Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

My right hon. Friend is absolutely right to highlight the fact that a very small minority—20%—of trusts across the health care provider sector, including trusts and foundation trusts, are anticipating a deficit. Many of those trusts have a direct legacy of debt from the private finance initiative arrangements that the previous Government put in place. That is one of the direct legacies of the poor PFI deals that were arranged. He is absolutely right to highlight the importance of integrated and joined-up health care. That is exactly what the £500 million we are providing for winter pressures is designed to do by focusing on better preventive care to keep people out of hospital.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Trust balance sheets are bound to be affected by the resources allocated to the commissioning groups. On 12 June last year, I asked the then Minister for

“a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula”.

He told the House:

“Yes, I can give that assurance.”—[Official Report, 12 June 2012; Vol. 546, c. 167.]

Why is the Minister’s Department now consulting on doing precisely what the then Minister said he would not do and taking £230 million out of the budget for the north-east and Cumbria?

[Dr Poulter]

The right hon. Gentleman has perhaps misunderstood the information imparted on that occasion. It is very clear that the allocation formula is now independently set and NHS England has primary responsibility for it. There is legitimate concern. There is a 10% deprivation weighting for some of the poorest communities in-built into that formula. It is also important that we recognise that demographics and an ageing population are putting pressure on a lot of CCG budgets, but these are matters for NHS England.

Children’s Heart Surgery

Nicholas Brown Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

We must all engage with the process thoroughly and fully. We, as Members of Parliament, have a responsibility to engage with our constituents about some of the complexities involved. The issue of mortality rates, which was raised by the right hon. Member for Leigh (Andy Burnham), is one of those complexities. They are very important, but they are not the only consideration, and, when it comes to specialised services, they are extremely difficult to interpret properly. We must engage in an intelligent and constructive way, and reassure our constituents that all of us—Government and Opposition—want the best outcome for children, the outcome that will save the most children’s lives.

Let me return to what the Prime Minister said earlier. I have no problem with explaining to my constituents that in the case of certain services, they are better off travelling further. I did not respond earlier to the right hon. Gentleman’s point about travel, so let me say now that I agree with him that it must be taken into consideration. According to the IRP’s report, the whole care pathway needs to be examined. That means not just the visit to the hospital for surgery, but follow-up care and early assessments. In that context, travel becomes much more important.

If we are honest with our constituents about the fact that there may be a difficult decision at the end of the process, we are much more likely to earn their trust.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

How much public money has been spent on taking us to the point that we have now reached? Is the IRP report available to Members of Parliament? Will the Secretary of State say a little more about the process that will take place between now and the day on which he must come to the Dispatch Box and announce very difficult and controversial decisions to the House, and will his decisions stick?

[Mr Hunt]

The cost to date of the Safe and Sustainable process is about £6 million and Members of this House will rightly ask whether that money has been spent well, given the flaws in the process identified today by the IRP. I would also say, however, that it is right to spend money on carrying out such processes properly. It would be the wrong approach to say that, based on the cost of the process, we are not prepared to consider how we can improve services.

On the timetable, now that the report is public—it is available to Members of the House and the public as of today—I have given NHS England and all stakeholders until the end of next month to come back to me with a revised plan.

Heart Surgery (Leeds)

Nicholas Brown Excerpts

Monday 15th April 2013 Commons Chamber

[Mr Hunt]

I entirely understand the concern of families, staff and doctors at the LGI. I simply say to my hon. Friend that the reason the data were not complete was because the hospital had failed to supply them. There is, therefore, an important warning to all hospitals to ensure that they supply accurate and timely information on their surgery survival rates.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Does the Secretary of State still accept the underlying premise of the Safe and Sustainable review, which is that there should be a smaller number of centres of excellence for children’s specialist heart surgery? If he still accepts that premise, will he say something to the House today about his timetable for bringing the issue, which has gone on for 12 years, to a conclusion?

[Mr Hunt]

I certainly accept the premise, on the basis of considerable clinical evidence, that for complex surgery greater specialisation leads to higher survival rates. On whether that is the right thing to do in this particular case, I would like to wait for the outcome of the legal process and the advice of the Independent Reconfiguration Panel, but I will just say this: I would like to conclude this as quickly as possible. I am subject, rightly, to legal due process. Families who feel strongly want this to be concluded quickly, but they also want to know that it has been concluded fairly, and I think that that underlies a lot of the concerns raised by Members this afternoon. The timetable is not within my gift but what is within my gift in terms of timings I will try to expedite as quickly as possible.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 12th June 2012 Commons Chamber

[Anne Milton]

I am always delighted to meet any hon. Member or hon. Friend and their constituents, particularly if they face inequality concerns.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

14. What his policy is on the resource distribution formula for primary health care commissioners.

[The Minister of State, Department of Health (Mr Simon Burns)]

From 2013-14, the NHS Commissioning Board will allocate resources to clinical commissioning groups. The Health and Social Care Act 2012 contains the first ever legal duties on health inequalities for NHS commissioners and the Secretary of State. This applies to everything the NHS Commissioning Board does, including allocating resources.

[Mr Brown]

Will the Minister give the House a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula?

[Mr Burns]

Yes, I can give that assurance. I know this has been of some concern to the right hon. Gentleman and the north-east, but I can tell him that we are not planning to alter resource allocation to transfer funds from the poorest parts of the country. There is also no mandate to propose a formula based purely on age. As he may or may not know, although age is the primary driver of an individual’s need for health services, the most recent primary care trust formula uses a range of factors to determine fair shares, including the age structure of the population, levels of deprivation and the unavoidable costs in providing services between areas.

Congenital Cardiac Services for Children

Nicholas Brown Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) in debate, something that I have not done for 15 years in this place, and as ever I agree with the broad thrust of what he has said. I welcome the opportunity to take part in this debate about the Safe and Sustainable review. I want to make two points about the case for the review itself and the case for children’s cardiac care at the Freeman hospital in my constituency.

The review of paediatric cardiac services in England and Wales was instigated in 2008 under the previous Government. It was instigated not by them, not by the civil service but by the health care professionals themselves. There were two previous reviews, in 2000 and 2003, recommending the establishment of fewer, larger cardiac surgical centres; in 2006, a national workshop of experts concluded that the current configuration was unsustainable; in 2007, the Royal College of Surgeons called for the concentration of surgical expertise in fewer, larger surgical centres.

The 2008 exercise has been carried out on behalf of the 10 specialised commissioning groups in England and their primary care trusts. The clinical case for the exercise is pretty formidable: clinical outcomes are better at high-volume centres; it is undesirable that surgical expertise is spread too thinly, because apart from anything else it mitigates against the provision of 24-hour surgical cover; the increasing complexity of what can be achieved argues for fewer specialist centres; it is easier for fewer units with larger case loads to retain surgeons and to develop expertise; and strong leadership from surgical centres underpins non-surgical cardiology care in local hospitals.

[Mr Kevan Jones (North Durham) (Lab)]

Will my right hon. Friend give way?

[Mr Nicholas Brown]

If my hon. Friend will forgive me, I will not.

There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.

I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.

The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.

Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.

No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.

I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.

My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made. I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.