flaws in it. Many clinicians themselves say that it is flawed.

[Mr Mudie]

I hear what the hon. Gentleman says. I think that the same case was made by the right hon. Member for Charnwood. We may prevaricate for one reason or another, but sometimes it may be necessary to make a decision even when we think that it is not perfect, and I think that this is an instance of that. If the life of a child is involved, we must make a decision.

If we continue to challenge the clinical aspect of the review, we will fall into the trap of allowing a bad situation to continue. The case for change has been proved, and, while we may differ on how that change should be made, what is important is for us to express the view—and I should like to see it challenged—that there should be equality of access. Each region should ensure that every part of it has equality of access where possible, although that will involve some difficulty if Yorkshire is lumped together with the north-east.

In the last year I have had to move from my constituency office, which was in the centre of the constituency. I was offered cheaper, perhaps even better, accommodation in the outer part, but I felt that it would be unfair on the other wards for me to move away from the centre. If option 4 is either Leeds or Newcastle, I think that that is unfair on both. I do not want to close Newcastle, and Newcastle does not want to close Leeds. Locating provision sensibly in each region is important, but the House should also recognise, as it rarely does, that the country has some corners in which there is no equality of access in any respect. Those in Newcastle, in the top corner, and those in Cornwall, in the bottom corner, do not have access to many facilities that are accessible to people in the midlands, in Yorkshire and, above all, in London.

I believe that the House should accept the motion, and that the review team should forget about the clinical arguments and produce a template that proves to every Member that the excellent services that we should be demanding for children’s care will be shared equally around the country. The team should give some real, positive, out-of-the-box thought to how to deal with areas that generally lose out.

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

It is a pleasure to follow my Leeds colleagues, and it is a pleasure to work with all the Leeds and Yorkshire and Humber Members of Parliament throughout the House in support of the inspiring campaign to save the Leeds unit. I too was proud to be there to help present that remarkable petition. Nearly half a million people in the region have spoken out in an attempt to save the unit. When I visited it, I had the same experience as other Members have had when visiting their local units. I found it incredibly moving to meet those babies and children and their families, while also being conscious that I was walking into a centre of excellence. It benefits from a genuine co-location of services, which is the gold standard that has been set, and 370 operations are already being performed there—very close to the 400 figure.

[Mr Kevan Jones]

I note the size of the petition, but as a former Defence Minister responsible for defence medical services I faced similar petitions when the Ministry of Defence was concentrating military health care at University Hospital Birmingham NHS Foundation Trust, which is now a centre of excellence not just in this country but internationally. Although petitions are valuable, clinical outcomes must be at the forefront of any decision, and the MOD’s decision to concentrate defence medical services at Birmingham was the right one.

[Greg Mulholland]

It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

[Stuart Andrew]

My hon. Friend mentioned the co-location of services. As I said in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?

[Greg Mulholland]

I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.

There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.

That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.

I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:

“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”

Jonathan Darling, a consultant paediatrician at the Leeds General infirmary, states:

“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”

I am afraid that it simply has not done so, which is worrying and quite extraordinary.

The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.

[Mr Mudie]

The point I was making was that if we are to take the review’s point and place units strategically, the obvious place with a mass population is Leeds. However, I said that that would leave Newcastle out on a limb, and something has to be done about that. The case for Leeds is unchallengeable.

[Greg Mulholland]

Indeed, and we have to get the point across to colleagues in other areas that perhaps we have to challenge the premise of the review and some of its figures if we are to reach other recommendations.

The third matter that I wish to mention, as the hon. Gentleman did, is travel. In the meeting yesterday with the review team, I was frankly dismayed by how little consideration was being given to the reality of ordinary working families and the effect that having to travel would have on them. I shall give a couple of examples. Johanne Walters, the mother of Emma, states that to them the change

“would mean her…surgery will be undertaken miles away from home and nobody would be there to support me—no family no friends—and it is incredibly difficult being there 24/7 at your child’s bedside, even with this support”.

Joanne and David Binns, whose son Oliver has been treated, have said:

“Oliver is our only child, and I’m sure you can imagine how it turned our world upside down. But we knew that we had family and friends who could just pop in and make us some food at the end of a long day, bring us clean clothes, and just be there if we needed a chat. I can’t imagine how much extra pressure it would have been at this point to have to think about long distance travel and accommodation on top of everything else.”

Matthew and Karen are the parents of Liam Hey, a constituent of mine who has become something of a celebrity. He is a wonderful young man who is being treated at Leeds. Karen has said:

“My son would not be here if it wasn’t for the LGI. It would be too much of a trauma to transfer children to another place.”

Travel has simply not received adequate consideration. It comes out top of the criteria that people give when we ask them, but it is not anywhere near the top of the list of the review’s considerations. That is wrong.

We have to re-examine the situation. I am delighted that the House has had a chance to debate it today, and that Ministers have been so accommodating in enabling us to do so. I urge the House to support the motion. We should come back with some proposals that will really work for children and that we can all support.

[Several hon. Members]

rose—

--- Later in debate ---

[Craig Whittaker]

I apologise if I left out women.

[Greg Mulholland]

Let me too say that it is a pleasure working with my hon. Friend, but can we debunk this myth that we are talking about a review without flaws that is based on clinical guidelines? Option B, which he mentioned, does not even get us to 400 operations for some centres. In too many places the review does not even follow its own logic.

[Craig Whittaker]

I agree with my hon. Friend, who is absolutely right. This comes back to my basic premise, because all we are asking for is an open, honest and transparent process that will produce the desired outcomes.

Last year, one of my constituents, Miss Libby Carstairs, spent many months in Leeds hospital and underwent heart surgery several times over several months. As we know, the aims of the consultation clearly show that parents would take their child anywhere to get the best treatment when they are as poorly as Libby is and was. Under the proposals, Libby would have gone backwards and forwards several times, probably between Newcastle for surgery and Leeds for her convalescence. Currently, her care and surgery all happen in one place. As with all families at such a stressful time, it was hugely beneficial that the family could visit regularly and help in the convalescence period. Libby’s mum spent her life in that unit with her, and her grandparents played a huge role with relief and support. Libby’s being in Leeds even allowed her head teacher, from Carr Green primary school, the opportunity to visit and take messages of support from her classmates and friends. I saw first hand not only how that cheered Libby up, but how it helped to fast-track the recovery of this poorly little girl. It also without question helped Libby eventually to go home, albeit with high levels of support. Such support from family and friends would not have been possible had Libby been up and down to, say, Newcastle or Liverpool, which are many miles away.

Although the main principle of parents taking their child wherever they need to go to get the best treatment is absolutely correct, it does not take into account the loss of income to the family through not being in work, the huge cost of travelling much further distances, and the incredibly important network of support from family and friends at what is an awfully frustrating and stressful time for everyone involved—the big society at its best, as it were. I cannot imagine what it is like not to know whether one’s child is going to live or die, so I cannot begin to comprehend the full extent of the support needed and appreciated by families.

Contrary to the e-mail received yesterday, MPs do understand the process, as do the 500,000 people who have signed the petition. However, it is scandalous that Leeds fits into only one of the four options, particularly as vital information has been missed out of Sir Ian Kennedy’s assessment. To sum up, if the Government are big enough to listen to the people and amend their proposals on issues such as the NHS and jail, surely clinicians at the JCPCT should be big enough to review their plans, by listening to what 500,000 people from Yorkshire, Humberside and Lincolnshire are telling them to do.

--- Later in debate ---

[Mr Burns]

I am grateful to my right hon. Friend for that intervention. With regard to Leeds teaching hospital, he will know that this is a complex issue. There are 36 different surgical procedures listed on the central cardiac audit database, but the three most relevant ones in the context of his question are those that deal with atrioventricular septal defect, arterial switch and Fallot’s tetralogy. Over the past six years, 304 operations have taken place involving those three specialties. Sadly, the number of patients who died within 30 days was 12, and 18 died within one year. The results of surgery in all units are good, with no significant divergence. The issue, however, is the future. We need to prepare for units that can deal with these highly complex procedures and the intense technology needed, and provide the qualified doctors and nurses involved, in order to keep up with professional and public expectations of the high quality of care required. This is not so much about today’s figures as about how we meet the challenges of the future to provide the finest and safest possible care in this deeply complex area of medical treatment.

The consensus among professional associations is that there should be no fewer than four congenital surgeons in a centre, each performing between 100 and 125 procedures every year, for a centre to be optimally staffed. Over the past few years, the outcomes for the services have remained good, as the figures that I have just given to my right hon. Friend illustrate, but there have been several warning signs that the current arrangements are fragile. For many years, professionals and national children’s charities, including the Children’s Heart Federation and the British Heart Foundation, have urged the NHS to review services for children with congenital heart disease. They have consistently raised serious concerns about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres.

Many of the 150 types of operation undertaken by these dedicated teams are among the most complex, challenging and technically demanding areas of surgery. Success requires intricate surgery on hearts often no bigger than a walnut, coupled with finely balanced judgments drawn from a combination of advancing science, personal experience and compassion. It involves a range of highly trained individual team members—before, during and after the operation.

The risks posed by the complex nature of heart surgery include not just possible death after surgery, but lifelong complications such as brain damage and other disabilities. The judgments of any expert medical team caring for a particular child therefore have a direct and long-lasting impact not only the future of each vulnerable child, but on that of their families.

There is also the issue of recruitment. The fact is that smaller centres have problems with recruiting and retaining the very best surgeons. There is a risk that those working in smaller centres will find themselves working in isolation and in units that are not as up-to-date with techniques and clinical practice as the larger ones are.

[Greg Mulholland]

We all understand the premise of the review about the need to move to larger centres, but does the Minister not understand—I am not trying to draw him—the real concern when Leeds is performing 370 procedures a year and Newcastle, a smaller unit, performed only 255 last year, yet Newcastle is in all four options and Leeds only in one?

[Mr Burns]

I fully appreciate the hon. Gentleman’s point, but I hope that he will appreciate that he is now trying to draw me into a discussion on the merits of Leeds as against Newcastle. As I said earlier, it is inappropriate for me as a Minister to do that. However, it is a point that the hon. Gentleman, my hon. Friend the Member for Pudsey and others can make more than adequately to the joint committee, which will be able to determine the merits of the argument prior to reaching a decision. I urge the hon. Gentleman to understand how inappropriate it would be for me to go down the route of arguing the merits or demerits of one area or another.

Smaller centres struggle to train and mentor junior surgeons, making these units less attractive to the senior surgeons of tomorrow and making it difficult to provide a safe 24-hour service. We must ensure that our surgeons and their teams are well supported. They need opportunities to develop their experience as they become increasingly expert in these intricate and complex procedures. We must ensure that all the hospitals that provide heart surgery for children can also provide care within safe medical rotas.

No parent would wish the care of their child to be entrusted to a surgeon who, though an excellent doctor, is overly tired because they have had to work around the clock without any peer support. This means that to reduce the risk of surgery in sick children and to improve their long-term outcomes, we must focus our surgical expertise in larger centres. The need has become ever more pressing with the increasing complexity of treatment.

As hon. Members will know, the national review is known as the Safe and Sustainable review. Its aim is to ensure that children’s heart services deliver the very highest standard of care. The NHS must use its skills and resources collectively to gain the best outcomes for patients. As I stated at the beginning of my speech, in line with the Government’s entire approach to the NHS, this review is both independent and clinically led. May I reassure hon. Members that the objective of the review is not to close children’s heart centres? Far from it. While surgery may cease in some centres, they will continue to provide specialist, non-interventional services for their local population.

Indeed, the review proposes to extend local care further, supported by the professional associations that support the increased clinical expertise across England. This wider support is crucial. Surgery is usually a single, short episode in what is often a lifelong relationship with specialist congenital heart services. The aim is to improve those services as a whole and to ensure that as much non-surgical care as possible is delivered as close to the child’s home as possible through the development of local congenital heart networks. These will enable children to be safely and expertly cared for nearer to home in the longer term.

Given the complexity of the issues for consideration, the NHS has held a four-month, rather than the usual three-month, consultation. Hon. Members should be reassured that the consultation process has been impressive in its scope, inclusiveness and transparency.