"Working for Patients": Implementation Costs (Hansard, 24 May 1989)

§ Lord Henley
My Lords, the Government will be making available an extra £40 million in the current financial year to cover the additional work in the National Health Service and in the department to begin implementing the review. This brings the total available for implementation this year to over £82 million. None of the costs of the implementation will be to the detriment of patient care.

§ The Countess of Mar
My Lords, the noble Lord will probably be aware that the resource management initiative has been welcomed largely by all sides in the health service. But is he aware that people working in the health service have projected costs of several million pounds per site for setting up the computers and hardware, and estimate that if the software is to be compatible with all the computers, it will cost much more? Is he further aware that at the moment the National Health Service is having difficulty in recruiting staff for secretarial work and similar jobs? How will the health service be able to recruit highly qualified computer technicians if it pays the salaries that it is paying at the moment?

§ Lord Henley
My Lords, an extra £2 billion was announced for the National Health Service in the Autumn Statement. The noble Countess will know that we have greatly increased funds to the health service over the past 10 years; funding is up 40 per cent. in real terms since 1978–79.

Lord Winstanley
My Lords, although the Government can calculate accurately the additional administrative costs incurred by health authorities and family practitioner committees as a result of this work, does the noble Lord agree that it is impossible for them to compute accurately the additional administrative costs incurred by general practitioners in shopping around for the best deal for their budgets and for their patients? Is he aware that some of the general practitioners' expenses qualify for direct reimbursement from the department? Will those additional administrative costs also qualify for direct reimbursement?

§ Lord Henley
My Lords, I take it that the noble Lord refers to practice budgets, in which case we shall allow the appropriate amount of money that a practice will need to meet its costs.

§ Lord Callaghan of Cardiff
My Lords, the noble Lord refers to the 40 per cent. increase in the amount payable to the health service since 1978–79, but is he aware that with the rise in the interest rates this morning the increase in the cost of interest is also up by 40 per cent. since 1978–79?

§ Lord Henley
My Lords, as noble Lords will know, the House had a very late night last night. I am afraid that I have not seen the announcement about the rise in interest rates. However, I can repeat that funding has increased by 40 per cent. in real terms since 1978–79.

§ Baroness Gardner of Parkes
My Lords, is my noble friend aware that the health service salaries referred to by the noble Countess, Lady Mar, are severely limited and restricted and that much higher rates have to be paid to agency staff at all times because people cannot be found to fill jobs? Will this point be looked at carefully in the new administration?

§ Lord Henley
My Lords, I am sure that that point will be looked at carefully. I shall certainly bring my noble friend's remarks to the attention of my right honourable friend.

§ Lord Molloy
My Lords, is the noble Lord aware that the vital points raised by the noble Countess, Lady Mar, and the noble Lord, Lord Winstanley, reflect very real apprehensions held by the medical, nursing and health visitors professions? Will he draw those points to the attention of his right honourable friend?

§ Lord Henley
My Lords, I shall certainly draw the attention of my right honourable friend to the noble Lord's remarks and I am aure that he will pay them a very great deal of attention.

§ Lord Rea
My Lords, will the noble Lord confirm or deny the accuracy of information that I have received to the effect that the resource management initiative in Wales alone will cost £40 million, which is the sum that he said the Government were allowing for the project for the whole country?

§ Lord Henley
My Lords, the figure that I gave was in fact £40 million addition to the £42 million. I do not have any figures for Wales but no doubt I shall be able to write to the noble Lord later on this matter.

§ Lord Auckland
My Lords, no doubt my noble friend is aware that the additional £40 million is extremely welcome, but can he say whether the district general hospitals will receive a reasonable share as well as the teaching hospitals? Is he aware that at the moment the district general hospitals have many difficulties with funding?

§ Lord Henley
My Lords, we shall certainly make sure that the district hospitals are treated as fairly as teaching hospitals. I think we made that clear in the White Paper.

§ Lord Ennals
My Lords, with only six more days to go for consultation and at a time when there is such opposition from all the professions in the National Health Service about their proposals, can the noble Lord assure the House that the Government still intend to proceed without giving further opportunity for consultation with the 398 professionals who have to carry out the work? Why are the Government rushing into this scheme at this stage? Does it make sense? I submit that it does not.

§ Lord Henley
My Lords, we are not rushing into it. We have listened a great deal and will continue to listen to the remarks of all interested parties. The noble Lord implies that there is no support whatever for the changes. We feel that there is a considerable amount of support within the profession. Many of the objections to the White Paper have been misguided.

§ Baroness Robson of Kiddington
My Lords, perhaps I may ask the noble Lord whether I have understood him rightly. If not, will he make the matter clear? He said that in a general practitioner service with a practice that goes in for a budget holding service, the administrative costs will be reimbursed by the department. Therefore, can he assure me that in order to run their practice, their budget, and give the right kind of service, a practice of six general practioners would need to employ an administrator, and that that cost will be reimbursed?

§ Lord Henley
My Lords, it would be up to the practice itself to decide who they needed to employ. They would receive enough money to run the practice.

§ Baroness Seear
My Lords, in reply to the noble Lord, Lord Ennals, the noble Lord said that the Government would continue to listen. Does that mean that genuine consultation will continue after the six days are up?

§ Lord Henley
My Lords, the Government always continue to listen.

§ The Countess of Mar
My Lords, is the noble Lord aware that it is being said that the White Paper should not be entitled Working for Patients, but Working for Consumers? In this case, the consumers are the family practitioner committees and the district and regional health authorities. Will the noble Lord please give the House an unqualified assurance that patient care and clinical management will take precedence over financial and other management?

§ Lord Henley
My Lords, patients are consumers. As the noble Countess, Lady Mar, correctly said, the White Paper is called Working for Patients. We shall continue to work for patients and I shall continue to make clear that none of the costs will be to the detriment of patient care.