NHS Administration: Representation (Hansard, 6 February 1989)

§ The Earl of Arran
My Lords, it will be for the chairman and non-executive members to decide who to appoint as executive members of each health authority in the light of the local situation. Chief officers will continue to have access to their authority, and of course applications for appointment as a non-executive member will continue to be welcomed from all quarters.

§ Lord Molloy
My Lords, is the Minister aware that the British Medical Association, the Confederation of Health Service Employees, the Health Visitors' Association and nearly everyone else vital to a successful NHS are somewhat concerned at the deterioration in the Whitley system and direct negotiations? Can the Minister give an assurance that all these professional associations that are vital to the NHS will be taken into full confidence on any changes and their views given the full consideration they deserve?

§ The Earl of Arran
My Lords, I believe that the best way of answering the supplementary question of the noble Lord, Lord Molloy, is to quote directly from my right honourable friend the Secretary of State in another place on 1st November: We all know that the costs incurred for staff vary from place to place, as do difficulties in recruitment. We have put in our evidence to the nurses review body the suggestion that we should now move to greater geographical variation and local flexibility, and similar discussions are taking place in the Whitley council about management and administrative staff. I believe that common sense dictates that we should start to reflect local variations in conditions in future pay negotiations for a giant service such as this.". [Official Report, Commons, 1 /11/88; col. 806.]

§ Lord Molloy
My Lords, does the Minister not agree that these matters involving the great bodies within the NHS are not simply about rates of pay or remuneration, but also relate to conditions, training and recruitment of future staff? Does the Minister not agree that those are vital issues and that these bodies have a great part to play in any reorganisation of the NHS?

§ The Earl of Arran
My Lords, I agree that conditions and in particular the recruitment of staff are vital to the NHS. As already appreciated, I believe, we are intending to move much more towards negotiation at local level.

§ Baroness Gardner of Parkes
My Lords, can my noble friend explain whether the appointments to these boards will be people from different categories of professions or lay people? Can he assure me that various professions such as the dentists will not fall between two stools, failing to be allocated a professional place and at the same time being ruled out as lay members? Can the Minister further elaborate on the means of nomination that he has mentioned? The noble Earl said that nominations as non-executive directors will be welcomed from all sources. Does he mean that members of the public will be able to apply? What about members of 1313 community health councils? Can the noble Earl elaborate on what he meant by all sources?

§ The Earl of Arran
My Lords, as regards places on a health authority, we expect the district general managers and the directors of finance to fill two places. It will be for the discretion of the individual health authority how it fills the remaining three executive places.

§ Lord Stallard
My Lords, does the noble Earl accept that whatever changes are made the cooperation and the involvement of local authorities will be absolutely essential in this new set-up? How does the Minister explain the Government's intention not to invite local authorities to be represented on these bodies?

§ The Earl of Arran
My Lords, health authorities have a key role to play in the provision of health care. The Government believe that it is essential that they fulfil their duties in the most effective way. The changes proposed in the White Paper will ensure that the smaller and more action-orientated membership of authorities will have a crisper decision-making process leading to more effective management which is more responsive to the needs of the consumer. The result would he a better, more flexible service and even higher standards of care. Finally, I point out to the noble Lord that community health councils on which local authorities remain strongly represented will continue to monitor consumer interests.

§ Baroness Gardner of Parkes
My Lords, can I bring my noble friend back to my question which he did not answer? I asked him to elaborate on his phrase that nominations for the non-executive directorships could come from all sources—presumably including local authorities. I wish the noble Earl to answer the question as to what arc the "all sources" or at least a few of the sources to which he referred.

§ The Earl of Arran
My Lords, the answer to that question may best be brought out in a forthcoming debate to be initiated by the noble Lord, Lord Hunter of Newington, on 22nd February in which all aspects of the National Health Service review will be looked at.

§ Baroness Turner of Camden
My Lords, is the Minister aware that the changes in the administration of the National Health Service, of which there have been a good many in the past few years, have destabilised the staff as a whole and have made them suspicious and resentful of further change? Can he assure the House that this will be taken into consideration and that steps will be taken to ensure that staff are adequately consulted so that the resentment can be removed?

§ The Earl of Arran
My Lords, when change is on the cards there is always concern and there is always suspicion. The whole point of the White Paper is that flexibility should abound.

§ Lord Underhill
My Lords, in regard to the noble Earl's reply on local authority representation, has 1314 there been any direct consultation with the local authority associations; and if not, why not?

§ The Earl of Arran
My Lords, I should not like to mislead the House on this point. It is not a question I can answer directly but I shall ensure that the noble Lord has a proper and correct answer in writing.

§ Lord Molloy
My Lords, is the Minister aware that all the professional associations covering the National Health Service, which have given magnificent service over the past 40 years and have made a great success of it, are firmly of the opinion that the principles on which the NHS was created are the best and the most efficient way of providing a comprehensive health service for this nation?

§ The Earl of Arran
Yes, my Lords, and our future purpose is to return the National Health Service genuinely to the community that it serves.

§ Lord Thorneycroft
My Lords, further to the question asked by the noble Baroness, Lady Gardner of Parkes, does the Minister agree that what matters is not who is represented in this debate but how we can pick the very best people available and enable them greatly to improve the present management of the health service?

§ The Earl of Arran
My Lords, I thank my noble friend for those remarks. He is absolutely right. It is very much skill and experience at a local level that are needed. The combination of those two factors will be decisive in electing people to those bodies.

§ Baroness Turner of Camden
My Lords, can the Minister respond more precisely to the questions raised on these Benches? We are talking about consultation with the present staff of the NHS and about changes in the administration of the NHS. That was the burden of the questions asked by my noble friend Lord Molloy and myself.

§ The Earl of Arran
My Lords, I cannot add to the answer which I have already given to the noble Lord, Lord Molloy.

§ Lord Taylor of Blackburn
My Lords, if the noble Earl accepts that we want only the best people to serve, why are most chairmen of the regional health authorities members of the Conservative Party? Are they always the best people?

§ The Earl of Arran
Yes, my Lords.