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Heart Surgery (Merseyside)

Volume 957: debated on Thursday 9 November 1978

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Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Snape.]

10.20 p.m.

I wish to draw attention tonight to the deplorable, indeed scandalous, state of affairs which now exists on Merseyside for patients waiting for heart surgery.

The region of Merseyside has the longest waiting list of any region for investigatory operations and has the fourth longest waiting list of any region in the country for open heart surgery. There are at the moment 581 patients waiting for investigatory operations, compared with only 24 in the South-East region. There are a further 173 patients awaiting open heart surgery on Merseyside, compared again with only 43 in the South-West region.

But worse—and in many ways much worse—is the length of time that people on Merseyside have to wait for both investigatory and open heart surgery. There are 210 patients on Merseyside who have been waiting for over two years for investigatory operations. A further 125 patients have been waiting for between one and two years. A further 91 patients have waited for between six and 12 months, and 125 have waited for up to six months. For open heart surgery 14 patients have been waiting for over two years for an operation, 23 patients have been waiting for between one and two years, and 38 patients have been waiting for up to 12 months.

These by any standards are extremely long waits. Such a time is an inordinate wait. It imposes considerable strains upon the individual and upon his family, particularly with a complaint such as a heart complaint. No one can adequately describe the psychological and emotional stress imposed upon the spouse, the children and the relatives of an individual who is known to be suffering from a heart complaint and when it is known that he will have an extremely long and excessive wait before he receives either the investigatory or the open heart surgery operation.

But what is totally indefensible is that it is known and accepted by the Minister that patients on Merseyside die while on the waiting list. Indeed, he confirmed to me in this Chamber before the Summer Recess that 20 patients on the waiting list on Merseyside had died simply and solely because they were not able to get the operation in time. It says very little for the apparently compassionate, caring and civilised society in which we allegedly live that it will allow people on the waiting list to die, not because we lack the knowledge, not because we lack the technology, not because we lack the personnel or the expertise, but simply and solely because we are not prepared to put sufficient funds into this essential service.

Indeed, it is ironic that there are no Opposition Members—except the leader of the Ulster Unionist Party—who could hear today that this in in fact the reality behind their demands for cuts in public expenditure. This is the harsh, sharp reality that lies behind the vociferous and ever-growing demands for cuts in personal taxation, and no one seems to make the connection between cuts in public expenditure, cuts in taxation and people on Merseyside on the waiting list dying for the want of adequate financial resources.

But this is not the case in other regions. It is specific to and peculiar to Merseyside. It is a fact, for instance, that patients in South Hammersmith and in Staffordshire will get investigatory and open heart surgery immediately and that in many other areas of the country the wait will be extremely small—in terms of months. In the Minister's own words in a letter to me earlier this year, they will get the operation "at their convenience". In South Hammersmith even non-urgent operations will be dealt with within six weeks.

There are, therefore, certain questions which need asking. First, why are there more of my patients waiting for open heart and investigatory operations than anywhere else in the country? Why is the wait longest on Merseyside? Why do my constituents have to face a long wait, in agony, under considerable stress and strain? Why are they discriminated against and provided with an inadequate and inferior service as compared with that provided in other parts of the country? The answer is that the region does not have sufficient resources provided nationally to enable it to provide adequate facilities. Most important, this situation arises because we do not have a truly national Health Service. What we have instead is a series of regional health services in which there are huge discrepancies and enormous anomalies as between areas in the type and quality of service.

Whatever the Minister may say later tonight, he is responsible for this service. I know that the regional health authorities have a managerial responsibility, but it is the Minister who has to come here to answer the debate. It is the Minister who has to answer in this House at Question Time. He has to take the criticism, the rap, for whatever goes wrong in the Health Service, whether in his Department or down at the regions. Given that, why has he not taken the step of applying the normal management function of monitoring the Service and finding out what is happening in the regions?

How can the Minister know that there is a bottleneck on Merseyside and yet, as it happens, spare capacity in Wessex or London, unless and until he collects national statistics on waiting lists and waiting times? I understand why the Minister has always been reluctant to provide this kind of information. Yet, unless the Department and the Minister take the initiative in finding out what is happening in the regions, how the money that is apportioned nationally is allocated and spent, they cannot know whether an effective local service is being provided, whether there is a surplus of resources in one area and a bottleneck in another. They cannot know whether they should be diverting resources from one area to another.

The answer to this is simple. All we need is a simple computer system. A policeman in the street can press a button on his personal radio, have someone punch in the number of a car licence, and obtain within minutes, sometimes seconds, the name, age, occupation, background and any previous criminal convictions of the driver. If that is so, why cannot my constituents, through their doctors and the regional health authority, punch a button on a computer and discover whether there is spare capacity in other parts of the country which should be made available to them? We should have a National Health Service, not a regional health service or a National Health Service lottery, which is what we have now.

There are many who will say that patients will not want to transfer and to travel. A Dr. Stuart Rubin, a cardiologist at Birmingham—where patients are said to have died while on the waiting list—is quoted as saying that it would be inhuman to send patients on long journeys for surgery. If the patients were given the information, they would make the decision, not the doctors. When they are given the opportunity to travel to London or elsewhere and have an operation at once, rather than spend months on the waiting list they invariably choose to travel. This happened recently with the two ladies from Liverpool who were rescued—it was disgraceful that it had to be the case—by private medical practice from the medical waiting list. It has happened frequently in the past when Merseyside children with congenital heart diseases have travelled the world to get an operation rather than wait on the Merseyside waiting lists and have their condition deteriorate.

The patients should come first. They should be given the information exactly as it applies to their condition and then, in the light of all the facts known to them, they should be the ones to make the decision. What we want to know tonight is what precisely is being done by the Minister to alleviate the terrible situation on Merseyside. When will the waiting list and the waiting time come down to a reasonable level, such as applies in the best region in the country?

We on Merseyside will not be satisfied with a simple answer saying "We shall do our best and try to bring about some amelioration of the present position by diverting more resources." We want no less than the best that is available in any other region. As that happens to be immediate operations, whether open heart or investigatory surgery, we want the same consideration to apply to Merseyside and to my constituents as applies elsewhere.

We also want to know what extra resources are being allocated. What plans has the Minister for transferring patients who wish voluntarily to make the transfer from Merseyside to London? My right hon. Friend knows that consultants in London hospitals have written to me saying that they have the places and that they are willing and able to take patients from Liverpool. He also knows that people from Liverpool want to travel. What is he doing to facilitate that transfer? How many people have already been transferred, are planned to be transferred and to where?

What provision is being made—this is an important question—for visits by relatives of patients who transfer to London or elsewhere? Will the Department meet the cost of travel of relatives who visit patients? It should. It is its responsibility because of the failure of the NHS to provide proper facilities on Merseyside. If patients have to travel elsewhere to get what is their right, the Department should pick up the Bill for the expenses involved.

I make no criticism of the National Health Service. Those who, like me, believe in the principle of a free medical service at the point of need should be even more vigorous and outspoken in their criticisms of the failings and shortcomings of the Service now. Labour Members expect higher standards from the National Health Service than do Opposition Members. Therefore, we should be far more vigorous and militant in exposing the failings that exist.

The guilding principle is simple. It is that patients—not doctors, nurses, bureaucrats, administrators or ancillary workers—should come first. The Minister must demonstrate tonight by both words and actions that we care about patients and that patients come first.

I shall not stand idly by whilst people in Ormskirk, in Kirkby and on Merseyside die waiting for heart operations. Nor do I expect the Minister to stand by complacently. I expect him now to tell us precisely what steps he is taking to provide a proper, effective and civilised service on Merseyside.

10.33 p.m.

The subject about which we are talking tonight has aroused much concern over the past few months. I have great sympathy with what was said by my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk). Indeed, he has demonstrated great zeal on behalf of his constituents and others on Merseyside and has been supported by a number of his hon. Friends.

I think that the opportunity should be taken to discuss the problems of cardiac services on Merseyside and to mention what is being done to develop and improve them. In passing, I am pleased that my hon. Friend has discovered that there are discrepancies in the level of health provision in different parts of the country. I think that he first gave vent to this discovery in an article in The Daily Telegraph a week or two ago. He asked why this should he so. It is because of 30 years of allocation of resources to the National Health Service on an irrational basis. That is what we have to try to counteract.

The discovery is not entirely new. The phenomenon was noticed in 1968 by Dick Crossman, who devised the unsuccessful Crossman formula as a means of equalisation. It was observed again by my right hon. Friend the Member for Blackburn (Mrs. Castle), who set up the resource allocation working party, which reported about two years ago. Since then my right hon. Friend the Secretary of State and I have been labouring hard to use the formula to counteract the discrepancies to which my hon. Friend has drawn attention. Therefore, I welcome him to the club of those of us who have been attempting to redirect resources.

I would counsel my hon. Friend, though, that waiting lists are no yardstick for measuring health discrepancy. Without going into too much precise detail, I put it to him that there are connections between waiting lists and the argument which goes on about the removal of pay beds from NHS, and also between those two about the introduction of common waiting lists. If my hon. Friend turns his mind to those matters, I am sure that in time he will come to the conclusion, as we have done, that the only proper basis on which to redirect resources is to use the RAWP formula, which, translated into English, means using death rates as an indication of illness and working out targets to meet the needs so revealed.

Let me first deal with some of the general matters raised by my hon. Friend. He suggested the national distribution of facilities and instituting a national waiting list for cardiac surgery. It is a regional specialty. Admittedly, postgraduate hospitals and other centres in London have traditionally attracted patients, especially those with rare or complex conditions, from all parts of the country. It is no wish of mine to restrict that freedom. But, on the whole, having considered the idea, I do not propose to institute a central clearing scheme, because I think that it would create a lot of major problems.

In general, it is not in the interests of patients to travel long distances for major operations. Obviously, we are in a slightly critical situation in Merseyside and, for that reason, we are tending to infringe that principle. But I do not think that it is a good idea to make it a major and continuing national policy.

That is not my right hon. Friend's decision. That is the patient's decision. If the patient decides in the light of all the evidence available to him that he will make that distressing journey, that is his right—not the Minister's or anyone else's.

Indeed, and there is nothing that I can do to stop patients travelling not only to London but to New York or California to get their treatment. But I am saying that I have decided not to assist them by setting up a national clearing house, for reasons which I am about to give.

There is considerable inconvenience to the patient and his family involved in travelling. My hon. Friend more or less admitted that. But, more important, it is very difficult to provide continuity of care when the cardiac condition occurs on Merseyside, the operative treatment is in London, and the post-operative treatment is back on Merseyside. That is a substantial obstacle, and I am advised—and I have no difficulty in accepting the advice—that the best interests of patients are served when they are treated throughout by a medical and surgical team who are working in close co-operation with each other for pre-operational, operational and post-operational care.

There is also the morale of hospital staff to be considered. Many medical and nursing teams in this specialty get great satisfaction from providing an efficient service to the populations which their units are intended to serve, and the health authorities should aim to provide the facilities to enable them to give such a service. Similarly, we need to consider the effect on the morale of such a team which builds up an excellent service and then is faced with a seemingly endless stream of urgent cases from other regions. That again might be an effect of a national clearing house.

Then, of course, our resource allocation policies, to which I have alluded already, are directed to achieving an equal distribution of health services among regions, and we want in the longer term to work the other way and, rather than lean on patients to bring them to hospital and specialised services, bring the hospitals and specialised services to the places where the patients live, even though, for historical reasons, that is not the siutation which prevails at the moment.

The introduction of a national waiting list could lead to a state of affairs in which there was little or no incentive to health authorities to fill the existing gaps in the provision of health services within their areas. This would perpetuate the situation which we inherited.

My hon. Friend will know what I mean when I cite the example of the Brook hospital in South-East London, which offered to take heart patients from Merseyside if that hospital were given an extra consultant. Appointing an extra consultant in South-East London is not the way to solve the problem of cardiac waiting lists in Liverpool.

The present arrangements in the Mersey region are that adult cardiac investigatory work involving catheterisation is carried out at Sefton general hospital. Cardiac surgery for adults is performed at Broadgreen hospital. This includes bypass surgery, to replace sections of the coronary arteries and valve replacement surgery. For childen, both cardiothoracic surgery and catheterisations are carried out at the Royal Liverpool children's hospital.

These three units are administered by the area health authority and draw patients from the whole of the Mersey health region. The facilities of these units are also available under an agency arrangement to patients from North Wales.

My hon. Friend has made clear his concern about the current cardiac waiting lists in Mersey. I share his concern. I do not question his figures. Mersey has the longest waiting list for investigations of any region.

I must repeat the warning that I gave earlier. Comparative figures such as these have to be interpreted with care. They give no indication of the urgency of individual patients' needs for treatment. Nor do they give any clue to why a particular patient has had to wait for a certain length of time. For example, a patient who, in his consultant's opinion, does not require surgery now but may do so in two or three years' time will not necessarily have to wait if the treatment is needed sooner.

Some patients condition might improve during the time that they are on the waiting list. Social factors and family circumstances may also affect the length of time an individual has to wait.

Despite these reservations, I accept that my hon. Friend's figures are so unsatisfactory that action is especially required for the Mersey region. The allocation of resources among individual specialties is essentially something for health authorities to decide. They must, for example, decide between cardiology and neurosurgery and the other specialties. Cardiology is a regional specialty.

One of our main jobs as Ministers is to ensure a fair share-out of NHS resources among the regions. We have given the Merseyside region a growth rate of 2 per cent. in its allocation for 1978–79 because it is a little below its target.

What are the plans and problems of the regional health authority? First, a steady throughput of investigations at Sefton general hospital could not be achieved because of the need for frequent maintenance of the catheterisation equipment. On some occasions equipment failed while investigations were under way, which meant that the work had to be abandoned and repeated at a later date. In order to remedy this situation the regional health authority has authorised expenditure of about £25,000 for the years 1977–78 and 1978–79 to buy new equipment for the cardiology unit at Sefton general hospital. With the exception of one item, the equipment has been delivered and is now in use.

The second main pressure is the increase in demand for cardiac bypass surgery, which is a difficult and time-consuming procedure. Demand for this operation is still increasing and it is not clear at this stage what level of resources would be needed to cope with this demand.

There are, of course, many competing demands on the resources of the Health Service and the development of specialties such as cardiology is something which has to be settled in consultation with the individual areas in the region. Developments in regional specialties are a call on the region's growth money. More money for them means less money for the areas to finance their own local services. Nevertheless, following a review of specialties completed in June this year, the Merseyside authority has now agreed with the areas on a broad level of development over the next three years.

There have been a number of staffing improvements in cardiac surgery. The region has already begun appointing extra nurses to both Broadgreen hospital and the Royal Liverpool children's hospital and financial provision has been made for a further consultant in cardiothoracic surgery to be appointed from February 1979. The regional health authority is continuing its efforts to fill an existing consultant vacancy and will be readvertising the post later this month. This may entail consultations with the Health Service in Wales.

A small scheme was completed in April this year at Broadgreen hospital to convert existing premises into an emergency operating theatre. There are already two theatres at Broadgreen, but the emergency theatre, which is now in use, allows emergencies to be handled without interruption to the throughput of the other two theatres. It is available for use in the event of one of the other theatres being shut down for any reason.

Looking further ahead, the regional health authority is carrying out feasibility studies into the possibility of transferring medical cardiology from Sefton general and providing both the medical and surgical services at Broadgreen. The authority's view is that this would lead to more efficient working and it is giving priority to this development.

These measures will improve the region's capacity to meet demands for cardiac surgery, but it will be appreciated that their effect on reducing the current backlog of cases will necessarily be gradual. There is an immediate need to be met. As I mentioned in answer to my hon. Friend's Question on 12th July, I have made arrangements for a number of patients to be referred from Liverpool to cardiac centres in London. As I indicated, I do not regard that as an ideal solution to the problem at all, but it is something that we have had to accept in the circumstances on Merseyside. Thirteen patients have so far been referred to the London National Health Service, and 12 have so far been treated at four National Health Service hospitals in London—eight at the Brompton, two at St. George's and, one each at Guy's and the National heart hospital.

We have looked at whether these arrangements might be extended, but the difficulty is that many hospitals in London also have quite long waiting lists of their own. However, a number have said that they will accept patients from Liverpool in an emergency. My hon. Friend has taken a particular interest in the Brook general hospital, and I mentioned that earlier in my speech.

Another event that attracted a lot of attention and that was quite controversial at the time was the acceptance by the Liverpool area health authority, which I endorsed, of an offer by American Medical (Europe) Ltd. to make two private beds available free of charge for cardiac surgery for patients from Liverpool. I stress "free of charge". Ten patients have had operations under this agreement so far. It has been the subject of some criticism and all I should like to say is that I am not concerned with the motive of the private sector. At the time, my view about the proposal was that the only consideration which really mattered was the welfare of the patients concerned and that I should not stand in the way of anything that offered help with the immediate problem. But, as the problem is only a temporary one, the facility has been sought for only a 12-month period and is subject to review after that.

That is a list of the action being taken and to be taken. It also sets out some of the emergency measures. The service about which we are talking is very much at the frontier of modern medicine. It is very difficult to keep the balance right between our investment in this service and what we do for others, but I hope that my hon. Friend will accept that the problems are well recognised and that the health authorities are reacting as quickly as they can to bring about improvements in Liverpool and to bridge the gaps in the short term.

I shall continue to keep closely in touch with the regional health authority and I give my hon. Friend the assurance that I am ready to consider giving any help I can in order to relieve the problems further. I am open to suggestions at any time.

My right hon. Friend did not touch upon the other matter about which I asked. Is he able to pay any contribution at all to the relatives of those patients who have been transferred to London, whether to NHS hospitals or private hospitals, because they are involved in considerable expense in coming down to London?

There are the provisions of the supplementary benefits scheme for assisting people who can travel, but people outside that must make their own arrangements. That will obviously affect their decision on whether to go to London or be treated elsewhere.

Why cannot the consultant who is taking up an appointment in February take up the appointment right away?

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at ten minutes to Eleven o'clock.