NHS: Hospital Waiting Times

Lord Evans of Rainow Excerpts

Tuesday 23rd January 2024 Lords Chamber

[Lord Sikka]

To ask His Majesty’s Government what assessment they have made of the number of people who have died while waiting for NHS hospital appointments in England in the past five years.

[Lord Evans of Rainow (Con)]

My Lords, cutting waiting lists is one of the Prime Minister’s top priorities. We are committed to ensuring that patients get the care they need when they need it. The department cannot provide an estimate of deaths on the waiting list as the data required is not held centrally. However, the ONS estimates that overall excess deaths in 2023 were 5% higher than expected. We plan to transform elective care and tackle waiting lists through initiatives focused on increasing activity, managing demand and increasing productivity.

[Lord Sikka (Lab)]

My Lords, I thank the Minister for that reply. Under this Government, the number of unfulfilled NHS hospital appointments in England has increased from 2.5 million in 2010 to 7.76 million. Everyone knows that the denial of timely healthcare leads to suffering and premature death. A study in the Times, to which I have referred the Minister, reported that around 300,000 people a year in England were dying while waiting for NHS hospital appointments. That is utterly unacceptable. Can the Minister explain why the Government have caused so many premature deaths?

[Lord Evans of Rainow (Con)]

I pay tribute to the noble Lord and the forensic accountancy skills that he brings to this place. He certainly brings excellence to debates in your Lordships’ House. The data on the number of people who have died while on waiting lists is not held centrally. The Office for Natural Statistics reports annually on avoidable mortality using OECD/Eurostat definitions. Our excess mortality model does not enable us to estimate how many excess deaths could be considered avoidable based on that definition. To prevent avoidable deaths and maximise outcomes, the NHS triages patients waiting for elective care by reflecting clinical judgment on need, targeting those waiting the longest, and by increasing the number of cancer referrals.

[Baroness Manzoor (Con)]

My Lords, I am surprised and rather shocked that the department does not hold such important data centrally. Accessibility to good data should be at the heart of evidence-based decision-making, particularly in the NHS, where we know that, for instance, mortality, morbidity and health outcomes are poorer, particularly for black and ethnic minority communities and vulnerable patients. What will my noble friend the Minister do to ensure that that is corrected? As we heard in the previous Question, good governance is based on transparency, accountability, delivery and honesty. If we do not have the data, how is service provision going to be made and improved compared with today?

[Lord Evans of Rainow (Con)]

My Lords, my noble friend makes a good point. Waiting list management and data collection are held locally by individual trusts and integrated care boards. As such, the department does not centrally collect or hold data on deaths or causes of death on the waiting list. Instead, the Department of Health and Social Care and NHS England measure elective performance using a number of existing robust data collections. The DHSC and NHS England both have statutory duties to promote an effective and comprehensive health service. Within that, NHS England is responsible for holding NHS providers and ICBs to account for their performance. However, my noble friend makes a good point and I will take it back to the department and the Secretary of State.

[Lord Allan of Hallam (LD)]

My Lords, long wait times for cancer diagnosis and treatment can be a matter of life and death for some people. However, we are still some way off meeting the Government’s faster diagnosis standard of 75% of people receiving a definitive yes or no to whether they have cancer within 28 days of an urgent referral. How confident is the Minister that the Government will meet this target by March 2024, as they promised they would?

--- Later in debate ---

[Lord Evans of Rainow (Con)]

Our ambition for cancer diagnosis is that by March 2024 75% of patients urgently referred by their GP for suspected cancer will receive a cancer diagnosis or have cancer ruled out within 28 days. In November 2023, 71.9% of patients received a diagnosis or all-clear within 28 days. We are confident that we will meet our March 2024 ambition.

[Lord Stirrup (CB)]

My Lords, the Minister will be aware that doctors who do not go on strike work frantically to cover for those who do. When the strike is over, they have to work frantically to try to eat into the backlogs, which have only grown during the strike. What action is being taken—apart from just wishing the strikes would go away—to manage clinical workloads in order to avoid plunging morale, burnout, premature retirements and all the compound consequences for waiting lists that flow from these?

[Lord Evans of Rainow (Con)]

The noble and gallant Lord makes a very good point. We are treating more patients than ever before due to the highest investment in the NHS, with community diagnostic centres, surgical hubs, more doctors and more nurses. Apart from the junior doctors, all parts of the NHS workforce—nurses, midwives, paramedics, consultant doctors and speciality doctors—have accepted the Government’s pay offers.

We urge the junior doctors to stop going on strike for their unreasonable pay demand. As the noble and gallant Lord rightly pointed out, it puts pressure on the whole workforce. The other parts of the workforce have accepted the pay offer. It is about everybody coming together, particularly junior doctors, at this difficult time. We are treating more people. The waiting lists came down in 2023. But, for as long as they go on unprecedented strikes, we will struggle to get to those targets.

[Lord Woodley (Lab)]

My Lords, a recent study from the Institute of Health Equity at University College London, led by Sir Michael Marmot, reported that between 2011 and 2019—before the pandemic—over 1 million people died earlier than they would have done if they had lived in areas where the richest 10% of the population lived. How is it that the institute can do a study, but the Minister does not know how many people have passed away, unfortunately, under these circumstances? When will the Government realise that their policies are killing the poorest people? When will they start transferring wealth from the richest to the poorest?

[Lord Evans of Rainow (Con)]

It is NHS England’s responsibility to record those figures. The noble Lord is right to highlight that health disparities happen and affect the most deprived sections of our communities in our country. The Government do all they can to make sure that NHS facilities are accessible to the poorest in our community.

[Baroness McIntosh of Pickering (Con)]

My Lords, is my noble friend aware that there is a tendency for hospitals to delay admissions and referrals for spurious reasons, such as an additional blood test—which is much quicker to effect in a hospital? Will my noble friend investigate this? I refer to my entry in the register working with the Dispensing Doctors’ Association.

[Lord Evans of Rainow (Con)]

My noble friend raises a specific issue I am not aware of. If she wants to write to me with the details, we will look into that. As I said in a previous answer, the Government have introduced a significant number of community diagnostic centres, where such blood analysis can be done. The whole point of the centres is that tests can be done very quickly to ascertain whether any further surgery is required. If my noble friend writes to me, I will respond to her directly.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can we get back to the Question? The Minister said that the information asked for is not kept centrally. Will he accept that the latest figures show an average of 750 people each week die prematurely from cardiovascular conditions, including heart attacks, coronary heart disease and stroke? That is 39,000 people per year. Many of those are waiting too long on a hospital waiting list. When can we expect the major conditions strategy to be published and will it deal with this really pressing problem?

[Lord Evans of Rainow (Con)]

The noble Lord makes an important point. Excess deaths from all causes involving cardiovascular disease have reduced year on year since 2020 to December 2023. Relative excess deaths involving cardiovascular diseases were higher in the years prior to that—2021 and 2022. Clearly, we still have a lot more to do on that front.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest. Is the Minister able to confirm whether there is a systematic approach to assessment of risk for poor clinical outcome for those patients on the waiting list? This would help in the earlier identification of those where the poorest outcome might be predicted and therefore drive intervention earlier in those cases.

[Lord Evans of Rainow (Con)]

The noble Lord raises a good point, as always. It is not always the number of people on waiting list, it is the amount of time they spend on it. As I said in a previous answer, the NHS now triages at an earlier stage to try to identify exactly those patients who need earlier intervention.

[Lord Watts (Lab)]

My Lords, is the Minister aware that you can jump the list if you pay to see a consultant first. Is that not breaking the NHS rule to treat people on the basis of need?

[Lord Evans of Rainow (Con)]

The noble Lord raises the point about consultant doctors. They work within the NHS but they also have private practices. That has happened for many years since the NHS was originally formed. He raises a good point but there is nothing new about that.