Health

Greg Mulholland Excerpts

Tuesday 17th July 2012 Commons Chamber

[Greg Mulholland (Leeds North West) (LD)]

I rise to take the opportunity to discuss the Safe and Sustainable review into children’s heart surgery in England and Wales and the concerns about the process that led to the closure of the excellent Leeds unit. The decision was taken on 4 July. Families from up and down the country were asked to be present to give their views and the joint committee of primary care trusts—the JCPCT—deliberated in public all day. The decision was due, but it was delayed, delayed and delayed again, until it was finally announced that Leeds would close. What left a particularly nasty taste in the mouth was that it was abundantly clear when documentation was produced that the decision had already been taken and that that day, including asking the families of children who had needed to use the surgery unit, was a charade. I am afraid that that was all too typical of the way in which this process has been handled.

There are serious questions about how the JCPCT reached that decision. It ignored clear evidence and, I am afraid to say, there has been a clear and obvious bias all along towards Newcastle. Leslie Hamilton was on the committee despite being based at Newcastle, but there was no one from Leeds. No one in Leeds or, I am sure, up and down the country was at all surprised at the decision, because we expected it. We could see that the JCPCT was simply not considering the evidence.

In the brief time I have available I shall raise a few points and I know that my hon. Friend the Member for Pudsey (Stuart Andrew) will raise a few more. I am sure that other hon. Members will also seek to do so and I shall look forward to having a full debate in the autumn, when we can place on the record the myriad serious concerns on this point.

First, 600,000 people signed a petition in support of the retention of the unit at Leeds, yet that was counted as only one response by the committee. At the same time, 22,000 text messages from unknown sources supporting Birmingham were counted as 22,000 submissions. So, how can the JCPCT say that it does not “count heads” when it is ignoring 600,000 people, counting them as one submission, yet counting 22,000 text messages as 22,000 separate responses?

Why has the JCPCT watered down expert advice on the gold standard of collocation? It has adopted a watered-down version on the advice of fewer than 10 clinicians in the steering group and on the recommendation of Sir Ian Kennedy, who is not a clinician. How can the panel justify following that advice rather than that of the country’s most respected gatherings of experts in this field? How can it be right, if this closure happens in Leeds, for the Yorkshire and Humber region to go from enjoying the highest standards of collocation in the country to having the lowest?

The Safe and Sustainable model of children’s heart surgery is also dependent on networks of care, but whereas the Leeds network was recognised as “excellent”, Newcastle’s was regarded as “poor”. Why is the Yorkshire and Humber moving from a centre that delivers an excellent network to one with a record of delivering a poor one?

The JCPCT accepted the advice that 90% of doctors in the relevant areas of option B would be happy to refer to Newcastle, yet the referring doctors in Yorkshire and Humber have never been asked about that. That is simply outrageous.

I am aware that there has been a referral from the joint overview and scrutiny committee in Yorkshire, which we fully support and insist is properly investigated. We must also consider the very worrying situation in Glasgow. The Yorkhill unit is currently failing and a separate report by Sir Ian Kennedy stated:

“The panel had significant concerns about important aspects of the service in the surgical unit and in the broader congenital heart network. Of most concern was a lack of leadership and coherent team working. Also of concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressed.”

That has not been part of the review, however, and extraordinarily the Scottish Government have now decided that three surgeons performing 300 operations is safe in Scotland. However, that is not considered to be safe in Yorkshire. That is simply unacceptable. Today we are saying that we have no confidence in the review and that we want the whole process to be reconsidered.

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[Jason McCartney]

I thank the Minister. I said earlier that the decision would go to the Secretary of State via the independent panel. I look forward to its going through that process.

The first test for redesigning services is that there should be clear clinical benefit. The health impact assessment was that option G—to keep Leeds open—had fewer negative impacts than the chosen option. The second test is clinician support. There is no evidence that the decision has the support of clinicians; in fact, most have given their support to the Leeds unit.

The third test involves the views of the public. Surely nothing can be clearer than the views of the 600,000 people who signed the petition to keep the Leeds unit open, and the admirable cross-party support for the campaign. The fourth and final test is that there should be support for patient choice. A survey in west and south Yorkshire clearly shows that patients would not travel up to Newcastle.

Many constituents with experience of the Leeds unit have been in touch since the announcement on 4 July.

[Greg Mulholland]

The evidence clearly shows that Newcastle will not hit the magic number of 400, making the point of the process farcical. As we now know that Glasgow will continue, but will perform only 300 operations a year, there will be two underperforming units, and we will have lost Leeds, which could easily reach those numbers. Does that not make the whole thing a farce?

[Jason McCartney]

My hon. Friend makes a good point. There is an assumption that all the patients who have been going to the Leeds unit will automatically migrate to Newcastle. That is a big flaw in the assessment, and I look forward to further exploration of that matter.

Constituents who have been in touch with me include teenager Seb, who recently did work experience with me. He had three heart operations and a pacemaker fitted at Leeds. He wants the Yorkshire unit to stay open; he stresses the fact that there are good transport links to the Leeds unit.

Paul told me about his 10-year-old stepson who suffered a cardiac arrest last August. His stepson had a defibrillator fitted internally, which he will have for the rest of his life. Paul said the Leeds location was key for their family.

Ruth told me about her six-month-old daughter Eleanor who was born with a heart defect caused by Down’s syndrome. Ruth fears for the emotional and financial stress families will be put under by the longer travelling distances, as parents try to hold down their jobs, care for other children and fulfil other responsibilities.

I was also contacted by the grandparents and, separately, the parents and siblings of four-year-old Lily Rose, who had surgery in the Yorkshire unit. They asked how a four-year-old was expected to cope at such a traumatic time without being able to see her mummy each day. The emotional impact on the rest of the family would be enormous. They stressed that distance from the centre is extremely important. They reiterated the population figures: 14.5 million people are within two hours of Leeds, whereas only 3 million are within two hours of Newcastle.

Those cases are real; the families were in touch with me over the past two weeks. In the past year, I have spoken in the Chamber about George Sutcliffe, Ben Pogson and Joel Bearder who, with their families, have been campaigning locally for the Leeds unit to stay open. I compliment them and all the families who have worked so hard on the campaign, and will continue to do so.

It is clear that the plans do not meet the four tests, which are factual; they are not about emotion. I look forward to the flawed decision eventually being referred by the independent panel to the Secretary of State so that the tests can be looked at again. I firmly believe the JCPCT decision clearly fails all the four tests for redesigning services, and I look forward to its being reconsidered.

[Mr Andy Slaughter (Hammersmith) (Lab)]

On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.

Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.

The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond Street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.

Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:

“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”

Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.

Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.

[Greg Mulholland]

The hon. Gentleman makes a passionate case for the Royal Brompton unit. The chief executive of Little Hearts Matter says that, in the Glasgow case, a unit that does 300 operations can be made perfectly safe by other means, without closing units. Does the hon. Gentleman share my frustration at the fact that in the Royal Brompton, Leeds and other places, those involved are not prepared to do that? It does not make sense.

[Mr Slaughter]

I am grateful for that intervention, because, in case my comments are seen as special pleading from the hospital, I was just coming on to mention some independent recommendations and sources that support the argument that, if there is no opportunity for research, and if experts—in Leeds, as well as the Royal Brompton—are prevented from working to the level of their abilities, many are likely to seek work elsewhere, possibly outside the UK.

Dr Neil Gibson, a consultant in paediatric respiratory medicine at Glasgow’s royal hospital for sick children, wrote to the chair of the review as follows:

“The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record…There is a significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.”

Professor J. Stuart Elborn, president of the European Cystic Fibrosis Society, wrote that

“high quality research is a key determinant of the ability of a centre such as the Royal Brompton to retain and recruit the world leading clinical and academic staff on whom its respiratory services depend. Adverse impact upon the ability of the clinical staff to carry out cutting-edge research will undermine the sustainability of the clinical services, to the detriment of its patients.”

Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign, and the Primary Ciliary Dyskinesia Family Support Group wrote a joint letter to the chair of the committee, saying:

“We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future.”

Patients and staff at Royal Brompton are understandably deeply distressed at the prospect of losing their high-performing children’s heart unit, soon to be followed by their specialist respiratory services. They do not understand how such a decision can be made by bureaucrats who have never visited the hospital and have no specialist knowledge of the care provided there. They have written to their MPs and to the Secretary of State. Indeed, one resourceful mother brought the matter to the attention of the Prime Minister in Downing street last Thursday.

The Secretary of State for Health assures the parents of these seriously poorly children, and the dedicated teams that treat them, that this is a matter not for him, but for the NHS. For the sake of the thousands of children whose care will be damaged by the decision of Sir Neil McKay’s committee, the sake of the research programmes that will be destroyed, and the sake of common sense, I hope that the Minister of State will realise that the time has come for him to meet clinicians from the Royal Brompton and at least hear what they have to say. Perhaps he will be able to persuade them that destroying NHS services and research programmes that are viewed by international peers as among the best in the world is a good idea. I wish him luck in doing so.

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[Stuart Andrew]

My hon. Friend is right. I am sure that that is the case for constituents across Yorkshire and the Humber.

[Greg Mulholland]

I am happy to be working so closely with my hon. Friend on this matter. When all the evidence is considered, is not the reality that Leeds is being sacrificed simply to allow Newcastle to achieve a level of operations that it might not even achieve? That is no reason to close a good unit.

[Stuart Andrew]

I could not agree with my hon. Friend more.

The decision flies in the face of a fundamental aspect of the NHS constitution: patient choice. The JCPCT asserts that Newcastle could reach the minimum number of procedures if parents are “properly managed” to go to there. That is simply unacceptable. The whole point of patient choice is that people decide where they want to go.

As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, the review ignored a petition of 600,000 people, counting it as only one response, when 22,000 text messages in support of the Birmingham unit were counted as 22,000 separate responses. Why was that?

The scores in the review were allocated to four bands. Each of the points from one to four were multiplied by the weighting. That gave 286 points to Newcastle and 239 points to Leeds. However, there was no clarification of how the figures had been arrived at. Also the figures were not definite, but were rounded up or down, which may have made a huge difference to the outcome.

As has been mentioned, clinical experts at the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists all say that surgical centres should be chosen on the basis of their having paediatric services all on one site. That is something that we enjoy in Leeds, which has a wonderful children’s hospital with all the services that are needed. On meeting such children, it is clear that they need the support not just of heart surgeons, but of other experts. In Newcastle, the extra support will be some 3 miles away. There will therefore be a worse service for people who live in and around Yorkshire, not the world-class service that we all want.

There is much more detail that I would like to go into. I sincerely hope that we will have a Back-Bench debate on this issue when we come back in the autumn, because it is of grave concern to hundreds of thousands of people in the Yorkshire region. We will not give up our fight to save our unit.