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Thursday, November 27, 2003

Alternative Universe

I have been holding back posting this until the record of proceedings for yesterday's Plenary in the National Assembly was published. This is because I did not want to get it wrong and because to capture the atmosphere of unreality that pervaded questions to the Health Minister I needed to quote extensively and I cannot write that fast.

Listening to Jane Hutt yesterday was a surreal experience. It was as if we had all slipped into an alternative universe where the growing waiting times for operations in the Welsh Health service do not exist, people do not get ill and all the problems of financial deficits, staff shortages, over-loaded casualty departments, closing maternity units, the shortage of beds and bed-blocking are a figment of our imagination. Here is an example:

Nick Bourne: You will be aware that we have had more disastrous
news on hospital waiting lists today-they went up again. I gather that, at today's meeting of the Health and Social Services Committee, you made an undertaking that no patient, from April 2004, will wait over 18 months for treatment. I hope that that promise will be worth more than the similar promise made in Labour's 1999 manifesto. Given that 14,000 people are currently waiting 18 months and more for in-patient and out-patient care, will you make greater use of the independent sector, with public money, to ensure that we can get waiting lists down? Otherwise, you will not, will you, Minister?

Jane Hutt: We certainly have not had disastrous news today, Nick, in relation to waiting times. To the end of October, waiting times figures show that there has been steady progress across all areas. I know that you do not like to recognise progress, but the number waiting 6 months for a first out-patient appointment is down over the month, and there were 10,000 fewer people waiting at the end of October this year than at the same time last year. The figures also show that our drive to carry out tonsillectomy operations as quickly as possible is having real effect-I put £3 million into that. Significant progress has also been made in reducing cardiac waiting times, with no-one waiting over 12 months; the figure will be reducing to 10 and 9 months. Therefore, we have made progress.

And it went on:

Rhodri Glyn Thomas: The Minister's ability to turn bad news into good is amazing. She believes that she can persuade us all that this is good news if she speaks at sufficient length. The truth is that waiting lists have doubled during her time as Minister with responsibility for those lists. Will she accept that the Wanless report states that one step that must be taken to deal with the problem of waiting lists is to ensure that we consider those hospital patients who do not need to be in hospital? We must consider the need for care sector beds, and transfer patients from hospital to the care of social services. That is the Minister's responsibility in dealing with waiting lists.

Jane Hutt: That is why I took action in July, in announcing £4 million to tackle delayed transfers of care, and giving the responsibility to local health boards. On the basis of plans that the local health boards would present to me, an allocation was made as to the targets by which they could reduce delayed transfers of care. Over the past two years, we have provided £17 million to local authorities to discharge their responsibility in this regard, and we are monitoring that carefully. Already, over 100 beds have been released as a result of the first tranche, which is an additional £4 million in funding.

And then it got really surreal.

Ieuan Wyn Jones: One way to measure success in the future is to look at past performance. The Minister has suggested-and the figures show this-that there has been a very small drop in the number of people who are waiting for hospital treatment and for out-patient treatment. During the first four years of the Assembly, the waiting list for hospital treatment rose by 204 per cent, and the waiting list for out-patient treatment rose by over 1,000 per cent. Who was responsible for that?

Jane Hutt: You always insist on referring back to issues around treatment and waiting times. They are vital, and I have already addressed them in answer to questions today, but are we going to measure the success of Government on the basis of improved health? If cancer survival rates are improving, which they are, and heart disease rates are falling, which they are, and our mental health services are improving, then we know that we are making progress. If you want to judge us on delivery, we have increased the numbers of staff by 12,800, increased medical education places by 89 per cent, and doubled the numbers of nurse training places. The people of Wales will judge us on that basis. I hope that you will take note of the targets and indicators for older people, which include targets to reduce hip fractures and stroke mortality, and that you will judge us on that basis also.

Ieuan Wyn Jones: It is interesting that you should accuse opposition Members of using waiting lists to measure your success, when your colleague, Gareth Thomas, a Welsh Labour Member of Parliament-[Interruption.] Directly elected, of course.

Nick Bourne: At the moment.

Ieuan Wyn Jones: For the moment, yes. He used a House of Commons debate to attack you for failing to reduce waiting lists. This matter is not just being raised by opposition parties, but by your party in Westminster. In addition, those Labour MPs went to see the First Minister, because they were not confident that you could tackle the issue. Against that background, how can we be confident that the situation will improve over the next four years?

Jane Hutt: It is a question of striking a balance between short-term measures and the long-term measures that we are taking to improve health. That is the strong message from Derek Wanless's review of health and social care. We need to be monitored, measured and scrutinised against our target waiting times. We have made progress. In July 2001 over 100 people were waiting more than a year for heart surgery. That wait has reduced to less than a year, at 10 or nine months. In July 2001, over 2,000 people were waiting for orthopaedic treatment; that is now down to 34 people. The Assembly is aware of the targets and we are making progress. There are 10,000 fewer people waiting over six months for an out-patient appointment now, compared with the number waiting this time last year. I recognise the short-term priorities. That is why I announced a new initiative, which was widely welcomed here, to ensure that patients had a second offer guarantee. I know that you will test me on the delivery of that guarantee, but let us also look to the long-term agenda of health gain.

By the time the Tory health spokesperson stood up we were all looking around for to check that we were indeed in the correct time space continuum.

Jonathan Morgan: According to today's figures, over 5,000 people are waiting over 18 months for in-patient treatment and over 9,000 people are waiting over 18 months for out-patient treatment. That is 14,000 people in total. Are you telling the Assembly, further to your comments in the Health and Social Services Committee this morning, that all those people will be treated by April 2004? If that is the case, how much will it cost and when will you start to consider the time that it takes to see the consultant?

Jane Hutt: You know from the statement that I made last week that the new initiative, on the second offer guarantee, relates to people who have been waiting over 18 months for in-patient and daycase treatment. We are looking to extend the responsibilities of local health boards to reduce the wait for out-patient appointments. I have already given the figures on the drop of 10,000 in the number of people waiting since this time last year.

No wonder people don't believe politicians anymore.

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