NHS Trusts: Financial Problems (Hansard, 15 February 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, in the new National Health Service more patients are being treated than ever before and long waiting times are falling. That is to the credit of both managers and clinical staff. Some hospitals have, however, completed their elective work earlier than planned. That has left them with spare capacity which they are looking to purchasers to fill. It is an issue we are addressing for future years, but overall the results for patients have been good. Many more have received their treatment earlier than would otherwise have been the case.

§ Baroness Jay of Paddington
My Lords, I thank the noble Baroness for her reply. However, is she aware that there is growing concern about the situation, which seems to show that even the very highly paid new executives in trust hospitals cannot sort the system out? Is she further aware that the present situation seems to reveal basic flaws in the mechanism of the internal market and probably at the bottom basic under-funding of the service as a whole?

§ Baroness Cumberlege
My Lords, never before has the National Health Service received so much funding. The Government have provided more than £1 billion extra for health services in England next year, a real increase of 3 per cent. over our original plans. Spending is at record levels. The noble Baroness suggested that perhaps managers are at fault. Never before have we had such a quiet winter. It is amazing that the health service is seeing more and more patients, waiting lists are going down and productivity is better than ever before.

§ Lord Hailsham of Saint Marylebone
My Lords, can my noble friend let me into a secret and tell me what elective surgery is? Is it a form of democracy, or is one allowed to choose for oneself?

§ Baroness Cumberlege
My Lords, there is an element of choice in that one can choose the consultant one wishes to see. Elective surgery is surgery which is not emergency surgery and can be carried out within a period of time.

§ Lord Ennals
My Lords, will the noble Baroness comment on the fact that before the election the numbers on the waiting list were consistently falling whereas since the election they have consistently increased and have now reached an all-time record level? Secondly, can she comment on the fact that an additional 18,000 people have been appointed to managerial posts since the reorganisation of the health service and the introduction of trusts?

§ Baroness Cumberlege
My Lords, the waiting lists have never been lower in terms of those who have been waiting for over a year. In 1992 the number of patients waiting over a year fell by a remarkable 45 per cent. The number of patients waiting over a year at the end of December was the lowest figure ever recorded. It is not the number of patients on the waiting list which matters; it is the length of time they have to wait. The Government took the decision to reduce the numbers 897 of people waiting over two years—and now there are none—and to reduce the number waiting over one year. As I have said, the record has never been better.

§ Lord Tordoff
My Lords, since the noble Baroness clearly will not tell us voluntarily, I shall ask the question. How many people are now waiting under a year compared with last year?

§ Baroness Cumberlege
My Lords, the number of people waiting over a year—

Noble Lords
Under a year!

§ Baroness Cumberlege
My Lords, I am sorry. The number of people waiting under a year is 904,323.

§ Lord Mackay of Ardbrecknish
My Lords, does my noble friend agree that the impressive fact about the trusts is that they have already treated more patients in this financial year than the hospitals did last year before they became trusts? Does she further agree that as the health service treats more and more patients on an elective basis, the number of people waiting for an appointment for their elective operations will naturally increase? The important factor is that the period that they wait is decreasing; and that is the aim that the Government are achieving currently.

§ Baroness Cumberlege
My Lords, my noble friend is absolutely correct. In the first 12 months of the reforms the number of patients treated in the NHS increased by 7.2 per cent. In NHS trusts the increase was 8.2 per cent. That is a remarkable record.

§ Baroness Fisher of Rednal
My Lords, will the noble Baroness consider the efficiency of the management of the West Midlands Regional Health Authority? Reorganisation was planned 10 years ago. Those plans have not yet been put into operation. Will she ensure that the new management which will take over, and others involved, will consult the citizens of Birmingham with the utmost speed on what is required in the area?

§ Baroness Cumberlege
My Lords, I am delighted to answer the noble Baroness's first question, yes. In answer to her second question, she will be aware that the plans are being reviewed at present.

§ Lord Stoddart of Swindon
My Lords, can the noble Baroness tell us the proportion of total expenditure on management and administrative staff in hospitals before and after trust status?

§ Baroness Cumberlege
My Lords, I do not have those figures with me. However, NHS management accounts for less than 1.8 per cent. of the NHS workforce. The ratio of clinical to support staff has never been higher. But over a quarter of administrative and clerical staff work in direct support of clinicians. That is a factor of which we are very proud.

§ Lord Hayhoe
My Lords, does my noble friend agree that attacks about managements in trust hospitals, or indeed elsewhere in the National Health Service, are grossly misjudged? Any reasonable 898 assessment of their contribution indicates that they ensure a more cost-effective use of the inevitably limited resources available for our health service.

§ Baroness Cumberlege
My Lords, my noble friend is quite correct. He will be aware that only three or four years ago the Government requested Sir Roy Griffiths, then managing director of Sainsbury's, specifically to review the management of the National Health Service. He was astounded at the lack of management, the poor management and the need to strengthen it. We are determined to get every penny out of every pound spent in the National Health Service. That requires managers to do a good and thorough job.

§ Baroness Jay of Paddington
My Lords, will the Minister elucidate on "over-performance on contracts" which seems to be the expression that guides managers at present? Over-performance on contracts seems to be another way of referring to reduction in services or cutbacks.

§ Baroness Cumberlege
My Lords, that is not the case. Over-performance is when a trust sees and treats more patients than it is contracted to do. Many trusts are doing that. They are squeezing their budgets as tightly as they can in order to treat more patients. However, we expect every trust and every directly managed unit to live within its means.

§ Lord Desai
My Lords, the noble Baroness referred to the "new National Health Service". Is she aware that according to articles in yesterday's newspapers patients do not have the same confidence in the National Health Service's ability to treat them that they had six months ago? I refer to an article on cancer patients. Is she further aware that fund-holding GPs are not using the full amount of money and are therefore not treating as many patients as they could because there is an incentive for them to save money and to plough it back into the practice? Is that good management?

§ Baroness Cumberlege
My Lords, I am surprised at the noble Lord's question. All the surveys that I have seen indicate that the public have greater confidence in the National Health Service. In fact a recent survey by the magazine, Doctor, indicates that the fund-holders reported that they had 70 per cent. cuts in waiting times and over 60 per cent. reported improved services for follow-up appointments. Over 50 per cent. reported improved dealings with consultants and were providing extra services such as physiotherapy. It is hardly surprising that the public are very satisfied with the National Health Service.

§ Lord Mellish
My Lords, some of us on this side of the House are delighted that the noble Baroness has the courage and the guts to get up and say something nice about the National Health Service.