Departmental Responsibilities (Hansard, 13 May 1983)

§ Mr. Fowler

The principal achievements of Her Majesty's Government in the areas of health, personal social services and social security since May 1979 are as follows.

We have proved the priority we give to the provision of health care for all by raising spending on the National Health Service in Great Britain from about £7¾ billion in 1978–79 to some 15½ billion in the current year, despite the need to contain public expenditure generally. This represents an increase against inflation of about 17 per cent. It has provided for 7½ per cent. growth in NHS services between 1978–79 and 1983–84, more than adequate to keep up with the growth in demand resulting from the increasing numbers of elderly people and of medical advance. We have reversed cuts in NHS capital spending. Capital spending has been raised by 17 per cent. since 1978–79. We have planned spending of over £1,100 million. At present 140 major new hospitals are being designed or are under construction in England alone.

We have substantially increased the numbers of staff engaged in direct patient care. We have improved their conditions of service. The nurses' working week has been reduced from 40 to 37½ hours. In September 1982 there were 6,500 more doctors and dentists, than in September 1978 and 45,000 more nurses and midwives—all whole-time equivalent figures.

The best measure of the quality of service given by the NHS is the number of patients treated. That increased significantly between 1978 and 1981; for example, half a million more inpatients and day cases, over 1½ million extra outpatients and emergency cases, 375,000 more people visited at home by district nurses and health visitors, 2 million more courses of dental treatment, 600,000 more sight tests and 400,000 more pairs of glasses. Staff-to-patient ratios in hospitals which care for elderly, mentally ill or mentally handicapped people have continued to improve. Average case costs in the acute sector have fallen, despite the increase in diagnosis and treatment provided for patients.

We have made it a priority to pursue greater efficiency in the NHS to give better value for money spent and to concentrate more resources on direct patient care. We have therefore streamlined NHS administration. We have abolished area health authorities. The proportion of resources spent on management will have been reduced by 10 per cent. between 1979–80 and 1984–85. We have complemented greater local responsibility with clear accountability for the way the responsibility is discharged. We have taken a number of initiatives to ensure that resources are used more effectively; in particular, improved manpower information and control arrangements; the institution of annual ministerial reviews of regional health authorities performance; NHS Rayner scrutinies; the development of standard performance indicators; the establishment of an independent management inquiry undertaken by businessmen to advise us on the effective use and management of manpower and 562W related resources in the NHS; a review of arrangements for audit including experimental use of commercial auditors; a major review of NHS information requirements and systems; the establishment of the supply council to improve procurement; and the greater use of investment appraisal. We have carried out a major review of under-used and surplus land and buildings and arrangements for disposal and estate management in order to raise more resources for patient care. We have requested all health authorities to test the cost effectiveness of hospital support services by going out to competitive tender.

In pursuing the development of services we have stressed particularly the importance of providing support and care for people in their own communities, and for state and local authority services to work in close partnership with the private and voluntary sector. For instance,

(i) Care in the community has been supported by a 51 per cent. real increase in joint finance between 1978–79 and 1983–84; and provisions in the Health and Social Services and Social Security Adjudication Bill (currently before the House) will extend joint finance arrangements to allow NHS funds to be used to support the provision of housing and of education for disabled people.
(ii) We have taken major initiatives on finding new ways of moving long stay patients out of hospitals and back into their communities and to speed up the transfer of mentally handicapped children to more homely accommodation in the community.
(iii) The emphasis on mobilisation of voluntary effort has been supported by a 33 per cent. increase in DHSS grants to voluntary bodies since 1978–79 and the introduction and expansion of the highly successful "Opportunities for Volunteering Scheme".

At the same time, we have taken specific action to encourage the development of local services in the priority areas identified in "Care in Action":

(iv) On mental health, we have introduced the first major legislative reform since 1959; and established the Rampton hospital review board.
(v) For the elderly we are arranging a new form of care through the establishment of three experimental NHS nursing homes; and we have developed demonstration services to help find the best means of treating elderly people suffering from mental disorder.
(vi) We have made significant improvements in the range and effectiveness of aids and artificial limbs; supported the opening and rebuilding of three spinal units; and provided further guidance and financial support to those working for the handicapped and disabled.

Apart from these priority groups, we have also made significant advances in other fields: for instance, a reduction of over 20 per cent. in perinatal mortality between 1979 and 1981; an initiative to promote fresh voluntary projects for under-5s; a major—pioneering—campaign on the prevention of rickets in the Asian community; further development of intermediate treatment for young people in trouble; and pilot projects with drug abusers.

We strongly welcome the development and expansion of the private sector—over 4 million people now choose to cover themselves and their families with private medical insurance. We believe the private sector adds a useful supplement to the total sum of health care and relieves the NHS of pressure that would otherwise fall upon it. We have ended the compulsory phasing out of pay beds from 563W NHS hospitals. We are working to encourage closer co-operation between the NHS and private hospitals to develop the exchange of facilities, ideas, and experience between both sectors in the interests of all patients.

On social security we have more than honoured our pledge to maintain the real value of pensions and other long-term benefits which are running ahead of inflation, and to protect the needy. Between November 1978 and November 1982 pensions were raised by 68.5 per cent. while the Retail Price Index rose by 61 per cent. The Social Security and Housing Benefits Bill now before the House will place this year's and future upratings on the solid basis of known fact in place of the inaccurate forcasting method introduced in 1976 by the Labour Government. Legislation was enacted in 1979 to make permanent the Christmas bonus to pensioners, which had not been paid in 1975 or 1976.

For families we shall be raising child benefit and one-parent benefit in November to their highest ever value in real terms and we have also achieved a 10 per cent. increase in the take-up of one parent benefit. We have increased the real value of family income supplement.

We have introduced a significant package to help early retirement. We are introducing, at the end of May , immediate payment of the long-term rate to men over 60 who are sick, disabled or unemployed. As from the beginning of April 1983, men over 60 can be awarded national insurance credits without having, as hitherto, to sign on as unemployed.

We have reformed the supplementary benefits scheme. The children's scale rates have been improved. We have introduced a tapered earnings disregard for single parents. We have increased the amount of savings people on supplementary benefit are allowed to have and still draw full benefit. We have introduced a new disregard for the surrender value of life assurance policies. We have reduced the qualifying period for the payment of the long-term scale-rate from two to one years. We have increased help in meeting fuel costs for those on supplementary benefit to over £300 million a year; in particular, the heating addition is now paid automatically to supplementary pension recipients aged over 70 and to families with a child under 5.

We have raised expenditure on cash benefits to the disabled by over 20 per cent. since 1979. The mobility allowance has been made tax free and increased by 83 per cent. in cash terms. We have increasd the earnings limit for the invalid care allowance. The therapeutic earnings limit for those on incapacity benefits will be raised in real terms for the second time in November. We are also removing the invalidity trap so that a period on invalidity benefit can count towards the qualifying period for the long term rate of supplementary benefit. The scope of the industrial injuries and occupational deafness schemes have been extended.

We have introduced a new Housing benefits scheme which will simplify the previous system. We have also introduced a new statutory sick pay scheme. Both of these have brought about considerable administrative savings and reduction in the number of civil servants.

We have fully protected the value of war pensions and war widows' pensions and have maintained the preference over the civilian pensions. We have taken war widows pensions and allowances out of taxation. We shall be replacing the existing war pensioners' vehicle scheme with a new cash mobility supplement. We have also improved 564W the arrangements for hospital treatment of war pensioners. By increasing from three to ten the centres for tropical diseases investigations for ex-far eastern prisoners of war we have dramatically reduced a back-log of cases.

We are working for greater efficiency in the operation of the Department. We have reorganised the Social Security Organisation reducing the number of regions from 12 to 7;implemented a programme of devolution of work: reorganised internal audit to provide a more efficient organisation; and a start has been made with the introduction of a system of budgetary control for administrative expenditure throughout the Department. For the longer term we have published consultative proposals for a social security operational strategy. This sets a framework for full use of computerised information in the future, with outlets at local offices designed to create better and more efficient services for the public. All these achievements have been carried out against the backgrond of an increasing work load. We have with the co-operation of staff secured greater efficiency and effectiveness. The staff of the Department has been reduced from over 98,000in 1979 to 94,000 in April 1983; a further reduction to less than 91,000 will be, made by April 1984.