§ 12.5 a.m.
§ Mr. Ian Gow (Eastbourne)
There is widespread and growing concern in all parts of the country, and, I would think, in all parts of the House, about the efficiency, the resources and the manpower of the National Health Service. This concern is, I know, shared by the Government, as it is by patients, actual and prospective, as well as by doctors, surgeons, nurses and hospital staff.
Tonight I shall raise the specific issues of the delays which occur for my constituents in obtaining treatment under the National Health Service. In the course of my remarks I shall refer to particular cases known to me, because I am sure we need to remember that the National Health Service, our hospitals and the medical profession are dealing all the time with human beings, with the relief of personal suffering and the cure of illness and disease, which, despite the advance of modern science and of the medical skill which we now have, are still the cause of immense human suffering and anxiety. A health service without humanity or without an urgent concern for its own improvement is a contradiction in terms.
Before I turn to the specific matters to which I want to draw the Minister's attention, I should like to make clear what the debate is not about. It is certainly not about any criticism of surgeons, doctors, medical staff or nurses in my constituency. On the contrary they are doing their best, and more than their best, in circumstances which are becoming daily more difficult.
There are four matters which I wish to raise with the Minister tonight. The first relates to radiology. I wrote to the Secretary of State on 10th September last year, drawing her attention to the delay in obtaining an X-ray in Eastbourne in non-urgent cases. On 12th September last I sent to the right hon. Lady a copy of a letter addressed to me by the consultant radiologist at St. Mary's Hospital, Eastbourne, in which he said:I understand that the particular problem with which you have been acquainted is that of a barium meal, stomach and duodenum, requested by a general practitioner. We are now doing these X-rays on patients 1232 who have been waiting about nine months, which is clearly a most unsatisfactory and largely meaningless situation. Unfortunately, we have had a few occasions when a patient has died before the X-ray appointment time, and it is often impossible to say whether the delay has or has not accelerated their deaths.There have now been serious delays for GP barium X-ray examinations for at least five years. There are now two NHS radiologists in Eastbourne, providing a total of 19 sessions per week, and with only four X-ray rooms available. This compares very unfavourably with the present establishment of three radiologists providing 29 sessions per week in the Hastings district, where they have the benefit of 10 X-ray rooms to serve a population almost identical in size, type and distribution to that served by the Eastbourne hospitals. Even the X-ray department now being built in the new Eastbourne District General Hospital will only have eight rooms ultimately available for the next generation.He goes on to say:We have made repeated pleas over the years for an increased consultant radiologist establishment, but the pattern is too little and too late.That letter was written 10 months ago. There has been no improvement since then. The present average waiting time for patients referred by a GP for non-urgent X-ray is eight months in the case of a barium meal and in the case of a barium enema a delay of seven months.
The most recent records show that in the months of March and May and in the first 10 days of July 1975 no one—I repeat, no one—was removed from the GP waiting list for these two types of X-ray.
We need an additional consultant radiologist in Eastbourne. We need him now. We are due to have six additional consultant appointments in the new district general hospital—accident and emergency, anaesthetics, obstetrics, orthopaedics, urology and radiology. All appointments have been approved with the exception only of the radiology appointment. I hope the Minister can confirm that this appointment will be made and that we can have an additional radiologist in Eastbourne now, before the new hospital opens in March next year.
The second matter to which I refer is the delay in obtaining non-urgent—in the medical profession the term is "cold"—operations. I wish to mention two cases known to me.
1233 One of my constituents saw a consultant surgeon in Eastbourne in January 1973. The patient was then aged 72. The surgeon told him that he must have an operation because "You have a nasty hernia". That operation was performed two years and two months later, in March 1975. In another case the consultant surgeon advised on 31st August last year that an operation should be carried out on one of my constituents to remove stones from her kidney. That patient has been No. 1 on the priority last since 19th March this year, nearly four months ago, but the operation still has not been performed. The surgeon concerned has been too busy doing emergency operations and other urgent surgery to operate on this lady. He is working far beyond his contract commitment already. He is anxious to carry out this operation. The patient is in considerable pain. The chairman of the local BMA has confirmed that pain in a case of this kind—I use his words—"is often excruciating".
I have mentioned two cases only, but there are hundreds of similar cases that I could quote. We need additional surgical registrar assistance in Eastbourne. We need it now.
The latest figures show that for non-urgent surgery in Eastbourne one surgeon has a patient who has been waiting since January 1969, another has a patient who has been waiting since September 1971 and a third has a patient who has been waiting since July of last year. I refer in each case to the separate lists of individual surgeons. There are at present 450 people on the general surgery waiting list and 178 on the waiting list for neurological surgery.
The third matter which I want to raise tonight relates to the geriatric situation in my constituency. In Eastbourne we have as high a proportion of people over the age of 60 as anywhere else in the country. For some months past one of the wards in the geriatric hospital of All Saints, containing 24 beds, has been closed owing to a shortage of nursing staff. Although the waiting list for admissions to geriatric hospitals is not as serious today as it was, the establishment of geriatric beds is 80 below the figure recommended, taking into account the proportion of the population over the age of 60. This makes it all the more important that the ward to which I have referred should be 1234 reopened as quickly as possible. The reason why it is closed is, I repeat, a shortage of qualified nursing staff. I hope the Minister will be able to tell us that this shortage will be replaced.
Fourthly I want to raise the question of the new district general hospital in Eastbourne. In a parliamentary reply last year the Minister of State told me that that hospital would he in operation in March of next year. We know, however, that only phase one of the hospital will be completed and that phase two has been postponed indefinitely. Phase one involves 361 surgical beds only. Phase two involves 270 medical beds. If phase two of the hospital is not completed, the description "district general hospital" is a complete misnomer, because if only phase one is completed it will be a surgical hospital only.
Can the Minister give an assurance that there will be proper registrar assistance at the new district hospital? It is the view of those whom I have consulted in Eastbourne that an absolute minimum for registrar assistance at this hospital is five. I understand that a decision about the appointment of registrars to the new hospital is to be made later this month. For that reason alone this debate comes at a very opportune moment, because I hope that the Minister will pass on to those whose task it is to make a decision about the number of registrars that we really must have an absolute minimum of five. If we do not have that minimum there is a real danger that the consultant surgeons will find it impossible to carry out their task and it may not be possible for the hospital to open on time.
The Eastbourne constituency and the area which is served by the Eastbourne hospitals cover not only the town of Eastbourne but also Hailsham and Seaford. The population in that area served by the Eastbourne hospitals has risen from approximately 110,000 in 1961 to nearly 150,000 today. I repeat that almost one-third of that number are of retirement age. During the summer months the population of this part of Sussex increases dramatically, not only because of those who come and stay there but also by the arrival of those who come only for the day. This influx of visitors, almost doubling the population of Eastbourne, 1235 inevitably places on additional strain on the health services in my constituency.
It is for that reason, because of the serious population imbalance in my constituency, the very serious delays in non-urgent surgery, the delay in obtaining X-rays, and the sheer impossibility in many cases of holding out any prospect of orthopaedic surgery—for all these reasons—that I welcome the opportunity of this Adjournment debate tonight. I hope that the Minister will be able to give some reassurance to my constituents and to those who visit Eastbourne during the summer months.
§ 12.21 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
I am grateful to the hon. Member for Eastbourne (Mr. Gow) for raising this subject for debate. In his comparatively short time in the House he has demonstrated in an informed way his very real interest in the health services in his constituency. I shall do my best to reply to the general points he has so eloquently and forcefully made.
I am not aware that the hon. Gentleman has raised ministerially all the cases to which he referred in his speech. If he will let me have full details I shall, however, be prepared to look into any particular case that causes him concern. I must make the crucial point that the relative priority afforded to each case is bound to involve, in the first instance, the clinical judgment of individual consultants.
At the outset, I must stress that my Department is fully seized of the considerable inconvenience caused by delays in obtaining treatment under the National Health Service. We are in no way complacent about the problems to which waiting lists for treatment give rise. In discussing delays one must recognise, however, that they do not in general apply to the wide range of primary care services such as those provided by general practitioners. We must also remind ourselves that the majority of admissions to hospitals are either emergency cases where there is no waiting list or people from urgent waiting lists where any delay is relatively short.
As the hon. Gentleman will appreciate, the measurement of delays in obtaining 1236 treatment is a very complex matter. There is, first, the time spent waiting for an appointment to see a consultant and, secondly, the time spent waiting for an admission to hospital after being placed on a waiting list.
Measurement of the waiting time for a first appointment with a consultant is particularly difficult, mainly because this information is not uniformly or routinely available. I am told that the present average for most specialities in Eastbourne is about 14 to 15 weeks. Of course this average must regrettably cover some specialities where waiting times are longer. For example, in traumatic and orthopaedic surgery it is as long as 26 weeks, while in general surgery it ranges from four to 50 weeks.
In radiology, too, I have been told of waiting times which, although they do not affect urgent or emergency treatment, nevertheless lead to unfortunate delays in providing services such as barium meal tests for patients referred by general practitioners. There has been a call for an additional consultant radiologist for the Eastbourne District, which the hon. Gentleman strongly endorsed in his speech. The South East Thames Regional Health Authority assures me that it is acutely aware of this need and is hopeful that discussions and negotiations which are now taking place will provide a satisfactory solution in the very near future.
I understand that there has also been an application for an orthopaedic registrar. My Department is giving urgent consideration to this. One of my medical staff visited Eastbourne on 19th May to see local conditions at first hand. The difficulty is that, under the staff structure agreement with the joint consultants' committee, extra training posts should not be established in specialties such as orthopaedics where there are already more than sufficient in training. It is, however, recognised that the application for Eastbourne has merit and it is being kept under review in contact with the Central Manpower Committee.
The patient's initial appointment with a consultant may sometimes result in the case being cleared. For patients who have to be admitted to hospital we have more detailed information on the time they have to wait. The latest figures which are available on a national basis 1237 are those for 1972. They show that, in England and Wales as a whole, the average time spent on a list waiting for an operation was 14.1 weeks, while the average waiting time in the South-East Thames Regional Health Authority area was 11.8 weeks.
The most recently available figures for Eastbourne relate to May of this year. These show that patients admitted in surgical specialities had on average waited 8.38 weeks, although this figure includes 13 weeks for traumatic-orthopaedic surgery which is much closer to the national average which I quoted earlier.
§ Mr. Gow
Before the Minister leaves the question of orthopaedic surgery, may I quote from a letter sent to the Health Administrator by a leading consultant orthopaedic surgeon on 18th March. He wrote:We have fewer registrars in the South-East region than in any other region in the UK. Eastbourne has fewer registrars than any other district in the region and I believe that I have less registrar assistance than any other orthopaedic surgeon in the whole of the National Health Service.
§ Mr. Morris
I have noted the point made by the hon. Gentleman. He was documenting further what he said in his speech. I was referring to average figures.
An indirect measure of waiting time is also available from the number of patients on waiting lists. One must be careful in the use of that figure, however, because it can be affected by the practice among consultants of placing patients on lists only when they have an expectation of being seen within a reasonable time. Keeping this factor in mind, my examination of figures for Eastbourne shows that the number has increased from about 1,500 at the end of 1971 to just over 2,000 at the present time. This demonstrates why local doctors are bound to feel that the service they provide is under increasing pressure, although the figures I have quoted on waiting times show that none of the problems we are debating tonight is unique to Eastbourne.
The whole question of waiting times must be looked at in this wider context. Not to do so would be to imply unjusti- 1238 fied criticism of the doctors and staff who work in Eastbourne and to minimise the difficulties which they face. I realise, of course, that many coastal towns like Eastbourne have serious problems. The high proportion of elderly residents in the population is bound to put increased strains and demands on health services. I am also aware that the local authority social services department in the town is short of staff and I appreciate that this does not make life easier for those who are responsible for providing medical care. Especially for these reasons, I take this opportunity to pay tribute tonight to the valuable work which is being done by the staff of the health services in the district under very difficult circumstances.
The hon. Gentleman will accept that there is one respect in which Eastbourne is more fortunate than many other parts of the country. I refer to the new district general hospital which is being built at a cost of some £9¼ million. Construction of the first phase began in September 1971.
It is expected that the main part of the scheme will be completed shortly and will open early in 1976. This will provide 361 beds in general surgery, orthopaedics, gynaecology, maternity and opthalmology, ENT, urology, paediatrics and isolation and intensive therapy units. Other major features include operating theatres, an accident and emergency unit, an out-patients' department, radiology and various other supporting services.
This development should do much to improve the working conditions of staff and the service which they can provide for the public. The second phase was intended to provide medical, geriatric and psychiatric beds with day hospitals and a department of rheumatology and rehabilitation, but no firm date can be given for its commencement.
I can well understand the disappointment in Eastbourne over the postponement of the second phase. The economic situation clearly prevents further remedying not only of Eastbourne's difficulties but of those of many other places in the country which have a deserving case for improved hospital facilities. This is a time when we have to make extremely difficult choices about priorities for health capital expenditure.
1239 In the House on 15th April my right hon. Friend explained the financial background against which the list of 1975–76 starts was drawn up. She recalled:We faced the prospect when we took office in March 1974 that if we could not restore some of the 20 per cent. cut announced in December 1973 by the previous administration, we would have faced a complete moratorium on all major scheme starts for two or three years.…It has nevertheless been possible to lift the moratorium on all hospital starts, but even so, many highly desirable schemes have had to be postponed and some will have to be redesigned The programme will, however, provide for continuing expansion of health centre construction, a tolerable level of work on essential minor schemes, maintenance of our medical student intake targets and of some priority for psychiatric and geriatric programmes".—[Official Report, 15th April 1975; Vol. 890, cc 85–6.]The consultants' industrial action has been a further factor in exacerbating the problem of waiting lists. The hon. Gentleman will know, however, that following the talks requested by the British Medical Association the ending of industrial action and a return to the normal pattern of work was recommended. We hope very much that medical work in hospitals is now returning to more normal levels.
I should like to say again that the problem of waiting times for treatment is neither unique to Eastbourne nor new to the National Health Service. It has been 1240 with us since 1948 in some part of the country and in some specialties. The potential demand for health care is practically limitless. To quote from a recent book on "Rationing Health Care" by M. H. Cooper, it is said with some truth that the only fit man is one inadequately examined by his doctor.
The Government want to tackle this long-standing problem, notwithstanding all the daunting economic problems facing us. For a start we have allocated £5 million in 1975–76 specially to deal with those aspects of the problem which can be improved by capital expenditure. This will be the first special allocation of money to help reduce waiting lists.
The hon. Gentleman referred to the shortage of nursing staff. That again is not unique to Eastbourne. It is general in other parts of the country. The Government are hopeful that the recent improvement in nurses' salaries arising from the Halsbury Report will improve the situation.
§ The Question having been proposed after Ten o'clock on Monday evening, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-five minutes to One o'clock.