Paediatric Cardiac Surgery

Baroness Morgan of Cotes Excerpts

Wednesday 7th July 2010 Westminster Hall

[Liz Kendall]

I agree absolutely with my right hon. Friend. Many parents and staff are rightly concerned about the implications of travelling longer distances, particularly in emergencies.

I am a former director of the Ambulance Service Network, and I know that paramedics are highly trained professionals—increasingly to degree level—who can provide lifesaving treatment for patients while taking them to specialist centres further away, but that is not always possible, and the review must thoroughly consider the implications of further travel for the lives that could and will be saved.

High-quality care is not just about standards of surgery, the links with other specialisms or the ability to access planned and emergency care. A recent event organised to discuss children’s heart surgery in Leicester was attended by more than 800 parents and former patients, and those present felt that many more people would have attended if the event had not been held mid-week and during working hours.

The families said that the help and support that they get from the nurses, doctors and other staff at Glenfield are outstanding, and the key point that came up time and again was the excellent communication and support provided by the centre. Parents spoke about how staff go the extra mile to explain diagnoses and procedures simply and clearly, often at a frightening and worrying time. Every child gets a diary that explains in a way the whole family can understand what care they have received. It provides something for the children to look back at when they are older.

Parents said that the staff were like members of their own family; they could ring them day or night if they had any concerns. That familiarity with individual patients and families is crucial. All the studies by groups such as the Picker Institute of patients’ experience of care prove that individual, personalised care and communication are vital. One young man said that the staff knew him as a person, not as just another case, and that he was worried that that would be lost in a larger unit or if his care were split between outreach clinics and other centres.

Families also spoke about the fantastic help they get from the Heartlink charity at Glenfield, which has raised money to provide accommodation so that parents can stay overnight with their children, a play area so that brothers and sisters can play while families are visiting the child, and day trips for the patients as they get older. Those wider aspects of care are vital to parents and patients, but are barely mentioned in “The Need for Change”. I urge the Minister to ensure that the review has fully considered those issues when it makes its recommendations.

The final factor that the review of children’s heart surgery needs to take into account is affordability. It must be driven by the need to improve quality, not to cut costs, and, in these financially constrained times, it must acknowledge that there will be costs associated with changing children’s heart surgery in England.

[Nicky Morgan (Loughborough) (Con)]

Like the hon. Lady, I have visited the Glenfield centre, which is close to my constituency. As the parent of a healthy child, I felt humbled by the care that I saw there. The point that she is making about cost is important, because we appear to be achieving neither safer care—there has always been safe care—nor more efficient care. I understand that the reconfiguration would be very expensive, and she speaks rightly about straitened economic circumstances at this time.

[Liz Kendall]

I agree absolutely with the hon. Lady. The costs associated with changing children’s heart surgery centres include not just physically expanding a centre’s buildings, beds and equipment, but retraining staff. When I went to Glenfield, I was told that many of the staff would not move if the centre were changed. It takes time and money to train new staff, particularly in such a specialised area, and the review must take that into account when it makes its recommendations.

--- Later in debate ---

[Mr Burns]

As I said a minute ago, that recommendation is the consensus within the professional bodies. However, I am more than happy to give the hon. Lady a commitment that I will write to her after this debate to elaborate, providing as much extra detail as I can, if she believes that will be helpful.

Turning to the other criteria, the review will also take account of surgical centres’ physical location relative to others and the impact of reconfiguration on other important services, including the highly regarded ECMO or total life support service at Glenfield hospital in the hon. Lady’s constituency, which she described with such eloquence in her remarks. The final part of the review will involve centres’ ability to attract key clinical staff and their families. I hope I can reassure the hon. Lady that transportation options and travel distances will be evaluated, including travel times specifically. The Paediatric Intensive Care Society has advised on the issue, and we continue to investigate and seek advice. I appreciate fully the importance of the issue and the concern that it causes many families.

[Nicky Morgan]

Will the review also consider the impact on other services? For example, at Glenfield, there are two intensive care units for children in the city, and I understand that one team covers both. If the centre were to be closed—this might also apply to other centres—it might destabilise other services within the hospital.

[Mr Burns]

The short answer is that I cannot make that commitment myself. As my hon. Friend will appreciate, the review is independent and will be carried out at arm’s length from the Department of Health and Ministers. I do not have a role, and it would not be correct for me to seek to interfere in the process. However, having said that, I am confident that my hon. Friend’s point will be considered as part of the review, because it will be comprehensive and across the board, considering all aspects of this highly specialised and important health care provision. I hope that reassures her.

The available research evidence suggests that larger surgical centres deliver better clinical outcomes. As cardiac expertise is available round the clock, they can perform a wider range of complex procedures, meaning fewer transfers between centres. Larger centres can still provide a personalised service. The service standards make it clear that tailoring services to the needs of each child is critical. That is an extremely important factor that I know the hon. Member for Leicester West understands and accepts fully.

I also assure the hon. Lady that any changes to local health services will not be driven from the top down. The review has strong support from external organisations. It has been instigated at the request of parent and patient groups, clinicians working in the service and professional associations, including the Children’s Heart Federation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain and Ireland. It is important to understand that any recommendations on the future number and location of surgical centres will be made not by any central body but by the 10 specialised commissioning groups working with local NHS commissioners. The review will consider access to services for the whole country.

The national specialised commissioning group was asked to lead the review because of its co-ordinating role across the 10 specialised commissioning groups. I am sure that the hon. Lady will agree that that was the most sensible approach to take when the review was devised and set up just over two years ago in 2008. The group was ideally positioned to engage with commissioners and clinicians from across the country.

I reiterate that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of paediatric cardiac services. It will be an open process; I assure the hon. Lady that the outcomes are not predetermined. It is a genuine review seeking genuine answers in order to maintain the highest standards of quality in a specialised and difficult area of patient care. The national specialised commissioning group will set up a consultation process on its recommendations and standards this autumn. We must wait and see what the review says and then go through the consultation process, during which anyone will be able to input their thoughts, recommendations, comments, criticisms or praises of the review’s findings, before any final decisions are taken.

I thank our external partners and their patients for their input to the review so far. I find it encouraging that the review has broad support across the board. As the hon. Lady will accept, children deserve the best possible care. The Government are determined to provide the best paediatric cardiac care possible after the review and consultation processes have been concluded and the final decisions reached.

Question put and agreed to.