My Lords, we are well on course to achieve the 100,000 reduction promised by the end of this Parliament. The latest data (for end November 1999) show that the number of patients on the National Health Service waiting lists is now 87,000 below the March 1997 level.
My Lords, is the Minister aware that the Government's obsession with reducing waiting list numbers obliges doctors to treat simpler and less urgent cases merely because that will bring down the numbers more quickly? Is the noble Lord further aware that since May 1997 the number of people waiting to see a consultant for more than 13 weeks has increased by more than a quarter of a million? Does that not indicate that, far from boasting about the waiting list initiative, the Government should abandon it forthwith?
My Lords, no. As one of the contributory factors in modernising the NHS, it is important that we attack waiting lists, as we are doing. Clinical priorities are a matter of clinical judgment. Emergencies will always be treated at once and urgent treatments will always be given priority.
My Lords, does the Minister agree that reducing waiting lists in the NHS often depends on the availability of adequate social care services? The commitment to increase the finance for the NHS is welcome. However, does the noble Lord agree that there needs also to be a guaranteed increase in the availability of social care?
My Lords, of course a number of factors are involved in developing a proper and appropriate response to the need to reduce waiting lists. One of them, as the noble Lord has just mentioned, is the facilities and support available in the community for people who may then be discharged from hospital. Resources for local government and social services are an important part of our general improvement of public services.
My Lords, does not the Question go to the heart of the management of the health service? The noble Lord, Lord Winston, is well-regarded in all parts of the House, as the Minister is aware. Would it not have been much better if the Prime Minister and his spokesman had responded to the criticisms of the noble Lord, Lord Winston, rather than trying to bully him into retracting them?
My Lords, my noble friend Lord Winston put his finger on the matter when he spoke of the horrendous legacy left by the previous government. That legacy was a divisive internal market: hospitals, doctors and nurses forced to compete with each other; chronic under-investment; and a reduction in nurse training places. That is why we have a 10-year programme of modernisation to put that situation behind us and to improve services to patients.
My Lords, while I do not wish to follow the Minister down the path that he has just set, will he recognise that there are waiting lists and waiting lists? It is rather confusing for the public, because there are waiting lists for appointments in hospitals, waiting lists to see a consultant and waiting lists to have an operation. When the Minister talks about waiting lists, will he please avoid the trap of lumping them all together? They really are quite different.
My Lords, the noble Baroness is right to point out the multi-faceted nature of the issues that we are determined to tackle. With regard to outpatient waiting times, the noble Baroness will probably know that we expect one third of a million more people to be treated as outpatients this year. We shall show the same determination that we have shown in relation to inpatients to tackle waiting lists for outpatients. Overall, it is right that we should focus on waiting lists as an important factor in modernising the service.
My Lords, does my noble friend recall that the alleged obsession with waiting lists was not invented by the present Government, but by our predecessors? They were constantly discussing waiting lists when we were in opposition. Am I right in understanding my noble friend when he refers to waiting lists as only one of the things at which the Government are aiming? If I recall correctly--perhaps my noble friend will assure your Lordships on the point--the Government, in their White Paper, referred much more significantly to reducing death rates from coronary heart disease, strokes, cancer and other such illnesses. Surely that is the sort of topic on which we should be concentrating and the sort of topic also on which one would rather like the Opposition to offer some support.
My Lords, my noble friend is quite right to point to the priorities we have set in relation to cancer, coronary heart disease and, indeed, mental health. As for the previous government's record on waiting lists, we should recall that they set a target specifying that no one should have to wait more than 18 months. They did not deliver. We, however, have done so.
My Lords, I always speak well of the Treasury. It is absolutely right that the future funding of the National Health Service is crucial to our modernisation programme. We have already signalled our determination to provide the required investment. That is why we were able to commission 37 new hospitals, which are currently on track; why we have been able to increase the number of nurses coming back into the health service; and why we have been able to increase the number of training places for doctors.
My Lords, will the Minister tell us on whom the Treasury is dependent, as he said that funding depends on the Treasury? Furthermore, is it not inevitable that there should have been a crisis in the National Health Service once the Government had accepted the spending limits of the previous government?
My Lords, it was quite right for the Government to focus during their first two years on getting the economy and public finances right and on a stable footing. Having done that, the Government are committed to real, sustained, long-term growth in the National Health Service, in great contrast to the gross under-investment of the party opposite over 18 years.
My Lords, is the Minister aware that the Government have cheated by removing from the waiting lists tens of thousands of patients with varicose veins, sebaceous cysts and lipomas who have been denied surgery altogether? Those are often poor people who have to go into the private sector. That is an example of the Government grinding their heels into the faces of the poor and the disabled.
No, my Lords, the basis of the statistics in relation to waiting lists has not changed since the Government came into power. With regard to varicose veins, I remind the noble Lord that he should go back to the introduction of the internal market. It was at that stage that operations such as those for varicose veins were listed by health authorities as excluded treatments.
My Lords, does my noble friend agree that in terms of modernisation of the health service, the provision of advice and information to patients and their families as and when they want it is of the utmost importance and that, in that regard, the provision of NHS Direct and the plans for walk-in centres have been of extreme importance to patients and their families?
My Lords, I could not agree more with my noble friend. I believe that NHS Direct has proved to be an enormous boon in the giving of sensible advice by experienced nurses. By the end of this year, the whole of the country will be covered by NHS Direct. It is but one feature of our general modernisation programme.
My Lords, the other day the noble Lord rightly reminded the House that we cannot obtain more medical treatment for cancer operations until the oncologists are in place. We must expect an increase in the number of oncologists in particular, and in various other specialisms. They are to come from the medical schools. Will the Minister now tell us what he is doing to increase the output from the medical schools and perhaps which medical schools he has in mind to be expanded in this particular operation?
My Lords, the noble Lord is quite right to refer to the importance of the increased number of doctors coming through for medical training. We expect to expand the number of those places by about 1,000 over the next few years. Of course, that very much underpins the more general point about the programme and process of modernisation. Given that it takes seven years or so to train a doctor, the pace of change in many services can operate only according to the number of doctors that can be brought into the system. The same applies to nurses. In relation to cancer services, in addition to looking at workforce issues, I believe that the biggest improvement that we can expect to see will also come about by the better organisation of services. The implementation of the Calman/Hine recommendations and the development of networks of care for cancer will enable us to improve the service at a quick pace.
My Lords, because my noble friend was wrong. We have replaced the internal market. We have a system which is based on partnership, co-operation and working together, rather than the crude internal market which forces hospitals to compete with hospitals, nurses to fight with nurses, and doctors to compete with doctors.