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Ophthalmic Services (Maidstone)

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Garel-Jones.]

2.31 pm

Miss Ann Widdecombe (Maidstone) : I am grateful for the opportunity to raise this issue, which is of growing importance to my constituents. I am grateful to my hon. Friend the Minister for being present to answer the debate. This is not the first of my Adjournment debates to which he has had to respond recently. I know that he was in his constituency this morning and has had to return to answer my debate.

In criticising the ophthalmic provision available to my constituents, I am not suggesting that there is not tangible evidence in my constituency of the Government's commitment to the National Health Service. In many ways, the medical and surgical provision within the Maidstone district health authority is exemplary and reassuring to those who need it.

Following recommendations for decades, a brand new hospital was built by the Government. It will soon be expanded to include a new mass radiography unit. We have received extra money under the waiting list initiative to help in orthopaedics. In 1987, under what I still claim was plain regional mismanagement, the South-East Thames regional health authority managed to move itself, having for several years spent £600,000 on rents and rates for an empty headquarters while at the same time closing wards in Maidstone because it claimed that it did not have enough funding. At that time, the then Minister--my right hon. Friend the Member for Braintree (Mr. Newton)--was helpful in getting us the money necessary to reopen the wards. He showed extreme courtesy in meeting the delegations of our nurses and others. We have been given a fair amount of attention. Nevertheless, there is a major blot on health service provision in Maidstone and in the South- East Thames regional health authority as a whole. That blot is the inadequate ophthalmic service, especially in terms of surgery and out- patient appointments.

By contrast with the district general hospital, which is large, new and well-equipped, the ophthalmic and aural hospital is extremely old and cramped and rather dilapidated. When I visited it in a routine fashion on Christmas day last year, I was horrified to find that the traditional turkey would not have been provided if the staff had not held a collection. That was because the health authority said that there was not enough money available. If we cannot produce a turkey for the handful of patients in the hospital on Christmas day, that shows that the hospital is being severely neglected.

The real problem relates to the waiting lists for ophthalmic services prevalent in the Maidstone district health authority. For many different reasons it is not easy to travel to hospitals outside the district, let alone outside the region, if one has eye problems. Largely that is because such problems afflict the elderly disproportionately and it can be extremely difficult for an elderly person with cataracts in both eyes and no transport to make a complicated journey.

Although I have always made a point since I was elected of getting patients complaining of long waits seen outside the area, it is extremely difficult to do that for ophthalmic patients and one consultant resists making referrals outside the area because he believes that adequate

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provision should be made for patients in the district itself. Even if I am successful in getting patients referred outside the area, there are long waiting lists for ophthalmic treatment throughout south-east Kent and throughout the country generally.

Cataract patients in my constituency must now wait 19 months for an operation. An elderly patient with a blocked punctum was offered an appointment one year hence. Her husband wrote on the card which announced the appointment that the NHS must be in "a hell of a state." He then sent the card back to the surgeon. I do not agree with that sentiment. I believe that by and large the NHS is extremely healthy, but it has its black spots and the ophthalmic service is one.

Second cataracts are on a reserve list. Out-patients must wait a year for an appointment and then wait another year for surgery. That has had such an effect that in some cases treatment is given where the diagnosis is not confirmed. I received a letter late last year from a surgeon who is trying to cope with this situation : He wrote :

"Returning to outpatients and the waiting times for an appointment, we are in a situation where frequently patients are referred to us suspected of having glaucoma as diagnosed by the optician. Glaucoma is an irreversibly blinding eye condition. If I was thought to have glaucoma, I would not wait more than a few weeks. We cannot accommodate these patients in that time and they are therefore supplied with treatment on the assumption that they do have glaucoma although a definitive diagnosis has not been made. This is a practice which most doctors would say is unacceptable and morally wrong, namely that a patient is being treated for a condition that he may not have purely because he has not yet been seen by a doctor." It is all very well for opticians in the area to ensure that they have adequate eye-testing facilities and for people like me to demand in the House that there should be health warnings where unprescribed spectacles are sold. Similarly, it is all very well to encourage the population to adopt preventive eye medicine and to have eye tests. However, if they have the tests and are found to have something as serious as glaucoma, they still cannot receive immediate appointments and must be treated on the assumption that they have that illness. It is hard to think of any other area in the NHS in which patients are treated merely on the assumption that they have a certain illness. Efforts have been made to rectify the situation. In January 1988 a fifth consultant was appointed with a view to reducing the waiting lists. Furthermore, additional money has been made available. Once again I will try the Minister's patience by quoting a letter from Sir Peter Baldwin, the chairman of South-East Thames regional health authority. He wrote :

"We expect that an increasing elderly population will place further demands on our ophthalmology services. The attached table shows that in the main the position regarding ophthalmology across the region is far from satisfactory. We have tried to remedy this through our location of the Secretary of State's waiting list fund. In 1987-1988 a total of five districts"--

that is, within the region--

"received additional funds for their ophthalmology services, two of those schemes being specifically for cataracts, and in 1988-89 seven districts received additional money for schemes either wholly or partly connected with ophthalmology, and of those three were for cataracts."

Despite all that effort, there is still a 19-month wait for cataract operations, a year's wait for out-patient appointments and another year's wait for surgery. Elderly

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patients, who do not have many years in which to enjoy the fullness of their faculties and of good health, are having to go on a reserve list for a second cataract operation. They must put up with routine conditions such as blocked punctums, which although not life threatening or sight threatening, are irritating and impair the quality of life. They are expected to put up with that for a year. Within the South-East Thames area, only Camberwell has reasonably short waiting lists. I do not know why that should be. Apart from that, there is no district health authority with a reasonable waiting list.

Despite the efforts that have obviously been made to improve matters--I am grateful for the efforts that have been made and I do not want to comment in any destructive way--ophthalmology is principally required by the elderly. The number of elderly people is increasing, and it is likely to increase as a proportion of the population for some time to come. We should look at the density of allocation of ophthalmologists throughout the NHS. In Belgium, for example, patients can be seen within five days at least to get a diagnosis, and surgery--even routine surgery such as cataract surgery --follows within six months. When we look at recruiting, and the emphasis in medical schools as people go on to train and specialise, we must question whether we have the right emphasis on a particular branch of medicine that is needed by the elderly. For years we have heard about the need to increase our orthopaedic provision, because the elderly are particularly susceptible and need hip replacements and so on, and we are doing that successfully. However, is it not time to have a similar increase in ophthalmology provision? Is there anywhere else in the country to which I could refer the fittest of our cataract patients where there are shorter waiting lists? If not, what is to be done and on what time scale? 2.42 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I congratulate my hon. Friend the Member for Maidstone (Miss Widdecombe) on securing this Adjournment debate. The frequency with which I have found myself at the Dispatch Box answering Adjournment debates in this calendar year is almost matched by the frequency with which my hon. Friend asks questions and raises important matters for her constituency and for the nation. I am well aware of her interest in and concern for the health care of her constituents. The zeal with which she looks after her constituents is an example to all hon. Members. I am sure that the constituents of Maidstone, whatever party they follow, are grateful to her as their excellent representative. My hon. Friend is also an active member of the Select Committee on Social Services, and her views are constructive and respected.

The debate is about the Kent county ophthalmic and aural hospital. I should not like this opportunity to go by without congratulating the National Health Service staff at the Maidstone health authority. The new district general hospital is a fine example of new construction in the Health Service and it is often visited by distinguished visitors to this country. It is a fine new building and the staff have a high morale. Ministers in the Department of Health and all Ministers in the Government congratulate the National Health Service staff on their thoroughly workmanlike and professional job.

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Before responding to the detailed points about eye services provided by Maidstone health authority, I should say that it is the Government's policy to delegate as much responsibility as possible for the local provision of services to local management. The Government can provide resources to regional health authorities, and set priorities and guidance. It is then up to the regions to allocate the resources to the districts, and up to the districts, such as Maidstone health authority, to settle the allocation of funds and other resources to different medical specialities, for example, the provision of the hospital eye service in the authority. The Government believe strongly in the delegation of that responsibility and the White Paper "Working for Patients" carries that philosophy further by delegating tasks and making authorities more streamlined and businesslike.

At the outset of the debate my hon. Friend the Member for Maidstone talked about the move of the South-East Thames regional health authority from Croydon to Bexhill. I well understand her concern about the fact that the office premises which it left in Croydon have remained empty. However, the move has saved money because I am advised that if the authority had stayed in Croydon the rent would have risen to about £1 million per annum, which is considerably in excess of the current occupancy costs in Bexhill. Therefore, there is a saving, albeit one which hinges crucially on the assumption about the rent that would have been paid. The saving has been ploughed back into patient services.

Miss Widdecombe : A saving may have been made on the rent payable on the misnamed Thrift house, but is it a saving on the rent payable on Thrift house, plus the rent and rates still shelled out on the empty Croydon premises that were not disposed of? By locating itself in the wilds of Bexhill-on-Sea, the authority has created travelling inconveniences and costs for its staff that have resulted in a considerable amount of adverse comment from the district health authorities. The public and the DHAs are not convinced that the region made a cost-effective decision.

Mr. Freeman : I should be delighted to write to my hon. Friend and set out the precise calculations. She is perfectly right to draw this matter to the attention of the House. I have considered the matter carefully and I am convinced that a sensible decision was made. The question of where an authority locates its headquarters is a matter for the region, but I noted what my hon. Friend said. I do not find it too inconvenient to travel to Bexhill and I look forward to my next visit to the regional health authority, partly because I can follow up the outcome of this debate.

I listened very carefully to what my hon. Friend said about eye services provided at the Kent county ophthalmic and aural hospital, especially about waiting lists and waiting times. I accept that these figures are not satisfactory and the Government recognise that, despite increased activity and reduced waiting lists across the country since 1979, some patients in some areas still have to wait too long for treatment. That is why the Government set up a special waiting list initiative which over the last three years has made £86 million available to tackle the worst waiting problems. This year, Maidstone will receive almost £200,000 from this fund, of which £50, 000 will enable an additional 160 ophthalmic operations to take place at Maidstone. This represents

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almost 20 per cent. of the waiting list at the end of March. It will be done by appointing a locum consultant to cover the annual leave of the five existing consultant surgeons, thus preventing theatre time being lost.

I am aware that perhaps the main problem is the waiting times for a first out-patient appointment. After a significant rise since June 1987, these have improved in the last few months--the minimum wait is now 24 weeks and the maximum 52 weeks, compared with 29 and 61 weeks just three months ago. However, I entirely agree that these figures are still too high. I understand that there is a relatively high number of non-attenders at clinics--that is, people who fail to attend for their appointment--and a high ratio of repeat attenders to new attenders. Both these factors tend to lengthen waiting times for new appointments and I understand that they are being investigated. I know that health authorities are worried about the problem and the district general manager has sent me a report which includes action that is taking place to improve it.

It might help if I briefly outlined the five main sorts of action. First, a clinical assistant is being employed for six sessions a week to provide additional medical help. Secondly, a number of consultants are now referring non-Maidstone residents to out-patient clinics which they hold in Gravesend and Medway, in order to spread the load. Thirdly, there is a wide variation in referral rates to the five consultant ophthalmic surgeons, so patients and GPs are increasingly being offered the opportunity of an earlier appointment with one of the consultants whose waiting time is shorter.

I was in Sunderland on Wednesday visiting an excellent new out-patient facility for ophthalmic in-patients and out-patients. During my visit I had cause to speak to officials of the Northern regional health authority, who drew my attention to the fact that the number of patients waiting for the various consultants might not be the same. Some GPs tend to refer most of their patients to a named consultant, and junior or new consultants may have relatively small waiting lists because they are unknown. As a result, their popularity is not as great as that of other consultants. It is clearly in the interests of patients that referrals be spread more evenly between hospital consultants--that is the third step that the health authority is taking, for which I commend it.

Fourthly, revised arrangements, including more screening of patients for treatment by nurses, should be introduced to the hospital's accident unit in September to reduce the effect of that unit's work on medical time.

Fifthly, the hospital and local family practitioner committee are discussing how to ensure that, when appropriate, patients go first to their GPs rather than directly to the hospital accident unit. Turning to waiting lists and times for in-patient admission, the district tells me that at the end of March 1989 there were 865 people on its list, the lowest number since September 1987, and that the number has gradually been falling. That is better news, and the additional patients to be treated this year from the Government's waiting list fund should significantly reduce the number. That is the fund which I said was going in part to help employ a locum consultant, to ensure that when one of the five consultants is on holiday, operations are not delayed.

I am concerned because my Department's figures show that the number of people waiting for longer than a year rose between the end of 1987 and September 1988 from 11

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per cent. of the total to 22 per cent. of the total--my hon. Friend referred to that. I should like that figure reduced. I hope that the attempt to equalise the waiting lists between the five consultants may go some way towards that.

I must stress that the waiting list during the past year has not resulted from any decrease in the number of patients being treated at the Kent county ophthalmic and aural hospital. Rather, it is a result of increasing demand for this specialty. A total of 21,094 out-patients were treated in 1988-89--that is, in the year ending 31 March 1989--compared with 19,500 in the previous year, an increase of 8 per cent. The figures for in-patient admissions, including day cases, was that 1,884 patients were treated, compared with 1,709 the previous year--an increase of 10 per cent.

My hon. Friend was right to say that as the population lives longer, so the need for eye surgery and treatment in hospital increases, because it is the very elderly who need corneal replacement. An increase in resources, particularly for ophthalmic services in Maidstone, could enable more patients to be treated and reduce waiting lists. In the first instance, it must be for the health authority to decide how it will allocate resources between the competing demands. Health authorities also need to look thoroughly at how improvements can be made in the way that the existing level of resources is used in individual specialties. I know that this has been happening in Maidstone in eye surgery services. I have noted the statement by the chairman of the health authority, in a letter in January to my right hon. Friend the Member for Tonbridge and Malling (Sir J. Stanley), that until Maidstone has exhaustively looked at how the resources for eye services are used, she is not

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confident that it could sustain a case for extra resources that would win any arguments beyond the district. I agree with the chairman that that must be the way to proceed. I have already mentioned some of the action being taken on out-patients. On in-patients, with the help of the clinicians concerned, the authority is actively looking into the procedure for reviewing waiting lists and the most effective use of operating theatre time. The district general manager has identified limitation of theatre capacity as a major restraint to increasing patient throughput. That shows where resources might be applied once other avenues have been explored, so as to reduce waiting lists and increase patient services even more. The Government's proposals on contract funding aim to resolve this sort of situation. In future, money will follow the patient, so there will be a financial incentive for a hospital to become increasingly efficient and obtain the contracts to treat more patients. I hope that my hon. Friend agrees that Maidstone health authority is concerned about the situation and that it is taking various actions to improve it. I shall be writing to the health authority chairman asking her to ensure that the use of resources for the provision of hospital eye services has been thoroughly investigated and to let me know, in six months, what effect these measures have had on waiting lists and waiting times.

I plan to visit Maidstone early next year, when I hope to see how the authority has coped with its problems. I hope that my hon. Friend and I can arrange a mutually convenient date so that we can make the visit on the same day not only to see the progress that I hope will have been made in eye services but to see and hear about the excellent services available at the Maidstone district general hospital.

Question put and agreed to.

Adjourned accordingly at three minutes to Three o'clock.

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