HL Deb 23 July 1980 vol 412 cc401-11

3.42 p.m.

The MINISTER of STATE, DEPARTMENT of EDUCATION and SCIENCE (Baroness Young)

My Lords, with the leave of the House, I will now repeat a Statement on changes in the organisation and management of the National Health Service in England, made in another place by my right honourable friend the Secretary of State for Social Services. My right honourable friend the Secretary of State for Wales is announcing his proposals for Wales today; and my right honourable friend the Secretary of State for Scotland will be announcing his proposals next week. The Statement is as follows.

"My department has received over 3,500 comments in response to last December's consultative document, Patients First. I have had an analysis of these comments prepared and a copy is in the Library; copies will be available in the Vote Office in a few days. There is considerable support for our proposal that the organisation of the National Health Service should be streamlined. I am, therefore, today issuing a circular to health authorities on the changes to be made to achieve this. Copies of this and of my Statement are in the Vote Office.

"On structure, we have decided to remove a tier of administration. Instead of 90 area health authorities administering 199 districts, we will create a single tier of district health authorities. Each will serve a population of, generally between 150,000 and 500,000 I have asked the regional health authorities to make recommendations to me on the boundaries of the new authorites by the end of next February after full consultation with interested bodies. I have told them that in order to minimise upheaval, the new district health authorities should as far as possible follow the boundaries of existing health districts (including single district areas) because this should in most cases provide a satisfactory pattern.

"I want the new authorities to enjoy considerble autonomy in managing their affairs. Greater freedom should encourage a greater sense of responsibility; and smaller authorities, closer to the communities they serve, should be more responsive to local needs.

"With a view to enhancing local autonomy still further, I intend, later on, to review the role of regional health authorities. Regions' responsibilities for strategic planning, the allocation of finance to the districts and the maintenance of financial discipline will remain. Talks will be held between representatives of the doctors, my department and the National Health Service on the future management of medical staff contracts, with a view to seeking a way of reconciling my desire for more autonomy at the local level with the doctors' genuine concern that the benefits which have resulted from the existing arrangements should not be lost.

"There is also strong support for our other main proposal—to strengthen management at the local level and remove the intermediate tier between the district and the local unit. Each district health authority, which will be served by a single management team, will therefore arrange the district's services into defined units, appoint senior people to manage them and give those people their own budgets. As far as possible, support services will be organised at that level. My objective is to get decision-making down to the hospital and the community level. In order to give authorities greater flexibility on this, I am cancelling most of the existing instructions which require them to appoint specified officers to a substantial number of posts. District health authorities will decide for themselves what posts to create.

"I attach high importance to effective collaboration between the National Health Service and local authorities. I propose, therefore, to retain the present statutory requirement for joint arrangements for collaboration. The creation of new district health authorities will however mean that in many parts of England, health authorities and local authorities will no longer have common boundaries on a one-to-one basis. It is my hope that in most cases two or more district health authorities will make up one complete non-metropolitan county. I am proposing, in line with many views put to us, that health authorities should average around 16 members—significantly fewer than existing area health authorities. Within this total, I propose that local authorities should appoint four nominees.

"There has been considerable support for community health councils; they will be retained in the new structure, with one community health council for each district. Later this year I will issue a consultative paper seeking views on their membership, role and powers. When, after a few years, we have had experience of the working of the more locally-based district health authorities, I will review the longer term case for retaining these separate consumer bodies.

"As foreshadowed in Patients First I intend to retain the structure of family practitioner committees, but I shall wish to study all the suggestions that have been made to improve collaboration with health authorities, especially in the planning of primary care.

"I attach importance to close working between the National Health Service and universities with medical schools. I will discuss with interested bodies the present arrangements for designating some health authorities as teaching authorities, taking account, for instance, of the extent to which medical students are now taught in hospitals run by non-teaching authorities.

"The changes I have announced imply no criticism of health service managers. They have had to work in what turned out to be an unduly complicated structure. It is much to their credit that the service has achieved what it has. However, staff at all levels will be affected by the changes, and there must be full consultation with staff interests on the ways in which change takes place. Staff must know that they are going to be treated fairly. We have put forward what I hope are seen as fair proposals for the filling of posts in the new authorities, for staff protection and for early retirement and redundancy compensation. These proposals are being discussed with the staff sides and I hope that satisfactory agreements can he reached soon.

"The 1974 reorganisation represented a major step forward in the integration of hospital and community health services, including primary care. It is the Government's policy, like that of our predecessors, that people should receive care in the community wherever possible. Further, the National Health Service is often criticised for neglect of prevention and of the more positive aspects of health promotion. The changes I am announcing in structure and management will, by making the Health Service much more a local service serving local communities, reinforce this priority for community care, and should lead also to the closer involvement of the public with policies to promote good health. In this, the role of the relatively new medical speciality of community medicine will be of increasing importance.

"The main purpose of the changes I am announcing is to provide a health service which is better and more efficiently managed, and where local decisions can be taken more quickly by local people. At the same time, I am confident that it will be possible to make significant reductions in management costs, and I have told the health service that I expect these to be reduced, after a transitional period, by some 10 per cent., equivalent to about £30 million a year at present costs. This will release resources which could be used for patient care.

"Mr. Speaker, management and structure, though important, will not solve all our problems. The Government have aready embarked on a number of initiatives designed to get better value for money, improve links between the health service and local communities, and raise standards. In the autumn, I intend to issue a document outlining the Government's strategy and priorities for health. The proposals I am announcing today will, when carried into effect, help to achieve what we all seek, a better service for our people".

My Lords, that is the end of the Statement. I am placing copies of it, together with copies of the circular to health authorities, in the Printed Paper Office. I am also placing a copy of the analysis of comments on Patients First in the Library, and further copies will be available in the Printed Paper Office in a few days.

3.51 p.m.

Lord WELLS-PESTELL

My Lords, we, on this side of your Lordships' House, should like to thank the noble Baroness the Minister for making this Statement. It is a very important Statement and has a large number of implications which are by no means clear as to the ultimate outcome. Perhaps this Statement is much more significant for what it does not say rather than for what it says. Before saying any more, I should like to congratulate the Government on doing what we wanted to do prior to 1974, which was to remove the area health authorities. I say that because we are in complete agreement on the desirability that this should be done and we are glad that this Government will do it.

I should like to comment on the fact that the noble Baroness the Minister said, with regard to structure and management, that a circular will be issued to health authorities today on what is implied in that. We have been rather puzzled as to why, in certain Bills that have come before your Lordships' House, the Government have been resistant to any change. That resistance is to be found today in the Health Services Bill, which is still before your Lordships' House and which has only completed its Committee stage. We question the advisability of the Secretary of State sending out this structure and management document to local health authorities when the Bill is not yet on the statute book; it is not completed. It quite clearly shows that the Government are quite resistant to any suggestion of change. By doing this I think that your Lordships' House has been quite badly treated.

Several noble Lords

Hear, hear!

Lord WELLS-PESTELL

My Lords, I want to ask about the considerable autonomy as regards the management of the affairs of the new health authorities. In point of fact, we on this side are glad that there will be considerable autonomy in the management of the affairs of the new health authorities, but we would ask the Government—and I do not ask for a reply to this now—to have regard to the fact that this can only be done if, on the district health committee, there is a sufficient number of people who have a working knowledge of the National Health Service and who are in a position to make objective judgments on what the service needs. I am thinking of those who work at the grass roots of our National Health Service—the employees. If I may say so, we are much too fond of appointing to authorities and to committees the great and the good. What we need are fewer great and fewer good people, and far more committed and concerned people. I hope that the Government will go in for the committed and the concerned, and not the others.

I am a little puzzled by what is said at the end of paragraph 6: In order to give authorities greater flexibility on this, I am cancelling most of the existing instructions which require them to appoint specified officers to a substantial number of posts. District health authorities will decide for themselves what posts to create". Are we really to understand that that is the intention of the Secretary of State? Will he not put a limit or a reservation on the number of people to be appointed and the amount of money that will be spent in consequence? I cannot believe that there will be that sort of unrestricted freedom given to the DHAs, and I am not so sure that I would welcome it if it were true.

With regard to paragraph 7, we support the first sentence which says: I attach high importance to effective collaboration between the National Health Service and local authorities". But it goes on to say that the membership of the district health authorities should average around 16, four of whom will be appointed by the local authorities. If—and I address this remark to the Minister—there is to be effective collaboration between the National Health Service and local authorities, I should have thought that there ought to be a representation of more than just 25 per cent. If my memory serves me correctly, on the area health authorities there are a third. Although I am not suggesting that the district health authorities should be inundated by local authority representatives, I shall ask the Minister to bear in mind that perhaps four is not adequate.

The same paragraph deals with the question of common boundaries, and quite rightly points out that this may not always be possible. However, I would ask the noble Baroness the Minister to ask her right honourable friend the Secretary of State to bear in mind that where it is not possible to have a district health authority that covers, shall I say, one or two local authorities, if it has to spread over into another local authority, that it will be on a district basis and not just on a small area basis. All local authorities are divided into districts. They have their district social work teams, as the noble Baroness knows better than anyone else. It ought to be clearly understood that if it has to go to another local authority area, it should take in a complete district so that there could be a working arrangement with that district's team.

With regard to paragraph 8, I note that later this year the Secretary of State will issue a consultative paper seeking views on the membership, role and powers of the community health councils. I want to ask the noble Baroness the Minister to indicate to her right honourable friend that the community health councils are, in fact, serving a very valuable purpose and that the consultative paper ought not to go only to a select member of people, but ought to go to a large number of organisations that are in touch with the consumers of our National Health Service —namely, the patients—and get their point of view.

I come to paragraph 11 because I think that this is a matter of some concern. The Secretary of State recognises that the staff must know that they will he treated fairly. But what bothers me is that he goes on to say: We have put forward what I hope are seen as fair proposals for the filling of posts in the new authorities, for staff protection and for early retirement and redundancy compensation". I know that these proposals are being discussed by the staff side, but can the noble Baroness the Minister say that the hospital staffs are really satisfied with that arrangement? My understanding of the situation is that while they are prepared for the Whitley staff side to deal with the question of posts, shall I say, they do ask for a health service staff protection commission to watch and oversee the transfer, and the effect that such transfers are going to have upon the staff.

I am very worried about the use of the word "redundancy" The Statement does not qualify it in one single instance. It does not say whether the redundancies are to be compulsory. It does not even say whether they are to be voluntary. I do wish to have, if it is possible this afternoon, an answer to that particular question.

My last word is that in paragraph 13 we come back to the saving of about 10 per cent. The noble Baroness and I have been over this ground before, but I feel strongly that we need a full explanation as to how this £30 million is going to be saved. I understand that the Secretary of State made a Statement some time ago to the effect that £45 million would be saved; that £15 million of that would be required for adjustments on the administrative side. If that is so, does it mean that the other £30 million is going to be saved as the result of people losing their jobs, either by redundancy—voluntary or compulsory—or by being discharged?

4.2 p.m.

Lord WINSTANLEY

My Lords, on behalf of my noble friends on these Benches, I should like to join with the noble Lord, Lord Wells-Pestell, in thanking the noble Baroness for repeating this important and interesting Statement made in another place.

May I ask the noble Baroness at the outset whether she will accept that the word "reorganisation" in connection with health services is calculated to strike terror into the hearts of doctors, nurses, administrators, patients, and indeed all those with connections with the health service? However, that having been said, the extent to which this Statement indicates a genuine attempt to move control and management of the health services closer to the grass roots and the people who really matter in the locality, the patients, it will be warmly welcomed on these Benches, and very fully supported.

Perhaps the noble Baroness will note that we warmly welcome the clear intention to retain, for the moment at least, the community health councils. However, with regard to the mention in the Statement of the possibility of a review of the longer-term case for retaining these separate consumer bodies, I would ask the noble Baroness to accept that until we have evolved some really democratic machinery for controlling the health service at local level, there will always be a need for a body to represent the needs and the wishes of the patient.

Finally, I would say we would wish to study this Statement more carefully before taking up detailed points. There is, however, one question I should like to put to the noble Baroness. The Statement refers to proposals for Scotland being announced next week. In so far as those proposals appear to indicate a move in the opposite direction, that is away from the grass roots towards regions rather than the reverse, may I express the hope that perhaps your Lordships' House may get an opportunity at some particular stage to discuss these proposals collectively rather than piecemeal.

4.4 p.m.

Baroness YOUNG

My Lords, I am most grateful to both the noble Lord, Lord Wells-Pestell, and the noble Lord, Lord Winstanley, for their general welcome of this Statement. May I begin my reply by assuring the noble Lord, Lord WellsPestell, that paragraph 1 of the circular clearly states, subject to the enactment of the Health Services Bill". Of course, there will be opportunities at Report stage and Third Reading for further debate on the Health Services Bill, which is still before your Lordships' House.

The noble Lord, Lord Wells-Pestell, also asked me about the composition of the new district health authorities. He asked whether they would in fact include representatives of the employees. I would assure him that the membership will include a consultant, a general practitioner, a nurse, a nominee of the appropriate university, a representative of the trade union movement, and four members appointed by local authorities. The rest of the members will be generalists appointed for the individual contribution they can make to the management of the service. He asked me also about community health councils and said that the consultative paper ought to go to the consumers of the National Health Service. I certainly will note this point and pass it on to my right honourable friend the Secretary of State.

On his points about the staff side, we have, of course, as he will know, debated this matter at considerable length in Committee on the Health Services Bill. The staff side have agreed the general arrangement for discussing the important arrangements which must be made for them in this reorganisation. We believe that the fall-off in the numbers of staff will be very largely achieved by natural wastage and early retirements. Of course, we must also look at the opportunities which can be afforded by redeployment and retraining. It would not, however, be right for me to give a guarantee that there could be no compulsory redundancies at all, but we hope that these will be the absolute minimum and we hope that most of the changes will take place in the way that I have described.

Finally, the noble Lord asked me about the calculation of the 10 per cent. saving. As he will know from our discussions before, we believe that £30 million will be saved at today's prices after the transitional period of four to five years. It certainly will not happen immediately. We estimate this to be about 10 per cent. of the management costs.

Turning to the points made by the noble Lord, Lord Winstanley, I am glad of his general welcome of this Statement. I certainly take his point about the community health councils and his support for them. They will remain as they are. The further consultations will not take place for some time yet. I am quite certain that through the usual channels an opportunity can be given to debate this whole subject, including the proposals for Scotland.

Lord WELLS-PESTELL

My Lords, I am very grateful to the noble Baroness the Minister. I do not know whether we have the same copy of the Statement: I can see no reference in mine to, "subject to the Bill becoming an Act of Parliament." Also, I note that, although this is a Statement made by the right honourable Patrick Jenkin, Secretary of State for Social Services, it starts off, "My Lords".

Baroness YOUNG

My Lords, I find it rather difficult to comment on what the noble Lord, Lord Wells-Pestell, has in his hand. Perhaps this is a matter we might resolve another time.