Children’s Cardiac Surgery (Glenfield)

Debate between Liz Kendall and David Tredinnick

Monday 22nd October 2012 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to follow such excellent speeches from hon. Members on both sides of the Chamber. I rise to speak both as the shadow Health Minister and as the Member of Parliament for Leicester West. My constituency is extremely fortunate to include Glenfield hospital. I welcome the members of staff who have taken time out from their busy jobs and travelled a great distance to attend the debate, and I thank them for doing so.

The future of children’s heart surgery matters greatly to the thousands of people who signed the e-petition that has made today’s debate possible. I thank the Backbench Business Committee and the hon. and learned Member for Harborough (Sir Edward Garnier) for securing the debate. The issue also matters to thousands of families right across the country, which is why my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and the hon. Member for Solihull (Lorely Burt) have attended this afternoon.

The issue of children’s heart surgery has needed to be resolved for many years. Following the findings of the Bristol royal infirmary inquiry 10 years ago, clinicians and professional bodies, including the Royal College of Nursing and the Royal College of Paediatrics and Child Health, have been very clear that children’s heart services need to change.

The problem is that services in England have grown up ad hoc and are too thinly spread across the country for every child to get the best possible standards of care. That is why the previous Government initiated the Safe and Sustainable review and why we continue to support the principle of fewer, more specialist centres for children’s heart surgery.

The issue is whether the Safe and Sustainable review has fully considered all the relevant clinical evidence in making its recommendations. The review has failed fully to consider the clinical implications of moving services from Glenfield, particularly the children’s ECMO service. I fear that that mistake is about to be repeated, because the new review being conducted by the Independent Reconfiguration Panel, which we learned about earlier today, will not include discussion of the former Secretary of State’s decision to sign off moving children’s ECMO services from Glenfield to Birmingham.

The two things cannot be separated and are inextricably linked: what happens to the children’s heart surgery happens to ECMO services. It is important to remember that any decisions about nationally commissioned specialist services, such as ECMO, must be signed off by the Secretary of State. I assume that the former Secretary of State made that decision only because of the recommendations of the Safe and Sustainable review, so we need to ensure that any review of those recommendations looks at both ECMO and children’s surgery.

At the risk of repeating the many eloquent speeches that we have heard, Leicester has one of the largest ECMO units in the world and it has long experience, having started in 1989. Glenfield has built up a team of more than 80 ECMO specialists. It is the only unit in the UK that can treat all age groups, which was critical during the H1N1 flu pandemic, because Leicester was able to flex its service to treat up to 10 adults simultaneously while training people working in other adult centres and co-ordinating the national service, triaging all the patients and providing the majority of the patient transport.

[David Tredinnick]

Will the hon. Lady dwell on the mobile service, because that is often a last-hope service for patients? I am informed that, without the mobile service, some patients would not survive.

[Liz Kendall]

The hon. Gentleman has predicted my next sentence. Leicester is also the only unit in England and Wales to provide a mobile ECMO service for babies and children. Once again, it is difficult, if not impossible, to separate the adult ECMO service from the children’s ECMO services. The two are linked. It is not just about equipment; it is about staff and teams working and learning together.

I do not want to denigrate any hospital’s work, but I understand that Birmingham has neither the capacity to continue the mobile ECMO service nor any plans to develop a mobile ECMO service for children. That is a serious cause for concern and something that the Independent Reconfiguration Panel must consider.

Hon. Members have already talked about the outcomes for ECMO patients at Glenfield being significantly better than elsewhere. This is not anecdotal opinion, but clinically audited, peer-reviewed evidence that has come from the very best clinical databases available in this country and internationally. Independently validated data from the UK paediatric intensive care unit database, or PICANet, show that survival rates are at least 50% higher in Leicester. That difference in mortality is maintained even when the severity of illness treated by Glenfield is taken into account.

Data from the best available international register, provided by the Extracorporeal Life Support Organisation, support the evidence of good outcomes in Leicester and show that crude mortality rates in Leicester are 19%, but nearly twice as high in other centres, at 35%. Both those independent, validated data sources show the high quality of ECMO care provided at Leicester and bring into sharp focus the risks of closing Glenfield’s children’s ECMO service.

A service cannot simply be picked up and moved to another city without losing vital skills and expertise. It takes years to build up the quality of care to the same level. Interestingly, the Safe and Sustainable review explicitly addresses the time it takes to build up the quality of care in relation to children’s heart surgery. It says that

“clinical outcomes improve with experience”,

due to factors such as team working, as well as the experience of individual clinicians. The review says that this is a

“statistically significant observation in keeping with analysis which demonstrates historically, an 8 - 10 year period of time before such a service matures to produce excellent clinical outcomes”.

If that is so in relation to children’s heart surgery services, it also pertains to children’s ECMO services.

It was unfortunate that, in his letter to the chair of the Independent Reconfiguration Panel, the Secretary of State referred simply to moving the equipment of the ECMO service. It is not just equipment; it is about staff. It is clear that the majority of staff at Glenfield will be unable to move due to family commitments. Many of the nurses there have homes, families and children, and they may be second earners. A family cannot simply be uprooted and moved. Indeed, an anonymised survey of all staff at the unit found that 80% are “not at all likely” to move to Birmingham. Significantly, none of the ECMO specialists who replied to the survey were able to consider working in Birmingham.

I am concerned that the Safe and Sustainable review has not considered the evidence about ECMO in sufficient detail. The review panel took advice about the future of ECMO services from the Advisory Group for National Specialised Services. There was no representative from any UK or international professional ECMO body on the advisory group, so it commissioned a report from ECMO experts, including Dr Kenneth Palmer, director of the ECMO unit at Karolinska university, whom several hon. Members have mentioned.

Following that report, the advisory group said that it would be “possible” to move Glenfield’s children’s ECMO service. However, the question is not whether it is possible, but whether it is desirable and whether it makes sense to move one of the best-performing services—if not the best, not just in this country but in Europe and internationally. That would not be considered in respect of children’s heart surgery services, so why consider that for ECMO?