NHS Planned Developments: Funding (Hansard, 20 November 1985)

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

§ Baroness Hooper
My Lords, I am not aware of any postponed plans, and on principle we would not expect centrally to monitor progress during the year. Service developments at health district level are a matter for local management. Health authorities receive a cash sum each year within which they are expected to fund pay and price changes and service developments. Inevitably, the level of pay and prices affects the resources available for service development. But the National Health Service cannot be isolated from the real world.

§ Lord Hatch of Lusby
My Lords, is it the case that on November 1 st the National Association of Health Authorities announced that 48 health authorities in the country had had to postpone their planned developments because of lack of money largely due to the increase in pay for nurses and doctors?

§ Baroness Hooper
My Lords, the department has heard from a large number of health authorities about this matter. Generally, the message has been that authorities have been able to accommodate this year's increase in paybill costs for nurses and doctors as Ministers predicted when the awards were announced and still continue with most of their planned developments. It is as a result of the announcement made in the other place by my right honourable friend the Chancellor of the Exchequer that we feel confident that the increases which are staged over a two-year period are going to be met by the increases in funding that have been promised.

§ Lord Lloyd of Kilgerran
My Lords, I am sorry: I did not quite catch what the noble Baroness said about local health authorities in Wales. Did she indicate the number of health authorities in Wales which have been affected by this matter?

§ Baroness Hooper
My Lords, I do not believe I referred specifically to Wales at all; but I may say that so far as Wales is concerned the excess cost of this year's pay awards, after allowing for discretionary growth and national insurance restructuring, amounts to only £3.5 million or 0.6 per cent. of total revenue resources. That small excess should not entail any reductions in service provision and should largely be met from efficiency savings. So I think the noble Lord need have no particular worries so far as Wales is concerned.

§ Lord Lloyd of Kilgerran
My Lords, I am extremely grateful to the noble Baroness for having reminded the House of what is happening in Wales.

§ Lord Ennals
My Lords, may I ask the noble Baroness two questions?

§ Lord Denham
One.

§ Lord Ennals
My Lords, may I ask the noble Baroness one question? If, as the noble Baroness said, at the DHSS there is no monitoring of the decisions taken about the postponement of projects, would she not agree that the people who do know best are in fact the health authorities, as represented by the National Association of Health Authorities? Is it not likely, therefore, that this figure is true? Does she agree that often a postponement entails no saving at all since, particularly if it is a building repair job, it adds to the burden of cost that may fall within the forthcoming year?

§ Baroness Hooper
My Lords, the whole object of the restructuring was to ensure that at local level responsible decisions would be taken. My information is that advice and plans at local level are going equally well and that the local health authorities are finding themselves able to cope with the financial situation as it faces them.

§ Lord Hatch of Lusby
My Lords, would the noble Baroness confirm the figure I gave in my first supplementary, that the National Association of Health Authorities has stated that 48 health authorities in England and Wales are postponing their planned development? Is she also aware that the same association, in the same report, declared that services to patients were being cut by the closing of wards and of hospitals because of lack of money, due to this year's increase in the pay of nurses and doctors not funded by central Government?

§ Baroness Hooper
My Lords, the increase in funding announced last week, as I have already mentioned, is helping the local health authorities to meet the requirements resulting from the increase in pay awards. I would not wish at this moment to confirm precisely the figure quoted by the noble Lord, but I understand that in making representations the 547 National Association of Health Authorities in fact ignored the contribution which cost-improvement programmes can make towards meeting the pressure for the service.

§ Lord Harmar-Nicholls
My Lords, is my noble friend aware that most people would welcome the fact that local authorities make decisions as to whether or not money is spent wisely and properly, and would deplore any suggestion, as the Question seems to imply, that the Government bail them out however they have spent their money and with whatever disregard they may have shown towards the actual financial situation?

§ Baroness Hooper
My Lords, I would agree in general. In fact, the most crucial measure of the National Health Service's success is not the amount of money spent but what is achieved with that money in terms of services to patients. Our hospitals are now able to treat more patients than ever before. In 1984 hospitals in England alone had 800,000 more inpatients cases, 340,000 more day cases and 3 million more out-patient attendances than in 1978.

§ Lord Cledwyn of Penrhos
My Lords, the noble Baroness is making the best possible case she can, and making it very agreeably, but is she aware that local health authorities are going through an extremely difficult time and that everyone who visits them from time to time is well aware of this? Is she also aware that the situation in Wales is particularly bleak at the present time? Is she, moreover, aware that the proof of this is the fact that private nursing homes for the elderly—very often not up to the required standard—are springing up all over the country? Is that not clear proof that the Government are not doing their job adequately in this important field?

§ Baroness Hooper
My Lords, I feel that the latter part of that question was slightly outside the terms of the original Question, and since we are due to have a very wide-ranging debate this afternoon over the whole of the National Health Service, perhaps the noble Lord's concern will be met in the course of it. So far as Wales is concerned, my information is that the Welsh authorities stated earlier in the year that they welcomed the considerable growth in the development of the health services which have been funded since 1979.

§ Baroness Seear
My Lords, would the noble Baroness not agree that if she had been of a different sex the noble Lord, Lord Cledwyn, would not have said that her replies were being made "very agreeably"?