HC Deb 15 May 1981 vol 4 cc1080-6

Motion made and Question proposed, That this House do now adjourn.—[Mr. Brooke.]

2.33 pm
Mr. John Heddle (Lichfield and Tamworth)

I am pleased to have the opportunity of raising the subject of orthopaedic waiting lists on the Adjournment debate. I am grateful that my hon. Friend the Under-Secretary of State for Health and Social Security is to reply to the debate. My right hon. Friend the Secretary of State for Social Services, my hon. Friend the Minister for Health and my hon. Friend the Under-Secretary of State have all been extremely helpful in the way in which they have answered the various written questions that I have tabled on orthopaedic waiting lists since I first raised the issue about 12 months ago.

On 31 March 1979 there were about 752,000 people awaiting admission to hospital. The total had dropped by 111,000 to 641,000 by 30 September 1980. That was excellent news for patient care and a great tribute to the staff who brought it about. It is also a credit to the Government for having honoured their manifesto commitment. Unfortunately, during that time, waiting lists and waiting times specifically for orthopaedic surgery have increased. Currently there are 126,917 patients awaiting orthopaedic and other traumatic surgery. My hon. Friend may tell me that only a small proportion are urgent, and I wish particularly to raise the matter of urgency.

Until a few weeks ago one of that number was my constituent Mrs. Caroline Pulcella of Tamworth, a delightful, 78-year-old great-grandmother. Following a car accident 12 years ago, which occasioned her great pain but not the need for admission to a casualty unit, she has, sadly lived with pain, depression and increasing immobility. Her life had ground to a standstill.

I invite the House to imagine how depressed Mr. Pulcella was when she learnt of a letter sent by her orthopaedic surgeon at the Good Hope hospital, Sutton Coldfield, which is in many respects an excellent hospital, serving the needs of my constituents. The letter written in December 1979 stated: During 1979 I have been able to do only one total hip replacement. Therefore, if Mrs. Pulcella keeps her place on the list and my annual rate of patient relief remains the same, she will not be coming in for relief for 40 years. It is slightly optimistic for a 78-year old great grandmother to look forward to the year 2020. There is no mention of Mrs. Pulcella's case being more urgent than others or of possibly persuading another surgeon in the same or an adjacent health district to place her on his waiting list. There was for her no ray of hope.

I shall not take up the time of the House in reciting exactly how, after a few months research and a series of coincidences and good fortune, I obtained for Mrs. Pulcella the promise of an operation in 14 months. This is the important point. She was not to be treated at her local hospital or at another hospital in Birmingham but at a hospital hundreds of miles away—the Stracathro hospital in Brechin, Scotland. There the waiting list was more manageable.

Mrs. Pulcella has travelled to Scotland two or three times. She was examined, admitted to hospital and endured a four-hour operation. In the past fortnight she has returned home to Tamworth to live free of pain and depression. The operation has literally given her a new lease of life.

That good fortune would not have been possible but for the coincidence of another constituent of mine, Mrs. Cameron of Greencroft, Lichfield, hearing of my campaign to find an orthopaedic bed for Mrs. Pulcella. She told me to get in touch with a Scottish hospital where her husband had endured a similar operation when they resided in Scotland. I pay tribute to the Good Samaritan act of Mrs. Cameron and more particularly and most importantly to the kind way in which the orthopaedic surgeon at Stracathro hospital, Mr. Kenneth Mills, who attended urgently to the case. He did so not by giving Mrs. Pulcella priority over his operating list but simply because he had the flexibility in his list to enable him to admit an urgent case from another part of the country.

Mrs. Pulcella's case has inevitably attracted considerable publicity. I have received letters from other orthopaedic surgeons in the West Midlands. A surgeon in the Birmingham Central health district, only a few miles from the boundary of the Birmingham North health district in which the Good Hope hospital is situated, stated in a letter to me: Why did I not know of your constituent's plight? I run a waiting list of only a few months for women, and none for men. I raise the matter to urge my hon. Friend to consult his hon. Friends in the Department to establish on a regional or national basis computer facilities to show doctors where the shortest waiting lists are for specialist operations. A computer bed bank should be established to match short waiting lists or vacancies in one part of the country with long-suffering patients like Mrs. Pulcella in another. I am certain that to an extent that is done at present on a voluntary old boy basis, but I was disturbed to read in today's Birmingham Post, which takes an interest in the matter because of its local and regional implications, the following: A spokesman for the West Midlands Regional Health Authority said last night that such a scheme had never been considered by the authority, but he added: 'There is already a lot of co-operation between hospitals and patients do get transferred from one to another for a variety of reasons."' Mrs. Pulcella's case is perhaps the one that got away. One of the other reasons for raising the matter today is to endeavour to see how many others may also have got away.

I have studied the report prepared by a working party set up by my hon. Friend's Department, under the chairmanship of Professor Duthie, to recommend how excessive waiting times for orthopaedic surgery might be eliminated. The report was published in March. My hon. Friend will have much deeper and more comprehensive knowledge than I of that excellent report.

I shall remind the House of comments made by the Minister for Health when the Duthie report was published on 12 March. He said: I particularly welcome the emphasis the report places on the need for collaboration between doctors, other professional and management teams, in evaluating the efficiency of their existing services, and in studying how they may be improved within the resources available to them. In my view, the approach proposed by the working party should be studied also by those in other surgical specialities. The report also identifies the need for more complete and comparative statistical information to help health districts in assessing their performance. A computer bed bank would do just that.

Among the many letters which I have received about the matter, I have received one from the honorary secretary of the British Orthopaedic Association. He says that it would be entirely reasonable for the profession to consider your idea of a … computerised waiting lists for certain major procedures, notably total hip replacements, because it bears so directly on the subjects covered in the 'Duthie Report'. There would … be considerable practical difficulties in such a scheme, and possibly some sort of pilot study would be the best way to try it out". The House might be interested to hear the contents of a letter written by a well-known Midlands personality who is a member of the Wolverhampton area health authority. He wrote to me on 6 May, saying: I am a member of the Wolverhampton AHA and we have a long waiting list for such operations. On several occasions, I have suggested that GPs should be better informed as to the waiting time to see a consultant, and the waiting time from seeing a consultant to treatment. These two different kinds of waiting are not immediately apparent from DHSS statistics, even though each patient suffers them consecutively. Both these waiting times differ quite considerably in the same AHA from one consultant to another; they differ from the same consultant at the different hospitals where he practises: they differ even more when one consultant (being under contract to the Regional Authority) practises in two or more Areas; and as you have found, they differ between different AHAs in various parts of the country. He goes on to say: The choice of consultant, and hence the time one waits to see him, and after that to be treated seems to be almost entirely the choice of the GP based on his own preferences, his knowledge of the consultant's expertise, and his knowledge of the way hospital consultants' 'lists' and admissions work. Very few GPs realise they have a right to send any patient to any consultant anywhere in the United Kingdom, fewer still realise that if treatment cannot be readily provided in this country, they can refer their patient anywhere in the EEC (providing the patient will meet the cost of travel, and the share of the treatment cost usually borne by the patient in that country). I do not deny that my hon. Friend's departmental officials may produce administrative objections to the scheme which I am proposing today. However, it is the role of politicians not to be put off by problems, but to find ways round them. I am sure that my hon. Friend agrees with that. What took me six months a computer could do in less than six seconds. I earnestly believe that my suggestion of a nationalised or regionalised computer bed bank is entirely in accord with the Duthie recommendations. If it will make the NHS more efficient, if it will provide long overdue relief for thousands of elderly people such as my constituent, Mrs. Pulcella, at no extra cost to the taxpayer, I submit that it is worth trying.

2.44 pm
The Under-Secretary of State for Health and Social Security (Sir George Young)

I am grateful to my hon. Friend the Member for Lichfield and Tamworth (Mr. Heddle) for giving me this opportunity to compliment him on what he has done to help his constituent, Mrs. Pulcella, to get the total hip joint replacement operation which she needed very much more quickly than had ever seemed to her possible, and so to relieve her of the pain which she was suffering. But this commendable initiative is not the only thing on which I should like to compliment him. He is also to be praised by his constituents for the attention he has paid to the very real problem of the long periods many other patients, too, have been having to wait for elective orthopaedic operations at the Good Hope hospital in Sutton Coldfield, which serves his constituency, and for the efforts he has made, not least by calling my hon. Friend the Minister for Health and myself to task, to have something done about it by the local health authorities.

Finally, my hon. Friend deserves to be commended not merely for having realised that the problems of the Good Hope hospital and his constituency are not unique, but for having sought to find a means whereby those who cannot get their total hip replacement operations early in one place may get them earlier in another where there is less demand for them.

The story that we have heard is a good example of democracy in action, and a very good reason for the citizens of Lichfield and Tamworth to retain the services of my hon. Friend for a very long time.

I should like to speak briefly on each of the points that my hon. Friend has mentioned, and then perhaps more generally, and in the course of doing so to give some indication of what my Department is seeking to do to reduce the distressing long waiting times for elective orthopaedic operations.

In passing, I must say that I am grateful to my hon. Friend for his kind words about our success to date in reducing the length of waiting lists.

Mrs. Pulcella, as my hon. Friend said, is an elderly lady, and such was the length of the waiting list at the Good Hope hospital of the consultant surgeon in whose charge she was, and such was the composition of his list, that in late 1979 it was suggested that she might not be able to have her operation for 42 years. With no disrespect to Mrs. Pulcella, by the time 42 years had elapsed, responsibility for her health would have passed from my hon. Friend to the Great Healer in the Sky, where I am sure there are no waiting lists. In practice, it might not have been as bad as that, but I think that it would have meant that Mrs. Pulcella would have had to spend the rest of her life in continuous and, save for drugs, unrelieved pain.

My hon. Friend, no doubt having noted what the presiding judge had said in a case which had been brought by four other patients of the same surgeon against the then Secretary of State and the Birmingham area health authority—that he must dismiss their motion because there was no evidence that they had sought relief in other hospitals—sought for such another hospital for his constituent.

I understand that my hon. Friend wrote a large number of letters in so doing. He was fortunate to hear that a possible hospital was the Stracathro hospital at Brechin, in Angus, which has 250 beds and is the centre for all total hip replacement operations in North-East Scotland. An understanding surgeon there agreed to see Mrs. Pulcella at his clinic in Aberdeen, and she had her operation at the Stracathro hospital last month. We all wish her a speedy and total recovery. The operation was on the NHS, and I understand that her home branch of an estimable and well-known charity paid the travelling expenses incurred.

I am as delighted as my hon. Friend, but I am sure that, like I do, he will realise that there would be obvious disadvantages if all the waiting list orthopaedic patients in his constituency had to be sent to the north of Scotland for their operations—and objections from my right hon. Friend the Secretary of State for Scotland and the Scottish health boards, who would rightly ask why they should finance the treatment of the sassenachs and why the Birmingham area health authority should not solve its own problems and provide the facilities needed by the population dependent on it.

The case of Mrs. Pulcella was, of course, an extreme case. My hon. Friend has not suggested that all such patients in need of hip replacements should go to Scotland. Rather, he has suggested, in letters and in the publicity he has given to his views, that there should be a "computer bed bank" and that by means of this it should be discovered, when one particular hospital was hard pressed, which other hospitals could help out and relieve it of some of its hip replacement patients. This need not involve patients in having to travel so far as Mrs. Pulcella travelled, but the distances could still be considerable, and there would be difficulties.

Moving patients around in this way would be not only expensive, as someone would have to bear the transport costs for both patients and visiting relative, but discomforting for the patients to be removed any distance from home at a time of worry when they most wanted relatives and friends to be close at hand. In addition, if patients were allocated to hospitals in too impersonal a way, the desirable close relationships between general practitioners and local surgeons would be lost, and the surgeons who were to operate might be so far away from their patients that they would not be able to give them the personal attention they must give them if they are to keep in touch with the progress of their conditions requiring treatment and to determine progressively the urgency with which they need the treatment they are to receive.

Patients operated on in hospitals far from home might well have to be kept there longer because of the distances they would have to travel home, and this could prevent the beds they occupied being released for other patients as quickly as they might otherwise be. It would also be much more difficult for their general practitioners and others in the community health services and the social services in the home areas of the patients to visit, to plan for their discharge and for the rehabilitation so essential to their complete recovery.

As my hon. Friend indicated, I am not anxious to sound like an extract from "Yes, Minister." I am anxious not to reject entirely the suggestion that hospitals and surgeons should help one another out. It is clearly easier to move patients to hospitals than hospitals to patients. Indeed, extant guidance to health authorities is that wherever appropriate selected waiting list information should be exchanged between hospitals and made available to general practitioners so that patients may be given the opportunity to be referred to hospitals with a shorter wait, though further from their homes. Depending on circumstances this information could be made available within the district, or the area, or sometimes the region. I think that the publicity that my hon. Friend has rightly given to this case will stimulate some of the health authorities to see whether they might do more in this area.

The Duthie working party on orthopaedic waiting times found that in many areas where the guidance was followed the general practitioners shopped around before referring their patients to particular hospital and consultants. To that limited extent computers could possibly help, although such research as has been done on their use to date in the control of admissions at hospital and district level has provided no evidence that their use reduced average patient waiting times, although it does more easily identify urgent cases.

There may still be work to be done on this subject, and should the British Medical Association, which has shown an interest in my hon. Friend's suggestion decide to go ahead with a project, which he has referred to us, to examine the feasibility of a national or regional computer bed bank, I repeat the assurance already given to him last December that my Department will certainly assist by making available such factual material as it needs and as the Department possesses.

The real problem is that patients do not have to wait too long for operations at the Good Hope hospital alone. The problem is a national one. I fear that the computer, when resorted to, would show that there were all too many patients wanting beds and surgeons wanting theatre time and all too few with the beds and the theatre time but no patients.

The ideal is for this problem to be tackled everywhere locally, at district and hospital level, so that, once it is solved, every patient needing an orthopaedic or any other operation can get it at his or her local district general hospital. It was to consider this problem and advise on how waiting times could be reduced that the working party, under the chairmanship of Professor Duthie, of Oxford, was appointed by the previous Secreatry of State, the right hon. Member for Norwich, North (Mr. Ennals) not long before the last election and kept in being by the present Government. It started work in mid-1979 and its report was published in March of this year. It revealed that there was no common reason why waiting times were long, except that all orthopaedic units bore the strains of the increasing skills of their surgeons, to whom I pay tribute, in finding new ways of treating orthopaedic disabilities, and in the increaing numbers of the elderly in the population as a whole who could most benefit from those skills. Otherwise, there were different reasons in different districts why their orthopaedic units so often could not cope adequately with the demands made on them.

The working party recommended ways in which health district managements and clinicians could evaluate the present performances of their orthopaedic units and determine to what extent they could improve on them by changes in management and clinical practices in order to reduce waiting times for both out-patient consultations and in-patient treatment within existing resources. Of course, such studies might show that additional facilities were necessary and that resources must be diverted to make possible their provision, but they would also show exactly what extra it was that was required. To know exactly what one needs is a great step forward on the way to looking for it and finding it.

There was also a section in the report that referred to the better use of statistics, which I think ties in with what my hon. Friend said about information being available locally on length of waiting lists.

I hope that all the health districts will act on the report, and I am happy to take this opportunity to thank the British Orthopaedic Association for making copies of it available to all its members and for giving it so encouraging a welcome.

I do not doubt that the North Birmingham health district and other districts in the West Midlands will find the Duthie report a great help in their evaluation studies and their planning, and I am glad that they and the Birmingham area health authority have, even before it was published, not been idle, and that the latter commissioned a study of its own, of which my hon. Friend is aware. What my hon. Friend wants is a better orthopaedic service at the Good Hope hospital and for his constituents in Tamworth and Lichfield. Let me describe what has been done towards this end.

First, and of immediate significance, is the decision made by my hon. Friend the Minister for Health last September that there should be an expansion of Good Hope hospital in Sutton Coldfield. There are to be 112 additional beds and supporting services, including operating theatres, and I understand that the 'Nest Midlands regional health authority is on the point of putting firm proposals to my Department—they will be dealt with quickly—for this scheme, and for work to start on it in 1983 and to be completed in 1986. In the meantime, I understand, the Birmingham area health authority has put in hand the construction of a temporary operating theatre, which should be in use within three months. This will, I hope, prove of some immediate help to patients such as Mrs. Pulcella, as well as meet the training requirements sought by the Royal College of Surgeons.

The area health authority is also exploring the possible use of additional facilities at St. Gerard's, a private hospital in Coleshill, which is already used by the National Health Service on a contractual basis, but some building work may have to be carried out there first. Mention of this private hospital makes it convenient for me to remind my hon. Friend that guidance issued to health authorities in January of this year advised them to make use of private hospital facilities to overcome temporary difficulties in provision of NHS services, for example to tackle a long waiting list or to maintain a level of service while NHS facilities are closed for building work". The Duthie working party acknowledged the help that such an expedient could provide towards clearing backlogs of waiting list patients, and I hope that the guidance will be followed.

Finally, let me revert to my hon. Friend's constituency, to which at this hour on a Friday I am sure he is as anxious to return, as I am, Mr. Deputy Speaker, to mine, and, indeed, you to yours. The West Midlands regional health authority is considering how best to provide more acute hospital facilities for the residents of Lichfield and Tamworth and the surrounding areas, and planning has reached the stage at which, understand, a meeting will shortly be held of both health and local authorities in an attempt to agree on a site for what will ultimately be a major hospital to serve both towns. Is it too much to hope that the Mrs. Pulcellas of the future will not have to wait so long or travel so far for the treatment that they require?

Question put and agreed to.

Adjourned accordingly at two minutes to Three o' clock.