Health Authorities: Finance (Hansard, 28 February 1992)

§ Baroness Denton of Wakefield
My Lords, at the end of the third quarter the National Health Service remained on course to achieve a financial balance for the year. Details of the number of authorities in deficit and surplus are collected during the year only as unaudited management information.

§ Lord Carter
My Lords, I thank the Minister for that Answer. Is she aware that a survey of health service managers in November showed that 65 per cent. were expecting to close beds or to cut services in order to break even by 1st April? Is she further aware that that shows that the main feature of the National Health Service reforms—the concept that the money should follow the patient—is not working.

§ Baroness Denton of Wakefield
My Lords, the noble Lord, Lord Carter, has great experience in this sphere. He knows that there are situations this year, as the reforms have been set up, where everything was not thrown into the pot. Matters developed in a systematic and slow manner. That applies to the Question asked by the noble Lord. As we have discussed in your Lordships' House on several occasions, the issue of beds is not what is important. It is the patient who is important.

§ Lord Renton
My Lords, is my noble friend aware that there is now evidence forthcoming that those health authorities and hospitals which have put their affairs into good financial order are giving good service to patients and satisfaction to their staff?

§ Baroness Denton of Wakefield
My Lords, I thank my noble friend. He pays tribute to the staff who are devoted to the care of people. I sometimes find it very strange that we are defensive of the best health service in the world.

§ Lord Taylor of Blackburn
My Lords, if the Minister cannot give the audited figure, will she give us the unaudited figure? I am sure that the department will be monitoring what is happening at the present time.

§ Baroness Denton of Wakefield
My Lords, the noble Lord is absolutely right that the standard of monitoring what is happening in the health service has improved enormously over the past two years. The proper way to report publicly on the financial position of the service and its component parts will be at the end of the financial year in the 1991–92 annual accounts. I reassure the noble Lord that not only do we monitor but in each region there are reserve funds —in the private sector, they would be called contingency funds—which enable support to be given to those people whose management may not be totally of the best.

§ Lord Mellish
My Lords, in order to put this matter in its true perspective, is the Minister aware that for 14 years I was chairman of a hospital management committee? We never had enough money to do all the things we wanted to do. That was years ago. The truth is that the National Health Service is the kind of body which takes in every possible amount of money that can be thrown at it. This is quite nonsensical. The real question is what we are putting in now compared with what was put in 10 years ago.

§ Baroness Denton of Wakefield
My Lords, as ever, the noble Lord addresses the relevant facts of the matter. This year the planned spending on the hospital and community health services in England amounted to £20 billion. Next year that will increase to £21.9 billion—a 9.5 per cent. cash increase. As the noble Lord rightly points out, the health service could absorb every penny that was ever directed towards it. We must have some sympathy with the experts and committed people who have to make difficult decisions about priorities.

§ Lord McColl of Dulwich
My Lords, does my noble friend not agree that it was a Socialist Government in 1976 which brought cash limits into the hospital service? Those responsible must be glad to know that we are breaking even. Does she also agree that it is refreshing not to have so many unscrupulous politicians hanging around Guy's Hospital wishing for it to fall? Does she further agree that the good news is that we are breaking even and will have broken even on 1st April?

§ Baroness Denton of Wakefield
My Lords, my noble friend's memory, experience and specific knowledge of Guy's Hospital greatly outweigh my own. The message that he always brings to your Lordships' House is that matters are improving and that money is being well used —again I stress—to the benefit of the patient.

§ Lord Jenkin of Roding
My Lords, is it not clear that the assumption of the noble Lord, Lord Carter, that the reforms are not working is not borne out by the facts? On the contrary, is it not clear that with the pressures now being generated by the reforms, particularly by the purchaser/provider provision, the money following the patient and the management changes made by the introduction of the trusts, a standard, policy and speed of service have been brought to the health service that will redound enormously to the advantage of patients? Is it not a tragedy that the party opposite has committed itself to reversing so many of those valuable reforms?

§ Baroness Denton of Wakefield
My Lords, I can only say to my noble friend that I could not have said it better.

§ Lord Carter
My Lords, is the Minister aware that the Bloomsbury in south west Hertfordshire, the Bromsgrove and Guy's at South Manchester and Withington Hospital, Manchester—to name but a few —have all forecast problems? Yes, the health authorities will break even. They will do that by closing beds and cutting services. In her answer to my supplementary question, the noble Baroness said that it is the throughput of patients that matters rather than beds. Therefore why, in south Manchester, has the health authority and the chief executive said that 100 beds have been closed to reduce the number of patients treated, as it is running above the level contracted for?

§ Baroness Denton of Wakefield
My Lords, there are many individual cases for discussion, and there are also leaked documents which your Lordships' House would not wish to discuss. I stress that the closing of beds bears a relationship to the new developments in medicine. Regional authorities have the opportunity to help individual situations. There is not, this year, a cash problem in the health service overall.

§ Baroness Phillips
My Lords, does the Minister have the answer to the question posed by the noble Lord, Lord McColl? Why would anyone want to hang around a hospital if they do not have to do so? I have just spent a little time in three hospitals and would quite cheerfully avoid them, being a politician.

§ Baroness Denton of Wakefield
My Lords, that is the second time this week that the noble Baroness, Lady Phillips, has brought common sense to a debate in which I have been involved.

§ Baroness Eccles of Moulton
My Lords, can I make my noble friend aware of another individual example; that is, the purchasing authority of Ealing? It will be in balance at the end of this year. I hesitate to say in surplus because we still have another month to go, but that is our hope. We have not achieved that through cuts, scrimping and saving. Within the budget allocated to us we have opened a new psychiatric hospital and will also have reduced a two-year waiting list from 500 to zero by the end of the financial year. I hope that that serves as an example that it has been possible both to improve our services and to remain within budget.

§ Baroness Denton of Wakefield
My Lords, I know that my noble friend Lady Eccles spends an enormous amount of time with her health authority. However, I hope that she will forgive me if I say that she is just one of many such chairmen who have accepted the challenge our reforms presented and have dealt with them to the benefit of all.

§ Lord Cledwyn of Penrhos
My Lords, is the noble Baroness aware that noble Lords and honourable Members of another place who ask questions about the National Health Service act in all sincerity and are not unscrupulous politicians?

§ Lord Peyton of Yeovil
My Lords, my noble friend may be rather on her own this morning. However, I hope that she will take encouragement from the fact that she has the warm support of those behind her, and that she will take the opportunity to contrast some of the questions she has faced from those opposite with that asked by the noble Lord, Lord Mellish, who is aware of the facts.

§ Baroness Denton of Wakefield
My Lords, I thank my noble friends for their support.

§ Lord McColl of Dulwich
My Lords, on the question of unscrupulous politicians, does my noble friend not agree that what is unscrupulous about them is their stating that 10 per cent. of the beds have been closed in the past 10 years? It is not 10 per cent.; it is 13 per cent. Does my noble friend not agree also that it was 13 per cent. in the previous 10 years? Every year since 1965 7,000 beds have been closed in the NHS irrespective of which government were in power.

§ Baroness Denton of Wakefield
My Lords, my noble friend states the facts. It is unfortunate, given the many thousands of people who work in our health service and acknowledging its good record of patient care, that it should be used as a political football.

Lord Morris
My Lords, can my noble friend help me? I know how to make a bed; I can unmake a bed; I can even remove a bed. Can she tell me how one closes a bed?

§ Lord Carter
My Lords, is the Minister aware that the last time the noble Lord, Lord McColl, intervened 491 on the question of bed closures, I had the Audit Commissioner's report with me? We showed him then that he was wrong.