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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 Sharples: My Lords, the noble Baroness mentions modern matrons. What is the difference between a modern matron and an old-fashioned matron?
Baroness Andrews: My Lords, I dread the perspicacious questions of the noble Baroness. I think that it is because matrons have been recreated.
The Earl of Listowel: My Lords, what is the current situation as regards adolescent residents in mental health units? To what extent are they divided between sexes?
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 projects—as a former NHS trust member, I understand that—rather 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.
NHS Waiting Lists
2.49 p.m.
Lord Campbell of Croy asked Her Majesty's Government:
- What action they are taking to shorten hospital waiting lists and the waiting times for patients on those lists.
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.
Lord Clement-Jones: My Lords, the recent Audit Commission report referred to widespread errors and
deliberate misreporting of waiting lists and waiting time figures. The Audit Commission said that there should be an open debate in the NHS about what led to such behaviour, so that lessons could be learnt and measures taken to avoid repetition. What can the Minister say about that? What is the department doing to implement the Audit Commission's recommendation?
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 generally—I stress that the Audit Commission emphasised that its findings did not affect the validity of the aggregate data and said that such figures were robust—we 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 them—the "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 interests—for example, skeletal disorders—so 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.
Baroness Andrews: My Lords, a number of your Lordships have waited for orthopaedic surgery, and it
is good to see those people back with us. Orthopaedics is a particular challenge, to which we have responded by setting up what we call an "action on" programme. That is a priority programme to speed things up. There are 43 projects in process at the moment addressing the particular question of timescales in orthopaedics. We are well aware of the situation.
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?
Baroness Andrews: My Lords, in this House, we know how young one can be at 60. I know of no cases of the kind to which the noble Lord refers. If he writes to me, we can follow it up.
Lord Turnberg: My Lords, does my noble friend agree that the sooner we bring the Community Care (Delayed Discharges etc.) Bill into effect, the sooner it will have an effect on the waiting lists?
Baroness Andrews: My Lords, at this time this week, I can certainly agree with my noble friend.
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
most urgent need at the top of the list. The agency works with clinicians in trusts to make sure that clinical priorities are observed and delivered on.
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