Health and Social Security

Part of the debate – in the House of Commons at 8:34 pm on 22 November 1994.

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Photo of Alan Milburn Alan Milburn , Darlington 8:34, 22 November 1994

John Maples's advice to Ministers to batten down the hatches on NHS matters clearly came too late for the Gracious Speech. The Government will live to regret that. The NHS management changes outlined in the Queen's Speech will bring yet further health trouble to a Government who are drowning in a mess of their own making.

In October last year, the Secretary of State for Health first told the House of her plans to reform the management of the NHS in England. Her intentions were radical. She said: These changes will slim down NHS management. They will make it simpler and sharper … They will save money on administration to spend on patients, and they will uphold and strengthen accountability. They will continue the process of decentralisation".—[Official Report, 21 October 1993; Vol.230, c.400.] How could anyone disagree with those aims? The claims will be judged when detailed proposals are laid before the House, but they also have to be judged against what has gone before. There, the Government's record betrays their rhetoric.

To date, the Government's assault on NHS red tape has turned out to be a damp squib. Even that inveterate self-declared campaigner against bureaucracy in the Welsh NHS, the Secretary of State for Wales, has failed to come up with the goods. Since he declared war on bureaucracy in the Welsh NHS in autumn last year the number of health service managers there has not fallen but has increased. The same is true in England, where the latest Department of Health figures show that in the year to September 1993 managerial numbers increased once again, this time by 13 per cent. That is despite a blatant attempt by Ministers to massage the figures. So much for the Secretary of State's claim about slimming down NHS management. It is not slimmer or leaner and it certainly is not fitter, but it is fatter.

What about the other side of the equation? What about saving money to spend on patients? The evidence is equally graphic. An extra £1.5 billion has been spent on managerial salaries since the advent of the market in the NHS. There are bumper salaries for a few but a pay squeeze for the many. This year there are 17,500 fewer nurses on England's hospital wards than there were last year. Increasing the number of managers and cutting back on nurses is hardly the priority for a national health service where 1 million patients are currently waiting for hospital treatment.

The Secretary of State for Health now says that she has learnt all the lessons. She says that the abolition of the regional health authorities will put matters right by launching a new assault on bureaucracy. Her Department's figures give the game away. They show that she has the wrong target in her sights if she wants to make an effective job of tackling NHS red tape. The abolition of the regions will do nothing to tackle the 7,500 extra managers outside the regional health authorities who have been recruited to implement the Government's market changes. The boom in health bureaucracy has taken place not at regional health authority level but at hospital level as a new contract culture has taken over inside the national health service.

The abolition of regional health authorities will achieve at least some of the Government's objectives. It will undermine health service planning and further undermine local accountability in the national health service. The light touch that the Secretary of State commends as a virtue of NHS management executive outposts is irrelevant in a region such as mine, where the incidence of ill health and health inequalities call not for a light touch but for strong Government intervention. Those health inequalities and the health problems that characterise the north also call for in-depth knowledge of the region so that resources can be targeted where they can be most effective.

The merger of Northern regional health authority with Yorkshire regional health authority will make for a more centralised, out-of-touch service and a less accountable NHS. The future of health care will be the preserve of people without any stake in the regions. Policy, however, will mirror the sort of confusion that exists at more local level.

There is no disputing the merits of the proposal to merge family health services authorities with district health authorities, which makes sense, but greater coterminosity is being compromised by other Government policies, most notably by the free market approach to health authority mergers, by the advent of health commissions, which are even further distanced from local communities, and by allowing the local government review to happen without reference to institutional change in the NHS.

In my own area, for example, the Local Government Commission is likely to recommend in a few weeks' time the welcome restoration of self-government to Darlington. Henceforth, the town will run its own social and housing services, but the devolution of local government powers from County Durham to Darlington is being accompanied by the centralisation of health powers from Darlington to County Durham. The forced merger of Darlington health authority has resulted in the purchase of health care being undertaken by a county-wide commission. Inevitably, the already yawning gap between social services and health services, so apparent in community care, will become a chasm as decision-making structures become ever more distant from one another.

It is a classic case of one set of Ministers not knowing what the other set is up to. The dog's breakfast that results can only compromise patient care. Nor is that a problem peculiar to my area. Across the country, a laissez-faire approach to health authority mergers has given rise to a patchwork quilt of purchasers. There is no direction from the centre, no overview and no planning. Instead, the market and the whims of local health managers are deciding the future shape of the NHS.

There is one bonus, of course, for the Conservatives in this hands-off approach: a further distancing of NHS decision making from the local communities that the health service is supposed to serve. That makes it easier for centrally determined free market thinking to be imposed on the NHS in all parts of the country.

That policy is aided and abetted by a secretive and closed health appointments system. Not surprisingly, that system puts the friends, supporters and even the relatives of members of the Conservative party into key positions, both in NHS trusts and in health authorities. To date, the public have footed a —40 million salary bill for turning NHS trusts into a lucrative job centre for redundant Conservatives.

Ministers could have used the Queen's Speech to make the minimum changes necessary to restore credibility to that discredited system. They could have used the speech to ensure that the lists of people nominated to serve on a health authority or an NHS trust are published. They could have insisted that the selection procedure and the criteria be made transparent. Finally, they could have insisted that, as is the case for people wishing to serve on magistrates benches, the party political affiliations of individuals be declared.

Ministers' refusal to accept those changes clearly shows that they believe that jobs for the boys and for the girls are more important than public accountability in the NHS. They are unscrupulously using the current appointments system to further Conservative interests in the NHS.

I remind Ministers that the health service is not their plaything. It is certainly not the plaything of those people appointed by Ministers. It belongs to the people as a whole. It is a public service and it should be properly and publicly accountable. In place of the chaos and inefficiency of the Government's health care market, we need an NHS that is free, fair, open, accountable, well planned and properly managed. I am afraid that that sort of vision for the NHS will have to await a future Queen's Speech from a future Government.