NHS: Cancelled Operations (Hansard, 12 December 2002)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we have invested £8.5 million in the current financial year to help reduce the number of cancelled operations and ensure that good practice in operating theatres is implemented throughout the National Health Service.

§ Earl Howe
My Lords, I thank the Minister for that reply. Is not the high number of cancelled operations simply part of a wider picture of falling productivity in the health service? Is the Minister aware that, over the three years to last April, the NHS budget increased by more than 21 per cent, yet, during the same period, NHS activity increased by only 1.6 per cent and the number of hospital admissions actually decreased? Do those figures cause the Minister any concern? Should we not question whether all the extra money promised for the health service will succeed in treating a commensurately large number of extra patients?

§ Lord Hunt of Kings Heath
No, my Lords, because it is not possible to measure NHS performance purely by hospital activity—although, by 2001–02, the number of finished consultant episodes had increased by 11 per cent compared with 1997–98. Surely the noble Earl will recognise that there has been a great expansion in services. Better and more expensive drugs can improve the quality of life and keep people out of hospital, and an expansion in primary care also is desirable. We need to paint a rounded picture to see the results of the extra expenditure. I am confident that we will meet the targets, reduce waiting, increase capacity and produce the type of health service the public want.

§ Lord Clement-Jones
My Lords, are not the real figures actually far worse than those published? It appears that only operations cancelled on the day are included in the figures, and that patients put on standby are not included. Whatever happened to the troubleshooting managers who the NHS announced in February and said were capable of tackling the problem?

§ Lord Hunt of Kings Heath
My Lords, we have taken action to improve the situation in relation to cancelled operations. The £8.5 million programme to which I referred has been accompanied by direct intervention and action in individual hospitals to help reorganise their processes. The figures I have seen for the first two quarters of the current financial year indicate that, by the end of the financial year, compared with last year, there will be a reduction in the number of cancelled operations.

Lord Campbell of Croy
My Lords, what are the most frequent reasons for cancellations? Is it non-availability of operating theatres or other reasons?

§ Lord Hunt of Kings Heath
My Lords, my information is that although the pressure on theatre time may be a contributing factor, there are a number 381 of reasons for cancelled operations, including bed availability and shortage of theatre staff. There are also emergency pressures on theatres whereby patients scheduled for routine treatment are asked to wait because of an emergency case. The real solution to these problems is to increase capacity in the health service. That is why we are seeing such a large increase in the number of nurses employed, up to 40,000 more since 1997; an increase in bed numbers; and an increase in staff training places. All those actions will enable the health service to increase capacity and, therefore, to deal with the problem most effectively.

§ Baroness Finlay of Llandaff
My Lords, can the Minister say to what extent the shortage of staffed intensive care beds is contributing to the cancellation of very major surgery in patients who are extremely ill with life-threatening conditions?

§ Lord Hunt of Kings Heath
My Lords, it is not possible for me to quantify how many operations might have been cancelled because of a particular problem with a critical care bed in a particular hospital. What I can tell the noble Baroness is that, just as we have seen an increase in the past three years—for the first time in 20 years—in the number of general and acute beds, we have also seen a big increase in the number of critical care beds. Using as a baseline 15th January 2000, there were 2,362 critical beds; by July 2002, the number had increased to 3,070.

§ Lord Turnberg
My Lords, does my noble friend agree that while the causes of cancelled operations are multiple and vary from place to place, in many instances surgeons find themselves unable to operate because of a lack of time or space in theatres? Is not this whole matter compounded by the difficulty in discharging patients into the community where they would be better off?

§ Lord Hunt of Kings Heath
My Lords, as regards the discharge of patients, we shall introduce a Bill to incentivise local authorities to do what is required to ensure that when a patient has finished his treatment and is ready to return to the community the relevant local authority makes the necessary arrangements. There are instances of pressures with regard to theatre use but that matter is being tackled. I believe that a more flexible working pattern on the part of staff in the NHS would enable those theatres to be used more effectively.

§ Lord Elton
My Lords, is the Minister aware of the growing body of anecdotal evidence that the money to which he referred in his reply to the first supplementary question of my noble friend on the Front Bench is simply not coming out of the other end of the pipe into which it is poured? Will the Minister reassure me as regards the following matter? In the spring I heard at a meeting held by people running cancer units in Greater London that they had not received the money that was promised to them. I also 382 heard at a meeting of people running hospices that they had not received the extra money promised to them in September. Does the Minister recognise that that makes it difficult for me to accept what he said?

§ Lord Hunt of Kings Heath
My Lords, we monitor carefully the two matters to which the noble Lord referred. I understand that the improvements that we wanted to see take place in cancer services are taking place. As regards the general resource question, as I think I have already said, one cannot judge the use of resources simply in terms of the number of hospital admissions. Resources are being used, for example, to increase drug budgets. That enables people to receive better treatment and often means that they do not have to go into hospital. We are also using resources more effectively by increasing the use of GPs and primary care. Overall, the NHS is treating more patients more quickly and more effectively. That is the pathway to an improved and excellent NHS.