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Health: Government Spending

Volume 719: debated on Monday 14 June 2010


Asked By

To ask Her Majesty’s Government which health agencies and arm’s-length bodies will be affected by cuts in government spending.

My Lords, the Government are committed to reducing bureaucracy and improving efficiency. By streamlining and simplifying the infrastructure, we can ensure that clinicians focus on what really matters: delivering the best possible health outcomes for patients. All non-front-line organisations will be expected to operate efficiently and contribute to the Government’s commitment to reduce central administration spending by one third. That is why we are reviewing how best to organise the national infrastructure. The review will report in due course.

I thank the Minister for that Answer. Notwithstanding the Government’s proposed intention to create the biggest quango of all in the NHS board, what can the Human Tissue Authority and the Human Fertilisation and Embryology Authority expect from the bonfire of the quangos? Will it be a third of their work, for example? I choose those two because the Minister and many noble Lords in this House were closely involved in considering the legislation that led to the creation of those two important bodies.

My Lords, the focus of the exercise that is going on at the moment is, on the one hand, to look at value for money and, on the other, to look at how best we can deliver quality. Therefore, the review will consider which functions should be carried out at a national or arm’s-length level, which could be stopped with no detriment to the delivery of front-line services and which could be undertaken elsewhere in the system or, indeed, left to the market. So there is no target as regards getting rid of a certain number of bodies. The point of view from which we come is that of functions.

My Lords, can my noble friend help me? He implied that savings were to be made, which is excellent. If we are going to make savings in the National Health Service budget, why is the rest of the budget ring-fenced? If you can save £20 here, why not cut the budget by £15 and keep £5 for something else? Why undertake to spend all the savings rather than make them contribute to help after the ghastly state of affairs that was left to the Government?

My Lords, the simple answer is that we have a duty to ensure that every pound that we spend is spent efficiently, wisely and with value for money at the end of it. As my noble friend will know, the cost of healthcare in this country has traditionally risen at a faster rate than inflation, so even if we are advantaged in the sense of being a protected department, we still have to find savings in order to continue to ensure that we can deliver quality care at an acceptable price.

My Lords, I declare an interest as a member of the Equality and Human Rights Commission. Can the Minister assure the House that public authorities will be able to meet their mandatory equality duties, including carrying out equality impact assessments for all relevant policies and decisions, in spite of the difficult financial constraints?

My Lords, I can reassure the noble Baroness that the imperative to ensure that quality and equality are considered is uppermost in our minds as we proceed with this exercise, and indeed as we go forward into what will be a very difficult financial year next year.

My Lords, given the huge success of the tobacco-control legislation passed in the previous Parliament, which has already produced so many benefits including, as we have seen from recent statistics, a dramatic reduction in the number of heart-attack victims admitted to hospital, will the Minister give an assurance that the excellent smoking-cessation programmes run by his department will be exempted from any programme of cuts?

My Lords, smoking cessation is extremely important as a public health measure. I am sure the noble Lord will know that the coalition Government have set great store by their public health agenda. I cannot imagine that smoking cessation is going to disappear off the radar.

My Lords, in respect of a number of agencies within the health and social care field, it is clear to practitioners that some of them have been inadequate in their regulatory and monitoring function and others have gold-plated way over the top in a quite counterproductive way. In his search for which agencies could be brought together and their experience shared or which could be changed in other ways, what are the principles that the Minister intends to use to produce a better and more appropriate regulatory monitoring framework within health and social care?

My Lords, there are several principles. A reduction in the number of arm’s-length bodies is only one of the possible outcomes. As I have said, we are not looking necessarily for a large-scale reduction in numbers, but we want to see both efficiency and the delivery of quality. With those two ends in view, the bodies that we end up with have to make sense in terms of what matters in our wider system reform, which is, as I have said, to deliver quality.

My Lords, the Minister has said that he will be looking at functions in the review of bodies and that he will be looking to save one-third of running costs. In carrying out this review, will PCTs be examined carefully in terms of divesting themselves of their provider-arm functions so that they can concentrate on their commissioning functions?

My Lords, strictly speaking, primary care trusts are not considered to be arm’s-length bodies, but the coalition agreement, which I am sure the noble Lord has read from cover to cover, indicates the new role and the functions envisaged for PCTs. Further details of our plans will be announced very soon.

My Lords, will the Minister be prepared to consider joining together animal and human medicines and health? With global warming, with so many of our illnesses now zoonoses—in other words, caused by animals—and with so many antibiotics and other drugs used in common, would it not be a good idea?

My Lords, I am grateful to the noble Countess, particularly given her wealth of knowledge and experience in this area, for putting forward that suggestion, which I shall certainly take back with me.

My Lords, if the Food Standards Agency is to be wound down, which would be regrettable since it would mean the loss of an important, independent voice, will its science-based public health work on nutrition continue to be funded at least at the present level, if not augmented, which it needs to be?

My Lords, the Government fully recognise the important role that the Food Standards Agency plays in food standards, nutrition and food safety. Public health is a priority, and I reassure the noble Lord that the function that the FSA currently fulfils—to advise the Government and the public on nutrition—is one that we believe is equally important.

My Lords, can the Minister give us the assurance that it is functions that matter at the expense of individual bodies, which may of course overlap?

My Lords, I am grateful to my noble friend. He is right to suggest that we should look not at each body individually but perhaps at several across the piece to see whether there is scope for rationalisation in a way that does not detract from the quality of service.

My Lords, the noble Earl has frequently argued in this House in favour of there being arm’s-length bodies to protect the patient’s interest in the NHS. Will extra resources be found to enable this aspiration of his—and I am sure, of the coalition’s—to be fully funded?

My Lords, the budgetary implications of our plans are being worked through at the moment but we are clear that we need to have a more powerful patient voice within the system than at present. I believe that that goes hand-in-hand with our agenda for patient choice, greater quality standards and more information being made available to patients to enable them to make choices.