Children’s Heart Surgery

Stuart Andrew Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

I think we have been having a constructive discussion about an extremely difficult issue, in which I hope I have spoken for the whole House in saying that there are things that we need to learn on all sides, as the earliest signs went back as far as 1984 and still, in 2013, we have not been able to make the progress we should. It is important that we maintain that bipartisan approach, because at the end of this process there will be difficult decisions to make and we need to maintain public confidence that we are thinking about this in a non-party-political way.

[Stuart Andrew (Pudsey) (Con)]

I think I can hear the cheers in Leeds as I speak. May I put on the record my thanks to the IRP and to my right hon. Friend the Secretary of State for listening to our concerns in a very difficult situation? These findings clearly vindicate what we have been saying all along, but as we move forward will he agree to meet me and clinicians to maximise confidence in the future review? Will he assure us that co-location of services, accessibility and patient experience are paramount and that all units will have the same scrutiny as the one in Leeds has undergone? May I invite him to visit the unit in Leeds, so that he can meet the patients, families and staff with whom it has been my privilege to work?

[Mr Hunt]

I congratulate my hon. Friend on campaigning for children’s heart surgery in Leeds in an exemplary way, and he deserves huge credit for the responsible approach he has taken throughout. I would be delighted to meet him and clinicians from Leeds. Many things need to be learned, but his points about the importance of the patient experience, of clinical outcomes and of an impartial process in site selection, which is at the heart of the concerns people had about this process, are ones we need to reflect on very hard indeed.

Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 11th June 2013 Commons Chamber

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight that there has, in the past, sometimes been unacceptable variation in the quality of post-natal care. That is why we are increasing the number of midwives and have done so by nearly 1,400, and why we are putting money and effort into increasing the number of health visitors, who play a vital role in supporting mums, babies and families in securing that important bond, and in supporting mums so that they get the right help when they suffer from post-natal depression.

[Stuart Andrew (Pudsey) (Con)]

3. What plans he has for the future of children’s heart surgery provision in Yorkshire and the Humber.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I asked the Independent Reconfiguration Panel to undertake a full review of the “Safe and Sustainable” review of children’s congenital heart services. I have received and am currently considering that advice, and will make my decision known shortly—perhaps very shortly.

[Stuart Andrew]

I am grateful for that answer. Will my right hon. Friend accept that the Leeds unit has undergone the greatest scrutiny of any of the units included in the review, and has met all the standards required? Will he therefore assure patients, families and staff that both he and NHS England have every confidence in the performance and standards of the Leeds unit? If we are to have informed choices on the future of heart units, surely all units must be subject to the same scrutiny.

[Mr Hunt]

First, I want to congratulate my hon. Friend on the sustained campaigning that he has done for that children’s heart unit, and on the very responsible way that he has conducted himself in what has been an extremely difficult campaign for the people of Leeds. I have full confidence in children’s heart surgery at Leeds; I know that the Leeds unit does an excellent job. He will understand, as I do, that when there are safety concerns, they have to be investigated, but I am delighted that those issues have been resolved, and that surgery is continuing.

Heart Surgery (Leeds)

Stuart Andrew Excerpts

Monday 15th April 2013 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

(Urgent Question): To ask my right hon. Friend the Secretary of State for Health if he will make a statement on Leeds children’s heart surgery unit.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Following the deaths of 30 to 35 children at the Bristol royal infirmary between 1991 and 1995 and the subsequent inquiry, children’s heart surgery is rightly the subject of great public concern.

With respect to Leeds general infirmary, there are three issues that the House will want to be updated on: was it right to suspend children’s heart services at Leeds on 28 March; was the decision handled in the best way possible; and, given his public comments, is it appropriate for Professor Sir Roger Boyle to have a continuing role in the Safe and Sustainable review of children’s heart surgery?

First, was the right decision made? The answer is categorically yes. The principle of “first do no harm” must run through the very heart of the NHS. If there is evidence that patient safety is at risk, it is absolutely right that the NHS acts quickly and decisively to prevent harm to patients. However difficult or controversial, we must never repeat the mistakes made at both Mid Staffs and Bristol, where arguments over the quality of data prevented action that could have saved patients’ lives.

Secondly, was the decision handled properly? On 26 and 27 March, Sir Bruce Keogh, NHS England’s medical director, was given a range of critical information about the quality of care at Leeds: statistical data that indicated higher than expected mortality rates; concerns about staffing rotas; and further concerns from parents and a national charity about the way the most complex cases were referred. With the agreement of the LGI, Sir Bruce took the entirely appropriate decision to suspend children’s heart surgery while further investigations were made. The families were informed on the day the decision was taken to suspend services, 28 March.

On 29 March—Good Friday—the day that decision became public, I spoke with the right hon. Member for Leeds Central (Hilary Benn) and my hon. Friends the Members for Pudsey (Stuart Andrew) and for Leeds North West (Greg Mulholland) to inform them of the situation. My conclusion is that, on the basis of the information available to him, Sir Bruce behaved entirely properly. He was also right to authorise the restarting of surgery from 10 April for low-risk patients on the basis of more complete data and assurances from the trust.

The third question is whether, in the light of his recent comments, Professor Sir Roger Boyle can have a continuing role in the Safe and Sustainable process. Sir Roger is one of our leading heart surgeons. He did the right thing in informing Sir Bruce of his concerns over Leeds’ mortality data. He has also played an important role as an adviser to the Safe and Sustainable review of children’s heart services. However, it is the view of Sir Bruce Keogh, with which I concur fully, that Sir Roger’s comments to the media on 11 April could be seen as prejudging any future conclusions of that review. It is therefore right that Sir Roger plays no further role in its deliberations.

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[Stuart Andrew]

I am grateful to my right hon. Friend for his answers. No one would disagree with the point that information that is provided about the safety of a unit should be investigated. However, the quality of the information and the source of the complaints raise serious questions about the proportionality of the action that was taken and, more importantly, about the motives of the complainants. Sir Roger Boyle was a key adviser to the Safe and Sustainable review, which proposed an illogical outcome for northern England. His recent actions and comments surely prove that the decision to close the Leeds unit was predetermined.

Sir Roger leaked data that were unverified to argue for the suspension of surgery—an action that was described as “appalling” by their author. The information was inaccurate and, when corrected, demonstrated that the Leeds unit was safe. In fact, it showed that it is in a similar position to the units at Guy’s and Alder Hey. Why did Sir Roger not recommend the suspension of surgery at those units? Is it because those are the ones that he and the Safe and Sustainable review recommended as designated centres?

Furthermore, on Friday, despite detailed scrutiny that proved that Leeds was safe, Sir Roger claimed that it was on the edge of acceptability and that he would not send his daughter there. Those comments demonstrated a clear bias against Leeds and were irresponsible in respect of parents whose children are facing surgery. In addition, one of the whistleblowers has been identified as a surgeon from the Newcastle unit, which is another example of vested interests.

The suspension of surgery and Sir Roger’s comments have caused huge anxiety and concern among patients and staff, and have hurt the reputation of the hospital, which it has taken years to build. I therefore ask the following questions of my right hon. Friend.

How can we have faith in the Safe and Sustainable review, given that its key adviser has behaved in such an appalling and biased manner? Despite the fact that he will no longer take any part in the review, the decisions remain. Does this matter not prove that Sir Roger acted in a predetermined manner? Is it not vital to put the patient’s interests first, rather than NHS politics? Does my right hon. Friend agree that Leeds has been treated disproportionately when compared with other units that have similar figures? Is he aware that there are reports of surgeons being anxious about providing data for fear of reprisals? Is there not an urgent need for the Independent Reconfiguration Panel to report to resolve the uncertainty that exists across the country with regard to children’s heart surgery? Is it not time to give serious consideration to the proposal that both Leeds and Newcastle should stay open, which is supported by clinicians and patients as it is in their best interests? Finally, will he pay tribute to the staff and patients at Leeds, who have acted with great dignity in the face of hostile criticism?

[Mr Hunt]

I do pay tribute to the staff at Leeds and to the families of patients. I recognise that this is an issue of huge concern. As my hon. Friend rightly says, they have behaved with great dignity in a difficult situation. I also pay tribute to him for the responsible way in which he has behaved in this difficult situation, as have many Leeds MPs.

My hon. Friend will understand, given that the NHS nationally was provided with data that suggested that mortality could be up to 2.75 times greater at that unit and given that there was a potentially busy holiday weekend ahead, when it did not know how complex the cases would be and when there were locums on the staff rota who may or may not have been up to the standard of the permanent staff, that Professor Sir Bruce Keogh had genuine concerns that led to his decision. But I hope the fact that surgery was restarted on 10 April will assuage my hon. Friend’s worry that the initial decision was linked to the Safe and Sustainable review—it was not; it was a concern about patient safety and because that concern has been addressed, surgery has restarted.

There were, however, issues about the quality of the data, which at least in part was because the hospital was not supplying data properly in the way it needed to. That was one reason why the mortality data were not as accurate and good as they should have been. Although I entirely agree that patient safety must always come first, and not NHS or national politics or whatever it may be, that also means that sometimes difficult decisions have to be taken. What happened at Mid Staffs, where we had a big argument about data that meant nothing happened for too long, and what happened originally at Bristol, where up to 35 children may have lost their lives, is a warning about the dangers of inaction. On this occasion, I think that overall the NHS got it right.

Suicide Prevention

Stuart Andrew Excerpts

Wednesday 6th February 2013 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am grateful for the opportunity to take part in the debate. I pay tribute to the hon. Member for South Antrim (Dr McCrea) and all Democratic Unionist party Members for bringing this important debate to the Floor of the House. I am sure they were tempted to debate many other issues, but it is important that we discuss suicide prevention, which is a crucial but difficult issue.

Yesterday, I spoke of some of the most difficult times in my life. I was lucky to have the support of a loving family and great friends, but many unfortunately do not have that. Before being elected, I worked in the hospice movement. In that time, I got to know a lot of the patients well, and, sadly, death became a norm—I did not want to use that word, but I am sure hon. Members understand what I am getting at. Bereavement is always difficult, but suicide bereavement is a different type of bereavement altogether.

Sadly, I say that from personal experience. When I was in the sixth form, I remember vividly walking in and a friend saying to me, “Have you heard about that boy?”—I will not mention his name. He had taken his own life because he had been bullied at school. I remember all the students sitting in the common room in complete and utter shock. All I could think about were the questions going around in my head. What could I have done? Why did I not spot that he was in that difficult place? If I am honest, those questions still haunt me today. In more recent times—since I have been elected as a Member of Parliament—there was the very sad case in my constituency of a father who killed his entire family and then himself.

The suicides I have seen and experienced have had a tremendous effect on the people who are left behind. That is why the debate is important, but more importantly we should act and not just talk about suicide. We must also start right at the beginning and change people’s attitudes. How many times have hon. Members been on a train that has been delayed because somebody has taken their life, and the instinct of some passengers is to moan about the delay, forgetting that somebody has lost their life?

Hon. Members have spoken a lot about attitudes to mental health. I am very proud of the fact that a lot of work has been done in the Chamber to address that. It is a good start to try and take away that stigma. I pay particular tribute to my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for North Durham (Mr Jones), who have spoken openly about their own personal battles. As hon. Members have said, however, suicide is a much wider subject than just mental health; it can be about finance, careers or family breakdown. It is important that we address all those issues, which is why I welcome the fact that the suicide prevention strategy is in place. It is important that the strategy is not just a piece of paper; it has to be backed up by action, and it is good to see that happening. Crucially, it is partly about identifying the risks.

[Andrew Stephenson (Pendle) (Con)]

I agree with what my hon. Friend is saying. In January, suicide-proof fencing was installed at a multi-storey car park in Nelson in my constituency, from which eight people have died in the past 10 years and a further 18 people have had to be talked down by police. I raised this issue on the Floor of the House in October 2010 in an Adjournment debate led by the hon. Member for Bridgend (Mrs Moon), yet it still took the car park owners years to act. In addition to what my hon. Friend is saying, does he agree that businesses have a key role to play in identifying risks?

[Stuart Andrew]

I am grateful to my hon. Friend for that intervention. He is absolutely right: we need to do everything we can—talking to individuals themselves or lessening the risks—to identify those areas. A lot of work has been done in the prison system to try to improve cells to reduce risks. Businesses also have an important role to play.

It is important that the strategy targets specific groups who we know may be vulnerable. Targeting young people will be important, because we want to change attitudes in the future. We also have to look at why so many young men are committing suicide. We have been talking about mental health, but let us face it: men are not very good at talking, and that is part of the problem. As we move into the digital age and we all spend so much time on our computers, being used to talking with others will lessen over time. I fear that we will have a generation who will be even worse than the current one in talking about their problems.

Improving access to “talking therapies”, the strategy’s four-year plan, and expanding it to all ages and different groups, is important. From my own experience, I know that we need to ensure that there is as much work on school intervention as possible to deal with bullying and violence. We must allow people to talk about the threats they feel, whether they are sexual abuse or bullying at home. We also have to remove barriers for people who are disabled, or who have mental health or other long-term conditions. We want to make them feel that they can play a full role in our society and do not become isolated.

Areas that require emphasis have been highlighted by a constituent of mine. I pay tribute to Mike Bush. He and I are unlikely friends. He describes himself as “red socialist”, but he and I have become very good friends and I have a huge amount of respect for him. He has done tremendous work in this field and is an active member of the all-party parliamentary group on suicide and self-harm prevention. On many occasions, he has highlighted the importance of working with bereaved families. I welcome the fact that the strategy gives greater prominence to measures that support those families; being there and helping them to cope with a family member whom they are worried might commit suicide, and helping them cope with the aftermath of someone who has committed suicide.

Getting better information through the research that is being offered can only be a good thing, but the emphasis must be on support, and I completely agree with the hon. Member for Bridgend that we need to ensure good national provision. We need to ensure that suicide prevention measures are available in every part of our country. In particular, bereavement support needs a suicide angle to it, because it really is very different. In my time at the hospice, I saw how fragmented bereavement services were around the country, but specific suicide bereavement support is even more fragmented.

I hope that as the strategy develops we will continue to work with the many wonderful organisations we have in this country, many of which have been mentioned today, such as the Samaritans. The APPG is a great start, bringing together a coalition of organisations with a wealth of experience, but it is also important that we listen to family groups that have been through this dreadful experience. What makes Martin House children’s hospice such a wonderful organisation is that it is parent-led. The parents describe the care they need, and that is why it can offer such wonderful support. In the same way, the best strategy for dealing with suicide will come from those families who have experienced it.

We need action on cyber-bullying. Bullying has existed in schools for many years, but it has taken on a different form now. People can be bullied at school, but when they get home it continues through the social networking sites and the computers in their bedrooms. In a sense, these children and young people are suffering from a silent bully. The suicide websites have been touched on. We must do more to close them down completely.

I hope that we can offer further training for organisations and—perhaps—the police in helping them to deliver that bad news. I have had several constituents tell me that they almost felt sorry for the police officer delivering the news because it was so difficult. It is important that these organisations be aware of the wealth of information out there. I am glad that the “Help is at Hand” document has been mentioned, because it is not used enough.

In conclusion, suicide is tragic in every sense: the loneliness of the person doing it, the long bereavement for those left behind, the guilt they suffer for years after and the great risk that they themselves might go on to commit suicide. It is crucial that we face this risk. This debate is just the start: let us now address and act on it.

Leeds Children’s Heart Surgery Unit

Stuart Andrew Excerpts

Tuesday 30th October 2012 Westminster Hall

[Stuart Andrew (Pudsey) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to have a further opportunity—you might wonder why we are taking another chance to raise the issue—to discuss the Leeds children’s heart unit. Given that there is a new ministerial team at the Department of Health—I am delighted to welcome the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry) to her new post—and that the decision on the unit has been referred to the Independent Reconfiguration Panel, it is critical that the independent review gets this right. The issues that we have been raising need to be assessed in great detail by the independent panel.

It is important for us to remind ourselves of the key issues. I want to make it crystal clear at the outset that we have always supported the objective of the review. Of course, we all want the best services for our children, and having fewer specialist centres is a principle that we have never doubted. My grave concern is that the review will fail to meet the objectives, particularly in the north of England, subjecting my constituents and those in Yorkshire and Lincolnshire to a worse service than the one that they currently enjoy. That is why I want to outline our concerns.

First, the review has always made it clear that units need to perform 400 operations or more a year. If that is the agreed standard, we must accept that. However, a survey by PricewaterhouseCoopers showed that the majority of patients who live in east, west and south Yorkshire would not travel to Newcastle. Instead they would go to Liverpool, Birmingham, or, in some cases, even to London. Anyone who knows our area knows that that is instinctively the case. Since the decision was made, adverse weather over the past couple of months has caused huge problems on the A1. Would a parent go there or would they choose less problematic routes? The issue is made clear in the analysis. The independent review document states:

“There was more reluctance amongst members of the public to consider travelling to Newcastle as a centre. If the preference of the parents and the public were factored into assumptions of patient flows, they may have implications for projected levels of activity at – in particular – the Newcastle centre.”

What is the review’s answer to the problem? At the decision-making process meeting—a seven-hour meeting to rubber-stamp a decision that clearly had already been made—it was said that patients preferring centres other than Newcastle would be influenced by referring doctors, with the assumption made that they would be pointed to Newcastle. Frankly, the evidence points to the contrary: all 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, said that they would not refer patients there for treatment.

In addition, the review argued that if 25% of patients from Leeds, Sheffield, Doncaster and Wakefield chose to go to Newcastle, that unit would perform 403 operations a year, conveniently just over the target of 400. That also assumes that 100% of patients in the other remaining postcodes, including Hull and Harrogate, would go to Newcastle. Newcastle can only reach the 400 figure if all the assumptions—that 25% will go from south and west Yorkshire, that clinicians will refer, and that 100% in Harrogate, Hull and elsewhere would use the centre—are correct, but there is no evidence to support such assumptions.

Given the importance of the 400 figure, it is staggering that it has been reached on the basis of assumptions. I know my hon. Friend the Minister was a barrister before entering the House. I wonder how the court would have reacted if she had based her defence or her prosecution on assumptions. That is why I believe the review is flawed. If we are going to change, it must be for a much better service.

That brings me to the issue of co-location. The foundation of the review was the inquiry at Bristol, and ensuring that such events never happen again is crucial. A key recommendation of the inquiry was to have all paediatric services under one roof. The British Congenital Cardiac Association has stated:

“It is important that the centres designated to provide paediatric cardiac surgery must be equipped to deal with all of the needs of increasingly complex patients. For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

I completely agree with that statement. Indeed, Professor Sir Ian Kennedy, in his report following the Bristol inquiry, stated in recommendation 178:

“Children’s acute hospital services should ideally be located in a children’s hospital, which should be physically as close as possible to an acute general hospital. This should be the preferred model for the future.”

Yet despite Sir Ian’s assessment panel describing the location of key services on a single site as optimal, Sir Ian accepted a watered-down definition of co-location, which allowed Newcastle to be described as a co-located service, and that led to the decision to close Leeds, despite the Paediatric Intensive Care Society’s assertion that it

“would dismiss any suggestion that a service located on another hospital within the same city can be regarded as being equivalent to a service located on the same hospital site.”

What has caused Sir Ian Kennedy to change his mind? Anyone visiting the Leeds unit will know that it is a wonderful, integrated unit. It has all the services that are needed for children with complex and multiple needs. They need paediatricians there with other specialities. On my several visits to that unit, on each occasion I have seen paediatricians coming to help patients with complex needs.

[Philip Davies (Shipley) (Con)]

My hon. Friend has led this campaign in Parliament with his customary charm and tenacity. As ever, he is making an excellent case. The national health service is paid for by the public for the benefit of the public. Ultimately, the services that we provide should be the ones that the public want. MPs from our region, from across the parties, are here today, and it is clear that the people in Yorkshire have confidence in the unit, want it to continue and believe it will offer the best possible treatment. Should that not be one of the most important factors that the Government bear in mind?

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[Stuart Andrew]

I am grateful for my hon. Friend’s kind words. It has been a tremendous cross-party campaign. People right across our region have been speaking in high praise of the unit. My hon. Friend is absolutely right that it should be about what patients want. Patient choice is a bedrock of the NHS. I hope that today’s debate will enable us further to put across our grave concerns about the review.

[Julian Smith (Skipton and Ripon) (Con)]

Another concern that people have raised is the initial consultation that took place, especially with regard to the language and translation for a large section of our community who suffer particularly from congenital heart disease. Will my hon. Friend comment on that? Does he think that that issue has been fully addressed thus far in the process?

[Stuart Andrew]

No, I do not. The projections of population growth, particularly in the south Asian community, are a huge issue that has not been fully addressed. I hope that that issue will be taken up by the independent panel when it considers the detail of the decision that was reached.

It would be a backward step for us to go to a unit that was separated from the rest of children’s services by three miles. We have a wonderful unit at Leeds general infirmary, where all the children’s services are under one roof. Staff there talk about the difference between now, and when the unit was at Killingbeck. There were great problems with getting doctors to travel there, even though it was only a couple of miles away. It is unacceptable for our constituents and poorly patients to receive a much lesser overall service, because the rest of the services will be three miles across the city of Newcastle.

A phrase that I have heard a lot in this campaign is, “Bring the doctors to where the patients are and not the other way around.” The review has been inconsistent regarding whether population density matters. The consultation document said that Birmingham gets a high number of referrals because of the large population in its catchment area, and it should therefore remain as a unit, but that simply does not seem to apply to Leeds. Leeds serves a population of some 5.5 million, double the 2.6 million in Newcastle, and projections show that that number will increase. The recent census showed that the population of the north-east had increased by 57,000, compared with an increase of 300,000 in Yorkshire, so surely we should put the services where the population is, and where it is growing.

The health impact assessment stated that options G and I were the only ones to induce few negative impacts—option G being the one that includes Leeds—and it admitted that option B would have a more negative impact than option G. That information was released only at the meeting on 4 July.

I want to talk about public opinion because, as my hon. Friend the Member for Shipley (Philip Davies) mentioned, support for the campaign has been phenomenal. Some 600,000 people have signed a petition, which shows the strength of feeling in our area, but those signatures were counted as just one response, while 22,000 separate text messages in support of Birmingham were counted as 22,000 separate responses. The NHS constitution states that the NHS is guided by several key principles, one of which is:

“NHS services must reflect the needs and preference of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.”

The fact that so many people felt compelled to sign the petition shows the strength of feeling that they have.

I have spent a great deal of time in the Leeds unit, speaking to families that use it. One of them is the family of one-month-old Lauren, who had problems with feeding and was referred to the Airedale hospital when she was approximately one week old. A heart problem was then suspected, and she was referred to Leeds general infirmary, which has strong links with Airedale. She was transferred to LGI through Embrace, the Yorkshire and Humber specialist ambulance service—a service that does not exist in Newcastle—and it took four hours to get the baby in a stable enough position to undergo the journey to Leeds. Imagine expecting that child to go all the way to Newcastle. Her mum, Sara, said that she could not understand why, given the size of the population in Leeds and the surrounding areas, as compared to the size of the population in Newcastle, it was contemplated making people travel further and separating them from their often crucial family support. I know from my time at Martin House children’s hospice how important it is to have family support close by. The patients are in incredibly stressful situations, and it is critical that others can share in the care and visit the children.

[Julian Smith]

What assurances has my hon. Friend had regarding ambulance services? He is right that Embrace, the Leeds service that looks after children in getting them from home to hospital, is second to none. How will Newcastle get anywhere near that quality of service in the time scale required?

[Stuart Andrew]

The answer is that I do not know. I have not been given any assurances that that will happen, which again highlights the crucial problem with the decision: we will be subjecting our constituents to a lesser service.

I spoke to another family at the unit. Libby was diagnosed at 20 weeks with complex heart problems, and her mum was referred for the rest of her antenatal care to LGI, where the baby was delivered; that again demonstrates the crucial co-location of services. It was clear that the daughter needed treatment immediately after birth, and at six days old she had her first of many operations. As she has complex medical needs, she has also needed support from the paediatric neurology and renal teams, and all those services are under one roof, which provides first-class care. My final example is of a child who had an operation in Leeds at 18 months. All the care was then delivered in Barnsley by doctors from Leeds. Leeds doctors have been out working in all the towns and cities across Yorkshire, at 17 different locations, over the past decade. We have a well-established network of services. Those are just a few examples of the kind of impact that the proposal could have on any of our families.

[Fabian Hamilton (Leeds North East) (Lab)]

I congratulate the hon. Gentleman on securing the debate, which, as he rightly points out, is extremely important. Does he agree that it is not just the children’s congenital heart problem services that serve us so well at Leeds general infirmary, but the post-16 services, which the review did not take into account? Does he also agree that Leeds is perhaps the leading centre in the country for training post-16 congenital heart problem surgeons in what is a valuable and important skill?

[Stuart Andrew]

The hon. Gentleman makes an absolutely first-class point. Indeed, I think we have all asked the question: why is the review into children’s services being held separately from that into adults’ services? It is bizarre. We know that the surgeons operating on adults are often the same people who operate on children. We have yet to get a sufficient explanation of why the reviews have not been run in tandem, and we expect, or at least hope, that the Independent Reconfiguration Panel will consider that issue.

That brings me on to my next point. I wholeheartedly welcome the fact that the Secretary of State has decided to refer the decision to the Independent Reconfiguration Panel—that is great news—but it is absolutely crucial that we get the decision right. There is no point in simply reviewing the decision; we want the panel to consider the whole process, right down to the information that was used at the very beginning regarding what the services were like at the different units. That must include the scoring.

[Hilary Benn (Leeds Central) (Lab)]

I echo other Members’ compliments about the force of the hon. Gentleman’s case. The review, if it is about anything, must be about the right clinical outcomes for children. That is why we are all here. We are all so passionate about the Leeds children’s heart surgery unit, which I have the privilege to represent. Will he confirm that despite the impression that is being given in some quarters, no assessment of the relative clinical effectiveness of the units considered in the review has been undertaken? Does he agree that the independent review must do that, as we all believe that it would lead to the decision being overturned?

[Stuart Andrew]

The right hon. Gentleman is absolutely right. He makes a clever and important point, because that is the foundation of the decision, and the information either does not exist or is incorrect. I want a root-and-branch review of the decision and all the information that was at the disposal of the Safe and Sustainable review team. I hope we can get an assurance today that the panel will do that.

There are further problems with the decision-making process. The joint committee of primary care trusts is still not disclosing information requested by the joint health and overview scrutiny committee in our area, including the agendas, minutes and reports of several meetings material to the JCPCT decision. There is also no evidence that the joint health and overview scrutiny committee’s report was even discussed by the JCPCT. The JCPCT has refused to disclose the breakdown of the Kennedy scores awarded to each children’s heart surgery unit by the panel. The value of the total scores, which are the supposed measure of quality, could neither be understood nor scrutinised.

I think we all believe that the JCPCT has misused the Kennedy scores. The JCPCT requested not to be shown the breakdown of the Kennedy scores, which raises many questions about the JCPCT’s ability to make an informed decision. The Kennedy scores were not prepared for the purposes of comparing one centre with another, yet a ranking of the units by total score was published. The scores were misused as indicators of quality, even though the scores did not assess units on what most of us would regard as measures of quality, such as clinical effectiveness, safety and patient experience.

The total unit score was given as 401 for Leeds and 425 for Newcastle. Those scores were published with the independent expert panel’s report in 2010. According to the first breakdown of the total scores, however, which was only released after the JCPCT made its decision, the Leeds unit gets 414 points and the Newcastle unit gets 421 points. Despite the enormity of the review, a basic mistake appears to have been made in the calculation. That matters because, in the eyes of the JCPCT, which saw only total scores, the advantage of the Newcastle unit was more than trebled from seven points to 24. When that was pointed out to the JCPCT, a second set of sub-scores was published that still did not add up to the original scores of 401 for Leeds and 425 for Newcastle; it stated that the Leeds unit outscored Newcastle on the core clinical standards used by Professor Kennedy by 347 points to 336. On care quality, Leeds is ahead; Newcastle outscores Leeds only because of the addition of leadership and vision standards, which are non-clinical standards covering IT and business strategy, working practices, and so on, that were developed by commissioners, not clinicians.

When the fact that Leeds outscores Newcastle on core clinical standards was pointed out to the JCPCT by the Yorkshire and Humber joint health and overview scrutiny committee, a third set of sub-scores was published, with the dubious claim that they were the raw Kennedy scores. The scores did add up to the original 401 for Leeds and 425 for Newcastle, but, mystifyingly, they now put Newcastle ahead of Leeds on core clinical standards. It is unclear which of those different sets of scores was used by the JCPCT because they give such different impressions.

The Kennedy scores were subject to a weighting system that disproportionately emphasised certain aspects of the assessment in a way that produced misleading results when used in a comparative process. No explanation was given for the way the weightings were worked out. I could address further issues, but I am aware that other hon. Members want to take part in this debate.

We suggested that the JCPCT’s decision be implemented elsewhere, but that in north-east England, both Leeds and Newcastle remain open and that the decision be delayed until April 2014. That would give an opportunity for patient choice and for parents to consider which centre they want to use, as is their constitutional right. By the end of that period, each centre would have to demonstrate that it is fully compliant with all the standards set by the Safe and Sustainable review. The judicial action brought against the JCPCT by Save Our Surgery might then cease; that would avoid the risk of sinking the review in its entirety. Leeds and Newcastle would have the opportunity to demonstrate their compliance with Safe and Sustainable standards. Less controversial decisions taken by the JCPCT could proceed elsewhere in the country, and the Government would be shown to be listening to the concerns of patients. That would give a clear message from the Department of Health that patient choice comes ahead of professional convenience. We made that suggestion, and it was rejected out of hand in no time at all. It is a sensible proposal for a solution that would allow us the very best services for our children and young people, as evidenced by where people go and what services they want.

Finally, I attended last week’s Westminster Hall debate on the Leicester unit. My hon. and learned Friend the Member for Harborough (Sir Edward Garnier) summed up the debate well. There is no point in my trying to come up with a fancier conclusion, so I will do him the honour of quoting what he said:

“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 Secretary of State has the levers of power in this question and he must pull them—he must exercise them—and make a decision…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.”—[Official Report, 22 October 2012; Vol. 551, c. 188WH.]

[Several hon. Members]

rose—

Children’s Cardiac Surgery (Glenfield)

Stuart Andrew Excerpts

Monday 22nd October 2012 Westminster Hall

[Martin Vickers (Cleethorpes) (Con)]

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.

[Stuart Andrew (Pudsey) (Con)]

My hon. Friend is making an important point. The Safe and Sustainable review found, from its own independent advice, that patients in his constituency would not travel to the units that would be kept open under the proposals.

[Martin Vickers]

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.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

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.

[Stuart Andrew]

rose—

[Liz Kendall]

rose—

[Anna Soubry]

I shall give way to my right hon. Friend the Member for Pudsey, then to the hon. Member for Leicester West.

[Stuart Andrew]

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.

[Anna Soubry]

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.

health

Stuart Andrew Excerpts

Tuesday 18th September 2012 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I cannot resist the opportunity in the time available to raise the same issue as that which my hon. Friend the Member for Leeds North West (Greg Mulholland) has just addressed, particularly given the fact that we now have a new ministerial team. I am delighted to see the new Minister on the Front Bench.

I realise that the Safe and Sustainable review is independent of Government, as the former Health Minister, my right hon. Friend the Member for Chelmsford (Mr Burns), told me on many occasions. It is clear, however, that there is a problem with the decision, particularly in the north-east of England, and I hope that we can try to find a solution today.

It is worth restating the issue. Despite claims by some, right hon. and hon. Members on both sides of the House, parents, the charity and clinicians are fully supportive of the review’s objectives. It has never been in doubt that safer and more sustainable units are the way ahead, but we are concerned that the outcome does not meet the review’s objectives. It goes against logical health planning, patient choice and clinical preferences. The fact is that patients in Yorkshire, Humberside and north Lincolnshire will simply be offered a poorer service.

Patient choice has been totally disregarded. A survey of patients showed that those in the major postcode areas would go not to Newcastle, but to Liverpool, Birmingham or, indeed, London instead. At the decision-making meeting, it was said that those patients would be influenced by referring doctors. The assumption was made that they would be pointed towards Newcastle, but no justification has been given for that assumption. Indeed, all of the 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, have said that they would not refer patients there for surgical treatment.

[Greg Mulholland]

It is a pleasure to carry on campaigning with my hon. Friend on this issue and we will continue to do so. Does he still agree with what we have said before, namely that the reason the Leeds unit is to be closed is the flawed assumption that that will allow Newcastle to reach the target of 400 operations, even though it will not? The unit is being sacrificed for something that will not even happen.

[Stuart Andrew]

I am grateful for that intervention, which brings me on to exactly that point. The review’s decision said that 25% of Leeds, Wakefield, Doncaster and Sheffield patients would go to Newcastle, when its own evidence said that they simply would not. Funnily enough, if 25% of those patients go to Newcastle, guess what? Suddenly, 403 patients a year will have surgical operations in Newcastle, which is just three more than the magic figure of 400. I do not believe that that 25% will exist, so Newcastle will miss the target of 400 operations, which is a key plank of the whole review.

We have heard about how public opinion has been discounted. A petition signed by more than 600,000 people was brought down to Downing street. That is an enormous number for one region, yet the review counted it as just one response. On the other hand, 22,000 text messages received in support of Birmingham were counted as 22,000 separate responses, which is blatantly unfair.

One of the most important issues is the co-location of services. What has impressed me about the Leeds unit is that it is part of the Leeds children’s hospital. All other surgeons get there within minutes, if needed. We are asking our patients in our constituencies to go to Newcastle, where all other services are some 3 miles away from the heart surgery unit. That is simply not acceptable and goes against the advice of the key recommendation of the Bristol inquiry, which was backed by the British Congenital Cardiac Association. The inquiry said:

“For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

It is important that we do not forget that.

The fact is that, allowing for patient choice and without the flow of patients from the populous areas of Yorkshire, as evidenced by the PricewaterhouseCoopers research, Newcastle will not reach the target of 400 surgical procedures. In 2010-11, Leeds delivered 336 procedures against Newcastle’s 271.

The impact assessment also showed that the options that included Leeds would have fewer negative impacts and that option B, which included Newcastle, would be particularly damaging for paediatric intensive care in Yorkshire and Humber.

It is also important to ask why Birmingham was chosen because of its density of population and Leeds was not, given the fact that we have a high south Asian population who, statistically, are more likely to need the service. As we have said time and again, doctors should go where the patients are, not the other way around.

Sheffield parents whom I have met at the unit travel three times a day to visit their children in hospital, because they have other children at home. We have to think about the impact this has on families.

[Martin Vickers (Cleethorpes) (Con)]

I congratulate my hon. Friend on his work on this issue. His point about distance is particularly relevant to my constituency. Cleethorpes is about 85 miles from Leeds and the parents will not travel to Newcastle, so it will not reach that figure of 403.

[Stuart Andrew]

I am grateful to my hon. Friend for the support that he has given to the campaign by meeting his own constituents who, he is right to say, will not travel to Newcastle. His comments further highlight the ludicrous nature of the decision.

I have presented the problem, so what is the solution? I recognise that the review is independent of Government, but we have to tackle the problem—it will not go away, because we as Yorkshire, Lincolnshire and Humberside MPs will not let it. Our view is that the review could happily be implemented elsewhere, that both Leeds and Newcastle should be kept open and that a decision on their future should be delayed until April 2014. That would provide an opportunity for patients and parents who require the services to exercise their constitutional right to patient choice and to determine which centre they wish to access. By the end of that period, each centre would have to demonstrate that they were fully compliant with all the standards set by the Safe and Sustainable review.

This solution would amount to only a one-year pause. Given that legal proceedings are likely to take place, there will be a one-year pause in any case. The reconfiguration of all children’s heart surgery centres in England is not due to commence until April 2014 and a decision taken at that time on Leeds and Newcastle could be implemented in 2015. The definition of a centre that delivers a sustainable service is that it should have a minimum of four surgeons, so if, after the one-year pause, commissioners did not think that the Newcastle unit had a sufficient work load, the Leeds unit could explore how it could provide support in conjunction with Newcastle.

If either of the centres did not meet the standards, it would, frankly, let itself down. This solution gives them the opportunity to provide the services that families are so desperate to keep. There are many benefits to the solution: it would avoid the risk of a costly judicial action from supporters of either unit, which could sink the review in its entirety; it would give Leeds and Newcastle the opportunity to demonstrate their compliance with the safe and sustainable standards, which is what we all want; it would allow the less controversial decisions made by the JCPCT to proceed elsewhere in the country; and it would show, frankly, that the Government are listening to the concerns of the 600,000 people who signed our petition, and I am sure that the public would respond accordingly.

I know that this is not an easy decision, but there is a great deal of concern and anxiety in our region. I hope that the Government will not just give us the line that this is a review independent of Government, but acknowledge that there are serious concerns and great anxiety among our patients and families, and that it is time to look at the issue in detail, to listen and to act.

--- Later in debate ---

[Dr Poulter]

The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.

[Stuart Andrew]

Will the Minister give way?

[Dr Poulter]

I have been very generous and indulgent but I must make some progress. The process was led by doctors and nurses, and there is an ongoing consultation to engage with, review and reflect on decisions at a local level. That came out clearly in comments by my hon. Friend the Member for Leeds North West, but some of those processes are under judicial review and I will not, therefore, be able to comment further. I hope that my hon. Friend the Member for Sittingbourne and Sheppey will accept my reassurance that these reviews are carried out on good clinical grounds that take into account local factors such as whether local health care services are well designed. The important thing is that they are being led and developed by local doctors and nurses. We need such clinical leaders in the NHS, because they are the best advocates of patients’ needs.

My hon. Friend the Member for Stafford (Jeremy Lefroy) has been a strong advocate of the needs of his constituents and the staff of Mid Staffordshire NHS Foundation Trust. I know that we will be meeting tomorrow to discuss his concerns further, and I will also meet my hon. Friend the Member for Stone (Mr Cash), who has sadly now left the Chamber. We will talk about a number of issues, and I reassure my hon. Friend the Member for Stafford in advance of that meeting that I and other Ministers will continue to do all that we can, as our predecessors did. He rightly paid a full tribute to my right hon. Friend the Leader of the House for all the work that he did as Secretary of State for Health to support staff of that trust and ensure that there are good outcomes for patients. On behalf of all members of the Health team, I commend my hon. Friend the Member for Stafford for his work as a strong advocate of the needs of local patients, and I look forward to meeting him tomorrow.

My hon. Friend the Member for Pendle (Andrew Stephenson) rightly raised the issue of paramedic prescribing. He talked about the need for more flexibility in urgent and emergency care services, on the basis that it is better to have prevention than cure. We know that paramedics do a great job every day of looking after people and providing essential care on the spot and in the ambulance that saves lives before people get to hospital. The more we can do to support paramedics in providing preventive care in the community, the better for patients.

As well as allowing flexibility in urgent care services, paramedic prescribing would allow eligible paramedics to deliver more treatment in the home and the community where appropriate. That should prevent hospital admissions and reduce demand on the system. At the moment, paramedics can administer a range of medicines, but they cannot write prescriptions for patients. A new system of paramedic prescribing should benefit both patients and the NHS. Due to resource and capacity issues it has not been possible to take forward that work yet, but it will be considered within the new architecture of the NHS Commissioning Board along with other work programmes on resources and capacity. I shall certainly raise the matter, and the good points that my hon. Friend made, with ministerial colleagues.

My hon. Friend the Member for Mid Derbyshire (Pauline Latham) talked about diabetes care, particularly for type 1 diabetes. It is commendable that a lot of her focus was on younger people with diabetes. The number of patients with type 1 diabetes and known to be on insulin pumps has increased. At the moment, at least 3,700 children and more than 10,000 adults are on insulin pumps, and they are particularly important for younger people who may find it more difficult to control their diabetes. However, they are important for all people who have difficulty with their insulin and their diabetes control.

We want people to lead more independent lives, and we want to support people with long-term conditions to enjoy the same life as anybody else, so it is right that we do more to support people with type 1 diabetes. Those with difficult diabetes control have to be mindful of their disease on a daily basis, and if we can do more to ensure that their diabetes is not a factor in how they live their lives, that has to be a good thing.

The NHS operating framework for 2011-12 highlights the need to do more to make insulin pumps available. The NHS Diabetes insulin pump network is promoting good practice, but as we have discussed, pump therapy is not suitable for everybody. We are waiting for the conclusion of the first ever national insulin pump audit early next year, which will give us a clearer picture of the number of pumps provided and the services that are available. Importantly, it will also include the first investigation of how services are provided compared with the guidance issued by NICE in 2008 and updated in 2011, which my hon. Friend outlined.

My hon. Friend also raised the issue of artificial pancreases. There is small-scale use of them in children, but the clinical trials are not yet conclusive as to their effectiveness and ease of use and there are currently no NICE guidelines on the subject. We need to use the commissioning process to address the disparities in NHS care and better reflect good medical practice, and nowhere is that more true than in diabetes care. We need to ensure that where there are NICE guidelines on good practice, that practice is carried out.

Finally, I wish to reflect on service reconfiguration and social care, which my hon. Friends the Members for Pudsey and for Milton Keynes South raised. Social care reform is important, and we need an integrated approach to health and social care. We must ensure that we reflect the health care needs of local populations and do more to support people with long-term conditions. That is a key driving force behind the vision for the NHS that my right hon. Friend the Leader of the House outlined in 2010 when he was Secretary of State for Health. It drives what should happen, and what does happen, at local level every day as doctors and nurses look after their patients.

Decisions about integration and what it means to have good joined-up care, particularly for older people and those with diabetes, chronic obstructive pulmonary disease, asthma, dementia and other long-term conditions, need to be made at local level, drawing on the best of local health care provision. The Government will ensure that the NHS Commissioning Board’s mandate includes guidance on what is good commissioning. I am sure that from 2013, when the Government’s reforms have gone through and we have an NHS that is truly locally led, there will be properly joined-up and integrated care that better looks after people with long-term conditions, focuses on prevention rather than cure and particularly focuses on looking after older people better.

Health

Stuart Andrew Excerpts

Tuesday 17th July 2012 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am grateful for the opportunity to speak in this debate, Mr Deputy Speaker. May I offer you my congratulations on the honorary degree that you received yesterday from Swansea university?

I recognise that I may repeat many of the things that have been said, but this is such an important issue for constituents in Yorkshire and Lincolnshire that I make no apology for doing so. I am going to talk about the Safe and Sustainable review as well. We have received a number of e-mails from charities yesterday, one of which said:

“As some MPs look to reignite”

the debate about changes to children’s heart units

“we urge MPs to think about the children.”

Frankly, I found that rather offensive, because throughout the whole campaign I have only ever thought about the children.

When I worked at Martin House children’s hospice, I saw the effect on families when they were driven apart because the poorly child had to be a long distance away. On my visit a week or so ago to the unit in Leeds, I met a family who live in Sheffield. They brought their baby who was a few days old into the unit when the baby suddenly went very blue. Thankfully, because of the excellent work at the unit, that baby’s life was saved. That child was described as “marginal” in the review meeting on 4 July. That is not my description, but that of the decision makers. That is a shocking statement in my opinion. I also met another family who live in Sheffield. The father is making three trips a day between Leeds and Sheffield because there are other siblings at home. How on earth are such people expected to travel three times a day up to Newcastle?

I recognise that the review has been independent of Government, but I have grave concerns over the way in which it has been run. I support a review, because I want the best services for our children. I was grateful for the Minister’s comments earlier, when he said that the call-in process means that the matter will go to an independent panel. I would be grateful for clarification of whether that panel is independent of the JCPCT.

[Mr Simon Burns]

May I reassure my hon. Friend that the Independent Reconfiguration Panel is nothing to do with the JCPCT, my right hon. Friend the Secretary of State or me? It is an independent organisation that is there to look at reconfigurations across the country that are referred to it by my right hon. Friend following an oversight and scrutiny committee writing to him.

[Stuart Andrew]

I am extremely grateful to my right hon. Friend for that clarification. I hope that the independent review body will look at the issues that I raise.

Logical health planning clearly dictates that services should be based on where the population live. Doctors should travel to where the patients are, rather than the other way around. Even the British Congenital Cardiac Association has said that:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

After all, it is not buildings that perform operations, but the doctors and surgeons within them. That definition seemed okay in the case of Birmingham. The review stated:

“The Birmingham centre should remain in all options due to the high level of referrals from the large population in its immediate catchment area.”

Why on earth does the argument about the large immediate population not apply equally to Leeds?

The independent analysis of patient flows states that many of the people in west and south Yorkshire and in Lincolnshire will probably go to Birmingham, Liverpool or even London instead. The JCPCT reaches the figure of 403 surgical procedures for Newcastle on the basis of only 25% of the patients going there. Even that is doubtful. How was the figure of 25% arrived at?

[Andrew Percy]

It is very convenient that the 25% figure gets Newcastle just over the 400 mark. However, my constituents in east Yorkshire and north Lincolnshire will not travel to Newcastle at a rate of 25%. They will go straight up the M62 to Liverpool or head south to Birmingham or even London, which are much easier to get to.

[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.

--- Later in debate ---

[Mr Burns]

It is difficult to give a time scale for this reason: as soon as my right hon. Friend receives representations from the overview and scrutiny committee, he will consider as quickly as he can whether to make a referral. As I have said, in the life of the IRP, every request for a referral has been granted—that is certainly true of my right hon. Friend’s time in office, but I believe it is also true of previous Secretaries of State under the previous Government. It is up to the IRP. I know of one example of my right hon. Friend requesting that the IRP respond within a certain time frame, but that was on a single issue. It is possible, with regard to the Safe and Sustainable review, that a number of referrals could be made by different OSCs in relation to the recommendations—I do not know but it is a possibility.

[Stuart Andrew]

Will the Minister give way?

[Mr Burns]

I will give way once more, but then I will have to make progress, because I only have 10 minutes to respond to the whole debate.

[Stuart Andrew]

Will the independent panel have the power to request all the documentation that the Safe and Sustainable review and the JCPCT have been looking at? Will everything be released so that it can look at the evidence in detail?

[Mr Burns]

The IRP?

[Stuart Andrew]

Yes.

[Mr Burns]

I think I can assure my hon. Friend that the IRP will have available to it all the evidence, in all shapes and forms, to help it to form its final opinion of the complaint referred to it. I hope that that reassures him. I say to my hon. Friend the Member for Loughborough and the hon. Member for Leicester South that the same can apply with regard to the decision about ECMO. I have no doubt that Leicester city council will give consideration to that.

I shall briefly respond to the remaining issues. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) made several extremely interesting suggestions. Some of them might not be in line with current Government thinking, but I shall certainly refer her ideas and views to the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who deals with our alcohol strategy. Similarly, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised an important issue, and again I will refer it to the Under-Secretary of State.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned the potential reconfiguration at St Helier hospital. As she will know, the proposals are still being worked on. There has not yet been a consultation process, but the decisions have been taken locally by the local NHS. I trust that, if and when there is a consultation process, she will get involved.

Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Burns]

The assurance I can give the hon. Gentleman is that we certainly believe so, but these are matters for the joint committee of primary care trusts, which carried out this review. As he will appreciate, it is totally independent from the Department of Health, and rightly so.

[Stuart Andrew (Pudsey) (Con)]

My right hon. Friend will be aware of the concerns in Yorkshire about the review. Can he confirm to us, for the sake of absolute clarity, with whom this decision will lie finally?

[Mr Burns]

I am very grateful to my hon. Friend; this is the hors d’oeuvre before the main meal later today. Ultimately, if any overview and scrutiny committees of relevant local authorities do not agree with the final decisions, they have a right to write to my right hon. Friend the Secretary of State asking him to refer the matter, with their concerns, to the Independent Reconfiguration Panel. If it is asked to look into the matter, it will then come to a conclusion, of which it will inform my right hon. Friend and he will then take a decision.

National Health Service

Stuart Andrew Excerpts

Monday 16th July 2012 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

I am extremely grateful for the opportunity to speak in this debate. The NHS is clearly important to all of us. I have seen it personally because I have had a number of operations and through my working life in the hospice movement, where I saw how the care that is provided is so important to the families we were looking after. Clearly, the dedication of the staff is great and I pay tribute to them.

Listening to the Opposition today, it is hard to take them seriously. We can see from their actions in Wales what they would do with the NHS if they were in power. They have cut the budget, resulting in an increase of 51% in the number of patients waiting to start treatment and an increase of 156% in the number of those waiting for more than 26 weeks. All the bad news from the Opposition is therefore difficult to swallow.

I will give a couple of examples from my area. I recently met some GPs and clinicians to talk about the work they are doing to redesign musculoskeletal services. They have brought in innovative ways of ensuring that the patient knows exactly what will happen to them. Clinicians across primary care, community services and secondary care are working together to ensure that the patient has a clear understanding of the care that they will receive. They use map displays, which show a clear pathway, offer educational content for GPs to ensure that patients get the highest standard of care, and ensure that information is available for the patient.

I am proud to say that on Friday, one of the surgeries in my constituency will open a new well-being centre, which will provide a place where health care, social care and the third sector can come together to provide better ways to improve health and well-being in the town.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman share the concerns of many Members, as I believe he does, over the closure of surgical units for children in the middle counties of England? If so, what is he doing to prevent it in his constituency?

[Stuart Andrew]

The hon. Gentleman pre-empts the next part of my speech and I am grateful to him for that.

As this is a health debate, I am sure that my right hon. Friend the Secretary of State would expect me to talk about the safe and sustainable review of children’s heart units. Like other Members, I have received a number of e-mails from various organisations today. One of them said that some MPs should seek to reignite the debate and that I should think about the children because if I had children, I would move heaven and earth to ensure that the service was the very best. Frankly, throughout the campaign on children’s heart units, I have only ever thought about the children. Of course I want the very best service for them, as do the right hon. and hon. Members from all parts of the House who have worked on the campaign. I have always accepted that there is a need for change. That is why I want to discuss a few related points this evening. I know that I will have an opportunity to raise it in greater detail tomorrow, but it is important that I speak about it tonight.

Access and travel times are incredibly important to the families who use children’s heart services. Logical health planning surely dictates that services should be based according to where the population lies. The British Congenital Cardiac Association states:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

[Andrew Percy]

That is exactly the point that Members who represent Yorkshire and northern Lincolnshire are concerned about. The proposals will mean that patients will have to travel, and expecting families in northern Lincolnshire to get to Newcastle is simply not acceptable.

--- Later in debate ---

[Stuart Andrew]

I thank my hon. Friend, who brings me to my next point. Independent analysis of patient flows showed that the majority of people in the Doncaster, Leeds, Sheffield and Wakefield area would not go to Newcastle; they would probably choose centres in Liverpool, Birmingham or even London. The NHS constitution states that patients have the right to make choices about their NHS care, yet the joint committee of primary care trusts has asserted that Newcastle could reach the minimum number of procedures if parents were “properly managed”. That flies in the face of patient choice.

Furthermore, the review has ignored the views of the people. I do not think there has ever been a petition as large as the one from Yorkshire, with more than 600,000 people’s signatures, but it counted as only one representation in the meeting at which the decision was made. I will raise a number of issues tomorrow to do with the scoring process that was used in the review, but I believe that the change will provide a poorer quality of service for Yorkshire and Humber families. Clinical experts from the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists say that paediatric services should all be under one roof. In Leeds, we have a dedicated children’s hospital with all the services under one roof, so it is ready-made.

I urge Ministers to look into the process of the review and see whether they believe it was properly run. Given the closeness of the scores for Leeds and Newcastle, and considering the outcry that has come from Yorkshire and the Humber, I hope that they will give both centres an opportunity, until April 2014, to demonstrate that they can comply with all the standards that the clinicians on the safe and sustainable steering group have recommended. If one or both centres fail to meet any of those standards, the decision should be reviewed.

This is a very important issue for my constituents. The number of letters that I and my colleagues from around Yorkshire and the Humber are receiving shows how strongly people feel about it, and I urge Ministers to listen to our concerns.