Elective Surgical Operations: Waiting Lists

Munira Wilson Excerpts

Tuesday 20th April 2021 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

It is a pleasure to serve under your chairmanship, Ms McVey, and I congratulate the hon. Member for Bootle (Peter Dowd) on securing this very important debate. I fear many of us will end up repeating some of his points, but hopefully I shall be digging into one or two of those points in a bit more depth.

I start by paying tribute to and thanking our incredible NHS staff up and down the country—not least in my constituency—for their incredible commitment, resilience and hard work. Frankly, they have all gone well above and beyond what they are paid to do and what they signed up for throughout this pandemic, both in treating those with coronavirus and in rolling out the phenomenal vaccination programme. Also, despite what we are discussing today, we must not forget that urgent treatment, urgent surgery and A&E visits were still taking place throughout the pandemic. We must not forget that, so a heartfelt thanks to them.

We often hear that the NHS has coped throughout the pandemic. Indeed, we did not see those awful scenes that we saw in Italy of people being treated in corridors and makeshift tents. I would say, though, that the NHS has coped, but at what cost? We have heard the startling figures of 4.7 million people waiting for treatment. We know that about 2.3 million of those are for elective surgery, and there are all sorts of estimates, of anywhere between 4 million and 6 million or 7 million hidden patients, or those who have not yet necessarily presented. There is that pent-up demand for treatment. We know that two thirds of those waiting for treatment have been waiting for more than 18 weeks, and just shy of 400,000 have now been waiting for over a year. As has already been outlined, the impact on patients’ quality of life, in terms of mental health and excess deaths, cannot be overstated, but I would also like to touch on the workforce impact, before moving to solutions and finance.

As the hon. Member for Bootle has stated, it is estimated that approximately half of those with cancer did not contact their GP in the first wave. In fact, I heard a story the other day, via a friend of a friend, about somebody whose cervical smear test was cancelled last year. She was trying to contact her GP with symptoms earlier this year, and was fobbed off. She has now been discovered with stage 4 cervical cancer. I suspect that those stories will be replicated up and down the country. Macmillan Cancer Support has estimated that there are 15,000 missing diagnoses. We all know the importance of early diagnosis. I used to work for a cancer charity and in a pharmaceutical sector that had a big interest in oncology. We all know that surgery, often combined with early chemotherapy and radiotherapy, is absolutely critical in improving life chances and sometimes in being curative.

On the subject of hip and knee replacements, we know that the second and third most common operations are hip and knee replacements. The vast majority of patients needing that kind of surgery have osteoarthritis. Again, waiting lists in those areas have gone up exponentially. It is clear from talking to health service leaders on the ground that these cases are not necessarily in the priority category, which is understandably where cancer resides. As we have heard, though, there is an impact on quality of life, in terms of pain and reduced mobility. A survey by Versus Arthritis found that over 50% of those waiting had increased pain and reduced mobility, and more than three quarters experienced a deterioration in mental health and wellbeing. The longer-term impacts on the NHS and, critically, the social care sector, which was already struggling and on its knees, will be huge. The direct and indirect cost implications, therefore, will be huge, not to mention further complexity from late surgery.

Although this debate is about surgery, it would be remiss of me not to mention mental health. The Minister knows that I have a personal interest in and passion for mental health. We all know that mental health waiting times were pretty dire before the pandemic, particularly for children and young people. Now they are worse still. I am hearing from parents week in week out about not just children, but young people—often those who have crossed from the CAMHS age to being young adults—who cannot access services and are waiting a year or more for treatment. Again, without early intervention and action on these problems now, we are storing up problems further down the line. We know from the Royal College of Psychiatrists survey that two fifths of those waiting for treatment have ended up contacting crisis services. That is not the best way to treat people with mental health conditions. The hon. Member for Bootle mentioned excess deaths, and modelling from the Scientific Advisory Group for Emergencies suggests that we could have 18,200 or so excess deaths that are not covid-related. I implore the Minister to make sure that we start to count excess deaths that are not covid-related. At the moment they are hidden by the covid figures, but I suspect that these delays to treatment are causing a huge number of excess deaths.

The other big issue that I want to talk about is the workplace impact. We know that staff morale is through the floor at the moment. I recently had a meeting in south-west London with other south-west London MPs, organised by the local Royal College of Nursing branch, at which we talked to nurses. I heard from one after the other about how they are struggling in terms of their mental wellbeing and morale. We know from an RCN survey that a third of its members are considering leaving. We already had huge numbers of vacancies in nursing and other parts of the NHS before this pandemic, and the turnover will increase. I have made the case, as have many Opposition Members, for a better pay settlement for our NHS workers—1% is frankly an insult and a pay cut, as we keep hearing again and again. I implore the Minister once again: pay is important, but so is greater support for NHS workers’ mental health and wellbeing. I know that local NHS leaders are trying to do what they can, but further support and a commitment from the Minister would be welcome.

Finally on the impacts, I want to touch on health inequalities. Covid has massively exposed the health inequalities in our country. The thing that I fear most is that those who know how to shout the loudest and navigate the system, and have access to the sort of remote technology that is being increasingly used, will be able to access the treatment they need. I say that as the MP for a relatively affluent part of London, where I suspect a higher than average number of people have access to private healthcare and health insurance, and will be able to get treated through that route. Those who have been worst hit by covid will be worst hit by these waiting lists.

On solutions, I have touched on the need to treat our staff better in terms of pay and mental health support, and reduce the turnover. Importantly, we need to give staff time to recover. That is what I keep hearing from the chief executives of hospital trusts and community trusts on the ground: they need time to recover.

That leads me to my second point on the solutions. I would love to hear the Minister explain why the block contracts with the independent sector ended at the end of March. I would have thought that continuing to use independent sector capacity in the short term would help. A number of the stakeholders who briefed us for today’s debate have raised concerns about the fact that independent sector provision is largely concentrated in the south-east, London, the south-west and the east of England. That is not ideal and could exacerbate the inequalities that I have talked about, but something is better than nothing. If it helps to reduce the pressure on the NHS, it is important that it is looked at as a solution.

Thirdly, I would like to talk about transparency. We need an honest discussion with the public about these waiting lists, and clear reporting about the waiting times for the different waiting lists. We have talked about support for patients who are waiting for treatment, and good, clear, regular communication is an important part of that. I mentioned the need for transparency about excess deaths as a result of people waiting for treatment. The Government need to level with the public if there are tough choices to be made around the prioritisation of what treatment people will get within a certain period of time, or if they will have to travel for treatment. They need to be up front and honest with the public, because that is the only way we will maintain public trust.

That relates to a point that I want to make about communication. We must continue to communicate with the public about whether it is safe to go to hospital for treatment, and we must look at how we engage hard-to-reach groups that might not be embracing some of the digital technology that is increasingly being used to improve efficiency, not just because of infection control measures.

There must be better local collaboration. I want to thank the two acute hospitals that serve my constituency: Kingston Hospital and West Middlesex University Hospital, which are part of South West London and St George’s Mental Health NHS Trust, and London North West University Healthcare NHS Trust respectively. I know they are working incredibly hard on community diagnostic hubs and the surgical hubs that we have talked about, and they are ensuring we have covid-light sites, and so on, in line with the NHS operational guidance. That is to be welcomed, championed and supported. We have touched on having greater support for patients waiting for treatment.

NHS providers have said that we need a bold, transformative approach to tackle these waiting lists, and ultimately that will need to be supported by cash. I will pre-empt the Minister, who will stand up and say, “We have committed £4 billion”—I am sorry to steal his lines. Yes, that is fantastic and to be welcomed, but last autumn the Health Foundation estimated that we will need about £10 billion to deal with the backlog.

We saw in the late 1990s and the early 2000s that the way to bring down waiting lists is huge injections of cash. The Chancellor said he would give the NHS whatever is needed. We know that a lot of these problems come from an underlying lack of funding in the NHS over the long term and that, for four years, the NHS has not met the target in the NHS constitution that 92% of patients should wait no longer than 18 weeks to start elective treatment. That was an underlying problem pre-pandemic, but it has been exacerbated. That is why at the last general election the Liberal Democrats suggested that we should raise income tax by a penny in the pound specifically for the NHS and social care.

I am sure that the Minister has the Chancellor on speed dial, just like the former Prime Minister does, and I know that the Secretary of State has the Chancellor on speed dial. I implore him to make the case for the cash injection needed to tackle waiting times and improve the health of the nation. I am sure he does not need my help, but I and the Liberal Democrats stand ready to help him to make the case, just as the hon. Member for Bootle has already offered.