HC Deb 19 May 2000 vol 350 cc646-54

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Tony McNulty.]

2.32 pm
Mr. Owen Paterson (North Shropshire)

I thank you, Mr. Deputy Speaker, and through you, Madam Speaker and her staff, for picking my name out of the hat in the ballot. I thank the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart) for attending what may be a lonely vigil this afternoon.

The subject of this debate is the severe problems and lack of capacity which were brought to my attention in January by my constituent Dr. Ian Rummens of Oswestry, who is secretary of the Shropshire local medical committee. I also wish to discuss the difficulties that I have had in bringing the matter to the attention of the Secretary of State through the medium of Health questions.

Dr. Rummens wrote to me in January, and sent me a copy of a letter he had written to the Shropshire health authority. He also sent copies to all the Shropshire Members of Parliament and even the Prime Minister. I shall give a flavour of the problem by quoting from that letter, in which Dr. Rummens says, it remains our firm belief that, despite the best efforts of the Health Authority in preparation and contingency planning, Shropshire Hospitals were unable to cope because there were insufficient acute beds. We, as general practitioners, have no doubt that we did not see a flu epidemic this winter and this is borne out by the statistics. Even so, cold surgery was cancelled for weeks on end. He continues: There were times when general practitioners were told that no bed was available in Shropshire to admit acutely ill patients and the ambulance service was reduced to taking 999 calls only. This was a fairly normal winter with the sort of seasonal rise in activity that is predictable and which should be coped with as a matter of routine. Had a flu epidemic occurred, the picture would have been very much worse. He adds: We fully appreciate that staff in the Hospital Trusts and the Health Authority have worked extremely hard to provide the best service possible. In our view bed numbers and staffing are largely determined by funding from Central Government and this is clearly inadequate. I should like to say at the outset that in no way am I blaming the health authority or the hospitals concerned for the problems over the winter. Using great skill, they have to make do with the tools that central Government give them. It is my role to bring those problems to the Government's attention. I have tried to do that, and I was lucky enough to have the sixth question at Health questions on 1 February. I quoted from Dr. Rummens's letter, and read out the passage stating that cold surgery was cancelled for weeks last winter. I was surprised that the Secretary of State did not listen to the problem, instead demanding to see a dossier of evidence to prove that priorities were any different from those in previous winters.

I therefore set about putting together a dossier with Dr. Rummens's aid. I have a substantial number of letters, although there is not time to go through them today. To give their flavour, I shall quote from one from a doctor in Bishop's Castle, which gives a sense of the problems faced by GPs in that period. He states: I had to visit a patient urgently with a suspected coronary. He had collapsed with chest pain and had previously had a heart attack and needed urgent admission to coronary care. On attempting to admit him to Royal Shrewsbury Hospital I was told by bed bureau that they were closed and had been instructed by their board of directors not even to take the name of the patients. I then attempted to admit him to Princess Royal Hospital— in Telford— Wrexham Maelor Hospital and Hereford Hospital all of whom were closed. Royal Shrewsbury Hospital is 23 miles from Bishop's Castle and all the others were at least 40. On telephoning the Director of Commissioning at the Shropshire Health Authority to ask what I could do I explained that Royal Shrewsbury was closed and was not accepting patients of which act he was unaware. He phoned back 10 minutes later to confirm that indeed Royal Shrewsbury Hospital was unable to accept patients. I explained that I had an ambulance with me but that they were unable to take the patient anywhere unless I was able to find a bed. In the event I made a pragmatic if not clinically correct or safe decision to admit this man to Bishop's Castle Community Hospital, on the grounds that he was better being monitored by nursing staff who could resuscitate him rather than risk not only the journey but also a long unpredictable wait in casualty and the increased stress that this would cause. Cases do not come much worse than that: a suspected heart attack, an inability to find a bed at any district general hospital and a man ending up in a local cottage hospital.

A sense of doctors' determination comes through in a letter from a doctor in Shrewsbury, who says; It is true that with monotonous regularity bed bureau's opening gambit is "We've got no beds", but I've simply said that the patient has got to come in and there has been no further discussion. Some of the patients have had to wait at home for a phone call summoning them some hours later. Some cases are very sad. A doctor in Wem in my constituency said: I attempted to admit to Royal Shrewsbury Hospital a patient…who was in the terminal stages of renal failure and heart failure…the bed bureau informed me that there were no medical beds…but that Telford still had some… Telford hospital was closed to patients from the Shrewsbury area. He said that he could not admit the patient to the Royal Shrewsbury until the following day, after approximately a three-hour wait for a bed to become available. The patient died the following day. I could go on at some length; what comes through in all such letters are the practical problems that Shropshire GPs face in emergency cases. Such cases should have been admitted immediately. That point completely ignores elective cases, for which there was no capacity at all.

One explanation could have been the incidence of flu, about which I went back to the local medical committee. The secretary told me that the incidence peaked in the west midlands at 230 per 100,000 population for a short period only, whereas normal seasonal activity is defined as between 200 and 400 per 100,000, and an epidemic as greater than 400 per 100,000. He also confirmed: planned surgery was cancelled as early as the last week in October at the Royal Shrewsbury…because of pressure from acute admissions. My constituent, Dr. Ian Rummens, was somewhat dismayed at the Secretary of State's reply in the House, saying that the situation had progressively deteriorated over the past two to three years and that the right hon. Gentleman's answer indicates a degree of complacency large numbers of Shropshire patients would not share. He was also concerned about the fixation with waiting lists, stating that now that there was a waiting list to go on the waiting list, such figures were discredited.

Yesterday, the Government had a big spin success, announcing that they had met their election target on waiting lists. However, that ignores those waiting to get on the waiting list. Those national figures are significant. The number of people waiting more than 13 weeks and up to 26 weeks increased from 262,484 in March 1997 to 401,833 by March 2000, and from 55,248 to 132,243 for those waiting more than 26 weeks.

One solution is spare capacity in the private sector. BUPA, the second largest private health care provider, was recently quoted as having spare capacity for 10,000 to 20,000 extra patients a year. Overall, the private sector could take up to 200,000 extra cases annually. Independent providers are willing to co-operate closely with the Government in any area where NHS capacity is currently inadequate and they have spare capacity.

It is worrying that increasing numbers of people are being forced to pay twice—first through their taxes and secondly by direct payment. On 19 March, The Observer reported that BUPA carried out 25,000 operations that were paid for directly by patients who did not have insurance. The incidence of that has increased by 30 per cent. in two years. That has been brought home to me in human terms in one or two cases. A typical case is that of Mrs. Hough of Whixall—a meritorious case which I should have thought would take priority. She looks after her husband, who has had two strokes, and she had two bad hips—so bad that last January it was agreed that both should be operated on through the NHS. Unfortunately, one of the hips collapsed, and she was forced to have it operated on privately in June, but she was promised at that time that the second operation would be done on the NHS. Here we are in May, and the other hip is so painful that although I wrote to the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), on 1 May, Mrs. Hough will be forced to go private and pay for the operation again on 8 June.

The obsession with waiting lists causes distortion. A case such as Mrs. Hough's should take priority, as she is doing society a great service by looking after her very ill husband. I raised the question again on 2 May, and mentioned the heart attack patients and the fact that at times no beds were free. I was surprised when the Secretary of State savaged me and said: As for the hon. Gentleman's allegation, he is simply wrong.—[Official Report, 2 May 2000; Vol. 349, c. 2.] Meanwhile, I had been discussing the matter with—

Mr. John Butterfill (Bournemouth, West)

On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker (Sir Alan Haselhurst)

May I take the point of order at the end, so as not to take up the valuable time of the hon. Member for North Shropshire (Mr. Paterson)?

Mr. Paterson

Thank you, Mr. Deputy Speaker.

I discussed the matter with Shropshire health authority, which, in fairness, had gone into great detail and done a lot of work with the representatives of hospitals, primary care and social services, and had daily meetings to co-ordinate those agencies during the winter period. Because of the lack of capacity, the health authority was forced to deliver a plan to suspend routine surgery for three weeks and admitted to me that the number of intensive care beds was at times insufficient.

It is clear that there is not adequate capacity to cope with the rising population of Shropshire and the extra costs of providing health services in a widely dispersed rural area. There are extra costs involved in staff travel, ambulance travel, and the need for more facilities. That has been confirmed by studies in Wales, Scotland and Cornwall. The formula appears to militate against a rural area such as Shropshire.

I understand that the allocation formula is frozen until 2001–02, but that the Government are reviewing it. I hope that the review will examine the costs of delivering in rural areas. In Shropshire, the population is set to grow over the next five years from 431,400 to 441,800—a growth of 2.4 per cent. It is worth pointing out that, currently, 57 per cent. of the people in that health authority live in rural areas with fewer than 25 people per hectare. In addition, those who are moving in tend to be rather more elderly: 17.3 per cent. are in the middle-aged group, 55 to 64, and 7.8 per cent. are over 65. Obviously, they are heavier users of health care services.

I am sure the Minister will tell the House that she is proud of her Government's achievement in giving Shropshire health authority a further £23 million in two tranches, in December and March. Of course, that is gratefully received, and I do not want to sound churlish, but there is a worry that almost £4 million of that money will be spent on paying back past debt or past overspend, not increasing capacity. There are anxieties about what will happen this winter.

I should like the Minister to study two reports, which are well worth reading, on the extra costs of delivering in rural areas. The first is a Welsh Office report from June last year entitled "The Allocation of Health Authority Discretionary Resources in Wales." The other, commissioned by the Cornwall and Isles of Scilly health authority in May last year, is entitled "The additional costs of providing health services to rural areas." The reports highlight the lack of economies of scale, additional travel costs, the high level of unproductive time, additional telecommunications costs, poorer access to training, and difficulties with consulting and other support services.

On travel, there is empirical evidence to confirm that significant differences exist between urban and rural areas. In Dorset, for example, occupational therapists in urban areas travelled 1,952 miles, compared to the 4,880 miles travelled by those in rural areas.

In conclusion, it is clear that demand is outstripping supply in Shropshire, particularly during the winter period, and that some waiting times have been intolerable. The current funding formula is not reflecting Shropshire's rural nature or its growing population. Last winter showed that capacity is inadequate. It is unacceptable for elective surgery to be stopped, or for such stoppage to be planned, and for emergencies to struggle to find beds.

Will the Minister please investigate the formula and the real problems that were created last winter, which have so far been dismissed at Health questions by the Secretary of State? Will she also consider the problem that £4 million of the extra £23 million has been spent on clearing debt instead of on increasing capacity to prevent problems next winter? Will she consider dropping the political slogan about waiting lists, which is now discredited, and concentrate on waiting times, which is the measure that counts for patients, and judging admissions on the basis of clinical need? Will the Minister also consider allowing health authorities to take advantage of private capacity, if it is available, to reduce waiting times for taxpayers when NHS capacity is inadequate?

If the Government insist on running the NHS rigidly from the centre, will they please listen to those like me, who represent patients, and not arrogantly dismiss us as they have dismissed me at Health questions.

2.46 pm
Mr. Butterfill

On a point of order, Mr. Deputy Speaker. For most of this morning, Whitehall has been blocked by a violent demonstration. Hon. Members have been hindered when trying to reach the House; access to Ministers' and Members' offices and Downing street has been impeded. Have you received any request from the Home Secretary to come to the House to make a statement about why Whitehall has not been cleared?

Mr. Deputy Speaker (Sir Alan Haselhurst)

I am grateful to the hon. Gentleman for raising that matter. The answer to the specific question is no, there has been no request for a ministerial statement. However, I am aware of the difficulties that hon. Members have experienced. I naturally regret that. I understand that the difficult problem has been confined to Parliament street and that the police are making all efforts to clear that street.

2.47 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I am grateful for the opportunity to discuss the subject of waiting times for hospital treatment in winter. I congratulate the hon. Member for North Shropshire (Mr. Paterson) on securing the debate. While parliamentary rules allow me to wear a hat, I am sure that he will appreciate the fact that I have not taken the opportunity to do so. That implies no discourtesy to the House. I hope that I shall be able to convince hon. Members that there is no need for either the Secretary of State or me to take up the challenge with which we were issued.

Before I focus on waiting times, I shall deal with several issues that the hon. Gentleman raised in his speech. He is right to say that we are facing a lack of capacity throughout the national health service. To facilitate expanding capacity, we have introduced several measures nationally and locally. It is important to consider the extension of manpower capacity through extra nurses and doctors, and training places. The national beds inquiry is also important. It has reported and we shall be able to reflect more carefully on where extra capacity is needed.

The hon. Gentleman also referred to the review of the allocation formula. He is right to say that the current formula is frozen until 2001. All factors, including those that he raised, will be taken into account in arriving at the new formula.

As for past debts, it is the statutory duty of any health authority to operate within its financial framework. We expect health authorities to work within their allocation. I am therefore afraid that I shall not be able to offer the hon. Gentleman any comfort on past debts. They simply have to be paid, as in any other organisation.

The hon. Gentleman also mentioned the private sector. I assure him that, for geographical reasons, there are capacity problems in the private sector. He will be aware of that when he considers the location of BUPA facilities and the needs of his constituents.

Overall, health authorities have worked with the private sector where that is advantageous and cost-effective, and many hospitals have made such arrangements where they are in patients' interests. The bottom line is that NHS patients receive the treatment that they need, and that that is funded by the NHS. My right hon. Friend the Prime Minister made it absolutely clear that there is no ideological aversion to such local arrangements.

I shall deal with winter hospital waiting lists and explain how we prepared for the winter pressures overall. The system coped much better than in previous years. That did not happen by accident, but because of careful planning. We established local winter planning groups, which first met last April, in all areas. For the first time ever, they provided careful co-ordination between all health providers including social services, health authorities, trusts, primary care groups, out-of-hours services, deputising services, pharmacists, and even the police and fire services and other local organisations. Last year, we also provided the money much earlier so that that planning was underpinned by funding. We allocated an additional £2.24 million, which was specifically targeted at waiting lists, to Shropshire health authority.

Before saying more about the effect of that money, I shall address the hon. Gentleman's concerns about the priorities in Shropshire being different from those for previous years. The overall plan in Shropshire for last winter was for routine elective in-patient work to cease in the three weeks from 20 December to 10 January. I accept that that was slightly longer than in previous years, but there was an extremely valid reason for that: the extended bank holiday period and the extra emphasis on winter planning over the millennium.

Some elective day-case procedures continued after 20 December and resumed fully in January. Emergency and urgent surgery was carried out as necessary during that period, so the NHS did what it normally does: it ensured that there was sufficient capacity to put emergency cases first. There was no distortion of clinical priorities; the right ones were used.

There were busy periods. I am advised that local hospitals were very busy over the new year because high levels of flu, bronchial infections, which disproportionately affected the elderly population, and viral pneumonia, which put greater pressure on the NHS. That, in turn, led to more emergency hospital admissions. Many of those admitted had more serious illnesses and needed to stay for longer, which resulted in increased demand for beds, especially among the elderly and other vulnerable groups.

Despite those pressures, the NHS in Shropshire coped admirably. No local hospital was closed to blue-light cases. Sound bed management between trusts kept disruption to the minimum. As far as I am aware, no individual complaints were logged with the health authority about services during that period, and I have not been made aware of any investigation by local trusts. As always, I should be happy to mount a proper investigation into any of the cases that the hon. Gentleman raised and let him have the results.

Taking account of the expected close-down during the holiday period, and the reductions in activity caused by winter pressures, is part of the normal winter planning that deals with waiting lists. Indeed, we always expect less elective activity to take place during December and January.

The waiting list figures rose in December and January, both nationally and locally, and those increases reflected the priority given to emergency cases by the NHS. The increases were anticipated and did not prevent us from meeting our manifesto commitment well in advance of the date pledged. The waiting list in Shropshire fell by 578 between the end of November 1999 and the end of March 2000.

Now I shall deal specifically with waiting lists. On coming to office, we inherited a record and disgraceful number of people waiting for NHS treatment, and increasing waiting times, which were unacceptable in the modern health service. That is why, unlike the Conservative party, we are committed to reducing not only the number of people waiting, but the time that they wait. We have already achieved our manifesto commitment to reduce NHS waiting lists by 100,000 from the numbers that we inherited, during the lifetime of this Parliament—and we did so well in advance of the deadline. The waiting list fell by 51,000 in March and is now 121,000 below the level inherited from the previous Government. In Shropshire, the in-patient waiting list fell by 704 last year, which made a welcome contribution to our achievement of the manifesto commitment.

As in-patient waiting lists have fallen, so have waiting times. It is important to recognise that the number of over-12-month waiters is a third lower than in June 1998. Most in-patients are seen within a much shorter time. The latest figures show that about 70 per cent. are admitted within three months of being placed on a waiting list.

Last year, the in-patient waiting list fell by 36,000, and the number of over-13-week out-patient waiters fell by 54,000. In the final year of the previous Administration, the number of in-patients rose by 110,000 and the number of over-13-week out-patient waiters by 31,000.

As I said earlier, we allocated a recurrent £2.24 million to Shropshire health authority to support reductions in waiting lists and times. The £660 million allocated to the service following the Chancellor's Budget statement included a further £5.3 million for Shropshire health authority.

That money will support various initiatives under way in Shropshire to reduce waiting lists and times. Those measures are important for the long-term planning and expansion of capacity, and for speed of treatment. They include the funding of additional out-patient and in-patient sessions at the Royal Shrewsbury, Princess Royal and Robert Jones Hunt hospitals, the employment of an extra consultant and part-time anaesthetist at the Robert Jones and Agnes Hunt Trust, and the use of fast-track back pain clinics run by physiotherapists.

We promised to tackle in-patient waiting lists, and we have done so. Now we are applying the same determination to tackling out-patient waiting lists and times. Between December 1999 and March 2000, the number of people waiting more than 13 weeks for an out-patient appointment fell by 94,000.

Mr. Paterson

Does the Minister think that the measures that the Government have taken will be enough to prevent similar problems from occurring this winter if the incidence of flu is roughly what it was in 1999–2000?

Ms Stuart

We hope that, with the measures that we are taking, we will manage the extra pressures over the winter period even more efficiently than we did this year.

We have also put in place measures for patients who are referred urgently with suspected cancer. They should be seen by a specialist within two weeks of their GP referring them. Patients with coronary heart disease will also be able to get easier and faster access to treatment. That is often achieved by reconfiguring the way in which the services are run. In October last year, we announced £50 million to be used over the next two years to increase the number of heart operations by 3,000.

On 6 March, my right hon. Friend the Secretary of State announced the national service framework for coronary heart disease. He also announced a new £3 million plan to test the streamlining of cardiac services to provide better and faster services for patients in different parts of the country—for example, through one-stop diagnosis or re-engineering services to reduce waiting times and cancellations.

We are improving services for patients with suspected or diagnosed cancer through the cancer services collaborative. The programme, which is funded by £6 million over two years, aims to streamline and re-design services at nine cancer networks across the country.

The cancer services collaborative is already producing excellent results. The hon. Gentleman may be interested to know that the Birmingham collaborative team have been able to cut the waiting time for oncology for patients with bowel cancer from 13 weeks to six weeks. We are encouraging the spread of the good practice developed by the Birmingham collaborative across the west midlands region. This year, we will be taking a similar approach to the cancer services collaborative for coronary heart disease.

We shall continue to ensure that clinical priority is the main determinant of when patients are treated. We have repeatedly made it clear that patients in the greatest need must continue to be treated first. We expect the NHS to implement this guidance in meeting its waiting list targets, and we have been absolutely clear about that. We have great expectations that those guidelines will be followed.

We want to modernise the NHS. That means re-designing the services that are crucial to patients. At a national level, the national booked admissions programme is part of our on-going commitment to modernising the health service. Through the use of booking systems, patients are able to agree dates that suit them, allowing them to make the necessary work and child care arrangements. The system also takes away the uncertainty of not knowing how long the wait will be. Booking means fewer operations cancelled by the hospital, and ensures that fewer patients fail to turn up for their appointments. The Royal Shrewsbury and Princess Royal hospitals in Shropshire were chosen to participate in the first wave of the national booked admissions programme, which began in November 1998. The trusts' work on booked admissions was supported by £195,000 in funding. A further project at the Princess Royal NHS trust to investigate different processes of care in delivering booked admissions will be funded until March 2001. We announced a third wave of the national booked admissions programme on 12 April, and we want every acute hospital to have such a programme eventually.

We want to bring down waiting lists and times and keep them down, and we are determined to ensure that the improvements we make are sustainable. This is not a one-off, short-term initiative. We have already started planning for next winter, and I am confident that an even better service will be provided for the hon. Gentleman's constituents next winter than the excellent service provided this year.

Question put and agreed to.

Adjourned accordingly at one minute past Three o'clock.