Congenital Cardiac Services for Children

Kevan Jones Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) in debate, something that I have not done for 15 years in this place, and as ever I agree with the broad thrust of what he has said. I welcome the opportunity to take part in this debate about the Safe and Sustainable review. I want to make two points about the case for the review itself and the case for children’s cardiac care at the Freeman hospital in my constituency.

The review of paediatric cardiac services in England and Wales was instigated in 2008 under the previous Government. It was instigated not by them, not by the civil service but by the health care professionals themselves. There were two previous reviews, in 2000 and 2003, recommending the establishment of fewer, larger cardiac surgical centres; in 2006, a national workshop of experts concluded that the current configuration was unsustainable; in 2007, the Royal College of Surgeons called for the concentration of surgical expertise in fewer, larger surgical centres.

The 2008 exercise has been carried out on behalf of the 10 specialised commissioning groups in England and their primary care trusts. The clinical case for the exercise is pretty formidable: clinical outcomes are better at high-volume centres; it is undesirable that surgical expertise is spread too thinly, because apart from anything else it mitigates against the provision of 24-hour surgical cover; the increasing complexity of what can be achieved argues for fewer specialist centres; it is easier for fewer units with larger case loads to retain surgeons and to develop expertise; and strong leadership from surgical centres underpins non-surgical cardiology care in local hospitals.

[Mr Kevan Jones (North Durham) (Lab)]

Will my right hon. Friend give way?

[Mr Nicholas Brown]

If my hon. Friend will forgive me, I will not.

There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.

I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.

The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.

Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.

No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.

I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.

My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made. I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.

--- Later in debate ---

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

It is a pleasure to follow my Leeds colleagues, and it is a pleasure to work with all the Leeds and Yorkshire and Humber Members of Parliament throughout the House in support of the inspiring campaign to save the Leeds unit. I too was proud to be there to help present that remarkable petition. Nearly half a million people in the region have spoken out in an attempt to save the unit. When I visited it, I had the same experience as other Members have had when visiting their local units. I found it incredibly moving to meet those babies and children and their families, while also being conscious that I was walking into a centre of excellence. It benefits from a genuine co-location of services, which is the gold standard that has been set, and 370 operations are already being performed there—very close to the 400 figure.

[Mr Kevan Jones]

I note the size of the petition, but as a former Defence Minister responsible for defence medical services I faced similar petitions when the Ministry of Defence was concentrating military health care at University Hospital Birmingham NHS Foundation Trust, which is now a centre of excellence not just in this country but internationally. Although petitions are valuable, clinical outcomes must be at the forefront of any decision, and the MOD’s decision to concentrate defence medical services at Birmingham was the right one.

[Greg Mulholland]

It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

--- Later in debate ---

[Mr Kevan Jones]

Does my hon. Friend agree that in County Durham, the concentration of adult cardiac surgery and emergency care at the Freeman hospital and the James Cook university hospital, which was controversial when it happened, has improved not only care but the survival rates of individuals from County Durham? Even though there are hospitals in the county closer to some people, survival rates have gone up because of that concentration.

[Pat Glass]

Absolutely, and we need to appreciate why such moves are necessary. None of us wants another Bristol baby tragedy, and I think there is general agreement that we need changes in the organisation of services to drive up the quality of treatment and bring together specialist surgeons to work in larger teams.