HC Deb 19 July 1977 vol 935 cc1363-6
8. Mr. Clemitson

asked the Secretary of State for Social Services if he is satisfied with the results of the reorganisation of the National Health Service.

Mr. Ennals

This Government's views on the 1974 reorganisation of the NHS are well known. When the Labour Government came into office three weeks before the date set for reorganisation of the Health Service, one of their first decisions was that it was not practicable in the time available to delay the reorganisation or to attempt to change immediately those features which it opposed.

We continue to have serious reservation about the structure of the NHS and we have asked the Royal Commission to look at this. Pending consideration of its report, it would in my view do serious harm to the Service to effect an early across-the-board reorganisation.

Mr. Clemitson

I am glad to hear that answer, because it is now generally accepted that the reorganisation has hardly been an unqualified success. Has not one of the results of it been that a higher proportion of resources has been spent on administration and consequently, a lower proportion on the patients? Is it not about time that we learned from our mistakes?

Hon. Members

Their mistakes.

Mr. Ennals

It is true that if we are to learn we must learn from the mistakes of others and also the mistakes of McKinsey, which gave advice to my predecessor. The Opposition already seem to have learned their lesson and to have recognised that the reorganisation is far from being a success. I agree with much of what my hon. Friend has said about administration and the fact that it has caused us who have responsibility for the NHS to do a great deal of work in slimming the administration without changing the structure. We are now going through a process of reducing management costs to make more funds available for patient care.

Mr. Fry

Whatever the merits or demerits of the original reorganisation, is there not now real concern, particularly in the Northampton area, about the way that the reorganisation is working in respect of the allocation of funds from the Oxford Region? Is the right hon. Gentleman prepared to meet a deputation of hon. Members representing Northamptonshire constituencies to discuss this unfairness before swingeing and damaging cuts must be made?

Mr. Ennals

Some months ago I received a deputation of hon. Members to discuss the situation in Northamptonshire, just as my colleagues and I have received deputations from people in many parts of the country. When we come to making the allocations for next year, we shall take all these things into consideration. I want to say to the whole House that the policy upon which the Government have embarked—of a redistribution of resources to ensure that traditionally deprived regions will get a higher rate of growth—is a policy that we shall stick to in the interests of social justice.

Mr. Pavitt

In view of the fact that the Government will be unable to make basic changes before 1982–83, in these slimming operations will the Government consider making immediate arrangements to get rid of one tier of the NHS—namely, the area health authority tier? Will the Government make the necessary arrangements for the redistribution of funds and people during the next two years so as to bring organisation down to a district level instead of there being an area authority?

Mr. Ennals

That would be a revolutionary change and would anticipate whatever the Royal Commission might decide. Some would say that if one tier were to be removed it should not be that one. I have made it clear to the health authorities that where they believe that it is in the interests of the management of the service, provided that there has been effective consultation with the local authorities and staff, I am willing to look at any changes that would create more single-district areas and change the balance. However, an across-the-board change such as my hon. Friend has suggested would undermine the work of the Commission.

Mr. Patrick Jenkin

Does the right hon. Gentleman recognise that we would go a long way to endorse the plea which has just been made by his hon. Friend the Member for Brent, South (Mr. Pavitt)—where, perhaps, the slogan ought to be "Prepare to shed thy tiers"? Does not the Secretary of State remember that no fewer than four Secretaries of State in the Labour Government last year signed a report which committed the Government to saying that the reorganised National Health Service provides an improved administrative framework within which it is now possible to look at priorities more comprehensively and to plan the allocation"—

Mr. Russell Kerr

Who wrote that?

Mr. Patrick Jenkin

It is signed by the right hon. Members for Blackburn (Mrs. Castle) and Kilmarnock (Mr. Ross), the Secretary of State for Wales——

Mr. Speaker

Order. We are getting untidy. This is a time for seeking information rather than for making arguments.

Mr. Patrick Jenkin

Will not the right hon. Gentleman give credit where it is due?

Mr. Ennals

I did not sign the report.

Mr. Patrick Jenkin

Your predecessor did.

Mr. Ennals

I did not. Nevertheless, there have been aspects of the reorganisation which have produced some improvements in administration, partly because they have brought together the community and the hospital services. That was an important step forward which would have been in any proposals, whether they were made from the Labour or the Tory side. I am glad to hear that the right hon. Gentleman has been reviewing the situation and is shedding "tears", be they crocodile or whatever else. I welcome the fact that he is now crying over the mess the Conservatives made.

Mr. Beith

If we are to have to make the best of a bad job, at least for the time being, is it not important that the right hon. Gentleman does all he can to try to get management decisions affecting local institutions taken at a more local level rather than have so many people running around in cars telling others in institutions to which they have never been before what to do?

Mr. Ennals

The hon. Gentleman is absolutely right. We have to operate at the moment as best we can within the structure we have. That is the way in which I am approaching this. That means that we need much more effective joint planning as between local authorities and health authorities. This move has received a tremendous stimulus by the £21 million which is available this year for joint spending by social service authorities and health authorities. This is bringing them together in a practical way that is immensely improving the quality of community service.