§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Fitch.]
§ 4.2 p.m.
§ Mr. R. F. H. Dobson (Bristol, North-East)
I first raised the question of the waiting list at Frenchay Hospital, Bristol, in November, 1966. The Minister said in reply to my Question on 20th February, 1967, that the waiting list was not abnormally large, except for plastic surgery. The position which I later established was as follows a total of 4,636 people were waiting for 518 beds. It raises another question about the number of beds in the hospital because the south-western area hospital book gives the total number of beds as 544.
I wonder whether the Parliamentry Secretary will tell me if there has been a reduction in the number of beds at the hospital, and, if so, the reason for that reduction. The main problem about the waiting list appears to lie in two areas. There is, first, plastic surgery, which had a waiting list of 2,938 as at 31st December last year, and there is the gynaecological service, which had a waiting list of 785 at the same date.
The figures are interesting in themselves, apart from their size, because they show that the plastic surgery list has doubled in a matter of five years. In 1962, there were only 1,696 people on the list. In 1962, in the gynaecological service, there were 162 people on the list. The gynaecology surgery list has been doubling each year for that period.
The plastic surgery position is well understood. I realise that Frenchay Hospital takes in work not only from the whole of the south-west region, but from other regions as well. A high degree of specialty is involved. I wonder whether the waiting list figure which I have given is still correct, or whether there has been a reduction. I notice from later Answers that 106 beds have been used in this specialty and that three operating theatres are now being used. But what surprised me was to find that only three part-time consultants were being used at the hospital. Why are there no full-time consultants in this specialty, bearing in mind that there are almost 3,000 people 2005 on the waiting list? Is there not a case at this stage for increasing the number of part-time consultants at the hospital?
People have been waiting for a very long time for plastic surgery. I have before me a letter from a lady whose son has been waiting seven years for plastic surgery at this hospital. At my request, I got her to confirm the situation. She writes in her letter:I saw my son this weekend and have his permission for you to use his case in your inquiry and have also checked with Frenchay Hospital. It will be seven years next month."—that is, January, 1967—I have checked again since writing to you".Not only is there a large number of people on the list, but people have been waiting for a very long time to get on the list.
I understand from an Answer which the Minister gave on 30th January this year that the South-Western Regional Hospital Board is considering what steps can be taken to provide additional beds and operating facilities for plastic surgery either at Frenchay, or elsewhere in the region. Has the Board completed its study? When will the list show signs of being reduced? Is it intended to provide additional beds at Frenchay for this work? Are more operating theatres to be supplied there over and above the three in operation?
May I give two reasons for thinking that the work should remain at Frenchay Hospital, despite the large waiting list. First, centralisation in this type of speciality is very good. Secondly, surely there must be difficulty in finding a suitable hospital elsewhere which can cope with the sort of figures involved. If we open up plastic surgery elsewhere in the region, the numbers on the waiting list might be reduced by shifting people on to other lists, but that does not necessarily mean that people will be dealt with much more quickly.
I have support for my view. I took the trouble to get some advice from a consultant gynaecologist who knows the hospital. He writes:Thank you for your letter. I think that you are perfectly right in being against dispersal. The right answer is, as you say, to improve facilities at Frenchay, as this is the only means by which some quick and substantial alleviation of the plastic surgery position can be achieved. It will be necessary to spend something like £75,000 to £100,000 in the 2006 next year or 18 months, but at least it would mean that it would stop the list being doubled in the next period of a year.Therefore, I ask the Minister to accept that there is an urgent need to deal with a list of this size. I hope that he will note the points I am making and try to improve the situation.
Plastic surgery has a different connotation of urgency in medical matters, because while some cases must be urgent there will be others which can be left for some time without dereliction to patients, but I would not regard this as applying to the other area of the list to which I want to draw attention—gynaecological cases. There is a large number of people—more than 700—waiting for gynaecological surgery.
Here, I would think, the problem is substantial, because I do not believe that a woman who applies for treatment should be told to come back in 18 months or two years' time for the operation. This kind of treatment not only upsets people, but makes them feel inferior, worries them and is possibly sometimes medically dangerous.
I know that some people are allocated to beds quickly if there is urgency, but I suggest that there are occasions when people who go to their doctor with a gynaecological complaint have to wait for some time on the list whilst their condition deteriorates from a medical point of view. In the long run, this could be fairly serious.
The position of the gynaecological work at Frenchay Hospital breaks down like this: for the 750 people who are waiting, there are 24 beds and two operating theatres, which are shared with two other specialties, 53 beds being used for general surgery and 22 for ear, nose and throat surgery. Worse still, there are only two part-time consultants for the whole range of this work.
In this specialty, why are there no full-time consultants and why are there not more part-time consultants to deal with this work? While, on the plastic side, there may be difficulty in getting highly experienced people quickly, there should not be quite the same difficulty with gynaecological surgeons and consultants. Is this because of budget restrictions on the part of the Ministry? 2007 It is interesting to note that an article in the Bristol Evening Post of 31st January this year had the headline:Frenchay problem lack of cash.I said that in an interview with the paper. The secretary of Frenchay Hospital, Mr. Ralph Clark, has also said it. He added:More beds, more theatre time and associated facilities, including staff, are required at this hospital.Mr. Harold White, secretary of the South-Western Regional Hospital Board, also agreed that there was need for more money to be spent. He said:The public will have to realise that more of the national income will have to be spent on these hospital services if these queues are to be cut down.Some people realise this very well.
Mrs. Teagle, one of my constituents, who has allowed me to use her name, has been waiting two years to enter the hospital for gynaecological treatment. She raised with me—and I had the opportunity to question my right hon. Friend the Minister about this—the important point that when told that she would have to wait two years, on indicating how worried she was, she was offered private bed treatment, although not at Frenchay Hospital, I hasten to say. She was antagonised by the fact that if she had several hundred pounds she could get private treatment elsewhere whereas she would have to wait for two years or more if she could not afford to pay. She could not afford it.
I have another case of a lady, who understandably declines to allow me to give her name, who says that she has been waiting for three years and suffers great pain. I suggested that she should see her doctor again, but she is still waiting.
I should like, in conclusion, to ask my hon. Friend the Parliamentary Secretary one or two general questions. Is it possible for him to agree to increase the financial allotment for capital works of the South-Western Regional Hospital Board to enable the Board to undertake further schemes at Frenchay? Is it possible for him to discuss with the Board the need to build more operating theatres there, the need for new buildings in that area; to increase the number of beds, if possible; 2008 to increase the number of operating theatres; to look at the whole question of consultants and an increase of other staff in the hospital accordingly?
If my hon. Friend can do all these things, I am sure that he will agree with me that this would give a real chance for the waiting list at Frenchay Hospital to be reduced, and that the public would be more satisfied, and the hospital staff, too, and also the regional board and the management committee would feel much happier and less worried about the situation I have laid before the House this afternoon.
§ 4.16 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)
May I, first, thank my hon. Friend the Member for Bristol, North-East (Mr. Dobson) for the responsible and moderate way in which he has raised this subject of the waiting list at Frenchay Hospital this afternoon? We at the Ministry are very well aware of the interest which he has taken in this matter. I think I shall be answering certain of his questions as I proceed.
I would say right away that if he would like to communicate with me, with the permission of the lady concerned, the details about her having been told to wait two years, when she was in pain, I will look into the matter right away and communicate with him.
§ Mr. Dobson
I hesitate to interrupt my hon. Friend, but she did communicate with the Ministry direct, but I will certainly get in touch with my hon. Friend.
§ Mr. Snow
Without knowing the lady's indentity, it is a little difficult to identify the case, but we will look into it.
The position at Frenchay Hospital, for various historical reasons, is not satisfactory. That is readily agreed. It is the case that the waiting list at the hospital has grown from 3,216 on 30th September, 1964, to 4,636 at the end of 1966. This is a gross figure, covering all specialties. If we exclude plastic surgery and gynaecology, there has been a decline over the same period from 987 to 913—a modest decline, but a decline, nevertheless.
Broken down still further, the number of waiting patients in each specialty other than the two mentioned is not excessive, 2009 bearing in mind the need for a proper balance between the obvious wish of patient to have immediate treatment and the full and effective use of available beds. We must aim to achieve this balance if the finite resources of the hospital service are to be used to the best advantage of the community as a whole.
I am the first to admit that the waiting list for plastic surgery and gynaecology are a good deal larger than we would wish to see. Between September, 1964, and September, 1966, the list for plastic surgery increased by 1,189 to 2,937. By March this year it had declined slightly to 2,870, and one must hope that this is the beginning of a steady reduction reflecting the improved facilities made available in 1965, when, as my hon. Friend will remember, the plastic surgery theatres were closed for major improvements and beds were closed for upgrading. The absolute size of the list reflects, however, the fact that the unit has to serve not only Bristol but the region as a whole.
Turning to gynaecology, the waiting list for this specialty increased from 589 at the end of 1965 to 785 at the end of 1966, despite a commendable increase in the volume of gynaecological work undertaken at Frenchay. There are, however, other units in the vicinity with gynaecological facilities to which general practitioners can refer their patients if they wish. Unfortunately that is not the case with plastic surgery.
In considering the size of both lists, regard must be paid to the condition awaiting treatment as well as the actual numbers of patients concerned. First and foremost, all patients needing urgent treatment receive it at once, which is why I was slightly bothered by the case which my hon. Friend mentioned. Those who are waiting are not suffering from conditions requiring urgent treatment, though this is not to underestimate the inconvenience, and sometimes discomfort, of delay in some instances. In the plastic surgery list, there are also a considerable number of patients—about 600, or over a fifth of the total list—awaiting either serial operations or operations which cannot normally be performed until a child has reached a certain age. Though included in the figures, these patients are not on the waiting list in the sense in 2010 which we are using the word for the purpose of this debate. Of the gynaecological list, over half of the patients are awaiting minor surgery. The gross figures give a somewhat distorted impression of the situation, but again I say that the situation is not satisfactory.
Now to look at the steps which the Board is proposing to take to remedy the situation. In the first place, it is only proper to stress again that the Board, in making decisions, can only do so within the context of the total amount of money available to it. It must therefore weigh the needs of one area against the other and one specialty against another.
I take my hon. Friend's point when he asked whether there could be a greater financial allocation to the region because of this situation. I should not like to mislead him. This problem is not peculiar to Bristol. We have a great backlog of reconstruction and modernisation work to do and the problem of financing all this is a continuing matter for the consideration of my right hon. Friend.
In 1963, a special sub-committee was set up in Bristol consisting of representatives of the regional hospital board and the board of governors to review the hospital services in the Bristol area. It reached the conclusion that the total number of acute beds—which include plastic surgery and gynaecology—would be unlikely to need significant expansion before 1975. There would, however, be an increasing need during this period in the first place for maternity, geriatric and special baby care and acute psychiatric beds.
In the light of its general assessment, the proposal was that in addition to the three major units at Southmead, Frenchay and the teaching hospital, a completely new hospital in South Bristol would be required after 1970. Meanwhile, in its plans for the years following 1963, priority would be given to maternity, geriatrics and special care baby units.
The 1963 sub-committee has, however, been reconvened to consider the needs of the area against the latest population trends. When the result of this review is available, the Board will consider whether developments can be expedited 2011 at Frenchay and, indeed, are already examining plans for extra ward accommodation there.
Thus, although the regional hospital board cannot undertake major developments in the Bristol area for some years —even if money permitted, it would not be possible for entirely practical reasons to bring forward by a substantial period the building of the proposed new hospital —interim measures to improve facilities at Frenchay, taking into account the need, in particular, for plastic surgery, are already under review.
The position about sending plastic cases elsewhere has been examined. So far as we can judge at the present moment, on examination, this does not appear to be a practical proposition. I agree with my hon. Friend that there is, from the purely technical point of view, a great deal to be said for concentrating and centralising this sort of treatment.
Looking at the wider needs of the region, the new hospital at Derriford, Plymouth, to be started in 1970 will have 50 beds for plastic surgery in the first phase. This will in time help to release the pressure on Frenchay and will be more convenient geographically for those living in the west of the region. Because it is not possible to contemplate early major building works directed solely to relieving waiting lists of plastic surgery and gynaecology. I should not like my hon. Friend to think that the hospital boards in Bristol have been lagging behind in new developments. Substantial building programmes are taking place or are planned. These have consisted, for the teaching hospital, of a new out-patient department for the Royal Hospital for Sick Children, now complete, a new accident and outpatient department under construction, a new radiotherapy centre to he started this year, and a new maternity unit to be started in 1969–70: for Southmead, new operating theatres, a new blood transfusion centre, and a special baby care unit; and, for Frenchay, new thoracic theatres.
All these developments will have an indirect effect on releasing pressure elsewhere. and thus allowing for improved use of existing accommodation for the specialties not directly catered for in the 2012 new buildings. This, 1 hope, gives my hon. Friend a better conspectus of the present and future development of the relevant hospital services in the Bristol region.
It is not simply a question of bricks and mortar. Staff is also important. I understand that the Board is considering urgently how the staffing of the plastic surgery unit might be improved. This will undoubtedly help.
I take my hon. Friend's point about consultant staff. We have serious problems there of recruitment and financing, but the matter is under urgent review and in due course I will communicate with my hon. Friend when conclusions have been drawn.
Finally, there has been a suggestion that gynaecological patients, in particular, can secure faster treatment if they choose to have it privately. My hon. Friend will recall that my right hon. Friend the Minister of Health, in replying to a Question on 5th December, 1966, said that he was not aware that consultants were suggesting to patients that they would receive quicker treatment if they would pay for a private bed. No evidence has come to light since then that this practice has taken place.
As my hon. Friend may know, the number of pay beds, of which at the moment there are 11 at Frenchay, is under review, and we should know shortly if any reduction is justified. How pay beds are distributed among the specialties is a matter for the regional board to decide. I should ask that if my hon. Friend has any evidence about earlier treatment being secured through payment, and he will let me have it, I shall be very pleased to consider it. I fully sympathise with my hon. Friend, because in my own constituency from time to time one gets these allegations and it is not always easy to obtain any sort of reasonable evidence. Thus, I quite understand that people, in their anxiety, throw off these accusations, and it is not easy to nail them.
I would sum up by saying: yes, the waiting lists for plastic surgery and for gynaecology at Frenchay Hospital are too long. The regional hospital board are well aware of this, and are taking steps, both in the short term to secure improvements, and in the long term to 2013 provide a satisfactory solution to the problem.
The people of Bristol are indebted to my hon. Friend for bringing forward this matter, and I hope that he will now feel, having regard to the facts as we know them to be, and in the light of 2014 certain undertakings which I have given, that the problem, although a serious one, has been properly aired.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Four o'clock.