§ 2.0 a.m.
§ Mr. John Sutcliffe (Middlesbrough, West)I have received a number of letters in the past year from constituents waiting for first out-patient appointments or hospital beds, and I am concerned at delay occurring within the National Health Service.
For example, my constituent, a Mrs. Brown, has had to wait three months 1687 for an out-patient appointment from the date of referral by her general practitioner for a psychiatric consultation. A Mr. Aithwaite, who was off work and in severe pain as a result of an accident to his back, was told originally that he must wait four months for an out-patient appointment. Fortunately, extra outpatient sessions have since been arranged, and his wait has been reduced to two months, but back trouble is a growing phenomenon, and delays of two months or more lead to a waste of resources through loss of employment. I must stress that the two cases I have cited are not exceptional, but typical.
My hon. Friend confirmed, in answer to my queries recently, that there was a waiting period of three months for routine psychiatric out-patient appointments at the North Tees General Hospital, a two to three months' wait for orthopaedic outpatients at the Stockton and Thornaby Hospital, and a waiting period of up to four months to see E.N.T. consultants at the North Riding Infirmary. Doctors in Teesside confirm the long delays experienced by their patients in these and other specialties such as physical medicine. They point out to me that, as a result, their relationship with their patients is suffering. This must be so when hospital authorities tell patients that, had their general practitioners considered their cases to be urgent, they could have been attended to earlier.
The length of time that patients have to wait for hospital beds seems to be even longer in some specialties. A Mrs. Scott, in Teesside, who suffers from mitralstenosis and is virtually bedridden, has been waiting for the past 15 months for an operation. I understand that her only hope of getting quick surgery is referral to London, where there is no waiting list.
Another constituent, a Mr. March, has a 19-month-old son who has been waiting for an operation on his deformed foot for seven months. During all this time the child has been unable to put on footwear of any kind and has, in consequence, been prevented from leading a normal life for a boy of his age. Only this morning I received a letter from another constituent complaining that she has been told that her small son must wait for about a year for orthoptic treatment.
1688 My immediate reaction was to assume that delays in Teesside are much worse than elsewhere. It is generally acknowledged that mortality and morbidity are higher in heavily industrialised areas, and that the standards and facilities of medical treatment which general practitioners are able to provide are lower. Both those factors might be expected to lead to longer delays. Neither my hon. Friend's Department nor the regional hospital boards possess anything like adequate statistics, but such evidence as there is suggests that waiting periods are far too long, not just in the Newcastle Hospital Board Region, but throughout the country.
There is evidence published in a study of hospital out-patients in the sixties by Messrs. Forsyth and Logan, entitled "Gateway or Dividing Line", based on a sample of 13,600 new out-patients in England and Wales, which shows that, taking all specialties together, more than 20 per cent., including urgent cases, had to wait more than four weeks for their first appointment, while a small number had a wait of four months or more. The survey confirmed long delays for 36 per cent. of routine orthopaedic cases and 25 per cent. in E.N.T. In the case of hospital beds, the information about waiting was collected by the Ministry of Health for the hospital in-patients inquiry in 1967. It confirmed appallingly long average delays throughout the country in certain specialities—in E.N.T., ophthalmology and pediatrics, between three and five months.
The averages did not reveal, however, the exceptional delays endured by a few—like the 119 people in the Newcastle region who waited a year or more for general surgery. That was four years ago. The very general information which I now have is for the last 12 months. In the area covered by the Newcastle Board, as well as the Cumberland area, 3,000 people were waiting 12 months or more to get into hospital and 6,000 waiting anything from four to 12 months. Such figures merely confirm how widespread delays within the National Health Service are one of the worst aspects of the Service.
What are the root causes of this problem and what can be done about it? First and foremost, the National Health 1689 Service suffers from a general lack of resources, including a shortage of consultants, a shortage probably not helped by the staffing policy of past Governments. But the inefficient use of available resources is also partly to blame.
One aspect of this is maldistribution between regions. There are variations in the numbers of consultants and beds per 1,000 population, both between specialities and generally—variations in no way related to regional differences in morbidity or social conditions. For example, the delay experienced by E.N.T. out-patients in Teesside may well be due to the fact that the Newcastle region has fewer consultants for this speciality than all other regions except East Anglia, Oxford and Liverpool, each of which has a far smaller population. It also seems likely that throughout the country delays are occurring as a result of unnecessary attendances at out-patient departments and prolonged hospital stays.
A hospital-dominated National Health Service and the gap between the hospital service and general practice are also probably two contributing factors. Why has not more been done to remedy the situation? Governments have made efforts, but these efforts have been of little avail. In 1964, for instance, a circular was issued laying down a norm of two weeks waiting in all specialities for out-patient appointments. Subsequent investigation by hospital authorities, not surprisingly, showed that it had evoked little response. It is to be hoped that the reorganisation of the National Health Service will strengthen central control and that the Department's current investigation into the problem of waiting lists generally will help to establish what is wrong.
But the problem is urgent and action is needed now. For a start, the Minister could see that hospital management committees compile detailed and accurate statistics on delays and that these are made available to regional hospital boards. The Minister would then be able to know how the situation varied throughout the country. Without such statistics, there can be no question of establishing and enforcing norms. While the investigation into the reasons for the delay is proceeding, I ask my hon. Friend to put further pressure on hospital management committees to make every effort to 1690 reduce delays by, for example, more efficient management of their waiting lists for elective surgery.
Governments have known about these delays. They have tolerated them until public patience is now stretched to the limit. I quote from a letter written to me three months ago by a general practitioner in my constituency. Referring to the delays he says:
My feelings on the matter range somewhere between frustration and cynicism with the efforts of the Department of Health and we can only hope that your continued agitation of this department will produce some results for the benefit of the patients as a whole. I feel that the patients have a genuine grievance about the inconvenience that they are caused and the Minister's rather complacent attitude will do little to dispel this.This illustrates the fact that so long as nothing effective is done, doctors endure frustration and patients endure unnecessary suffering.
§ 2.11 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)I am obliged to my hon. Friend for giving the House, even at this late hour and following a contentious debate about a very different subject, an opportunity to consider a subject which is certainly of constituency interest but is of wider application and interest as well. I am bound, therefore, to deal with this subject very largely in the context of South Teesside but I will obviously stray into a wider context.
To the extent that some patients with non-urgent conditions have to wait longer for hospital attention than we would wish, the hospital service provided in South Teesside is of a less high standard than my Department, the regional hospital board and the South Teesside Hospital Management Committee would like to see.
The hospital authorities are, however, taking energetic measures to remedy the situation and their plans include the provision of two new district general hospitals in Teesside. The general picture is one of a steady improvement in both the quality and quantity of service given. The policy of the South Teesside Hospital Management Committee and the Newcastle Regional Hospital Board since the inception of the National Health Service has been to make the Teesside area as 1691 self-sufficient as possible so far as hospital facilities are concerned. To this end they have introduced a number of new specialties and considerably strengthened others, so much so that Teesside needs to rely less and less upon other hospital centres, for example, Newcastle and has now almost achieved the self-sufficiency which has been the aim of the authority concerned.
In addition to the increase in in-patient hospital facilities there has been a progressive improvement and expansion of out-patient facilities and a corresponding development of pathology and X-ray diagnostic facilities.
As my hon. Friend may be aware, my Department is carrying out a study of the problem of waiting lists and earlier this year obtained a national sample of waiting lists in selected specialties known to be under heavy pressure. Comparison of the South Teesside figures with the national picture shows that patients there are in no worse position than those in the rest of the country and indeed in certain respects fare better. The group's average waiting time in some specialties is less than the national average.
This does not mean that we are content with the situation. I would rebut any charge of complacency in this context. But the problem has to be tackled, as my hon. Friend appreciates, in the context of a national appraisal. In South Teesside the position has improved as a result of the measures already taken. A year ago the general waiting list overall was nearly 4,000 and it currently stands at a little less than 3,400. This improvement has been achieved in spite of the fact that the demand for in-patient care continues to rise. Discharges in 1970 were 42,185 compared with 32,103 at the beginning of the decade. The average length of stay has also been reduced from 16 days to 13 days. My hon. Friend will agree that against this increase in the scope and work done by hospitals, to have achieved in the last year a quite appreciable reduction in the waiting list is no mean achievement.
Urgent cases, as my hon. Friend confirmed, are always admitted without delay and in addition a bed bureau exists for the Teesside area as a whole which 1692 arranges admissions promptly at the request of general practitioners.
In some specialties the waiting time for non-urgent outpatient appointments exceeds one month. Over the past year the position has improved in the general surgery, orthopaedic and gynaecological departments but still gives rise for concern in E.N.T. and ophthalmology. I take my hon. Friend's concern particularly in respect of E.N.T. The hospital management committee is actively studying the situation with a view to making further improvements to those it has already achieved.
Since the end of June this year, the number of new out-patients seen at existing clinics has been increased, the number of new patients seen each week having increased from 70 to 97. It has to be borne in mind that in E.N.T. and ophthalmology there is a gradual broadening of the spectrum of medical conditions treated and a corresponding expansion of diagnostic facilities such as audiometry which inevitably extend the consultation period for patients seen as outpatients.
My hon. Friend has referred to the question of medical staffing. Of course I accept that there are shortages of doctors in a number of hospital specialities, and that these shortages are sometimes the cause of waiting lists being much longer than they should be. The numbers of hospital doctors increase every year, but patients' needs also continue to increase.
Before dealing with medical staffing in this region in more detail I want to say something about the arrangements for regulating hospitals' complements of medical staff. These are, in the first place, primarily a matter for hospital authorities. Regional boards can on their own authority create new posts in junior training grades, and also part-time posts for doctors whose main work is in other fields such as general practice, but they need my Department's approval for new posts of consultant or medical assistant, or for the training grades of senior registrar and registrar. Boards of governors of teaching hospitals need my Department's approval for the creation of new medical posts in any grade. In each case, however, it is for the board to propose the additional posts which they consider are necessary and can be provided having 1693 regard to the financial and other resources available.
In considering whether to approve consultant and medical assistant posts, the Department is advised by a special advisory committee consisting of representatives of the medical profession and medical staff of the Department. There are also professional advisory committees—one for each main speciality—on senior registrar posts. The purpose of these controls is to improve the geographical distribution of hospital staffing and also the balance between the numbers of career posts and the numbers of doctors in training to fill them. New arrangements which we are about to set up, jointly with the profession, are intended to increase progress towards these aims while reducing the need for central control of individual posts.
The great majority of proposals for new consultant posts which come to my Department are approved. We want to see a very considerable increase in the rate of expansion of the consultant grade, and boards have been asked to help in achieving this. However, it is found necessary sometimes to reject or defer boards' proposals. This occurs mainly in shortage specialities in which there are not enough doctors becoming fully trained each year to replace losses and also to fill all the posts which boards wish to create. The specialities concerned include anaesthetics, radiology, geriatrics, paediatrics and some sub-specialities of psychiatry and pathology. In these specialities we have to try to identify the most urgent needs and, in particular, we have to try to ensure that those parts of the country which have more difficulty than others in attracting medical staff should have reasonable prospects of filling their posts. This means we must not approve too many posts in the regions which readily attract doctors because this tends to have the effect of drawing away any potential applicants for posts in other regions.
In general the regional pattern of hospital staffing is that there are more doctors per million population in Southeastern England than elsewhere and staffing in northern England generally is relatively low, but the Newcastle hospital region is much better served in this respect than other northern regions. In the region as a whole there are 176 1694 consultants per million population; this compares with a national average for England and Wales of 165, and makes Newcastle the best staffed region apart from the metropolitan regions. There are variations between one specialty and another, which reflect partly the different priorities given to different specialties. The Newcastle Regional Hospital Board, for example, has attached great importance to staffing in anaesthetics and the staffing ratio in this specialty—almost 25 per million population—is the highest of any region.
The fact that the region is relatively well staffed has not, however, impeded growth. Of 21 proposals for new consultant posts put forward by the regional hospital board in the past 12 months, 16 have been approved and the remaining five are under consideration. Of 14 medical assistant posts proposed, only five have been approved, but here it must be borne in mind that a general moratorium on the creation of new whole-time posts in this grade was agreed three years ago, because of fears in the medical profession that the grade was being used improperly, in effect, as a lower-paid substitute for the consultant grade. Since then, new whole-time posts are agreed only where there is special justification.
Of 15 posts in the senior registrar and registrar grades, it has been possible to approve 10, even though there are certain constraints on the growth of the training grades arising from the need to secure that the numbers of doctors given highly specialised training in each specialty are kept properly related to the number of career posts expected to be available in the specialty. If too many are trained, those who cannot get consultant posts tend, alas to emigrate. With these constraints in mind, I think that the figures show that my Department has by no means been restrictive in considering proposals from the Newcastle Regional Hospital Board.
As I mentioned earlier, one of the problems facing the hospital authorities was not so much a shortage of beds but their distribution among 17 different hospitals. The remedy to this situation lies in building new hospitals. In this respect, as no doubt my hon. Friend is aware, the board has planned new district general hospitals in Stockton and Middlesbrough.
1695 The main phase of the new Stockton hospital is due to be completed in 1974, at a cost of over £3.5 million, at which point over 740 beds will have been provided, together with a new accident and emergency department, a new out-patient department, geriatric day centre and other supporting services. These are the completions envisaged for 1974.
Planning of a new hospital at Middlesbrough is well advanced, and building is expected to start before the mid-1970s. This hospital will be the first step in a plan to concentrate general hospital services in the South Teesside area in two new hospitals.
I hope that I have said enough to convince my hon. Friend and his constituents that neither the Hospital Management Committee, the Board nor my Department are complacent in their attitude to the present level of hospital services in Teesside. The hospital service is admittedly under pressure there, just as it is in many other parts of the country, 1696 but, as I have tried to show, many improvements, some minor and some of major importance, have been and will be made with the object of enabling more patients to be treated more quickly without loss of efficacy and humanity.
I shall carefully read all that my hon. Friend has said tonight about his problems, and I shall note, in particular, the personal cases to which he referred. If, prima facie, any seem to give rise to immediate cause for concern, I shall write to him about them and take them up.
I hope that, in the light of the figures and the broad perspective which I have presented, my hon. Friend will accept that, although we readily agree that everything is far from perfect, we are definitely making progress in his region and progress which is comparable with that being made in other parts of the country.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-four minutes past Two o'clock a.m.