Elective Surgical Operations: Waiting Lists

(Limited Text - Ministerial Extracts only)

Tuesday 20th April 2021 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure, as always, to serve under your chairmanship, Ms McVey.

May I start, as other hon. Members have done, by congratulating the hon. Member for Bootle (Peter Dowd) on securing the debate on this hugely important subject? As colleagues have said, this subject is so important not just to hon. Members, but to all our constituents. Given its importance, I suspect that it will not be in 12 months’ time that we next debate it. I would hope that, in the coming weeks and months, we will continue to debate the progress on reducing waiting lists and getting waiting times down, because that is important. I pay tribute to the hon. Gentleman’s typically reasonable and measured tone. I know that he takes a close interest in these matters, working with the all-party parliamentary heath group. If it is helpful to him, I am happy to meet him outside the Chamber to have further discussions about exactly what he said.

I of course join hon. Members in paying tribute to the amazing work of all those who work in our NHS. Once again, I thank them for their tireless efforts throughout the pandemic. Like other hon. Members, I make no apology for reiterating those thanks every time I have the opportunity to do so.

As the hon. Gentleman set out, and as the House will know, our goal throughout the pandemic has been to protect the NHS and save lives. At the peak of the pandemic, we focused on caring for covid-19 patients, while seeking to continue to prioritise urgent treatments such as surgery for cancer and other life-saving operations. The temporary pauses in other elective activity, and the reduction in the volume of such activity, were put in place to limit the number of patients and to help prevent the NHS from being overwhelmed, as well as for infection control. We have to be very clear, however, as hon. Members have been, about the impact that that necessary action has had on many tens of thousands of our constituents. All hon. Members have alluded to the fact that their constituents have suffered not just pain, but anxiety, nervousness and the impact that such delays can have on mental health.

By the summer of 2020, the NHS had started to recover elective activity after the first wave. Having learned from the first wave, it was able to keep elective activity going at a higher level, albeit not as high as some might have wished, through the second and subsequent waves. The situation is looking better for our NHS: there has been a huge fall in hospitalisations and deaths from covid-19, as the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), alluded to in his remarks, and the success of our vaccination programme means that more people now have longer-term protection from the virus.

Once again, the NHS has done incredible work in keeping as many services as possible going at a time of unprecedented strain. Despite the pressure of the pandemic, by December 2020, the NHS has recovered to carrying out nearly 80% of elective treatments compared with the previous year’s figures. As we continue on our journey to recovery, we must focus on addressing the pressures beyond covid that have been caused by the pandemic. To do that, we are providing the funding, the support for staff and the legal foundations to help our NHS build back better.

We as a Government, in partnership with the NHS, have turned our focus to recovering the activity that was lost following those necessary reductions in activity and, in some cases, the halting of elective treatments. As part of that, we encourage the public to please come forward, through campaigns such as “Help Us, Help You”, and to contact their GP if they are worried about symptoms, especially if they are potential cancer symptoms. The hon. Member for Bootle was absolutely right to highlight that this is not just about surgical procedures in an acute setting, but about the entire patient journey: getting people through the front door of their GP’s surgery; giving them a diagnosis or a provisional diagnosis on the phone, with diagnostic tests; and then the treatment that follows.

We know that waiting lists continue to grow for elective services, as all hon. Members have set out, with 4.7 million people currently waiting for treatment. Of course, we and the NHS are working incredibly hard to reduce that backlog. We will rightly continue to prioritise patients according to their medical needs as well as how long they have been waiting.

We have already seen promising recovery in services—the hon. Member for Ellesmere Port and Neston alluded to that—but it is also important that we recognise at this point, as hon. Members have done, the huge strain that staff and the NHS workforce have been under throughout this pandemic. As such, it is very important that in seeking to recover levels of activity, we do so in a way that enables those staff to have the time and space they need to recover physically and mentally from what they have been through.

I want to reassure hon. Members about the funding and the fact that there is a plan. That plan is being developed on the basis of evidence and pilots that we saw undertaken in London, for example, which I will turn to a moment. On 18 March, as part of the spending review, we announced a further £7 billion of funding for healthcare services. Over the next six months, the NHS will receive £6.6 billion to support that recovery. That comes on top of the funding increases that are already hard-baked into the NHS Funding Act 2020. At the last spending review, we announced an additional £1 billion investment to further kick-start recovery and begin addressing backlogs and tackling long waits. Looking at the shadow Minister, I reiterate from this Dispatch Box the words of the Prime Minister making it clear—very clear—that the NHS will have the resources and funding it needs to do the job.

As well as funding, we have been supporting the NHS to innovate because, as has been alluded to, funding alone is not the answer. We need to look at how we tackle the backlog, the care pathways and the approaches we adopt. That planning is already happening, working with the frontline. In elective surgery, the NHS is basing its approach on lessons learned from the London pilot programme that ran in October 2020 to redesign treatment pathways. Of course in that context I pay tribute to Professor Tim Briggs for his work on the Getting it Right First Time programme, which offers a huge opportunity to reform and improve the way we deliver care and those care pathways.

We have seen some great examples of innovation. I spoke to Tim Briggs this morning and he highlighted some of them, such as joint replacements and the impact that treatment can have on people. The Queen’s Hospital in Romford, the Nuffield Orthopaedic Centre in Oxford, the United Lincolnshire hospitals and the Royal Cornwall Hospital are all using innovative approaches to try to tackle that backlog. Croydon Elective Centre physically separated emergency and elective theatre units in what was the hospital’s blue zone, enabling it to run at 120% of pre-lockdown activity levels for routine procedures, including cancer, cardiac and hip operations. It is only one example, but it is an example of what the system is doing to innovate and try to get activity levels back to where we would like to see them.

During the pandemic last year, the out-patients programme avoided 18 million face-to-face appointments through the use of virtual appointments and reduced the number of unnecessary appointments, but I take the point made by the hon. Member for Bristol South (Karin Smyth) that there will always be some people or some people’s medical condition that will result in their wanting or needing to see a GP or a practitioner face to face.

On diagnosis, we are rolling out 44 community diagnostic hubs with the plan to deliver over 1 million additional scans and tests across CT, MRI, X-ray, ultrasound and ECGs. These are just examples, but these numbers are already helping the NHS to recover, and they have the potential to play a key part in the long-term approach to tackling waiting lists.

In the few minutes I have before the hon. Member for Bootle winds up, I will deal with some of the specific points he raised on behalf of the Royal College of Surgeons. On the first issue—urgently increasing bed capacity and critical care bed capacity—we continue to work with the NHS very closely to ensure we have sufficient beds to meet future demand, with hospitals flexing their bed capacity as required. It is important to note that one of the points Professor Briggs made to me is that the ability, with modern medicine and approaches, to tackle more elective procedures in day case surgery maximises the use of theatres and eases the pressure on beds. Where previously somebody might have been kept in overnight, the beds can be used for patients having procedures that require overnight stays.

The hon. Gentleman mentioned the consolidation of covid-light sites in every ICS region and talked about widening the adoption of the surgical hub model across all English regions. NHS England continues to design and refine the future operating models in the light of ongoing levels of community infection. The London region pilot has been looking at exactly that model and testing it. We have to make sure it does the job and delivers the results, as we want this to be an evidence-based recovery plan, but the early indications are promising. Using surgical hubs and separating out elective services through hot and cold sites are key components of the London region pilot.

A number of Members rightly said that we must not lose sight of health inequalities in our plan and our approach to tackling the waiting list backlog. We believe that the accelerated restoration of elective services and innovations in primary care will play a key part in improving local health outcomes and tackling health inequalities. That is an explicit part of what I am looking at as I draw up the plan with colleagues.

Finally, the hon. Gentleman talked about ensuring that all ICSs urgently consider what measures can be put in place to support patients facing long waits for surgery. We continue to work very closely on this. The hon. Member for Bristol South is right that many people who are communicating with patients are doing an extremely challenging and sensitive job, so it is absolutely right that we give them the support they need to know how to do it to the best of their ability, so that they, just as much as the patients, do not find it any more difficult than it inherently is. Local systems have been asked to plan their recovery as quickly as possible and in a way that supports those patients through their waits.

On statistics, the shadow Minister was kind to me. He raised a point of order a couple of weeks ago about statistics and over 52-week waits, but he did so very gently. When answering written questions, we are required to use published data, and at the moment it is not cut in the way that he wanted, which is fortnightly or weekly— 52 to 53, 53 to 54 and so on. He raises an important point, and I will write to him shortly to set out what we can do to increase the transparency with that level of granular data in the coming months. Again on a point made by the hon. Member for Bristol South, it is absolutely right that everyone can see what the challenge is at a local level, what approach is being taken to address it working in partnership with those local systems, and what progress is being made against the targets and the backlog.

In the 10 seconds or so that I have before I hand over to the hon. Member for Bootle, let me say that recovery of NHS elective services is one of the greatest challenges, but also one of the greatest opportunities that we have to transform patient care. We are completely committed to building the NHS back better, learning the lessons from the pandemic and doing all we can to ensure that patients—our constituents—receive the best possible treatment as quickly as possible, and that we reduce the waiting lists and waiting times.