Health: Congenital Heart Disease

Lord Hunt of Kings Heath Excerpts

Thursday 20th July 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, congratulate the noble Baroness, Lady Boothroyd, on instituting what has been an excellent debate. Of course, these proposals have had a long gestation. They really go back to Ian Kennedy’s review of the tragic events at Bristol in relation to cardiac surgery for children. I well remember as a Minister receiving his report and discussing with him and Alan Milburn what action needed to be taken, not just in Bristol but more generally in the NHS as a whole. That really started the review of the number of hospitals considered safe and appropriate to provide for children receiving complex cardiac surgery.

As the Minister will know, no one should underestimate the difficulties of such a debate or the tensions between the expert view, coming generally from the centre, and the view locally of clinicians, parents and the NHS of the impact of closing those services, not just on children because of the distances that then must be travelled, but also on the institutions where those services are provided. We heard eloquent contributions about the consequences of closing one service at Brompton and the domino impact it would have on many other of its services.

I read very carefully the review document prepared by NHS England. It makes the point, with which I agree, that we have had far too many reviews and there has been too much uncertainty, now going back 17 years, about the future of many of these centres. Fortunately, outcomes generally in relation to CHD surgery and interventionist procedures have improved across the NHS and compare well with other countries. However, the NHSE paper argues that our outcomes could be better if the standards it sets out were implemented more generally. It is also worthy of note that the review, which looks at the importance of hospitals having the right staffing and skill mix, improved resilience and the elimination of isolated and occasional practice, is accompanied by a warning that it will be difficult for all hospitals approved to go forward to meet these standards immediately.

We then have the specific question of the Brompton and the argument in the paper that it should cease to provide surgery and interventional cardiology for children and adults, principally because it does not have enough of the required paediatric services on site and is stated not to support an adult level 1 service on its own. On the other hand, we heard from every noble Lord here, led by the noble Baroness, Lady Boothroyd, and had a briefing paper from the Brompton itself, arguing that there is no evidence from NHS England to support its contention that the collocation of children’s services improved patient outcomes. It also argues that NHS England is inconsistent on the issue of collocation and that no cost-benefit analysis of its proposals has been produced. It is also clear from what we heard from the Brompton that there is real concern that the closure of its level 1 service would have a wider and destructive impact on its research and respiratory medicine treatments. My noble friend Lord Darzi and the noble Lord, Lord Patel, spoke about the impact on the Brompton’s teaching, service excellence and research.

I do not envy the Minister in coming to her conclusions. I just suggest two things to her. First, it would be fair to say that the noble Baroness, Lady Boothroyd, was not entirely complimentary about NHS England, which is not exactly a visible presence in Parliament. It is sometimes difficult to understand how its accountability is discharged. NHS England owes it to the noble Baroness, Lady Boothroyd, and parliamentarians to arrange a meeting and briefing between them, and those who have taken part in this debate, to discuss these issues further before they come to a conclusion. I hope the Minister might be able to facilitate that.

The principal point I want to put to the noble Baroness, Lady Chisholm, is that these issues have been debated and there have now been endless reviews going back 17 years. It is of course possible that NHS England will come to a conclusion shortly and propose the closure of certain units in the report it produced, which concerns other units including those in Manchester, Leicester and other parts of the country. My supposition is that when it does that, whichever centre is fingered for closure, there will be an outcry. My second guess—if it is a guess—is that Ministers will then try to find another reason for a further review, to delay making the decision.

It is becoming pretty clear that Ministers find this situation very difficult and are simply not prepared to accept a decision for closure. But they want to put it in the long grass because they cannot face up to the fact that someone at some point has to say, “These are the units we’re going with and we’re going to do everything we can to make sure they’re up to standard. But we’re not going to have further reviews”. The one thing I would say about the NHS England paper is that it points out the problem of managing a unit where uncertainty continues over many years.

In the end, the public are owed a decision, which would either be to go ahead with the recommendations of NHS England or to say, “We’re not going down that route at all but we will keep the units and do what we can to improve them”. I am afraid that I expect there to be another review and that the noble Baroness, Lady Boothroyd, will be instituting a debate in three years’ time. However, I hope that will not be the case.