HC Deb 28 April 1958 vol 587 cc133-52

9.3 p.m.

Mr. E. Partridge (Battersea, South)

We have been engaged for five hours on discussing a problem of some substance and a very great importance, although the last half-hour of the debate was not quite as important, and in the time which is left I should like to make reference to a few problems in respect of a subject which I hope the House will regard as not less important. I wish to refer to some problems of the National Health Service.

The Minister has stated that the search for economy in the National Health Service is relentless and unending. A large number of people quite mistakenly assumed that he was advocating a cutting down of the Services. In my view, no such intention lay in his words or in his thoughts. What he was asking for was precisely what he said—economy.

I believe that economy can be effected in the health services without any detriment to them, but in a way that would improve them and make them more far-reaching and effective in the only way that counts, and that is the well-being of the patient. This could be carried out either at less expenditure for the same number of people benefiting from the health services, or for a greater number, more speedily, for the same cost.

This could be done by a more extensive use of work study. There seems to be some idea that work study is the same thing as the work done by the Organisation and Methods Department of the Treasury, but I do not regard it so at all. The work at present given by that Department to the health services is devoted more particularly to mechanical means of carrying out clerical communication and accounts services. I regard work study rather as the pointer and stimulus to efficient management and administration.

Any jobs, services or processes that can be performed with the minimum of physical effort, while, at the same time, sustaining the greatest possible interest and giving the greatest amount of satisfaction to those engaged in the work, will make for a happy staff, and that in itself brings efficiency. Wherever work study investigations have been carried out they have been attended by beneficial results to a greater or less degree.

I do not think that I would be disclosing any secrets if I said that in Westminster Hospital, just a few yards from here, a number of work study investigations have been done. As a result, the staff in one department was reduced from five people to three, overtime was cut out, there was a non-recurring economy of about £600, and an annual saving of between £1,000 and £1,500.

Arising from a request for additional staff, a number of experiments have been carried out in a hospital in the North Liverpool Hospital Management Committee's area, and a saving of about £40,000 has resulted. The investigations were carried out over a fairly wide field, and in various categories. There were small jobs, involving just one or two, or even only one process. There were investigations of the whole operations of a department. Those investigations showed that additional staff was not necessary, and that the work of the present staff could be lightened and made more attractive. The third category were large investigations in some of the largest departments of the hospital.

Many results flowed from those investigations. The training of new staff was made easier. There were fewer requests for additional staff, and there was a more contented staff. There was a saving in money and time. What is probably most important in the healing profession, there was a saving of tempers, not that I suggest for a moment that any member of that profession loses his temper, though I imagine that the effort to keep it in check brings about a nervous exhaustion which, in its turn, reacts upon the individual.

The results obtained from the investigations are only what one would expect. These studies have been going on in industry for many years, always with beneficial results. I was introduced to the subject of work study, although I did not recognise it at the time, when I first came to the City and it was my duty to assist in checking postings from a day book to a ledger. I was instructed about which hand to put the blotting paper in and to change it from hand to hand while throwing over the folios of the ledger. The advice remained with me, and I was able to get through the job, at all events without too much boredom.

Although the problem is not quite the same, what has been done in industry can be applied very effectively to the Health Service. One has to decide which is the best method of proceeding in this aspect of its affairs, whether to employ industrial consultants or develop methods inside the service, whether this activity should be centrally arranged from the Ministry or regionally grouped. There are many other questions which, in themselves, could form a subject for work study. However, whatever be the correct answer, the well-being of the patient must be the prime consideration.

Talking about hospitals first, I suggest that, certainly in the experimental stage, the work study groups should be in the hospital itself, if it be large enough to carry such a group. The personnel should be selected from the staff at the hospital, and they should have special training either at the instance of the Council of Productivity or, if representations were made to Imperial Chemical Industries, who had been so helpful in many ways to hospitals and other departments of the Health Service which had asked for assistance, no doubt something could be arranged. I am quite certain that, if it were decided in a hospital to set up a study group, it would not be difficult to get the necessary help from industry to provide for proper training.

It must be recognised that work study should receive encouragement from the Minister, from the regional boards and from hospital management committees. The incentive, of course, must remain with the hospital and must not be used as a means of cutting down the cost of the service. What I mean is that if as a result of work study there is a saving of money in the department or hospital, then that department or hospital should be able to keep the savings and utilise them in directions which they know would be beneficial. It may be for that reason that one should ensure that the administrators of the future, whether lay, nursing or medical, should have some practical knowledge and, indeed, experience of work study while they are on their way up.

That this subject is receiving closer attention by so many branches of the Health Service is evidenced by the fact that, last year, a three-day conference was held by the Royal College of Nursing, where most valuable discussions took place and great lessons were learnt. A more recent conference was held by the South-East Metropolitan Regional Hospital Board. These conferences give us hope that, with encouragement, work study will increase. If we take advantage of the modern techniques involved in work study, and then apply the findings intelligently, we shall have a better, wider and more fruitful Health Service which will serve the country well, and those who devote their lives to ministering to the sick and the suffering will benefit greatly because their loads will be lightened and they will find more satisfaction in their own work and in a job well achieved.

I commend those observations to my right hon. Friend the Minister and the Parliamentary Secretary. I ask them to give every encouragement on this subject of work study to all who wish to make use of this most valuable instrument.

9.17 p.m.

Dr. Edith Summerskill (Warrington)

I am sure that those of us who are interested in health questions will thank the hon. Member for Battersea, South (Mr. Partridge) for raising this matter tonight. I confess that when I read the Motion which he had put on the Order Paper I wondered what aspects he would address himself to, because he said that he would make proposals for substantial savings. I have listened carefully to everything that he has said and I must say that I do not think that he has enlightened the House very much. He said that certain amounts of money had been saved in various hospitals and that in one case three workers were reduced to two. We should have liked to hear more about the kind of workers to whom he is referring. We should have liked to hear how savings were effected.

Mr. Partridge

Had it not been for the extraordinary intervention of the hon. Member for Dudley (Mr. Wigg) I would have gone into more detail. The department to which I referred, in the Westminster Hospital, was the central syringe department. If I had had the time I would have given far more detail, but I knew that other right hon. and hon. Members wished to speak.

Dr. Summerskill

I am sure that the House is a generous place. The hon. Member waited a long time to raise the subject of his Motion. Had he taken half an hour, I am sure that we would have listened to him patiently.

We are all anxious to contribute what knowledge we have to this problem, bearing in mind that the estimated cost of the Health Service next year is £740 million. The hon. Gentleman will forgive me when I say that I looked up his background and discovered that he is an accountant and a director of various engineering firms. However, I am sure that his kindly heart was softened very early on, because his father was a doctor and he has, therefore, interested himself in these matters.

Nevertheless, I felt that I was listening to an accountant who sees the story in black and white, on a piece of paper. Perhaps the hon. Member is concerned also with those engineering firms where it is possible to inject a measure of efficiency of a specialised kind which cannot possibly be introduced into the hospital service.

Perhaps I may illustrate my remarks in this way. When the hon. Member talks about the workers, the fact is that our hospital services—and, indeed, of the whole world—are conducted by women, because the great majority of workers in the hospitals are the nurses. These nurses have absolutely no relationship, in their work or in their payment, to other workers, because they are universally underpaid and overworked. These women have a vocation which, I believe, is consistently exploited by the community.

These women are not well organised. Except for the mental nurses, they are not paid overtime. They have no knowledge at all of the meaning of restrictive practices. They work at night, whereas other women workers are never called upon to work at night. They do domestic work without complaint, although they may be qualified nurses. Therefore, when the hon. Member was talking about workers, how he would reduce overtime for workers and how it could be possible to improve their conditions, I felt that he was a little unrealistic.

Sir Keith Joseph (Leeds, North-East)

I, for one, hoped that the right hon. Lady would address her great knowledge to the subject raised by my hon. Friend the Member for Battersea, South (Mr. Partridge). My hon. Friend was considering the ancillary workers, the domestic and maintenance staff, believing, as I do, that the load of the nurses can be lightened and that their efforts can go further by scientific study of their work load. My hon. Friend was not for one moment suggesting that there was any question of restrictive practices.

Dr. Summerskill

The hon. Member must allow me to develop my argument. I listened to his hon. Friend, as he did, and I can interpret him just as well. There is no need for the hon. Member to help me about how a hospital is run. The fact is, as I have said, that a hospital is run by a very large number of women, who do not think in terms of overtime, who are underpaid and who cannot be approached, in the way that the hon. Member has suggested, as workers in, say, an engineering firm can be approached.

Mr. Partridge

I never suggested it.

Dr. Summerskill

When one is thinking of the organisation of a business or an institution, one cannot approach it unless, first, one considers what kind of workers one has to handle. Indeed, when the hon. Member, kindly and quite rightly, said that he hoped that any money saved would still be spent in the institution, if he was completely realistic he would say that he would then increase the wages of the workers.

Here is the background of the nurses. For the hon. Member to think that he can go to a hospital and tell those workers, who comprise the great majority, that by a scheme he will be able to reduce overtime and make life infinitely better—indeed, he then said, in parenthesis, how much easier it would be if the time in which a particular job was done was reduced——

Mr. Partridge

I did not say that at all.

Dr. Summerskill

I am being kind to the hon. Member. He must not think that I wish to misinterpret him. He told the House how nice it is for people to be better tempered at work, and we all agree with him.

Mr. Partridge

Of course.

Dr. Summerskill

Certainly, I agree with the hon. Member. What I am trying to point out to him is that unless our hospitals are better staffed, unless our nurses are not overworked, what he suggested about improving the temper of the workers, and so on, will not come to pass. I am trying to show him that all this is not as simple as he made it appear.

Mr. Partridge

The right hon. Lady need not tell me how simple it is, because I have practical experience, at the receiving end as well.

Dr. Summerskill

The hon. Member should realise that we are all trying to contribute, as far as we can, what we know of this subject.

Now, we come to the clerical workers. The hon. Member for Leeds, North-East (Sir K. Joseph) told me that his hon. Friend was dealing only with clerical and ancillary workers. Let us think about the clerical workers. There must be an increase in their number. I find it extremely difficult to understand how the hon. Gentleman can argue that we can decrease the number of clerical workers. The out-patients' department in any hospital has completely changed. Instead of a vast number of patients having to sit on hard forms awaiting their turn to be treated, every patient attending a properly conducted hospital is given an appointment. That necessitates a great deal of correspondence. It involves a large number of telephone calls which have to be answered by extra clerical or administrative workers.

As to records, the hon. Gentleman may think that if he introduces the right kind of unit they will be able to examine the records and make recommendations so that the records can be carried on in an efficient, businesslike manner. I would remind him that physicians and surgeons in the hospitals are equally concerned with this. I was discussing this matter with a consultant only this morning, and he said that the Ministry did send somebody to the hospital to examine the records, and that that official saw a number of administrative workers but, unfortunately, did not call for the consultants, who were very much concerned about how the records should be kept. If we apply a work study we must ask the right questions of the right people.

Is it possible, for instance, to save money on this item? Before the advent of the National Health Service it was not always the practice to send the practitioner a record of each of his patients' complaints. Very often a practitioner did not have a letter on the admission of a patient. Very often he did not have a letter on the patient's discharge. That is completely changed. A well-conducted hospital sends a letter to the practitioner on the admission and discharge of every one of his patients. Before the Service was introduced it was quite common in the wards for a junior houseman to write details of a case on the record of the patient and for a clerical worker to try to decipher the junior houseman's writing and to make a short form of the record to be filed. Those are the old methods. Now clerical workers have been introduced—and we hear a great deal about them, I agree—to improve the records and to keep general practitioners informed of what is happening in the hospitals.

A unit may go to a hospital and suggest that if the administrative workers were housed in another part of the hospital the amount of their work might be cut. We have to remember that this service is being conducted very often in antiquated buildings. The hon. Gentleman says he knows many hospitals in the country. He will agree with me that there are some buildings a hundred years old and that some of these administrative workers are not working efficiently, not through any fault of their own or through any fault of the matron or superintendent, but simply because they have to work in buildings which are quite unfitted for the purpose.

I am sorry that the hon. Gentleman could not address himself more fully to the whole question. I should have liked him to have taken an illustration and told us in detail how, for instance, he would save money on the new geriatrics service, on the administrative and nursing and ancillary service sides. He did not. It would be absolutely impossible, because those who conduct the Health. Service and administer it are saying that it needs much more money. The hon. Gentleman must not think that our objective is not the same. He must not think I am defeatist, but I am very well aware of the tremendous problems. So many of them want to expand their services, and, in consequence, this demands more administration.

No doubt—and I agree with the hon. Gentleman fully here—in limited non-medical fields some economies can be made. We could have more efficient equipment. I am told by some of the people who examine the boilers of our hospitals that the stoking is inefficient and that the boilers are too old. Money could be saved in that direction.

Mr. Partridge

That is organisation and methods, not work study.

Dr. Summerskill

The hon. Gentleman must not quibble about work study and organisation and methods. Our object is precisely the same.

We are anxious to save more of the vast amount of money which is being spent on the National Health Service. At the same time, we are anxious to see that what is saved is re-expended in another direction. Here, he might well have said that there was a field for saving. Bulk buying and the pooling of resources of hospitals is being done very widely. I believe that a great saving is being effected there.

The question for the hospitals, and I am very glad that the hon. Gentleman emphasised it, is not how we can save money, but how we are to give the best services to the patient. We must realise that in business, we are dealing with healthy people, who can be speeded up and their processes streamlined, while in a hospital we are dealing with sick people, people in pain who call for two things—the exercise of judgment and the expression of sympathy. The time and effort involved in rendering these services cannot be computed and, consequently, organisation and methods, as understood by the hon. Gentleman, can only succeed in a very limited way. Inevitably, if we plan in detail how a hospital could be conducted——

Mr. Partridge

We cannot do that; we must deal with each hospital separately.

Dr. Summerskill

I am very glad that the hon. Gentleman agrees with me. Inevitably, the working of a hospital is such that it must conflict with a cut-and-dried plan. All of us here are anxious to save money in every direction, but what we are primarily anxious to do is to ensure that every patient is effectively cared for.

9.33 p.m.

Sir Keith Joseph (Leeds, North-East)

As the right hon. Lady the Member for Warrington (Dr. Summerskill) agrees that the cost of the National Health Service is probably bound to rise, she speaks, and I agree with her, of the need in due course to pay higher wages. I do not claim that these modern management techniques are in any way a panacea, but they may be able to make way for some of the desirable increases which we all want. If the right hon. Lady says that she has no hope except of minor cheese-parings, she is much less humble about the capacity for doing the work in a more efficient way than most of the great experts in all fields of industry and administration.

Public and private enterprise have found these new techniques invaluable. The continuing scrutiny by sceptical experts on every facet of administration and conduct, in factories and offices, in the Navy, the Army and the Royal Air Force, in farming, and in my own industry, that of building, is perpetually finding methods of economies of effort, making the job lighter, the possibility of a more efficient method, which enable fewer people at higher wages to do the same work to the better satisfaction of the client, and I see no reason why the Government should not use the same techniques for the National Health Service.

Here is a Service employing 2 per cent. of the working population of the country—424,000 people. An industry such as I.C.I. employs 1,500 work study experts for a working force of 100,000. Yet the Minister of Health has to confess that for the 424,000 people employed in the National Health Service he has nine. I remember that the right hon. Lady joined with me in a supplementary question in condemning the smallness of the number of these experts in the whole Service. There is not an annual report which private enterprise produces which does not show the progress made in this sort of research, and yet the Annual Report of the Ministry of Health devotes only two paragraphs to the whole subject.

There is, however, a great deal of work being done. There is a statistical section in the Ministry of Health, and there is the raw material for all the work that for one, would like to see done in the Hospital Costing Return of the National Health Service. There is scope for ample investigation to the benefit of the patient, lightening the burden of all the workers, and enabling there to be fewer of them, each better paid.

There is the question of maintaining the morale of the workers. Any redundancy that is recommended by the experts who look into this subject can be dealt with merely by not refilling wastage. There need be no dismissals. The only movement in salary and employment will be upwards. My hon. Friend did not say that the three people left in the central syringe department of the hospital to which he referred had received higher pay as a result. That is at least the practice in industry.

Whether the experts be consultants from outside, or are specially trained staff from inside, is certainly not for me to suggest, but I would say that there is need in the Health Service for two particular kinds of investigation: first, for operations research on the inter-relation of different medical institutions and on the effect of different systems of medical deployment. I mean by that rather complicated phraseology, for instance, the reduction in hospital use which might emerge from much more ample domiciliary provision and the location of consultants: whether it is better to invite patients to travel a great deal to a relatively few consultants, or to invite consultants to travel to local points where patients can come at closer range to them. Here is the province of operational research and, I believe that the statistical department of the Ministry is starting on this field.

Then there is the job analysis and methods study for all the non-medical departments—the administrative, the portering, the clerical work, the catering, the maintenance and the laundry. These departments cost £100 million a year. Is it possible to suggest that when industry can continually chip away at just this kind of activity, the National Health Service cannot find some savings to make in £100 million? If the Ministry is already doing these things, I hope my hon. Friend will tell us. Raw material exists in this Hospital Costing Return and I have chosen from it two examples, unaffected, I think, by the age and unsuitability of the buildings to which the right hon. Lady rightly referred, of the kind of danger signal that I think should attract closer investigation.

As the House knows, this records average cost per patient per week in different kinds of hospitals and in different areas of hospital management committees. I have taken my first example from two hospitals, both acute, and both of the size of 300 to 900 beds. The subject of the cost is clerical and administrative work. In Sedgefield Hospital, in the Newcastle area, which is a 311-bed hospital, the average cost per patient per week of clerical and administrative work is 5s. 9d.

In the Royal Devon and Exeter Hospital, which is a 320-bed hospital, of the acute type, the average cost per patient per week of clerical and administrative work is 33s., which is six times as much. I should have thought that my right hon. Friend would say to himself, with this admirable document to consult, "Here is where I send for an expert." Perhaps we shall hear that he has done so. I hope that the right hon. Lady will agree that here is something into which, at first sight, it looks as if the age and unsuitability of the building does not enter. This is probably not all wages, it may be materials. There are all kinds of possible explanations, but I think they should be looked for.

Dr. Summerskill

I am sure that the hon. Gentleman realises that that amount of information is not sufficient. Can he say how extensive the out-patients' departments are in those hospitals?

Sir K. Joseph

The out-patients' department at Sedgefield dealt with 48,000 consultations per year and the Royal Devon and Exeter out-patients' department with four times as many, 171,000. But the cost was six times as much. It may well be that the right hon. Lady has put her finger on the answer, but I should have thought that there was a prima facie case for an investigation.

Perhaps the right hon. Lady can prick this bubble. What about printing and stationery costs? Both hospitals in this example are for acute cases. Printing and stationery costs for St. Giles' Hospital, Camberwell, with 337 beds, are 3s. per patient per week, while at Chase Farm Hospital, Enfield, with 335 beds, the cost is 12s. 10d. per patient per week. Obviously, I am not criticising those hospitals, but simply using the raw material which the Ministry of Health provides.

Dr. Summerskill

The hon. Gentleman asked me to prick bubbles. I can prick most of the bubbles he has put up; it is very easy to do so. We must know the proportion of acute to chronic cases in those hospitals, because, obviously, the number of letters sent is related to that.

Sir K. Joseph

The right hon. Lady did not understand me clearly. Both hospitals deal with acute and not with chronic cases. I was careful to take my examples from two hospitals each dealing with acute cases.

Dr. Summerskill

Are there no chronic cases in either?

Sir K. Joseph

This is an "acute" hospital, not a "mainly acute" hospital. I hope that I have persuaded the House that this is an example of sufficient raw material for an investigation.

If there is no enthusiasm for these savings, is it, perhaps, that we are face to face with the old disincentive, that the regional hospital boards and the hospital management committees are not allowed to keep for their own use any savings which they get by employing experts of this sort, or by having experts of this sort trained? I recognise that many hospitals are now beginning to seek the services of consultants in this work, or are having their own experts trained from their staffs, by benevolent industries such as I.C.I., or in normal colleges where these techniques are taught.

If it is true that the Ministry feels that only by giving more freedom to hospital management committees will savings be sought, then we are face to face with a structure which needs revision, because a colonel in charge of a battalion in the Army does not expect to be able to spend money, which he saves by avoiding extravagances, on anything he wishes. It is public money and if it is necessary for the boards to become mere agents of the Ministry of Health so that the Ministry of Health can seek the savings through agents instead of through semiautonomous bodies, I, for one, would welcome such a change.

The Ministry of Health has here a weapon which is used by many other Government Departments and public services and by a mass of private industry and which will enable it to save public money. It is not a panacea, but these savings would enable the Ministry to expand the Service as I know all hon. Members desire and, in due course, to pay higher wages, permit shorter hours and secure better working conditions and a first-class Service.

9.44 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

My hon. Friend the Member for Battersea, South (Mr. Partridge) has raised a matter of great interest to those concerned with the efficient working of the National Health Service, and I only wish that we had more time to do justice to this important subject.

Work study, and organisation and methods are not quite the same thing. Work study as such originated in the study and timing of the physical movements required to produce a given product so that the quickest and simplest method of production could be worked out and standard timing for the operation fixed. That is what the right hon. Lady the Member for Warrington (Dr. Summerskill) had in mind when wondering whether it was applicable to the nursing profession. It has developed very widely in recent years, but its most spectacular results have probably been on the factory floor where it has been used with the aid of incentive payments or bonuses to stimulate workers and to reward those who achieve or who do better than the standard.

In its original sense the application of work study to the hospital sphere is limited, as there are many branches of hospital activity, of which the most obvious is nursing, which do not lend themselves so readily to this kind of analysis. However, there are several branches of hospital activities which are analogous to industrial activity—laundries, building maintenance, catering and matters of that kind—to which work study can be fruitfully applied.

Organisation and methods is a system which casts its net wider than work study. It involves the study of almost any procedure, including clerical and office procedure, examines the end the procedure is designed to achieve, the methods used for achieving it and the organisation of the establishment in which the procedure is carried out. Where appropriate, it uses the techniques developed by work study.

The Hospital Organisation and Methods Service of the Ministry of Health was set up by the Department and began operations in September, 1954. Its main object was to discover whether the hospital service was a suitable field for the sort of organisation and methods investigations which had proved their value in national and local government service; and if so, which branches of the hospital services were most likely to repay investigation.

As the service was instituted as an experiment in the first instance, its size was limited, and the field of its investigation had to be restricted to areas readily accessible from London. Hospital authorities were informed of the setting up of this service, which was an advisory one. The initiative in requesting investigations was left to the individual authorities concerned on the ground that experience had shown that it was essential to the fruitful use of organisation and methods that investigations should not be imposed on unwilling authorities. In other words, if they wanted help they had to ask for it.

Up to December, 1957, the unit had completed 78 assignments, and a further 28 were either in hand or awaiting their turn. These assignments have dealt with almost all aspects of the hospital service. Examples of the procedures and arrangements which have been investigated and in respect of which recommendations for improvements have been made—if I may give a few—include stores and supplies, medical records, finance and accounting procedures, collection of statistics, outpatient department and clinical organisation, laundry and linen stores, domestic services, portering services, nursing administration and building maintenance. That is an impressive list, and I agree with my hon. Friends that if we look at what has been achieved in the organisation of such services in other spheres of activity it ought to be possible to effect greater rationalisation and make improvements on what we are now doing. Among the results which these investigations have produced are changes in the layout of a chest clinic and a saving of £4,500 on rebuilding; a saving of £5,000 a year by the redeployment of domestic staff, and a 10 per cent. reduction in portering staff, to mention just a few.

It rarely happens that an investigation into a particular subject at an individual hospital produces results capable of general application throughout the hospital service. This is because the circumstances and arrangements at individual hospitals obviously vary very widely. With the co-operation of the hospital authorities, the experimental unit, therefore, initiated a number of comparative studies in which the same subject and methods used are studied at a large number of hospitals giving a cross-section of hospitals in the country as a whole Inevitably, such investigations require a good deal of time before they can be completed and useful recommendations of general application made. But I hope that the results will prove of value to all hospitals.

Comparative studies which have so far been undertaken on this basis deal with the following subjects: outpatients' waiting time, chest clinic administration arrangements, maintenance of inventories, stores accounting methods, analysing hospital expenditure, methods of producing statistical data, medical records work, domestic services and portering services. That is, again, quite an impressive list, and although all of it is away from the main activities of medical and nursing care, it shows that there is undoubtedly a very wide field where these studies can usefully be pursued. The report on outpatients' waiting time—a sore point with many of our correspondents—has been completed and will shortly be published. I hope that it will be the first of a whole series of such reports.

It is clear that the experimental service has, to a large extent, achieved the object for which it was created, and it has shown that techniques of investigation which have proved very valuable in other fields are capable of showing worthwhile results in the hospital service also. Investigation of administrative arrangements in hospital departments and clinics, and investigation into activities in which a comparatively large number of manual workers are employed, such as domestic and portering services, show valuable results. Our experience has been that investigations of clerical and accounting procedures, while leading to greater efficiency and speed, rarely show possibilities of very large savings. The job is done better, but the actual money saving is not as great as one might think.

This suggests a cautionary word. Our experience so far has not shown that there is much scope for very large and dramatic economies. It frequently happens that, owing to the nature of hospital work and its emphasis upon personal service throughout the twenty-four hours, savings which could be made in theory prove in practice to be very hard to attain. That is not to say that greater efficiency and economy are not within the reach of almost all hospitals or that a number of small but useful economies at individual hospitals will not produce an overall saving in the country as a whole.

I ought to say something about the attitude of the nursing profession to the kind of suggestion that has been made this evening. The profession has recently been showing a very active interest in work study. The Royal College of Nursing has held a three-day conference on the subject, at which much enthusiasm was shown. The college, also, with the encouragement of the Ministry of Health, organised short courses for senior nursing staff in which ward organisation plays a large part. There is evidence that these courses have led to some improvement in nursing organisation in some hospitals. This interest has clearly been stimulated by the publication of various studies, on the lines of job-analysis, of the work of hospital nurses. All these reports provided evidence of scope for improvement in nursing organisation, and the nursing profession appears to be ready to take up the challenge which these reports provide.

Preliminary investigation by the departmental O. and M. unit of the scope for the application of work-study methods to nursing indicates that the scope is limited and that the techniques developed in industry are not entirely suitable for use in the nursing field. We intend, however, to explore the possibilities further, naturally with the collaboration of the nursing profession and the hospital authorities, to see whether the established techniques can be adapted in a modified form to the needs of nursing, or new techniques evolved.

The problem now facing us is how best to extend the work so that the application of O. and M. investigation and of the appropriate techniques, whether those of work study or otherwise, becomes an integral feature of the hospital service throughout the whole country. In other words, we want to make use of the good experimental work that has been done. What we want to encourage is the making of individual hospital managements alive to the benefits of what might be called the organisation and methods approach in the conduct of their day-to-day administration. This involves a considerable degree of propaganda, if I may put it that way, and education, to which I am sure this short but useful debate will make a contribution.

The next problem is to devise methods as a result of which each hospital of any size throughout the country will have available to it, perhaps as a member of its own staff, an officer whose duty it is to examine searchingly the ordinary activities of the hospital with a view to eliminating wastage and unnecessary procedures and improving efficiency and economy. The part which the regional boards and the Ministry of Health will have to play in this expanded and integrated service requires careful study. We shall have to evolve some sort of machinery by which experience can be pooled, and activities co-ordinated, and a large training programme will have to be carried out. No doubt some form of central specialised unit will be required to carry out the more complex investigations and to initiate and conduct further comparative studies of the kind I have mentioned.

In addition to all this, my right hon. and learned Friend and I have had informal discussions with management consultants about the contribution which their techniques can make to the achievement of economies in the hospital service. My right hon. and learned Friend is pursuing a correspondence on this subject. We must bear in mind, however, that there are special features of the hospital service which distinguish it from the main field of management consultants' work. This limits practical application of some of the work study techniques. They could probably be applied, for example, to laundries, catering, clerical work and maintenance, but not necessarily across the main field of hospital activity. It may be that management consultants will have a real contribution to make to the hospital service and if, on a full understanding of the special problems involved they would wish to make their illustrative surveys and feel confident of worthwhile results, we should certainly not lightly reject their offer. A few hospital managements have already engaged the services of industrial consultants for specific problems affecting ancillary and clerical staffs.

I hope that the House will see that we are alive to the importance of this subject. We shall continue our efforts to apply these techniques in all cases where they would be of benefit. We recognise that it is not a straight industrial, or business operation. We realise that we have to use the experience that is available in a rather special way, but we believe that in this field of very well worthwhile expenditure opportunities must exist. Perhaps they can be disclosed by our own Department and others can perhaps best be made use of when they are the product of outside expert advice, but we believe that we should be very wrong not to make the utmost use of all the knowledge that exists on this kind of technique which has been applied so successfully in other fields.

Therefore, although we have had only a short debate this evening, it has been a useful one. I would have welcomed the opportunity of enlarging on the matter a little more. I am convinced that by what he has said this evening my hon. Friend the Member for Battersea, South and the right hon. Lady have given us many things of——

It being Ten o'clock, the debate stood adjourned.

Committee Tomorrow.