NHS Hospital Trusts: Economic Viability (Hansard, 16 October 1996)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, if any NHS trust is unable to meet its obligations, the Secretary of State concerned will first act through the NHS executive to help resolve the problem and then, if necessary, take whatever action is considered appropriate in the circumstances.

§ Lord Dean of Beswick
My Lords, I am grateful to the Minister for that considerate reply, but she must be aware that senior members of the BMA, including the chairman, issued a statement earlier this month stating that this winter could be the most perilous one facing the National Health Service because of the present financial structure. The BMA said that substantial sums of extra money may well need to be found in certain areas if the service is not to collapse. Will the Minister give an undertaking that if that occurs patients will not be allowed to suffer and funding will be made available?

§ Baroness Cumberlege
My Lords, this is nothing new. Nearly every winter we hear cries such as these from the BMA and indeed from other bodies. I remember that when the reforms were introduced the BMA said that the NHS would collapse. That is not the case. The NHS has become stronger and stronger and indeed we are putting more money than ever into it. The Prime Minister of course gave a guarantee only a few days ago that in our manifesto pledge the NHS will receive more money over and above inflation, year on year, throughout the next Conservative government.

§ Viscount Ullswater
My Lords, my noble friend's answers on this matter are helpful, but does she realize 1680 that the providers of capital for the PFI in the health service are concerned that the Secretary of State cannot be forced to dissolve a trust and therefore transfer the liabilities to another body? Will my noble friend reassure the House that the NHS executive will ensure through its monitoring programme that the NHS trusts will always be able to fulfil their responsibilities and not allow liabilities to remain undischarged for ever? I do not think the National Health Service (Residual Liabilities) Act provides that comfort.

§ Baroness Cumberlege
My Lords, because we were aware of these concerns we passed the residual liabilities Act earlier this year, as my noble friend has mentioned. However, I am aware that some people in the private sector would like us to go even further. The assurance I can give my noble friend is that the proposition that the Secretary of State would stand by and do nothing in circumstances where an NHS trust was unable to meet its liabilities is untenable given all his statutory responsibilities.

§ Lord Howell
My Lords, if the Government are putting more money into the National Health Service every year, why do we hear of more closures, especially of accident and emergency departments? Those two factors do not square up. Can the Minister assure the House that before people close accident and emergency services—I refer to Hillingdon—and refuse people over the age of 75, they are required to consult with neighbouring hospitals and to make known to the public the alternative arrangements made before they take such drastic action as we have seen at Hillingdon?

§ Baroness Cumberlege
My Lords, I would not deny that there is pressure in the National Health Service, partly because we are doing so much more. We are treating more patients. We have increased the number of hospital treatments by 25 per cent. in the past four years. The number of people treated as day cases has doubled. We are of course making changes as populations move, as demands change, and as high technology comes on stream. Clearly we are having to look at the hospital services that are provided.
Hillingdon is a very interesting case because there is a hospital closer to the population served. GPs are being asked to refer their patients to the Mount Vernon Hospital which is just up the road. Of course we shall see changes as circumstances change.

§ Lord Peyton of Yeovil
My Lords, does my noble friend agree that pressures will always continue to mount within and upon the National Health Service? There is nothing surprising about that. It will always be a difficulty for every government. Will the Minister also agree that to treat the National Health Service as an arena for party politics, as so many questioners do, is profoundly unhelpful?

§ Baroness Cumberlege
My Lords, I agree with my noble friend. The pressures on the health service will continue as indeed they will all over the world in every health service. The more that we can keep party politics 1681 out of the National Health Service the better. We know that the staff in the National Health Service do not like it. Indeed when the National Health Service is diminished by party political argument it does nothing for recruitment or the confidence of patients.

Lord Bruce of Donington
My Lords, as one of the surviving members who was responsible in a minor part for the introduction of the health service, I do not intend in any way to raise party politics in my question. It does not lie in the mouth of the Government even to mention party politics in connection with this matter. What assurance will the Government give that people who are over 75 years will receive treatment? Will the Minister guarantee that there will be no kind of capitation by the Government as regards the age at which people are entitled to full service under the National Health Service?

§ Baroness Cumberlege
My Lords, I congratulate the noble Lord on his vision and foresight in establishing the National Health Service. As he refers to those over 75 years, I presume that he is declaring an interest in this matter. However, I can give him an assurance that the Secretary of State is very concerned about this issue. Indeed we shall be making some proposals later this year.

§ Baroness Hayman
My Lords, while one may wish to take party politics out of the health service, is it not correct that one cannot take party policy out of it? The Minister stated today, as she has stated before, that this winter is no different from any other winter. Is she aware that many people within the service consider that this winter will be as bad as in 1987–88 simply because of the paucity of the settlement that the NHS received last year? Will the Minister tell the House exactly how many trusts and health authorities are forecasting financial deficits this year?

§ Baroness Cumberlege
My Lords, I was a chairman in 1987–88. In fact I was the chairman of the National Association of Health Authorities. I can tell the noble Baroness that it was far worse then. What is more, we were not providing nearly the services that we provide today. The National Health Service is a great deal stronger today than it was then. I understand that the majority of trusts will balance their books this year. Only one health authority is in severe economic problems. The remainder believe that they can manage their deficits before the end of the year.

§ Baroness Jay of Paddington
My Lords perhaps I may ask a question about organisation rather than politics. As my noble friends have illustrated this afternoon, is not the real problem that the organisation of the so called internal market means that healthcare is not delivered where people need it and at the time they need it? Does the Minister agree that at the local level 1682 services are now being driven by the rather spurious constraints of that market and not by a sensible strategy for the NHS?

§ Baroness Cumberlege
My Lords, no. I believe that we are providing services which are much more sensitive to people, not least through primary care where we have seen GPs in their local surgeries, in their health centres, providing services that were undreamt of ever before. Therefore I cannot agree with the noble Baroness.

§ Lord Annan
My Lords, will the noble Baroness explain this? In 1989 there was one senior administrative officer whereas today there are 10. Does she consider that the health service is hampered by too many administrative posts in relation to those connected with patients?

§ Baroness Cumberlege
My Lords, the noble Lord is right to be concerned about bureaucracy and administration. However, we believe that this £42 billion business needs good management. But we have reduced bureaucracy. We have reduced the staff in the department by 20 per cent. We have abolished regional health authorities. We have merged district health authorities and family health service authorities. We have reduced management costs by 5 per cent. this year alone. That is a saving of £300 million over two years.