Monday 22 October 2012
[Mr Philip Hollobone in the Chair]
Children’s Cardiac Surgery (Glenfield)
I beg to move,
That this House has considered the e-petition from Adam Tansey relating to children’s cardiac surgery at the East Midlands Congenital Heart Centre at Glenfield, Leicester.
Mr Hollobone, I welcome you to our proceedings and thank the Backbench Business Committee for agreeing to the debate this afternoon. Parliament can respond to issues of public concern quickly. More than 100,000 names —I think that the total is about 103,000 at the last count—appear on the e-petition that I have referred to.
The new Secretary of State for Health has responded in short order to the facts presented to him, and I thank him for that. In a letter sent by him today to the various councils that referred the Glenfield decision to him, he says that the Independent Reconfiguration Panel will now conduct a full review of the decision by the Safe and Sustainable review. That is most certainly to be welcomed. However, he also says that the IRP will not consider the decision taken by his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to remove ECMO from Glenfield, as that decision was not taken by the joint committee of primary care trusts; I will say what ECMO means in a moment.
That last statement is illogical and certainly difficult to understand; we are surely entitled to assume that the previous Secretary of State made his decision on the basis of the recommendations from the Safe and Sustainable review. We need to find out, as an urgent priority, whether the new Secretary of State can reverse the decision on ECMO. As I am sure contributors to this debate will demonstrate, it would be sensible for him to do that and I look forward to receiving confirmation from my hon. Friend the Minister that that is going to happen. Cardiac services and an ECMO facility go hand in hand. We know that; I am sure that the Department for Health knows it, and I look forward to hearing in due course from my hon. Friend that she knows it, too.
I have had some intermittent contact over the years with the campaigners supporting the case for Glenfield’s ECMO and children’s cardiac units and I have visited the hospital on many occasions as the MP for Harborough, which is in south-east Leicestershire—most recently, when the additional facilities funded by the Thomas Cook travel company’s charitable foundation were formally opened in May this year. However, owing to the time and other constraints imposed on me as Her Majesty’s Solicitor-General, a post I held until last month, I have not been able to follow the development of the issues surrounding the Government’s reconfiguration of children’s heart services with as much attention to detail as I might have wished.
Now, what does ECMO mean? It stands for “extracorporeal membrane oxygenation”, and it is a highly technical, very clever and hugely successful medical means of recovering people who have both severe heart problems and severe respiratory problems. It might interest you to know, Mr Hollobone, that the only survivor of the house fire in Prestatyn at the weekend—the father of the household—is alive today only as a consequence of his being transported to the Glenfield ECMO unit, where he is under the treatment of Mr Giles Peek, one of the consultants there.
I am happy to report that, despite my absence from the battlefield, two other hon. Members from Leicestershire, my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall), have been at the forefront of the campaign to bring this matter to the attention of the Government and the wider public. That is not to say that my hon. Friends the Members for North West Leicestershire (Andrew Bridgen) and for Bosworth (David Tredinnick) have not played their part, nor that the Minister for the Armed Forces, my right hon. Friend the Member for South Leicestershire (Mr Robathan), and the Minister at the Department for International Development, my right hon. Friend the Member for Rutland and Melton (Mr Duncan)—colleagues who, unlike me, continue in Government—have not been working below the radar. Nor do I mean to suggest that my right hon. Friend the Member for Charnwood (Mr Dorrell), the Chairman of the Health Committee, has been a mere spectator—of course, he has not. All of us have been doing our best to ensure that the case for Glenfield is heard in the right quarters. That is also true of the right hon. Member for Leicester East (Keith Vaz) and the hon. Member for Leicester South (Jonathan Ashworth); despite their being respectively the Chairman of the Home Affairs Committee and an Opposition Whip, they have played their part in this campaign.
We have an abundance of parliamentary talent in Leicestershire, but if any praise is due, it is due to my hon. Friend the Member for Loughborough and the hon. Member for Leicester West, who have led the cross-party campaign—I stress that it is cross-party—to ensure that the case we are here to make has been, and continues to be, waged so effectively. The hon. Member for Leicester West is the constituency MP for Glenfield, but she is also the shadow Minister for Health, so she has a double reason for taking an interest in today’s proceedings. It goes without saying that she has been working very hard for her constituents, both human and institutional, in this regard, but she has been doing so in co-operation with my hon. Friend the Member for Loughborough, who is now a Government Whip; my departure from the Government has been more than compensated for by my hon. Friend’s promotion.
However, by convention and practice that means that my hon. Friend is no longer able to speak in Parliament, either here in Westminster Hall or in the main Chamber of the House of Commons. Nevertheless, she is in her place this afternoon and I know that she will continue, as we all will, to support vigorously the medical and ancillary staff at the Glenfield hospital and the patients and their families who benefit from the services provided by those doctors, nurses, technicians, administrators and the many others connected to that great hospital, some of whom are with us in Westminster Hall today.
My constituents Dr Sanjiv Nichani, the senior consultant paediatrician at the Glenfield hospital, who specialises in children’s heart care, and Mr Giles Peek, the director of the paediatric and adult ECMO programme and a cardiothoracic consultant surgeon, have travelled here today to hear the debate and to speak to the Minister afterwards, all being well.
May I express my support for the comments of my hon. and learned Friend? As you, Mr Hollobone, and he both know, Newark has all sorts of problems with health care at the moment. Glenfield hospital is crucial to my constituency. I particularly draw the attention of my hon. and learned Friend to the comments by Mrs Pamela Durney, who owes so much to this crucial hospital for her children’s health.
I am grateful to my hon. Friend for that intervention. His support demonstrates that the issue is not only for Leicestershire, but one that affects patients from right across the east midlands and, I would suggest, from well beyond the east midlands.
Before my hon. Friend the Minister feels a little surrounded, may I thank her for being here to respond to the debate? I also congratulate her, although she must be bored of hearing congratulations, on this first step in what will be a long and successful ministerial career; I say that not as a question but as a statement of fact, and on that basis I am sure that we have won the case. I have no doubt that her response to this debate will act as an accelerant to her progress and provide great hope to those of us who want to see the Glenfield hospital’s ability to save lives continue.
Let me read out part of a letter from some members of staff at the Glenfield hospital:
“As members of the East Midlands Congenital Heart Centre team, we feel that we have a responsibility to our patients to ensure that we make clear our intentions with regards to the implementation of the recommendation of the safe and sustainable review. We are not in a position to leave our homes and families, to move to Birmingham to work. As a team of (predominantly) women, we are (predominantly) second wage earners, with husbands, children and homes. The toll of this review on both our work and home lives has been immense. It has created uncertainty and confusion, as well as intense anxiety. The repeated mantra of the review team that it will all be ok ‘with the help of the EMCHC team’ is meaningless in that we have not even been consulted. Unfortunately, we have been placed in a position where to refuse to relocate is openly criticized as being obstructive by the review. This is not the case. Our patients remain our priority within our working life, yet we have a responsibility to our families which, when push comes to shove, will over ride this.”
They go on:
“This letter is in no way representing a threat. It is an open expression of our concerns, over another assumption made by the review team, and which places us in a position where we are forced to choose between our patients and our families. We are a group of dedicated professionals, who have worked hard to achieve the excellence that we have done. Our patients deserve the best, and we fear that the recommendations will not give them that, and we will be unable to be there to support them.”
In my view, that letter speaks for them all—from doctors through to cleaners—and I hope that the Secretary of State will not forget the work that employees of the national health service do at the Glenfield unit when he comes to decide how best to proceed.
It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and thus they will all be working at full capacity. Can the Minister ensure that in the event of a superbug outbreak, for example, as happened at the Belfast neonatal unit this year, or of a fire, as happened at Birmingham hospital in 2010 and in Leicester in 2011, or of any other catastrophic event in one of the cardiac units under consideration, that the remaining six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?
Glenfield already takes patients not just from Leicestershire, but from across the east midlands, as my hon. Friend the Member for Newark (Patrick Mercer) said. It also receives patients from Birmingham, Southampton, Northern Ireland and elsewhere in the United Kingdom—and even from Scandinavia and mainland Europe.
The Safe and Sustainable cardiac review for children in England has been under way for more than three and a half years. It proposes that the Glenfield unit be closed and its patients and neonatal and paediatric ECMO services be transferred to Birmingham. The Minister and the Secretary of State are, we now know, to revisit the medical and economic evidence that the review board has considered, but I look to them to make a different, better and more logical decision, based on the evidence that is there for all to see.
Four available options emerged from the review, and they were predicated not so much on the cost of providing children’s cardiac services—albeit that cost must play a significant part—as on their sustainability. I will not, for reasons of time, list the options or their components, but option A suggested that there should be seven surgical centres: at Glenfield, at Freeman hospital in Newcastle, at Alder Hey children’s hospital in Liverpool, at Birmingham children’s hospital, at Bristol royal hospital and at the two centres in London, each with four surgeons looking after a minimum of 400 children every year.
Following the public consultation between 1 March and 1 July this year, option A received the greatest support. The consultation was the largest ever public consultation within the national health service, with more than 75,000 respondents; nevertheless, that number is much smaller than the number of people who signed the e-petition that provoked this debate. Option A was supported by six of the 10 health regions in England. It is, at £22 million, the least expensive option—the next cheapest costs £44 million—and it has the added advantage of ensuring shorter travelling distances for families.
None of the four options is perfect or ideal, but the option that includes Glenfield satisfies many of the objective criteria that one would expect of a good solution—not least in respect of Glenfield’s nationally commissioned ECMO services. Given today’s letter from the Secretary of State, it is in that regard that our attention now needs to focus. Glenfield provides both cardiac and respiratory ECMO. Its national ECMO centre has been in operation since 1991, and it treats babies, children and adults from across the country and abroad.
ECMO is an invasive life-support system, which can be used on patients with severe respiratory or cardiac failure. It consists of removing blood from a patient, taking steps to prevent clots from forming in the blood, adding oxygen to the blood and pumping it artificially to support the lungs. There is an increased chance of survival of half as much again when a patient is treated in an ECMO centre rather than in a conventional intensive care unit. The Glenfield ECMO unit has the best results in the world, has more expertise and success than any other ECMO unit in the country and is the only such unit in the country to provide mobile ECMO. We have four national centres for ECMO, and the ideal scenario would be to maintain ECMO services in their current locations.
There is the fact that Glenfield’s ECMO unit was applauded by the national health service during the H1N1 crisis and that Glenfield’s ECMO survival rates are 20% higher than the United Kingdom average. Kenneth Palmer, director of the ECMO unit of the Karolinska university hospital in Stockholm and an international expert on ECMO treatment, wrote to my right hon. Friend the Member for South Cambridgeshire, the former Health Secretary, on 7 July, on learning about the proposal to shut the Glenfield unit:
“You will take over 20 years of experience from one of the world’s...best ECMO units and throw it away...to rebuild it in another place...You cannot move a unit, you can just destroy it and rebuild it with many years of decreasing survival rates and increasing morbidity”.
Mr Jim Fortenberry, paediatrician-in-chief of children’s health care in Atlanta, Georgia, also wrote to my right hon. Friend on 6 July:
“Glenfield has one of the finest ECMO programmes in the world and was the source of the recent CESAR trial, a landmark study that helped sort out the benefits of adult ECMO...The impact on care of attempting to move out this program in toto to another location would be devastating. ECMO is not merely the equipment, but the incredible collective expertise and institutional memory of its entire team”.
Glenfield has, over the years, built up a team of more than 80 ECMO specialists.
Dr Thomas Müller, ECMO co-ordinator at the university medical centre in Regensburg, Germany, wrote to my right hon. Friend on 9 July:
“Glenfield Hospital has won an excellent reputation for their expertise in paediatric and adult ECMO treatment and is deemed to be one of the world’s leading centres. The knowledge and experience of the staff in Glenfield probably is unmirrored in Europe and the US. To my knowledge, Glenfield treats the largest number of patients with severe cardiac and respiratory failure with ECMO worldwide...centres with less expertise certainly will experience a higher mortality. Therefore, in the interest of best patient care the decision to close down the most experienced centre of the UK is difficult to comprehend for somebody from abroad.”
Dr Leslie Hamilton, a cardiothoracic surgeon at the Freeman hospital in Newcastle, has also acknowledged that there is a risk in moving ECMO services from Glenfield.
Glenfield performs about 100 ECMO procedures a year, which accounts for 80% of the neonatal and paediatric activity in England and Wales. As I have mentioned, Glenfield also takes patients from other countries, including Scotland, Sweden, Finland and Ireland. The mortality rate at Glenfield is 20%, compared with 34% in the rest of the United Kingdom. Two additional surgeons have expressed an interest in going to work there. The centre is a popular place to work and can be made more “sustainable”—to use the jargon—with more surgeons and space.
In advancing the case for Glenfield, I do not need to denigrate the facilities and expertise of other hospitals. I see the right hon. Member for Newcastle upon Tyne East (Mr Brown) in the Chamber along with my hon. Friend the Member for Solihull (Lorely Burt), who no doubt represents the interests of the Birmingham children’s hospital. In advancing the case for the retention of the internationally acclaimed ECMO centre in Glenfield, I do not need to undermine the good work and dedication of cardiac and thoracic specialists elsewhere. I do not want to do that, and I would not have the time, even if I thought it a proper or sensible thing to do. It just so happens that Birmingham children’s hospital regularly refers patients to Glenfield. Why? Because unlike Birmingham, which conducts only cardiac ECMO, Glenfield does both cardiac and respiratory ECMO.
I fully endorse my hon. and learned Friend’s comments about Glenfield. Indeed, one of my youngest constituents, Yvie Beards, would probably not be here today were it not for Glenfield. However, does my hon. and learned Friend not agree that the type of expertise that we have in Leicester should be replicated in other parts of the United Kingdom? Although the Birmingham children’s hospital has one of the best child treatment centres, it could also contribute to that same level of care for children and others in the west midlands.
I am sure that my hon. Friend is right, but we do not replicate what goes on in Glenfield by closing down Glenfield. If she and I are right about this, we need more Glenfields, not one fewer. We certainly do not need Glenfield itself to be closed.
Glenfield has this year opened a paediatric intensive care unit—a PICU—which will also become unviable as a result of losing paediatric cardiac surgery. Currently, 71% of those in the PICU are cardiac patients, so closing it down will no doubt affect the non-cardiac patients whom the unit treats. The loss of the ECMO service would also make the adult ECMO unit unviable. As of 18 October, option A is supported, on the e-petition, by about 103,000 signatories.
The Guardian, not necessarily a newspaper that a Conservative Member of Parliament leaps to quote from, pointed out on 28 April 2010:
“There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres… Survival and recovery rates would improve markedly with many lives saved.”
The ECMO unit at Glenfield works: it helps children survive and, as we just learned from the Prestatyn case, it helps adults survive. The medical evidence shows that the ECMO unit works, and now it is up to the Secretary of State to understand that and let both the unit and the children it treats survive.
It is a pleasure to speak in this debate under your chairmanship, Mr Hollobone.
I pay tribute to the hon. and learned Member for Harborough (Sir Edward Garnier) for securing this debate, and I am grateful to the Backbench Business Committee for allowing us to hold it this afternoon.
The hon. and learned Gentleman, who is one of my parliamentary neighbours, spoke with typical eloquence, as is his wont, and I for one am disappointed that he no longer graces the Government Front Bench. The Front Bench’s loss is the Back Bench’s gain, and I thought that he spoke extremely well. I apologise in advance if I echo many of his points, but that indicates the cross-party support for the campaign. Although we are perhaps blessed in not having any Liberal Members in the east midlands, I am sure that, if we did, they, too, would support the campaign.
As I am sure that the Minister, who represents an east midlands seat, is aware, this issue has caused considerable concern, not only in my Leicester South constituency, but across the east midlands region. It is no surprise to those of us who have been involved in the campaign that the e-petition has hit 100,000 signatures, and I pay tribute to Adam Tansey, the father of Albert Tansey, who set up the e-petition.
There has been widespread opposition to the proposals from the Safe and Sustainable review and how they affect Leicester. The review recommended the closing of the children’s heart unit and the associated moving of Leicester’s world-class extracorporeal membrane oxygenation service to Birmingham. Local people have campaigned vigorously against the proposal, and I pay particular tribute to Ms Robyn Lotto—a constituent of mine who has magnificently led much of the local campaigning in recent weeks. We should also pay tribute to Glenfield’s staff, who are very concerned, as the hon. and learned Gentleman indicated when he read out the circular that we were all sent.
Many organisations in Leicester and beyond have spoken out. The vice-chancellor of Leicester university, Sir Bob Burgess, said:
“Glenfield is a leading international heart hospital where excellent clinical care takes place within a context of internationally significant research. I would therefore ask that the proposal to move the Glenfield services be reconsidered and this valuable facility retained for people of our region.”
The Bishop of Leicester, who I see observing us, said:
“It is not…clear that the movement to Birmingham will be straight forward… In fact I fear that the movement of these services will be harmful to the nation as a whole”.
As I have mentioned, politicians from all parties have come together on this campaign. Politicians on the Labour-dominated Leicester city council are working alongside politicians on the Conservative-dominated Leicestershire county council and on what I assume is the Conservative-dominated Lincolnshire county council, and they have all expressed their concern.
MPs on both sides of the Chamber are speaking up, and, as the hon. and learned Gentleman did, I pay tribute to my hon. Friend the Member for Leicester West (Liz Kendall), who in many ways has spearheaded the campaign from our side with her usual pizzazz, and to the hon. Member for Loughborough (Nicky Morgan), who cannot speak in this debate because she is a Government Whip—fortunately for me, Opposition Whips can speak—but who I am sure would speak if parliamentary convention allowed.
I am, of course, pleased that the Secretary of State for Health has today announced that the independent committee will conduct a full review and report back at the end of February next year. Notwithstanding that welcome announcement, I want to make a number of points on which I hope the Minister can provide clarification.
On demand and capacity—I appreciate some of these points might be for the review committee, but it is important to get them on the record—genuine questions have been raised about the assumptions on demand and the capacity on offer at Birmingham that the joint committee of primary care trusts used. As I understand it, the national projections used by the review assume that demand will be flat, yet the most up-to-date data show demand increasing, because birth rates in the east midlands and west midlands are well above national averages. The projections of population trends used by the review team were based on data from 2006-07. Using those data would suggest a relatively stable work load rising to 3,990 cases in 2025, but, if the latest data on population expectations from the Office for National Statistics are used, the projected rise in surgical case loads hits 5,422 in 2025. Questions have also been raised about the likely patient flows, with clinicians suggesting that Sheffield and Doncaster have indicated a preference for Birmingham rather than Newcastle.
Given that extra surgery work, the movement of the ECMO provision, the increased population projections for the midlands and the worries about increased patient flows from south Yorkshire, I would be grateful to the Minister if she let us know whether the Department is confident that Birmingham has the capacity to meet what is clearly set to be considerably increased demand.
The hon. Gentleman knows, of course, that the Independent Reconfiguration Panel will no doubt consider all his points. As he knows, from the outset, this has been an independent process decided by clinicians. In those circumstances, I am sure that he will make it clear that I am in no position to answer any of his points, which must be addressed by the IRP. Does he agree with me on that?
The Minister makes an important point. None the less, I still think that, even if it is not appropriate for her to respond, as I suggested might be the case, this is an appropriate forum to put some of those points on the record, and I will continue to do so. I entirely understand her position.
I have a couple of points to make on Leicester’s paediatric cardiac intensive care unit, which the hon. and learned Member for Harborough mentioned. There is concern about how the decision will affect the wider paediatric cardiac intensive care on offer in Leicester, with the potential closure of the unit at Glenfield increasing pressure on the other Leicester hospitals and, more generally, reducing the supply of paediatric intensive care across the east midlands and placing more demand on Birmingham. Again, that is an important point. If the Minister cannot respond, I hope that the committee at least will take it into account.
I want to focus on the ECMO service, as the hon. and learned Gentleman did, and as I suspect many other hon. Members will, too. As I said at the outset, I entirely welcome the Secretary of State’s announcement this morning, but—I will quote from the letter, as the hon. and learned Gentleman did—I am disappointed that he said:
“The decision of the SoS taken regarding the removal of the ECMO equipment”—
he uses the rather bland word “equipment,” but the decision is quite controversial, so describing it in that way is unfortunate—
“from Glenfield to Birmingham should not form part of the review as the decision was not taken by the Joint Committee of Primary Care Trusts.”
That is right, but as has been said, the two things go hand in hand.
I shall repeat some of the points that have already been made. The ECMO service at Glenfield is the longest-established and provides 80% of ECMO capacity nationally. Many of its staff have more than 20 years’ experience. Glenfield’s ECMO service has some of the very best mortality rates. The mortality rate for ECMO at Glenfield is 20%, but the national mortality rate is 50% higher. Will the Minister address the decision not to include ECMO in the review? Does she expect to be able to pick up an ECMO unit in one hospital, plonk it into another and find that the same expertise and mortality rates will transfer with it? As has been said, many international experts do not think so—certainly not in the short run. We have already heard about Kenneth Palmer, the expert ECMO adviser, who told BBC Radio Leicester:
“They could never have the same survival rate in another unit if you move it like this.”
He also said—I think that the hon. and learned Member for Harborough quoted this, and I will repeat it:
“Moving one unit to another place is the same as totally closing down and rebuilding from zero in the new place... I have been very clear…that you cannot move a unit; you can just destroy it and rebuild with many years of decreasing survival rate and increasing morbidity.”
In other words, he is concerned that lives will be lost.
Another international ECMO expert, Dr Thomas Müller, says that
“in the interest of best patient care the decision to close down the most experienced centre in the UK is difficult to comprehend.”
Jim Fortenberry, the chair of the ECMO leadership council in Atlanta, has already been quoted in the debate. He said on BBC Radio Leicester that the ECMO unit is
“considered one of the finest ECMO units”
and described it as a “real jewel”. When he was asked on the radio whether he thought lives would be lost he said:
“I do agree with that unfortunately, I think the risk is great”.
International experts are therefore deeply concerned about moving ECMO from Leicester to Birmingham. One of their concerns is that the institutional memory, built up over a generation by the team, will be lost. That is one reason why I find it slightly disappointing when the Secretary of State presents the matter as just moving equipment from Glenfield to Birmingham. We have already heard that many of the staff feel that they will not be able to move. I shall repeat the quotation from the letter that they sent us all, because it is worth focusing on:
“We are not in a position to leave our homes and families, to move to Birmingham to work. As a team of (predominantly) women, we are (predominantly) second wage earners, with husbands, children and homes.”
As I understand it, 13 nurses are required for one ECMO bed, so there are concerns about Birmingham’s ability in the short run to build and develop a dedicated team of expert staff similar that at Leicester.
Given that the review panel will not consider the ECMO decision, I should be grateful to the Minister if she shared her analysis, or the Department’s analysis, of the risk assessment of moving the ECMO facility. It has been suggested in past debates—indeed, if my memory serves me correctly, it was suggested in a useful meeting that we had with the previous Minister, now the Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns)—that different experts had advised the Department and that they did not share the analysis of Mr Palmer and others. I apologise if my memory of that is slightly wrong, but if that is the case, perhaps the Department will agree to publish the evidence.
We have a campaign including an e-petition signed by 100,000 people—clinicians, staff and members of the public—who are deeply concerned about the proposal to move the ECMO unit. They accept the argument made by Mr Palmer and others. If the Department thinks that there is a different analysis to be considered, perhaps it will finally publish it, so that both sets of analysis can be properly scrutinised, and we can come to a considered opinion. That would reassure us on the point about mortality rates.
I would be interested in hearing the Minister justify the decision not to allow the IRP to consider the ECMO decision. Was not the decision to move ECMO taken and presented as a necessary consequence of the decision taken by the JCPCT in relation to the Safe and Sustainable review? Given that that was the context in which the ECMO decision was made, does it not seem odd that the review committee will not now consider the decision to move ECMO? If the justification is that there is a procedural argument that the various local authorities have asked the committee to consider the outcome of the Safe and Sustainable review and that ECMO was not part of that, fair enough, but it would leave a rather sour taste in the mouth of many campaigners who signed the petition. If that is the case, is there any way in which the ECMO decision can be reviewed? Can the Secretary of State consider reversing the decision of the previous Secretary of State? Many of us who are involved in this cross-party campaign would be grateful for guidance on that from the Minister. I am not sure whether the campaigners would feel pleased if, despite their winning the review, the ECMO unit were still to be shifted.
Many hon. Members want to speak, and because of the cross-party nature of the campaign, we are probably all making similar points, so I will conclude my remarks, but I encourage the Minister to focus on the point about ECMO. There is deep concern about it. People will be pleased about the review, but concerned that ECMO seems to have been excluded from it, and I hope that she can give us some reassurance.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I offer many congratulations to my hon. and learned Friend the Member for Harborough (Sir Edward Garnier), who very deservedly received a knighthood recently. I remind him that that is of course a tradition in his constituency, as his predecessor was also knighted. I served with Sir John Farr in my first Parliament, and he did so much for hosiery and knitwear in his constituency. I welcome my hon. Friend the Minister to the Front Bench. It is very nice to see her there.
It is clear from remarks that hon. Members have made that there is universal and cross-party support for retaining children’s services at Glenfield. One of the first decisions of the new Secretary of State for Health was to call the matter that we are debating in for review. That bodes well, because my right hon. Friend did so well with the Olympics that I believe he will do just as well as Secretary of State for Health. His decision shows his light touch. The fact that we now have a second chance to consider the issues, and the welcome arrival of a letter today, saying that the Independent Reconfiguration Panel will commence a full review and report not later than 28 February, is a huge relief for the county. My hon. Friend the Minister has already intervened to point out that she cannot second-guess what it will say, but the point of today’s debate is to give Leicestershire Members on both sides of the House an opportunity to show how concerned we are about the decision and to make some points about it.
I shall not repeat the points made by my hon. Friend the Member for Harborough or the hon. Member for Leicester South (Jonathan Ashworth), who engagingly described my hon. Friend as learned; I think, Mr Hollobone, that we are not allowed to do that any more. Did not the reforms of the House say that we could not call—
My hon. and learned Friend says I can make an exception for him, and I am delighted to do that.
The first point I want to make is that there is real concern that we are working on faulty statistics. The data used to make the decision were based on 2006-07. We need only consider the recent publication of the census in London to see the huge increase that there has been in population. There are shifting populations, and there is concern that the analysis is fundamentally flawed. It is not only my right hon. Friend the Secretary of State for Health who has had to consider flawed data recently. What about the west coast main line, whereby we found we were operating with completely inaccurate information? The right hon. Member for Newcastle upon Tyne East (Mr Brown) nods his head. This can happen in Departments, and we must take note of it.
My hon. and learned Friend the Member for Harborough and the hon. Member for Leicester South have addressed the issue of the ECMO link. To most reasonable people, it seems absurd that the two decisions will not be linked. I am sure that there are legal arguments, but somehow we must get a sensible decision so that both issues can be considered together.
The next point concerns the site of Glenfield. Glenfield is a hugely popular hospital not just with patients, but with surgeons. From, one might say, a feng shui point of view, it is on top of a hill outside the city, and it has a good, clean, clear energy. That is why everybody likes working there: it is nicer for everybody than the Birmingham site, as is proven, I would suggest, by a survey showing that only 2% of the staff in Glenfield want to move to Birmingham. It is not just BBC current affairs programmes that are jumpy about moving out of their current locations, as there is a real problem with the decision to move from Glenfield to Birmingham, as the hon. Member for Leicester South said. The body of knowledge built up over 20 years will dissipate, because many of the people who work at Glenfield simply will not move.
My next point involves the increased pressure on Birmingham, which has been referred to. Can Birmingham deal with it? Somewhere in the briefing papers is a point about Bristol. What happens if something goes wrong at Bristol and patients are moved around? My hon. and learned Friend the Member for Harborough made the point about the terrible tragedy in Wales, during which patients have been brought to Glenfield. Is it wise to concentrate all the resources in the midlands in one centre? I wonder whether it is.
Birmingham is already having to send patients to Glenfield because it cannot cope with the numbers. Does my hon. Friend not agree that it seems silly to close such a popular centre? As he said, there will be a knock-on effect if other centres close, but patients are already being sent from Birmingham to Glenfield, and children are being sent to different hospitals because there is no room at Birmingham. It seems absolutely crazy that my constituents cannot continue to use the Glenfield hospital, where so much expertise has been created over a number of years.
I agree absolutely with my hon. Friend, who makes another valid point.
I will not detain the House for long, as other hon. Members want to speak, but I want to make two more points. I have had letters from all over my constituency from people who have benefited from Glenfield. Let us think for a moment. Who put the money into the unit in the first place? Was it all Government money? No, it was not. A lot of charities in Leicestershire have raised money to support the unit. What about their efforts? How will they feel, having struggled over the years to provide a superb local service? It will be a great injustice if that money is dissipated in a reorganisation.
I am delighted to see my hon. Friend the Minister in her place, and I congratulate my hon. and learned Friend the Member for Harborough and all the other Leicestershire Members, including my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall), across the Floor, who has worked on the issue. I say to my hon. Friend the Minister that this is a critical problem. Please help us.
It is a great pleasure to serve under your chairmanship, Mr Hollobone. I welcome my hon. Friend the Minister to her post and congratulate my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) on securing this important debate.
As the Member for North West Leicestershire, I speak for a constituency roughly equidistant, in distance and travel time, from the Glenfield site and the Birmingham children’s hospital site. For my constituents, there is nothing to choose between the two, so I have a position of relative impartiality. I am interested in patient outcomes.
I recently toured the congenital heart centre at Glenfield, and two main concerns from the report were raised with me. The first was the issue of capacity and demand, which was raised by the hon. Member for Leicester South (Jonathan Ashworth) and my hon. Friend the Member for Bosworth (David Tredinnick). The figures given by the Department of Health were queried. It has been calculated that Birmingham children’s hospital will be expected to deal with 611 cases a year. However, clinical teams have suggested that it could be 900 to 1,000 procedures a year. Birmingham children’s hospital, having done its own modelling, expects the number of procedures to be more than 900.
I understand that senior commissioners acknowledge that the number is likely to be significantly higher than the figure of 611 used in the review, as does Sir Roger Boyle, the recently retired cardiac tsar, who initiated the project. The calculations demonstrating that the closure was a safe and sustainable option for the midlands, which considered travel, access, quality, deliverability, sustainability and affordability, were based on 611 operations, not 900 or 1,000. Doctors at Glenfield doubt very much that Birmingham children’s hospital has the capacity to handle that volume of work. In addition, Birmingham children’s hospital has stated that it wishes to move to a new site within 10 years, as it has already reached the limit of what can be achieved in the space that it has. Based on that, I would like the points that I have raised to be addressed to ensure that the Safe and Sustainable exercise was carried out using the correct data.
I turn to extracorporeal membrane oxygenation, or ECMO, a life support service currently delivered at Glenfield. There is a strong argument that the value of the service has not been fully appreciated throughout the review. Glenfield pioneered ECMO treatment in the UK and delivers education, training and clinical support to other ECMO centres in the UK and abroad. Survival after ECMO treatment in the Glenfield unit is far more likely than in other UK and international centres—that is, more children survive.
Several concerns have been raised with me about the Safe and Sustainable process for assessing the risks and practicalities of moving the service. I understand that only two experts were consulted about moving ECMO, and that the Swedish ECMO expert Kenneth Palmer, of the Karolinska Institute, has publicly expressed his anger at how his views have been used to justify the move from Glenfield, and has withdrawn his support for the process. Another issue is how a Sea King helicopter carrying a patient might land in central Birmingham. Glenfield can handle that, because it designed a system to accommodate it. Although the use of a Sea King helicopter is rare, we have heard that when they are used, as in the recent fire in Wales, they are life-savers. I would welcome a further review of the matter.
I remain concerned that Birmingham children’s hospital will not see ECMO as a strategic priority and might contemplate splitting the service among other providers, which would defeat the principles of the Safe and Sustainable review and put at risk the world-class results that we are achieving. The review’s aim is to concentrate expertise and deliver more positive outcomes. However, there are no plans for any other ECMO provider, including Birmingham children’s hospital, to use what my hon. and learned Friend the Member for Harborough termed the mobile retrieval service. That goes against the principle of the whole review.
The mobile retrieval service that Glenfield provides is a fundamental aspect of the service, and it partly explains why Glenfield produces so many positive outcomes. Its team travel by ambulance to the hospital where the sick child is located, taking all the necessary kit with them to start ECMO treatment. ECMO is then started on site and continued in the ambulance on the way back to Glenfield, ensuring that children receive the treatment as soon as possible at a time when their life expectancy without treatment might be measured in hours rather than days, and avoiding a much riskier ambulance journey on a simple ventilator. If that aspect of the service is not taken up by others in Glenfield’s absence, there is a danger that fewer children will survive horrific illnesses.
Will the Minister clarify the level of scrutiny of the results achieved at Glenfield and Birmingham children’s hospital? Since the decision was made, the unit has stated that it invited various members of the Safe and Sustainable review to Glenfield to show them the results of the past 10 years, which, it believes, demonstrate the success of its service. It has no record of that data being shared previously, and I would welcome clarification on what data were looked at during the initial review process.
A significant concern, highlighted by my hon. and learned Friend the Member for Harborough and the hon. Member for Leicester South, is the fact that it cannot be assumed that the staff who deliver the service at Glenfield will relocate to Birmingham. Many live east of Leicester and will find the commute to Birmingham unviable. I understand from Glenfield hospital’s own surveys that a number of staff have indicated that they are unwilling to move to the new unit.
There is also concern regarding the air of uncertainty that surrounds these units. Once a unit is earmarked for closure, the most able and gifted personnel quickly find jobs in other areas. That puts the process under great strain and leads to a rise in mortality rates. I hope the Minister gets on with this review as quickly as possible, so that we have a rapid resolution and can provide some reassurance to staff to ensure that we keep the service at its superb, world-class level.
We need to ensure that the conclusions of the Safe and Sustainable review are safe and sustainable—not only for the remaining structure of the NHS, but for my constituents in North West Leicestershire and all constituents in Leicester, Leicestershire, the east midlands and the midlands as a whole. I hope the Minister will take account of that.
It is a pleasure once again to take part in a debate under your chairmanship, Mr Hollobone. I join other hon. Members in congratulating my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) on securing the debate.
I feel like something of an intruder, coming from the remote parts of Lincolnshire to this east midlands event. I rise to speak because many of my constituents’ children and grandchildren have received treatment at Glenfield and Leeds, and I have campaigned with my hon. Friend the Member for Pudsey (Stuart Andrew) for the retention of the Leeds unit. We have centres of excellence and we want to retain them. My constituency is at the end of the line and somewhat remote, so the geography of where people receive life-or-death treatment is of particular concern. We joined the campaign for the Leeds unit and heard from parents how the distance to the life-saving unit has made a big difference. Cleethorpes is 80 miles from Leeds and 90 miles from Leicester.
The alternatives suggested to my constituents—in Newcastle—have been a significant factor in the opposition to the proposed changes. We already feel remote and out of it. I do not want to be frivolous, but if, for example, some of my constituents were involved in an accident, Humberside police would attend and summon an ambulance from the east midlands, which would then take them to Grimsby hospital, which is administered by the Northern Lincolnshire and Goole Hospitals NHS Foundation Trust. All these factors give people a sense of unease, and a sense that they are at the end of the line and do not matter. It is essential that we ensure that services are as close as possible to the people.
Parents will go to the ends of the earth to take their children to emergency treatment, but as a national health service we have to ensure that services are, wherever possible, as close as possible to the centres of population. We need to bear in mind the need to have centres of excellence, which, as the clinicians constantly tell us, means more and more concentration, but remoteness will mean that these proposals are unlikely to be achieved.
My hon. Friend is right. I think it was proposed that the likely number of operations taking place in Newcastle would be 403. That will not be achieved, because people in Cleethorpes and northern Lincolnshire will not travel to Newcastle; they will look for alternatives. With doubts being cast on the centre at Birmingham, inevitably, if Leeds and Glenfield closed, people would gravitate south rather than towards Newcastle.
We have heard expressions of concern about the process of consultation, and there is no doubt that the view that the consultation was flawed is widespread. Indeed, my hon. Friend the Member for Pudsey drew attention to that in an Adjournment debate a few weeks ago. I appreciate that the Minister said, in an intervention, that the review was by clinicians. The problem is that clinicians always tend to want to gather together in more and bigger centres of excellence, and our constituents want as local a service as possible.
I hope that when the Minister and the Secretary of State make their decision they will consider other aspects. The expertise of the professionals is important, but access to services is also important. The last thing that people want is a decision that comes from a review by people they do not know and about whom they are doubtful—expert opinion—at the best of times. They want the Secretary of State to weigh up all the factors, not just the expertise. Parents and grandparents of children who have received treatment from these units know, from personal experience, the care and attention that they provide, and they fear being shunted away.
We have centres of excellence. Please, Minister, do not rubber stamp a review that wants to close them. Consider, first of all, the children who are treated by these centres.
It is a pleasure to serve under your chairmanship, Mr Hollobone, and to follow such excellent speeches from hon. Members on both sides of the Chamber. I rise to speak both as the shadow Health Minister and as the Member of Parliament for Leicester West. My constituency is extremely fortunate to include Glenfield hospital. I welcome the members of staff who have taken time out from their busy jobs and travelled a great distance to attend the debate, and I thank them for doing so.
The future of children’s heart surgery matters greatly to the thousands of people who signed the e-petition that has made today’s debate possible. I thank the Backbench Business Committee and the hon. and learned Member for Harborough (Sir Edward Garnier) for securing the debate. The issue also matters to thousands of families right across the country, which is why my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and the hon. Member for Solihull (Lorely Burt) have attended this afternoon.
The issue of children’s heart surgery has needed to be resolved for many years. Following the findings of the Bristol royal infirmary inquiry 10 years ago, clinicians and professional bodies, including the Royal College of Nursing and the Royal College of Paediatrics and Child Health, have been very clear that children’s heart services need to change.
The problem is that services in England have grown up ad hoc and are too thinly spread across the country for every child to get the best possible standards of care. That is why the previous Government initiated the Safe and Sustainable review and why we continue to support the principle of fewer, more specialist centres for children’s heart surgery.
The issue is whether the Safe and Sustainable review has fully considered all the relevant clinical evidence in making its recommendations. The review has failed fully to consider the clinical implications of moving services from Glenfield, particularly the children’s ECMO service. I fear that that mistake is about to be repeated, because the new review being conducted by the Independent Reconfiguration Panel, which we learned about earlier today, will not include discussion of the former Secretary of State’s decision to sign off moving children’s ECMO services from Glenfield to Birmingham.
The two things cannot be separated and are inextricably linked: what happens to the children’s heart surgery happens to ECMO services. It is important to remember that any decisions about nationally commissioned specialist services, such as ECMO, must be signed off by the Secretary of State. I assume that the former Secretary of State made that decision only because of the recommendations of the Safe and Sustainable review, so we need to ensure that any review of those recommendations looks at both ECMO and children’s surgery.
At the risk of repeating the many eloquent speeches that we have heard, Leicester has one of the largest ECMO units in the world and it has long experience, having started in 1989. Glenfield has built up a team of more than 80 ECMO specialists. It is the only unit in the UK that can treat all age groups, which was critical during the H1N1 flu pandemic, because Leicester was able to flex its service to treat up to 10 adults simultaneously while training people working in other adult centres and co-ordinating the national service, triaging all the patients and providing the majority of the patient transport.
The hon. Gentleman has predicted my next sentence. Leicester is also the only unit in England and Wales to provide a mobile ECMO service for babies and children. Once again, it is difficult, if not impossible, to separate the adult ECMO service from the children’s ECMO services. The two are linked. It is not just about equipment; it is about staff and teams working and learning together.
I do not want to denigrate any hospital’s work, but I understand that Birmingham has neither the capacity to continue the mobile ECMO service nor any plans to develop a mobile ECMO service for children. That is a serious cause for concern and something that the Independent Reconfiguration Panel must consider.
Hon. Members have already talked about the outcomes for ECMO patients at Glenfield being significantly better than elsewhere. This is not anecdotal opinion, but clinically audited, peer-reviewed evidence that has come from the very best clinical databases available in this country and internationally. Independently validated data from the UK paediatric intensive care unit database, or PICANet, show that survival rates are at least 50% higher in Leicester. That difference in mortality is maintained even when the severity of illness treated by Glenfield is taken into account.
Data from the best available international register, provided by the Extracorporeal Life Support Organisation, support the evidence of good outcomes in Leicester and show that crude mortality rates in Leicester are 19%, but nearly twice as high in other centres, at 35%. Both those independent, validated data sources show the high quality of ECMO care provided at Leicester and bring into sharp focus the risks of closing Glenfield’s children’s ECMO service.
A service cannot simply be picked up and moved to another city without losing vital skills and expertise. It takes years to build up the quality of care to the same level. Interestingly, the Safe and Sustainable review explicitly addresses the time it takes to build up the quality of care in relation to children’s heart surgery. It says that
“clinical outcomes improve with experience”,
due to factors such as team working, as well as the experience of individual clinicians. The review says that this is a
“statistically significant observation in keeping with analysis which demonstrates historically, an 8 - 10 year period of time before such a service matures to produce excellent clinical outcomes”.
If that is so in relation to children’s heart surgery services, it also pertains to children’s ECMO services.
It was unfortunate that, in his letter to the chair of the Independent Reconfiguration Panel, the Secretary of State referred simply to moving the equipment of the ECMO service. It is not just equipment; it is about staff. It is clear that the majority of staff at Glenfield will be unable to move due to family commitments. Many of the nurses there have homes, families and children, and they may be second earners. A family cannot simply be uprooted and moved. Indeed, an anonymised survey of all staff at the unit found that 80% are “not at all likely” to move to Birmingham. Significantly, none of the ECMO specialists who replied to the survey were able to consider working in Birmingham.
I am concerned that the Safe and Sustainable review has not considered the evidence about ECMO in sufficient detail. The review panel took advice about the future of ECMO services from the Advisory Group for National Specialised Services. There was no representative from any UK or international professional ECMO body on the advisory group, so it commissioned a report from ECMO experts, including Dr Kenneth Palmer, director of the ECMO unit at Karolinska university, whom several hon. Members have mentioned.
Following that report, the advisory group said that it would be “possible” to move Glenfield’s children’s ECMO service. However, the question is not whether it is possible, but whether it is desirable and whether it makes sense to move one of the best-performing services—if not the best, not just in this country but in Europe and internationally. That would not be considered in respect of children’s heart surgery services, so why consider that for ECMO?
Mr Hollobone, I apologise for not being able to follow the whole debate; I am participating in the debate on Hillsborough.
A number of hon. Members from all parties have praised the work of the campaigners. Our best evidence that the facilities work comes from people such as Ria Pahwa, the young girl from Rushey Mead in my constituency, who had seven operations in Glenfield and who has been an essential part of this campaign. If we are looking for evidence that the facilities need to stay in Leicestershire, the evidence is in the campaigners themselves.
We have all met many children, some of whom are now adults, and families who have received excellent care and support. It is important that we put their views forward strongly and that the best peer-reviewed and validated clinical evidence is considered in the new review.
As many hon. Members have said, Dr Palmer wrote to the former Secretary of State saying that he sharply opposes the use of his name for the proposed transfer of services from Leicester to Birmingham. A similar view is taken by leading international ECMO experts from the Extracorporeal Life Support Organisation, which also wrote to the former Secretary of State:
“We are united in our dismay. We are united in our dismay at the proposed move of ECMO services from the Glenfield programme in Leicester to elsewhere…The Glenfield program is clearly and objectively recognised as one of the finest ECMO programs in the world. Movement of an established unit such as Glenfield in the manner described will have profound negative consequences on the outcomes of patients needing ECMO. This move…is one clearly likely to produce results that will have a human toll in increased deaths.”
That is why the specific evidence on ECMO must be fully considered, including by the new review.
An issue raised by my hon. Friend the Member for Leicester South (Jonathan Ashworth) and several other hon. Members must also be considered by the new Independent Reconfiguration Panel: whether the assumptions about the level of cases remain based on the best available evidence. The Safe and Sustainable review looked at surgical activity data from the central cardiac audit database for 2002 to 2006—the latest evidence available at the time—which suggest that the number of cases for heart surgery would remain roughly stable over the next 20 years. New validated data, however, are now available for three more years—to 2010—showing a consistent rise in activity, suggesting that adult and paediatric activity will each increase by approximately 75 cases per year.
We also have new evidence from the Office for National Statistics about population growth, which comes from data published in October last year and indicates that there will be substantial increases in the number of nought to four-year-olds, in particular in the east midlands, the east of England and London. That causes real concern about whether Birmingham will be able to cope with all the extra cases that it will receive.
Birmingham’s case load will also increase because of the closure of Northern Ireland’s children’s heart surgery services. The Safe and Sustainable review reports an all-Ireland framework, with Northern Ireland cases going to Dublin, but that will take several years to establish and, in the meantime, a significant and increasing number of babies will continue to travel to Birmingham.
The Birmingham children’s hospital itself is concerned about whether it has the capacity to cope with all the extra cases that it will receive from a closing Glenfield, from the likely increase in surgical activity, from the increase in population, in particular among the nought to fours, and from the increase in cases coming from Northern Ireland. The hospital, I understand, has analysed the case load and produced an internal paper concluding that it would have to perform 1,000 cases a year, which is at the very limit of what the Safe and Sustainable review panel reported as a safe number for cases to be treated. I urge the IRP—rather than the Minister, if she cannot do anything—to look at whether that paper has been written and to assess all such evidence in its review.
Finally, like the previous Government, this Government rightly want changes to children’s heart surgery services so that they provide not only safe standards of care, but excellent, high-quality standards for every child in every part of the country. Just as they want that for children’s heart surgery services, they must want that for children’s ECMO services. It is not good enough to say that it is possible to move a service; we want to know whether it is desirable to move a service to get the very best outcomes.
Glenfield survival rates are 50% higher than any other unit’s in this country and internationally. It will take at least five and probably up to 10 years to redevelop the same quality of service. No one would take the best service in the country for children’s heart surgery and close and move it, so no one should do that for ECMO either.
The issue is of concern to my constituents and those of hon. Members from throughout the east midlands, and to families everywhere in the country. Such people include Clare Johnson, a constituent of my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson). She contacted my right hon. Friend to tell him about the experience of her son, Michael. Michael was born in July last year with severe meconium aspiration, which means that his lungs fill with a substance that makes it very difficult to breathe. His lungs haemorrhaged and his heart failed. The paediatric mobile ECMO service from Leicester came to collect him and transferred him to Glenfield. He was on the ECMO machine 24 hours a day for four days; when he came off it, his heart and lungs were working for themselves. Ms Johnson said:
“As soon as the team arrived to prepare him for transfer, their evident skill and professionalism gave us that very first glimmer of hope…The care we received was second to none.”
Ms Johnson also said that:
“although I am not the best person to point out facts and figures, I cannot help but pore over the evidence available and the main thing that strikes me is the ECMO survival rate”,
which is so much better. She said:
“Glenfield is the only unit to offer Mobile ECMO”—
the very service to save her son—and concludes:
“I understand that I probably sound like a Mother who is just wanting to support the unit who saved her baby’s life”
“My beautiful baby boy Michael Martin Johnson died at 10.40 pm, 8 days after his birth and 3 hours after being transferred back to Hull from Leicester. He had a reaction to some medication he was given and died very suddenly and unexpectedly of a severe gastric perforation. A successful result will not bring my son back. But it WILL prevent other mothers from losing their child, as that IS the ultimate and inevitable result that stopping ECMO at Glenfield will have.”
Clare Johnson makes the case far more eloquently than I ever could. I hope that the IRP looks properly at Glenfield’s ECMO service and at the real benefits that it brings. The Minister has rightly said it is up to the IRP to consider the evidence, but it was the new Secretary of State who decided not to include ECMO as part of the review—that is what he says in his letter today—and that is a mistake, because the two services need to be looked at together. I ask the Minister to explain why the Secretary of State has explicitly excluded ECMO from the new review. That is the wrong decision and I hope that it will be changed.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) on securing the debate and other Members on all the contributions that we have heard. I pay tribute to all Members who have attended today, as well as those who have spoken. My hon. Friend the Member for Pudsey (Stuart Andrew) attended the debate but, unusually perhaps, has not made a speech, although we have not been discussing the hospital for which he has campaigned so hard.
I pay tribute to all Members who have spoken in numerous debates in the House, written letters to Ministers, met and conferred with local groups and experts and spoken at length to their ordinary constituents. As a result, we have heard a moving story from the hon. Member for Leicester West (Liz Kendall) about the services offered at Glenfield, and there are many more stories to be told about children’s heart services centres throughout England. All such Members have campaigned locally to have decisions overturned or reviewed in some way, or to ensure that the right decisions have been made on the right basis. They have brought such arguments and their campaigns to the House, as they should do, because each of them is doing their job as a first-class, local constituency MP by bringing important issues to this place.
I also pay tribute to great cross-party work, which my hon. and learned Friend the Member for Harborough mentioned, both in Parliament and locally. Forgive me for speaking not only as a Minister but with my other cap on as the Member of Parliament for Broxtowe. On my local television service, I have seen and witnessed such cross-party work, which is to be commended; such issues are not party political and certainly nothing to do with any alleged cuts. This is about how we ensure that our children and babies get the very best heart surgery services that we can give them.
I must pick out my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West, who together have spearheaded the campaign, but I also pay tribute to all the work and effort of the hon. Member for Leicester South (Jonathan Ashworth), who joined them at the meetings. Everyone involved in the process up to the decision of the joint committee of primary care trusts has been motivated by the very highest of intentions to ensure that our children and babies receive the very finest heart surgery services that we can provide, and that those services are sustainable.
I will deal with as many of the points that have been raised today as I can. As I said at the outset, hon. Members should make and have made their points so that they can be recorded—not just so that their constituents can see how they have advanced the argument, but so that those who, in turn, must look at the decisions that have been made and consider the arguments can see how important these matters are, because they have been raised in Parliament by local Members.
I turn to what has happened today and what is, in some respects, the nub of the debate, which has been very good. As many hon. Members know, councils have a right to challenge the JCPCT’s decision, and today the Secretary of State has agreed that the Independent Reconfiguration Panel should conduct a full review. I will come to what that means in a moment. He has asked the panel to report back by the end of February—my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) was worried about the time factor—or, and this may concern my hon. Friend, after conclusion of the legal proceedings brought by a Leeds-based charity, which may delay things, although I hope not.
The review will consider whether the proposals for change under the Safe and Sustainable review of children’s congenital heart services will enable the provision of safe, sustainable and accessible services, and if not, why not. The panel’s review will also be able to consider how the JCPCT made its decisions and—hon. Members may think that this is the most important point—the implications of those decisions for other services.
The Independent Reconfiguration Panel today received instruction from the Secretary of State and will now begin to consider how to constitute its review. It is, of course, a matter for the panel to decide how to conduct that review. It is an independent body, but I make it clear that it will look at all the decisions and—for many hon. Members this is most important—at the implications of those decisions, which includes the implications for the unit at Glenfield.
I thank my hon. Friend for the promotion. I am grateful that there has also been cross-party support in the campaign to keep the unit in Leeds open. I want absolute clarification on the IRP. Will she assure me that it will consider the whole decision-making process, including the initial assessments and all the data that were submitted? That is where many of us believe there to be inaccuracies, which have brought about the wrong decision.
I am grateful to my hon. Friend. It will be for the IRP to decide the full extent of its review of all the decisions that have been made, but the points that he has made here and in various letters will no doubt be put to it for consideration. I am told that, so far, it has not had a formal request from Leeds city council’s overview and scrutiny committee, and perhaps he can prevail on the committee to make that submission as a matter of urgency, so that we can all be absolutely sure that the review will be concluded by the end of February, and that there will be as few delays as possible.
The Secretary of State’s letter today says that his decision regarding removal of ECMO from Glenfield to Birmingham should not form part of the review. Is the Minister saying that the IRP will not look at the Secretary of State’s decision, but that it can look at ECMO services, although not at what he said? I am afraid that that is still unclear.
I am grateful for that intervention. I will explain why the Secretary of State has not been able to review the previous Secretary of State’s decision in this way. However, I am making it clear that the IRP will look at the implications of the decisions, and I will shortly turn to why the previous Secretary of State’s decision is not part of the process. I will then answer some of the specific points that have been raised by the hon. Member for Leicester South, but I want to finish dealing with the IRP.
More generally, in undertaking its review—this may assist my hon. Friend the Member for Pudsey—the IRP will interview and take evidence from a number of parties, including, but not limited to, NHS organisations, local authorities and local Members of Parliament. That will normally include evidence used in developing recommendations and proposals, taking decisions and national guidance.
I turn to the specific point about why the decision to move the children’s ECMO services over to Birmingham from Glenfield is not part of the review, or at least part of today’s decisions. Decisions about ECMO for children at Leicester being moved to Birmingham follow from the decision to transfer heart surgery to Birmingham. In other words, it was a consequence of the JCPCT’s decision. Children’s ECMO services are a nationally commissioned service, so the decision was taken by the Secretary of State, not the JCPCT. The Secretary of State made his decision based on the Advisory Group for National Specialised Services. To be clear, the JCPCT having made the decision, AGNSS then looked at the children’s ECMO services at Leicester and recommended to the Secretary of State that, in light of the JCPCT’s decision, those services should also be transferred to Birmingham.
I want to make it clear that it is unfortunate that the word “equipment” has been used. I am more than aware that the matter involves considerably more than pieces of equipment at Glenfield, and I pay full tribute to the team who work there, and indeed to the children’s heart surgery team there and to every team throughout the country. It is important to make it clear that no one is saying that a good service is not being provided, or that a service is bad or poor. The issue is all about ensuring that we get the very best service in fewer but bigger centres.
The Minister said that the issue is all about patients getting the best service, but I take her back to the point about the mobile service, which has been the subject of the thoughts of various hon. Members. Is there any way we can ensure that that aspect of the service is fully considered? If Birmingham will not commit to providing a mobile service, it is crystal clear that a number of patients will suffer.
I am grateful for that intervention. It may be argued that that is one of the implications of the JCPCT’s decisions. The children’s ECMO services at Leicester are being been moved over to Birmingham. That is an implication of that decision. Another implication is that there are concerns about the mobile unit for children’s ECMO as well.
The previous Secretary of State accepted the recommendations of AGNSS—the advisory group for national specialist services—and it is that information to which the hon. Member for Leicester South referred when he told us about his meetings with the then Minister, now the Minister of State, Department for Transport, my right hon. Friend the Member for Chelmsford (Mr Burns). The recommendations of AGNSS are made to the Secretary of State, on, as I understand it, a confidential basis. It is not normal for them to be disclosed, but the previous Secretary of State made his decision based on the advice of that service.
The question, as it has been rightly put today, is whether there is any challenge now to that decision. I am told that that is for the Secretary of State; he can, in exceptional circumstances, revisit that decision if those exceptional circumstances are made out. If the IRP wants another full review of all that has happened—it effectively calls into question the whole process, and so on—it obviously flows from that that the ECMO children’s service at Leicester must be retained in that event, because it flows from the JCPCT’s decision about where to have the specialist children’s heart services. In any case, if there is some other new or exceptional evidence that can be placed before the Secretary of State, or that he is aware of, he may be able to look again at the decision that was made by the previous Secretary of State. I hope that that is of some help. I can go no further and give no more detail, except, safe to say, that I am told that that is a rare and unusual event.
I remind everyone, as I conclude my remarks, what led to the review, the recommendations and the decisions. Concern about children’s heart services began a long time ago as a result of serious incidents in Bristol back in the 1990s. For some 15 years, therefore, it has been accepted, almost by everyone, that children’s heart surgeries were of great concern. National patient groups all agreed that what was needed was to ensure that we had surgeons, nurses and other health professionals based in larger, but fewer, specialised centres. That is why, as the hon. Member for Leicester West has identified, the previous Government set up the review. In many ways, it took courage to do so, because there had been a lot of talk about the issue but not much action. Everyone agreed absolutely that reducing the number of centres was necessary, so that we would have bigger numbers of surgeons, nurses and other specialists, and that the service could be better, but in fewer units. Therefore, to put it crudely, somebody was always going to lose out.
Although I have listened with great care to the remarks made by my hon. Friend the Member for Cleethorpes (Martin Vickers), this is an example in which we do not want a greater number of smaller units; it is a good example of where we want fewer, but much bigger units. It is perhaps worth remembering that children’s heart surgery has advanced considerably over the years, so that surgeons now operate on children who are often only two days old, with hearts the size of walnuts. It is argued that that is the most specialist, delicate and difficult of all surgery.
It is not surprising, given the service’s nature—the fact that it is for children and babies—that so many people who have experienced what Glenfield provides speak with such passion about it, and why they are so concerned about its future. That, too, goes for other places that have been told their facilities will be moved away—for example, from Leeds up to Newcastle. I pay tribute to all who have gone to the trouble of signing the e-petition in support of Glenfield. I can speak about the great campaign that was organised, having attended a Leicester Tigers rugby match some time last year; every seat had a leaflet on it and an event was organised in support of Glenfield. Other places, too, have organised campaigns, and rightly so. It is an indication of the passion and loyalty that such services engender in people.
There has, however, been a long process. There has been an independent review, aimed at ensuring that our children are operated on safely and given the very best services. As a result, tough decisions have been taken by the JCPCT. It has done that independently, and with considerable support from clinicians, royal colleges and many eminent bodies, as well as others who have spoken out in favour the proposals. However, today’s decision by the Secretary of State is to be welcomed. Everybody can now be assured that there will be an independent review of the decision—I stress the word “independent”. I have also made my observations about the possibility, if there is new evidence in exceptional circumstances, that the previous Secretary of State’s decision about the future of children’s ECMO at Glenfield may also be considered.
I hope that that will give some reassurance to hon. Members who have attended the debate. All their comments are listened to by both the Department and me. It is to be hoped that the review will be thorough, as I am sure that it will be, and swift; it will be concluded by the end of February.
I thank everyone who has contributed to the debate—whether the Minister, the Opposition Front Bencher or Back Benchers. It has been thoroughly useful, informed and informative, and I am grateful to everyone who has assisted in the process.
On the process, I suspect that my hon. Friend the Minister was tiptoeing around the issue, not wishing to trespass across a difficult line, but it is important not to confuse process with what we are sent here to do as Members of Parliament and as Ministers, which is not to confuse the substance with the means by which we make decisions. Our constituents expect us, as elected politicians, to come here and speak for them and say things that may be disobliging to those who hold the levers of power—and that is what we have done.
I know that the Minister is concerned—of course, she should be—that anything she says might be taken as ammunition that would fuel someone’s thoughts about a judicial review of a decision made by a previous Secretary of State, and I do not want to push her in any direction that might cause her that problem. None the less, we all know what lies behind her careful words. At least I do—I am sure that many others do as well—and I am entitled, as she is not, to rip away that veil and get to the heart of this question: what is to happen to the ECMO services, both adult and children’s, at the Glenfield centre, and what is to happen to the cardiac services for children at Glenfield? As has been agreed across the Chamber this afternoon, those are inextricably linked questions.
The House does itself no great service if it shilly-shallies around process and avoids the question. As Members of Parliament, we must ensure that the question is put. The question this afternoon has been put, and the Minister has done her best to answer it, but the message that she must take back to her Department is that we are not as fascinated as some of her departmental lawyers might be by who made which decision and whether or not the joint committee of PCTs is an independent reviewing body.
The Secretary of State has the levers of power in this question and he must pull them—he must exercise them—and make a decision. That is what he is paid to do, what he was appointed by my right hon. Friend the Prime Minister to do and what he was elected to Parliament to do. I am sure that the Minister will give him every assistance in reaching what is the inevitable answer to the questions posed this afternoon—namely, that the Glenfield ECMO unit, for children and adults, and the Glenfield cardiac services unit should remain open.
I do not care who made the decision or how the dainty route was created to get to it. We all know that the current decision is wrong and needs to be dealt with. The Minister, please, will go back to her Department and inform the Secretary of State that Parliament thinks that that decision is wrong and that Parliament requires the Government, through the Department, to change it. How they do that is up to them, but they must do it.
I thank the Minister for her patience in listening to us. I thank her for dealing with a difficult and, as she rightly says, emotionally charged subject. None the less, we have to set aside the emotion and the personal and heart-rending stories, make the right decision and just get on with it. I look forward to the Secretary of State writing us another letter, in a very short time, in which he adds to the letter of today’s date a decision to review the ECMO matter as well, because, as we all know, it is not possible to separate the two, and it is not possible to separate us, as elected representatives for our constituents, from this issue. We will stick to it like a barnacle until we are satisfied that the matter has been properly resolved. I look forward to having further such discussions with my hon. Friend the Minister in the very near future, but I thank her most sincerely for her presence here today and her contribution.
Question put and agreed to.
That this House has considered the e-petition from Adam Tansey relating to children’s cardiac surgery at the East Midlands Congenital Heart Centre at Glenfield, Leicester.