HL Deb 22 July 1975 vol 363 cc147-50

My Lords, I beg leave to ask the first Question which stands in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government what steps are being taken to avoid an excessive growth of administrative staff in the re-organised National Health Service operating against the primary objective of patient care.


My Lords, my noble friend will be aware that my right honourable friend the Secretary of State for Social Services has expressed dissatisfaction with the management arrangements resulting from the form of reorganisation introduced by the previous Administration. However, we are doing our best to ensure that management costs are kept to the minimum necessary to maintain an acceptable standard of patient care. A planning system is being introduced to ensure that health authorities bring commitments, including staff employed in administration, into balance with resources according to established priorities. Authorities are fully aware of the need for strict economy in appointments to management posts generally.


My Lords, while thanking my noble friend for that Answer, may I express my sympathy with the Secretary of State for the legacy she inherited? May I ask my noble friend whether he is aware that drastic economies can and must be made by the reorganised Service without affecting the care of patients? Would he agree that in any event there is a logical case for either the reduction or the abolition of Regional Health Authorities, where much planning is done in ivory castles but very little by way of practical care for the patient?


My Lords, broadly speaking, the Government would accept what my noble friend has said. Nevertheless, we are in a position where we have to accept the reorganisation and structure as it is. We are not unmindful that a good deal has to be done on the administrative side. This is a matter which my right honourable friend has very much in mind, and in hand.


My Lords, may I ask my noble friend whether the Secretary of State has looked at the way in which the salaries of the administrative staff have spiralled? Will he also look into the question of how far their salaries are fixed by bodies over which the Minister appears to have no control?


My Lords, I can say to your Lordships that we have this matter in mind. Some senior and middle management grades are subject to control by the Department. These are posts which start at about £4,008, rising to £4,983. An allocation of a quota of posts has been imposed on each region.


My Lords, can my noble friend tell me how the ratio between the administrative and nursing staffs has altered, and to what extent?


My Lords, the ratio of administrative and clerical staff to consultants, doctors, nursing and ancillary staff is as follows. In 1970, there was one administrative person as against 7.6 consultants, doctors, nurses and ancillary staff. The ratio fell in 1971 to one as against 7.5; it fell again in 1972 to one as against 7.4; and in 1973 the ratio was one as against 6.9. I am sorry that I cannot give your Lordships the 1974 figures, because these are not available.


My Lords, is the noble Lord aware that there are naturally difficulties in any reorganised Service, because it takes time to settle down? Is he also aware that the reorganised National Health Service absorbed whole departments from the local authority health departments? Therefore, necessarily, the administrative staffs increased and I do not think it either generous or right of the noble Lord to blame all his difficulties on the previous Government.


My Lords, I was not aware that I had done that. I merely said that I did not like it, which is rather different. It is not true to say—I am not suggesting that the noble Lord said this, but he may have implied it—that all the staff employed by local authority health departments were transferred on 1st April 1974. The fact is that we are alive to the situation, and I want to assure your Lordships that we are dealing with it.


My Lords—

Several Noble Lords


The LORD PRIVY SEAL (Lord Shepherd)

My Lords, with respect to my noble friend, the noble Baroness, Lady Robson, has been trying unsuccessfully for some moments to put a question.


I thank your lordships very much. I am very polite, my Lords, so I do not start speaking until I get on my feet. May I ask if the noble Lord, Lord Wells-Pestell, agrees that, irrespective of whether or not one agrees with the present structure of the National Health Service, a large part of the high administrative costs can be attributed to the proliferation of designated posts at all levels of the Service coming out from the departments? Is the noble Lord aware that it seems to many working within the Service that posts such as area linen service managers and sector administrators are unnecessary at this time of shortage of money? Also, will the noble Lord agree that the Whitley machinery is to a certain extent being used to advance career structures by creating posts at high levels?


My Lords, we are not unmindful of what the noble Baroness has said, but I said in my Answer to my noble friend that a planning system is being introduced to ensure that health authorities bring these commitments into balance with resources and priorities. This is one of the matters we are dealing with.


My Lords, is the Minister aware that this is the fourth time that I have tried to speak? Will Her Majesty's Government accept that improvements and economies which could be made in the Health Service can be made only by the co-operation of the administrative and medical staffs, and that this co-operation has been made a great deal more difficult by the re-organisation of the Health Service?


My Lords, I do not think any useful purpose would be served by my saying that I agree. What we must give our minds to is the fact that certain difficulties exist. It is not much use thinking in terms of the past, but rather we should deal with the problems that face us at the moment and try to do something about them.


My Lords, is my noble friend aware that I should not have been so keen to ask the question which I am now going to ask if it had not been for his first Answer, which suggested that the previous Government were responsible for the changeover? Can my noble friend tell me, as a past member of a hospital management committee, whether the new organisation which now exists is more efficient than the organisation it replaced?


My Lords, I do not think the Government are in any way questioning peoples' efficiency. What we are concerned about is keeping some trends within certain limitations.

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