NHS: Scope of Inquiry (Hansard, 8 March 1983)

§ Baroness Lane-Fox
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, the management inquiry team will advise my right honourable friend the Secretary of State on further action that needs to be taken, within existing funding, to secure the most effective use and management of NHS manpower and related resources. The inquiry will not cover doctors and dentists and it will not deal with clinical matters as such.

§ Baroness Lane-Fox
My Lords, in acknowledging that very interesting reply, may I ask my noble friend the Minister whether the aim of the inquiry will be to get better value for money combined with better patient care, particularly since I understand that in the year 1983–84 the National Health Service will cost the record figure of £15frac12; billion?

§ Lord Trefgarne
My Lords, my noble friend is quite right that the sum of money anticipated is of the order of the figure that she mentioned. Certainly it is one of the purposes of the inquiry to ensure that we get the very best value for money. There are others, too, such as the ones that I described in the Answer.

§ Lord Molloy
My Lords, may I ask the noble Lord whether he would be prepared also to recommend to the Secretary of State that he should point out to the inquiring body that the fundamental feature ought to be that all doctors, nurses, specialists of all kinds and ancillary and ambulance staffs, should be provided with conditions of work that will create a great harmony which will be of benefit and increase the efficiency of our National Health Service to our fellow countrymen?

§ Lord Trefgarne
My Lords, nobody underestimates the importance of the point that the noble Lord makes, but of course there is other machinery for determining the conditions of work. For example, there is the review board for doctors and dentists and the Whitley Council machinery for the other workers in the Health Service. I do not think that it would be right to expand the inquiry that I have referred to in that way.

§ Baroness Gaitskell
My Lords, would it not be true to say that, despite all the criticism of the National 84 Health Service, most people who use it—I am one of those who has used it recently—do not find as much to blame as comes out in this Chamber? It is a real boon to most people. It is a great pity that we are always running it down in this Chamber.

§ Lord Trefgarne
My Lords, I am certain that the noble Baroness is quite right to put her question in that way, if I may say so. It is very easy to criticise the National Health Service, but we hear compliments less often.

§ Baroness Faithfull
My Lords, may I ask my noble friend the Minister whether the management team is to visit every region and every district, and how long that will take?

§ Lord Trefgarne
My Lords, the question of how the team seizes itself of the problems that it is to consider is a matter for the inquiry team itself. I cannot say whether it will be visiting all the regions or indeed any, although doubtless it will be visiting some. As for the time-scale, we hope to get a preliminary assessment of the way things are going towards the end of June and I cannot say quite how long it will take after that, if at all.

Lord Winstanley
My Lords, may I ask the noble Lord whether the management inquiry team will be able to examine the Elephant and Castle district and the Department of Health and Social Security centrally in addition to the hospitals and the health service in the regions?

§ Lord Trefgarne
My Lords, I certainly see no reason why not.

§ Lord Prys-Davies
My Lords, will the Minister confirm whether or not the Secretaries of State for Wales and Scotland are to establish a team for their respective countries parallel to this management inquiry team?

§ Lord Trefgarne
No, my Lords. This inquiry will particularly address itself to the problems of England but the conclusions which it reaches will of course be made available by my right honourable friend to his colleagues responsible for the other regions.

§ Baroness Hornsby-Smith
My Lords, can my noble friend—

§ Lord Molloy
My Lords, is the noble Lord aware that reformation and examination of the Whitley Councils—their scope broadened—must be part of the examining inquiry's writ?

Several noble Lords
Order, order!

§ Baroness Hornsby-Smith
My Lords, may I ask my noble friend whether this inquiry will study very closely the enormous increase in the administrative staff, because we hear so many speeches about how much better it was in the past than now, which I for one do not accept? But, nevertheless, there has been a monumental increase in administration and what we are really interested in is seeing that the people who 85 deal with the patients are there. Many of us think that the administration has become overburdened and I hope that this inquiry will deal with that.

§ Lord Trefgarne
My Lords, I am afraid that I have to tell my noble friend that she really is not correct in her assertion that there has been a massive increase in administrative staff within the National Health Service. On the contrary, there has been a reduction in grades in the particular area in recent times. But my noble friend might care to ponder on this particular point: is it really right, for example, that an experienced and highly trained specialist should spend his time typing his own letters when it might be better if someone was employed for the purpose?

Lord Wallace of Coslany
My Lords, is the Minister aware that I should like to ask him three questions? What will be the relationship between this team and the management efficiency groups which have been set up in England? Secondly, what use will be made by the Government of the findings and conclusions of the team, and in particular is it intended that they should link in with programmes or measures for the privatisation of the National Health Service? Finally, what is the cost involved and will that fall on NHS budgets? Finally, is the Minister aware—

Several noble Lords
Fourth question!

Lord Wallace of Coslany
That is right, my Lords, four. Finally, is the Minister aware that it is about time that the Government ceased messing about with the National Health Service and let the dedicated people in the service get on with the job?

§ Lord Trefgarne
My Lords, may I in answer to the last point suggest that the noble Lord consults the noble Baroness, Lady Gaitskell, who I think took a slightly different view on that matter than the noble Lord now advances. My Lords, the inquiry will of course be separate to the other matters that the noble Lord referred to. The purpose of the inquiry will be to enable my right honourable friend to implement the recommendations that it makes to improve the management, efficiency and, above all, the value for money that we get out of the health service. The inquiry has no relation whatever with any privatisation proposals, as the noble Lord said. As for cost, the four members of the inquiry are giving their services free of charge.

§ Lord Renton
My Lords, will the inquiry be concerned with the rather disquieting information which has come to light about the care and treatment of the mentally handicapped in some of the National Health Service hospitals?

§ Lord Trefgarne
My Lords, the inquiry will not be specifically concerned with the matter to which my noble friend refers because, as I said, it is concerned with the management of the Health Service and the value for money considerations to which I referred earlier. But of course it will not be debarred from considering those particular problems with the sector to which my noble friend referred.

§ Lord Davies of Leek
My Lords, is the noble Lord aware that during all these supplementary questions and all this simple analysis that we have heard one vital social factor has not been taken into account: namely, that whatever this may cost, it must be balanced against the saving of life and limb and economic productivity by keeping people healthy and well? That side of the balance sheet should be put against any expenditures.

§ Lord Trefgarne
My Lords, naturally I agree that the primary purpose of the National Health Service is to provide the care that sick people need. The purpose of this inquiry is to assist us in doing that better.

§ Lord Avebury
My Lords, will the inquiry look at the development of computing within the National Health Service?

§ Lord Trefgarne
My Lords, it will certainly not be disbarred from looking at that matter if it wishes to do so.

§ Lord Davies of Penrhys
My Lords—

§ The Lord Privy Seal (Baroness Young)
My Lords, we have been nearly nine minutes on this Question. I know that the noble Lord, Lord Davies of Penrhys, has been trying to speak. Perhaps we might take his question and then move on to the next one.

§ Lord Davies of Penrhys
My Lords, will the Minister not accept that there is a problem here? Next Sunday I shall be going into a national health hospital for the removal of cataracts, but I have been able to do so only because I am connected with a brewery which will pay. Unless that were so, it would be impossible for me to be admitted. I was told by the specialist—

Several Noble Lords
Order!

§ Lord Davies of Penrhys
My Lords, is the noble Lord aware that I was told by the specialist that that was the only way in which I could have them dealt with quickly? Is it not wrong that someone who has been against this system for so long should have to resort to this type of thing?

§ Lord Trefgarne
My Lords, it is unhappily the case that the waiting lists for non-emergency treatment—which I gather is the cause of the difficulty with which the noble Lord is faced—are longer than we would wish. Up to the beginning of the dispute last year we had succeeded in significantly reducing those waiting lists, but naturally as a result of the dispute they again lengthened. I hope that one of the results of this inquiry will be that improved management efficiency in the health service will emerge, which will again assist us in reducing the lengths of the waiting lists.