NHS: Industrial Action and Waiting Lists (Hansard, 23 July 1982)

§ Baroness Gardner of Parkes
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ Lord Lyell
My Lords, any disruption of services which denies patients admission to hospital must inevitably lengthen the time they have to wait for operations and other treatment. It is also bound to increase the numbers on in-patient waiting lists and will cause hardship to people who have to wait longer for relief from pain or illness. We do not yet have statistics to show the precise effect on waiting lists of the strikes so far.

§ Baroness Gardner of Parkes
My Lords, I would thank my noble friend for that Answer. Could he confirm that it is very hard to differentiate between emergency and non-emergency cases, and that in many cases the patient is to be admitted for investigation of a condition which may appear non-emergency but may very well be emergency? Did the noble Lord see the report in the Sunday Times of seven women with lumps in their breasts who normally would have been admitted within 24 hours to St. Thomas' Hospital, but who instead were placed on the waiting list? One became so distraught that she was considered to be an emergency on psychiatric grounds and was later admitted. Is it not possible that all those women could really require emergency treatment and are not getting it?

§ Lord Lyell
My Lords, as I am sure my noble friend will appreciate, emergency and non-emergency classification is very much a clinical judgment of the doctors and specialists concerned. With regard to my noble friend's second point, indeed we have noted the article to which she refers.

Lord Wallace of Coslany
My Lords, will the noble Lord not agree that even before this regretted action waiting lists were already very long? Secondly, would he not agree that even at the present time the pattern is very varied throughout the country; that in some cases the action is causing minimal delay? Finally, bearing in mind the present situation of already existing long waiting lists, will the Government withdraw their freeze on new appointments of medical staff?—they are at the moment held back.

§ Lord Lyell
My Lords, as far as the noble Lord's first supplementary question is concerned, waiting lists are coming down; the latest figure which we have available is 620,000. That was in September last year. Your Lordships will be aware that during the last major disruption of this type, during the winter of 1978–79, waiting lists rose by 70,000 in three months. We do not have the figures of the effects on the waiting lists of the disruption so far.
So far as the noble Lord's second question is concerned, any action of this type, as I stressed in my first answer, is regrettable. Happily, we are able to confirm that this action is patchy; in some parts of the country there are more staff out on strike or taking industrial action than in others. So far as the third question of the noble Lord is concerned, no, we shall not.

Lord Wallace of Coslany
My Lords, did I understand the noble Lord to say that the Government will not stop their freeze on new medical appointments?

§ Lord Lyell
My Lords, it is rather a specialised question. I think perhaps I had better write to the noble Lord. We shall not withdraw.

§ Lord Richardson
My Lords, is the noble Lord aware, when he said that the decision as to whether a case was an emergency or not was a matter of clinical judgment, that in all cases it is indeed a matter of clinical judgment, and that the judgment is not taken for reasons other than clinical or by people other than those qualified to take that judgment?

§ Lord Lyell
My Lords, we are very grateful for the question from the noble Lord, who, of course, knows far more than anybody in your Lordships' House about clinical judgments and the terrible decisions that have to be taken as to whether a case is an emergency or not. It is regrettable that any decisions might be taken by people who are totally unqualified to give a proper decision as to whether patients should or should not be admitted.

§ Baroness Faithfull
My Lords, may I ask my noble friend the Minister if the situation is not very serious in mental hospitals, when they are having to deal with section cases for compulsory admission under the 1077 Mental Health Act? Would he not agree that the doctors are doing splendid work in doing work which is not rightly theirs?

§ Lord Lyell
My Lords, so far as my noble friend's first question is concerned, I am afraid I have no specific figures of mental patients. Perhaps I could ascertain the answer and possibly write to her. I did not quite catch her second question.

§ Baroness Faithfull
My Lords, my experience and knowledge is that many of the doctors are standing in for the staff because, of course, the patients must be cared for and, therefore, must we not congratulate them for doing this?

§ Lord Lyell
My Lords, if, as my noble friend says, doctors are caring for patients in the absence of staff, then we certainly give our unqualified congratulations.

§ Lord Davies of Leek
My Lords, when figures are given for waiting lists, can the noble Lord tell us whether outpatients are included who normally go for a check-up once every two, three or six months? Are those people included in the waiting lists?

§ Lord Lyell
My Lords, I am afraid that I do not have the length of the waiting as regards the figures which I gave—namely, approximately 620,000. That was the situation last September. The only classification which I have available this morning concerns the different types of treatment for which these patients were waiting—general surgery, orthopaedic surgery, ear, nose and throat and those types of classification. I do not have classification as to how long patients have been waiting.

§ Lord Auckland
My Lords, serious as the situation is in the teaching hospitals, would my noble friend not agree that in the non-teaching hospitals, particularly in rural areas, the situation is still more critical? Will he ask his right honourable friend to pay special attention to these hospitals, where there is often a shortage of staff in any case?

§ Lord Lyell
My Lords, certainly I shall be very glad to draw the attention of my right honourable friend to my noble friend's comments.

§ Lord Harmar-Nicholls
My Lords, is my noble friend aware that I did not quite understand the result of the answer he gave to the question on clinical authority to decide emergency cases? Is the final decision about whether a case is an emergency that will be allowed through taken by the medical man, or is it taken by the non-medical man, such as the porter or any such person? Who makes the final decision as to whether a case is an emergency?

§ Lord Lyell
My Lords, I understand that my noble friend wishes me to give a ruling. I understand that the judgment about whether a patient is or is not an emergency is given according to clinical parameters. The question of whether the patient is or is not admitted to the hospital I do not think necessarily, in the final outcome, has anything to do with the judgment as to whether the patient is or is not an emergency.

§ Lord Campbell of Alloway
My Lords, is my noble friend aware that the practical and effective decision is taken in the street, at the gates, by the pickets?

§ Lord Harmar-Nicholls
My Lords, that is what I am asking.

§ Lord Lyell
My Lords, regrettably it seems that the final judgment as regards entry of the patient into hospital—the patient may well be an emergency case and that will certainly be decided by the clinical specialist concerned—is not always taken by the medical specialist.

§ The Lord Privy Seal (Baroness Young)
My Lords, I can see that this is a matter of great interest to the House, but I think your Lordships would recognise that we have now spent nine minutes on this Question. Therefore, I think that we should move on to the next one.