NHS Funding (Hansard, 5 July 1988)

§ Lord Skelmersdale
My Lords, the Government do not run hospitals. We have no place and no wish to intervene in their day-to-day management which is quite properly the responsibility of health authorities. The Government provide funds to the health authorities which are for them to manage according to local needs and priorities. These funds have increased in real terms in each year since this Government took office.

§ Lord Ennals
My Lords, while regretting that the Minister is unable to answer the Question I put, perhaps I may ask this question. Will he and the whole House express thanks to those who work in the National Health Service, on its 40th anniversary, for their magnificent achievement in improving the quality of life for the people of Britain over the past 40 years? I ask the Minister whether he recognises the double irony that, first the National Health Service is now suffering from a cumulative underfunding of over £1 billion pounds? That is according to the 143 Social Services Select Committee which gave this information yesterday? Secondly, is the Minister aware that the celebration is orchestrated by a series of proposals put to the Prime Minister's Review Committee which, if accepted, would undermine the basic principle of the National Health Service—that is, to provide a service available to all regardless of their ability to pay?

Noble Lords
Order, order!

§ Lord Skelmersdale
My Lords, in answer to the first part of the noble Lord's supplementary question, yesterday I was very proud and privileged to be at a party (at the invitation of my right honourable friend) to celebrate the 40th anniversary of the National Health Service held at the Queen Elizabeth II conference centre. Among the guests were people who had served continuously in the health service at various levels from ordinary nurses and community staff right the way up to family practitioner committee members and others. They had been working in health care before the health service came into existence. I certainly associate myself with the comments made by the noble Lord.
As regards the Social Services Select Committee in another place, I am sure that the noble Lord will have seen Cmnd. Paper No. 405 which is the response of the Government to the interim report that that Committee produced. I merely make the point that this year the Government have provided an extra £1.8 billion for the National Health Service as a whole, which is nearly £1 billion more than was was originally planned.

§ Lord Nugent of Guildford
My Lords, is my noble friend aware that it is unlucky that there was not a 30th anniversary celebration 10 years ago because the health service would then have been celebrating the biggest cut it had ever experienced?

§ Lord Ennals
My Lords, there was a great celebration.

§ Lord Skelmersdale
My Lords, that is a point of view with which I totally agree.

§ Baroness Blatch
My Lords, is not the noble Lord, Lord Ennals, on rather weak ground in raising the issue in quite this way in view of his party's record of funding the NHS and on the aspect of bed closures in particular? Would not his energies be better employed in joining the Government in determining a positive way forward for the NHS?

§ Lord Skelmersdale
My Lords, I am not quite sure how to answer that question. I am responsible only for my answers and not for noble Lords' questions. I note that from May 1979 to the end of 1986 hospitals were approved for closure at the rate of 38 each year compared with 54 each year when the Labour Government were in office.

§ Lord Mellish
My Lords, will the Minister help by giving us figures on which to base an argument and 144 a case? Can be say how many beds were occupied 10 years ago and how many beds are occupied today?

§ Lord Skelmersdale
My Lords, I am not sure whether I can. However, my noble friend Lord Arran told the House on Friday that the number of beds fell by 35,000 in the period 1974–1979 and by a further 36,000 to date. I hope that that helps the noble Lord.

Lord Winstanley
My Lords, does the Minister accept that what really matters is not so much the precise number of beds in a particular hospital on a particular day but whether a bed is always available for the receipt of an acute case whenever a general practitioner wishes to send one in? Does he recall that in the old days of the municipal hospitals resident medical officers, of which I was one, were not allowed to refuse a case when a doctor wished to send one in? They had somehow to find room for that case, and always managed it. Similarly, in the out-patients departments before the appointments system, the consultant or his registrar saw every case on the day on which that case was sent to the hospital. That meant that some of those patients had to wait five to seven hours, but some of us think that that is better than their having to wait five, six or seven months, as happens now.

§ Lord Skelmersdale
My Lords, as I have said time and again from this Dispatch Box, the Government's responsibility is for the totality of services. I cannot guarantee that a particular bed will be found in a particular hospital at a particular time for a particular case. However, looking at the global picture, since 1979 in-patient treatments have increased by 19 per cent., out-patient treatments by 11 per cent. and day-care treatments by 87 per cent. Certainly for day-to-day treatments one does not normally need beds.

§ Baroness Masham of Ilton
My Lords, are the Government not worried about the case in Sheffield at the Hallamshire Hospital where the osteopetrosis unit is under threat of closure? The consultant has had to find £12,000 from the bank to keep it going. One woman in three suffers from osteopetrosis—brittle bones—during her ageing life.

§ Lord Skelmersdale
My Lords, I should not like to comment specifically on that case. But more generally overspending is often the result of increased activity that was unplanned earlier in the year. The Government have made it clear to health authority chairmen that we expect measures to restrict overspending to be taken so far as possible in areas that do not directly affect patient care.

Lord Wallace of Coslany
My Lords, is the Minister aware that just over 40 years ago I was present in the other place when the health service legislation was passed? Is he further aware that, unfortunately, the Conservative Opposition voted against it and were supported by the British Medical Association?

§ Lord Hailsham of Saint Marylebone
No!

Lord Wallace of Coslany
Oh yes, they did my Lords. Since then they have changed their tune. Will the Minister now give an assurance that the present inquiry into the health service will be revealed to the public first and not at the Tory conference, as has already been stated?

§ Lord Skelmersdale
My Lords, I was not aware of the details underlying the noble Lord's question but I am aware that, of those 40 years, only one third of them were under the administration of the party opposite.

§ Lord Hailsham of Saint Marylebone
My Lords, as one who was also present on the occasion that the noble Lord mentions, may I ask my noble friend whether he will look up Hansard and find that he is entirely wrong? This is not an appropriate occasion for a party political broadcast.

§ Lord Skelmersdale
My Lords, I am not sure whether that last remark of my noble and learned friend was made to correct impressions given by the noble Lord or to correct something I said in response. However, I shall guarantee to look at Hansard for the period.

§ Lord Broxbourne
My Lords, as one who had the privilege of following Aneurin Bevan in another place in the debate to celebrate the 10th anniversary of the National Health Service, may I respectfully associate myself with the congratulations expressed by the noble Lord, Lord Ennals, on the work of the health service, and hope that we can now, as then, keep these matters free from political controversy?

§ Lord Skelmersdale
My Lords, I certainly join in both those sentiments.

§ Lord Cledwyn of Penrhos
My Lords, if I may return to the substance of the Question, the noble Lord referred to the report just published by the Social Services Select Committee of another place. Is he aware that it said that ward closures and other service reductions will recur if the Government fail to meet the full cost of pay awards in 1988–89? Is he further aware that the British Medical Association fully supports this contention? Will he say what the Government's response to that will be?

§ Lord Skelmersdale
My Lords, it would ill behove me to respond on behalf of the Government to a report that has only just been published. We shall of course study it and respond by Command Paper in the usual way. The report I referred to was an interim report headed The First and Second Reports of the Social Services Committee Sessions 1987–88. The Government's response will be found in Cmnd. 405.

§ Lord Cledwyn of Penrhos
My Lords, will the Minister confirm that he is aware that his right honourable friend is aware of the profound concern of the Social Services Select Committee of another place and also of the British Medical Association?

§ Lord Skelmersdale
My Lords, I am also aware that the Whitley awards have not yet been settled, whereas the nurses' awards were settled earlier this year and were responded to in full.

§ Lord Ennals
My Lords, is the noble Lord aware that during the period of the Labour Government from 1974 to 1979 there was an increase in real terms to the health service more substantial than increases during the past nine years? Will he accept that there was a happy celebration of the 30th anniversary of the National Health Service and that at that time there was not nearly the controversy there now is about underfunding, bed closures and lengthening waiting lists?

§ Lord Skelmersdale
My Lords, perhaps the reason is that we did not then have the Opposition we have now; namely, the noble Lord opposite.