HL Deb 17 October 2000 vol 617 cc875-7

2.54 p.m.

Lord Peyton of Yeovil asked Her Majesty's Government:

What skills administrators in the National Health Service require before they qualify for appointment as business managers exercising control over medical staff.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, it is for National Health Service employers to determine what skills are required for any post involving management of NHS staff, including medical staff. For the most senior posts, a rigorous selection process is required, including the appointment of an external assessor.

Lord Peyton of Yeovil

My Lords, I wonder whether the noble Lord has troubled to assess the effect on morale in the health service when an experienced and skilled person who has spent years acquiring those skills is obliged to submit a business plan to someone who is half his or her age, with little experience and no knowledge of either medicine or health. Is it not time that there was a widespread appreciation within the health service that accountants have never yet made anyone feel better in any way? Is it not time that people who sometimes magnify their own importance should appreciate that they are there to serve their colleagues?

Lord Hunt of Kings Heath

My Lords, I think it was the internal market introduced by the previous government that brought many more accountants into the health service. Much of the managerial and other decision-making responsibility in hospital trusts is devolved to clinical directorates which are usually headed by doctors, and by nurses and other professionals in a limited number of cases. Business managers are there to advise and support those clinical directors, not to dictate to them. I should be very surprised if, in the NHS, there were situations such as those described by the noble Lord. It would be the clinician who would have ultimate responsibility for the way in which matters were conducted and who would then be reporting to the senior management of the hospital trust.

Lord McCarthy

My Lords, the noble Lord, Lord Peyton, mentioned business skills. Does the Minister agree that certain skills are required of the medical staff, including consultants, when they are put in charge of non-medical staff? I refer, for example, to general managers. If, as I believe, what is required of them is very little in the way of management skills, does the Minister further agree that it may be just as well for patients that someone in the hospital knows something about management?

Lord Hunt of Kings Heath

My Lords, if we are to modernise the National Health Service, we need high calibre leadership and high calibre management. We have a very skilled and committed workforce in the NHS, including managers. Many of our managers are doctors and nurses who have transferred or who continue in clinical positions but also take on management responsibilities. I accept what my noble friend says in that we need to do more to support people in leadership positions. That is why we are making all NHS employers accountable for the training and development of all their staff, and why we are establishing an NHS leadership centre to help to develop the skills of everyone in the health service.

Lord Clement-Jones

My Lords, many of us agree with the Minister that in order to go forward the health service needs high-quality leadership, whether that comes from clinicians or from managers. Will the Minister give more details about the setting up of the leadership centre which was promised in the national plan by 2001? Can he say also what budget is being devoted to the setting-up of the centre?

Lord Hunt of Kings Heath

My Lords, I cannot give the noble Lord details of the budget yet. I shall be happy to supply that information when it becomes available. Among other things, we envisage the centre providing, first, an overarching leadership framework for the National Health Service to confirm and disseminate common leadership values, which is important to ensure consistency of approach throughout the health service. We envisage that it will also set competencies and standards for leadership activity at all levels. Again, I make the point that leadership will involve not merely general managers but many clinicians, nurses and other professional staff.

Lord Laming

My Lords, does the Minister agree that the time has come to give priority to the development of a proper system of performance management, so that the work of every doctor and every unit is consistently evaluated against volume, effectiveness and value for money?

Lord Hunt of Kings Heath

My Lords, the noble Lord will be glad to know that we have agreed in principle with the British Medical Association that the new consultants' contract will make annual appraisal and effective job plans mandatory for all consultants from April of next year. Having agreed the principle, we are now engaged in discussions on the details with the BMA.

The Countess of Mar

My Lords, is the Minister aware that I am becoming more and more worried about his answers to these questions? It seems that we are setting up an enormous bureaucracy in the National Health Service. Everyone will be expected to fill in bits of paper to justify his or her occupation, stating how many patients are being treated and how many have recovered. Can the Minister give me an assurance that this will not be so and that doctors' priority will be the patients? Can the noble Lord also assure me that clinical directors still have some contact with clinical work? The myth is that they were no "blankety-blank" good as doctors, so they have gone into administration.

Lord Hunt of Kings Heath

My Lords, the whole point of having clinical directors is to enable men and women who are practising clinicians to be involved also in leadership of their particular section of the hospital, or NHS trust. Surely that must be right. The more that people in leadership positions are involved in the experience of dealing with patients and of providing front-line services to them, the more effective those organisations are likely to be. I can assure the noble Countess that we are also very keen to ensure that we keep administrative costs to a minimum; indeed, from a figure of 5.3 per cent of total budget in 1997–98, they fell to 4.6 per cent by April of this year.

Lord Elton

My Lords, will the new arrangements allow for doctors, and others, in the National Health Service to record the amount of time that they spend on filling in forms, as well as on undertaking other activities?

Lord Hunt of Kings Heath

No, my Lords. We need to ensure that we keep bureaucracy to a minimum. We must enable clinical directors not to be administrators or form-fillers, but to lead their colleagues in ensuring that resources are used effectively and that high-quality services are delivered.

Earl Howe

My Lords, to what extent does the National Heath Service participate in the Investors in People initiative?

Lord Hunt of Kings Heath

My Lords, we are very much involved in that initiative. We have encouraged many individual NHS organisations to develop systems and processes in order to meet those standards. In addition, as I have already said, we expect every NHS organisation to be a good employer. We shall be monitoring that situation most effectively and rigorously over the next few years. If we are to meet the commitments in the national plan and recruit and retain more staff, we must be good employers. We must ensure that staff are dealt with fairly, effectively and in a supportive environment.