Lord Beecham
To ask Her Majesty’s Government how many patients currently waiting more than 18 weeks for treatment will benefit from the recent directive on waiting times; and what are the most common conditions from which they suffer.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we have introduced a strong performance measure in 2012-13 for patients still waiting to start treatment more than 18 weeks after referral. This, and the requirement to treat patients in order of clinical priority, will ensure that the NHS focuses on minimising waiting times for all patients. At the end of September 2011, 242,540 patients were waiting longer than 18 weeks to start treatment. The largest numbers of patients were waiting in trauma and orthopaedics specialties.
Lord Beecham
My Lords, does not this U-turn underline the folly of abandoning targets in the first place? Will the Minister say how, under the provisions of the Health and Social Care Bill, the Secretary of State will be able to intervene in similar circumstances should they arise in future?
Earl Howe
My Lords, this is not a U-turn. The Government have always been clear that the standards laid down in the NHS constitution should be adhered to. As the noble Lord will know, that includes the expectation that patients should not wait for longer than 18 weeks. It is also a condition built into the NHS standard contract. We have been absolutely consistent all the way along. Those things will continue to have to be measured after the Government’s modernisation proposals are put in place.
Baroness Finlay of Llandaff
What percentage of patients in hospital are currently awaiting discharge because of delays in establishing a suitable care and follow-up package for them at home, thereby preventing the admission of others for investigation and treatment?
Earl Howe
My Lords, in the first quarter of the current financial year, 0.4 per cent of occupied bed days were taken by patients who were delayed while waiting for a care package. That picture has deteriorated over the past year but that deterioration masks some variations. Some hospitals have improved dramatically and others have started reporting for the first time. It is not possible to compare this year’s figures with the previous year, although these are very important figures which we do monitor.
Lord Naseby
My Lords, is it not strange that the figures show that certain hospitals consistently get nowhere near meeting the 18-week target? What action are the Government going to take to help those hospitals ensure that they perform like the average?
Earl Howe
Yes, my Lords, my noble friend is right. Five hospitals account for a very significant proportion of the number of patients waiting for longer than 18 weeks. We are working with those hospitals to look at ways in which that performance can be improved. We know that it can be because many hospitals are more than achieving the desired standard.
The Chancellor of the Duchy of Lancaster (Lord Strathclyde)
Perhaps we may hear from one noble Lord from the other side at a time, and then from my noble friend.
Lord Warner
I am grateful to the noble Lord. Blessed is the sinner who repents. However, will the Minister tell us whether in the light of this repentance, he will, following my noble friend Lord Beecham’s Question, look sympathetically at amendments to the Health and Social Care Bill which will give patients the kind of safeguards that targets did under the previous Government?
Earl Howe
My Lords, we believe that the safeguards are already in place, but the figure I cited in my original Answer is very similar to the figure we have seen over the past two and a half years. Little progress has been made over that time. We do not think that that is satisfactory, so we are broadening the operational standard to ensure that more patients are treated in a timely way. I am sure all noble Lords would wish to see that.
Baroness Jolly
My Lords, approaching 250,000 patients have been waiting for more than 18 weeks and I expect that they would like to know why, as would the House. Can the Minister give us any indication, apart from the five hospitals mentioned earlier, of whether there is a regional pattern to this—while we still have regions—or of whether it is the result of financial pressures, clinical management issues or maybe a combination of all three?
Earl Howe
It does seem to be a combination of all three, although it is clear that in certain areas there is a shortage of the necessary specialist consultants. Sir Bruce Keogh, the NHS medical director, is addressing this urgently with the British Orthopaedic Association in particular. That is expected to result in a solutions paper being put to the NHS Operations Executive in the new year.
Baroness Thornton
My Lords, this weekend the Royal College of Nursing reported that around 50,000 nursing posts are either in jeopardy or lost completely due to the ill conceived implementation of the economies being driven through the NHS. Does the noble Earl accept this figure and what effect does he think that figure might have on waiting times and waiting lists? Is it not time for the Government to accept that cuts to front-line staff are going to have an effect on patient care?
Earl Howe
My Lords, in that press release, which I think was from the Royal College of Nursing, there was a blurring of the distinction between the number of nursing posts which have been lost and the number which might, if certain things happen in the future, be lost. We recognise that in some cases local organisations will have to make difficult choices about staffing changes in the coming years. In making any changes, we have been clear that we expect them to ensure that the quality and safety of care is maintained or improved. That may involve changing the skill mix of the workforce in a particular hospital but, if that happens, it has to be safety and quality assured so that there is no adverse effect on patients.