HC Deb 15 January 1988 vol 125 cc645-52

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]

3.3 pm

Mr. David Winnick (Walsall, North)

The whole country is hoping and praying that my constituents' child, four-year-old Matthew Collier, will win his battle for survival after 10 hours' major heart surgery on Wednesday. All our hopes go out to Matthew and his parents.

My Adjournment debate is about the intensive care unit at the children's hospital, Birmingham. Everyone in the west midlands knows about the splendid job that the hospital does and the kind of work that the surgeons do, including the most complicated heart operations such as that performed on Matthew two days ago. The utmost praise should be given to the surgeons, consultants, nurses and the other medical and non-medical staff at the children's hospital.

The hospital faces financial problems, and as far as major heart surgery is concerned, there are nowhere near sufficient trained nurses for the intensive care unit. That is the part of the hospital to which the child goes after major surgery and where he or she may spend weeks being cared for, before being allowed home. It was the lack of bed availability in the intensive care unit that led to the position where my constituent's son, Matthew Collier, could not be admitted. Moreover, no date was given for admission.

Matthew had already had three operations. In September last year, his parents were told by the hospital that major heart surgery was urgently necessary. An appointment was given—I stress only an appointment—for 24 February. All that happened because beds were not available in the intensive care unit. Matthew's parents were told that he could be admitted only if he became an emergency case. In all the circumstances, what could the parents do except go public over their beloved son, especially since, although Matthew's health was deteriorating, he was not considered an emergency case? We are, of course, pleased that a bed became available this week and that Matthew has had his lengthy operation.

When I visited the hospital last week, I was shown round the intensive care unit. Although in total there were six beds, only five were in use. I stress to the Minister that only five beds are serving the entire west midlands region. It is reported that over 90 children are waiting for major heart surgery at the children's hospital in Birmingham.

One of those children is another Matthew—in this case Matthew Mulhall, who is eight months old. He has a serious heart condition and his parents have been told that major surgery is required. In a letter to her Member of Parliament, his mother wrote: I cannot sleep at nights worrying about the cutbacks and the effects it could have on our son". It was that case in Coventry which led my hon. Friend the Member for Coventry, North-East (Mr. Hughes) to make his protest in the Chamber on Monday. I cannot and will not condemn a colleague who feels, as a religious person, so strongly about the position of his constituents and their child that he made the protest that he did. I am sure that my hon. Friend did not make his protest lightly.

I received a prompt reply from the Under-Secretary of State for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie) to the letter that I wrote to the Minister for Health at the beginning of this month about Matthew Collier's case and the intensive care unit at the hospital. In her reply, the Under-Secretary referred to an intensive care nursing course that is apparently due to commence next January. However, I should like to ask the Minister about the position in the meantime, before the proposed course produces the further trained nurses who will be employed in the children's hospital intensive care unit.

Moreover, as we know, the chairman of the regional health authority responded to the spotlight on the hospital by suggesting six courses of possible action to deal with the position. Of course, any action that can be taken, even on a temporary basis, which could assist the children who are urgently in need of major heart surgery, is to be welcomed. All hon. Members would welcome that. However, the four heart consultants at the hospital were somewhat sceptical about some of the suggestions. The local press in Birmingham reported that, in the consultants' view, some of the chairman's proposals demonstrated a limited appreciation of the special needs of children with heart diseases. The four said, for example, that it is impracticable and inappropriate to move children from region to region.

Ms. Clare Short (Birmingham, Ladywood)

My hon. Friend will be aware that that hospital is in my constituency. There are grave shortages throughout the hospital, not just in the intensive care unit, as a direct result of the Government's underfunding of the Health Service.

In the regional health authority's plan, to which my hon. Friend has just referred, one of the proposals is that money should be given to private hospitals, to assist. I hope that my hon. Friend shares my deep objection to that. We want the children's hospital in Birmingham, which is loved and respected throughout the region, to be properly funded and to function properly. We do not want money to be creamed off to build up a private hospital, while we fail to resolve the problems in the children's hospital.

Mr. Winnick

The point made by my hon. Friend is one which all Labour Members share.

The position of the intensive care unit is part of the current crisis in the NHS, no less in the west midlands than elsewhere. It is not acceptable to the large majority of people, no matter how they vote, that children requiring major surgery on the NHS, such as the two children whom I mentioned, should have to wait literally months before they can be admitted. That is unacceptable. If it is unacceptable to the large majority of people, it should be no less acceptable to the Minister and his colleagues.

Neither should the parents have to undergo the anxiety and stress of wondering whether a bed can be found for their child, in addition to all their constant worries and fears over the child. Can one imagine what it must be like for parents, knowing that their young child requires major heart surgery, and wondering whether that child will survive? They have all the constant worry and, in addition, at least in the west midlands and, no doubt, in other parts of the country, there is the problem such as the one faced by Mr. and Mrs. Collier and Mr. and Mrs. Mulhall, of whether a bed will be found in time. That is why, in those two cases, the parents decided to go public.

At the end of my brief speech, I should like to leave a few minutes for my hon. Friend the Member for Stoke-on-Trent, North (Ms. Walley) to speak. She will then have to leave for an urgent constituency engagement.

The Government must take urgent action now to try to resolve the crisis and the need for more nurses at the intensive care unit in the children's hospital, Birmingham. It is no good saying that next year there will be a course. It is no good for the Minister to say that suggestions have been made by the chairman of the regional health authority. Nothing less than urgent action will do. It should never again be necessary for parents such as my constituents or other parents to have to go public to draw attention to what is happening.

I quoted this on Monday, and I repeat, that the Prime Minister has said that she wanted to go to hospital on the day, at the time and with the doctor that I choose. That is fine. That is the Prime Minister's wish. If it is fine for the Head of the Government to have that wish, should it be any less right for our constituents and their children to be able to have operations in the same way, without a lengthy delay, and to be able to have them on the NHS?

I plead with the Minister to understand what is happening, to understand the difficulties and the need for more funding and more nurses in the intensive care unit. Let us try to resolve the problem. Let us hope that never again parents have to contact the media and so on before there is an understanding of such cases by the Government. I hope that the Minister will respond accordingly.

3.13 pm
Ms. Joan Walley (Stoke-on-Trent, North)

rose——

Mr. Deputy Speaker (Mr. Harold Walker)

Order. Does the hon. Member for Stoke-on-Trent, North (Ms. Walley) have the consent of the Minister to speak?

The Minister for Health (Mr. Tony Newton)

Yes.

Ms. Walley

I am grateful to my hon. Friend the Member for Walsall, North (Mr. Winnick) for allowing me a short time to put across these views, about which I feel strongly. I hope that hon. Members will forgive me if I have to leave before the end of the debate because of urgent constituency business.

I speak on behalf of families in North Staffordshire with children who need that treatment, especially the parents of Clare Wise, who lives in Kidsgrove. Clare needs her shunt operation urgently. She needs it now while she is still well. Will the Minister give me a date when she can be admitted for her operation?

On Tuesday this week we heard that Sir James Ackers made an announcement. He has at least and at last acknowledged that we have a problem in the west midlands. However, will the Minister take note that extra money is needed to provide the proper levels of intensive care, not just five beds? That extra money must be spent on the NHS so that everyone can benefit, not just the private sector. Clare's family do not want her to have a private operation, even though money has been raised locally to pay for it. Her parents want the consultant who has treated her throughout to do the operation. They want to know that there will be a bed available in the intensive care unit if it is needed.

I would be grateful if the Minister will say how he intends to make extra money available for this very important service in the west midlands, so that when the "Young at Heart" lobby comes here on Monday, it can be assured that the intensive care unit will be fully staffed in a matter of only days or weeks.

3.15 pm
The Minister for Health (Mr. Tony Newton)

I associate myself with the opening words of the hon. Member for Walsall, North (Mr. Winnick), who expressed his good wishes to Matthew Collier and his parents, and also the hopes of us all that the operation yesterday will succeed.

I wish to record the advice that I have been given about the position of Matthew Mulhall, who was also mentioned by the hon. Gentleman, and who was the subject of comments in the House earlier this week. I understand that his parents, with their Member of Parliament, met the consultant — Eric Silove — yesterday. Matthew has a leaking heart valve and I understand that Dr. Silove has advised Matthew's parents that it would be best to allow him to grow so that the largest possible replacement heart valve can be used. It is envisaged that his operation will take place in four to six months' time, although his condition will be kept under regular review in the meantime.

I thought it important to place that information on the record because, in the light of the apparent clinical advice, it places the case in a rather different context than might have been assumed from some of the remarks made earlier. Having said that, I stress that I fully accept that those remarks were made in good faith.

Ms. Short

It now appears that only if one goes to the media, or forces a child to be named in the House, can one obtain attention. Delays for operations, even when dates had been set, have been occurring at the Birmingham children's hospital for years. It is important that that point is made clear. If the Minister says that he cannot solve the problem this week, the question must be: why was a solution not sought when the problem first arose years ago?

Mr. Newton

I acknowledge the hon. Lady's sincerity. The point I made about Matthew Mulhall was intended to help the House to understand the position in the light of the advice given to me. It was not intended to minimise the anxieties that we all feel when delays occur.

I well understand that the hon. Member for Stoke-on-Trent, North (Ms. Walley) has to leave the House shortly. I do not have sufficient information about the case of Clare Wise to feel it right to make any comment. Obviously, I have noted the hon. Lady's remarks and will make inquiries. I am sure that she and other hon. Members will understand that I cannot dictate to clinicians the order in which their patients should be treated.

I had intended to say a word or two about the fact that, obviously, I do not accept everything that the hon. Member for Walsall, North said about the National Health Service. However, rather than extend that argument, I shall say something about the particular problems of Birmingham children's hospital. I do not intend to minimise the concerns that have been expressed, but I want to remind the House of the very real achievements of that hospital in recent years.

The number of in-patients treated in the hospital in the past seven years for which I have figures has risen by 15 per cent. The number of out-patients has risen by 16 per cent. and the number of day cases has more than doubled to 121 per cent. Since the cardiac unit, which is the focus of our debate, was designated by the Department in 1984 as a supra-regional centre, which protects its funding, as I am sure that hon. Members are aware, 569 open-heart operations have been performed by surgeons. I know that all hon. Members, whatever their current concerns, would want to join in acknowledging the achievement which that represents.

Many of the treatments that now take place at the hospital were not available a few years ago, and that is one of the causes of the hospital's current difficulties. More than a dozen highly specialised treatments are provided, and that has placed additional pressure — I clearly acknowledge this — on some key services and, in particular, on the hospital's intensive care unit. To put the matter clearly, the pace of medical advance has run ahead of the hospital's ability to recruit and retain enough trained nurses, and the intensive care unit has not been able to operate at full capacity. Even so, admissions to the paediatric intensive care unit have risen from 207 in 1977 to 470 in 1986. The figures have much more than doubled in just under 10 years. However, I recognise that, despite that very large increase in the amount of work, some operations have had to be postponed, as we are all aware.

As the hon. Member for Walsall, North is aware from the recent letter to which he referred from my hon. Friend the Under-Secretary of State, we have been taking a very close interest in the matter in response to the concern expressed inside and outside the House. The issues have been explored at a series of talks between officials and officers from the West Midlands regional health authority and the Central Birmingham health authority. The outcome of those talks and the work of our officials, as well as regional and district officials, enabled Sir James Ackers the chairman of the West Midlands regional health authority to make his statement earlier this week in which he outlined six areas of action intended to ease the position and ensure that in future children do not wait for cardiac surgery for long periods.

The first priority relates in some ways to the point made by the hon. Member for Stoke-on-Trent, North. The priority is to ensure that children currently awaiting an operation are treated as quickly as possible. The regional health authority is therefore considering urgently whether arrangements can be made with other regions or private hospitals to improve the immediate position. While I acknowledge what the hon. Member for Birmingham, Ladywood (Ms. Short) said about the use of the private sector, as a matter of practical concern for those who are awaiting operations if it is possible to obtain those operations within the capacity that currently exists in the private sector, it would be wrong to stand in the way of that, whatever long-term view the hon. Lady may take. At any rate that option, and the possibility of making arrangements with comparable centres in other regions, are among the ideas being considered urgently by the regional health authority.

I know that some doctors at the children's hospital have said that it would be impractical to send children out of the region for treatment. I want to make it clear that it is not the intention to impose a solution that is unacceptable to the children's doctors or their parents. If such a solution were acceptable to the clinicians and parents, I would fully support the regional health authority's objective to ensure that all the necessary arrangements for a possible transfer were in place. If that is the right practical solution to a particular practical problem, no one would want to stand in its way.

A number of other initiatives are under way to improve the recruitment and retention of nurses who have the range of special skills needed by the children's hospital including—the hon. Member for Walsall, North fairly referred to this — the establishment of a new training course in Birmingham for paediatric intensive care. Work is in hand for the course—the first of its kind outside London—to start later this year. I have made very clear my concern that every possible step should be taken to get that course into place as early as possible.

Mr. Winnick

The second paragraph of a reply that I received from the Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie) states: It is anticipated this course will commence in January 1989.

Mr. Newton

That was the position when my hon. Friend wrote that letter. Part of the purpose of our exercise, and of the statement from the RHA chairman during the week was to show that further steps are being taken to accelerate that process. It is my direct concern, as a Minister, to ensure that no step fails to be taken to accelerate the introduction of that course. As the House knows, the principal problem at the Birmingham children's hospital intensive care unit is not a shortage of money but a shortage of intensive care nurses. We need to focus on that problem beyond anything else at this stage. There is no question of the introduction of that course being delayed due to lack of money. We would not allow that to happen.

Ms. Short

That is good news. Another suggestion by the hospital is that there should be a special course for returning nurses who are resident in Birmingham and who would not be attracted to other regions. That has enormous potential. I have written to the Minister about it, but I have not yet received a reply. I hope that the Minister will comment on that suggestion, which may be more fruitful than a fresh course for new young nurses.

Mr. Newton

I am sorry if the hon. Lady has not received a reply. The two courses are complementary. The idea emerged from the work done jointly by the Department and the region, and I very much hope that it will prove possible to pursue that course as well as the new paediatric intensive care course. Both courses are needed.

In the short term and in the longer term both those efforts will be reinforced by what we are doing at national level in the profession with the nurses and midwives negotiating council to advance a review of the clinical grading structure which, to a significant extent, will aim at ensuring that the skills of nurses in key specialties are better reflected in their grading and, therefore, in their pay. As the House is aware, there has been agreement in the negotiating council about new grading definitions. Proposals are going to the review body for pricing in its report that is due later this year.

The hospital building programme to which I referred is currently under way in the west midlands. Apart from the objective of providing a modern hospital service in the parts of the region that historically have had fewer facilities — the constituency of the hon. Member for Walsall, North is among those benefiting from the building programme— another important feature is the replacement of the old single specialty hospitals in Birmingham, including the Birmingham children's hospital, by new facilities on district general hospital sites.

Despite its hugely increased capital programme, the region has had to make difficult decisions in recent months between competing priorities. Clearly such decisions have to be taken at regional level. At present, it is planned that the Birmingham children's hospital will be rebuilt on the site of the Queen Elizabeth hospital beginning in 1994–95. That will include an expanded intensive care unit.

As Sir James Ackers made clear in his statement, which I welcomed, he is considering whether there is a speedier alternative to that proposal. I should very much welcome it, and I should be anxious to support the region. It would be wrong of me and of hon. Members—who have not sought to do so— to pretend that a complex problem such as that at the Birmingham children's hospital can be resolved overnight, but I hope that I have given the House and hon. Members a measure of assurance, and indeed reassurance, that not only is no obstacle being put in the way of finding an early solution to that hospital's difficulties but that we shall be doing everything possible — and have already taken action — to support and encourage the west midlands region to overcome those difficulties.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Three o'clock.