Congenital Cardiac Services for Children

Nigel Evans Excerpts

Thursday 23rd June 2011 Commons Chamber

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. To accommodate more Members, I am reducing the time limit to five minutes. I hope that both Front Benchers will take into account the popularity of the debate and the need to get Back Benchers in when they make their contributions.

--- Later in debate ---

[Mr Andrew Turner (Isle of Wight) (Con)]

I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:

“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.

It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.

Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.

In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team

“based retrieval times between the island and the mainland on travel by air. This was an oversight”

because the policy is

“to retrieve children from the Isle of Wight by road and ferry”.

That is very odd, because the consultation document explicitly states:

“Air travel has not been considered because it cannot always be relied upon”.

The statement goes on to say that

“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.

The conclusion was that

“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”

On remote areas, the consultation document states:

“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—

meaning three hours or less from Southampton in my case.

On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognised that the island,

“by its very nature, is remote from the mainland”.

Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are

“unique factors around retrieval times by ferry”.

My Glyde was very helpful. He explained:

“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.

They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]

Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Just to inform the House of the procedure, I will now call the Minister. The recommendation from the Backbench Business Committee is that he speaks for about 15 minutes. However, I should remind the House that if he takes persistent interventions, that will extend the time that he spends on his feet, which will deny other Back Benchers the opportunity of speaking. The shadow Minister will be speaking towards the end of the debate.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am sure that hon. Members will show time discipline, so that we can get as many of them in as we possibly can.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. If hon. Members speak for just under four minutes, everyone will get in.

--- Later in debate ---

[Damian Hinds (East Hampshire) (Con)]

The review document is called “Safe and Sustainable”, and that is absolutely the right title for it. It is worth repeating what has been said by every speaker today, and by the clinical leadership of the review: this is about saving lives, not about saving money. We must bear in mind the link between scale and quality and between quality and safety. The “scale” factor applies to the number of procedures per surgeon per year and to the number of surgeons per unit. The challenge was summed up best by the statement from the Royal College of Surgeons, to which the right hon. Member for Oxford East (Mr Smith) referred, that although the country has the right number of surgeons carrying out these complex operations, they are too thinly spread. Change is clearly needed.

Coincidentally, in the last three weeks my family has had occasion to rely on the paediatric intensive care units and surgery at Southampton General hospital, in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), where we benefited from outstanding care. This was not heart surgery, but the experience gave me plenty of cause to reflect on the value of not just convenience and location but, above all, quality of care. In such circumstances, families will do what they have to do, although it may be very difficult, and they will find a way of securing care of the highest quality. The experience also taught me something about the interconnection between services.

All the criteria set out in the review document have a role to play, but in my view the most important criterion of all must be quality, and I do not think that that comes across as much as it should in the review. How can it, given that the centre that is ranked second out of the 11 in the country for quality appears in only one of the four options? The question also arises, in the context of Southampton General hospital, of whether—given the role of scale and quality—sufficient consideration has been given to the most recent trends since the suspension of paediatric cardiac surgery at the John Radcliffe hospital.

Other factors have also not been given sufficient weight. First, there is the requirement for co-location of paediatric surgery with other essential services for children. Secondly, there is the impact on paediatric intensive care units, paediatric intensive care retrieval, and the other networks mentioned by the right hon. Member for Oxford East. Thirdly, there are the implications for services that provide longer-lasting care for people with cardiac conditions from birth to adulthood.

Our objective must not be to stall or jam the process, because there is a need to reduce the number of centres. We must avoid the politician’s tendency to say that of course we agree with the general principles of the review, except in the particular circumstances that apply to our own constituency. I hope I have not done that, but I do think that Southampton has a particularly strong case based on the excellence of its clinical record. I strongly support the drive for us not to be restricted only to the four options in the review, considering the additional evidence that has come to light during its course.

[Mr Deputy Speaker (Mr Nigel Evans)]

To resume his seat at 3.32 pm, I call Mr Percy.

[Andrew Percy (Brigg and Goole) (Con)]

Outrageous, Mr Deputy Speaker! But obviously accepted.

I associate myself with many of the comments of my fellow Yorkshire and the Humber MPs, particularly my near neighbour the hon. Member for Scunthorpe (Nic Dakin). I want to mention a couple of issues raised by our local health trust, which is opposing anything other than option D very strongly. Indeed, North Lincolnshire council’s scrutiny committee met to discuss the matter on Tuesday and similarly supports that option, which would help to maintain the Leeds unit. That is not simply because it is our local centre. My constituents have to travel a considerable distance to get to Leeds, as it is not exactly next door. It is okay for some of us, but it is quite some distance for my constituents over in Brigg, in particular.

My constituents accept the regionalisation of health services when it is of proven benefit. That is so in the case of adult cardiac services, which are currently provided in Hull, and the same applies to children’s cardiac services. However, if we are to go down the route of regionalisation and big centres, it seems sensible to put services where the population is rather than try to move the population to where the clinicians are.

I wish to quote a couple of points that my local health trust has made. It has stated:

“Leeds has the largest population centre and therefore it is most sensible to ask fewer patients to travel the least distance”.

As I said earlier, the conclusion of the North Lincolnshire and Goole Hospitals NHS Foundation Trust was that it believed babies, children and families in North Lincolnshire would largely be disadvantaged in their access by the proposed changes.

I am aware of the very short time available, so I cannot say most of what I would have liked to say, but my final point is that under the proposals we could end up in the rather odd situation that some of my constituents could be served by one centre and others by another. Given that they are all in the same health trust area, that could mean different services being provided to different constituents.

[Mr Deputy Speaker (Mr Nigel Evans)]

To speak for 10 minutes, I call the shadow Minister, Liz Kendall.