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Children's Heart Surgery (Leeds)

Volume 524: debated on Thursday 3 March 2011

Motion made, and Question proposed, That this House do now adjourn.—(Mr Dunne.)

I am grateful for the opportunity to hold an Adjournment debate to discuss the Leeds children’s heart unit.

Before being elected, I spent a considerable part of my career in the children’s hospice movement. During that time, I built up a great deal of understanding of the issues faced by families who have a child who is very poorly. Leeds MPs are working as a cross-party group to do the best for our city. We have each taken on a role, and mine has been in relation to health. During the Christmas recess, I spent two days at the two hospitals in Leeds. I was particularly interested to see Leeds general infirmary’s children’s services, which have recently been reconfigured and are all in one place. It was my first opportunity to visit the heart surgery unit there. At that point, I learned for the first time about the safe and sustainable review of heart units across the country: at the moment, there are 11 units in the United Kingdom, and the national health service propose to reduce that number to six or seven.

The review has already published four options, and I am surprised and disappointed that Leeds features in only one of those. It is my belief that if the Leeds unit closes, it will leave a huge gap in provision, from Leicester or Birmingham in the south, to Newcastle in the north, and Liverpool to the west. It will mean that children from Yorkshire, north Derbyshire and north Lincolnshire will have to travel long distances, at considerable expense to their families. Indeed, I am aware of families in your constituency, Mr Deputy Speaker, who have been using the service. People from far and wide are dependent on the service at Leeds, so there is an effect not just on Leeds but across Yorkshire and neighbouring counties.

I congratulate the hon. Gentleman on having secured this timely debate. Like him, I spent some time observing children’s heart services in Leeds a few months ago. Only this week I was contacted by a constituent who expressed concern about the impact of closures. That constituent’s daughter is now five years old. When she was eight days old, she was able to undergo important surgery in Leeds. Does the hon. Gentleman agree that Leeds is particularly well placed, and that its expertise and critical mass of children’s services make it very necessary for it to continue its excellent work?

I entirely agree. I was about to deal with that point. I believe that there is a very strong case for Leeds. It has the capacity to expand, and is within a two-hour drive for nearly 14 million people. It has one of the highest population coverages among all the units in England, with 5.5 million people in the Yorkshire and Humber region. Leeds is, of course, centrally located in the north of England, and can accommodate patients from outside the current catchment area.

I congratulate my hon. Friend on securing a debate on an issue that is vital to the people of our city. Leeds is not only central, but has been described as the motorway city. It has excellent rail links as well, which makes speedy access to the hospital possible.

I am beginning to think that some Members have already seen my speech. I am getting ahead of myself. We have the M1, the A1, the M62 and excellent rail links, which make Leeds very accessible. The Leeds Hospitals NHS Trust has centralised children’s services, which I think meets the requirements of the Department of Health’s critical interdependency report. On 18 February the British Congenital Cardiac Association, which is a leading support organisation of the safe and sustainable review, released a statement saying:

“For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

Leeds General Infirmary is at the forefront of work on inherited cardiac conditions, and has an excellent record of providing safe, high-quality children’s heart surgery. The Yorkshire region has significantly higher birth rates than other parts of the country, particularly the north-east, and there is no doubt that demand will increase.

The review is informed by the overall opinion that a reduction in the number of centres is the best way in which to secure a safe and sustainable future service. It is guided by four principles, and I believe Leeds more than meets their requirements. The first is quality. The paediatric cardiac service at Leeds General Infirmary extends from pre-natal diagnosis to the treatment of congenital heart disease in adults, with excellent clinical outcomes. It has high standards and a personal service, and, as I have said, is located very centrally.

During the assessment process, Sir Ian Kennedy and his assessment panel visited every children’s heart surgery unit in England. They produced individual assessment reports on each of the units two weeks before the presentation meeting at the joint committee of primary care trusts on 16 February. At the meeting, the four reconfiguration options were presented. They were based on a number of factors contained in the panel’s assessment reports. However, I understand that there are significant factual inaccuracies in Sir Ian Kennedy’s report on the Leeds unit, and that its representatives were given no opportunity during the process to comment or request amendments of the factual inaccuracies before decisions were made about the configuration of the options for consultation.

At a meeting of the all-party parliamentary group on heart disease on 9 February, when asked when units would be able to challenge and amend inaccuracies in their reports, Jeremy Glyde, the programme director of the safe and sustainable review, said that that could be done during the consultation process.

The reports that the reconfigurations were based on contain fundamental inaccuracies, but they can be challenged only during the consultation period to decide which option is preferred. For Leeds, these inaccuracies include the following. Sir Ian Kennedy’s report documented that Leeds has no transition nurse and separate paediatric intensive care unit; neither point is factually accurate, to the extent that his assessment panel actually met, and talked to, one of the unit’s three transition nurses. The joint committee of primary care trusts advised at its meeting on 16 February that Leeds had stated that it could not do more than 600 operations. Again, that is factually incorrect— Leeds was never asked—but it was stated as the reason why two of the 14 options that were considered were discounted. The commissioners have acknowledged that this was an assumption and not based on what Leeds had said. In the pre-consultation business case for Leeds, start-up costs were reported as £2 million. That figure was not provided by Leeds, and is not representative of the accurate costs provided to the safe and sustainable review panel.

I congratulate my hon. Friend on securing the debate. A young constituent of mine, Libby Carstairs, was in a poorly state and spent more than six months in the Leeds heart unit. The beauty of her being in Leeds was that her parents, her grandparents, and sometimes even some of her friends, could come over to aid her recovery process. Also, her head teacher from Carr Green school had the privilege of being able to go there with cards from her friends. Does my hon. Friend agree that the value of that to young Libby’s recovery process far outweighs any monetary value?

I completely agree. When I worked at Martin house, we found that one of the big problems was the travelling distances—some people lived on the coast in Scarborough, for instance. It is very important that families are able to get to a centre quickly, because when a child is sick they want their mum and dad there—and we want that when we are a bit more than a child too. These facilities must be accessible, therefore.

I too congratulate my hon. Friend on securing this important debate for our region. Many of my constituents in York are very concerned about the potential closure, which would mean that they would go to Newcastle, so my hon. Friend makes a good point when he says this is about the whole region. Because of the lack of transport links on the eastern coast of our region, it could be greatly affected by the closure, and I do not think sufficient account has been taken of that.

Given the location of Leeds and the extent of the population all around it, it seems very odd that Leeds is not being considered.

I cannot think of a better colleague to lead this debate than my hon. Friend. Earlier today, I received an e-mail from Lois Brown, whose daughter Amelie was born with half a heart. She and her surgeons believe that her daughter would have died if Leeds had not been geographically close. Does my hon. Friend agree that the presence of LGI is the difference between life and death for many children in North Yorkshire, one of the most rural counties in England?

I absolutely agree. For hearts, time is of the essence. We need to be sure that people can get where they need to be quickly. I met my hon. Friend’s constituent the other day, and she spoke very powerfully and emotionally about what that meant in her case. I cannot imagine how families in these situations must feel. It is imperative that there is a facility close by.

Returning to the reviews, there are also inconsistencies in the application of some of the principles. So, for example, Liverpool and Birmingham are in all the options because of density of population and access for patients, but the same does not seem to apply to the Leeds case. That is odd and I do not know why the Liverpool and Birmingham cases are different.

Not enough emphasis has been given to co-location. The facility at Leeds general infirmary is wonderful now—I am given to understand that it is the second largest children’s service in the whole country—so taking away its heart unit and the expertise that has been gathered there over the years is strange. This is not just about children’s heart services, because the process has failed to seek views from adult congenital patients. The doctors who operate on the children also operate on the adults and it appears obvious that wherever the children’s heart services go, so, too, will the services for adults. Will they have had an opportunity to be consulted on what was going to happen to those services? This is about a much wider point than just children’s services.

My hon. Friend may be coming to this issue, but could he comment on the fact, which has been put forward every now and again, that Newcastle is favoured because its facility performs adult heart transplants? We recognise that surgeons have equal skills and just because somewhere does the adult heart transplants, it does not necessarily mean that we should move the children’s heart surgery to that department.

That is a very valid point and I shall shortly discuss something that was said the other day because it will comment on that.

I shall conclude now because I know that a couple of other Members have expressed an interest in speaking in this debate. I understand that this process is going to be difficult and that there is a need for a review. Severe problems have been experienced in parts of the country and it is right that a clinically led decision is made, but I want that decision to be made on the basis of facts that matter to local people and that are accurate. As I have mentioned, there are real problems with the assessment and the options that have been mentioned. Emotions will of course run high, because this is a very emotive subject. It is incredibly moving to listen to the families I have been speaking to since this matter first arose. They describe how their children and their babies were so close to death but how, thanks to the expertise that was provided at this location, which they were able to reach, their children are at least here and receiving the wonderful care that is provided, although they may be poorly.

There is a case to be made for the facility at Leeds in terms of geography, population and access. We like to tick boxes in this country and everything is ticked in this case for Leeds. I would be grateful if the process could be examined. Some powerful comments were made and cases were mentioned at a meeting held with parents and clinicians here on Tuesday. They are desperate for this unit to remain open. As someone said at that meeting, the doctors should move where the patients are; it should not be the other way round.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate and I thank hon. Members on both sides of the House who have signed early-day motion 1459, which expresses the views that we have just heard in his eloquent speech—he has really made the case.

I simply wish to say a couple of things, the first of which is that I have the honour to represent Leeds general infirmary and I had the opportunity, as the hon. Gentleman did, to visit the heart surgery unit about a month ago. I met the staff, who with care, compassion and enormous skill look after very sick children and their families, and I had a chance to talk to some of the families themselves. It is, as he said, a very stressful and difficult time for the families and children, particularly when the children reach an age at which they become aware of what they are about to go through and see other children who are sick—but they are in very capable and reassuring hands.

The case that has been made by all who are concerned that the unit at Leeds general infirmary should remain open is overwhelming. I wanted to put that directly to the Minister, and it is good to see him here. For all the reasons that have been set out, which I shall not repeat, there is a clear case for keeping Leeds open. Like the hon. Member for Pudsey, I do not for a second argue with the basis of the review and its origins. Clearly, for anyone who has responsibility for ensuring that children’s heart surgery is as safe as it possibly can be, not least the Minister, it is right, given what has happened in certain places, to look at the things that will tell us that we have that safety and security for patients. We from Leeds and the region are not campaigning for anyone else’s unit to close, and I share others’ disappointment that Leeds figures in only one of the options. We are simply saying that the Leeds unit should remain open and that that should happen alongside other decisions that the Minister and others have to take. That is a heavy responsibility to bear.

My final point concerns the meeting that took place earlier this week and I thank the hon. Member for Pudsey for giving us the opportunity to come together. I, too, listened to Amelie’s mother speak and the room was absolutely silent as she described what she had been through. I want to convey to the House the depth of feeling about and the strength of support for the Leeds unit. The determination of the thousands of parents whose children’s lives have been saved by the unit and of the millions of parents who hope that the unit will continue should their children face the same difficulties is very powerful. This debate, which is very timely, is part of the campaign we are waging because we are determined that the Leeds unit should remain open. The Minister will soon get a request to receive a delegation from the large number of Members who represent constituents who have benefited from the unit’s work and who hope to benefit in the years ahead; it is good to see so many of them here. We will not rest until the unit is declared safe for the future in the interests of the people whom we have the honour to serve.

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this important debate. It is a strong reflection of hon. Members’ commitment not only to their local health service but to the Leeds hospital and its facilities and services that so many are present. I am particularly pleased to see my hon. Friends the Members for Harrogate and Knaresborough (Andrew Jones), for Elmet and Rothwell (Alec Shelbrooke), for Skipton and Ripon (Julian Smith), for York Outer (Julian Sturdy) and for Calder Valley (Craig Whittaker). I am also pleased to have heard from the right hon. Member for Leeds Central (Hilary Benn) and to see the hon. Member for Scunthorpe (Nic Dakin) here. Their presence reinforces their commitment to their local health service and the facilities in the local hospital.

Let me take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in Leeds and across the country. They do a fantastic job for which we are all incredibly grateful.

As I know my hon. Friends and Opposition Members will appreciate, this is a complex and, understandably, highly emotive area, but it is worth reminding ourselves of the genesis of this review. For years, experts in the field, including professionals and national children’s charities, have urged the NHS to review services for children with congenital heart disease.

Although there has been no specific problem, concerns have been raised about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres. Experts agree that, with small centres, there are issues with the recruitment and retention of surgeons and that there is a risk that those who are recruited find themselves working in isolation in units that are not up to date with modern techniques and clinical practice. Smaller centres struggle to train and mentor junior surgeons, making such units less attractive to the surgeons of tomorrow.

The provision of children’s heart surgery has been a cause of concern since the Bristol inquiry in the late 1980s. Understandably, there has been considerable pressure from national parent groups to ensure that children receive the best treatment. The Monro report in 2003 set out standards of care and pointed to the need for reconfiguration to concentrate expertise. That need has become ever-more pressing with the increasing complexity of treatment.

In the light of clinical concern in June 2006, Roger Boyle, the national clinical director for heart disease and stroke, and Sheila Shribman, the national clinical director for children, young people and maternity, chaired a consensus workshop of service providers, specialised service commissioners and relevant parent groups. The unanimous view was that there should be fewer, larger centres of excellence. The workshop concluded that the current service configuration was not sustainable and that a long-term national view of how services might be reorganised should be developed.

In 2008, the NHS medical director, Sir Bruce Keogh —a heart surgeon—asked the national specialised commissioning group to explore how the reconfiguration of children’s heart surgery services in England could improve the sustainability of the current service and lead to better clinical outcomes for children. The national review, known as “Safe and Sustainable”, aims to ensure that children’s heart services deliver the highest standard of care regardless of where patients live or which hospital provides the care.

I must emphasise that the review is clinically-led and that both it and the case for change are supported by parent and patient groups and by clinicians working in the service and their professional associations, including the Children’s Heart Federation, the British Heart Foundation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain.

Does the Minister agree that, as well as the importance of the clinical need, distance is vital and that the points made in the debate for this most rural and sparsely populated area of our country must be taken into account in the decision?

Distance is one of a number of factors that, of course, will be considered by those people who are involved in the consultation process, although I advise my hon. Friend that some of the organisations involved in such medicine have certainly told me—I have met some of them personally—that many parents think not so much about the distance that must be travelled as about getting the best treatment for their children. They are prepared to travel further to secure that fine treatment for their children than we may think from what our constituents who want to have district general hospital treatments tell us. The question of distance must be put into perspective, and it is not an overriding factor that secures any decision one way or another solely on that basis.

I recognise what the Minister says about distance. Parents want good outcomes for their children—that is why parents in Scunthorpe travel to Leeds—but distance can have an impact on clinical outcomes. Certainly, when the weather was terribly bad around Christmas time, the distance to travel to get good clinical outcomes made a difference. Distance and clinical outcomes are related.

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.

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?

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.

I understand that, before the consultation document came out, one member of the steering committee gave her personal view of which unit should stay open. Does the Minister not agree that that might give some cause for concern?

My hon. Friend is pushing me and tempting me, but I shall be up front and straightforward: I am unaware of that situation, and it would be unwise of me to start commenting on something that I do not know the background to or—if the conversation was had or the statement made—the circumstances of it. I hope he will forgive me if I do not go down that path.

I thank the Minister for giving way, because I know that he wants to make progress.

As part of the process, may I ask that the support facilities for families will be considered, because, at a time when one is dealing with sick children, families are under very great pressure? There is a new facility at LGI, Eckersley house, which has been in existence for a while, but it has moved to a new location and opened only last year. It provides 22 rooms for families to stay in while visiting sick children, it is a key part of the broader provision of support that is necessary and I know that it will be a very welcome development for families.

I am very grateful to my hon. Friend for mentioning that facility, which I have no doubt is not only welcome but extremely helpful to families, particularly at a very difficult time in their lives. Again, it would be inappropriate for a Minister, in a top-down way, to start decreeing what should or should not happen; I believe that decisions about such services and facilities must be taken locally. I am sure, however, that the relevant authorities will not only learn of my hon. Friend’s contribution, but no doubt benefit from his expertise in lobbying them to ensure that the service continues.

Some of us were rather caught short, because we did not realise that the debate would start so early. For someone who lives in Huddersfield with a child who needs specialist care, the common sense consideration seems to be accessibility. Why do we not get more specialists in Leeds, so that we can access the vast population in our parts of Yorkshire and Lancashire?

The hon. Gentleman is a very experienced parliamentarian, and I do not say this in any rude way, but he was not present when his right hon. Friend the Member for Leeds Central spoke. That is not a criticism, but I shall make to the hon. Gentleman the same point that I made to his right hon. Friend: the consultation process and review is being carried out not by Ministers and politicians, but by the JCPCT. As we are engaged in the consultation process, it would be inappropriate and wrong of me to pontificate from this Dispatch Box on the merits or demerits of one case or another. I hope that the hon. Gentleman will accept that that is meant to be a helpful reply, even if it is not the answer that he was seeking. [Interruption.] Fair enough. I am not criticising; I just want him to understand the position that I am in, because I do not want—[Interruption.]

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.

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.

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.

I knew that it was probably a slight mistake to be quite so helpful. I will first take my hon. Friend’s intervention and then the hon. Gentleman’s.

I thank the Minister for giving way yet again. Given that PCTs are in the last phase of their lives, does he agree that it is concerning that PCTs, whose eyes may not totally be on the ball, are making this critical decision?

I can see where my hon. Friend is coming from and I appreciate that he may have concerns. I hope that I can give him the reassurance that he seeks. I do not think that PCTs are in a situation where they have not got their eyes completely on the ball. First, from all the evidence that I see, day in, day out, of the work of PCTs up and down the country, they continue to be highly professional and to do a first-class job. Secondly, the date when PCTs will cease to exist because of the modernisation of the NHS is not so close that they will not be able to fulfil their functions properly. I have every confidence in the JCPCT doing a first-class job of carrying out the consultation and reaching its conclusions in a highly professional and acceptable way. I hope that reassures my hon. Friend.

I understand entirely where the Minister is coming from and that he must leave the matter to those with expertise. We had a similar situation in relation to maternity services in Huddersfield and the number of cases there had to be for people to be fully trained up. At the end of the day, it will always be a political decision. What if all the experts said that there could be only one unit—in London or somewhere else? Surely that would be politically unacceptable to the Minister and he would have to intervene.

The hon. Gentleman is trying to tempt me to go places where I should not stray. I believe that the premise of his intervention is incorrect, and that the situation he describes will not happen, because the outcome will not be the recommendation of just one site in the whole of England.

I hope my remarks over the past few minutes have reassured the hon. Gentleman that in the lead-up to the consultation process, the drawing up of the final report and the options has been carried out by people who are very familiar with this specialised and sensitive area of medical care and with clinicians. They have come up with recommendations in which I have confidence, to be considered and consulted on. What we have to do now is use the consultation process so that everyone who has an interest, whether they are clinically qualified people in the NHS or members of the public, patients or Members of Parliament, can get across their views and arguments. In that way, the right decisions can be made at the end of the process, within the framework that I have outlined in the debate.

I reinforce the point that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of children’s heart services. I can give the assurance that it is a genuinely open process and the outcomes are not predetermined. The options have been arrived at by a thorough and comprehensive process that has the support and endorsement of the professional associations and national children’s charities. I thank all those involved for their time and their input into the review so far. Children deserve the best possible care, and we are determined to provide it.

Finally, I make the plea again that in this crucial matter, we have to get the finest quality care for a vulnerable group of patients—very young children. We have to ensure the best outcomes because, frankly, that is all that matters to parents when their children are suffering. I urge everyone who has an interest, a view and a contribution to make to take part in the consultation and help ensure that the right decisions are taken to achieve the aims and ambitions on which we are all united.

Question put and agreed to.

House adjourned.