NHS: Numbers Awaiting Surgery (Hansard, 25 October 1990)

The Parliamentary Under-Secretary of State, Department of Health (Baroness.Hooper)
My Lords, figures published yesterday which relate to all hospital admissions and not just to operations show that 710,300 patients were awaiting admission as inpatients and 202,500 as day cases in England at 31st March 1990. The equivalent figures for September 1989 were 698,600 and 182,300. However, the number of patients waiting for more than 12 months has been reduced significantly.

§ Lord Ennals
My Lords, is it not deplorable that after this Government have been in power for 11 years hospital waiting lists are at their highest since the National Health Service was created, following the biggest six-month jump since the last general election? To what extent is that due to the massive bed closures —mostly temporary—due to the shattering effect of high inflation rates? Why does the noble Baroness refuse to answer questions that I put down asking for information about temporary bed closures in the London area?

§ Baroness Hooper
My Lords, I was not aware that I was refusing to answer any of the noble Lord's questions. I am always delighted to try to answer his questions.
To answer the main thrust of the noble Lord's supplementary question, it is not the total number of patients on the waiting list which is the main issue. The National Health Service treats more and more patients and, therefore, inevitably the total number of patients who go on waiting lists before admission will also rise. What matters is the time the individual patient has to wait. Half the total admissions to hospital are immediate, let us not forget, and half of those admitted from waiting lists are admitted within five weeks.
However, having said that, we recognise that patients in some districts have to wait too long for treatment. That is why we introduced the waiting-list initiative in 1986 and that is why the National Health Service Management Executive is now agreeing tough targets for reducing waiting time in each of the 14 regional health authorities.

§ Lord Mellish
My Lords, what percentage of admissions are for serious operations and what percentage are for minor operations? Secondly, is there any hope of speeding up the arrangements for people to be operated on on the day of admission and discharged the same day?

§ Baroness Hooper
My Lords, not only is there hope but there has been an enormous increase in day care cases. The numbers are currently 11 per cent. higher than in September 1989 and are considerably higher than when we came into office in 1979. That is due in part to new techniques and new technology. So far as concerns the specific information which the noble Lord requested, we shall shortly be publishing a book of waiting-list information by district and specialty. The details of the different types of cases on waiting lists may be of interest to the noble Lord.

§ Lord Carr of Hadley
My Lords, does my noble friend agree that as well as considering the numbers on waiting lists it is important to consider the number of operations which are carried out? Can she give any figures as to the increase in the number of operations, since the two are closely related?

§ Baroness Hooper
My Lords, my noble friend has made an important point. What matters is, indeed, the increase in the number of patients being treated. In 1988–89 approximately 6.6 million in-patients were treated, which is 22 per cent. more than in 1979. As I have already said, the number of day cases has increased by 72 per cent. over the same period. I believe that those figures represent real advances in all forms of care.

§ Baroness Hollis of Heigham
My Lords, if my noble friend Lord Underhill were here he would have referred to his own experience. He is, alas, away ill. Appointments at the Westminster Hospital have frequently been postponed because the hospital has been forced to close 64 beds to meet Department of Health requirements. Has the Minister seen the letter that was sent to my noble friend Lord Underhill which states that the hospital has no option but to reduce further the number of staff and out-patient clinics? Has she also seen in that letter that because of similar financial pressures the majority of London hospitals are now in the same position? Does the Minister agree that waiting lists have lengthened as wards have been closed, and would she care to explain to waiting patients, many in pain, why their suffering should be necessary?

§ Baroness Hooper
My Lords, I have not had the pleasure of seeing the letter to which the noble Baroness referred. Extra money has gone into the health service since this Government came into office in considerable amounts. We have recognised that there is a problem regarding waiting lists and a need for a review. That review has led to the reforms with which many of your Lordships will be familiar. The National Health Service reforms put issues of quality such as waiting lists at the top of the management agenda and provide incentives for improving them.

§ Lord Gisborough
My Lords, is my noble friend aware that in one of the health authorities in the North the waiting list for serious operations is nil and that in the neighbouring authority the waiting list is at its lowest for four years? Is she aware that most of those waiting are, for example, women waiting for sterilisation for whom other options are available?
1525 Furthermore, is she aware that day facilities for operations are under-used and the waiting-list initiative has been very much appreciated?

§ Baroness Hooper
My Lords, I am grateful to my noble friend for pointing out that the waiting-list initiative has been very much appreciated. Indeed, it has had considerable success. One specific region, the Mersey region, has been particularly successful in reducing its longest wait patients. It is the first region to have no patient waiting longer than two years on a waiting list. It is our aim by March 1992 to have no one anywhere waiting for over two years. However, the Mersey success shows what can be achieved through good management. We congratulate the chairman and officers of the regional health authority and those responsible for the other health authorities who are having considerable success in this field.

§ Lord Kilmarnock
My Lords, will the noble Baroness confirm that it is the Government's intention to continue the waiting-list initiative, that is to say, to direct earmarked funds at this specific problem; and will there be another tranche?

§ Baroness Hooper
Yes, my Lords, we plan to continue the waiting-list initiative and health authorities that have already used the waiting-list fund to experiment with a variety of initiatives will continue. The reforms that we are introducing through the National Health Service and Community Care Act will allow further developments along those lines to enable waiting-list patients to be treated more quickly.

§ Baroness Masham of Ilton
My Lords, does the noble Baroness know how many acute surgical beds are being blocked by disabled people who may, for example, have had an amputation or have a broken back and have to use a wheelchair and who must remain blocking those acute beds because there is no suitable housing for them to which they can be discharged?

§ Baroness Hooper
My Lords, I do not have any figures or information on that point but if the noble Baroness wishes to pursue the matter I shall be very happy to answer her on another occasion should she choose to table a Question.

Lord Wallace of Coslany
My Lords, is the Minister aware that the widespread closure of beds in hospitals throughout the country is one of the main factors in the situation?

§ Baroness Hooper
My Lords, the reasons for the National Health Service reforms to which I referred are to improve the efficiency of the service and to ensure that quality issues such as waiting lists are at the top of the agenda.

§ Lord Diamond
My Lords, I am one of the no doubt many recipients of the letter from the Westminster Hospital to which reference was made and which the Minister said had not been brought to her attention. Perhaps she would be good enough to let me know whether she has any difficulty in seeing the letter, in which case I can show her a copy. Rather more seriously, with regard to the information that she said 1526 was being prepared by the Government, does she agree that one of the elements of a waiting list in which everybody is interested is the period of waiting as well as the seriousness of the operation? Will she use her best offices to ensure that something relevant, such as a weighted average, could be statistically produced so as to give people a quick view of how the totality of waiting varies from period to period?

§ Baroness Hooper
My Lords, I thank the noble Lord for his kind offer to produce a copy of the letter referred to. I agree with him on the importance of the waiting time as opposed to the total numbers on the waiting list. I shall look into the question of how the statistics are presented in the future.

§ The Countess of Mar
My Lords, is the Minister aware that our concern about the length of waiting lists is largely because of the anxiety which it causes the patients who have to wait? Not many people like having to go into hospital and the longer one has to wait the worse the anxiety becomes. Would she examine whether anything can be done about the supporting services—for example, X-ray and physiotherapy—for which there are now long waiting lists and where practitioners are having to work with outdated equipment because there has not been the capital expenditure to bring it up to date?

§ Baroness Hooper
My Lords, as I said earlier, one of the reasons why waiting lists are longer is that more people than ever before are being treated. Inevitably the waiting lists have responded to that situation. I take this opportunity to mention, in response to the noble Countess, that the figures which have been quoted for total numbers include a number of self-deferred people —that is to say, people who simply do not turn up for their appointments—and day cases for which statistics were not collected before 1987. In a sense that distorts the total figures.

§ Lord Ennals
My Lords, would the Minister—

§ Lord Denham
My Lords, perhaps the noble Lord will give way. There is no right of any noble Lord to have a final word on his own Question. If the noble Lords who ask Questions want to ask further supplementary questions, perhaps they could do so a little earlier. We have now taken 11 minutes on this Question, having got through the first three Questions in 12 minutes. If the noble Lord wishes to ask his question, I shall of course give way but after that and after my noble friend has answered, perhaps we can move on.

§ Lord Ennals
My Lords, I am most grateful to the noble Lord for the very courteous way in which he dealt with the matter. The Minister referred to the fact that it was not a question of numbers. Does she agree that if one happened to be among the nearly 1 million people waiting for an operation one would feel that the question of numbers had some importance? Secondly, she said that she did not know that she was not giving me the information for which I had been asking. She gave me a reply on 23rd October when I asked about the number of temporary bed closures in Greater London during 1990. She said that the information was not available centrally. It must be 1527 available. Will the Minister confirm that it is quite extraordinary that it should not be available? Finally—

§ Lord Denham
My Lords, that would make three questions.

§ Lord Ennals
My Lords, in view of the noble Lord's earlier courtesy, I shall show him the same consideration.

§ Baroness Hooper
My Lords, I consider that the noble Lord has received a reply from me to his question. The fact that we do not have the information available must be the most appropriate reply in the circumstances. With regard to his other point, of course it is important to the person on the waiting list at what time he has his operation. It is also very important to all those other people who have received treatment over the past years as a result of the increased activity and the increasing numbers of people being treated.