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Norman Lamb (North Norfolk): My reason for calling the debate is to draw attention to how long people in Norfolk have to wait, often in real pain, to see an orthopaedic specialistand then even longer for an operation. We all agree that waiting more than a year for a first appointment with a specialist is unacceptable. From first referral to the specialist to having an operation performed can sometimes take a further two to three years. The Government must now respond with additional resources to recruit more specialist staff and enable the Norfolk and Norwich healthcare trust to deal with this waiting-times scandal.
I shall refer to three particular cases. Depressingly, they are not exceptional. The first case is that of Mrs. Green of Trunch, who tells me that she suffers so badly from pain some days that she is unable to walk. She saw her GP in March this year and he wrote to the hospital requesting an appointment with a specialist. Two months later she received a letter from the hospital dated 24 May. It stated:
The third case involves a lady who, understandably, wants to remain anonymous. She is 54 and worried about losing her job. She is on long-term sick leave, waiting for an operation. It has been pencilled in for January 2002, but her employers told her that they would retain her job for only six months.
Those are just three examples of people who have come to see me, often in distress, deeply worried about when they will have their operations. Long waiting times have other implications. One consultant explained that a patient's condition often worsens while they are waiting, which can result in more complex, more expensive surgery. Sometimes the patient suffers other medical problemsa stroke or a heart attackso it is not possible to operate. Patients are likely to remain in pain for the rest of their lives, or simply die before ever being treated. That cannot be what a modern, efficient and responsive health service aspires to.
Mr. Henry Bellingham (North-West Norfolk): The hon. Gentleman will not be surprised to hear that in my travels around my adjoining constituency of North-West Norfolk, I have encountered many similar cases.
I want to deal with the extent of the problem in Norfolk in comparison with the rest of the country. I shall focus first on the out-patient and then on the in-patient waiting times. Regarding the time that patients have to wait between a GP appointment and seeing the specialist, in the first quarter of 1997, just 59 people in Norfolk were waiting more than six months for the first appointment. In the first quarter of 2001, that number had increased dramatically to 461. Interestingly, trusts and hospitals do not even keep statistics on the number waiting more than a year for an appointment, presumably because nobody ever imagined that it would be necessary to compile them. We now know that that is the reality for people in Norfolk.
In-patient waiting times between seeing a specialist and having an operation are similarly worrying. The Norfolk and Norwich trust now has 3,392 people waiting for operations in this specialty. Of those, 445 are waiting more than a year from their specialist appointment. That compares with just 68 people waiting more than a year back in March 1997. The Government should be ashamed of that record.
The Norfolk and Norwich health authority has one of the highest in-patient waiting lists in the countryit is eighth out of 99 health authorities in England, and the proportion of those waiting more than a year is almost double the national average. The Minister may wish to reflect on the enormous variations across the country. In North Yorkshire, only 0.2 per cent. of those on the waiting list wait more than a year, compared to Norfolk's 12 per cent. That demonstrates the postcode lottery in orthopaedic care, which should be taken into account in determining whether it would be fair and equitable to provide additional funds for the worst affected areas.
Why is the position in Norfolk so bad? The problem stems from winter 1996. In the run-up to the 1997 general election, there was a serious problem with emergency admissions. Resources were switched away from specialisms such as orthopaedics to deal with the crisis in emergency admissions and the resulting curtailment of elective activity quickly led to a backlog, which has remained ever since. Depressingly, the year-on-year figures demonstrate that the position has worsened.
I must stress that it is not the problem of an under-performing or inexperienced department. Norfolk's specialists are among the most highly regarded in the country. Among their number is a past president of the British Orthopaedics Association, the president of the British Knee Society and the secretary of the British Hip Society. These are eminent professionals and Norfolk is lucky to have them, but they need extra support and additional resources. Their throughput of patients is one of the best in East Anglia, but because of their reputation, they have specialist work from
Another cause of the continuing failure to eat into the backlog of patients is that there are not enough beds in Norfolk's main hospital. Shortage of beds means cancelled operations and longer waiting times. Bed numbers have fallen year after year. Although the recent arrival of Philippino nurses has helped, it remains a depressing picture.
Last year, the occupancy rate at the Norfolk and Norwich hospital was 91 per cent., which compares with the nationally accepted standard of 85 per cent. The inevitable result of a hospital operating at such a high occupancy rate is that for much of the time, and not just during the normal winter crises, the hospital is full. That means that operations have to be cancelled, because no beds are available. In the past two years, 500 operations at the Norfolk and Norwich hospital have been cancelled. That is a ludicrous state of affairs, because it leaves expensive highly trained surgeons twiddling their thumbs rather than operating on patients.
What can be done? We have had reassuring words from Norfolk health authority about more funds being invested in this specialty and more people being treated than ever before. I am sure that the Minister will allude to that. I fully recognise that Norfolk has a growing elderly population, but that is an extra justification for more resources to deal with the appalling backlog of patients and to keep pace with demand.
A plan is in place for an eight-month overlap between the opening of the new Colney hospital and the closure of the old Norfolk and Norwich hospital, so that both hospitals operate simultaneously. That could help to reduce the backlogalthough it will not remove itbut to achieve that, the hospitals will have to recruit short-term contract surgeons. That has not yet been achieved and will not be easy. Recruitment to permanent posts is hard enough, but recruitment to short-term contracts is even more difficult. I think that it is accepted across the board that the transfer to the new hospital will result in a reduction in activity for a time. It is possible that no operations will take place for two weeks.
Overall, therefore, there is little reason to believe that things will improve in the foreseeable future. Waiting times for orthopaedic appointments and surgery in Norfolk are unacceptably long. It is critical that the Government respond to the debate by providing additional funding to remove the backlog of cases. Further significant investment is needed now, so that the trust can plan its way forward. It must not be left with more uncertainty until the new financial year.
In reality, we have a two-tier health service in this specialty. If people have money, they can opt out of that horror, but if people are on a low wage, unemployed or reliant on the state pension, they simply have to wait and wait and wait. We cannot accept that any longer. The Government must deal with the underinvestment in this specialty and provide the resources that Norfolk needs.
The Minister of State, Department of Health (Jacqui Smith) : I congratulate the hon. Member for North Norfolk (Norman Lamb) on securing what I believe is his first Adjournment debate and I welcome him to Westminster Hall. Without wishing to sound patronisingI am probably failinghe has done an excellent job on behalf of his constituents. I am aware that there has been considerable local interest in orthopaedic waiting times in Norfolk, and I appreciate his concerns and those of his constituents. I hope that I can reassure him that progress is being made.
As the hon. Gentleman will be aware, the Government have made significant progress in reducing waiting times. As part of the NHS plan, maximum in-patient waiting times will fall on a staged basis from 18 months now to 15, 12, nine and eventually six months by 2005. As a first step towards that, the 15-month maximum waiting time for an in-patient appointment will be achieved by the end of March 2002.
Most out-patients are already seen within six months, which will be an absolute requirement by the end of March 2002. The plan is that by the end of 2005, the maximum waiting time for a routine out-patient appointment will be halved from more than six months to three months. Within those new guaranteed maximum waiting times, patients will be treated according to individual assessment of clinical urgency. The Government's eventual objective is to reduce the maximum wait for any stage of treatment to three months.
We are committed to reducing waiting times for orthopaedic treatment, in line with the national targets set out in the NHS plan. The NHS plan will see year-on-year increases in equipment, facilities and staff. As the extra capacity becomes available, the Government will be able to reduce waiting times. The areas with particular problems will be targeted for special action. On the specific issue of Norfolk, we are committed to increasing resources to the NHS to achieve our aims, and I am pleased to announce that Norfolk has received record increases in funding. I am sure that the honourable Gentleman is aware of the announcement in this year's Budget statement of the largest ever increase in funding for the NHS in England. The total allocation for Norfolk in 2001-02 is £504 million, which represents a total cash increase of £40 million and an increase of 8.6 per cent., or 5.9 per cent. in real terms.
The Government have therefore already to some extent recognised the hon. Gentleman's call for resources and his plan for the future. As he pointed out, we may need to reform and improve the system to ensure that his constituents and people throughout the country receive the treatment that they deserve. The hon. Gentleman is right to be concerned about waiting times for orthopaedic treatment in his area. As he said, waiting times for orthopaedics began to rise in 1995 and increased dramatically in 1997. However, that trend was halted at the end of 1997 and the trust responded with a range of waiting list initiatives and activities to begin dealing with the problem. Those initiatives halted the rise in waiting lists but, as the hon. Gentleman has rightly pointed out, could not address the large number of patients that had been added to the waiting list. I recognise the honourable Gentleman's concern about
Since 1997, an additional £1.5 million has been invested in orthopaedic surgery. That includes the appointment of two additional consultants and supporting orthopaedic investment. There remains the issue of the total number of patients waiting for surgery, which is proportionally higher than the national average. The average waiting time for an orthopaedic operation at the Norfolk and Norwich hospital is 4.9 months, compared with the national average of 4.1 months. That has put a great deal of pressure on the trust, an issue to which I shall return.
Norfolk health authority is reviewing orthopaedic services, under the leadership of Dr. Norman Pinder, Norfolk health authority's director of public health. The review will look at Norfolk as a whole. Importantly, it will identify best practice from independent sources such as the National Institute for Clinical Excellence and the Audit Commission and will relate it to implications for the NHS plan and national service frameworks. It will focus not just on hospital services, but will also give opportunities to examine how current orthopaedic referrals are managed, looking particularly at alternative ways of treating patients. Examples could include the use of surgical podiatry, therapy services for the management of back pain and increasing capacity in rheumatology for the treatment of medical musculo-skeletal problems. Those matters are important, because I agree with the hon. Gentleman that the wait for out-patient appointments is too long and that action must be taken.
On one case that the hon. Gentleman raised, it is worth saying that patients who are in considerable pain while waiting for an operation may return to their general practitioner for reassessment of their condition to be re-referred as an urgent case. Notwithstanding that, we must ensure that the system operates properly with appropriate resources.
In addition to the specific orthopaedic services review and to ensure that the Government's targets are met, the national health service plan implementation programme committed the NHS to undertaking local modernisation reviews during the summer. The reviews are intended to aid implementation of the NHS plan by genuinely localising implementation and engaging staff, patients and partners in local government and the private and voluntary sectors. The findings from each review will be used to create robust three to five-year plans, describing specifically how the NHS plan will be implemented in local health communities. There will be a two-stage approach to the local modernisation reviews, the first of which will be completed by the end of this month. The orthopaedic review in Norfolk will inform its local modernisation review by identifying what additional provision must be made and where it should be provided.
Mr. Bellingham : Will the review envisage out-of-area treatment? For example in the case of the Queen Elizabeth hospital in King's Lynn, there was a period last summer when there were so many road accidents
Jacqui Smith : I am sure that the balance between emergency and elective care, and the pressures on the system from wherever they come, will be part of that review, and that the hon. Gentleman will be able to feed into the review's conclusions.
As the hon. Member for North Norfolk suggested, the Norfolk and Norwich hospital is recognised as an efficient trust and is opening a new hospital later this year. It will be a brand new, purpose-built hospital for the residents of Norwich and the surrounding area, and will cost £229 million. It will be the largest new single-build hospital to be built in the country under public-private partnership. Although completion was contracted for January 2002, construction has proceeded considerably ahead of schedule, and I am pleased to note that it will open to its first patients this autumn.
The hospital is designed with the latest state-of-the-art facilities and technology, which will provide substantial improvements in accommodation. Perhaps more importantly given today's debate, the new theatre complex will include four orthopaedic theatres that will benefit from an airflow system that will minimise the risk of post-operative infections and allow a greater range of orthopaedic procedures to be performed.
I am pleased to report that the health system has identified an opportunity, as the hon. Member for North Norfolk suggested, to use the vacated space at the old hospital to provide additional surgery, including orthopaedics. That will cover the three-week period during the hospital move when, as the hon. Gentleman pointed out, no elective surgery will be performed. To do that, Norfolk health system has funded an extra £3.9 million to carry out 2,000 additional operations at the old hospital during an eight-month period beginning in the autumn.
Through the proactive work of the local health system, an extra 1,200 patients will be treated during this financial year, at least half of whom will receive joint replacements. The trust aims to reduce the number of long waiters on the waiting list, depending on the suitability of patients to be treated at the old hospital.
The hon. Gentleman rightly raised the issue of staff. The trust is actively recruiting staff at present with a view to commencing the project in October and operating it until July 2002. There will be two additional wards, and two further locum orthopaedic consultants will be appointed. Hon. Members from the area will be interested to know that the programme will offer patients general surgical and urological facilities as well.
I recognise that the trust did not achieve its in-patient targets last year and reported a shortfall of 1,470 against its target for in-patient surgery. I have already referred to the historical difficulties with orthopaedic activity at Norfolk and Norwich hospital. However, recent work by local commissioners has revealed that the department's efficiency compares favourably with departments of similar size and similar large acute hospitals. That has been verified through the use of well-accepted modelling techniques and was highlighted by the hon. Member for North Norfolk.
How is the trust tackling its waiting list targets? It has produced a recovery plan and support has been provided by the regional modernisation action team. In addition, expert advice has been sought on waiting list management to improve the capability to model and forecast waiting list pressures and to work through how different solutions could be used. Despite that efficiency and the additional investment that I outlined, in-patient and out-patient waiting times are still too long, and hon. Members are right to be concerned. However, the GP referral rate is not rising and the number of patients being added to operation lists following out-patient attendance is in equilibrium with the number of operations being carried out.
In addition to the review of orthopaedic services and input into the local modernisation review, the local NHS is clear that early action will need to be taken to reduce waiting times. The trust and health authority are currently developing a proposal to open two additional operating theatres at the new Norfolk and Norwich site, which will considerably alleviate the waiting list problem. The plan will be presented to the regional office in September and, if approved, the new theatres will be operational in July 2002. The local modernisation review will report later this month, and I would be happy to follow up any significant issues if hon. Members would find that helpful.
I recognise that the targets are challenging, but I am reassured that collaborative working with the regional office, health authority and local primary care organisations will allow the targets for 26-week out-patient appointments and 15-month in-patient and day-care waiters to be achieved by the end of the financial year. I can assure the hon. Gentleman that, in addition to the extra investment in the system and the action taken to ensure that that investment is spent in the most effective way, I, and no doubt other hon. Members, will be keeping a close eye on ensuring that his constituents get the health service that the Government are committed to delivering.