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Lord Hunt of Kings Heath: My Lords, as part of the planning operations for the millennium and winter pressure period, I am happy to say that local

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authorities and social service departments were fully involved. I pay tribute to the tremendous work undertaken. During the Christmas period, I visited a number of social service facilities where staff were being employed and facilities opened. The point made by the noble Lord is relevant.

As for the preparations made for this winter by the statutory agencies, the most pleasing aspect has undoubtedly been the co-operation at local level between the NHS, general practitioners, local government, social services and all the other agencies in the voluntary and private sectors who have had a part to play.

Baroness Masham of Ilton: My Lords, is the Minister aware that the deputy headmaster of a successful school near Leeds died over the weekend from meningitis when it was thought he had influenza? Will the Minister try to protect patients who have other conditions so that they are not neglected and sent home after being told it is flu? Does the Minister agree that when there is a big influenza problem, as there is now, extra care in diagnosing symptoms should be taken?

Lord Hunt of Kings Heath: My Lords, it would be hard to disagree with the noble Baroness, Lady Masham and I was sorry to hear of the case she mentioned. I have no doubt that there are lessons to be learnt in relation to how the NHS responded this winter, not only in terms of planning and preparation but also in terms of the way clinicians and nurses have had to operate. While we must do everything we can to ensure that the right diagnosis is made at the right time, we should also understand the pressures on staff at present.

Lord Rix: My Lords, does the Minister agree that self-diagnosis with NHS Direct could lead to mistakes of that nature being made?

Lord Hunt of Kings Heath: My Lords, I understand the point made by the noble Lord, Lord Rix. The signs are that NHS Direct has worked well. Those of us who live in areas where it is available and who have used it have found it to be an effective system. Careful protocols have been developed for use by the highly qualified and professional people on the end of the phones at NHS Direct. We will constantly review the situation to ensure that the right advice has been given, but my judgment is that NHS Direct has been of enormous value to thousands of people who can obtain advice at the end of a phone. In being alert to the issues rightly brought to our attention by the noble Lord, Lord Rix, we should recognise that the introduction of NHS Direct and the recognition of the wider role that community pharmacists have to play in giving advice to the public are enormous gains.

Baroness Young: My Lords, I agree that we should thank all NHS staff and others who have worked so hard and so well. However, does the Minister agree that there is a serious situation in the country and in

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the hospital service at this time? We read about in the newspapers and see on television screens patients on hospital trolleys for hours; people being put, I understand, into freezer trucks after they have died because there is no room for them anywhere else; and people waiting hours for treatment. At least one man has died through being taken a long distance to an intensive care bed. Does the Minister agree that it is no use saying that good plans were made if, at the end of the day, such things happen?

My noble friend Lord Howe raised the important point of the effect on hospital waiting lists and the fact that all those whose operations have been cancelled for weeks, I understand, will add to the backlog. Will the Minister make it clear that hospitals will not be judged as having performed badly? Above all, does he recognise the great concern not only of the patients themselves but of their families over this extreme delay? It is not a time for being complacent about anything. The situation is serious and critical and the Government ought to address the issues more forcefully than they have done so far.

Lord Hunt of Kings Heath: My Lords, there is no question of the Government being complacent. It was hardly being complacent to set up the kind of preparations put in place over the past few months. There is no doubt in my mind that the preparations have enabled us to withstand tremendous pressure. However, it cannot be denied that there has been pressure on the system and that the public have had to wait. In certain circumstances, as the noble Baroness mentioned, it has caused distress. But the overall impression that we have of how the NHS is responding is that it is busy, but the situation is manageable and is being managed. As ever, we are anxious to learn the lessons in order to ensure that, year on year, we are better prepared. We learnt lessons last year. The previous government learnt lessons over many years in relation to the kind of pressures being faced.

As for waiting lists for non-urgent treatments, in planning the programme for the year we aimed at a reduction in the number of non-urgent treatments taking place over this period. As regards urgent treatments, of course, along with emergencies, they must be our priority and we are doing everything we can to ensure that patients are treated as soon as possible.

Baroness Emerton: My Lords, I add my thanks to the Minister for repeating the Statement. I take up the point of waiting lists as chairman of an acute trust. Will the Government make any allowances at all for the slippage in the waiting list target as that target will be almost impossible to meet due to the cancellation of the elective cases? Last week in my trust 64 elective patients were cancelled and this morning 15 were cancelled. This morning we had four empty beds available, one of which had to be allocated to an orthopaedic patient who had been waiting 17 months to avoid exceeding the 18-month waiting period. Twelve patients were waiting for the four beds. If the

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Government will reassure the NHS that where the pressures are great allowances will be made, that would be a great help.

I, too, thank the staff. On New Year's Eve I walked around every ward and department. Many of the staff were working double shifts and were extremely tired, but I heard not one grumble. I walked to a street party of 70,000 people. The St John Ambulance staff treated 150 casualties and prevented 70 having to go to the accident and emergency department. I pay tribute to the planning that the statutory and voluntary agencies undertook for that evening.

This morning, the chief executive, the deputy chief executive, the medical director and the finance director of my trust were all off work with flu. I receive hourly bulletins on what is happening in the trust. It is a serious situation.

Lord Hunt of Kings Heath: My Lords, the noble Baroness represents a group of people, the chairs of trusts and health authorities, who have carried an enormous leadership load over the past few weeks and months. In paying tribute to the noble Baroness and to the work of her trust, which is much admired, I recognise the pressures not just on doctors, nurses and ambulance crews but also on those in senior management positions and those who sit on the boards of the corporate authorities of trusts.

As regards waiting list issues, individual trusts will have to consider these matters in the light of their experience over the past few weeks. No doubt there will be dialogue between them and the regional offices of the NHS Executive. We have made enormous strides in reducing the number of people on waiting lists. It is important that over the year we maintain our efforts to continue to do that.

Baroness Fookes: My Lords, if I heard the Minister aright, he said that there were 8 million "jabs" or doses available. However, as there are far more than 10 million old age pensioners, plus all the NHS staff and all those who may be at risk, is that really an adequate number?

Lord Hunt of Kings Heath: My Lords, it is an increase on the previous year. As I said earlier, we made arrangements to allow the vaccine to be given to NHS staff. When the information becomes available we shall of course want to look at the figures and consider particularly who took advantage of the availability of the vaccine to determine what lessons need to be learned for future years.

Baroness Ashton of Upholland: My Lords, on behalf of health authority chairmen, of whom I am one, I thank the Minister for his kind remarks. I believe that the planning has been a huge success. I spent part of the millennium weekend in my part of Hertfordshire working with the staff of NHS trusts and considering intensive care needs. I recognise that the collaboration that occurred between local government, the police

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and different emergency services made a tremendous difference to the situation. Those who made the plans and the Government are to be congratulated on that.

I pick up the point made by the noble Lord, Lord Rix, about NHS Direct. Our area has a fully functioning NHS Direct. Due to the protocols involved, the staff err always on the side of caution. Indeed, some of our GPs complain that too many people are referred to them as a result of NHS Direct. That occurs as a result of erring on the side of caution, which we believe is correct.

The noble Lord, Lord Clement-Jones, and the noble Earl, Lord Howe, mentioned deja vu. I do not think that the flu epidemic is the fault of the Government. It is always a problem at this time of the year. All the staff in the NHS have been cautious as regards being exuberant at the success of the service over the millennium weekend. Many have said to me that they have to be sure the service can get through the winter. It is difficult to leave intensive care beds open on the off chance that a flu epidemic may occur. We try to keep our occupancy high because we are trying constantly to treat people. Therefore, when an epidemic arises--I am delighted that the Government have declared an epidemic so that we know what we are dealing with--we have to ensure that we can work together to resolve the issues. I congratulate all the staff, including those with whom I have had the privilege of working in the past week, many of whom have worked on their days off, and the Government on the planning that has been undertaken.

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