HEALTH SERVICES, LEICESTER (Hansard, 14 December 1971)

§ Mr. John Farr (Harborough)

I am grateful for the opportunity of raising tonight the question of waiting time in Leicester and Leicestershire for a consultation under the National Health Service. I hope that the concern which I shall express in my few words will result in some improvement for my constituents in the service which they now have in Leicester and district.

I remind my hon. Friend the Under-Secretary that on 30th November I asked him why a wait of three months was necessary in Leicester before someone could have a consultation under the National Health Service. He replied that whilst he conceded that a wait of 12 419 weeks or even longer might be necessary in certain circumstances, he stressed that the delay was caused by a shortage of facilities due to be remedied." —[OFFICIAL REPORT, 30th November, 1971; Vol. 827, c. 232.] I further remind my hon. Friend of the case of Mrs. M., about whom I have written to him. This lady, a constituent of mine, was forced to have a private consultation because of her worry, and I here come to the first point that I wish to make to my hon. Friend. In his reply to me at Question Time on 30th November my hon. Friend said that urgent cases always received immediate attention. One could assume from that reply that Mrs. M., who had to wait three months, was regarded as a non-urgent case.

Mrs. M. was not prepared to wait that long, because her complaint was very painful, and she was worried about exactly what was the cause of it, so she managed to obtain enough money to have an immediate consultation privately, which cost her £7.50. At that consultation her condition was found to be so serious that she was admitted to the list for a priority National Health Service operation on a date well before the date offered to her for a consultation under the National Health Service. Indeed, if she had not had that private consultation, she would not have been seen under the National Health Service until the date after which the operation actually took place.

I am sure that my hon. Friend in his reply on 30th November gave his answer in good faith, but I ask him to re-check his system of vetting when a case is serious and when it is not, because it seems to me that there should be no chance of a priority case being delayed in any way for a Health Service consultation. This is the gist of the answer he gave, and yet it can be seen clearly from the case I have quoted that the lady in question needed a priority consultation and that her condition necessitated a priority National Health Service operation. Yet she had not been so classified. It therefore appears to me that as she had particularly unpleasant lumps which might well have been cancerous, in her case as in all such cases a priority consultation under the National Health Service should have been arranged at once.

420 I would not have raised this question of the long wait for consultation in Leicester for just one case, but from time to time I have had lengthy correspondence with my hon. Friend on the long wait for N.H.S. operations and in addition to this case other cases have been brought to my attention by constituents. One of them again serves to illustrate my reason for concern at the service my constituents receive at the moment. It concerns a Mrs. H., whose husband applied for a consultation in July 1971, and was given the date of 25th October —a wait of nearly four months. Her husband was then put on the waiting list for an N.H.S. operation and told that he might have to wait for up to two years for it. Mrs. H. herself applied for an appointment to see an orthopaedic consultant on 7th October last and was given an N.H.S. consultation date in the distant future-31st January, 1972, a wait of more than four months for a consultation on a condition which was very painful.

My hon. Friend told me on 30th November that things would be better soon. I am sure that he does not accept that 12 weeks is a reasonable time to wail. I would be glad of his assurance on this point. I am certain that lie does not feel that just because one goes to the N.H.S. one should be expected to wait in a queue for three or four months before a consultation. If any hon. Friend has the figure, I would be grateful if he could give it to me as I would like to know how the wait of three or four months in Leicester and district compares with waiting times for N.H.S. consultations in the rest of the country and how it compares with what he regards as a reasonable time to wait.

I believe that a wait of three or four months for an N.H.S. consultation and of two to three years for an N.H.S. operation, as still applies to many of my constituents, is a wholly unreasonable state of affairs, and I think that a service which risks giving its patients this sort of treatment can be classed only as second rate.

The fear amongst many of my constituents can be summed up in a letter from yet another person who has written to me. This lady, to whom I will refer as Mrs. R., writes that she recently discovered a lump in her breast and immediately visited her 421 doctor, who arranged for her to see a surgeon privately. She states: He suggested it would be a long wait for a National Health appointment, though I was not denied the choice. I visited the surgeon and was told I needed an operation as quickly as possible—and I quote: 'There should not be any lumps in a woman's breast, for it could mean cancer.' Again it was emphasised it would be a long wait under the National Health scheme and so he booked me in a hospital privately within three weeks of visiting him. I did have a blood test and X-ray on the National Health arranged for me by the surgeon who realised the great expense involved. He also made arrangements for me to enter the hospital at 8 a.m. in the morning and I had a very skilful operation at 9 a.m. I was allowed home the following day as it was far too expensive to stay, but I was more or less immobile and still in some pain, and really needing hospitalisation for a whole week. I went back to the hospital one week later to have the stitches removed. I was lucky—I had a non-malignant cyst removed—and did not have cancer, otherwise I would have had to have had my breast off with further investigation surgery. I cannot imagine how much that would have cost. I feel I must impress upon you that I was so terribly worried at the time this lump was discovered, and I was convinced I had cancer, that I had not the fight in me to find out all about the National Health scheme. I was only too glad to have this operation completed as early as possible. It is a vary worrying time for a mother thinking perhaps she has not many years to live! Cancer is a terrible thing to worry about. I was not told I could not have this operation under the National Health Service, but all along the line the theme was that things must be dealt with immediately and there is always a long wait under the National Health scheme. I apologise for reading from that letter at some length but it is a very significant letter and sums up rather poignantly the case I seek to make. Quite simply, the letter illustrates how in many parts of my constituency, in Leicester and in the county the National Health Service is regarded. It is regarded in a very poor light, with a long wait for overcrowded facilities which are to be used only if one has to use them. To some people its public image is the same as that of British Railways after the war.

I believe in the National Health Service and I know that my hon. Friend does. I hope that he will give an assurance tonight which will convince me that we as a party in Government mean to make the Health Service work and provide a service to the nation of which we can all be proud. Will my hon. Friend give a date when the service will be 422 better in Leicester, and will he say how much better?

§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

I am glad that my hon. Friend the Member for Harborough (Mr. Farr) has provided the opportunity for me to deal rather more fully than was possible during Question Time on 30th November with the matter of the time which some patients have to wait for an out-patient consultation in hospitals in Leicester. In the few words I shall be able to say in reply I shall cover the case of Mrs. M., about whom we both have details. I shall leave that until later and fill in the general picture first.

Regarding Mrs. H. and Mrs. R., I ask my hon. Friend kindly to let me have more particulars about them. I would not with to make ex cathedra statements without a little more background information.

I accept that the hospital services in some parts of the Sheffield region are under pressure and that much remains to be done in the way of new provision and increased resources in order to enable the region to cope with the growing demand made on its hospital services. It is also clear that in Leicester particularly hospital provision must be increased both to cater for service needs and to meet the teaching requirements of the new medical school which it has been decided to open in Leicester. Since the city is the natural centre for much of the surrounding county, these needs must be met largely by hospitals in the city centre.

Patients with urgent conditions are always given a consultation without delay. I stress this to my hon. Friend because it bears particularly, I think, on the case of Mrs. H., the last lady he mentioned. I stress again that patients with urgent conditions are always given a consultation without delay, and non-urgent cases can always have their appointment dates brought forward if their general practitioner considers that their condition has in any way deteriorated during their wait for a consultation. The most protracted waiting times for non-urgent cases are in the specialities of general surgery, ophthalmic surgery and orthopaedic surgery. At Leicester Royal Infirmary the waiting 423 time could be 12 weeks or more. At Leicester General Hospital the waiting time for an appointment in general surgery could be up to 16 weeks. But the position in other specialties is much better. For example, in E.N.T., neurology, paediatrics and plastic surgery the waiting time is four weeks and in urology it is six weeks. The waiting time for virtually all other specialties is two weeks or less.

The Sheffield Regional Hospital Board acknowledges that levels of medical staffing are lower than average in Leicester and it is, of course, planning to remedy these deficiencies but this cannot be done in isolation from the planning of other hospital developments in which, as I will show, Leicester plays a prominent part.

As an interim measure by way of improvements, work is proceeding on a scheme of short-term improvements at the Leicester Royal Infirmary to provide additional accommodation in the outpatient department there. Some of the improved accommodation is already in use and the remaining work is expected to be completed in the New Year. The board has managed to make a number of additional senior medical staff appointments in the Leicester area this year and plans more for next year.

As I have indicated, however, increases in consultant staff must be matched by increases in hospital facilities which need to be considered in the context of the board's general plan for the Leicester area. For example, new operating theatres need supporting beds, pathology and X-ray facilities, and so on. They all hang together. I have earlier made it clear that during this time of acute pressure general practitioners may ask for priority if the condition of patients worsens while waiting, so that they can become urgent in the technical sense of that term.

Longer-term improvements to hospital services in Leicester, about which my hon. Friend inquired, both physical, by which I mean building, and financial in terms of improved allocations of funds are necessary to achieve a permanent solution to the problem of waiting time and they loom large in the development planning for the area. As my hon. Friend knows, Leicester is a natural 424 centre for the area with a road net-work radiating to the peripheral centres of population in the county. With the exception of the Hinkley-Lutterworth area there is little opportunity for patients to seek alternative hospital services to those provided in Leicester itself.

In recent years the demand for hospital services has increased in common with the rest of the country but, due to an inherited shortage of beds and resources in the Sheffield region generally, it has been difficult up till now—unless it had been done at the expense of more needy areas in the region—to make good the backlog whilst at the same time planning to meet increasing needs.

The situation in Leicester is not helped by the distribution of beds. Although in the county population catchment area as a whole the total number of acute beds is generally in line with national norms, a high proportion of the beds is in the periphery and many are allocated to general practitioners. The problem in Leicester has also been heightened, as I am sure my hon. Friend is only too well aware, by the influx of workers attracted by the prosperous light industries in the area.

It should not be thought from what I have said that there have been no developments in Leicester. In fact nearly £6 million has been spent in capital developments since 1948. This has included new X-ray, accident, emergency and maternity departments, extension of the pathology department, a group pharmacy and a new maternity unit at the Leicester Royal Infirmary and a new operating theatre suite, new out-patient department and new pathology department at the Leicester General Hospital.

Work is in progress amounting to £1–3 million to provide 120 geriatric beds and other improved facilities at the Leicester General Hospital. Work will start in 1973–74 on phase II of the new redevelopment of Leicester Royal Infirmary including 431 beds, 12 operating theatres, four diagnostic X-ray rooms, a new outpatient department and an accident and emergency centre. At Leicester General Hospital a further 120 geriatric beds are to be provided by 1973 in furtherance of our aim to improve services for those who need to stay longer in hospital. The 425 capital cost of these planned developments amounts to over £8 million.

The establishment of the new medical school in Leicester, while presenting the board with major problems in planning the disposition of resources, will help to increase the hospital services earlier than would otherwise have been the case. For example, the board is planning interim improvements at the Leicester General Hospital, including an extension to the out-patient department—this has a special bearing on consultations—for use by teaching staff expected to be appointed by 1973–74.

The main hospital concentration for the whole of the Leicester catchment area will need to be in and around Leicester and the service needs will be met initially by the Leicester Royal Infirmary, which will also become the major teaching hospital, and the Leicester General Hospital. Plans are also being considered for a further district general hospital to achieve a better concentration of hospital resources in Leicestershire as a whole.

As to provision of finance, we recognise that the Sheffield region as a whole has a below-average share of the total moneys available for recurrent expenditure on hospital services. This is being put right progressively over a period of 10 years under revised revenue distribution arrangements introduced last year which will enable all regions to achieve equality of revenue provisions for hospital services without disrupting the services of those regions which are at present better off. As a direct consequence of these arrangements, the allocation per head of population in the Sheffield region has already been increased from 82 per cent. of the average of all regions in 1969–70 to over 85 per cent. of the average in the 1972–73 allocations recently notified.

But these comparisons between regions' relative financial resources and populations do not tell the whole story. Additional revenue support can help only up to a point; beyond that point a situation of need arising from inadequate hospital facilities—in the sense that demand exceeds the physical capacity of the existing hospitals—can be corrected only by the provision of additional capacity under the hospital capital development programme.

426 From what I have said, my hon. Friend will appreciate that the needs of Leicester have certainly not gone unheeded. The shape of financial investment in Leicester to come is quite striking. Much progress has been made to remedy the inherited deficiencies of the area in the face of sharply rising demand. The situation will not, I am sorry to say, be wholly redressed until the major development schemes now in progress have matured. Since major building is involved, there is no way of accelerating this progress, but it is definitely in the pipeline.

My hon. Friend has said something about Mrs. M. This patient was given an appointment at the Leicester Royal Infirmary on 6th August following an approach by her general practitioner in May—a waiting time of three months. She was also offered an appointment at Leicester General Hospital, but this was cancelled by telephone. I understand that following a private consultation in June she was admitted seven weeks later to Leicester General Hospital on 27th July as a National Health Service patient, and she had an operation which had a satisfactory outcome.

When referring the case, Mrs. M.'s general practitioner did not indicate a need for priority treatment. The consultant who saw her privately on 7th June apparently agreed that there was no urgency but in view of Mrs. M.'s anxiety placed her on his list for admission in the category "soon but not urgent". In fact Mrs. M.—and this can be judged by the length of time which elapsed between her private consultation and subsequent admission, nearly two months—was not either, in the view of her general practitioner or the consultant, an urgent case. Had she been such in the view of either, not only would a National Health Service consultation have been available earlier but an immediate admission would have been available.

My hon. Friend has referred to the case of two other ladies, one of whom had a lump on the breast. It is difficult for me, from the evidence he has been able to place before the House tonight, to judge whether this was an urgent case. From what he has said there seems to be no indication from the consultant concerned that he would have placed this in the category of an urgent case. If he 427 had done so, there is no doubt but that she could have had an immediate Health Service admission. If my hon. Friend would be kind enough to let me have details of the cases referred to I will consider whether they give rise to the need for any further advice or for any exchanges with the regional board.

428 In the round I readily admit that the waiting time for some specialities in Leicester is excessive, but the capital provision the Board is now making will in time make substantial improvements.