Children’s Heart Surgery

Oral Answers to Questions — Prime Minister – in the House of Commons at 12:35 pm on 12th June 2013.

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 12:35 pm, 12th June 2013

With permission, Mr Speaker, I would like to make a statement on the Safe and Sustainable review of children’s congenital heart services.

On average, around 3,700 heart procedures are carried out each year on children who have been diagnosed with congenital heart conditions. The mortality rates at Bristol royal infirmary identified as far back as 1989 indicated that we are not as successful as we should be in such operations. The Safe and Sustainable review began in 2008 and set out to ensure that children’s heart services are the best they can be for all children across the country. Whatever the controversy about the location of such services, we all have a responsibility to ensure the best possible outcomes for children and their families, who must always come first in any decision about service provision.

Sir Ian Kennedy, in his Bristol inquiry report in 2001, recommended the concentration of medical and nursing expertise in a smaller number of centres. Subsequent working groups and reports have endorsed that recommendation, including the Royal College of Surgeons in 2007. The public consultation on the Safe and Sustainable review received more than 75,000 responses. This was the largest review of its kind, conducted independently of Government by the NHS. In July 2012, the then Joint Committee of Primary Care Trusts, on behalf of local NHS commissioners, decided that children’s heart surgery networks should be formally structured around specialist surgical centres in Bristol, Birmingham, Liverpool, Newcastle and Southampton, as well as Great Ormond Street and the Evelina children’s hospital in London. The JCPCT recommended that services should no longer be provided in Leicester, Leeds and Oxford or at the Royal Brompton or Harefield in London.

Following the JCPCT’s announcement, three local health overview and scrutiny committees formally referred its decision for me to review. I wrote to the Independent Reconfiguration Panel asking it to undertake a full review of the proposals. I received that report on 30 April, and I would like to thank the IRP for producing such a comprehensive review of such a challenging topic. It strongly agrees with the case for change—specifically, that congenital cardiac surgery and interventional cardiology should be provided only by specialist teams large enough to sustain a comprehensive range of interventions, round-the-clock care, specialist training and research. I agree with the IRP’s analysis.

However, the report also concludes that the outcome of the Safe and Sustainable review was based on a flawed analysis of the impact of incomplete proposals and leaves too many questions about sustainability and implementation. This is clearly a serious criticism of the Safe and Sustainable process. I therefore accept the recommendation that the proposals cannot go ahead in their current form, and I am suspending the review today. NHS England will also seek to withdraw its appeal against the judicial review successfully achieved by Save Our Surgery in Leeds. None the less, the IRP is clear that the clinical case for change remains, and its report is helpful in setting out the way forward in terms of broadening the scope of the discussion and looking in detail at the affordability and sustainability of the proposals. The IRP says, and I agree, that this is not a mandate for the status quo or for going back over all the ground already covered during the last five years. The case for change commands widespread support, and we must continue to seek every opportunity to improve services for children.

The recommendations in the report set out the IRP’s view of what needs to be done to bring about the desired improvements in services in a way that addresses the gaps and weaknesses in the original proposals. Specifically, they include better co-ordination with the review of adult heart surgery services; expanding the detailed work on the clinical model and associated service standards for the whole pathway of care, beyond surgery; services to be fully modelled, and their affordability re-tested; NHS England to establish a systematic, transparent, authoritative and continuous stream of data and information about the performance of congenital heart services; NHS England and the relevant professional associations to put in place the means to continuously review the pattern of activity and optimise outcomes for the more rare, innovative and complex procedures; NHS England to reflect on the criticisms of the JCPCT’s assessment of quality and to learn lessons to avoid similar situations in its future commissioning of specialist services; and NHS England to use the lessons from this review to create with its partners a more resource-effective and time-effective process for achieving genuine involvement and engagement in its commissioning of specialist services.

NHS England now must move forward on the basis of these clear recommendations and the Leeds court judgment. I have therefore written today to NHS England, and to the local overview and scrutiny committees that originally referred the JCPCT’s decision to me, to explain that the IRP’s report shows that the proposals of the Safe and Sustainable review clearly cannot go ahead in their current form. It is right to give all the parties some time to reflect on the best way forward, now that the IRP report is in the public domain, so I have asked NHS England to report back to me by the end of July on how it intends to proceed. In the meantime, it is important to stress that I believe that care for children with congenital heart conditions is safe in the NHS, and that ensuring it continues to be will be the top priority for all involved in this process.

I know that many families have found the Safe and Sustainable review to be a traumatic experience. People are rightly proud of the hospitals and the staff that have saved, or tried their very best to save, the lives of their children. However, there is overwhelming consensus that we cannot stick with the model of care that we have now. To do so would be a betrayal of the families who lost loved ones in Bristol and who want nothing more than for the NHS to learn the lessons from their personal tragedies. So it is right we continue with this process, albeit in a different way. But it is also essential that the process should be performed correctly so that any decisions, as difficult as they might ultimately be, carry the confidence of the public. I commend the report and this statement to the House.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 12:42 pm, 12th June 2013

I thank the Secretary of State for giving me early sight of his statement. He was right to begin by reminding the House of the events that led to the Safe and Sustainable review. Terrible failings in the care of very sick children at the Bristol royal infirmary in the 1980s and 1990s led Sir Ian Kennedy to call for expertise to be concentrated in fewer surgical sites—a call supported by more recent events, including those at the John Radcliffe hospital in 2010. Since Bristol, Sir Ian’s important conclusion has had the full support of the health professions and of those on both sides of this House. As we digest what the Secretary of State has just said, two considerations must remain at the forefront of our minds. First, that this issue must continue to transcend party politics. Secondly, that the complexity it presents should not derail our determination to deliver the safest possible care for children in England.

That said, changes of this magnitude must be able to command public confidence and consensus, but that has not emerged since the decision on site selection by the Joint Committee. I fully support the reduction in sites, but when the decision was published I expressed concern about the distribution of the seven sites, which was skewed towards the western half of England and left a large swath of the east, from Newcastle to London, without a surgical centre. For a family in Hull or Lincoln, already at their wits’ end with worry, the wrench of leaving home to travel hundreds of miles, along with the cost of accommodation and time off work, would add to high levels of stress and anxiety. That is why the issue has aroused such strength of feeling, particularly across Yorkshire, the Humber and the east midlands—a concern well voiced and represented by Members throughout the House.

Although clinical safety must predominate, does the Secretary of State agree that the NHS needs to give more consideration to public access and travel times when reconfiguring services? The truth is that the NHS has a habit of minimising these concerns in all reconfigurations—in this case, as the IRP report points out, the Joint Committee considered access the least important factor. The IRP concluded, surely rightly, that

“the decision used a flawed and incomplete analysis of accessibility”.

Going forward, will the Secretary of State ensure that this is corrected and that access is made a significant factor in any future decision?

Turning to the review itself, the Secretary of State will know that one of the main concerns has been that the mortality data were not given enough weight. Although decisions of this kind cannot be based on death rates alone, we agree with John Deanfield, director of the National Institute for Cardiovascular Outcomes Research who wrote in his letter to NHS England in April:

“Mortality is only one measure of quality, but currently is the most…available outcome.”

Will the right hon. Gentleman confirm that this data will feature more prominently in the further process of review announced today?

My main concern with what the Secretary of State has just announced is the proposal to link the children’s review with the review of adult heart services, and the implications that might have for the timetable. The Secretary of State will know that there are around 30 centres across England carrying out adult heart surgery. The seven selected children’s centres are not all co-located with adult heart surgery and, indeed, a number of them are on specialist children sites, so the link between children’s and adult heart surgery is not clear.

Is there not a real danger that by linking the review with adult heart surgery, the Secretary of State is introducing more complexity and, potentially, controversy, risking a loss of focus and more delay? By broadening out in this way, is there not a danger that we will lose the consensus that has already been gained over the future of children’s heart surgery? I would be grateful if the right hon. Gentleman would say more on those points.

This decision will also have implications for the timetable of the children’s review and it will not have escaped the House’s notice that that Secretary of State has not announced a clear timetable. Can he set out more precisely a timetable for the decision making that will now follow? He says that the review will be concluded by the autumn. What people will want to know is when the decisions will be made and implemented. Can he say more about that?

The statement sets out a major role for NHS England going forward and questions may be asked about the independence of the review he has announced. What guarantees can he give that NHS England will operate independently of vested interests linked to the 10 sites?

Finally, I am sure the right hon. Gentleman will agree that we cannot risk any loss of confidence in the process, damaging confidence in all 10 existing sites. Will he say more about what he will do in the interim period to support all existing units and ensure that there is no loss of expertise?

In conclusion, it is, of course, essential that the public have confidence in the process and the final decision. Balanced against that, however, is the fact that unnecessary delay will not bring the best results for the children who most need our help. The Secretary of State is right to say that we need a process that is seen to be fair by all concerned, but, equally, a point will come when decisions must be made. In the end, I want to assure the Secretary of State that when he comes to face up to those difficult decisions, he will have our support in doing so.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I thank the right hon. Gentleman for the tone of his comments and the bipartisan way in which he has approached these issues. I particularly welcome his last point. We have many debates in this House, but this is one issue where we are completely at one. If there is a difficult decision to be made that will save children’s lives, we must have the courage to take it. I am grateful for the right hon. Gentleman’s support on that.

I think that the right hon. Gentleman will also agree with me that while this issue transcends party politics, it is one from which all of us—on both sides of the House, throughout the NHS and indeed in local authorities—have things to learn. I think that the biggest issue for us all to consider is the sheer amount of time that it has taken. The original concerns about what happened in Bristol were raised in 1989. I am pleased to say that they have been dealt with, but there are broader, system-wide lessons to be learnt. It took until 2001 for Sir Ian Kennedy’s report to be completed, it took until 2008 for the Safe and Sustainable review to begin, and now, in 2013, we are having to suspend the process yet again. What has happened is not the right outcome for children, and we must all learn the lessons from that.

The right hon. Gentleman mentioned site selection. I consider that to be one of the most crucial areas in which the process was flawed. Whether we should involve adult heart services is a difficult question, but one of the key recommendations in the IRP’s report is that they should be taken into account. I think that we should pay attention to that recommendation, because the panel thought about it very carefully. The reason for its view was that the same surgeons often operate on children and on adults. Adults also have congenital heart conditions that require operations. The panel also says that if the best outcomes are to be achieved for children, services must be concentrated in teams that have four full-time surgeons, provide specialist training, and conduct research. The knock-on impact of what is happening in adult heart services is relevant.

I agree with the thrust of what the right hon. Gentleman said about mortality data, but I know that he will also understand the difficulty of publishing such data on a very small number of cases when it may not be statistically significant. That was one of the great debates that we had over the temporary suspension of services at Leeds. We must be careful not to publish data that could lead the public to make the wrong conclusions. In principle, however, transparency is the most important thing for us to bring about.

I entirely agree with the right hon. Gentleman about the timetable. I think that we must get on with this process: I do not want to delay it any more than is necessary. I have talked extensively to NHS England about how it should be approached. NHS England—along with all the stakeholders involved—needs time in which to digest the contents of the IRP report, which was published only today. I consider that the minimum period that I need to allow it in which to come up with the timetable is until the end of next month. I appreciate that that is six weeks, but I think that it is a sensible period. I certainly want to be able to publish an indicative timetable by then, so that people can understand how the process will continue and how we will learn the lessons.

I also agree with the right hon. Gentleman that nothing in my statement should undermine the public’s confidence in the brilliant work being done by heart surgeons all over the country for adults and children. Our heart surgery survival rates have improved so much that they are now some of the best in Europe, and we can be very proud of the work that those surgeons do, day in, day out. However, that does not mean that we cannot strive to be even better.

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee

I welcome the statement, although, in a sense, I welcome it with a heavy heart. Does my right hon. Friend agree that the Safe and Sustainable process could not go ahead because it had fundamentally lost the confidence of both patients and clinicians, and therefore did not form a proper basis for necessary change?

Given that it is now more than 12 years since the publication of Sir Ian Kennedy’s report, does my right hon. Friend agree that this is not a success for the NHS? Does he agree that it is a real challenge for NHS England to put a proper time frame around necessary change for these services, and then to use that as a basis for changes that we know to be needed in other specialist services in the national health service?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I agree with my right hon. Friend on both those points, as, indeed, on many others. It is true that the Safe and Sustainable process did not have the confidence of the public. It should be emphasised that when a controversial and difficult change is proposed, there is always likely to be public opposition. However—as I am sure we shall hear from Leeds Members in particular—this process did not command confidence in Leeds, or in other centres, because there was a sense that the outcome had been determined before the start of the consultation. The public found that totally unacceptable, and indeed it is unacceptable. The point of a consultation is for those who initiate it to listen genuinely, and to engage with stakeholders. That must be one of the most important lessons to learn.

My right hon. Friend was also right to suggest that, in general, this is not a success for the NHS. We need a much better process to enable us to face difficult decisions about reconfigurations of services, and, in particular, carrying the public with us when we must make a difficult change that will save lives. We have not done that as well as we need to.

Photo of Hilary Benn Hilary Benn Shadow Secretary of State for Communities and Local Government

It has been clear to many of us for a long time that this process was flawed, and that has now been recognised by the IRP. I pay tribute to the extraordinary campaign in support of the Leeds children’s heart surgery unit in my constituency, which has helped to bring us to this day.

I welcome the Secretary of State’s statement, but does he agree that it is important for the process to be open and transparent this time, and to focus on what it is meant to be about, namely ensuring that the very best surgery is available for our very sick children?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is entirely right. On this occasion, it is clear that the concerns of the campaigners were valid, and that the process was not conducted as it should have been. Interestingly, the campaigners commented that they felt that their engagement with the IRP was a much more open process than their engagement with the NHS.

Many people in the NHS believe passionately, and for absolutely the right reasons, that we need to change the way in which services are delivered. I agree with them, and specialised services such as those that we are discussing today provide a very good example of that. We know that the more operations a heart surgeon performs, the better he or she will become at his or her job, and the more likely a successful outcome is. However, if we are to carry the public with us—and they are, after all, the people whom the NHS is there for—we must do a much better job of genuine engagement.

Photo of Edward Garnier Edward Garnier Conservative, Harborough

I thank the Secretary of State for an intelligent and thoroughly considered statement which will have brought great joy to many people in Leicestershire. I also commend the shadow Secretary of State for dealing with the matter on a cross-party basis. We in Leicestershire have dealt with it on that basis as well: my hon. Friend Nicky Morgan and Liz Kendall have been, if I may say so, the leading ladies in the Glenfield hospital campaign.

I am grateful for the respite that we are being given by the Secretary of State. What advice can he give us to give to the clinicians, nurses and parents of patients at Glenfield hospital about how best to present, or re-present, their case between now and the time at which he and his advisers will reach a final conclusion about the disposition of children’s heart services?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We must all engage with the process thoroughly and fully. We, as Members of Parliament, have a responsibility to engage with our constituents about some of the complexities involved. The issue of mortality rates, which was raised by Andy Burnham, is one of those complexities. They are very important, but they are not the only consideration, and, when it comes to specialised services, they are extremely difficult to interpret properly. We must engage in an intelligent and constructive way, and reassure our constituents that all of us—Government and Opposition—want the best outcome for children, the outcome that will save the most children’s lives.

Let me return to what the Prime Minister said earlier. I have no problem with explaining to my constituents that in the case of certain services, they are better off travelling further. I did not respond earlier to the right hon. Gentleman’s point about travel, so let me say now that I agree with him that it must be taken into consideration. According to the IRP’s report, the whole care pathway needs to be examined. That means not just the visit to the hospital for surgery, but follow-up care and early assessments. In that context, then travel becomes much more important.

If we are honest with our constituents about the fact that there may be a difficult decision at the end of the process, we are much more likely to earn their trust.

Photo of Nick Brown Nick Brown Labour, Newcastle upon Tyne East

How much public money has been spent on taking us to the point that we have now reached? Is the IRP report available to Members of Parliament? Will the Secretary of State say a little more about the process that will take place between now and the day on which he must come to the Dispatch Box and announce very difficult and controversial decisions to the House, and will his decisions stick?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The cost to date of the Safe and Sustainable process is about £6 million and Members of this House will rightly ask whether that money has been spent well, given the flaws in the process identified today by the IRP. I would also say, however, that it is right to spend money on carrying out such processes properly. It would be the wrong approach to say that, based on the cost of the process, we are not prepared to consider how we can improve services.

On the timetable, now that the report is public—it is available to Members of the House and the public as of today—I have given NHS England and all stakeholders until the end of next month to come back to me with a revised plan.

Photo of Jason McCartney Jason McCartney Conservative, Colne Valley

I agree with the Secretary of State that families must come first. For me, that means the families of Ben Pogson and Joel Bearder, young constituents of mine who have been treated at the wonderful Leeds unit. Will my right hon. Friend give an assurance that the new review will be based on the fundamental principle of patient choice and that doctors should go where the patients are, rather than the other way around?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Patient choice is very important, but it is also fair to say that there are other considerations in such a review, such as clinical best practice and what outcomes will get the best results for children. We need to be up front with the public that that will not mean specialist children’s heart surgery being offered in every major city in this country. There will be some difficult decisions at the end of the process. The broader point about patient choice, when it comes to considering mortality rates, is that it ties in very well with the concept of peer review. The way we can get better outcomes for children is by being able to compare what happens in different centres, and that is a very important part of the process.

Photo of John Denham John Denham Labour, Southampton, Itchen

Will the Secretary of State acknowledge one fact that has complicated this process? A foundation trust that loses children’s heart surgery will probably lose paediatric intensive care and, therefore, all the rest of its paediatric service activities, doing potentially catastrophic damage to the budgets of some trusts. Are the institutional pressures on individual trusts not one reason why it has been so hard to get a collaborative approach to that fundamental change? How does the Secretary of State intend to resolve that issue as he moves forward with the review?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The independent review says that the knock-on effects on adult heart surgery, and the interrelationship between the two, need to be considered. There are always knock-on effects of a service reconfiguration. Within reason, one must consider them, but one must also bear in mind what Andy Burnham said: one must ensure that one does not overcomplicate the reviews. If we consider every single knock-on effect of every single change, the danger is that we end up not being able to change anything at all, which on this occasion would be an abdication of our important responsibilities.

Photo of Greg Mulholland Greg Mulholland Liberal Democrat, Leeds North West

I have called consistently for leadership and accountability. I believe that we have had those things today, and I thank the Secretary of State and his colleagues in the Department for that. I have said consistently that there was something wrong with the decision-making process. We were right, whereas those who told us that we should be quiet and ignore the serious flaws, clear bias and utter lack of transparency were wrong. May we have a full investigation into the clear maladministration in the course of the review? Will the Secretary of State assure the House that lessons will be learned, which is key, and that those conflicted people who have let children down and wasted taxpayers’ money will play no part in any further review in the NHS?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I can confirm that a thorough process of learning the lessons will happen. As I said earlier, we must learn big lessons about the time it takes to make very important service changes in the NHS, not just in children’s heart surgery but in many other areas. We need to learn those lessons. The person who was responsible for the JCPCT, Sir Neil McKay, is no longer responsible and has retired from the NHS. We need to look at everyone who was involved in the process and see where the right calls were and were not made. If we do not, we will never be able to make important changes in the NHS—and we have a big responsibility to make those changes.

Photo of Mary Glindon Mary Glindon Labour, North Tyneside

The proposed reconfiguration of children’s heart surgery has gone on for years. Meanwhile, children are suffering and even dying. Why cannot the Secretary of State have a more rigorous timetable based on the lessons learned from the review so far?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is what I absolutely want to do. One huge frustration for those on both sides of the House has been how the process has dragged on. If I could have come to the House today with a detailed timetable, I would have. Although we had internal access to the report before today while I considered its findings and reached a judgment, we believed that it was necessary for external stakeholders to see the report and give their view of how the timetable should proceed. That is why I have given NHS England until the end of July to come back with that timetable.

Photo of Nicola Blackwood Nicola Blackwood Conservative, Oxford West and Abingdon

The Health Secretary is absolutely right that parents in my constituency have found this process deeply destabilising. Although they also want to see quality, they felt that their concerns about building up a good relationship with their medical teams and about accessibility and co-located services were simply dismissed. Will the Health Secretary assure me that that will not be the case in the future, and will he look more closely at the networking solution we have in Oxford and Southampton, which strikes a good balance between having a quality site further away and providing aftercare in an accessible site with trusted medical teams?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is a very interesting thought. My hon. Friend will be pleased to note that the IRP report states that the whole care pathway, not just the surgery on its own, needs to be considered when we make this very difficult decision. I agree with her that this has been a very distressing process for every family involved and although we are suspending the process today, we have a responsibility to be honest with people. At the end of the process, there will be a difficult decision to take and we will honestly do our duty as Members of this House.

Photo of Fabian Hamilton Fabian Hamilton Labour, Leeds North East

I know that all the families of children affected throughout Yorkshire will welcome today’s statement from the Secretary of State. Will he reassure the House that any future review panel, following whatever timetable he decides, will comprise representatives fairly and equally chosen from all the centres that will be affected by any decisions? Secondly, what assurances can he give that rather than the data used in flawed reports, such as the now infamous National Institute for Cardiovascular Outcomes Research 8 April report on mortality data in children’s heart surgery units, we will use data that are consistent and reliable?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

On the hon. Gentleman’s second point, we need to be very careful about how we use any mortality data, particularly on specialist services where distortions can be based on just one or two operations. I know that he will agree, however, that we have a responsibility to act if we have genuine concerns. That is what happened and the process over Easter was very difficult. One lesson we have learned in the NHS is that in Bristol it took a very long time—years—before anything was done about the higher mortality rates and we do not want to make that mistake again. I take on board the hon. Gentleman’s other point, too.

Photo of Jane Ellison Jane Ellison Conservative, Battersea

I know that many of the staff and patients at the Royal Brompton hospital will very much welcome my right hon. Friend’s statement today. Although the hospital is not in my constituency, many of the staff live in my constituency and other hon. Members have been extremely active in making the Royal Brompton’s case over recent months. There was particular concern about the possible impact on other specialisms of any decision to withdraw children’s heart surgery, so can my constituents be assured that such concern will be taken into account in any future process?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The IRP report says that we must consider the broader impact of any changes beyond the narrow question of children’s heart surgery, so I am sure that that is one of the lessons that will be learned.

Several hon. Members:

rose—

Photo of John Bercow John Bercow Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons, Speaker of the House of Commons

Order. On the assumption that Dr Lee has now put his phone away, may I say to Members that they should not stand to speak while at the same time fiddling with a phone? It is multi-tasking in a way that is perhaps a tad discourteous. We do, however, want to hear from Dr Lee, who is a distinguished physician, so let us hear from him.

Photo of Phillip Lee Phillip Lee Conservative, Bracknell

My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

May I commend my hon. Friend, because he is one of the few Members of this House who has been prepared to campaign for changes in acute services in his own constituency, which might not necessarily be what his constituents would want? He has shown considerable bravery on this issue. I will mention his idea of a national plan for acute and emergency services to Sir Bruce Keogh, who is carrying out the review of emergency services as part of the vulnerable older people plan. We definitely need to have a different national approach to service reconfigurations.

Photo of John Healey John Healey Labour, Wentworth and Dearne

What a waste of everybody’s time. Why should anyone believe that the new review process will be better than the last one or that the Secretary of State will make decisions at the end of it? Will he apologise now to the parents, the families and the staff for allowing this flawed and failing process to go on for so long and for the anguish that they have suffered during it?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

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.

Photo of Stuart Andrew Stuart Andrew Conservative, Pudsey

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?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

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.

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards

I welcome the statement that the right hon. Gentleman has made today. Notwithstanding the fact that we would all want the best possible outcomes from this surgery, wherever it takes place, site selection or geography is a concern for us, for the health service and for patients and their families, so can we make sure it is taken into account? If skills are seen to be weak in certain geographical areas of the UK, we should improve those skills, not think about moving people elsewhere.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right hon. Gentleman makes an important point. Site selection needs to be done by people who are completely independent of any local interest in where the surgery should happen. That is the crucial point we need to learn, but the point about skills is also important.

Photo of Andrew Bridgen Andrew Bridgen Conservative, North West Leicestershire

May I praise my right hon. Friend for his brave and eminently sensible statement today on this most emotive of topics? However, will he assure the House that any future plans to remove children’s cardiac services from the Glenfield hospital in Leicester will take full account of the world-leading extra corporeal membrane oxygenation services which will also have to be moved? The Secretary of State is completely right on this issue and many others: we do not need a quick solution; we need the right solution.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I agree with my hon. Friend, but I would actually like a solution that happens as quickly as possible, provided the process is done properly. He will be pleased to know that the IRP report does say that the impact of suspending the review and thinking again should be borne in mind in respect of decisions that have already been made as to the siting of ECMO services, and I know that NHS England will be reflecting on that.

Photo of Alan Whitehead Alan Whitehead Labour, Southampton, Test

Does the Secretary of State appreciate the sheer difficulty in respect of recruitment, retention, planning and maintenance of an excellent service that has been incurred by the units affected, particularly the one in Southampton? Is he prepared to look at the possibility of providing additional resources to those trusts affected to enable them to maintain those excellent services during a continued period of uncertainty? Not only is it a continued period of uncertainty, but there has been continued oscillation between near certainty, uncertainty, no certain and possible certainty as a result of this interminable review and the way it has been conducted.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I actually agree with the hon. Gentleman; one of the biggest casualties of the length of time it is taking to resolve this very difficult issue is morale at the excellent children’s heart units that we have across this country, and recruitment is one of the biggest concerns in that regard. Resources are now allocated independently by NHS England, but I know that its priority is to ensure the safety of services.

Photo of Steve Brine Steve Brine Conservative, Winchester

May I thank the Secretary of State for his statement? Once he received the IRP report, he had little choice but to make this decision. I feel sure that it will be met with a deep sigh in Southampton, just because of the lack of certainty that it now extends for the trust there. To what extent will the Safe and Sustainable process now be rolled back? How far will it be rolled back? Is the number of centres now back in the “not sure” box? As he has said, we still face an incredibly difficult decision and there is still a reduction in the number of centres—or is there?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

There will be a reduction in the number of centres at the end of this process, as is clear from what the IRP report says. It thinks we would have better outcomes for children if we concentrated surgery in fewer places, with more comprehensive facilities offered in all those places. However, we need to get the process right in order to get there.

Photo of George Mudie George Mudie Chair, Statutory Instruments (Joint Committee), Chair, Statutory Instruments (Select Committee)

I thank the Secretary of State for, and congratulate him on, his decision. However, as an outsider I watched this process descending into almost a medical beauty contest, with comparing and deciding. Surely if we are rationalising the centres, the key starting point should be their placement for the maximum benefit of the populations, the patients and the parents, not this business of who has the lowest mortality rate. Doctors can move, but populations cannot.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The answer is this needs to be a mix of both; this needs to be about clinical excellence and issues such as accessibility and travel. A wide range of factors are involved. I accept, and this is widely accepted, that it is particularly difficult with specialist services to interpret mortality rates in a meaningful way, but that does not mean we should not look at them and seek to learn what we can.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

My right hon. Friend’s statement will have given great hope to all those in and around Leicestershire who campaigned to keep Glenfield hospital, and we welcome the acceptance that the original site selection was flawed and the implicit acceptance of bias against the east midlands and against the east of the country in general. On a positive note, if we are going to have the clinical case for change accepted and consolidation in the future, what is his understanding of the number of lives that would be saved if we have to go through this painful process?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I do not want to pluck a number out of the air; I want to listen to the clinical evidence on that. However, it is important to say that as a result of the excess mortality identified at Bristol the Kennedy report said that up to 170 lives could have been saved over a 10-year period in just one location. That is why it is so important that we get this decision right.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

The Secretary of State is right to say that, sadly, the process did not have the confidence of the public. I very much welcome his statement. In moving forward, will he ensure that any data used are independent, transparent and credible, and that patient experience and access are given the right priority in the decision making?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Those are all things that the IRP talked about in its review, and I very much accept its recommendations in those areas.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I congratulate the Secretary of State on calling in the Independent Reconfiguration Panel, which has successfully exposed this shambles. I imagine that my constituents strongly suspect that the thick end of the £6 million cost of the exercise has gone on fat fees for management consultants. Given that the IRP concludes that there was flawed analysis and too many questions left unanswered, surely those management consultants should be banned from taking part in any further NHS reviews?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

If there are management consultants responsible for what went wrong, I am sure that the NHS will make the appropriate conclusions.

Photo of Diana R. Johnson Diana R. Johnson Shadow Minister (Home Affairs)

I am pleased to hear that care pathways as a whole will be looked at and given consideration. Will the Secretary of State confirm, as he made clear in response to a number of questions, that the genuine concerns of constituents, including mine in Hull, will be listened to? Transport and access are very important to my constituents because of the city’s geographical location. Whoever makes these decisions should fully understand the geography of the country and be able to make a proper decision.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I completely accept what the hon. Lady says, and obviously transport and access do matter; that comes out in the IRP report. However, we have to be honest about the fact that if we are conducting surgery at fewer sites, the end result is that some people in the country will have to travel further than they currently do. That is why this is such a difficult decision. She will understand that a choice has to be made in that respect.

Photo of Bob Stewart Bob Stewart Conservative, Beckenham

Last Saturday I attended the funeral of a girl, with my wife and my daughter Delphine. The girl was a 16-year-old in my daughter’s class. A month ago, she suddenly dropped dead. She had not been aware of any problem. Arabella Campbell was a beautiful, highly intelligent, vivacious girl who had everything to live for, and nothing was known about her problem. Can Arabella’s death, and the death of hundreds of other children and young adults, be used as a spur to reinvigorate the NHS campaign to identify young people who may suffer a heart attack as a result of a problem that has not been detected before, difficult as that may be?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I know that the whole House will want to send its condolences to Arabella Campbell’s family, and the way that my hon. Friend has brought the issue to the attention of the House shows the seriousness of the issues that we are considering. Part of what the IRP talks about is a proper review of the screening process for people who have congenital heart failure. Yesterday I met a group of campaigners on sudden adult death syndrome who had an equally tragic story, and I am waiting for advice from the national immunisation and screening committee on the right way forward in this respect. I thank my hon. Friend for his comments.

Photo of Jon Ashworth Jon Ashworth Opposition Whip (Commons)

Clinicians at Glenfield hospital, and people across Leicester and the wider east midlands, will welcome what the Secretary of State said today on the suspension of Safe and Sustainable, but I want to ask him a further question on the point that Andrew Bridgen made about the future of the extra corporeal membrane oxygenation centre. The decision to move ECMO from Leicester to Birmingham was a direct consequence of Safe and Sustainable. That decision is now suspended—I hope that is what the Secretary of State is saying. Will he reconfirm that the future of ECMO provision will be fully taken into account by NHS England?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I can confirm that. One of the recommendations of the review was that the ECMO decision be linked to what is decided under Safe and Sustainable, and I know that NHS England will want to consider that carefully. I hope to be able to come back to the House to report what it decides as soon as possible.

Photo of Martin Vickers Martin Vickers Conservative, Cleethorpes

My Cleethorpes constituency is on the very edge of the area served by the Leeds unit, and I particularly welcome the acknowledgement that future investigations will consider geography, but as well as feeling isolated geographically, many of my constituents felt somewhat isolated from the whole process. We do not want to prolong the process unnecessarily, but will the Secretary of State assure me that there will be some mechanism allowing input from individual constituents?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I can absolutely give that assurance. The fact that the engagement with the public in this process was not as genuine as it should have been is one of the biggest lessons for the NHS to learn.

Photo of Catherine McKinnell Catherine McKinnell Shadow Minister (Treasury)

Two years ago, almost to the day, we debated the issue in the House. I said at the time, and reiterate today, that the issue must be resolved as quickly as possible to end the damaging delay and uncertainty, and to secure the safety of children and the best clinical care for them. The Secretary of State has given a variety of reassurances, but I would like to hear a cast-iron reassurance, for my constituents, that in any future decision, clinical expertise and care will be paramount, and that this will be resolved as quickly as possible.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am very happy firmly to give both those assurances.

Photo of Julian Smith Julian Smith Conservative, Skipton and Ripon

The Health Secretary is absolutely right to push ahead with specialisation in cardiology services. I represent one of the most rural constituencies in England, and I thank him for taking on board the need for more focus on access. In the future, I recommend that more money and time be spent working with members of review panels, because about a year and a half ago, when MPs met them, it was clear that some of them were out of their depth. It would do everybody a lot of good if we spent more money and time helping them.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend, and I am sure that that lesson will be learned.

Photo of Julian Sturdy Julian Sturdy Conservative, York Outer

I very much welcome the Secretary of State’s statement, as will concerned families across my constituency of York Outer, and across the county of Yorkshire. Will he ensure that the new review recognises that units where paediatric and maternity services are located on a single site offer the optimal patient experience?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I think we need to be guided by the clinical evidence in that respect, but I urge my hon. Friend and his constituents, if they have a strong representation to make in that respect, to make it to the review when it re-proceeds.