Health Service: Birmingham (Hansard, 15 December 1987)

§ The Countess of Mar
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ Lord Skelmersdale
My Lords, the letter from the Birmingham consultants to the chairman of the regional health authority is clearly an expression of concern for the difficulties facing the district health authorities which have become apparent over recent months. However, health services in Birmingham have continued to expand despite the acknowledged pressures upon them.

§ The Countess of Mar
My Lords, I thank the noble Lord for his reply to my Question. Would he not agree that it really is unprecedented that 200 consultants and, in recent days, the heads of the three colleges; midwives, nurses, community health councils, and even the regional and district health authorities themselves have brought to the Government's attention their concern about the situation? If the noble Lord believes that Her Majesty's Government are paying enough for the National Health Service, would he not consider having an inquiry, or even a Royal Commission, into the management of that money?

§ Lord Skelmersdale
No, my Lords, I certainly do not think that a Royal Commission or an inquiry—should I say, another inquiry—into the management of the health service is appropriate. I would make the point that this year the West Midlands region is getting a cash increase of 9.3 per cent., taking its total resource allocation to over £1.1 billion, and a 24.7 per cent. real terms increase from 1978–79. As I have said on numerous occasions, health authorities have the legal obligation to live within their means which involves, on occasions, making very difficult choices. This is what is happening at the moment in Birmingham.

§ Lord Molloy
My Lords, is the noble Lord aware that there is deep concern at the parlous state of the National Health Service not only in Birmingham but throughout the entire country? if he wants confirmation, would he be prepared to ask for the views of the British Medical Association, the surgeons, the midwives, the nurses and all those who are the fundamental contributors to creating our National Health Service? They are all of one opinion—that our NHS is in a parlous state throughout the entire nation. What are the Government going to do to stop this dismay among all the people who work in our NHS?

§ Lord Skelmersdale
My Lords, if the health service was in as parlous a state as the noble Lord suggests from the evidence, which I agree has been coming from the heads of the three Royal colleges, from the BMA, and all sorts of sources within the health service, I would find it extremely difficult to reconcile that with the fact that so many more patient treatments continue to be made year after year.

§ Lord Molloy
My Lords, is the Minister really saying that the nurses' representatives, the Royal College of Nursing, the health visitors, the surgeons and the doctors are giving false information? Is the noble Lord saying that he does not believe the BMA, that he does not believe CoHSE, and that he does not believe the Royal College of Nursing? Is he saying that they are all misleading the country, that he alone is right, and that all these organisations are out of step with the Government?

§ Lord Skelmersdale
No, my Lords. Of course, that is not what I am saying. That is not at all what I said. I said that while recognising the concerns that have been expressed from all these organisations, one must realise also that continuing to spend extra money, which is in an unallocated form, cannot be the sole answer to the very intractable problems which we all know exist in the health service.

§ Lord Pitt of Hampstead
My Lords, cannot the Minister understand that while spending an additional amount of money may not be the sole requirement, it is obvious that additional resources are needed? Why cannot the Government merely accept that fact? Cannot the Minister see that? If you are spending a certain amount of money to achieve a certain objective and the objective is not being achieved and you have said that people must save in 599 order to help achieve that objective and they are still not achieving it, cannot the noble Lord take it that you need to spend a little more money?

§ Lord Skelmersdale
My Lords, the Government are spending a little more money, to use the noble Lord's phrase. An extra £700 million is being made available for hospital services next year out of a total of £1.1 billion extra money for health.

§ Lord Pitt of Hampstead
My Lords, when you are asked for £925 million and you have given £700 million are you not presenting an insufficient amount?

§ Lord Skelmersdale
My Lords, the noble Lord, Lord Ennals, who, I know, is wanting to ask a supplementary question, faced exactly the same difficulties when he was Secretary of State for Social Services. The fact that money continues to be made available for the health service, and will continue to be made available in increasing amounts for the health service, does not mean that the intractable problems of the health service will disappear just because of that extra money.

§ Lord Ennals
My Lords, will the Minister accept the fact that, to the best of my knowledge, there was never a time—and certainly not when I was Secretary of State—when all those concerned with the interests of patients and all the organisations involved in the National Health Service were so united in their pleas to the Government for additional funds? In the light of opinion polls, does the Minister not accept that no government have ever had a greater mandate than do his Government now to produce more funding which is quite clearly needed and demanded, in place of the repeating of tired statistics that do not fit with the experience of those who work in the health service or those who depend upon it?

§ Lord Skelmersdale
My Lords, I disagree with the last point. First, statistics are not tired, as the noble Lord suggests; secondly, most certainly they show that extra treatments are continually being provided often in excess of the amount of money that is provided. I accept that difficult decisions must be made. That means not only the Government seeing whether extra money can be made available in whatever amount at whatever time. It also means that for that money, we must see that we have proper control of the health service by the health service.

§ Lord Gisborough
My Lords, does my noble friend not find anomalous criticism from a party that reduced spending on hospitals by 3 per cent. in 1977 and spending on nurses' pay by 10 per cent. in real terms when in office?

§ Lord Skelmersdale
My Lords, I find equally anomalous the fact that Labour Ministers managed to have disputes with the nurses in 1974; with junior doctors in 1975; and with doctors and the Royal Colleges in 1975–76.

§ Lord Ennals
My Lords, is that not a repetition of what I called "tired statistics" and statements. We are dealing with the situaton which exists today. Does the Minister not accept that the public would prefer see much more money being spent on the health service rather than have some potential reduction of a penny or two on income tax? They know where their priorities lie.

§ Lord Skelmersdale
My Lords, if the noble Lord wishes to judge government policy on polls, that is entirely up to him, However, I observe that when asked specifically, "Are you prepared for a reduction in your take-home pay in order to find extra money for the health service?", only 10 per cent. of the respondents in a recent poll said, yes.

§ Lord Hailsham of Saint Marylebone
My Lords, at the risk of being accused of statistical fatigue, I should like to ask my noble friend whether it is a fact that the expectation of life in this country has steadily improved throughout my lifetime?

§ Lord Skelmersdale
My Lords, yes, it has, and, returning to the Question. I should like to add even in Birmingham.

§ Baroness Fisher of Rednal
My Lords, is the Minister aware that at a public meeting in Birmingham last Friday, attended by the chairman of the West Midlands Regional Health Authority and his officers, including the manager and the chief medical officer, and a cross-section of people, the same kind of questions that are being asked today were put to the chairman of that authority? He was obviously not speaking of increases in cash that would be available; but he was saying that the struggle would get worse. He told the meeting, "It is up to you to make sure that the Government know how you feel." That is a different point of view to the one expressed by the Minister this afternoon.

§ Lord Skelmersdale
My Lords, if "up to you" means reporting to the Government via myself, then the message has most certainly gone home. The extra allocation for regional health authorities will be made shortly, but, as I have said repeatedly, I do not think that that will solve the particular problems.

§ Lord Mackie of Benshie
My Lords, I should like to congratulate the Minister on the way he has answered the Question and for the courtesy that he has shown. I am sure that the Minister has the figures available. Will he therefore say how the extra money paid to the West Midlands Regional Health Authority has been spent? For example, has it been spent on more geriatric beds, or is there an improvement in the number of operations carried out? Can the Minister tell the House where the increase has been spent.

§ Lord Skelmersdale
My Lords, speaking from memory, approximately 24 per cent. extra funding has been made available in real terms since 1978–79. I told the House recently that that resulted in an increase of 25 per cent. in hospitalised boarding treatments; a 78 per cent. increase in day patient cases; and a 17 per cent. increase in other ways.

§ Lord Somers
My Lords, I am inclined to agree with the statement that money alone will not solve the problem. However, does the Minister not agree that the problem cannot be solved without money?

§ Lord Skelmersdale
My Lords, this year the Government spent approximately £24 billion on the health service as a whole and that amount will be increased next year and the year following. I do not call that going "without money". However, I take the point that should a sensible arrangement be made for spending extra money, we must obtain value for that money.

Earl Ferrers
My Lords, does the Minister not agree that it is one of the easiest things in the world to say that something is in a "parlous" state? Is it not a fact that, despite the requirements for the future, more money is now being spent on the health service than ever before? There are more doctors and more dentists and more operations are being carried out. Is it not a fact that one problem is that modern machines and equipment are progressively becoming geometrically more expensive? Is that not one of the difficulties in financing the health service?

§ Lord Skelmersdale
My Lords, yes, my noble friend is right; expensive machinery which now goes into health care is a factor in the equation. So also is the fact that, for example, there are more nurses in this country per 10,000 of the population than there are, for example, in the United States of America or Germany.

§ The Countess of Mar
My Lords, the Minister has spoken of the additional operations which have been carried out and the number of people who have been cared for in hopsital. I should like to say that those people working in the National Health Service should be congratulated for that. Is it not the very consultants and nurses who are worried about the situation today who have made possible the extra operations? Are they not suffering from the effects of the cutbacks along with patients who have accepted being sent home early after operations and who have been treated as day cases whereas a few years ago they might have been treated as in-patients on a slightly longer term?

§ Lord Skelmersdale
My Lords, clincial practice always changes over time. I am not able to accept the fact that because today patients stay for a shorter time in hospital than five or 10 years ago, one can draw conclusions from that as regards the state of the health service.

§ Baroness Seear
My Lords—

Noble Lords
Next Question!

§ Baroness Seear
My Lords, nobody has spoken from these Benches for a long time. While not in the least wishing to let the Government off the hook, is not a great deal of the problem attributable to the fact that many of us, including myself, are living beyond our allotted three score years and ten?

§ Lord Skelmersdale
My Lords, I think I had better refer the noble Baroness to the answer I gave to my noble and learned friend.