National Health Service: Staff Ratios (Hansard, 17 July 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, overall numbers of directly employed staff in the National Health Service remained steady between September 1988 and September 1990 at the 1 million mark. The proportion of administrative staff, in the broadest sense, to clinical staff was 1:4.7 at September 1988 and 1:4.2 at September 1990.

§ Lord Gisborough
My Lords, I thank my noble friend for that Answer. Is she aware that many chairmen of district health authorities report a great increase in efficiency and service within the health service resulting from the reforms and in particular from better management of the people in the service?

§ Baroness Hooper
My Lords, I welcome the information that my noble friend has given. Of course, many of the problems which the reforms were introduced to resolve were administrative. I can quote examples such as the North Middlesex Trust which plans to make 15 administrative staff redundant. The savings which result will go into direct patient care. There is more direct patient care than ever before.

Lord Winstanley
My Lords, I welcome the figures which the noble Baroness has given to the House. Does she accept that they do not mean much until we know precisely who is included in which category? There are a great many National Health Service employees who might not appear to be clinical staff but who are crucial to the clinical care of patients. I refer to hospital secretaries, who are essential to the clinical care of patients. Are they administrative or clinical? Hospital porters are important to the care and comfort of patients. Are they administrative or 188 are they ignored? Under which column do they come? How can we obtain further details so that we are better able to understand the figures?

§ Baroness Hooper
My Lords, the important people are those involved in direct patient care. Overall, those numbers have increased. The figures for doctors, nurses, midwives and consultants have all increased dramatically. In addition, because of the increase in patient activity, there are more administrative staff. I shall seek to separate the figures for the direct care staff to which the noble Lord referred.

§ Lord Carter
My Lords, is the Minister aware that in the Observer last Sunday there was a statement signed by 600 consultants, leading members of the medical profession and others? Among other things it said: We … face increasing problems providing decent patient care because an already underfunded service is overstretched by an untested, expensive and top-heavy bureaucracy". Those are senior, responsible people who care passionately about the health service. What proposals do the Government have to put right that state of affairs?

§ Baroness Hooper
My Lords, there have been a number of recent initiatives. I have said on many occasions in your Lordships' House that more money than ever before is being spent on the health service. There has been the announcement of 100 new consultants appointed between 1987 and 1989; 100 new consultants to tackle waiting times covering the period from 1989 to 1992; and 200 consultants and 60 staff grade doctors for 1991–92 under the initiative to help reduce the hours of junior doctors. All the initiatives will provide an even better health service.

§ Baroness Phillips
My Lords, does the Minister appreciate that the noble Lord who has just spoken phrased his supplementary question in a way that is hurtful and insulting to young house doctors who struggle on night after night? As I recall, the administrative staff work from 9 a.m. to 5 p.m. Let us pay tribute to the staff who are really important in hospitals and not denigrate them.

§ Baroness Hooper
My Lords, I am not sure to which noble Lord the Baroness is referring. However, I wish to pay tribute to all those involved in direct patient care who are working towards improving our National Health Service system.

§ Lord Mellish
My Lords, as the Minister has been good enough to say that she will write to many noble Lords to provide up-to-date figures, will she inform me in writing how many doctors and nurses are employed in the National Health Service today compared with, say, 10 years ago? This is the fundamental matter irrespective of what has been mentioned today.

§ Baroness Hooper
My Lords, I can give the noble Lord those figures now. More patients are being treated nationally than ever before. There has been a 25 per cent. increase in activity since 1979. The number of doctors employed in the National Health Service has increased by 17 per cent. since 1979, while 189 the number of consultants has risen by 24 per cent. The number of GPs has risen by 20 per cent. since 1979 and in addition 100 consultants have been employed in connection with the waiting time initiative. There are also the 200 consultants who have been employed to deal with the initiative on junior doctors' hours.

The Earl of Halsbury
My Lords, in saying who is responsible for what duties, will the noble Baroness inform the House who those people are responsible to? To whom are they answerable for the exercise of whatever authority is delegated to them?

§ Baroness Hooper
My Lords, the bodies that are responsible for the health care of the public—that is what we are all most interested in—are the district health authorities. Those district health authorities enter into contracts with units, hospitals or other bodies. Responsibility for health care is devolved through a contract to the unit concerned.

§ Lord McColl of Dulwich
My Lords, does my noble friend agree that, although the administrators in the National Health Service have come in for a great deal of criticism over the past 10 to 20 years, nevertheless the Government's reforms are enabling them to be transformed into managers? We in this country still spend far less on administration and management than is the case in most other countries. Does my noble friend further agree that many of the 600 doctors who signed the letter published in the Observer on Sunday had the words "honorary" or "emeritus" after their names? That is a polite way of stating that those doctors are retired.

§ Baroness Hooper
My Lords, my noble friend draws attention again to the fact that the needs of direct health care are covered by a team approach which involves administrative staff as well as medically qualified staff.

§ Lord Williams of Elvel
My Lords, the words "honorary" and "emeritus" do not necessarily mean that the people to whom those titles belong know nothing about their subject. On the contrary they have great experience. Will the noble Baroness focus her attention on the thrust of the question of my noble friend Lord Carter? Is there not an overweight bureaucracy in the National Health Service which the Government should tackle?

§ Baroness Hooper
No, my Lords.

§ Lord Nugent of Guildford
My Lords, is my noble friend aware that the recently introduced resource management initiative is the most effective and radical introduction of improvements in the administration and management of the health service since the service began? My noble friend can take great credit for that.

§ Baroness Hooper
My Lords, I am grateful to my noble friend for his comments. As I said at the outset, many of the problems which the reforms aim to tackle are administrative problems.