Health Authorities: New Management Structure (Hansard, 18 December 1985)

§ Lord Hunter of Newington
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, since health authorities are only about half way through the process of appointing general managers it is too early to attempt to quantify results. With regard to the noble Lord's second point, waiting lists continue to fall. General management is, of course, as much about improving the quality of services to patients as it is about the effective use of resources.
Some savings from general management are already becoming evident. For example, a review of management structures in one large region has yielded savings in excess of £1¼ million. Similarly, changes to the planning and management of ancillary services in one district alone have saved nearly £1¼ million. On a national scale the total savings are much larger.

§ Lord Hunter of Newington
My Lords, may I thank the Minister for that reply which is hopeful. As the unit managers have now been appointed, may I ask the Minister whether she is aware of the concern in the nursing profession about who the unit managers in the wards will be? Does she think there is a possibility that the ward sister might be in charge of her ward, as she used to be before other activities were taken over by cleaning services and so on?

§ Baroness Trumpington
My Lords, any manager worth his or her salt will, of course, want to involve key support staff in the fullest possible way. Within units, the role of ward sisters will be absolutely crucial to good management and to patient satisfaction. I am sure that we can rely on unit managers, where they are not ward sisters, to recognise this and build on it.

§ Lord Kilmarnock
My Lords, since the Question mentions savings, is it not the case that savings have been achieved by the Bloomsbury Health Aurthority by the closure of whole wards in central London all over Christmas? What emergency measures will the Government take to remedy that situation?

§ Baroness Trumpington
My Lords, I am not prepared to go into individual cases. The short closure of wards is a matter for the local health authorities. They close them only in extreme cases, and they take extreme care when they do.

§ Lord Ennals
My Lords, perhaps the Minister will go into a little more detail about the waiting lists, which were asked about earlier by the noble Lord. Will she give us the actual figures? Can she confirm that the present figures for waiting lists are still roughly 100,000 higher than they were during the days of the previous Administration, even taking into consideration the time when waiting lists shot up during periods of industrial action? Will she give the House some more information, please?

§ Baroness Trumpington
My Lords, on 31st March 1985 there were 674,534 people on in-patient waiting lists for all specialities. That is almost 80,000 fewer than at March 1979. This shows that there is a continuing downward trend following the disruption caused by the 1982 industrial action. Of course, some 50 per cent. of all admissions to hospital are immediate, and many of those on waiting lists already have a planned date of admission.

§ Lord Ennals
My Lords, will the noble Baroness recognise that she was making a comparison with a figure which I said had, during the period of industrial dispute, risen to a very high level? Does she not accept that the average during the period of the Labour Government was 95,000 lower than the figure she has now given us? When will the figures come down to even the average of those under the previous Government?

§ Baroness Trumpington
My Lords, that is a slightly unreasonable question, considering that I have just said there is a continuing downward trend. As the noble Lord said, during the period of industrial action 800 the total increased by more than 120,000. I have just given the noble Lord the figures. If he does not remember them, perhaps he would like to read them in Hansard.

§ Baroness Seear
My Lords, does the noble Baroness agree that giving only two figures does not show a trend of any sort?

§ Baroness Trumpington
My Lords, how many more figures would the noble Baroness like?

§ Baroness Seear
My Lords, the noble Baroness would like to have figures which show a statistically sound trend. Two figures do not show a statistically sound trend.

§ Lord Molloy
My Lords, will the noble Baroness be prepared to examine the anxiety that exists both within the British Medical Association and the Confederation of Health Service Employees? Since the introduction of managers who have concentrated on reducing costs there seems to have been, along with that policy, a demonstrable and disturbing drop in morale among nursing staff. What I am saying is supported by the British Medical Association and the Confederation of Health Service Employees who represent nurses and junior doctors.

§ Baroness Trumpington
My Lords, before I answer the noble Lord perhaps I may say to the noble Baroness, Lady Seear, that I shall be delighted to send her an entire table of statistical figures.
To turn to the noble Lord's question, I am aware of concerns expressed by nursing organisations. We take these very seriously, but I cannot go into the details now. We are barely 18 months into the introduction of a new system of health authority management. I sincerely hope that nurses will give it a go and play their full and vital part in developing the new system, especially when the new round of appointments comes up in 1987.

§ Lord Molloy
My Lords, will the noble Baroness take into her confidence at the Ministry both the representatives of the BMA and the Confederation of Health Service Employees? If she does so, I believe that what she and I wish to attain can be achieved.

§ Baroness Masham of Ilton
My Lords, is the Minister satisfied that there is good movement of patients between districts if there are very long waiting lists in one district and vacant beds in the next district? Can the general managers look into this?

§ Baroness Trumpington
My Lords, we are, of course, aware of differences in waiting times in different districts. We are concerned that patients are not always able to see consultants as quickly as we would wish. Guidance has been issued to the health authorities over the years aimed at reducing the times patients have to wait. General practitioners are free to choose where they refer their patients, and waiting times are one factor they may take into account. This need not mean sending the patients very far. Neighbouring districts may well have considerable differences in waiting times.