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Will the Minister confirm tonight that the MIO unit in Exeter will continue until such time that it is safely-and I mean safely-established in Plymouth? If not, why is
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this being done against the clear recommendations of the health scrutiny committee and contrary to what was promised personally to surgeons, patients and MPs by the primary care trust? Why has Plymouth failed to develop a total MIO, despite giving the reassurance that it would develop it in September 2009, by which time we would have hoped that it would be well on the way to being established?

Will patients in Devon now have to accept the choice of open surgery, which they do not want-those who have seen what is done at Exeter clearly opt for the minimally invasive surgery-or will they be faced with the very real risks of a learning curve in developing a new highly complex operation in a unit not familiar with this procedure? As I have mentioned, there have been disastrous parallels in previous examples of centralisation. I will not name them, but I am happy to tell the Minister privately where we have seen the procedure bomb as a result of the transition not being implemented properly and surgeons not having sufficient time or a team built around them to carry out the transition properly.

A final aspect of the problem is that people come from far and wide for the procedure in Exeter-not just from the south-west but from all parts of the country, because the procedure is unique. If the MIO unit closes in Exeter and is not reopened in Plymouth, a private patient could opt to have the MIO procedure and all the associated benefits if they are prepared to pay for it. NHS patients, however, who until now have had the choice and the benefits of the procedure, will be denied it. I really do not understand why something so groundbreaking and so important to our constituents, as well as being in the national interest, should be denied to the NHS. Something has gone seriously wrong with the way in which the process has been carried out, and I would like the Minister to investigate what it is and put it right.

7.28 pm

The Minister of State, Department of Health (Mr. Mike O'Brien): I congratulate the hon. Member for Tiverton and Honiton (Angela Browning) on securing the debate.

The fast and effective treatment of cancer is one of the national health service's highest priorities. As a result of massive and sustained investment in the NHS and in cancer services by this Government, paying for more consultants, more nurses, more National Institute for Health and Clinical Excellence-approved drugs and far better facilities, there are now almost 9,000 fewer deaths every year than there were before 1997.

In 2000, we published the NHS cancer plan, setting out how we would improve cancer treatment and ensure high-quality services for patients. The plan committed the NHS to implementing the latest authoritative guidance available on all aspects of NHS cancer care. However, I can assure the hon. Lady that decisions about exactly where and how care will be provided are local decisions. It is a matter for the local NHS, working with cancer networks, clinicians, patients and other stakeholders; it is not for Ministers to decide that in Whitehall.

The Department, supported by the national cancer action team, has been monitoring progress in the context of local plans. Although I understand the concern
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expressed by the hon. Lady, I am sure she will appreciate that if further improvements are to be made in cancer surgery and if better outcomes are to be delivered for patients, local clinicians must be able to secure local solutions to the various issues that are raised. In 2008-09, a total of 3,668 major oesophagogastric procedures took place in England. I understand that about 50 patients currently undergo surgery for oesophagogastric cancer each year at Derriford hospital in Plymouth, some of whom are from Cornwall. About 47 patients undergo surgery at Royal Devon and Exeter hospital in Exeter, and about 20 undergo surgery at Royal Cornwall hospital in Truro.

I understand that Devon primary care trust, working with the South West strategic health authority and the peninsula cancer network, has considered the improving outcomes guidance recommendations for upper gastrointestinal cancers, and that discussion took place with local people. The proposal is that from 1 January next year the oesophagogastric surgical unit at Plymouth Hospitals NHS Trust will expand to become the centralised specialist surgical unit for patients from Devon and Cornwall with oesophageal and gastric cancer.

As part of its commitment to placing patients and the public at the centre of health services, the Government have established an independent scrutiny and review process for local change. I will deal with that shortly, and will deal in particular with the views of the overview and scrutiny committee, which were raised by the hon. Lady. The proposed change is intended to start from 1 January, which is fairly soon. The local NHS has finalised implementation plans, and patients in the south-west peninsula requiring specialist upper gastrointestinal cancer surgery will be given their surgical treatment in Plymouth from that date. The surgical element of their treatment will no longer be provided by Royal Cornwall hospital in Truro or by Royal Devon and Exeter NHS Foundation Trust. I recognise that there is a specific case of which I was not aware. I shall establish further information about it and report to the hon. Lady on whether it indicates any sort of precedent, because at present I simply do not know.

The peninsula cancer network has told my Department that the whole surgical team is experienced and properly trained in both open and minimally invasive techniques for oesophageal and gastric cancer surgery.

Angela Browning: Will the Minister give way?

Mr. O'Brien: If the hon. Lady allows me to say a little more, she may understand my point.

There is no nationally recognised definition of MIO, although this is a national issue. In Plymouth, the plan is to investigate both the role and the definition of minimally invasive techniques for oesophageal cancer as part of a multi-centre study.

Angela Browning rose-

Mr. O'Brien: The hon. Lady may still wish to respond, bearing that point in mind.

Angela Browning: I said I was aware that keyhole surgery had been performed at Plymouth. So far, however, a single case has not involved keyhole surgery throughout the procedure. Only hybrid operations have been performed
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at Derriford. I believe that this is an urgent matter involving the safety of patients. If what the Minister is telling me is accurate, either those at Derriford are going to replicate what is done at Exeter-they have not done that to date, which that means that they would practise on the first few patients, and that would worry me-or they will drop the full MIO procedure.

Mr. O'Brien: I will make further inquiries about the hon. Lady's point. I will say, however, that the intention is for the internationally recognised research on MIO at Exeter to be supported and developed at Plymouth. Once the clinical service has been established, it is intended to support and pursue the research programme currently under way in Exeter and to develop further projects. It is also the case that, following the publication of the review carried out by Professor Mike Griffin and Mr. Bill Allum, a period of public engagement was carried out, with various local meetings.

I understand the concerns that have been raised, and we have looked into some of those raised by the Devon OSC. The PCN has confirmed that equipment to undertake open and minimally invasive procedures is in place in Plymouth. Additional equipment has been ordered, after discussion with a senior surgeon at the Royal Devon and Exeter, and it will be delivered shortly. This will not impact on the delivery of the service from 1 January.

Angela Browning: I hear what the Minister says about the equipment being ready at Derriford. However, if I wanted to climb Everest, I could order the equipment over the internet and have it all ready, but although I might be a bit of a mountaineer, that would not make me ready to climb Everest. Experience and practice are required to go with that kit, and an experienced team as well.

Mr. O'Brien: The hon. Lady puts her case very eloquently, but I have to say that the PCN has confirmed that the whole surgical team is experienced and properly trained in both open and minimally invasive techniques for oesophageal and gastric cancer surgery. As was described in the AUGIS-Association of Upper Gastrointestinal Surgeons of Great Britain-consensus statement of 2008, there will be two consultant surgeons operating on each case, which will allow for the incorporation of skills from around the peninsula and the appropriate supervision and mentorship model for minimally invasive surgery. As also described in the AUGIS consensus statement, there is no recognised definition of MIO, and these matters will need to be looked at.

I am concerned by what the hon. Lady says and I will make some further inquiries, but we have been given reassurances, and, essentially, this is a local matter. We therefore have to rely on local clinicians to say whether they can do this. At present, they are coming back to us, through the appropriate procedures they have, and saying, "Yes, we can do this." She is saying that she believes the qualifications and experience are not in place. I will look again, and we will go back to the local clinicians, but she says something different from what they are currently telling us. I am not an expert clinician, and no more is she, and neither of us knows whether those skills are in place. All she can do is report what is being said to her, and all I can do is report back what I am being told. This is, however, a matter to be resolved locally, rather than nationally.

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That brings me on to the hon. Lady's point about the local health OSC. I am concerned about that, of course, because such committees can refer proposals to the Secretary of State for Health, which he can then pass on to the independent reconfiguration panel for consideration and independent advice. On 20 November 2009, the Devon OSC informed the Department of Health that it would refer the proposals to the Secretary of State. A letter from the committee providing the grounds for its referral was received by the Department on 4 December. However, I now understand from the local NHS that the committee has said it will be writing again to the Secretary of State, seeking to "clarify" its position on its original referral. We await that letter, to discover what the clarification is, and whether or not it is referring, and if so, what exactly it is referring. I initially thought the letter was clear, but it now appears that it is not and that it needs further clarification. As the hon. Lady will appreciate, it is not appropriate for me to comment in detail on the issue at this stage, and certainly not before the Secretary of State has had the opportunity to consider the additional letter from the OSC. I understand that the local NHS is continuing to ensure that there will be full implementation of upper GI surgery at Plymouth on 1 January. That is the current situation.

All patients affected by planned changes will be given support with transport and accommodation. As I stated earlier, the local organisation of health care services is dictated not by Ministers or civil servants in Whitehall, but by the local health care professionals on the ground. The criteria by which any changes should be introduced are that they are clinically-led, that they are focused on the best outcomes for patients and, of course, that they meet the highest levels of patient safety. I urge MPs who have concerns about the proposals coming from their local health service to contact their primary care trust. I understand from NHS Devon that the hon. Lady has not, as yet, been engaging with it and that it would appreciate it were she to do so. I also made inquiries as to whether Hannah Foster, a prospective Conservative parliamentary candidate who was quoted in the local media, had been in contact with NHS Devon. Sadly, she has apparently not raised issues with NHS Devon, other than by attending an engagement meeting. If she wants to do something that is to be taken seriously, engaging with NHS Devon would be an appropriate course for her to take, rather than just dealing with the media.

With local leadership and national guidelines based on the latest evidence, we are continuing to seek to ensure that cancer care is delivered in centres of excellence, which ensure that people get the best quality treatment. The hon. Lady has raised a number of concerns. I shall go back to NHS Devon to make inquiries about some of the points that she has raised and then write to her or meet her, if she wishes me to do so. I aim to ensure that in so far as she or I can be satisfied, given that neither of us are clinicians, such reassurances as can be given will be given. It is important that people know that they are receiving safe treatment at a centre of excellence and that such an important operation is being delivered at a place where they can rely on that excellence being delivered to them.

Question put and agreed to.

7.41 pm

House adjourned .

9 Dec 2009 : Column 479

Deferred Division

Environmental Protection

The House divided: Ayes 284, Noes 192.
Division No. 18]


Abbott, Ms Diane
Ainger, Nick
Alexander, rh Mr. Douglas
Allen, Mr. Graham
Anderson, Mr. David
Anderson, Janet
Armstrong, rh Hilary
Austin, Mr. Ian
Austin, John
Bailey, Mr. Adrian
Bain, Mr. William
Balls, rh Ed
Barlow, Ms Celia
Barron, rh Mr. Kevin
Battle, rh John
Bayley, Hugh
Beckett, rh Margaret
Begg, Miss Anne
Bell, Sir Stuart
Benn, rh Hilary
Benton, Mr. Joe
Berry, Roger
Betts, Mr. Clive
Blackman, Liz
Blackman-Woods, Dr. Roberta
Blears, rh Hazel
Blizzard, Mr. Bob
Blunkett, rh Mr. David
Borrow, Mr. David S.
Bradshaw, rh Mr. Ben
Brennan, Kevin
Brown, Lyn
Brown, Mr. Russell
Browne, rh Des
Bryant, Chris
Burden, Richard
Burgon, Colin
Burnham, rh Andy
Butler, Ms Dawn
Byers, rh Mr. Stephen
Byrne, rh Mr. Liam
Caborn, rh Mr. Richard
Campbell, Mr. Alan
Campbell, Mr. Ronnie
Caton, Mr. Martin
Cawsey, Mr. Ian
Challen, Colin
Chaytor, Mr. David
Clapham, Mr. Michael
Clark, Ms Katy
Clark, Paul
Clarke, rh Mr. Charles
Clarke, rh Mr. Tom
Coaker, Mr. Vernon
Cohen, Harry
Cook, Frank
Cooper, rh Yvette
Corbyn, Jeremy
Cousins, Jim
Crausby, Mr. David
Creagh, Mary
Cryer, Mrs. Ann
Cummings, John
Cunningham, Mr. Jim
Cunningham, Tony
David, Mr. Wayne
Davidson, Mr. Ian
Dean, Mrs. Janet
Denham, rh Mr. John
Dismore, Mr. Andrew
Dobbin, Jim
Dobson, rh Frank
Donohoe, Mr. Brian H.
Doran, Mr. Frank
Eagle, Angela
Eagle, Maria
Efford, Clive
Ellman, Mrs. Louise
Engel, Natascha
Ennis, Jeff
Field, rh Mr. Frank
Fitzpatrick, Jim
Flint, rh Caroline
Flynn, Paul
Follett, Barbara
Foster, Michael Jabez (Hastings and Rye)
Francis, Dr. Hywel
Gapes, Mike
George, rh Mr. Bruce
Gerrard, Mr. Neil
Goggins, rh Paul
Goodman, Helen
Griffith, Nia
Griffiths, Nigel
Grogan, Mr. John
Gwynne, Andrew
Hain, rh Mr. Peter
Hall, Mr. Mike
Hall, Patrick
Hamilton, Mr. David
Hanson, rh Mr. David
Harman, rh Ms Harriet
Harris, Mr. Tom
Havard, Mr. Dai
Healey, rh John
Hendrick, Mr. Mark
Hepburn, Mr. Stephen
Heppell, Mr. John
Hesford, Stephen
Hewitt, rh Ms Patricia
Heyes, David
Hill, rh Keith
Hillier, Meg
Hodge, rh Margaret
Hodgson, Mrs. Sharon
Hoey, Kate
Hoon, rh Mr. Geoffrey

Hope, Phil
Hopkins, Kelvin
Howarth, rh Mr. George
Howells, rh Dr. Kim
Hoyle, Mr. Lindsay
Humble, Mrs. Joan
Hutton, rh Mr. John
Iddon, Dr. Brian
Illsley, Mr. Eric
Ingram, rh Mr. Adam
Irranca-Davies, Huw
Jenkins, Mr. Brian
Johnson, rh Alan
Johnson, Ms Diana R.
Jones, Helen
Jones, Mr. Kevan
Jones, Lynne
Jones, Mr. Martyn
Joyce, Mr. Eric
Keeble, Ms Sally
Keeley, Barbara
Keen, Alan
Keen, Ann
Kelly, rh Ruth
Khan, rh Mr. Sadiq
Kidney, Mr. David
Knight, rh Jim
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Lammy, rh Mr. David
Laxton, Mr. Bob
Lazarowicz, Mark
Lepper, David
Levitt, Tom
Lewis, Mr. Ivan
Linton, Martin
Lloyd, Tony
Llwyd, Mr. Elfyn
Love, Mr. Andrew
Lucas, Ian
Mackinlay, Andrew
Mactaggart, Fiona
Malik, Mr. Shahid
Mallaber, Judy
Mann, John
Marsden, Mr. Gordon
Martlew, Mr. Eric
McAvoy, rh Mr. Thomas
McCabe, Steve
McCarthy, Kerry
McCarthy-Fry, Sarah
McCartney, rh Mr. Ian
McDonnell, Dr. Alasdair
McDonnell, John
McFadden, rh Mr. Pat
McFall, rh John
McGuire, rh Mrs. Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNulty, rh Mr. Tony
Merron, Gillian
Michael, rh Alun
Milburn, rh Mr. Alan
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Moffatt, Laura
Mole, Chris
Moon, Mrs. Madeleine
Morden, Jessica
Morgan, Julie
Morley, rh Mr. Elliot
Mountford, Kali
Mudie, Mr. George
Mullin, Mr. Chris
Murphy, Mr. Denis
Murphy, rh Mr. Jim
Murphy, rh Mr. Paul
Naysmith, Dr. Doug
Norris, Dan
O'Brien, rh Mr. Mike
O'Hara, Mr. Edward
Olner, Mr. Bill
Osborne, Sandra
Owen, Albert
Palmer, Dr. Nick
Pearson, Ian
Plaskitt, Mr. James
Pope, Mr. Greg
Prentice, Bridget
Prentice, Mr. Gordon
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Mr. Ken
Purnell, rh James
Raynsford, rh Mr. Nick
Reed, Mr. Andy
Reid, rh John
Riordan, Mrs. Linda
Rooney, Mr. Terry
Roy, Mr. Frank
Roy, Lindsay
Ruane, Chris
Ruddock, Joan
Russell, Christine
Ryan, rh Joan
Salter, Martin
Sarwar, Mr. Mohammad
Seabeck, Alison
Sharma, Mr. Virendra
Shaw, Jonathan
Sheerman, Mr. Barry
Sheridan, Jim
Simon, Mr. Siôn
Simpson, Alan
Singh, Mr. Marsha
Skinner, Mr. Dennis
Slaughter, Mr. Andy
Smith, rh Mr. Andrew
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, rh Angela E. (Basildon)
Smith, Geraldine
Snelgrove, Anne
Soulsby, Sir Peter
Southworth, Helen
Spellar, rh Mr. John
Spink, Bob
Starkey, Dr. Phyllis
Stewart, Ian
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Straw, rh Mr. Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr. Gerry
Tami, Mark
Taylor, Ms Dari
Taylor, David
Taylor, Dr. Richard
Thornberry, Emily
Timms, rh Mr. Stephen
Todd, Mr. Mark

Touhig, rh Mr. Don
Trickett, Jon
Truswell, Mr. Paul
Turner, Mr. Neil
Twigg, Derek
Ussher, Kitty
Vaz, rh Keith
Waltho, Lynda
Ward, Claire
Wareing, Mr. Robert N.
Watson, Mr. Tom
Watts, Mr. Dave
Wicks, rh Malcolm
Williams, rh Mr. Alan
Williams, Hywel
Wilson, Phil
Winnick, Mr. David
Wood, Mike
Woodward, rh Mr. Shaun
Woolas, Mr. Phil
Wright, David
Wright, Mr. Iain
Wright, Dr. Tony
Wyatt, Derek

Afriyie, Adam
Ainsworth, Mr. Peter
Alexander, Danny
Amess, Mr. David
Ancram, rh Mr. Michael
Arbuthnot, rh Mr. James
Atkinson, Mr. Peter
Bacon, Mr. Richard
Baker, Norman
Barker, Gregory
Baron, Mr. John
Barrett, John
Beith, rh Sir Alan
Bellingham, Mr. Henry
Benyon, Mr. Richard
Blunt, Mr. Crispin
Bone, Mr. Peter
Boswell, Mr. Tim
Bottomley, Peter
Brady, Mr. Graham
Brake, Tom
Brazier, Mr. Julian
Breed, Mr. Colin
Brooke, Annette
Browne, Mr. Jeremy
Browning, Angela
Burns, Mr. Simon
Burrowes, Mr. David
Burstow, Mr. Paul
Burt, Alistair
Burt, Lorely
Butterfill, Sir John
Cameron, rh Mr. David
Campbell, Mr. Gregory
Campbell, rh Sir Menzies
Clark, Greg
Clarke, rh Mr. Kenneth
Clegg, rh Mr. Nick
Cormack, Sir Patrick
Cox, Mr. Geoffrey
Crabb, Mr. Stephen
Curry, rh Mr. David
Davey, Mr. Edward
Davies, Mr. Dai
Davies, David T.C. (Monmouth)
Djanogly, Mr. Jonathan
Dodds, Mr. Nigel
Duddridge, James
Dunne, Mr. Philip
Evans, Mr. Nigel
Fabricant, Michael
Farron, Tim
Featherstone, Lynne
Field, Mr. Mark
Foster, Mr. Don
Fox, Dr. Liam
Francois, Mr. Mark
Fraser, Christopher
Garnier, Mr. Edward
George, Andrew
Gibb, Mr. Nick
Gidley, Sandra
Gillan, Mrs. Cheryl
Goldsworthy, Julia
Goodman, Mr. Paul
Goodwill, Mr. Robert
Gray, Mr. James
Grayling, Chris
Green, Damian
Greening, Justine
Grieve, Mr. Dominic
Hague, rh Mr. William
Hammond, Stephen
Hancock, Mr. Mike
Hands, Mr. Greg
Harper, Mr. Mark
Heald, Mr. Oliver
Heath, Mr. David
Hemming, John
Hendry, Charles
Herbert, Nick
Hoban, Mr. Mark
Hollobone, Mr. Philip

Holloway, Mr. Adam
Holmes, Paul
Howarth, David
Howarth, Mr. Gerald
Howell, John
Hughes, Simon
Huhne, Chris
Hunt, Mr. Jeremy
Hunter, Mark
Hurd, Mr. Nick
Jack, rh Mr. Michael
Jackson, Mr. Stewart
Jenkin, Mr. Bernard
Jones, Mr. David
Keetch, Mr. Paul
Kennedy, rh Mr. Charles
Key, Robert
Knight, rh Mr. Greg
Kramer, Susan
Laing, Mrs. Eleanor
Lait, Mrs. Jacqui
Lamb, Norman
Lansley, Mr. Andrew
Laws, Mr. David
Leech, Mr. John
Leigh, Mr. Edward
Letwin, rh Mr. Oliver
Lewis, Dr. Julian
Liddell-Grainger, Mr. Ian
Lidington, Mr. David
Lilley, rh Mr. Peter
Loughton, Tim
Luff, Peter
Mackay, rh Mr. Andrew
Main, Anne
Malins, Mr. Humfrey
Maples, Mr. John
Mates, rh Mr. Michael
May, rh Mrs. Theresa
McCrea, Dr. William
McIntosh, Miss Anne
McLoughlin, rh Mr. Patrick
Miller, Mrs. Maria
Milton, Anne
Moore, Mr. Michael
Moss, Mr. Malcolm
Mulholland, Greg
Murrison, Dr. Andrew
Neill, Robert
Newmark, Mr. Brooks
O'Brien, Mr. Stephen
Öpik, Lembit
Ottaway, Richard
Paterson, Mr. Owen
Pelling, Mr. Andrew
Penning, Mike
Penrose, John
Pickles, Mr. Eric
Pugh, Dr. John
Randall, Mr. John
Redwood, rh Mr. John
Reid, Mr. Alan
Rennie, Willie
Robathan, Mr. Andrew
Robertson, Hugh
Robinson, Mrs. Iris
Robinson, rh Mr. Peter
Rogerson, Dan
Rosindell, Andrew
Rowen, Paul
Russell, Bob
Scott, Mr. Lee
Selous, Andrew
Shapps, Grant
Shepherd, Mr. Richard
Simmonds, Mark
Simpson, David
Simpson, Mr. Keith
Smith, Chloe
Spelman, Mrs. Caroline
Spicer, Sir Michael
Spring, Mr. Richard
Streeter, Mr. Gary
Swayne, Mr. Desmond
Swinson, Jo
Swire, Mr. Hugo
Syms, Mr. Robert
Tapsell, Sir Peter
Teather, Sarah
Timpson, Mr. Edward
Tredinnick, David
Turner, Mr. Andrew
Vara, Mr. Shailesh
Wallace, Mr. Ben
Waterson, Mr. Nigel
Watkinson, Angela
Webb, Steve
Wiggin, Bill
Williams, Mr. Roger
Williams, Stephen
Willis, Mr. Phil
Willott, Jenny
Wilson, Mr. Rob
Wilson, Sammy
Winterton, Ann
Winterton, Sir Nicholas
Wright, Jeremy
Young, rh Sir George
Younger-Ross, Richard
Question accordingly agreed to.
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