Hip Replacements (Hansard, 30 April 1984)

§ Baroness Lane-Fox
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ Baroness Trumpington
My Lords, the estimated number of total and partial hip replacements in National Health Service hospitals in England and Wales in 1979 was 31,130. The lastest available figure is for 1981, when the total was 35,220—an increase over the period of 13 per cent.

§ Baroness Lane-Fox
My Lords, I appreciate the reply given by my noble friend. May I assume that the growing popularity of the operation stems from its high success rate?

§ Baroness Trumpington
Yes, my Lords. I am glad to agree with the assumption of my noble friend Lady Lane-Fox. I should say that both techniques and materials used have greatly improved over the years.

§ Lord Ennals
My Lords, will the noble Baroness accept that this operation is probably one of the most effective and pain-relieving that has been established in the last 25 years? But will she confirm that the increase over the years in question is simply part of a rise that has spread over the last 10 years? Will she also accept that the increase shown in the figures she gave was partly due to the planning that has gone on in advance into suitable medical teams and operating theatres? The planning was done in advance to ensure that the numbers showed a steady increase.

§ Baroness Trumpington
My Lords, in answer to the noble Lord, I agree with the first part of his supplementary question. With regard to the second part of his supplementary question, I imagine that all medical research and care is the result of forward planning.

§ Baroness Gaitskell
My Lords, may I ask the noble Baroness whether she agrees that the present situation as regards this operation is much healthier and much more desirable? It is not an operation that people should indulge in at a moment's notice, and I am very pleased to hear that some of the numbers have gone down.

§ Baroness Trumpington
My Lords, I entirely agree with the first part of the noble Baroness's question. As 330 regards the second part, I said that the numbers had gone up.

Lord Paget of Northampton
My Lords, would the noble Baroness say that a lot of pain is caused by having to wait for this operation? There was a time when it would take up to 18 months to have the operation done under the National Health Service. What is happening now with regard to that?

§ Baroness Trumpington
My Lords, of course to anybody who is suffering pain any wait for an operation must seem a very long time. But the figures went up in 1982, following the National Health Service dispute. We are glad to say that the latest figures show some improvement, but it is perfectly true to say that there are quite a lot of people waiting.

§ Lord Dean of Beswick
My Lords, may I ask the Minister whether in the figures she gave—and an increase of that dimension is something of a success story—there is any variation in waiting times in the different regions of the country, bearing in mind that in Leeds people are being confined to wheel chairs while they wait for this operation? If there is a regional variation, will she look at it?

§ Baroness Trumpington
My Lords, health authorities are encouraged to notify general practitioners who make the initial referral of a patient to hospital about where the shortest waiting lists are likely to be. It is always open to a general practitioner to refer his patient to a consultant at any hospital where it is felt that earlier treatment may be available.

§ Lord Somers
My Lords, may I ask the noble Baroness whether she has heard of a case of which I know where the patient had her operation last year after waiting six years?

§ Baroness Trumpington
My Lords, I am not aware of the particular case to which the noble Lord refers.

§ Lord Hale
My Lords, may I ask the noble Baroness whether she is aware that my sister has twice undergone this operation, both times with maximum success, minimum pain, and admirable attention, very often from foreign nurses who have come into the health service to assist? Everything has been admirable throughout and my sister, who is 90 years of age, has had her life substantially prolonged.

§ Baroness Trumpington
My Lords, I thank the noble Lord for that very encouraging information. I should just add that the urgency with which a particular patient is treated is a matter for the clinical decision of the consultant concerned.

§ Baroness Lane-Fox
My Lords, may I ask my noble friend whether the most encouraging aspect of these rather tortuous delays is surely that so many more surgeons now perform these operations, which I believe are part of the training of orthopaedic surgeons?

§ Baroness Trumpington
My Lords, in answer to my noble friend Lady Lane-Fox, I would say that she is 331 perfectly right. In the early stages there were a few highly specialised surgeons who pioneered this form of operation. Now it is a general part of every orthopaedic surgeon's training.

§ Lord Ennals
My Lords, bearing in mind that noble Lords and noble Baronesses have raised the disturbing question of the waiting period, will the noble Baroness confirm that the figures which were given to me last month by her noble friend Lord Glenarthur show that in fact general waiting lists are roughly 100,000 more than they were in 1978?

§ Baroness Trumpington
My Lords, I can give the noble Lord the exact figures. On 30th September 1983 there was an overall total of 142,113 waiting for in-patient treatment in the specialty of traumatic and orthopaedic surgery. I would add that there are additional problems. First, some of those who were operated on in earlier years may now require a revision of their operation because the replacement joint has worn out or become loose. Secondly, hip replacement is increasingly being used as treatment following the emergency admission of an elderly patient with a fractured femur. Thus, a significant proportion of the increased capacity of the National Health Service is not available for operations on waiting list patients.

§ Lord Ferrier
My Lords, while welcoming the figures which my noble friend has given, would she agree that the pressures which still exist on the orthopaedic side of the National Health Service could be relieved if there were more acceptance of complementary medicine which provides manipulative therapy, such as chiropractic therapy?

§ Baroness Trumpington
My Lords, I imagine that that is a question for the general practitioner of the patient involved.