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Orthopaedic Surgery

: May I say to both my hon. Friends the Members for Waveney (Mr. Blizzard) and for Great Yarmouth (Mr. Wright) how grateful I am that they have had the opportunity of this Adjournment debate to discuss this issue? Undoubtedly, there are issues about resources in the NHS and I will explore them in more detail. Resources are needed, but this is not just about them; it is about thinking outside the normal framework and the traditional way in which things have always been done. One pleasing aspect of this Adjournment debate, secured by my hon. Friend the Member for Waveney, is that it seems that in his hospital, in which my hon. Friend the Member for Great Yarmouth also shares an interest, there is a culture of opportunities for staff to raise issues and ideas. Management will then try to pay heed to those and consider where they can be introduced and supported to make a difference to the patients in Waveney and Great Yarmouth. There has been a view, which I am glad to say is changing, that the NHS is characterised by long waits in accident and emergency, long waits to see a GP and very long waits to see a hospital consultant. Many patients were waiting more than 18 months for an operation. To be honest, when we came to power in 1997 the situation was out of control. It was particularly bad for patients waiting for orthopaedic operations, who would often be in pain and have restricted mobility that could affect their work and other aspects of their lives, thereby having a knock-on effect on their families. Against that background, the changes that we have brought in, with the help of dedicated staff, have been astonishing. Gone are the days of 18-month-plus waiting times. Now nobody should wait more than nine months, and that will be down to six months by the end of the year. In 1998, the average waiting time for an orthopaedic operation was more than 19 weeks; it is now down to just 12 weeks, and it is still falling.It is our ambition that by 2008 we will have brought down the entire time from GP referral to the start of treatment to a maximum of 18 weeks. What is heartening about today's debate is that it highlights that as well as what we are doing, we can explore problems and achieve innovation in the way that Mr. Petri has shown. It is important to examine the practices that exist and how they can work better. As my hon. Friend the Member for Waveney pointed out, not only has Mr. Petri led in this area, based on his experience of working in France, but he has convinced the team that he works with that what he has pioneered can make a difference to the patients. I am sure that that must lead to more job satisfaction—for example, from the look on the faces of patients who are told, ““There are no waiting lists, so we can see you as soon as possible.”” That makes a welcome change from the long waits that people are often used to. I am glad to see that that, and what people expect from the NHS, is changing. We have made a huge investment in the NHS. We have increased the budget from £34 billion in 1997–98 to £70 billion this year, and that figure will top £90 billion in 2007–08. In orthopaedics, we have increased the number of consultant doctors by more than 40 per cent., and I understand that there have been similar increases in the numbers of physiotherapists, occupational therapists, specialist nurses and theatre staff. I read in a newspaper a call from the Royal College of Surgeons for more theatres and more staff. Clearly, in Mr. Petri's hospital there was an understanding that in order to initiate reform and shorten the waiting lists there had to be investment, and it is my understanding that that was attended to in respect of both theatre facilities and staff. We have to challenge those who say, ““It's just a question of more money,”” by asking them, ““How are you using the facilities and the staff that you already have in your hospitals?”” It is always possible to come up with a thousand reasons why systems of working cannot change, but it would be nice if people occasionally looked at the example of what is happening in Great Yarmouth under the leadership of John Petri—and with the support of other hospital staff—and if they said, ““If they can do it there, why can't we do it here?”” That is an issue for a patient-led NHS. Patients often accept that what they are being told is what they can expect; it is what they are used to. I hope that the recent publicity might make more trusts question how they operate. I hope, too, that patients will have read the story and will ask questions of their GPs and others. I would also like the patient representatives who are involved in our local patient forums, and those who are on the boards of PCTs and trusts, to say, ““Well, hang on; it might not be simple to do the same thing in our community, but can we at least explore why it can't happen here as well as in Great Yarmouth?”” Orthopaedics presents particular challenges in respect of getting waiting times down. That is why we set up the national orthopaedics project. The project team built support among clinicians, and provided management support where it was most needed, and the results so far have been impressive. The number of patients waiting longer than six months has fallen from 57,000 to just over 15,000. Moreover, as I said, we are also on track to achieve our target that by the end of the year no one will wait longer than six months for an operation. In seeking to sustain these gains and to tackle waiting times by treating people within 18 weeks of their GP referral, it is clear that resources alone will not work. Resources and reform have to go hand in hand. We need to search for innovative new ways to drive up standards. That is why we have talked about selective use of the independent sector, and that is why we are introducing greater patient choice, extending the number of foundation trusts and setting a national tariff for NHS services. These fundamental changes are part of a coherent package to revolutionise patient care, abolish the second best and reward good and popular services. However, we need to build on that by considering what is being done in the NHS. Today we have heard about a good example of what an NHS hospital with NHS staff can achieve. I noticed the quotes from Mr. John Petri in the article in The Sunday Times. He said:"““If you were running a factory, you wouldn't allow your most important and most expensive machine to stand idle. The same is true in a hospital.””" I shall take the idea of dual operating back to the Department and we shall consider it further. I know that Mr. Petri is up for an award tomorrow and I wish him all the very best. Whether he gets that award or not, he should be congratulated on not only talking the talk but walking the walk by providing the services that people need. Innovation such as the dual-surgery approach pioneered by Mr. Petri is to be welcomed, and we need to consider further how we can complete a framework for treating people with muscular-skeletal conditions so that they can be given the most appropriate treatment as soon as possible. We have also considered how we can prevent people with such problems having falls, which lead to hospital treatment. Furthermore, we have considered how to make sure that there are packages that prevent people, particularly the elderly, coming back to our hospitals after treatment because of another, preventable, fall. Some excellent work is going on between PCTs and hospitals to put together a care package for that. I was interested by something my hon. Friend said earlier, when we were discussing this issue, about the number of cases referred to orthopaedic surgery that do not necessarily need surgery. That is another area that can be considered; other professionals can work with GPs to ascertain whether time is being wasted on referring people to surgeons when they do not need surgery. We can look at a number of areas to reduce the waiting times for hospital care, particularly orthopaedic care. With unprecedented investment, the NHS has the money and staff to deliver the standard of care that all patients deserve. We have created a strong NHS and tried to reduce the influence from Whitehall. The combination of investment, support and reform can work. Average waiting times have come down by 40 per cent., but we can do more. We need to look to innovation and share best practice in professional exchange, so that the public know what they can expect and should demand from their local services. Only by doing that will we truly have a patient-led NHS that best serves patients' interests and, importantly, maintains its good reputation as an organisation that does not stand still, but can move with the times and be a health service fit for the 21st century.