HL Deb 21 November 1984 vol 457 cc569-72
Lord Hunter of Newington

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

The Question was as follows:

To ask Her Majesty's Government whether they will make a statement about the Griffiths Report on management in the NHS.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)

My Lords, my right honourable friend the Secretary of State for Social Services gave a full statement of the Government's objectives for management of the Health Service in a written reply in another place on 4th June. At the same time he issued guidance to health authorities on implementing the recommendations of the Management Inquiry Report. Good progress is being made in carrying forward the changes required, including the appointment of general managers.

Lord Hunter of Newington

My Lords, in thanking the Minister for that reply may I ask him whether he is aware of the great deal of concern there has been over the fact that during this last period the chairman of the management board in the Department of Health and Social Security has not been in post? Is the Minister also aware that the districts are concerned about the future and their reorganising? They have no real guidance about the general management. Particularly concerned in these matters are the clinical managers who have run their own department since the initiation of the National Health Service.

Lord Glenarthur

My Lords, so far as the chairman of the National Health Service management board in the DHSS is concerned, it is important to fill this post with the right person. That is more important than to make the appointment quickly because, as the noble Lord realises, the appointment is a crucial one. It requires a rare mixture of quality and experience. It has certainly taken longer than we had hoped to make the appointment. However, good progress has been made in implementing other aspects of the Griffiths Report, despite the delay in appointing the chairman of the board itself. So far as clinicians are concerned, I was surprised to hear what the noble Lord said. Of course, clinicians will play a very important role. They do now, but they will play an even more important role in future. I think that their particular use will be felt not just at regional and district level, but also when it comes to the appointment of general managers for units.

Lord Molloy

My Lords, is the noble Lord prepared to accept that since the period he mentioned there is now grave apprehension and consternation among all levels of staff within the National Health Service? Rather than have the Government, of all people, issue a form of diktat, will the Minister be prepared to consider with his right honourable friend in another place whether perhaps, together with the British Medical Association (who are willing), the Confederation of Health Service Employees (who are willing), and the Royal College of Nursing (who are willing), discussions could now be held on what has happened so far, so that some of the ructions that are expected in future could be avoided?

Lord Glenarthur

My Lords, the ructions to which the noble Lord refers are not nearly so serious as he seems to think they are. My right honourable friend is in touch with all the bodies to which the noble Lord refers.

Baroness Robson of Kiddington

My Lords, will the noble Lord please inform me on what criteria the unanimously approved appointment of an administrator in the West Midlands was turned down by the Department of Health and Social Security; whether East Anglia have yet appointed their administrator; and how many regions have appointed their district administrators?

Lord Glenarthur

My Lords, I certainly cannot give the noble Baroness information about the specific appointment to which she referred. However, among regional general managers appointed so far there are an ex-regional medical officer, an ex-regional nursing officer and two former treasurers. Of the 38 district general managers who have been appointed, one is a former district treasurer and three come from outside the health service altogether. So the situation is not as bad as some people think it is.

Lord Kilmarnock

My Lords, will the noble Lord say, in answer to Lord Hunter's question, why there is such delay in finding a chairman for this very important post? Will he tell us whether he does not foresee some conflict of interest between the accountability of consultants to district general managers and their professional accountability outside?

Lord Glenarthur

My Lords, as I said in answer to the noble Lord, Lord Hunter's earlier question, the important thing is to obtain the right person for the job. Without that, the whole scheme would probably founder. In any case, appointments at this level are made by the Prime Minister. I understand the selection process is not yet complete, but we certainly hope that an appointment will be made soon.

With regard to the noble Lord's second question—that is to say, about the conflict of interest—the guidance circular, with which the noble Lord will be familiar, made clear that authorities must make proper provision to continue to receive authoritative professional advice. It is for authorities to formulate their own proposals, which will then be scrutinised by Ministers.

Lord Ennals

My Lords, may I put one or two questions to the Minister? First, will the Minister confirm that the advertisement for the chairman of the board nationally first appeared on 30th April? Does the Minister not feel that seven months is an extraordinarily long time in order to find the right person? Would it not have been easier for the whole operation to have been carried out at regional and district level after the national appointment had been made? Finally, will he say whether he thinks it is a good thing that the Secretary of State should interfere too much in the regional appointments? Do not the regional people know best? In how many cases has the Secretary of State called in short lists that have been drawn up by the regions?

Lord Glenarthur

My Lords, the noble Lord quotes 30th April. I am afraid that I do not have with me the exact date when the appointment was advertised, but it must have been round about then. The reason is exactly the same as the one I gave just now to the noble Lord, Lord Kilmarnock. People who possess the quality that this responsibility requires do not come easily and it is absolutely essential that we get the right person. As I explained, it was perhaps unfortunate that the delay has been so long but it was necessary in this particular case. As I said, the appointments are made by my right honourable friend the Prime Minister. The noble Lord asked another supplementary question. Perhaps he will repeat, it, and then I can answer him.

Lord Ennals

My Lords, I am grateful to the Minister for what he said in response to my first question. My second question related to regional appointments and to whether it was wise that the Secretary of State should become involved in them. Is it not best that they should be made by the regions themselves? In how many cases has the Secretary of State called in a short list to seek to add names to it?

Lord Glenarthur

My Lords, I cannot give the noble Lord a figure off the top of my head. Of course, Ministers remain ultimately responsible for the management and efficiency of the health service centrally and that is why it is important for Ministers to scrutinise many of these appointments.

Lord Winstanley

My Lords, are the Government not starting at the wrong end with these appointments? Is the noble Lord aware that noble Lords on these Benches are broadly in favour of the principle of named individuals being given specific management responsibilities for specific areas of the service? Does he agree that for them to be of benefit to the consumer—that is, the patient—these people must operate as close to the grass roots as possible? Therefore, it is much more important for managers to be appointed at district level rather than in the regions.

Lord Glenarthur

No, my Lords, I would not agree with the noble Lord. The cascade principle of appointing regional managers, to be followed by general managers, to be followed in turn by district general managers (of which many appointments are now under way), ultimately to be followed by the appointment of general managers for units, is the way that we should go. It is clear from discussions that we have had with regional health authority chairmen that they prefer that way, too.

Baroness Masham of Ilton

My Lords, may I ask the Minister whether he is aware that the appointment of general managers is a sensitive matter within health authorities? When they are all appointed, will the Government do as much as possible to encourage all sections of the health service to work in harmony for the good of patients?

Lord Glenarthur

My Lords, I think that the noble Baroness is absolutely right. It is a sensitive matter, because it involves a fairly substantial difference, and, I am quite sure, it is one in the right direction. I entirely agree with her that everything ought to be done to promote harmony within the service.

Baroness Faithfull

My Lords, may I ask my noble friend the Minister whether it is the intention of Her Majesty's Government to appoint at any rate to some of the managerial posts people from outside the service? If so, are the salaries comparable to make it worth while for businessmen to apply for such posts?

Lord Glenarthur

My Lords, it is very much a matter for them to decide whether the salaries are comparable. There are those who have come from outside, and I shall be happy to let my noble friend have the figures.

Lord Wells-Pestell

My Lords, if the chairman of a board has yet to be appointed, who in fact approves or vets the appointments made at regional level?

Lord Glenarthur

My Lords, the appointment of regional general managers is for regions and for my right honourable friend the Secretary of State.