Tonsillectomies (North Devon) (Hansard, 6 April 1989)

§ Mr. Tony Speller (Devon, North)

In raising the subject of delays in tonsillectomy operations in north Devon I am talking of a drama which has no villains in the cast, although some members of it may regard their opponents as villainous.

Although there are no villains, there are victims, and they are children. They are children who need tonsillectomies, and they are children of my north Devon constituents who look for help to the North Devon health authority and, in particular, to our ear, nose and throat specialist, Mr. John Riddington Young. The problem, expressed simply, is that, although Mr. Riddington Young works within the National Health Service and within the North Devon health authority, for several years there has been a stalemate over the use of facilities in our excellent North Devon general hospital, where no tonsillectomies are being performed.

The stage is the hospital and the cast are the highly qualified, well-respected members of the health authority, the consultants, and all the medical and administrative staff within the authority. In essence, the problem is simply that, because of his fears for the safety of youngsters in their post-operative period, the ENT specialist refuses to use the post-operative facilities which the health authority wishes him to use.

Should the young patient be placed in the paediatric ward or in a surgical ward? On one side of the argument is the health authority, which considers that a paediatric ward is the right place for a youngster to recover. On the other side is the argument of the ear, nose and throat specialist, who will only accept placement of his patients in a surgical ward. He wants a physically separate ward or area in which patients may recover, free from fear of cross-contamination. Those are sensible and logical, but argumentative positions. I truthfully have no idea who is in the right.

Now an element of farce appears. The consultant will not operate under the conditions laid down by the health authority. Recently, the Government have provided £75,000 towards cutting the queues of people on waiting lists. I was grateful for that until I found out that, because the consultant will not operate until the health authority accepts his conditions for the children, the health authority, disagreeing with its consultant, is sending 40 children for tonsillectomies at Nuffield hospital in Plymouth. So out of our £75,000 of extra funds, £49,000 will be spent on sending our youngsters 50 or 60 miles to Plymouth for their operations. It seems ludicrous. We have the surgeon and we have the beds, but because the beds are in the wrong ward—or seem to be—we send our youngsters across the county and pay for the privilege of not using our own facilities. We have an outstanding surgeon and a super hospital and they are part of a good local health authority, but no operations are carried out. That waste of abilities and facilities must cause my right hon. and learned Friend the Secretary of State to reach with a shudder for his White Paper.

The problem goes back to 1984. I was first involved when one parent, who was a qualified nurse, complained about the lack of access to her child in the post-operative 463 period after a tonsillectomy and was in great dispute with Mr. Riddington Young. Time passed, and during 1987 there were rumblings of discontent over the growing list of young people needing tonsillectomies, but having either to go to Exeter—where, I believe, the post-operative system used is that preferred by Mr. Riddington Young—or to go private.

Constituents sought my help and I, in turn, contacted the community health council and the North Devon health authority. As nothing seemed able to break the stalemate, I sought help from the previous Under-Secretary of State, my hon. Friend the Member for Derbyshire, South (Mrs. Currie), but the stalemate continued. We are now into our fourth year of no tonsillectomies, although beds and a consultant are available. We reached the stage that the stalemate always seemed to be on the point of compromise, but whenever the usual channels were used they silted up so it was necessary to find a way over or round them. The purpose of this debate is to ask my hon. Friend the Under-Secretary to use the national part of our National Health Service to effect or even impose a solution.

I want to make two further points. Mr. John Riddington Young has the reputation of being an outstanding ear, nose and throat specialist. His patients appreciate his work and many constituents have written to me in his support. He is from Yorkshire and has many of the talents of that great county and it may be that he also has some of the stubbornness for which it is also renowned. Compromise seems alien to him, as he believes that any compromise may damage his patients. Who can complain about a medical officer who cares more for his patients than for the bureaucracy? I have no specific complaint about the consultant.

Secondly, my North Devon health authority is excellent. In 10 years in the House, I could count on the fingers of one hand the number of complaints about the authority. I listen to colleagues in Question Time and debates complaining about their local health authorities, but I do not have that problem. My constituents like the health authority and they like its consultants. None the less, there are no operations and that is ludicrous. I have used the word "silly" in the past and been criticised for it, but it must be silly that the taxpayers' money is not being used to help the children who need help.

The North Devon health authority claims to be following Government guidelines in making the best use of the beds. Perhaps following the problems of Cleveland, it is unwilling to put young children in an adult ward overnight. The crux of the problem is that the consultant specialist says, "I will operate only if children are placed in a surgical adult ward overnight." However, he would prefer a separated ward and I understand his argument on that. The health authority says, "We have good paediatric staff, with excellent nurses with excellent qualifications, and the paediatric ward is where children should go." Both arguments carry complete conviction to the layman but taken together the two arguments mean that none of the children in my constituency are getting their tonsillectomies, which must be nonsense under any circumstances.

Therefore, I can see both points of view in the play. I do not use the word "play" humorously because this is a play. Although we are talking about operating theatres, the issue is theatre with a play that has a cast of excellent characters who are highly qualified people. They are people of whom I have no personal criticism because they 464 are specialists in their own procedures. However, they are none the less at loggerheads and we have reached the stage where only my hon. Friend the Minister can assist us in making a breakthrough.

My fear is that if we do not resolve the problem soon my area, covered by the North Devon health authority, will lose its ENT operating capacity. Unusually, it is a single consultant facility. Children need to be near their parents, especially when they are in hospital and although Exeter is an excellent hospital it is 50 miles away and for a low-income constituency such as mine that is 50 expensive miles. That is my problem; the children should be near their parents; the parents live in the Barnstaple and the Ilfracombe area, which makes that the logical place for operations.

I turn finally to the White Paper of my right hon. and learned Friend the Secretary of State for Health. It is not to the taste of many medical people and nor are some of my hon. Friends deeply enamoured by it. I believe in local health care and respect Mr. Riddington Young, the consultant, but equally I know well and have full confidence in councillor Mrs. Ro Day the chairman of the authority.

It may be that our regional health authority in far-away Bristol—we in the west country think of Bristol as south midlands, not south west—should have done something earlier. Perhaps the local consultants, individually or collectively, should have brought pressure to bear. But whatever the reason, only the children are suffering. No one else has lost a thing—not a penny, not a pound. No one has lost a night's sleep except for the parents—and the children have suffered. The community is sick and tired of what seems to us to be a dispute that should have been resolved long ago.

Therefore, I ask my hon. Friend the Minister to bring; down the curtain on this too long running farce. The cast is excellent but it must get its act together because beyond the size and the scope of what is a petty dispute to the outside world is the whole question of our National Health Service. Some of my constituents were sent to Exeter last year for treatment for cancer and it is well known nationally that a number were badly damaged by an overdose. For what it is worth, constituents come to me and say, "We were promised help but we have not got it. There is some form of delay. There is a problem over legal aid."

While I am a supporter of the NHS—my family and myself are users of our National Health Service—none of us, ordinary laymen, doctors, nurses or consultants, can say that the Health Service is beyond criticism. It is too important for that. That is why I ask my good friend the hon. Member for Kettering (Mr. Freeman) to see what he can do to break this deadlock. We love and are proud of our Health Service, but sometimes it does not work and that is why, late at night like this, I must keep some of us in the House awake to try to help those who need help.

§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I congratulate my hon. Friend the Member for Devon, North (Mr. Speller) on his success in winning this opportunity to debate a matter of some concern to his constituents. He is recognised for his unflagging interest in the welfare of the people of his constituency and I pay particular tribute to him.

465 These matters undeniably involve clinical judgment and it would not be right for me to pass judgment. However, I am concerned, as is my hon. Friend, about the consequences for the children.

I, like perhaps many other hon. Members, had my tonsils out when I was 10 in my local, excellent National Health Service hospital. It was local, and I appreciate what my hon. Friend has said about the need for young children, in particular, to be close to their families and to avoid, if possible, extensive travel.

Perhaps it would be appropriate for me to talk briefly about waiting lists, especially as they affect ear, nose and throat services.

The Government have been concerned in the past two years to tackle the problem of waiting lists and times for people waiting for treatment under the National Health Service. To this end, my right hon. and learned Friend the Secretary of State has set aside considerable sums of money—£25 million in 1987–88, £30 million in the year just ended and £31 million in 1989–90—to enable health authorities to attack those areas and specialties where the number of people waiting, and the length of time they have to wait, is a problem. The money provided will enable more than 300,000 extra in-patients and day cases and over 200,000 extra out-patients to be treated by April 1990.

Looking at the picture more broadly, an impressive 6.5 million in-patients in all specialties are now being treated each year in our hospitals. This represents an increase of nearly one quarter over the past 10 years.

How does north Devon fit into this picture of expanding health care? Current expenditure has increased by over 30 per cent. in real terms since 1982–83. The proportion of frontline staff—doctors, nurses and other health professionals—has increased. Numbers of patients treated have risen correspondingly in the same period. The way in which statistics are collected has recently changed but between 1982 and 1986 in-patient cases rose by 26 per cent., out-patients by the same amount and day cases by 29 per cent.

I mention all this because it is important to see how far we have come in a short time, and what great strides have been made in access to health services for the population as a whole and for north Devon in particular. We do not rest on our laurels, however. We drive on. Problems remain, as this debate testifies, and it would be foolish to suppose that we could ever elininate them all, even if they could be anticipated.

There are various reasons for the build-up of waiting lists and times, where these occur at levels which begin to cause concern. They can often be resolved by changes in patient management, and by better informed referrals. In the south-west, general practitioners are sent information on waiting list numbers by specialty throughout the region on a quarterly basis. In other instances, it means specially targeted resources to help ease bottlenecks. Hence the existence of the waiting list fund.

The South Western region has received substantial sums with which to tackle its waiting list problems—£1.65 million in 1987–88, £1.9 million in 1988–89, and £1.55 million for 1989–90. The regional health authority has made £60,000 available to North Devon in 1988–89, and allocated a further £76,000 for the coming year, out of 466 which, as my hon. Friend said, £49,000 is intended for a project in the ear, nose and throat specialty to tackle that particular problem. The project, which involves contracting with the Nuffield hospital, Plymouth, to take 40 patients and which will last from July to October, will aim to reduce the number of children awaiting removal of tonsils and adenoids. I would draw the attention of my hon. Friend to the fact that the operations on these children would have to be funded by the health authority from either the waiting list initiative or from the authority's allocation.

If the children were not operated on in Plymouth, using the funds available under the waiting list initiative, and if they were looked after in hospital in north Devon, resources would be needed for those operations, so it would not be true to say that we are wasting £49,000 by applying this remedy to the problem.

I wish to comment on one other point that my hon. Friend made. The national and regional policy is that children should be treated in designated children's wards by specially trained staff so as to safeguard both their physical and psychological well-being. I believe that that is an opinion that is generally held, although, I admit, not universally agreed.

My hon. Friend will be aware of some of the background to the rise in the waiting list figures for ear, nose and throat operations in north Devon, about half of which are performed on children. Matters of clinical judgment were involved, which it is not appropriate to go into here, but about which I understand discussions have been taking place between the health authority and the consultant concerned, with independent expert advice. The health authority is optimistic that matters will soon be resolved. I understand that from 10 April Mr. Riddington Young has agreed to operate on children requiring the removal of tonsils and adenoids who are over the age of 10 years. That is recent and good news.

The matter is clearly one for the North Devon health authority to deal with, in consultation with the regional health authority, who hold the consultant's contract of employment. On that point, we have always believed that the level where the contract is held is less important than the actual management of the contract. We would expect the regional and district health authorities to work together in the day-to-day management of consultants and for local managers to deal with problems that arise. As my hon. Friend said, the proposals in the recent White Paper will strengthen those arrangements.

However, even after that recent and welcome news concerning the consultant involved, I appreciate that there may still be a problem to be resolved. I can tell my hon. Friend that I will ask Sir Vernon Seccombe, chairman of the South Western regional health authority, to report to me within one month from today on how the position has developed and on the extent to which it has been resolved. I can give my hon. Friend an assurance, which I hope he will convey to his constituents—especially to the parents of the children involved—that I place great importance on what he has said and that I will write to him at the end of one month.

My hon. Friend raised the altogether separate subject of compensation payments for patients who received radiation overdoses at the Royal Devon and Exeter hospital last year. That matter is being handled by the legal advisers of Exeter health authority and the patients concerned or their executors. As my hon. Friend knows, 467 the health authority has, following an independent inquiry, accepted that it had failed in its duty and it has already paid out interim sums. It is working with its legal advisers to effect satisfactory final settlements as quickly as possible.