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Harefield Hospital

Volume 984: debated on Tuesday 6 May 1980

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Motion made, and Question proposed. That this House do now adjourn.—[ Mr. Berry.]

1.41 am

I am grateful—even at 1.41 am—for having been given an opportunity to acquaint the House with the serious threat being posed to the future of the cardiac surgery unit at Harefield hospital, in my constituency.

The future of advanced cardiac surgery, including heart transplants, is in doubt. The recommendations of the London Health Planning Consortium will shortly be considered by the North-West Thames regional health authority, and subsequently by my right hon. Friend the Secretary of State for Social Services. The consortium's terms of reference are as follows:
" to identify planning issues relating to health services and clinical teaching in London as a whole; to decide how, by whom and with what priority they should be studied; to evaluate planning options and to make recommendations to other bodies as appropriate, and to recommend means of co-ordinating planning by health and academic authorities in London."
In short, the consortium comprises a group of planners par excellence. As such, paragraph 94 of its report of October 1979, recognises:
"In our view, no more paediatric cardiac surgery should be carried out at Harefield. This work should be transferred to one of the three designated paediatric cardiac centres.
We are also of the opinion too, that there would be clear advantages in the transfer of the adult work to a general teaching hospital elsewhere in the region.
The possible hospitals referred to, include Hammersmith, Charing Cross, The National Heart, Northwick Park, the Middlesex, St. Mary's and the Westminster.

It is the proposed termination of both paediatric and adult cardiac surgery at Harefield hospital that has aroused intense opposition, not only from the medical staff committee, but from thousands of my constituents. It has also aroused intense opposition among the constituents of my hon. Friend the Member for Ruislip—Northwood (Mr. Wilkinson)—who is in the Chamber—the hon. Member for Hayes and Harlington (Mr. Sandelson), my hon. and learned Friend the Member for Beaconsfield (Sir R. Bell) and my hon. Friends the Members for Watford (Mr. Garel-Jones) and for Hertfordshire, South-West (Mr. Page), who are also in the Chamber at this late hour.

Public attention has been focused on this matter because, if the consortium's recommendations are approved, it will also mean the end of heart transplant surgery at Harefield. To my constituents and many thousands of well-wishers in Britain and overseas, the closure of the cardiac unit is unthinkable. It has, after all, attracted massive private donations, exceeding £320,000, which is over three times the amount recently allocated from public funds by my right hon. Friend for heart transplants at Papworth hospital.

The reason for the substantial public support for cardiac surgery at Harefield is the existence of one of the world's finest medical teams, led by Mr. Magdi Yacoub, who enjoys a world-wide reputation for excellence in that field. That reputation has been built up steadily over the years, during which Harefield has been carrying out cardiac and thoracic surgery and coronary angiography. Such a team of doctors, nurses and therapeutic staff simply cannot be built up at will, nor can it be moved around from one hospital to another to comply with a neat and tidy plan.

In the words of the hospital medical staff in a recent memorandum commenting on the consortium's report:
" The peculiar genius which inspires the team in a demanding specialty such as cardiac surgery cannot be uprooted and expected to flourish elsewhere. The Harefield team feel that talk of transplanting this excellence to other hospitals is simply a euphemism for its destruction.
Harefield is a centre of excellence in the art, of wordwide repute. Its sense of purpose has meant that its industrial relations and its service to the public is likewise excellent. Its results with patients and its cost-effectiveness are unsurpassed."

Does my hon. Friend agree that his comments also apply to Mount Vernon hospital in my constituency? He and I attended a public meeting in my constituency at which the future of cardiac surgery at Harefield and the future of the radio therapy department of Mount Vernon were raised, both of which are under threat from the planning consortium. That consortium has produced some pretty daft recommendations, including that for the Westminster hospital, which we were discussing only a few days ago.

I agree that Mount Vernon is very important in the scheme of things. I am happy to support my hon. Friend in maintaining that important hospital.

The medical staff committee memorandum continued:
"It has the space and ability to expand. Its location is convenient. The quality of its treatment and the quiet peace of its surroundings outweighed all other considerations."
That is a different picture from that which may be seen by the medical staff at other hospitals to which it is recommended this type of surgery should be transferred.

Perhaps they, and may be the Health Service planners, see Harefield as an unfashionable suburban hospital, which has recently sprung to prominence and which is threatening famous London teaching hospitals. If anyone thinks that, I assure them that they are wrong. Harefield is not a suburban area. It is a lovely village, separated by two and a half miles of green belt from its neighbouring community, but it is very easy to get to. It is only 18 miles from central London, three miles from the A40-M40 motorway, about six miles from the M4 and Ml and within easy reach of Heathrow and Northolt airports. It also has British Rail access at Denham and Watford.

Nor is Harefield's reputation for cardiac surgery threatening any other hospital, although I can quite understand that some doctors see the advanced heart transplant surgery that follows aortic valve and coronary bypass surgery as the new" cutting edge "of modern medicine, and they naturally want to see it carried out at their hospital. So I believe it is being argued in the corridors of medical power that this surgery should be carried out in what is called an advanced technological environment rather than in a fairly simple yet relatively modern hospital such as Harefield, whose recent fame results, as I have said, from the brilliance of Mr. Yacoub and his superb team.

Perhaps those who argue thus also forget that this reputation has been built up over the years since Sir Thomas Holmes Sellers, who later became president of the Royal College of Surgeons, did the first closed heart surgery at Harefield in the 1960s. Before that, Harefield was the country's leading tuberculosis hospital and has been a major cardiothoracic centre since 1939. It commenced caring for the sick after Gallipoli, when Australian and New Zealand Service men were treated there. It has a long, impressive and honourable history.

Harefield does not accept the unproven assertion of the consortium of the supposed need in cardiac surgery for the supporting services of a general hospital. Although Harefield has a district general hospital within two miles it has seldom needed its services. Harefield has a general paediatrician, a nephrologist, vascular and general surgeons, dentistry and all the usual medical disciplines. None of the four major hospitals in London not sited in a general hospital has felt the need to have the services of a large hospital on hand at all times.

I hope that my hon. Friend is aware that Dr. Shumway, one of America's leading heart transplant surgeons, does not have at his hospital certain sophisticated facilities—immunology for example—but, as with Harefield, they are available nearby and can be used without difficulty. Harefield uses the immunology facilities at Northwick Park hospital, which is only 20 minutes distant.

Recurrent themes in the consortium's report are that cardiology and cardiac surgery, should, as a matter of course, be carried out in the context of the general hospital, and still more desirably, in a teaching hospital. Yet there is no evidence in the report to show that cardiac centres so located perform better than those which are not. On the contrary, the available evidence suggests otherwise. The leaning towards relocation of units in undergraduate hospitals is highly significant and may well spring from the special interest of the authors of the planning consortium's report, nearly all of whose practising members are on the staff of teaching hospitals.

The staff at Harefield feel that from the point of view of service to the patients, teaching should be a subordinate and not a dominant consideration. Why should it be the surgeons and their support team, and patients, who move? Is it not possible for the students to do a little travelling to them? Harefield is, after all, not at the end of the world. In teaching hospitals, severe competition from other major specialties understandably places a limit on the development of excellence.

The argument that cardiac centres not located in general or teaching hospitals suffer from the lack of appropriate services and academic influence is not supported by any evidence in the planning consortium's report. Indeed, it is positively contra-indicated by evidence of their throughput and the quality of their worldwide contribution to the state of the art. There are numerous informal links between Harefield and post-graduate teaching centres as well as formal links with teaching hospitals. There are also four or five research grants and a number of research fellows as well as attached fellows from overseas.

Each year Harefield plans an advanced course in echo cardiography attended by United Kingdom and overseas students. There is also a special course in chest physiotherapy in addition to a Joint Board of Clinical Nursing Studies postgraduate cardiothoracic nursing course. Harefield is, beyond argument, a hospital of secondary referrals. There is no evidence, therefore, that children treated in cardiac centres not located in paediatric centres fare less well.

If adult and paediatric divisions of the speciality are to be torn apart for the sake of planned tidiness, there should be evidence—hard evidence—to show that the children will benefit. There is no such evidence. Some of the best and most innovative cardiac surgery for children has been achieved in centres which do both adult and paediatric surgery. An operation to transpose the great vessels in children was pioneered at Harefield, where adult and paediatric surgery have always been done together.

I should like to conclude my remarks by quoting from the memorandum which the medical staff have prepared on this subject. They say:
" But it is not only money and convenience which will be lost by the urge to absorb (and, one supposes, to benefit by digesting) a centre of excellence. The excellence itself will be lost. The consortium seem not to have any conception of how diverse the team in a cardiac centre really is. It is not only a question of competent surgeons. There are also competent cardiologists, anaesthetists, radiologists, pathologists, theatre sisters, ITU sisters, cardiac ward sisters, physiotherapists, pump operators, cardiology, physiology and pathology technicians and ODAs, all of whose expertise is specially orientated towards cardiac surgery. These people all live round about Harefield and have their roots, their friends and their children's friends and schools in the countryside. They are particularly well-integrated at Harefield. Harefield has excellent industrial relations. They will not be willing to uproot themselves and their families to migrate to parts of London, to satisfy some plan. This organic growth cannot just be torn apart into sub-divisions and transplanted to satisfy some sterile logic. What is proposed will, in execution, be the destruction of Harefield as a centre of excellence in the particular discipline, in favour of a tidier plan. This truth needs to be faced: and having been faced, it needs to be justified with good reasons."
I have yet to find them in the consortium's report.

I feel thereby that my job as the elected representative of the people is to make these views and facts known to Parliament. It is my contribution, if one likes, to the consultative process which I hope will be considered by the regional health authority and by my right hon. Friend. I shall shortly present a large petition to Parliament in support of these views.

I therefore urge my hon. Friend to have regard to the excellence of the people at Harefield rather than the desire of the planners for a neat and tidy plan. Above all, I ask my hon. Friend for a quick decision after the matter has been considered by the regional health authority so that the sense of uncertainty can be ended, because it is already undermining the confidence of those who heal the sick in this very fine hospital.

1.58 am

I should like to say at the outset that I fully understand the concern that my hon. Friend the Member for Uxbridge (Mr. Shersby) has expressed so eloquently, as one would expect from him, about the future of cardiac surgery at Harefield hospital.

A number of hon. Members from both sides of the House have written to me, to my hon. Friend the Minister for Health and to my right hon. Friend the Secretary of State for Social Services. We have had letters from patients and members of staff, past and present. So we are keenly aware that there is widespread concern about this and that this unit commands affection and support throughout the country. I accept entirely what my hon. Friend said about the need for a quick decision.

I should like to make it clear before going any further that no decision has been taken to remove cardiac surgery from Harefield hospital. The report which suggested this is out for consultation. It has been circulated widely and is being discussed by health authorities, community health councils and others with an interest. We shall have to see, in the first instance, what the Hillingdon area health authority and, in its turn, the North-West Thames regional health authority have to say about it. The proposal arises from the report of a study group which was set up by the London Health Planning Consortium. The consortium was itself set up by our predecessors in 1978 by the main authorities concerned with the Health Service in London. Its job is to look at major planning issues which affect London, or the Thames regions, as a whole.

One of the major problems which concerned the consortium was the planning of the main regional specialties. One of its priorities was to look at the distribution of these services across the Thames regions. In many cases units have been built up by different authorities over the years, almost in competition with one another. Many are small. Others, not always the smaller ones, have grown up in older, smaller hospitals in relative isolation from other specialties and some of them have built up distinguished reputations. In many cases health authorities are finding it difficult to fund and support these long-established units.

To look into the problem of the regional specialties, the consortium set up five independent study groups. Each of the groups comprised eminent clinicians and specialists, who were asked to take, as far as possible, a detached view and to present proposals for achieving the best distribution of services across the Thames regions as a whole. All the reports have been completed and are the subject of consultation. Copies have been placed in the Library of the House. It is, of course, the report on cardiology and cardiac surgery which is important to Harefield hospital. My hon. Friend gave much history about Harefield which I shall not repeat. Harefield is a comparatively small hospital of some 300 beds, under the control of the Hillingdon area health authority, which is a single-district area. About half the beds are allocated to chest medicine and surgery. The rest of the beds are devoted to local general and acute services, such as general medicine and surgery, geriatrics and traumatic and orthopaedic surgery.

Cardiac surgery is a comparatively young specialty, developing out of chest surgery. In the early stages cardiac surgery was confined to procedures which could be undertaken while the heart was still beating. But the introduction of the heart-lung machine, enabling surgeons to perform "open-heart" surgery, opened the door to dramatic developments. Valves weakened by rheumatic fever or degenerative disease could be replaced. Gross congenital defects could be corrected, and over the years this has been done in the case of ever younger patients so that neonatal cardiac surgery is now a recognised sub-specialty. More recently, there has been an increasing number of operations to bypass narrowed coronary arteries. We have had a number of successful transplants, a subject to which I shall return later.

Harefield hospital as my hon. Friend said has been at the forefront of all these developments. Over the last 10 years this has been because Harefield has had the services of one of the world's outstanding cardiac surgeons—Mr. Magdi Yacoub. In paying tribute to him I should also pay tribute to the staff at Harefield who support him—the cardiologists, the anaesthetists, the devoted nursing staff—and to the tradition he inherited. The result is that Harefield now draws patients for cardiac surgery from a very wide area—all over the Thames regions and beyond. In paediatric work it is an international centre.

The London health planning consortium was not just concerned with Harefield, or with the Hillingdon area or the North-West Thames region. The group did, in fact, visit 18 hospitals where cardiac surgery is practised. It was looking at the scene across the whole of London. As a matter of deliberate policy the group decided to visit first, so that it would have no preconceptions, and then to weigh up the evidence not only of what it had seen and heard but of the views of professional bodies on how cardiac services should be organised.

The group visited Harefield in October 1978, when it met Mr. Yacoub, the senior cardiologist, Dr. Malcolm Towers, and many other members of staff including nursing staff. It also saw round the hospital. Immediately after the visit it wrote to the staff saying how impressed it was with the service provided. I make this point to stress that nothing in its report should be taken as a criticism of the staff there or as a reflection on the standing and tradition of Harefield as a cardiac centre.

However, it noted that some of the facilities were under intense pressure, although I understand there has been some upgrading since, and that with only one part-time cardiac surgeon waiting times for surgery were long and increasing. In some cases this meant that after cardiac catheterisation—the investigation which almost always precedes heart surgery—some patients were being referred elsewhere for their operations, which is disruptive and distressing for doctor and patient alike. It also found that there were serious problems in nurse recruitment.

When the study group came to draw up criteria for its recommendations it took into account not only what it had seen and heard but also two reports published while it was at work from bodies representing the views of the medical profession on how cardiac services should be organised. The joint committee on cardiology of the Royal Colleges of Physicians and Surgeons made a number of recommendations on how large units should be and what supporting services they should have. It also recommended that a cardiac unit should be sited in association with a general hospital because of the undisputed value of remaining in close contact with other medical and surgical disciplines.

This recommendation was mirrored by one from the British Paediatric Association to the effect that paediatric cardiac work should be concentrated in a few large units where other paediatric specialities are available on site. During its visits the study group came to the conclusion that there were considerable advantages to patients and staff in the location of cardiac units in general teaching hospitals.

It found that such hospitals could most easily provide the wide range of sophisticated support facilities which modern techniques in cardiac catheterisation and surgery demand, and were less constrained by shortage of key staff in important support services such as anaesthetics, radiology, and specialist nursing services. It found, too, that there was wide support for the view that cardiac services benefit from being in close contact with the range of specialties which are available in a large general hospital.

As far as the paediatric work is concerned the group accepted the view of the British Paediatric Association that this is the best practised in the context of other paediatric specialties. It noted that some general teaching hospitals in the region had only small cardiac units but either had under-used facilities which, if fully used, would enable them to expand, or were envisaging such facilities being provided as part of a planned redevelopment. The group decided that, because considerable investment at Hare-field, both in terms of staffing and facilities, would in any event be necessary to put the unit there on to a secure footing for the future, it would be better for patients and staff alike for this investment to be used to relocate the service within a general teaching hospital elsewhere in the region.

The group proposed that the adult work be relocated, as my hon. Friend said, at either Charing Cross hospital or, if that were not found to be possible, at St. Mary's as part of the planned redevelopment there. It recommended that the paediatric work be transferred to one of three centres designated to specialise in this field. Once the consortium has reached its own conclusions it will be for the responsible health authorities or, if necessary, Ministers to take decisions about their implementation. In some cases it will not affect more than one authority. Particularly in the peripheral parts of the regions, it will be possible for the authorities to decide what they wish to do and to get on with it. But any changes which they wish to make—if they involve closure or change of use of a hospital—would still have to go through the formal consultation procedure. As my hon. Friend knows, that may mean that the issue comes to Ministers for decision.

I turn briefly to the question of heart transplants. In a written reply to my hon. Friend the Member for Cambridge (Mr. Rhodes James) on 13 March my right hon. Friend the Secretary of State made the Government's policy on heart transplants quite clear. Heart transplantation is now an established procedure in a number of centres abroad. Although the results of the latest programmes of heart transplants in this country are encouraging, we believe that the Government and the National Health Service should put only limited resources into heart transplant surgery until it can be shown that the results here compare with those being achieved abroad.

The transplant advisory panel has advised the Government that transplants should be carried out only as a planned programme of at least eight operations a year, in centres which conform to certain conditions and which can carry out the work without detriment to other established cardiac services. My right hon. Friend made it clear that the Government accepted the panel's advice, but with the proviso that any programme of transplants should not be to the detriment of non-cardiac as well as cardiac services in the area concerned.

The transplant advisory panel has accepted Papworth hospital, Cambridge, as suitable for a programme of transplants and, on the basis of undertakings from the local health authority that such a programme would not be to the detriment of other services, we have agreed to make a special contribution centrally to the capital costs of improvements that the authority needs to make to carry forward the programme.

The question of a future programme of transplant work at Harefield hospital must now be a matter for local decision in the light of my right hon. Friend's clear policy statement. As a key element in this local consideration, the North-West Thames regional health authority is asking a small panel of experts to consider the situation at Harefield. The panel is being called on to examine whether the facilities available at Harefield conform to the transplant advisory panel's criteria and how other services at Harefield are affected by a programme of transplant work. The membership of this group has not yet been finalised, but I gather that it is to be chaired by Professor Goodwin of the Hammersmith hospital and that it will draw other members from outside London. I understand that the team at Hare-field hospital has been informed of this and that the region hopes that the panel will be able to report by the middle of July.

I end by joining my hon. Friend in paying tribute to the skill and dedication of all the staff at Harefield hospital, in particular the small team engaged in heart transplant work. In a thriving Health Service there has to be a place for local initiative in pushing forward pioneering work of this sort and, in this connection, I was particularly heartened to hear about the donation of £300,000 made by Mr. John James to support cardiac transplant work at Harefield. This should go a long way towards easing the financial burden that this type of surgery inevitably imposes on a health authority, and I welcome it as a splendid example of how private money can act as a positive supplement to public funds in the National Health Service.

Question put and agreed to

Adjourned accordingly at eleven minutes past Two o'clock.