Hospitals in London: Waiting Lists (Hansard, 27 January 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, in the year to September 1992, the total number waiting for in-patients or day case treatment in inner London fell by 13 per cent., while the number waiting over a year was more than halved. Information on out-patient waiting lists is not collected centrally. However, under the Patient's Charter health authorities are setting and publishing local charter standards for waiting times for first out-patient appointments for each hospital speciality and consultant.

§ Baroness Jeger
My Lords, I thank the noble Baroness for that Answer. Is there not some contradiction in the figures we are getting and in the figures which occur on page 39, paragraph 145, of the Tomlinson Report? There it is stated that 1,700 beds in London have already been closed, and the Tomlinson proposals would reduce the number by another 2,500. Surely there is some relationship, even in the mind of the Government, between supply and demand. Does she agree that the closure of so many beds will make it more difficult for doctors to get their patients into hospital or to get appointments for out-patients?

§ Baroness Cumberlege
My Lords, your Lordships will be aware that we will be debating the recommendations of the Tomlinson Report in terms of the Statement shortly to be made by my right honourable friend the Secretary of State. Last Monday I answered a Question on the Tomlinson Report. I explained the great dilemma that exists in London in terms of beds and the way that they are used. We know that 60 per cent. of people coming into accident and emergency departments are visiting London and would not normally use those departments. One of the main thrusts of the Tomlinson Report, upon which my right honourable friend will be commenting, is the provision of primary care. It is not just beds and acute services; it is the whole range of London healthcare that is important.

§ Baroness Robson of Kiddington
My Lords, can the Minister tell us whether she is concerned about the frequency with which general practitioners in London need to have recourse to the emergency bed service to get their patients into hospital?

§ Baroness Cumberlege
My Lords, yes. I believe that is the answer I gave a moment ago.

Lord Bruce of Donington
My Lords, the noble Baroness may not have the figures available today, although she has quoted percentages. Is she aware that to be able to quote percentages means that she must have the figures and statistics upon which those percentages are based? Presumably it would be quite easy to obtain the figures and publish them. It is perhaps too late to ask the noble Baroness to do that today. However, when she comes armed to debate the Tomlinson Report, will she ensure either in advance or at the time that the actual figures are made available as distinct from the percentages?

§ Baroness Cumberlege
My Lords, in my short time in your Lordships' House I have learnt never to come to Questions unprepared. There are 78,573 people on waiting lists in London. It is not the total number that is important; it is the time that they wait for their appointments that is important. Should there be any hospitals about which the noble Lord has a specific question, I am prepared and I hope able.

§ Lord Mackay of Ardbrecknish
My Lords, does not my noble friend agree that the problem in regard to the health service in London is that the obsession about which we hear in this Chamber and read of outside regarding the hospital provision and the 1265 dominance that that provision has had on the budget of the health service in London has led to what is the poorest primary health service in the country? The Government must turn their hand to that.

§ Baroness Cumberlege
My Lords, my noble friend is right. I am sure that that will be a major plank in the Government's strategy for the future.

§ Lord Annan
My Lords, is it not correct that in some of the departments in our great teaching hospitals there is a waiting list; but, equally, in other departments there are vacant beds? Is not the answer the kind of rationalisation which was suggested in the Tomlinson Report? For instance, while rendering great gratitude to St. Bartholomew's Hospital for the services it renders to those who come and work in the square mile of the City of London, is it not reasonable that obstetrics and gynaecology should be concentrated at the Royal London Hospital? That hospital serves an area in which many babies are born, whereas one hopes that in the square mile of the City of London there are relatively few babies born.

§ Baroness Cumberlege
My Lords, I thank the noble Lord for that question and those comments. I am sure that he will make a major contribution to the debate which will be before us in the next few months.

§ Lord Hayhoe
My Lords, does not my noble friend agree that it is not the number of beds which is of high significance but rather the number of patients who are treated? To have beds which are not used efficiently and effectively does not help the healthcare provision in our capital city. Let us concentrate on patients while of course recognising the significance of beds in any specific specialty in a hospital.

§ Baroness Cumberlege
My Lords, my noble friend is correct. One of the great thrusts in the health service at the moment is the use of day-case surgery which does not involve beds at all. People prefer it; it is more efficient, and we know that in this respect London lags behind the rest of the country.

§ Lord Howell
My Lords, will the noble Baroness consider the experience I have just undergone? I spent several days in Westminster Hospital where the demand for emergency work was astronomical. On two occasions on two successive days four patients were brought into my ward when the previous occupants of the beds were still in them. That illustrates the demand. There were people from hostels and those who were tourists in the Westminster area; there were people from the large day-time working population. The suggestion that Westminster Hospital and possibly also St. Thomas's should close and that the whole of the Westminster area should be left with an inadequate amount of emergency beds is lunatic.

§ Baroness Cumberlege
My Lords, the reasons for some of those problems revert back to the earlier questions on primary care and its inadequacy in London. At this moment, I do not want to make any comment regarding the future of London hospitals. However, I can reassure the noble Lord that we shall 1266 be looking at accident and emergency services specifically. We recognise how crucial they are to people living and working in the City.

§ Lord Desai
My Lords, will the noble Baroness give us an assurance that primary healthcare facilities will be in place before beds are closed in London?

§ Baroness Cumberlege
My Lords, I am afraid your Lordships will have to wait for the announcement by my right honourable friend the Secretary of State in another place.