HL Deb 18 July 1979 vol 401 cc1448-55

4.I4 p.m.


My Lords, with the leave of the House, it might be convenient if I were now to repeat a Statement made in another place by my right honourable friend the Secretary of State for Social Services on the Report of the Royal Commission on the National Health Service. The Statement is as follows:

" The Royal Commission, set up by the right honourable gentleman the member for Huyton in 1975, have presented their report to my right honourable friend the Prime Minister. It has been published today, and copies of the full report are available in the Printed Paper Office.

" The Government are grateful to the Chairman, Sir Alec Merrison, and the other members for the time and trouble they have devoted to this important task.

"The Commission's Report is long and detailed. It merits careful study. Today I can make no more than a preliminary reference to a few of the issues with which it deals.

" The Commission recommend that the administration of the Health Service should be simplified by eliminating, in most cases, one tier of management; and they recognise that management decisions should be taken at the lowest effective level.

"A number of the Commission's recommendations will be costly, as they themselves recognise. They state, and I quote, 'It would be unrealistic to suppose that the fortunes of the NHS can be insulated from those of the nation '.

"On the question of private practice, the Commission see no objection to a significant expansion of the private sector, providing that the interests of the NHS are adequately safeguarded. Nor do they consider the presence or absence of pay beds in NHS hospitals to be significant at present from the point of view of the efficient functioning of the Health Service. It is, of course, the Government's policy to welcome the contribution that independent medicine can make to the health care of the nation, and we published our proposals in a consultative letter last month.

" I would like to tell the House how we propose to handle the report. This report has been made to the Government, and it is now tip to the Government to respond with our own proposals. On the major issues of structure and management we shall put forward proposals in a document in the autumn, and will invite early comments on that document from the interests affected. Subject to this consultation, it is our view that early progress is essential to simplify the structure of the Health Service and to devolve management authority to the lowest effective level.

" A number of the Commission's more detailed recommendations will be studied by the Health Departments through the ordinary machinery.

" Finally, Mr. Speaker, this Statement deals with general matters relating to the United Kingdom. My right honourable friends the Secretaries of State for Scotland, Wales and Northern Ireland will be making separate arrangements for dealing with those recommendations which relate to their separate interests."

My Lords, that is the end of the Statement.

4.18 p.m.


My Lords, we are grateful to the noble Lord the Minister for repeating this Statement. If I begin by making a complaint, I think the noble Lord knows me well enough to know that it is not directed at him personally. However, I really do feel that it was lacking in consideration that the Opposition parties in your Lordships' House received no copy of that report. I myself did not receive a copy of the report until 3.30 this afternoon, although obviously copies must have been made available to the Press on Monday, or certainly yesterday, because the recommendations of the Commission were printed in the mid-day papers of today and there was a very lengthy announcement of their recommendations on the one o'clock news on the BBC. I could not even get hold of a copy of the brief report of the recommendations—I am referring to this one here—until three minutes to half-past three; and there was only one copy in your Lordships' House at a quarter to two, and that was in the Library.

I feel that in a matter of some import the Opposition should have access to reports when they have obviously been made available to the Press on the previous day. I received a copy of the Statement which the noble Lord has just made only at about 10 minutes past three this afternoon. As I say, I think it is important that in matters of this kind, the Opposition should be furnished with copies. I hope, therefore, that the noble Lord will have a word with his right honourable friend. It is not so much that I am complaining about personal treatment but that the Opposition, in a matter of this kind, should be better informed much earlier.

The only thing I want to say is that the report, after three years of thorough investigation, has endorsed the fundamental principles upon which the National Health Service was established by Nye Bevan 31 years ago. I call in aid two of their recommendations: one is that the service should be nationally financed and charges should be abolished so that the service once again is wholly free at time of use.

We on this side of the House all welcome strongly the Commission's proposals to move us towards a more integrated Health Service than even, I think, Nye Bevan himself felt able to introduce. I refer to the Commission's recommendations that an option should be introduced for a salaried general practice, that Family Practitioner Committees should be integrated with the rest of the Health Service and that the Health Services Board should have still tighter control over the development of private hospitals, and I emphasise this because we have rumours that the party opposite want to get rid of the Health Services Board.

We on this side of the House have always fought to improve the standard of the Health Service, and the Commission endorse our view in so far as they say that more should be spent; and I am sure it is not by coincidence that they pick out the very things in the community which we ourselves picked out and which appeared in our election programme: that the prevention services and services to children, the elderly and mentally ill are priorities where there must be extra spending. I do not want to labour this but the Royal Commission criticise the cumbrous multi-tier structure of administration which the right honourable gentleman Sir Keith Joseph was responsible for, and they endorse the move towards single district areas which we initiated when we were in government.

I am quite sure that the Royal Commission are right in suggesting that the trade unions and the health departments need to work more closely together to improve industrial relations, and we on this side of the House were particularly glad that the Commission welcomed the proposals which we worked out with the unions when we were in office for new procedures to deal speedily with local disputes. I am disappointed that the Commission did not see the fundamental need to establish a public sector firm in the drugs industry, but they have made useful recommendations about improving the information that doctors get on drugs and to encourage generic prescribing.

I want to conclude with just one other quotation from the Commission's report. It says: In our view of the National Health Service as it exists, we found much about which we can be proud. Our examination of foreign health systems for the most part reinforced that view. If in considering some aspects in detail we have made specific criticisms we have done this in the hope that in the future the National Health Service can provide a better service, not because we think it is in danger of collapse "— as we are so often told by friends of the noble Lord opposite!

I want now to put three questions to the noble Lord. First, whether his right honourable friend the Secretary of State joins with the Commission in endorsing the present method of financing the service, and will he give an undertaking that he will not consider any divisive method of insurance financing of the type which was headlined in last Monday's Daily Mail?

With regard to pay beds, I want to ask the noble Lord whether the Secretary of State will abandon his politically inspired plan to abolish the Health Services Board, which deals with pay beds. We think this would be a major step forward in improving industrial relations, and I want to ask him whether, instead, he will strengthen its powers, as recommended by the Commission. Whatever we may feel from a political point of view about pay beds we cannot deny that the Health Services Board, which has met regularly under the chairmanship of the noble Lord, Lord Wigoder, a Member of your Lordships' House, has done really magnificent work. That work has been commended in the Commission's report and the implication is very clear that it should continue.

My final question is on a matter of spending. Will the noble Lord the Minister ask his right honourable friend the Secretary of State to undertake that the budget for the service will not only be protected from all cuts in public spending, but increased to enable the Commission's spending recommendations to be implemented?

4.26 p.m.


My Lords, we on these Benches wish to join with the noble Lord, Lord Wells-Pestell, in thanking the noble Lord, Lord Cullen of Ash-bourne, for repeating the Statement made in another place. With regard to both the content of the Statement and the very complex and lengthy report to which it relates, the noble Lord will understand that we will wish to study these very carefully before coming to final conclusions.

In that connection is it not perhaps regrettable that the shortened version of the report, which was apparently issued to the Press at noon today, was not available for noble Lords in your Lordships' House until a few minutes ago? Nevertheless, we would wish to congratulate and thank Sir Alec Merrison and his colleagues for the speed—perhaps a speed uncharacteristic of a Royal Commission—with which they have reported on a very complex and urgent matter. It is a degree of speed which appears to have been achieved without detriment to the quality of the report.

I should like to conclude by asking the noble Lord two questions. First, will Her Majesty's Government rapidly endorse what is said in the report about the dedicated work of some of those employed in the National Health Service, which has maintained the standards of health care in the service during very difficult times and in the face of an ever-increasing workload?

Secondly, I would ask the Government to ponder most carefully recommendation No. 112 in the report, regarding the phasing out of charges levied on the patient at the time of the patient's need. In that connection, is it not unfortunate that Her Majesty's Government should have seen fit to " jump the gun ", as it were, with regard to prescription charges without awaiting the publication of this report? And will the Government note, as is demonstrated in the report, that the need for a prescription bears no relation to the demands made by the patient on the service? One patient may take an hour of the doctor's time for advice, need no prescription and have no charge; whereas another patient with a chronic ailment may take two minutes and yet need a prescription with six items costing two or three pounds.

Finally, will the Government give your Lordships' House an early opportunity to debate very important matters within the report, such as the administration of the National Health Service and the need to phase out one tier of administration while preserving some local and consumer accountability and, of course, the need for vastly improved industrial relations within the National Health Service, before rather than after the Government make up their own mind on these important matters? I think noble Lords in all parts of your Lordships' House have important and well-informed advice to offer on these matters.


My Lords, I am grateful to the noble Lord, Lord Wells-Pestell, and to the noble Lord, Lord Winstanley, for what they have said. I am sorry about the non-availability of the report. I understand that that was not in any way our own fault but that of the people delivering the reports. I myself managed just before lunch to get hold of one from the Department; but there was not one in this House, and I have not really had time to read it either. There was no discourtesy intended; it was simply unavoidable.

I do not know whether I can well answer the questions which have been put to me, because this is a report which has taken three years to produce. There are 400 pages; there are 100 specific recommendations and many other suggestions for further study and work. A really vigorous period of consultation will now take place. There are some matters on which the Royal Commission fully agree with the Government's thinking, and some on which they do not; I think I would be unwise to give any indication as to what the Government's final suggestions and recommendations will be until those consultations are over. I should like, if I may, not to go any further than that, and would thank the noble Lords for what they have said.


My Lords, I welcome in particular the last sentence of the Statement which my noble friend has repeated; namely, that the Secretaries of State for Scotland and Wales are expected to make separate recommendations in due course. In the presentation of any proposals will the Government make very clear that there is a different and separate system of health services in Scotland, for which the Scottish Secretary and the Scottish Office are responsible, and not the DHSS. Will they also especially bear in mind that, in that Scottish system, which was restructured in a Scottish Act in the early 1970s, there is only one tier of health boards. While that Scottish service may be far from perfect, whatever criticisms are being levelled and have been levelled at the Health Service in England and Wales, many of those criticisms are not applicable to the Health Service North of the Border.


My Lords, I wonder whether I could follow on, if I might, what the noble Lord, Lord Wells-Pestell, said, but from a rather different angle. I am asking really about the handling of Statements of this kind. In the old days papers about which announcements were being made were normally laid immediately after the announcement, though there had no doubt been some Press conference and possibly a hand-out before that. In this case there seems to have been an abbreviated report that was available in very small quantities, so that what we had, if I may say so—I hope I give no offence in this to the noble Lord, Lord Wells-Pestell—were questions not about the Statement being made but about the contents of a report which nobody had seen, even in brief, except the noble Lord, Lord Wells-Pestell, himself. I feel that this is not a very satisfactory way of proceeding, and I wonder if my noble friend will take this into account.


My Lords, I am grateful to my noble friend Lord Campbell of Croy for pointing out the differences between Scotland and England, and I am also grateful to my noble friend Lord Drumalbyn for what he has said.