Congenital Cardiac Services for Children

Stephen Dorrell Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

Like the right hon. Member for Oxford East (Mr Smith), I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on introducing the motion, which is of huge importance to my constituents and to the national health service. In contributing to the debate, I wear two hats. First, I represent the village of Glenfield. Glenfield hospital is actually in the neighbouring constituency of the Opposition spokesman, the hon. Member for Leicester West (Liz Kendall), but it takes its name from the village in my constituency. Secondly, I am Chair of the Health Committee. The Committee has not approached the subject specifically, because we have been looking at a number of other matters, but we have so far published two reports on commissioning, which is precisely at the heart of today’s debate.

In a sense, I personify the conflict that every Member feels between the constituency interest and the national interest, and in this case I do so in a particularly dramatic form, as one of the surgical units involved is closely associated with my constituency. My first point is that that conflict exists for all Members. We are of course here to represent our constituents’ interests, but I argue that we are here first and foremost as Members of a national Parliament and should seek, as my hon. Friend the Member for Pudsey recognises, the right answer for all NHS patients, not simply for a particular local interest.

[Chris Bryant (Rhondda) (Lab)]

I wish to make a very small point because the right hon. Gentleman used the word “national”. Many of the services we are considering are also used by Welsh and Scottish constituents, so it is important to ensure that there is that communication between the different elements.

[Mr Dorrell]

I agree with the hon. Gentleman’s point.

My hon. Friend the Member for Pudsey said that this is not a political issue, by which he meant that it is not a party political issue. That is exactly right, but issues can be political without being party political. It is important that the House, in approaching the subject, makes it clear that the issue should ultimately be resolved according to clinical standards, not as a form of political bartering, whether party political or through the general representation of local interests.

I am in the happy situation, personifying, as I do, the conflict between local and national interests, that the specialist group has recommended a solution that accords with my constituents’ views, but I think that in approaching the subject it is important to be clear about the ladder of interest: we should approach this from the point of view of national standards for the service delivery. We of course should represent the views of our constituents, but we should be clear that the national view should come first.

Writing in The Times today, Sir Bruce Keogh, the medical director of the NHS, states:

“Intellectually, the case for change is compelling and widely accepted. Sadly, the realpolitik is that the closer we get to a solution, the more personal, professional and political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence…For too long this has been filed in the ‘too difficult’ box. Time is running out.”

Those words should ring loud in our ears as we debate the subject this afternoon.

We should recognise that the whole issue of child heart surgery has form in the history of the national health service. It is now over a decade since Sir Ian Kennedy published his review of circumstances that illustrate what can go tragically wrong when things are allowed to drift on and when real issues are not addressed. Although I am of course here as a Member representing my constituents’ interests, I think that the key priority for the House this afternoon is to support the principle that this issue must be decided in the interests of the children who are the patients and who will become the adult patients, and in a way that satisfies the key driver of the pursuit of excellence in clinical standards.

I welcome the fact that the previous Government set up the review to ensure that we addressed the issues that had been left to drift on for too long since the Bristol heart review a decade ago, and I wholeheartedly endorse the view, expressed by Sir Bruce in today’s Times, that the time to act is now.

As a local MP, I wonder what the effect is on Leicester of this drive to a decision. I have already referred to the fact that I am not in an uncomfortable position, because on page 93 the review states:

“Option 2”—

which became option A—

“is viable as it is consistently the highest scoring potential option.”

The review’s recommendation is that the process go ahead based on option A, and that is convenient from the point of view of the person arguing the case that I do, but I conclude that if anyone wants to argue for an alternative outcome, it behoves them, particularly in view of the history of this issue in the national health service, to present a coherent, whole argument for how their solution represents a better solution for the patients of those services, while reflecting, of course, the local interest of the people we are elected to represent.

--- Later in debate ---

[Mr Dorrell]

I think that the hon. Gentleman slightly misrepresented what I said. I did not say, “You must accept it”, or “Take it or leave it”. I said that those who wished to argue for a different approach must argue for the whole approach, and not for a sectional interest.

[Mr Mudie]

I entirely accept that, and I did not intend to suggest that the right hon. Gentleman had said anything different. My point is that, while the clinical case for a rationalisation is unarguable, equality of access is as important a consideration as any. Excellent treatment must not be available to only a certain number of people.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a real privilege to take part in today’s debate, and to follow the thoughtful, moving and at times passionate speeches of Members of all parties. I thank the Backbench Business Committee, and I particularly thank the hon. Member for Pudsey (Stuart Andrew) for securing the debate.

Like the right hon. Member for Charnwood (Mr Dorrell), I wear two hats today. As the Member for Leicester West, home of Glenfield hospital’s superb congenital heart centre, I know how important the review of children’s heart surgery is for my constituents, as it is for those of each of the hon. Members who have spoken. As the Opposition spokesperson, however, I am also well aware of my national responsibility, and that of the House, to ensure that every child gets the very best quality of care.

I want to start by making the case for change, as did other Members including my hon. Friends the Members for Liverpool, West Derby (Stephen Twigg) and for North West Durham (Pat Glass), my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), who made brave and courageous speeches.

Following the devastating findings of the Bristol Royal infirmary inquiry almost 10 years ago, clinicians and professional bodies have been clear that children’s heart services need to change to ensure that every child gets the best standard of care now, and crucially also in the future. They include the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Society for Cardiothoracic Surgery, the British Congenital Cardiac Association, the Paediatric Intensive Care Society and many others.

The reason why services need to change is that children’s heart surgery is becoming ever more sophisticated. Technological advances mean that care is increasingly specialised and capable of saving more lives and improving outcomes for very sick children. However, services in England have grown up in an ad hoc manner. As my right hon. Friend the Member for Oxford East (Mr Smith) said, surgeons are too thinly spread. Care needs to be better planned to pool expertise in specialist centres so that all children get excellent quality care. I therefore welcome the Safe and Sustainable review, which was initiated by the previous Government. The challenge, as the House has rightly demonstrated today, is to ensure that the right aims, objectives and criteria drive the review, and, crucially, that they have the right weighting and that the right balance is struck.

Of course, improving the quality of care must be our primary concern. The review rightly calls for fewer, larger surgical centres to provide 24/7 consultant cover, and seeks to ensure that surgeons treat a sufficient number of patients with a sufficient variety of problems to ensure that they have the best possible skills.

The review also recommends the development of congenital heart networks, so that care is better co-ordinated at all stages of a child’s life, and that assessments and ongoing care can be provided closer to where patients live. However, as several hon. Members have said, the review cannot look at children’s heart surgery services in isolation; it must also fully consider the knock-on effect on other specialties at the hospitals in question.

As my hon. Friend the Member for Leicester South (Jon Ashworth) and the hon. Member for Loughborough (Nicky Morgan) rightly said, the work of Glenfield children’s heart surgery centre is closely linked with its extra corporeal membrane oxygenation service. ECMO helps patients with reduced heart or lung functions to have complex surgery that they might not otherwise survive. Glenfield is the country’s leading specialist ECMO centre, and trains and supports other services nationally and internationally. There is real concern at the possibility that that service will be moved to another hospital, because of the time that it would take to build up expertise elsewhere. Not only does it take up to 18 months to train new specialist nurses, but it takes many years to develop equivalent experience.

Ensuring high quality care is not just about surgery standards or links with other specialisms. The wider help and support that families get from doctors and nurses are vital. I was genuinely moved when hon. Members spoke of their conversations with parents and staff in their centres. Time and again, parents emphasise the communication skills of staff, and their ability to explain diagnoses and procedures simply and clearly, at what is often a frightening and worrying time.

Parents at Glenfield tell me that staff are like members of their families—they can ring day or night if they have any concerns. Such familiarity and trust is crucial, and it links to the issue of providing ongoing help and support, which many hon. Members mentioned. When children who have had heart surgery grow up, they have to deal with difficult issues such as whether they can have children. Many families are understandably concerned about having to build new relationships with a different team of doctors and nurses if their local centre closes. It is vital that the review look closely at the links between child and adult congenital heart services, but it has probably paid insufficient attention to that so far. I hope and believe that that will change before the review concludes.

As well as stressing the importance of the quality of clinical care, many hon. Members stressed the importance of ensuring fair access to services. We heard passionate speeches about that from my hon. Friends the Members for Leeds East (Mr Mudie) and for Scunthorpe (Nic Dakin). Accessibility matters, because time is of the essence when seriously ill children need to get to heart surgery centres in life-or-death situations, as the hon. Members for Meon Valley (George Hollingbery) and for Isle of Wight (Mr Turner) rightly said.

However, travel times also matter to families who need ongoing care and support. My hon. Friend the Member for North West Durham rightly said that many parents would travel to the ends of the earth for their children, but as the hon. Members for Leeds North West (Greg Mulholland) and for Oxford West and Abingdon (Nicola Blackwood) said, making families travel further than they already travel would make such a difficult time even harder for them, especially if they must also hold down a job or care for other children.

The difficult balance between specialising services in some areas but ensuring fair access is the crucial issue for the review.

[Mr Dorrell]

The hon. Lady is making an important point about access being one of the quality characteristics that need to be taken into account in making these decisions. However, does she agree that the Safe and Sustainable work programme has taken that into account? It was one of the key factors it took into account in making its recommendations and drawing its conclusions on the relative merits of these units.

[Liz Kendall]

The right hon. Gentleman makes an important point, but hon. Members have said that they feel the issue was given insufficient weighting. At the Leicester consultation, one parent said to me, “If we’d known that all the services were safe”, as the review has said, “we might have placed more importance on the issue.”

The affordability issue has not been mentioned. Hon. Members will, I am sure, be as one in saying that the review must be driven by the need to improve the quality of care, not by reducing costs. However, it is important to recognise, particularly in these financially constrained times, that significant costs are associated with all the current, and likely future, options in the review. That needs to be taken into account.

In conclusion, changing how we provide any hospital service is difficult, but when changes are necessary to improve patient care, as I believe they are for children’s congenital heart services, the House must have the courage to make them happen. Hon. Members have rightly raised a range of concerns on behalf of their constituents, but I am sure we would all agree that the final decision must be made by clinicians on the basis of evidence, not on political considerations. I hope that the joint committee will seriously consider the points raised in this debate and then make final recommendations in patients’ best interests.