Elective Surgical Operations: Waiting Lists

Esther McVey Excerpts

Tuesday 20th April 2021 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall. Members are expected to remain for the entire debate. I also remind Members participating virtually that they are visible at all times to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and as they leave the room, and take the wipes with them and bin them. I also remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall. Members attending physically who are in the later stages of the call list should also use the seats in the Public Gallery and move to the horseshoe when seats become available.

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[Peter Dowd]

That is a fair point, and I will touch on it later. I know that the Minister is well aware of the situation and has his own challenges in getting the point home to his colleagues in the Treasury, among others. We will give him the support that he needs when he has those conversations.

In terms of support to weather this crisis, the Government cannot put the brakes on this vital area of public expenditure. Given the figures I have outlined, it is better to pre-empt this tsunami, because once it comes, it will be all the more damaging. Putting it right after the fact will be more expensive, more difficult and lives will be in danger, not to mention the ongoing economic impacts for the nation. If we have learnt anything from the covid-19 crisis, it is the point made by my hon. Friend the Member for Bristol South (Karin Smyth) that assessment and planning, followed by focused, comprehensive action, are required.

I have set out the issues as many in the health field have them set out. They are not my figures, they are not made up, they are in the public domain. The Minister knows the organisations concerned, as do hon. Members, so I will not list them.

I have attempted to be as concise and factual as possible and to set the scene, but there is a second element: how the issue can be tackled. The rest of my time will be spent on that. Again, this is not me making this up—is is not the hon. Member for Bootle’s version. It is, in a sense, the health organisations’ view. In this respect, the Royal College of Surgeons has set out a clear way in a comprehensive fashion. Other royal colleges and health organisations have expressed their views too. I have no doubt that the Minister will listen to those voices, which will be helpful and constructive. However, they are also unambiguous in their view of the need for the Government to act now with specific proposals that go beyond a balance-sheet approach. I believe the time for details and proposals is fast approaching.

I want to highlight four recommendations. The first is increasing NHS bed capacity. For many years in the run-up to the pandemic, the NHS was far too close to capacity. It was running hot, to use that phrase. International comparisons, which I acknowledge do not tell the full story, but do give a partial story, show that the UK has 2.5 hospital beds per 1,000 people, which is well below the OECD average of 4.7, and behind countries such as Turkey, Slovenia and Estonia. Remember, beds have been reduced from 108,000 in 2010-11 to 95,000 in 2021.

Secondly, during the pandemic the Royal College of Surgeons of England called for the setting up of green or covid-light sites with a separation of elective surgery from emergency admissions. As the college says, there is, “evidence of the risks to patients if covid-19 is contracted during or after surgery, including a greater risk of mortality and pulmonary complications”. In this regard, covid-light sites are critical to process ongoing planned surgery, given that patients and staff are segregated from situations where those who have the virus are treated. In addition, there is a regime whereby patients self-isolate and test negative before any surgical intervention is in operation. Meanwhile, staff without symptoms are regularly tested.

The third recommendation is for surgical hubs. During the pandemic, professionals have worked in partnership to provide mutual aid during periods of intense pressure, thereby enabling a seamless process of surgical intervention. Because of the multi-agency, multidisciplinary co-operation, trusts have also been able to designate certain hospitals as surgical hubs. As such, a capacity for particular types of elective procedures has been facilitated through skills and resources coming together in one place in covid-secure environments. While this hub model, as it is called, is not a total solution, it is none the less a practical way to enable many geographies and surgical specialities such as orthopaedics and cancer to work together.

The fourth recommendation is support for patients, and I touched on that earlier. Again, the Royal College of Surgeons has welcomed the prioritisation of patients in NHS England’s 2021-22 priorities and operational planning guidance. None the less, I agree that we need to go further and provide more guidance about how to develop and expand the options to address those waiting longest, and to ensure that health inequalities are tackled throughout the plan.

In my view, there should also be cross-departmental work on more comprehensive support for those directly affected by covid isolation requirements and people whose livelihood is threatened by longer waiting lists. Before I go on to summarise the four recommendations I have just put to Members, I emphasise that I am aware, and appreciate, that NHS England and NHS Improvement have been working on an elective recovery frame- work covering workforce logistics, clinical prioritisation, patient focus reviews, waiting list validation and patient communication. I welcome that, as will other hon. Members. I acknowledge that the NHS has completed almost 2 million operations and other elective care in January and February this year, and non-urgent surgery times have begun to recover.

In summary, there are four recommendations arising out of the narrative. Recommendation one: the Government should urgently invest in increasing bed and critical care bed capacity across England. Recommendation two: the Government should consolidate covid-light sites in every integrated care system region, and ensure that at least one NHS hospital acts as a covid-light site in each integrated care system in England. Recommendation three: the Government should widen adoption of the surgical hub model across all English regions for appropriate specialities, such as orthopaedics and cancer. Recommendation four: all integrated care systems should urgently consider what measures can be put in place as soon as it is practical to support patients facing long waits for surgery. I would like to put on record my thanks to the Royal College of Surgeons for its advice, information and support in relation to this matter.

Finally, the whole question of workforce-related issues—numbers, pay, conditions at work—needs a comprehensive, fair, equitable and inclusive review. The Secretary of State can initiate a wholesale review of organisational structures in the NHS in the middle of this crisis, which is causing angst and concern across the NHS—we cannot pretend that is not happening. He can therefore initiate a review of the terms that I have suggested.

Many lessons need to be learned from this crisis. I stress the value, commitment and professionalism of all staff in the NHS. Staff across all professions, disciplines and sectors are feeling drained after a year of hard, unrelenting work and we need to thank them for that. Without them, in particular, this country would be in an even worse social and economic predicament than it already is. We owe it to them to ensure that they get all the support they need to support the rest of us. Who could disagree with that?

[Esther McVey (in the Chair)]

Before I call Back Benchers to speak, I remind Members that in this 90-minute debate we will be calling the Front Benchers no later than 3.40 pm, and obviously Peter Dowd will be winding up again after the Minister.

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[Justin Madders (Ellesmere Port and Neston) (Lab)]

As a fellow Cheshire MP, it is a pleasure to see you in the Chair, Ms McVey.

Every Member who has contributed to the debate has spoken with great knowledge and sincerity about the challenge we face as a society. I pay particular tribute to my hon. Friend the Member for Bootle (Peter Dowd) for securing the debate and for his excellent introduction. As every Member has pointed out, he was right to say that we have record waiting lists. We should never forget that we had already seen a huge rise of over 40% in the decade before the pandemic. As some Members mentioned, it is possible that covid is masking an even worse situation. We know that the number of referrals plummeted around this time last year, as the NHS rightly focused all its intention on the pandemic.

As Members have said, we know that the NHS aims to ensure that no more than 8% of patients wait more than 18 weeks for treatment. That is a target that has not been met for five years, so this situation cannot be laid entirely at covid’s door. Indeed, just over a year ago, in February 2020, 17% of people on waiting lists had been waiting longer than 18 weeks. It is clear that the past year has had an impact, because the figure has now doubled to 35%.

Sadly, it is now the case that over a million people have waited longer than six months for hospital treatment. There are now 388,000 people waiting more than a year. Again, that is the highest number on record. That is nearly 400,000 people waiting for things such as knee and hip replacements. As Versus Arthritis points out, they

“are in extreme distress, with many struggling to cope with pain which is impossible to ignore, worsening mental health and reduced quality of life.”

My hon. Friend the Member for Bootle set out clearly some of the implications not just for physical pain, but for mental health and uncertainty about job prospects. My hon. Friend the Member for York Central (Rachael Maskell) eloquently set out the reduced outcomes and difficulties we will face if the process is not followed as well as we would like and patients enter the system at a later date.

As my hon. Friend the Member for Bootle said, this is an issue that cannot and should not be ignored. He described the challenges as possibly overwhelming—an apposite description, given that the Government’s strategy for the last year has been to avoid the NHS being overwhelmed. As that challenge was met, we hope that this challenge will be met as well. He also made the important point that, if we do not get this right, it will cost us more in the long run and will have economic and as well as physical and social impacts. The lessons learned from the pandemic ring true in that respect as well.

When we look very closely at the figures, we see that around 18,000 people are now waiting longer than 18 months. The figures we have relate to people waiting more than a year. Obviously, I have discussed this with the Minister on previous occasions and we hope that we will get the official figures shortly. We must remember that at the moment, we only have details for people waiting over a year, but the information I have suggests that more than 175 people have been waiting for more than two years. Those figures are slightly out of date, as they are from January, but that is a horrendous situation and I hope it has got better in the last few months. If it has got worse, I hope and expect that the Minister will be on the phone to those trusts inquiring exactly why people are waiting over two years to receive their treatment.

The importance of dealing with the backlog quickly cannot be overstated, because of the likely pressure that will manifest itself over the coming months. As my hon. Friend the Member for Bootle said, the Health Foundation has estimated that there could be as many as 4.7 million missing patients. If only three quarters of those are referred to treatment, that would lead to a waiting list of 9.7 million people by 2023-24. Obviously, that is an estimate, but if the Minister has done his own calculation, can he tell us what it is?

Over the last year, the NHS has adapted fantastically to the challenges of covid in a way that has rightly won the respect of everyone in this place and in the country. That has meant decisions have been taken about how treatments should be prioritised. We have seen appointments cancelled, operations postponed and staff redeployed, but even with those challenges, the NHS managed to carry out 1.9 million operations in January and February this year, which Stephen Powis, NHS England’s medical director, said is

“a testament to the hard work and dedication of staff”.

I join him in paying tribute to those staff for delivering that. However, even with that fantastic effort—to put into context the challenge that we face—the number of routine operations in January was down 54% on last year and in February it was down 47%.

Thankfully, I think we are past the peak of the third wave and there are only just over 2,000 patients with covid in hospital, which is the lowest since last September. However, the NHS is still under enormous pressure, with so many people now waiting for treatment, stricter infection control measures and, as many Members have referred to, an exhausted healthcare workforce. We have to be realistic: this could take years to address unless there is a credible and costed plan in place at the earliest opportunity.

Modelling by the NHS Confederation suggests that the sustained impact of the pandemic will leave a backlog of care in excess of anything seen over the last 12 years and that to maintain any sense of control over its waiting list, the NHS will need to increase capacity considerably above levels that have previously been sustained. My hon. Friend the Member for Bristol South (Karin Smyth) referred to the huge efforts that were made by the previous Labour Government to get waiting lists down. It seems that a strategy at least on a par with that will be needed.

The NHS Confederation has said:

“Without a comprehensive new plan, the government faces the…legacy of hundreds of thousands of patients left with deteriorating conditions”.

It warns that the additional £1 billion agreed in the spending review will not be enough to clear the backlog. The chief executive of the NHS Confederation Danny Mortimer said:

“health leaders are clear that the NHS will be recovering for years to come, and this must be appropriately resourced in the long-term.”

He called for

“investment in growing and maintaining the workforce”.

NHS Providers has said that the situation could take three to five years to resolve. Its chief executive, Chris Hopson, said:

“Trusts believe they can clear the backlog within a reasonable period of time”,

but that treating this like another waiting list initiative, relying on overtime and private sector use, will be insufficient. He said that the NHS will need to transform “how it provides care” and that the Government will need to provide

“the extra funding required to enable that transformation.”

As my hon. Friend the Member for Bootle set out, a number of practical steps can be taken to deliver transformation, but they come with a price tag. The Prime Minister was quick to pledge that the Government will ensure that the NHS has the funds it needs to beat the backlog, but how can we have confidence in him when he has already gone back on a promised pay rise for NHS staff? NHS England said that although the £1 billion fund will help, it will not be enough. Of course it will help and it is welcome, but helping is not the same as solving. Nobody, probably not even the Minister, believes that what is on the table represents a solution.

There is no doubt that the NHS has a monumental task ahead of it to restore services, meet demand and reduce the care backlogs, but it also must support staff and take steps to reduce inequality in access, experience and outcomes. Now is the time for the Government to deliver on their promise to deliver to the NHS whatever it needs. It certainly is not the time for another expensive reorganisation, as my hon. Friend the Member for Bristol South said. If that is the road we go down, it is important that patients’ voices are put front and centre of those new bodies, particularly if they are forced to deal with some of those extremely tricky issues.

As many Members said, 10 years of underfunding have left us in this precarious position. The challenge is there for the Minister. The experts say that we can tackle the backlog, but it will need funding. If the Minister can confirm any specific figures, that would be wonderful. I suspect we will not get that today, but at the very least will he confirm on the record that he agrees that the £1 billion that has been allocated so far is insufficient?

To pick up on what Chris Hopson, chief executive of NHS Providers, said about relying on the private sector, we know that huge sums were provided last year. As my hon. Friend the Member for York Central said, we have never had transparency about what that money was spent on. Can the Minister tell us how many NHS patients were seen in the private sector last year, and how many procedures were carried out using taxpayers’ money? I am sure that he is as keen as all of us to ensure that the best value has been achieved.

Many Members said that none of the backlog will be tackled if we do not have the staff to do it. A recent Institute for Public Policy Research report based on a YouGov poll of 1,000 healthcare professionals said that a third more nurses and midwives are leaving the NHS than a year ago. Those figures are scaled up across the workforce—that means 100,000 nurses and 8,000 midwives leaving. With 40,000-plus vacancies already, we cannot afford to lose one more, never mind 100,000 more.

Dame Donna Kinnair of the Royal College of Nursing said that that is

“The reality of a failure to properly invest in the nursing workforce”

and must be a

“wake-up call to the Government.”

It should indeed, especially when we are still waiting for the publication of the substantive long-term workforce plans to deliver a lasting solution to recruiting and retaining the workforce and ensuring there are enough skilled staff to provide safe and effective care now and in the future. That is why it is vital that Ministers bring forward a fully funded plan to tackle the backlog—we have been calling for that for a long time: an NHS rescue plan that will bring down waiting lists and ensure that patients can receive the quality of care that they deserve. As my hon. Friend the Member for York Central put it, we cannot carry on with business as usual.

Let me end with the important comments from Dr Rob Harwood, the chair of the British Medical Association’s consultants committee:

“Without further financial support and investment in increasing staffing numbers, patients will be waiting even longer for care, and there is a risk that patient care becomes unsafe the more exhausted staff become. The future of our NHS, already walking wounded, must not be put in jeopardy.”

The NHS is the jewel in our crown, but it needs protecting, sometimes as much as the patients it treats. We need financial support, a detailed people policy and a credible plan to deal with the backlog if we are to avoid coming back in 12 months to talk about an even worse situation.

[Esther McVey (in the Chair)]

I call the Minister, mindful that we will have a winding-up speech from Peter Dowd at the end.