Bone Marrow Treatment Unit: Closure (Hansard, 6 July 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, wide consultation took place on the transfer of the Westminster Children's Hospital to the new £230 million Chelsea and Westminster Hospital. The North West Thames Regional Health Authority admits that it did not consult on the transfer of the bone marrow transplantation service. There are eight hospitals in London that undertake bone marrow transplants, many for children. Of the four units in North West Thames, two undertake transplants in children.

§ Lord Howell
My Lords, I thank the Minister for that Answer, but is it not a serious indictment that the divisional court held that the closure of the bone marrow unit, which carried out 20 operations a year at Westminster, was unlawful? Can the Minister tell us, first, what action has been taken in view of that illegality? Further, why has no apology ever been given to the parents of the lad who brought the action? Can the Minister also tell us why, since Guy's and Great Ormond Street Hospitals were prepared to take him, the Department of Health or North West Thames health authority could not offer the £800,000 needed to keep this excellent unit in operation? Is it not disastrous that, from the unit which has served us so well, the consultant is not now working on such cases; the very experienced sister in charge has been made redundant and the trained nurses have been dispersed? It is a serious matter when children suffer in this way.
I am sorry that noble Lords protesting are not prepared to hear the Question put as it should be on behalf of the people of this country who are suffering.

§ Baroness Cumberlege
My Lords, I would just like to say to the noble Lord that my understanding is that there were not 25 operations carried out per year. That was half the problem. The problem was that there were eight to 10 carried out per year. When a review was done of the services, it was recommended that 1198 there should be 25 done per year. That is why the proposal was made to transfer the unit to another hospital where the number of cases per year would be increased. I understand that a number of hospitals were approached in order to take this unit. All of them declined, for various reasons, and the situation was exacerbated because the charitable trust, the Cogent Trust, which was involved moved the equipment unilaterally to Bristol.
The findings of the court were that the regional health authority acted in breach of obligations to consult the community health council. But there was no evidence before the court to justify the conclusion that the regional health authority acted irrationally in letting the unit close without making arrangements for it to transfer elsewhere.

§ Lord Molloy
My Lords, in her recent reply to my noble friend, the Minister said that she understood that approaches had been made. Who made those approaches?

§ Baroness Cumberlege
My Lords, the regional health authority told the district health authority to explore sites for the service. It negotiated with the Hammersmith Hospital, the Great Ormond Street Hospital for Sick Children and Guy's Hospital, but it failed to make the necessary arrangements.

§ Lord Swinfen
My Lords, may I ask my noble friend whether there is a danger that, by moving a medical team of great expertise from one place to another, that team may be broken up through its members being unable to move, due to family and other commitments? Therefore their expertise is lost.

§ Baroness Cumberlege
My Lords, both the regional and the district health authorities tried very hard to move this particular team. There were two consultants involved; both are now at the Chelsea and Westminster Hospital haematology department. There was also a staff grade paediatrician, a registrar and a senior house officer. The registrar and the senior house officer are part of the paediatric rotation and they have moved to other posts. The paediatrician is now in an academic post in the medical school.

§ Lord Williams of Mostyn
My Lords, will the Minister bear in mind that she said that it was "admitted" that there was no consultation? Will she attend to the question put by the noble Lord, Lord Howell, as to whether any apology was ever forthcoming? Or is this yet another example of overweening arrogance, not on the part of the Minister but on the part of those immediately responsible? Will the noble Baroness further inform the House as to how many patients are currently waiting for bone marrow operations in the London area? Will she further invite the Secretary of State, even if the Secretary of State will not listen to Members of this House, to read some of the editorials about this and related topics in the Evening Standard, a newspaper which on this occasion speaks for a large number of people in London?

§ Baroness Cumberlege
My Lords, I refute the allegation that anybody was arrogant in this case. The 1199 regional health authority and the district health authority tried hard to transfer this unit to another hospital, but failed for various reasons, some of which it would be inappropriate to go into this afternoon. I do not have the figures for bone marrow transplants at the moment. The case which has received a lot of publicity recently is the Rhys Daniels case. I am sure that noble Lords will be very pleased to know that this little boy is to be treated at Bristol in this coming month, I believe very shortly. With regard to the Evening Standard, it is a newspaper which I believe all of us find compulsive reading.

§ Lord Mackay of Ardbrecknish
My Lords, is my noble friend aware that there is adequate evidence from this country and around the world that, in highly specialised medical procedures such as this one, there is a critical mass in the number of operations that a team ought to carry out if they are to have good outcomes so far as the patients are concerned? Does she agree that that is the principal argument for concentrating these rare procedures in centres where that critical mass can be obtained, rather than scattering them around the country?

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right. That was the motivation behind this particular move.

§ Lord Young of Dartington
My Lords, in view of the judgment of the court, is the Minister prepared to undertake to advise health authorities of the importance in future of consulting community health councils whenever there is any question of a closure or major variation in the provision made?

§ Baroness Cumberlege
Yes, my Lords. I believe that district health authorities and trusts are well aware of the obligation on them to consult community health councils, and health authorities intended to do that. But once they had the results of that review, which showed that the unit had a 50 per cent. success rate, there was concern. The proposal then to move the unit was too late, because by that time the new hospital had been built and the services transferred.

§ Lord Peyton of Yeovil
My Lords, does my noble friend agree that the suggestions which appeared to come just now from the Front Bench opposite that her right honourable friend does not listen to representations made from this House are wholly unjustifiable and very wide of the mark?

§ Baroness Cumberlege
My Lords, I thank my noble friend for that comment. Indeed, the court stated that the Secretary of State, who had overall responsibility in this matter, had dealt with it properly and delegated it to the regional health authority and the district health authority.