§ 6. Mr. Christopher Hawkinsasked the Secretary of State for Social Services what response there hs been to the publication of the first annual report on the National Health Service.
§ Mr. Kenneth ClarkeThe report has been widely welcomed as a clear description of the developments and 174 achievements of the Health Service in England over the past five years and of some longer-term trends over the past decade.
§ Mr. HawkinsDoes my right hon. and learned Friend agree that the main conclusion to be drawn from the report is that we have significantly expanded the Health Service and that it is safe in our hands? Will he ensure that if the annual report is repeated in future years more emphasis will be given to the performance of the Health Service in the regions, rather than just the national position?
§ Mr. ClarkeI agree with my hon. Friend. The report focuses attention on the real measure of what is happening in the Health Service—the number of patients treated and the results in patient terms. The report shows that in 1983 alone 300,000 more inpatients were treated in our hospitals, which is a bigger increase than the Labour Government achieved in five years. I agree that future annual reports should show more on progress, perhaps broken down by regions.
§ Mr. MeadowcroftI recognise the usefulness of the report, but is not one of its defects the fact that it fails to evaluate whether the people of this country are actually healthier, and merely seeks to determine whether more people have been treated, which is far from the same question?
§ Mr. ClarkeThe health status of this country remains extremely good. I see no evidence that people are getting more ill. There is, however, evidence that the Health Service is providing ever more treatment.
I agree that we should consider how to give more emphasis to preventive medicine so that people do not become sick in the first place, as my hon. Friend suggested yesterday. We are concentrating on all those areas because the purpose of the entire system is to look after the health of the country.
§ Mr. EggarI welcome the annual report. May we hope that future reports will set clear performance targets for each region and assess performance against those targets?
§ Mr. ClarkeWe are devoting a great deal of work to producing a credible means of measuring the performance of authorities. That is now well advanced and the sooner we can put it in place and have a real means of comparing performance in different areas the better it will be for all of us, including the service and the patients.
§ Mr. Carter-JonesDoes the Minister accept that the whole House would approve that part of the report which describes the advantages of taking elderly people out of hospital and into the community? Will he tell the House now or publish in the Official Report, the impact of rate-capping on that highly desirable exercise?
§ Mr. ClarkeI am grateful for the hon. Gentleman's support of our policy of care in the community, which reduces the number of unnecessary long-stay hospital patients and provides better facilities elsewhere in the Health Service and in the community. I do not believe that rate-capping need have any impact on that. Rate-capping affects the totality of local authority expenditure. It affects the expenditure of those local councils which are spending excessively across the whole range of their activities. It is thus quite wrong to suggest that its impact need affect desirable community care, which other authorities provide without getting into trouble with rate-capping.
§ Mr. ChurchillWhile I warmly welcome the positive step that the Government have taken to increase the number of kidney donor transplants, is my right hon. and learned Friend aware of the great anxiety about the inadequate provision of dialysis? Does he accept that it is wholly unacceptable, given the resources already within the Health Service, that each year several hundred people are condemned to death by the failure to provide a known treatment?
§ Mr. ClarkeThroughout our period of office we have recognised the need for more renal treatment and have given it a high priority. The figures show that we are increasing the number of patients substantially each year. Now that our new drive is going forward on the transplant programme in particular, the transplant figures are extremely encouraging. Obviously we have further to go. With respect to my hon. Friend, the figures that he quoted in the second part of his question are of an elastic quality, because we depend on a mass of statistics. His emotive language is not justified by facts from hospitals. It is not necessary to dramatise the case in that way or to persuade us of what we already know, which is that there is a need to continue to develop the kidney services.
§ Mr. MeacherHow does the Minister justify blocking the appointment of general managers whom Conservative health authorities wish to appoint, for example, in the Oxford region and Lambeth, when at the same time he insists on appointing as chairman of the NHS management board a man who, at his press conference, admitted that he knows little about the NHS and always uses private health insurance for his family, and whose immediate background is confined to the Port of London Authority and the National Freight Corporation?
§ Mr. ClarkeWe shall come to questions about the specific issues later. The point is that if we are to improve the service, put more money into it and get better value for money we must, among other things, improve its management. With a good, cost-effective management more patients are treated, whatever resources are available at a given time. It is wrong for the hon. Gentleman to question us, although he is entitled to do so, about what he perceives to be inadequacies in the service, and then to say that Ministers should not take a view about who holds key posts within it. Presumably, the hon. Gentleman prefers jobs for the boys, Buggin's turn, to allow NALGO to dominate the process, or whatever else takes his fancy. The new general manager of the NHS has an excellent track record of management, which is now being put at the service of the NHS and its patients. That is a wholly welcome development.