National Health Service (Hansard, 5 November 2001)

§ Lord Clement-Jones
asked Her Majesty's Government:
What is their response to the proposals contained in the consultation paper Shifting the Balance of Power within the NHS.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the discussion document on proposals to shift the balance of power in the NHS was published by the Department of Health on 27th July 2001. Detailed analysis of the 400 plus responses is still taking place. The department proposes to publish a response to the discussion exercise around the end of November.

§ Lord Clement-Jones
My Lords, I thank the Minister for that reply. However, does he accept that NHS managers cannot be expected to meet the challenging targets set out in the NHS Plan while they are in the middle of making major structural changes? Does he not agree with those NHS chief executives who said in a recent survey that they overwhelmingly view these reforms as disruptive, a distraction and likely to torpedo the achievement of the NHS Plan?

§ Lord Hunt of Kings Heath
My Lords, I do not agree with that at all. The structural changes we are making will enhance and support those chief executives in ensuring that we deliver on the NHS Plan. The principal aim is to place decision-making at the 2 primary care trust level so that the people who make the decisions—by 2004 they will have control of three-quarters of the NHS budget—will make them informed by their day-to-day contact with patients. That will enhance the NHS Plan.

§ Earl Howe
My Lords, is the Minister aware—I somehow think that he may be—that we on these Benches welcome the devolution of more decision-making power to local clinicians and managers? However, can he tell the House how that transfer of decision-making will be reconciled with the other concept on which the Government have placed great emphasis; namely, that of earned autonomy?

§ Lord Hunt of Kings Heath
My Lords, they are easy to reconcile. It is important, of course, that the structure of decentralisation is implemented as quickly as it can be as we believe that the primary care trust level is the right level for most of the key decisions to be made. Earned autonomy takes that one stage further. Within that overall context of decentralisation those organisations which have performed particularly well will have even more authority and decentralised control than the rest of the NHS.

§ Baroness Byford
My Lords, is the Minister confident that these changes will help people who enter hospital as accident and emergency cases? There are still horrific tales of people in hospitals waiting hours and hours on trolleys before they are examined. What guidance are the Government giving on that matter?

§ Lord Hunt of Kings Heath
My Lords, the Government announced only a few days ago a continued drive to improve the A&E situation—£100 million is being put in over the next three years to reduce long waits and to end inappropriate trolley waits. In addition, we are seeking changes to the way in which A&E services are run. Patients will be streamed. Those with minor injuries or illnesses will be dealt with separately from those with serious conditions. Specialist nurses and GPs will treat those minor 3 conditions. I believe that will result in a much better organisation of A&E departments. That process has proved extremely successful in the A&E services where it has already been implemented.

§ Lord Taylor of Blackburn
My Lords, what steps is my noble friend taking to make people aware of these semi-minor accident units, as I find that many people are unaware of their existence?

§ Lord Hunt of Kings Heath
My Lords, the changes I explained will be implemented in every A&E department in the country. However, my noble friend is right to point out the existence of what are described as minor A&E facilities or, indeed, NHS walk-in centres. Local publicity campaigns are in place and through NHS Direct patients are referred to those services when that is considered appropriate.

Lord Clark of Windermere
My Lords, does my noble friend accept that the vast majority of the million people using the National Health Service every day contact their local GP? What do the Government plan to do to modernise GP surgeries?

§ Lord Hunt of Kings Heath
My Lords, I certainly agree with my noble friend that contact with primary care and GPs forms an important element of National Health Service provision. We recognise the enormously valuable role that GPs play and we are committed to improving primary care in a number of ways; for example, by increasing the recruitment and retention of GPs, by investing in the GP infrastructure to improve the facilities of GP services and by extending the practice within primary care so that many more services in the future can be provided within the primary care setting as opposed to secondary care hospitals.

§ Baroness Sharples
My Lords, is the noble Lord aware that many patients do not take up their appointments at GP surgeries? That is one of the problems.

§ Lord Hunt of Kings Heath
My Lords, I am aware of that. There is a problem throughout the NHS of patients and the public not taking up their appointments. Obviously we do everything we can to urge responsibility on the part of the public and to get home the message that if they do not take up appointments they are depriving another member of the public of the opportunity to see a consultant in hospital or a GP in primary care services. The public have a responsibility in this regard but I also believe that GPs can improve their booking systems. One of the problems at the moment is that often patients have to wait far too long for a non-urgent appointment. If one has to wait a number of days for a non-urgent appointment, one is more likely not to take up one's appointment. We have set a target of a 48-hour maximum wait for non-urgent appointments.

§ Baroness Carnegy of Lour
My Lords, when the Government implement the proposed devolution, will 4 they leave it to local hospitals to find their own ways of reducing waiting lists, or will they continue to set targets from the centre, which we know distorts everything in a hospital and is damaging rather than helpful?

§ Lord Hunt of Kings Heath
My Lords, it is right that central government should set targets for reducing waiting times in the NHS. That is a key issue that is raised time and again by members of the public. It is absolutely right that the Government should set tough targets for the NHS. However, it is then for the NHS and individual hospitals to decide how they will meet those targets. Our role then is to support those NHS trusts through various mechanisms, such as the Modernisation Agency, which is endeavouring to share best practice throughout the National Health Service. What is involved is a combination of national targets and then local discretion on how they should be implemented.