Children’s Cardiac Surgery (Glenfield)

Lord Garnier Excerpts

Monday 22nd October 2012 Westminster Hall

[Sir Edward Garnier (Harborough) (Con)]

I beg to move,

That this House has considered the e-petition from Adam Tansey relating to children’s cardiac surgery at the East Midlands Congenital Heart Centre at Glenfield, Leicester.

Mr Hollobone, I welcome you to our proceedings and thank the Backbench Business Committee for agreeing to the debate this afternoon. Parliament can respond to issues of public concern quickly. More than 100,000 names —I think that the total is about 103,000 at the last count—appear on the e-petition that I have referred to.

The new Secretary of State for Health has responded in short order to the facts presented to him, and I thank him for that. In a letter sent by him today to the various councils that referred the Glenfield decision to him, he says that the Independent Reconfiguration Panel will now conduct a full review of the decision by the Safe and Sustainable review. That is most certainly to be welcomed. However, he also says that the IRP will not consider the decision taken by his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to remove ECMO from Glenfield, as that decision was not taken by the joint committee of primary care trusts; I will say what ECMO means in a moment.

That last statement is illogical and certainly difficult to understand; we are surely entitled to assume that the previous Secretary of State made his decision on the basis of the recommendations from the Safe and Sustainable review. We need to find out, as an urgent priority, whether the new Secretary of State can reverse the decision on ECMO. As I am sure contributors to this debate will demonstrate, it would be sensible for him to do that and I look forward to receiving confirmation from my hon. Friend the Minister that that is going to happen. Cardiac services and an ECMO facility go hand in hand. We know that; I am sure that the Department for Health knows it, and I look forward to hearing in due course from my hon. Friend that she knows it, too.

I have had some intermittent contact over the years with the campaigners supporting the case for Glenfield’s ECMO and children’s cardiac units and I have visited the hospital on many occasions as the MP for Harborough, which is in south-east Leicestershire—most recently, when the additional facilities funded by the Thomas Cook travel company’s charitable foundation were formally opened in May this year. However, owing to the time and other constraints imposed on me as Her Majesty’s Solicitor-General, a post I held until last month, I have not been able to follow the development of the issues surrounding the Government’s reconfiguration of children’s heart services with as much attention to detail as I might have wished.

Now, what does ECMO mean? It stands for “extracorporeal membrane oxygenation”, and it is a highly technical, very clever and hugely successful medical means of recovering people who have both severe heart problems and severe respiratory problems. It might interest you to know, Mr Hollobone, that the only survivor of the house fire in Prestatyn at the weekend—the father of the household—is alive today only as a consequence of his being transported to the Glenfield ECMO unit, where he is under the treatment of Mr Giles Peek, one of the consultants there.

I am happy to report that, despite my absence from the battlefield, two other hon. Members from Leicestershire, my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall), have been at the forefront of the campaign to bring this matter to the attention of the Government and the wider public. That is not to say that my hon. Friends the Members for North West Leicestershire (Andrew Bridgen) and for Bosworth (David Tredinnick) have not played their part, nor that the Minister for the Armed Forces, my right hon. Friend the Member for South Leicestershire (Mr Robathan), and the Minister at the Department for International Development, my right hon. Friend the Member for Rutland and Melton (Mr Duncan)—colleagues who, unlike me, continue in Government—have not been working below the radar. Nor do I mean to suggest that my right hon. Friend the Member for Charnwood (Mr Dorrell), the Chairman of the Health Committee, has been a mere spectator—of course, he has not. All of us have been doing our best to ensure that the case for Glenfield is heard in the right quarters. That is also true of the right hon. Member for Leicester East (Keith Vaz) and the hon. Member for Leicester South (Jonathan Ashworth); despite their being respectively the Chairman of the Home Affairs Committee and an Opposition Whip, they have played their part in this campaign.

We have an abundance of parliamentary talent in Leicestershire, but if any praise is due, it is due to my hon. Friend the Member for Loughborough and the hon. Member for Leicester West, who have led the cross-party campaign—I stress that it is cross-party—to ensure that the case we are here to make has been, and continues to be, waged so effectively. The hon. Member for Leicester West is the constituency MP for Glenfield, but she is also the shadow Minister for Health, so she has a double reason for taking an interest in today’s proceedings. It goes without saying that she has been working very hard for her constituents, both human and institutional, in this regard, but she has been doing so in co-operation with my hon. Friend the Member for Loughborough, who is now a Government Whip; my departure from the Government has been more than compensated for by my hon. Friend’s promotion.

However, by convention and practice that means that my hon. Friend is no longer able to speak in Parliament, either here in Westminster Hall or in the main Chamber of the House of Commons. Nevertheless, she is in her place this afternoon and I know that she will continue, as we all will, to support vigorously the medical and ancillary staff at the Glenfield hospital and the patients and their families who benefit from the services provided by those doctors, nurses, technicians, administrators and the many others connected to that great hospital, some of whom are with us in Westminster Hall today.

My constituents Dr Sanjiv Nichani, the senior consultant paediatrician at the Glenfield hospital, who specialises in children’s heart care, and Mr Giles Peek, the director of the paediatric and adult ECMO programme and a cardiothoracic consultant surgeon, have travelled here today to hear the debate and to speak to the Minister afterwards, all being well.

[Patrick Mercer (Newark) (Con)]

May I express my support for the comments of my hon. and learned Friend? As you, Mr Hollobone, and he both know, Newark has all sorts of problems with health care at the moment. Glenfield hospital is crucial to my constituency. I particularly draw the attention of my hon. and learned Friend to the comments by Mrs Pamela Durney, who owes so much to this crucial hospital for her children’s health.

[Sir Edward Garnier]

I am grateful to my hon. Friend for that intervention. His support demonstrates that the issue is not only for Leicestershire, but one that affects patients from right across the east midlands and, I would suggest, from well beyond the east midlands.

Before my hon. Friend the Minister feels a little surrounded, may I thank her for being here to respond to the debate? I also congratulate her, although she must be bored of hearing congratulations, on this first step in what will be a long and successful ministerial career; I say that not as a question but as a statement of fact, and on that basis I am sure that we have won the case. I have no doubt that her response to this debate will act as an accelerant to her progress and provide great hope to those of us who want to see the Glenfield hospital’s ability to save lives continue.

Let me read out part of a letter from some members of staff at the Glenfield hospital:

“As members of the East Midlands Congenital Heart Centre team, we feel that we have a responsibility to our patients to ensure that we make clear our intentions with regards to the implementation of the recommendation of the safe and sustainable review. 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. The toll of this review on both our work and home lives has been immense. It has created uncertainty and confusion, as well as intense anxiety. The repeated mantra of the review team that it will all be ok ‘with the help of the EMCHC team’ is meaningless in that we have not even been consulted. Unfortunately, we have been placed in a position where to refuse to relocate is openly criticized as being obstructive by the review. This is not the case. Our patients remain our priority within our working life, yet we have a responsibility to our families which, when push comes to shove, will over ride this.”

They go on:

“This letter is in no way representing a threat. It is an open expression of our concerns, over another assumption made by the review team, and which places us in a position where we are forced to choose between our patients and our families. We are a group of dedicated professionals, who have worked hard to achieve the excellence that we have done. Our patients deserve the best, and we fear that the recommendations will not give them that, and we will be unable to be there to support them.”

In my view, that letter speaks for them all—from doctors through to cleaners—and I hope that the Secretary of State will not forget the work that employees of the national health service do at the Glenfield unit when he comes to decide how best to proceed.

It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and thus they will all be working at full capacity. Can the Minister ensure that in the event of a superbug outbreak, for example, as happened at the Belfast neonatal unit this year, or of a fire, as happened at Birmingham hospital in 2010 and in Leicester in 2011, or of any other catastrophic event in one of the cardiac units under consideration, that the remaining six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?

Glenfield already takes patients not just from Leicestershire, but from across the east midlands, as my hon. Friend the Member for Newark (Patrick Mercer) said. It also receives patients from Birmingham, Southampton, Northern Ireland and elsewhere in the United Kingdom—and even from Scandinavia and mainland Europe.

The Safe and Sustainable cardiac review for children in England has been under way for more than three and a half years. It proposes that the Glenfield unit be closed and its patients and neonatal and paediatric ECMO services be transferred to Birmingham. The Minister and the Secretary of State are, we now know, to revisit the medical and economic evidence that the review board has considered, but I look to them to make a different, better and more logical decision, based on the evidence that is there for all to see.

Four available options emerged from the review, and they were predicated not so much on the cost of providing children’s cardiac services—albeit that cost must play a significant part—as on their sustainability. I will not, for reasons of time, list the options or their components, but option A suggested that there should be seven surgical centres: at Glenfield, at Freeman hospital in Newcastle, at Alder Hey children’s hospital in Liverpool, at Birmingham children’s hospital, at Bristol royal hospital and at the two centres in London, each with four surgeons looking after a minimum of 400 children every year.

Following the public consultation between 1 March and 1 July this year, option A received the greatest support. The consultation was the largest ever public consultation within the national health service, with more than 75,000 respondents; nevertheless, that number is much smaller than the number of people who signed the e-petition that provoked this debate. Option A was supported by six of the 10 health regions in England. It is, at £22 million, the least expensive option—the next cheapest costs £44 million—and it has the added advantage of ensuring shorter travelling distances for families.

None of the four options is perfect or ideal, but the option that includes Glenfield satisfies many of the objective criteria that one would expect of a good solution—not least in respect of Glenfield’s nationally commissioned ECMO services. Given today’s letter from the Secretary of State, it is in that regard that our attention now needs to focus. Glenfield provides both cardiac and respiratory ECMO. Its national ECMO centre has been in operation since 1991, and it treats babies, children and adults from across the country and abroad.

ECMO is an invasive life-support system, which can be used on patients with severe respiratory or cardiac failure. It consists of removing blood from a patient, taking steps to prevent clots from forming in the blood, adding oxygen to the blood and pumping it artificially to support the lungs. There is an increased chance of survival of half as much again when a patient is treated in an ECMO centre rather than in a conventional intensive care unit. The Glenfield ECMO unit has the best results in the world, has more expertise and success than any other ECMO unit in the country and is the only such unit in the country to provide mobile ECMO. We have four national centres for ECMO, and the ideal scenario would be to maintain ECMO services in their current locations.

There is the fact that Glenfield’s ECMO unit was applauded by the national health service during the H1N1 crisis and that Glenfield’s ECMO survival rates are 20% higher than the United Kingdom average. Kenneth Palmer, director of the ECMO unit of the Karolinska university hospital in Stockholm and an international expert on ECMO treatment, wrote to my right hon. Friend the Member for South Cambridgeshire, the former Health Secretary, on 7 July, on learning about the proposal to shut the Glenfield unit:

“You will take over 20 years of experience from one of the world’s...best ECMO units and throw it away...to rebuild it in another place...You cannot move a unit, you can just destroy it and rebuild it with many years of decreasing survival rates and increasing morbidity”.

Mr Jim Fortenberry, paediatrician-in-chief of children’s health care in Atlanta, Georgia, also wrote to my right hon. Friend on 6 July:

“Glenfield has one of the finest ECMO programmes in the world and was the source of the recent CESAR trial, a landmark study that helped sort out the benefits of adult ECMO...The impact on care of attempting to move out this program in toto to another location would be devastating. ECMO is not merely the equipment, but the incredible collective expertise and institutional memory of its entire team”.

Glenfield has, over the years, built up a team of more than 80 ECMO specialists.

Dr Thomas Müller, ECMO co-ordinator at the university medical centre in Regensburg, Germany, wrote to my right hon. Friend on 9 July:

“Glenfield Hospital has won an excellent reputation for their expertise in paediatric and adult ECMO treatment and is deemed to be one of the world’s leading centres. The knowledge and experience of the staff in Glenfield probably is unmirrored in Europe and the US. To my knowledge, Glenfield treats the largest number of patients with severe cardiac and respiratory failure with ECMO worldwide...centres with less expertise certainly will experience a higher mortality. Therefore, in the interest of best patient care the decision to close down the most experienced centre of the UK is difficult to comprehend for somebody from abroad.”

Dr Leslie Hamilton, a cardiothoracic surgeon at the Freeman hospital in Newcastle, has also acknowledged that there is a risk in moving ECMO services from Glenfield.

Glenfield performs about 100 ECMO procedures a year, which accounts for 80% of the neonatal and paediatric activity in England and Wales. As I have mentioned, Glenfield also takes patients from other countries, including Scotland, Sweden, Finland and Ireland. The mortality rate at Glenfield is 20%, compared with 34% in the rest of the United Kingdom. Two additional surgeons have expressed an interest in going to work there. The centre is a popular place to work and can be made more “sustainable”—to use the jargon—with more surgeons and space.

In advancing the case for Glenfield, I do not need to denigrate the facilities and expertise of other hospitals. I see the right hon. Member for Newcastle upon Tyne East (Mr Brown) in the Chamber along with my hon. Friend the Member for Solihull (Lorely Burt), who no doubt represents the interests of the Birmingham children’s hospital. In advancing the case for the retention of the internationally acclaimed ECMO centre in Glenfield, I do not need to undermine the good work and dedication of cardiac and thoracic specialists elsewhere. I do not want to do that, and I would not have the time, even if I thought it a proper or sensible thing to do. It just so happens that Birmingham children’s hospital regularly refers patients to Glenfield. Why? Because unlike Birmingham, which conducts only cardiac ECMO, Glenfield does both cardiac and respiratory ECMO.

[Lorely Burt (Solihull) (LD)]

I fully endorse my hon. and learned Friend’s comments about Glenfield. Indeed, one of my youngest constituents, Yvie Beards, would probably not be here today were it not for Glenfield. However, does my hon. and learned Friend not agree that the type of expertise that we have in Leicester should be replicated in other parts of the United Kingdom? Although the Birmingham children’s hospital has one of the best child treatment centres, it could also contribute to that same level of care for children and others in the west midlands.

[Sir Edward Garnier]

I am sure that my hon. Friend is right, but we do not replicate what goes on in Glenfield by closing down Glenfield. If she and I are right about this, we need more Glenfields, not one fewer. We certainly do not need Glenfield itself to be closed.

Glenfield has this year opened a paediatric intensive care unit—a PICU—which will also become unviable as a result of losing paediatric cardiac surgery. Currently, 71% of those in the PICU are cardiac patients, so closing it down will no doubt affect the non-cardiac patients whom the unit treats. The loss of the ECMO service would also make the adult ECMO unit unviable. As of 18 October, option A is supported, on the e-petition, by about 103,000 signatories.

The Guardian, not necessarily a newspaper that a Conservative Member of Parliament leaps to quote from, pointed out on 28 April 2010:

“There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres… Survival and recovery rates would improve markedly with many lives saved.”

The ECMO unit at Glenfield works: it helps children survive and, as we just learned from the Prestatyn case, it helps adults survive. The medical evidence shows that the ECMO unit works, and now it is up to the Secretary of State to understand that and let both the unit and the children it treats survive.

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I offer many congratulations to my hon. and learned Friend the Member for Harborough (Sir Edward Garnier), who very deservedly received a knighthood recently. I remind him that that is of course a tradition in his constituency, as his predecessor was also knighted. I served with Sir John Farr in my first Parliament, and he did so much for hosiery and knitwear in his constituency. I welcome my hon. Friend the Minister to the Front Bench. It is very nice to see her there.

It is clear from remarks that hon. Members have made that there is universal and cross-party support for retaining children’s services at Glenfield. One of the first decisions of the new Secretary of State for Health was to call the matter that we are debating in for review. That bodes well, because my right hon. Friend did so well with the Olympics that I believe he will do just as well as Secretary of State for Health. His decision shows his light touch. The fact that we now have a second chance to consider the issues, and the welcome arrival of a letter today, saying that the Independent Reconfiguration Panel will commence a full review and report not later than 28 February, is a huge relief for the county. My hon. Friend the Minister has already intervened to point out that she cannot second-guess what it will say, but the point of today’s debate is to give Leicestershire Members on both sides of the House an opportunity to show how concerned we are about the decision and to make some points about it.

I shall not repeat the points made by my hon. Friend the Member for Harborough or the hon. Member for Leicester South (Jonathan Ashworth), who engagingly described my hon. Friend as learned; I think, Mr Hollobone, that we are not allowed to do that any more. Did not the reforms of the House say that we could not call—

[Sir Edward Garnier]

You can make an exception.

[David Tredinnick]

My hon. and learned Friend says I can make an exception for him, and I am delighted to do that.

The first point I want to make is that there is real concern that we are working on faulty statistics. The data used to make the decision were based on 2006-07. We need only consider the recent publication of the census in London to see the huge increase that there has been in population. There are shifting populations, and there is concern that the analysis is fundamentally flawed. It is not only my right hon. Friend the Secretary of State for Health who has had to consider flawed data recently. What about the west coast main line, whereby we found we were operating with completely inaccurate information? The right hon. Member for Newcastle upon Tyne East (Mr Brown) nods his head. This can happen in Departments, and we must take note of it.

My hon. and learned Friend the Member for Harborough and the hon. Member for Leicester South have addressed the issue of the ECMO link. To most reasonable people, it seems absurd that the two decisions will not be linked. I am sure that there are legal arguments, but somehow we must get a sensible decision so that both issues can be considered together.

The next point concerns the site of Glenfield. Glenfield is a hugely popular hospital not just with patients, but with surgeons. From, one might say, a feng shui point of view, it is on top of a hill outside the city, and it has a good, clean, clear energy. That is why everybody likes working there: it is nicer for everybody than the Birmingham site, as is proven, I would suggest, by a survey showing that only 2% of the staff in Glenfield want to move to Birmingham. It is not just BBC current affairs programmes that are jumpy about moving out of their current locations, as there is a real problem with the decision to move from Glenfield to Birmingham, as the hon. Member for Leicester South said. The body of knowledge built up over 20 years will dissipate, because many of the people who work at Glenfield simply will not move.

My next point involves the increased pressure on Birmingham, which has been referred to. Can Birmingham deal with it? Somewhere in the briefing papers is a point about Bristol. What happens if something goes wrong at Bristol and patients are moved around? My hon. and learned Friend the Member for Harborough made the point about the terrible tragedy in Wales, during which patients have been brought to Glenfield. Is it wise to concentrate all the resources in the midlands in one centre? I wonder whether it is.

--- Later in debate ---

[Sir Edward Garnier]

I thank everyone who has contributed to the debate—whether the Minister, the Opposition Front Bencher or Back Benchers. It has been thoroughly useful, informed and informative, and I am grateful to everyone who has assisted in the process.

On the process, I suspect that my hon. Friend the Minister was tiptoeing around the issue, not wishing to trespass across a difficult line, but it is important not to confuse process with what we are sent here to do as Members of Parliament and as Ministers, which is not to confuse the substance with the means by which we make decisions. Our constituents expect us, as elected politicians, to come here and speak for them and say things that may be disobliging to those who hold the levers of power—and that is what we have done.

I know that the Minister is concerned—of course, she should be—that anything she says might be taken as ammunition that would fuel someone’s thoughts about a judicial review of a decision made by a previous Secretary of State, and I do not want to push her in any direction that might cause her that problem. None the less, we all know what lies behind her careful words. At least I do—I am sure that many others do as well—and I am entitled, as she is not, to rip away that veil and get to the heart of this question: what is to happen to the ECMO services, both adult and children’s, at the Glenfield centre, and what is to happen to the cardiac services for children at Glenfield? As has been agreed across the Chamber this afternoon, those are inextricably linked questions.

The House does itself no great service if it shilly-shallies around process and avoids the question. As Members of Parliament, we must ensure that the question is put. The question this afternoon has been put, and the Minister has done her best to answer it, but the message that she must take back to her Department is that we are not as fascinated as some of her departmental lawyers might be by who made which decision and whether or not the joint committee of PCTs is an independent reviewing body.

The Secretary of State has the levers of power in this question and he must pull them—he must exercise them—and make a decision. That is what he is paid to do, what he was appointed by my right hon. Friend the Prime Minister to do and what he was elected to Parliament to do. I am sure that the Minister will give him every assistance in reaching what is the inevitable answer to the questions posed this afternoon—namely, that the Glenfield ECMO unit, for children and adults, and the Glenfield cardiac services unit should remain open.

I do not care who made the decision or how the dainty route was created to get to it. We all know that the current decision is wrong and needs to be dealt with. The Minister, please, will go back to her Department and inform the Secretary of State that Parliament thinks that that decision is wrong and that Parliament requires the Government, through the Department, to change it. How they do that is up to them, but they must do it.

I thank the Minister for her patience in listening to us. I thank her for dealing with a difficult and, as she rightly says, emotionally charged subject. None the less, we have to set aside the emotion and the personal and heart-rending stories, make the right decision and just get on with it. I look forward to the Secretary of State writing us another letter, in a very short time, in which he adds to the letter of today’s date a decision to review the ECMO matter as well, because, as we all know, it is not possible to separate the two, and it is not possible to separate us, as elected representatives for our constituents, from this issue. We will stick to it like a barnacle until we are satisfied that the matter has been properly resolved. I look forward to having further such discussions with my hon. Friend the Minister in the very near future, but I thank her most sincerely for her presence here today and her contribution.

Question put and agreed to.

Resolved,

That this House has considered the e-petition from Adam Tansey relating to children’s cardiac surgery at the East Midlands Congenital Heart Centre at Glenfield, Leicester.