NHS Waiting Lists (Hansard, 31 March 2003)

Noble Lords
Hear, hear!

§ Baroness Andrews
My Lords. I am grateful for the encouragement. We have put in place a major program me of investment, modernisation and reform designed to shorten waiting times. As a consequence, by the end of 2005, we will see maximum waiting times of 13 weeks for a first outpatient appointment and six months for inpatient treatment.

Lord Campbell of Croy
My Lords, I thank the noble Baroness for her reply, particularly as she is so busy today. Apart from emergency cases, are patients offered available beds in other establishments, as a press report indicates today, even if they are some distance from their homes?

§ Baroness Andrews
My Lords, in the case of coronary heart disease, in particular, if there is a possibility of getting the patient into hospital faster, there is a choice scheme, whereby the patient can be offered treatment in a different hospital. I believe that a high proportion of patients make that choice.

§ Lord Clement-Jones
My Lords, the recent Audit Commission report referred to widespread errors and 1044 deliberate misreporting of waiting lists and waiting time figures. The Audit Commission said that there should be an open debate in the NHS about what led to such behaviour, so that lessons could be learnt and measures taken to avoid repetition. What can the Minister say about that? What is the department doing to implement the Audit Commission's recommendation?

§ Baroness Andrews
My Lords, it is important that we put it in perspective. Three of the 41 hospital trusts on which spot checks were carried out were found to be seriously in default. The Government want to see an end to such situations, and Nigel Crisp described them as reprehensible and unacceptable. I endorse that view. Some other trusts were discovered to have system reporting failures that were essentially technical.
In the case of the three trusts mentioned, we set up investigations immediately before the report came through. Two reports are still outstanding. There have been suspensions, and some people have resigned. More generally—I stress that the Audit Commission emphasised that its findings did not affect the validity of the aggregate data and said that such figures were robust—we have introduced a code of conduct for managers to make it clear that giving in to any temptation to alter figures will be a serious matter. We are examining ways of supporting better systems, and we have set up a better investigative framework for responding when things go wrong.

§ Baroness Pitkeathley
My Lords, does my noble friend agree that there is a problem, in trying to get waiting lists and waiting times down, with patients who have admission and appointment dates but do not keep them—the "no shows"? In that regard, does she consider that the Government's programme of informing and empowering patients through the patient and public involvement programme will have an effect on the behaviour of patients?

§ Baroness Andrews
My Lords, we are already beginning to see that effect. The programme is called "Waiting and Choosing", I believe, and the difference is that patients can decide when they go into hospital; it will be at their convenience. That makes it much less likely that they will cancel. That is a positive step.
Another positive step is for GPs to develop special interests—for example, skeletal disorders—so that, instead of having to go into the hospital, the patient can be treated at home by the GP. It is not just a question of managing the waiting list more effectively; there must be a range of strategies to support better referral and appointment systems.

§ Lord Pilkington of Oxenford
My Lords, is the Minister aware that, behind all the rhetoric, the fact in Somerset, where I come from, is that elderly people needing a hip replacement must wait nine months to a year? They are crippled. In spite of all that the Minister said, I do not think that she is aware of the distress that exists in the health service.

§ Baroness Andrews
My Lords, a number of your Lordships have waited for orthopaedic surgery, and it 1045 is good to see those people back with us. Orthopaedics is a particular challenge, to which we have responded by setting up what we call an "action on" programme. That is a priority programme to speed things up. There are 43 projects in process at the moment addressing the particular question of timescales in orthopaedics. We are well aware of the situation.

§ Lord Forsyth of Drumlean
My Lords, does the Minister share my concern that, although the Government have put more resources into the National Health Service, that huge increase in resources has not been matched by a huge increase in output? The best way to get waiting lists and waiting times down is to treat more patients. Why, despite the huge sums of public money being put into the health service, do we not see outputs increase? Instead, we see large numbers of people whose job it is to produce the Figures that Ministers want.

§ Baroness Andrews
My Lords, I could answer the question simply by referring the noble Lord to the modernisation board's report, which shows how much progress we are making on outputs across the board. The waiting lists are lower by 104,000 people than those that we inherited in 1997. In itself, that speaks volumes for the way that the money is being used and the effectiveness of our funding and investment.

§ Lord Marsh
My Lords, is the Minister aware of another category of people, some of whom are in their 60s, who are refused hip replacement treatment in the National Health Service because they are too young?

§ Baroness Andrews
My Lords, in this House, we know how young one can be at 60. I know of no cases of the kind to which the noble Lord refers. If he writes to me, we can follow it up.

§ Lord Turnberg
My Lords, does my noble friend agree that the sooner we bring the Community Care (Delayed Discharges etc.) Bill into effect, the sooner it will have an effect on the waiting lists?

§ Baroness Andrews
My Lords, at this time this week, I can certainly agree with my noble friend.

§ Earl Howe
My Lords, a fundamental worry about the Government's waiting list initiative remains. It produces a system in which hospital managers are under greater pressure to deliver on government targets, which is rather a different thing from saying that they should be under pressure to deliver the right patient care and treating the sickest patients first. Is not that a fundamental worry about the initiative?

§ Baroness Andrews
My Lords, that claim is often made about waiting lists. The Modernisation Agency has worked out a clinically prioritised waiting list that addresses that precise issue and puts the patients in 1046 most urgent need at the top of the list. The agency works with clinicians in trusts to make sure that clinical priorities are observed and delivered on.

§ Lord Blackwell
My Lords, does the Minister accept that experience suggests that waiting time objectives are more likely to be met by freeing up doctors and local managers through programmes such as the Government's foundation hospital programme, rather than through centralised initiatives, and by freeing up patients to take their treatment elsewhere? What do the Government expect the rate of development of the use of non-NHS facilities by NHS patients in the next year to be?

§ Baroness Andrews
My Lords, I agree with the noble Lord that it is not simply a question of delivery through the hospitals and through centralised systems. One of the reasons why we are so pleased to see GPs develop special interests is that it means that we are taking a whole-system approach. We attach priority to getting people treated and out of pain, and we are considering various ways of doing that. I cannot, however, put timescales or figures on it, in the way that the noble Lord suggested.

Lord Acton
My Lords, is my noble friend aware of what an outstanding performance she has just given? If she was not aware before, is she aware now?

§ Baroness Andrews
My Lords, I simply cannot answer that question.

§ Baroness Trumpington
My Lords, is the Minister aware that what the noble Lord, Lord Marsh, said about people being refused treatment because they were too young is true? I speak as somebody who has two false knees. If somebody has that operation at the age of 60, it is possible that the replacements will wear out. Going through such an operation again is something to be avoided.

§ Baroness Andrews
My Lords, the point is well taken. The sooner we treat people with deteriorating conditions, the better.

Noble Lords
Oh!

§ Baroness Andrews
My Lords, I have just blown my reputation.

§ Baroness Howells of St Davids
My Lords, can the Minister tell the House what the primary care trusts do specifically to end waiting lists?

§ Baroness Andrews
My Lords, because of the devolution of power and the shift in the balance of power, primary care trusts have greater responsibility to work with GPs, including specialist GPs, and to inform and support patient choice. That means that the whole system works more effectively together.