§ Mrs. Renée Short
asked the Secretary of State for Social Services what assessments have been made by his Department of cost-effectiveness of services provided within the National Health Service since the implementation of the recommendations of the Griffiths report.
§ Mr. Hayhoe
I am determined to consolidate and develop the significant improvements which have already been achieved in the cost-effectiveness of the National Health Service so that the increased resources provided by the Government are used to give the best possible service to patients. This has been one of the Government's major aims both in setting up the Griffiths inquiry and in implementing its proposals for strengthening management and making it more accountable at all levels. I endorse the inquiry team's view that line managers have a key responsibility to seek out cost improvements in all the services they manage and should be held to account for their achievement. Within the Department the NHS212W management board, established by my right hon. Friend on the recommendation of the inquiry team, has been developing the arrangements which already existed for health authorities to achieve a significant level of measurable cost improvement each year. Cost improvements achieved in 1984–85 amounted to over £100 million—more than 1 per cent. of health authorities' revenue allocations. The cost improvement targets proposed by authorities for 1985–86 give a total of about £150 million—more than 1½ per cent. of revenue allocations.
Higher cash spending and improved efficiency resulted in very significant increases in services to patients in 1983, as the service recovered from industrial action, and 1984. For example, in-patient and day cases increased by 650,000 and out-patient attendances by nearly 1.7 million between 1982 and 1984.
My right hon. Friend introduced in 1983 a programme of "Rayner-type" scrutinies which are conducted by seconded NHS officers who examine in detail a particular field where there is potential for improving efficiency. A number of scrutiny reports have now been published and regional health authorities are specifically asked to identify savings from implementing these in their cost improvement programmes.
The Department introduced performance indicators for the NHS in 1983. These are an important source of information for local managers on variations between their own and comparable districts' performance in key areas which can help them identify scope for improvement. The original indicators have been revised and expanded and indicators based on 1984–85 data have now been issued to all authorities.
The management board will in future be undertaking annual reviews of the performance of individual regions. The first of these reviews—which supplement arrangements already existing for reviews at Ministerial level—are about to take place. They will be used to examine key aspects of authorities' performance, including the short-term programme submitted annually by each RHA and the cost improvements it proposes. They will draw on performance indicators and other key data to help in identifying aspects of performance requiring particular scrutiny. Regional health authorities are taking up similar performance issues in their reviews of districts.
The NHS management board is actively considering ways in which these monitoring and review arrangements can be further developed and strengthened, and local management supported in its task of seeking greater cost-effectiveness in all services.