Thursday, 26 September 2013

The debate - Northern Ireland Assembly - 7th May 2013

Paediatric Cardiac Surgery

Mr Principal Deputy Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for the debate.  The proposer will have 10 minutes to propose the motion and 10 minutes to make a winding-up speech.  All other Members who wish to speak will have five minutes.
Mr Swann: I beg to move
That this Assembly notes the publication of the preferred option document by the paediatric congenital cardiac services working group and the related Children's Heartbeat Trust report; calls on the Minister of Health, Social Services and Public Safety to reject the recommendation of a Dublin-only service for the future commissioning of regional paediatric cardiac surgery and interventional cardiology; and to select a model which retains primary provision and the ability to operate on emergency admissions in Belfast.


I start today by thanking the Business Committee for allowing today's debate to be changed.  As stated in the draft Order Paper, the debate was to have been on the significant drop in farm incomes.  Although that is an important issue, the Ulster Unionist Party replaced that motion with today's one on the future of paediatric cardiac surgery in Belfast, following the Health and Social Care Board's recommendation to the Minister that Northern Ireland lose that capability and everything move to Dublin.
It is with regret that I have to move the motion.
It is regrettable that the recommendation to remove paediatric cardiac surgery was even considered, never mind recommended.  I hope that the Minister makes it down to the Chamber before I finish my speech.
As I have done previously in the House, I declare an interest as the father of a three-month-old son awaiting cardiac surgery.  I thank Members and staff of the Assembly who continue to ask how Evan is.  I thank them for their stories and support, including Members who have lost a son or a daughter and the usher who has been where I am now.  It is on such occasions that this place transcends party or tribal politics and becomes what it should be: a place that can make a difference to people's lives.  We can become what we should be: politicians who do not just want to make a difference to people's lives but actually do make a difference.
I pay tribute to and thank every member of staff of the children's hospital, without whom Evan would not be with us today: the consultants, the surgeons, the doctors,  the anaesthetists, the nurses, the PICU team and the auxiliaries.  The removal of paediatric cardiac surgery would mean a deskilling of many of these professional groups.  Evan went through what I am glad to say was a successful bowel operation on Thursday.  If the PICU team or the anaesthetist had not had the necessary experience to operate on a child with a cardiac condition, we do not know whether that surgery could have been performed in Belfast, even though it was non-cardiac.
The Minister has received a recommendation from the Health and Social Care Board that would end paediatric cardiac surgery in Belfast, with everything moving to Dublin.  Through the motion, I want to ensure that the Minister knows the feeling of every Member before he makes that final decision, which is his alone.  I call on him to reject the recommendation of the board, accept the concerns listed in the minority report of the Children's Heartbeat Trust and retain paediatric cardiac surgery in Belfast, working in collaboration with Our Lady's Children's Hospital in Dublin, an option also noted in the document on the identification of a preferred option, which I read as meaning that the Minister can make a difference here by doing what is right for Northern Ireland.
Mrs Dobson: I thank the Member for giving way.  Does he agree that all Members should, as we have, visit the mummies and daddies huddled around the cots of their infants at the Royal Belfast Hospital for Sick Children?  If they did so, I do not think that they would be so quick to support moving the service out of Northern Ireland.
Mr Swann: I thank the Member for her intervention.  I also thank the Minister for taking the time last week to come to Clark clinic to visit the parents, children and clinicians there.
Evan William-Robert Swann was born on 8 February at 10.32 am.  He was born with a congenital heart defect — one single wee soul who has already been through more than any parent would want their child to go through.  He is just that: one soul.  He is a son, a brother, a grandson, a nephew, a cousin and a great-grandson.  So you can understand the frustration, anger and hurt when commissioners and John Compton use flippant lines such as "It is a numbers game" and "This affects only a small number of children across Northern Ireland".  Liam Clifford has had two operations and one catheterisation.  Lexie Callender has had two operations.  Odhran Gallagher has had four operations and three catheterisations.  Charlie McCombe has had four operations and one balloon septostomy.  Riley Ann Moss has had four operations.  Shay Smith has had two operations and two catheterisations, one planned and one emergency.  Caiden Dalzell has had two operations.  Katie O'Neill has had two operations.  Nadine McGaffin has had two operations and three catheterisations.  None of their parents sees them only as a number, and there are many, many more.
I labour the point on numbers because they are the sole premise on which the recommendation that Belfast has to close is based.   Belfast does not reach the magic number of 450 surgeries that is dictated by the Safe and Sustainable review.  These standards have not been endorsed by professional organisations such as the Royal College of Surgeons, the Paediatric Intensive Care Society and the British Congenital Cardiac Association.  Minister, in your response, will you please clarify once and for all where that number came from?  I have heard that it came from the recommendation of experts.  How did they come up with that figure?  Who were the initial experts?  Only 15% of hospitals worldwide with paediatric cardiac services perform that number of surgeries, so are the other 85% unsafe?  Have you received evidence that, if that number is not achieved, children will die at surgeons' hands, or do you accept that Belfast is safe?  Today, you should say to the House, as you have done before, that paediatric cardiac surgery in Belfast is safe and dispel the myth.
The board has accepted the Safe and Sustainable numbers for Belfast, and so the recommendation is to close it.  Will the Minister inform the House whether he has had any conversation with his Scottish counterpart, who told the Safe and Sustainable review what it could do with its figures?  Does he know why the Safe and Sustainable review recommended that it was OK for University Hospital Southampton and a hospital in Newcastle upon Tyne to stay open, both of which do fewer than 250 operations?  Minister, if numbers are crucial, why are groups of children being sent elsewhere for surgery that they could safely receive in Belfast? 
Independent external experts who recently reviewed the service concluded in all cases that there was not an undue safety issue.  Despite that, the restrictions on the operations being performed in Belfast has not been removed.  So, it is seen as part of a process of attrition aimed at running down the service to a point of no return, possibly the numbers game that was referred to earlier. 
What a piece of propaganda the preferred options document put forward by the Health and Social Care Board is.  Even its name shows that it is a document that has the sole raison d'être of removing children's heart surgery from Northern Ireland.  This is not a preferred option.  It is not the preferred option of the parents.  It is not the preferred option of the trust.  It is not the preferred option of the children.  And it is not the preferred option of the vast majority of medical experts.  Indeed, in the response to the public consultation, those currently practising in paediatrics, neonatology, paediatric cardiology and other fields stated that their preferred option was to retain provision in Belfast as part of an all-island network.  A central point of having such a network is to ensure that emergency interventions, such as those that take place in Belfast, should continue.  Removing those to Dublin will increase the likelihood of the death of a critically ill child.  Those are the words of Dr Connor Mulholland FRCP FESC.
We were fortunate.  We knew from a prenatal 22-week scan that Evan had a congenital heart defect and a number of other complications.  From speaking to the families I have encountered who have children with a congenital heart defect, I still maintain that we were fortunate.  We knew and were able to plan.  The prenatal and neonatal provisions of any Dublin-only option needs detailed review before the Minister accepts it.  Evan was the example.  He was due to be born on 18 February, and his delivery was planned for 11 February when all the professionals were in place.  However, there is a wee thran thing in him, and he was born on 8 February at 10.32, 10 days early.  All the professionals were on hand because he was born in Belfast. 
I have studied the planned care pathway for Dublin-only, and it is full of potholes, to say the least.  Mothers could be moved a week before delivery, but that would not have worked for us.  I have heard recently of one hour 30 minutes from Belfast to Dublin being achieved.  That is fantastic, but is it repeatable?  Was it the fact that it was done at 10.00 pm on a Sunday with clear roads and everybody at hand?  There was no congestion, and no waiting for the availability of surgeons or PICU beds.
“The safety of children and adults in Northern Ireland relies on continued congenital heart surgery at the Royal Victoria Hospital. I pledge to ensure that this world-class service continues and that children here can avail of the best surgical services in Belfast, Dublin and across centres in Britain. I will vote against any move to remove this surgery from Belfast”
Those are not just my words; they are the words of the Children's Heartbeat Trust pledge, which, to date, has been signed by 87 MLAs, including Ministers.  That pledge is entwined in and substantive to the motion before us today.  It is not up to me to remind other MLAs of their conscience or their individual pledges when they speak and eventually vote on the motion. 
From my opening remarks, there are many more questions that still have to be answered.  I believe that, until the Minister can answer all these questions to his satisfaction that the decision that he makes will not cause the loss of a single soul, he cannot accept the recommendation of the Health and Social Care Board to end paediatric cardiac surgery and interventional cardiology for the entire population of Northern Ireland and our children by removing it from Belfast.

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