Children's Heart Surgery (Leeds)

Debate between Simon Burns and Hilary Benn

Thursday 3rd March 2011 Commons Chamber

[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.

--- Later in debate ---

[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.