§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]
2.32 pm§ Mr. Ian Gow (Eastbourne)I welcome the opportunity to draw the attention of the House and the Minister to the number of people on the waiting list at Eastbourne general hospital and the length of time that patients have to wait before seeing a consultant and before an operation can be performed.
This debate is part of a paradox. We all know that spending on the National Health Service this year will be £23 billion—up by more than one third compared with 1979, after allowing for inflation. We know that there are 13,000 more doctors and dentists and 65,000 more nurses working for the National Health Service than there were in 1979. We know, too, that a week ago yesterday nurses were awarded a pay increase averaging 15.3 per cent., backdated to 1 April, and funded in full by the Government—or, perhaps I should say, by the taxpayer. In Eastbourne, phase 2 of our district general hospital will be complete before the end of this year and it will be operational next year.
All of that sounds and is—most impressive. In Eastbourne, however, waiting lists have been getting bigger, and waiting times longer. I will compare the figures for December 1979 with those for March 1988, giving the number of patients on the waiting list for our district general hospital without an admission date for the key specialties.
For general surgery, the figures are 395 for 1979 and 491 for 1988; ear, nose and throat, 269 in 1979 and 561 in 1988; orthopaedics 518 in 1979 and 1,104 in 1988; ophthalmology, 69 in 1979 and 398 in 1988; oral surgery, 18 in 1979 and 175 in 1988; gynaecology, 363 in 1979 and 777 in 1988. Overall, the number of patients on the waiting list without an admission date has virtually doubled, from 2,006 in 1979 to 3,905 in 1988.
The number of patients on the waiting list is only part of the story. As my hon. Friend the Minister knows, the length of time that they have to wait is far more important. The notional waiting time for ophthalmology increased from 25 weeks last year to 39 weeks this year, for gynaecology from 39 weeks last year to 58 weeks this year, and for ear, nose and throat operations it more than doubled from 26 weeks last year to 59 weeks this year. So the position has been getting worse.
It is easy to be mesmerised by statistics. The National Health Service exists, however, not to provide figures for Ministers and others to produce, but to heal the sick and, wherever possible, to prevent our people from becoming sick. I shall give two examples of the way in which those statistics actually affect my constituents. In both cases, I have been authorised to give the details to the House.
On 11 February this year, Mr. B. wrote to me as follows:
My wife is on the waiting list for a hysterectomy peration. She went to see our GP in January 1987. He made an appointment for her to see Mr. Shardlow at the district general hospital, which she eventually did on 29th June 1987. She was told there was a waiting list of up to two years. My wife is a very patient person, and has been waiting now for almost eight months. Unlike my wife, I am not patient, and resent the fact that the quality of her life is not as it should be. In desperation, I am writing to you, hoping that in some way you can suggest something more that I can do.701 On 17 February I wrote to the chairman of our district health authority. The manager of the district general hospital replied on the chairman's behalf on 25 February:I have discussed this with Mr. Shardlow, who is the consultant responsible for Mrs. B's care. He has confirmed that Mr. B's account of the case is accurate and that there is a wait of approximately two years for non-urgent operations.On I March I wrote to my right hon. Friend the Minister for Health. On 24 March, my hon. Friend the Under-Secretary of State for Health and Social Security, my hon. Friend the Member for Derbyshire, South (Mrs.Currie), who is to reply to this debate, explained that Eastbourne health authority had been allocated £155,000 from the waiting lists fund, which would mean that an extra 150 gynaecological operations, mostly hysterectomies, and 250 extra ear, nose and throat operations could be performed.I sent a copy of my hon. Friend's letter to the chairman of our district health authority, who replied three days ago, on 26 April, in the following terms:
You ask me about Mrs. Irene Barber. Regrettably, all that she says in her letter to you is correct. The earliest that it is possible to open the temporary surgical unit is the beginning of October. That unit will certainly remove a number of people from the waiting lists, but whether Mrs. Barber will be fortunate, I am unable to say, since this is a decision to be made by the consultant nearer the time. The best estimate I can give of the date on which Mrs. Barber will have her hysterectomy operation is not less than six months from now and not more than 18 months from now.I ask my hon. Friend to note the words,not less than six months from now and not more than 18 months from now.Mrs. Barber was put on the waiting list for a hysterectomy operation on 29 June 1987–10 months ago today. Even if her operation is carried out midway between the dates given to me by the chairman of the district health authority, she will have been waiting for 22 months. I advise my hon. Friend that for a woman, aged 72, to have to wait 22 months for a hysterectomy operation is unacceptable to her Member of Parliament. I hope that my hon. Friend will say that it is unacceptable to her, too.I wish to give another example to the House. Mrs. G wrote to me on 22 March:
I am 42"—30 years younger than Mrs. B—and need a hysterectomy. I have been told the waiting list for this is two years. As I am in a lot of pain, amongst other symptoms, I am absolutely appalled at this terribly long waiting list. I would ask for your help, please.I wrote to Mrs. G's consultant on 30 March in the following terms:I spoke to your patient and my constituent Mrs. G, on the telephone this afternoon. She tells me that you saw her earlier this month, and that she would have to wait for two years for her hysterectomy. Is that really so, please?The consultant replied on 8 April:Overall, the waiting time for the person who comes up when their name is called forward is about two years for a hysterectomy.I repeat that that letter was dated 8 April.We have the statistics that matter much, we have the patients who matter more and we have my hon. Friend the Minister who, mercifully, has the power to bring about an improvement in a situation that certainly I, and I suspect she, believe to be unacceptable.
The Eastbourne health authority has an outstanding chairman and general manager. On the basis of figures that I have seen, it is one of the most efficient health authorities in the country. It is not wasting money. The problem is 702 that this year it is receiving only 85 per cent. of the amount to which, under the Government's RAWP formula, it is entitled. The revenue cash allocation for the current year is £47.4 million—£47 million short. Mrs. Barber and Mrs. Grayling and the growing numbers on our waiting lists are a direct consequence of giving to Eastbourne only 85p in every pound that the Government say that it needs.
The regional health authority is proposing that Eastbourne should receive 96 per cent. of its RAWP target in 1994—so, even then, it will not receive the amount which, according to the Government, it should receive. It needs a supplementary allocation from a supplementary waiting list fund. That would at least halt the rise in the length of time that my constituents are having to wait for operations.
My hon. Friend knows that the whole of my constituency and parts of the constituencies of my hon. Friends the Member for Wealden (Sir G. Johnson Smith), for Lewes (Mr. Rathbone) and for Bexhill and Battle (Mr. Wardle) are served by the Eastbourne health authority. Each of my hon. Friends has an engagement in his constituency today. Although they cannot be here, each has authorised me to say that I speak on behalf of all four of us. Even if my hon. Friend the Minister cannot this afternoon announce any specific measures to help to resolve a problem that is becoming worse all the time, I hope that she will agree to consider very carefully the facts that have been drawn to her attention in this debate, and to which her officials will have drawn her attention since they first knew a week ago that the debate would take place.
If my hon. Friend's constituents were faced with the same problems as those that face my constituents, I know that she, too, would raise the matter with the appropriate Minister. I remind her of the advice given in St. Luke's gospel:
Though he will not rise and give him, because he is his friend, yet because of his importunity he will rise and give him.Today's debate is only the start. My hon. Friends and I will continue to raise these matters with the Minister of Health and with my hon. Friend until justice is done for the people of Eastbourne.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)I congratulate my hon. Friend the Member for Eastbourne (Mr. Gow) on securing the debate. Of course, I am aware of his interest in and concerns about health services in his constituency. My right hon. Friend the Minister for Health and I met my hon. Friend and the other hon. Members whom he mentioned—my hon. Friends the Members for Lewes (Mr. Rathbone), for Bexhill and Battle (Mr. Wardell), and for Wealden (Sir G. Johnson Smith)—on 10 February, and we had a most useful discussion.
Eastbourne health authority serves a population of around 180,000, but more than 25 per cent. of those people are over 65. From 1983–86, there was an increase of 10.5 per cent. in the number of people aged over 85. The overall population is also rising. Between 1981 and 1986 Eastbourne's population increased by more than 30,000. So the population is increasing and the average age is rising. We are aware of the pressures—particularly the over-85s—and have been studying them in the light of the resource allocation working party.
703 One of the recommendations in the National Health Service management board's interim report on RAWP is that an over-85 age band be introduced into the national calculations by which we allocate resources. That will particularly benefit South-East Thames region, which covers my hon. Friend's constituency. In fact, in setting targets for districts in this current year, 1988–89, South-East Thames regional health authority incorporated the 85-plus age band in its allocation formula to the districts, and that helped districts such as Eastbourne. Our national review analysis research on the issue is complete. We are considering recommendations, and shall shortly make announcements.
Partly as a response to demographic pressures, the funding of Eastbourne health authority has been substantially increased. In 1982, when the health authority was created, its cash allocation was £34|.5 million. In addition, £2.3 million was allocated for smaller capital schemes within the district. The initial money is the basis of funding and is not the whole story. Last year, 1987–88, the initial cash allocation had jumped to £41.8 million. On top of that, there was £3.2 million for smaller capital schemes.
Cost improvement schemes since 1984–85 have also improved, through better efficiency, with a substantial movement of nearly £2 million within the authority to improve patient care. There has also been the sale of land and surplus property since 1982–83, which has provided the district with £4.7 million on top of that. In these ways, we expect the health authority to make itself more efficient and use the cash released for improved patient care.
In 1987–88, the year just ended, adding together all the funding elements for that year, total funding stood at £46.6 million, which is clearly a substantial increase—25 per cent.—over 1982. This year's initial allocation is a further increase of 13 per cent., up to the £47.4 million that my hon. Friend mentioned. That increase is clearly much more than inflation, and it is the highest increase of all health authorities in South-East Thames region.
On the capital side, since 1982, a total of almost £40 million has been allocated to Eastbourne, the major share of which is for the new district general hospital phase II, which is costing £16.6 million. There has also been refurbishment at Hellingly—I gather that the health authority has some interesting ideas about developments there—plus a new chiropody school that cost almost £1 million, and two health centres. The Forest Row health centre is costing nearly £400,000, and the Seaford health centre, which is costing £1.44 million, was opened by my noble Friend Lord Skelmersdale last year. There are considerable developments going on.
That achievement is translated into more staff. From 1982–86, front line staff increased by 75 whole-time equivalents. I note with interest that there was a substantial rise in the number of general practitioners, dentists and opticians. That should have been sufficient to keep pace with demographic change and many of the increasing demands placed on them. Most of all, it means that far more patients are being treated in Eastbourne. I am sure that my hon. Friend is aware of the figures. In 1982, there were 22,500 in-patients. In 1986, the latest year for which figures are available, there were 24,800—an increase of over 10 per cent. For day cases, the increase 704 was even larger—34 per cent. Overall, there has been a small reduction in out-patient attendances, but that is largely due to a change in obstetric attendances, which, again, is a feature of the demography of the area. But, for example, there has been a rise of over 14 per cent. in the number of gynaecological out-patient attendances. Again, to look at where things are going well, there has been a 25 per cent. increase in general surgery in-patients. Clearly, some of the consultants and staff are working harder and are enabled thereby to increase their productivity.
One of the calculations that it is possible to do on this data, and which I have had done in the week since the debate was called, which shows day cases as a percentage of all in-patients and day cases, demonstrates that there is considerable variation between specialities in this district. Day case work is valuable. It tends to increase throughput faster than costs, and patients like it. In 1986 in general medicine, general surgery and opthalmology the district was among or close to the bottom 10 per cent. of districts in the entire country. Yet for trauma, orthopaedic surgery and gynaecology it was in the top 10 per cent. of districts. It may be, therefore, that some of the consultants need to share their worthwhile experiences with their colleagues.
I met the district general manager, Mr. Sully, and the chairman, Mr. Platt, of the Eastbourne district health authority early this morning. They came to my office here at the House of Commons at my request. I am deeply grateful to them for giving me so much of their time today and I am satisfied that they are aware of my concerns and those of my hon. Friend. I do not feel that all the difficulties are due to funding, for, as I have indicated, increased funding has been relatively generous whereas the level of activity around the district is distinctly variable.
My hon. Friend has drawn attention to the waiting lists and I told him that we share his anxiety. The picture is possibly not as black as painted. For example, the numbers on the longest list, trauma and orthopaedics, were starting to come down during 1987, partly because the district received £110,000 from the waiting list initiative last year and partly because it managed to do some 94 additional hip replacement operations in six months. Nevertheless, my hon. Friend is right that other lists remain stubbornly high and are tending to increase.
This year Eastbourne's main priority is to reduce its gynaecology and ENT waiting lists. I was interested to hear what my hon. Friend said about his constituents, Mrs. Barber and Mrs. Grayling. If he would be kind enough to allow me, I shall look again at the details of those cases. He will realise that the decision when to operate is not mine but their clinicians'. That £155,000 that we have made available to district health authorities is available now and we do not expect it to be held over until October or any other arbitrary date. We expect it to be used promptly.
I noticed that the health authority issued a press statement on Thursday 21 April about a committee of inquiry into services for women in the area. The committee has now reported to the health authority on problems in maternity and gynaecological services. Several recommendations have been made to the health authority which may include the appointment of an additional specialist and the realignment of clinical responsibilities between consultants.
In the light of what my hon. Friend said, I am surprised that the health authority has asked its general manager to report back in July. It seems entirely right that it should 705 acquire a sense of urgency about this matter and report back sooner. Perhaps it cannot report back in May, but I would expect it to deal with the issue at the June meeting and I should like to know if it does not.
My hon. Friend should not assume that because patients have no booked date they will never be seen or will be seen only by chance. I obtained the latest figures for the quarter June to September 1987 and I established that Eastbourne health authority admitted 1,696 cases from the waiting list to the hospitals who did not have booked admission dates. The median waiting time for these cases was 10 weeks. Therefore, it is not entirely a matter of gloom.
I am also told that in Eastbourne the September 1987 figures, again the latest available, show that 95 per cent. of those admitted as in-patients or day patients were admitted within 12 months, which is roughly the same as the national average. That suggests, as do some of the other figures that my hon. Friend mentioned, that a list of two years is both most unusual in this district and most unacceptable to those concerned. I think that I have made my remarks about gynaecology clear to him and the district health authority, and we expect action on that.
Some of these difficulties were made much worse last year by the temporary closure of half the operating theatres for three months during the summer. They were very much in need of upgrading and redecorating. Nevertheless, I take the view that arrangements should have been made for as many patients as possible to be treated elsewhere. It is not good enough to close theatres, keep the staff on and leave patients waiting. I gather that some 300 waiting list cases were lost during that period.
I have taken another close look at the figures for ophthalmology, which is one of the bad waiting lists. Although Eastbourne's throughput figures are generally good, they are only around average in gynaecology and among the lowest 20 per cent. in the country in ophthalmology. If in ophthalmology the district were to reduce the length of time that beds are left empty between patients from six days to even the regional average of three days, which is still too high, and if in the same specialism the throughput was increased from its low level of barely 75 per cent. of the national average, a lot more patients would be seen and perhaps a lot more patients would be able to see.
706 My calculation is that between 250 and 300 more ophthalmology patients would be attended to, which would virtually clear the waiting list. I am told that they are all busy doing out-patient clinics. I have suggested to the health authority that it needs to review its links between its general practitioners, clinical assistants, out-patient clinics, in-patient work and day case work in a speciality such as ophthalmology to ensure that people are not merely seen and sent away without treatment.
The district is doing other things which are helping to develop services in other important areas. To be fair to it, we should note them. An extra consultant paediatrician will shortly be appointed. Staffing levels for midwives and those who care for the elderly will be improved. Temporary out-patient clinics in, for example, rheumatology, are to be made permanent and more homes in the community for people with mental handicaps will be opened.
I have indicated my concern, which I hope my hon. Friend recognises. I am giving some thought to how districts that face rapid increases in the number of very old people in their areas during the next few years should manage their affairs to avoid a build-up of waiting lists. I have therefore asked my officials to consider whether a study would be useful, perhaps building on expertise elsewhere and possibly looking at several districts on the south coast, including Eastbourne. If we decide to proceed on those lines, I hope that my hon. Friend could give such a study his full support. I put the same point to the chairman this morning. He said that the authority would co-operate enthusiastically with such a study, which would be of wide interest.
Service provision in the district will be invigorated when the second phase of the district general hospital becomes operational next year. It will provide another 350 beds for elderly psychiatric patients and general medical patients, and there is to be a 120-place psychiatric day hospital. More money will therefore go to Eastbourne in the coming years to help run services from this major capital development.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes past Three o'clock till Tuesday 3 May, pursuant to Resolution of the House of 25 March.