NHS Management: Codes of Conduct (Hansard, 13 April 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, very shortly.

§ Lord Dean of Beswick
My Lords, I saw some information the other day in a Written Answer, but nowhere have I found any intention to introduce the question of surcharge against these people. Is the Minister aware that in a few weeks' time over 10,000 candidates will fight the local government elections, and that some of those who win will take over very important offices in local government where they will control large sums of money? Can the Minister tell me why those people will be held liable to be surcharged if they cross the dividing line between legality and illegality, and why the people who are appointed and do not face the electorate receive preferential treatment and are treated like untouchables?

§ Baroness Cumberlege
My Lords, it is not a question of preferential treatment. People who serve as non-executive directors in the National Health Service are governed by statutes very different to those that govern serving councillors in local government. Councillors are locally elected and are not generally answerable to the Secretary of State for the Environment, whereas board members of NHS trusts and authorities are appointed by the Secretary of State for Health, who answers to Parliament and to the Public Accounts Committee. In local government there is no accounting officer answerable to the Public Accounts Committee, whereas the permanent secretary and the chief executive of the management executive are both accounting officers and are responsible to the PAC. Local authorities have wide powers to raise finance through local taxation and charges, whereas the NHS raises only a very, very small percentage in charges and has no powers to tax. There are many other differences that I could outline, and I have cited only three.

§ Lord Dean of Beswick
My Lords, I am grateful for the Minister's very detailed answer. However, the sad facts are that on the evidence so far the sanctions that are available have been altered very little. They did not prevent what happened in Wessex and the West Midlands and will not prevent a recurrence. It is not 1532 good enough for the Minister to say that one section of people will be treated differently to another and will be dealt with only by the Secretary of State instead of through the courts of law.

§ Baroness Cumberlege
My Lords, surcharging in this instance is not relevant. The National Health Service does take action where there are faults to be remedied. That is why the Secretary of State has introduced the Codes of Conduct and Accountability for the National Health Service—codes which have been warmly welcomed by the Audit Commission, the Public Accounts Committee and the Institute of Chartered Accountants.

§ Baroness Robson of Kiddington
My Lords, will the Minister accept my assurance that I understand why there should be codes of accountability? But does she agree that it is a terrible slur on modern society that the Government should have to issue codes of conduct for people taking on responsible positions? I thought that in this country we knew what it meant to take on responsibility.

§ Baroness Cumberlege
My Lords, the Secretary of State studied very carefully the Cadbury Report which was introduced for private commercial concerns and took from that the principles that are now established in these codes of conduct. It is right that where issues arise that need remedying the Secretary of State should take action—as indeed she has.

§ Lord Molloy
My Lords, does the Minister agree that the health service is recognised throughout our country as a tremendously great service? But does she further agree on the matters that are causing consternation: namely, that many doctors are leaving the service; thousands of nurses and health visitors have left the service; and the numbers of managers and similar staff have been increased? That situation is giving general concern throughout the country. Will the Minister accept that there is a problem, and say that the Government think it well worth while to investigate such a problem?

§ Baroness Cumberlege
My Lords, fewer and fewer people are leaving the National Health Service. That is partly due to the recession and is partly for other reasons. Nurses are staying longer and longer in their posts. They are not leaving now. If one looks at the increase in managers, there are 26 doctors, nurses and clinicians in the field to every manager. I think that one has to get this into perspective. Management accounts for only 3 per cent. of the pay bill and 2 per cent. of the workforce.

§ Lord Howell
My Lords, if a surcharge is inappropriate for people who are appointed to the trusts by the Secretary of State, will the noble Baroness kindly tell us what redress is available in cases where there has been misappropriation of funds in one way or another? How can the community at large call these people to account, as it would be able to do in the case of local government? There must be some way in which we can secure the same ends.

§ Baroness Cumberlege
My Lords, there is a lot of monitoring in the National Health Service not only through the NHS executive but also through the Audit Commission, the Public Accounts Committee and the National Audit Office. The noble Lord is probably thinking of the case in Birmingham in the West Midlands Regional Health Authority and that in the Wessex Regional Health Authority. In those cases none of the people involved in the difficulties that arose, which were studied by the Public Accounts Committee, is still in post. We take prompt and serious action when it needs to be taken.

§ Baroness Jay of Paddington
My Lords, could the Minister give the House her response to the report published yesterday of the National Association of Health Authorities and Trusts which states that one in 10 health trusts is at present in financial difficulties? Would she give her reaction to the idea that such a statement suggests that there should be some very much more formal system of district audit within the health service?

§ Baroness Cumberlege
My Lords, I was a health authority chairman for many years. As the chairman of the National Association of Health Authorities, I remember making representations to the Government every year around Christmastime to obtain further allocations from the Treasury to get the National Health Service through that financial year. That has not happened. We now see much tighter control with trusts and health authorities. Indeed, the National Health Service should be congratulated on living largely within its means.