NHS: Patient Statistics (Hansard, 14 March 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the data are based on information collected directly from the health service, including Körner data.

§ Baroness Jay of Paddington
My Lords, I am grateful to the Minister for that reply. Perhaps I may ask her for a little more detail? Is she aware that many 4 people working in the health service and those using it find difficulty in understanding that the present system of arranging data for patients treated in the health service is based on the somewhat artificial concept of completed consultant episodes, in which people moving about the hospital or within the system are separately counted each time they move? Does that in fact support the Government's repeated assertion that more people are being treated? In the real world waiting lists have increased by some 29,000 in the past three months and there are now nearly 2 million people waiting in this country.

§ Baroness Cumberlege
My Lords, perhaps I may take the waiting list figures first. In 1987 there were more than 200,000 people waiting over a year. The figures published in September 1993 show that just over 71,000 people were waiting. That is a drop from 200,000 to 71,000. In 1987, 90,000 people were waiting over two years. Today, nobody in the regions is waiting over two years. So we have seen tremendous progress with waiting lists.
With regard to the information that is collected, prior to using finished consultant episodes, the data used to be based on deaths and discharges. People in the health service found that very unhelpful because it was impossible to tell whether people were leaving by the front gates or the pearly gates. The information that we now collect shows what activity happens within the hospital. It also shows the workload of individual consultants, which the National Health Service is very eager to assess.

§ Lord Ennals
My Lords, is the Minister aware—though there is no reason why she should be—that my wife was admitted to hospital five times in the past 12 months, so far as I know for different conditions? Can the Minister say whether my wife was counted as five people or one person? Secondly, we often hear stories of the increase in numbers being treated. Does she feel that it would be helpful to have statistics for the numbers of people treated in the health service?

§ Baroness Cumberlege
My Lords, if five different consultants were involved, it would be counted as five finished consultant episodes. One of the difficulties is that people now come into hospital with a multiplicity of problems. Therefore it is important that we know exactly what happens to them when they are in the hospital and which consultants treat them. That is why we have adopted the new process of counting. The process has been in use since 1988 when for three years we used both systems so that we could measure the difference. The difference is about 3 per cent. When we say that 100 patients were treated in 1990–91 and last year 112 were treated, that is using the same baseline.

§ Lord Dean of Harptree
My Lords, does my noble friend agree that the figures that she has just given amply prove that the "internal market" is working very effectively?

§ Baroness Cumberlege
Yes, my Lords, we know that more patients are treated year on year.

§ Lord Mellish
My Lords, in order to help the House generally, will the Minister give us some indication of the number of nurses and doctors and how much money has been spent in the past 10 years on the National Health Service?

§ Baroness Cumberlege
My Lords, I do not have those figures with me this afternoon, but I shall very gladly place them in the Library.

§ Lord Stallard
My Lords, in the context of this Question, will the noble Baroness accept that such information about separate consultant episodes is misleading? Without straining too hard, I can think of someone who has had 11 admissions and related discharges. That patient has been in hospital 11 times. That is one patient, but according to your statistics she is counted as 11 patients. Does the Minister agree that that must cause confusion to people who are looking at the figures in the context of this Question?

§ Baroness Cumberlege
My Lords, the basis on which we compile our figures of more people being treated goes back to 1988 so we can make a direct comparison. We are using the same baseline for the number of people treated as for finished consultant episodes. On that basis we know that we are treating more people year on year not only as in-patients but as day-case patients as well. We are also improving the health of the nation. When we look at GP activity in surgeries and health centres, we see that general practitioners are also exceeding the targets they were set two or three years ago.

§ The Countess of Mar
My Lords, the noble Baroness gave the waiting list figures up to September 1993 First, does she have more up-to-date figures? Secondly, do the Government find it acceptable that a number of hospitals now say that they are not admitting any more patients to the waiting lists unless they happen to be patients of fund holders?

§ Baroness Cumberlege
My Lords, I do not have any further validated information this afternoon beyond September last year. With regard to patients of GP fund holders being admitted, we have made it very clear to the National Health Service that there should be common waiting lists for urgent cases and that GP fund holder patients should not get priority treatment. When hospitals have completed the contract that has been set by the district health authority, we are seeing spare capacity being used quite properly by the patients of GP fund holders.

§ Lord Skelmersdale
My Lords, will my noble friend accept that the health of the National Health Service is better described in terms of completed consultant episodes rather than waiting list figures? Waiting list figures will always be necessary because, regretfully, with the best will in the world from all sides, there will always be a need for the rationing of treatment in the health service.

§ Baroness Cumberlege
My Lords, I agree. It is important that we look at the activity within the health service. It is not the numbers of people who are waiting 6 for treatment that matter; it is the time that they wait. We know that half of all admissions to hospital are immediate; of those admitted from waiting lists, almost half are admitted within five weeks, nearly three-quarters within three months and 98 per cent. within a year.

§ Lord Molloy
My Lords, I acknowledge the fact that the Minister's department will do its best to deal with this serious problem, but will the noble Baroness be prepared to consider discussing these matters with, the British Medical Association and UNISON? They are waiting to be consulted because they believe that they can assist the department in trying to resolve this difficulty.

§ Baroness Cumberlege
My Lords, I do not believe that there is a problem in terms of the activity within the National Health Service. We are investing more; we are seeing more professional staff employed; we are seeing more people treated. That is a success, not a problem. We make a point of working with the professional organisations such as the BMA, the RCN and others. The guidelines drawn up with GP fund holders were the result of an agreement reached by the consultants working within the National Health Service.

§ Baroness Jay of Paddington
My Lords, does the noble Baroness agree that the discussion this afternoon reveals that there is confusion around this complex method of adopting statistics on consultant episodes? Why is it not possible to reinstate the old system of deaths and discharges? Does the noble Baroness also agree that, on the validated statistics on waiting lists that were quoted, the number of those waiting for more than a year has risen by 30 per cent. in that period?

§ Baroness Cumberlege
My Lords, there is no question of going back to the old system of accounting. As I explained, the problem with deaths and discharges is that that system does not show us what is happening in the hospital. For the patient, the difference between death and discharge is considerable. It is not as great a problem as the noble Baroness implies, and the longer this system runs the easier it will be to make comparisons.

§ Baroness Jay of Paddington
My Lords, will the noble Baroness please reply to my question regarding the 30 per cent. increase in the number of people waiting for more than a year?

§ Baroness Cumberlege
My Lords, we know that the number of people waiting over a year has markedly improved since 1987. There are of course fluctuations and at the moment we may be seeing an increase. However, we are still meeting the target of 18 months' wait for hip replacements, 18 months' wait for cataracts and nobody waiting for more than two years.

§ Baroness Nicol
My Lords, does the waiting time quoted by the Minister include the time spent waiting to see a consultant or is it counted from the time the patient sees the consultant?

§ Baroness Cumberlege
My Lords, it is counted from the time that the patient is referred by the general practitioner.