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Orders Of The Day

Volume 175: debated on Tuesday 26 June 1990

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Pakistan Bill Lords

Not amended (in the Standing Committee), considered.

Motion made, and Question proposed, That the Bill be now read the Third time.

10.14 pm

The Bill welcomes Pakistan back into the Commonwealth. The first conference following the readmission of Pakistan to the Commonwealth, which was attended by representatives from Pakistan, was opened by Mr. Speaker, being the Commonwealth conference on delegated legislation. The conference is held about every five years and is concerned with the scrutiny of delegated legislation passing through the various commonwealth legislatures. As chairman of the conference, and as the United Kingdom was its host, I was pleased to welcome a delegate from Pakistan who played a useful part in providing the conference with information about the scrutiny of delegated legislation in that country.

The conference examined the scrutiny of delegated legislation. Many other Commonwealth countries have had far more comprehensive powers of scrutiny than we have in our legislature. The Commonwealth has some good examples of how the delegated legislation committee can invoke powers to stop abuses by Ministers, as sometimes occurs in our legislature.

It was a good conference and Pakistan took its first step back into the Commonwealth by attending it. It was a coincidence that the conference took place then, but Pakistan's move was welcomed by delegates from other Commonwealth countries, more than 30 of which were represented. On that basis—I am sure that the whole House approves—I welcome the Bill's Third Reading.

10.16 pm

The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs
(Mr. Tim Sainsbury)

I am glad that the hon. Member for Bradford, South (Mr. Cryer) joins the others who have welcomed the Bill, as does the whole House. I assure him that nothing in the Bill affects the procedures of scrutiny of legislation in either the British or Pakistani Parliament. I hope that the House will give the Bill a good Third Reading.

Question put and agreed to.

Bill accordingly read the Third time, and passed, without amendment.

Killingbeck Hospital (Heart Surgery)

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

10.17 pm

I am grateful for this opportunity to raise the subject of Killingbeck hospital and heart transplants. I raise the issue, which is a Yorkshire and Humberside regional matter and not a constituency one, because it relates to the provision of heart transplant services in the Yorkshire region. I am involved because a friend whose young daughter recently had a heart transplant asked me why Killingbeck hospital in Leeds was not designated as a regional heart transplant centre.

Killingbeck hospital was the first paediatric cardiology unit in the country. Since it was designated as a centre for child heart surgery it has built up quite a reputation and one would have thought that it would therefore have become a designated centre for heart transplants. A tremendous amount of skill and expertise has been built up at the hospital in the past few years, and it can offer as good a service as anywhere else in the country.

The facilities that have been built up at Killingbeck hospital are first class, as is the surgeon, Mr. Duncan Walker. It also has facilities that one would not usually expect. For instance, it has a bungalow in which parents can stay overnight or for extended periods when their children are undergoing heart surgery. Most of the cost of those facilities comes from charitable donations. Yet the Government have refused to recognise Killingbeck as a heart transplant centre and have even criticised the unit for carrying out transplants. As I hope to show today, that means that the Government are, in effect, criticising Killingbeck hospital for saving lives.

At present, the designated centres for child heart and lung transplants are Great Ormond street hospital in London, Harefield hospital and Freeman hospital in Newcastle, although at present Freeman hospital has no programme of heart transplants for children and Harefield hospital is not itself a designated centre. Technically, therefore, Great Ormond street is the only hospital which can offer that service.

There is a tremendous shortfall in the provision of this acute medical service for people in Yorkshire, Humberside and the north midlands. Great trauma surrounds heart transplant surgery. Apart from the obvious trauma of one's child or relative having to undergo such surgery, there are the added strains and stresses placed on parents who have to visit units for assessment over three to six weeks before an operation takes place. The patient has to spend about eight weeks in intensive care after the operation. Following that, the patient has to visit the hospital twice and sometimes three times a week. That all adds to the pressure placed upon parents. In addition, there is the problem of arranging time off work and travelling, with the associated costs, so as to be near children undergoing this type of surgery.

A letter was sent to the consultant surgeon at Killingbeck hospital by a couple whose child had a heart and lung transplant. The letter has been passed to me. In it the parents said that they supported the surgeon at Killingbeck. They said that their daughter, Debbie, had a heart and lung transplant at Harefield hospital on 18 October 1985. Unfortunately, the child died in 1986. They had to go to Harefield hospital because no other transplant centre was available. In the letter, the parents said that it was extremely good of the surgeon at Killingbeck to stick his neck out and do such operations locally. The couple spent nearly four months at their daughter's bedside. She received extremely good care and attention, but they were 200 miles from home and from their family and relatives and the young child was away from her brother. That illustrates the type of problems experienced by parents in such cases.

The expectations of parents and children in Yorkshire and Humberside should be the same as those of parents and children in any other area of the United Kingdom. They should have access to a local heart transplant centre, and Killingbeck should be the designated centre for that type of surgery.

The Northern general hospital in Sheffield has been designated as a heart transplant centre for our region. I believe that that hospital has carried out one heart transplant so far and has stated that surgeons at the hospital would not have attempted heart surgery on a three-year-old child. Sheffield hospital has little expertise or experience in this field of surgery. Killingbeck, however, is an experienced centre for child heart surgery. The Freeman hospital in Newcastle has carried out heart transplants but currently has no programme for heart transplants on children. It is interesting to note that Freeman hospital has carried out heart transplants even though it was not a regionally recognised centre. The Government in their wisdom decided that it would be designated as a heart transplant centre and it is continuing with its programme.

The Leeds general infirmary has been mooted as a possible successor to Killingbeck, and it has been agreed that facilities at Killingbeck should be transferred to Leeds. It seems that the Leeds general infirmary is being set up as a centre to opt out of the national health service. Facilities have been transferred to that hospital even though they are already in situ at Killingbeck, whose expertise could be broken up by a transfer to Leeds. Already there are reports of surgeons leaving Killingbeck because of the doubt and uncertainty surrounding that hospital. I have also been told that nurses at Killingbeck are wary of transferring to a hospital where late shifts could mean being in the city centre late at night. It is a glaring omission that Killingbeck has not been designated as a transplant centre. The political ideology reflected in the transfer to Leeds general infirmary will lessen the service and will cost lives in Yorkshire and Humberside.

The Government maintain that, by taking hearts and other donated organs, Killingbeck is reducing the supply to the national network. Before its current programme, the Leeds hospital donated hearts to the national network, but when it began its heart transplant programme it used organs which had been donated locally. The Government maintain that Killingbeck is threatening the national donor scheme by not offering those organs nationally, but if Killingbeck did not have its own heart transplant programme, those organs would not have been donated. It is only as a result of increased awareness that the number of organs donated has increased. If Killingbeck did not use the heart and lungs donated to it, they would be wasted. Hearts have been offered to Harefield and to Great Ormond street and have been refused, either because there was no surgeon to carry out the operation or, surprisingly, because no recipient was available.

On the reverse side of the coin, organs have been donated to Killingbeck through the national network despite the fact that it is not a regional centre. One young chap, Stephen Hollis, is alive today with a new heart and lungs because Killingbeck was ready and willing to undertake a transplant operation when the heart and lungs became available through the national network after being turned down by the two other national centres.

The French experience shows that when one moves from a centralised national system to a regional system, the number of donated organs increases dramatically. Harefield is not a designated heart transplant centre—it has simply carried out such operations in the past—but the Government have not complained that it is undermining the national scheme or doing anything wrong. Why is Killingbeck treated differently?

Killingbeck hospital is clearly increasing the number of organs available for transplant as a result of its programme. It is essential that that programme should be encouraged to continue and that the hospital should be designated as a transplant centre. I ask the Governnment to recognise Killingbeck as a transplant centre mainly for child heart transplants. That hospital, with its wealth of expertise, cries out to be made a designated centre.

10.28 pm

I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on raising this important issue about the long-term future of Killingbeck hospital. He has clearly shown the extent to which the hospital and its staff are a national asset and resource.

I want to ask the Minister one or two questions and to ask him to consider one or two of the issues raised by myself and my hon. Friend. I am sure that the Minister will accept that the work of Duncan Walker and his colleagues at Killingbeck hospital is of high repute. It has put Leeds on the map and it is good for Britain and the NHS.

There is widespread concern in Leeds that a team with such a reputation of excellence is in danger of being broken up. I hope that the Minister, with his responsibility for the NHS, will be able to assure us tonight that he will make every effort to ensure that that team stays together so that its excellence and expertise are available to all NHS patients. It would be a great pity if those skills were lost to the national health service or, as seems likely, to this country. What steps will the Minister take to ensure the future of the team that has developed so well under Duncan Walker at Killingbeck hospital?

My next question arises from the confusion felt by many of my constituents and by most residents in Leeds. A decision has been made, which I am not criticising, to develop certain facilities at Leeds general infirmary. At the same time, facilities at Killingbeck, which have an excellent reputation and record, are to be closed. In doing that, the regional health authority has also sanctioned a decision to put extra money into Killingbeck in the short term. It seems strange that a good team and a good hospital should be threatened with closure, while at the same time more money is to be put into that hospital in the short and medium term. Surely the logic that flows from that decision is to keep the hospital open and, above all else, to keep Duncan Walker's team working there.

The Minister should look again at the future of Killingbeck hospital. I can tell him from my local knowledge and experience that it has a great deal of public support and sympathy, and the people of Leeds would like the Minister to reconsider the hospital's future, keep the hospital open, and keep Duncan Walker's team working there.

There is much pressure to bring a regional heart centre to Leeds, and I am sure that the Minister relates to that. But in the shorter term, we also want assurances about Killingbeck's future. I hope that the Minister will agree tonight to consider that issue and that he will return with a positive answer.

10.32 pm

I congratulate the hon. Member for Barnsley, Central (Mr. Illsley) on creating the opportunity to debate the issue that he has brought before the House this evening, and the hon. Member for Barnsley, Leeds, Central (Mr. Fatchett) on his contribution. I am conscious that they have raised a matter of considerable concern to people in Leeds and more widely throughout Yorkshire, who understandably want the undoubted cardiothoracic skills in the Leeds area developed.

I am more than happy to acknowledge that Duncan Walker is a distinguished surgeon and that his team has done a great deal of valuable work at Killingbeck hospital. However, the hon. Member for Barnsley, Central made it clear that he was prompted to raise the issue after a conversation with a friend that concentrated on the particular question of developing transplant surgery at Killingbeck. The hon. Gentleman described it as not a constituency but a regional matter. I shall try to explain to him and to he House why the Department does not regard transplant surgery even as a regional matter but one properly ordered on a national basis, and why that is in the interests of heart transplant patients generally in Yorkshire, like everywhere else.

Before doing so, I may say that a considerable expertise in cardiothoracic surgery has been developed in the Leeds area, and the Government are anxious to see it increase still further. There is more than one reason why. We recognise that heart disease occurs more extensively in Yorkshire than elsewhere in the country. That clearly establishes the need for a proper regional centre of expertise in general cardiothoracic care—I am not talking at the moment about transplant surgery, to which the regional health authority has demonstrated a real commitment.

In 1988, the authority set up a review of the arrangements for cardiothoracic surgery in the county, and it decided that two major sites should be developed. I understand that there is little disagreement about the site which should be developed in the eastern side of the region, and that Castle Hill hospital was decided upon. There was somewhat more discussion about precisely where the centre for the western side of the country should be based.

The regional health authority asked the Leeds hospitals to provide alternative proposals for the development of an area facility for the western side of the region by March 1990. In response to the proposals made to it, the authority recently decided that the best course of action open to it was to develop a major new facility at Leeds general infirmary.

In answer to the hon. Gentleman's point about why the region is apparently committed to the closure of Killingbeck hospital—although that decision has not yet been taken—two points have to be made. First, any impartial analysis would recognise that Killingbeck hospital does not have the highest standards of physical accommodation. There is a desire that the new facilities should offer the highest standard of accommodation possible. That is why the scheme that the regional health authority is promoting now involves the expenditure of £16.8 million to provide the new facility as part of the phase 1 development of Leeds general infirmary, which has a total budget of some £56 million. That is a major commitment of health service money to the development of cardiothoracic care in the Leeds area.

As regards the future of Mr. Walker's team, it seems inconceivable to me that anyone planning the future of cardiothoracic care in West Yorkshire would be seeking to do so without a role for the expertise that Mr. Walker has developed.

Although, understandably, the hon. Member asked why there was not a role for Killingbeck, the answer is that the regional health authority and the people directly involved in the field in Leeds have considered the available options, and have concluded that the best interests of patients in the area are served by developing cardiothoracic care at Leeds general infirmary, and have provided a substantial investment budget to back up that commitment.

Could the Minister give an indication of the Government's attitude to Leeds general infirmary's designation as a transplant centre? Assuming that there was a complete transfer of Duncan Walker's unit from Killingbeck, what would be the status of the LGI?

The hon. Gentleman has neatly anticipated the matter that I was about to deal with. I wanted to set the context of general cardiothoracic care in the county, to underline the recognition that such care is really needed in Yorkshire, and that the region and the health service plan to meet that need.

Before the Minister moves on to that point, could he make the position clear about the development of the Leeds general infirmary? Will he tell us what action he will take to ensure that Mr. Walker and his team have a future role of some significance in its development?

I am not sure that it is open to me to do that. Clearly, it will be for the managers of the infirmary and for Mr. Walker to agree the terms under which Mr. Walker might work in that context. I am not sure that it would be sensible for me, in the House of Commons, to seek to determine a contract between a man and a manager whom I have never met. As I have said, it seems to me inconceivable that someone should seek to develop cardiothoracic care without using the resources that have been developed at Killingbeck hospital.

Let me deal now with the question of heart transplant surgery and the way in which we seek to develop the management of that facility within the service. I think that it is important to recognise that the national health service seeks to develop heart transplant surgery as a national facility, rather than—as the hon. Member for Barnsley, Central suggested in his opening remarks—purely a local one. It is not realistic to suggest that heart transplant surgery should be available, within a local heart transplant service, to every heart transplant patient around the country.

Heart transplant surgery is still a relatively new branch of surgery and, as the hon. Member for Barnsley, Central stressed, involves considerable trauma for the patients concerned. The heart transplant programme started with a grand total of three operations in 1979, and by 1988 had expanded to 375. Until this year, it has been carried on in four designated centres. The hon. Gentleman listed a number of names, and not everything that he said about the designated centres was precisely correct. So that there should be no misunderstanding, let me make it clear that the four centres which, until this year, have been designated centres for heart transplant surgeries are the Freeman hospital in Newcastle, Papworth hospital, Harefield hospital and the Wythenshawe hospital in Manchester. Great Ormond street does some operations in association with Papworth; they are counted as one designated centre.

On the advice of the appropriate committee, the Secretary of State has recently designated two new centres for heart transplant surgery—St. George's in London and the Northern general hospital in Sheffield. It has also been made clear that heart transplantation in young children is still regarded as very much an experimental course of treatment and that heart transplant surgery on young children should be concentrated, within the designated sites, on the Great Ormond street hospital in London and the Freeman hospital in Newcastle. Even within the limited programme of designated sites, our policy is to seek to concentrate heart transplant surgery for children at two of the six.

But as Killingbeck has now carried out five heart and lung transplants on children as young as three, the Government ought surely to consider Killingbeck as a designated centre along with the Freeman hospital in Newcastle. Moreover, I understand that at present the Freeman hospital has no programme of child heart transplants.

The Secretary of State has chosen to designate those sites because child transplant surgery is regarded as an experimental course of treatment. Given the high-tech nature of the treatment, and as it is still regarded as experimental and therefore relatively high-risk surgery, all the evidence suggests that it is good management for us to concentrate the resources on a few centres and to seek to develop in those centres teams of particular expertise, rather than encouraging the development of teams offering such treatment on a more general basis around the country.

We do not have, and do not seek, the power to interfere with clinical judgments. But we have, and we seek to use, the power to encourage the concentration in regional centres because we believe that that is the best way of facilitating an effective heart transplant programme. The object of the arrangements is to foster the planned development of services, including the concentration of services at a limited number of sites, because we believe that it is in the best interests of patients to do so. The policy is based on evidence that success rates in complex therapeutic procedures or in managing rare conditions depends on the number of operations or therapies performed. In simple terms, centres with a large throughput get the best results.

Other countries have experienced a proliferation of activity; the hon. Member for Barnsley, Central (Mr. Illsley) referred to France. In France and elsewhere, there has been a proliferation of activity, with many small units doing too little work to achieve the best results from that course of treatment. It is not unfair to say that those countries look with envy at our heart and liver transplant programme and regard it as a role model for them to emulate.

The arguments for concentrating services apply with particular force to heart transplants, because the units depend on the supply of a scarce resource. The success of the British organ sharing arrangements depends on priority being given to designated units.

The hon. Member for Barnsley, Central referred to organ availability. We have set up elaborate arrangements to try to ensure that organs are passed on as quickly as possible when they become available. Only by concentrating around the arrangements that have been created will the NHS have the best opportunity of delivering the most effective heart transplant programme that can be engineered. That is my objective and I am sure that it is the objective of the hon. Member for Barnsley, Central. The arrangements that we have put in place are the best way to deliver that objective.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to Eleven o'clock.