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Trolley Task Force
4. Mr. Christopher Chope (Christchurch): If he will make a statement about the work of the trolley task force. [110856]
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): Last year we set up an accident and emergency modernisation programme team, backed by an investment of £115 million, to spearhead improvements in accident and emergency departments. The programme has a much wider remit than looking at trolley waits. The team produced an interim report last
November, which is available in the Library. Its final report will be presented to Ministers within the next three months.
Mr. Chope: That answer shows, in effect, that this is another new Labour broken promise. The Prime Minister addressed a big conference of health administrators on 20 June 1996 and said:
- Today I want to announce that in Government we will set up a task force to report urgently on how we can end trolley waits in the NHS for good.
Ms Stuart: I hate to suggest that Opposition Members could be mistaken, but on this occasion I am afraid that I have to do so. As my right hon. Friend the Prime Minister said on his visit to St. Thomas's A and E department, we are witnessing a revolution in critical care and in casualty care. One element of that is the process of how we deal with patients between the ambulance and the A and E department, and then subsequently.
Trolley waits are being studied by the winter planning team and by the A and E modernisation programme team. Chief executives of hospital trusts were given strict instructions over the winter regarding the management of trolley waits. Any wait of more than four hours is directly reported to the hospital's chief executive and any wait of more than 12 hours is reported to the regional director. A senior manager in each hospital has been given personal responsibility for trolley waits. As a result, since October the incidence of trolley waits of more than 12 hours has fallen by 48 per cent., and of more than 24 hours by 90 per cent. Far from breaking our promise, the Government have delivered far more than we initially promised.
Mrs. Louise Ellman (Liverpool, Riverside):
I thank my hon. Friend for the £700,000 spent on accident and emergency at the Royal Liverpool hospital, which virtually eliminated long trolley waits over the Christmas period. I also look forward to the completion of the new medical assessment unit at the hospital. That is being built, at a cost of £1.4 million, to support the work of the A and E services.
However, does my hon. Friend agree that A and E services cannot be addressed in isolation? Does she also agree that we need more investment in our overall hospital services, such as the £15 million that has already been made available for the Broadgreen site in Liverpool? Can she promise that there will be further support for services in Liverpool to remedy the cuts in the years of Tory Government?
Ms Stuart:
My hon. Friend is right: the problems in A and E departments cannot be dealt with in isolation. That is why we are reviewing ambulance services and making extra investment available. It is also why, as part of the national beds inquiry, we are reviewing the way that beds are used. That review includes observation units, acute beds and step-down facilities.
My hon. Friend requested more money for her constituency. We shall take that into account when we consider all the other bids.
Dr. Liam Fox (Woodspring):
What was interesting about the Prime Minister's casualty stunt this morning was that there was no mention of how new Labour would abolish trolley waits in accident and emergency departments, nor of the fact that in 1999 patients waited for up to 49 hours on trolleys, nor of the fact that the average wait in casualty has risen to between four and five hours. To be fair to the Prime Minister, however, he did mention that there would be more nurse prescribing in casualty. If that is a real change, and not a stunt, will the Minister say what changes to the Medicines Act 1986 will be required?
Ms Stuart:
To assume that an accident and emergency department will never use trolleys is to misunderstand how admissions to such departments work. Patients will always have to wait on trolleys for a certain time while assessments and tests are carried out before a permanent bed can be made available.
The hon. Gentleman asked about the changes that might have to be made to the Medicines Act 1986. We are looking into that matter at the moment.
Dr. Fox:
The Minister could not answer my question. Her answer means that Downing street has not yet told the Department of Health what the Department's policy on A and E departments is to be. It is No. 10 that determines health policy, not the Secretary of State and his Ministers.
Today, the Prime Minister promised us that nurses would be able to prescribe and order blood tests and X-rays, both of which are already being done. He also said that major cases would be separated from minor ones in the A and E department, and that too is already being done. We are used to the Government reannouncing financial decisions, but now they appear to want to reannounce what is current medical practice and call that a revolution. Is not the £20,000 that Ministers will spend on replacing the tropical plants in their headquarters likely to be far better window dressing than the Prime Minister's waffle this morning in St. Thomas's?
Ms Stuart:
The hon. Gentleman might find it useful to spend some time looking at what happens in the accident and emergency departments in our hospitals around the country. Some of the announcements that were made today are about things that are happening in some parts of the country. The legacy of the previous Government is the huge difference in the services that are being provided across the country. That is why we invested £115 million to ensure that every major hospital that needs improvement will get it. There are some 244 projects for improvement, and about 80 per cent. were finished this summer. It is clear that the previous Government would not have spent £115 million on improving the health service.
5. Mr. Nicholas Winterton (Macclesfield):
When the National Institute for Clinical Excellence will conclude its assessment of beta interferon. [110857]
The Minister of State, Department of Health (Mr. John Denham):
The timetabling of the work programme is a matter for the National Institute for Clinical Excellence, although I understand that it should have finalised its deliberations on beta interferon by 30 May, leaving time for appeals and dissemination of the results. The results of NICE's appraisals should be available in late summer this year.
Mr. Winterton:
I am grateful to the Minister for that reply, but how does he reconcile the addition of affordability to the remit of NICE with the Government's policy statement in June 1998 that NICE would not become a national council for rationing? Does he not agree that all patients in the national health service should expect the best possible drug for the treatment of their condition?
Mr. Denham:
It is certainly the case that NICE will provide authoritative guidance on the clinical effectiveness and cost-effectiveness of treatments. That will enable us to ensure that clinically effective and cost-effective treatments are spread as quickly as possible throughout the national health service, and that the best use is made of NHS resources. I think, to be fair, that the hon. Gentleman has misunderstood the nature of the amendment to the establishment order of NICE earlier this year, which was to ensure that it could examine questions of cost-effectiveness.
Mr. John Healey (Wentworth):
Will my hon. Friend reaffirm that one of the principal purposes of NICE is to overcome the long-standing problems of postcode prescribing of drugs such as beta interferon? What assurances can he give multiple sclerosis sufferers that the current NICE study will lead to greater consistency, transparency and equity in prescribing this drug?
Mr. Denham:
My hon. Friend is absolutely right. One of the features of the national health service that, regrettably, we inherited from the previous Government was the unacceptable variations in access to care and treatment in different parts of the country. The guidance that is being followed on beta interferon was introduced by the previous Government. One of the great strengths, we hope, of NICE is that by providing consistent guidance to health authorities and to clinicians, those unacceptable variations in treatment and care for a whole range of conditions will be tackled effectively.
Mr. Douglas Hogg (Sleaford and North Hykeham):
Is the hon. Gentleman aware that I have been in correspondence with his Department about the problems in the Lincolnshire health authority area? Is he further aware that over the past four and a half years, of those for whom beta interferon has been recommended as treatment 81 per cent. remain untreated? Is he also aware that the Lincolnshire health authority contends that those numbers are because there are insufficient funds available within the Lincolnshire health authority area to treat more
Mr. Denham:
I am grateful to the right hon. and learned Gentleman for recognising in his question that the variations in access to care stemmed from the previous Administration. My advice is that the reason for referring beta interferon--and a range of other important, controversial, questioned drugs such as the taxanes--to NICE is to ensure that authoritative guidance is available to the right hon. and learned Gentleman's authority, and to others, which they should take full account of when making decisions.
Such guidance did not exist previously and that is why, on a range of treatments, health authorities take different decisions about priority or about the effectiveness or availability of different drugs. The National Institute for Clinical Excellence will enable us to tackle that problem.
Mr. Peter L. Pike (Burnley):
One of my constituents moved from Burnley to Cheshire to obtain beta interferon under the present arrangements, which, as my hon. Friend rightly pointed out, came from the previous Conservative Government. Will he give an assurance that everything possible is being done to ensure that when the current assessment has been completed, provision will be clinically based--on medical need and not on cost?
Mr. Denham:
My hon. Friend raises the sort of example of which all hon. Members will be aware. NICE will give guidance both on the clinical effectiveness and the cost-effectiveness of the drugs--that is the basis on which the institute was set up. It will ensure that the most clinically and cost-effective treatments are spread rapidly throughout the NHS and that we make the best use of NHS resources--both factors will be taken into account.
Rev. Martin Smyth (Belfast, South):
One understands the role of NICE, but can we have an assurance that cost-effectiveness will not rule out modern, more expensive drugs that could be cheaper for the health service in the long run and more effective in the care of patients? What about those patients who have already benefited from beta interferon, but have been taken off the drug because they were taking part in a random test? The patients and the clinicians discovered the benefits; cannot the patients continue their treatment?
Mr. Denham:
The hon. Gentleman raises a couple of important points. When any drug is under consideration by the national institute, it is expected that manufacturers and others--such as patients' groups--will submit evidence on the best use of both NHS and personal social services resources, so that the full economic impact can be taken into account. Indeed, it will be open to people to submit evidence over a wider range of costs. I hope that that reassures him.
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