Paediatric Intensive Care (Hansard, 24 November 1993)

§ Mr. David Blunkett (Sheffield, Brightside)
(by private notice): To ask the Secretary of State for Health if she will make a statement on the report of the multi-disciplinary working party on paediatric intensive care convened by the British Paediatric Association.

§ The Minister for Health (Dr. Brian Mawhinney)
I welcome the report from the British Paediatric Association on the care of critically ill children, and would like to thank Dr. Peter Fleming and his colleagues for their work.
The report is based on a study of critically ill children and their care in hospital. My Department funded this study, the most comprehensive ever undertaken anywhere, because of the priority which we attach to the care of those children. Today's report needs to be seen against the background of significant improvements in children's health achieved in recent years.
In the past 14 years, infant mortality has halved. Over the same period, the number of children dying at birth or in the first week of life has dropped by about 40 per cent. Rates of immunisation against major childhood infections are at an all-time high. Since the introduction of the HIB vaccine a little over a year ago, the incidence of HIB meningitis has declined by 74 per cent.
The House will also want to know that the total number of designated paediatric intensive care beds has increased from 127 in 1987 to 209 this year. Two out of three children who need paediatric intensive care are admitted to specialist units. There are many such units in the national health service providing first-class care, and I wish to record my appreciation to the doctors, nurses and other staff who work in them.
Today's report rightly expresses concern that some children are still not able to receive the care that they need in specialist units. While those children receive skilled care, nevertheless, as the report identifies, they should be cared for by nurses and doctors trained and experienced in paediatric intensive care. We therefore need to extend our existing facilities and training programmes.
District health authorities have the responsibility for assessing local health care needs and determining how they should be met. They do so within the priorities set by Government. Child health is a priority. Consequently, I have already asked the national health service management executive to ensure that health authorities are aware of today's report and the importance we attach to its main findings, and to ensure that health authorities make a co-ordinated and effective response.

§ Mr. Blunkett
I am grateful to you, Madam Speaker, for granting this question. Can the Minister tell the House how we can claim to have a national health service when we cannot guarantee equal treatment and access for the most severely ill children across the country? Will he acknowledge that the fact that we have an internal market has severely damaged the chance of co-ordinating the planned and invested care that we need for severely ill children?
Will the Minister accept the recommendations in the report that such specialist facilities cannot be subjected to the internal market and to the mechanisms of local purchasing care? Will he tell the House why, with a 34 per cent. shortfall in specialist children's intensive care, the 454 Government are prepared only to refer the report to local district health authorities and to ask the NHS Management Executive to supervise their reaction?
What would any parent feel if they took their child to an intensive care unit only to be turned away? That happened at every single specialist unit during the period of the report's survey. It happened to 77 children this year at the Royal Manchester children's hospital—a situation which the Prime Minister is reported in today's Manchester Evening News as describing as "heartbreaking".
What will the Minister do about this? Why are the Government simply referring the report to local level when 76 per cent. of adult units have no trained child nurse available, when there is a shortfall of 34 per cent. in the places available, and when we know from the report that there is scandalous under-investment in these absolutely crucial specialist facilities?
Will the Minister this afternoon agree with the recommendations of the report that paediatric intensive care should be organised not on a district basis, but on a regional or multi-regional basis to co-ordinate the necessary investment and a sufficient availability of these units?
Will the Minister, instead of merely passing the buck and passing responsibility down to the internal market and the district health authorities, guarantee today that he accepts the clear recommendation of the specialist report that we should have a co-ordinated national programme … instituted by the Department of Health and not by someone else, for the care of the most sick and needy children? Will he accept the Government's responsibility for co-ordinating, planning and investing in intensive care facilities for children in every part of Britain?

§ Dr. Mawhinney
Clearly, the hon. Gentleman did not listen to my answer. We are in no sense passing the buck, as he so inelegantly phrases it.
We agree with the report's conclusion that the overwhelming number of children who are very sick should be treated in paediatric intensive care units. I suspect that that is common ground between us all because the concern for very sick children is not a partisan matter. Indeed, I was able to tell the House of the strides that have been made over the past six years in providing extra facilities. I recognise that further facilities must be provided.
I remind the hon. Gentleman that the report makes it clear that these matters should be dealt with in the context of the reformed NHS. He will see in the recommendations that reference is made to purchasers and providers. He is right to point out that the report recommends that it may be necessary for these facilities to be provided on a wider basis—perhaps a regional basis—than simply by each individual district health authority. I am happy to accept that recommendation. I have made it clear in the instructions that I have already given to the NHS Management Executive that, as it works with the district health authorities to ensure that these priorities are addressed and met, it should have that recommendation very much in mind.

§ Mr. Roger Sims (Chislehurst)
Does my hon. Friend agree that the increase in beds between 1987 and now is substantial, but that the report suggests that there is scope for more? They are certainly needed. Does he also agree 455 that the rate at which knowledge is increasing and technology developing in this area is outpacing the rate at which we can train doctors and nurses in those new techniques?

§ Dr. Mawhinney
My hon. Friend is right on both counts. Since 1987, the number of paediatric intensive care beds available has increased by some 70 per cent. Indeed, the increase of about 70 beds recommended by the report is less than the increase that has taken place since the last report in 1987, so I have no doubt that we can address the report with the same success as the previous one.
My hon. Friend is right on the second point also. Part of the pressure has arisen because of the skill of the medical profession, which can now offer treatment, care and hope to very sick children who, some years ago, would have been beyond the scope of medical help. We recognise that that is itself creates an upward pressure on the need for provision.

§ Ms Liz Lynne (Rochdale)
The Minister just said that this is the second report in seven years. Although I am glad that he has agreed to act on the report, why are we in such a sorry state if the previous report was fully implemented? Will he assure the House that this report and the intensive care beds needed for children will be properly funded, and that trained staff will be available? Does he now accept that this is just another example of how the NHS reforms have not worked?

§ Dr. Mawhinney
It is a pity that the hon. Lady put in the last point, because, until then, she was on reasonably solid ground. Her last point was nonsense, as we both know.
We responded to the 1987 report with a 70 per cent. increase in the number of paediatric intensive care beds. On the basis of research, which we funded because we recognised that a problem was developing again, we now learn that more beds need to be provided. Our response will be as strong and directed as our response to the 1987 report. We shall continue to treat this as a priority and shall make it clear to district health authorities that they, too, must treat it as a priority.

§ Mr. Alan Duncan (Rutland and Melton)
Will my hon. Friend confirm that there is good news to tell about children's health? Will he confirm that, whereas the World Health Organisation has set a target of 90 per cent. for the immunisation of children, the record in this country is not 70,80 or 90 per cent. but exceeds 90 per cent. and for some diseases has even reached 95 per cent?

§ Dr. Mawhinney
My hon. Friend is absolutely right, which is why I put in the answer to my question the significant information about the halving of infant mortality and the 40 per cent. reduction in perinatal mortality in the past 14 years. The report raises serious issues, to which we shall respond with commitment and priority, but it is against a background of improvement in child health which I should have thought hon. Members on both sides of the House would welcome.

§ Mr. Alfred Morris (Manchester, Wythenshawe)
Is it not high time that we had centrally available information on where children receive intensive care? Is the Minister aware that many children in need of intensive care have 456 had to go to adult intensive care units, while, at the same time, adult patients have had to go from Greater Manchester to as far afield as Blackpool at times of critical need—indeed, in life-or-death situations—and that some of them died en route?

§ Dr. Mawhinney
I am certainly aware, as the right hon. Gentleman is, that most of the very sick children in need of paediatric intensive care were treated in paediatric intensive care beds. Some were treated in intensive care general beds, and some in children's wards. He and I both recognise that it is preferable for very sick children to be treated in paediatric intensive care beds. No Government can guarantee that no child will ever have to move out of a paediatric intensive care unit because, as he knows, there are peaks and troughs in demand, for which it is impossible to plan. It ought to be the case that, where possible, very sick children should be treated in paediatric intensive care unit beds. That is what we are seeking to achieve.

§ Mr. David Congdon (Croydon, North-East)
It was useful that my hon. Friend was able to remind hon. Members of the excellent improvement in child health care in this country, but there is no room for complacency, as the report makes clear. Will he assure the House that he will put maximum pressure on district health authorities in the reformed health service to ensure that they update their purchasing plans so that we do acquire the improved facilities that we need?

§ Dr. Mawhinney
We have already told the NHS Management Executive to take the proposal forward as a priority. I hope that my hon. Friend will accept that as the best answer to his question.

§ Mrs. Alice Mahon (Halifax)
The Minister has already said that this is a heartbreaking report which tugs at the emotions. Therefore, will he give a guarantee extra resources will be provided for more intensive care beds for children rather than pass the buck to district health authorities? As the subject is emotional, to avoid the heat those authorities might move money from other departments in serious need. Will he fund the service properly by provided extra resources?

§ Dr. Mawhinney
The hon. Lady knows that the priorities of the health service are set by Ministers and reflected down to district health authorities, which have the responsibility for ensuring that the priorities are met, taking account of their assessment of local health needs and how best to meet them. I have told the hon. Lady and the House that we give the subject priority. Each year in the health service, we deliver new services to patients because they constitute a priority. Within that framework, we will, as a priority, deliver the new services to patients.

§ Dr. Liam Fox (Woodspring)
I greatly welcome the frankness with which my hon. Friend has talked about the report. Is not the simple truth that Ministers with responsibility for health will continue to be victims of the success of the NHS? In many sectors, such as neonatal paediatrics, medicine will always be able to deliver more than we can practise. Is not the way that the Opposition use even the health service as a political football testimony to their sickening cynicism?

§ Dr. Mawhinney
My hon. Friend speaks with great authority as, unlike most of us in the House, he has had responsibility for such matters. I am grateful to him for 457 underlining the point that I made a few minutes ago. In the sector medical skill under discussion, rapid developments are being made. Doctors can offer patients care and treatment that would have been literally inconceivable a few years ago. We must accommodate that in the health service because it is a priority for the Government, the health service and the House.

§ Rev. Martin Smyth (Belfast, South)
The Minister's statement is to be generally welcomed. However, does he agree that there is still room for improvement, not only in intensive paediatric care, but in paediatric orthopaedics? Does he accept that, even in Britain, there is a need for development in that sector? The process of rationalisation brings added pressures—as happened at the Royal children's hospital in Belfast in my constituency. Will he admit that some of the leading work has been done through charitable work, as in the Gait unit at the Musgrave Park hospital, of which the Minister has personal experience?

§ Dr. Mawhinney
I am grateful to the hon. Gentleman for his welcome for my statement. I accept that, in various parts of the country, pressures involving the delivery of paediatric care must be addressed. The hon. Gentleman will understand that I am not familiar with the details of his constituency, but I shall ensure that they are brought to the attention of my noble Friend who has responsibility for such matters in Northern Ireland.

§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
I welcome the Minister's new-found recognition of the fact that the shortage of specialised trained nurses and doctors in the sector is contributing to the crisis. Will he investigate why, in Alder Hey children's hospital in my constituency, of the 15 nurses who qualified last year, only four found work at the hospital after three years' training in precisely those specialised skills of which he now recognises there is a shortage? Is it not only a shocking waste of resources to train people, but an indictment of the way in which the health service is being run that, after all that investment, those nurses could not find work?

§ Dr. Mawhinney
The hon. Lady wishes to widen the debate, and that is perfectly acceptable. The proportion of nurses moving into jobs is high, and many are remaining in posts much longer than before. If the hon. Lady was 458 alluding to the fact that there is some evidence that nurses who are trained in paediatric intensive care specialties are not remaining in those specialties, she is right, and we are looking at that special issue. I have asked the chief medical officer and the chief nursing officer to enter into urgent discussions with the professions to address the question of the necessary extra training.

§ Dr. Tony Wright (Cannock and Burntwood)
The Minister will recall events at Birmingham children's hospital a few years ago, when many children needing heart surgery were turned away because of the lack of paediatric intensive care beds. I was the parent of one of those children waiting for such surgery, and my child later died. We were all assured that that situation would never recur. Several years later, and after and two further reports, we are being told the same story. Is that not cause for enormous shame and great anger?

§ Dr. Mawhinney
I was not aware of the hon. Gentleman's personal circumstances, and I shall bear them in mind in my response, when I say that significant change has taken place since 1987. There has been a 70 per cent. increase in the number of paediatric intensive care beds since the events occurred to which the hon. Gentleman has referred. It is widely accepted among the professions that it is a developing specialty. We funded the report precisely because we wish to have an authoritative assessment of where we are now, so that we can plan to build on the decisions that have already been implemented.

Several hon. Members
rose—

§ Madam Speaker
Order. We are now going to move on to the next item of business, which is the Welsh Grand Committee.