Children's Heart Surgery (Leeds)

Nigel Evans Excerpts

Thursday 3rd March 2011 Commons Chamber

[Mr Burns]

The hon. Gentleman is a very experienced parliamentarian, and I do not say this in any rude way, but he was not present when his right hon. Friend the Member for Leeds Central spoke. That is not a criticism, but I shall make to the hon. Gentleman the same point that I made to his right hon. Friend: the consultation process and review is being carried out not by Ministers and politicians, but by the JCPCT. As we are engaged in the consultation process, it would be inappropriate and wrong of me to pontificate from this Dispatch Box on the merits or demerits of one case or another. I hope that the hon. Gentleman will accept that that is meant to be a helpful reply, even if it is not the answer that he was seeking. [Interruption.] Fair enough. I am not criticising; I just want him to understand the position that I am in, because I do not want—[Interruption.]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. We cannot have chit-chat across the Chamber in this way.

[Mr Burns]

Thank you, Mr Deputy Speaker. [Interruption.] The hon. Gentleman is indeed being nice to me, and I appreciate it.

As I was saying, smaller surgical units often struggle to recruit and retain new surgeons. They also find it difficult to provide a safe service around the clock.

Under the auspices of the review, an expert group has developed a comprehensive set of service standards, taking into account the contributions of parents and professionals. The standards cover the whole of children’s heart services. They also reference other relevant professional standards and guidance, including the co-location of other clinical services that are interdependent with children's heart surgical services, the need for larger surgical teams to be able to provide a 24/7 emergency service, and the development of clinical networks of providers to ensure a coherent service for children and their families. I think that in some ways that picks up on the point made by my hon. Friend the Member for Pudsey. The current centres have been visited and assessed against these standards by an independent expert panel.

I would like to go into a little more detail on a few of these standards to clarify areas which cause particular concern. On the standard on the number of procedures and surgeons, I can assure my hon. Friends and Opposition Members that there is convincing evidence from this country and overseas that larger centres, seeing more cases, are better able to consolidate their expertise and deliver better clinical outcomes. The recommendation on the number of procedures—between 400 and 500 a year—is based on the level of activity needed to provide good-quality care around the clock while enabling ongoing training and mentoring of new surgeons. This recommendation is based on the outcome of international research on minimum numbers of procedures in surgical centres. It has strong professional support in this country, including from the steering group of professional experts that was convened under the auspices of this review. In addition, there is a consensus among professional associations on minimum staffing levels that four surgeons in each centre should avoid the risk of surgeons not being able to maintain and develop their skills.

At this point, I would like to pay tribute to the commitment and dedication by talented NHS staff delivering congenital cardiac services. We have a responsibility to ensure they are supported as well as possible, and that includes ensuring that they do not risk burn-out if left to practise alone. Transforming a service from one that is “adequate” to one that is “optimal” requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls “accomplished teams”.

Co-location, which I mentioned earlier, refers to the proximity of other critical services to the children’s heart surgery service. In this context, these services include specialised paediatric surgery; paediatric critical care; paediatric ear, nose and throat; and paediatric anaesthesia. The accepted definition of “co-location”—services either on the same hospital site or on a neighbouring hospital site—and which services should be co-located was set out in the 2008 publication, “Commissioning safe and sustainable specialised paediatric services: a framework of critical inter-dependencies”. This guidance is endorsed by the relevant professional associations, including the Royal College of Paediatrics and Child Health, the Royal College of Surgeons and the Royal College of Physicians. I can assure hon. Members that the safe and sustainable review has correctly applied the accepted definition of “co-location”, as set out in the guidance, as meaning either on the same hospital site or on a neighbouring hospital site.