§ 2.45 p.m.
§ Mr. Robert Kilroy-Silk (Ormskirk)Like many thousands of parents, I am extremely disturbed by the queues and the waiting time for children with congenital heart disorders. My own inquiries suggest that although there are acute difficulties in certain areas this may well be a problem of national proportions.
The figures for children with congenital heart disorders who are awaiting investigatory or surgical operations are very difficult to ascertain. There are no centrally collected statistics on queues or waiting times for this type of surgery. However, my investigations suggest that this could be a rather alarming problem.
In Liverpool, for example, the Royal Liverpool Children's Hospital serves a population of between 4 million and 5 million in the North-West. At the moment, 170 children are waiting for an investigatory operation, and they wait for a period of up to two years. A further 100 children in Liverpool wait for surgical operations, and they wait for a period of up to a year. In other words, for these very serious and urgent operations, children in the North-West may have to wait for a total period of up to three years.
I am told that in Birmingham, 190 children are waiting for investigatory 699 operations, and they, too, can wait for a period of between three and 24 months.
In Manchester, 28 children are waiting for investigatory operations, and they will wait for up to six months. A further 50 wait for surgical operations, and they will wait for a period of between 15 and 18 months.
In Bristol 180 children are waiting for cardiac catheterisation, which seems rather strange. They may have to wait for seven years, and children are constantly pushed back on the waiting lists as others are added.
At Hammersmith, 50 children are waiting for cardiac catheterisation, and they wait between three and 12 months. A further 27 wait between one and six months for surgical operations.
All this in spite of the fact that many children are not on waiting lists, because of problems of definition. A pediatric case may be put into an adult ward. Many other children are not on waiting lists for the simple reason that surgeons know that they will never be reached and, so as to alleviate or prevent anxiety to parents, they do not even enter children's names on the lists.
As I say, I have been unable to obtain figures from the Ministry, despite asking two Parliamentary Questions. If my figures are wrong—I hope that they are—the Minister may be able to say what the true figures are.
What I seek first of all is an inquiry into the situation in Liverpool, which seems to be the most acute area. In Liverpool I include Manchester, from which Liverpool draws a large number of its patients. Second, I ask for a national inquiry to estimate the depth and scale of the problem, so that effective action may be taken.
We need the full facts in order to be able to formulate a national plan to establish the correct number of units in terms of size and equipment appropriate to the population of the country. We also need to know the number of children born each year with congenital heart disorders. It is estimated to be about 5,000 a year. Some people may say that there are many other children and adults on hospital waiting lists and that there is a whole series of different specialties.
700 What is so different about this category is the consequence of having to be put on a waiting list for such a long time. These children clearly need urgent surgery, because they are more prone than others to chest and other infections.
The testimony of Professor John Hay, of the Child Health Department of Liverpool University, consultant paediatrician to the Royal Liverpool Children's Hospital, on television, quoted in the Lancashire Evening Post on 1st April, was that occasionally patients have died whilst on the waiting list. If that is true, it is scandalous. If not, it is for the Department to show it to be unfounded. I think that the Minister will agree that Professor Hay has a very distinguished career and is of high repute in his profession. On his testimony, occasionally patients on the waiting list have died for no other reason than the lack of adequate resources. I want the Minister to tell us whether that is true, and, if it is, what he proposes to do about it. I understand that even the Great Ormond Street Children's Hospital has a mortality rate on its waiting list.
Those children who do not die whilst waiting for investigation or surgical operations suffer—or may suffer—permanent injury. Irreversible changes can take place in vital organs, which will affect their lives as young adults and often turn them into people who suffer from a permanent disability. For example, children who suffer from what is colloquially called a "hole in the heart" often get an increase of pressure in their lungs. If surgery is delayed, heart failure can take place when they are young adults, even though the operation, performed on them as children, has apparently been successful. The longer they wait the more likely they are to be affected as children, to suffer permanent disability, and to die as young adults even after an apparently successful operation.
The Mayo Clinic in the United States has clearly shown that the longer the operation is postponed the more likelihood there is that the pressure in the lungs will remain or will rise and result in a shorter and less full life for the individual concerned.
The longer the operation is delayed the more dangerous it becomes. It causes inevitable anxiety and distress to the 701 parents of these children, as the correspondence that I have received in the last three weeks clearly demonstrates. Parents undergo a tremendous amount of psychological agony watching their children suffering, in many cases for no other reason than that the necessary resources are not available. It is not that the operation is not possible, not that techniques have not been developed, but that, for one reason or another, this area of the National Health Service has been given insufficient priority and has not been allocated the appropriate resources.
I understand that in the Liverpool region parents are often told that an investigatory operation is urgent, yet they still see their children on the waiting list six to nine months later. Surgeons in clinics are constantly apologising to parents for the failure to provide surgery on the dates promised.
I should like to go through some specific cases where this kind of thing has happened, and the consequences for some individuals in Liverpool.
One mother who took her child to the Royal Liverpool Children's Hospital before Christmas last year was told that the child would have to wait two years for surgery in Liverpool. She approached the Mayo Clinic in the United States, was offered an appointment on 1st February, and the child was operated upon on 8th February. The child is now back in England after a successful operation costing about 8,000 dollars. Putting it mildly, it seems a very poor reflection upon our National Health Service that parents, if they are wealthy enough to afford it, should be forced to pay for treatment abroad, where it can be undertaken much quicker than in this country.
Another case was brought to my attention by my hon. Friend the Member for Chorley (Mr. Rodgers). Amanda Lawrence, of Chorley, is six years old and has attended the Royal Liverpool Children's Hospital since the age of one. She waited until the end of 1972 for an investigatory operation which resulted in an acknowledgement that she had a hole in the heart and a serious valve disorder. Her parents were then told that there would be a surgical operation within nine months. In December 1973 the parents were told that it would be February or March this year. She is still waiting.
702 Another case, reported in the Lancashire Evening Post on Tuesday of this week, concerns Helen Watson of Leyland, who is 18 months old. She has a hole in the heart and desperately needs an operation if she is to lead a full and active life, yet she has been waiting since September for a two-day series of tests to locate the hole. Her parents were told that the tests would take place in six weeks. In January they were told that it would be another six weeks. They are still waiting. Mr. and Mrs. Watson still do not know the date of the tests, let alone the date of the operation.
I could quote many other cases which demonstrate the distress of parents and children in this area, These are Liverpool cases. I could refer to others from different parts of the country.
I now wish to refer to services in the city of Liverpool. I suggest that to maintain the existing number of beds over the next few years more funds need to be allocated to Liverpool. The board of governors of the Royal Liverpool Children's Hospital has already made a temporary, once-for-all donation. We now need additional funds from the Department to ensure that the facilities can be made available.
I ask for special funds on the basis of those given to Great Ormond Street several years ago. That money was given to finance a pilot scheme, but it enabled Great Ormond Street to have a throughput of 600 hole-in-the-heart operations a year. The same could be done in Liverpool. In Liverpool there is a clear demand for more nurses. The Royal Liverpool Children's Hospital reviewed its nursing needs in 1970, and still the recommendations await implementation. The hospital is still not up to the required intensive-care standards.
Again, there is no time either at Liverpool or Birmingham to reinvestigate after surgery to see whether the pressure in the lungs is still there, or rising. We ought to know that. It is impossible to devote resources to a follow-up investigation because the resources available are in any case inadequate for those already on the waiting list. There is a need for more facilites, so that tests can be made on what appear to be successful operations.
We should determine a national strategy. We need the full facts in order 703 to establish a national plan, to establish the correct number of units in terms of size appropriate to the population and to get the most efficient use of services in this field, as in anything else.
That would seem to indicate that the units would have to be large to make the optimum use of the facilities required for this kind of surgery. Great Ormond Street Hospital is probably the only one that is making the optimum use of its resources.
I suggest that the Minister should consider a reassessment of the present policy. There is a limited number of cardiac units of adequate size. There should be an amalgamation of the smaller units, and the Government should resist the tendency for small units to proliferate to try to cope with the overload on the big cardiac centres. What is needed is not a proliferation of new hospitals but an injection of resources and cash into the big units that are already performing a valuable function. More resources should be pumped into the big cardiac centres. There is a need to build upon the centres that are well established, and it would be extremely unwise to start new ones.
Liverpool has a throughput of two or three operations per week. The figure should be at least four or five, and it is because Liverpool is not doing that number that it is wasting expensive resources in terms of machinery that becomes obsolete within 10 years. Just as with any production line or any factory, those resources and that capital investment are expensive, and should be used on a full-time basis if optimum use is to be made of them. Moreover, there is a need for more nurses, and an agreed training scheme for paediatric cardiac surgeons, which is not available at present.
I should like the Minister to accept that this is an area of top priority. Even if action is taken now it will take a long time to clear the waiting list. In the jargon of the prices and incomes policy, these children have a special case. Their case is the right to live a normal life, and it is a right that we cannot and should not deny them.
I end as I began by asking the Minister to set up an inquiry, first, to consider the services in Liverpool and, secondly, to discover the depth and scale of the problem 704 nationally. We want from my hon. Friend a commitment that he will treat the problems of children with congenital heart disorders as a special case, and that he will provide far more Government funds and earmark them for this very necessary and urgent surgery.
§ 3.3 p.m.
§ Mr. Ian Percival (Southport)As every minute from which I speak comes out of the limited time left to the Minister, whom, I am sure, we all want to hear, I shall be brief. We all feel deeply, both for these children and their parents. I want to stress the need for co-operation. Our feelings are not in doubt.
I am glad that some parents have formed an association to keep us informed about these matters, and I am proud that the first chairman of the Liverpool members of the association lives in my constituency. They brought one specific fact to the attention of some of us, and that matter has been dealt with. I hope that they will go on bringing these facts to the attention of those of us in that area, and that branches of the association in other areas will bring the facts to the attention of their Members, because only if we have all the information can we ever hope to do a useful job in this field.
Of course, we all work in our different ways, but we have one objective—to combine to improve the situation. We do that best by addressing our minds to the bottlenecks at any moment. I understand from Professor Hay that the bottleneck at the moment is the shortage of trained nurses. The payment of those nurses, if they were available, has been overcome for three years. But we must not rest on that. We must look three years ahead to make sure that the finances will still be available when the endowment funds are no longer there to pay for them.
The practical bottleneck is the shortage of trained nurses, and this can be dealt with only by the Department and the profession. All of us who are urging them to deal with it must recognise that they want to deal with it and provide the necessary quality. We should all be looking ahead—so far as possible in an unemotive way—at the realities of the situation and the practical requirements. I hope that we shall all be able to get information from this association and 705 from other sources and pool it so that, together, we may play some part in bringing about the improvement which all of us so dearly want.
§ 3.6 p.m.
§ The Under-Secretary of State for Health (Dr. David Owen)I think that the House will congratulate my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk). He drew attention to this problem in his maiden speech and he has pursued it since. It is a very important and in some parts urgent issue which deserves our attention. I can assure my hon. Friend that it concerns me deeply.
Over 4,000 children are born each year with some form of congenital cardiac defect. Tragically, about a third die within the first few hours of life; the remaining two-thirds need treatment, often an operation. We are therefore discussing a subject of the utmost importance to several thousands of parents, who will not forgive any of us—Government, health service officials or doctors—if their children get anything but the most effective and prompt treatment possible. Inevitably and understandably this is an emotive subject, but it is one we must try to approach in as clear headed and rational a way as possible.
My hon. Friend has spoken of lengthy waiting lists—and indeed some of the waiting lists are lengthy. I am advised that at present the waiting list for investigation at the Royal Liverpool Children's Hospital is 185, while the waiting list for surgery is 84. I am advised that 14 children have been waiting for investigation, and six for surgery, since before January 1973—that is, over 15 months. This is an extremely worrying situation.
But do these bare statistics represent the true position? They may overstate the problem. Some of these children on a hospital waiting list are waiting for treatment at the earliest possible moment, and we must see that they receive it. Others are on the list because at some future time, when they are older, bigger or stronger, they will need an operation which would be inadvisable now. In other words they do not represent a current demand for treatment, but must wait for sound medical reasons. Yet others may be on lists because their con- 706 sultants have not decided definitely on an operation, and it is a way of keeping in touch with them—they are called in for a periodic check-up and may never need treatment. Again, they do not represent a current demand for treatment. This is why we must consider the waiting list problem seriously.
I cannot tell the House at present exactly how many of the children on the lists at the Royal Liverpol Children's Hospital really need investigation or treatment now, and whether the chance of successful treatment will diminish the longer they wait. The same is true of the waiting lists at all the other hospitals my hon. Friend has mentioned. I intend, however, to find this out urgently. We do not need a numbers survey, as my hon. Friend has asked, so much as an analysis in depth of the existing waiting lists to see what categories of children are on them. I have already asked officials in my Department to undertake an urgent review of the Liverpool waiting lists. I expect to know—before the end of this month—how many children are in need of treatment and whose chances of successful treatment will diminish if that treatment is delayed. This is the vital figure I need before making any decisions for the future. I also intend to look at the problem nationwide.
Resources will always be limited in the National Health Service. I was glad that my hon. Friend stressed, in his maiden speech on the Budget and again today, the need to concentrate resources in a few major centres. In Liverpool, Professor Hay, to whose dedicated service I should like to pay tribute, has expressed his concern about the waiting lists for several years. A great deal has been done. The board of governors has been considering this problem with some urgency and agreed to develop the staffing of the Royal Liverpool Children's Hospital in an effort to improve the output of work in paediatric cardiology.
In June 1973, the United Liverpool Hospital approached my Department for £25,000 a year for five years towards a scheme of expansion of the paediatric cardiology service, at an estimated cost of £47,000 a year; the remaining £22,000 was to be found by the board of governors. This was to take account of the work from outside the region falling 707 on the hospital. This money was to remedy deficiencies in
nursing staff, technicians, operating theatre time and consultant sessions".This request was turned down in June 1973 by the Department. This decision was made by a previous Government.It appears that one of the main reasons for that decision was that a new paediatric cardiology facility was to be completed at Wythenshawe Hospital in the Manchester region. Since 25 per cent. of the Liverpool patients come from the Manchester region, it was expected that when these facilities were in full use, pressure on the Liverpool Children's Hospital would ease. Indeed, on 4th December my predecessor as Under-Secretary at the Department, the hon. Member for Barkston Ash (Mr. Alison) answered a Question from my hon. Friend the Member for St. Helens (Mr. Spriggs), saying that new facilities recently completed in Manchester would reduce the load on the Liverpool unit since many patients come from the Manchester area.
Yet I am now told, as part of my inquiry following my hon. Friend's speech, that the new facilities at Wythenshawe intended for use in paediatric cardiology are not being used for that purpose. I am advised that 30 beds, which were to be made available for this use, and the appointment of an additional cardiologist, which had been approved by my Department, have not been used. I have asked for an immediate investigation why this surprising situation has occurred, and I intend to review the whole investment strategy for dealing with paediatric cardiology. We need a few centres of excellence ensuring that any child needing surgery urgently can receive it.
The Board of Governors at the Royal Liverpool Children's Hospital has done its best. I have no criticism of what it has done. It has used its endowment fund. If the facilities which it has now provided are still needed after the money allocated from the endowment fund has been exhausted, the extra cost for the new Area Health Authority (Teaching) will be met by my Department. This charge, which is being met from the endowment fund now, should not be a continuing charge on the endowment fund.
708 Reference was made to the question of children dying on the waiting list. I am advised that this has not happened in the case of the Liverpool Children's Hospital since 1971. But a word of caution in interpreting the matter. People do die while on waiting lists. This is not always due to the fact that urgent surgery is required. Some of these children are very sick and ill children. But I am not complacent about this. Paediatric cardiology is certainly not the only speciality where there are anxieties over waiting lists and where people feel that there are insufficient resources.
The House has the right to know the new Government's general attitude to these problems. We cannot achieve miracles, but a great deal can be done by using existing facilities to the full, and planning sensibly. It is not always a question of more money—though this is a great help. A lot can and must be done within existing resources.
On waiting lists generally, I am determined to introduce a nationwide programme substantially to reduce waiting lists, which in many important areas are indefensibly long. The Press, particularly the Sun, has rightly attached a great deal of importance to this area. I am grateful to the Press. But it is not a problem only in acute life-saving areas. There are long lists for other conditions, such as inguinal hernia, where men are unable to work or have to be moved to different jobs for more than a year, and gynaecological operations, where women are below par. We rightly attach great importance to the acute life-saving side of medicine, but there is also another side. These are complex issues. It would be dishonest of me to try to pretend that we can achieve immediate success.
Waiting lists are one of the indicators of lack of facilities. We shall use these indicators to help determine the allocation of future resources. We intend to develop these indicators to identify areas which are relatively deprived of adequate health services. We shall then give them priority and switch resources into them. This will take time, but my target is to be in a position to start using these indicators when we begin allocating capital and revenue funds for the next financial year. I am looking urgently not only at acute paediatric cardiology, but at other areas.
709 I can only hope that by using rigorous methods we can switch resources to where they are most needed and redress the imbalance in health service provision that is so apparent today. At a time of financial stringency we shall all have to accept the need for greater selectivity in the use of skilled personnel—one of the scarcest of all our resources. The hon. and learned Gentleman was right to draw attention to that. We also have to face the consequences of the 20 per cent. cut-back in financial investment that was imposed in December 1973 by the previous Government. We are deeply concerned about these issues. I am determined that in Liverpool and in the country as a whole families with children suffering from cardiac complaints will get a service which will put the minds of the anxious parents at rest.
We should not be too selective in considering this area. There are many areas which need more resources. My hon. Friend has drawn attention to a vitally important area. I promise to keep him informed of the facts that we discover in Liverpool and nationwide.