NHS Managers: Staff Levels (Hansard, 23 November 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, before 1985 there were no staff in the NHS described as managers. Following the Griffiths inquiry, general management was introduced and phased in over a number of years. In 1989 there were 4,940 general and senior managers. That increased to 22,540 in 1993. Since 1986 large numbers of administrative and professional staff, many of them nurses, have transferred to general management grades. Those transfers account for two-thirds of the increase between 1991 and 1992 and half of the increase between 1992 and 1993.

§ Lord Molloy
My Lords, I thank the Minister for that comprehensive reply. Notwithstanding what she said, is she aware that there are reports extant that nurses are deeply aggrieved by the fact that their numbers are running down, and that the number of health visitors is being decreased? Those staff are more vital to the health service than a surfeit of managers. Would it not be possible for the department to have talks with the nursing associations and health visitors about a problem which is causing them some anxiety?

§ Baroness Cumberlege
My Lords, there is no question of a reduction in the number of nurses. Since 1983 the number of qualified nurses has increased by 18,500. As to meeting with the Royal College of Nursing, the Health Visitors Association, and other nursing organisations, I met them last Monday.

§ Lord Ennals
My Lords, is it not true that almost all those who work in the NHS, except the managers, recognise that there are far too many managers now? Is 275 it the Minister's view that the NHS has been better managed since that great influx of managers, or worse managed, as is the view of many people?

§ Baroness Cumberlege
My Lords, those who receive treatment from the NHS recognise that it is now better managed. During the past year the number of patients treated has risen for the first time to over 8 million. That is twice the annual average of the 1980s and five times the number achieved under Labour.

§ Lord Elton
My Lords, is it not misleading to talk of a vast influx of managers when the figures given by my noble friend show that a large proportion of them relate to people delivering the service who are being given the proper managerial function within the service that they are delivering? If we put that together with her second supplementary answer, has not the net loss of places as a result been made up by the recruitment of new additional nurses to the system, which is why such a vast improvement of service delivery has taken place?

§ Baroness Cumberlege
My Lords, that is right in that we rely on clinical staff to provide care and treatment. That is of paramount importance. When you enter a hospital, find it clean, cheerful and well maintained, the staff happy and well motivated, that the laundry works, the food is good and the medical records are at hand, you experience good management. We are giving better service, as shown by the British Attitude Survey published last week. It showed that dissatisfaction with the NHS had fallen and that there was a seven percentage point increase in satisfaction.

§ Lord Dean of Beswick
My Lords, what criteria are used for setting the salaries of the top managers? Figures were published only last week showing that top managers in the National Health Service have enjoyed percentage increases almost rivalling those of chairmen and directors of privatised public utilities. Is it not strange that we are seeing the salaries of managers in the NHS touching £100,000 a year, which is £20,000 a year more than the Prime Minister receives? Will the Minister enlighten the House about the substantial increases and who has taken the decisions relating to them?

§ Baroness Cumberlege
My Lords, trusts have the freedom to set their own levels of pay but few have moved away from the national terms and conditions. The rates of pay for regional general managers, district general managers and unit general managers are within wage brackets set by the Whitley councils. Last week publicity was given to five managers who are receiving salary levels of approximately £100,000 per year. All those managers were doctors who had a management function and also had distinction awards.

§ Baroness Rawlings
My Lords, as a former nurse, I know the good value of management at board level. Does my noble friend agree that much of the recent achievement in the National Health Service has been brought about by involving not only nurses but also doctors in general management?

§ Baroness Cumberlege
My Lords, my noble friend is right. Clearly, if we are going to improve the National 276 Health Service we must ensure that teams which include doctors, nurses and skilled managers are well established. The results show not only more patients being treated but also a considerable reduction in waiting times.

§ Lord McCarthy
My Lords, although we may argue about whether the health service is getting better, does the Minister agree that the figures she has given show a 400 per cent. increase over eight years? That is 50 per cent. a year. How long will this go on?

§ Baroness Cumberlege
My Lords, NHS managers account for just 2.6 per cent. of the NHS workforce and 3.6 per cent. of the salary levels. I do not believe that that is excessive. We need a National Health Service that is well managed. We are putting more investment into the service and the results are coming through.

Lord Campbell of Croy
My Lords, my noble friend was helpful in giving precise figures. Do they include the National Health Service in Scotland and Wales? That is relevant to the figures she has given when such precision is offered.

§ Baroness Cumberlege
My Lords, the figures are for the United Kingdom.

§ Baroness Jay of Paddington
My Lords, from what has been said today, it is clear that we are all aware that the Government would like a news blackout on the number of managers in the health service. We heard about that this week. I return to the question asked by my noble friend Lord Dean of Beswick. It is clear that large salary increases are being given to managers in the health service. Do not the Government believe that that is inappropriate when they are recommending that in the statutory bodies there should be a pay freeze for doctors and nurses?

§ Baroness Cumberlege
My Lords, we shall be monitoring closely the management levels and the cost of management in the National Health Service. From April next year trusts must publish management costs in their annual reports. We have put a ceiling on health authorities regarding the increased number of managers that they can employ. Therefore, the situation is under control.
As regards the media and the National Health Service, I am always surprised when I visit hospitals and wards and go into the community that the people who have experienced the service have a totally different picture from that published in the press. There are two National Health Services: there is the health service that is there and the health service that is written about.

§ Lord Monkswell
My Lords, in answering a parliamentary Question in another place, the Prime Minister said that the salary increases of the privatised public utilities were the responsibility of the shareholders, and that directors and senior managers were accountable to the shareholders. In answering a 277 supplementary question, the Minister effectively said that trust hospitals are able to set their own salary levels. In doing so, to whom are the trust hospitals accountable?

§ Baroness Cumberlege
My Lords, trusts are accountable to the Secretary of State and they have to publish the costs of their management. They are accountable; there is no secret about it. The matter has been widely published and the salary levels of chief executives are well known. Trusts must set up a remuneration committee composed of non-executive members who decide not only the salary levels but also the conditions of service.

§ Lord Molloy
My Lords, bearing in mind what the Minister confidently said, and despite reports of midwives and nurses being somewhat disgruntled, will she consider talking directly not to the press but to the representatives of Britain's nurses, midwives and specialist doctors? That would greatly contribute towards resolving the difficulty that threatens our health service.

§ Baroness Cumberlege
My Lords, there is no threat to the health service. It improves day on day, year on year. I have a continuing dialogue with those in the nursing profession and, as I said, I saw them last Monday.