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National Health Service (Reorganisation)

Volume 975: debated on Tuesday 11 December 1979

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asked the Secretary of State for Social Services when he will implement his proposals for the administrative streamlining of the Health Service; and if the plans will include the abolition of Derbyshire area health authority.


asked the Secretary of State for Social Services if he will make a statement about the progress of his consultations on changes to the administrative structure of the National Health Service.

We have today published our proposals to streamline the structure and management of the National Health Service in England and Wales in a consultative paper entitled "Patients First". It would not be appropriate for me at this stage to speculate about the future of specific area health authorities.

May we have an assurance that the Government will use an axe, rather than tweezers, on those health authorities that prefer to close hospitals than to cut their own waste and inefficiency? Is it not true that under proper management there wouldbe more than enough cash to provide better facilities for patients in need?

We believe that the closer that management decisions are taken to the point of patient care the more likely it is that patients' interests will predominate. Our proposals are designed to strengthen management at the local hospital level and to bring health authorities closer to the people.

I welcome my right hon. Friend's announcement, but is he aware that there is considerable feeling that the Health Service is over-weighted in administration and that those who work with those who suffer in our society are becoming increasingly separated, in terms of experience and salary, from those who take the decisions? Is my right hon. Friend aware that urgencyis necessary in order to save the morale of the NHS?

I entirely accept what my hon. Friend says. If he reads the consultative document he will see that our proposals are designed to deal with precisely those problems.

We note that the Secretary of State is to attempt to put right the disastrous reorganisation carried out by the present Secretary of State for Industry. Can the right hon. Gentleman tell us whether the House will be able to debate the consultative document and the Royal Commission report before the Second Reading of the Health Services Bill?

The question of debates is a matter for my right hon. Friend the Chancellor of the Duchy of Lancaster. On the right hon. Gentleman's substantive question, a great deal of benefit flowed from the unification of the primary care, community and hospital services, which was one of the principal objectives of the 1974 reform. However, there is now common consent that the Service has an over-elaborate structure and planning system and that decisions are taken too far away from the point of patient care. We have published today proposals to put that right.

Will my right hon. Friend take into account, when considering streamlining the NHS, the growing number of recent reports about ancillary workers who are apparently overpaid, under worked and not pulling their weight within the NHS? If the reports are true, is not the position that they reveal grossly unfair on the majority of workers in the NHS, medical and others, who are doing a good job? Will my right hon. Friend tell us what action he proposes to take in light of those reports?

I too have read the reports, and I regard them as disturbing. However, they are no great surprise. The primary need—and this is the central point in the document published today—is to strengthen management at the local level—and by that I mean in the hospital and the community. I stress "management" because I agree with what was said to me a few months ago by a wise hospital head porter who remarked "The trouble with the Health Service is that there is too much administration and not enough management".

I agree with what was said by my right hon. Friend the Member for Salford, West (Mr. Orme).Will the Secretary of State admit that there is something rather cheeky about a paper entitled "Patients First" being produced by a Government who have just put up prescription charges to 70p and have squeezed the NHS of money for patients more than any previous Government?

If I wanted lessons on how to manage the NHS, I am not sure that I would go to the right hon. Gentleman. He knows that even 70p, which will apply from next April, is no bigger a proportion of the cost of a prescription than was the 20p charge when it was introduced in 1971. We are doing no more than keeping the charge level with the rising costs of prescriptions.

Will the right hon. Gentleman ensure that in the local units to which he referred the trade unions that organise doctors, technicians and nurses are represented?

No. We are putting forward the proposal that we should not follow up the suggestion of, I think, Mrs. Barbara Castle that there should be automatic representation of staff interests on health authorities. It is noteworthy that in the five years since she made that proposal, during which time a Labour Government were in power, no one succeeded in even bringing forward for consultation a procedure under which that proposal could be implemented. Our view is that staff interests are more properly taken account of in proper joint consultation procedures. We lay great emphasis on that.