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Paragraph 51 contains an encouraging quotation from Mr. Edwards of Trent regional health authority who, referring to the conversations that are now being held between administrators and doctors, asks : " How can we together manage this important part of our business?' This is the first time this has happened in 30 years, and for me this is one of the most exciting bits of the new world [the NHS reforms] ; managers and doctors getting together to share a view about the way forward."In no other district has that spirit, which is wanted and desired by both the Select Committee and the Government, been put into practice to more effect than in my own authority of Bury, and I pay tribute to Bury district health authority for that.
I shall first give some statistics about Bury's waiting lists and then say how it has tackled them and how that work might be affected by future policies. We want to talk about waiting lists--and this is Bury's story. The hon. Member for Peckham said that there was no district health authority in the country that did not have a waiting list for general surgery. She is wrong--there is mine. In 1989, 86 per cent. of patients for general surgery waited less than three months. In 1990-91, no patient waited for more than three months for general surgery. The hon. Lady might say that a wait of nought to three months is still a waiting list, and that is fine, if that is what she wishes to do, but to most people the fact that no patient has waited longer than three months for general surgery means that there is no waiting list.
In 1989, 84 per cent. of ear, nose and throat patients waited less than 12 months, with 30 patients waiting more than a year. In 1991, that had improved to 98 per cent. of patients waiting less than 12 months, with only seven waiting between one and two years and none waiting more than two years. In the three years 1988-91, between 99 and 100 per cent. of orthopaedic patients waited less than two years and there was a decrease in the number of people waiting for more than 12 months, from 49 in 1989 to only three in 1991. In oral surgery, between 1989 and 1990, 100 per cent. of patients waited less than three months. Again, I submit that that is no waiting list. In 1991, only one patient waited between three and six months while the rest waited less than three months. In 1989, 97 per cent. of gynaecology patients waited less than 12 months, with nine patients waiting for more than a year. In 1990-91, there was a further improvement, with no one waiting for more than 12 months. That is the record of just one district--Bury district health authority in the north-west. I submit that those statistics on waiting lists would stand comparison with figures anywhere in the world. The way in which those statistics have been achieved is worthy of comment because that is what is at the heart of paragraph 49 of the report, which deals with the improved co-operation between administrators and doctors. That is what has happened in my district in the past decade or so.
How has the district achieved that? First, it has been committed to reform- -to the sort of reforms that are now being discussed as possible ways forward. Bury district health authority has always been open to following through any reforms in an effort to try to improve its service. Secondly, there has been a commitment to competitive tendering to which I shall return later. In Bury, 17 services have been put out to competitive tender,
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resulting in savings of hundreds of thousands of pounds for the health authority each and every year, which might stand to be lost in the future. I should be interested to hear the hon. Member for Peckham explain how that shortfall might be made up if competitive tendering ends.However, more important than those two matters and the statistics is the way in which Bury health authority has managed its services because that is the key to how it has been able to treat more patients and why it has fewer waiting lists. First, there has been an increase of 43 per cent. in the number of doctors employed. Additional consultants have been appointed, all in the specialties where waiting lists have been reduced in accident and emergency services ; anaesthetics ; paediatrics ; obstetrics and gynaecology ; radiology ; geriatrics ; psychiatry ; pathology ; ear, nose and throat ; adult health and orthopaedics. These are not just statistics-- real doctors have been appointed. Our waiting lists have fallen because our health authority has had the funds to employ them.
Secondly, we in Bury have been able to commit £25 million to capital expenditure in the past few years to provide the facilities for the operations that will help us to reduce waiting lists. Some of that money has been provided through savings on the health authorities' own resources- -achieved by such things as competitive tendering. The savings have not just been a nebulous figure that has somehow gone into somebody's pocket ; they have been used for a new obstetrics unit so that more people can be treated and the waiting lists can be reduced.
In 1978-79, some 17,780 in-patients were treated and there were 1, 575 day cases. The latest figures show an increase to 26,700 in-patients and 4,100 day cases. That represents a total increase over 10 years of 55 per cent. in the number of in-patients, and 160 per cent. in the number of day cases treated. If the Government and the Select Committee want waiting lists to be reduced, the way is through co-operation between the doctors and the administrators in health authorities, such as happens in Bury. Our policies, together with the attention being paid to waiting lists during the past few years, are doing the job. The Conservative party has ideas, facts, statistics and achievements. All we hear from the hon. Member for Peckham is criticism--not a single idea about how to deal with the problems that we are tackling.
I worry about the future, and about what will happen if the policies that we have put into effect were no longer followed. If the economy cannot provide the growth which it has provided over the past 10 years, and which has allowed expenditure in our health authorities to rise by 19 per cent.-- under the previous Labour Government NHS spending in Bury fell by 2 per cent.--my constituents would be badly disadvantaged and waiting lists would rise again. I do not want my constituents to face that risk.
The abolition of competitive tendering would mean the loss of hundreds of thousands of pounds for my health authority, and I see no commitment to make up that loss. Whose waiting lists would rise first to deal with that change in policy? Such facts and figures make a compelling case for what we are doing to tackle waiting lists. We do not have just rhetoric ; we have achievements, determination and a commitment to the health service that I suspect Labour Members only dream about. They wish that they could actually deliver what they say, but they know that only the Conservative party can do that. On waiting lists, on the Select Committee report, and on the way in which problems are tackled, only the
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Conservative party shows the determination and the commitment to deal with the human casualties behind the statistics. That is far better than the empty rhetoric that we hear from Labour Members. 9.12 pmMr. Charles Kennedy (Ross, Cromarty and Skye) : I shall be brief. I echo the congratulations to the hon. Member for Macclesfield (Mr. Winterton), the Chairman of the Select Committee, and his colleagues on their excellent report on this important matter. The hon. Gentleman opened the debate in splendid fashion and he set the parameters very effectively. For a moment, I thought that he had found the whole debate so moving that he had crossed the Floor of the House, but I see that he has now returned to his usual lair. It is understandable that in such a debate there should be claims and counterclaims about what is happening in the NHS and about its health or otherwise. However, in discussing waiting lists we would do well to remember what Mr. Yates said in his evidence to the Committee. That was fairly reproduced on page ix of the report, which stated :
"Two issues emerge from his replies. The first was his concern that a large amount of public money had been spent on attempting to reduce the numbers of people waiting over a year for treatment, only to see the numbers rise."
It is worth bearing in mind that rather basic point when listening to some of the claims that are made, not least those of the hon. Member for Bury, North (Mr. Burt).
Mr. Yates told the Committee :
"I have been concerned about its failure"--
that is, the failure of the waiting list initiative--
"in terms of delivering the goods in terms of what was expected in the first three years it has been somewhat of a disappointment to see that the Department of Health investment of (£80.6 million) has led to a rise in the generally accepted measure to waiting time, the number of long wait patients, waiting over a year."
That is not much of a success story--and it came from the man who was in charge of trying to deliver an improved service and who, indeed, went a long way towards achieving that.
The Committee mentioned the need for a good, high-quality flow of information. That is certainly crucial. As I have said in other health debates, I am worried about what will happen under the new arrangements--an internal market, self-governing trusts, GP budget-holding and so forth. Although finance has been made available, I do not think that the computer technology is advanced enough for, in particular, the big hospitals to be able to evaluate their own information systems as professionally as they do now. They could have an important effect on waiting lists.
I am glad that the Committee, in dealing with developments in the primary- care sector, drew attention specifically to the contrast between rural and urban needs. Because I represent a vast rural area, I am especially conscious of that distinction. There is no doubt, however, that that blanket or blueprint approach should not be adopted to that important function of the health service ; the position in, for instance, the Scottish highlands is not the same as the position in one of our cities. I am encouraged to note that the Government have responded positively to what the Committee said.
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Let me echo what was said by the hon. Member for Macclesfield by quoting from point 15 of the Department of Health's response : "Management is also responsible for ensuring that private practice does not, to a significant extent, interfere with the performance of the function of the health service".How right the hon. Gentleman was to remind us that there should be no interference with the performance of the health service, and that non- paying patients should not be disadvantaged. I hope that the Minister, too, will emphasise that ; after all, taxpayers' money is being spent. The Select Committee is right to be concerned about efficiency and value for money.
Like every other debate that we have had about the health service, this one is ultimately concerned with finance. The Select Committee said that more finance was available for the waiting list initiative ; in their response, the Government said that they did not feel that that was viable at this stage in the financial year, and gave various other reasons.
There is no doubt that health care is a bottomless pit, which, by definition, can never prove 100 per cent. satisfactory. As soon as a procedure is discovered, whereby a physical ailment or deficiency can be cured, a new waiting list is created. We appreciate that ; but Conservative Back Benchers who retail the more repeatable details of their trips to Scandinavia, drawing telling contrasts between British and Swedish health care, should bear in mind the fact that Scandinavian countries--and most other developed countries that can be compared with Britain--spend a much larger proportion of their gross domestic product on health care. That is why it is right to continue to underscore the need for more cash for the waiting list initiative. Although we want value for money and quality, we cannot escape the argument about quantity.
In highlighting those and many other points, which I do not have time to touch on tonight, the Select Committee has performed to its credit and I commend its report.
9.20 pm
Mr. David Amess (Basildon) : I congratulate the Select Committee on its excellent report and the Government on their positive response. The speech of the hon. Member for Peckham (Ms. Harman) was, to put it crudely, a cop-out. It totally lacked any details about policy. Considering that the subject under discussion was money, it was a bit cheap of the hon. Lady not to respond to my request for some details.
All hon. Members understand the trauma that someone experiences when they are on a waiting list for an operation. I have been fortunate as I have never been admitted to hospital for an operation. Obviously, patients want the operation to be carried out as quickly as possible. However, it is totally irresponsible for any politician to pretend that there is an easy answer to enable a patient to have that operation quickly.
I am privileged to have in my constituency one of the finest hospitals in the country--Basildon hospital. I regret the way in which local Labour and Alliance politicians try to run down our excellent hospital. Basildon hospital is at the bottom of my garden. My family uses its services. My wife has had four babies there under the excellent national health service and, God willing, she will have a fifth in September. My family has used its excellent accident and emergency unit--
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Mr. Nicholas Winterton : Were all the babies accidents?Mr. Amess : None of our children were accidents. We regard every one of them as a blessing. In two weeks' time, the Duke of Kent will open our brand new accident and emergency unit. My wife had an ear operation in our excellent hospital. My constituents are extremely proud of their hospital.
Hon. Members can imagine my anger when one of those ridiculous health monitoring committees was set up by the local Labour party. The chairman-- or chair, as he likes to be called--used to be employed by our hospital, when he was in charge of the private patients' waiting list. When he was working at the hospital he considered it acceptable that the hospital admitted private patients but as soon as he left he immediately castigated private health care.
I hope that the hon. Member for Peckham will soon return to her place because she and I were on a Committee of this House two or three years ago when the Government first announced the waiting list option. Walworth road, bless its heart, undertook the initiative of spewing out literature highlighting waiting lists in various hon. Members' constituencies. One such list referred to my constituency. In the 1987 general election campaign, when the Opposition guns were firing at me, the then Opposition spokesman--I think that it was the hon. Member for Holborn and St. Pancras (Mr. Dobson)--came to my constituency and found a child who had been waiting for rather a long time to have an operation. The national newspapers took up the child's plight and highlighted it during the campaign. As soon as the campaign was over and I was returned as hon. Member for Basildon, the Opposition ducked the issue and I was left to deal with it, which I did successfully.
I am delighted that there have been major reductions in the size of waiting lists during the past year in the hospital in my constituency. It has achieved the biggest overall reduction out of 15 districts in the Thames region. If we compare March 1991 figures with those for one year earlier, there were nearly 2,000 fewer people on the waiting list--a reduction of one quarter. That is why I did not respond to the point that I think that the hon. Member for Peckham had in mind when I tried to intervene. There are nearly 1,600 fewer people waiting longer than one year--a reduction of more than one half.
Mr. Gill : Does my hon. Friend accept that the statistics that he has just given are not isolated examples? In Shropshire, the county from where I come, the total waiting list for operations is down by 32 per cent. and the number of people waiting for more than one year has been reduced by 67 per cent.
Mr. Amess : Those figures are quite magnificent and I join my hon. Friend in saluting his local authority, and the men and women who work at his local hospital who have achieved such excellent results. In Basildon, there has been a 37 per cent. reduction in the number waiting for general surgery, a 20 per cent. reduction in those waiting for ear, nose and throat treatment and a 10 per cent. reduction in those waiting for oral surgery and orthopaedic surgery. In Basildon, we have already adopted many of the recommendations in the report of the Select Committee on Health. All waiting lists are now routinely checked to
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ensure that those on them still need the operation. We have increased medical staff in problem sectors. A new consultant oral surgeon, whom the authority shares with Southend health authority, started in August 1990. New consultant posts were created in urology and plastic surgery in April 1991. The additional urology service set up in January 1991 resulted in more operations during the first three months.Basildon has "short notice" waiting lists for filling last minute cancellations by patients. It gives appropriate notice of admission to ensure a minimum number of cancellations by patients. It has matched theatre capacity to bed availability. It has blitzed problem sectors of the list such as special sessions for day case urology. It has reduced "bed blocking" by returning patients to their home with proper support in order to free acute beds more quickly. It has introduced new clinical techniques and increased the use of day care surgery.
For 1991-92, Basildon and Thurrock health authority has obtained from the North East Thames regional health authority the following waiting list initiative funds : more than £500,000 to build and equip a dedicated day surgery unit at Orsett hospital ; £12,000 to purchase arthroscopy equipment, used in the examination of joints ; £28,000 for a hysteroscope to enable gynaecology surgical procedures to be carried out on an out-patient day-case basis ; and £30,000 for equipment to enable key-hole surgery to remove gall bladders, substantially reducing average lengths of stay for such procedures and reducing the trauma.
In conclusion, I pay tribute to the former chairman of our health authority, Mrs. Joan Martin, the acting chairman, Mr. Gould, and the hospital manager, Ken Sharp. On 1 April 1992, the hospital will apply to become a national health service trust and the application is supported by local hospital doctors, nurses and managers, who believe that when it becomes a trust it will bring benefits to patients and staff, and a guarantee of job security to all those who work at the hospital. When I open the hospital fete on Saturday I shall thank all the women and men for their efforts in seizing the Government's initiative and reducing hospital waiting lists so dramatically in Basildon.
9.28 pm
Mr. Gareth Wardell (Gower) : I am pleased to have the opportunity to take part in the debate. In addition to debating the Select Committee's report on waiting lists we were also meant to look at the evidence taken by the Select Committee on Welsh Affairs. I am disappointed to have been called as late as this in the debate. We have completed our evidence on elective surgery in Wales. Rather than taking a wide-brush approach I shall concentrate on an initiative unique to Wales which the Welsh Office, to its credit, has innovated--the three all-Wales regional specialist treatment centres : at Ysbyty Gwynedd in Bangor we looked at ophthalmology, at the Prince of Wales hospital at Rhydlafar in Cardiff we looked at hip and knee replacement surgery, and at Bridgend hospital we looked at hernia and varicose vein surgery. It is fascinating to see England lagging so far behind in this area.
It has given me great satisfaction to promote these centres in Gower, as I have visited all three and can vouch for the superb quality of service attained. Less than two
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weeks ago I was privileged to witness the brilliant skills of Mr. Mehta, one of the three consultant ophthalmic surgeons at Ysbyty Gwynedd, carrying out cataract surgery followed by lens implant. It was obvious from my visits that the work of the treatment centres brings about dramatic improvements in the quality of people's lives. The issue that deserves full attention is that of how to increase the number of patients treated so that human suffering, often for long periods, may be alleviated. It is significant that Mr. John Yates, giving evidence before the Welsh Select Committee, estimated that the more than 11,000 people waiting in Wales for more than a year for elective surgery could have their operations and treatment in only three weeks' work by the surgeons that specialise in their conditions. If the treatment centres are to be truly successful in dramatically reducing waiting lists, I believe that the Welsh Office must institute six changes.First, the Welsh Office must commit itself to a future period for funding that is radically different from the present one, so that general practitioners and consultants know that post-operative, follow-up care will be available at centres on a long-term basis. The Minister and the Welsh Office must be more definite than they were in the parliamentary reply that the Minister gave me on 29 April. He must no longer be prepared to offer the type of parliamentary reply that he gave me on 3 May, which showed that the throughput targets for 1991-92 are yet to be agreed.
In passing I must also mention the need for the Welsh Office to have a care about the temptation now and again to rewrite history. Mr. John Wyn Owen, director of the NHS in Wales, informed the Public Accounts Committee in a letter of 3 April 1991--it is reprinted in appendix 1 of the Select Committee's report--that the orthopaedic treatment centre at Rhydlafar had a contracted throughput in 1990-91 of 172 hip replacements, 29 knee replacements and 44 other operations. But in a parliamentary reply to me on 3 May 1991, only a month later, the Under-Secretary of State for Wales gave the throughput for 1990-91 at the same hospital as 233 hip replacements, 57 knee replacements and 73 other procedures. Great care must be exercised when bandying about information like that.
Secondly, the Minister must insist that any patient who has waited for more than four months on a consultant's waiting list, as specified in the contract between the Welsh Office and the three treatment centres, is automatically informed by the local consultant that he can be referred to the treatment centre. That will get rid of the widespread practice among GPs and consultants of presenting the options to their patients as either a long wait or private treatment. The treatment centres exist, so this could be a constructive way forward.
Thirdly, Welsh Office funding must be made available to ensure that the waiting period after the patient has been referred to the treatment centre is short. Last week I was told that one of my constituents from the village of Pontarddulais had been referred by his GP to Rhydlafar hospital for a knee joint operation. The hospital sent the referral back to the GP, saying that no more knee operations could be carried out on any patient in Wales for the remainder of the financial year 1991-92, no matter how severe the pain and suffering of the patient. Officials might find that amusing, but I do not. We are only three months into the financial year.
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Expectations for early treatment should not be cruelly raised only for people to see their hopes dashed because the quota for knee surgery for the current year seems to be a miserly 50 for the whole of Wales. The quota for hip operations is only 160. According to the figures given to me on 3 May, that compares with 233 hip operations, 57 knee operations and 73 other procedures carried out last year. Obviously there is a decline. How can the Minister rest content when East Dyfed health authority has already taken up its quota of one knee and five hip operations? Is he content that Clwyd has already taken up its quota of two hip and two knee operations or with the 37 hip and five knee operations by West Glamorgan health authority, while the much less populated Pembrokeshire health authority area benefits disproportionately with 26 hip and 11 knee operations? The answer for orthopaedics seems straightforward. When I visited the hospital at Rhydlafar I saw the obvious need to use the two main theatres exclusively for major joint surgery. To achieve that simple goal, the so-called plaster theatre could be a dedicated theatre for minor joint surgery performed on a day basis. It is also obvious that an empty ward is available to complement the additional theatre, enabling a substantial increase in major joint surgery. It is imperative that the present level of major joint work at Rhydlafar be substantially raised. I urge the Minister to raise it to as many as 1,200 operations a year and seriously to consider making the hospital a major centre.Fourthly, a time bomb is ticking away in orthopaedics, and it is the time bomb of hip and knee replacement revisions, for which the Minister needs an action plan. Within 10 years of a major joint replacement, 10 per cent. of patients have to be revised with another 10 per cent a year after that requiring revision. Thus within 20 years of the initial major joint replacement surgery, all patients will need revision surgery. The Secretary of State for Wales must prepare for the setting up of joint revision centres in Wales together with specialist surgeons and the necessary infrastructure. As he knows, the Welsh Office contract with the Prince of Wales orthopaedic hospital does not permit revisions. That issue must be addressed.
Fifthly, if the treatment centres are to be truly Welsh regional centres they must not be permitted to discriminate in favour of the host authority. Allowing Ysbyty Gwynedd in Bangor to treat 306 patients for cataracts between 1 September 1990 and 31 March 1991, with only 23 residents outside Gwynedd being treated and only three of those residents from the county of West Glamorgan, was a major blot on the Welsh Office. That happened when 1,345 patients were waiting for non-urgent ophthalmic treatment at Singleton hospital, 476 of whom had been waiting for more than a year.
Sixthly, the Minister must move ahead quickly to establish the second specialist centre for cataract treatment at Bridgend general hospital. It would be useful to know the time scale for that. I am delighted that the Welsh Office has set up treatment centres. I think that it is a major step forward in the reduction of waiting lists. England should learn from what the Welsh have done. In terms of the Select Committee's report, the fundamental issue is that the Minister for Health and the Under-Secretary of State for Wales must be extremely careful, if they decide quickly-- perhaps too quickly--to adopt what the Audit Commission says about day surgery, not to fall into the
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trap of failing to provide sufficient support services. My hon. Friend the Member for Peckham (Ms. Harman) has drawn attention to that danger.The Government's response to recommendation No. 12 is the most disappointing of all. When the Minister for Health replies, it would be helpful if she could substitute, even at this late stage, something for the comment with which the Government end their response. In fact, it is a non- response to a vital problem. It reads :
"We expect health authorities and family health service authorities to take account of any increases in day case work when planning primary and community health care services."
That is a blatant disregard of a massive job if day surgery is to be expanded. The members of the Select Committee went to the United States to see the expansion that has taken place there, and particularly to California. We know that without community back-up facilities the day- surgery initiative will never get off the ground in a big way. We must not put the cart before the horse. Instead, we must ensure that the necessary services are provided. That is why the next report of the Select Committee on Welsh Affairs, following the one on elective surgery, will be on community care.
9.42 pm
The Minister for Health (Mrs. Virginia Bottomley) : It is a great pleasure to respond to the first report of the new Select Committee on Health. I share with my hon. Friend the Member for Macclesfield (Mr. Winterton) an understanding of the priority that needs to be given to tackling waiting lists in our national health service. There was a waiting list for those who wanted to speak in the debate and I am sorry that there has not been time for all hon. Members to participate.
I have the invidious task of responding in a short time to some of the comments that have been made before leaving time for my hon. Friend the Member for Macclesfield to respond. I say to the hon. Member for Gower (Mr. Wardell) that my hon. Friend the
Under-Secretary of State for Wales heard his speech and awaits the Select Committee's report. When he has had the opportunity to read it, he will respond.
There is no doubt that we have heard some excellent speeches this evening. My hon. Friends the Members for Harlow (Mr. Hayes), for Bury, North (Mr. Burt), for Basildon (Mr. Amess) and for Ludlow (Mr. Gill) once again set out their strong commitment to our NHS, to the developments, to the progress and to the challenges. How strongly that contrasts with the whinges of Opposition Members. I would loathe to be a member of the health authority that comes within the area represented by the hon. Member for Peckham (Ms. Harman), or to be in the health service in that area. She seems oblivious to the fact that a day surgery unit is being constructed at the hospital in her constituency at a cost of £9 million. The unit will be completed in the autumn. It is expected that work will start later this year on a new theatre block that will cost £14.8 million. There will be a new AIDS and HIV unit. There will be a great increase in the number of day cases that are treated.
The hon. Member for Preston (Mrs. Wise) mentioned the important topic of plastic surgery, which poses some difficult questions in the handling of waiting lists. John Yates questioned our emphasis on the need to be rid of all
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who find themselves on waiting lists for more than two years. But the hon. Member has forgotten to tell the House that there is an additional registrar and consultant in plastic surgery in her district health authority, a new waiting list scheme for day cases and further initiatives and developments.Once again, as my hon. Friend the Member for Bury, North pointed out, the hon. Member for Peckham ducked putting a figure on the amount by which she believes the NHS to be under-funded. I am surprised that she even failed to rally to the call of her hon. Friend the Member for Livingston (Mr. Cook), who said recently that he thought that an extra £6 billion was in the right ball park. But we know, as my hon. Friends have pointed out so clearly and forcefully, that every Labour Government, despite their words, policies and commitments, have always left Government with waiting lists longer than they were when they took over. Conservative Governments have consistently reduced waiting lists. I think that all my hon. Friends will agree that the Labour party is essentially a walking waiting list disaster area.
Opposition Members have told us of disasters and of confusing facts and figures. My hon. Friends have pointed out clearly and forcefully the developments that they have seen in their health authority areas. The simple and central fact is that under this Government in-patient waiting lists have fallen by 6 per cent. and 40,000 fewer patients now await in- patient treatment than was the case in 1979. Long waiting times are falling even more quickly. The latest figures obtained direct from the regions since the Select Committee's report was published show a 19 per cent. fall in long-wait patients--those waiting more than a year--in the year to this April. Those waiting more than two years fell even faster--by 38 per cent. over the same period. Long waiting times are tumbling and that fact should be welcomed by hon. Members on both sides of the House. The reduction in waiting lists looks all the more impressive in the context of the steady increases in the number of patients being treated. There are 24 per cent. more in-patients than in 1979. That is a substantial figure. Five patients are treated now for every four that were treated then. There are nearly twice as many day cases and 8 per cent more out-patient attendances than in 1979. That is in addition to the phenomenal expansion that we have seen in the family doctor services which have grown faster than any other area of health spending over those years. Not only has the number of patients waiting been reduced, but as a proportion of those being treated it has fallen even faster than the figures show.
One important point that I want to address is the discussion to which my hon. Friend the Member for Macclesfield and other hon. Members referred about the waiting list information being published. We have revolutionised the information available about the health service. When the Labour party was in power there was a fog over the health service, as there was over education and any other area of the public sector. We have created an awareness and an understanding of the resource implications, outputs and waiting lists. But what is important is that under the new regime the waiting list information will, rightly and properly, be held by the purchasing health authority. It is the purchasing health authority that is the champion of its patients and it is the purchasing health authority that is accountable to the Secretary of State.
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A misunderstanding may have arisen because the present information is based not on provider units but on provider districts. It is concerned with where the treatment is provided, not where people live. But what is clear, and it is important, is that the information will continue to be available to health authorities to enable them to establish contracts in which they drive waiting times down and seek those improvements.In all the work of the health authorities we have seen greater pressure put on providers, all of whom will be required to make that information available so that even better quality improvements and waiting times can be achieved. In other words, the new way in which we will collect information will be a major step forward for patients and reduce waiting times still further.
Conservative Members have almost become weary of the debate about resources. Our investment in terms of financial input into the health service scarcely needs repeating. Let me say simply that we are spending £1,000 every second on the health service. In the time that it took my hon. Friend the Member for Macclesfield to make his speech, another £1.5 million was spent on the health service. A little less than that figure was spent during the speech of the hon. Member for Peckham--and, because of time constraints, my contribution will not produce expenditure anywhere near that figure.
My right hon. and hon. Friends know that it is not only the amount of money that is important but the way that it is spent. Time and again, Labour denigrate management skills, business expertise, and cost-effectiveness. However, we know--and Mersey demonstrated this--that the use of management techniques such as list validation, running a tight ship, and informing patients of their appointment times can ensure efficiency and effectiveness. That makes the health service much more rewarding for those who work in it.
We will soon provide all health authorities with guidance on best practice and principles in managing waiting lists. John Yates showed the way forward by advancing the debate and clarifying the many aspects that must be considered, such as the proper use of nurses, doctors, general practitioners and even booking systems, and the need for proper collaboration between family doctors and hospitals. I welcomed the comments made by several hon. Members about consultants holding out-patient sessions in GPs' surgeries. Yesterday, my hon. Friend the Member for Hexham (Mr. Amos) introduced me to a GP who arranged such sessions in his own surgery. We have seen also GP fundholders driving forward standards, innovating, and devising ways of serving their patients, to provide better health care and a better health service.
We owe John Yates and IACC a great debt of gratitude. I visited Mr. Yates' centre at Birmingham, and he has regularly visited me to discuss his progress. I am pleased that he is now working with the West Midlands regional authority on its waiting lists.
In the early days, the waiting list initiative organised by the health service did not make the same progress that John Yates has achieved, but there can be no doubt that it has taken ownership of the issue of driving down waiting lists. The targets set by the chief executive, regions and districts are being vindicated by the remarkable results now being achieved --such as in Mersey. I hope that my
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hon. Friend the Member for Macclesfield will ensure that his illustrious constituent, Brian Redhead, is made aware of the great progress made by his district health service.North East Thames region has presented a particularly intractable problem over the years, and right hon. and hon. Members will not need to be reminded of the contributions of my hon. Friend the Member for Harlow. However, that region has experienced a remarkable fall of 37 per cent. in the one-year waiting list, and of 58 per cent. in respect of those waiting for more than two years since March 1990. Trent, North Western, and many other regions have made similar excellent progress.
We will build on that progress. This year, a larger amount of money than ever before will be directed at the waiting list initiative, with the £35 million from the Department joined by another £25 million from the regions. I do not accept the suggestion that more resources for the waiting list initiative should be provided from the centre, because our argument is that priority is for the health service to deliver. Above all, it is for district health authorities to seek further improvements, because they are accountable for the time that their patients have to wait.
Our targets are ambitious, but we are confident, because of the success that we have already achieved, that there will be further progress.
A number of hon. Members asked about extra-contractual referrals. The key point about them is that in the past there was no financial benefit for a hospital from another area to receive a patient from outside its district. The money did not follow the patient. This year there has been an unprecedented level of consultation between the district health authorities and local general practitioners about where they wish to refer their patients and about historical patterns. At the same time, money has been kept back from extra-contractual referrals. Urgent cases have to be seen immediately. The debate should not overlook the central point that 50 per cent. of patients are admitted at once and of those who wait another 50 per cent. are treated within five weeks. The debate has concentrated on those whom we all agree have to wait longer than is right.
My hon. Friend the Member for Macclesfield made a number of other points. He knows that we have made considerable progress over developing job plans for consultants. It is important that their commitment to the NHS is properly understood and recognised. If we are to cut waiting lists, we must ensure that the health team works together as fast and as effectively as it can. My hon. Friend also made an important point about urban and rural areas. I hope that my remarks have already demonstrated to him that different ways of using resources and the NHS team to cut the time that people have to wait are part of our intention to provide better health care.
My hon. Friend mentioned regional centres. They are monitoring the work of the trusts. They are not an essential ingredient of the waiting list initiative. The waiting list initiative is a matter for the entire national health service, not for a particular part of it. We have created 100 fully- funded consultant posts to tackle waiting lists. We have maintained our investment in improved information systems to enable hospitals to manage better. We funded the waiting list helpline with the College of Health and 68 per cent. of GPs are now providing minor surgical procedures. Qa Business Services is now helping us to develop our waiting list work even further. We fully agree with the Select Committee's view that long waiting lists for treatment are unacceptable. The
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reduction of waiting times is a key priority for the reformed national health service. We want to put patients first. We can learn from the South Western regional health authority's new idea of a booking system. Reducing waiting times is a key objective of our reforms. Waiting times are tumbling. The reforms that we have introduced will help to drive them down still further.9.57 pm
Mr. Nicholas Winterton : I am grateful to my hon. Friend for her response to the debate. It is a pity that it was not longer, but that criticism is often levelled by Back Benchers when a number of important questions remain inadequately answered. I come back to a point that both I and other speakers raised forcefully. If the Government are serious about the success of the reforms that they are implementing in the national health service, not just health authorities but fund-holding practices and patients--the clients, the customers--must have the information that is essential if they are to exercise responsible choice and take informed decisions. I hope that my hon. Friend will ensure that when waiting lists and times are published they are published on both a provider basis and a purchaser basis.
I return to the point that I made in my speech : if the citizens charter that the Government are so keen should succeed is to be meaningful, there must be a means by which the ordinary citizen--not just health authority officials as purchasers, but doctors acting on behalf of patients and the patients themselves--can exercise rights and have information upon which to exercise those rights. This has been an interesting debate. It is sad that party politics--almost electioneering--reared its ugly head once or twice in the debate. One or two people who could have made valuable contributions to the debate were not called because of a lack of time. It has been a useful debate and shows just how important Back-Bench Members believe the health service to be. It also shows how important the waiting list is and how important it is to have accurate information not only about the numbers on the list, but about the time that people have to wait.
The debate was concluded, and the Question necessary to dispose of the proceedings was deferred, pursuant to paragraph (4) of Standing Order No. 52 (Consideration of estimates).
It being Ten o'clock, Mr. Speaker,-- pursuant to paragraph (5) of Standing Order No. 52 (Consideration of estimates), put the deferred Questions on Estimates and Supplementary Estimates (Class IV, Vote 1 and Class XIII, Vote 1) and the remaining estimates appointed for consideration this day.
Class IV, Vote 1
Resolved,
That a further sum, not exceeding £81,404,000, be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Department of Trade and Industry on regional development grants, regional selective assistance, selective assistance to individual industries and firms, UK contributions arising from its commitments under the International Natural Rubber Agreements a strategic mineral stockpile, support for the film, aerospace and shipbuilding industries, assistance to redundant steel workers, and other payments.
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Class XV, Vote 3
Resolved,
That a further sum, not exceeding £421,137,000, and including a Supplementary Sum of £161,194,000, be granted to Her Majesty our of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Scottish Office Industry Department on Scottish Enterprise and Highlands and Islands Enterprise ; on regional enterprise grants ; on technical and vocational education ; on the promotion of tourism ; on financial assistance to the electricity industry and local enterprise companies ; on residual expenditure for the Scottish Development Agency and the Highlands and Islands Development Board ; on roads and certain associated services, including the aquisition of land, lighting, road safety and related services ; on assistance to local transport ; on support for transport services in the highlands and islands ; on piers and harbours, and on certain other transport services and grants ; and on other sundry services in connection with trade and industry, etc.
Class XIII, Vote 1
Resolved,
That a further sum, not exceeding £9,962,627,000, and including a Supplementary Sum of £162,196,000, be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Department of Health on hospital, community health, family health and family health service administration services, and on related services.
Class XVI, Vote 8
Resolved,
That a further sum, not exceeding £697,400,000, and including a Supplementary Sum of £10,291,000, be granted to Her Majesty out of the Consolidated Fund to defray the charges that will come in course of payment during the year ending on 31st March 1992 for expenditure by the Welsh Office on hospital, community health, family health (part) and family health service administration services and on related services.
Mr. Speaker-- then proceeded to put forthwith the Question which he was directed to put, pursuant to paragraph (1) of Standing Order No. 53 (Questions on voting of estimates, &c.).
Resolved,
That a further sum, not exceeding £78,863,754,000, be granted to Her Majesty out of the Consolidated Fund to complete or defray the charges for Defence and Civil Services for the year ending on 31st March 1992, as set out in House of Commons Papers Nos. 236, 237, 238 and 486.
Bill ordered to be brought in upon the foregoing resolutions and upon the three resolutions yesterday by the Chairman of Ways and Means, the Chancellor of the Exchequer, Mr. David Mellor, Mr. Francis Maude, Mrs. Gillian Shephard and Mr. John Maples.
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