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12.5 am

The Minister of State, Department of Health (Mr. Alan Milburn): I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on securing this important debate on the future of Harefield hospital--one of the best-known heart hospitals in the national health service. I am grateful for the opportunity to describe the high regard in which we hold its services.

Coronary heart disease is the most common cause of premature death in the United Kingdom. It accounts for about a quarter of deaths under the age of 65 and is on the increase. In 1997-98 in England, 389 heart and lung transplants were performed, of which around a quarter were undertaken at Harefield.

The Government have recognised the importance of getting the treatment and the prevention of the disease right by making it a major national priority for the NHS. It will be one of the first two services to be subject to uniform standards through a new national service framework. The framework will be published in April 1999 and will seek to improve the quality and consistency of services by setting clear national standards for providing care.

Today's service must be of high quality, but we also need to invest in tomorrow's service by researching the disease and teaching and training the young doctors and nurses who will provide care in years to come. The Government's commitment to research on cardiac and respiratory diseases is unwavering. This year, NHS providers in England will receive a total of £349 million for spending on research. The Royal Brompton and Harefield NHS trust is the health service's pre-eminent provider of research into cardiac and respiratory diseases and is receiving £20 million--just under 6 per cent. of that total.

Many people are aware that, under the inspirational leadership of Professor Sir Magdi Yacoub, Harefield hospital has become a world leader in heart and lung transplantation. It has the largest transplant programme in Europe, as the hon. Gentleman rightly said, and has accumulated experience over the past two decades that is second to none, not just in this country or in Europe, but in the world. Since its programme was set up in the early 1980s, Harefield has completed well over 2,000 transplants. I pay tribute to Sir Magdi and the whole team at Harefield, who have helped so many people over so many years to live a rich and fulfilling life.

Harefield not only provides top-quality medical care, but makes a major contribution to world-class research into cardiac disease through its links with the Imperial college school of medicine. The research output of the

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cardiac and respiratory sciences department at Imperial has been recognised in successive assessments by the Higher Education Funding Council for England as of the highest international quality. Some 20 per cent. of the UK's research output in cardiac and respiratory diseases is completed at Imperial and its associated NHS hospitals. Perhaps even more impressively, two thirds of top-quality research citations in the UK are generated by the same department.

However, like all hospitals, Harefield is not immune to pressures and it would be wrong to try to ignore them. Some of those pressures are the inevitable result of its own pioneering effort. Following the success of Harefield's transplant programme in the 1980s, eight centres in England are designated to undertake heart and lung transplantation. Harefield continues to have the largest transplant programme, although Papworth hospital in Cambridge is now of a broadly similar size. All centres have benefited from Harefield's work and from the teaching and training that it has provided to young specialists, many of whom have gone on to work in other centres throughout the country. Through its success in sponsoring the development of other centres, Harefield has seen a substantial fall in the size of its transplant programme, with 98 transplants this year compared with 219 when the hospital was at its peak 10 years ago.

The key to future success in the research of cardiac and respiratory disease is also changing. Increasingly, top-quality medical research needs to combine basic scientific research with more specialist condition-based research, which tends to take place closer to the patient. That is why we were pleased to announce the opening of the new £67 million basic medical sciences building at Imperial college in September 1998--£20 million was contributed by the NHS, a further £20 million came from the Department for Education and Employment and the remainder was funded by the university itself.

Recently, Imperial has expressed concerns that the level of fragmentation in specialist cardiac services in and around west London may erode the future international competitiveness of the university and the national health service's research base. Those are serious concerns and we need to look at them seriously.

As part of the independent review of London's health services, the Government asked Sir Leslie Turnberg to assess the need for change in that area of London. He was also asked to look at the process that had been developed involving both the NHS and its academic partners to shape the change. Sir Leslie was encouraged by the progress that he saw. His report registered a particular concern that the way in which the service is organised in west London may not be maximising its long-term contribution to national and international research. He advised the Government to ensure that plans were carried out for a more rational distribution of specialist services across west London. The hon. Member for Ruislip-Northwood may recall that we accepted all Sir Leslie's Turnberg's recommendations, including that one.

The NHS executive asked hospitals and health authorities in that part of west London, along with Imperial college, to take part in a review of specialist cardiac and thoracic services. The review commissioned expert clinical input from a panel chaired by Sir Terence English, an internationally respected figure in heart transplantation who completed the very first heart transplant in this country and who is a former president of the Royal College of

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Surgeons. The review was completed in July and broadly confirmed Sir Leslie's impression that cardiac and thoracic services in west London were not organised in a way that would continue to support the highest-quality service and academic endeavour.

Sir Terence English said that three of the four cardiac centres in west London were not seeing a sufficient critical mass of patients. He recommended that existing services should be focused on fewer, larger centres. He also advised that collocation of specialist cardiac services with other related specialties would bring benefits that were not available to single specialty hospitals such as Harefield.

We have also received advice on the national heart and lung transplant programme from the joint consultants committee, which comprises the royal medical colleges and the relevant specialist associations. The advice was that the NHS should be working to a position where such complex acute services are provided only from multi-specialty hospital sites.

Sir Terence English's recommendations are being considered, alongside the conclusions of parallel reviews into specialist paediatric services and renal transplantation in west London, by the west London partnership forum. The forum comprises the hospitals and health authorities in west London as well as Imperial college and the NHS. It is chaired by the noble Lord Newton of Braintree, for whom I have the highest regard; I am sure that he will do a very good job for NHS services in that part of London and, indeed, in the rest of the country.

As the hon. Member for Ruislip-Northwood rightly said, the forum is examining a number of options for the future of cardiac services. Those include consolidating all the work of Harefield at the Royal Brompton site in Chelsea, keeping Harefield as a specialist centre and investing in the site, and building a new major heart and lung hospital adjacent to St. Mary's hospital in Paddington. Any firm proposals will be subject to formal consultation.

As the hon. Member for Ruislip-Northwood knows, I cannot comment further, since I would have to adjudicate in the event of a community health council objecting to any such proposals. I can tell him that the Government recognise the unique nature of Harefield. The interaction of science, research, teaching and services is an enormous strength. We also know that, if the Harefield team were broken up, it would be very difficult--if not impossible--to reassemble it.

My right hon. Friend the Secretary of State has met with Sir Magdi and given him a personal assurance that, while the issues are being considered, planning blight will not be allowed and funding will be made available to ensure continuing essential investment at Harefield. I hope that the hon. Member for Ruislip-Northwood finds some comfort in those reassurances, and that he will think again about some of the language, about asset stripping and so on, which he deployed in his speech.

There are difficult issues to consider in this case, and we will take the time and the trouble to do so. We will take advice from leading clinicians in the land, we will listen carefully to what Sir Magdi and others have to say and we will listen to the proposals of Lord Newton and his team. We will then reach our conclusions, following a full and proper public consultation.

Question put and agreed to.



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