Children's Heart Surgery (Leeds)

Simon Burns Excerpts

Thursday 3rd March 2011 Commons Chamber

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

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. It is a strong reflection of hon. Members’ commitment not only to their local health service but to the Leeds hospital and its facilities and services that so many are present. I am particularly pleased to see my hon. Friends the Members for Harrogate and Knaresborough (Andrew Jones), for Elmet and Rothwell (Alec Shelbrooke), for Skipton and Ripon (Julian Smith), for York Outer (Julian Sturdy) and for Calder Valley (Craig Whittaker). I am also pleased to have heard from the right hon. Member for Leeds Central (Hilary Benn) and to see the hon. Member for Scunthorpe (Nic Dakin) here. Their presence reinforces their commitment to their local health service and the facilities in the local hospital.

Let me take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in Leeds and across the country. They do a fantastic job for which we are all incredibly grateful.

As I know my hon. Friends and Opposition Members will appreciate, this is a complex and, understandably, highly emotive area, but it is worth reminding ourselves of the genesis of this review. For years, experts in the field, including professionals and national children’s charities, have urged the NHS to review services for children with congenital heart disease.

Although there has been no specific problem, concerns have been raised about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres. Experts agree that, with small centres, there are issues with the recruitment and retention of surgeons and that there is a risk that those who are recruited find themselves working in isolation in units that are not up to date with modern techniques and clinical practice. Smaller centres struggle to train and mentor junior surgeons, making such units less attractive to the surgeons of tomorrow.

The provision of children’s heart surgery has been a cause of concern since the Bristol inquiry in the late 1980s. Understandably, there has been considerable pressure from national parent groups to ensure that children receive the best treatment. The Monro report in 2003 set out standards of care and pointed to the need for reconfiguration to concentrate expertise. That need has become ever-more pressing with the increasing complexity of treatment.

In the light of clinical concern in June 2006, Roger Boyle, the national clinical director for heart disease and stroke, and Sheila Shribman, the national clinical director for children, young people and maternity, chaired a consensus workshop of service providers, specialised service commissioners and relevant parent groups. The unanimous view was that there should be fewer, larger centres of excellence. The workshop concluded that the current service configuration was not sustainable and that a long-term national view of how services might be reorganised should be developed.

In 2008, the NHS medical director, Sir Bruce Keogh —a heart surgeon—asked the national specialised commissioning group to explore how the reconfiguration of children’s heart surgery services in England could improve the sustainability of the current service and lead to better clinical outcomes for children. The national review, known as “Safe and Sustainable”, aims to ensure that children’s heart services deliver the highest standard of care regardless of where patients live or which hospital provides the care.

I must emphasise that the review is clinically-led and that both it and the case for change are supported by parent and patient groups and by clinicians working in the service and their professional associations, including the Children’s Heart Federation, the British Heart Foundation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain.

[Julian Smith]

Does the Minister agree that, as well as the importance of the clinical need, distance is vital and that the points made in the debate for this most rural and sparsely populated area of our country must be taken into account in the decision?

[Mr Burns]

Distance is one of a number of factors that, of course, will be considered by those people who are involved in the consultation process, although I advise my hon. Friend that some of the organisations involved in such medicine have certainly told me—I have met some of them personally—that many parents think not so much about the distance that must be travelled as about getting the best treatment for their children. They are prepared to travel further to secure that fine treatment for their children than we may think from what our constituents who want to have district general hospital treatments tell us. The question of distance must be put into perspective, and it is not an overriding factor that secures any decision one way or another solely on that basis.

[Nic Dakin (Scunthorpe) (Lab)]

I recognise what the Minister says about distance. Parents want good outcomes for their children—that is why parents in Scunthorpe travel to Leeds—but distance can have an impact on clinical outcomes. Certainly, when the weather was terribly bad around Christmas time, the distance to travel to get good clinical outcomes made a difference. Distance and clinical outcomes are related.

[Mr Burns]

I am grateful to the hon. Gentleman for his intervention, which in many ways reflects that made by my hon. Friend the Member for Skipton and Ripon. I was making a simple, factual point about the view of many parents at present. As a Minister, it is certainly not for me to interpret and give a view on that, because, as will become apparent later in my remarks, the consultation is being done by others. It would be totally inappropriate for me, as a Minister, to seek to interfere, prejudge or prejudice any outcome of the consultation process. I hope that both my hon. Friend and the hon. Gentleman will appreciate the position that I am in in, that respect.

The review wants to ensure that as much non-surgical care is delivered as close to the child’s home as possible through the development of local congenital heart networks. The joint committee of primary care trusts agreed the shortlist of four options for the future of children’s heart surgery on 16 February 2011. The committee was set up as the formal consulting body for the review and to take decisions on the issues arising from it. My hon. Friend the Member for Pudsey will know that Leeds general infirmary is included in one of the shortlisted options that went out to consultation on 1 March, and the consultation will continue right through until 1 July. There are also public events taking place during the four-month consultation, and there is one in Leeds on 10 May at the Royal Armouries museum. I urge all hon. Members and as many individuals, not only in the local community, but those interested in the services that Leeds provides for patients, to attend.

I want to pick up on the point that my hon. Friend made about inaccuracies in Sir Ian Kennedy’s report. In response to the safe and sustainable interim report last summer, the report’s team received correspondence from the trust about concerns on inaccuracies. The team thought that they had addressed those in the final report in December, and I can only assume that that information is correct, because the trust has made no further approach to the team on the concerns about the information in the final report. I hope that that clears up the problems identified between the interim report and the final report in December.

I also want to emphasise that no decision has been made on which centres should continue to undertake surgery. That will be decided only after the responses to the consultation have been properly and fully considered. I give that assurance to hon. Members today. It is also important to recognise that the safe and sustainable review is only one element of a larger NHS review of congenital cardiac services in England. The NHS is also reviewing the provision of services for adults with congenital heart disease, and I understand that the designation process to determine where the adult services will take place will start later this year.

There are powerful clinical reasons driving the review. The trend in children’s heart care is towards increasingly complex surgery on ever smaller babies. This requires working in surgical teams large enough to provide sufficient exposure to complex cases so that surgeons and their teams can maintain and develop their specialised skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons and other staff.

[Hilary Benn]

Does that not strengthen the argument for looking at centres where there is co-location of services, because, as the Minister will recognise, a sick child with a cardiac condition might have a bowel obstruction, for example, and the ability to call on a skilled surgical colleague straight away to deal with that on the same site is a powerful argument for retaining the unit at Leeds, where co-location of services is found?

[Mr Burns]

I am very grateful to the right hon. Gentleman for making that point. He puts me in a slightly difficult position, because I genuinely do not want to be unhelpful. A consultation is ongoing through the joint committee of primary care trusts, however, and it would be totally inappropriate to start debating the rights and wrongs, the pluses and the minuses, of any one individual hospital or centre. It would be inappropriate—it might be construed as trying to influence, pre-judge or prejudice the consultation process—and I am sure that the right hon. Gentleman agrees wholeheartedly that it would be totally unacceptable for Ministers to start getting involved in that way. I hope he will accept that, for the best of intentions, it would be inappropriate for me to start debating that issue with him, however right or wrong he might be. I can tell him, none the less, that he has ample opportunity during the consultation process to make those very points to the JCPCT.

[Stuart Andrew]

I understand that, before the consultation document came out, one member of the steering committee gave her personal view of which unit should stay open. Does the Minister not agree that that might give some cause for concern?

[Mr Burns]

My hon. Friend is pushing me and tempting me, but I shall be up front and straightforward: I am unaware of that situation, and it would be unwise of me to start commenting on something that I do not know the background to or—if the conversation was had or the statement made—the circumstances of it. I hope he will forgive me if I do not go down that path.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

I thank the Minister for giving way, because I know that he wants to make progress.

As part of the process, may I ask that the support facilities for families will be considered, because, at a time when one is dealing with sick children, families are under very great pressure? There is a new facility at LGI, Eckersley house, which has been in existence for a while, but it has moved to a new location and opened only last year. It provides 22 rooms for families to stay in while visiting sick children, it is a key part of the broader provision of support that is necessary and I know that it will be a very welcome development for families.

[Mr Burns]

I am very grateful to my hon. Friend for mentioning that facility, which I have no doubt is not only welcome but extremely helpful to families, particularly at a very difficult time in their lives. Again, it would be inappropriate for a Minister, in a top-down way, to start decreeing what should or should not happen; I believe that decisions about such services and facilities must be taken locally. I am sure, however, that the relevant authorities will not only learn of my hon. Friend’s contribution, but no doubt benefit from his expertise in lobbying them to ensure that the service continues.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the Minister take a very quick view from the Opposition Benches? We are old friends.

[Mr Burns]

Yes.

[Mr Sheerman]

Some of us were rather caught short, because we did not realise that the debate would start so early. For someone who lives in Huddersfield with a child who needs specialist care, the common sense consideration seems to be accessibility. Why do we not get more specialists in Leeds, so that we can access the vast population in our parts of Yorkshire and Lancashire?

[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.

[Hilary Benn]

I am grateful to the Minister for giving way again. It would be very helpful for the Members present who care about Leeds if he could clarify whether it is the case that to figure in any of the options—obviously Leeds figures in one—the units that are listed must have met the test that he has just very helpfully described to the House. If that is the position—he cannot say this, but we will—it further strengthens the case that we have been making this afternoon.

[Mr Burns]

I am just giving a moment’s thought to that, partly because I do not want to interfere. Probably the most helpful thing that I can do so that I do not mislead the right hon. Gentleman is to write to him shortly with a definitive response to that important question.

On the question of travel times, which has been raised in this debate, I recognise that there may be concerns that with fewer centres, people will have to travel greater distances. However, the review has consulted parents around the country, and they have said repeatedly, as I mentioned to the House earlier, that issues of quality and good clinical outcomes are paramount in the treatment of their children. The review team recognises that this is a significant issue, and I have sought and received assurances that it has been looked at extensively as part of the review process. We need to recognise that although some families will have to travel further for elective surgery, the review proposes to reduce journey times for non-surgical care by bringing assessment and follow-on care closer to home through the development of congenital heart networks. I have also been assured that all the options comply with the Paediatric Intensive Care Society standards, which have been developed by experts in the field and stipulate maximum journey times for children who require emergency retrieval by ambulance.

The review has taken account of other criteria such as a centre’s physical location in relation to others and the impact of reconfiguration on other important services, such as paediatric intensive care services and heart transplant services.

For the information of hon. Members, who I think will be interested, I will briefly answer the question of who will take the final decision. Once the public consultation has been concluded, the decision on the future number and location of surgical centres in England will be made by the joint committee of primary care trusts on behalf of local NHS commissioners. There are circumstances in which the Secretary of State for Health may be called upon for a decision. However, as we are currently in the consultation period, it would be premature to consider that further at this point.

--- Later in debate ---

[Mr Sheerman]

rose—

[Mr Burns]

I knew that it was probably a slight mistake to be quite so helpful. I will first take my hon. Friend’s intervention and then the hon. Gentleman’s.

[Julian Smith]

I thank the Minister for giving way yet again. Given that PCTs are in the last phase of their lives, does he agree that it is concerning that PCTs, whose eyes may not totally be on the ball, are making this critical decision?

[Mr Burns]

I can see where my hon. Friend is coming from and I appreciate that he may have concerns. I hope that I can give him the reassurance that he seeks. I do not think that PCTs are in a situation where they have not got their eyes completely on the ball. First, from all the evidence that I see, day in, day out, of the work of PCTs up and down the country, they continue to be highly professional and to do a first-class job. Secondly, the date when PCTs will cease to exist because of the modernisation of the NHS is not so close that they will not be able to fulfil their functions properly. I have every confidence in the JCPCT doing a first-class job of carrying out the consultation and reaching its conclusions in a highly professional and acceptable way. I hope that reassures my hon. Friend.

[Mr Sheerman]

I understand entirely where the Minister is coming from and that he must leave the matter to those with expertise. We had a similar situation in relation to maternity services in Huddersfield and the number of cases there had to be for people to be fully trained up. At the end of the day, it will always be a political decision. What if all the experts said that there could be only one unit—in London or somewhere else? Surely that would be politically unacceptable to the Minister and he would have to intervene.

[Mr Burns]

The hon. Gentleman is trying to tempt me to go places where I should not stray. I believe that the premise of his intervention is incorrect, and that the situation he describes will not happen, because the outcome will not be the recommendation of just one site in the whole of England.

I hope my remarks over the past few minutes have reassured the hon. Gentleman that in the lead-up to the consultation process, the drawing up of the final report and the options has been carried out by people who are very familiar with this specialised and sensitive area of medical care and with clinicians. They have come up with recommendations in which I have confidence, to be considered and consulted on. What we have to do now is use the consultation process so that everyone who has an interest, whether they are clinically qualified people in the NHS or members of the public, patients or Members of Parliament, can get across their views and arguments. In that way, the right decisions can be made at the end of the process, within the framework that I have outlined in the debate.

I reinforce the point that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of children’s heart services. I can give the assurance that it is a genuinely open process and the outcomes are not predetermined. The options have been arrived at by a thorough and comprehensive process that has the support and endorsement of the professional associations and national children’s charities. I thank all those involved for their time and their input into the review so far. Children deserve the best possible care, and we are determined to provide it.

Finally, I make the plea again that in this crucial matter, we have to get the finest quality care for a vulnerable group of patients—very young children. We have to ensure the best outcomes because, frankly, that is all that matters to parents when their children are suffering. I urge everyone who has an interest, a view and a contribution to make to take part in the consultation and help ensure that the right decisions are taken to achieve the aims and ambitions on which we are all united.

Question put and agreed to.