My Lords, in moving my amendment I will speak also to Amendments 205 and 301. I thank my noble friends Lord Moylan and Lady Fraser of Craigmaddie for their support for these amendments.
It is a pleasure to follow two excellent debates. I suspect—although, as the noble Baroness, Lady Hayman, said, we are never quite sure how feisty the debates on these groups will get—that we may spend an even shorter time on this group to enable the Committee to make progress. These amendments are relatively simple, designed to improve transparency, quality and access to healthcare for residents in all parts of the United Kingdom. I thank Ministers for their engagement so far on the amendments. In particular, Amendments 205 and 301 were tabled in the House of Commons by Robin Millar MP and others.
The NHS is a UK institution. It could not have been developed without the combined economic strength of our United Kingdom and has developed from unifying United Kingdom values—you might even say that the NHS embodies them. It includes a promise that, wherever in the United Kingdom you are from and whatever your situation, you are entitled to the same protection and treatment. That is why the first two amendments, Amendments 17 and 205, are about access by patients to a consistent national standard of healthcare.
The unfortunate reality, of course, is that many UK residents do not have equal access to healthcare. Referral-to-treatment waiting times for England, Scotland and Wales are, respectively, 11 days, 32 or 42 days—depending on whether you are talking about in-patients or out-patients in Scotland—and 21.5 days. These headline figures are concerning enough. However, they obscure even more stark differences when treatments are considered separately.
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For example, in Wales, waiting times in Swansea for routine shoulder, hip and knee operations before the pandemic averaged, respectively, 128 weeks, 120 weeks and 103 weeks. By comparison, 95% of routine hip replacements and 94% of knee operations in England at that time—of course, we all know how very difficult and challenging the last two years have been for waiting lists in our NHS—were taking place within 18 weeks, a seventh of the time.
Although we, in both this House and the other, often talk about people living in one area or another, or one country or another, patients and their families do not think like that; they do not think about barriers and borders. They simply want the best treatment, and if necessary they are prepared to travel to get it in an
appropriate time, particularly where, as many people will know, without that necessary treatment their quality of life is literally endangered.
Amendment 301 is about improving public services, because the key step towards improvement of public services is securing transparency, scrutiny and accountability. Data that is not collected or not comparable limits public access to information about the quality of the public services that those who pay for them are entitled to expect. As a result, if that information is not easily available, elected leaders avoid pressure to improve those public services.
For example, cancer referrals in England and Scotland both have “test within six weeks” targets. However, comparisons are frustrated by different numbers of tests—there are eight tests in Scotland and 15 in England—and different measures for when the period ends. It is until the last test is complete in England, but until the report is written up in Scotland.
England has condition-specific targets for children’s mental health—for example, children with eating disorders must be seen within a week—whereas Scotland has a generalised target of seeing a specialist within 18 weeks, for all conditions.
I have already mentioned orthopaedic surgery, but Scotland and England have that 18-week target for hospital admission for knee and hip replacements. However, those unavailable for treatment due to ill health, work or family commitments are discounted from statistics by Scottish but not English trusts. Patients waiting in Scotland who are suffering chronic pain are discounted from orthopaedic waiting lists unless they choose to opt in for treatment.
This pattern has continued during the pandemic. In one example, an extra 300 care home deaths were identified in Scotland when a media campaign forced the revelation that the original figures had excluded residents who died in ambulances and intensive care units.
Comparable health data helps everyone. Access to data on waiting lists and outcomes helps both healthcare professionals and patients make informed decisions about referrals, treatments and where to live. As we have seen in the last two years, when the quality of data in relation to Covid-19 cases and treatments has improved beyond all recognition, a larger pool of healthcare data drives better public health policy and intelligence on population health.
I thank noble Lords who have expressed an interest in these amendments and Ministers who have engaged so far. I look forward to hearing from the Minister on these important amendments, which are really all about recognising, as I said at the start of my remarks, that the NHS is a UK institution embodying United Kingdom values.