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Wythenshawe Heart Transplant Centre

12.30 pm

Mr. Graham Brady (Altrincham and Sale, West): I am grateful to have the opportunity to take part in this debate. I am especially grateful to speak up for the Wythenshawe hospital transplant unit, which is a centre of excellence not only in the north-west and the United Kingdom but in western Europe. I am pleased to be able to put on record the appreciation of people across the north-west for the work done by Wythenshawe, and the Opposition's determination to ensure that that work continues.

The background to the debate is the Government's decision to reduce the number of heart transplant centres from seven to four, and then to three, with the closure of Harefield hospital in 2006. The Government have said that it is right on clinical grounds to have fewer units carrying out more transplant operations. They have said that the poor availability of donor organs and the development of alternatives to transplantation mean that it is desirable to have fewer centres. I do not intend to question those views, or to denigrate the Northern General hospital in Sheffield or the Queen Elizabeth hospital in Birmingham. The transplant centres at both of those hospitals do excellent work. The purpose of the debate is to demonstrate that if only one of those three centres is to survive, it must be Wythenshawe.

Wythenshawe is the obvious choice on the basis of the Government's criteria. The Government want centres with high volumes of transplant surgery. Wythenshawe performs heart, lung and heart-lung transplants. The unit has performed 44 double lung transplants, 92 single lung transplants, 326 heart transplants, and 38 heart-lung transplants--a total of more than 500 transplant operations. It has had much greater experience than the other centres under consideration. Ministers want experienced surgeons. At Wythenshawe, three of the six transplant surgeons who have been in place for some time have each performed more than 100 transplant operations. The transplant team at Wythenshawe has considerable experience and expertise. In her reply to a debate on a related subject on 31 January, the Minister's departmental colleague, the hon. Member for Birmingham, Edgbaston (Ms Stuart), said that the successful centre should have an on-call rota of no more than one to four. That implies a minimum team of five surgeons. Wythenshawe has had six surgeons and has recruited a seventh, so it can meet that criterion comfortably.

The Government have said that they are worried about the decreasing availability of donor organs. Wythenshawe has an outstanding recovery system, with people on standby to ensure that no suitable organ would ever be missed because of recovery problems. The Government have said that they want efficiency in the operation of the transplant system. Wythenshawe transplant unit has the benefit of guaranteed intensive care bed provision when an organ is found. No transplant will be missed, and no organ wasted, because of a shortage of intensive care beds. The Government want to develop centres of excellence. Wythenshawe is already one. It is one of the finest centres in the United Kingdom for cardiac work, and it has the north-west lung centre and an adult cystic fibrosis unit on the same site. Many of the patients who go for lung

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transplantation are cystic fibrosis sufferers. With the opening of the new, dedicated transplant ward in a few weeks' time, Wythenshawe will be the only fully comprehensive transplant centre in the United Kingdom, and possibly in western Europe. The Wythenshawe transplant unit is a magnificent achievement that has inspired great loyalty and commitment from people throughout the north-west.

Mr. Stephen O'Brien (Eddisbury): The Wythenshawe transplant unit is indeed a centre of excellence, as is confirmed by the experience of my own constituents, who, if it were closed, would have to go to Sheffield or Birmingham, which are considerably further away. I wonder whether my hon. Friend has heard of the experience of my constituent, Sylvia Hinde, of 23 Hockenhull crescent in Tarvin, near Chester, who states:

Mr. George Stevenson (in the Chair) : Order. I believe that the hon. Gentleman has got the message.

Mr. Brady : I had got the gist of the point, as my hon. Friend expressed it so eloquently that he could convey the meaning in just a few words. The letter that he received from his constituent contains a message that I am sure is reflected in letters that hon. Members from all parties who represent the north-west have received. There has been an enormously positive response to the work that Wythenshawe has done. The furthest afield place from which I have received a letter is Dorset, which shows the extent to which the work of Wythenshawe has impacted on the lives of people throughout the country. Retaining it is vital.

Mr. Stephen Day (Cheadle): My hon. Friend the Member for Eddisbury (Mr. O'Brien) mentioned the fact that people from the local area, including my constituency, which is just to the east of Wythenshawe, would have to travel to Birmingham or Sheffield. Sheffield presents a great difficulty because of the physical presence of the Pennines, which in winter are impenetrable. Travelling to Sheffield is often virtually impossible. Equally, travelling to Birmingham from Manchester is, because of traffic on the congested M6, virtually impossible. Is my hon. Friend aware of the serious anxiety in my area, and that he speaks for the entire north-west, not only his constituency?

Mr. Brady : My hon. Friend makes an important point. I am pleased that some people manage to travel across the Pennines. He is a case in point, and we are pleased to have him on the right side of the Pennines. He makes an important point about the serious difficulties that would face many of our constituents in the north-west, who would have a difficult journey not only to travel for transplant surgery but, perhaps more importantly, in the post-operative period, for continuing care and assessment.

The unit has inspired tremendous loyalty and commitment from people throughout the north-west, as has been shown by the fantastic fundraising effort of the

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New Heart, New Start charity, which has so far raised more than £6 million to support the transplant unit. That includes the entire £1.9 million cost of the new transplant ward. Until his death last year, New Heart, New Start benefited from the energetic chairmanship of my constituent Jim Quick, who himself benefited from 13 years of productive life post-transplant and whose name will be borne by the new transplant ward at Wythenshawe.

Like the centres at Sheffield and Birmingham, Wythenshawe has been in limbo for several months. When I expressed anxieties in this Chamber on 31 January, the Minister said that it was a close race and that no decision had been taken. Still no decision has been taken. Professor Harnden, chairman of the trust, has written:

All hon. Members can understand why the Government may wish to put off an unpopular decision until after a general election. However, any further delay is untenable, when real damage is being done to morale, to the recruitment and retention of staff, and to the unrivalled voluntary fundraising effort of New Heart, New Start, donations to which have fallen. Ministers must set out clearly their criteria for the choice of which unit will survive. They must say which unit is to be chosen, and say it now.

12.40 pm

Mr. Paul Goggins (Wythenshawe and Sale, East): I thank the hon. Member for Altrincham and Sale, West (Mr. Brady) for giving me the opportunity to contribute to the debate. The Wythenshawe transplant unit is in my constituency but, as he said, its future has aroused concern among hon. Members throughout the north-west, and across all parties.

I underline the impressive clinical record of the Wythenshawe transplant unit. More than 500 transplants have taken place, including double lung and heart-lung transplants. The unit is embedded in a hospital that provides first-class cardiology and thoracic services. The hon. Gentleman acknowledged the importance of the New Heart, New Start charity. It has contributed £6 million to the unit and is providing funding of £1.9 million for the new dedicated transplant ward. The charity has raised impressive amounts of cash, and just as importantly, it has won the affection and support of people throughout the north-west.

I hope that the Minister will reassure us that when a judgment is made in the review of transplant services, it will be based not merely on the record to date--which in Wythenshawe's case is very impressive--but on the physical and clinical capacity that the chosen unit has to

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absorb the work of the two units that will inevitably close. I strongly believe that Wythenshawe has that capacity and I want to place on record the assurances that I have received from the chairman and chief executive of the South Manchester University Hospitals trust. They see the unit as an important part of the future of Wythenshawe hospital.

My hon. Friend the Minister will know that the £110 million redevelopment of the hospital will be completed by September. It is vital that the Wythenshawe transplant unit remains part of what will be a world-class hospital in my constituency.

12.43 pm

The Minister for Public Health (Yvette Cooper) : I congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing the debate. The future of our organ transplant services is important, and a matter of concern for many people. The Department has received many representations, not only about the future of the transplant centre in Wythenshawe hospital but about the future of the centres in Sheffield and Birmingham. As hon. Members will know, there was an earlier debate on the future of the Sheffield centre. It was right for my hon. Friend the Member for Wythenshawe and Sale, East (Mr. Goggins) and the hon. Member for Altrincham and Sale, West and others to raise the concerns of their constituents and make the case for the Manchester centre.

I shall explain why the Government need to find four specialist centres for heart transplants. Clearly, it is a vital health care service. In cases of liver, cardiothoracic, heart and lung transplants, the procedure is literally life saving. In the case of kidney failure, renal dialysis can sustain people while they wait for a suitable organ to become available. Ultimately, however, we need to ensure a secure future for organ transplant services in this country. We perform approximately 3,000 transplants a year with organs from 900 donors, but more than 6,000 people remain on the transplant waiting list.

The Government's commitment to modernising organ transplant services was set out a year ago in another place by the Under-Secretary, my noble Friend Lord Hunt of Kings Heath, in response to a report from the Royal College of Surgeons on the future of the then United Kingdom Transplant Support Service Authority and an inquiry by the permanent secretary into conditional organ donation. Much progress has been made, but critical issues remain in relation to the future of organ transplant centres.

The need for change and reorganisation in cardiothoracic transplant services is determined by two key factors. The first is the number of operations that take place. Improvements in road safety and the prevention of strokes in younger people are important health gains and are very much to be welcomed, but the fact that fewer young people are admitted to hospital and subsequently die has had an inevitable effect on the supply of organs for transplant. In the past five years, the number of organ donors under 60 has fallen by 15 per cent. The fall could have been greater had it not been for the dedication of staff in intensive care units and the efforts of transplant co-ordinators and teams in identifying donors.

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The Government are committed to doing everything possible to maximise organ and tissue donation and maintain the very high standards of our organ transplant services. That commitment was demonstrated at an organ and tissue donation summit on 27 February, at which the Secretary of State for Health announced an NHS action plan intended to double the number of people on the organ donor register by no later than 2010. The problem is that the fall in organ donations has meant a year on year reduction in the number of cardiothoracic transplants being performed--from 423 in 1995 to 290 last year, which is a reduction of more than 30 per cent. Over the same period, heart transplants performed in the seven centres in England fell from 262 in 1995 to 172 last year.

Although there is much that we can do to boost the supply of kidney donors, the number of younger donors for heart and lung transplants is expected to continue to decline. We will have to work very hard to reach our target of a 10 per cent. increase in donors by optimising organ donation and retrieval arrangements. Even if we achieve our target, however, the current programme will be increased by only 30 transplants a year.

Hon. Members will be aware that it is vital that surgeons have sufficient expertise and experience to perform the complex operations under discussion. They must carry out sufficient operations to maintain the skills and expertise of the team, to avoid standards being jeopardised or falling. Clearly, it would be unacceptable if the standard of treatment received by patients in need of cardiothoracic transplants declined as the numbers of transplants declined.

The second important factor affecting the organisation of services is the need for proper staffing cover. In considering how best to modernise transplant services, the Government have accepted recommendations from the Royal College of Surgeons on minimum staffing levels for transplant units. As the hon. Member for Altrincham and Sale, West mentioned, it recommends that surgeons should work no more than a one in four rota for being on call out of normal working hours. That is because so much of organ transplantation takes place at night or over the weekend. Surgeons' working hours must now comply with the European Union working time directive, which means that we need teams of a minimum of five surgeons. At the time of the report, only two of the seven adult cardiothoracic transplant centres had at least five transplant surgeons.

Cardiothoracic transplantation has been a national service since 1986. A national designation prevented the proliferation of a large number of transplant centres, which happened in other countries. Nevertheless, a major expansion of the service was agreed in the late 1980s in the belief that the number of organs would continue to increase. Four new adult cardiothoracic transplant centres were designated, and by 1991 there were seven adult centres in England. The intention was to ensure that each centre performed at least 50 transplants a year.

Wythenshawe Hospital in Manchester is one of those new centres, and last year it carried out 36 of the 290 heart, heart-lung or lung transplants performed in English centres. Another of the new centres, St. George's hospital in London, performed only 10 transplants before its programme was suspended

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following a run of poor results. That programme is currently the subject of an investigation by the Commission for Health Improvement. The other two new centres were Queen Elizabeth hospital, Birmingham and Northern General hospital in Sheffield. Last year, Birmingham performed 21 cardiothoracic transplants and Sheffield 23. The three original centres are Papworth hospital in Cambridge, which carried out 78 transplants, Freeman hospital in Newcastle, which performed 56, and perhaps the best known of all, Harefield hospital in Middlesex, which undertook 65 transplants.

Hon. Members will be aware of the need to ensure that those carrying out the transplants have sufficient expertise to perform complex operations, and the relevant skill to keep standards up. We are concerned that too few operations are being performed throughout the country. In some units, the number of transplants performed is insufficient to maintain the skills and expertise of a team of five surgeons. If that continues, transplant team members could begin to lose their skills and standards could fall. For the sake of current and future patients, we must ensure that each transplant team is well staffed and supported, and performs sufficient operations for all its members to maintain high skill levels.

Mr. Stephen O'Brien : The Minister helpfully read out statistics in which Wythenshawe ranked highly among transplant centres in terms of the total number of operations and the success rate. Given that record, would it not be an appalling shame to lose that excellence? My constituent made that point in the letter that I was unable to finish quoting earlier. The Government talk a lot about partnership, but it would be an unfortunate example if the Wythenshawe unit closed as a result of the Government's decision--yet to be confirmed--when voluntary groups have undertaken such a fantastic fundraising effort. At a time when the Government are trumpeting partnership, surely such a closure would be a kick in the teeth for those volunteers?

Yvette Cooper : I understand the points made by the hon. Gentleman, and I know of the strong feeling in the Manchester area about the importance of the organ transplant service.

The national specialist commissioning advisory group is responsible for advising on which services should be provided nationally. Last year, it recommended that the national programme should be delivered from only four centres in England. The hon. Member for Altrincham and Sale, West said that there would be only three, but I can assure him that that is not the case. Each unit would have the optimum infrastructure to support a programme of approximately 50 heart transplants.

Mr. Brady : Perhaps I am a little confused, but I understood that Harefield is due to close in 2006, leaving only three centres.

Yvette Cooper : No. Notwithstanding discussions taking place about the location of services in London, I can assure the hon. Gentleman that there will continue to be a London centre and that the Harefield transplant team will continue. In addition to the centre yet to be

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decided, there will be a London centre, one at Papworth hospital in Cambridge and one at Freeman hospital in Newcastle. To minimise disruption to existing services, the advisory group advised that two units with sufficient surgical staff should continue--at Papworth and Freeman hospitals. It also recommended that the transplant services based in London should be consolidated into a single centre. We have accepted that recommendation. It further recommended that a fourth national centre be created by merging the three smaller transplant programmes that are currently provided by the Birmingham, Manchester and Sheffield centres.

Those recommendations are supported fully by many organisations, including the Royal College of Surgeons, the cardiothoracic transplant advisory group of UK Transplant and Dr. Roger Boyle, the heart services director. The Government agreed that such principles are right and that the reconfiguration is necessary if we are to maintain the high quality of one of the best cardiothoracic transplant services in the world. Agreement has already been reached on the reorganisation of the London-based service and the new arrangements will start from 1 April.

To remove uncertainty, we recognise the need to make as early a decision as possible about the siting of the fourth centre. However, it is important that we make the right decision. It is also important to ensure that the decision is based on all the available evidence, with a full assessment of the options and the capacity of the different centres. We do not want to be tempted into making a rush decision, which could be the wrong decision, which would be bad for those areas affected and for cardiothoracic patients throughout the country.

Mr. Brady : Of course, it is important that a thorough assessment is made. The Minister must accept, however, that damage is being done by the delay. When will a decision be made and when will it be announced?

Yvette Cooper : I can say a little more about the timetable for further consideration. The Birmingham, Sheffield and Manchester centres have all made persuasive cases. Understandably, and rightly, the Members of Parliament for those areas have made strong representations on their behalf. We must take into account the impact of the enlarged transplant team on other priority areas for cardiac operations as set out in the national service framework. Clearly, it would not

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benefit the local population if their access to essential coronary artery bypass surgery was reduced to allow people from other areas to have a heart or lung transplant.

We must consider future capacity as well as track record. That is why the Government have asked for a more detailed study of the three sites, to enable us to assess the impact of an enlarged team on the capacity at the centres, as well as other important factors such as access for patients. We recognise the importance of access and travel for patients. I assure the Chamber that, whatever decisions are made, all centres have adequate accommodation for those patients who have to travel and for their families. We shall also be looking further to improve shared care arrangements, so that travelling to distant centres is minimised.

When that further work is concluded and Ministers have all the facts, we shall issue a document setting out the proposals, to inform the public. We shall also seek comments because it is important that such a decision takes place in as transparent a manner as possible. The public and those in the areas that will be affected will be given the opportunity to comment before the final decision is made. That means that we are unlikely to reach a final decision before the summer, to give proper time for public comment on the proposals and for the facts to be assessed fully.

However, when the decision is taken we will work hard to complete the necessary changes by 1 April 2002. I understand the enthusiasm for speedy decision making and I accept that all the areas and the Members of Parliament who represent them will want to make the strongest possible representations. I assure my hon. Friend the Member for Wythenshawe and Sale, East and the hon. Member for Altrincham and Sale, West that we shall take into account the points that they raised on behalf of the Manchester centre.

I am sure that hon. Members understand that we need to recognise our responsibility to make the right decision, which means making a proper assessment of all the competing claims of the different centres to ensure that the decision is made on the basis of the facts, and to offer time for public comment and debate once those facts are known. The issue is extremely important, not simply for those areas that are affected, but for cardiothoracic patients throughout the country. It is too important for a hasty or wrong decision to be made on it; we must make the right decision in the interests of people not only in the Manchester area, but in Sheffield, Birmingham and throughout the country.

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