20/11/2011 The Politics Show East Midlands

In the East Midlands: Hospital waiting lists, reform of care for

the elderly and the doctors who'll ring you if you want an appointment.

Find out more with the chairman of the health select committee,

Apology for the loss of subtitles for 2347 seconds

Stephen Dorrell, and Shadow Health Hello, I'm Marie Ashby. We are

looking at issues vital to the region's help. With me, the

chairman of the Health Select Committee, Stephen Dorrell, and

Shadow Health Minister Liz Kendall, who represents Leicester West. We

will be looking at a radical new scheme that puts doctors and much

closer contact with their patients. Should it be the shape of things to

come? Patients love it because they can be speaking to a GP within

minutes, not days. If they need to see a GP, they will be offered

usually the same day. And we will be discussing moves to protect us

from dangerous foreign doctors, like this man, after pressure from

one of our members of the European Parliament.

First, waiting-lists are firmly back on the political agenda.

Health secretary Andrew Lansley said as many as a quarter of a

million people have been waiting more than 18 months for hospital

appointments, and he is imposing a new director of to tackle the

problem. Stephen Dorrell, from a coalition that was sceptical about

targets, this is a U-turn, isn't it? It is 18 weeks, not 18 months,

but the position is the government has always, in truth, made clear to

commissioners and the health service and for those providing

care, that the objective of delivering - as it was to find

under the last government - 90% of patients to be seen within less

than 18 weeks, that has continued since the change of government.

There has been a change in that objective. Stephen does his best to

try and defend the government. The Conservatives or were completely

against what they called top down targets. Politically motivated,

they called them. In fact, it was about making sure that patients

were seen within 18 weeks. Whatever Andrew Lansley says, they have lost

a grip of waiting times. We now see 43% more patients waiting more than

18 weeks for their treatment since the general election. That is not

good for patients. Actually, what we have done this week is to

increase the grip, as it happens. We can play party politics here.

But let's be clear. There is consistency in the definition of

what good looks like not having changed from the last government.

One of the improvement that has been made this week is that instead

of just defining the 90% target, we have also addressed what happens to

those people who wait longer. The Secretary of State has this week

address that question to make it clear that those have to be treated

with an acceptable time scales. our six primary care trusts, only

one - Derbyshire - is meeting the target to treat 90% of patients

with an 18 weeks. So something had to be done, didn't it? It is

absolutely right. There is a lot of party political ardour and that

goes on about these target seats. I stand a little bit away from that.

Some of the target date back from that time were low as a junior

minister. The introduction and the application of waiting time targets,

as a proper measure of what the health service feels like for

patients, I think is right. Where waiting times to start to extend,

action is necessary to improve the service. One of the problems with

Labour's targets is that hospitals will try their best to keep

politicians of their backs but you do get cases where patients'

appointments are cancelled because of a lack of beds or something.

Hospitals effectively restart the clock and it looks like the targets

are being met. I think a lot of doctors and nurses galore while

they would have struggled with the targets to begin with, now think

they have made a real difference in getting patients seen them having

their tests done in one day, and getting the care they need when

they wanted. Stephen says we should not be party-political about this

but unfortunately, it was the Conservatives who said they did not

like the targets and were going to scrap them. I pointed out that it

was the Conservatives that originally introduced them. You may

have done, but Andrew Lansley did not want targets. He has been

forced to wait -- make a U-turn because people are waiting too long.

We have got double the number of patients waiting more than six

weeks for their diagnostic tests. It is really frightening when you

are not getting your test result. I want to see those targets in place

to make sure patients get the care they need. Good. The be good news

is that patients are monitored by the people who provide the care.

And except that there has been some difficult rhetoric and unclear

rhetoric around this. But the position is that, as so often in

this subject, policy has changed very much less than the

speechifying would suggest. The definition of what is unacceptably

long waiting time has roots before the last Labour government. It was

developed by the last Labour government. Let's get away from who

started of the targets. I do want to say that it was Labour who said

that we wanted a maximum 18 week wait. Be bold did not believe it

could be done. We have had but highest patient satisfaction. --

people did not believe a. We have been looking at how our biggest

hospitals are balancing their books. The Nottingham hospital trust says

it has a surplus of �4 million, but Derby is just under �7 million in

the red and Leicester has a deficit of �13 million. If Nottingham can

stay in the black, so should Leicester, surely? It is time for

radical rethinking of the whole NHS. Why do we need is to look at the

way different services are run and improve those services. -- what we

need. In Leicester, I think the thing we need to do is more to

prevent people ending up in A&E when they don't need to and more to

get older people, who are stuck in the hospital but could get care in

the community or at home, out of the hospital, too. That means

different parts of the system working together. We don't need

this big, wasteful, risky organisation. In fact, I think it

has been a distraction for people when they should be getting round

the table. They have spent all their time losing their jobs,

reapplying for their jobs. That is why we are calling on the

government to drop its bill - so hospitals and doctors can get on

with their jobs. Next week, your select committee resumes its

inquiry into social care. A commission recommended a radical

funding, but the man who headed the commission has made a statement.

But government set up there are the to make recommendations about the

right way forward for social care reform. The committee is taking

that work Fordham the government is committed to a white paper in the

early part of next year. I agree absolutely with what you said that

the priority is 30% of non- emergency hospital admissions being

avoidable, if you take the kind of steps that Liz describes, to make

certain you have community-based services. Andrew Dilnot's work is a

bigger part of that Jigsaw and it is the most important challenge.

And what he suggested was raising the means testing level from

�23,000 to �100,000 and capping the amount for which individual would

be liable at �35,000. That would cost about 2 billion. Would Labour

by that? This is an area where we don't want the usual party politics

to be played. We need cross-party agreement. We have offered cross-

party talks with the government on this issue. We have written to

David Cameron and Andrew Lansley, saying what we think we need to

make those cross-party talks happen. With an ageing population, unless

you get long-term agreement for how you're going to pay for social care,

all parties would have to find a way of making that happen. That is

a really tricky in our political environment. We are serious about

those talks because we have to find a way of properly funding care for

older people. But will politicians have the guts to do this? What Liz

said is extremely welcome and it is exactly the right way to approach

this issue. The reason for that is that you are right to say that

Andrew Dilnot recommended some changes, which will cost public

money. What he also said was that if we are going to do that, part of

the argument for doing it is that it makes it easier for individuals

to plan to make a contribution themselves towards their care. That

is the basis on which we have to create long-term arrangements for

funding social care. It is what worries the elderly the most, isn't

it was that yes, and it is not only important for those older people

but it is vital for the feature of the NHS. That is not where the best

care and treatment would be provided. If we don't find a

solution to social care, we are going to have a real crisis in the

NHS. We need to put party politics aside, get round the table and see

if we can reach an agreement about how to thunder system that is both

fair and sustainable for the long term will stop it is not just the

cost of care but the standard of care. The Commission is under

increasing pressure. But next spring, it will be regulating

doctors, too. We have actually put that off by a year. We did at the

Care Quality Commission in the select committee. Can I just pick

up the last point that Liz made, in response to last question? I want

to stress the importance of a cross-party approach to social care.

That is why the select committee, as a cross-party committee, is

doing the work that it is Curran redoing a social care. When we did

Danby Care Quality Commission as a select committee in the summer, we

criticise them are in fairly straightforward terms for

registering dentists rather than focusing on the things that are

important and that the very heart of what they should be doing, which

is looking not so much at individual instances of care -

because an inspector will never pick up every failure - but looking

at the culture that exists within organisations that provide care, in

order to ensure that the professionals working within those

organisations have the right culture to provide the high quality

of care we all want. Let's move on to an issue which is a constant

gripe for many of us. Robert White House has been looking at a radical

new scheme in Leicestershire at which has the enthusiastic backing

of patients and GPs, when it comes to making an appointment with your

The tension and hassle of the GP waiting room is enough to send your

blood pressure rocketing. And that is before you've even got to see

the doctor! But this medical centre in Thurmaston in Leicestershire

think they have come up with a solution. It is called Patient

Access. The patient's call is lobbed at reception and the doctor

then cause the patient back. They are booked in, diagnosed and

advised over the phone, was sent for tests - easy! We realised we

were seeing the patience that actually needed to be seen and were

able to advise patients with very minor illnesses who did not need to

be seen it on the phone. Tell me about will sleep - are you

getting to sleep? I am not getting to sleep until about 4am. Wendy

suffers with depression and finds the new system really helpful.

did have days when I did not want to leave the house, so being able

to speak to the doctor in the comfort of my own home is a lot

better. What has this new system meant for doctors? It has made it

huge difference to our day-to-day work in that it flows much better.

We can control our time much better and the consequences of that have

been that we have been able to reduce patient waits. So far, 40

surgeries around the country have taken up the scheme, run by Harry

along them. An engineer by training, he was attracted by the innate

simplicity of the system. -- Harry Longman it. If they need to see the

GP, they will be offered the same day. The GPs love it because it

helps them manage their workload. It is good, because you get your

diagnosis fairly quickly. If you have to get a booking, they give

you a booking. It helps me a lot because I live a little bit out in

the wilds. If they say they want to see you, you are there the same day.

The scheme has been running for about eight weeks. About nine miles

away in the village of Quorn, a similar patient access programme

has been in place much longer. think it is definitely the right

thing to do. We would never go back because of the patient feedback

that we get and the benefits that we see as doctors. In those areas

where they have been operating the telephone system, they have found

attendance at A&E has dropped by 80% -- 20%, and the number of

patients who could fail to keep their doctors' appointments has

dropped dramatically. We cannot see a reason why everybody would not

want to do this, which is why we are talking to people all round the

country. Under the old system, patients could get angry, get fed

up of waiting and miss appointments. Now the days of losing patience -

in more ways than one - may be over. So, it seems a good idea and such a

simple one, too, and you can see the patients clearly like the idea

of it. Do you think we should all get the chance to benefit from a

scheme like this? I think it looks like a fantastic scheme, because it

is giving patients quicker, easier access to their GP on the phone or

in person, but is also reducing the number of patients who turn a bad

A&E. I think that we often focus a lot on what happens in hospitals. -

- turned up at A&E. It is important that we did lose focus on GPs. They

have a massive role to play in making sure people get the right

care at the right time. As you say, A&E cases are down and people get

to see their doctor on the same day if necessary, and fewer people are

failing to turn up for appointments. Surely this should be rolled out

across the region collar if not the whole country. I agree. It is

clearly a good thing for those patients and not just for the

patience that are seen, but all the whole generality of patients

because it means that resources are being used more effectively. I

think there is one word of caution, which is that the whole history of

the health service is peppered with examples of people developing good

ideas, demonstrating they are successful and then the health

service tries to make it universal in a whole series of

circumstances... You want to see how it works a bit more? Not so

much that. Though it lesson is that when people have a problem they

should be empowered to get on and do it. The solution often looks

quite different in different communities. Most of us are happy

with our GPs and the worst problem seemed to rise without valid

doctor's, and the appalling case of a Cambridge man who died after

being injected with a massive overdose of diamorphine by this man,

Dr Ubani, caused an outcry. He was already accused of negligence in

Germany. Any MP persuaded the European Parliament to alert all

countries of the doctor is struck off or suspended. Can you see this

working? I think it is essential that there are much more effective

safeguards against doctors coming in from overseas. Two risks

associated with this - the first is that they can't communicate in

English. It is impossible, in my view, to operate proper medicine

unless the doctor can communicate flawlessly with the patient. It is

one of the things I am glad to say we are at long last taking some

steps to try to ensure that it is properly provided for. The second

thing is to understand that in other countries in the world,

general practice is defined very differently to what it is here. So

the fact that you have a general practitioner Certificate in one

country does not necessarily mean you have a transferable skill into

a different country, where the phrase GP mean something different.

That is a step that we have not addressed and we do need to as a

matter of urgency. Are we doing enough on this issue to protect us?

I think there is absolutely more that we should be doing. Some of

the examples Stephen talked about, about we have heard about

throughout the programme, what I would say is that none of the

improvements we have seen or heard about today require a big change in

the legislation or a big change in the NHS's structures. Stephen would

probably admit that this big bill of reorganisation is not what we

need to get on with the very real improvements that we need in the

NHS, whether that is making sure we have got us up to standard, better

access to GPs or making possible to balance their books. We want the

government to drop its whisky bill and focus on precisely these issues,

so that they improve patient care. -- risky bill. All of the issues we

have talked about today are immeasurably more important than

the provisions of another Bill changing of the organisation of the

health service. I don't agree with the conclusion list draws from it,