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NHS Waiting Times

1 pm

Mr. Gregory Barker (Bexhill and Battle): I was grateful to be drawn in the ballot for debates, because escalating NHS waiting times are a matter of extreme concern to my constituents, and I am grateful to the Minister for taking time out of her day to reply to me.

Since I entered Parliament last June, many of my constituents have entreated me to take up their cases. Some, of course, are trivial, but many are important—often desperately so—to the person writing. All hon. Members must find that many people turn to them as a last resort. Despite a huge mailbag, however, nothing has moved me more than the plight of cancer patients in my constituency, who now face the most dreadful and stressful wait for treatment following surgery.

The issue was first brought to my attention by a remarkably brave and sensible lady, who was diagnosed with breast cancer on 21 November. To the Government's credit, she was referred promptly for surgery, but what followed was totally unacceptable. Her surgeon advised her that she would need to begin radiotherapy within four to six weeks. Six weeks elapsed, but her calls to the hospital did not result in an appointment. She went back to her surgeon, who said that he was powerless to begin radiotherapy and that the decision lay with the hospital managers. Eventually she was told that she would begin treatment on 25 March, a full 16 weeks after surgery. At a time when she should be focusing all her energy on healing, her condition is being compounded by having to deal with NHS bureaucracy. She has had to face yet more stress and anxiety, which can only have hindered her recovery. She has still to begin her radiotherapy treatment.

When the issue was first brought to my attention, I wrote immediately to the Secretary of State to seek his intervention. Such was the urgency of the case that I not only wrote, but faxed the letter to his private office. My office followed that up with a telephone call on 8 February. The issue was clearly urgent, but despite raising it on the Floor of the House and chasing an answer to a parliamentary written question, I succeeded in securing an answer from a Minister only on 4 March. I appreciate that many increasingly vocal demands are being made on the Government by people who are competing for Ministers' attention, but given the personal nature of my intervention, the Government's response time was nothing less than disgusting. I hope that the Minister will deal with that specific point.

Since I first highlighted the case, other people have contacted me. My constituent's experience was not an isolated incident. Sadly, she is just one of the many victims of a system that, under a Labour Government who are approaching their sixth year in office, faces chronic shortages of staff and equipment.

Britain has about half the number of radiotherapy machines per million people that France and Germany have and a third the number that the United States has. The problem is compounded by a national shortage of radiographers. There are about 500 vacancies across the country, including five at the Maidstone and Tunbridge Wells NHS trust in my area. This morning, following a meeting, I received a letter from the trust's chief executive, which concludes:

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that of my constituent and others—

We are told that, historically, we have failed to train enough specialists and that it takes time for them to come through the system. However, a third of the people who train as radiographers never enter the profession because of pay and conditions in the NHS. Of the 34 new radiotherapy machines acquired by the NHS in the last two years, most have been used to replace existing equipment, rather than to provide a material increase in capacity.

The experience of my constituent is typical of that of thousands of cancer patients throughout the country who find themselves quickly referred into the system. However, once they have ticked the box to hit the headline target of prompt referral, they are starved of the necessary care and treatment to be certain of full recovery—driven, effectively, into a deadly bottleneck. I know that Ministers work long and hard to try to deliver a better health care system, but the new Labour preoccupation with just a few selective headline targets is conning the British public into a false sense of security. A quick first-rate referral is vital, but it is by no means the whole picture.

It is no wonder that Britain still boasts among the worst cancer survival rates of any country in Europe. At the cancer care summit in November 1999, Britain was famously described as having a third world level of cancer care. Other countries in Europe spend far more per head of population on cancer drugs than the UK does. According to a report in the British Medical Journal, chemotherapy spending in the UK works out at only 95p per head, compared with £3.31 in Italy and £6.24 in Germany, and the Royal College of Radiologists reports that the number of patients waiting for a dangerously long time for treatment has doubled in two years. The number of patients starting radiotherapy within the Government target of four weeks since their consultant recommended it has fallen from 68 per cent. in 1998 to 32 per cent. in 2001. The author of the report, Dr. Nick James of Birmingham university's institute for cancer studies, has said that patients are dying while they wait, due to widespread failure to meet waiting time targets. According to the royal college's report, waiting times for radiology are rising in all parts of the UK, apart from Wales and Northern Ireland.

The average wait rose from 5.1 weeks in 1999 to six weeks last year. However, as evidenced by my constituent's experience in the Maidstone and Tunbridge Wells NHS trust, there are huge regional variations. It is particularly bad in the south-east—I believe that there was a debate earlier today about the funding and resourcing of health care there. Rather than confront the appalling situation head on, Ministers have consistently tried to hide behind other, more flattering, statistics. When questioned in the House of Commons on 6 March concerning this genuine crisis in radiology, the Prime Minister immediately fell back on referral statistics for surgery, rather than face up to the difficult issues of chronic waiting times for follow-up treatment, particularly radiology.

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Sadly, the Government's prioritisation of cancer has done little to improve the care of cancer patients. In the recent study by the Royal College of Radiologists, 21 per cent. of lung cancer patients who were curable when diagnosed were found to be incurable by the time that treatment began, and it was found that, on average, patients' tumours tripled in size while they waited for their radiotherapy to begin. The same report also chronicled doctors complaining that they had to lie to patients because, although they knew of drugs that could help sufferers, they also knew that they could not afford them.

Whereas 20 per cent. of breast cancer patients in Europe receive drugs to alleviate the side effects of chemotherapy, in Britain only 5.9 per cent. do. Cancer patients in the UK have their chemotherapy doses reduced to avoid the onset of neutropenia—which reduces protection against infection—in order to ensure that they do not need the expensive drugs required to counteract it. A study by doctors at Addenbrooke's hospital in Cambridge showed that 32 per cent. of breast cancer patients receive sub-optimal treatment as a result of the rationing.

Results collected by the recent World Health Organisation survey are expected to show that as many as 10,000 lives could be saved each year in the United Kingdom by raising cancer care to the European Union average. But cancer is not the only area that is affected by chronic waiting lists. More than five years on from that modest 1997 pledge to reduce in-patient waiting lists by 100,000, that famous Labour pledge remains broken. According to the January figures, more than 1 million patients are still waiting for treatment, despite unprecedented attempts to massage down the figures, including the creation of waiting lists to get on to waiting lists.

Pressure from Whitehall to reduce headline figures at all costs found its nemesis at the end of last year when the National Audit Office exposed a record of what it called "deliberate manipulation" of waiting lists over four years at hospitals throughout Britain. The NAO report found that one in five of 300 hospital consultants who were interviewed said that they had frequently prioritised patients not according to medical need, but to meet waiting list targets. Surrey and Sussex Healthcare NHS trust put only urgent patients on waiting lists and offered appointments at short notice or when patients were on holiday.

One of my constituents in Bexhill had a similar experience. She was left perplexed and angry after she had filled in a form for treatment at the Conquest hospital in Hastings last autumn, only to be promptly offered treatment in the one specific period that she had ruled out while she took a long awaited week's holiday abroad. St. Bartholomew's hospital was reported as having amended patients' records to make it look as though they had been treated on time. The BBC reported that more than 6,000 patients were affected. The NAO said that the condition of many

Figures released last week, on which I hope we can rely, showed that more than 36 per cent. of NHS trusts still had patients waiting for more than 15 months for in-patient treatment. I have spoken a great deal so far about the plight of cancer patients, but that is by no

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means the only area that is affected. In advance of the debate, the Patients Association provided me with information from its report on NHS ophthalmology waiting times. It found that, in the United Kingdom as a whole, only 1 per cent. of authorities and boards can offer patients a routine appointment with an ophthalmologist within a month.

The average waiting time throughout the United Kingdom for routine referral to an ophthalmologist is three to six months, during which time a patient's eyesight can seriously deteriorate. Furthermore, the report found many cases of the waiting time governed not by clinical need, but by trivial indicators such as postcodes. In March 2000, it was reported that the number of heart bypass operations fell for the first time in 25 years as a result of a shortage in intensive care and recovery beds. At the time, Mr. Jules Dussek, president of the Society of Cardiothoracic Surgeons, speaking on Radio 4, said:

He said that doctors were twiddling their thumbs while waiting for the necessary beds to be made available.

A recent survey found surgeons operating at 25 per cent. below usual rates. In 2000, the average surgeon carried out 170 coronary artery operations compared with 250 in 1995. What should the Government do to drive down the dangerous and unacceptable level of waiting lists in Britain? First, they should have the honesty to acknowledge their failure to make real headway over the past five years and cease hiding behind selective targets that do not tell the whole story. Karol Sikora, the professor of cancer medicine at Hammersmith hospital where radiotherapy waiting times currently stand alongside those in Brighton and Maidstone at three months, told The Observer on Sunday 3 March:

Secondly, the Government should give doctors and surgeons greater autonomy to tackle clinical priorities. They should stop imposing artificial targets to flatter Labour's selective election promises. Thirdly, the Government should address the chronic regional imbalance in waiting times. My constituents are routinely referred to either the Conquest hospital in Hastings, Eastbourne district general hospital, or the hospitals of the Maidstone and Tunbridge Wells NHS trust. All those hospitals face an average occupancy of about 95 per cent.—way above the Government's optimum occupancy of 82 per cent. No wonder waiting lists in the south-east, and particularly East Sussex, are spiralling.

The Government's cash for change programme offered some temporary relief from regional bed blocking, but I understand that it expires at the end of the month, and there is no sign of further funding to replace it. I should welcome a comment from the Minister on the future of cash for change. Most of all, the Government need to change the way in which the NHS works. Ministers are still running that vast organisation on lines that would be only too familiar to its founders in post-war Britain. The working habits of Britain have moved on, but not those of the Whitehall-dominated NHS.

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People are dying because they cannot get the necessary treatment in time, yet right across the health service valuable equipment procured at great expense to the taxpayer—equipment for which there is huge demand—sits idle at weekends and in the evenings. In the 21st century we can do our supermarket shopping 24 hours a day and our banking round the clock. Shops and services are increasingly available on Sundays, but our hospitals close promptly at 5 pm on a Friday. We can go to Tesco at the weekend and can change our direct debits out of hours, but we cannot get life-saving medical treatment. Too many hospitals close for all but emergency treatment at 4 pm at the end of the week.

My constituent with breast cancer had the misfortune to require treatment shortly before Christmas, just as the system was beginning the big seasonal shutdown. Although the rest of Britain is able to cope with the flexibility of the demands of the 24-7 consumer—evenings, weekends and bank holidays—the NHS seems stuck in a 1940s time warp. It is time to throw open the doors of the NHS and allow patients round-the-clock access to vital equipment and services. The Prime Minister told the country in 1997 that it had just 24 hours to save the NHS, but as Labour approaches its sixth year in office, waiting lists are worse and the number of trained medics coming into the system is failing to rise to match the needs of today's NHS.

I do not doubt the Minister's sincerity in wanting to improve the NHS, but until the Government have the guts to admit their failures and confront the scale of the problem in an honest and transparent way, patients will continue to suffer.

1.17 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate the hon. Member for Bexhill and Battle (Mr. Barker) on securing a debate on NHS waiting times, which is clearly an important issue not just for his constituents but for people throughout the country. Surveys of public opinion have repeatedly shown that waiting times are a key concern of NHS users. We recognise that concern, and as part of the commitment to building a modern NHS it is important that access to services becomes faster and more convenient. Reducing waiting times is a main priority for the Government and lies at the heart of the NHS plan.

The Government have already made significant progress in reducing waiting times for secondary care, and, as part of the NHS plan, the maximum in-patient waiting times will fall on a staged basis in the next few years to reach six months by 2005. Similar reductions are planned for out-patients too. Most out-patients are already seen within six months. By the end of March that will be an absolute requirement, and 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. Under those new guaranteed maximum waiting times, patients will continue to be treated according to individual assessment of clinical urgency.

Two things are needed to improve waiting times. Capacity must be increased, and the NHS and its processes must be reformed. To increase capacity,

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additional investment in the NHS is needed. That is why the Government have put record levels of additional investment into the NHS during the past few years, and we must continue to do that.

The East Sussex, Brighton and Hove health authority was given £596.7 million for the current financial year, which is a 5.8 per cent. increase in real terms and an 8.4 per cent. increase in cash terms. Overall, investment has doubled during the past few years, compared with the historical average increase in investment. That is because, historically, the NHS has been underfunded; it has had a legacy of long-term underfunding, and it needs additional investment, which it is now receiving.

Additional investment is not the only necessary measure. The way in which the NHS provides care must also be reformed. The hon. Gentleman raised concerns about cancer care. The key issue with regard to that is to shorten waiting times at every step along the way, and to ensure that patients have access to top-quality care. The Government have drawn up the first national cancer strategy—"The NHS Cancer Plan". It is a 10-year plan, and it is part of the NHS 10-year plan. For the first time, we have a national strategy to deal with cancer all the way through from prevention, to diagnosis, to treatment, to palliative care.

With regard to waiting times for cancer care, the key issues concern not simply the time to in-patient treatment, as they do in some other areas. For cancer sufferers, it matters how long one has to wait to see a specialist and to undergo diagnostic tests, and how long one has to wait for different stages of treatment. This information has not previously been gathered in the NHS—previous Governments have not done that—and targets on the whole cancer process have never previously been set. It is important that that has now happened, as part of the NHS cancer plan, because we need to improve the cancer care that people receive throughout the country.

That requires improving the information that we gather on cancer care. It also requires improved investment and reform. There will be extra capacity for cancer services and extra cancer specialists—by April, there will be 428 extra cancer consultants, compared with April 1999. There will also be new cancer equipment—27 new MRI scanners, 66 new CT scanners, and hundreds of extra new pieces of breast cancer equipment. We must continue to increase capacity with regard to specialists and equipment.

It is also necessary to reform the way in which people are provided with cancer care, and that is why the cancer collaboratives were established. They have been doing impressive and innovative work, by reforming the way in which care is provided and by focusing on patients and their needs. For example, the cancer collaborative in west London has cut the diagnosis time for prostate cancer from 20 weeks to 14 days, simply by changing the way that it provides the service. Wirral hospital has halved the waiting time for treatment for prostate cancer. On average, since the cancer collaboratives were introduced, there has been a drop of two and a half weeks in waiting times for treatment.

The overwhelming majority of cases that are urgently referred to specialists are seen within two weeks. I welcome the hon. Gentleman's endorsement of the increase in the speed of referral, but I wish to impress

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upon him that that was not easily achieved. Huge improvements have been made as a result of considerable work by not only specialists, but GPs and support staff throughout the country. He is right to say that it is essential that people are seen speedily. It is also essential that they are diagnosed speedily, and that we speed up time to treatment. That is why we introduced the new target for the time taken to see a specialist, and it is why we are also gradually introducing new targets, stage by stage, for every other section up to treatment.

New targets for times to diagnosis and treatment are already being introduced. From last December, there has been a maximum one-month wait between urgent referral from a general practitioner to treatment for children with cancer and patients with acute leukaemia and testicular cancer, and a target for women with breast cancer of a maximum one-month wait from time of diagnosis to beginning of treatment. We need to improve treatment times across the board, which is why we put in place new targets and extra investment. It is not possible to do that without extra investment in capacity.

The hon. Gentleman asked about radiotherapy. From the beginning of the cancer plan, we had particular concerns about radiotherapy. The number of therapy radiographers is inadequate, and we need to improve facilities. Considerable work has been going on to try to improve difficult circumstances. The number of patients referred for radiotherapy has increased rapidly during the past few years following the establishment of specialist cancer teams. Radiologists have increased by 14 per cent. since 1997, and we are increasing training places for therapy radiographers at universities. Training places increased by 62 per cent. between 1996-97 and 2001-02, and by 2003-04, the projected increase will be up 120 per cent. over 1997. The numbers are increasing, but we need to go further.

We also need to consider different skill mixes in trying to improve and speed up treatment. Different skill-mix programmes are already being piloted, including the creation of a new grade of assistant practitioner, perhaps through vocational routes. The pilots continue in 10 centres, and early indications are positive.

Huge additional investment is being made in radiotherapy facilities, with replacement and additional linear accelerators being brought into operation. However, there is much to do, and we need to go further.

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The hon. Gentleman referred to cancer treatment. For the first time we have national guidelines on treatment and drugs as a result of the work of the National Institute for Clinical Excellence. Improving cancer treatment in our 10-year plan needs extra capacity and extra reforms.

The hon. Gentleman was full of complaints and laments about the NHS and cancer care, but his diagnosis and prescription were fundamentally lacking. Throughout the country, there are NHS patients who are receiving excellent care. However, it is also true that many patients wait too long for their treatment. We do not have sufficient capacity, and we need to keep increasing it. We need to continue the reforms that are making excellent progress in some areas of the NHS, and spread them nationwide.

In his diagnosis, the hon. Gentleman quoted Karol Sikora, who has said that he wants more people to pay privately for cancer care. I believe that we should provide free care according to need, not ability to pay. If the hon. Gentleman recognises the need for extra investment in cancer services and across the board to improve capacity, he needs to say where those resources should come from. The Government have set out a major programme of investment and reform not only for cancer but across the board. I hope that he will support that and the extra investment in cancer care, and the measures being taken to continue to increase resources for the NHS. If he does not, he will need to say how improvements in cancer care should take place and where he expects the additional resources to come from. For most people who suffer from cancer, it is simply not an option to pay for their own cancer drugs or treatment. The cost of providing cancer care for an individual is extremely high, and it would be morally wrong to expect cancer patients to have to pay out of their own pockets rather than receive care on the NHS.

The hon. Gentleman is right to say that waiting times are important. They are clearly more important in cases of cancer and coronary heart disease than in other areas, and that is why we made those the clinical priorities.

The hon. Gentleman referred to the need to increase the number of coronary heart disease operations. The number of revascularisations increased substantially between 1995-96 and 1999-2000—from 34,000 to 41,000—and in the first 10 months of 2000-01, more than 45,000 procedures were performed. Revascularisation is an important, life-saving procedure, which is why we have put extra money into increasing the number of operations.

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