HL Deb 23 October 1997 vol 582 cc817-20

3.33 p.m.

Lord Judd

asked Her Majesty's Government:

What steps they are taking to reduce bureaucracy in the National Health Service.

Lord McIntosh of Haringey

My Lords, I apologise to the House as I am not my noble friend Lady Jay who has a commitment outside London, nor my noble friend Lady Gould who unfortunately was taken ill and had to go home this morning.

The Government are committed to maximising the proportion of National Health Service resources devoted to patient care. We are doing this by removing the bureaucratic processes of the internal market and reducing management costs. On 22nd May we announced a programme of measures to make a start in reducing bureaucracy surrounding the internal market and to reduce management costs by £100 million this year. Further target reductions in the costs of managing the National Health Service for 1998–99 will be set shortly. Savings made will be ploughed back into direct patient care.

Lord Judd

My Lords, I thank my noble friend for standing in for his noble friends and answering the Question so fully. Does he not agree that, while efficient administration of the health service is essential, the Government should be confident that they will have the public fully behind them in anything they can do to ensure that not a penny is wasted on bureaucratic inessentials to the detriment of quality of service at the front line? Will he assure the House that in the review of bureaucracy the Government will investigate any waste, duplication and unnecessary expenditure in the administration of budget holding practices as well as considering what is going on in hospitals and other parts of the health service?

Lord McIntosh of Haringey

My Lords, I am grateful to my noble friend for his first question. In answer to his second question, the search for savings will include fundholding general practice. There are certainly savings which can be made. In the first place, savings will be gained from having a common waiting list based on clinical need rather than where a patient comes from. Secondly, management allowances to fundholding GPs amount to £150 million per year. Much of that work, for example on patient invoices, will be taken over by our locality commissioning groups. We shall therefore seek significant savings in management allowances.

Lord Molloy

My Lords, will my noble friend consider the possibility of discussing this important subject with representatives of the NHS staff associations?

Lord McIntosh of Haringey

My Lords, the National Health Service Efficiency Task Force which has been set up consists of employees of the National Health Service; in other words, it comprises professionals not politicians. I am quite sure that it is holding discussions with the National Health Service staff associations and unions.

The Countess of Mar

My Lords, will the new arrangements involve getting rid of the system of extra-contractual referrals, which has been contentious? In many cases bureaucrats have interfered with clinical decisions made by doctors as to where a patient should be treated.

Lord McIntosh of Haringey

My Lords, that question concerns administration rather than savings and it is somewhat wide of the Question on the Order Paper. However, as I said, common waiting lists operating on the basis of clinical need rather than where patients come from will also affect where patients are sent for treatment.

Earl Howe

My Lords, following what the Minister said about the internal market within the NHS, can he say a little more about which elements of the internal market the Government intend to dispense with and whether they intend to abolish or retain the purchaser/provider split?

Lord McIntosh of Haringey

My Lords, we are at an early stage of the first year of the review which is being carried out by the National Health Service Efficiency Task Force but already we have identified a considerable number of savings. For example, £20 million has been saved by deferring the eighth wave of GP fundholding. As regards the wider issue of the purchaser/provider split, as the noble Earl knows we are preparing a White Paper on all of these issues and that will certainly be an important element of that.

Earl Russell

My Lords, does the treatment of the millennium bug in the NHS computer system count as bureaucracy within the meaning of this Question? Will the Minister confirm that he will not attempt to pay for the treatment of that bug by making savings elsewhere in the NHS?

Lord McIntosh of Haringey

My Lords, a number of estimates are circulating about the cost of management in the National Health Service. The department reckons that the figure is about £1.7 billion and the National Health Service Consultants' Association reckons it is about £1.5 billion. Inevitably, part of those management costs arises from processes which are essential for patient care. Effective information technology systems—I stress the word "effective" in view of some of the disasters that have occurred—clearly must be considered as contributing to patient care.

Lord Campbell of Alloway

My Lords, does the noble Lord accept that nurses serve in the front line and that any benefits that are achieved might involve their receiving some recompense for their services?

Lord McIntosh of Haringey

My Lords, I am the first to acknowledge that nurses are in the front line of patient care. It is true that the reclassification of some nurses into managerial posts, reflecting the proportion of their duties spent on managerial tasks, is one of the problems that we have inherited. We would like to see nurses spending as much of their time as possible on patient care rather than filling in forms.

Lord Avebury

My Lords, further to the final part of the Minister's reply, is he aware that every time a patient attends hospital he or she is asked the same questions repetitively; for example, his or her name and address, or whether he or she suffers from diabetes or epilepsy? Is it not within the resources of the National Health Service to have a database of patients who regularly attend so that these time-wasting questions can be dispensed with?

Lord McIntosh of Haringey

My Lords, that is a very sensible question, but one which I am not qualified to answer. I believe it relates to the question from the noble Earl, Lord Russell, who stressed the importance of effective information technology systems.