HC Deb 24 January 1989 vol 145 cc856-9
3. Mr. Allen

To ask the Secretary of State for Health when he anticipates making a statement to the House on the National Health Service review.

6. Mr. Macdonald

To ask the Secretary of State for Health what representations he has received concerning the Government's review of the National Health Service.

12. Mr. Squire

To ask the Secretary of State for Health if he will include the abolition of the regional health authorities in his review of the National Health Service.

18. Mr. Blunkett

To ask the Secretary of State for Health if it is his intention to bring forward proposals to remove local authority representatives from district health authorities.

20. Mr. Yeo

To ask the Secretary of State for Health what representations he has received regarding the working of the internal market of the National Health Service.

Mr. Kenneth Clarke

I shall be publishing a White Paper on Tuesday 31 January. I shall make a statement on that day.

Mr. Allen

Is the Secretary of State aware that Nottingham district health authority which covers my constituency of Nottingham, North, as well as his own constituency, meets on Thursday? Will that be the last ever meeting at which there is local authority representation on the health authority? Is the right hon. and learned Gentleman aware that the health authority is underfunded by £8 million, even on his own reckoning? Will he use the review to put that money back into the health authority or will the review be used to fiddle the figures and get rid of the RAWP formula?

Mr. Clarke

Nottingham health authority, like all the others, is a statutory body and legislation would be required to change its composition or its powers. The hon. Gentleman quoted the figure of £8 million. That is the target for the spending set under the RAWP formula, and one to which the region is much nearer than it has ever been before. The target is not any measure of underfunding—the hon. Gentleman is misusing the figure when he quotes it in that way. It is a target towards which the Government have moved the health authority rapidly.

There has been a huge growth in the resources going to Nottingham health authority over the past few years, not least because of the Government's consistent policy of sharing resources more fairly across the country and making sure that they are provided more equally than they used to be.

Mr. Macdonald

Does the Secretary of State appreciate that the National Health Service spends less of its budget on administration and bureaucracy than Marks and Spencer does? Is he committed to maintaining that level of efficiency? If so, will he give a categorical assurance that as a percentage of the National Health Service budget administrative and bureaucratic costs will not increase once the review proposals are implemented?

Mr. Clarke

I am not responsible for Marks and Spencer, so I cannot make the instant comparison that the hon. Gentleman seeks to make. We need a non-bureaucratic and effective management system. Many of the figures bandied around about administrative costs of the National Health Service are not always what they appear because they tend to include only the staff costs of the health authorities which are, of course, just a small proportion of all the administration that goes on in hospitals and units throughout the country.

Mr. Squire

Does my right hon. and learned Friend accept that many people are concerned about the continuing high cost of bureaucracy in the Health Service and that many, if not all, of the powers currently exercised by the regional health authorities could be devolved to the district authorities if not to the hospitals? If the Department of the Environment can negotiate successfully with 400 local authorities, presumably my right hon. and learned Friend's Department can manage with fewer than 200 district authorities.

Mr. Clarke

What we want is good quality decision-making and the right choice of priorities and that needs clear lines of management responsibility and accountability. We want good, effective management involving all the people in the Health Service and no bureaucratic systems at all. My hon. Friend will have to judge our proposals when he sees them in the White Paper. I agree with his instincts that the best decision-making is often taken at the lowest level in large organisations and in this case it should take place as near as possible to the place where the patient has to be treated.

Mr. Blunkett

Just in case I am accused by The Guardian of reading my question, as I was last Friday, I shall put my notes down on the Bench.

Will the Secretary of State confirm that, if the press speculation is correct, he believes that elected members at local level interfere politically with the management process? If he believes that, does he agree that that applies at national level and that if he removes elected members who are accountable at local level the first elected member who should be removed from interference with the Health Service is himself?

Mr. Clarke

I sympathise with what the hon. Gentleman says about reporting in The Guardian. It is because we have such experiences that I do not always answer questions which begin, "If speculations in the press are to be believed". I ask the hon. Gentleman to wait until he has read the White Paper proposals and the arguments in favour of them. I should then be grateful for his contribution and comments on the arguments.

Mr. Yeo

Does my right hon. and learned Friend agree that the introduction of a more free internal market within the NHS would contribute, first, to a reduction in waiting lists in some areas and secondly, to keeping the costs of treatment down; and, thirdly, would enable those doctors and nurses who are particularly good at providing certain kinds of treatment to offer their skills for the benefit of a larger number of patients?

Mr. Clarke

There is now widespread interest in the concept of internal markets inside the NHS. The Government's review team has probably taken the work on internal markets and the possibility of turning that idea into a practical reality further than most other groups.

The point of interest in this subject is exactly as my hon. Friend says. We are seeking methods whereby money can move to those places where it will be used most effectively on behalf of the patients, so that where good quality care is being given by hospitals in response to the demands of GPs and their patients the resources will follow quickly and directly and people will have the incentive to do more.

Mr. Gill

What assurance can my right hon. and learned Friend give the House that under the terms of the review urgent attention will be paid to the important aspect of putting managers in a position to manage without the unnecessary constraints of bureaucracy?

Mr. Clarke

That must be an important aim in strengthening the NHS. We want everyone in the Health Service—managers, doctors, nurses and others—to be in a position to take clear, quick decisions in the interests of the patient. At the moment, as we all know, that clear, quick decision-making and choice of priority is not always made and the system is certainly capable of some improvement.

Mr. Rowlands

If the review is meant to cover the question of contracts for consultants, will it also cover the abuse that appears to be taking place whereby those consultants are recruiting their private patients from long waiting lists, particularly in the hip section and the ear, nose and throat section?

Mr. Clarke

Waiting lists are shorter than they used to be and we are making progress in bringing down waiting times. The waiting times initiative has already enabled 200,000 extra in-patients and 120,000 extra day cases to be treated. The key is waiting times. I can assure the hon. Gentleman that the Government are determined to put a great deal of effort into getting waiting times down to more acceptable levels in areas and specialties where they are excessive, although in a great deal of the service and in many specialties there are no longer excessive waiting times and I am glad to say that we are making substantial progress.

Mr. Atkinson

Will my right hon. and learned Friend's White Paper next week also include his response to the Griffiths report on community care and if not, when we can expect that response?

Mr. Clarke

No, it will not, but we owe the House and Sir Roy Griffiths and his colleagues a response to their report. It is an important subject and I hope to come forward with the Government's conclusions in the not too distant future.

Mr. Robin Cook

Has not the Secretary of State's White Paper now been so thoroughly leaked that it is already shot full of holes? Now that he has been good enough to give us a date for bringing forward his White Paper, will he tell us when he intends to respond to the Griffiths report which has been gathering dust for almost a year? Does his White Paper say anything about community care for the elderly? Does he recognise that if the only thing that his White Paper offers the elderly is a tax subsidy for private medical care it will be transparent that the only health problems he is worried about are those out of which someone else can make a profit?

Mr. Clarke

It is certainly true that there has been a great deal of speculation about the White Paper and it was predictable that the hon. Gentleman should denounce each and every proposal that he thinks we shall make. At least the knee-jerk reactions of the Labour party are now out of the way. I hope that we have cleared the ground for a serious discussion when the White Paper appears on 31 January. We shall follow it up with our reactions to and our decisions on the Griffiths proposals on community care as soon as possible.