NHS Waiting Times

Lord Markham Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Baroness Merron (Lab)]

With the permission of my noble friend Lord Hunt of Kings Heath, and on his behalf, I beg leave to ask the Question standing in his name on the Order Paper.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

In February 2022, we published the elective recovery plan, setting ambitious targets to recover services, backed by more than £8 billion in funding from 2022-23 to 2024-25 and supported by a £5.9 billion investment in new beds, equipment and technology. We are providing an additional £3.3 billion in 2023-24 and 2024-25 to ensure that the NHS can take rapid action to improve performance, including urgent and emergency care and getting elective performance back towards pre-pandemic levels.

[Baroness Merron (Lab)]

My Lords, last week’s report from the National Audit Office laid waste to the idea that all of the NHS’s current woes are down to the pandemic. By 2019, NHS England had not met the elective waiting time performance standard for four years, nor its full set of eight operational standards for cancer services for six years. Following the Government’s announcement last week of a review into NHS efficiency, can the Minister confirm whether the Government are still committed to their 18-week target between GP referral and consultant-led treatment, as well as their other targets around A&E waiting times, ambulance responses and cancer treatment?

[Lord Markham (Con)]

I thank the noble Baroness. With reference to past performance, that is what the spending increases were all about. They were an acceptance that we need to do more in this space, and we are doing more. The pandemic clearly brought unprecedented circumstances and that is why we have announced more funding to get on top of that in the next few years, tackling all the areas that the noble Baroness mentioned in terms of A&E wait times, GPs and all the rest.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we know that part of the problem is that ambulances are going to A&E departments but are not able to deposit their patients in A&E. We know that there is a blockage at the other end in social care, with people not being able to be discharged fast enough back into the community or into care homes. Until that is sorted out, I cannot see how we are ever going to sort out the waiting lists. Can my noble friend the Minister tell me what might happen that will perhaps make those problems better?

[Lord Markham (Con)]

I thank my noble friend. Adult social care, as many have heard me say before in this House, is a crucial part of this, because it is all about the flow. That is why I was delighted that, in addition to the £500 million discharge fund for this year, we have secured up to £2.8 billion of funding for next year. That is in addition to the 7,000 extra beds and the tailored help for the 15 worst-performing hospitals with the ambulances, so we have a complete answer to all these areas.

[Lord Patel (CB)]

My Lords, patients with complex and long-term conditions are finding it increasingly difficult to access the care that they need, resulting, as the British Heart Foundation report indicated, in 10,000 excess deaths in people suffering from chronic cardiac conditions. The Minister referred recently to the system being a failure. Does he agree that we need a system that develops care for these patients, one that is accessible and timely, in community and primary care settings?

[Lord Markham (Con)]

I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.

[Baroness Brinton (LD)]

The Minister referred to the worst-performing hospitals and ambulance trusts, but news from the Health Service Journal today has shown that the longest waiting times are mainly in rural, deprived areas, with an elderly population that is much higher than in the rest of the country. Can the Minister say what special resources will be provided for those areas—rather than just using words like “worst”, which punish them unnecessarily?

[Lord Markham (Con)]

I thank the noble Baroness. If I have used a poor choice of words, I apologise. What we are looking at is identifying the areas where we most need to focus resources to solve wait times. That might be because it is a rural area or it might be, candidly, because it is not performing so well. The point that I was trying to make is that there is targeted support. We spent £150 million on ambulance performance and new facilities last year, and it is something that we will continue to do if those rural areas and other areas need the spend.

[Lord Watts (Lab)]

My Lords, will the Minister deal with the issue of 18 weeks? Are the Government still committed to that policy? If they are, when does he think it will be achieved?

[Lord Markham (Con)]

We are committed to timely appointments. The whole point about the community diagnostic centres that were set up—and we have set up more than 90—is so that patients can be referred straight to those centres and get their screening and tests straightaway, getting them more quickly and, I hope, getting peace of mind more quickly as well.

[Baroness Meacher (CB)]

My Lords, I very much welcome the recent change, which enabled GPs to refer patients direct for assessments instead of having to refer to a consultant, and for the consultant then to refer, which I think saved about 30 days. What other procedural changes are the Government considering that would further reduce waiting times, without actually costing more money, and save doctors time—for example, patient self-assessments in the home, which we pioneered in east London 30 years ago?

[Lord Markham (Con)]

I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.

[Lord Kamall (Con)]

My Lords, in learning from best practice in other countries, are my noble friend, the department or the NHS aware of the pioneering work of Dr Shetty in Bangalore, who has pioneered production-line surgery for certain procedures? Are the Government considering that at the moment? If not, why not?

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will be aware that innovation, be it therapeutic or in models of care, is essential to improve efficiency and efficacy in the delivery of NHS services. Is he content that there is sufficient protection in the NHS budget to drive that adoption of innovation and ensure that staff are properly trained for its application?

[Lord Markham (Con)]

I thank the noble Lord. As I have said previously, innovation, and being able to back that up with investment, is key. The House will see that we have protected a lot of the research funds so that we can do exactly that. That is the direction of travel. The new hospital programme, which I look after, is very much about looking at best practice and innovation around the world and making sure that we employ the best in our new hospitals and across all our trusts.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister is relatively new to his department, but even in the number of weeks he has been there, he must recognise that, whatever statistics on inputs he announces at the Dispatch Box, it is not working. There was a time, two decades ago, when we managed as a Government to reduce the maximum waiting time from three years to 18 weeks and the numbers on the waiting list from 1 million to 500,000. There are now 7.2 million on the waiting list—incidentally, there were 4.2 million before Covid. Whatever the Government have been doing for 10 years is not working and people are remaining in pain for prolonged periods, quite apart from the effect on the economy. Will the Minister institute an immediate review centred particularly around patient choice, which is the only thing that will drive down waiting times and waiting lists? It should never have been abandoned in the way it has been by the Government.

[Lord Markham (Con)]

I believe that customers—call them patients—should drive performance and improvements. Inputs are important, but I totally agree that in a performance culture outputs are very important. I give credit to the work done in the early 2000s, from which I have tried to learn in the short time I have been here, to really bear down and create a performance culture to get waiting lists down by holding trusts, and now the new ICB CEOs, to account. That is definitely the direction of travel, and I am very happy to learn from things that have worked well in the past.