Children’s Cardiac Surgery (Glenfield)

Jonathan Ashworth Excerpts

Monday 22nd October 2012 Westminster Hall

[Jonathan Ashworth (Leicester South) (Lab)]

It is a pleasure to speak in this debate under your chairmanship, Mr Hollobone.

I pay tribute to the hon. and learned Member for Harborough (Sir Edward Garnier) for securing this debate, and I am grateful to the Backbench Business Committee for allowing us to hold it this afternoon.

The hon. and learned Gentleman, who is one of my parliamentary neighbours, spoke with typical eloquence, as is his wont, and I for one am disappointed that he no longer graces the Government Front Bench. The Front Bench’s loss is the Back Bench’s gain, and I thought that he spoke extremely well. I apologise in advance if I echo many of his points, but that indicates the cross-party support for the campaign. Although we are perhaps blessed in not having any Liberal Members in the east midlands, I am sure that, if we did, they, too, would support the campaign.

As I am sure that the Minister, who represents an east midlands seat, is aware, this issue has caused considerable concern, not only in my Leicester South constituency, but across the east midlands region. It is no surprise to those of us who have been involved in the campaign that the e-petition has hit 100,000 signatures, and I pay tribute to Adam Tansey, the father of Albert Tansey, who set up the e-petition.

There has been widespread opposition to the proposals from the Safe and Sustainable review and how they affect Leicester. The review recommended the closing of the children’s heart unit and the associated moving of Leicester’s world-class extracorporeal membrane oxygenation service to Birmingham. Local people have campaigned vigorously against the proposal, and I pay particular tribute to Ms Robyn Lotto—a constituent of mine who has magnificently led much of the local campaigning in recent weeks. We should also pay tribute to Glenfield’s staff, who are very concerned, as the hon. and learned Gentleman indicated when he read out the circular that we were all sent.

Many organisations in Leicester and beyond have spoken out. The vice-chancellor of Leicester university, Sir Bob Burgess, said:

“Glenfield is a leading international heart hospital where excellent clinical care takes place within a context of internationally significant research. I would therefore ask that the proposal to move the Glenfield services be reconsidered and this valuable facility retained for people of our region.”

The Bishop of Leicester, who I see observing us, said:

“It is not…clear that the movement to Birmingham will be straight forward… In fact I fear that the movement of these services will be harmful to the nation as a whole”.

As I have mentioned, politicians from all parties have come together on this campaign. Politicians on the Labour-dominated Leicester city council are working alongside politicians on the Conservative-dominated Leicestershire county council and on what I assume is the Conservative-dominated Lincolnshire county council, and they have all expressed their concern.

MPs on both sides of the Chamber are speaking up, and, as the hon. and learned Gentleman did, I pay tribute to my hon. Friend the Member for Leicester West (Liz Kendall), who in many ways has spearheaded the campaign from our side with her usual pizzazz, and to the hon. Member for Loughborough (Nicky Morgan), who cannot speak in this debate because she is a Government Whip—fortunately for me, Opposition Whips can speak—but who I am sure would speak if parliamentary convention allowed.

I am, of course, pleased that the Secretary of State for Health has today announced that the independent committee will conduct a full review and report back at the end of February next year. Notwithstanding that welcome announcement, I want to make a number of points on which I hope the Minister can provide clarification.

On demand and capacity—I appreciate some of these points might be for the review committee, but it is important to get them on the record—genuine questions have been raised about the assumptions on demand and the capacity on offer at Birmingham that the joint committee of primary care trusts used. As I understand it, the national projections used by the review assume that demand will be flat, yet the most up-to-date data show demand increasing, because birth rates in the east midlands and west midlands are well above national averages. The projections of population trends used by the review team were based on data from 2006-07. Using those data would suggest a relatively stable work load rising to 3,990 cases in 2025, but, if the latest data on population expectations from the Office for National Statistics are used, the projected rise in surgical case loads hits 5,422 in 2025. Questions have also been raised about the likely patient flows, with clinicians suggesting that Sheffield and Doncaster have indicated a preference for Birmingham rather than Newcastle.

Given that extra surgery work, the movement of the ECMO provision, the increased population projections for the midlands and the worries about increased patient flows from south Yorkshire, I would be grateful to the Minister if she let us know whether the Department is confident that Birmingham has the capacity to meet what is clearly set to be considerably increased demand.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The hon. Gentleman knows, of course, that the Independent Reconfiguration Panel will no doubt consider all his points. As he knows, from the outset, this has been an independent process decided by clinicians. In those circumstances, I am sure that he will make it clear that I am in no position to answer any of his points, which must be addressed by the IRP. Does he agree with me on that?

[Jonathan Ashworth]

The Minister makes an important point. None the less, I still think that, even if it is not appropriate for her to respond, as I suggested might be the case, this is an appropriate forum to put some of those points on the record, and I will continue to do so. I entirely understand her position.

I have a couple of points to make on Leicester’s paediatric cardiac intensive care unit, which the hon. and learned Member for Harborough mentioned. There is concern about how the decision will affect the wider paediatric cardiac intensive care on offer in Leicester, with the potential closure of the unit at Glenfield increasing pressure on the other Leicester hospitals and, more generally, reducing the supply of paediatric intensive care across the east midlands and placing more demand on Birmingham. Again, that is an important point. If the Minister cannot respond, I hope that the committee at least will take it into account.

I want to focus on the ECMO service, as the hon. and learned Gentleman did, and as I suspect many other hon. Members will, too. As I said at the outset, I entirely welcome the Secretary of State’s announcement this morning, but—I will quote from the letter, as the hon. and learned Gentleman did—I am disappointed that he said:

“The decision of the SoS taken regarding the removal of the ECMO equipment”—

he uses the rather bland word “equipment,” but the decision is quite controversial, so describing it in that way is unfortunate—

“from Glenfield to Birmingham should not form part of the review as the decision was not taken by the Joint Committee of Primary Care Trusts.”

That is right, but as has been said, the two things go hand in hand.

I shall repeat some of the points that have already been made. The ECMO service at Glenfield is the longest-established and provides 80% of ECMO capacity nationally. Many of its staff have more than 20 years’ experience. Glenfield’s ECMO service has some of the very best mortality rates. The mortality rate for ECMO at Glenfield is 20%, but the national mortality rate is 50% higher. Will the Minister address the decision not to include ECMO in the review? Does she expect to be able to pick up an ECMO unit in one hospital, plonk it into another and find that the same expertise and mortality rates will transfer with it? As has been said, many international experts do not think so—certainly not in the short run. We have already heard about Kenneth Palmer, the expert ECMO adviser, who told BBC Radio Leicester:

“They could never have the same survival rate in another unit if you move it like this.”

He also said—I think that the hon. and learned Member for Harborough quoted this, and I will repeat it:

“Moving one unit to another place is the same as totally closing down and rebuilding from zero in the new place... I have been very clear…that you cannot move a unit; you can just destroy it and rebuild with many years of decreasing survival rate and increasing morbidity.”

In other words, he is concerned that lives will be lost.

Another international ECMO expert, Dr Thomas Müller, says that

“in the interest of best patient care the decision to close down the most experienced centre in the UK is difficult to comprehend.”

Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, has already been quoted in the debate. He said on BBC Radio Leicester that the ECMO unit is

“considered one of the finest ECMO units”

and described it as a “real jewel”. When he was asked on the radio whether he thought lives would be lost he said:

“I do agree with that unfortunately, I think the risk is great”.

International experts are therefore deeply concerned about moving ECMO from Leicester to Birmingham. One of their concerns is that the institutional memory, built up over a generation by the team, will be lost. That is one reason why I find it slightly disappointing when the Secretary of State presents the matter as just moving equipment from Glenfield to Birmingham. We have already heard that many of the staff feel that they will not be able to move. I shall repeat the quotation from the letter that they sent us all, because it is worth focusing on:

“We are not in a position to leave our homes and families, to move to Birmingham to work. As a team of (predominantly) women, we are (predominantly) second wage earners, with husbands, children and homes.”

As I understand it, 13 nurses are required for one ECMO bed, so there are concerns about Birmingham’s ability in the short run to build and develop a dedicated team of expert staff similar that at Leicester.

Given that the review panel will not consider the ECMO decision, I should be grateful to the Minister if she shared her analysis, or the Department’s analysis, of the risk assessment of moving the ECMO facility. It has been suggested in past debates—indeed, if my memory serves me correctly, it was suggested in a useful meeting that we had with the previous Minister, now the Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns)—that different experts had advised the Department and that they did not share the analysis of Mr Palmer and others. I apologise if my memory of that is slightly wrong, but if that is the case, perhaps the Department will agree to publish the evidence.

We have a campaign including an e-petition signed by 100,000 people—clinicians, staff and members of the public—who are deeply concerned about the proposal to move the ECMO unit. They accept the argument made by Mr Palmer and others. If the Department thinks that there is a different analysis to be considered, perhaps it will finally publish it, so that both sets of analysis can be properly scrutinised, and we can come to a considered opinion. That would reassure us on the point about mortality rates.

I would be interested in hearing the Minister justify the decision not to allow the IRP to consider the ECMO decision. Was not the decision to move ECMO taken and presented as a necessary consequence of the decision taken by the JCPCT in relation to the Safe and Sustainable review? Given that that was the context in which the ECMO decision was made, does it not seem odd that the review committee will not now consider the decision to move ECMO? If the justification is that there is a procedural argument that the various local authorities have asked the committee to consider the outcome of the Safe and Sustainable review and that ECMO was not part of that, fair enough, but it would leave a rather sour taste in the mouth of many campaigners who signed the petition. If that is the case, is there any way in which the ECMO decision can be reviewed? Can the Secretary of State consider reversing the decision of the previous Secretary of State? Many of us who are involved in this cross-party campaign would be grateful for guidance on that from the Minister. I am not sure whether the campaigners would feel pleased if, despite their winning the review, the ECMO unit were still to be shifted.

Many hon. Members want to speak, and because of the cross-party nature of the campaign, we are probably all making similar points, so I will conclude my remarks, but I encourage the Minister to focus on the point about ECMO. There is deep concern about it. People will be pleased about the review, but concerned that ECMO seems to have been excluded from it, and I hope that she can give us some reassurance.