Hospital Admissions: Criteria (Hansard, 29 June 1988)

§ Lord Skelmersdale
My Lords, consultants' decisions on admission to hospital are based on their clinical judgment. Each case will be treated as individual.

§ The Countess of Mar
My Lords, I thank the noble Lord for that Answer. Is he aware that the problem caused with the closure of beds—I shall not say "cuts" because the Minister does not like the word—is that the consultants are no longer able to use their clinical knowledge when deciding whether or not a patient should be admitted to hospital? Is he aware that patients are suffering because they cannot have a guaranteed bed when they need it in an emergency, in particular for intensive care?

§ Lord Skelmersdale
My Lords, it is important that people in emergency should be treated somewhere. It depends how one classifies "emergency." If one means by "emergency" within 12 hours, I believe that this is always achieved. There have indeed been closures of beds for a number of reasons. We have discussed this a number of times over the past 12 months in this Chamber. However, I have also pointed out that the number of cases treated, and operations conducted, has consistently risen over recent years.

§ Lord Ennals
My Lords, in the Minister aware that, while some noble Lords were sitting very late last night, I was with the Hereford Health District where I was being told by the chairman of the medical committee of drastic cuts in the basic services to patients, including the closure of theatre wards and the standing down of theatre staff, doctors and nurses? Is he surprised that some local people were saying to me that this is a deliberate policy to boost the private sector of the health service because people are now having to wait longer and longer?

§ Lord Skelmersdale
Yes, my Lords, I am very surprised on two counts. First, I regard myself standing at this Dispatch Box as a rather tired statistic. Secondly, because in his discovery I am surprised that the noble Lord did not achieve understanding of the fact that, in spite of the closures to which he referred, even in that district health authority the number of cases treated has gone up, as in other parts of the country.

§ Lord Campbell of Alloway
My Lords, does my noble friend agree that it is extremely difficult to answer this Question on the Order Paper in the form in which it is put because, quite fairly, the criteria must depend largely on ruling circumstances?

§ Lord Skelmersdale
Yes, my Lords, they must depend on ruling circumstances, but clinical judgment forms the major part of all decisions on admission to hospital.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that in some places, for people who have not been able to get treatment in this country, their communities have raised money and sent them abroad for treatment? How does he view that kind of circumstance? Does it not show how keen the community is for health services?

§ Lord Skelmersdale
My Lords, I could not guarantee that every treatment possible in the world is available in this country. There are some treatments which the medical establishment here treats with a certain amount of suspicion. Therefore it is hardly surprising that if people are determined to have a particular treatment which they cannot have here they raise funds both privately and publicly to send their relatives, or indeed themselves, to other parts of the world to be treated.

The Earl of Halsbury
My Lords, tired as we both are—the noble Lord on the Front Bench and myself on the Cross-Benches—has the Minister read the extremely interesting leading feature article in The Times this morning about the unique opportunity presented by the present investigations into the 1588 National Health Service to rectify conceptual misconceptions in the original Bevan scheme? Will he write to me about it?

§ Lord Skelmersdale
No, my Lords, I have not read it. Yes, I shall certainly write to the noble Earl.

§ The Countess of Mar
My Lords, will the noble Lord agree that the general population in this country must be coming round to realising that National Health Service facilities have to be rationed? Would it not be a good idea if the Government opened to public debate clear guidelines of some kind for who should and who should not be treated and for how long they should be treated?

§ Lord Skelmersdale
No, my Lords, I do not think that that is the proper role of government. Rationing in the health service in certain areas has existed for many years. An example of such rationing is the waiting lists.

§ Lord Mellish
My Lords, is the Minister aware that some of us have very close association with the health service? We have been very proud indeed of the National Health Service since its inception, as we are today. It is doing a magnificent job. Is it not a fact that it has always been taken for granted that the consultant will decide whether a case is urgent enough for a patient to be admitted? My experience, which spreads over a large number of years, is that consultants usually get their way.

§ Lord Skelmersdale
My Lords, I am extremely grateful to the noble Lord. I only add that I am alive today purely because of the good services of the National Health Service.