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Orthopaedic Surgery

Most debates in this Chamber take the form of an hon. Member identifying a problem and asking a Minister to tackle it. Unusually, that is not what I want to do today. I want to tell, and share with my hon. Friend the Minister, a remarkable success story at my local hospital and to show how the whole National Health Service can benefit. Our NHS has two distinctive features. First, it is free at the point of delivery, regardless of ability to pay, which is why it commands overwhelming public support. That is a principle that must never be abandoned. The second feature is not good: the wait for treatment. That is the worst feature of the NHS and is what most people want changed. The Government undertook a massive public consultation on the NHS in 2000 and waiting was by far the main concern of the millions of people who responded; that is the same today. One of the largest contributors to overall waiting lists is orthopaedic surgery, such as elective work on hips and knees, which also has some of the longest waits. As people live longer and medical health improves, the demand for replacement of worn-out joints continues and will continue to increase. National figures and those that I have seen for my local hospital show that, over the years, those on orthopaedic waiting lists comprise at least one quarter of the total of all those waiting up to six months for treatment. On average, they have comprised those waiting six to nine months and form the vast bulk of those who have had to wait more than nine months. The Government's record on reducing waiting lists by around 300,000 and getting waiting times down from 18 months or more under the previous Government to a maximum of nine months last year and a maximum of six months by the end of this year is one of their best achievements. They have increased resources and set targets. However, The Department of Health has said:"““Orthopaedics is considered the biggest challenge to delivering the December 2005 target.””" In January 2004, the national orthopaedic project had to be set up, in the words of the then Health Minister, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton),"““to reduce long waits in a challenging area.””" With effort and drive, our aim is that by the end of December this year, no one will wait more than six months. Any objective observer would conclude that that represents huge progress since 1997. However, the wait is still six months and to an individual patient, that seems a long time, especially if he is in pain. As people forget the old 18-month waits, they will feel that the NHS is not what it should be if they have to wait for six months or even 18 weeks. As things stand, waiting is still set to be part of the NHS. I can tell the Chamber, however, that at my local hospital, the James Paget healthcare trust, patients of orthopaedic surgeon Mr. John Petri do not wait for six months or 18 weeks. Mr. Petri, as I told the Prime Minister this afternoon, has no waiting list at all. Let me explain how that remarkable achievement came about. John Petri used to work in France. When he arrived at the James Paget, he could not understand why we had long waiting lists. The hospital at which he had worked in France was of a similar size, serving a similar size of population with fewer resources—but with no waiting lists; they were unheard of. At James Paget, there were twice as many orthopaedic surgeons and twice as many anaesthetists as in his hospital in France, but they worked in a different way, in different hours, and performed fewer operations. In France, it was normal for a surgeon to work with two teams in two theatres, moving, after scrubbing up, straight from an operation in one theatre to another in a second. Here, he found that after an operation it was normal for a surgeon to sit around drinking tea and waiting for his one team to prepare the next patient for the same theatre. That is what is wrong with the surgery system in our hospitals. In a typical three-and-a-half-hour operating session, only two hours of a surgeon's time may actually be spent operating. As Mr. Petri put it, if we were running a factory, we would not allow our most important and expensive machine to stand idle for that length of time. I would suggest that the same is true of a surgeon in a hospital. There was another key difference. The French hospital had three theatres, compared with two at James Paget. We have the wrong balance of resources between surgeons and theatres. In about 2000, when Mr. Petri saw more resources coming in to the NHS, he put a proposal to the management of the hospital to introduce the dual operating system there. That was when I first met him. He felt that orthopaedic patients were being let down by the NHS; there was something seriously wrong and they deserved better. Sadly, the other surgeons at that hospital did not wish to change. They said that dual operating would not work and so, at that time, did the Royal College of Surgeons. However, the chief executive of the hospital, David Hill, and his managers backed John Petri. In 2001, Mr. Petri began a pilot scheme of one dual operating session a week, and his team visited France to see the system in operation. Quickly, his waiting list for hip operations reduced from one year to three weeks. The system worked, but more theatre space was needed for it to continue. A business case was put to the strategic health authority, and it supported it with £2 million for a new theatre, which was opened in 2003. Dual operating was phased in as additional theatre and ward staff were recruited, additional beds opened and the process was refined. Dual operating has been running fully in 2005. Mr. Petri performs two such sessions a week in addition to one conventional session. It involves his being allocated two theatres for five hours instead of the conventional three and a half hours. Both theatres are fully staffed, and he operates on one patient while the next is prepared in a second theatre. He then moves on to the second patient, leaving a support doctor to complete the first operation by stitching up and such like. By the time he has finished in the second theatre, a third patient is waiting for him in the original theatre, and so on. He can perform two or three major operations and four or five minor ones in a five-hour session, compared with one major and a couple of minors in the conventional way. There is more flexibility and there are fewer cancellations. Trial figures show that in 50 operating sessions, John Petri performed 270 operations. Two colleagues, in 50 sessions each using single theatres, totalled 225 operations. That is why John Petri now has no waiting list. Not only is he maintaining that position, he is now taking patients off his colleagues' lists, reducing waiting times across the hospital.