National Health Service: Resources (Hansard, 13 December 1982)

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

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)
My Lords, over the period since 1979 neither the NHS as a whole nor any region within it has suffered any decrease in resources, and none is now contemplated. On the contrary, the overall increase in services over the same period has been 5½ per cent. or more, and further growth is planned for 1983–84.

§ Lord Molloy
My Lords, I am very grateful to the noble Lord the Minister for that reply, which seems encouraging except when it is put against the facts. Does he realise that every time we get a statement of that kind from the Government, some great hospital, for example, Great Ormond Street and Tadworth Hospitals, are put under threat? At this very moment there are hospitals in Glasgow, and in particular the leukaemia wards, under threat of closure. There is the leukaemia ward in the East Birmingham hospital which is now under threat of closure simply because they cannot find staff. Would the noble Lord be prepared to look at the examples that I give, and perhaps inform me that the fears I have expressed on behalf of those hospitals will not be realised—or will they perhaps be realised?

§ Lord Trefgarne
My Lords, I will certainly look into the specific examples the noble Lord has referred to and let him know the position in regard to them. The question of Great Ormond Street has, of course, been discussed in your Lordships' House on more than one occasion and I do not think I need to repeat what has been said about that.
There are two real answers to what the noble Lord is asking: first, on the question of priorities, we do need to establish the right order of priorities, because there is a finite sum of money available for the health service, not an unlimited sum of money, as some people seem to think. The other thing is that we do necessarily have to decide the priorities to keep the system going smoothly. I hope the noble Lord would not want us to depart from that.

§ Baroness Jeger
My Lords, can the noble Lord say whether the figures he gave relate only to the hospital 362 service, or are they totals for the whole of the NHS, including the family doctor service and ophthalmic and dental services for which the charges to the public have gone up?

§ Lord Trefgarne
My Lords, the figures I gave related to the Question on the Order Paper, which was about the National Health Service as a whole. The financial considerations so far as the family practitioners are concerned are, of course, different.

§ Baroness Masham of Ilton
My Lords, may I ask the noble Lord if he is aware that I was at a reception last week at the London Hospital and an occupational therapist told me that that district was thinking of not supplying the Roho cushion to paralysed people? If the noble Lord is not aware of what a Roho cushion is, it is a special cushion filled with air which can stop people from getting pressure sores, thus keeping them out of hospital and saving money. Would the noble Lord please look into this and let me know?

§ Lord Trefgarne
My Lords, I will certainly look into the specific case which the noble Baroness has drawn to my attention. I suspect that the same arguments will apply in that case as in the cases that the noble Lord, Lord Molloy, put to me—namely, the question of priorities.

§ Lord Hooson
My Lords, is the noble Lord aware that over a quarter of the annual cost of the National Health Service seems to be administrative costs? If there is to be a cutting down or slimming of services, could it be confined to the administration, rather than to the medical and associated services?

§ Lord Trefgarne
My Lords, I certainly agree that that is an area that needs to be very carefully looked at. It is not always the case, however, that administrative expenditure is misspent. For example, I heard of a case recently where it paid to provide a further private secretary for a particular consultant because it freed the consultant to get on with his proper work.

§ Lord Cledwyn of Penrhos
My Lords, is the noble Lord aware of the profound concern which exists in this House, as expressed by the noble Baroness and by my noble friend, about individual cases and units, and indeed about hospitals like Tadworth? Is he able now to tell the House, in view of the encouraging statement he has made, that reconsideration will be given to the closure of these units and this hospital? His answer to that would be heard very carefully by all of us and by the country.

§ Lord Trefgarne
My Lords, there are two points, as I was saying to the noble Lord, Lord Molloy, which we need to take into account when considering specific cases like Tadworth. They are, first of all, the priorities, but, secondly, we must ensure that we get the very best value for money from the funds that we can make available. In the case of Tadworth—and the noble Lord will know that my honourable friend is considering that matter specifically and we have made additional funds available in the short term—that hospital at the moment is less than half used, and I do not think that that is the best use of the resources available.

§ Lord Hale
My Lords, would the noble Lord bear in mind that in the case, for example, of Kings College Hospital, where I have had the good fortune to have had almost continuous care for 12 months, the question of administrative costs is very largely a question of definition? They have a very remarkable system there under which the patient can spend much more time at home, with less cost to the hospital, by utilising administrative services and giving the patient special examinations from time to time at the hospital in the various departments, and supplying special treatment at those interviews.

§ Lord Trefgarne
My Lords, the noble Lord is right to point to certain changes in some of the procedures within the National Health Service in recent years—for example, the greater use of day surgery and the greater use of short stay facilities, which frees beds to be used by other patients. But one does have to remember that such arrangements do sometimes throw a greater burden on the local social services.

§ Baroness Robson of Kiddington
My Lords, does the noble Lord agree that it is generally accepted that the National Health Service needs an increase of between 1 per cent. and 1½ per cent. per annum for demographic changes which, against 5½ per cent., in my view does not leave anything for growth? Will the Minister please ask the Secretary of State not to talk about growth.

§ Lord Trefgarne
My Lords, with respect I do not think that the Secretary of State needs any lessons from me on how to address himself to these matters. We have more than covered the growth in resources required by the demographic changes to which the noble Baroness refers—for example, there has been the increase for the elderly, of which, I have no doubt, the noble Baroness is very much aware. This is a matter of which we, too, are aware, and the increase in resources that we have made available has more than covered that particular point.

§ Lord Molloy
My Lords, is the noble Lord aware that, in addition to the very valid point made by the noble Baroness, there is apprehension running through all grades of staff throughout the National Health Service? As I have said, they hear that there are to be improvements and that the NHS is safe in the hands of this Government, but within a few weeks of such statements there are threatened closures which stretch from Surrey, through London, Birmingham and Glasgow. Will the Minister please give some assurances on matters which are perturbing staff and patients about what appear to be promises made on the one hand and the reverse being applied when the promises have faded away?

§ Lord Trefgarne
My Lords, I am not going to give an assurance that money misspent in the health service will continue to be misspent or that half-empty hospitals will continue to remain so when there are other facilities nearby that could equally be used.