NHS Rheumatology Consultancy Service (Hansard, 15 October 1986)

§ Lord Bottomley
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, if I may, I should like to answer the Question of the noble Lord, Lord Bottomley, from a rather different point of view. The Government wish to see improvements in services to patients, including rheumatology services, and have laid down broad priorities for these improvements. It is for health authorities to plan in detail what services to provide and what staff they need to provide them. The Government are satisfied that there are sufficient numbers training in rheumatology to meet the likely requirements for consultant staff.

§ Lord Bottomley
My Lords, is the Minister aware that there are 20 million sufferers from rheumatism in the country? It is estimated that 65 million working days are lost as a result of this illness, which is damaging to the economy. Is the Minister further aware that in some districts there are no consultant rheumatologists, and in other areas there is a great shortage? Last week at the Conservative Party Conference the Secretary of State for Health and Social Security said that it was hoped to increase the number of hip operations carried out in the country from 38,000 to 50,000 in 1990. Unless there is an increase in the number of rheumatologists and the Minister can give an assurance on this, certainly the Minister will not meet that target.

§ Baroness Trumpington
My Lords, we are concerned at the evidence of inequalities in the provision of rheumatology services. Some regions have recognised the need to improve services and are actively planning to do so. We are following that up through the regional review machinery. In answer to the second part of the noble Lord's question, hip operations are performed by orthopaedic surgeons and not rheumatologists.

§ Baroness Masham of Ilton
My Lords, how many health districts do not have a rheumatologist? Is the Minister aware that in the past few years so much emphasis has been put on health districts getting the mentally ill and the mentally handicapped out of long-stay hospitals that the physically disabled, who include those with rheumatic diseases— as the noble Lord, Lord Bottomley, said, there are many people in this country with those diseases—have gone a long way down the list of health priorities?

§ Baroness Trumpington
My Lords, it is simply not possible to have a consultant in every specialty in every district. In some districts, a rheumatology service can be provided in other ways; for instance, by a general physician with a special interest in rheumatology. As I said in my original Answer, it is for health authorities to plan in detail what services to provide and what staff they need to provide them.

Lord Winstanley
My Lords, is the noble Baroness aware that the log-jam in rheumatology in certain hospitals arises not only from the shortage of consultant rheumatologists but from a shortage of consultant radiologists, without whose services the proper practice of rheumatology is impossible? In that connection, is the noble Baroness aware that consultant radiologists do not have to talk very much to patients, which means that they can easily leave Britain to practise in the EC at higher salaries, which is what many of them are in fact now doing? Finally, does the noble Baroness accept that however many consultant rheumatologists she is able to appoint, that will not solve the problem unless radiological services are adequate?

§ Baroness Trumpington
My Lords, I take note of what the noble Lord, Lord Winstanley, said about radiologists in the context of the Question, though I think he will agree that the subject of radiology is for another day. The Government's policy on medical manpower is to increase the proportion of medical care provided by fully trained doctors, and to relate the number of training grade posts to the career opportunities expected to arise.

§ Lord Ennals
My Lords, is the noble Baroness aware that I am surprised to hear her say that she is satisfied that there will be sufficient consultant radiologists in the years ahead as the population steadily ages and the demands upon rheumatology services steadily increase? As she did not answer the question put by the noble Baroness, Lady Masham, about the number of districts which did not have a rheumatologist, does the Minister accept from me that there are substantial parts of the country where there are no rheumatologists available to provide a service for elderly people? To say that the service can be provided by other means, means that one is taking a consultant away from a task that he is already perfoming. Will the Minister answer the question about what the Government are doing?

§ Baroness Trumpington
My Lords, I have a table of consultant rheumatology posts. I shall gladly place a copy of it in the Library. There are now 24 more consultants in that speciality than there were in 1979–an increase of nearly 12 per cent. Health authorities' forward plans suggest that that rate of expansion may be maintained or even increased. I think the noble Lord will agree that I answered other questions as they were asked.

Lord Wallace of Coslany
My Lords, is the noble Baroness aware that it is no good talking about employing more consultants if the consultants are not given back-up staff? Is she further aware that it is no good referring the solution of the problem to district 805 health authorities, because financial resources are not available for them to improve the service?

§ Baroness Trumpington
My Lords, I have nothing to add to the fact that it is for health authorities locally to make the best use of the funds available to them in deciding where their priorities lie. As a rheumatism sufferer, I have a personal wish to see good care from doctors wherever there is a need. It is my belief that the health authorities have so provided.

§ Baroness Masham of Ilion
My Lords, is the noble Baroness aware that some of the health districts without rheumatologists are those which cover rural areas? It is impossible for patients to reach hospitals to obtain treatment. Will she therefore emphasise that districts should do more in the important field of rheumatology?

§ Baroness Trumpington
My Lords, if the noble Baroness has any particular cases I hope that she will write to me and draw them to my attention. The government cannot plan in detail how local services are to be provided; that is for health authorities. In the last resort, the need for additional medical staff, as opposed, say, to more physiotherapists, can only be judged locally.