Select Committee on Public Accounts Minutes of Evidence

Annex A

  Over a weekend the urology waiting list was "reduced" by 340 patients.

  On enquiry I was told that patients who required operations/procedures that did not occupy a hospital bed were no longer to be counted as on the waiting list. These patients include those who would be waiting for diagnosis/treatment of conditions such as bladder cancer and patients waiting for lithotripsy treatment for their kidney stones. There can be no valid reasons for excluding these patients from the list of those "waiting for treatment," apart from cynical manipulation of the figures.

  In addition, should additional resources become available to further reduce waiting lists—as sometimes happens—this group of patients will no longer have access to these funds, because they are no longer on the list. Thus they will have to endure relatively longer waits.

  There is absolutely no doubt that successive government initiatives have distorted clinical priorities. Over the years there has been great pressure to expand day surgery, not only because it is efficient, but also because with simple and short procedures large numbers of patients can be rapidly removed from the waiting list. The result is that patients with more complex problems have to wait considerably longer for their treatment as there are less inpatient places on the operating list, which are more expensive than day cases.

  For example: if you have an inconvenient ganglion on your wrist you will wait for three to six months, but if you cannot walk properly because of a defective hip, you will have to wait for one to two years. In my department, if you have an irritable penis which requires circumcision, the average wait is four months, but if you are over 65 and cannot get a night's sleep because you have to get up four or five times, you will have to wait an average of 14 months for your prostate operation. It is not difficult to assess which of these deserves more rapid treatment.

  Turning to the much vaunted two week wait for patients with possible cancer, though we have to see these patients within two weeks of referral from their GP, there have been no additional staff or other funding to facilitate this. As a result an 80 year old man with possible early prostate cancer—low clinical priority—is seen very soon but a 40 year old with a kidney stone causing potential long term kidney damage—high clinical priority—now has to wait even longer to be seen, because he or she does not have cancer!

  In addition, even though we see cancer patients quickly, it is seldom possible to make a firm diagnosis at the initial consultation, so further tests are necessary. Because of the shortage of pathologists and radiologists this part of the process takes as long or longer than before, so there is no overall benefit to these patients. Yet the Government can legitimately claim that all patients with possible cancer are being seen within two weeks, which makes for good public consumption.

  There are several flaws in the new proposals, particularly relating to the waiting times from referral to treatment. At first glance these seem sensible, but generally they are thoroughly impractical. For an easily identifiable condition such as a hernia, it is simple to measure the time between the GP's initial diagnosis and the operation. But for something more difficult to assess, there can be many different circumstances that will affect the time from referral to treatment, and this will distort the figures. For difficulty in passing water, I might decide to operate and will put the patient onto the waiting list; or I may want more information and arrange tests. Then drugs might be tried, and only if these fail will I decide to operate. There are innumerable similar examples.

  My latest problem describes just how little control we have of clinical priorities. The Trust is overspent and the telescopes which I use to remove kidney stones are broken and will cost £3,000 to repair. I also have a patient who has been waiting 17 months for a penile prosthetis which costs £3,000. My clinical view is that the repair of the telescopes should have priority, but this has been rejected because if the penile prosthetis patient waits any longer he will slip over the 18 month wait limit and the hospital will be in trouble with the Region. Once again clinical judgment is rejected by administrators.

Byron Walmsley FRCS
Consultant Urologist
St Mary's Hospital

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Prepared 18 September 2002