National Health Service (Hansard, 11 July 1985)

§ The Prime Minister

The National Health Service is now treating more patients a year than ever before. This has been achieved by spending more money and taking steps to see that Health Service money is used to better effect. We are also developing a more modern health service better fitted to care for and prevent sickness and respond to changing demands.

We believe that the National Health Service's aim is to meet the needs and convenience of public and patients and we have been pleased by the recorded satisfaction of the public with the National Health Service. A recent opinion poll has shown that over three-quarters of the public thought the service "very good". The increased level of service provided is shown by the facts that, comparing 1984 with 1978: over ¾ million more in-patient cases were treated; over ¼ million more day cases were treated; there were over 3 million extra outpatient attendances; health visitors and home nurses visited or treated ⅔ million more people, ¼ million of them elderly; over 1 million more children aged five and under attended child health clinics; the number of coronary artery by-pass grafts rose from 3,191 in 1978 to 9,443 in 1984, an increase of nearly 200 per cent.; there were over 4½ million more courses of dental treatment; 496W the number of new renal patients accepted for treatment has increased by 60 per cent. The number of patients being treated for end stage renal failure rose from 5,390 to 9,330, an increase of 73 per cent. For most renal patients, the preferred method of treatment is by kidney transplant; the Government launched a campaign, in February 1984, to increase the number of organs becoming available for transplant and to provide the donor card scheme. During the following 12 months, kidney transplants rose by 35 per cent., from 1,089 to 1,470; latest figures (September 1984) show that the waiting list for hospital treatment has been reduced after rising by almost 250,000 between 1974–1979. It would have been lower still but for the 1982 industrial action. This downward trend has been achieved at a time when there are increasing demands for treatment and when the Health Service is treating more patients than ever before; it must also be remembered that half of all admissions to hospitals are immediate and many of those on the waiting lists will have firm dates for planned admissions.

This improved performance has been supported by record spending on the health service. Total spending has more than doubled from £7¾ billion in 1978–79 to a projected £17½ billion in 1985–86. By 1984–85, expenditure has increased by more than 20 per cent. measured against general inflation. These extra resources have been more than enough to meet the growth in demand resulting from the increasing numbers of elderly people. Capital spending has increased by over 20 per cent., in real terms, following a cut of one-third, under the previous administration. As a result 52 major hospital schemes costing over £5 million each, have been started since 1979. One hundred and fifty eight further projects are currently being designed or are under construction. Health authorities are planning further development worth over £123 million.

We have provided record levels of financial support but we are also succeeding in achieving better value for money spent in the health service. This has been the key to enabling the Service to treat more patients than ever before. A first step was to simplify the structure of the health service by abolishing one tier-area health authorities. From 1 April 1985, independent family practitioner committees directly accountable to the Secretary of State for Social Services were established. Other steps have been taken or are in train to achieve clearer accountability and better management within the health service. These include: annual accountability reviews by Ministers of the performance of regional health authorities at which objectives are set and RHAs held to account for their achievements. The review process has now been extended to district health authorities and their units; the appointment — as recommended by the (Griffiths) management inquiry report on National Health Service management which we commissioned — of general managers, with personal responsibility for performance, at regional and district level and in hospitals and other units; and the revision of management structures to complement this; management has been aided by a series of initiatives to enable National Health Service authorities to scrutinise and improve their own performance. This includes Rayner-style efficiency scrutinies on particular aspects of health service activity; the development of performance indicators to enable health authorities to compare their service with those provided by other authorities; a major review of National Health Service information requirements and systems (the Körner review): health authorities are now implementing the results; improved audit; the development of management budgeting, involving doctors, to improve resource usage and control; a report on the disposal of under-used and surplus land and 497W buildings, following which health authorities are reexamining their property holdings to free resources for patient care; competitive tendering for hospital support services to test their cost-effectiveness: significant and growing savings (already some £13 million) are being realised for patient care; the introduction of health authority cost improvement programmes: health authorities planned to make cost improvements valued at £100 million in 1984–85, and are planning further improvements worth £150 million for 1985–86; better arrangements for the planning and control of manpower, so that the proportion of staff providing direct patient care (eg doctors and nurses) has continued to rise. By September 1983 there were over 5,000 more hospital doctors and dentists and nearly 57,000 more nurses and midwives than in September 1978.

These improvements in management and efficiency are directed at not simply more treatment for patients but also a better quality of service. This is reflected not only in developments in acute services mentioned above and advances in new forms of diagnosis and treatment (e.g. previously untreatable eye conditions which now make use of laser techniques) but also in progress made towards the development of the priority services for the elderly, mentally ill and mentally handicapped people.

In addition, we have been making real achievements in the prevention of health and social problems. We have seen a reduction of 33 per cent. in perinatal mortality between 1979 and 1983; reductions in cigarette smoking; the development of urgent plans by health authorities to tackle drug misuse; new campaigns on rubella immunisation, and measures to combat glue sniffing and drug and alcohol misuse.

In the field of primary care opticians' unjustified monopoly in the dispensing of glasses has been ended. The drug bill has been reduced by a selected list of prescribeable medicines in certain categories and savings are already being used to improve other parts of the NHS. In 1984 there were over three thousand more family doctors and nearly 2.5 thousand more dentists than in 1978–79. The average family doctor's patient list size had reduced from 2,253 in 1978 to 2,068 in 1983.

We have welcomed the development and expansion of the private sector of health care. The compulsory phasing out of pay beds from National Health Service hospitals has been ended and we are working to encourage closer cooperation between private hospitals and the National Health Service for the benefit of patients. About 4.5 million people now choose to cover themselves with private medical insurance, providing a useful supplement to the total sum of health care, and relieving pressure on the National Health Service.

These massive improvements in the volume and standard of care provided by the National Health Service have not been achieved by the Government alone. We have taken steps which were necessary to enable those who work in the service to raise its standards of performance. I would like to pay tribute to the dedication and hard work of the overwhelming majority of all types and grades of staff in the Service, doctors and nurses, administrators and treasurers, cleaners and porters, who serve the patients so well. We have provided more finance, clearer planning and decision making and improved management to expand the service that their efforts provide.