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Mr. John Butterfill (Bournemouth, West): On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker (Sir Alan Haselhurst): May I take the point of order at the end, so as not to take up the valuable time of the hon. Member for North Shropshire (Mr. Paterson)?

Mr. Paterson: Thank you, Mr. Deputy Speaker.

I discussed the matter with Shropshire health authority, which, in fairness, had gone into great detail and done a lot of work with the representatives of hospitals, primary care and social services, and had daily meetings to co-ordinate those agencies during the winter period.

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Because of the lack of capacity, the health authority was forced to deliver a plan to suspend routine surgery for three weeks and admitted to me that the number of intensive care beds was at times insufficient.

It is clear that there is not adequate capacity to cope with the rising population of Shropshire and the extra costs of providing health services in a widely dispersed rural area. There are extra costs involved in staff travel, ambulance travel, and the need for more facilities. That has been confirmed by studies in Wales, Scotland and Cornwall. The formula appears to militate against a rural area such as Shropshire.

I understand that the allocation formula is frozen until 2001-02, but that the Government are reviewing it. I hope that the review will examine the costs of delivering in rural areas. In Shropshire, the population is set to grow over the next five years from 431,400 to 441,800--a growth of 2.4 per cent. It is worth pointing out that, currently, 57 per cent. of the people in that health authority live in rural areas with fewer than 25 people per hectare. In addition, those who are moving in tend to be rather more elderly: 17.3 per cent. are in the middle-aged group, 55 to 64, and 7.8 per cent. are over 65. Obviously, they are heavier users of health care services.

I am sure the Minister will tell the House that she is proud of her Government's achievement in giving Shropshire health authority a further £23 million in two tranches, in December and March. Of course, that is gratefully received, and I do not want to sound churlish, but there is a worry that almost £4 million of that money will be spent on paying back past debt or past overspend, not increasing capacity. There are anxieties about what will happen this winter.

I should like the Minister to study two reports, which are well worth reading, on the extra costs of delivering in rural areas. The first is a Welsh Office report from June last year entitled "The Allocation of Health Authority Discretionary Resources in Wales." The other, commissioned by the Cornwall and Isles of Scilly health authority in May last year, is entitled "The additional costs of providing health services to rural areas." The reports highlight the lack of economies of scale, additional travel costs, the high level of unproductive time, additional telecommunications costs, poorer access to training, and difficulties with consulting and other support services.

On travel, there is empirical evidence to confirm that significant differences exist between urban and rural areas. In Dorset, for example, occupational therapists in urban areas travelled 1,952 miles, compared to the 4,880 miles travelled by those in rural areas.

In conclusion, it is clear that demand is outstripping supply in Shropshire, particularly during the winter period, and that some waiting times have been intolerable. The current funding formula is not reflecting Shropshire's rural nature or its growing population. Last winter showed that capacity is inadequate. It is unacceptable for elective surgery to be stopped, or for such stoppage to be planned, and for emergencies to struggle to find beds.

Will the Minister please investigate the formula and the real problems that were created last winter, which have so far been dismissed at Health questions by the Secretary of State? Will she also consider the problem that £4

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million of the extra £23 million has been spent on clearing debt instead of on increasing capacity to prevent problems next winter? Will she consider dropping the political slogan about waiting lists, which is now discredited, and concentrate on waiting times, which is the measure that counts for patients, and judging admissions on the basis of clinical need? Will the Minister also consider allowing health authorities to take advantage of private capacity, if it is available, to reduce waiting times for taxpayers when NHS capacity is inadequate?

If the Government insist on running the NHS rigidly from the centre, will they please listen to those like me, who represent patients, and not arrogantly dismiss us as they have dismissed me at Health questions.

2.46 pm

Mr. Butterfill: On a point of order, Mr. Deputy Speaker. For most of this morning, Whitehall has been blocked by a violent demonstration. Hon. Members have been hindered when trying to reach the House; access to Ministers' and Members' offices and Downing street has been impeded. Have you received any request from the Home Secretary to come to the House to make a statement about why Whitehall has not been cleared?

Mr. Deputy Speaker (Sir Alan Haselhurst): I am grateful to the hon. Gentleman for raising that matter. The answer to the specific question is no, there has been no request for a ministerial statement. However, I am aware of the difficulties that hon. Members have experienced. I naturally regret that. I understand that the difficult problem has been confined to Parliament street and that the police are making all efforts to clear that street.

2.47 pm

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I am grateful for the opportunity to discuss the subject of waiting times for hospital treatment in winter. I congratulate the hon. Member for North Shropshire (Mr. Paterson) on securing the debate. While parliamentary rules allow me to wear a hat, I am sure that he will appreciate the fact that I have not taken the opportunity to do so. That implies no discourtesy to the House. I hope that I shall be able to convince hon. Members that there is no need for either the Secretary of State or me to take up the challenge with which we were issued.

Before I focus on waiting times, I shall deal with several issues that the hon. Gentleman raised in his speech. He is right to say that we are facing a lack of capacity throughout the national health service. To facilitate expanding capacity, we have introduced several measures nationally and locally. It is important to consider the extension of manpower capacity through extra nurses and doctors, and training places. The national beds inquiry is also important. It has reported and we shall be able to reflect more carefully on where extra capacity is needed.

The hon. Gentleman also referred to the review of the allocation formula. He is right to say that the current formula is frozen until 2001. All factors, including those that he raised, will be taken into account in arriving at the new formula.

As for past debts, it is the statutory duty of any health authority to operate within its financial framework. We expect health authorities to work within their allocation. I

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am therefore afraid that I shall not be able to offer the hon. Gentleman any comfort on past debts. They simply have to be paid, as in any other organisation.

The hon. Gentleman also mentioned the private sector. I assure him that, for geographical reasons, there are capacity problems in the private sector. He will be aware of that when he considers the location of BUPA facilities and the needs of his constituents.

Overall, health authorities have worked with the private sector where that is advantageous and cost-effective, and many hospitals have made such arrangements where they are in patients' interests. The bottom line is that NHS patients receive the treatment that they need, and that that is funded by the NHS. My right hon. Friend the Prime Minister made it absolutely clear that there is no ideological aversion to such local arrangements.

I shall deal with winter hospital waiting lists and explain how we prepared for the winter pressures overall. The system coped much better than in previous years. That did not happen by accident, but because of careful planning. We established local winter planning groups, which first met last April, in all areas. For the first time ever, they provided careful co-ordination between all health providers including social services, health authorities, trusts, primary care groups, out-of-hours services, deputising services, pharmacists, and even the police and fire services and other local organisations. Last year, we also provided the money much earlier so that that planning was underpinned by funding. We allocated an additional £2.24 million, which was specifically targeted at waiting lists, to Shropshire health authority.

Before saying more about the effect of that money, I shall address the hon. Gentleman's concerns about the priorities in Shropshire being different from those for previous years. The overall plan in Shropshire for last winter was for routine elective in-patient work to cease in the three weeks from 20 December to 10 January. I accept that that was slightly longer than in previous years, but there was an extremely valid reason for that: the extended bank holiday period and the extra emphasis on winter planning over the millennium.

Some elective day-case procedures continued after 20 December and resumed fully in January. Emergency and urgent surgery was carried out as necessary during that period, so the NHS did what it normally does: it ensured that there was sufficient capacity to put emergency cases first. There was no distortion of clinical priorities; the right ones were used.

There were busy periods. I am advised that local hospitals were very busy over the new year because high levels of flu, bronchial infections, which disproportionately affected the elderly population, and viral pneumonia, which put greater pressure on the NHS. That, in turn, led to more emergency hospital admissions. Many of those admitted had more serious illnesses and needed to stay for longer, which resulted in increased demand for beds, especially among the elderly and other vulnerable groups.

Despite those pressures, the NHS in Shropshire coped admirably. No local hospital was closed to blue-light cases. Sound bed management between trusts kept disruption to the minimum. As far as I am aware, no individual complaints were logged with the health authority about services during that period, and I have not been made aware of any investigation by local trusts. As

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always, I should be happy to mount a proper investigation into any of the cases that the hon. Gentleman raised and let him have the results.

Taking account of the expected close-down during the holiday period, and the reductions in activity caused by winter pressures, is part of the normal winter planning that deals with waiting lists. Indeed, we always expect less elective activity to take place during December and January.

The waiting list figures rose in December and January, both nationally and locally, and those increases reflected the priority given to emergency cases by the NHS. The increases were anticipated and did not prevent us from meeting our manifesto commitment well in advance of the date pledged. The waiting list in Shropshire fell by 578 between the end of November 1999 and the end of March 2000.

Now I shall deal specifically with waiting lists. On coming to office, we inherited a record and disgraceful number of people waiting for NHS treatment, and increasing waiting times, which were unacceptable in the modern health service. That is why, unlike the Conservative party, we are committed to reducing not only the number of people waiting, but the time that they wait. We have already achieved our manifesto commitment to reduce NHS waiting lists by 100,000 from the numbers that we inherited, during the lifetime of this Parliament--and we did so well in advance of the deadline. The waiting list fell by 51,000 in March and is now 121,000 below the level inherited from the previous Government. In Shropshire, the in-patient waiting list fell by 704 last year, which made a welcome contribution to our achievement of the manifesto commitment.

As in-patient waiting lists have fallen, so have waiting times. It is important to recognise that the number of over-12-month waiters is a third lower than in June 1998. Most in-patients are seen within a much shorter time. The latest figures show that about 70 per cent. are admitted within three months of being placed on a waiting list.

Last year, the in-patient waiting list fell by 36,000, and the number of over-13-week out-patient waiters fell by 54,000. In the final year of the previous Administration, the number of in-patients rose by 110,000 and the number of over-13-week out-patient waiters by 31,000.

As I said earlier, we allocated a recurrent £2.24 million to Shropshire health authority to support reductions in waiting lists and times. The £660 million allocated to the service following the Chancellor's Budget statement included a further £5.3 million for Shropshire health authority.

That money will support various initiatives under way in Shropshire to reduce waiting lists and times. Those measures are important for the long-term planning and expansion of capacity, and for speed of treatment. They include the funding of additional out-patient and in-patient sessions at the Royal Shrewsbury, Princess Royal and Robert Jones Hunt hospitals, the employment of an extra consultant and part-time anaesthetist at the Robert Jones and Agnes Hunt Trust, and the use of fast-track back pain clinics run by physiotherapists.

We promised to tackle in-patient waiting lists, and we have done so. Now we are applying the same determination to tackling out-patient waiting lists and

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times. Between December 1999 and March 2000, the number of people waiting more than 13 weeks for an out-patient appointment fell by 94,000.


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