Congenital Cardiac Services for Children

Stuart Andrew Excerpts

Thursday 23rd June 2011 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I beg to move,

That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.

I thank the Backbench Business Committee for allowing us the opportunity to hold this valuable debate. I apologise to the Committee and the Clerks for taking so long to table the motion, but I feel passionate that it is right to get a motion that has the effect that we want. I have probably learned more this week than in the past year, and if I have not got it right, I am sorry. I also thank the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood), for Leeds North West (Greg Mulholland) and for Winchester (Mr Brine), who have helped me through the past week.

This debate is timely, as the consultation by the review of children’s heart surgery around the country will come to an end soon. I completely agree with and support the professionals and patients who say that the review of congenital cardiac services is needed. Of course, we all want what is best for our children, and we want the best centres in the world. It is absolutely right and necessary that we learn from past mistakes in other units, but serious concerns about the process have been raised with me by clinicians and parents. I believe that it is my duty and that of others to scrutinise the review if we feel that there are problems.

There have been accusations that this has been turned into a political campaign. I stress that I have been keen not to make this a political campaign, and I have been incredibly impressed by the cross-party support of the Members from across the country who have been helping us. We will hear from other Members from all over the country—the debate is not just about the unit in Leeds—but I want to highlight the fact that my concerns relate to the review and not just to one centre. Although I will naturally refer to Leeds to highlight examples, I am sure that other Members will highlight similar problems with the review and relate them to their units. I am keen that the campaign does not set one centre against another, but that they are all considered equally.

I want first to deal with what I perceive as the flaws in the review. That is my main concern. From speaking to patients and families, I know that that has made them lose confidence in the review. We would all agree that public confidence in the review is important. The review has stated that the objective is to have centres that perform 400 procedures a year. The first version of the pre-consultation business case showed that patients from Doncaster and Sheffield would travel to Birmingham. That is absolutely right and in line with advice from the Yorkshire and Humber specialised commissioners, but in version 2 and the consultation options, the flow had changed to Newcastle. I understand that that helps the Newcastle figures, but I and anyone else who knows the area would surely question the likelihood of that happening. Far more plausible is that people would go to Birmingham or Leicester. What happens to Newcastle then? In addition, one of the options—the 400 minimum procedures—is not even met. The JCPCT explains that that is due to new patient flows.

At a number of centres, activity has increased in the past year. For example, Leeds is now doing 370 procedures a year, but in the pre-consultation assessment it was not afforded the same consideration as other centres that carry out similar numbers of procedures. Furthermore, the health impact assessment had not been completed before the final options were presented for consultation. The independent company undertaking that work said that this was not the usual approach taken in large reconfiguration proposals. That means that the public will have no access to the findings during the consultation period.

An issue that affects the black and minority ethnic community is that until 24 May the consultation questionnaire was available only in English and Welsh. As a Welsh speaker, I approve of having a Welsh version, but it was not until 12 weeks after the consultation began that the questionnaire became available in other languages, leaving just five weeks for the community to respond. In Leeds, more than 20% of the patients come from the BME community, so this is an important issue that needs to be addressed.

Finally, on the flaws, yesterday when the Safe and Sustainable team were here, we heard them say that co-location of services, in their view, meant anything up to 10 minutes away, yet the British Congenital Cardiac Association issued a statement on 18 February 2011, two days after the release of the business case, to clarify its professional view of the importance of co-location. I believe this demonstrates the BCCA’s dissatisfaction with the review’s interpretation of co-location.

[Julian Smith (Skipton and Ripon) (Con)]

My hon. Friend refers to a meeting of the steering group with MPs yesterday. Does he agree that it was a slightly strange meeting and that there was a significant degree of defensiveness on the part of the steering group?

[Stuart Andrew]

That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.

On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds General infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.

How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel when there could be alternatives?

The Yorkshire and Humber congenital cardiac network board has a well-established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.

On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and it will have the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.

The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.

[Greg Mulholland (Leeds North West) (LD)]

I thank my hon. Friend and neighbour for giving way. Going slightly further on his last point, does he realise that if those surgeons are no longer there, they will not be able to perform operations on adults? Adult surgery would be very detrimentally affected.

[Stuart Andrew]

I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.

I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that will be made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.

I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.

Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well-organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.

[Several hon. Members]

rose—

--- Later in debate ---

[Greg Mulholland]

It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

[Stuart Andrew]

My hon. Friend mentioned the co-location of services. As I said in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?

[Greg Mulholland]

I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.

There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.

That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.

I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:

“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”

Jonathan Darling, a consultant paediatrician at the Leeds General infirmary, states:

“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”

I am afraid that it simply has not done so, which is worrying and quite extraordinary.

The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.

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[Pat Glass (North West Durham) (Lab)]

I do not have a children’s heart unit in my constituency. I do not even have one close by. There are parents in my constituency who are 50 miles from the nearest unit, but they tell me that they do not care about that. They would travel to the ends of the earth to get access to the best provision. That is what matters to them, not having somewhere on their doorstep.

[Stuart Andrew]

I have to take issue with that. The parents I have spoken to are very concerned that they might have to travel. Of course they will travel as far as they have to, but if we can provide a service closer to their homes, should we not strive for that?

[Pat Glass]

They are saying that because they have a unit on their doorstep now. We do not all live in big cities, and some people have to travel a long way. Parents tell me that what they want is the best services, and even if they have to travel to get them, that is what comes first. Travel and access are issues to consider, but every parent who has contacted me has confirmed that the most important thing for them is that their child gets access to the best provision available, and to surgeons who carry out these complex operations a couple of times a week, not a couple of times a year. They tell me that they will go anywhere to ensure that their child gets the best chance of surviving and that their condition improves.

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[Catherine McKinnell]

The hon. Gentleman has put his thoughts and concerns issue on the record.

I mentioned the intentions of the Safe and Sustainable review, which was instigated by national parent groups, NHS clinicians and their professional associations. Those intentions must be the primary drivers in deciding the final outcome of the review.

I am equally concerned at suggestions that the decision and outcome of the review should be stalled, or that the remit should be altered. I am not alone in expressing such concerns. The Children’s Heart Foundation argues that that would leave

“the door wide open for another Bristol Baby tragedy”.

Meanwhile, the charity Little Hearts Matter believes that the Safe and Sustainable service reconfiguration offers—

[Stuart Andrew]

Will the hon. Lady give way?

[Catherine McKinnell]

No, I will not.

Little Hearts Matter says:

“The Safe and Sustainable Service reconfiguration offers a monumental opportunity to ensure that every child with a heart problem has access to the best heart surgery service that this country can offer—a gold standard service.”

I urge anyone in a position of influence, including hon. Members, to support that step forward, and not to halt the process because of personal bias.

A number of hon. Members are concerned about the co-location of children’s services. However, it is important to note that during the development of the £100 million new Great North Children’s hospital at the Freeman’s sister hospital, the Royal Victoria infirmary, a deliberate decision was made to retain children’s heart services at the Freeman, aligned with the world-renowned adult heart services there.

Services that simply did not exist 20 years ago have created a new generation of adults needing care, and the service at the Freeman allows for a seamless transition into adulthood. Of course, services at the Great North Children’s hospital are available to the Freeman in a matter of minutes—throughout the review process, they have been recognised as though they are on the same site.

In conclusion, I am not asking those who will make the final decision to give special treatment to the children’s heart unit at the Freeman, or indeed to the people of Newcastle and the north-east. I am all too aware how difficult this process has been for all children’s heart units under consideration. Each is valued and each has a great story to tell. However, I am asking that the decision is made on the grounds of clinical excellence and the quality of services that are currently provided, and on those grounds alone. I urge that a decision on the future of children’s congenital cardiac services is not put off or prolonged, because the safety of babies and children in need of heart surgery should be paramount in this debate.

--- Later in debate ---

[Stuart Andrew]

I thank everyone who has taken part in this debate, which I think all will agree has been very good and knowledgeable. Members have spoken passionately in favour of their units. The right hon. Member for Newcastle upon Tyne East (Mr Brown) and the hon. Members for North Durham (Mr Jones) and for North West Durham (Pat Glass) spoke passionately in favour of the Freeman hospital. The right hon. Member for Oxford East (Mr Smith), the hon. Member for Southampton, Test (Dr Whitehead) and my hon. Friends the Members for Isle of Wight (Mr Turner), for Poole (Mr Syms), for Meon Valley (George Hollingbery), for Winchester (Mr Brine), for Oxford West and Abingdon (Nicola Blackwood), for Salisbury (John Glen), for Romsey and Southampton North (Caroline Nokes) and for East Hampshire (Damian Hinds) spoke in favour of Southampton. My hon. Friend the Member for Chelsea and Fulham (Greg Hands) spoke for the Royal Brompton—I do not think I am going to get through all these.

The fact is that this debate has got to the heart of the matter. We have discussed the issues that parents and patients have been talking about, but also the concerns that clinicians have been talking about. It is important that we hear those. We heard concerns that if this review does not happen, there could be another Bristol baby tragedy. However, it was reassuring to hear that the units we have are safe. We just need to make them sustainable.

In conclusion, this has been a most excellent debate. I am sure that the Safe and Sustainable team have been listening to Members on both sides of the House. Above all, what has been brilliant about the debate has been the reassurance from the Minister that the Safe and Sustainable review is now flexible over the options and should be flexible over the number of units. That will mean a lot to the people who have been campaigning so hard on this issue, and it shows that a Backbench Business debate can work and make a real difference.

Resolved,

That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.