I rise to take the opportunity to discuss the Safe and Sustainable review into children’s heart surgery in England and Wales and the concerns about the process that led to the closure of the excellent Leeds unit. The decision was taken on 4 July. Families from up and down the country were asked to be present to give their views and the joint committee of primary care trusts—the JCPCT—deliberated in public all day. The decision was due, but it was delayed, delayed and delayed again, until it was finally announced that Leeds would close. What left a particularly nasty taste in the mouth was that it was abundantly clear when documentation was produced that the decision had already been taken and that that day, including asking the families of children who had needed to use the surgery unit, was a charade. I am afraid that that was all too typical of the way in which this process has been handled.
There are serious questions about how the JCPCT reached that decision. It ignored clear evidence and, I am afraid to say, there has been a clear and obvious bias all along towards Newcastle. Leslie Hamilton was on the committee despite being based at Newcastle, but there was no one from Leeds. No one in Leeds or, I am sure, up and down the country was at all surprised at the decision, because we expected it. We could see that the JCPCT was simply not considering the evidence.
In the brief time I have available I shall raise a few points and I know that my hon. Friend the Member for Pudsey (Stuart Andrew) will raise a few more. I am sure that other hon. Members will also seek to do so and I shall look forward to having a full debate in the autumn, when we can place on the record the myriad serious concerns on this point.
First, 600,000 people signed a petition in support of the retention of the unit at Leeds, yet that was counted as only one response by the committee. At the same time, 22,000 text messages from unknown sources supporting Birmingham were counted as 22,000 submissions. So, how can the JCPCT say that it does not “count heads” when it is ignoring 600,000 people, counting them as one submission, yet counting 22,000 text messages as 22,000 separate responses?
Why has the JCPCT watered down expert advice on the gold standard of collocation? It has adopted a watered-down version on the advice of fewer than 10 clinicians in the steering group and on the recommendation of Sir Ian Kennedy, who is not a clinician. How can the panel justify following that advice rather than that of the country’s most respected gatherings of experts in this field? How can it be right, if this closure happens in Leeds, for the Yorkshire and Humber region to go from enjoying the highest standards of collocation in the country to having the lowest?
The Safe and Sustainable model of children’s heart surgery is also dependent on networks of care, but whereas the Leeds network was recognised as “excellent”, Newcastle’s was regarded as “poor”. Why is the Yorkshire and Humber moving from a centre that delivers an excellent network to one with a record of delivering a poor one?
The JCPCT accepted the advice that 90% of doctors in the relevant areas of option B would be happy to refer to Newcastle, yet the referring doctors in Yorkshire and Humber have never been asked about that. That is simply outrageous.
I am aware that there has been a referral from the joint overview and scrutiny committee in Yorkshire, which we fully support and insist is properly investigated. We must also consider the very worrying situation in Glasgow. The Yorkhill unit is currently failing and a separate report by Sir Ian Kennedy stated:
“The panel had significant concerns about important aspects of the service in the surgical unit and in the broader congenital heart network. Of most concern was a lack of leadership and coherent team working. Also of concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressed.”
That has not been part of the review, however, and extraordinarily the Scottish Government have now decided that three surgeons performing 300 operations is safe in Scotland. However, that is not considered to be safe in Yorkshire. That is simply unacceptable. Today we are saying that we have no confidence in the review and that we want the whole process to be reconsidered.
In south-west London, the NHS has just proposed to close the A and E, maternity unit and various other services at my local hospital, St Helier. It will take 200,000 people longer to get to hospital in an emergency. On its website, outlining why it is doing this, NHS South West London states that providers
“will have to deliver £370 million savings each year…a reduction of around 24% in their costs.”
Yet thanks to birth rates, an ageing population and poor health due to poverty, A and E visits will go up 20% in five years and births will increase by 10%. The area’s four hospitals are overcrowded now, so let us try cramming the same number of patients into just three.
What is worse is that there is no extra funding for the hospitals that remain. In no way do I support the hospital closures in north London, but at least that area gets an extra £138 million for “out of hospital” care to cope with the closures. Down in south-west London, we will get nothing. If St Helier loses its A and E, visits to the remaining three hospitals will rise by a third. Many will have to be admitted, but, with no extra funding, where can they go? Will they go on to the corridors, as in the 1990s?
It is claimed that 50% of A and E patients will go to GPs or community services instead, but even the report by the watchdog, the national clinical advisory team, does not believe that they could cope. That is a key paper and no cuts should take place without the public knowing what the watchdog thinks, so it should be published immediately. NCAT is right to be sceptical about whether GPs can halve the numbers going to A and E. Clinical commissioning obviously makes that very attractive for GPs, but for most people in my constituency it is easier to go to a walk-in centre or A and E than to a GP, so A and E visits have continued to rise year after year. The fact that GPs, who are making all the financial decisions, will get more funding if there are fewer A and E visits, does not mean that people will stop going. Apparently, some GPs now realise that those plans are looking very dodgy. A poll of Sutton’s GPs has shown a majority against the closure and a similar poll is taking place of Merton’s GPs that will, I am sure, show the same.
It is not just St Helier’s A and E that is under threat—so is its maternity unit. However, of the four hospitals, St Helier has the only maternity unit that meets clinical standards. If we lose St Helier, the other three hospitals will need to deliver a third more babies than they do now. It is widely accepted that maternity units delivering more than 6,000 births a year are a bad thing. It is far better, and far safer, to have slightly smaller units with good midwife cover, but not in south-west London, it seems.
We will lose our children’s unit and other services, such as intensive care. The “Better Services Better Value” review states that, to compensate, GPs will force patients from all around south-west London to go to St Helier for minor, planned treatments, but who would want an operation, even a routine one, in a hospital as depleted as St Helier? What is more, making people in St Helier drive across the suburbs for A and E and maternity and making people drive to St Helier for routine operations will add literally millions of miles of journeys to our already congested roads. No, the impact of that is not considered.
The other obvious questions have not been asked. Why would a patient from Kingston want to drive the best part of an hour to St Helier for a treatment they can currently get in Kingston? The other three hospitals do not like the idea either, as they cannot afford to lose the income from those planned treatments.
These plans are all over the place; they are a total shambles. Next Thursday, NHS South West London was due to rubber-stamp St Helier’s closures. It booked a big theatre in Croydon in readiness, but now it has put the decision off. Good, but this is obviously not the end. St Helier has been under threat before, but now it is under threat again from a combination of cuts and GP commissioning. The demands on our four hospitals are growing, not shrinking. I hope the Minister will reassure me, and my constituents, that that disaster will not happen on his watch.
I, too, rise to speak about the Safe and Sustainable review of children’s heart surgery. The joint committee of primary care trusts—the decision-making body comprising local commissioners—was tasked with considering the pattern of children’s heart surgery services. On 4 July, it announced its decisions, which included the news that Leeds general infirmary will not provide children’s heart surgery in future.
The two-hour radius around the Leeds heart surgery unit reaches 14.5 million people. Including check-up appointments, the unit sees 10,000 children annually and performs about 350 operations.
I acknowledge that the decision was independent of the Government. Local council overview and scrutiny committees are free to refer decisions to the Secretary of State, via the independent panel. I heard this morning that our OSC has just done so; I welcome that move. Our Yorkshire body was due to meet on 24 July. Now that the committee has referred the decision to the Health Secretary, I hope he will revisit it based on the four tests stipulated for the redesign of services.
If my hon. Friend is correct—and I am sure he is—in saying that his local authority OSC has referred the matter to my right hon. Friend the Secretary of State, the process is that the OSC explains why it does not agree with the decision and asks my right hon. Friend to refer it to the independent reconfiguration panel for consideration. The panel will then respond to my right hon. Friend and state whether it thinks the decision is right or wrong.
I thank the Minister. I said earlier that the decision would go to the Secretary of State via the independent panel. I look forward to its going through that process.
The first test for redesigning services is that there should be clear clinical benefit. The health impact assessment was that option G—to keep Leeds open—had fewer negative impacts than the chosen option. The second test is clinician support. There is no evidence that the decision has the support of clinicians; in fact, most have given their support to the Leeds unit.
The third test involves the views of the public. Surely nothing can be clearer than the views of the 600,000 people who signed the petition to keep the Leeds unit open, and the admirable cross-party support for the campaign. The fourth and final test is that there should be support for patient choice. A survey in west and south Yorkshire clearly shows that patients would not travel up to Newcastle.
Many constituents with experience of the Leeds unit have been in touch since the announcement on 4 July.
The evidence clearly shows that Newcastle will not hit the magic number of 400, making the point of the process farcical. As we now know that Glasgow will continue, but will perform only 300 operations a year, there will be two underperforming units, and we will have lost Leeds, which could easily reach those numbers. Does that not make the whole thing a farce?
My hon. Friend makes a good point. There is an assumption that all the patients who have been going to the Leeds unit will automatically migrate to Newcastle. That is a big flaw in the assessment, and I look forward to further exploration of that matter.
Constituents who have been in touch with me include teenager Seb, who recently did work experience with me. He had three heart operations and a pacemaker fitted at Leeds. He wants the Yorkshire unit to stay open; he stresses the fact that there are good transport links to the Leeds unit.
Paul told me about his 10-year-old stepson who suffered a cardiac arrest last August. His stepson had a defibrillator fitted internally, which he will have for the rest of his life. Paul said the Leeds location was key for their family.
Ruth told me about her six-month-old daughter Eleanor who was born with a heart defect caused by Down’s syndrome. Ruth fears for the emotional and financial stress families will be put under by the longer travelling distances, as parents try to hold down their jobs, care for other children and fulfil other responsibilities.
I was also contacted by the grandparents and, separately, the parents and siblings of four-year-old Lily Rose, who had surgery in the Yorkshire unit. They asked how a four-year-old was expected to cope at such a traumatic time without being able to see her mummy each day. The emotional impact on the rest of the family would be enormous. They stressed that distance from the centre is extremely important. They reiterated the population figures: 14.5 million people are within two hours of Leeds, whereas only 3 million are within two hours of Newcastle.
Those cases are real; the families were in touch with me over the past two weeks. In the past year, I have spoken in the Chamber about George Sutcliffe, Ben Pogson and Joel Bearder who, with their families, have been campaigning locally for the Leeds unit to stay open. I compliment them and all the families who have worked so hard on the campaign, and will continue to do so.
It is clear that the plans do not meet the four tests, which are factual; they are not about emotion. I look forward to the flawed decision eventually being referred by the independent panel to the Secretary of State so that the tests can be looked at again. I firmly believe the JCPCT decision clearly fails all the four tests for redesigning services, and I look forward to its being reconsidered.
On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.
Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.
The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond Street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.
Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:
“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”
Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.
Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.
The hon. Gentleman makes a passionate case for the Royal Brompton unit. The chief executive of Little Hearts Matter says that, in the Glasgow case, a unit that does 300 operations can be made perfectly safe by other means, without closing units. Does the hon. Gentleman share my frustration at the fact that in the Royal Brompton, Leeds and other places, those involved are not prepared to do that? It does not make sense.
I am grateful for that intervention, because, in case my comments are seen as special pleading from the hospital, I was just coming on to mention some independent recommendations and sources that support the argument that, if there is no opportunity for research, and if experts—in Leeds, as well as the Royal Brompton—are prevented from working to the level of their abilities, many are likely to seek work elsewhere, possibly outside the UK.
Dr Neil Gibson, a consultant in paediatric respiratory medicine at Glasgow’s royal hospital for sick children, wrote to the chair of the review as follows:
“The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record…There is a significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.”
Professor J. Stuart Elborn, president of the European Cystic Fibrosis Society, wrote that
“high quality research is a key determinant of the ability of a centre such as the Royal Brompton to retain and recruit the world leading clinical and academic staff on whom its respiratory services depend. Adverse impact upon the ability of the clinical staff to carry out cutting-edge research will undermine the sustainability of the clinical services, to the detriment of its patients.”
Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign, and the Primary Ciliary Dyskinesia Family Support Group wrote a joint letter to the chair of the committee, saying:
“We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future.”
Patients and staff at Royal Brompton are understandably deeply distressed at the prospect of losing their high-performing children’s heart unit, soon to be followed by their specialist respiratory services. They do not understand how such a decision can be made by bureaucrats who have never visited the hospital and have no specialist knowledge of the care provided there. They have written to their MPs and to the Secretary of State. Indeed, one resourceful mother brought the matter to the attention of the Prime Minister in Downing street last Thursday.
The Secretary of State for Health assures the parents of these seriously poorly children, and the dedicated teams that treat them, that this is a matter not for him, but for the NHS. For the sake of the thousands of children whose care will be damaged by the decision of Sir Neil McKay’s committee, the sake of the research programmes that will be destroyed, and the sake of common sense, I hope that the Minister of State will realise that the time has come for him to meet clinicians from the Royal Brompton and at least hear what they have to say. Perhaps he will be able to persuade them that destroying NHS services and research programmes that are viewed by international peers as among the best in the world is a good idea. I wish him luck in doing so.
I am very fortunate never to have been in a situation where I have continuously required alcohol to blot out misery or pain. I am fortunate enough to have never been so drunk in a public place that my safety or personal dignity was compromised. In fact, I abhor drunkenness, public or otherwise. It upsets and frightens me that some people become so inebriated that they are incapable of standing, speaking or securing their safety.
Although I do go to the pub, like hundreds of thousands of professional women up and down the country, I do most of my drinking at home. I probably do not think I am doing anything wrong because, every day, women go home after work and pour themselves a large glass of wine—and then another. How can it be wrong? I do not get drunk, throw up in the street, or wake up with a hangover. Yet could that be why alcohol consumption among women is becoming a problem, albeit one that may not present itself for decades?
Alcohol consumption by women has been rising steadily since the 1960s. Since 2002 alone, the number of alcohol-related admissions accounted for by women has more than doubled, from just below 200,000 to more than 400,000 in 2010. Although I accept that there is some debate about those sets of figures, the trend is undeniably upward, not downward. Alcohol consumption by women remains at a historic high, but it is interesting to note that it is falling at a faster rate among 16 to 24-year-olds. However, a significant number of middle-aged and older women, usually on higher incomes, prefer to drink at home to dangerous levels. It is the silent majority of drinkers we should be looking to prevent from becoming risky, harmed or dependent drinkers.
I agree entirely. We should remember that a significant number of people in this country do not drink at all; it is those who drink to excessive levels whom we need to be concerned about.
Since the 1960s, many more women have entered the work force. Some have put off raising families and the associated responsibilities in favour of pursuing their career. As a result, they have much more money and time to spend drinking. That is statistically demonstrated by the fact that women in managerial or professional roles admit to drinking almost double the amount drunk by women on lower incomes.
Where the drinking takes place, and not just the quantity, is a cause for concern. While men still account for the majority of regular pub goers, women are more likely to drink at home, drinking cheaper supermarket wine that is aggressively marketed and probably bought in bulk.
Does the hon. Lady agree that providing calorific information, as opposed to just the unit content of alcohol, on a bottle might have a significant impact on a large number of women who care a lot about the calories that they consume? If that was set out on alcohol packaging, it might help to alleviate the problems that she mentions.
The hon. Gentleman makes a good point. Labelling of alcohol has improved significantly over the past few years, particularly in relation to pregnant women.
In many ways, drinking at home poses a real issue. It is difficult to assess the true extent of the problem of home drinking because the only data we have to go on are results from surveys, and many respondents are likely to under-report their consumption. However, recent studies have shown a clear link between harm and home drinking. An overwhelming 93% of recent interviewees who had all suffered alcohol-related harms bought the majority of their alcohol from off-licences and supermarkets. With alcohol now part of most people’s weekly shop, and women less likely to buy alcohol in pubs, it is no surprise that the impact of home drinking on a person’s health is likely to be more pronounced among women. Little stigma attaches to home drinking, and it is perhaps only later in life that women realise that there was any drawback to what they have been doing. Liver damage is an obvious related condition, but breast cancer and dementia are also often cited as conditions with a link to alcohol.
Given that what somebody does in their own home is a matter for them, what role is there for the Government in tackling the issue? The introduction of a minimum unit price for alcohol is a welcome development and will tackle many alcohol-related problems, but I doubt very much that it will tackle the high level of drinking among well-off and professional women. It may dissuade somebody who is doing the weekly shop from taking advantage of deep discounting, and prevent the pre-loading that goes on among some younger drinkers, but more needs to be done on education and awareness.
For professional women drinking at home who do not come into contact with the traditional services that offer alcohol-based education and interventions, the workplace could prove particularly important. Alcohol Concern is championing the need for businesses to take a responsible approach to alcohol, calling for the inclusion of an alcohol policy in the corporate governance code. In principle, workplace interventions should definitely be encouraged, and I hope that the Government will support that campaign.
Undoubtedly, home drinking is extremely difficult to quantify. The only indication we have of the scale of the harm done is the level of alcohol-related admissions. It is therefore a concern that the official measurements used to calculate alcohol-related hospital admissions could be altered in the near future to reflect only those admissions where alcohol is a primary diagnosis. That could potentially exclude the reporting of conditions for which excessive alcohol consumption were partly responsible, such as a broken leg as a result of falling at home, or even domestic violence. I urge the Government to reconsider carefully the changes to the measurements. If they do not, we may never truly understand the scale of the problem, and the idea that we could achieve the targets set out by the Prime Minister for reducing alcohol dependency could be simply farcical.
A vast number of women, especially in professional roles, are steadily drinking at home to the detriment of their health. That is an issue on which it is difficult to provide direct intervention, but not one that we should simply ignore. I hope that this Government, who are responsibly trying to tackle alcohol misuse, will recognise the problem and do whatever they can to ensure that it is not simply left to fester behind the closed doors of homes up and down the country.
Like many other Members, I should like to say a few words about the outcome of the Safe and Sustainable review. Children’s heart surgery services in Glenfield, in the constituency of my hon. Friend the Member for Leicester West (Liz Kendall), have been earmarked for closure—a decision that came as shattering news when we heard it the other week to many of the staff who work there and many families of patients who have been treated there.
Many of my constituents have got in touch with me, and I have also been contacted by people across Leicester and the country. I do not have time to go through everything that they said, but Stacey Whiteley from Lincoln has contacted me. People have contacted me from Corby, Coalville and Northampton to express deep concern and opposition to the decision. Many of them said that there were a number of questions that they wanted answered and, as I think that they are legitimate concerns, I want to put them on the record.
My constituents have asked me, for example, why the extra options I to L were not presented for public consultation. Other constituents have pointed out that option A was the most popular, but was apparently ignored. Some constituents have questioned the impartiality of some advisers to the panel and others have pointed out that, in the consultation document, option A was described as being consistently the highest scoring option. Why was there a U-turn and option B chosen? It is right that those decisions should be made by clinicians, but these are legitimate questions from people concerned about the decision.
The hon. Gentleman makes an important point, but the decision was made not by clinicians but by commissioners, who have left the eastern side of England between Newcastle and England without a heart unit. Many of my constituents would have gone to Leicester in preference to Newcastle. Now they will probably travel to London or Liverpool.
Indeed. Many of the hon. Gentleman’s constituents would have been welcome in Leicester. He is quite right: where do our constituents in the east of the country, between Newcastle and London, go? That is something else that many of my constituents have raised with me.
I wish to concentrate on the biggest deficiency of the decision, which is the impact on our world-class ECMO—extracorporeal membrane oxygenation—service. On Friday, the Secretary of State announced that he would accept the recommendation to shift our ECMO service from Leicester to Birmingham. In Leicester, we have had a brilliant, world-renowned ECMO service for 20 years.
I am grateful to my hon. Friend for accepting my intervention, as I cannot speak in the debate because I am a Front-Bench spokesperson on health. Is he aware of the international evidence that shows that Glenfield’s ECMO survival rates for children are 50% to 75% higher than other centres? Those very good survival rates, and the benefits that they bring for children, must be taken into consideration as part of the review.
My hon. Friend is right, and she makes the point with her usual eloquence and insight. I pay tribute to the work that she has done and, indeed, the work of other Leicestershire Members—I see that the hon. Member for Loughborough (Nicky Morgan) is in the Chamber—on the ECMO service. I thank the Minister for agreeing to meet a delegation of east midlands MPs, as we had a useful discussion.
Giles Peek, a consultant paediatric heart surgeon, said last year of the ECMO service:
“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are always full and often take children from other hospitals…Our role at Glenfield as a national reference centre for this treatment is important and underestimated.”
I fear that Giles Peek’s concerns have come true and that our ECMO service has been underestimated.
I was grateful that the Minister said in the meeting that the Secretary of State’s decision was based on the Agnes review, but there are other ECMO experts who disagree with that review, so I hope that he will consider publishing the Agnes report. In the few minutes I have left, I shall run through the points that various ECMO experts have made. For example, Glenfield has a world-class facility with more than 20 years’ worth of service. There are deep concerns that by uprooting it from Leicester to Birmingham expertise will be lost along the way. Mr Kenneth Palmer, an ECMO expert, gave a stark warning on Radio Leicester today that, as a result of shifting the children’s ECMO service from Leicester to Birmingham, lives would be lost, saying:
“They could never have the same survival rate in another unit if you move it like this. Leicester has one of the highest survival rates in the world, 10%-20% higher than the normal survival rate in the world. To come up to the same skill it will take 5 years at least.”
He has been joined by other experts who have warned about the impact of shifting the unit from Leicester. Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, when asked whether he agreed that lives would be lost, said:
“I do agree with that unfortunately. I think the risk is great that by attempting to move and start over that you’d really start the learning curve all over again and the improved outcomes take time and experience to develop, and so by effect starting over on the learning curve you certainly would potentially put lives at stake and it could be very significant.”
I accept that the Minister takes advice from experts, but given that there is one set of experts making one argument, presumably he receives advice from a different set. If he published his evidence, those of us who are laymen on health policy can try to make our own judgments as those experts scrutinise one another’s work.
Concerns have been raised about the Birmingham facility and whether it can deal with the new ECMO service. Dr Andrew Coe, a paediatrician from Coventry, said on Radio Leicester this morning that he was
“not convinced that Birmingham will cope with increased demand following closure”
of Glenfield. It was suggested to me that if the 80 ECMO nurses at Leicester are not prepared to leave Glenfield, it will take up to eight years for nurses in Birmingham to be trained to the appropriate level of expertise.
I conclude by mentioning the family from South Cambridgeshire, which the Secretary of State represents, who appeared on Radio Leicester this morning. They said clearly and movingly that the service they received for their little girl was the best they could receive and went beyond what staff needed to do. I hope that the Minister will give us guidance on what is next for Leicester’s ECMO service. I hope that he will consider publishing his evidence, and that we can have some sort of review of, or at least look again at, the shift of Leicester’s ECMO service to Birmingham.
I wish to raise the issue of neuroblastoma. I do so as someone who is proud of this Government’s record on the health service and who strongly supports their introduction of the cancer drugs fund.
Neuroblastoma is an aggressive childhood cancer affecting about 100 new children in the UK each year. It is the most common cancer diagnosed in infancy and is responsible for 15% of cancer deaths in children. There are very few treatments available in the United Kingdom for children with high-risk neuroblastoma, particularly those who have relapsed, and they have to travel abroad for treatment, generally to Germany or the USA.
I had never heard of neuroblastoma before my constituent, Mr John Macglashan of Dunstable, came to see me in March this year. His two-year-old daughter Lilly has stage 4 neuroblastoma. The Neuroblastoma Alliance, along with the people of Dunstable and the surrounding area with the help of The Dunstable Gazette, have helped to raise funds to send Lilly for treatment in America. The whole family is going through an enormous ordeal, and I want to relay their experiences to the House, and make four suggestions to the Minister as to how the UK can improve the provision of treatment for children with neuroblastoma.
First, I know that the Government want high-quality treatment for children with neuroblastoma to be available in the United Kingdom, and I strongly support that. To that end, the Government are participating in a European collaborative research network on neuroblastoma through the Société Internationale d’Oncologie Pédiatrique en Europe. That European trial does not appear to adhere to UK ethical standards of offering the best treatment available as a baseline for all children meeting the eligibility criteria. I urge the Minister to make sure that the best treatment available is offered as a baseline for all children in the United Kingdom.
My second concern is that clinical trials in the UK are taking far too long to begin. In March 2010, the Department of Health agreed to commence a new trial to give monoclonal antibody therapy to all children who might benefit from it, but according to the Neuroblastoma Alliance, that has not yet begun. The Government should ensure that this trial commences as quickly as possible.
Thirdly, it is important that the Government ensure that there is a standard procedure for allocating funds for treatment abroad across all primary care trust areas. That is particularly important as there are currently no NICE guidelines on the subject, which remains important while there is no viable treatment available in the UK. My constituent Mr Macglashan has taken his daughter Lilly to the Memorial Sloan-Kettering cancer centre in New York at considerable personal expense and with huge funds raised by the Neuroblastoma Alliance, a charity that campaigns for children with the condition. Mr Macglashan tells me that in the same hospital there are children from Norway, France, Spain, Italy and Greece, all of whom are being funded by their national health services while his family has had to rely on charity.
Fourthly, it is important that the best treatment options from abroad, whether from Germany or the USA, should be examined and, where the clinical evidence supports the case, introduced into the United Kingdom as quickly as possible. At the moment, there are too few options available for high-risk neuroblastoma children who fail to achieve a lasting remission after front-line treatment. In the UK, parents see a system that gives up on their children too soon while there should still be hope. Much higher numbers of children are surviving for much longer with the American treatment, and some are achieving permanent remission following treatment at the Memorial Sloan-Kettering cancer centre in New York. We need to make sure that that level of expertise is available here in the United Kingdom.
This is not simply a call for even greater NHS spending than the Government are currently budgeting for, as the costs of prolonged chemotherapy and radiotherapy in the UK are not cheap and have been shown to have less success than the treatments provided in America. It appears that the UK is not spending its health budget as effectively as it could in this regard, and I ask the Government to look again at the issue. The NHS already sends children suffering from cancer for treatment in America—for proton radiation treatment, for example—so no precedent would be set by sending more children for treatment in America and Germany.
Finally, I ask the Government to look at the training of consultants in neuroblastoma, as there are too few who specialise in this area.
It is a pleasure to speak in this debate and particularly to follow the remarks of the hon. Member for Leicester South (Jonathan Ashworth) about children’s heart surgery at Glenfield hospital in Leicester. In view of the time limit, I will not repeat the issues to do with the Safe and Sustainable review, because those have been well rehearsed by other Members.
It is no great surprise that all Members, as well as all patients, all staff, all parents and all families, want the best services when dealing with children’s heart surgery. We are talking about very sick young babies and children, and there is no doubt that high-quality services are wanted across the country. At the same time, we have to recognise that in the 21st-century national health service there are bound to be reconfigurations. The reconfiguration that has been worked on by the Safe and Sustainable review arises out of what happened in Bristol, and there is a very good reason for what it proposes. As we have heard, there are some serious questions still to be answered about the process and the way in which decisions have been made.
In the debate in this Chamber in June 2011, I talked about the ECMO—extracorporeal membrane oxygenation —service offered in Leicester, which the hon. Member for Leicester South discussed. It is a world-class, excellent service, and the question is what will happen to it if the children’s heart surgery unit is moved from Leicester to Birmingham. Like the hon. Gentleman, I thank the Minister very much for meeting a delegation of east midlands MPs this afternoon to talk about this. ECMO is a nationally commissioned service and the Secretary of State is therefore required to sign off the move. I understand that he accepted the recommendations of the panel last Friday.
Those of us who are most interested in this and have been listening to constituents and to consultants and staff at the Glenfield unit have a number of questions to raise with the Minister. I would like to be sure of three things before I can be happy with how the decision has been taken. First, before the Secretary of State signed off the move, was he aware of the misgivings of experts that have been described by the hon. Member for Leicester South? Letters are still arriving from international experts. Indeed, since I have been sitting in the debate I have seen a letter that has arrived from the medical director of the Children’s Hospital of Philadelphia. I should like to read out a couple of quotes. The first is from Stephen Conrad, who is chairman of the steering committee of the Extracorporeal Life Support Organisation and who says that
“moving an ECMO program is non-trivial and amounts to much more than moving equipment and some key personnel. Excellent outcomes that are now characteristic of the Leicester group, whose work was instrumental in the worldwide adoption of pediatric and adult ECMO, would not be maintained following such a move.”
I am grateful to the hon. Lady for her work on, and support for, this important issue. Does she agree that this is not simply a matter of moving the machines but also about the expertise and skills of the staff, which would not be easy to move? Leading international experts on ECMO say that it could take between five and 20 years for the excellent level of service that is available in Glenfield to be made available anywhere else in the country.
I am grateful to the hon. Lady; she is absolutely right. The hon. Member for Leicester South referred to Kenneth Palmer, who was retained to give his expert advice to the Joint Committee of Primary Care Trusts on the move. Since the decision was made on 4 July, he has said:
“You will take over 20 years of experience from one of the world’s absolute best ECMO units and throw it away and then to rebuild it in another place and probably it will take at least 5 years to have some kind of quality and probably 20 years to come back to top quality, if it’s ever possible.”
As the hon. Lady said, it is about the staff. Of course the machinery is important, but what has been built up in Leicester, and what it is most renowned for, is the expertise of its consultants, nursing staff, and all the other staff. That is what people particularly rely on. In addition, Leicester has the only paediatric mobile ECMO unit, which is often called out to fly by helicopter to other parts of the country to retrieve patients and take them back to Leicester. I hope that the Secretary of State and the JCPCT were aware of that when they made their decision.
My constituent, Mrs Edith Felstead, who wrote to me and talked about the risk of moving the service, says that survival rates at Glenfield are 20% better than in the rest of the world. The point that I made last year and still want to make is that we have an excellent, internationally renowned service, and if we move it, we must be sure that we are doing so to obtain better outcomes. Will the Minister tell me what advice was given to the JCPCT about the likely outcomes if the move were made?
The rather hefty tome that was published to help the JCPCT to make its decision on 4 July, refers to the secretariat being able to provide “reasonable assurance” that paediatric respiratory ECMO could be transferred safely to Birmingham. I am concerned about that phrase. What assurances have been given? In particular, if the move goes ahead and has to be implemented, what will happen if it then becomes clear in the course of preparing for the move that the service cannot be safely moved and we need to undo some of what has happened as a result of the review?
As the hon. Member for Leicester South said, two narrow questions could be independently reviewed in relation to the Leicester move. I very much hope that following the meeting that we have just had and this debate, the Minister will agree to such a review. I would like to know what advice was available to the Secretary of State and to the JCPCT and the Advisory Group for National Specialised Services before they made their decision.
I am grateful for the opportunity to speak in this debate, Mr Deputy Speaker. May I offer you my congratulations on the honorary degree that you received yesterday from Swansea university?
I recognise that I may repeat many of the things that have been said, but this is such an important issue for constituents in Yorkshire and Lincolnshire that I make no apology for doing so. I am going to talk about the Safe and Sustainable review as well. We have received a number of e-mails from charities yesterday, one of which said:
“As some MPs look to reignite”
the debate about changes to children’s heart units
“we urge MPs to think about the children.”
Frankly, I found that rather offensive, because throughout the whole campaign I have only ever thought about the children.
When I worked at Martin House children’s hospice, I saw the effect on families when they were driven apart because the poorly child had to be a long distance away. On my visit a week or so ago to the unit in Leeds, I met a family who live in Sheffield. They brought their baby who was a few days old into the unit when the baby suddenly went very blue. Thankfully, because of the excellent work at the unit, that baby’s life was saved. That child was described as “marginal” in the review meeting on 4 July. That is not my description, but that of the decision makers. That is a shocking statement in my opinion. I also met another family who live in Sheffield. The father is making three trips a day between Leeds and Sheffield because there are other siblings at home. How on earth are such people expected to travel three times a day up to Newcastle?
I recognise that the review has been independent of Government, but I have grave concerns over the way in which it has been run. I support a review, because I want the best services for our children. I was grateful for the Minister’s comments earlier, when he said that the call-in process means that the matter will go to an independent panel. I would be grateful for clarification of whether that panel is independent of the JCPCT.
May I reassure my hon. Friend that the Independent Reconfiguration Panel is nothing to do with the JCPCT, my right hon. Friend the Secretary of State or me? It is an independent organisation that is there to look at reconfigurations across the country that are referred to it by my right hon. Friend following an oversight and scrutiny committee writing to him.
I am extremely grateful to my right hon. Friend for that clarification. I hope that the independent review body will look at the issues that I raise.
Logical health planning clearly dictates that services should be based on where the population live. Doctors should travel to where the patients are, rather than the other way around. Even the British Congenital Cardiac Association has said that:
“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”
After all, it is not buildings that perform operations, but the doctors and surgeons within them. That definition seemed okay in the case of Birmingham. The review stated:
“The Birmingham centre should remain in all options due to the high level of referrals from the large population in its immediate catchment area.”
Why on earth does the argument about the large immediate population not apply equally to Leeds?
The independent analysis of patient flows states that many of the people in west and south Yorkshire and in Lincolnshire will probably go to Birmingham, Liverpool or even London instead. The JCPCT reaches the figure of 403 surgical procedures for Newcastle on the basis of only 25% of the patients going there. Even that is doubtful. How was the figure of 25% arrived at?
It is very convenient that the 25% figure gets Newcastle just over the 400 mark. However, my constituents in east Yorkshire and north Lincolnshire will not travel to Newcastle at a rate of 25%. They will go straight up the M62 to Liverpool or head south to Birmingham or even London, which are much easier to get to.
I am happy to be working so closely with my hon. Friend on this matter. When all the evidence is considered, is not the reality that Leeds is being sacrificed simply to allow Newcastle to achieve a level of operations that it might not even achieve? That is no reason to close a good unit.
I could not agree with my hon. Friend more.
The decision flies in the face of a fundamental aspect of the NHS constitution: patient choice. The JCPCT asserts that Newcastle could reach the minimum number of procedures if parents are “properly managed” to go to there. That is simply unacceptable. The whole point of patient choice is that people decide where they want to go.
As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, the review ignored a petition of 600,000 people, counting it as only one response, when 22,000 text messages in support of the Birmingham unit were counted as 22,000 separate responses. Why was that?
The scores in the review were allocated to four bands. Each of the points from one to four were multiplied by the weighting. That gave 286 points to Newcastle and 239 points to Leeds. However, there was no clarification of how the figures had been arrived at. Also the figures were not definite, but were rounded up or down, which may have made a huge difference to the outcome.
As has been mentioned, clinical experts at the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists all say that surgical centres should be chosen on the basis of their having paediatric services all on one site. That is something that we enjoy in Leeds, which has a wonderful children’s hospital with all the services that are needed. On meeting such children, it is clear that they need the support not just of heart surgeons, but of other experts. In Newcastle, the extra support will be some 3 miles away. There will therefore be a worse service for people who live in and around Yorkshire, not the world-class service that we all want.
There is much more detail that I would like to go into. I sincerely hope that we will have a Back-Bench debate on this issue when we come back in the autumn, because it is of grave concern to hundreds of thousands of people in the Yorkshire region. We will not give up our fight to save our unit.
I wish to raise the issue of wet age-related macular degeneration and the treatments that are available.
The condition usually affects the sight of people from the age of 60, although it can affect people at an earlier age. AMD is the most common cause of sight loss in the western world. In the UK, more than 500,000 people have the condition and about 250,000 people are registered as visually impaired. Because people are living longer, the number of people who are affected by AMD is increasing.
Although the condition causes central vision loss and can have a devastating impact, it does not lead to complete blindness as sufferers retain their peripheral vision. Unfortunately, there is no known cure, but drugs are available that can slow the growth of blood vessels in the eye. Such anti-vascular endothelial growth factor medicines prevent blood vessels from forming or growing. Three drugs have been used in the treatment of wet AMD: Macugen, Lucentis and Avastin. It is the latter two drugs with which my speech is concerned.
Fundamentally, what is the difference between the two drugs? At first glance, the answer is the cost. Lucentis costs about £700 an injection, while Avastin costs £60. The bigger answer is that Avastin is not officially approved for eye treatments. Lucentis gained its European Medicines Agency approval in 2007. It is officially approved for use in eyes and is the treatment recommended in England and Wales by the National Institute for Health and Clinical Excellence. The certification is based on extensive trials that show that is safe and effective for all lesion types in wet AMD. The trials have shown that it stabilises sight in more than 90% of cases and improves sight in 40% of cases.
The cheaper Avastin has not been approved by the EMA for use in treatments of the eye because it has not gone through the proper clinical trials. It has been approved as a treatment for colorectal cancers, and is therefore readily available. When used for colorectal cancers, the drug is injected into a vein in the arm. When it is used for the treatment of wet AMD, it is given into the eye.
The findings of two trials comparing Avastin and Lucentis have been published recently. Those are the comparison of age-related macular degeneration treatments trial, known as CATT, which was carried out in the United States, and the inhibit VEGF in age-related choroidal neovascularisation trial, known as IVAN, which was carried out in the UK and was funded by the National Institute for Health Research. The IVAN trial, which was NHS funded, involved 610 patients in 23 hospitals. It was one of the largest research projects studying eye diseases in the UK. The one-year results were presented at an international conference in May this year and have been accepted for publication in the peer-reviewed journal, Ophthalmology.
The greatest debate about the differences between the two drugs is likely to be over their safety when used to treat wet AMD. Academics say that, overall, both drugs are extremely safe. My contention is that it is likely that cost pressures on the NHS will lead to increased use of Avastin. The IVAN researchers estimated that if the NHS were to substitute Lucentis for Avastin across the UK, it would save £84.5 million each year if 17,295 eyes were treated.
However, I am aware of the financial environment in which pharmaceutical companies operate. Like other industries, they manufacture products that must be sold at a profit, but in contrast to manufacturers in other industries their research and development costs are prohibitive. That means that they must make money on their investment. I recognise that they must not only regain their expenditure through profit but achieve profits to cover all the drugs that fail to get on to the market.
There has been criticism of NICE’s failure to recognise and adopt innovative new medicines. The UK is a world leader in medicines research, development and manufacture, but it is one of the slowest countries to enable patients to have access to innovative treatments. Avastin fits into that classification. I do not seek the Department’s licensing it immediately, but I call for the Government to establish an independent appraisal of it for use in ophthalmology. Clinicians are already using it off-label, so that would not be a leap in the dark. The savings that there would be for the NHS if the drug did work have already been quantified. However, if it is not safe, we must act to ensure the public’s health. I therefore ask the Minister to consider my request.
My comments will focus on the treatment of one GP in my constituency and his patients in Kelvedon, and on the state of health services in Witham town.
With the Government rightly empowering patients and medical practitioners, it is deeply alarming to see how one GP in my constituency is being treated. Dr Conor Macnamara has served the people of Kelvedon for a quarter of a century and is currently a salaried GP at the Brimpton House surgery in Kelvedon. He has been a stalwart of our local community, and whole families throughout the locality respect and trust him. He has upheld the values of the NHS on the front line and enthusiastically supported local residents.
Despite Dr Macnamara’s strong record, the primary care trust, which is now called NHS Mid Essex, and the GP principal at Brimpton House surgery, Dr Alsayed, have decided to end his employment and stop him treating local patients. They did so at the end of last year without consulting his patients, and they issued a statement informing his patients of the decision before Dr Macnamara himself was formally notified of it.
The decision to remove Dr Macnamara, and the way in which it was carried out, have caused considerable consternation among local residents. They are up in arms, and they have signed a petition objecting to any attempt to remove this long-standing family doctor from Brimpton House surgery. Yesterday, alongside the patient action group, they handed in a petition and delivered a letter to Dr Alsayed, reiterating their wish to see Dr Macnamara reinstated. I pay tribute to them for their campaign and remain extremely disappointed by the lack of engagement by the PCT and Dr Alsayed in addressing local concerns, and by their failure to address Dr Macnamara’s concerns. In my view, that is a classic example of NHS bureaucracy overriding patient choice. I hope that my right hon. Friend the Minister will look into the matter and help us find a good resolution that will lead to Dr Macnamara’s reinstatement.
As well as ignoring patient choice in Kelvedon, NHS bureaucrats have neglected health provision in Witham town. It is a growing town, and the local community is being overlooked in the provision of health services. We have a growing population, and the demand for new health service provision is reaching breaking point. Our population is increasing and more and more new homes are being built, so the provision of good-quality local health services is vital. Instead of investing in local services, the PCT has shamelessly spent hard-pressed taxpayers’ money on more managers and administrators.
The number of patients registered at the four GP practices covering the town and surrounding villages has reached almost 30,000. Those patients are covered by just 13.5 whole-time equivalent GPs, which makes more than 2,000 patients per GP. That is 40% higher than the 2011 national average of about 1,600. Local people need more GPs instead of managers, and I hope that my right hon. Friend the Minister can offer us some advice as local health campaigners. We want to press the new clinical commissioning groups to increase local GP provision. Progress must be made, and my constituents in Witham would welcome any intervention and encouragement that he can provide to nudge the process along, particularly given the Government’s reforms.
The Government have rightly prioritised the NHS, and their reforms will help save it in a time of financial uncertainty. I hope they will now do everything possible to ensure that their commitment to support patient choice and invest in front-line health services can be delivered in Witham, to avoid a health crisis and bring much-needed and long-overdue benefits to my constituents.
This has been an interesting and diverse debate, giving hon. Members an opportunity to raise a range of different subjects affecting their local communities and the health and well-being of their constituents. If there has been a main theme, it has been the Safe and Sustainable review of paediatric heart surgery. I fully recognise the strength of feeling and emotion on that difficult and sensitive subject, which is why so many Members have talked about it. They have included the hon. Member for Leeds North West (Greg Mulholland); the hon. Member for Hammersmith (Mr Slaughter), who mentioned the Brompton hospital in London, which is part and parcel of that review; the hon. Member for Leicester South (Jonathan Ashworth), who took interventions from the hon. Member for Leicester West (Liz Kendall); and my hon. Friends the Members for Pudsey (Stuart Andrew), for Colne Valley (Jason McCartney) and for Loughborough (Nicky Morgan).
I fully accept that the reorganisation of children’s cardiac services is a matter of real concern for the families involved, as indicated by the strength of feeling shown in the contributions of all the Members who have taken part in the debate. I know that some families have been disappointed by the outcome of the JCPCT’s recent decision. As hon. Members will know, children’s heart surgery has been a subject of concern for more than 15 years. Clinical experts and national parents groups have repeatedly called for change, and there is an overwhelming feeling that change is long overdue.
As passionately as people want to defend their local hospitals, it is far more important to ensure safety and quality of care for all children with congenital heart disease. We must ensure that those children continue to receive the very best care that the NHS can deliver, and I know that no Member would disagree with that overarching principle. That was what the NHS Safe and Sustainable review was aimed at, and as I have told many Members over the past 22 months, it was wholly independent of Government.
The review was led by clinicians and had the support of the Royal Colleges and national charities. Its conclusions were clear: for children with congenital heart disease to receive the very best care, specialist surgical expertise needs to be concentrated in a smaller number of centres. That will mean that surgeons have sufficient clinical work to maintain and develop their skills; that they can provide those services around the clock; and that they can train and develop the next generation of surgeons. I must stress that the JCPCT’s decision is not about closing or cutting back on children’s heart services—quite the opposite. It is about ensuring that the whole range of children’s heart services can deliver the very best care now and in future.
I thank in passing my hon. Friend the Member for Loughborough and the hon. Member for Leicester South for meeting me earlier this afternoon to discuss the important issue of ECMO and how it directly affects Glenfield hospital in Leicester.
I am afraid other duties in the House prevented me from being at the meeting. Had I been there, I would have supported what the hon. Member for Loughborough (Nicky Morgan) and my hon. Friend the Member for Leicester South (Jonathan Ashworth) said.
I am extremely grateful to the right hon. Gentleman. Not only am I sure he would agree with every word that my hon. Friend the Member for Loughborough and the hon. Member for Leicester South said, but I have considerable sympathy with him, as he was unable to attend the meeting owing to other pressing parliamentary duties in his role as Chair of the Select Committee on Home Affairs. To be even fairer to the right hon. Gentleman, the meeting was originally planned for 3 pm or 3.15 pm, but unfortunately, neither my hon. Friend, the hon. Gentleman nor I would have been able to attend because we were at that moment in the Chamber.
I understand from the nature of our discussions, as they will, that this is a difficult issue, because there are a number of complicated parts to the problem. I hear what they and other hon. Members have said about the Safe and Sustainable review, but I stick to my original position. The review is independent and is carried out not by the Government, but by the JCPCT. It would be inappropriate for me to become directly involved, to take sides or to pass comment because it would be felt that I was interfering. If hon. Members’ local authorities disagree with the decisions or recommendations of the JCPCT, their overview and scrutiny committees can write to my right hon. Friend the Secretary of State for Health to express their disagreement with the decision as it affects their local community or local hospital, and to request that the matter be referred to the independent reconfiguration panel, so that it can consider it independently and come up with a decision.
As my hon. Friend the Member for Colne Valley said, his local authority has today done just that. It may be helpful to him if I explain the procedure. My right hon. Friend the Secretary of State receives the representations and communication from the local authority overview and scrutiny committee specifying that it believes that the decision and recommendation as they affect the local hospital—Leeds, in my hon. Friend’s case—are wrong. The overview and scrutiny committee then asks my right hon. Friend whether he will refer the matter to the independent reconfiguration panel. I do not want to prejudge, but it is almost certain that my right hon. Friend will refer the matter. It will be then be up to the IRP, which is independent, to look at the recommendation and the criticisms made by the overview and scrutiny committee, and to reach a conclusion, which will be an independent conclusion, on whether it agrees with the recommendation or the criticisms of it and perhaps of the procedures involved. The IRP will then make my right hon. Friend aware of its independent view of the complaint.
It is difficult to give a time scale for this reason: as soon as my right hon. Friend receives representations from the overview and scrutiny committee, he will consider as quickly as he can whether to make a referral. As I have said, in the life of the IRP, every request for a referral has been granted—that is certainly true of my right hon. Friend’s time in office, but I believe it is also true of previous Secretaries of State under the previous Government. It is up to the IRP. I know of one example of my right hon. Friend requesting that the IRP respond within a certain time frame, but that was on a single issue. It is possible, with regard to the Safe and Sustainable review, that a number of referrals could be made by different OSCs in relation to the recommendations—I do not know but it is a possibility.
I think I can assure my hon. Friend that the IRP will have available to it all the evidence, in all shapes and forms, to help it to form its final opinion of the complaint referred to it. I hope that that reassures him. I say to my hon. Friend the Member for Loughborough and the hon. Member for Leicester South that the same can apply with regard to the decision about ECMO. I have no doubt that Leicester city council will give consideration to that.
I shall briefly respond to the remaining issues. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) made several extremely interesting suggestions. Some of them might not be in line with current Government thinking, but I shall certainly refer her ideas and views to the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who deals with our alcohol strategy. Similarly, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised an important issue, and again I will refer it to the Under-Secretary of State.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned the potential reconfiguration at St Helier hospital. As she will know, the proposals are still being worked on. There has not yet been a consultation process, but the decisions have been taken locally by the local NHS. I trust that, if and when there is a consultation process, she will get involved.
I thought she would say that. That is very good. After the consultation, the due processes of reconfiguration can move forward.
My hon. Friend the Member for Hendon (Dr Offord) asked about Avastin. A study is being done into its effects. We are following that closely, and when we find out more we will consider the matter and potentially reach a judgment, but I cannot give him any commitments at the moment.
Finally, I turn to my constituency neighbour, my hon. Friend the Member for Witham (Priti Patel). I am sorry to hear about the problems that she highlighted on behalf of her constituents. I do not want to disappoint her, because she is my neighbour and I have to live with her on a weekly basis, but given the background to the case, I think it is a matter for the GP practice as the employer of the GP whom she mentioned. I encourage her to engage with Mid Essex PCT, even though it has no direct powers or role in this matter, and the clinical commissioning group in the mid-Essex area, because they are best placed to address the concerns about the provision of services for her constituents, which I know she is fearless in defending, protecting and promoting.
I thank the Minister. I wish him and those Members not staying for the other debates a happy and productive recess. We now move to a short debate on foreign and commonwealth affairs, after which we will proceed to a debate on the environment, food and rural affairs. Members listed under other topics will then be taken in the general debate. We still have the five-minute limit on speeches.