National Health Service: Expenditure (Hansard, 18 January 1988)

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

§ The Earl of Arran
My Lords, acute sector expenditure is not separately defined in health authority allocations and can only be identified retrospectively from costing returns. Of £9.1 billion spent on the hospital and community health services in 1984–85, it is estimated that £4.2 billion was spent on hospital in-patient and out-patient services in the acute sector. In 1985–86, the latest year for which detailed breakdowns of this expenditure are available, the figures were £9.5 billion and £4.4 billion respectively. In real terms, after allowing for pay and price inflation in the hospital and community health services, the level of expenditure on acute services stayed broadly level while the number of cases treated increased significantly.

§ The Countess of Mar
My Lords, I thank the noble Earl for that reply. Can he break down those figures into administration costs, preventive care costs and hospital in-patient treatment?

§ The Earl of Arran
My Lords, I think it would somewhat try the patience of the House to read out the whole of the table when answering the noble Countess. I shall put the information as it stands in table form into the Library for your Lordships to 2 consult. At this time I shall simply offer the House a synopsis of that information giving an impression of the allocations. To explain the table very briefly, in terms of millions of pounds spent under the hospital and community health services, compared with 1984–85 the figures for 1985–86 were as follows: on regional and district health authority administration, the figure was down by 0.4 per cent; on acute in-patient services, it was down by 0.4 per cent.; on acute out-patient services, it was up by 0.3 per cent.; and on community health services, it was up by 0.4 per cent.

§ Lord Jay
My Lords, if, as one reads, there is so much revenue available to allow for large tax reductions, why cannot some money be found for the acute needs of the health services?

§ The Earl of Arran
My Lords, that is impossible to anticipate precisely.

§ Lord Ennals
My Lords, do I understand from the noble Earl's reply that he accepts that in real terms there was no growth in the acute sector between 1983 and 1986 as regards in-patients, and that in fact there was a shortfall? Does that not explain the present crisis over beds, closed wards and lengthening waiting lists? Does it not also explain why the Secretary of State for Social Services at the end of last week said that there was a need to increase the total resources available for health care? Is not my noble friend right in saying that if there is money available to the Chancellor of the Exchequer, a substantial proportion of it should be put into the National Health Service which is gravely ailing at the present time?

§ The Earl of Arran
My Lords, I do not accept the noble Lord's interpretation of my answer as stated in his first question. I thought that I had made clear in my original Answer that in spite of the figure remaining broadly level, nevertheless some 103,000 extra in-patient cases have been treated. In addition, the Government plan to give continuing priority to the health and personal social services in public expenditure plans with further increases in real terms. Between 1988–89 and 1990–91 public spending on 3 the National Health Service in Great Britain is planned to increase by £2.1 billion to a total of £23.2 billion. In addition health authorities will have the benefit of savings from cost improvement programmes and the income from private patient charges, land sales and income-generating schemes.

§ Lord Boyd-Carpenter
My Lords, is not the capacity of the community to sustain the massive costs of the National Health Service dependent upon the health of the economy and is that not also a matter to which his right honourable friend the Chancellor of the Exchequer must give the closest attention if we are to continue our ability to sustain those burdens?

§ The Earl of Arran
My Lords, I am very grateful to my noble friend for his comments. I should like to add that the health service is spending more money than ever before and is treating record numbers of patients. That success, together with almost unlimited demand for health care, places services under pressure. That pressure causes anxieties and frustrations. However, whatever the level of resources, health authorities have to make hard choices between competing priorities. We shall continue to look for value for money in the health service and in that way to serve the interests of both the patient and the taxpayer.

§ Lord Kilmarnock
My Lords, will the noble Earl agree that rather than continue with the warfare of statistics, we should be looking at what is happening on the ground? The evidence before all our eyes is that a vast number of needs are not being met. Would this not be an occasion to take a fresh look at the question of National Health Service funding, possibly through a Royal Commission?

§ The Earl of Arran
My Lords, I believe I am correct in saying that my right honourable friend the Secretary of State does not expect to establish another Royal Commission on the health service. The National Health Service is under constant review by the Government as it has to treat many more hundreds of thousands of patients.

§ Lord Molloy
My Lords, may I put two short questions to the noble Earl? On the very valid point made by his colleague a few moments ago about the economic sector being vitally important, is he aware that one of the difficulties is the fact that for the past four to five years we have had about 3 to 4 million unemployed? That is an expense for which part of the. health service is now paying.
My other question is this. Notwithstanding the statistics given by the noble Earl, will he be prepared to confer with the professional organisations, such as the British Medical Association, the Royal College of Nursing, CoHSE and the junior doctors' association? I feel quite sure that they would dispute the attitude that he has taken this afternoon with regard to general medicine and the acute situation.

§ The Earl of Arran
My Lords, I do not think that I can draw any particular comparison between unemployment and the state of the National Health Service at the moment.
On the second point raised by the noble Lord, I understand that such organisations are being continually consulted with a view to seeing what can be done to be more helpful in that area.

§ Lord Auckland
My Lords, arising from the noble Earl's very encouraging answers, can be say what amount is being diverted to paediatric care, in particular in Great Ormond Street Hospital, where—perhaps my noble friend and others saw the recent television programme—there is a great deal of concern especially by the local regional health authority?

§ The Earl of Arran
My Lords, I can understand the anxiety of my noble friend. I think, however, in the circumstances that I would need further notice of that question.

§ Lord Wyatt of Weeford
My Lords, following the Answer given by the noble Earl, would be care to define what an acute case is? He may be aware that recently the consultant surgeon at Charing Cross Hospital, Mr. Grant William, resigned because sex change operations were being given precedence over acute cancer surgery cases.

§ The Earl of Arran
My Lords, I am not aware of that case. However, obviously acute services are the front line services of the National Health Service.

§ Lord Dean of Beswick
My Lords, in his Answer the noble Earl referred to community health services. Is he aware that the majority of those services were administered by local authorities prior to the last local government reorganisation? Will be comment on views now being openly expressed that the customers are now receiving a worse service under the National Health Service than they did when these services were controlled by local authorities?

§ The Earl of Arran
My Lords, I cannot agree with the point that the noble Lord makes.

§ Lord Nugent of Guildford
My Lords, as discussion on the Question has now been continuing for nine minutes, is it not time that we moved on to the next Question?

Noble Lords
Hear, hear!

§ Lord Underhill
My Lords, I was going to ask a question which is relevant to this matter. Will the Minister agree that the National Health Service stands in very high regard among the great majority of people in this country?

A noble Lord
It is now 10 minutes.

§ Lord Underhill
My Lords, it stands much higher than 10 minutes. It stands very high in the conception of most people. Will the Minister also agree that, 5 despite the figures that he gave, the administrative costs are among the lowest for any health service throughout the world?

§ The Earl of Arran
My Lords, I cannot comment on the administrative costs of health services in other parts of the world. However, I readily agree that the performance of the National Health Service is held in very great esteem by all in this country.