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Departmental Achievements

Volume 77: debated on Thursday 18 April 1985

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asked the Secretary of State for Social Services if he will list his Department's principal achievements since 1979.

In the field of health, we have supported a National Health Service in England which is treating more patients a year than ever before. This objective had been achieved by providing record resources; taking steps to see that Health Service money is used to better effect; and developing a more modern health service better fitted to care for and prevent sickness and respond to changing demands.The increased level of service provided is shown by the facts that, in England alone, comparing 1983 with 1978:

almost 667,000 more in-patient cases were treated:
250,000 more day cases were treated:
there were over 2½ million extra outpatient attendances;
667,000 more people were treated by district nurses or visited nurses or were visited at home by health visitors;
in 1983, 1 million more children aged five and under attended child health clinics;
the number of coronary artery bypass grafts rose from 3,191 in 1978 to 9,443 in 1983, an increase of nearly 200 per cent. (United Kingdom figure);
there were almost 3½ million more courses of dental treatment;
the number of new renal patients accepted for treatment rose from 1,094 in 1978 to 1,846 in 1983, an increase of 69 per cent. The number of patients being treated for end stage renal failure rose from 5,390 to 10,266 an increase of 90 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 twelve months, kidney transplants rose by 30 per cent., from 1,089 to 1,415 (United Kingdom figures).

This improved performance has been supported by record spending on the health service. Total spending has increased from £6½ billion in 1978–79 to a projected £14½ billion in 1985–86. By 1984–85, expenditure had 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 been increased, in real terms, following a cut of one-third, in real terms, under the previous administration. As a result, 20 major new health building projects have begun and been completed since 1979. 130 further projects are currently being designed or are under construction. Health authorities are planning further developments worth over £213 million.

Against the background of these record levels of financial support, we are succeeding in achieving better value for money spent in the health service and thus in treating more patients than ever before. A key first step was to simplify the formal structure of the health service by abolishing area health authorities. Then, from 1 April 1985, we established independent family practitioner committees accountable to me. Many 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 NHS management which we commissioned—of general managers, with personal responsibily for performance.. at regional and district level and in hospitals and other units; and the revision of management structures to complement this;
Rayner-style efficiency scrutinies on particular aspects of health service activity. The first round of scrutinies has shown scope for considerable savings by better management and more effective use of resources. Of the seven scrutiny reports published so far, one report alone (on cheaper ways of advertising for staff) is likely to achieve savings of up to £4 million per annum. A second round is being launched;
the development of performance indicators to enable health authorities to compare their services with those provided by other authorities; a second, more sophisticated package of indicators is about to be issued;
a major review of NHS information requirements and systems (the Körner review): health authorities are now implementing the results;
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 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 savings (£9.4 million on 72 contracts) 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 for 1985–86;
better arrangements for the planning and control of manpower so that while the number of patients treated in the National Health Service has increased, the overall level of staff employed in the health service had levelled out by 1983 and fell in 1984. Nonetheless, by September 1984 there were over 4,000 more doctors and dentists and nearly 47,000 more nurses and midwives than in September 1978.

Within my Department I have, as recommended by the Griffiths report, set up a Health Service Supervisory Board to advise me on major issues and appointed as chairman of the National Health Service Management Board a senior industrialist with outside management experience to improve the management performance of the Service.

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 but also in progress made towards the development of the priority services identified in "Care in Action":

health authorities enabled to make continuing payments to local authorities and voluntary organisations to provide community care for people moving out of long-stay hospitals;
a 50 per cent. real increase in joint finance between 1978–79 and 1984–85; and legislation to make joint finance funds available for educational and housing projects;
Government funding for projects to re-locate long-stay patients moving out of hospitals and in particular to provide homely accommodation for mentally handicapped children in the community;
a real increase of over 35 per cent. in the value of DHSS general grants to voluntary bodies and new central initiatives involving the voluntary sector such as the drug misuse initiative;
the first major legislative reform in the field of mental health since 1959, including the setting up of the Mental Health Act Commission;
the establishment and extension for a further period of the Rampton hospital review board;
the establishment of three experimental National Health Service nursing homes and measures to improve standards in residential homes for elderly people;
an initiative to promote fresh voluntary projects for under fives.

The Government have also given a major push to the prevention of health and social problems. We have seen a reduction of 30 per cent. in perinatal mortality between 1979 and 1983; reductions in cigarette smoking; the development of intermediate treatment for young people in trouble; central grants for projects to tackle drug abuse; new campaigns on rubella immunisation, the ante-natal care of Asian mothers and babies, and drug misuse; and other measures to combat glue sniffing and drug and alcohol misuse.

In the field of primary care we have ended opticians' unjustified monopoly in the dispensing of glasses, allocated £9 million specifically to improve primary care in inner cities, and reduced the drug bill by a selected list of prescribable medicines in certain categories. In 1983–84 there were over two thousand more family doctors in England and nearly 1,800 more dentists than in 1978–79. The average family doctor's patient list size had reduced from 2,312 in 1978 to 2,116 in 1983.

Apart from the statutory services, 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 co-operation between private hospitals and the National Heath Service for the benefit of patients. About 4½ 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. Their right to make such extra provision is one which this Government have vigorously defended.

In the field of social security we have more than honoured our pledge to maintain the real value of pensions and other long-term benefits. Between November 1978 and November 1984 pensions were raised by 83·6 per cent. while the Retail Price Index rose by 77·2 per cent. Pensions are now uprated in line with the actual movement in prices — an improvement on the forecast method which was previously used and which led to inaccuracy and uncertainty. The Christmas Bonus for pensioners, which was not paid in 1975 or 1976, has been made permanent through an Act of Parliament. From November 1984 periods after people reach age 80 have counted towards the 10 year residence test for the over 80's noncontributory retirement pension. Before that date people entering, or returning, to the United Kingdom after the age of 70 were usually unable to qualify no matter how long they lived in this country afterwards.

We have fully protected the value of war pensions and war widows' pensions and have maintained the preference over the civilian pensions. War widows' pensions and allowances are no longer taxable. A new mobility allowance for war pensioners has been introduced and higher rates of benefit are paid under the new scheme. We have made significant improvements to the age allowances payable to war widows, especially those aged 80 and over.

For families, under this Government, child benefit and one-parent benefit have reached their highest ever value in real terms. The real value of Family Income Supplement has also been increased.

Expenditure on cash benefits to the long-term sick and disabled has increased by about 30 per cent. in real terms since 1978–79. Significant improvements in the benefits have been made:

mobility allowance has been made tax free and has doubled in cash; the earnings limit for invalid care allowance has been doubled;
there has been a real increase in the therapeutic earnings limit for those on incapacity benefit;
the "invalidity trap" has been removed;
the proposed severe disablement allowance has ended the controversial household duties test;
the scope of the industrial injuries occupational deafness scheme (in particular its coverage) has been extended.

The supplementary benefit schemes rules have been published in regulations and in publicly available guidance for staff. Substantial improvements in benefits have taken place:

an increase in the real value of the scale rates;
automatic entitlement to the long-term scale rate for men over 60;
a reduction in the qualifying period for the payment of the long-term scale rate from two years to one;
an increase in the amount of savings people on supplementary benefit can have while still drawing full benefit; and a new disregard for the surrender value of life insurance policies;
increased help in meeting fuel costs: we expect to spend about £400 million in 1984–85 on heating additions which are now paid automatically to supplementary benefit householders aged 65 and over or with a child under 5;
equal access for men and women to supplementary benefit;
a tapered earnings disregard for single parents.

During 1984, the Government set in train the most wide-ranging review of the social security system since the Beveridge report over 40 years ago. Four review teams were appointed to examine the four main benefit areas — provision for retirement, supplementary benefit, housing benefit, and benefits for children and young people. In parallel with this, we instituted a review of provision for maternity and we also commissioned a major new survey, by the Office of Population Census and Surveys, into the prevalence of the needs arising from disablement.

The review has been conducted in a uniquely open way. Three of the main review teams were chaired by DHSS Ministers and the fourth—the housing benefit review—had an independent chairman. Each chairman was assisted by two outside members in assessing the evidence and analysing the issues raised. All four review teams invited written and oral evidence; over 4,000 individuals and organisations responded by submitting written evidence, and 19 public sessions were held at which the teams led by Ministers heard and discussed oral evidence. In addition, the housing benefit review team heard oral evidence at informal meetings with interested organisations and individuals.

The review has led to extensive public debate about the social security system and has enabled Ministers to hear at first hand views and ideas for change from a wide spectrum of opinion. The Government are now considering the conclusions of the review and proposals for change and we will be publishing these as soon as possible. The main objectives underlying our considerations are: to secure the most effective use of the huge resources directed to social security, now running at about £40 billion a year (some 30 per cent. of all public spending); to ensure that resources are directed to those who need help most; to simplify what has become an extremely complicated system; and to improve its administration.

Within my own Department, measurers to improve operational efficiency have helped to reduce staff from over 98,000 in 1979 to 93,361 in March 1985, despite an increased workload. We have reduced the number of social security regions from 12 to seven, implemented a programme of devolution of work, reorgansised internal audit to increase efficiency, and introduced a system of budgetary control for certain administrative expenditure. In the Department's headquarters, I have instituted a management accounting system which seeks to clarify organisational objectives and monitor their achievement. At the same time, the headquarters staff of the Department has been reduced by 20 per cent. since 1979.

For the longer term, we have published consultative proposals for a social security operational strategy which will make full use of computerised information at national and local level to improve services for the public. Early projects within the strategy providing microcomputing facilities in DHSS local offices and improved enquiry facilities through terminals in unemployment benefit offices are being developed for implementation in the next 12 months.

As well as being more efficient, we are also providing a better service to the public. For example, nearly half of our local offices have set up a working group on service to the public; a freefone enquiry service has been introduced to answer social security enquiries; 112 staff found from efficiency savings have been allocated to local offices exclusively to improve service to the public and provide better information; postal claiming has been introduced for supplementary benefit for unemployed claimants and is being extended to other groups shortly; and applicants for legal aid can now provide information by post instead of at a local office interview.