HL Deb 24 January 1990 vol 514 cc1054-8

2.45 p.m.

Lord Orr-Ewing asked Her Majesty's Government:

By how much the balance between medical and non-medical staff in the National Health Service has changed each year since 1979.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, for the UK in 1979 there were 49,200 medical and dental staff—by that I mean doctors and dentists —and 927,000 non-medical staff. That figure includes nurses. By 1988 there were 55,900 medical and dental staff and 953,700 non-medical staff. That shows an increase in medical and dental staff over the period of 13.6 per cent., with non-medical staff increasing by 2.8 per cent.

For the convenience of the House I have placed tables showing the position year by year in the Library.

Lord Orr-Ewing

My Lords, I thank my noble friend for those interesting figures. Is it not alarming and a tremendous challenge to the management that the NHS now employs over 1 million people and is thereby the biggest employer in the whole of Europe, with the one exception of the Red Army? Is it not also satisfactory that the number of people concerned particularly with patient care —the doctors and dentists —has increased by 7,000 in the 10 years and that the number of nurses has increased by 60,000? Those groups now number over half a million. That is a very great achievement for the organisers and all those dedicated to this wonderful task.

Is it not satisfactory that as a result of putting matters out to contract the ancillary staff has fallen in this period by no less than 74,000?

Baroness Hooper

My Lords, I am grateful to my noble friend for informing the House that the National Health Service as an employer is second only to the Red Army. I am also grateful to him for drawing attention to the very encouraging trend in the provision of direct patient care. The number of ancillary staff has fallen by 33.4 per cent., and although administrative and clerical staff have risen by 12.9 per cent. the nursing and midwifery, medical and dental staff have risen by 13.2 per cent. and 13.6 per cent. respectively. I believe those are very encouraging figures.

Lord Ennals

My Lords, I understand the staff of the Red Army is now being cut, but perhaps that is not relevant.

What conclusion does the Minister draw from those interesting figures? Do they in any way explain the current disturbing trend towards the treatment of fewer patients rather than more, which was confirmed by figures from her department last week? Those figures show a 42,000 fall in in-patient treatment together with the closure of 5 per cent. of the total of NHS beds —a reduction in one year of 14,000. Does one flow from the other?

Baroness Hooper

My Lords, the conclusions I draw from the figures —and indeed other figures —are that they are proof that we are spending more on our National Health Service than ever before; proof that we have more doctors in the National Health Service than ever before; and proof that even taking account of the reduction in nurses' working hours, nursing staffs have increased by 13.2 per cent. since 1979, which must speak volumes for our patient care.

Lord Ennals

My Lords, that is spending more on fewer patients, is it not?

Baroness Hooper

My Lords, as the noble Lord will realise, with technical advances many of the treatments that have to be provided are far more expensive than they were.

Lord Nugent of Guildford

My Lords, is the reduction in in-patients mentioned by the noble Lord, Lord Ennals, to some extent due to the great increase in day-patients?

Baroness Hooper

Yes, my Lords. I am grateful to my noble friend for making that point.

Lord Hunter of Newington

My Lords, will the Minister tell the House whether the recent campaign to recruit more nurses has been successful?

Baroness Hooper

Yes, my Lords. The nursing campaign has proved to be successful. We are in the process of fully implementing the recommendations of the KÖrner Steering Group on Health Service Information which will provide us with more information on nursing trends.

Baroness Robson of Kiddington

My Lords, can the Minister tell us her estimate of the increase expected in administrative staff as a result of the implementation of the new health and community service Bill? The noble Baroness told us that there has been an increase of 12.9 per cent. between the years 1979 and 1989. I believe that the House will be very interested to hear how much the figure for administrative staff will increase under the new conditions.

Baroness Hooper

My Lords, what is interesting about the increase in the number of administrative and clerical staff to which I referred is that the major increase is in relation to the direct support of clinicians. The number of non-clinically-related administrative and clerical staff has in fact decreased by almost 10 per cent. In regard to the effects of the White Paper, it is too early to give the noble Baroness any detailed figures. There is a document called Working Paper 10 which outlines future proposals for the service. This paper is now out for consultation. The consequences arising from that consultation will be effective somewhat later. In due course we shall have the relevant information.

Lord Molloy

My Lords, does the noble Baroness not agree that simply to keep pace with expenditure on the NHS in 1979 we have to spend more? Is she aware that many nurses and junior doctors are concerned that they have to do work which was formerly done by ancillary staff? Does the Minister further agree that this state of affairs is damaging the National Health Service? Other important people in the NHS —for example, the ambulance drivers —are also upset. Therefore we have junior doctors, nurses, ancillary staff and ambulancemen who are all disgruntled with the present manner in which the NHS is being organised by this Government.

Baroness Hooper

My Lords, we have an important programme of education and training going forward. Perhaps I can cheer up the noble Lord by saying that, as a result of the improvement in the ratio between consultants and junior doctors, a greater proportion of medical care is given by fully-trained doctors.

Lord Stoddart of Swindon

My Lords, I ask the Minister whether she will reject the disparaging remarks concerning ancillary staff made by her noble friend who asked this Question. They are an essential part of the National Health Service. Is the Minister aware that since the reduction in such staff and the privatisation of some services there has been increasing complaint about the state of some of our hospitals? I suggest to the noble Baroness that that proves that the ancillary staff are essential to a good, working National Health Service.

Baroness Hooper

My Lords, I cannot speak for my noble friend, but I am sure that he did not intend to be disparaging about the important work done by many ancillary staff. The decrease in staff of nearly 74,000 between 1979 and 1988 represents a reduction of 33.4 per cent., to which I referred. That decrease reflects a more efficient use of staff in this area and the effects of competitive tendering.

The Lord Bishop of Manchester

My Lords, does the noble Baroness not agree that the employment of staff in privatised services of this kind has often led to severe underpayment among people who are often already very poorly paid?

Baroness Hooper

No, my Lords.

Lord Ennals

My Lords, I am disturbed that the noble Baroness did not reply to the question from the noble Baroness, Lady Robson. Is it really true that another place is now considering the National Health Service and Community Care Bill without knowing what the extra administrative burden will be? Can the noble Baroness give the House an assurance that before the Bill reaches your Lordships' House we shall know what are the implications in terms of the administrative burden?

Baroness Hooper

My Lords, I give the noble Lord an assurance that I shall give the House the best information available at that point.

Lord Carr of Hadley

My Lords, perhaps I may return somewhat nearer to the original Question by asking my noble friend whether she will comment further on the alleged reduction in treatments referred to by the noble Lord, Lord Ennals. Can the Minister say whether it is really a fact that the number of treatments has been reduced, or rather that the number of patients staying overnight in hospitals has declined? If it is the latter, can the Minister say whether we should expect that to happen because so much more treatment is now given on a without-stay basis?

Baroness Hooper

My Lords, the encouraging trend in hospital care is towards more day care in order to avoid the unnecessary use of beds.

Baroness Masham of Ilion

My Lords, can the Minister say whether therapists are classed as medical or non-medical staff? I am referring to occupational and speech therapists and physiotherapists. Does the Minister feel that there are enough of these therapists to carry out the rehabilitation needs of patients within the National Health Service?

Baroness Hooper

My Lords, I believe that therapists come within the category of professions allied to medicine. In terms of statistics I believe that they come within the definition of medical staff. Manpower requirements are a matter for local bids and for the regions to consider.

Lord Mellish

My Lords, perhaps we can get this matter into perspective. The National Health Service is a magnificent service. Does the Minister not agree that in the past 20 years —never mind the past 10 years —there has been a dramatic improvement in the quality and the knowledge of medical staff? That situation is now being reflected in patient care. Does the Minister not agree that it is a fact that a few years ago, for example, we had never heard of hip replacements; of transplants or some of the other advances which are now taken for granted? I suggest that we should give credit where it is due.

Baroness Hooper: My Lords, I am very happy to give credit where it is due. We have an excellent National Health Service which we intend to improve and keep absolutely up to date.

Noble Lords

Next Question!

Lord Nugent of Guildford

My Lords, is my noble friend aware that we have now spent 20 minutes on two Questions? That is the amount of time we are supposed to devote to all Questions.

Lord Boyd-Carpenter

My Lords, 21 minutes!

Lord Nugent of Guildford

My Lords, does my noble friend not agree that we should speed up a little?

Lord Wallace of Coslany

My Lords —

The Lord Privy Seal (Lord Belsteacl)

My Lords, I think we should take the next Question. I know that the noble Lord would like to speak. Perhaps we can take his supplementary question and then pass on to the next Question.

Lord Wallace of Coslany

My Lords, can the noble Baroness explain why, if the numbers of nurses and doctors have increased, waiting lists are getting longer and longer?

Baroness Hooper

My Lords, I believe that in part that is due to the fact that expectations are increasing and there are new methods of treatment.