CLASS XIII, VOTE I

HC Deb 04 July 1991 vol 194 cc503-35

Motion made, and Question proposed, That a further sum, not exceeding £9,962,627,000, and including a Supplementary Sum of £162,196,000 be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payments during the year ending on 31st March 1992 for expenditure by the Department of Health on hospital, community health, family health and family health service administration services, and on related services.—[Mrs. Virginia Bottomley.]

Mr. Deputy Speaker (Sir Paul Dean)

With this, it will be convenient to discuss also the next estimate on the Order Paper under class XVI, vote 8: That a further sum, not exceeding £697,400,000 and including a Supplementary Sum of £10,291,000, be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Welsh Office on hospital, community health, family health (part) and family health service administration services and on related services.

7.36 pm

Mr. Nicholas Winterton (Macclesfield)

I am pleased to initiate a debate this evening under class XIII, vote 1 and class XVI, vote 8 on waiting lists in the national health service and to enable the House to debate a report of the Select Committee on Health on waiting lists and waiting times.

Waiting lists for treatment have been a feature of the national health service since its inception in 1948. In a cash-limited system such as the NHS in the United Kingdom, waiting lists represent the main rationalising mechanism for reconciling supply and demand. While actual list sizes are of legitimate concern, not only to the House but to people outside, the more important issue is the time that people have to wait for their treatment. In theory, waiting lists are for only elective, non-emergency cases which are ordered in relation to a doctor's assessment of clinical priority. The lower the priority of an individual's condition, the longer that individual is likely to wait for treatment.

The most recent validated figures from the Department of Health show that at the end of September 1990 almost 750,000 people were waiting for in-patient admissions. In addition, slightly more than 210,000 people were waiting for day case admissions. In my view and that of the Select Committee on Health, strong measures are required to reduce those lists and, more importantly, to reduce the time that people have to wait for treatment.

The figures also show that, of all those waiting for treatment in September 1990, more than 200,000 people had been waiting for more than one year and more than 70,000 had been waiting for two years or more. Those are stark but important statistics.

In its first report since being formally instituted in January this year, the Select Committee on Health described the potential consequences of long waiting times as follows: People may lose their jobs as they may have to wait longer than their sick pay conditions entitle them to; others may have to give up their jobs to look after a relative who is waiting for an admission; some people may experience a further deterioration of complication in their conditions. This may add to eventual financial cost to the NHS as they may then require even greater levels of medical intervention. I am sure that my hon. Friend the Minister for Health properly understands that. The report continues: People waiting for admissions represent a continuing cost to the health and social services: community nursing visits, prescription charges, sick pay, GPs' time, social support in people's homes all continue as the person waits. We concluded in paragraph 6: The human misery and financial cost of long waiting lists is impossible to quantify. The Committee also found unacceptable variations in the size of lists and in the time that people had to wait for treatment, depending on which region, district, hospital, specialty or consultant a person was referred to. Those variations could not be explained by differences in need between different places. We therefore inquired into the steps that the Government are taking to reduce the size of NHS waiting lists and, more importantly, to reduce the time that people have to wait for treatment.

Mr. Christopher Gill (Ludlow)

When my hon. Friend's Committee considered the different factors that might have affected waiting lists in different areas, what investigation did it make into the quality of management in different health authorities?

Mr. Winterton

That is an important point and I hope to answer it in my speech. I am about to refer to it en passant in relation to my area. Perhaps good management has a part to play in reducing waiting lists. I refer first to the Mersey regional health authority. I do not always see eye to eye with its chairman, Sir Donald Wilson, but I must give him full credit for the excellent work that he and his staff in Mersey have done to achieve the lowest waiting lists in the country. He deserves congratulations on that.

I know rather more, however, about Macclesfield health authority than about Mersey. Macclesfield's waiting list record is one of the best in the Mersey region. I pay tribute to the district general manager, Mr. Bill Dobson, and to the chairman of the health authority, Mr. Peter Hayes, who has done an amazing job. I quote from the Macclesfield Express Advertiser: Health Minister, Mrs. Virginia Bottomley, recently gave Mersey region credit for having done more to reduce its waiting lists than any other region, having no-one waiting more than two years". In Macclesfield we have gone one step further. According to Mr. Dobson, 'We now have only two people on our waiting lists who have been waiting longer than 18 months and I expect that figure to go down again very soon.' But there is no room for complacency … We should continue to monitor waiting lists closely. Our next target is to have no one who has been on a waiting list for treatment in Macclesfield longer than 12 months. To return to the point made by my hon. Friend the Member for Ludlow (Mr. Gill), good management did play an important part in Macclesfield in reducing waiting lists and waiting times, but I would not be allowed to get away with saying that without adding that, possibly in most areas, additional resources could also make a large contribution to further reductions in waiting lists and times.

I should also pay tribute and express my thanks to our specialist adviser, Dr. Steve Engleman, for his help in this inquiry into waiting lists and times. I am also grateful to our specialist adviser Gregor Henderson who has done exceptionally good work for the Committee. The Committee is also grateful to Mr. John Yates of the university of Birmingham's Inter-Authority Comparisons and Consultancy for his frank and thoughtful evidence to the Committee. I do not think that we have ever been given such competent, informed, and well-researched evidence.

The Government published their reply to our report on Tuesday 2 July, just two days ago. They said in their introduction: The Committee's report makes a number of helpful comments on how waiting fists and times might be reduced. Most of these are firm policy: others are being considered carefully. That is encouraging to the Select Committee and we are especially pleased that the Government have accepted 13 of our 22 recommendations.

There are five areas in our report and the Government's reply to it to which I wish to draw the attention of the House. The first I call, "Leaving things to the district health authorities." The Government agree that the validation of waiting lists is a normal part of waiting list management, but in some circumstances extra resources may be required for information systems and clerical support to help some specialties to validate their lists effectively. These extra resources may not be easily identifiable from within a district budget. The Department should therefore give districts support to ensure that the people responsible for validating waiting lists do not start from a disadvantaged position.

We were pleased to see that the Department is encouraging the development of more day case work, but, as we pointed out in the report, a further shift of resources to more day case work will necessitate further strengthening of primary and community health care services. We look to the Department to ensure that its monitoring of health authorities is capable of assessing the implications of the shift to more day case work for primary and community care services.

Similarly, it is not enough to say that health authorities are responsible for the provision and organisation of services to meet the health needs of their resident populations when central help can be provided by the Department to help them in that task. For example, we believe that the Department should investigate the likely cost-effectiveness and impact on services, in both urban and rural areas, of providing out-patient clinics in different specialties in community and primary care settings. We call on the Government to fund assessments of cost-effectiveness in this area and then to disseminate the relevant experiences.

When we visited Huntingdon we found that consultant obstetricians from Hinchingbrooke hospital are conducting out-patient antenatal clinics in GPs' surgeries every week. Other districts can learn from such examples and then apply what is relevant to their local needs.

Districts also need help in dealing with problems caused by the few consultants who, regrettably, do not pull their weight in their national health service work. Everyone is aware of the local effects of that and of the money wasted if a consultant is suspended while a long inquiry takes place. We recommend that the Department carry out a study to try to determine the influence that private practice in the same unit or specialty has on the time people have to wait for NHS treatment. Unfortunately, the Government rejected that recommendation as they were unsure of what it would achieve. They told us that it is up to the district health authority to ensure that consultants match their service contracts to their job plans. That, however, is a difficult task, since districts hold only consultants' job plans, not their service contracts—they are held by the region. Of course, trust hospitals employ their consultants directly. May I suggest to Ministers that consultants' service contracts in directly managed units be held by the hospitals concerned, not by the regions?

The Select Committee of which we used to be part, the Social Services Select Committee, made that recommendation in more than one of its reports. I reiterate our recommendation that a study be carried out on the influence, if any, of private practice on waiting times. We believe that most doctors would welcome such a study.

I should like to make one further point connected with the Government's reply to our conclusions on the effect of private medical practice. It concerns the Government's choice of words, and I quote from their response: Management is also responsible for ensuring that private practice does not, to a significant extent, interfere with the performance of the functions of the health service or disadvantage non-paying patients. Surely that should read "to any extent". I should welcome an assurance on that.

The second area requiring immediate and careful attention is money. The Government rejected our calls for more resources to reduce waiting lists and times. The central allocation of money to this year's waiting list initiative was increased in cash terms in 1991–92 by £2 million—from £33 million to £35 million. Some £25.5 million of that will be paid to regions only if they achieve the targets that they have agreed with the NHS management executive. Regions have also to match the central contribution of £25.5 million pound for pound from their own resources. That effectively removes £25.5 million that could be spent by the regions on other services.

Targets have to be met before any money is paid up front, and there is a chance that central expenditure for 1991–92 on the waiting list initiative will not be as high as last year. An assurance about that would be helpful. Paying money only when targets are met reduces the perverse incentive for specialties to increase their lists to attract more money. It does not make adequate provision for paying money up front to help specialities reduce their lists in the first place.

Our report recommends that some waiting list money should be kept aside to reward good practice. We made that recommendation after hearing the views of Mr. John Yates, whose work in reducing the worst waiting lists has rightly been commended by the Government and the Committee. Mr. Yates thinks that hospitals or specialties should be given an incentive—a good practice bonus for specialties or authorities that keep their lists down. We call that a preventive incentive scheme aimed at preventing waiting lists and waiting times from rising in the first place by rewarding those who manage their specialties effectively.

Sadly, the Government's reply to our report failed to respond to that recommendation and I invite the Minister to respond in her winding-up speech. However, the Government's reply states that they are considering future initiatives for tackling waiting lists and times and their funding. We would welcome clarification about when we will know what those initiatives are and whether they will involve more resources which, as I said earlier, are necessary to deal with the problem. An announcement today about more resources to reduce waiting lists and times would be welcome news not only for the thousands of people on the waiting lists, but for doctors who are constantly required to arbitrate between patients with similar clinical needs, one of whom may be seen the following week while the other cannot be seen for six months or more.

The third main area is that of extra-contractual referrals. I am confident that the hon. Member for Preston (Mrs. Wise) will have more to say on that matter if she speaks in the debate. The Committee heard evidence that where there are block contracts between health authorities and provider units and when the health authority has set aside a small reserve for extra-contractual referrals, GPs have a restricted choice about where to send patients.

A new sort of waiting list may be appearing consisting of patients who could be treated immediately outside their districts but who are having to wait for treatment, not because the hospital concerned cannot treat them immediately, but because their district health authority has not kept sufficient money in its back pocket to pay for that treatment in the current financial year. I hope that the NHS reforms will not simply replace one sort of waiting list with another.

The fourth area of concern to the Select Committee is the monitoring of NHS reforms and the information that will be made available. The Government responded to the Committee's concern that close and careful monitoring of the reforms should take place by citing the work of the six NHS sites which are working with the management executive on assessing the local impact of reforms. We all eagerly await some feedback on the lessons to be learnt from Cornwall and the Isles of Scilly, Halton in my neck of the woods in Cheshire, St. Helens, Knowsley and Warrington, which is close to my area, Newcastle, Portsmouth, Wandsworth and West Dorset. When will those sites make their first reports to the management executive?

The Committee was pleased to hear about the establishment of a joint NHS review committee with the general medical services committee. However, we are not sure of the purpose and authority of the committee that has been established. Will it monitor and evaluate the reforms, or will it be a forum only for raising and discussing issues that arise from the reforms? If it is to be the former, evaluation implies that a judgment will be made at the end of the exercise on whether the venture has been successful and is worth continuing in its present form. The Select Committee would welcome such an approach.

If that is to be the joint committee's purpose, what resources will be made available to it to enable it to carry out the required monitoring, research and evaluation? Further clarification of the Government's intentions in agreeing to the setting up of the new joint review committee is needed to give a clear sign that the Government intend to develop a more meaningful relationship with the profession than has been possible in the past.

We were also concerned that information on waiting lists and waiting times should not be restricted to collecting only purchaser-based figures. The Committee viewed that as important and took the view that information on waiting lists and times should continue to be collected and disseminated for each provider unit. If that is not done, how will GPs and, much more importantly, their patients, the clients, be able to compare the waiting times of different hospitals and exercise choice about where to go for treatment? If the Government proceed on the lines that they imply in their reply to our report, the philosophy behind the reforms will be negated by Government action.

The Government say that people should have more choice. However, they must have the proper information on which to base that choice. That is why we need not only purchaser-based figures but provider-based figures. I hope that on mature consideration the Minister and her Department will assure the House that that is the future intention. We hear a great deal and speak a great deal about the Prime Minister's citizens charter and what I have asked the Minister to do is entirely in accordance with the concept of that charter. I hope that in her winding-up speech the Minister will give the Committee and the House the assurances that I seek.

Finally, our report on waiting lists raises the need for a wide and open public debate about what the NHS can and should do. We are worried that the reformed NHS may lead to unplanned changes or inequalities in access to health services. We need to ensure that the NHS continues to deliver a national health service that meets the needs of all our people in a co-ordinated and planned way. We were concerned that the reforms might not succeed in reducing waiting lists and times for treatment to a manageable and reasonable level because of an inability to face the key question of how to meet the demand for services from limited health resources. We were also concerned that the new arrangement of purchasers and providers could lead to the stage at which people were waiting not only for treatment but for money.

The logical outcome of the NHS reforms is that the responsibility for waiting lists will shift from hospitals to general practitioner fund holders and district health authorities. I hope that that does not mean that the period that a patient waits for treatment will be determined solely by the amount of money left in the authority's or general practitioner's kitty. I look to the Government to continue to target their waiting list initiative in such a way that, wherever possible, patients in need of treatment can be promptly admitted to a hospital as a day case or on an in-patient basis as required.

I hope that my hon. Friend the Minister for Health will consider that the Committee's report is sound and well-researched and that the views that I have expressed on behalf of the Committee are constructive and merit the Government's serious consideration. I hope that I shall receive some reassurances when my hon. Friend contributes to the debate.

8 pm

Mrs. Audrey Wise (Preston)

When talking about waiting lists, we need to bear in mind exactly what we mean by the term. Waiting list figures are serious enough but there is what might be called a hidden waiting list. As a patient is considered to be on a hospital waiting list after the first visit to a consultant, we ignore the many months that the patient may have waited between the general practitioner's referral and the visit to the consultant. I endorse everything that was said so well and clearly by the hon. Member for Macclesfield (Mr. Winterton), but I sound the warning that waiting-list figures, serious though they are, underestimate the extent of the problem.

General practitioners are aware that there are long waiting lists in certain specialties or in certain areas, and that it may be necessary for a patient to wait a long time to see a consultant for the first time. That can act as a profound disincentive to a GP to make a referral. Once he tells the patient that he wants to send him to a hospital, he knows that that patient will be on tenterhooks while waiting for the visit and wondering what the outcome will be. Accordingly, the GP may be strongly inclined to delay referral, if that is at all possible. That can happen if someone is suffering from cataracts, for example. The temptation not to refer is a strong one.

We should not forget that there are two layers, as it were, before we reach the waiting list proper. I have noticed also that there is a tendency to use the term "elective surgery" as if that means that someone can take it or leave it and that the surgery is an optional extra in someone's life. I fully accept that those who go on waiting lists are not suffering from conditions that require emergency treatment. If someone is knocked over or he or she falls in the street, or is involved in some other accident that requires emergency treatment, he or she will be taken to hospital immediately and treated. We are all extremely proud of the national health service's record in providing that sort of treatment, and grateful for it. However, someone can suffer from a condition that is extremely important to him or her even though it cannot be described as one that requires emergency treatment. The use of the term "elective surgery", the tone in which it is uttered and the context in which it is used, often underestimates the vital part that the appropriate treatment can play in people's lives.

Cataract operations are described as elective surgery, as are hip replacements. People who need the operations to be carried out can languish in waiting lists for a considerable time, during which they can involve various public services in considerable expense. Those who find themselves in that position suffer considerable misery, distress and anxiety. Elective does not mean unimportant.

Waiting lists have been long in the north-west but I am glad to say that there are improvements. However, one or two matters still concern me. I have been reading a document that was published by the regional health authority in March 1991. It contains a column that sets out reductions in waiting lists, which is headed "Waiting Lists Reduced". The document states that the region's total waiting list stands at 87,579. The list has been reduced, but it is still considerable. The document states: It is an encouraging sign that the majority of these patients have been on the list for less than a year, with 12 per cent. waiting over a year"— that is more than 10,500— and only 6 per cent for more than two years. The word to which I wish to draw attention is "only". When "only" precedes 6 per cent., it means that 5,255 people have been waiting for more than two years. A reference to "only 6 per cent." may give the impression that only a few people are involved, but 5,255 sounds a lot more. If they have been waiting for more than two years, for how long have they been waiting?

A young woman in my constituency—I shall not name her for obvious reasons—has been waiting for surgery since 1984. The term "over two years" can hide a waiting time that is considerably longer than two years. It is significant, however, that the specialty involved is plastic surgery. There are many who choose to think of plastic surgery as an optional extra and as something that is not especially important, and in doing so they often make a grave mistake. The young woman who has been waiting since 1984 wrote to me in the autumn of 1990—she is still waiting—and explained the position. She wrote: I was assaulted in 1983. My nose was broken. I have recently had an operation on my nose to help me breathe easier as I could not sleep properly at night. She waited several years for an operation to help her to breathe properly after a criminal assault. Her letter continues: But I still need plastic surgery on it for my appearance. I am 28 years old now. I do not have a social life as I have lost my confidence due to my nose. When she saw the plastic surgeon shortly before writing that letter, she was told that she might still have to wait a further three or four years. I think that she is reasonable when she writes: I think this is ridiculous as I was the innocent party in this assault. If someone suffers a criminal assault we are all extremely sorry and we wish to see the assailant brought to justice. Surely we have some further responsibility to the victim. It is ridiculous and disgraceful that my constituent has had to wait so many years because she requires plastic surgery. I have now been informed—naturally I am in contact with the health authority about the matter—that it is hoped that she will be seen in the next financial year. That is progress. It is better than three or four years. But I am still deeply distressed on behalf of that young woman.

In the Preston health authority 1,010 people have been waiting for plastic surgery for more than two years. I have given one example. In case people are tempted to think that these are cases where, for example, a person goes along for plastic surgery having been foolish enough to have a tattoo saying "Judy" and is now going out with a young lady called Carol, I remind the House that before those 1,010 people got on the waiting list they had to satisfy their general practitioner that the treatment was necessary and proper for the NHS and they had to satisfy the consultant likewise.

It is reasonable for us to assume that those 1,010 people who have waited more than two years are genuinely waiting for clinically necessary treatment. I deplore any suggestions—they are sometimes made—that because a specialty is plastic surgery it somehow does not matter that there are these outrageous waiting lists.

Extra-contractual referrals have been mentioned and I certainly intend to say a word about them. That issue was raised with the Secretary of State when he was being cross-examined on the Department's spending plans in general. On that occasion I quoted from advice, perhaps better described as instructions, to general practitioners in the Preston health authority area that extra-contractual referrals could be authorised only after reference to the health authority, and general practitioners were advised that previous consultation about the case was desirable in order to avoid the "embarrassment" of having "to defer or even reject" the extra-contractual referral.

In response to my complaint about that, the Secretary of State said that the clinical judgment of where, when and if to refer a patient remained with the general practitioner. However, he somewhat undermined that welcome statement with the qualification that the health authority might have to defer the referral. Clinical judgment which can be exercised but which can then be deferred by the health authority is the exercise of clinical judgment in theory only and that is no use to any patient. If a patient is referred by a general practitioner outside the health authority's contractual area, that patient wants to have the consultation and the treatment if appropriate. It is no earthly use to that patient if the referral can be deferred, and it may mean deferred indefinitely, by the health authority.

Mrs. Alice Mahon (Halifax)

My hon. Friend makes a good point. Just today I received a letter from my district health authority's general manager giving me the reason for refusing 18 extra-contractual referrals and one of them was the refusal of a general practitioner referral direct to Leeds for in vitro fertilisation treatment because Calderdale has a contract with Hull. It said that charges can be accepted only if referred through a Calderdale consultant.

Mrs. Wise

I am grateful to my hon. Friend because that is another example from an entirely different area of the restriction of the general practitioner's exercise of his clinical judgment; a refusal to allow a GP to exercise clinical judgment. It is valueless for the Secretary of State to tell general practitioners that these judgments can be made by them if in practice no such thing can happen.

In reply, the Secretary of State said that we are used to waiting lists and that this is simply a waiting list. I find it deeply disturbing that we are contemplating the creation of yet another layer of waiting lists. I hope that the Secretary of State and the Minister for Health will look carefully at this and will not be content with empty words.

We should take care in relation to one of even the Select Committee's recommendations. The Select Committee's recommendations are, as always, excellent, but it has been drawn to my attention, and perhaps to that of other members of the Committee, that recommendation 7 concerning the South Western regional health authority's efforts to replace waiting lists by new arrangements giving all patients booked appointments may have many pitfalls.

Therefore, when recommendation 7 says: We recommend that the NHS Management Executive study closely the progress of such efforts, I hope that in doing so they will also study the exact working of such efforts to ensure that they are not just another method of causing problems for general practitioners and their patients.

Recommendation 12 refers to day case work which the Select Committee and the Department think is highly desirable. However, the Select Committee makes the vital point that: This will necessitate further strengthening of primary health care services and substantial improvements in community health systems and services to enable people to be discharged from hospital earlier and supported in their own home environment. One of the things that I am sorriest about is that I see no evidence of any such improvements. We cannot come to a satisfactory solution of waiting list problems or health service problems without carrying out the recommendation contained in that sentence.

8.18 pm

Mr. Jerry Hayes (Harlow)

I admire, like and respect the hon. Member for Preston (Mrs. Wise)—I hope that that does not do her political career too much damage —but it is not right for her to say, as she did a moment ago, that there have not been improvements. There have been significant improvements in waiting lists. I will explain to the hon. Lady in a moment where they have been. They have been widespread.

Mrs. Wise

I did not say that there have been no improvements; there have been improvements. I acknowledged that there have been improvements.

Mr. Hayes

I am grateful. I completely misunderstood what the hon. Lady said. I am delighted that she accepts that there have been improvements. It is very easy for Conservative Members to tell people that we are spending more on health than any other Government, which is true; that for the first time we are spending more on health than on defence, which is true; that we are spending about £33 billion per year on health compared with £7.5 billion in 1979, which is true. It is true also that waiting lists increased by 40 per cent. under the last Labour Government and have fallen by 6 per cent. under the present Government. However, that does not cut a lot of ice with our constituents, for whom the measure of the health service is not the amount of money that is spent on it—important though that is—but the treatment that people receive and the relief from pain and suffering that the service provides.

In the eyes of the electorate, the measure of the health service is its success in getting people off the waiting list who should not be on it. All right hon. and hon. Members can tell appalling stories about waiting lists. I await with interest the speech of the hon. Member for Peckham (Ms. Harman), who is Labour's health spokesman. How is it that, under every Labour Government, waiting lists increased, whereas they have decreased under every Conservative Government?

The recent April-on-April figures look much better than some of us ever imagined. The number of persons waiting for elective surgery for more than a year has fallen by 19 per cent.; and for longer than two years by more than 39 per cent. That is incredibly good news. People may say that that is not the case in their areas. I hope that it will not be too tedious if I give the figures region by region, because the public should know them.

Those who have been waiting for more than two years for elective surgery in the Northern region has fallen by 47.9 per cent.; in Yorkshire, 18.1 per cent.; Trent, 87.4 per cent.; East Anglian, 24.5 per cent.; North West Thames, 22.3 per cent.; North East Thames, 58.3 per cent.; South East Thames, 30.2 per cent.; South West Thames, 50.1 per cent.; Wessex, 30.2 per cent.; Oxford, 31 per cent.; South Western, 19.8 per cent.; West Midlands, 32 per cent.; North Western, 45.9 per cent.; and Mersey, 100 per cent. Thank goodness one public service in Merseyside is working—and it is not surprising that the people who run it were appointed by a Conservative Government. However, the polling stations in Walton are just about to close, and no one voting in by-elections pays the slightest attention to what is said in this place anyway.

People should know that there is good news. We always hear good news from my hon. Friend the Member for Macclesfield (Mr. Winterton), who spoke of the great strides forward in his area—which is doubtless partly due to his splendid advocacy. In 1979, the number of people on the waiting list in his constituency was more than 1,000, but the figure today is fewer than 120. That may be rough on the 118 individuals concerned, but it is still a tremendous achievement. Why not give credit where it is due?

Mr. Gareth Wardell (Gower)

I refer the hon. Gentleman to page 31 of the Select Committee's report, which shows waiting list statistics for in-patient admissions in England in respect of those waiting more than one year. If one compares September 1986 with September 1990, one sees that the figure for the Northern region, for example, increased from 6,426 to 7,264; for East Anglian, from 6,793 to 8,650; and for North West Thames from 10,837 to 12,632. I will not continue, because I might then have to truncate my speech.

Mr. Hayes

The hon. Gentleman may not be called, if he goes on. I was making the point that many more people are being treated under the present Government than ever before. It is good to see a Select Committee report so universally welcomed by the Government. It prompted so many responses of "agree" and "entirely agree" that I could not believe my ears. If there is good management, and if funds are used properly, waiting lists can be significantly reduced.

I was delighted to see from the Government's response that clerical validation, which is an aspect to which more thought ought to be given, has increased by 52 per cent. We can do better than that. In his evidence to the Committee, Duncan Nichol said: I was talking this morning with general practitioners in Oxford; they had secured their waiting lists from the hospitals, got their patients who were currently waiting back in front of them and they had gone through this list and removed 34 per cent. of the patients that they knew did not require to be on that waiting list. That is a remarkable reduction. Validation should be not just 52 per cent. but 100 per cent. Inter-Authority Comparisons and Consultancy wrote: Some of the failures to validate lists properly almost defy belief. When the largest single surgical list in the country was validated in 1989, 4,000 were written to from that one specialty alone. One half of the patients did not reply at all and a further 450 patients asked to be removed from the waiting list. By the time the validation was completed only 35 per cent. of those written to remained on the list. In another specialty all general surgical patients were written to in two successive years and on both occasions all the patients who failed to reply were left on the waiting list. An enormous amount of work remains to be done on that aspect. It may be boring, painstaking and clerical work, but it must be done.

The fact remains that national health patients are operated upon far more quickly than in the past. I am delighted that the Government are spending more money, and I am sure that all right hon. and hon. Members share my view.

In today's issue of The Independent, its political correspondent, Nicholas Timmins, who is an expert on health matters, writes that the Government are to cease publication of hospital waiting lists. No doubt the hon. Member for Peckham will say that that is because the waiting lists are so rotten and miserable. The truth is that far more information about waiting lists is to be given by the Government than ever before. Mr. Timmins knows a great deal about health matters, and I do not mean to be difficult, but I refer him to the final paragraph of the Government's response: We shall continue to publish waiting list and time figures, as we have done since 1984. In the short term, figures will be published on both a provider basis, as now, and on a purchaser basis. In future, we will publish purchaser-based figures, as these will reveal health authorities' performance in purchasing early treatment for their local populations. The hon. Member for Peckham is always announcing new policies, but she may be afraid that my right hon. and learned Friend the Chief Secretary will cost them. On the other hand, we hear from Labour that it will not spend more money on the health service. Nevertheless, we want to hear what the hon. Lady has to say about how Labour will reduce waiting lists, and improve hospital efficiency and management.

In health care today, money travels with the patient. For the first time, hospitals will have an incentive to produce effective, quality contracts, and to perform operations as quickly as they can. There will be a financial incentive for not just health service trust hospitals—which will be opting out of nothing except bureaucracy—but all others to publish the maximum information, so that the public can make the right choice. We know that the Opposition do not believe in choice, unless it is choice for a little more money for NUPE and COHSE and £175 million for the minimum wage for the NHS. All that will not help patient care [Interruption] The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) suggests that I should get on with it. He is right. He talks a lot of common sense some of the time. I should not be too unkind to the hon. Member for Peckham. She will have the opportunity to put her case. It is nonsense to say that there will be insufficient information—quite the opposite.

While I am on the question of national health service trust hospitals, I hope that the hon. Member for Peckham will have the grace to say that all the talk about profits before patients and all the talk just about profits is not true. She was a member of the Standing Committee that considered the National Health Service and Community Care Bill which is now an Act. She knows that it is unlawful for any NHS trust hospital to make a profit. I hope that, once and for all, she will have the grace to put the record straight.

As for the publication of information, the Audit Commission has done a fantastic job. All the members of the Select Committee were very impressed by the evidence it gave us. Within one year, it has produced a health and financial profile for every single district. I should like the Government to consider carefully the fact that these profiles are not in the public domain. They should be. The Audit Commission put forward all sorts of ways in which the national health service could use its resources far more efficiently. Many of the Select Committee members would like the Audit Commission to extend the scope of its investigation into the national health service.

Our report referred to the importance of day surgery. The Select Committee has just returned from Sweden. The hon. Member for Ross, Cromarty and Skye has one of those looks that suggests something that did not happen. It was a perfectly respectable and sensible visit to Sweden.

We visited one of the finest hospitals that Sweden, and Stockholm, has to offer. The members of the Select Committee found in that plush hospital that the walls were almost lined with money. It should not be forgotten that we were in a socialist mecca. Lots of patients were being treated; there were hardly any waiting lists; there was an air of hushed excitement and expectancy among administrators and doctors; they were treating more and more people.

We said "What's the secret of your success?" "Actually," we were told, "we have removed one tier of management—the politicians; we have got rid of them. We have brought in industrialists to help to run our hospitals." "Oh," said some of the members of the Committee, "how very interesting." "Also," said the administrator, who is also a professor, "we are going to be in competition with other hospitals. You know what?" he said: "it's very exciting; we're going to have to work to a budget." We realised, in this mecca of socialism, that the finest hospital in Stockholm and in Sweden was effectively a national health service trust hospital. It was only nine months behind the reforms that this Government have introduced.

One of the members of the Select Committee said, "This is a spotlessly clean hospital; you must employ lots of people to keep it clean." "No," said the administrator, "We put all that out to private tender some time ago." If that is good enough for socialist Sweden, it is good enough for us. Despite all the problems, the Government have nothing to be ashamed about in waiting lists. We need a little bit more money to reduce them, but the figures that have been published are very good news.

It is also good news that, at last, the British Medical Association is beginning to appreciate that many doctors are queuing up to become fund holders. That is why there has been a change of mood. NHS administrators are beginning to realise that these reforms are very good. At trust hospitals such as Guy's, doctors and nurses are treating more and more patients than ever before. That is what the reforms are all about. I hope that we shall hear about what the Labour party intends to do.

8.35 pm

Ms. Harriet Harman (Peckham)

I intend to concentrate on the excellent report that the Select Committee has produced and on the Government's response to it. This is an important debate. The Committee produced an important and weighty report. I welcome the chance to debate it. I welcome also what was said by way of introduction by the hon. Member for Macclesfield (Mr. Winterton), the Committee's Chairman, who was supported by my hon. Friend the Member for Preston (Mrs. Wise). The fact that they chose the waiting list issue for their first report shows a sharp sense of priorities. Waiting times are the major source of complaint.

Most people are happy with the care that is provided by the NHS. They have great affection for it and they support it. However, people are very worried about waiting times. The hon. Member for Harlow (Mr. Hayes) thinks that it is just a clerical or a statistical issue. He produced loads of statistical and clerical figures in an effort to suggest that this is all a figment of our imagination. Whatever the figures may suggest, if one goes into the orthopaedic ward of any hospital and talks to the people there, following surgery, they say, "Thank goodness I've had my operation. Yes, I'm getting on really well and beginning to look forward to the future, but it has been the most terrible thing to have to wait for my operation." Then out pour stories of family relationships broken, of the husband having to move into another bedroom because his wife has been unable to sleep for month after month and therefore argues with the children, of someone who has lost his job because he has been off work sick for so long waiting for his operation that he feels, when the firm hits hard times, that he cannot stand in the way of others who might be made redundant if he does not stand down from the firm.

Mrs. Mahon

The one statistic that the hon. Member for Harlow (Mr. Hayes) did not give was the number of people who had been in so much pain that they decided to pay for a hip operation. It would have been interesting if he had referred to every district and said how many people had been forced by pain to pay thousands of pounds for a hip operation.

Ms. Harman

My hon. Friend has made a very important point that I was about to make. We are talking not just about statistics but about people who are waiting in pain for their operations, about people who lose their jobs because they cannot get around and also about people who become immobile, even when they have had their operations, because they had to wait for it for so long. They never made the complete recovery that they would have made if they had had their operations when they needed them. I support the point made by the hon. Member for Macclesfield in the Committee's report, that the human misery and financial cost of long waiting lists are impossible to quantify. That is the starting point to which we must continue to return.

In addition to the pain, misery and financial cost of long waiting times for individual patients, there is also anger that, having paid their national insurance and taxes, the national health service was not there when they needed it. There is also bitterness because people know that, if they could go private, they could be treated the following week and would not have to wait. It is not fair that only those who can pay again, having already paid through their national insurance and taxes, should get the treatment when they need it.

As the hon. Member for Macclesfield said, it is inefficient to treat people long after they need their operations. We should think of the work and the time that is lost to industry, and of the fact that an operation often needs to be larger if it is delayed—for example, hip operations. We should also think of the people who, after waiting immobile for a year and a half, never really get the courage to re-enter life in the outside word, even after they have had their operation and have regained their physical mobility. That recognition of the cost of long waiting lists is one of the reasons why so many employers offer health insurance to their employees. It is not as a perk to their staff, but because they cannot afford to have their employees off sick for a long time while they wait for operations.

About 93 per cent. of the people on waiting lists are classed as non-urgent cases, but we should not be complacent. I reinforce what was said by my hon. Friend the Member for Preston about calling it "elective surgery". We are referring to people waiting with failing eyesight for cataract operations or those who are waiting for hip replacements. The idea of non-urgency is a strictly medical definition about whether someone is likely to die, rather than whether he needs the surgery. Doctors are not gung-ho about surgery. People are not put on to a list unless they need an operation. An operation is always a significant step for the individual, quite apart from the background of a lack of resources or beds. People are not put on lists without a second thought.

The numbers waiting more than two years have dropped, but worryingly the numbers waiting for more than a year have increased from 161,326, to 172,025. The problem of waiting is endemic. It is not a question just of local efficiency—of some areas not getting their act together—or of a lack of information—that if only people knew where to go to get the operation matters would improve. As the figures in the report show, 23 per cent. of people are waiting for more than a year. The problem does not affect only in-patients; day and out-patients are also waiting for treatment.

Part of the Government's response is to imply that there is a lack of information, and that if there was more information about where people could get treatment quickly they would travel there and there would be less of a problem. The College of Health initiative—the national waiting list help line—shows, not surprisingly, that most of the calls are from people who need operations for which there are long waits in all areas. From the figures, we can see that about half the calls were from orthopaedic patients, most of whom were waiting for hip or knee replacements. Incidentally, a great many people were not able to get through when the lines were first opened because the lines were jammed. The next largest group were waiting for general surgery, such as hernia operations. After that came those wanting cataract operations and then those waiting for ear, nose and throat services, such as grommets for children with hearing problems.

Faced with so many people calling about general surgery or orthopaedic services, it is worth examining the waiting lists for those services to see whether the problem can be dealt with by simply shifting patients from one area with long waiting lists to another area where there are not. The statistical section of the Library has kindly gone through the figures for me. If we examine the waiting lists for general surgery, trauma and orthopaedics, district by district, we see that all the districts have waiting lists. Large numbers of people are waiting for the same operation in every part of the country.

Mr. David Amess (Basildon)

rose—

Ms. Harman

Perhaps the hon. Member for Basildon (Mr. Amess) would like to know the figures for Basildon district health authority. It has a waiting list for general surgery, and for trauma and orthopaedics. If his constituents want to travel to find a place where they might find no waiting lists for those services, perhaps we cart hear from him, an advocate of the free market, where they can go to escape those waiting lists.

Mr. Amess

I thank the hon. Lady for that generous billing. I hope that when I catch your eye, Mr. Deputy Speaker, I shall be able to talk about Basildon. I have been following the hon. Lady's speech carefully. I know that she is anxious to make progress, and to tell the House how Labour party policy will address the gloomy situation that she is describing. How much extra money has the Labour party pledged to spend on the national health service, especially on hospital waiting lists? Could she give us that information a jump ahead in her speech?

Ms. Harman

I said from the outset that I would address myself to the report of the Select Committee and to the Government's response. I should be grateful if I could be allowed to carry on with my comments in that vein.

The Government's response is to imply that the problem is simply one of people not knowing where there are no waiting lists and that if people had the information and could ring the helpline, they could go where there were no waiting lists. I hope that the Minister will admit that for the things that the people are ringing up the helpline for there are waiting lists in all areas. The idea for them simply to travel is not possible. It will be a shame if the Government get into the business of raising people's hopes by saying that all that they need to do is to make a telephone call or a train journey, and the problem will be solved. It is deeper than that—the problem is endemic.

As has been pointed out, the problem will be that there will be less information as a result of the Government's intention to change the way in which waiting list information is collected. There will be less information about where the waiting lists are shorter. John Yates, commenting on the revelation that the Government are to change the way in which waiting lists information is collected, said in The Independent today: These changes undermine the Government's own reforms. If health authorities and fund-holders want to shop around for the shortest wait, they need to know how long the wait is at hospitals with which they don't have contracts. The Government have acknowledged that there is a problem with waiting lists. We need to have information on which to assess the position. The Government have admitted that there is a problem, yet they are ending the means by which we can measure progress. Not only are they ending the means by which they say that people can travel to where waiting lists are shorter, but they are ending our opportunity to compare year by year whether improvements are being made, or whether the position is getting worse.

The hon. Member for Harlow (Mr. Hayes) said that hospitals will publish their waiting lists. I hope that we shall have a more sophisticated response from the Minister because she will know that hospitals selectively publishing what they want to do as part of their sales patter is not the same as national Government responsibility for collecting information from all hospitals—those that want to reveal the information as well as those that do not. We cannot simply use information from an ad hoc marketing strategy as a substitute for nationally collected data, which we need to compare year on year. It is a cynical attempt to break the opportunity to compare because the Government think that things will get worse.

Mr. Alistair Burt (Bury, North)

Will the hon. Lady give way?

Ms. Harman

No, because I hope that I shall come to the problem that the hon. Gentleman seeks to address later in my speech.

Does the Minister really think that the problem is that people do not know where the treatment is and that, if they did, they could simply travel to it?

The other assumption lurking behind the Government's relaxed, laid-back complacency is that we are talking merely about inefficiency at local level and that, if we beef up the management, everything will be all right. They say, "Everyone should model themselves on the best, and the best have managed to crack the problem. If the problem has not been sorted out, there is clearly a problem with management at local level"—or "the bureaucrats", as I understand the Secretary of State now calls them.

A group of south London Members went to see the Under-Secretary about King's College hospital, which had 120 of its beds cut in the last financial year. People are having to wait longer for operations and people are even having to wait in the accident and emergency department because there are simply not enough beds available for them to be admitted to hospital even as emergencies. The Minister said, "King's cannot have the money to reopen its beds. The length of stay is too long." He took no account of the number of people in that hospital who cannot be discharged because the support services simply are not there.

The point that the Select Committee made in its report is critical not just because of the moves to day care and the placing of greater emphasis on out-patient treatment but because we need an effective and appropriate use of in-patient beds. We all know that some people are ditched out of hospital and suffer because the necessary support services are lacking. Others remain in hospital because they simply cannot be discharged. The hospital social workers at King's told me of a patient on an orthopaedic ward who was desperate to go home. He was growing -depressed because, although he had been officially discharged over a month before, he could not go home: the hospital simply could not arrange the necessary support services; there was simply not enough care and support available in the community.

In their response, the Government dealt with the matter in a narrow and shallow way. They said, "We expect health services and family health service authorities to take account of any increase in day case work when planning primary and community health services." That is not good enough, given that the support services are insufficient to allow people to be discharged when they need to be, let alone to cope with the welcome shift away from in-patient treatment to day-patient treatment. I hope that the Minister will show that she recognises the problem that already exists—quite apart from the growing problem. We are talking not just about the community nursing, psychiatric and chiropody services but about home helps, care assistants and all the other support services which should be there to enable the hospitals to do hospital work and people to be cared for in the community thereafter.

Even if travelling were the way to deal with the problem—if people could get an away-day ticket to the magical place where there is no waiting list— the Government should not be urging people in that direction. I thought that it was the Government's view—I thought there was a consensus—that treatment should be as locally based as possible so that, if there were post-operative complications, the patient would have an easy trip back to the person who had done the operation, to facilitate visiting and so that the patient could be discharged as early as possible because there was a close connection between the hospital and the community services. I do not accept the idea that people can get the information and then travel around but, even if I did, I would still be asking whether that is really the direction in which we should be going, especially as the operations for which there are long waiting lists—hip replacements and cataract removals—are mostly performed on elderly people who are the last people who should be shoved on a train and told to go somewhere else, even with the money following them.

The trouble is that the money will not be following the patient. When people rang the College of Health on the helpline to ask where the shortest waiting times were, they were asked, "Do you have a fund-holding GP, or are you one of the 90 per cent. who do not, because if you are, and if we suggest that you go to a hospital miles away from where you live, you may not be able to get financial approval from your district health authority for the referral." The problem is not just that there are waiting lists in all parts of the country and not just that people should not be forced to travel. The Government's reforms and the internal market will make it more difficult for people to cross boundaries for their treatment.

Mr. Hayes

No.

Ms. Harman

The hon. Gentleman says no. The point was well made by my hon. Friend the Member for Preston, who explained that the money for extracontractual referral is already running out and that the contract referral pattern sets in concrete existing local referrals. There are not contracts all over the place, so people are looking for extracontractual referrals and the budgets are already running out.

The Government have failed to solve the problem of waiting lists. We should bear in mind the fact that they have been the Government for 12 years. I hope that, instead of making cheap, party-political points about the unions, as the hon. Member for Harlow did, the Minister will deal with her own Government's record and with the important points made by the Select Committee.

There are three fundamental reasons why the Government have failed to deal with the problem of waiting lists. The first element is lack of political will. Although I do not believe this of the Minister, there are many in her party who would be happy to see NHS waiting lists grow because they know that that is the biggest boost that they can give to the private sector, and that affects the political climate in which the hon. Lady has to work. The No Turning Back group has made it clear that it wants the national health service to be reduced to an accident and emergency service and that it does not think it appropriate for elective surgery to be undertaken by the health service. I do not accuse the Minister of holding that view. She is one of the more reasonable members of the Government. Nevertheless, it is part of the political background against which we must measure the Government's failure to deal with the problem of waiting lists.

The second element in that failure is a failure also to face the underfunding that lies at the root of the problem. As long as the Government talk about clerical audit of the waiting lists, administrative changes and management, we know that they are ducking the issue and not providing enough resources.

Mr. Hayes

No.

Ms. Harman

John Yates himself recognised the importance of resourcing adequate services to meet demand. Clearly, the hon. Gentleman has not read his Committee's report.

The third element in the Government's failure to solve the problem is that at national, regional and local level, the national health service has been diverted away from the task of dealing with waiting lists and towards other tasks —commercialisation of services, opting out, the internal market and GP budget-holding. What are they talking about at every health authority unit general managers' meeting? Are they talking about reducing the waiting list? No, they are talking about how on earth they will cope with the administrative changes forced on a reluctant British people by the Government.

If the Government cannot acknowledge the great diversion of energy, effort and resources that the NHS reforms have entailed, and if they cannot acknowledge that that has prevented the NHS from dealing with the problems with which everyone wants it to deal, they are failing—and will continue to fail—to address the issues that the Select Committee has so sensibly and seriously put before the House.

8.58 pm

Mr. Alistair Burt (Bury, North)

I. am delighted to follow the hon. Member for Peckham (Ms. Harman) who finally reached the meat of the issue for some of us—although not all of us—when she referred to the reasons why she believed that the Government could not deal with the problem of waiting lists. If I remember correctly, her second point related to the underfunding of the health service. At that point 1, like many other hon. Members, was waiting for the hon. Lady to announce the figure by which she considers the health service to be underfunded and for her commitment to restore that funding under a future Labour Government. I waited for that information with bated breath, but there was nothing and 1 was not surprised about that.

The idea that the national health service is somehow safer with Labour is one of the longest running deceits in British politics. With no experience of reducing waiting lists and with no pledge to increase resources for the NHS, how does the hon. Member for Peckham expect to tackle the problem of waiting lists? We heard no answers tonight.

Once again a serious debate on the NHS has resolved itself to its component parts. While we heard the rhetoric from Opposition Members about their commitment to the health service, the facts make their commitment just an idle boast. It must be rather depressing for them. Whether on the number of staff employed, on capital expenditure or patients treated—whatever the form of level playing field or horizontal operating table upon which the debate is to be conducted—the Opposition always come out second best. On this occasion, they have chosen the Select Committee's report on waiting lists to make their point.

I pay tribute to the Select Committee for the way in which it went about its task. We all care about waiting lists. My background in the health service is that I am the son of an NHS general practitioner. My brother works in the hospital service. I am a member of the NHS and of no other health care plan. I have a very close association with the hospitals in my area where I was born and brought up. 1 need no lectures on commitment to the health service from Opposition Members.

Hon. Members on all sides of the House share a commitment to reducing waiting lists. We recognise what the hon. Member for Peckham said, that behind each statistic there is a human story because no one would voluntarily wish to be on a waiting list. People are put on waiting lists because they are ill and something needs to be done. They would rather not be on one.

However, a waiting list does not tell the whole story. It is an indicator of the service provided through the NHS, but it is not the only indicator. For example, waiting lists do not tell us much about the remarkable stories of medical advance that now enable people to receive treatment that was undreamed of barely a decade ago. With regard to heart operations and hip replacements, new waiting lists are created as a result of medical expertise for which we should all be enormously grateful.

Waiting lists do not tell the full story about the efficiency of health authorities and how many people are actually treated. The hon. Member for Peckham did not mention the significant increase in the number of patients treated—both in-patients and day cases—under this Government. That is surely the bottom line for the health service—not beds, or waiting lists, but the actual number of people treated. That is the point at which the human stories of pain and suffering are dealt with. We hear too little of the successes of the health service from Opposition Members and too much about problems which they have no idea how to tackle.

I am pleased about the way in which the Government have dealt with the problem identd by the Select Committee and have tried to tackle waiting lists. I want to refer to several parts of the Government's national programme to tackle that problem.

The special management teams that were sent in to investigate the worst lists halved the number waiting more than one year in 43 long lists in 1989–90. Provisional figures for 1990–91 show that they reduced long waits in the worst 100 lists by 36 per cent. Those are not simply statistics—there is a human case behind each one.

The special waiting list fund of £190 million over the four years 1987–88 to 1990–91 has helped health authorities to treat more than 300,000 extra in-patients and day cases and more than 200,000 out-patients from waiting lists.

The special team led by John Yates, which the Government acknowledged and expected would do its work more efficiently than some health authorities, has had a profound effect on identifying and dealing with the problems. I pay tribute to the Government's work in tackling those problems and to the identification and acknowledgement given to them in the Select Committee's report.

We all want to concentrate on our own areas. That is where we see the health service in practice most often. We can deal with global and national statistics as much as we like, but what is really important is what is happening in our own back yards. In that respect, I draw the attention of the House to paragraph 49 of the Select Committee's report which deals with improved management and co-operation with clinicians. That paragraph deals with the importance of management and staff getting together to cut down waiting lists and to deal with the problems.

Paragraph 51 contains an encouraging quotation from Mr. Edwards of Trent regional health authority who, referring to the conversations that are now being held between administrators and doctors, asks: 'How can we together manage this important part of our business?' This is the first time this has happened in 30 years, and for me this is one of the most exciting bits of the new world [the NHS reforms]; managers and doctors getting together to share a view about the way forward. In no other district has that spirit, which is wanted and desired by both the Select Committee and the Government, been put into practice to more effect than in my own authority of Bury, and I pay tribute to Bury district health authority for that.

I shall first give some statistics about Bury's waiting lists and then say how it has tackled them and how that work might be affected by future policies. We want to talk about waiting lists—and this is Bury's story. The hon. Member for Peckham said that there was no district health authority in the country that did not have a waiting list for general surgery. She is wrong—there is mine. In 1989, 86 per cent. of patients for general surgery waited less than three months. In 1990–91, no patient waited for more than three months for general surgery. The hon. Lady might say that a wait of nought to three months is still a waiting list, and that is fine, if that is what she wishes to do, but to most people the fact that no patient has waited longer than three months for general surgery means that there is no waiting list.

In 1989, 84 per cent. of ear, nose and throat patients waited less than 12 months, with 30 patients waiting more than a year. In 1991, that had improved to 98 per cent. of patients waiting less than 12 months, with only seven waiting between one and two years and none waiting more than two years. In the three years 1988–91, between 99 and 100 per cent. of orthopaedic patients waited less than two years and there was a decrease in the number of people waiting for more than 12 months, from 49 in 1989 to only three in 1991. In oral surgery, between 1989 and 1990, 100 per cent. of patients waited less than three months. Again, I submit that that is no waiting list. In 1991, only one patient waited between three and six months while the rest waited less than three months. In 1989, 97 per cent. of gynaecology patients waited less than 12 months, with nine patients waiting for more than a year. In 1990–91, there was a further improvement, with no one waiting for more than 12 months.

That is the record of just one district—Bury district health authority in the north-west. I submit that those statistics on waiting lists would stand comparison with figures anywhere in the world. The way in which those statistics have been achieved is worthy of comment because that is what is at the heart of paragraph 49 of the report, which deals with the improved co-operation between administrators and doctors. That is what has happened in my district in the past decade or so.

How has the district achieved that? First, it has been committed to reform—to the sort of reforms that are now being discussed as possible ways forward. Bury district health authority has always been open to following through any reforms in an effort to try to improve its service. Secondly, there has been a commitment to competitive tendering to which I shall return later. In Bury, 17 services have been put out to competitive tender, resulting in savings of hundreds of thousands of pounds for the health authority each and every year, which might stand to be lost in the future. I should be interested to hear the hon. Member for Peckham explain how that shortfall might be made up if competitive tendering ends.

However, more important than those two matters and the statistics is the way in which Bury health authority has managed its services because that is the key to how it has been able to treat more patients and why it has fewer waiting lists. First, there has been an increase of 43 per cent. in the number of doctors employed. Additional consultants have been appointed, all in the specialties where waiting lists have been reduced in accident and emergency services; anaesthetics; paediatrics; obstetrics and gynaecology; radiology; geriatrics; psychiatry; pathology; ear, nose and throat; adult health and orthopaedics. These are not just statistics—real doctors have been appointed. Our waiting lists have fallen because our health authority has had the funds to employ them.

Secondly, we in Bury have been able to commit £25 million to capital expenditure in the past few years to provide the facilities for the operations that will help us to reduce waiting lists. Some of that money has been provided through savings on the health authorities' own resources—achieved by such things as competitive tendering. The savings have not just been a nebulous figure that has somehow gone into somebody's pocket; they have been used for a new obstetrics unit so that more people can be treated and the waiting lists can be reduced.

In 1978–79, some 17,780 in-patients were treated and there were 1,575 day cases. The latest figures show an increase to 26,700 in-patients and 4,100 day cases. That represents a total increase over 10 years of 55 per cent. in the number of in-patients, and 160 per cent. in the number of day cases treated. If the Government and the Select Committee want waiting lists to be reduced, the way is through co-operation between the doctors and the administrators in health authorities, such as happens in Bury. Our policies, together with the attention being paid to waiting lists during the past few years, are doing the job. The Conservative party has ideas, facts, statistics and achievements. All we hear from the hon. Member for Peckham is criticism—not a single idea about how to deal with the problems that we are tackling.

I worry about the future, and about what will happen if the policies that we have put into effect were no longer followed. If the economy cannot provide the growth which it has provided over the past 10 years, and which has allowed expenditure in our health authorities to rise by 19 per cent.—under the previous Labour Government NHS spending in Bury fell by 2 per cent.—my constituents would he badly disadvantaged and waiting lists would rise again. I do not want my constituents to face that risk.

The abolition of competitive tendering would mean the loss of hundreds of thousands of pounds for my health authority, and I see no commitment to make up that loss. Whose waiting lists would rise first to deal with that change in policy? Such facts and figures make a compelling case for what we are doing to tackle waiting lists. We do not have just rhetoric; we have achievements, determination and a commitment to the health service that I suspect Labour Members only dream about. They wish that they could actually deliver what they say, but they know that only the Conservative party can do that.

On waiting lists, on the Select Committee report, and on the way in which problems are tackled, only the Conservative party shows the determination and the commitment to deal with the human casualties behind the statistics. That is far better than the empty rhetoric that we hear from Labour Members.

9.12 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

I shall be brief. I echo the congratulations to the hon. Member for Macclesfield (Mr. Winterton), the Chairman of the Select Committee, and his colleagues on their excellent report on this important matter. The hon. Gentleman opened the debate in splendid fashion and he set the parameters very effectively. For a moment, I thought that he had found the whole debate so moving that he had crossed the Floor of the House, but I see that he has now returned to his usual lair.

It is understandable that in such a debate there should be claims and counterclaims about what is happening in the NHS and about its health or otherwise. However, in discussing waiting lists we would do well to remember what Mr. Yates said in his evidence to the Committee. That was fairly reproduced on page ix of the report, which stated: Two issues emerge from his replies. The first was his concern that a large amount of public money had been spent on attempting to reduce the numbers of people waiting over a year for treatment, only to see the numbers rise. It is worth bearing in mind that rather basic point when listening to some of the claims that are made, not least those of the hon. Member for Bury, North (Mr. Burt).

Mr. Yates told the Committee: I have been concerned about its … failure"— that is, the failure of the waiting list initiative— in terms of delivering the goods in terms of what was expected … in the first three years it has been somewhat of a disappointment to see that the Department of Health investment of (£80.6 million) has led to a rise in the generally accepted measure to waiting time, the number of long wait patients, waiting over a year. That is not much of a success story—and it came from the man who was in charge of trying to deliver an improved service and who, indeed, went a long way towards achieving that.

The Committee mentioned the need for a good, high-quality flow of information. That is certainly crucial. As I have said in other health debates, I am worried about what will happen under the new arrangements—an internal market, self-governing trusts, GP budget-holding and so forth. Although finance has been made available, I do not think that the computer technology is advanced enough for, in particular, the big hospitals to be able to evaluate their own information systems as professionally as they do now. They could have an important effect on waiting lists.

I am glad that the Committee, in dealing with developments in the primary-care sector, drew attention specifically to the contrast between rural and urban needs. Because I represent a vast rural area, I am especially conscious of that distinction. There is no doubt, however, that that blanket or blueprint approach should not be adopted to that important function of the health service; the position in, for instance, the Scottish highlands is not the same as the position in one of our cities. IF am encouraged to note that the Government have responded positively to what the Committee said.

Let me echo what was said by the hon. Member for Macclesfield by quoting from point 15 of the Department of Health's response: Management is also responsible for ensuring that private practice does not, to a significant extent, interfere with the performance of the function of the health service". How right the hon. Gentleman was to remind us that there should be no interference with the performance of the health service, and that non-paying patients should not be disadvantaged. I hope that the Minister, too, will emphasise that; after all, taxpayers' money is being spent. The Select Committee is right to be concerned about efficiency and value for money.

Like every other debate that we have had about the health service, this one is ultimately concerned with finance. The Select Committee said that more finance was available for the waiting list initiative; in their response, the Government said that they did not feel that that was viable at this stage in the financial year, and gave various other reasons.

There is no doubt that health care is a bottomless pit, which, by definition, can never prove 100 per cent. satisfactory. As soon as a procedure is discovered, whereby a physical ailment or deficiency can be cured, a new waiting list is created. We appreciate that; but Conservative Back Benchers who retail the more repeatable details of their trips to Scandinavia, drawing telling contrasts between British and Swedish health care, should bear in mind the fact that Scandinavian countries —and most other developed countries that can be compared with Britain—spend a much larger proportion of their gross domestic product on health care. That is why it is right to continue to underscore the need for more cash for the waiting list initiative. Although we want value for money and quality, we cannot escape the argument about quantity.

In highlighting those and many other points, which I do not have time to touch on tonight, the Select Commitlee has performed to its credit and I commend its report.

9.20 pm

Mr. David Amess (Basildon)

I congratulate the Select Committee on its excellent report and the Government on their positive response. The speech of the hon. Member for Peckham (Ms. Harman) was, to put it crudely, a cop-out. It totally lacked any details about policy. Considering that the subject under discussion was money, it was a bit cheap of the hon. Lady not to respond to my request for some details.

All hon. Members understand the trauma that someone experiences when they are on a waiting list for an operation. I have been fortunate as I have never been admitted to hospital for an operation. Obviously, patients want the operation to be carried out as quickly as possible. However, it is totally irresponsible for any politician to pretend that there is an easy answer to enable a patient to have that operation quickly.

I am privileged to have in my constituency one of the finest hospitals in the country—Basildon hospital. I regret the way in which local Labour and Alliance politicians try to run down our excellent hospital. Basildon hospital is at the bottom of my garden. My family uses its services. My wife has had four babies there under the excellent national health service and, God willing, she will have a fifth in September. My family has used its excellent accident and emergency unit—

Mr. Nicholas Winterton

Were all the babies accidents?

Mr. Amess

None of our children were accidents. We regard every one of them as a blessing. In two weeks' time, the Duke of Kent will open our brand new accident and emergency unit. My wife had an ear operation in our excellent hospital. My constituents are extremely proud of their hospital.

Hon. Members can imagine my anger when one of those ridiculous health monitoring committees was set up by the local Labour party. The chairman—or chair, as he likes to be called—used to be employed by our hospital, when he was in charge of the private patients' waiting list. When he was working at the hospital he considered it acceptable that the hospital admitted private patients but as soon as he left he immediately castigated private health care.

I hope that the hon. Member for Peckham will soon return to her place because she and I were on a Committee of this House two or three years ago when the Government first announced the waiting list option. Walworth road, bless its heart, undertook the initiative of spewing out literature highlighting waiting lists in various hon. Members' constituencies. One such list referred to my constituency.

In the 1987 general election campaign, when the Opposition guns were firing at me, the then Opposition spokesman—I think that it was the hon. Member for Holborn and St. Pancras (Mr. Dobson)—came to my constituency and found a child who had been waiting for rather a long time to have an operation. The national newspapers took up the child's plight and highlighted it during the campaign. As soon as the campaign was over and I was returned as hon. Member for Basildon, the Opposition ducked the issue and I was left to deal with it, which I did successfully.

I am delighted that there have been major reductions in the size of waiting lists during the past year in the hospital in my constituency. It has achieved the biggest overall reduction out of 15 districts in the Thames region. If we compare March 1991 figures with those for one year earlier, there were nearly 2,000 fewer people on the waiting list—a reduction of one quarter. That is why I did not respond to the point that I think that the hon. Member for Peckham had in mind when I tried to intervene. There are nearly 1,600 fewer people waiting longer than one year —a reduction of more than one half.

Mr. Gill

Does my hon. Friend accept that the statistics that he has just given are not isolated examples? In Shropshire, the county from where I come, the total waiting list for operations is down by 32 per cent. and the number of people waiting for more than one year has been reduced by 67 per cent.

Mr. Amess

Those figures are quite magnificent and I join my hon. Friend in saluting his local authority, and the men and women who work at his local hospital who have achieved such excellent results.

In Basildon, there has been a 37 per cent. reduction in the number waiting for general surgery, a 20 per cent. reduction in those waiting for ear, nose and throat treatment and a 10 per cent. reduction in those waiting for oral surgery and orthopaedic surgery.

In Basildon, we have already adopted many of the recommendations in the report of the Select Committee on Health. All waiting lists are now routinely checked to ensure that those on them still need the operation. We have increased medical staff in problem sectors. A new consultant oral surgeon, whom the authority shares with Southend health authority, started in August 1990. New consultant posts were created in urology and plastic surgery in April 1991. The additional urology service set up in January 1991 resulted in more operations during the first three months.

Basildon has "short notice" waiting lists for filling last minute cancellations by patients. It gives appropriate notice of admission to ensure a minimum number of cancellations by patients. It has matched theatre capacity to bed availability. It has blitzed problem sectors of the list such as special sessions for day case urology. It has reduced "bed blocking" by returning patients to their home with proper support in order to free acute beds more quickly. It has introduced new clinical techniques and increased the use of day care surgery.

For 1991–92, Basildon and Thurrock health authority has obtained from the North East Thames regional health authority the following waiting list initiative funds: more than £500,000 to build and equip a dedicated day surgery unit at Orsett hospital; £12,000 to purchase arthroscopy equipment, used in the examination of joints; £28,000 for a hysteroscope to enable gynaecology surgical procedures to be carried out on an out-patient day-case basis; and £30,000 for equipment to enable key-hole surgery to remove gall bladders, substantially reducing average lengths of stay for such procedures and reducing the trauma.

In conclusion, I pay tribute to the former chairman of our health authority, Mrs. Joan Martin, the acting chairman, Mr. Gould, and the hospital manager, Ken Sharp. On 1 April 1992, the hospital will apply to become a national health service trust and the application is supported by local hospital doctors, nurses and managers, who believe that when it becomes a trust it will bring benefits to patients and staff, and a guarantee of job security to all those who work at the hospital. When I open the hospital fete on Saturday I shall thank all the women and men for their efforts in seizing the Government's initiative and reducing hospital waiting lists so dramatically in Basildon.

9.28 pm

Mr. Gareth Wardell (Gower)

I am pleased to have the opportunity to take part in the debate. In addition to debating the Select Committee's report on waiting lists we were also meant to look at the evidence taken by the Select Committee on Welsh Affairs. I am disappointed to have been called as late as this in the debate.

We have completed our evidence on elective surgery in Wales. Rather than taking a wide-brush approach I shall concentrate on an initiative unique to Wales which the Welsh Office, to its credit, has innovated—the three all-Wales regional specialist treatment centres: at Ysbyty Gwynedd in Bangor we looked at ophthalmology, at the Prince of Wales hospital at Rhydlafar in Cardiff we looked at hip and knee replacement surgery, and at Bridgend hospital we looked at hernia and varicose vein surgery. It is fascinating to see England lagging so far behind in this area.

It has given me great satisfaction to promote these centres in Gower, as I have visited all three and can vouch for the superb quality of service attained. Less than two weeks ago I was privileged to witness the brilliant skills of Mr. Mehta, one of the three consultant ophthalmic surgeons at Ysbyty Gwynedd, carrying out cataract surgery followed by lens implant. It was obvious from my visits that the work of the treatment centres brings about dramatic improvements in the quality of people's lives.

The issue that deserves full attention is that of how to increase the number of patients treated so that human suffering, often for long periods, may be alleviated. It is significant that Mr. John Yates, giving evidence before the Welsh Select Committee, estimated that the more than 11,000 people waiting in Wales for more than a year for elective surgery could have their operations and treatment in only three weeks' work by the surgeons that specialise in their conditions. If the treatment centres are to be truly successful in dramatically reducing waiting lists, I believe that the Welsh Office must institute six changes.

First, the Welsh Office must commit itself to a future period for funding that is radically different from the present one, so that general practitioners and consultants know that post-operative, follow-up care will be available at centres on a long-term basis. The Minister and the Welsh Office must be more definite than they were in the parliamentary reply that the Minister gave me on 29 April. He must no longer be prepared to offer the type of parliamentary reply that he gave me on 3 May, which showed that the throughput targets for 1991–92 are yet to be agreed.

In passing I must also mention the need for the Welsh Office to have a care about the temptation now and again to rewrite history. Mr. John Wyn Owen, director of the NHS in Wales, informed the Public Accounts Committee in a letter of 3 April 1991—it is reprinted in appendix 1 of the Select Committee's report—that the orthopaedic treatment centre at Rhydlafar had a contracted throughput in 1990–91 of 172 hip replacements, 29 knee replacements and 44 other operations. But in a parliamentary reply to me on 3 May 1991, only a month later, the Under-Secretary of State for Wales gave the throughput for 1990–91 at the same hospital as 233 hip replacements, 57 knee replacements and 73 other procedures. Great care must be exercised when bandying about information like that.

Secondly, the Minister must insist that any patient who has waited for more than four months on a consultant's waiting list, as specified in the contract between the Welsh Office and the three treatment centres, is automatically informed by the local consultant that he can be referred to the treatment centre. That will get rid of the widespread practice among GPs and consultants of presenting the options to their patients as either a long wait or private treatment. The treatment centres exist, so this could be a constructive way forward.

Thirdly, Welsh Office funding must be made available to ensure that the waiting period after the patient has been referred to the treatment centre is short. Last week l[was told that one of my constituents from the village of Pontarddulais had been referred by his GP to Rhydlafar hospital for a knee joint operation. The hospital sent the referral back to the GP, saying that no more knee operations could be carried out on any patient in Wales for the remainder of the financial year 1991–92, no matter how severe the pain and suffering of the patient. Officials might find that amusing, but I do not. We are only three months into the financial year.

Expectations for early treatment should not be cruelly raised only for people to see their hopes dashed because the quota for knee surgery for the current year seems to be a miserly 50 for the whole of Wales. The quota for hip operations is only 160. According to the figures given to me on 3 May, that compares with 233 hip operations, 57 knee operations and 73 other procedures carried out last year. Obviously there is a decline. How can the Minister rest content when East Dyfed health authority has already taken up its quota of one knee and five hip operations? Is he content that Clwyd has already taken up its quota of two hip and two knee operations or with the 37 hip and five knee operations by West Glamorgan health authority, while the much less populated Pembrokeshire health authority area benefits disproportionately with 26 hip and 11 knee operations?

The answer for orthopaedics seems straightforward. When I visited the hospital at Rhydlafar I saw the obvious need to use the two main theatres exclusively for major joint surgery. To achieve that simple goal, the so-called plaster theatre could be a dedicated theatre for minor joint surgery performed on a day basis. It is also obvious that an empty ward is available to complement the additional theatre, enabling a substantial increase in major joint surgery. It is imperative that the present level of major joint work at Rhydlafar be substantially raised. I urge the Minister to raise it to as many as 1,200 operations a year and seriously to consider making the hospital a major centre.

Fourthly, a time bomb is ticking away in orthopaedics, and it is the time bomb of hip and knee replacement revisions, for which the Minister needs an action plan. Within 10 years of a major joint replacement, 10 per cent. of patients have to be revised with another 10 per cent a year after that requiring revision. Thus within 20 years of the initial major joint replacement surgery, all patients will need revision surgery. The Secretary of State for Wales must prepare for the setting up of joint revision centres in Wales together with specialist surgeons and the necessary infrastructure. As he knows, the Welsh Office contract with the Prince of Wales orthopaedic hospital does not permit revisions. That issue must be addressed.

Fifthly, if the treatment centres are to be truly Welsh regional centres they must not be permitted to discriminate in favour of the host authority. Allowing Ysbyty Gwynedd in Bangor to treat 306 patients for cataracts between 1 September 1990 and 31 March 1991, with only 23 residents outside Gwynedd being treated and only three of those residents from the county of West Glamorgan, was a major blot on the Welsh Office. That happened when 1,345 patients were waiting for non-urgent ophthalmic treatment at Singleton hospital, 476 of whom had been waiting for more than a year.

Sixthly, the Minister must move ahead quickly to establish the second specialist centre for cataract treatment at Bridgend general hospital. It would be useful to know the time scale for that.

I am delighted that the Welsh Office has set up treatment centres. I think that it is a major step forward in the reduction of waiting lists. England should learn from what the Welsh have done. In terms of the Select Committee's report, the fundamental issue is that the Minister for Health and the Under-Secretary of State for Wales must be extremely careful, if they decide quickly —perhaps too quickly—to adopt what the Audit Commission says about day surgery, not to fall into the trap of failing to provide sufficient support services. My hon. Friend the Member for Peckham (Ms. Harman) has drawn attention to that danger.

The Government's response to recommendation No. 12 is the most disappointing of all. When the Minister for Health replies, it would be helpful if she could substitute, even at this late stage, something for the comment with which the Government end their response. In fact, it is a non-response to a vital problem. It reads: We expect health authorities and family health service authorities to take account of any increases in day case work when planning primary and community health care services. That is a blatant disregard of a massive job if day surgery is to be expanded. The members of the Select Committee went to the United States to see the expansion that has taken place there, and particularly to California. We know that without community back-up facilities the day-surgery initiative will never get off the ground in a big way. We must not put the cart before the horse. Instead, we must ensure that the necessary services are provided. That is why the next report of the Select Committee on Welsh Affairs, following the one on elective surgery, will be on community care.

9.42 pm

The Minister for Health (Mrs. Virginia Bottomley)

It is a great pleasure to respond to the first report of the new Select Committee on Health. I share with my hon. Friend the Member for Macclesfield (Mr. Winterton) an understanding of the priority that needs to be given to tackling waiting lists in our national health service. There was a waiting list for those who wanted to speak in the debate and I am sorry that there has not been time for all hon. Members to participate.

I have the invidious task of responding in a short time to some of the comments that have been made before leaving time for my hon. Friend the Member for Macclesfield to respond. 1 say to the hon. Member for Gower (Mr. Wardell) that my hon. Friend the Under-Secretary of State for Wales heard his speech and awaits the Select Committee's report. When he has had the opportunity to read it, he will respond.

There is no doubt that we have heard some excellent speeches this evening. My hon. Friends the Members for Harlow (Mr. Hayes), for Bury, North (Mr. Burt), for Basildon (Mr. Amess) and for Ludlow (Mr. Gill) once again set out their strong commitment to our NHS, to the developments, to the progress and to the challenges. How strongly that contrasts with the whinges of Opposition Members. I would loathe to be a member of the health authority that comes within the area represented by the hon. Member for Peckham (Ms. Harman), or to be in the health service in that area. She seems oblivious to the fact that a day surgery unit is being constructed at the hospital in her constituency at a cost of £9 million. The unit will be completed in the autumn. It is expected that work will start later this year on a new theatre block that will cost £14.8 million. There will be a new AIDS and HIV unit. There will be a great increase in the number of day cases that are treated.

The hon. Member for Preston (Mrs. Wise) mentioned the important topic of plastic surgery, which poses some difficult questions in the handling of waiting lists. John Yates questioned our emphasis on the need to be rid of all who find themselves on waiting lists for more than two years. But the hon. Member has forgotten to tell the House that there is an additional registrar and consultant in plastic surgery in her district health authority, a new waiting list scheme for day cases and further initiatives and developments.

Once again, as my hon. Friend the Member for Bury, North pointed out, the hon. Member for Peckham ducked putting a figure on the amount by which she believes the NHS to be under-funded. I am surprised that she even failed to rally to the call of her hon. Friend the Member for Livingston (Mr. Cook), who said recently that he thought that an extra £6 billion was in the right ball park.

But we know, as my hon. Friends have pointed out so clearly and forcefully, that every Labour Government, despite their words, policies and commitments, have always left Government with waiting lists longer than they were when they took over. Conservative Governments have consistently reduced waiting lists. I think that all my hon. Friends will agree that the Labour party is essentially a walking waiting list disaster area.

Opposition Members have told us of disasters and of confusing facts and figures. My hon. Friends have pointed out clearly and forcefully the developments that they have seen in their health authority areas. The simple and central fact is that under this Government in-patient waiting lists have fallen by 6 per cent. and 40,000 fewer patients now await in-patient treatment than was the case in 1979.

Long waiting times are falling even more quickly. The latest figures obtained direct from the regions since the Select Committee's report was published show a 19 per cent. fall in long-wait patients—those waiting more than a year—in the year to this April. Those waiting more than two years fell even faster—by 38 per cent. over the same period. Long waiting times are tumbling and that fact should be welcomed by hon. Members on both sides of the House.

The reduction in waiting lists looks all the more impressive in the context of the steady increases in the number of patients being treated. There are 24 per cent. more in-patients than in 1979. That is a substantial figure. Five patients are treated now for every four that were treated then. There are nearly twice as many day cases and 8 per cent more out-patient attendances than in 1979. That is in addition to the phenomenal expansion that we have seen in the family doctor services which have grown faster than any other area of health spending over those years. Not only has the number of patients waiting been reduced, but as a proportion of those being treated it has fallen even faster than the figures show.

One important point that I want to address is the discussion to which my hon. Friend the Member for Macclesfield and other hon. Members referred about the waiting list information being published. We have revolutionised the information available about the health service. When the Labour party was in power there was a fog over the health service, as there was over education and any other area of the public sector. We have created an awareness and an understanding of the resource implications, outputs and waiting lists. But what is important is that under the new regime the waiting list information will, rightly and properly, be held by the purchasing health authority. It is the purchasing health authority that is the champion of its patients and it is the purchasing health authority that is accountable to the Secretary of State.

A misunderstanding may have arisen because the present information is based not on provider units but on provider districts. It is concerned with where the treatment is provided, not where people live. But what is clear, and it is important, is that the information will continue to be available to health authorities to enable them to establish contracts in which they drive waiting times down and seek those improvements.

In all the work of the health authorities we have seen greater pressure put on providers, all of whom will be required to make that information available so that even better quality improvements and waiting times can be achieved. In other words, the new way in which we will collect information will be a major step forward for patients and reduce waiting times still further.

Conservative Members have almost become weary of the debate about resources. Our investment in terms of financial input into the health service scarcely needs repeating. Let me say simply that we are spending £1,000 every second on the health service. In the time that it took my hon. Friend the Member for Macclesfield to make his speech, another £1.5 million was spent on the health service. A little less than that figure was spent during the speech of the hon. Member for Peckham—and, because of time constraints, my contribution will not produce expenditure anywhere near that figure.

My right hon. and hon. Friends know that it is not only the amount of money that is important but the way that it is spent. Time and again, Labour denigrate management skills, business expertise, and cost-effectiveness. However, we know—and Mersey demonstrated this—that the use of management techniques such as list validation, running a tight ship, and informing patients of their appointment times can ensure efficiency and effectiveness. That makes the health service much more rewarding for those who work in it.

We will soon provide all health authorities with guidance on best practice and principles in managing waiting lists. John Yates showed the way forward by advancing the debate and clarifying the many aspects that must be considered, such as the proper use of nurses, doctors, general practitioners and even booking systems, and the need for proper collaboration between family doctors and hospitals.

I welcomed the comments made by several hon. Members about consultants holding out-patient sessions in GPs' surgeries. Yesterday, my hon. Friend the Member for Hexham (Mr. Amos) introduced me to a GP who arranged such sessions in his own surgery. We have seen also GP fundholders driving forward standards, innovating, and devising ways of serving their patients, to provide better health care and a better health service.

We owe John Yates and IACC a great debt of gratitude. I visited Mr. Yates' centre at Birmingham, and he has regularly visited me to discuss his progress. I am pleased that he is now working with the West Midlands regional authority on its waiting lists.

In the early days, the waiting list initiative organised by the health service did not make the same progress that John Yates has achieved, but there can be no doubt that it has taken ownership of the issue of driving down waiting lists. The targets set by the chief executive, regions and districts are being vindicated by the remarkable results now being achieved—such as in Mersey. I hope that my hon. Friend the Member for Macclesfield will ensure that his illustrious constituent, Brian Redhead, is made aware of the great progress made by his district health service.

North East Thames region has presented a particularly intractable problem over the years, and right hon. and hon. Members will not need to be reminded of the contributions of my hon. Friend the Member for Harlow. However, that region has experienced a remarkable fall of 37 per cent. in the one-year waiting list, and of 58 per cent. in respect of those waiting for more than two years since March 1990. Trent, North Western, and many other regions have made similar excellent progress.

We will build on that progress. This year, a larger amount of money than ever before will be directed at the waiting list initiative, with the £35 million from the Department joined by another £25 million from the regions. I do not accept the suggestion that more resources for the waiting list initiative should be provided from the centre, because our argument is that priority is for the health service to deliver. Above all, it is for district health authorities to seek further improvements, because they are accountable for the time that their patients have to wait.

Our targets are ambitious, but we are confident, because of the success that we have already achieved, that there will be further progress.

A number of hon. Members asked about extra-contractual referrals. The key point about them is that in the past there was no financial benefit for a hospital from another area to receive a patient from outside its district. The money did not follow the patient. This year there has been an unprecedented level of consultation between the district health authorities and local general practitioners about where they wish to refer their patients and about historical patterns. At the same time, money has been kept back from extra-contractual referrals. Urgent cases have to be seen immediately. The debate should not overlook the central point that 50 per cent. of patients are admitted at once and of those who wait another 50 per cent. are treated within five weeks. The debate has concentrated on those whom we all agree have to wait longer than is right.

My hon. Friend the Member for Macclesfield made a number of other points. He knows that we have made considerable progress over developing job plans for consultants. It is important that their commitment to the NHS is properly understood and recognised. If we are to cut waiting lists, we must ensure that the health team works together as fast and as effectively as it can. My hon. Friend also made an important point about urban and rural areas. I hope that my remarks have already demonstrated to him that different ways of using resources and the NHS team to cut the time that people have to wait are part of our intention to provide better health care.

My hon. Friend mentioned regional centres. They are monitoring the work of the trusts. They are not an essential ingredient of the waiting list initiative. The waiting list initiative is a matter for the entire national health service, not for a particular part of it. We have created 100 fully-funded consultant posts to tackle waiting lists. We have maintained our investment in improved information systems to enable hospitals to manage better. We funded the waiting list helpline with the College of Health and 68 per cent. of GPs are now providing minor surgical procedures. Qa Business Services is now helping us to develop our waiting list work even further.

We fully agree with the Select Committee's view that long waiting lists for treatment are unacceptable. The reduction of waiting times is a key priority for the reformed national health service. We want to put patients first. We can learn from the South Western regional health authority's new idea of a booking system. Reducing waiting times is a key objective of our reforms. Waiting times are tumbling. The reforms that we have introduced will help to drive them down still further.

9.57 pm

Mr. Nicholas Winterton

I am grateful to my hon. Friend for her response to the debate. It is a pity that it was not longer, but that criticism is often levelled by Back Benchers when a number of important questions remain inadequately answered. I come back to a point that both 1 and other speakers raised forcefully. If the Government are serious about the success of the reforms that they are implementing in the national health service, not just health authorities but fund-holding practices and patients—the clients, the customers—must have the information that is essential if they are to exercise responsible choice and take informed decisions. I hope that my hon. Friend will ensure that when waiting lists and times are published they are published on both a provider basis and a purchaser basis.

return to the point that I made in my speech: if the citizens charter that the Government are so keen should succeed is to be meaningful, there must be a means by which the ordinary citizen—not just health authority officials as purchasers, but doctors acting on behalf of patients and the patients themselves—can exercise rights and have information upon which to exercise those rights.

This has been an interesting debate. It is sad that party politics—almost electioneering—reared its ugly head once or twice in the debate. One or two people who could have made valuable contributions to the debate were not called because of a lack of time. It has been a useful debate and shows just how important Back-Bench Members believe the health service to be. It also shows how important the waiting list is and how important it is to have accurate information not only about the numbers on the list, but about the time that people have to wait.

The debate was concluded, and the Question necessary to dispose of the proceedings was deferred, pursuant to paragraph (4) of Standing Order No. 52 (Consideration of estimates).

It being Ten o'clock, MR. SPEAKER, pursuant to paragraph (5) of Standing Order No. 52 (Consideration of estimates), put the deferred Questions on Estimates and Supplementary Estimates (Class IV, Vote 1 and Class XIII, Vote I) and the remaining estimates appointed for consideration this day.