:00:45. > :00:48.In the East Midlands: Hospital waiting lists, reform of care for
:00:48. > :00:51.the elderly and the doctors who'll ring you if you want an appointment.
:00:51. > :01:01.Find out more with the chairman of the health select committee,
:01:01. > :01:01.
:01:01. > :40:08.Apology for the loss of subtitles for 2347 seconds
:40:09. > :40:13.Stephen Dorrell, and Shadow Health Hello, I'm Marie Ashby. We are
:40:13. > :40:17.looking at issues vital to the region's help. With me, the
:40:17. > :40:20.chairman of the Health Select Committee, Stephen Dorrell, and
:40:20. > :40:24.Shadow Health Minister Liz Kendall, who represents Leicester West. We
:40:24. > :40:29.will be looking at a radical new scheme that puts doctors and much
:40:29. > :40:33.closer contact with their patients. Should it be the shape of things to
:40:33. > :40:37.come? Patients love it because they can be speaking to a GP within
:40:37. > :40:41.minutes, not days. If they need to see a GP, they will be offered
:40:41. > :40:45.usually the same day. And we will be discussing moves to protect us
:40:45. > :40:49.from dangerous foreign doctors, like this man, after pressure from
:40:49. > :40:53.one of our members of the European Parliament.
:40:53. > :40:56.First, waiting-lists are firmly back on the political agenda.
:40:56. > :40:59.Health secretary Andrew Lansley said as many as a quarter of a
:40:59. > :41:02.million people have been waiting more than 18 months for hospital
:41:02. > :41:07.appointments, and he is imposing a new director of to tackle the
:41:07. > :41:13.problem. Stephen Dorrell, from a coalition that was sceptical about
:41:13. > :41:20.targets, this is a U-turn, isn't it? It is 18 weeks, not 18 months,
:41:20. > :41:22.but the position is the government has always, in truth, made clear to
:41:22. > :41:28.commissioners and the health service and for those providing
:41:28. > :41:32.care, that the objective of delivering - as it was to find
:41:32. > :41:37.under the last government - 90% of patients to be seen within less
:41:37. > :41:43.than 18 weeks, that has continued since the change of government.
:41:43. > :41:48.There has been a change in that objective. Stephen does his best to
:41:48. > :41:54.try and defend the government. The Conservatives or were completely
:41:54. > :41:58.against what they called top down targets. Politically motivated,
:41:58. > :42:03.they called them. In fact, it was about making sure that patients
:42:03. > :42:09.were seen within 18 weeks. Whatever Andrew Lansley says, they have lost
:42:09. > :42:13.a grip of waiting times. We now see 43% more patients waiting more than
:42:13. > :42:19.18 weeks for their treatment since the general election. That is not
:42:19. > :42:26.good for patients. Actually, what we have done this week is to
:42:26. > :42:31.increase the grip, as it happens. We can play party politics here.
:42:31. > :42:35.But let's be clear. There is consistency in the definition of
:42:35. > :42:38.what good looks like not having changed from the last government.
:42:38. > :42:43.One of the improvement that has been made this week is that instead
:42:43. > :42:48.of just defining the 90% target, we have also addressed what happens to
:42:48. > :42:52.those people who wait longer. The Secretary of State has this week
:42:52. > :43:00.address that question to make it clear that those have to be treated
:43:00. > :43:05.with an acceptable time scales. our six primary care trusts, only
:43:05. > :43:10.one - Derbyshire - is meeting the target to treat 90% of patients
:43:10. > :43:15.with an 18 weeks. So something had to be done, didn't it? It is
:43:15. > :43:23.absolutely right. There is a lot of party political ardour and that
:43:23. > :43:28.goes on about these target seats. I stand a little bit away from that.
:43:28. > :43:33.Some of the target date back from that time were low as a junior
:43:33. > :43:36.minister. The introduction and the application of waiting time targets,
:43:36. > :43:42.as a proper measure of what the health service feels like for
:43:42. > :43:46.patients, I think is right. Where waiting times to start to extend,
:43:46. > :43:50.action is necessary to improve the service. One of the problems with
:43:50. > :43:54.Labour's targets is that hospitals will try their best to keep
:43:54. > :43:58.politicians of their backs but you do get cases where patients'
:43:58. > :44:02.appointments are cancelled because of a lack of beds or something.
:44:02. > :44:07.Hospitals effectively restart the clock and it looks like the targets
:44:07. > :44:12.are being met. I think a lot of doctors and nurses galore while
:44:12. > :44:17.they would have struggled with the targets to begin with, now think
:44:17. > :44:20.they have made a real difference in getting patients seen them having
:44:20. > :44:25.their tests done in one day, and getting the care they need when
:44:25. > :44:28.they wanted. Stephen says we should not be party-political about this
:44:28. > :44:34.but unfortunately, it was the Conservatives who said they did not
:44:34. > :44:37.like the targets and were going to scrap them. I pointed out that it
:44:37. > :44:42.was the Conservatives that originally introduced them. You may
:44:42. > :44:46.have done, but Andrew Lansley did not want targets. He has been
:44:46. > :44:49.forced to wait -- make a U-turn because people are waiting too long.
:44:49. > :44:53.We have got double the number of patients waiting more than six
:44:53. > :44:57.weeks for their diagnostic tests. It is really frightening when you
:44:57. > :45:05.are not getting your test result. I want to see those targets in place
:45:05. > :45:12.to make sure patients get the care they need. Good. The be good news
:45:12. > :45:16.is that patients are monitored by the people who provide the care.
:45:16. > :45:22.And except that there has been some difficult rhetoric and unclear
:45:22. > :45:28.rhetoric around this. But the position is that, as so often in
:45:28. > :45:34.this subject, policy has changed very much less than the
:45:34. > :45:38.speechifying would suggest. The definition of what is unacceptably
:45:38. > :45:44.long waiting time has roots before the last Labour government. It was
:45:44. > :45:50.developed by the last Labour government. Let's get away from who
:45:50. > :45:54.started of the targets. I do want to say that it was Labour who said
:45:54. > :46:00.that we wanted a maximum 18 week wait. Be bold did not believe it
:46:00. > :46:05.could be done. We have had but highest patient satisfaction. --
:46:05. > :46:10.people did not believe a. We have been looking at how our biggest
:46:10. > :46:15.hospitals are balancing their books. The Nottingham hospital trust says
:46:16. > :46:21.it has a surplus of �4 million, but Derby is just under �7 million in
:46:21. > :46:26.the red and Leicester has a deficit of �13 million. If Nottingham can
:46:26. > :46:32.stay in the black, so should Leicester, surely? It is time for
:46:32. > :46:37.radical rethinking of the whole NHS. Why do we need is to look at the
:46:37. > :46:46.way different services are run and improve those services. -- what we
:46:46. > :46:50.need. In Leicester, I think the thing we need to do is more to
:46:50. > :46:55.prevent people ending up in A&E when they don't need to and more to
:46:55. > :46:59.get older people, who are stuck in the hospital but could get care in
:46:59. > :47:02.the community or at home, out of the hospital, too. That means
:47:03. > :47:07.different parts of the system working together. We don't need
:47:07. > :47:10.this big, wasteful, risky organisation. In fact, I think it
:47:11. > :47:14.has been a distraction for people when they should be getting round
:47:14. > :47:18.the table. They have spent all their time losing their jobs,
:47:18. > :47:22.reapplying for their jobs. That is why we are calling on the
:47:22. > :47:26.government to drop its bill - so hospitals and doctors can get on
:47:26. > :47:31.with their jobs. Next week, your select committee resumes its
:47:31. > :47:41.inquiry into social care. A commission recommended a radical
:47:41. > :47:43.
:47:43. > :47:47.funding, but the man who headed the commission has made a statement.
:47:47. > :47:51.But government set up there are the to make recommendations about the
:47:51. > :47:55.right way forward for social care reform. The committee is taking
:47:55. > :48:01.that work Fordham the government is committed to a white paper in the
:48:01. > :48:11.early part of next year. I agree absolutely with what you said that
:48:11. > :48:12.
:48:12. > :48:18.the priority is 30% of non- emergency hospital admissions being
:48:18. > :48:23.avoidable, if you take the kind of steps that Liz describes, to make
:48:23. > :48:28.certain you have community-based services. Andrew Dilnot's work is a
:48:28. > :48:34.bigger part of that Jigsaw and it is the most important challenge.
:48:34. > :48:36.And what he suggested was raising the means testing level from
:48:36. > :48:42.�23,000 to �100,000 and capping the amount for which individual would
:48:42. > :48:48.be liable at �35,000. That would cost about 2 billion. Would Labour
:48:48. > :48:53.by that? This is an area where we don't want the usual party politics
:48:54. > :48:59.to be played. We need cross-party agreement. We have offered cross-
:48:59. > :49:02.party talks with the government on this issue. We have written to
:49:02. > :49:06.David Cameron and Andrew Lansley, saying what we think we need to
:49:06. > :49:14.make those cross-party talks happen. With an ageing population, unless
:49:14. > :49:17.you get long-term agreement for how you're going to pay for social care,
:49:18. > :49:21.all parties would have to find a way of making that happen. That is
:49:21. > :49:26.a really tricky in our political environment. We are serious about
:49:26. > :49:31.those talks because we have to find a way of properly funding care for
:49:31. > :49:35.older people. But will politicians have the guts to do this? What Liz
:49:35. > :49:40.said is extremely welcome and it is exactly the right way to approach
:49:40. > :49:42.this issue. The reason for that is that you are right to say that
:49:42. > :49:49.Andrew Dilnot recommended some changes, which will cost public
:49:49. > :49:53.money. What he also said was that if we are going to do that, part of
:49:53. > :49:57.the argument for doing it is that it makes it easier for individuals
:49:57. > :50:01.to plan to make a contribution themselves towards their care. That
:50:01. > :50:07.is the basis on which we have to create long-term arrangements for
:50:07. > :50:11.funding social care. It is what worries the elderly the most, isn't
:50:11. > :50:20.it was that yes, and it is not only important for those older people
:50:20. > :50:24.but it is vital for the feature of the NHS. That is not where the best
:50:25. > :50:29.care and treatment would be provided. If we don't find a
:50:29. > :50:33.solution to social care, we are going to have a real crisis in the
:50:33. > :50:36.NHS. We need to put party politics aside, get round the table and see
:50:36. > :50:41.if we can reach an agreement about how to thunder system that is both
:50:41. > :50:49.fair and sustainable for the long term will stop it is not just the
:50:49. > :50:52.cost of care but the standard of care. The Commission is under
:50:52. > :50:59.increasing pressure. But next spring, it will be regulating
:50:59. > :51:03.doctors, too. We have actually put that off by a year. We did at the
:51:03. > :51:08.Care Quality Commission in the select committee. Can I just pick
:51:08. > :51:11.up the last point that Liz made, in response to last question? I want
:51:11. > :51:15.to stress the importance of a cross-party approach to social care.
:51:15. > :51:21.That is why the select committee, as a cross-party committee, is
:51:21. > :51:25.doing the work that it is Curran redoing a social care. When we did
:51:25. > :51:30.Danby Care Quality Commission as a select committee in the summer, we
:51:30. > :51:34.criticise them are in fairly straightforward terms for
:51:34. > :51:36.registering dentists rather than focusing on the things that are
:51:36. > :51:40.important and that the very heart of what they should be doing, which
:51:40. > :51:44.is looking not so much at individual instances of care -
:51:44. > :51:48.because an inspector will never pick up every failure - but looking
:51:48. > :51:51.at the culture that exists within organisations that provide care, in
:51:51. > :51:54.order to ensure that the professionals working within those
:51:54. > :51:59.organisations have the right culture to provide the high quality
:51:59. > :52:04.of care we all want. Let's move on to an issue which is a constant
:52:04. > :52:08.gripe for many of us. Robert White House has been looking at a radical
:52:08. > :52:12.new scheme in Leicestershire at which has the enthusiastic backing
:52:12. > :52:22.of patients and GPs, when it comes to making an appointment with your
:52:22. > :52:29.
:52:29. > :52:33.The tension and hassle of the GP waiting room is enough to send your
:52:33. > :52:37.blood pressure rocketing. And that is before you've even got to see
:52:37. > :52:42.the doctor! But this medical centre in Thurmaston in Leicestershire
:52:42. > :52:48.think they have come up with a solution. It is called Patient
:52:48. > :52:51.Access. The patient's call is lobbed at reception and the doctor
:52:51. > :52:56.then cause the patient back. They are booked in, diagnosed and
:52:56. > :53:00.advised over the phone, was sent for tests - easy! We realised we
:53:00. > :53:04.were seeing the patience that actually needed to be seen and were
:53:04. > :53:09.able to advise patients with very minor illnesses who did not need to
:53:09. > :53:14.be seen it on the phone. Tell me about will sleep - are you
:53:14. > :53:18.getting to sleep? I am not getting to sleep until about 4am. Wendy
:53:18. > :53:23.suffers with depression and finds the new system really helpful.
:53:23. > :53:28.did have days when I did not want to leave the house, so being able
:53:28. > :53:34.to speak to the doctor in the comfort of my own home is a lot
:53:34. > :53:38.better. What has this new system meant for doctors? It has made it
:53:38. > :53:42.huge difference to our day-to-day work in that it flows much better.
:53:42. > :53:48.We can control our time much better and the consequences of that have
:53:48. > :53:52.been that we have been able to reduce patient waits. So far, 40
:53:52. > :53:57.surgeries around the country have taken up the scheme, run by Harry
:53:57. > :54:06.along them. An engineer by training, he was attracted by the innate
:54:06. > :54:10.simplicity of the system. -- Harry Longman it. If they need to see the
:54:10. > :54:16.GP, they will be offered the same day. The GPs love it because it
:54:16. > :54:19.helps them manage their workload. It is good, because you get your
:54:20. > :54:25.diagnosis fairly quickly. If you have to get a booking, they give
:54:25. > :54:31.you a booking. It helps me a lot because I live a little bit out in
:54:31. > :54:36.the wilds. If they say they want to see you, you are there the same day.
:54:36. > :54:39.The scheme has been running for about eight weeks. About nine miles
:54:39. > :54:45.away in the village of Quorn, a similar patient access programme
:54:45. > :54:47.has been in place much longer. think it is definitely the right
:54:47. > :54:52.thing to do. We would never go back because of the patient feedback
:54:52. > :54:56.that we get and the benefits that we see as doctors. In those areas
:54:56. > :55:03.where they have been operating the telephone system, they have found
:55:03. > :55:06.attendance at A&E has dropped by 80% -- 20%, and the number of
:55:06. > :55:10.patients who could fail to keep their doctors' appointments has
:55:10. > :55:13.dropped dramatically. We cannot see a reason why everybody would not
:55:13. > :55:18.want to do this, which is why we are talking to people all round the
:55:18. > :55:22.country. Under the old system, patients could get angry, get fed
:55:22. > :55:29.up of waiting and miss appointments. Now the days of losing patience -
:55:29. > :55:33.in more ways than one - may be over. So, it seems a good idea and such a
:55:33. > :55:37.simple one, too, and you can see the patients clearly like the idea
:55:37. > :55:42.of it. Do you think we should all get the chance to benefit from a
:55:42. > :55:46.scheme like this? I think it looks like a fantastic scheme, because it
:55:46. > :55:52.is giving patients quicker, easier access to their GP on the phone or
:55:52. > :56:01.in person, but is also reducing the number of patients who turn a bad
:56:01. > :56:08.A&E. I think that we often focus a lot on what happens in hospitals. -
:56:08. > :56:11.- turned up at A&E. It is important that we did lose focus on GPs. They
:56:11. > :56:16.have a massive role to play in making sure people get the right
:56:16. > :56:20.care at the right time. As you say, A&E cases are down and people get
:56:20. > :56:23.to see their doctor on the same day if necessary, and fewer people are
:56:23. > :56:27.failing to turn up for appointments. Surely this should be rolled out
:56:27. > :56:31.across the region collar if not the whole country. I agree. It is
:56:31. > :56:35.clearly a good thing for those patients and not just for the
:56:35. > :56:39.patience that are seen, but all the whole generality of patients
:56:39. > :56:43.because it means that resources are being used more effectively. I
:56:43. > :56:46.think there is one word of caution, which is that the whole history of
:56:47. > :56:51.the health service is peppered with examples of people developing good
:56:51. > :56:54.ideas, demonstrating they are successful and then the health
:56:54. > :56:59.service tries to make it universal in a whole series of
:56:59. > :57:03.circumstances... You want to see how it works a bit more? Not so
:57:03. > :57:07.much that. Though it lesson is that when people have a problem they
:57:07. > :57:11.should be empowered to get on and do it. The solution often looks
:57:11. > :57:15.quite different in different communities. Most of us are happy
:57:15. > :57:18.with our GPs and the worst problem seemed to rise without valid
:57:18. > :57:25.doctor's, and the appalling case of a Cambridge man who died after
:57:25. > :57:32.being injected with a massive overdose of diamorphine by this man,
:57:33. > :57:40.Dr Ubani, caused an outcry. He was already accused of negligence in
:57:40. > :57:43.Germany. Any MP persuaded the European Parliament to alert all
:57:44. > :57:48.countries of the doctor is struck off or suspended. Can you see this
:57:48. > :57:54.working? I think it is essential that there are much more effective
:57:54. > :57:58.safeguards against doctors coming in from overseas. Two risks
:57:58. > :58:02.associated with this - the first is that they can't communicate in
:58:02. > :58:07.English. It is impossible, in my view, to operate proper medicine
:58:07. > :58:11.unless the doctor can communicate flawlessly with the patient. It is
:58:11. > :58:16.one of the things I am glad to say we are at long last taking some
:58:16. > :58:19.steps to try to ensure that it is properly provided for. The second
:58:19. > :58:23.thing is to understand that in other countries in the world,
:58:23. > :58:27.general practice is defined very differently to what it is here. So
:58:27. > :58:30.the fact that you have a general practitioner Certificate in one
:58:30. > :58:37.country does not necessarily mean you have a transferable skill into
:58:37. > :58:41.a different country, where the phrase GP mean something different.
:58:41. > :58:46.That is a step that we have not addressed and we do need to as a
:58:46. > :58:51.matter of urgency. Are we doing enough on this issue to protect us?
:58:51. > :58:54.I think there is absolutely more that we should be doing. Some of
:58:54. > :58:58.the examples Stephen talked about, about we have heard about
:58:58. > :59:02.throughout the programme, what I would say is that none of the
:59:02. > :59:07.improvements we have seen or heard about today require a big change in
:59:07. > :59:11.the legislation or a big change in the NHS's structures. Stephen would
:59:11. > :59:15.probably admit that this big bill of reorganisation is not what we
:59:15. > :59:20.need to get on with the very real improvements that we need in the
:59:20. > :59:24.NHS, whether that is making sure we have got us up to standard, better
:59:24. > :59:29.access to GPs or making possible to balance their books. We want the
:59:29. > :59:39.government to drop its whisky bill and focus on precisely these issues,
:59:39. > :59:39.
:59:39. > :59:42.so that they improve patient care. -- risky bill. All of the issues we
:59:42. > :59:47.have talked about today are immeasurably more important than
:59:47. > :59:50.the provisions of another Bill changing of the organisation of the
:59:51. > :59:56.health service. I don't agree with the conclusion list draws from it,