Sir George Young: By a miracle, my hon. Friend the Minister for Further Education, Skills and Lifelong Learning is now in his place and will have heard those wishes for a happy birthday, which I am sure are shared by hon. Members on both sides. I pay tribute to him for what he has been doing. It is a substantial achievement to have delivered 326,700 apprenticeships in the first nine months of this academic year and

23 Jun 2011 : Column 492

114,000 in the previous year—more than double what we set out to do. That is the right way to provide a sound platform for long-term economic prosperity.

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): May we have a debate on the Floor of the House about why the Government have decided to stop publishing time to pay statistics in July and whether this is the beginning of the end of time to pay?

Sir George Young: I will make suitable inquiries and write to the hon. Gentleman about time to pay.

Gavin Barwell (Croydon Central) (Con): Notwithstanding yesterday’s Opposition day debate, may we have a specific debate on tax so that we can, among other things, consider the shadow Chancellor’s proposal for a £12 billion unfunded tax cut, on which all Members, but perhaps members of the shadow Cabinet in particular, might appreciate the chance to have an opinion?

Sir George Young: We all enjoyed yesterday’s debate in which my right hon. Friend the Chancellor trounced the shadow Chancellor on his economic strategy. The Opposition have left their tax cut open-ended and unfunded. They have not given any definition of what constitutes “growing strongly again” and would simply be adding £51 billion to the deficit at the end of this Parliament.

Fiona Mactaggart (Slough) (Lab): May we have a statement on the accountability of the Government on women and equalities? Today, an oral question on the impact on women of the increases in fees for courses in English as a second language was transferred to the Department for Business, Innovation and Skills. The Department has form on this: on 3 March, I raised in questions to the Leader of the House the fact that questions on women and pensions had been transferred. How can we hold the Government to account given that we have only quarter of an hour for questions and no topical questions and given that questions specifically about the impact of Government policies on women are ducked by the Ministers responsible for women’s policies?

Sir George Young: I say to the hon. Lady that we have adopted precisely the same arrangements for questions about women as we inherited from the outgoing Government.

Alex Cunningham (Stockton North) (Lab): I have been delighted by the response to my ten-minute rule Bill to ban smoking in cars when children are present, but I am aware that despite support from across the House and the country, the chances of the Bill getting a further detailed hearing are very slim. Will the Leader of the House therefore provide time for a full debate on the Floor of the House so that the topic can be aired in much greater detail?

Sir George Young: I congratulate the hon. Gentleman on having got a Second Reading for his Bill yesterday but I would be misleading him if I said that there was any time within the Government’s programme to adopt it. However, there will be an opportunity in the next Session for him to apply for a private Member’s Bill slot.

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Chris Bryant (Rhondda) (Lab): May we have a debate on the solving of conundrums? Or perhaps the Leader of the House could solve one for me. The latest figures show that, at the moment, for every job available in the Rhondda there are 84 people seeking that job, whereas in his constituency of North West Hampshire there are only two people seeking each available job. So far as I can understand the Department for Work and Pensions’ view on all this, the way to resolve the situation is for everybody from my constituency to move to his constituency. The vast majority of my constituents own their own home, but their homes are not worth the kind of money they would need to buy a home in his constituency, so what are my constituents to do to try to get into work?

Sir George Young: The hon. Gentleman’s constituents would always be very welcome in North West Hampshire, but I understand the issue he raises. I think that the answer to his question is the Work programme, which is the biggest and most ambitious work programme ever to get people back into work. In addition, the Government are taking steps to build long-term, sustainable recovery, which I am sure will reach south Wales as fast it reaches anywhere else.

Mr Kevan Jones (North Durham) (Lab): May we have a Government statement on the Government’s plans to mark the 100th anniversary in 2014 of the beginning of the first world war? I visited Belgium a few weeks ago, as a member of the Commonwealth War Graves Commission, and the other commissioners and I were briefed on the extensive work going on there. That contrasts with the confusion in the UK, where it appears that a decision is yet to be taken on whether the Ministry of Defence or the Department for Culture, Media and Sport will take the lead on that anniversary.

Sir George Young: I share the hon. Gentleman’s concern that we should commemorate this anniversary properly. As a former Minister in the MOD, he will have a good background to this matter. I will raise it with MOD Ministers to make sure that we take appropriate action to commemorate this important anniversary.

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Points of Order

12.25 pm

Kevin Brennan (Cardiff West) (Lab): On a point of order, Mr Speaker. I notice that the hon. Member for The Wrekin (Mark Pritchard) is the lead Member on one of the motions we are debating later, but yesterday a pager message was sent out to Conservative MPs cancelling all leave and requiring them to come and vote against the Back-Bench motion this afternoon. Is there any way that the hon. Gentleman, who is a Conservative Member of Parliament, can be forced by the Conservative Whips to withdraw or vote against his own motion, and what would happen in those circumstances?

Mr Speaker: First of all, I do not entertain hypothetical questions. Secondly, that is not a point of order and, thirdly, I say—with an audible sigh of relief—that I am not responsible for the conduct of the Whips.

Fiona Mactaggart (Slough) (Lab): On a point of order, Mr Speaker. You will have heard my question to the Leader of the House about the accountability of the Government on women and equalities matters. He said that the arrangements had not changed at all, but I dispute that. I do not believe that the previous Government ever transferred oral questions on women and equalities to other Government Departments—and certainly not with the frequency that this Government are doing so. Is there something that you can do to protect the rights of Back Benchers to hold the Government to account on issues of women and equalities? At present, we do not have a Select Committee, we have only 15 minutes for questions, there are no topical questions and Ministers are not answering questions if they do not like them.

Mr Speaker: I am grateful to the hon. Lady for her point of order and for advance notice of her intention to raise it. She has put her views very firmly and explicitly on the record. There is very little I can do about this matter, but let me say to her that I have considerable sympathy with Members who seek to ask oral questions on what might be described as cross-cutting subjects. As she and the House are aware, transfers are a matter for the Government, but I am sure that her point of order will have been noted. When a Member tables an orderly question to a Department in respect of that Department’s responsibilities, it is unfortunate if it is transferred and we need to keep an eye on the matter. The hon. Lady should seek the advice of the Table Office before the next oral questions to the Minister for Women and Equalities.

Chris Bryant (Rhondda) (Lab): On a point of order, Mr Speaker. Further to the point that was raised in questions to the Leader of the House by the hon. Member for Kettering (Mr Hollobone), there is still the remaining issue of how to deal with the fact that the Government are regularly briefing the press before briefing the House of Commons. [ Interruption. ] Many of us also deprecated it when it was done by the Labour Government. I realise that it is very difficult for you to exercise any direct powers in relation to the Government, but this is a question not only of supply but of demand. Might I suggest that any journalist whom you find has written an article saying, “Tomorrow, the Government will announce that…” should have their pass withdrawn so that they cannot work in the House any longer?

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Mr Speaker: Let me say to the hon. Gentleman, who is a very experienced Member of the House, that it is extremely naughty of him to tempt me in that way. I think he should be careful about such an approach. The wider point he raises has been raised a number of times in the past couple of weeks. I have made my views about it extremely clear in the House and in the conversations that inevitably take place about these matters. I think it is extremely important that the responsibility of Government to explain and answer first to Parliament is accepted and that effect is given to it. It would be very unfortunate if a regular pattern of the kind that the hon. Gentleman has been complaining about were to develop. If, in extremis, this were to continue to happen, and as a consequence the Government’s own business were to be damaged or lost as a result of what might be described as retaliatory action, that would of course be very unfortunate.

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Backbench Business

[29th Allotted Day]

Transport Committee Report (Coastguard)

12.30 pm

Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op): I beg to move,

That this House notes the publication of the Sixth Report from the Transport Select Committee on The Coastguard, Emergency Towing Vessels and the Maritime Incident Response Group, HC 948.

I am delighted to present the Transport Committee’s report on the Floor of the House, and I thank the Backbench Business Committee for giving me this opportunity. It is an encouraging development for the House and I hope that it will continue to be utilised for other key Select Committee reports.

This report warrants being presented here today because there has been so much interest across the House and from many members of the public about the future of the coastguard service. It is fair to say that the overwhelming view of Members, from all parties and regardless of whether their constituency happens to include a coastguard centre, has been deep concern about the proposals.

The report looks at the three areas addressed by the Government: first, the plans for the drastic closure of coastguard co-ordination centres; secondly, the withdrawal of the Government’s funding for emergency towing vehicles; and, thirdly, the removal of Government funding for the specialist firefighting service at sea. We received a great deal of written evidence from serving and volunteer coastguards, all of which was critical of the Government’s proposals, and most of which was highly critical. Unfortunately, most coastguards were prohibited by the Government from giving oral evidence to the Committee; we criticise that decision in our report. However, we were able to visit the coastguard centres at Falmouth, Clyde and Stornoway, and I am sure that my colleagues on the Committee agree that those visits proved invaluable in learning about the operation of the centres at first hand and enabling us to speak to serving and volunteer coastguards about their concerns, although those were informal discussions rather than official evidence.

Albert Owen (Ynys Môn) (Lab): I congratulate the Committee and my hon. Friend as its Chair on an excellent report. I think the Government will take notice of it, because they said they would wait for the report and act on its conclusions. Does my hon. Friend agree that had coastguards across the United Kingdom had an opportunity for input into the future of the service, MPs’ debates would have had a different tone? More important, are not the proposals a way forward for the Government, not a way out, and must they not include input from all coastguards?

Mrs Ellman: We were extremely critical of how the proposals were put together, excluding any opportunity for input from serving coastguards.

Our report is unanimous. We recognise that modernisation of the coastguard is desirable. We see the coastguard as an essential emergency service, whose work load is increasing, and any proposals to restructure the service must not be made in haste.

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Sheryll Murray (South East Cornwall) (Con): Does the hon. Lady agree that willingness to listen and change policy is a sign of strength, as the Prime Minister asserted at this week’s press conference? My regional paper emphasised that point today in an article which concluded that the consequences would be counted in lives lost.

Mrs Ellman: The hon. Lady makes an important point. Our concern is about the saving of lives. The Government have indeed stated that they are listening; the test will in part be their reaction to our report.

The Committee cannot support the Government’s proposals for the future of the coastguard in their current form, and we call on the Government to withdraw them. The evidence that we received raised serious concerns that safety would be jeopardised if the proposals proceeded. That is why we call on the Government to withdraw them and issue revised plans that address the points that we have raised. Those proposals should be substantially different from those that have been offered, and they should be subject to a further short period of consultation.

Mr Philip Hollobone (Kettering) (Con): I congratulate the hon. Lady on her report. One of the most devastating of her recommendations was:

“It appears to us that the current proposals pay more attention to the MCA’s statutory obligations towards the commercial shipping industry and far less to its obligations towards leisure craft and small boat users. Accidents involving commercial vessels represent only a small proportion of all those that the Coastguard manage.”

Mrs Ellman: The hon. Gentleman raises an extremely important point; we noted that although the proposals appeared to address the commercial shipping sector to some degree, they seemed to ignore smaller vessels and the fishing industry. We were extremely concerned about that omission.

Dr Julian Huppert (Cambridge) (LD): I congratulate the hon. Lady and the Committee on an excellent report that raises a number of alarming concerns about both coastguards and emergency towing vessels, about which I am particularly worried and which she describes as “inviting disaster”. Given that the proposals were started under the previous Government and have taken a while to reach this stage under the current Government, does she agree that the Government should take their time to work out proper proposals? They do not have to rush into things.

Mrs Ellman: The hon. Gentleman makes an important point. I will talk about emergency towing vehicles shortly; I accept his point that decisions about human life should not be made in haste.

Our major concern is about safety and the loss of local knowledge, or “situational awareness”, among coastguard officers which will inevitably occur under the proposals. Reducing the number of full-time maritime rescue co-ordination centres so drastically, from 18 to three, with five centres operating in daytime only, and completely closing 10 centres, would reduce the quality and rate of exchange of information, particularly at critical points when it must be passed swiftly to save lives.

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Mr John Leech (Manchester, Withington) (LD): I thank our Chairman for giving way. Does she agree that regardless of how many coastguard stations we end up with, it is vital that existing stations are open 24 hours a day to ensure operational continuity when there is an incident?

Mrs Ellman: The hon. Gentleman played an important part in producing the report and, like the Committee, I agree that 24-hour stations should be the way forward. The Committee expresses serious concerns about the concept of daylight-only stations. The proposals assume that technology can replace local knowledge, but we were not convinced and think that that puts lives at risk. To refer again to his comments, we are not convinced that the proposal for daylight-only stations should be proceeded with.

Dr Alan Whitehead (Southampton, Test) (Lab): I, too, congratulate my hon. Friend and her Committee on their excellent report. I have visited the Solent coastguard station, which would be the radio centre for most of the country under the proposals, and it was clear that it would be difficult to achieve local knowledge on the basis of those radio arrangements. Does my hon. Friend agree that even the stations that will be saved under the proposals face inadequate operating arrangements, particularly in terms of local knowledge and radio communication?

Mrs Ellman: I agree with my hon. Friend’s comments. The concern about local knowledge or, perhaps more broadly, situational knowledge cannot be emphasised enough. Our concern in that respect relates not only to the coastguard officers themselves, but to the volunteer coastguard. When we conducted our inquiry, particularly when we visited the coastguard stations, we were struck by the amount of teamworking, which is essential. We were concerned that the proposals would endanger that teamworking. To refer to the point made by the hon. Member for Kettering (Mr Hollobone), I stress again the importance of considering the safety of leisure craft and small fishing vessels, as well as the commercial sector, and we felt that that part of shipping was omitted from consideration in producing the proposals.

Iain Stewart (Milton Keynes South) (Con): I am grateful to the hon. Lady, who is the Chair of the Committee. I, too, gained a great deal from visiting the three stations—Falmouth, Greenock and Stornoway—and what struck me particularly was the willingness of the serving officers there to adapt and move forward. They do not necessarily wish to keep the status quo, but they want to be properly involved and to tap into their vast experience in shaping a sensible way forward.

Mrs Ellman: I thank the hon. Gentleman for his comments. He played an active part in drafting our proposals, and I certainly agree with what he says. Indeed, our Committee is asking the Government not just to withdraw their current proposals, but to introduce alternatives and, in doing so, to consider the alternative proposals that have been submitted by coastguard officers across the country.

I should like to refer now to the proposals on the withdrawal of funding for emergency towing vessels—the tugs that are there to prevent major pollution incidents.

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That decision for change was made against the findings of an independent risk assessment, and we consider it unwise and short-sighted; it is quite literally inviting disaster. Our evidence strongly suggests that no suitable commercial alternative exists to replace the current arrangements. We urge the Government to reverse their decision to terminate the provision of emergency towing vehicles by the Maritime and Coastguard Agency, although we welcome efforts to find alternative sources of funding to help to fund such procedures.

The third part of the Government’s proposals concerns the withdrawal of Government financial support for the firefighting service at sea—the maritime incident response group, which is funded by the Government and firefighting authorities. We are extremely concerned that the Government have withdrawn their funding from that service and appear to expect the local fire and rescue authorities to fund it themselves. It is a national firefighting service, and we consider it unreasonable to expect the local fire services to fund it, particularly at this time of financial constraint. Our concern is that, if the burden was put entirely on the local fire and rescue authorities, that excellent service would cease to exist. The service is extremely important; not only is it to do with firefighting, but it is deals with chemical hazards. I ask the Government to remember how important that is and what the consequences of withdrawing the service could be.

Taken together, the proposed changes to the coastguard service, with the drastic closure of coastguard co-ordination centres and the possible loss of emergency towing vehicles and the maritime incident response group, represent a significant restructuring of the country’s marine search and rescue and accident and pollution prevention capabilities. It is deeply regrettable that the Department for Transport announced all three sets of proposals with no prior consultation whatsoever and did not consider their combined impact on safety. Although this cross-party Committee recognises the pressure on the Government to make financial savings and the need to modernise and use new technology, we simply cannot support proposals that reduce maritime safety in that way.

Albert Owen: Does my hon. Friend agree that any future proposal should be made in an oral statement to the House, so that Members on both sides have an opportunity to ask questions on that initial statement?

Mrs Ellman: My hon. Friend makes an important point. New proposals should enable the widest possible consultation, including the involvement of hon. Members.

I call on the Government to withdraw their proposals and to produce alternatives that address the concerns that we have identified. I present the report to the House.

Question put and agreed to.

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Congenital Cardiac Services for Children

12.45 pm

Stuart Andrew (Pudsey) (Con): I beg to move,

That this House notes the review led by the Joint Committee of Primary Care Trusts into the reconfiguration of children’s heart surgery; welcomes its aim of establishing a more sustainable provision of congenital cardiac services in England which has strong support from professional associations and patient groups; notes that concerns have been expressed during consultation on the proposals; calls on the review to take full account of accurate assessed travel and population projections, the views of ethnic minority communities affected, evidence supporting the co-location of children’s services, and the need for patients and their families to access convenient services; and therefore calls on the Joint Committee not to restrict itself to the four options outlined in the review but instead to consider further options in making its final recommendations.

I thank the Backbench Business Committee for allowing us the opportunity to hold this valuable debate. I apologise to the Committee and the Clerks for taking so long to table the motion, but I feel passionate that it is right to get a motion that has the effect that we want. I have probably learned more this week than in the past year, and if I have not got it right, I am sorry. I also thank the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood), for Leeds North West (Greg Mulholland) and for Winchester (Mr Brine), who have helped me through the past week.

This debate is timely, as the consultation by the review of children’s heart surgery around the country will come to an end soon. I completely agree with and support the professionals and patients who say that the review of congenital cardiac services is needed. Of course, we all want what is best for our children, and we want the best centres in the world. It is absolutely right and necessary that we learn from past mistakes in other units, but serious concerns about the process have been raised with me by clinicians and parents. I believe that it is my duty and that of others to scrutinise the review if we feel that there are problems.

There have been accusations that this has been turned into a political campaign. I stress that I have been keen not to make this a political campaign, and I have been incredibly impressed by the cross-party support of the Members from across the country who have been helping us. We will hear from other Members from all over the country—the debate is not just about the unit in Leeds—but I want to highlight the fact that my concerns relate to the review and not just to one centre. Although I will naturally refer to Leeds to highlight examples, I am sure that other Members will highlight similar problems with the review and relate them to their units. I am keen that the campaign does not set one centre against another, but that they are all considered equally.

I want first to deal with what I perceive as the flaws in the review. That is my main concern. From speaking to patients and families, I know that that has made them lose confidence in the review. We would all agree that public confidence in the review is important. The review has stated that the objective is to have centres that perform 400 procedures a year. The first version of the pre-consultation business case showed that patients from Doncaster and Sheffield would travel to Birmingham. That is absolutely right and in line with advice from the Yorkshire and Humber specialised commissioners, but

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in version 2 and the consultation options, the flow had changed to Newcastle. I understand that that helps the Newcastle figures, but I and anyone else who knows the area would surely question the likelihood of that happening. Far more plausible is that people would go to Birmingham or Leicester. What happens to Newcastle then? In addition, one of the options—the 400 minimum procedures—is not even met. The JCPCT explains that that is due to new patient flows.

At a number of centres, activity has increased in the past year. For example, Leeds is now doing 370 procedures a year, but in the pre-consultation assessment it was not afforded the same consideration as other centres that carry out similar numbers of procedures. Furthermore, the health impact assessment had not been completed before the final options were presented for consultation. The independent company undertaking that work said that this was not the usual approach taken in large reconfiguration proposals. That means that the public will have no access to the findings during the consultation period.

An issue that affects the black and minority ethnic community is that until 24 May the consultation questionnaire was available only in English and Welsh. As a Welsh speaker, I approve of having a Welsh version, but it was not until 12 weeks after the consultation began that the questionnaire became available in other languages, leaving just five weeks for the community to respond. In Leeds, more than 20% of the patients come from the BME community, so this is an important issue that needs to be addressed.

Finally, on the flaws, yesterday when the Safe and Sustainable team were here, we heard them say that co-location of services, in their view, meant anything up to 10 minutes away, yet the British Congenital Cardiac Association issued a statement on 18 February 2011, two days after the release of the business case, to clarify its professional view of the importance of co-location. I believe this demonstrates the BCCA’s dissatisfaction with the review’s interpretation of co-location.

Julian Smith (Skipton and Ripon) (Con): My hon. Friend refers to a meeting of the steering group with MPs yesterday. Does he agree that it was a slightly strange meeting and that there was a significant degree of defensiveness on the part of the steering group?

Stuart Andrew: That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.

On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds General infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.

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How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel when there could be alternatives?

The Yorkshire and Humber congenital cardiac network board has a well-established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.

On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and it will have the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.

The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.

Greg Mulholland (Leeds North West) (LD): I thank my hon. Friend and neighbour for giving way. Going slightly further on his last point, does he realise that if those surgeons are no longer there, they will not be able to perform operations on adults? Adult surgery would be very detrimentally affected.

Stuart Andrew: I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.

I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently

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than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that will be made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.

I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.

Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well-organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.

Several hon. Members rose—

Mr Deputy Speaker (Mr Nigel Evans): Order. As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.

12.59 pm

Mr Andrew Smith (Oxford East) (Lab): I congratulate the hon. Member for Pudsey (Stuart Andrew) on introducing the motion and arguing his case so powerfully. The debate shows the value of Back Bench-initiated topics, which has enabled the House to speak out on an issue of enormous concern to the public, as demonstrated by the petition he referred to and by the Southern Daily Echopetition of nearly 250,000 signatures that was taken to Downing street earlier this week in support of the Southampton centre, which is mainly what I want to speak about. I will make just a few key points, as many Members wish to speak.

First, I want to praise the work done in the existing centres, including the John Radcliffe hospital in my constituency, which commands fantastic support from the parents of children who have been treated there. The Young Hearts organisation, which was set up to support parents of children with heart conditions in Oxfordshire, has been leading a great campaign, rightly paying moving tributes to the skill and dedication of surgeons, doctors, nurses and whole medical teams who have saved children’s lives and to whom we all owe a debt of thanks.

Secondly, as the hon. Gentleman noted, a key concern in the debate, and in considering the Safe and Sustainable review, must be to secure the best possible treatments and outcomes for children with congenital and other heart conditions. We must be guided by medical and research expertise, which few of us in this place are in a position to second-guess. I am therefore mindful of the

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joint statement by the Royal College of Surgeons and the Society for Cardiothoracic Surgery, in which they strongly support the concentration of treatment centres. They state:

“England has the right number of heart surgeons treating rare heart conditions in children, but we do know that they are thinly spread over too many units. A better service would be provided if this expertise were condensed in fewer units with the critical number of staff to support each other, disseminate new techniques and train the next generation of specialists.”

They believe that the proposals

“will result in rapid and significant improvement in treatment for some of the most vulnerable patients treated by the NHS.”

We should give great weight to that unequivocal statement.

The joint statement went on to suggest—this brings me to my third point—that:

“The benefits of undertaking this change, however, need to be balanced against longer journeys for some families”.

That, along with quality, is a matter of great concern on both sides of the House, and certainly in Oxfordshire. It was also stressed by the Oxfordshire joint health overview and scrutiny committee and the Young Hearts campaign in relation to the implications for patients in our area if any option other than option B, which is to retain the centre at the Southampton University Hospital NHS Trust, is chosen. As today’s Oxford Mail editorial states:

“If Southampton loses out in the Government shake up of children’s heart services, then so does Oxford.”

The benefits of this option, and in particular of retaining the Southampton centre, lie not only in the fact that the Kennedy review ranks Southampton highest in the country outside London for quality, but that the Oxford Radcliffe Hospitals NHS Trust has developed a joint network of care with Southampton, enabling local children who have surgery in Southampton to receive follow-up care and support services in the excellent facilities at the Oxford children’s hospital and to be able to progress as they grow older to the Oxford heart centre, thereby maintaining continuity of care, which the hon. Gentleman rightly said was so important in the relationship between children’s services and adult services. I very much hope that this south of England congenital heart network, with Southampton and Oxford working closely together, will be part of the option that is finally chosen.

That network does not figure in the present options, but I welcome the news in today’s briefing from Safe and Sustainable that a specialist team is examining it. The need for this flexibility is a key reason why I support the call in the motion for the joint committee not to restrict itself narrowly to the options set out in the original review. As Young Hearts has pointed out, it is important to consider the children needing paediatric cardiac services who were not born with a heart defect but who have suffered a virus or accident requiring cardiac treatment. The Oxford-Southampton partnership will retain ready access to the skills and facilities needed for that care.

That form of partnership network, with collaboration between a surgical centre and another cardiac care centre, offers a good model for other parts of the country. It enables us to ensure that children have the benefit of both the critical mass of surgery, which surgeons advise can significantly and rapidly improve treatment, and more convenient access to related services and continuing care nearer their homes. Surely that is

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the outcome that we all want. I very much hope that the review and the Government will take it forward, with the Southampton-Oxford partnership being the best way to retain high-quality and accessible services for central southern England.

1.5 pm

Mr Stephen Dorrell (Charnwood) (Con): Like the right hon. Member for Oxford East (Mr Smith), I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on introducing the motion, which is of huge importance to my constituents and to the national health service. In contributing to the debate, I wear two hats. First, I represent the village of Glenfield. Glenfield hospital is actually in the neighbouring constituency of the Opposition spokesman, the hon. Member for Leicester West (Liz Kendall), but it takes its name from the village in my constituency. Secondly, I am Chair of the Health Committee. The Committee has not approached the subject specifically, because we have been looking at a number of other matters, but we have so far published two reports on commissioning, which is precisely at the heart of today’s debate.

In a sense, I personify the conflict that every Member feels between the constituency interest and the national interest, and in this case I do so in a particularly dramatic form, as one of the surgical units involved is closely associated with my constituency. My first point is that that conflict exists for all Members. We are of course here to represent our constituents’ interests, but I argue that we are here first and foremost as Members of a national Parliament and should seek, as my hon. Friend the Member for Pudsey recognises, the right answer for all NHS patients, not simply for a particular local interest.

Chris Bryant (Rhondda) (Lab): I wish to make a very small point because the right hon. Gentleman used the word “national”. Many of the services we are considering are also used by Welsh and Scottish constituents, so it is important to ensure that there is that communication between the different elements.

Mr Dorrell: I agree with the hon. Gentleman’s point.

My hon. Friend the Member for Pudsey said that this is not a political issue, by which he meant that it is not a party political issue. That is exactly right, but issues can be political without being party political. It is important that the House, in approaching the subject, makes it clear that the issue should ultimately be resolved according to clinical standards, not as a form of political bartering, whether party political or through the general representation of local interests.

I am in the happy situation, personifying, as I do, the conflict between local and national interests, that the specialist group has recommended a solution that accords with my constituents’ views, but I think that in approaching the subject it is important to be clear about the ladder of interest: we should approach this from the point of view of national standards for the service delivery. We of course should represent the views of our constituents, but we should be clear that the national view should come first.

Writing in The Timestoday, Sir Bruce Keogh, the medical director of the NHS, states:

“Intellectually, the case for change is compelling and widely accepted. Sadly, the realpolitik is that the closer we get to a

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solution, the more personal, professional and political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence…For too long this has been filed in the ‘too difficult’ box. Time is running out.”

Those words should ring loud in our ears as we debate the subject this afternoon.

We should recognise that the whole issue of child heart surgery has form in the history of the national health service. It is now over a decade since Sir Ian Kennedy published his review of circumstances that illustrate what can go tragically wrong when things are allowed to drift on and when real issues are not addressed. Although I am of course here as a Member representing my constituents’ interests, I think that the key priority for the House this afternoon is to support the principle that this issue must be decided in the interests of the children who are the patients and who will become the adult patients, and in a way that satisfies the key driver of the pursuit of excellence in clinical standards.

I welcome the fact that the previous Government set up the review to ensure that we addressed the issues that had been left to drift on for too long since the Bristol heart review a decade ago, and I wholeheartedly endorse the view, expressed by Sir Bruce in today’s Times, that the time to act is now.

As a local MP, I wonder what the effect is on Leicester of this drive to a decision. I have already referred to the fact that I am not in an uncomfortable position, because on page 93 the review states:

“Option 2”—

which became option A—

“is viable as it is consistently the highest scoring potential option.”

The review’s recommendation is that the process go ahead based on option A, and that is convenient from the point of view of the person arguing the case that I do, but I conclude that if anyone wants to argue for an alternative outcome, it behoves them, particularly in view of the history of this issue in the national health service, to present a coherent, whole argument for how their solution represents a better solution for the patients of those services, while reflecting, of course, the local interest of the people we are elected to represent.

1.12 pm

Mr Nicholas Brown (Newcastle upon Tyne East) (Lab): It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) in debate, something that I have not done for 15 years in this place, and as ever I agree with the broad thrust of what he has said. I welcome the opportunity to take part in this debate about the Safe and Sustainable review. I want to make two points about the case for the review itself and the case for children’s cardiac care at the Freeman hospital in my constituency.

The review of paediatric cardiac services in England and Wales was instigated in 2008 under the previous Government. It was instigated not by them, not by the civil service but by the health care professionals themselves. There were two previous reviews, in 2000 and 2003, recommending the establishment of fewer, larger cardiac surgical centres; in 2006, a national workshop of experts concluded that the current configuration was unsustainable; in 2007, the Royal College of Surgeons called for the concentration of surgical expertise in fewer, larger surgical centres.

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The 2008 exercise has been carried out on behalf of the 10 specialised commissioning groups in England and their primary care trusts. The clinical case for the exercise is pretty formidable: clinical outcomes are better at high-volume centres; it is undesirable that surgical expertise is spread too thinly, because apart from anything else it mitigates against the provision of 24-hour surgical cover; the increasing complexity of what can be achieved argues for fewer specialist centres; it is easier for fewer units with larger case loads to retain surgeons and to develop expertise; and strong leadership from surgical centres underpins non-surgical cardiology care in local hospitals.

Mr Kevan Jones (North Durham) (Lab): Will my right hon. Friend give way?

Mr Nicholas Brown: If my hon. Friend will forgive me, I will not.

There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.

I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.

The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.

Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.

No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.

I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far

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as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.

My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made. I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.

1.18 pm

Greg Hands (Chelsea and Fulham) (Con): I very much support the principle that lies behind the review—that we need larger, more sustainable centres with the same overall number of specialists throughout the country. That is why charity and campaign groups, such as the Children’s Heart Federation and Little Hearts Matter, back the change.

I recognise that people will have to travel further as a consequence, and that will sometimes be extremely difficult, for families in particular, but the choice is between people travelling further and getting the best outcome for their child, and people having a shorter distance to travel but perhaps compromising the outcomes that can be achieved. The clinical evidence is unambiguous: travelling further means that some children will live who would otherwise die. On that basis—the whole basis behind the review—we have to bite the bullet and make change.

I support the principle of fewer, larger units, but the experience of Royal Brompton hospital in my constituency has made me question the process that is being used to make individual decisions. As my hon. Friend the Member for Pudsey (Stuart Andrew) pointed out, the matter needs to be depoliticised from the outset. The review is taking place at arm’s length from the Government. Indeed, as the right hon. Member for Newcastle upon Tyne East (Mr Brown) said, it was set up under the previous Government and is being administered by a body called the joint committee of primary care trusts, which I assume is up for abolition.

Phase 1 of the assessment process involved ranking all the existing units on core standards, sustainability, facilities and so on. Great care was taken, and that makes the next phases all the more mystifying. Out of the 11 units ranked, the Royal Brompton came joint fourth, on 464 points. Of the 11 units assessed, only two had the maximum number of four surgeons—the Royal Brompton and Great Ormond Street. In terms of the number of procedures undertaken each year, the Royal Brompton came fourth highest of all. In each of the three objective criteria, the Royal Brompton was in the top four nationally. I therefore asked the joint committee

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of PCTs this question: why bother to rank all the units only then to stipulate that one of the top four has to close whatever else happens? That is the consequence of the decision arbitrarily to rule out keeping three centres open in London. One of the top four units in the country is to be axed, no matter its size and no matter its quality, due merely to its location. That flies in the face of the starting point of the review—that it was all about clinical outcomes, not geography.

The Royal Brompton has four specialist surgeons who perform 520 operations, including 453 children’s heart operations, per year. It has a fantastic safety record, with an aggregate mortality rate of 0.94 of 1%—less than half the national average of 2%. Why, then, when it is already a model example of what the review wants to create, does the consultation, in all the options available, decree that it must close? The joint committee of PCTs is claiming that it has an open mind, but in reality it is consulting on four options, all of which would shut the unit at the Royal Brompton.

The knock-on effects on services elsewhere in the trust would be considerable, especially on children with cystic fibrosis, of whom there are 300 in the country. The future of provision for those children would be extremely unclear. It is also unclear what capacity the remaining two hospitals in London would have to take on—

The Minister of State, Department of Health (Mr Simon Burns) I will speak with great care because—my hon. Friend is as aware of this as I am—of the possible judicial review with regard to the Royal Brompton. I would like to say, though, as I think it may help him, that no decisions have yet been made. The consultation literature specifically asks consultees for their views on how many centres it is best to have in London—two or three. If they agree that two is optimal, they are asked to state which two they prefer, including the Royal Brompton. Even though it is not included in any of the pillars, people who are taking part in the consultation process can argue its case, and it will be considered because the JCPCT is taking a flexible approach to the consultation process.

Greg Hands: I welcome that intervention from the Minister. He is right that it is open to the consultation to consider it, as it says on the last page of the consultation document, but the document was contradictory on this point in the first place. On page 84, it says:

“London requires at least 2 centres due to the size of the population it covers”,

but in a footnote on page 93 it still imposes the arbitrary limit of two centres at most.

The joint committee has belatedly recognised a problem. Under pressure, it announced at the beginning of May that an expert panel would be established to review the wider impact on other services if cardiac paediatrics were to close. That was welcome, but it has continued to press ahead with the original consultation and names for the new panel were not proposed until this week. By the time the new panel reports in August, the consultation will have closed. What happens if its response reflects the serious concerns about a whole series of national services? Having consulted on options A, B, C and D, it can hardly go for an option E that no one was asked about. It would then probably have to re-consult.

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I became the MP for the Royal Brompton in May last year, although, as the neighbouring MP previously, I have been very familiar with its work for many years. Its previous MP, my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind), also strongly supports its campaign to fight the proposal. I have visited the hospital three times in the past year. The proposal to end its cardiac paediatrics has been brought to the attention of parliamentary colleagues across all parties and across large parts of London, the south-east and East Anglia. A huge petition has been gathered, signed by more than 30,000 people, and tomorrow we are delivering it to No. 10. I have written at length and in detail to the Secretary of State on the matter, and he helpfully replied—I think this was confirmed by the Minister—that

“no decisions have yet been made”,

including on the number of units to be located in London. That is a cause for encouragement.

I repeat that I support the aims of the review, but the consultation has been badly flawed. Three units in London, perhaps restructured, should have been an option, and the knock-on effects of closing services should have been considered. The case must now be re-examined. The Royal Brompton is good enough, large enough and loved enough to survive.

1.26 pm

Jon Ashworth (Leicester South) (Lab): I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) and other members of the Backbench Business Committee on securing this timely debate.

When I delivered my maiden speech in the Chamber two weeks ago I mentioned my support for the campaign to maintain the children’s heart unit at Glenfield hospital, which, as the right hon. Member for Charnwood (Mr Dorrell), said, is in the constituency of my parliamentary neighbour, my hon. Friend the Member for Leicester West (Liz Kendall). The campaign is supported by my hon. Friend and by my right hon. Friend the Member for Leicester East (Keith Vaz), as well as by many Members from across the county, if not the east midlands as a whole. It is right that this does not become a party political matter.

Last week, my hon. Friend the Member for Leicester West and I attended the public consultation event on Glenfield at the Walkers stadium in my constituency attended by hundreds of concerned parents, dedicated staff and local people, not only from Leicester but beyond the east midlands. Many of those people have never used the unit at Glenfield and, one hopes, will never need to use it, but they were all convinced of the logic of maintaining it. We heard moving stories from parents telling us how outstanding was the quality of care provided to their children. We heard testimonies from many of the staff at Glenfield, who described in remarkable detail the quality of the care that they provide and how they intend to continue to improve it.

We also heard many people, particularly members of the Asian community, express frustration, if not anger, about the fact that Glenfield features in only one option—option A. Many Members will know that Leicester has a very diverse population. Evidence shows that there is a high prevalence of heart disease in Asian communities, and some of my constituents from those communities

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are particularly concerned that Leicester features in only one option. In the past few weeks, people from mosques, gurdwaras, Hindu temples and the Federation of Muslim Organisations have been very vocal about this.

I want to focus my remarks on something that is unique and specific to Glenfield: our world-class ECMO—extracorporeal membrane oxygenation—service. An ECMO machine—I have to concede that I am far from an expert on these things, so Members may want to correct me—rests the heart and/or lungs of a patient waiting for recovery. I have been told by many at Glenfield that this procedure was pioneered there 20 years ago. Today, Glenfield has more than 10 machines, and it is no exaggeration to describe it as a world-leading centre in this field. Glenfield is the only centre in the country that provides ECMO for patients of all ages, from newborns to adults. Its expertise has been recognised on many occasions. For example, last year 110 adults were treated during the swine flu outbreak at Glenfield’s ECMO centre.

How is that relevant to the future of the children’s heart unit? Quite simply, the ECMO service is provided by the same staff who work in the congenital heart centre. Therefore, if that centre closes, Glenfield will lose its ECMO service as well. Of course, the ECMO service could go to Birmingham, as is mooted in the consultation, but that rather misses the point. Many of the staff working at Leicester’s ECMO centre have done so for nearly 20 years. Their combined expertise has helped to make Glenfield’s ECMO unit the world-class facility it is today. Many of my constituents are concerned that it would be years before an ECMO unit could be re-established elsewhere with the same level of competence. Training new staff to have the level of expertise offered at Glenfield could take up to 10 years. That is why many people in my constituency feel that keeping this national service is vital. Giles Peek, a consultant paediatric heart surgeon, told the Leicester Mercury:

“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are almost always full and often take children from other hospitals… Our role at Glenfield as national reference centre for this treatment is important and underestimated.”

Although I understand that this is a consultation and that it is right that these decisions are made by clinicians and not politicians, I hope that the joint committee will consider further options because of the expertise at our ECMO centre. Many of my constituents would be grateful if the Minister reflected on the national implications of Glenfield losing its ECMO centre and, at an appropriate time, made some remarks about that.

1.31 pm

Jason McCartney (Colne Valley) (Con): I, too, thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his hard work, along with other colleagues, in securing this Back-Bench debate.

I will speak on behalf of the Leeds children’s heart surgery unit, which serves the whole of Yorkshire. I was fortunate enough to visit the unit in November. I met its wonderful staff and surgeons, and spoke to many parents and some of the patients. Over the next couple of hours, we will hear a lot of intricate detail, just as we have already. There will be many statistics, facts and figures. I want to give a few facts and figures of my own. Half a

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million names were on the petition to save the Leeds unit, which we delivered to No.10 Downing street on Tuesday. That is the biggest petition ever raised in Yorkshire, and we can be very proud about that. The two-hour radius around the Leeds heart surgery unit reaches 14.5 million people. Including check-up appointments, the unit sees 10,000 children annually, and it performs 340 operations.

Julian Smith: As well as the number of operations performed at Leeds, will my hon. Friend talk about the rurality of many of the areas it serves? Skipton and Ripon is the most rural part of North Yorkshire. I have received many representations from my constituents about the issue of distance that there will be if Leeds does not survive.

Jason McCartney: My hon. Friend makes an important point. Many of those 14.5 million people are in rural areas, such as his North Yorkshire constituency. I will touch on that issue in relation to my Colne Valley constituency shortly.

I want to say a few words about the inconsistencies in the options. The Safe and Sustainable review has said consistently that centres should perform a minimum of 400 operations a year, and ideally 500. However, under option B, Bristol and Southampton would fail to achieve that number. The review’s projected figures show that they would perform 360 and 382 operations respectively. During the meeting in Leeds, campaigners were told that it was not viable to have three centres in the north of England because the figures would be 347 for Leeds and 381 for Newcastle. If option B is viable, why is it not viable to have three centres in the north of England? Would not a solution be to keep Leeds and Newcastle open, and to give them two years in which to achieve all the standards set out by the review?

Mr Steve Brine (Winchester) (Con): That is precisely why the motion calls on the JCPCT to show maximum flexibility and not to restrict itself to the four options. The answer could be, “Yes we can.”

Jason McCartney: I agree that that is what we are looking for. The idea behind the motion is to ask for more flexibility.

I have talked about statistics and about the 500,000 names on the petition, but there are three compelling reasons why I am speaking in this debate—or perhaps I should say three young reasons. Those three young reasons all happen to be at one school in my Colne Valley constituency. I met three pupils at Linthwaite Clough school near Huddersfield, who back the campaign to save Yorkshire’s only children’s heart surgery unit because they owe their lives to it. George Sutcliffe is a 12-year-old who uses a wheelchair six days a week and attends the heart surgery unit in Leeds about once a month. Ben Pogson, who is 10, and Joel Bearder, who is just four, both underwent major heart surgery at the unit. Ben and Joel’s mums, Sam and Gaynor, have played leading roles in the campaign to save the unit, along with many others, and I praise their contributions. As well as those three pupils, one of the teachers at the school owes his life to the skill of the medical staff in Leeds. Richard Quarmby, a learning mentor at the school who will start his teacher training in September, had major surgery for his congenital heart condition at the Leeds heart surgery unit.

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Those people owe their lives to the unit. They cite its wonderful staff and its proximity to Huddersfield as crucial. It takes less than an hour to get there. The unit gives fantastic family support and there is accommodation for parents if needed. As a result of George, Ben and Joel’s treatment at the unit, the Linthwaite Clough school council has decided to support it as its annual chosen charity. Already, it has organised a series of fundraisers, including a colourful, cheerful day. For the reasons I have given, I think that the Safe and Sustainable review should be renamed the safe, sustainable and supporting families review.

Finally, on behalf of Ben, Joel, George and many others, I shall support the motion.

1.37 pm

Mr George Mudie (Leeds East) (Lab): I congratulate the hon. Member for Pudsey (Stuart Andrew) on the hard work he has put in to secure this debate. I compliment him on the sensitivity with which he phrased his contribution. I hope that that will allow the Government Whips to stay out of the decision and allow Members to get what we seek, which is not interference in clinical observations, but a review of how this is being carried out geographically.

The right hon. Member for Charnwood (Mr Dorrell) was more sanguine than I am about the involvement of Sir Bruce Keogh, the NHS medical director. I found his article in The Times this morning ill-timed, coming on the morning of a debate, when feelings are running high. I do not find it acceptable for him to say that anyone who opposes his view is “disingenuous” and that

“political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence.”

I find that offensive. Nobody in the Chamber argues with the clinical objectives. I find it unacceptable that some youngsters who are taken to centres for medical treatment get excellent treatment and that others get less than excellent treatment. I find it sensible and laudable that we should rationalise those centres to build up experience and techniques, and so that there are more people to share their experiences.

The right hon. Member for Charnwood said that we should not oppose the proposal because it is right clinically. He told us not to think of our own hospitals, but to think nationally. “Nationally”, however, also means “regionally”. The point that has not been made is that, while the Chamber should accept the clinical arguments, equality of access is also important. That is what is being said by most of the opponents of the proposals, and they are not being disingenuous. For instance, in the Newcastle versus Leeds argument, it would not be acceptable for me to argue in favour of the Leeds case on the basis that Leeds children should not have to travel 100 miles to Newcastle, because if we won our case, Newcastle children would have to travel 100 miles to Leeds. If it is wrong for us, it is wrong for them.

If the rationalisation, which we accept, takes place properly—and this is where the Minister comes in—there will be an underlay of fairness and equality of access. We have a National Theatre in London, but it is not a National Theatre for Yorkshire. It is nice for Hampstead, but it is not very good for Seacroft in Leeds.

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Mr Dorrell: I think that the hon. Gentleman slightly misrepresented what I said. I did not say, “You must accept it”, or “Take it or leave it”. I said that those who wished to argue for a different approach must argue for the whole approach, and not for a sectional interest.

Mr Mudie: I entirely accept that, and I did not intend to suggest that the right hon. Gentleman had said anything different. My point is that, while the clinical case for a rationalisation is unarguable, equality of access is as important a consideration as any. Excellent treatment must not be available to only a certain number of people.

Greg Mulholland: We all accept the clinical premise of the review, but is it not incredibly arrogant for anyone to suggest that it cannot be fallible? There are obvious flaws in it. Many clinicians themselves say that it is flawed.

Mr Mudie: I hear what the hon. Gentleman says. I think that the same case was made by the right hon. Member for Charnwood. We may prevaricate for one reason or another, but sometimes it may be necessary to make a decision even when we think that it is not perfect, and I think that this is an instance of that. If the life of a child is involved, we must make a decision.

If we continue to challenge the clinical aspect of the review, we will fall into the trap of allowing a bad situation to continue. The case for change has been proved, and, while we may differ on how that change should be made, what is important is for us to express the view—and I should like to see it challenged—that there should be equality of access. Each region should ensure that every part of it has equality of access where possible, although that will involve some difficulty if Yorkshire is lumped together with the north-east.

In the last year I have had to move from my constituency office, which was in the centre of the constituency. I was offered cheaper, perhaps even better, accommodation in the outer part, but I felt that it would be unfair on the other wards for me to move away from the centre. If option 4 is either Leeds or Newcastle, I think that that is unfair on both. I do not want to close Newcastle, and Newcastle does not want to close Leeds. Locating provision sensibly in each region is important, but the House should also recognise, as it rarely does, that the country has some corners in which there is no equality of access in any respect. Those in Newcastle, in the top corner, and those in Cornwall, in the bottom corner, do not have access to many facilities that are accessible to people in the midlands, in Yorkshire and, above all, in London.

I believe that the House should accept the motion, and that the review team should forget about the clinical arguments and produce a template that proves to every Member that the excellent services that we should be demanding for children’s care will be shared equally around the country. The team should give some real, positive, out-of-the-box thought to how to deal with areas that generally lose out.

1.45 pm

Greg Mulholland (Leeds North West) (LD): It is a pleasure to follow my Leeds colleagues, and it is a pleasure to work with all the Leeds and Yorkshire and

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Humber Members of Parliament throughout the House in support of the inspiring campaign to save the Leeds unit. I too was proud to be there to help present that remarkable petition. Nearly half a million people in the region have spoken out in an attempt to save the unit. When I visited it, I had the same experience as other Members have had when visiting their local units. I found it incredibly moving to meet those babies and children and their families, while also being conscious that I was walking into a centre of excellence. It benefits from a genuine co-location of services, which is the gold standard that has been set, and 370 operations are already being performed there—very close to the 400 figure.

Mr Kevan Jones: I note the size of the petition, but as a former Defence Minister responsible for defence medical services I faced similar petitions when the Ministry of Defence was concentrating military health care at University Hospital Birmingham NHS Foundation Trust, which is now a centre of excellence not just in this country but internationally. Although petitions are valuable, clinical outcomes must be at the forefront of any decision, and the MOD’s decision to concentrate defence medical services at Birmingham was the right one.

Greg Mulholland: It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

Stuart Andrew: My hon. Friend mentioned the co-location of services. As I said in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?

Greg Mulholland: I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.

There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.

That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.

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I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:

“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”

Jonathan Darling, a consultant paediatrician at the Leeds General infirmary, states:

“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”

I am afraid that it simply has not done so, which is worrying and quite extraordinary.

The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.

Mr Mudie: The point I was making was that if we are to take the review’s point and place units strategically, the obvious place with a mass population is Leeds. However, I said that that would leave Newcastle out on a limb, and something has to be done about that. The case for Leeds is unchallengeable.

Greg Mulholland: Indeed, and we have to get the point across to colleagues in other areas that perhaps we have to challenge the premise of the review and some of its figures if we are to reach other recommendations.

The third matter that I wish to mention, as the hon. Gentleman did, is travel. In the meeting yesterday with the review team, I was frankly dismayed by how little consideration was being given to the reality of ordinary working families and the effect that having to travel would have on them. I shall give a couple of examples. Johanne Walters, the mother of Emma, states that to them the change

“would mean her…surgery will be undertaken miles away from home and nobody would be there to support me—no family no friends—and it is incredibly difficult being there 24/7 at your child’s bedside, even with this support”.

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Joanne and David Binns, whose son Oliver has been treated, have said:

“Oliver is our only child, and I’m sure you can imagine how it turned our world upside down. But we knew that we had family and friends who could just pop in and make us some food at the end of a long day, bring us clean clothes, and just be there if we needed a chat. I can’t imagine how much extra pressure it would have been at this point to have to think about long distance travel and accommodation on top of everything else.”

Matthew and Karen are the parents of Liam Hey, a constituent of mine who has become something of a celebrity. He is a wonderful young man who is being treated at Leeds. Karen has said:

“My son would not be here if it wasn’t for the LGI. It would be too much of a trauma to transfer children to another place.”

Travel has simply not received adequate consideration. It comes out top of the criteria that people give when we ask them, but it is not anywhere near the top of the list of the review’s considerations. That is wrong.

We have to re-examine the situation. I am delighted that the House has had a chance to debate it today, and that Ministers have been so accommodating in enabling us to do so. I urge the House to support the motion. We should come back with some proposals that will really work for children and that we can all support.

Several hon. Members rose

Mr Deputy Speaker (Mr Nigel Evans): Order. To accommodate more Members, I am reducing the time limit to five minutes. I hope that both Front Benchers will take into account the popularity of the debate and the need to get Back Benchers in when they make their contributions.

1.54 pm

Pat Glass (North West Durham) (Lab): I do not have a children’s heart unit in my constituency. I do not even have one close by. There are parents in my constituency who are 50 miles from the nearest unit, but they tell me that they do not care about that. They would travel to the ends of the earth to get access to the best provision. That is what matters to them, not having somewhere on their doorstep.

Stuart Andrew: I have to take issue with that. The parents I have spoken to are very concerned that they might have to travel. Of course they will travel as far as they have to, but if we can provide a service closer to their homes, should we not strive for that?

Pat Glass: They are saying that because they have a unit on their doorstep now. We do not all live in big cities, and some people have to travel a long way. Parents tell me that what they want is the best services, and even if they have to travel to get them, that is what comes first. Travel and access are issues to consider, but every parent who has contacted me has confirmed that the most important thing for them is that their child gets access to the best provision available, and to surgeons who carry out these complex operations a couple of times a week, not a couple of times a year. They tell me that they will go anywhere to ensure that their child gets the best chance of surviving and that their condition improves.

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Mr Kevan Jones: Does my hon. Friend agree that in County Durham, the concentration of adult cardiac surgery and emergency care at the Freeman hospital and the James Cook university hospital, which was controversial when it happened, has improved not only care but the survival rates of individuals from County Durham? Even though there are hospitals in the county closer to some people, survival rates have gone up because of that concentration.

Pat Glass: Absolutely, and we need to appreciate why such moves are necessary. None of us wants another Bristol baby tragedy, and I think there is general agreement that we need changes in the organisation of services to drive up the quality of treatment and bring together specialist surgeons to work in larger teams.

Andrew Percy (Brigg and Goole) (Con): Will the hon. Lady give way?

Pat Glass: Practically everyone remains in agreement that those changes need to be made.

Andrew Percy: Will the hon. Lady give way?

Pat Glass: The argument is simply about which units will specialise in surgery, even though all existing units will continue to offer ongoing cardiology care.

Andrew Percy: Will the hon. Lady give way?

Pat Glass: I am not going to give way, no matter how much the hon. Gentleman hassles me. I can see that that is what he plans to do.

Many local campaigns have been mounted, and they have been supported by local MPs fighting for their own units or fighting to delay decisions. I absolutely understand that, but the decisions have been put off before for many reasons, which I believe is to the detriment of patients.

The decision should not be made on a political basis. Few of us in the House are qualified to judge the quality, sustainability and deliverability of clinical outcomes in children’s heart provision. On 7 June, when I questioned the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), on the matter, he gave me a categorical assurance that decisions would be

“based on clinical outcomes, not political considerations.”—[Official Report, 7 June 2011; Vol. 529, c. 12.]

I hope that he will keep his nerve in the face of sustained political lobbying.

The Minister of State, Department of Health (Mr Simon Burns): If it encourages or reassures the hon. Lady, I will give her that commitment again today.

Pat Glass: I thank the Minister.

The Children’s Heart Foundation has advised me that the closer we get to a decision, the more difficult the political battle will become. In a bid to save surgery facilities in their areas, some parents and clinicians are asking MPs to stall progress towards a decision. Parents have been told that some units will close, when in fact even if surgery is centred elsewhere, local units will continue to provide specialist medical treatment on a “hubs and spokes” model. I believe that parents have been misled on some matters.

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These decisions are crucial to the future clinical outcomes and life chances of our children. The Minister has again today categorically assured me that they will be based on clinical outcomes only, and I thank him for that.

1.59 pm

Mr Andrew Turner (Isle of Wight) (Con): I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:

“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.

It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.

Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.

In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team

“based retrieval times between the island and the mainland on travel by air. This was an oversight”

because the policy is

“to retrieve children from the Isle of Wight by road and ferry”.

That is very odd, because the consultation document explicitly states:

“Air travel has not been considered because it cannot always be relied upon”.

The statement goes on to say that

“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.

The conclusion was that

“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”

On remote areas, the consultation document states:

“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—

meaning three hours or less from Southampton in my case.

On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an

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area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognised that the island,

“by its very nature, is remote from the mainland”.

Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are

“unique factors around retrieval times by ferry”.

My Glyde was very helpful. He explained:

“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.

They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]

Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—

Mr Deputy Speaker (Mr Nigel Evans): Order.

2.4 pm

Catherine McKinnell (Newcastle upon Tyne North) (Lab): That the children’s heart unit at Newcastle’s Freeman hospital is cherished across the north-east is undisputed. One has only to read the coverage of the Newcastle Evening Chronicle “Keep Our Children’s Heart Unit” campaign in recent months to appreciate just how the unit has changed the lives of countless young people and families over the past decades.

Indeed, because of the pioneering work of the children’s heart unit at the Freeman, it is recognised nationally and internationally as a centre of excellence, with particular strength in quality and outcomes. The unit has also had significant investment over recent years. It is the only unit in the country able to offer all forms of heart treatment, regardless of age, under one roof, and the Freeman is recognised as having led the way in the UK in providing end-stage heart failure treatment for children.

As my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) said, the Freeman famously and bravely performed the UK’s first successful baby heart transplant in 1987. It has performed more than 200 child heart transplants overall, and was recently the first hospital in the world to enable a young child to survive for four months with an artificial heart, while the baby’s own heart recovered.

The quality of the work carried out at the Freeman means that young patients and their families travel to Newcastle for treatment not just from the west of Cumbria or north Yorkshire, but from as far afield as Scotland, Northern Ireland and even the Republic of Ireland.

For those reasons, I believe that the children’s heart unit at the Freeman is well-placed to continue providing its excellent, world-leading cardiac surgery services for children. Three of the four options put forward by the Safe and Sustainable review propose that that should be the case. However, I have concerns about attempts to

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move the debate away from the key issue at hand: ensuring that congenital cardiac services provided to children in England and Wales continue to be high quality, and therefore safe, and sustainable and deliverable. That was the intention of the Safe and Sustainable review.

Andrew Percy: Will the hon. Lady give way?

Catherine McKinnell: I shall give way once.

Andrew Percy: I do not think any hon. Members who are fighting to save their local units are trying to move the debate away from that. I shall quote what health professionals from the North Lincolnshire and Goole NHS Foundation Trust say:

“In summary, we believe the babies, children and families of northern Lincolnshire would be largely disadvantaged…knowingly relocating a well run and safe service without providing additional advantage to our families is questionable and unnecessary.”

We are not moving the debate away from the clinical issues at all.

Catherine McKinnell: The hon. Gentleman has put his thoughts and concerns issue on the record.

I mentioned the intentions of the Safe and Sustainable review, which was instigated by national parent groups, NHS clinicians and their professional associations. Those intentions must be the primary drivers in deciding the final outcome of the review.

I am equally concerned at suggestions that the decision and outcome of the review should be stalled, or that the remit should be altered. I am not alone in expressing such concerns. The Children’s Heart Foundation argues that that would leave

“the door wide open for another Bristol Baby tragedy”.

Meanwhile, the charity Little Hearts Matter believes that the Safe and Sustainable service reconfiguration offers—

Stuart Andrew: Will the hon. Lady give way?

Catherine McKinnell: No, I will not.

Little Hearts Matter says:

“The Safe and Sustainable Service reconfiguration offers a monumental opportunity to ensure that every child with a heart problem has access to the best heart surgery service that this country can offer—a gold standard service.”

I urge anyone in a position of influence, including hon. Members, to support that step forward, and not to halt the process because of personal bias.

A number of hon. Members are concerned about the co-location of children’s services. However, it is important to note that during the development of the £100 million new Great North Children’s hospital at the Freeman’s sister hospital, the Royal Victoria infirmary, a deliberate decision was made to retain children’s heart services at the Freeman, aligned with the world-renowned adult heart services there.

Services that simply did not exist 20 years ago have created a new generation of adults needing care, and the service at the Freeman allows for a seamless transition into adulthood. Of course, services at the Great North Children’s hospital are available to the Freeman in a matter of minutes—throughout the review process, they have been recognised as though they are on the same site.

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In conclusion, I am not asking those who will make the final decision to give special treatment to the children’s heart unit at the Freeman, or indeed to the people of Newcastle and the north-east. I am all too aware how difficult this process has been for all children’s heart units under consideration. Each is valued and each has a great story to tell. However, I am asking that the decision is made on the grounds of clinical excellence and the quality of services that are currently provided, and on those grounds alone. I urge that a decision on the future of children’s congenital cardiac services is not put off or prolonged, because the safety of babies and children in need of heart surgery should be paramount in this debate.

2.9 pm

Mr Robert Syms (Poole) (Con): I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on the measured, sensible and sensitive way in which he moved his motion. There is clearly a lot of strong feeling in the Chamber today, which is understandable given the number of people potentially affected by these changes. We all know that geography in this country is an important consideration, and although a political argument can be made for having fewer centres—it might save some lives—it can also be argued that for some families, particularly those living further from theses hospitals, these proposals could cost lives, if people are unable to get to one of the hospitals.

My hon. Friend the Member for Isle of Wight (Mr Turner) made an extremely good point about the difficulties with moving the Southampton unit. Yes, parents will go wherever they can get the best treatment, but they prefer to go somewhere nearby. I have constituents who have moved to Poole simply because of its proximity to the Southampton unit, and I expect that families around the country with similar problems also sometimes vote with their feet by buying a home in close proximity to a unit. This point needs to be taken into account. A Mrs Owen made the point to me quite forcefully that it was one reason she and her family moved to Poole.

The chairman of Poole borough council’s health and social care overview and scrutiny committee has concerns, as do Councillor Charles Meachim and Antoinette McAaulay, who is a consultant paediatrician at Poole hospital. The latter raised concerns about the impact on the Southampton unit and pointed out that Southampton had the highest quality score for clinical care outside London and the second highest in the UK following the Kennedy review in 2010, suggesting that the children’s cardiac paediatrics service in Southampton is a safe service. She also points out that the numbers for Southampton might be wrong because since the suspension of services in Oxford, the numbers have gone up considerably from those quoted in the study.

Although I agree with the motion and think it silly to stick only with options A, B, C and D, people in my area of the country would prefer B because of the impact it would have on the Southampton centre. People in my constituency have pointed out that the option B proposal includes the centre with the highest quality score, the centre with the best surgery survival rates and the centre with the highest score for research. A strong argument can be made for retaining the Southampton unit. It has strong support from my constituents and people in Dorset, so I hope that the joint committee will consider it carefully.

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Annette Brooke (Mid Dorset and North Poole) (LD): Representing part of Poole, I am aware of the strong feelings there. Equally, however, I take on board the need for clinically driven decisions. Many Members are raising concerns about flaws in the proposals, so it makes a lot of sense to proceed with the motion, because whatever happens we want to be sure that the best decisions are being made. Does my hon. Friend feel that there is great uncertainty?

Mr Syms: I agree with the hon. Lady. It is important to get this right, rather than to rush. Clearly there are concerns. I know that the Minister is a sensible soul and will respond—[Laughter.] Well perhaps he was once a sensible soul. I am sure that he will respond to Members’ concerns. The important thing is that many people out there have concerns that we need to address if we are to deliver a first-rate service that our constituents feel is good for them.

2.13 pm

Stephen Twigg (Liverpool, West Derby) (Lab/Co-op): I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. I have the privilege to have in my constituency the hugely impressive and world-class Alder Hey children’s hospital, which I am delighted is included in all four options in the motion. I would express some concern, however, were the motion to be agreed to and were we to go beyond those four options. I hope that Alder Hey would be included in any further options that the joint committee would consider and consult on.

Alder Hey’s cardiac unit treats children with all forms of heart disease, not only in Liverpool and the wider Merseyside area, but those travelling from the wider north-west of England, north and mid-Wales and the Isle of Man. The total catchment area for children using Alder Hey’s cardiac unit covers about 7 million people, so many people already travel very long distances to use the excellent services there. Since 2006, the hospital has treated more than 4,000 patients for cardiac conditions and performed surgery on more than half of them. I spoke to the hospital this week in anticipation of today’s debate, and it expects that the concentration of surgery at Alder Hey will further increase demand, and has built that into its current plans. Alder Hey is on track to have a brand-new hospital with a children’s park. The plans are very exciting and have got a strong commitment from the local community in my constituency in West Derby. The hospital is strengthening its services. For example, it is investing in the existing team to add a sixth cardiologist and an eighth intensivist, increasing its theatre capacity to enable the delivery of 637 cases per year, and it has already achieved the minimum required activity for this operational year of 447 cases.

Members have spoken about the balance between our responsibilities to consider the national picture and our constituency responsibilities. Happily I am in a position to argue that the proposals work both in terms of national policy and for my constituents. The Children’s Heart Federation has highlighted some of the benefits of the Safe and Sustainable review’s proposals, which have been mentioned by hon. Members today: minimal cancellations and short waiting times for surgery; better outcomes from surgery; and an end to high-risk rotas in which a surgeon in a small team covering for a colleague on leave can operate all day and be on call all night

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several days running. As has been pointed out, these changes have been put forward by clinicians, and I would urge the House to tread with great care in jeopardising the outcome of such a clinician-led review. We must remind ourselves that the review does not propose the closure of any centres, and would instead concentrate surgery in the centres where it can be performed safely.

I finish with a broader point that the Minister might like to reflect on. This review is a good example of evidence-based policy making in the NHS. Perhaps we can have more of that as the process of NHS reform moves forward.

2.17 pm

Craig Whittaker (Calder Valley) (Con): I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his incredible hard work on this issue, not just this week but over many months.

Yesterday many MPs received an e-mail from the chief executive of the Children’s Heart Federation, who is also a member of the Safe and Sustainable programme steering group. She wrote:

“'Clinicians have led these changes and we believe it is wrong that some politicians are now trying to block the process that will lead to the vital improvements in children’s care.”

I do not agree with that assessment because I agree absolutely with the aims of the review, as do many of my hon. Friends. However, I have an issue with the process of the review and what it has missed out. In the case of Leeds, there has been no formal opportunity to correct factual inaccuracies in Sir Ian Kennedy’s pre-consultation assessment report, and no impact assessment was undertaken before the four options were announced in the consultation

As my hon. Friend the Member for Leeds North West (Greg Mulholland) said, Leeds delivers what is considered a gold standard of service, and is one of only two hospitals that offer this gold standard. However, the weighting in the criteria did not take account of that at all. It would be fair to say, therefore, that I, my fellow Yorkshire, Humber and Lincolnshire MPs and the more than 500,000 fellow Yorkshiremen who handed in a petition to the Prime Minister this week have little faith in an open and transparent process that is fair for the people in the current Leeds catchment area.

Diana Johnson (Kingston upon Hull North) (Lab): And women.

Craig Whittaker: I apologise if I left out women.

Greg Mulholland: Let me too say that it is a pleasure working with my hon. Friend, but can we debunk this myth that we are talking about a review without flaws that is based on clinical guidelines? Option B, which he mentioned, does not even get us to 400 operations for some centres. In too many places the review does not even follow its own logic.

Craig Whittaker: I agree with my hon. Friend, who is absolutely right. This comes back to my basic premise, because all we are asking for is an open, honest and transparent process that will produce the desired outcomes.

Last year, one of my constituents, Miss Libby Carstairs, spent many months in Leeds hospital and underwent heart surgery several times over several months. As we know, the aims of the consultation clearly show that

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parents would take their child anywhere to get the best treatment when they are as poorly as Libby is and was. Under the proposals, Libby would have gone backwards and forwards several times, probably between Newcastle for surgery and Leeds for her convalescence. Currently, her care and surgery all happen in one place. As with all families at such a stressful time, it was hugely beneficial that the family could visit regularly and help in the convalescence period. Libby’s mum spent her life in that unit with her, and her grandparents played a huge role with relief and support. Libby’s being in Leeds even allowed her head teacher, from Carr Green primary school, the opportunity to visit and take messages of support from her classmates and friends. I saw first hand not only how that cheered Libby up, but how it helped to fast-track the recovery of this poorly little girl. It also without question helped Libby eventually to go home, albeit with high levels of support. Such support from family and friends would not have been possible had Libby been up and down to, say, Newcastle or Liverpool, which are many miles away.

Although the main principle of parents taking their child wherever they need to go to get the best treatment is absolutely correct, it does not take into account the loss of income to the family through not being in work, the huge cost of travelling much further distances, and the incredibly important network of support from family and friends at what is an awfully frustrating and stressful time for everyone involved—the big society at its best, as it were. I cannot imagine what it is like not to know whether one’s child is going to live or die, so I cannot begin to comprehend the full extent of the support needed and appreciated by families.

Contrary to the e-mail received yesterday, MPs do understand the process, as do the 500,000 people who have signed the petition. However, it is scandalous that Leeds fits into only one of the four options, particularly as vital information has been missed out of Sir Ian Kennedy’s assessment. To sum up, if the Government are big enough to listen to the people and amend their proposals on issues such as the NHS and jail, surely clinicians at the JCPCT should be big enough to review their plans, by listening to what 500,000 people from Yorkshire, Humberside and Lincolnshire are telling them to do.

2.23 pm

Dr Alan Whitehead (Southampton, Test) (Lab): Southampton children’s services are located at Southampton General hospital, right in the middle of my constituency. The hard work undertaken by the large numbers of people who organised the petition presented at No. 10 yesterday—I and a number of fellow Members from across south-central England managed to get ourselves very wet helping to deliver it—showed not partisan fighting on behalf of a particular unit, regardless of its quality or the service that it represents, but genuine mystification that the process appears to have dealt so peripherally with Southampton’s role in the national roll-out of services. In 2010, Sir Ian Kennedy rated Southampton as provider of the highest quality service outside London, rating it particularly highly on paediatric intensive care and support for parents, and highly on training and innovation.

That mystification as to why such a unit should feature in just one of the options in the review was

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compounded by an examination of the background to that review. Indeed, perhaps the explanation for why Southampton appears to have been treated so peripherally can be found in the review itself. Of course it is important that the review should be completed, that changes should be made and that judgments be made on clinical grounds. However, I would suggest that it is not on clinical grounds that anyone should have forgotten that the Isle of Wight exists. That is the province of geographers rather than clinicians. If clinicians depend on the material in a review setting out the factors that will be taken into account in their final decision, much of their power in making that decision could be overthrown by what goes into that review in the first place.

It is not a clinical decision for the review to state that Southampton has two surgeons and undertakes 231 procedures, when in fact it will have four surgeons by this summer and undertake almost 400 procedures, as a result of, among other things, its excellent collaboration with Oxford, which my right hon. Friend the Member for Oxford East (Mr Smith) mentioned earlier, but which the review appears to neglect. If such a decision is made by the review, which appears to have got so many things wrong about the background to Southampton’s excellent services, the 250,000 petitioners who signed the petition that went to No. 10 yesterday will justifiably feel let down by the process, whoever conducts it. The national health service has a long and honourable record of stitching people up for the right reasons. If as a result of the review those 250,000 people end up feeling stitched up for the wrong reasons, they will have every right to feel very aggrieved indeed.

Several hon. Members rose

Mr Deputy Speaker (Mr Nigel Evans): Order. Just to inform the House of the procedure, I will now call the Minister. The recommendation from the Backbench Business Committee is that he speaks for about 15 minutes. However, I should remind the House that if he takes persistent interventions, that will extend the time that he spends on his feet, which will deny other Back Benchers the opportunity of speaking. The shadow Minister will be speaking towards the end of the debate.

2.28 pm

The Minister of State, Department of Health (Mr Simon Burns): I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate on the review of children’s heart surgery services. He has a strong record of campaigning on this issue and of bringing the concerns of his constituents to the attention of the House. I also congratulate him and the other hon. Members on the motion they tabled. The Government and I wholeheartedly support its contents, and I urge other hon. Members to do so as well.

I should also like to take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in my hon. Friend’s constituency and across the country. They do a tremendous job, for which we are all incredibly grateful, more often than not in complex and difficult circumstances.

I should like to confirm that the review is totally independent of the Government, and that it is clinically led. It is not driven by me, by other Ministers or by the Department of Health. It is therefore not appropriate for me to comment on the specific hospitals consulted

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during process. I do not wish to act, or to be seen to act, in a way that could influence or prejudice the process that is going on. As many hon. Members have said, this is a highly emotive issue, particularly for those whose children’s lives have been saved by the services under review. It is worth reminding ourselves why the review was conceived and planned and is now being carried out.

This is not a new issue. The provision of children’s heart surgery has been a cause for concern since the Bristol Royal infirmary inquiry in the late 1990s. Understandably, there has been considerable pressure from national parents groups and professionals to ensure that children receive the best treatment, and the sole purpose of the Safe and Sustainable review is to ensure that children with congenital heart problems receive the best possible care now and long into the future. To do that, we must be certain that the centres in which surgery takes place are as good as they can be.

Mr David Davis (Haltemprice and Howden) (Con): The Minister will not be surprised to hear that my constituents, like all the others in Yorkshire, are in favour of Leeds, but I do not want to draw him on that. I would like him to help us in our argument by telling us what the clinical outcomes for Leeds are and how they compare with other centres. In particular, will he confirm that they are all safe?

Mr Burns: I am grateful to my right hon. Friend for that intervention. With regard to Leeds teaching hospital, he will know that this is a complex issue. There are 36 different surgical procedures listed on the central cardiac audit database, but the three most relevant ones in the context of his question are those that deal with atrioventricular septal defect, arterial switch and Fallot’s tetralogy. Over the past six years, 304 operations have taken place involving those three specialties. Sadly, the number of patients who died within 30 days was 12, and 18 died within one year. The results of surgery in all units are good, with no significant divergence. The issue, however, is the future. We need to prepare for units that can deal with these highly complex procedures and the intense technology needed, and provide the qualified doctors and nurses involved, in order to keep up with professional and public expectations of the high quality of care required. This is not so much about today’s figures as about how we meet the challenges of the future to provide the finest and safest possible care in this deeply complex area of medical treatment.

The consensus among professional associations is that there should be no fewer than four congenital surgeons in a centre, each performing between 100 and 125 procedures every year, for a centre to be optimally staffed. Over the past few years, the outcomes for the services have remained good, as the figures that I have just given to my right hon. Friend illustrate, but there have been several warning signs that the current arrangements are fragile. For many years, professionals and national children’s charities, including the Children’s Heart Federation and the British Heart Foundation, have urged the NHS to review services for children with congenital heart disease. They have consistently raised serious concerns about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres.

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Many of the 150 types of operation undertaken by these dedicated teams are among the most complex, challenging and technically demanding areas of surgery. Success requires intricate surgery on hearts often no bigger than a walnut, coupled with finely balanced judgments drawn from a combination of advancing science, personal experience and compassion. It involves a range of highly trained individual team members—before, during and after the operation.

The risks posed by the complex nature of heart surgery include not just possible death after surgery, but lifelong complications such as brain damage and other disabilities. The judgments of any expert medical team caring for a particular child therefore have a direct and long-lasting impact not only the future of each vulnerable child, but on that of their families.

There is also the issue of recruitment. The fact is that smaller centres have problems with recruiting and retaining the very best surgeons. There is a risk that those working in smaller centres will find themselves working in isolation and in units that are not as up-to-date with techniques and clinical practice as the larger ones are.

Greg Mulholland: We all understand the premise of the review about the need to move to larger centres, but does the Minister not understand—I am not trying to draw him—the real concern when Leeds is performing 370 procedures a year and Newcastle, a smaller unit, performed only 255 last year, yet Newcastle is in all four options and Leeds only in one?

Mr Burns: I fully appreciate the hon. Gentleman’s point, but I hope that he will appreciate that he is now trying to draw me into a discussion on the merits of Leeds as against Newcastle. As I said earlier, it is inappropriate for me as a Minister to do that. However, it is a point that the hon. Gentleman, my hon. Friend the Member for Pudsey and others can make more than adequately to the joint committee, which will be able to determine the merits of the argument prior to reaching a decision. I urge the hon. Gentleman to understand how inappropriate it would be for me to go down the route of arguing the merits or demerits of one area or another.

Smaller centres struggle to train and mentor junior surgeons, making these units less attractive to the senior surgeons of tomorrow and making it difficult to provide a safe 24-hour service. We must ensure that our surgeons and their teams are well supported. They need opportunities to develop their experience as they become increasingly expert in these intricate and complex procedures. We must ensure that all the hospitals that provide heart surgery for children can also provide care within safe medical rotas.

No parent would wish the care of their child to be entrusted to a surgeon who, though an excellent doctor, is overly tired because they have had to work around the clock without any peer support. This means that to reduce the risk of surgery in sick children and to improve their long-term outcomes, we must focus our surgical expertise in larger centres. The need has become ever more pressing with the increasing complexity of treatment.

As hon. Members will know, the national review is known as the Safe and Sustainable review. Its aim is to ensure that children’s heart services deliver the very highest standard of care. The NHS must use its skills

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and resources collectively to gain the best outcomes for patients. As I stated at the beginning of my speech, in line with the Government’s entire approach to the NHS, this review is both independent and clinically led. May I reassure hon. Members that the objective of the review is not to close children’s heart centres? Far from it. While surgery may cease in some centres, they will continue to provide specialist, non-interventional services for their local population.

Indeed, the review proposes to extend local care further, supported by the professional associations that support the increased clinical expertise across England. This wider support is crucial. Surgery is usually a single, short episode in what is often a lifelong relationship with specialist congenital heart services. The aim is to improve those services as a whole and to ensure that as much non-surgical care as possible is delivered as close to the child’s home as possible through the development of local congenital heart networks. These will enable children to be safely and expertly cared for nearer to home in the longer term.

Given the complexity of the issues for consideration, the NHS has held a four-month, rather than the usual three-month, consultation. Hon. Members should be reassured that the consultation process has been impressive in its scope, inclusiveness and transparency.

Julian Smith: Will the Minister give way?

Mr Burns: I will, but it will be for the last time.

Julian Smith: I thank the Minister. Will he comment on the lack of translation of certain consultation documents, which has affected many communities, particularly in and around the Leeds area?

Mr Burns: I am grateful to my hon. Friend for raising that issue, and I will address it later in my speech.

No decision has yet been made about which centres should continue to undertake surgery. That decision will be made only after the responses to the consultation have been properly and fully considered. The chair of the joint committee of primary care trusts, Sir Neil McKay, has made it clear that it is a genuine consultation and that all viable proposals will be considered, and I agree with that. There has been no pre-determination of the number of centres that will be selected. Rather, the review remains flexible and open-minded as to the final number and is happy to listen to all options that would produce the excellent clinical outcomes for our children that we desire.

As I have said however, this review is being driven by a powerful clinical imperative. The trend in children’s heart care is towards increasingly complex surgery on ever-smaller babies. That requires surgical teams that are large enough to provide sufficient exposure to complex cases, so that surgeons and their teams can maintain and develop their specialist skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons. In recent years, other countries have recognised the clinical necessity of larger surgical units and have reconfigured their services along the lines proposed by the Safe and Sustainable proposals. Here in the United Kingdom, there are successful precedents for centralisation. In the past 15 years, the congenital cardiac services in

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Cardiff and Edinburgh have ceased heart surgery on children, as they recognised that their centres were just too small to be sustainable.

I also want to reassure Members about the integrity of the process that was followed in developing the options for consultation. In the past, concerns have been put to me in this House about mistakes in the assessment process, particularly relating to the Leeds service, and Members have referred to that again today. I understand that since our last debate in February or March of this year the chair of the joint committee, Sir Neil McKay, has written to the chief executive of the trust in Leeds to explain why mistakes have not been made in relation to the Leeds centre.

Members, including my hon. Friend the Member for Skipton and Ripon (Julian Smith) in his recent intervention, have also raised the issue of documents not being made available in a sufficiently wide range of languages, thereby excluding those who speak those languages from the consultation process. The relevant documents have for several weeks been available in 10 different languages, including Urdu, Arabic, Farsi and Punjabi. [Interruption.] The hon. Member for Leicester West (Liz Kendall) shakes her head, but I assure her that they have been available for several weeks, although I accept that they were not available from the first day of the review. That may be the point the hon. Lady was seeking to make, and I agree with her if she thinks they should have been from the first day. We cannot change the fact that they were not available from then, however, but they have been available from, I believe, 20 May, and the consultation process runs until 1 July, which gives sufficient time for people who need to access the documents in those languages to do so and to be able to input their views.

I hope to be able to reassure my hon. Friend the Member for Isle of Wight (Mr Turner) on retrieval times and access times from the Isle of Wight, given its unique geographical situation. It is my understanding that the joint committee of primary care trusts has agreed that Southampton University Hospitals NHS Trust has provided evidence on this issue that requires further consideration and has invited the trust to develop a detailed case regarding retrievals from the Isle of Wight, which the committee will consider as part of the evidence to determine the optimum reconfiguration.

Several Members raised the issue of the inclusion of black and minority ethnic communities in the consultation process. There have been a number of workshops and focus groups, many of which have been aimed specifically at the BME communities. Almost 2,000 community groups and organisations that have an interest in BME issues have been contacted and invited to take part in the proceedings. Public meetings have been arranged, particularly in Leeds, specifically for the Asian population of Yorkshire in partnership with representatives of local BME groups. The Leeds meeting is on 29 June, there is a meeting planned for Bradford on 30 June and a further meeting is planned for Kirklees. I hope that hon. Members who represent parts of Yorkshire and the surrounding catchment areas will be assured by that.

To abide by your rules, Mr Deputy Speaker, I will now conclude by saying that I am confident about the consultation. Everyone will accept that all consultations of this nature can be difficult, when tough decisions have to be taken. The decisions have to be taken for the

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right reasons, based on clinical evidence about the best way to improve and enhance care and the quality of care for patients. That is particularly true in this case because more often than not the patients are very young children with very complex needs—that is what makes this issue so difficult.

Let me reiterate that no decisions have been taken or will be taken until the joint committee has had an opportunity to consider the independent analysis of the consultation responses, reports from any local overview and scrutiny committees and a health impact assessment. Throughout, it will remain open-minded and flexible as to the number of centres. The only important consideration will be the sustainability of clinical excellence at the centres chosen. I doubt whether this is the case, but if any hon. Members have not taken part in the consultation I urge them to do so. I also urge them to ensure that their constituents and organisations in their constituencies with an interest in this matter take part in the consultation if they have not already done so, so that the committee can have the widest range of views, information and opinion before reaching what will, in any circumstances, be difficult decisions.