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Baroness Andrews: My Lords, we must be realistic. There must be scope in hospitals to manage unplanned admissions and to treat patients quickly and appropriately. The guidelines suggest that when people are admitted on an emergency or unplanned basis they enter admission wards, which are sometimes mixed sex but within 48 hours they must be found single-sex accommodation. If the noble Earl asked any patient to choose between waiting until a bed in a single-sex ward became available and receiving the treatment that they need, I think I know which they would choose.
Baroness Andrews: My Lords, 96 per cent of NHS trusts have met the additional criteria for mentally ill patients. It is very important, particularly for women and young people, that we develop the best possible quality mental health accommodation. A range of issues, including safety, surround the treatment of turbulent and disturbed adolescents. We are making good progress, but it would be good if we hit the 100 per cent target as soon as possible.
Lord Geddes: My Lords, further to the noble Baroness's reply to my noble friend Lady O'Cathain, and accepting, for the sake of the question, that the vast majority of the 2 per cent of mixed-sex wards exist because of massive new building projectsas a former NHS trust member, I understand thatrather than name and shame, would it not be a good thing just to name and give the reason? If that happened, the country would have a fair idea why the 2 per cent were not meeting the target.
Baroness Andrews: My Lords, as I said in my first Answer, it is difficult for people to grasp that such a small number of wards in the 22 trusts are involved. It is too easy to extrapolate that, if a ward is not compliant, the trust has not complied. It is a subtle process.
Baroness Andrews: My Lords, I am grateful for the encouragement. We have put in place a major programme of investment, modernisation and reform designed to shorten waiting times. As a consequence, by the end of 2005, we will see maximum waiting times of 13 weeks for a first outpatient appointment and six months for inpatient treatment.
Lord Campbell of Croy: My Lords, I thank the noble Baroness for her reply, particularly as she is so busy today. Apart from emergency cases, are patients offered available beds in other establishments, as a press report indicates today, even if they are some distance from their homes?
Baroness Andrews: My Lords, in the case of coronary heart disease, in particular, if there is a possibility of getting the patient into hospital faster, there is a choice scheme, whereby the patient can be offered treatment in a different hospital. I believe that a high proportion of patients make that choice.
Baroness Andrews: My Lords, it is important that we put it in perspective. Three of the 41 hospital trusts on which spot checks were carried out were found to be seriously in default. The Government want to see an end to such situations, and Nigel Crisp described them as reprehensible and unacceptable. I endorse that view. Some other trusts were discovered to have system reporting failures that were essentially technical.
In the case of the three trusts mentioned, we set up investigations immediately before the report came through. Two reports are still outstanding. There have been suspensions, and some people have resigned. More generallyI stress that the Audit Commission emphasised that its findings did not affect the validity of the aggregate data and said that such figures were robustwe have introduced a code of conduct for managers to make it clear that giving in to any temptation to alter figures will be a serious matter. We are examining ways of supporting better systems, and we have set up a better investigative framework for responding when things go wrong.
Baroness Pitkeathley: My Lords, does my noble friend agree that there is a problem, in trying to get waiting lists and waiting times down, with patients who have admission and appointment dates but do not keep themthe "no shows"? In that regard, does she consider that the Government's programme of informing and empowering patients through the patient and public involvement programme will have an effect on the behaviour of patients?
Baroness Andrews: My Lords, we are already beginning to see that effect. The programme is called "Waiting and Choosing", I believe, and the difference is that patients can decide when they go into hospital; it will be at their convenience. That makes it much less likely that they will cancel. That is a positive step.
Another positive step is for GPs to develop special interestsfor example, skeletal disordersso that, instead of having to go into the hospital, the patient can be treated at home by the GP. It is not just a question of managing the waiting list more effectively; there must be a range of strategies to support better referral and appointment systems.
Lord Pilkington of Oxenford: My Lords, is the Minister aware that, behind all the rhetoric, the fact in Somerset, where I come from, is that elderly people needing a hip replacement must wait nine months to a year? They are crippled. In spite of all that the Minister said, I do not think that she is aware of the distress that exists in the health service.
Lord Forsyth of Drumlean: My Lords, does the Minister share my concern that, although the Government have put more resources into the National Health Service, that huge increase in resources has not been matched by a huge increase in output? The best way to get waiting lists and waiting times down is to treat more patients. Why, despite the huge sums of public money being put into the health service, do we not see outputs increase? Instead, we see large numbers of people whose job it is to produce the figures that Ministers want.
Baroness Andrews: My Lords, I could answer the question simply by referring the noble Lord to the modernisation board's report, which shows how much progress we are making on outputs across the board. The waiting lists are lower by 104,000 people than those that we inherited in 1997. In itself, that speaks volumes for the way that the money is being used and the effectiveness of our funding and investment.
Lord Marsh: My Lords, is the Minister aware of another category of people, some of whom are in their 60s, who are refused hip replacement treatment in the National Health Service because they are too young?
Earl Howe: My Lords, a fundamental worry about the Government's waiting list initiative remains. It produces a system in which hospital managers are under greater pressure to deliver on government targets, which is rather a different thing from saying that they should be under pressure to deliver the right patient care and treating the sickest patients first. Is not that a fundamental worry about the initiative?
Baroness Andrews: My Lords, that claim is often made about waiting lists. The Modernisation Agency has worked out a clinically prioritised waiting list that addresses that precise issue and puts the patients in
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