NHS Administration (Hansard, 6 November 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the Department of Health does not collect information on the number of committees operating within the National Health Service. The Government are, however, committed to saving £1 billion on management costs over five years from 1997–98 and are well on course to do so.

§ Lord Peyton of Yeovil
My Lords, I hope that the noble Lord will accept that to ask even as energetic a Minister as himself to count up to so vast a number would be unreasonable. I hope that the noble Lord agrees with me on this matter. Will he do all that he can to cut out a fungus that has been growing for years, stifling initiative, blurring responsibility and wasting resources? It is a terrible phenomenon.

§ Lord Hunt of Kings Heath
Well, my Lords, I had considered whether to set up a committee to inquire into the number of committees! I fully accept that the National Health Service needs a lean administrative structure, and that is our aim. I accept also that we should, so far as possible, attempt to make decisions in time-limited task forces and small groups which bring together managers, commissions and other professional staff within the National Health Service, overseen by the necessary statutory committees.
I must, however, say to the noble Lord—whose autobiography is a very good read—that he himself is not short of sitting on a committee or two. I particularly commend his membership of the Confederation of European Ministers of Transport, which he describes as an "unusual international body". He says that it, generated goodwill, mutual understanding, and never even looked for anything to have a row about".

§ Lord Peyton of Yeovil
My Lords, I am grateful to the noble Lord for giving my book a much-needed puff!

§ Lord Tebbit
My Lords, does the Minister recollect that I asked a question earlier this year to which he was not able to give an answer—namely, how many layers of management there are in the National Health Service between a staff nurse in a hospital and the Secretary of State? Has anyone managed to count them, or is the figure too high for a human to comprehend?

§ Lord Hunt of Kings Heath
My Lords, I do not recall the noble Lord putting the question in precisely that manner. Clearly, it is not possible to describe the activities of 500 different organisations in the National Health Service. Each will have different management arrangements. We are seeking to ensure that decisions are made as speedily as possible. I have no doubt that the NHS Plan, which is focused on ensuring that doctors, nurses and other professionals are fully involved in decision-making, will lead to the most effective decisions being taken as quickly as possible.

§ Earl Howe
My Lords, does the Minister agree that my noble friend Lord Peyton makes an essentially wise point—namely, that the decision-making processes in the NHS are often painfully slow and cumbersome? What initiatives have the Government taken to streamline decision-making and to bring about savings?

§ Lord Hunt of Kings Heath
My Lords, as I explained, we are well on course to make the savings that I mentioned. As a percentage of NHS expenditure, the total spent on management costs has come down from 5.5 per cent in 1996–97 to 4.6 per cent in 1999–00. We shall continue to make reductions in management costs, as we have pledged to do. The most visible example of the Government's approach to more effective and streamlined management is the establishment of the NHS Plan. It was produced within four months, and involved nearly 150 people working in the front line of health to bring about change. As a result, we have produced a practical, effective plan which will lead to major change. We are expecting each local health community to undertake a similar process, which I believe will be equally successful.

§ Baroness Gardner of Parkes
My Lords, is the Minister aware that many people—of whom I am one—no longer believe that there are too many chiefs as opposed to not enough indians in the Health Service? There may not be enough indians, but the service certainly needs strong management at the top. It is wrong to think that such a huge enterprise can be run without that. Does the Minister agree on the importance of top management?

§ Lord Hunt of Kings Heath
Yes, indeed, my Lords; the quality of leadership in the NHS is crucial. That is why, in the NHS Plan, we have set out proposals for establishing a leadership centre in order to identify and give support to the lay managers and professional managers who will lead the NHS through a process of change. But at the same time we need to ensure that we reduce unnecessary administration to a minimum level. That was the whole purpose of abolishing the internal market, which made the NHS suffer through a countless and endless paperchase. We have very good leadership in the NHS. That will lead to effective change in the way services are provided.

§ Lord Elton
My Lords, the Minister focuses on committees and leadership. Given that his interest in these subjects is now aroused, will he recall that a committee cannot lead? Leadership comes from individuals. Is it too late to look back to the hospital matron, who has disappeared from the National Health Service—to its eternal loss?

§ Lord Hunt of Kings Heath
My Lords, I commend to the noble Lord the NHS Plan, which refers to the creation of "modern matrons". It is true that, over a period of 20 years, senior ward sisters have lost autonomy. Functional management in relation to catering and cleaning has taken away their responsibility for the direct management of individual wards. One of the most important ways in which we can improve patients' quality of experience is to give back to senior ward sisters many more powers than they have had in the past few years. That is what the concept of the "modern matron" is all about.

§ Lord Taylor of Blackburn
My Lords, does my noble friend recall that the Salmon report did away with matrons, sisters and so on? It was implemented by Sir Keith Joseph.

§ Lord Hunt of Kings Heath
Yes, my Lords. That report also created an extensive hierarchy. In the past few years, particularly with the introduction of the internal market and general management, the hierarchy was removed. This created problems because, having attained a level above that of ward sister, very few nurses entered senior management positions. At board level in particular, a senior nurse became a professional adviser rather than a manager. We need to turn that situation around. We need senior nurse leaders who can have an enormously influential impact on the quality of decisions taken within an individual hospital.

§ Baroness Carnegy of Lour
My Lords, the Minister said that the Government do not know how many committees there are within the NHS. If they do not know the number of such committees, how will they know when the number is reduced?

§ Lord Hunt of Kings Heath
My Lords, we are talking about 516 NHS bodies. It would be quite a waste of time and resources for us to undertake a census or audit of each committee in existence within such bodies. We use the concept of management costs as a way of keeping control on the amount of money spent on management. As I explained, we are seeing a reduction in management costs that will net the health service £1 billion for expenditure on patient services over a five-year period.

§ Lord Peyton of Yeovil
My Lords, is the Minister aware that we shall be very keen to help him count the number of committees that are cut out as a result of that process?