Health

Liz Kendall Excerpts

Tuesday 17th July 2012 Commons Chamber

[Jonathan Ashworth]

Indeed. Many of the hon. Gentleman’s constituents would have been welcome in Leicester. He is quite right: where do our constituents in the east of the country, between Newcastle and London, go? That is something else that many of my constituents have raised with me.

I wish to concentrate on the biggest deficiency of the decision, which is the impact on our world-class ECMO—extracorporeal membrane oxygenation—service. On Friday, the Secretary of State announced that he would accept the recommendation to shift our ECMO service from Leicester to Birmingham. In Leicester, we have had a brilliant, world-renowned ECMO service for 20 years.

[Liz Kendall (Leicester West) (Lab)]

I am grateful to my hon. Friend for accepting my intervention, as I cannot speak in the debate because I am a Front-Bench spokesperson on health. Is he aware of the international evidence that shows that Glenfield’s ECMO survival rates for children are 50% to 75% higher than other centres? Those very good survival rates, and the benefits that they bring for children, must be taken into consideration as part of the review.

[Jonathan Ashworth]

My hon. Friend is right, and she makes the point with her usual eloquence and insight. I pay tribute to the work that she has done and, indeed, the work of other Leicestershire Members—I see that the hon. Member for Loughborough (Nicky Morgan) is in the Chamber—on the ECMO service. I thank the Minister for agreeing to meet a delegation of east midlands MPs, as we had a useful discussion.

Giles Peek, a consultant paediatric heart surgeon, said last year of the ECMO service:

“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are always full and often take children from other hospitals…Our role at Glenfield as a national reference centre for this treatment is important and underestimated.”

I fear that Giles Peek’s concerns have come true and that our ECMO service has been underestimated.

I was grateful that the Minister said in the meeting that the Secretary of State’s decision was based on the Agnes review, but there are other ECMO experts who disagree with that review, so I hope that he will consider publishing the Agnes report. In the few minutes I have left, I shall run through the points that various ECMO experts have made. For example, Glenfield has a world-class facility with more than 20 years’ worth of service. There are deep concerns that by uprooting it from Leicester to Birmingham expertise will be lost along the way. Mr Kenneth Palmer, an ECMO expert, gave a stark warning on Radio Leicester today that, as a result of shifting the children’s ECMO service from Leicester to Birmingham, lives would be lost, saying:

“They could never have the same survival rate in another unit if you move it like this. Leicester has one of the highest survival rates in the world, 10%-20% higher than the normal survival rate in the world. To come up to the same skill it will take 5 years at least.”

He has been joined by other experts who have warned about the impact of shifting the unit from Leicester. Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, when asked whether he agreed that lives would be lost, said:

“I do agree with that unfortunately. I think the risk is great that by attempting to move and start over that you’d really start the learning curve all over again and the improved outcomes take time and experience to develop, and so by effect starting over on the learning curve you certainly would potentially put lives at stake and it could be very significant.”

I accept that the Minister takes advice from experts, but given that there is one set of experts making one argument, presumably he receives advice from a different set. If he published his evidence, those of us who are laymen on health policy can try to make our own judgments as those experts scrutinise one another’s work.

Concerns have been raised about the Birmingham facility and whether it can deal with the new ECMO service. Dr Andrew Coe, a paediatrician from Coventry, said on Radio Leicester this morning that he was

“not convinced that Birmingham will cope with increased demand following closure”

of Glenfield. It was suggested to me that if the 80 ECMO nurses at Leicester are not prepared to leave Glenfield, it will take up to eight years for nurses in Birmingham to be trained to the appropriate level of expertise.

I conclude by mentioning the family from South Cambridgeshire, which the Secretary of State represents, who appeared on Radio Leicester this morning. They said clearly and movingly that the service they received for their little girl was the best they could receive and went beyond what staff needed to do. I hope that the Minister will give us guidance on what is next for Leicester’s ECMO service. I hope that he will consider publishing his evidence, and that we can have some sort of review of, or at least look again at, the shift of Leicester’s ECMO service to Birmingham.

--- Later in debate ---

[Nicky Morgan (Loughborough) (Con)]

It is a pleasure to speak in this debate and particularly to follow the remarks of the hon. Member for Leicester South (Jonathan Ashworth) about children’s heart surgery at Glenfield hospital in Leicester. In view of the time limit, I will not repeat the issues to do with the Safe and Sustainable review, because those have been well rehearsed by other Members.

It is no great surprise that all Members, as well as all patients, all staff, all parents and all families, want the best services when dealing with children’s heart surgery. We are talking about very sick young babies and children, and there is no doubt that high-quality services are wanted across the country. At the same time, we have to recognise that in the 21st-century national health service there are bound to be reconfigurations. The reconfiguration that has been worked on by the Safe and Sustainable review arises out of what happened in Bristol, and there is a very good reason for what it proposes. As we have heard, there are some serious questions still to be answered about the process and the way in which decisions have been made.

In the debate in this Chamber in June 2011, I talked about the ECMO—extracorporeal membrane oxygenation —service offered in Leicester, which the hon. Member for Leicester South discussed. It is a world-class, excellent service, and the question is what will happen to it if the children’s heart surgery unit is moved from Leicester to Birmingham. Like the hon. Gentleman, I thank the Minister very much for meeting a delegation of east midlands MPs this afternoon to talk about this. ECMO is a nationally commissioned service and the Secretary of State is therefore required to sign off the move. I understand that he accepted the recommendations of the panel last Friday.

Those of us who are most interested in this and have been listening to constituents and to consultants and staff at the Glenfield unit have a number of questions to raise with the Minister. I would like to be sure of three things before I can be happy with how the decision has been taken. First, before the Secretary of State signed off the move, was he aware of the misgivings of experts that have been described by the hon. Member for Leicester South? Letters are still arriving from international experts. Indeed, since I have been sitting in the debate I have seen a letter that has arrived from the medical director of the Children’s Hospital of Philadelphia. I should like to read out a couple of quotes. The first is from Stephen Conrad, who is chairman of the steering committee of the Extracorporeal Life Support Organisation and who says that

“moving an ECMO program is non-trivial and amounts to much more than moving equipment and some key personnel. Excellent outcomes that are now characteristic of the Leicester group, whose work was instrumental in the worldwide adoption of pediatric and adult ECMO, would not be maintained following such a move.”

[Liz Kendall]

I am grateful to the hon. Lady for her work on, and support for, this important issue. Does she agree that this is not simply a matter of moving the machines but also about the expertise and skills of the staff, which would not be easy to move? Leading international experts on ECMO say that it could take between five and 20 years for the excellent level of service that is available in Glenfield to be made available anywhere else in the country.

[Nicky Morgan]

I am grateful to the hon. Lady; she is absolutely right. The hon. Member for Leicester South referred to Kenneth Palmer, who was retained to give his expert advice to the Joint Committee of Primary Care Trusts on the move. Since the decision was made on 4 July, he has said:

“You will take over 20 years of experience from one of the world’s absolute best ECMO units and throw it away and then to rebuild it in another place and probably it will take at least 5 years to have some kind of quality and probably 20 years to come back to top quality, if it’s ever possible.”

As the hon. Lady said, it is about the staff. Of course the machinery is important, but what has been built up in Leicester, and what it is most renowned for, is the expertise of its consultants, nursing staff, and all the other staff. That is what people particularly rely on. In addition, Leicester has the only paediatric mobile ECMO unit, which is often called out to fly by helicopter to other parts of the country to retrieve patients and take them back to Leicester. I hope that the Secretary of State and the JCPCT were aware of that when they made their decision.

My constituent, Mrs Edith Felstead, who wrote to me and talked about the risk of moving the service, says that survival rates at Glenfield are 20% better than in the rest of the world. The point that I made last year and still want to make is that we have an excellent, internationally renowned service, and if we move it, we must be sure that we are doing so to obtain better outcomes. Will the Minister tell me what advice was given to the JCPCT about the likely outcomes if the move were made?

The rather hefty tome that was published to help the JCPCT to make its decision on 4 July, refers to the secretariat being able to provide “reasonable assurance” that paediatric respiratory ECMO could be transferred safely to Birmingham. I am concerned about that phrase. What assurances have been given? In particular, if the move goes ahead and has to be implemented, what will happen if it then becomes clear in the course of preparing for the move that the service cannot be safely moved and we need to undo some of what has happened as a result of the review?

As the hon. Member for Leicester South said, two narrow questions could be independently reviewed in relation to the Leicester move. I very much hope that following the meeting that we have just had and this debate, the Minister will agree to such a review. I would like to know what advice was available to the Secretary of State and to the JCPCT and the Advisory Group for National Specialised Services before they made their decision.