HL Deb 04 June 1986 vol 475 cc1013-9

5.30 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)

My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer to a Private Notice Question that is being given in another place on the resignation of Mr. Victor Paige from the chairmanship of the National Health Service Management Board. The Statement is as follows:

"In October 1983, I announced that the Government accepted the recommendations of the NHS Management Inquiry, under the chairmanship of Sir Roy Griffiths, that general management should be introduced into the NHS, and that a board should be set up within my department to be responsible to Ministers for the department's functions in relation to the management of the NHS.

Mr. Victor Paige took up appointment as chairman of the board, and as Second Permanent Secretary within my department, on 2nd January 1985. His contract was for three years. The board was established in April 1985 and contains members drawn from business, from the National Health Service and from the Civil Service. Mr. Paige has paid tribute to the abilities of the board and the progress the board has already made. I should like to express my thanks to Mr. Paige for his part in this progress.

I confirm that very substantial improvements have already been made in the efficient management of the NHS. These achievements reflect great credit on the health service itself, including authorities, managers and staff, and on the direction and leadership which the service has had from my department.

As the House will be aware, Mr. Page has resigned from his position as chairman of the Management Board. He discussed his intention with me, and we agreed that it would be right for him to stand down. I have published the exchange of letters between us in which Mr. Paige explained his reasons. There is nothing that I can add to what he has said and my reply. I have therefore appointed Mr. Len Peach, who is the board's director of personnel on secondment from IBM, as acting chairman of the board. I shall make a substantive appointment as soon as possible.

The Government remain fully committed to better management of the National Health Service. I have every confidence that under the leadership of the management board, health authorities and their general managers will continue to ensure that more and better care is provided for patients and that the best value for money is obtained".

My Lords, that concludes the Statement.

Lord Ennals

My Lords, I would first thank the noble Baroness for repeating the Statement made by her right honourable friend in another place. One has to accept that this is a devastating blow to the Secretary of State and to the National Health Service. Personally, I had the privilege of knowing Mr. Victor Paige over many years. In my view, he is an extremely able man and deeply committed to the National Health Service. His record is not one of a man who acts lightly or in a fit of temper. He has confirmed today that his decision to resign is one on which he had been reflecting "for some time"; so that we must assume that the decision to resign from his £70,000 a year job, with the undoubted effects which this action would have, and would have on the National Health Service, was over a major and fundamental issue. In order that we may learn some of the lessons from this resignation there is a range of issues which I think we need to probe and which, with respect, were not dealt with in the Statement read by the noble Baroness but delivered by her right honourable friend.

Is it in fact a viable prospect to appoint a man to preside over the management board when he has a motley group of senior and junior Ministers breathing down this neck? He said in his published statement today: Ministers and the chairman of the management board can approach the same issue with different perspectives, priorities, objectives, and restraints. The conclusions are not always compatible. Also, there are always others in the action—or trying to be. 'Within my remit, that makes for difficulties in working to the management standards and style to which I am committed. I have brought this to your notice"— he says to the Secretary of State— on several occasions. You are aware that this is not working out as I believe it should". He listed as among the key issues that he had addressed: improving employee commitment and motivation, more devolution to health authorities within clearly defined standards of accountability and monitoring, the implementation of more effective financial management and planning and creating a high awareness of the importance of consumer and quality care". Let us also remember that since he was appointed, whatever Ministers may say about the totality of resources, public concern about cuts in the National Health Service has greatly increased. I am certainly not implying for one moment that this was Mr. Paige's fault. But it leads to a series of questions which I want to put to the noble Baroness.

First, did he resign or was he sacked? Secondly, was it a breakdown of personal relations with the Secretary of State? Quite clearly, he found it impossible to work with the Secretary of State. Or were the issues ones of major principle? If so, what were those issues of major principle? We and the public are entitled to know. Thirdly, was the resignation linked with the inadequacy of resources? Fourthly, who was really in charge? Was it the Secretary of State and the Minister of State, Mr. Hayhoe, or Mr. Paige? What was the role of the Permanent Under-Secretary, Sir Kenneth Stowe? I think that I once said in the presence of the noble Baroness here in your Lordships' House that the structure, as it had been created, was a scenario for a new "Yes, Minister" series. I think that this is proved by today's announcement.

Fifthly, is it not an impossible job to manage the National Health Service when it is Ministers who are accountable to Parliament? Sixthly, will this resignation at the top affect the role and status of other general managers in trying to do their work throughout the country? Seventhly, will there not be a major issue of morale—when National Health Service morale is already at a very low level? Finally, how many down the line of managers have resigned since their appointments? I know that some have done so and that some have publicised their resignations. How many have resigned? Bearing in mind the very long time that it took to find and appoint Mr. Paige and the qualities that we all know that he holds, is there not now a real question not just about the competence of Mr. Victor Paige but about the competence of the Secretary of State for Social Services?

Lord Kilmarnock

My Lords, we on these Benches should also like to thank the noble Baroness for repeating the Answer in the form of a Statement; but, frankly, this does not take us very much further than the press reports that we were all able to read this morning in the national press. The Statement that the noble Baroness has just repeated on Mr. Paige's resignation vindicates the argument that we advanced from day one that it was most ill-advised to go for the full implementation of the new management structure on a nationwide scale without a prior pilot scheme in one or more regions. This is a point we made at the time.

Mr. Paige must have been confronted with an impossible task in getting to grips with some 750 general managers, some from within the service and some from outside it, with widely varying ideas, all at once. If Sir Roy Griffiths had been advising a Sainsbury re-organisation, he would surely have experimented with one or two supermarkets first before decreeing it throughout the chain. But the Government, as so often, were determined to rush in where angels fear to tread.

Mr. Paige has reaffirmed his commitment to the general management concept. Do the Government not agree that this will be undermined by his early departure and that there must be severe misgivings over its future? Can the Government say any more than what emerges from between the lines of the correspondence between Mr. Paige and the Secretary of State as to what were the real difficulties? Was the problem perhaps that the original scheme involved substantial devolution of decision and responsibility to local managers and authorities but that civil servants and Ministers were determined to keep their fingers in the pie at all levels and would not allow Mr. Paige or his network of managers to manage?

Should not the ideological commitment to privatisation of ancillary services at all costs have been dropped and left to local management decisions? Was that one of the specific difficulties? Perhaps the noble Baroness could enlighten on that. How can we get to the bottom of this unless there is an inquiry? Will the Government agree to an immediate review of what went wrong? Do the Government not think that this would be an appropriate task perhaps for the Select Committee on Social Services of another place, which, after all, could take evidence from Mr. Paige and other people concerned, many of whom were mentioned by the noble Lord, Lord Ennals; or what alternative do they have in mind? There is no use in just going on as if nothing had happened. Something has obviously gone badly wrong and surely we must seek to learn all the lessons we can from this regrettable episode.

Baroness Trumpington

My Lords, may I say first of all to the noble Lords, Lord Ennals and Lord Kilmarnock, that I have absolutely no wish to interpret Mr. Victor Paige's letter. He wrote the letter; he is responsible for its contents and it is not for me to interpret them. Secondly, with regard to the question of whether Mr. Paige resigned or was sacked, he resigned. The letter makes it perfectly clear and my right honourable friend's reply makes it equally clear.

The noble Lord, Lord Ennals, asked me about a "motley group of people" breathing down his neck—which I think is a strange way to describe a lot of people who are working very hard to make a good National Health Service. There are a lot of people from different disciplines involved with everything in the National Health Service, as the noble Lord knows. Inevitably, people have their own particular interests and to advance those interests is of paramount importance to those involved. The whole process of government, and certainly not just the DHSS, is a question of competing priorities. Inevitably some may feel disappointed. There are horses for courses and just because somebody is a great success in industry does not necessarily mean that the person will be happy with a hybrid animal such as the DHSS. Some people will feel happy and others will not. That is just a fact of life.

With regard to differences with Ministers, of course there were differences in points of view from time to time on some issues. That is perfectly normal in any healthy and vigorously-managed organisation. But, as regards the particular issues, we have nothing to add to what Mr. Paige himself said about his resignation. I really think that the noble Lord, Lord Kilmarnock, is making a mountain out of a molehill when he asks for inquiries and things of that nature. I have never heard such exaggeration.

With regard to the question of resources, Mr. Paige's letter makes it perfectly clear that the reasons for his resignation are not related to disagreements on policy nor to resources or anything of that kind. For example, Mr. Paige considered that more money was needed this year to meet the cost of implementing from 1st July the review body's awards for doctors, dentists, nurses and professions allied to medicine. The Government are providing the necessary funds to the health authorities—an extra £60 million—to do just that. Morale in the NHS is good. The future of the NHS management board is sound and in very good hands: it will continue the excellent work done by its members.

The noble Lord, Lord Kilmarnock, asked about a pilot study, but experience shows that general management is on the whole working well in the NHS. Major difficulties have been very much the exception rather than the rule. This fully justifies the decision to implement the Griffiths Report for the country as a whole.

Lord Auckland

My Lords, I should like to join in the thanks given to my noble friend the Minister for having repeated this very disturbing Statement. Those of us on the Back Benches will of course be far less au fait with what has been going on than is my noble friend. Indeed, it was only this morning that I myself heard about this. Will my noble friend take on board the fact that all those concerned with the National Health Service—those who serve on house committees, regional boards and so on—will be very upset by what we have just heard.

While recognising that it would be quite wrong at this stage to put too many technical questions, can my noble friend the Minister say what links Mr. Paige has had not only with Ministers and permanent civil servants but with those who are actually working in the health service as nursing officers, doctors, and so on? Also, when his successor is appointed, what will the relationship be there? Quite clearly a breakdown in communications will be the interpretation of many of those working within the health service. While recognising that the record of the relationship between the Government and the National Health Service has been a very good one, will my noble friend finally appreciate that Parliament on all sides will need to study this matter very much more carefully at some future date?

5.45 p.m.

Baroness Trumpington

My Lords, I thank my noble friend for what he has said. In reply, I should like to assure him that close liaision with the DHAs and RHAs will continue, as they have always done under Mr. Victor Paige's management up to the present. On a personal note, I should like to say that I am very sorry that Mr. Victor Paige is going.

May I take this opportunity of remedying an omission? I realise now that I did not answer a question concerning the resignations that have taken place, which I believe both noble Lords asked me. Out of 191 DGM appointments, three gentlemen have resigned. Of those 191 appointments, 41 were from outside the NHS. One health authority chairman has resigned from his post. The NHS has over 700 general managers, and some have been in post for nearly two years; so perhaps three resignations is not all that numerous.

Lord Ennals

My Lords, I am most grateful to the noble Baroness for some of the comments she has made. However, may I press her a little further? What she did not say in answer either to my questions or to those raised by the noble Lord, Lord Kilmarnock, was what went wrong. Certainly the statement made by Mr. Victor Paige was very clear indeed and I expect we have all read it. But if there is not to be an inquiry then surely at some stage, in a public appointment of this kind with a resignation after 16 months, we are entitled to know what went wrong. How can we learn anything unless we learn from the experience of this particular matter? The noble Baroness referred to horses for courses. Was this the wrong horse for this course or was the course the wrong course? Is it better that you appoint as general manager for the National Health Service someone whose experience has not been in that service? All these questions are going to be asked and at some time or other, if not now, answers will have to be given.

The noble Baroness implied that this was perfectly normal; but really it is not perfectly normal for such a responsible post and one which has been awaited for many months by those in the health service. A very admirable and fine man (as we both admit) was appointed. For him to resign in 16 months is really most unusual and most disturbing. I think that was a point which was recognised by the noble Lord, Lord Auckland. Really, I think the noble Baroness should not underestimate the effects this announcement will have within the National Health Service, not only among the general managers but among others working generally within the National Health Service. If the man at the top resigns because he cannot get on with Ministers, we must learn what it was that went wrong.

Baroness Trumpington

My Lords, I must take up the noble Lord, Lord Ennals, on his last remark. So far as I know, there is no question of Mr. Victor Paige not getting on with Ministers, and I regard that as a slant which implies things which are not written directly in Mr. Victor Paige's letter. I cannot answer for Mr. Victor Paige and his letter. It is up to him, if he so wishes, and he has expressed himself fully in his letter.

With regard to appointments such as Mr. Victor Paige's, we believe that fresh blood is important. We have tried to choose the best man for the job in every case, regardless. It may happen that people are not happy. But there is no reason to make sinister suggestions about a letter of resignation which is perfectly reasonable. I should not speak personally, but it looks to me as if the man was not happy, and that can happen anywhere and for any reason. The team will continue to work in its usual efficient and helpful way carrying on the work of the board. I very much hope that the NHS will regard this as merely another step and that we shall get over what is really not so great a tragedy as was implied by the noble Lord, Lord Ennals.

Lord Thorneycroft

My Lords, may I ask the noble Baroness one question? I am not sure that I press her too earnestly to answer it, but it could be asked. It is: where do we go from here? I ask the noble Baroness whether she agrees that there is a view that money has been poured into the National Health Service. I know there are views that more should be poured, but there is certainly one view that masses of money have been poured, and grave doubts exist about the quality of management to manage an organisation of that size and that cost. Mr. Paige was given some degree of responsibility concerned with management and, though we may talk about horses for courses, I could ask the noble Baroness if she would consider whether the next horse ought to be given infinitely more authority over the management side of the health service, if any real impact is to be made on that organisation, to ensure that whatever sum is eventually agreed to be paid is spent to the best advantage.

Baroness Trumpington

My Lords, in answer to my noble friend Lord Thorneycroft, the management board's achievements so far have been that a general management has now been largely established throughout the NHS, with over 700 general managers appointed; important new management systems and tools have been introduced; there is a new series of performance indicators and performance reviews at regions; there are much better short-term programmes and better management of the estate; streamlined organisations and procedures for hospital building have been ensured and the foundations have been laid for the long-term job of the better and more professional management of the NHS. The Secretary of State has expressed his full support for the board. It will develop and build on the foundations already laid. There is an enormous amount still to be done and the board are detemined to tackle it with vigour and resource.

Lord Kilmarnock

My Lords, since the noble Baroness has accused me of making a mountain out of a molehill does she agree that the best course for demonstrating whether or not that is so would be to hold an inquiry and see what comes out of it?

Baroness Trumpington

No, my Lords.