2.56 p.m.
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what is the percentage of the total annual expenditure on salaries and wages in National Health Service hospitals spent on medical staff, on administrative staff and on ancillary staff.
My Lords, I regret that the relevant figures for salaries and wages for hospitals are not collected centrally. However, the relevant figures in the United Kingdom hospital and community health services in 1986–87 were 14 per cent. for medical staff, 11 per cent. for administrative staff and 12 per cent. for ancillary staff.
My Lords, I thank the Minister for that Answer. In view of the number of beds being closed, will the Minister agree that it would be more sensible to cut down on the number of pen-pushers and paper-shufflers rather than cutting down on the number of nurses?
Indeed it would, my Lords. That is the reason why, in the past six years, there has been a reduction in, for example, the number of ancillary workers amounting to something over 120,000. That is the result of management action on manpower levels and the introduction of competitive tendering. The money saved in that way has gone directly into patient care.
My Lords, is it not clear from the experience in other countries that any sort of private insurance scheme is likely to be approximately twice as expensive in terms of administration as a tax-supported service such as the National Health Service? How does the Minister justify the low proportion of gross domestic product dedicated to the National Health Service in comparison with comparable countries which have a far higher level of payment?
My Lords, if the noble Lord refers to the total amount of gross domestic product from both private and public sources, I do not believe that there is much difference between the countries in Europe. If the noble Lord is speaking only of the state provision, then I agree that there is sometimes a large difference. However, the objective is for the state to pay for the amount of medical care which it believes can be justified by the economy of the country concerned. I believe that that is what we have done over the past six years.
My Lords, are we to understand from the Minister's helpful reply that he is accepting that private or insurance-financed health care is far more costly from an administrative point of view than a tax-paid national health service?
No, my Lords. I did not say that. In terms of gross turnover, I confirm the figure which I have used before. Five per cent. is spent on administration and management. I am not able to confirm whether that figure would be higher or lower with a partially or totally private insurance-based medical service.
In that case, my Lords, what did his reply actually mean?
My Lords, in a nutshell, my reply meant that it is extremely difficult to make the kind of comparisons which the noble Lord was asking me to make.
My Lords, does that confirm my suspicion that the three percentage figures that the Minister gave in his original Answer do not add up to 100? If I am right, what sort of staff receives salaries and wages in the National Health Service that cannot be described as either medical, administrative or ancillary?
My Lords, one enormous group would of course be the nurses. Another would be the professional and technical services, such as laboratory services.
My Lords, is the noble Lord aware that I have been advised that there is no such thing as administrative staff in the National Health Service today? In my experience, under this Government everybody seems to be a manager or a deputy manager, with resultant chaos.
My Lords, I find that very difficult to believe when 46 per cent. of all employees in the health service are nurses.