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4. Mr. Paul Burstow (Sutton and Cheam): When he expects the National Institute for Clinical Excellence to issue further recommendations. [106241]

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): The National Institute for Clinical Excellence will be disseminating its guidance at various times throughout the year. In December, the Secretary of State set out the timetable for this year's work programme, and we expect the next guidance to be issued in the spring.

Mr. Burstow: I am grateful to the Minister for that answer. Will she assure the House that, when NICE's recommendations on targeting the drug beta interferon for multiple sclerosis sufferers are considered, MS sufferers will not be placed in a catch-22 situation, in which everyone is denied access to the drug because it is not possible to identify its principal beneficiaries?

Yvette Cooper: Obviously, I cannot pre-empt the guidance that NICE will provide on beta interferon. However, we have referred beta interferon to NICE because there is such wide variation across the country in prescribing the drug. We think that that type of postcode lottery is unfair.

Mr. Kevin Barron (Rother Valley): Will my hon. Friend assure the House that any decisions that the national institute takes will be taken by clinicians, and that they will improve the clinical effectiveness of our health service?

Yvette Cooper: Certainly the whole purpose of the National Institute for Clinical Excellence is to tackle the postcode lottery--in the biggest onslaught on the postcode lottery in the history of the NHS--and to ensure that decisions are taken on the basis of the latest clinical evidence about what works and what is best for patients.

Mr. John Bercow (Buckingham): Will NICE's evaluation of the cost-effectiveness of beta interferon take account of the cost of domiciliary care or of the required domestic adaptations in the absence of its supply?

Yvette Cooper: Certainly NICE will be able to take account of all the data that are submitted, and that includes the costs of care and of social services. NICE will be able

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to take into account all those matters when it considers both the cost effectiveness and the clinical effectiveness of beta interferon.

Mr. David Chaytor (Bury, North): May I tell my hon. Friend about the case of two of my constituents? They were advised by their consultant that beta interferon was the appropriate treatment; invited in for training in the use of beta interferon; but then, only at that point, were told that the budget would not allow them to be issued with the drug. Will she ensure that when NICE produces its guidelines, it will include some guidance to trusts on processes and the information that should be provided to patients well in advance, to avoid the type of disappointment that my constituents experienced?

Yvette Cooper: I have been informed of the case that my hon. Friend mentions, and I have asked the regional office to provide me with a detailed report on the circumstances of the provision of beta interferon for those patients. I can also tell him that we shall be ensuring that NICE's guidance is available to be followed across the country, to tackle some of the problems that he mentions.

Waiting Lists (Consultants)

5. Mrs. Ann Winterton (Congleton): How many patients are waiting more than 13 weeks for their first referral to see a consultant. [106242]

The Minister of State, Department of Health (Mr. John Denham): At 30 September 1999, 512,000 patients were waiting for more than 13 weeks for a first out-patient appointment following general practitioner referral.

Mrs. Winterton: Now that we know that there is a growing waiting list for the waiting list, will the Minister abandon the pledge to cut the waiting list by 100,000 and measure success instead in terms of waiting times? Would it not be better to break a pledge than to force the sickest patients to continue to wait the longest for their treatment?

Mr. Denham: I am afraid that the hon. Lady is wrong on all of those points. We are not going to abandon our target of reducing in-patient waiting lists because as we have brought down in-patient waiting lists, we have brought down in-patient waiting times. Also, we will tackle the problem of out-patient waiting times--which were rising under the previous Government--into which we are investing an extra £30 million this year and an extra £90 million next year.

There is a big difference between the Government and the Opposition. We are determined not just to invest more in tackling waiting times, but to modernise the system, so that it is not inconceivable--as it was under the Tories--that someone could be offered a convenient appointment or be seen in bright, modern surroundings. The Opposition have a different view. They say that hip and cataract operations will have no waiting times because they will not be available on the NHS. The choice is between the Government, who will invest in modernising

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and tackling waiting times, and the Opposition, who want to remove those common but essential treatments from the NHS.

Mr. John Austin (Erith and Thamesmead): Does my hon. Friend recall a report by the Select Committee on Health in 1990-91 which commented on the time spent by NHS consultants in private practice? Will he conduct a review of the impact on waiting lists of private practice work by NHS consultants? Does he agree that if NHS consultants spent more time working in the NHS, waiting lists would be reduced considerably?

Mr. Denham: Recently, we have reached a heads of agreement with the BMA on a new consultants' contract--the most significant change in that contract since 1948. My view is that we should concentrate on what consultants do in the time that they are paid to work in the NHS. The new contract offers the possibility of ensuring not just that NHS consultants' time is spent effectively in the NHS, but that consultants get professional and proper appraisals, in which their development needs can be met. We will concentrate on investing in consultants to make sure that we get the best deal for the NHS in the time that consultants are paid to work in it.

Mr. John Burnett (Torridge and West Devon): The Minister will know that an inquiry has been set up at Derriford hospital in Plymouth to look into the way in which waiting lists there have been collated. A number of individuals at the hospital have complained to me of incidents of bullying, racism and failures properly to follow disciplinary procedures. Will the Minister extend the remit of the inquiry to cover those matters, and the culture of the trust generally?

Mr. Denham: Allegations of that sort are serious and must be looked at carefully. If the hon. Gentleman writes to me, setting out the allegations made to him, I will look into them and make sure that they are dealt with appropriately. The Government have introduced legislation to protect whistle-blowers to ensure that, for the first time, people are able to bring such matters of concern to the attention of the proper authorities, or to the attention of the public if necessary.

Ms Rosie Winterton (Doncaster, Central): What can be done to overcome the problem of GPs referring patients constantly to one particular consultant, even though that consultant may have a longer waiting time than others within the same department? How can we ensure that patients have proper access to all the information about the waiting times and waiting lists of every consultant within a department, so that they can make an informed choice about which consultant they wish to be referred to?

Mr. Denham: My hon. Friend makes an important point and we are tackling several issues that will help to address those problems. Clinicians have a responsibility to make the appropriate referrals to the right doctor, but there are examples of GPs referring out of habit or past practice, even though another consultant may be more specialised in an area of treatment and it would be more appropriate to refer the patient to them.

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Much work is going on between health authorities, primary care groups, hospitals and individual doctors to ensure that doctors are fully aware of the waiting list position and the alternative referrals that are available. That work, backed up by the work that we have asked the National Institute for Clinical Excellence to do to produce referral guidelines for GPs, will help to tackle the problems that my hon. Friend rightly raises.

Waiting Lists (Treatments)

6. Mr. Owen Paterson (North Shropshire): If he will make a statement on treatment waiting times. [106243]

7. Mr. Nicholas Winterton (Macclesfield): If he will make a statement on the role of clinical need within his waiting list initiative. [106244]

The Secretary of State for Health (Mr. Alan Milburn): As waiting lists fall, waiting times are falling, too. The in-patient waiting list is now 87,000 below the level we inherited. We have made it clear throughout that patients should always be treated according to their clinical priority. Emergencies are always treated immediately and patients who need urgent treatment are given priority.

Mr. Paterson: If so, why was cold surgery cancelled for weeks on end this winter in Shropshire?

Mr. Milburn: The NHS did this winter what it does in normal winters.

Mr. Paterson indicated dissent.

Mr. Milburn: I would be astonished if the hon. Gentleman could produce a dossier of evidence that showed that in previous winters, when his party was in power, the NHS in Shropshire did not do what it always does, which is to prioritise emergency cases. I would eat my hat even though I am not wearing one.

Mr. Winterton: As I was the Chairman of the Health Committee when it produced the report that the hon. Member for Erith and Thamesmead (Mr. Austin) mentioned in his question, I hope that the Secretary of State will take my question seriously. Does he accept that grave concern is felt that, in seeking to reduce the in-patient waiting list, clinical priority is--sadly--being ignored in many cases? He gave a forthright response to the question from my hon. Friend the Member for North Shropshire (Mr. Paterson), but will he assure me and the House that clinical priority will take precedence in all situations, even if that means that, for a time, the in-patient waiting list increases?

Mr. Milburn: I have the greatest respect for the hon. Gentleman's views on health. He will know that from the outset we made it clear--by issuing guidance to trusts and to other parts of the NHS--that in tackling the waiting list problems that we inherited, priority should be given to conditions associated with the most severe clinical need. That must be right.

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On the issue of rising waiting lists, the NHS has done this winter what it should always do--it has prioritised emergencies. There are always more pressures on the NHS from emergency admissions in the winter months. The hon. Gentleman knows that and I know that, and I know too that when the waiting list figures for December are published they will probably reflect the fact that the NHS did give priority to emergency cases. I hope that he and his party will welcome the figures when they are published.

Mr. Peter L. Pike (Burnley): Is not the reality that, with an increasing elderly population and the ability of the NHS to do ever more complex surgery, the demands on health service provision will continue to rise rapidly? The simple fact is that this Government are doing much better at meeting the public's demands than their predecessor did over 18 years.

Mr. Milburn: I am grateful for my hon. Friend's views. He is right to say that demands on the NHS, from changes in the demography and the advent of new treatments and technologies, place additional stresses and pressures on the system. The debate in this country is about what form of health care can best deal with those pressures. The Conservatives' answer is that the future for our health care system should rely on more people being made to go private: we say that that is not the answer because it will not work and it is not fair. We say that the best means to secure health improvement for the majority of our citizens is through a modernised and expanded NHS.

Mr. Bruce Grocott (Telford): Given that Opposition Front-Bench Members repeatedly describe our spending plans as reckless, can my right hon. Friend give me an idea of how many Tory Members have asked him to reduce expenditure on health?

Mr. Milburn: None. [Laughter.]

Madam Speaker: Order. Dr. Brand.

Dr. Peter Brand (Isle of Wight): The Secretary of State will know that many patients languish in a sort of statistical purgatory while investigations are carried out and decisions to begin treatment are made. Is the right hon. Gentleman collecting information on the number of people who, having been seen by a consultant, are still waiting for a decision about treatment? Does not he consider it unacceptable that the number of patients who seem to be parked in a queue awaiting a decision is not measured at present?

Mr. Milburn: The hon. Gentleman will know, from his political and clinical experience, that the Government are taking steps to tackle that problem. We are investing in one-stop diagnosis and testing, precisely to avoid the difficulty that he describes. In the modern age, at the beginning of a new century, it seems to me that it is not beyond the wit of the national health service to provide faster and more convenient care for patients, so that people going into hospital are not passed from pillar to post. We are striving to ensure that diagnosis, results and, where possible, treatment are dealt with in one day. It will take time to reach that objective, not least because we

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have to reorganise how services are delivered. We also need to expand the number of staff available to deliver the new services.

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