HC Deb 01 November 1988 vol 139 cc808-10
5. Mr. Brandon-Bravo

To ask the Secretary of State for Health how he intends to improve value for money in the National Health Service.

Mr. Kenneth Clarke

We remain committed to ensuring that health authorities continue to improve efficiency in all areas in order to maximise the resources available for patient care. We expect authorities to look critically at all their unit costs, including supplies, energy and, increasingly, clinical costs. Substantial progress has already been made by authorities with over £700 million worth of cost improvement savings expected to have been diverted into providing patient services by the end of this financial year. Health authorities have increased the number of patients they have treated at a faster rate than the increases in their expenditure, and they should continue to do so.

Mr. Brandon-Bravo

I am sure my right hon. and learned Friend will agree that few reasonable people would quibble with the concept of value for money in the Health Service or anywhere else in the public service. I seek assurances on behalf of the well-run districts which believe in value for money and sensible budgeting, and understand that there are 12 months in a year, and not 10 or 11, as some districts seem to think. I ask for an assurance that sensible, well-run districts will not lose money as a result of the activities of profligate ones, and that their income will be properly protected.

Mr. Clarke

I can give my hon. Friend that assurance. The Department allocates all its money each year and does not keep any in reserve centrally. Authorities receive their allocation—allocations are based on the same principles throughout the country—to improve their patient services by a combination of the new money and their efficiency in making use of it. It would be wrong to raid the budgets of better-run districts to help those who get into difficulties. The Health Service sees increasingly that authorities have the remedy in their own hands when they face any short-term financial problems.

Dr. Moonie

Does the Minister agree that the poorest value for money in the Health Service arises from closing acute units for two months at the end of the year? Will he guarantee that that disgraceful situation which occurred in the Health Service last year will not be repeated this year?

Mr. Clarke

I covered that point in reply to my hon. Friend the Member for Nottingham, South (Mr. Brandon-Bravo). We allocate money in England on the same basis to all authorities, using the RAWP formula. The vast majority of health authorities are extremely successful at using that money, increasing their efficiency and increasing the number of patients they treat. Obviously all the authorities face difficult problems and some get into difficulty with their services. I believe that we have provided the funds to enable the service to be expanded and we should see a reduction in local difficulties which crop up from time to time.

Mr. Latham

Does my right hon. and learned Friend accept that mothers-to-be will not regard it as value for money if the Leicestershire health authority tries to close all rural maternity units? Will he tell the authority that such policies are simply not acceptable in rural areas?

Mr. Clarke

We have a well-tried procedure whereby there is full consultation about proposals of that kind. Eventually the proposal comes to my Department and my hon. and learned Friend the Minister of State would have to approve any closure proposal. There are long-standing arguments all over the country about whether the service is most effectively provided in small maternity units or in the maternity sections of large district general hospitals. If the proposal comes to us, we will look very carefully at the particular situation in Leicestershire and at any representations that my hon. Friend and his constituents wish to make.

Mr. Allen

Does the Minister agree that the best value for money is to be found in preventive medicine rather than in trying to treat ailments after they have developed? Will he therefore even at this late stage read the document produced by his district health authority's local dental committee and the document from the local optometrists, which demand that the changes in the amounts charged for dental examinations and eye tests should not proceed today? Will he read those documents?

Mr. Clarke

I have read those documents, and obviously it would be most sensible for me to address myself to the arguments that they contain later, when the hon. Gentleman and I will have an opportunity to debate the matter. Of course I agree that preventive medicine is the best value and should be encouraged. I do not agree that the proposed charges will reduce the amount of preventive medicine. I would regard a decision to keep the charges in the pockets of the six out of 10 of the better off who will be liable to them as a very poor use of resources which could be put to much better use elsewhere in the Health Service.