§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chapman.]
10.41 pm§ Mr. Kenneth Hind (Lancashire, West)I welcome the opportunity given to me by Mr. Speaker to raise the problems caused by the waiting lists at Wrightington hospital in my constituency and within the West Lancashire health authority which is almost coterminous with my constituency.
Before I enter into the arguments on the matter, I pay tribute to the dedicated staff and doctors at the two main hospitals which make up West Lancashire health authority —Wrightington hospital and Ormskirk district and general hospital. In the past 12 months we have been granted £25 million by the North Western regional health authority to build a new hospital. I am pleased to say that it is now under construction. My hon. Friend the Minister for Health recently visited West Lancashire to cut the sod to start building the new hospital.
The purpose of the debate is to draw attention to the problems of orthopaedic surgeons at Wrightington hospital. Waiting lists in West Lancashire health authority are low compared with national averages. That is a tribute to the staff. However, the position of the orthopaedic side, particularly upper limb, is extremely bad. It is acute and needs to be brought to the attention of the House. Action must be taken to deal with this problem.
The major problem arises from the waiting list of Mr. John Stanley, the upper limb surgeon. He is in need of additional support. The problem arises because Wrightington hospital is a regional centre of excellence. It draws patients from all over the country. During the past 12 months, 94 district health authorities have referred patients there. It is one of those hospitals that has been in the forefront of orthopaedic surgical technique developments and has played a major part in the development of hip replacement surgery for people afflicted with arthritis. That has become an operation that is widely carried out throughout the Health Service, and much of the work on it was pioneered at Wrightington.
Wrightington is also a centre of excellence for rheumatology and contains one of the small units in the north-west which deal with rheumatology in children. In recent years, the rheumatology ward at Wrightington has been the subject of debate in this House. I am pleased that, due to the attitude of my hon. Friend the Member for Derbyshire, South (Mrs. Currie) when she was a Minister, that institution continues to supply a good service to the people of the north-west.
At present, there are 1,660 patients awaiting admission to Wrightington hospital. Of those, 1,065 have been waiting six months or more. Of those, 791 patients are on Mr. John Stanley's list for upper limb surgery. His difficulty is that he is one of six specialist upper limb surgeons practising, particularly on hands and arms, in the United Kingdom. Of his patients, 568 have been waiting for six months, and 427 for more than 12 months.
Therefore, the problem has existed for some time. When the Department of Health recently analysed the worst 100 waiting lists in the country, Wrightington's list came 58th. It was hoped, at that time, both by the district health authority and me, that the announcement by the Department of Health in the White Paper "Working for 1527 Patients" that 100 new consultants would be created would result in Wrightington receiving a consultant to alleviate its problems.
The North Western regional health authority absorbs about 9 per cent. of the total national expenditure on health care. But an examination of the number of consultants who had been appointed by the Department, following the undertaking in "Working for Patients", found that only six had been appointed to the north-west —less, on a global examination of the position, than would be expected according to the number of patients and the volume of NHS resources absorbed by the North Western region.
Today, the NHS treats more patients, with more staff, than ever before. It is a demand-led system. Resources have to be placed at the points where the pressure arises and demand is greatest. Wrightington falls into that category. Since 1985–86, the number of patients treated at Wrightington has slowly increased, from 2,305 in 1985–86 to 2,715 in 1989–90—an increase of more than 400 in discharges. But in 1985–86, the number of patients who had been on the waiting list for 12 months or more was 218; in 1989–90, it was 628. Therefore, despite the fact that more patients are being treated, the number on the waiting lists is increasing.
That is a tribute to the success of Wrightington and to the ability of the doctors there to provide excellent service —but it is making matters more difficult. Ministers in the Department of Health have tried to lessen the problem by means of the waiting list initiative. We are grateful that in 1987–88 another 250 patients were allowed operations because of the increased resources from that initiative. The comparable figures for 1988–89 were 120, and for 1989–90, 140.
However, despite consideration by the Department and its clear understanding that the problem needs tackling, the waiting lists continue to grow. It appears that Wrightington is a victim of its own success. If the problem continues, the waiting lists will only grow.
An application has been made to the Department under the so-called Yates initiative, whereby the Government determine whether waiting lists can be reduced by providing funds to hospitals centrally. I hope that my hon. Friend the Minister will look with some sympathy at our application for £235,000 to carry out more operations so as to reduce the waiting list.
It is impossible to discuss the waiting lists in one hospital without also considering the district health authority as a whole. West Lancashire district health authority has two major hospitals—the district hospital at Ormskirk, where a new hospital is being built, and Wrightington itself.
Over the past 12 months the formula by which the regions are funded by the Department has been changed. As a result, West Lancashire health authority has received a budget increase of 6.5 per cent. in the past year. That is made up of amounts of 5.8 per cent. and 0.7 per cent., the latter being a non-recurring sum.
I am sure that my hon. Friend will make the point that the retail prices index and health pay and prices costs are not necessarily one and the same, because the RPI contains some elements that are not relevant to pay and prices in the Health Service, such as mortgage interest rates, and so on. But some aspects of health costs, especially those relating to drugs, have risen in price well above the rate of inflation. So the district health authority, 1528 those who take an interest in health in the area and 1 all believe that 6.5 per cent. is not enough. If it is implemented, it will unfortunately entail a reduction in the health authority's resources over the coming years.
The change in the formula, as it has affected the North Western region, worries me. Unless it is reconsidered, we shall face the same problem next year, and the year after. This year the problem has been concealed, to some extent, by the large increase in the NHS budget generally, but the same formula for determining increases will apply next year. The North Western region's morbidity rate is extremely high, and the formula has been changed to the detriment of the region. If the Department were to look into that, it would benefit the health authorities in the region, which is the second biggest in the country.
When my hon. Friend does his calculations for Wrightington and examines the health authority's problems, I ask him to consider the performance of West Lancashire district health authority over the past few years. It is a model of financial rectitude and has followed Government guidelines time and time again. Over the past five years it has increased the number of patients it treats by 20 per cent. and has never overspent its budget. Unlike other district health authorities which have closed wards when they have overspent to reduce costs, West Lancashire has never called on that requirement, although major structural changes have been made as small cottage hospitals have been closed, such as Greenlane—Brandreth is planned for the future—to centralise treatment in Ormskirk, which is the geographical centre of the district, in modern facilities that are being built.
The cost improvements asked for by the regional health authority and the Department have always been delivered, but a small authority which covers 120,000 patients who are served by the hospitals within its environs has its limits. There is a deep feeling, particularly among the members of the district health authority, that overspenders benefit, while they have done everything that they have been called on to do.
I ask my hon. Friend the Minister to look at all those factors when he considers West Lancashire health authority, particularly at the morbidity ratio and the changes in the formula that will affect the North Western region as a whole and West Lancashire in particular. I again impress on him that the service at Wrightington will be a demand-led service of excellence. It is recognised throughout the country as second to none. It is demanded and will continue to be demanded by the public. The consultants who are doing such a good job deserve the support not only of their colleagues on the district health authority, but of Members of the House and the Government as a whole. I hope that my hon. Friend will look with sympathy on the difficult task that they face, perhaps with a view to helping to alleviate those problems while improving the service to patients.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)I congratulate my hon. Friend I he Member for Lancashire, West (Mr. Hind) on presenting a case on behalf of his constituents with his customary clarity and courtesy.
It is nice to see you back in the Chair, Mr. Deputy Speaker, after your visit to New Zealand. I understand. 1529 that you and your wife were able to combine it with a few days holiday. I hope that you enjoyed your holiday and that your official visit was a great success.
§ Mr. Deputy Speaker (Mr. Harold Walker)I am grateful to the hon. Gentleman.
§ Mr. FreemanMy hon. Friend concentrated his remarks principally on Wrightington hospital, which is just without his constituency boundaries. He would want me to say that our hon. Friend the Member for Chorley (Mr. Dover) represents the constituency that includes Wrightington. I understand that a good proportion of the staff and patients must come from my hon. Friend's constituency. It is part of the West Lancashire health authority, to which I pay tribute for achieving significant improvements in health care over the past six years. Indeed, my hon. Friend will be interested to know that the most recent accurate statistics for 1982 to 1987–88 show in-patient admissions up 22 per cent., out-patient treatments up 33 per cent. and day cases, principally day case surgery, up 60 per cent. It is interesting that treatment of patients in the trauma and orthopaedics specialty increased by 29 per cent. between 1982 and 1988–89. Those are truly remarkable figures which are a tribute to the skill, dedication and hard work of the staff.
Trauma and orthopaedic work, in which my hon. Friend is particularly interested tonight, includes broken limbs, hip and knee replacements and investigations into chronic arthritic conditions.
I understand that, last year, some 3,730 patients in west Lancashire were treated for trauma and orthopaedic conditions requiring hospital treatment compared with 2,880 in 1982—a significant increase. One understands that the population is aging and that the pressure for orthopaedic care is consequently increasing, and that technological advances, particularly the modern marvel of the hip replacement, which my hon. Friend and I, if we ever reach a great age, may well be candidates for, make possible surgery that was not dreamed of by our parents, let alone our grandparents.
My hon. Friend referred to the visit to Ormskirk of my hon. Friend the Minister for Health to kick-start a piece of construction equipment preparing the site for the new hospital—a £25 million development, with 139 beds for medical and general surgery, 23 for children and 8 for intensive therapy patients, and a modern accident and emergency department. I am sure that my hon. Friend is looking forward to the completion of that project, which will be of great value to the people of Lancashire.
My hon. Friend referred to the revenue allocation for west Lancashire, and I was busily trying to calculate the figures as he spoke. For the record, it is important to note that, for the year 1989–90, the year that has just ended, I calculate that the authority received some £25,310,000, made up of £24,568,000, to which was added AIDS money of £165,000, growth or development money of £379,000 and a number of other miscellaneous items totalling £198,000. The record should also show that, in the year to come, the allocation is £27,051,000, to which should be added an allocation for AIDS, certain White Paper work and capital charge preparation of some £200,000, giving a total of £27,251,000. I make that an increase of about £2 million, or 8 per cent.
1530 I would not argue with my hon. Friend about the precise mathematics, but when we start moving in 1991–92 to full and proper weighted capitation, I believe that, from advice that I have received, albeit provisional, my hon. Friend's district will be a gainer, presumably reflecting the fact that either the population is forecast to increase and/or demographic factors will move in favour of his constituents—that is, if their average age is particularly high in comparison with the rest of the region, or if their relative health is such that the district merits a greater allocation of funds. The provisional signs are that my hon. Friend's district will benefit.
I understand that Wrightington hospital has located within it a regional specialty service for joint replacements, including upper limb, hip and knee replacements. One associates the hospital with the late Professor Sir John Charnley, who, even to a relative layman such as myself, is well known for his pioneering work on hip replacements.
It is relevant to note that, of the 942 hip replacements carried out in 1988–89, 34 per cent. were for patients living outside the north-western region. My hon. Friend quoted a slightly different figure, but it made the same point, that on orthopaedic work the hospital is serving a broad area.
The service deals with the lion's share of complex rheumatoid cases for the whole of the north-west and Mersey regions, and provides the only service for those two regions for wrist replacement and 90 per cent. of elbow replacements. It provides the only wrist surgery service in Great Britain, so it is not surprising that the hospital is facing a growing demand for surgery that is reflected in the activity figures for that specialty and in the waiting lists.
Over the past four years, patient activity has increased from 2,232 cases in 1986–87 to 2,715 in 1989–90—an increase of 22 per cent. At the same time, the number of patients coming forward for treatment has increased at an even faster rate. One understands the reasons—the hospital's reputation and the increase in the aging population.
The increase has been so fast that the number of patients waiting for more than 12 months increased from 339 in 1986–87 to 628 in 1989–90. At 1 March, 628 patients had been waiting for more than one year. My hon. Friend drew my attention to the fact that 427 patients are on Mr. Stanley's list for upper limb surgery.
Wrightington hospital has met all the efficiency targets set for it by the region. Last year, a target baseline figure of 2,304 treatments was set, and 2,715 were achieved. The irony is that, the better and more successful a hospital is at treating patients, the more likely it is to run up against cash constraints imposed by the current funding system.
My hon. Friend knows that, from April 1991 onwards, the new regime will benefit the hospital in two ways. First, there will be a contracting system whereby, if patients are referred from outside to a hospital of such distinction, money will follow those patients. The hospital's budget will become more flexible to the extent that, the more that it can attract patients from outside its district, the more money will flow into it. Secondly, our new system of allocating funds on the basis of weighted capitation should work in favour of districts where demographic and relative health factors indicate the necessity of allocating further funds.
§ Mr. HindIs my hon. Friend aware that the consultants at Wrightington hospital have expressed interest in 1531 becoming a self-governing trust because, as my hon. Friend pointed out, it is in their interests to do so? That change could be of some help to them in the future.
§ Mr. FreemanI am grateful to my hon. Friend for bringing that interesting fact to my attention. If we receive Parliament's permission to proceed with the initiative, we do not expect that the hospitals and other units announced this summer will comprise the full and definitive list. If Wrightington is not in the first wave, in the fullness of time we expect that it, together with all other establishments having the proper qualifications, will be included in what will be an experiment of great value to hospitals throughout the country.
My hon. Friend referred to our inability to allocate an extra consultant to Wrightington hospital. It would not be helpful or constructive if I sought to justify that action. Suffice it to say that that decision was made by the Department and not individually by Ministers, which was the right way to proceed. We received twice as many bids as there were available consultants, so we were to some extent constrained by the number of qualified senior doctors able to become consultants. However, I understand my hon. Friend's specific point concerning the need for additional help in respect of upper limb surgery, which I shall bring to the attention of my Department's officials. I had not fully appreciated the point that my hon. Friend made.
I may be able to give my hon. Friend some further encouragement in respect of the hospital's waiting list. Over the past three years, we sought to concentrate waiting list moneys on reducing the number of patients waiting for operations for more than 12 months. That was our top priority. We know that such patients numbered 628. 1532 I understand that the region has allocated some £431,000 to the district health authority over the past three years to treat 761 more trauma and orthopaedic patients, 500 of whom will be at Wrightington. In 1990–91, some £77,400 is being allocated to Wrightington as bridging money until Mr. Yates and his team make up their minds about any further allocation of funds to the hospital. That money will permit another 45 knee or hip operations, and another 25 upper limb operations.
John Yates looks after a special fund: £12 million has been set aside to be allocated nationally, following an examination of all the waiting lists in every district specialty by the management team from the inter-authority comparisons and consultancy unit, led by Mr. Yates. The valuable work started by the team in 1989 will continue this year. I understand that it is now considering a bid from the district for some £232,000 to carry out 135 more knee and hip replacement operations and 75 more upper limb operations, and I know that it will consider the bid very carefully.
It will take full account of the specialist nature of the work undertaken, and will know that the management executive led by Duncan Nichol is taking a particular interest in the number of hip replacements to be achieved in the North Western region this year. I understand that the team will meet the district chairman and managers in May to discuss the bid. Mr. Nichol will be interested in how it proceeds, and so will I.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes past Eleven o'clock.