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Covid-19: Cancelled Medical Operations

Volume 803: debated on Wednesday 10 June 2020


Asked by

To ask Her Majesty’s Government what assessment they have made of the impact of cancelled medical operations due to the COVID-19 pandemic.

My Lords, NHS trusts were rightly asked to postpone elective activity to free up capacity to support the response to Covid-19. The latest data shows that there was a 30% reduction in the number of completed admitted patient pathways in March 2020 compared to the same month last year. Data for April is due to be published by NHS England tomorrow. The NHS is safely restoring urgent non-Covid services, catching up on the backlog, and ensuring that surge capacity can be stood up again should it be needed.

My Lords, thousands of patients with non-Covid conditions are not getting the treatment they need, and thousands more with life-threatening diseases such as cancer are going undiagnosed every day. Yet we see reports that private facilities, which the Government are paying for, are either empty or hosting only a trickle of NHS patients. Can the noble Lord say how many private beds paid for by the Government are being used by the NHS, and what is the Government’s plan to stop waiting lists hitting 10 million by Christmas?

My Lords, I do not have the precise figures which the noble Baroness asked for. However, I reassure the Chamber that the NHS is working hard to ensure that those who need urgent surgery, such as cancer patients, have it, and we have committed a substantial amount to the Help Us, Help You media campaign, which is having an impact in restoring confidence in returning to hospitals.

My Lords, given the disproportionate effect of Covid-19 on those aged over 75 and the likely knock-on effects of cancelled operations, will the Minister take steps to encourage the reintroduction of routine GP health checks among people in this age group which, understandably, have been largely suspended during the pandemic?

My Lords, the impact on the over-75s is, as has been described, profound. We have worked hard to try to protect those who are shielding. The reopening of GPs’ surgeries is a priority but, at the moment, we are not encouraging those who are over 75 to make the journey to surgeries that are a potential source of infection. Therefore, we will not be taking the steps the right reverend Prelate described.

My Lords, as the waiting lists caused by Covid create huge pressures, harder-to-treat patients must not be left behind. Last month, Eurordis released a survey which included UK rare disease patients and found that nine out of 10 had experienced disruptions in care, while more than half who needed surgery had had it cancelled or postponed. Many rare disease patients are in the shielding group and many have degenerative conditions. Can the Minister set out the plans to improve access to care and communications about care for rare disease patients, and can he please undertake to meet with patient groups about this?

The work of my noble friend Lady Blackwood on rare diseases is well known and acknowledged in the House. Those with rare diseases are in exactly in the kind of vulnerable groups that are being hard hit by Covid. They are given particular access to local support systems and they should have access to home testing services if they feel vulnerable to the effects of Covid. Further, I am happy to undertake a commitment to meet with the relevant stakeholder groups to discuss how we could be working harder to support them.

My Lords, I have unmuted my microphone and I hope that my voice is coming through. I am sorry for the delay.

As the Minister will know, several million patients are on waiting lists for surgery. Given the increased levels of hygiene safety that will be required, it is inevitable that productivity will be down. This means that there will be a need for the prioritisation of cases. Does he agree that the professional organisations should draw up advisory guidelines for clinicians, rather than leaving it to the individuals?

The noble Lord may be interested to know that, frustratingly, waiting lists have gone down rather than up, from 4.42 million in February to 4.32 million in March. This is an indication of people not coming forward for operations that they may need, and it is something that we are keen to address. However, we are putting the decision-making on how to handle the lists into the hands of local clinicians, who will use a combination of clinical need and waiting list times to make their decisions.

My Lords, which NHS trusts, following Sir Simon Stevens’ letter to them of 29 April, have made full use of all contracted independent sector hospital capacity, and will the contract between NHS England and the private healthcare sector be renewed at the end of June?

The noble Baroness has asked for a very specific figure, which I am afraid I do not have to hand. However, I can assure her that the private healthcare contract has provided us with incredibly valuable surge capacity and we will be looking at how to use that kind of capacity to protect the NHS from a potential surge in the wintertime.

My Lords, can the Government guarantee that there are safe spaces for all cancer services and ensure that these spaces are Covid-protected? Further, will the Minister update the House on testing numbers and the number and frequency of tests in hospitals and in cancer hubs in England? I understand that he may not have all the figures to hand, but I would be grateful if he could write to me and put a copy of the letter in the Library.

The noble Baroness, Lady Jolly, is right to emphasise the importance of safe spaces. Cancer surgery requires a completely hygienic environment for those who have immune challenges. Safe spaces are found for all those who need to have cancer practices. They may not be in absolutely every hospital, but if one hospital cannot make that kind of offer, an adjacent or nearby hospital will be found to provide the kind of safe spaces that are needed to carry out the procedures she described.

When will treatment begin for post-operative patients who are waiting for chemotherapy, do we have instances where chemotherapies have been halted during their term of treatment, and will these therapies recommence? Do we know whether trusts are beginning to do this?

The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.

My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?

I should first like to pay tribute to all those who have been involved in setting up the Nightingale hospitals. People have worked extremely hard to deliver a valuable service to the country. Bed allocation arrangements are made by local trusts and testing within the NHS is now intense. Decisions on the traffic of staff between safe zones and non-safe zones are taken by the local director of infection control.

My Lords, it is important that the Minister informs the House about how beds there are in the private sector, how many were occupied, at what cost and whether there will be a renewal. Does the noble Lord share my concern that if there is a second spike of Covid-19, it will lead to further delays in life-saving operations? What contingency arrangements do the Government have in place for this?

The noble Baroness is right to raise this concern. The bigger focus is less on the operational restraints, because the NHS has in fact done extremely well to keep the flow of operations going during this period. It is actually on demand. What we are most deeply concerned about is that patients return to hospitals and that their confidence in undertaking procedures is restored. That is why we have put a huge amount of emphasis on the marketing side of things. That is not to understate the importance of the operational side, but it is patient confidence that is our focus at the moment.

My Lords, the time allowed for this Question has elapsed and I apologise to the noble Lord, Lord Dobbs, and the noble Baroness, Lady Barker, that we have not been able to take their questions.