HC Deb 03 November 1999 vol 337 cc252-9 12.30 pm
Mr. Steve Webb (Northavon)

In desperation, I have initiated a debate on orthopaedic out-patient waiting times. I feel able to achieve something for my constituents on many of the topics about which I receive letters, but on this subject, I feel helpless.

In the few years that I have been a Member of Parliament, I have received a stream of letters, telling me of increasingly outrageous waiting times. I do my best—I write to the trust, to the health authority and to the Government—but, every month, the letters keep coming. Therefore, I am grateful for the opportunity that the debate gives me to raise the issue of where the buck stops—with the Minister of State on behalf of the Department of Health.

I start with a brief excerpt from a letter from a general practitioner in Yate in my constituency, who copied to me his letter to the Secretary of State dated 18 October. It reads: I have an 81 year old patient who was referred for an Orthopaedic appointment in June 1998…he…heard nothing…We…phoned the hospital who told us that the likely date for his appointment was April 2000; he will have therefore waited 22 months. That gentleman will have to wait 22 months to see a consultant, perhaps to be placed on a waiting list. I have written to all the bodies involved. All express concern, but little happens.

I shall cite two cases that show how people on the ground are experiencing these delays. My constituent Mrs. Evans, a civil servant from Chipping Sodbury, now gets around on crutches because of her orthopaedic problems. She would like to stop work because of the pain that she is in, but she has received a letter saying that she will have to wait 78 weeks to see a consultant. She cannot afford to take 78 weeks off work, so she is getting by by working part-time, in pain. She told me that she feels betrayed because she paid national insurance when she could and now, when she needs the system, it is not there.

I told Mrs. Evans—admittedly, with some trepidation—that 78 weeks was a relatively short wait. It did not help her to hear that 104 weeks was the norm, and that 78 weeks seemed a step in the right direction. However, as the chief executive of the relevant trust wrote to me about Mrs. Evans, waiting times for orthopaedic outpatient appointments…continue to be unacceptable. The trust does not deny that. The chief executive was delighted that the Trust was able to appoint a 5th orthopaedic consultant", as a result of which waiting times have come down from 104 to 78 weeks. The chief executive says: I…acknowledge that a reduction in waiting times from 104 weeks to 78 is scant comfort for the patient, and that there is a health authority problem. She says: the area served by Avon Health Authority is under-resourced in terms of orthopaedic surgery". Ominously, she continues: however, there are no resources earmarked for further investment in orthopaedic services, and there are no plans to provide additional capacity for orthopaedic outpatient appointments. Therefore, waiting times have shortened slightly, but, this summer, the trust chief executive told me that it was a health authority problem, and that there were no plans for extra investment. When we write to the trust, the trust does its best, but says that the health authority is responsible.

Having seen that waiting times were shortening slightly, I was shocked to receive a letter from a constituent, Mrs. Aze, who sent me a letter from the trust, saying that she would have to wait not 78 weeks and not 104 weeks, but between 115 and 125 weeks—nearly two and a half years. Mrs. Aze says: I am approaching 70 years of age…my GP…considers that I am in need of an examination in the near future to prevent me from becoming a cripple…It is obscene to send…a letter to a patient who has been referred to you for ACTION", saying that it will be 125 weeks before she is seen.

Mrs. Aze has found out that it would cost £8,000 to obtain a private operation. She cannot afford that. She has been told that she could get a private consultation to skip the 125-week wait, and then wait for an NHS operation, but the health authority, understandably, does not encourage that because, although it would solve one person's problem, it would not tackle the underlying problem.

Not surprisingly, the Aze family wrote to everyone that they could think of. On 29 October, they wrote to the previous Secretary of State. He did not reply, of course; he passed the letter to the south-west region of the national health service executive. Its parliamentary business officer wrote: how sorry I was to read about your wife's wait for an outpatient appointment…The Government sets a standard waiting time of 26 weeks". We all fell about when we heard that, because it is nothing like the experience of real people. The letter continues: clearly North Bristol NHS Trust are not keeping to this target,"— we had noticed that— so I will refer your letter to the chief executive of the health authority. For what? I will ask her to write to you with an explanation for the delay". So the constituent writes to the Government, assuming that the Government have a hand in the matter. The Government pass the problem down to the regional branch, and the region says that the trust is not performing and that it will ask the health authority to explain why. Understandably, the constituent feels slightly dissatisfied with that response.

I know that action is being taken. The health authority has set up an investigation into out-patient waiting times, which will take 12 to 18 months to complete. Why is that only now being done? I was elected two and a half years ago, and within weeks was receiving letters saying that out-patient waiting times would be 104 weeks. Why has the subject only now acquired urgency? Why did not the investigation start two years ago?

In August, I received a letter from Avon health authority. We seem to be exchanging many letters on the topic. After telling me about all the money that the Government are putting in, which does not seem to be making much impact, the geographical director of the health authority says: monitoring of the service agreement between ourselves and the…Trust shows an under-performance of 2,203 new outpatient attendances. We remain in very close dialogue with the Trust on this issue. I would like to be a fly on the wall and listen to that dialogue.

However, let us get this straight. The trust says that Avon health authority area is under-resourced in terms of orthopaedics—which is true, given the number of orthopaedic consultants per head of the elderly population. Therefore, the trust says that the authority is part of the problem. The authority says that the trust is under-performing. The Government say, "We will get the health authority to write to you to explain why the trust is not performing".

My plea is, will someone, somewhere, take responsibility for this disgraceful situation? I have been writing these letters for two years, and two years is a fairly typical wait in my authority area to see a consultant. I am impatient for action. My constituents are impatient. That is why I have raised the topic today.

Where do we go from here? What does the future look like? This morning, I spoke at length to the chief executive of North Bristol NHS trust. She tells me that the case of Mrs. Aze has moved on considerably. She tells me that Mrs. Aze was told that she would have to wait between 115 and 125 weeks because she had been referred by her GP to a specialist orthopaedic surgeon; that she has now been placed on the list of the fifth orthopaedic surgeon—who, I understand, is more of a generalist—and that therefore she will wait not 125 weeks, but perhaps 25 weeks. I should like to think that her waiting time has been shortened by 100 weeks as a result of my intervention, but I doubt it. However, that does not change the underlying issue.

In response to my debate, and in response to my publicly raising the issue locally, the health authority still admits that 70 weeks is a typical wait. Although Mrs. Aze was an extreme case of someone who wanted to see a specialist orthopaedic consultant, and although this individual case is nearer resolution than it was, Mrs. Evans and many other people are still no nearer resolution.

What of the future? The new Secretary of State has said that heart and cancer treatment is a priority for him, and of course those issues are vital to people who are affected. Are those new priorities to be funded from a fixed cake?

I know that the Government can tell us about the £21 billion; we can all argue whether that is a meaningful figure. There is money going into the health service, but does the designation of heart disease and cancer priorities mean more money for those specialties, and not less for the rest of the NHS? Or is money to be directed from less glamorous parts towards those high-profile and important concerns? If the latter is so, will orthopaedic waiting times in Avon rise rather than fall? Yes, heart disease and cancer matter, but if funding for them will come from a fixed overall cake, will the unglamorous be left behind?

The Minister of State, Department of Health (Mr. John Denham)

That is stupid.

Mr. Webb

The Minister says that that is stupid, but we must be clear whether the Government's declared new priorities are to be funded at the expense of other parts of the NHS, or whether new money, over and above the amount that had already been announced when the new Secretary of State took his post, has been found. If it has not, the less headline-grabbing, glamorous priorities will be left aside.

What do my constituents have in common? What about my 81-year-old constituent about whom the GP from Yate wrote, or Mrs. Aze, who is nearly 70 years old? Are elderly people who need routine operations such as hip operations to be forced to wait for years and, in the words of Mrs. Aze, left to become a cripple?

This debate is about out-patient waiting times in Avon, not just orthopaedic services; there are many more horror stories. I plead with the Minister to spare us from bombardment by a raft of statistics on all the money that is being invested in the NHS. We have heard it all before. My constituents hear it on the television time and again, and write to me asking, "What do these people know?" We are told that waiting times are falling, but I receive letters about 70 or 100-week waits, and about how my constituents must either take a year and a half off work or wait two years at the age of 70 or 80 for treatment. Such matters need urgent attention.

My plea is for the Minister to accept that the buck stops with him. The trust has been investigated several times by the Government and various departments, but its consultants are working their socks off. There is no suggestion that they are not pulling their weight. Indeed, the trust chief executive suggests that some may be working too hard.

When will people waiting for orthopaedic appointments in the Avon health authority have to wait only 26 weeks? Will the Minister please tell us today when he expects the Government's target on orthopaedic out-patient waiting times to be met? Will he accept responsibility for the NHS—not blame the trust or the health authority, but accept that the buck stops with him? Will he ensure that, the next time that someone writes to his Department about such problems, they are not fobbed off and told how concerned the Government are, but how somebody else has been asked to explain? I have no answer for my constituents when they ask why they must wait 100 weeks to see a consultant just to be put on a waiting list. I have no answer; I hope that the Minister does.

12.43 pm
The Minister of State, Department of Health (Mr. John Denham)

I congratulate the hon. Member for Northavon (Mr. Webb) on securing a debate on a subject of great importance to his constituents. I shall cover the Government's overall waiting list policy, and the measures that we are taking nationally to improve patient access to NHS services, and then look at the level of Government investment in both the national health service nationally and the Avon health authority, and the measures that are being taken in Avon to reduce the number of patients who are waiting longer than 13 weeks to see a consultant.

It is important to say at the outset that I recognise, as everybody does, that waiting a long time to see a consultant is distressing and worrying for patients and their families, particularly if people are in pain. That is why we as a Government are committed to tackling out-patient waiting times. As the constituency cases that the hon. Gentleman brought to the attention of the House make clear, Avon health authority has major problems with long out-patient waits in certain specialties. Considerable effort will have to be made to address that problem. In fairness, it is important to emphasise that the extremely long waiting times that he raised are the exception. The average first out-patient appointment waiting time is the same as that in Avon health authority: seven weeks.

Waiting times and lists are a key concern of NHS patients, which we recognise. In modernising the NHS, we are determined to make access to services faster and more convenient. We are committed to reducing both the number of people waiting and the time that they wait. We are working to improve access for all NHS users.

We are also introducing important, special measures for patients for whom rapid access to the NHS is vital, such as those who are suspected of suffering from one of the big killers of modern times—cancer. The new focus on diseases such as cancer and coronary heart disease that my right hon. Friend the Secretary of State announced is within the context of achieving our targets for waiting lists and waiting times. It is not an alternative.

Yes, of course all that we do in the NHS is funded by the resources that we make available to it, including the additional £21 billion investment. However, it is right for us to set our overall aims—as we have very clearly on waiting lists—and, within that, to make clear our targets.

It was disappointing that the hon. Gentleman had nothing to say about the hard work of staff in Avon. As he will know, we have already instituted a two-week wait for patients who are referred urgently with suspected breast cancer. The Avon health community has responded marvellously to the challenge of meeting the breast cancer waiting targets. The whole health community can be proud of the out-patient waiting list. In the first quarter of this year, 100 per cent of patients were seen by a consultant within two weeks when the urgent referral was received from the GP within 24 hours.

The hon. Gentleman would have painted a fairer picture of the work of staff in Avon health community had he referred to that considerable success. The staff are excellent, and I am sure that, when the two-week wait for urgent referrals is extended to cover all cancers next year, Avon will once again be among the leaders in achieving that standard.

We have tackled in-patient waiting lists: the list has fallen by 200,000 over the past year, and is now 69,000 below the level of March 1997. We are on track to achieve our manifesto commitment to reduce waiting lists by 100,000 from the level that we inherited.

This year, we are applying the same determination and good practice to reducing waiting times for out-patients. Last year, NHS trusts saw 175,000 new out-patients. This year, we expect the NHS to see more than a third of a million more new out-patients. That will mean that, in 1990–2000, more than 11 million new out-patients will be seen—for the first time in the history of the NHS.

In September, following a top-level meeting with NHS staff and Health Ministers, the Prime Minister announced a package of measures to tackle out-patient waiting times, including a £30 million boost to out-patient services, tough new monitoring of performance and the extension of the booked admissions programme.

Money from the £30 million waiting lists and times performance fund will go directly to the NHS to help tackle out-patient waiting times. It will allow the NHS to focus on tackling problems locally, providing additional out-patient clinics, employing additional staff and investing in new medical equipment. It will also help to fund sustainable solutions, modernising out-patient services and access to the NHS.

The national patients access team, which this Government established, is in the lead in taking forward such initiatives. It is providing intensive programme management for the booked admissions programme, and runs a visit programme to advise trusts and health authorities on how to reduce waiting lists and times and ensure widespread adoption of best practice. I understand that NPAT visited North Bristol NHS trust and made several suggestions, which the trust is beginning to implement. It is also assisting in the review of orthopaedic services across Avon.

The booked admissions programme is part of the Government's on-going commitment to modernise the health service, to make it more dependable, and to enable the NHS of the future to provide immediate access to dependable health advice, same-day testing and diagnosis, and prompt and convenient access to care and treatment.

We announced the first wave of 24 booked admissions pilot schemes in September 1998, with an investment of £5 million. A further £20 million is being invested this year in a significant expansion of the programme. The Royal United hospital in Bath was one of the hospitals in that first wave, and has received an NHS beacon award for the excellence of its pilot scheme.

In September, the Prime Minister announced a further 60 new pilot sites, taking the total number of people benefiting from the programme to 2 million. Three of those schemes are in Avon—at the Weston Area NHS trust, the North Bristol NHS trust and the Royal United Hospital Bath NHS trust. Since that announcement by the Prime Minister, the programme has been extended to cancer services in order to streamline services and minimise delays for patients with suspected or diagnosed cancer.

Cancer services in Avon, together with those in Somerset and Wiltshire, will benefit from an additional £500,000 to develop a scheme for booked admissions. That will enable patients whom their GP suspects of having cancer to receive the earliest possible appointment with a specialist. It will avoid delays between different treatments and enable care to be carefully co-ordinated.

As I mentioned, to underpin the Government's programme for the modernisation of the NHS, we are spending more than ever before on the health service. The comprehensive spending review provides £17 billion for the NHS in England over the next three years. That is the biggest cash injection in the history of the NHS.

The money is now reaching local health authorities. Avon health authority will this year receive £582.5 million—a cash increase of £36.5 million or 6.69 per cent. That gives Avon the highest level of growth in the south-west region, and includes almost £5 million from the modernisation fund specifically to target waiting lists. In addition, the health authority has received £5.6 million in targeted funding in areas such as staff recruitment and retention, mental health, cancer waiting times and nurse prescribing.

We are not neglecting the fabric of the NHS. As part of the largest capital programme in the history of the NHS, it is forecast that the total capital spend in Avon will be more than £83 million. That includes £2.64 million from the modernisation fund to improve the accident and emergency departments at all the major acute trusts in Avon.

Unlike the hon. Gentleman, I pay tribute to the staff of the NHS in Avon, who last year treated 11,331 more elective cases than in the previous year, an increase of 11.9 per cent. They also dealt with a growth in the number of emergency admissions of 3,800 or 4.5 per cent.

However, there is no doubt that Avon's performance in certain specialties is worse than that of the NHS as a whole. I am happy to acknowledge that Health Ministers must take responsibility for what happens in the health service, but, in the delivery of services, there is a huge responsibility on everyone working in the NHS in Avon to work together to tackle the problems and bring the standards in Avon up to the levels achieved in other parts of the country. We will support Avon through the national patients access team, the finance and additional measures that I have set out and the booked admissions programme, but it is the local NHS that must deliver.

As I stated at the start of my speech, the health authority and the trusts recognise that the current position is unsatisfactory. This year, the health authority and trusts have planned to reduce substantially the number of patients waiting more than 13 weeks for an appointment. Although the problem of long waiters is common to all the major hospitals in Avon, it is most marked in the United Bristol Healthcare NHS trust and the North Bristol NHS trust.

I can confirm that in the case of Mrs. Aze, who was sent an appointment date of 125 weeks, her consultant wrote to her GP on 19 October and she will be seen by another consultant with shorter waiting times.

On the position in the key hospitals, I hope that the hon. Gentleman will acknowledge that there has been a new management team at the North Bristol NHS trust since its creation earlier this year. We are looking to the team to provide a clear management lead in tackling the problem of long lists. The trust has already taken various steps to improve the position. Extra staff have been appointed and extra clinics are being established. Additional measures have been and will be taken to reduce the number of patients waiting more than 13 weeks.

Mr. Webb

I am grateful to the Minister and I do not want to interrupt his flow. I hope that in the remaining four or five minutes, he will address my specific question. When will the target waiting time of 26 weeks for out-patient orthopaedic appointments be hit in Avon? Given all that the Minister has said and all the money that he told us is being put in, he must be confident that that target will be hit soon. When?

Mr. Denham

There has been a long period of poor service and underinvestment, which has led to the length of waiting lists that the hon. Gentleman described and which I acknowledged. My priority, which must also be the priority for the trusts and those working in them, is to get a grip on the problem and to make sure that waiting times are reduced. I shall set out the measures through which that must be done. We start from a position that is worse than that experienced in the NHS as a whole. People working in the health service in Avon must get a grip on that.

Various measures have been and will be taken to reduce the number of patients waiting more than 13 weeks. For example, an additional two new consultant clinics per week in general surgery have been established at Frenchay hospital, with additional clinics at Southmead hospital.

In orthopaedics, which is of particular concern to the hon. Gentleman, the North Bristol NHS trust has appointed a new consultant and will use money from the performance fund to appoint additional physiotherapists as clinical assistants. The trust has also agreed low back pain referral protocols with GPs to allow direct referral to a physiotherapist, rather than to a consultant.

In ophthalmology, another problem area, a new consultant has been appointed from October this year. A new locum consultant gynaecologist appointment is being made from January next year. It is intended to use money from the performance fund to develop plans to provide four nurse practitioner-led clinics a week doing minor procedures to release consultants to see additional out-patients. A new staff-grade doctor in ear, nose and throat is being appointed from January. New clinics are being established in plastic surgery, rheumatology, dermatology and neurology, some of which it is intended to support through the use of performance fund moneys.

The trust is examining various measures to improve the way in which out-patient services are provided and to ensure that the best use is made of out-patient clinics by reducing the number of non-attenders and by filling vacant out-patient slots. The trust is engaged in discussion with other NHS trusts identified as "beacons" for good waiting list management to ensure that the trust identifies best practice and applies it to the local situation.

The United Bristol Healthcare NHS trust intends to increase activity in ophthalmology, dermatology, neurology, dental specialties and ENT. This activity will be targeted at long-waiters. The trust is working with local primary care groups and considering the increased use of physiotherapy screening for orthopaedic out-patients to ensure that patients are seen by the most appropriate professional. In addition, the trust is working to ensure that its management of out-patient appointments process is in accord with best practice.

Orthopaedics is the specialty with the longest wait to see a consultant. Over the past five years, the Avon health authority has invested an additional £5.1 million in improving the orthopaedic service. As I said, the health authority is conducting a wide-ranging review of orthopaedic services across the Avon area to inform its funding decisions for next year. It will be assisted in that by the national patients access team.

In conclusion, I believe that action taken by the Avon health authority and the local NHS trusts will lead to a reduction in the number of patients waiting more than 13 weeks and, more importantly, a reduction in the maximum length of time taken to see a consultant. Current times are far too long. The regional office of the NHS Executive has carried out an assessment of the action plans prepared by the health community, and is satisfied that the waiting list objectives will be met. We want patients in Avon to wait less time to see a consultant in future, and will continue to work with the local NHS to achieve that aim.