National Health Service: Costs (Hansard, 11 April 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, total spending by the National Health Service in the United Kingdom has increased from £8.1 billion in 1978–79 to over £39.3 billion in this financial year—a real terms increase of nearly 63 per cent.

§ Lord Orr-Ewing
My Lords, I am grateful to my noble friend for giving us such good news. Can we find some way of stopping people saying that the National Health Service is underfunded? Never has any expansion been in such terms. How does it compare with what happened in the last five years of Labour Government?

§ Baroness Cumberlege
My Lords, in a country which extols free speech, it is difficult to tell people that they must not say that the National Health Service is underfunded. However, the facts are that the Labour Government cut spending by 2.9 per cent. in real terms in 1978–79, the only real terms cut in total NH spending in recent times.

§ Lord Mellish
My Lords, do not the figures which the Minister has announced give the lie to the fact that the Government have no regard for the NHS?

§ Baroness Cumberlege
My Lords, the noble Lord is absolutely right. The Government have every commitment to the National Health Service. We gave a commitment in the last election manifesto that year by year we would increase the level of resources. We have done that.

§ Lord Avebury
My Lords, how many patient bed days were delivered by the National Health Service in 1979 and 1993 respectively?

§ Baroness Cumberlege
My Lords, we do not count activity now in terms of bed days because increasingly we use beds less and less in the National Health Service. The government strategy is to seek to do more in primary care. If one considers the developments in new medical technology we find, for instance, that drugs for peptic ulcers ensure that people do not have to go into hospital for treatment of any kind; it can be done in the community. The increase, too, in day surgery of 42.7 per 1276 cent. in 1992–means that it is inappropriate now to count bed days. We count the number of people who are treated through finished consultant episodes.

§ Lord Hailsham of Saint Marylebone
My Lords, can my noble friend tell me how greatly the expectation of life has increased in the years in question?

§ Baroness Cumberlege
My Lords, the evidence in your Lordships' House proves that it has increased considerably.

§ Baroness Jay of Paddington
My Lords, can the Minister confirm that during this period of increased expenditure on the health service increased expenditure on changes in administration have cost £1.2 billion in the past few years, that the number of NHS managers has risen by 25 per cent. in the last year, and that at: the last estimate their management pay increased from £25 million in 1987 to £494 million last year? In other words, the increased expenditure is not being spent on patient care.

§ Baroness Cumberlege
My Lords, no. The figure that is often quoted by the Labour Party on the cost of the NHS reforms totally excludes the 100 new consultants who have been appointed. We are treating more people year on year. That is very evident. One has only to look at the figures. We recognise that there needs to be more investment in management in the National Health Service.
When I consider some of the trusts and see the level of qualified accountants within their trusts compared with the turnover of the budgets that they have, I have to say that I am quite concerned. For the Doncaster Royal Infirmary, the turnover is £66 million; the number of qualified accountants is five. At St. James's Hospital, Leeds, with a turnover of £125 million, the number of qualified accountants is 9.5. That is worrying. The health service should have better management.

§ Lord Dean of Beswick
My Lords, in reply to my noble friend the Minister referred to the city of Leeds. Will the noble Baroness comment on the report in the press this morning that the eye unit in Leeds General Infirmary, which is a centre of excellence and does a marvellous job, has been asked to restrict its activities because the trust will run out of money?

§ Baroness Cumberlege
My Lords, we have always said to trusts that they have to live within the resources available. It is up to them to ensure that they get the contracts from the health authorities, who are the purchasers of services. If they are failing to do that, then it has to say something about the way the trusts are run and the service that patients are given. If the trusts are carrying out more work earlier in the year and they run out of money, then they have to spread their workload so that they have enough work to last the whole of the year. Any other business would do that.

§ Baroness Oppenheim-Barnes
My Lords, does my noble friend agree that the important people—the patients, the customers of the health service —are now 1277 more satisfied than ever before, whether in relation to general practice or to the hospitals? It is those opinions which count above all.

§ Baroness Cumberlege
My Lords, certainly the surveys which we have seen on GP fund holding, which was a major plank of the reforms, show that patients in fund-holding practices have noticed a difference. They believe that the services are better.

§ Earl Russell
My Lords, if the noble Baroness is right that the health service is not underfunded, can she tell us why so many people think that it is?

§ Baroness Cumberlege
My Lords, I think that is a matter of effective propaganda, it has nothing to do with the facts.

§ Baroness Jay of Paddington
My Lords, perhaps I may return to the question of how many patients have been treated under the new system. We have repeatedly asked that question in the House and are always given the phrase about completed "consultant episodes". I should like the noble Baroness to confirm the figures on the number of patients treated having increased under the new system. Would she further reflect on her use of the word "business" in relation to the National Health Service and on the remarks of the noble Baroness, Lady Oppenheim-Barnes, about "customers" of the National Health Service? Does that not show the lack of public sector values intruding into the health service, which is precisely what the Public Accounts Committee in another place asked the Government to reflect on?

§ Baroness Cumberlege
My Lords, recently I looked up the definition of "patient" in one of the well-known dictionaries. The definition is: somebody who suffers pain patiently". I do not think that people should suffer pain patiently. The way in which we have reduced waiting times shows that we are increasing our activity. We are treating people to a far greater extent. We are doing things that years ago would have been undreamt of in the National Health Service.
With regard to finished consultant episodes, the noble Baroness, Lady Jay, and I have had this little debate before. She knows that for three years we kept figures on finished consultant episodes and also deaths and discharges. I think that we came to the conclusion that deaths and discharges were a very unsatisfactory way in which to assess patient activity, for there is a world of difference between a death and a discharge.