§ 2.56 p.m.
§ The Question was as follows:
§ To ask Her Majesty's Government what is the percentage of the total annual expenditure on salaries and wages in National Health Service hospitals spent on medical staff, on administrative staff and on ancillary staff.
§ Lord SkelmersdaleMy Lords, I regret that the relevant figures for salaries and wages for hospitals are not collected centrally. However, the relevant figures in the United Kingdom hospital and community health services in 1986–87 were 14 per cent. for medical staff, 11 per cent. for administrative staff and 12 per cent. for ancillary staff.
§ Earl AttleeMy Lords, I thank the Minister for that Answer. In view of the number of beds being closed, will the Minister agree that it would be more sensible to cut down on the number of pen-pushers and paper-shufflers rather than cutting down on the number of nurses?
§ Lord SkelmersdaleIndeed it would, my Lords. That is the reason why, in the past six years, there has been a reduction in, for example, the number of ancillary workers amounting to something over 120,000. That is the result of management action on manpower levels and the introduction of competitive tendering. The money saved in that way has gone directly into patient care.
§ Lord EnnalsMy Lords, is it not clear from the experience in other countries that any sort of private insurance scheme is likely to be approximately twice as expensive in terms of administration as a tax-supported service such as the National Health Service? How does the Minister justify the low proportion of gross domestic product dedicated to the National Health Service in comparison with comparable countries which have a far higher level of payment?
§ Lord SkelmersdaleMy Lords, if the noble Lord refers to the total amount of gross domestic product from both private and public sources, I do not believe that there is much difference between the countries in Europe. If the noble Lord is speaking only of the state provision, then I agree that there is sometimes a large difference. However, the objective is for the state to pay for the amount of medical care which it believes can be justified by the economy of the country concerned. I believe that that is what we have done over the past six years.
§ Lord EnnalsMy Lords, are we to understand from the Minister's helpful reply that he is accepting that private or insurance-financed health care is far more costly from an administrative point of view than a tax-paid national health service?
§ Lord SkelmersdaleNo, my Lords. I did not say that. In terms of gross turnover, I confirm the figure which I have used before. Five per cent. is spent on administration and management. I am not able to confirm whether that figure would be higher or lower with a partially or totally private insurance-based medical service.
§ Lord EnnalsIn that case, my Lords, what did his reply actually mean?
§ Lord SkelmersdaleMy Lords, in a nutshell, my reply meant that it is extremely difficult to make the kind of comparisons which the noble Lord was asking me to make.
§ Lord McNairMy Lords, does that confirm my suspicion that the three percentage figures that the Minister gave in his original Answer do not add up to 100? If I am right, what sort of staff receives salaries and wages in the National Health Service that cannot 993 be described as either medical, administrative or ancillary?
§ Lord SkelmersdaleMy Lords, one enormous group would of course be the nurses. Another would be the professional and technical services, such as laboratory services.
Lord Wallace of CoslanyMy Lords, is the noble Lord aware that I have been advised that there is no such thing as administrative staff in the National Health Service today? In my experience, under this Government everybody seems to be a manager or a deputy manager, with resultant chaos.
§ Lord SkelmersdaleMy Lords, I find that very difficult to believe when 46 per cent. of all employees in the health service are nurses.