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Glenfield Hospital Children’s Heart Surgery Unit

Volume 615: debated on Wednesday 19 October 2016

I beg to move,

That this House has considered the future of Glenfield Hospital’s Children’s Heart Surgery Unit.

It is a pleasure to serve under your chairmanship, Mrs Gillan. The future of Glenfield’s children’s heart surgery unit is a hugely important issue not only for my constituents and patients in the east midlands but for people across the country—Glenfield currently serves patients from 296 parliamentary constituencies. The Minister will know that 34,000 people have signed an online petition to save the unit, and I understand that many thousands more have signed the paper petition. That shows the strength of local feeling.

Like the hospital, I support NHS England’s desire to achieve the highest possible standards for children’s heart surgery across the country. NHS England’s standards rightly state that it must be able to

“reserve the right not to commission services from a provider that is so significantly at variance from the standards as to cause safety/quality concerns. Such a decision would only be taken following a risk assessment of the costs and benefits of both closure and non-closure.”

However, there is no evidence that Glenfield is at significant variance from the standards—in fact, quite the opposite. According to independent assessments, Glenfield has among the best clinical outcomes in the country, including for mortality rates and readmission rates, which are significantly lower than those in other centres. Clinicians at Glenfield rightly say that it makes no sense to close a centre that is already achieving precisely the good clinical outcomes NHS England wants.

I congratulate the hon. Lady on achieving this debate, which continues the public debate we have been having in the county and the city in respect of the hospital. Does she agree that the hospital and its children’s heart unit not only has a regional and national reputation of the highest order but is a world centre of excellence, and for it to be closed or for any of its services to be decreased would be little short of wanton destruction? I urge her to urge the Minister to take that message firmly back to his Department.

I completely agree with the right hon. and learned Gentleman. I am sure that not only the 57 patients from his constituency who are currently receiving treatment but the thousands of patients who receive ongoing care, including for extracorporeal membrane oxygenation, which I will come back to, rightly value the high standards at Glenfield. It would be a huge and terrible mistake to close the centre.

In a recent letter to the hospital, NHS England raised concerns that more complex cases are being referred to Birmingham from Glenfield. I take issue with that. I would like the Minister to confirm that, in fact, only four such cases have been referred to Birmingham in the past three years, and that it is a professional obligation to seek second opinions when that is in the best interests of patients. That is enshrined in General Medical Council good practice guidelines and was recommended by the paediatric and congenital services review group in its recommendations in 2003. Few complex cases are referred but, when they are, it is in the best interests of patients. That should not be used as a reason to close the unit.

A second part of the standards that NHS England has set out is ensuring that sustainable numbers of children have surgery in each unit every year. The aim is to have 375 operations per year over the next three years, with 500 a year in the longer run. I want to make this clear: the hospital has told me and NHS England that it is on track for 375 cases this year and that, if it does not quite achieve that, it will not be by significant numbers. It therefore rightly asks: “Why put a centre on track to reach those standards at risk by this proposal?”

On the longer term goal of achieving 500 cases a year, there is an important question. More than 500 children in the east midlands need congenital heart surgery every year but do not all go to Glenfield. NHS England claims that that is due to patient choice. Some patients in Peterborough or Northampton will choose to go to places such as Great Ormond Street, but the claim that all patients in Northampton choose to go to Great Ormond Street while all patients from Peterborough choose to go to Leicester suggests the goals are more about historic referral patterns than about genuine patient choice.

I thank my hon. Friend for securing the debate and for all the campaigning she is doing on this important issue. I could raise many constituency cases, but I will raise just one. Scarlett from Kirkby was minutes from dying by the time she arrived at Glenfield. Her mum, Zoë, told me that she would not have made it any further than Glenfield. Keeping Glenfield open is a matter of life and death for so many children.

I thank my hon. Friend for raising that point. She is absolutely right. Many patients and their families have told me that they simply would not be alive if they had had to travel much further. If the proposal goes ahead, the east midlands will be the only region in the country without a children’s heart surgery unit. It does not have to be this way, because if we properly manage the number of referrals across the east midlands, there will be enough for Glenfield and other surgery units to keep going. It is a balance between getting the right numbers and having quick access to a centre.

I thank the hon. Lady for initiating the debate. May I reiterate the point made by the hon. Member for Ashfield (Gloria De Piero)? My constituents who have contacted me about the hospital live a long way from Leicester—some of them live virtually on the South Yorkshire border, many miles away—and have used the hospital not just for routine surgery but for emergencies. They already have to drive 60 miles to get to Leicester, but if they had to go to Birmingham or Great Ormond Street, it would put lives at risk.

I share the hon. Gentleman’s concerns. We have to be aware that it is not just about the essential, vital emergency care and surgery when it is a matter of life or death and whether children can reach a centre in time. It is also about ongoing care and support. It is not just that they have one or two operations when they are little; they need care and support right through into adult life.

We must remember that children are part of families, and families have obligations. They have other children they need to get to school and they have work commitments. To throw that up in the air when they have those arrangements and their children need ongoing care and support is denying those patients choice.

My hon. Friend is doing an excellent job in presenting the case. My young constituent, Jack Phillips, will be celebrating his first birthday later this month thanks to life-saving open heart surgery at Glenfield. His dad, Christopher, wrote to me:

“At such a devastating time having the support of our family who were able to visit from Nottingham regularly while we were in Leicester was vital to us.”

Is that not one of the issues about a centre being within easy reach of other parts of the east midlands?

My hon. Friend is absolutely right. We have to think about people’s needs in the round—the need for high-quality surgery; ongoing care and support; and, critically, help for those families for whom this is a terrible, frightening and ongoing experience. Making the east midlands the only place without a heart surgery unit does not make sense.

It does not have to be this way. In its own standards, NHS England says:

“Networks will need to establish systems to ensure that referrals…between centres are managed in such a way as to ensure that each clinician is able to achieve their numbers”.

Its own standards say that people need to work together so that everyone can achieve the best. However, at the moment NHS England is not developing the work. I am a long-standing champion of patient choice, but the current proposals deny choice to patients from across the country who use Glenfield children’s heart surgery unit on an ongoing basis.

I pay tribute to the hon. Lady for securing this important debate. The Glenfield children’s heart unit is vital not only to my constituents but, as she said, to people across the east midlands and beyond. She has alluded to the significant progress that the hospital has made in just the past year in driving up the number of referrals and operations. That significant progress gives me confidence that it is on track to meet its target. Will she join me in urging the Minister to press NHS England to pause, look at the excellent clinical outcomes and the progress on increasing referral numbers, and think again, to keep this hugely important children’s heart unit open?

The hon. Gentleman makes an extremely important point. The clinicians at the unit and the hospital bosses have striven continually to improve patient care. They are not complacent for a second. They bust a gut to keep making improvements. Those improvements will, I am sure, be recognised and acknowledged by the 58 patients in the hon. Gentleman’s constituency who are receiving continuing care at Glenfield. He is right to say that NHS England needs to look in detail at the improvements that have been and are being made. When NHS England came to the centre in September—I was more than a little disappointed that it had not made a visit before it launched its proposals to close the unit—it found that some of its perceptions were wrong.

One important standard for improving care is co-locating—bringing together, in other words—the different children’s services, which includes not just surgery but other heart support, paediatric intensive care and wider services available to children. NHS England initially marked Glenfield down for not having plans to co-locate services. I am afraid that that was completely and utterly wrong. On coming to the centre it discovered that there are indeed such plans. I would like the Minister to confirm that University Hospitals of Leicester trust has plans to complete the co-location of all the services before April 2019, and has secured all the capital budget necessary to build its new children’s services hospital. To put all that at risk when the hospital is trying to improve services would be a big mistake.

Finally, I want to discuss the impact on other services in Leicester and the region of closing the children’s heart surgery unit. It is extremely important. As I said earlier, NHS England has itself said that it would not put forward proposals to close the unit unless it had done a risk assessment of the costs and benefits, including the knock-on effect on other services. It has not yet done that. I am concerned about two services in particular. Glenfield has a world-leading extracorporeal membrane oxygenation service. Essentially, if someone has a weak heart and needs surgery on it, ECMO enables oxygen to be pumped back into the blood during the operation. Glenfield’s is only the second ECMO service in the world to treat more than 2,000 patients. It conducts 50% of the entire ECMO activity in the UK. It also has the country’s only national patient transport service enabling people who need ECMO to be transferred swiftly from anywhere in the country to Glenfield. The huge benefits of that service were seen during recent flu crises.

I thank my hon. Friend for being so generous in giving way again. My constituent, Alice Parker, was born at Queen’s Medical Centre 17 years ago. Her condition was so grave that her mum, Vicki, was told to expect the worst, but thanks to the expertise of staff at Glenfield who provide ECMO, Alice is now studying for her A-levels at Bilborough College and hoping to go to university to study biochemistry. Vicki describes the centre as “a true national treasure”, but actually, as my hon. Friend has said, it is an international treasure and it is vital that we do not lose the service.

That is right, and in fact Glenfield’s ECMO training is currently being provided not only to people from three other UK centres, but to people from seven other countries. NHS England seems to think that that work can be picked up and transferred somewhere, quickly and immediately, without loss of quality. In fact, as I know from speaking to many clinicians and nurses, that is not as easy as NHS England says.

I thank the hon. Lady for bringing this important debate. Given that Glenfield’s outcomes are among the best in the country, and having listened to accounts of the expertise it offers, I wonder whether she will, with me, encourage the NHS to rethink its decision to close it.

Absolutely. It would be a big mistake and it does not have to be this way. The unit is improving its care. It already has some of the best outcomes in the country. If we manage the referral patterns, we can ensure that Glenfield and other units continue to improve their care and support. I am sure that the 41 patients from the hon. Lady’s constituency who are currently being treated at Glenfield will appreciate her speaking out.

UHL is one of five tier 1 providers of acute specialised services in the midlands and the east region. Our amazing paediatric intensive care unit is part of a network of centres covering 17 million people. Any significant change in the number of children with complex heart problems being moved away from UHL will have a serious impact on the PICU and destabilise the network. That is not my view—I am not a clinician—but what the clinicians in the hospital tell me, yet so far NHS England has failed to publish any risk assessment of those knock-on effects on Glenfield’s ECMO or paediatric intensive care. The continuing uncertainty about the unit is terrible for the clinicians who are working there and trying to improve care. The threat of closure may be one of the reasons why it is not receiving as many referrals as it normally would, but it is also deeply destabilising for the families whose children need ongoing care and support.

I am grateful to the hon. Lady for letting me intervene on her twice. I concur with the point she made: the situation makes it very difficult to attract clinicians, nursing staff and technicians to such a hospital. We need the expertise but, if there is a state of confusion or uncertainty, things become more difficult. I know that my hon. Friend the Member for South Leicestershire (Alberto Costa) wanted to make that point—he has many constituents who work in or use the hospital—but unfortunately, owing to parliamentary business, he was unable to be here at 11 o’clock.

I know the hon. Member for South Leicestershire (Alberto Costa) would have spoken up on behalf of the 94 patients in his constituency who are receiving ongoing care and support.

It is a miracle that Glenfield is providing such incredible standards of care when it has been under the cloud of uncertainty for so many years. It makes no sense to close a unit whose clinical outcomes are already among the best in the country. It makes no sense to deny choice to hundreds of patients who are treated or want to be treated at Glenfield, and their families, when, if services worked together to achieve the number of referrals that we need, our unit and others could benefit and improve. It makes no sense to leave the east midlands as the only region in the country without a children’s heart surgery unit, or to put at risk a world-leading ECMO unit and a vital, high-quality paediatric intensive care unit that supports millions of patients across the midlands and the eastern region.

The Government must think again. They must look in detail at the current evidence from the hospital about its outcomes; they must listen to the views of patients; and they must balance all of those issues—high-quality surgery, ongoing care and support, the knock-on effect on other services and whether other units in the country would be able to treat all those extra patients before they have made huge improvements, which will take time. It does not make sense. It does not have to be this way. We can work together to save the unit and improve care for everybody.

It is a great pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Leicester West (Liz Kendall) on securing the debate and on speaking with such evident passion and knowledge on the subject. I think she has impressed us all with her grasp of the issues. I also congratulate all other hon. Members, from both sides of the House, who managed to secure an intervention during her speech. They made their points clear, with some personal testimony from constituents who have used these facilities, and also made clear how important it is to the region of the whole, in their eyes, that the facility continues.

The future of congenital heart disease services at Glenfield hospital is an important subject, not just regionally but as part of the national plan to ensure that we have world-class heart facilities for infants and children in this country. It is a matter that has been around for some time, and I understand the point the hon. Lady and others made about how unsettling the uncertainty around the future of services is for the dedicated staff who work in those units. It is appropriate that we try to bring these discussions to a head in an orderly, thoughtful and timely way, so that that is not prolonged.

It is worth emphasising that NHS England’s review is about ensuring that CHD services are delivered with high quality and that they are consistent and sustainable for the future. The common standards, which have been agreed by clinicians, other experts and patients, are the driving force to make sure every patient benefits from the same excellent care. It is worth reminding hon. Members present that the proposals for changes to adult and children’s congenital heart services at Glenfield and the other centres across the country are at present just that: proposals. They are not final decisions. NHS England will be consulting on the proposals in the coming months, so it is not appropriate for me to respond in detail to all the concerns raised here today.

The hon. Member for Leicester West asked some specific questions, some of which I will be able to address but most of which, I regret to say, I will not. Those will be drawn out when we come to the consultation, so that the points she made about the current performance of the hospital can be brought to attention through the consultation process.

I am soon to meet the Minister at the Department of Health. If he is not able to answer the specific questions I have raised, perhaps he can come back to me on those issues at that meeting next month.

The hon. Lady has put her points on the record. I will be able to respond to some next month, but some will be part of the consultation, which we anticipate will get under way in the new year.

I am trying to put this in context, particularly in relation to the amount of time that we have been considering how to create excellent centres of congenital heart surgery for children across the country, which has been the subject of concern for more than 20 years. Clinical experts and national parent groups have repeatedly called for change, and there has long been an overwhelming feeling that change is needed. Added to that is the fact that children’s heart surgery has become ever more complex and technically demanding. Surgeons now operate on babies who may be only hours old, which demands a highly-skilled and technical team of doctors and nurses who maintain those skills through regular practice. That is why standards are being progressively raised for each surgeon over time, as the hon. Lady referred to.

As I am sure everyone involved in the Glenfield debate is aware, the process of consultation began quite a long time ago. A Safe and Sustainable review was launched in 2008 by the Department of Health under the previous Labour Administration—of which the hon. Lady was a member—to start addressing these issues. The decisions that came out of that review were challenged in court, via referral to the Secretary of State and subsequently to the independent reconfiguration panel. As a result of those challenges, the Safe and Sustainable review was halted. Responsibility for reviewing children’s CHD services was then handed to NHS England, which decided that its new review of those services would also encompass services for adults.

NHS England’s review team consulted extensively with patients and their families, clinicians and other experts before publishing the new standards for CHD services, which only came into effect in April this year. Hospital trusts providing CHD services were then asked to assess themselves against those standards and report back on their plans to meet the standards within the set timeframes. In July this year, following those assessments and further verification with providers, NHS England announced its proposals for change.

In the case of Glenfield, NHS England is minded to work with University Hospitals of Leicester to safely transfer CHD surgical and interventional cardiology services from there to appropriate alternative hospitals. The rationale for that is that NHS England is currently of the view that Glenfield does not meet the standards to be a centre for surgery and interventional cardiology, and is unlikely to do so in the future. The hon. Lady eloquently expressed her belief, presumably based on conversations with the hospitals and with clinicians, that they are on track to meet those standards. That will be important evidence to make available to the consultation, and I am sure that she and other hon. and right hon. Members will do so over the months of the consultation. NHS England’s assessment is based on information provided by the trust itself about surgical numbers, surgeons and their expertise, and which specialist services are located together. It has not come from the centre; it has come from the trust itself.

There is no plan to close Glenfield as a provider of CHD services, other than in relation to surgery. NHS England is instead proposing to continue to commission specialist medical services that make up much of the pre and post-surgical care required by people with congenital heart disease. Closing the medical services for CHD at the hospital is not mentioned under any of the proposals. That has understandably prompted much concern, including about the impact that such a transfer might have on issues such as children’s extracorporeal membrane oxygenation—ECMO—services and paediatric intensive care services, as the hon. Member for Leicester West identified. As I understand it, when the review was undertaken in 2008, Glenfield was not only the first hospital in the country providing ECMO services but was the leading hospital. There were not many others. Today there are five centres offering ECMO services, so Glenfield is not in quite as strong a position as it was a few years ago.

The hon. Lady referred to the petition on Glenfield and the many hundreds of thousands of people who have signed it, which demonstrates the strength of public support for maintaining the service. It shows how passionately people feel about these issues and their strong desire to defend their local services. At this stage I reiterate to those people that no final decisions have been made. We need to wait and see what comes from the next stage of the process, and I am sure the petitioners will make their views known during that. I appreciate that hon. Members may be frustrated that I cannot answer all their questions at this stage. The hon. Member for Leicester West has referred to the meeting we will have in the coming weeks. I look forward to that and to attempting to answer some of her questions.

I remind hon. Members that this is not about cutting costs—that allegation has not been made by anyone during the debate, which I appreciate. It is about trying to improve the standard of service for some of the most sick infants and children in the country, and to ensure that we have a robust, sustainable pattern of expertise in a slightly smaller number of hospitals. Precisely where we get to in deciding which hospitals should provide those services in future will come through the consultation that will take place. The intent is for a formal, three-month public consultation that will conclude in the spring, with decisions being made next summer. I am sure all hon. and right hon. Members present will participate in that debate and I look forward to hearing their contributions.

Question put and agreed to.

Sitting suspended.