| Previous Section | Index | Home Page |
8.42 pm
Mr. Jacques Arnold (Gravesham): This debate is about bureaucracy and patient care in the NHS, and I would like to concentrate on patient care.
The Government have carried out massive reforms of the NHS, and the British people should judge patient care within the NHS by the results. In the past year alone, the NHS has carried out 8.6 million consultant episodes in our hospitals.
It is worth reflecting that in the four years since the reforms the number of such episodes has risen by no less than 25 per cent.--a massive increase in health care. I well remember that when I first entered the House the talk in the NHS was very much about waiting lists. It is worth noting that, following the reforms, no more people are waiting more than 18 months for an operation, and the 12-month waiting list has fallen throughout the country to just over 4,000 people.
That is no surprise, as the Conservative Government have spent an immense amount on the NHS compared to the previous Labour Government. There are now 55,000 extra qualified nurses and midwives and 22,500 extra doctors and dentists, so we should take no lessons from Labour about our record of improving health services and about the treatment given to our constituents.
The motion refers to bureaucracy in the NHS. There has been an increase in the number of administrators in the NHS, but let us be clear about what has been going on. We always used to take pride--and perhaps some amusement--from the fact that the NHS was the largest employer in the world after the Indian railway and the Red Army. The massive bureaucracy that we inherited from Labour has been transformed into a new structure that provides better health care for our people.
In making this massive transition, the scope for cock-ups and disasters has been immense. Therefore, I do not begrudge the Government and the NHS taking the sensible decision to manage the transition as they have done. We must not put at risk the lives of patients. There are massive transitions in industry, but we are not talking in this case about tins of beans that can be left out in the rain as a result of a change in management practices--we are talking about the lives of our constituents. The Government have had to think carefully about the administration of the transition. It is worth bearing it in mind that, in this year alone, the Government have set a
target--now that the reforms are bedded down--of an 8 per cent. reduction in the administrative costs of the NHS. Unsurprisingly, Labour made no mention of that policy decision in the motion.
Where are the bureaucrats and administrators? They are up front and at the sharp end, ensuring that we get value for money from our NHS. For instance, there are now more secretaries, bursars and administrators in fundholding practices to ensure that, under the direct control and instruction of GPs, efficiency is achieved. More than half my constituents now receive excellent services from general practitioners who have chosen to become fundholders. Why have they done so? They have done so because they care about the health of their patients and they want to be able to get things done. That is precisely what they are doing by investing the funds available to the NHS much more sensitively. Considerable as those funds are, we want value for money.
Fundholding practices are now contracting consultants to their surgeries. One of the fundholding practices in my constituency now has a physician consultant once a week, a surgical consultant every fortnight and a urological consultant every month. The practice is bringing more and more expert health care closer to the patient. But that needs to be managed and administered so that the practice gets the maximum value from those consultants by carefully timetabling and co-ordinating what needs to be done.
Proper administration is a good thing, but that is not mentioned in the motion. During the transition, we said goodbye to the massive bureaucracy so beloved of the Labour party. In my area, the regional health authority, which has a vast building at Bexhill-on-Sea, is a thing of the past. It has packed its tent, and gone off to goodness knows where. But we no longer have that massive bureaucracy trying to direct health care in my area from all the way up the Sussex coast.
Likewise, the district health authority's vast bureaucracy at Darenth Park is no more, and I am delighted to see that even the buildings have been bulldozed. As I told the House this morning, the whole area has been cleared for our brand new £100 million district general hospital. That is being built not thanks to the old-fashioned capital provision arrangements to which the Labour party is harking back but because of the PFI. Hospital work is well advanced for that site.
The purpose of administrators is to help to reduce waiting lists. When I became a Member of Parliament, one of the first problems that I encountered at my surgery was constituents complaining about the handling of their bookings for consultations at hospital. They were called 20 or 50 at a time, like so many potatoes in a row and stuffed in a waiting room. Consultants suited themselves about how many patients they would see and in what order. Under the old Labour system, consultants were responsible to the region for contracts, so the local hospital service had no control over them. When consultants had completed the time that they had deigned to make available, patients were sent packing to book another time. Under proper administration, with the efficiency required by the Conservative Government, patients are seen on time.
The hon. Member for Peckham (Ms Harman) spoke with ghoulish glee about patients whom she claimed had to lie on trolleys in corridors. She does not realise that in
any big business such as the health service decisions must be made. To be certain that beds will be available for a peak demand from accident and emergency departments, 20 per cent. of bed space must be left unutilised to ensure that there is enough room for emergency admissions at all times. A choice has to be made. Should bed use be kept down to 80 per cent.? If so, higher waiting lists will result, as they did in the past. The number of operations achieved by the NHS has gone up and up while waiting lists have gone down and down because of the maximum use. The price that we pay is that at times of unexpected peaks, which, thank goodness, are comparatively rare, patients may have to wait on trolleys.
Mr. Kevin Hughes (Doncaster, North):
Once again, we are debating health issues at an embarrassing time for the Government. Then again, every time that we debate them it is embarrassing for the Government. We can tell that from the tirade of personal attacks that have been launched on my hon. Friend the Member for Peckham (Ms Harman), not least by the Secretary of State. He and other Conservative Members have launched such attacks, rather than political ones, because they are bankrupt of policies. Never mind what the Secretary of State said; I have every confidence that my hon. Friend will be the Secretary of State for Health after the next general election.
The British Medical Association is holding its annual conference, at which it has warned that disaster threatens our national health service because of the exodus of general practitioners. The issues that we are debating show why doctors and nurses suffer from low morale and are leaving the medical profession and why most people do not trust the Tories with our national health service.
It is obvious that bureaucracy in the national health service has risen sharply since the reforms of 1991. Even the Government admit that. However, they have failed to clarify to the public how huge the rise is and how detrimental the misallocation of resources is to patient care. They keep saying that the NHS is funded sufficiently. Yet at a time of limited resources, they have introduced reforms that have sent the bill for NHS bureaucracy rocketing sky high. At the same time, patient care is suffering because of a lack of funding.
More than one in six NHS acute beds have been cut since 1990--7,664 beds were cut in England last year alone. Patient services are being cut. Paediatric intensive care has faced a crisis. Accident and emergency provision faces financial catastrophe. Only this week, the chairman of the BMA commented that dangerous cuts in funding were sinking the NHS, yet the Government do not respond to the crisis. They do not listen to the medical profession. The cost of bureaucracy in the NHS continues to soar.
Today, Labour released figures on administrative spending by health authorities that highlight the huge rise in bureaucracy. In the Trent region alone, the cost of bureaucracy rose by £32 million to more than £90 million--a rise of nearly 55 per cent. in only four years. That is the highest rise of any region. During the same period that administrative costs have soared, patient care has suffered because of the lack of financial resources: 2,986 beds have been cut in Trent region since 1990-91. That is a shocking 13 per cent. of its total beds. In the past year, the number of cancelled operations in the region has risen by 36.5 per cent. and the number of nurses has been cut by 9 per cent. in only five years. However, in the same period, the number of managers in the region has increased by a staggering 470 per cent.
In Doncaster, the purchasing administration budget has risen by £641,000 in only three years--an increase of more than 25 per cent.--yet patient services have had to be cut at local hospitals for financial reasons. It is absurd. Money is being thrown into paperwork, management and massive bureaucracy in negotiating contracts while patient services are being drastically and wrongly cut because of a lack of resources.
Primary care is also suffering from increased bureaucracy. GPs feel that additional bureaucracy is putting them under pressure and that patient care is therefore suffering. Many responses to our recent consultation of GPs concerned bureaucracy. There was frequent mention of the massive increase in the paperwork involved daily in general practice. Comments that I received from GPs in my constituency highlighted concern about mushrooming bureaucracy and the increase in the management tier, which needs to be kept in proportion to the number of people being managed.
The BMA also condemns the increase in bureaucracy, citing it as a reason for
In a survey carried out by Middlesex university earlier this year, 98 per cent. of GPs questioned complained that their paperwork had increased by nearly 90 per cent.
It is clear that the changes in the NHS brought about by the Government are swamping GPs with paperwork and damaging patient care. Britain has an excellent record on primary care. We cannot let the Government go on pushing it past its limits.
The GP fundholding scheme has increased spending on managers. Management costs within health authorities and extra contracting and transaction costs for trusts are not met by efficiency savings. Those are the findings of the Audit Commission; they are not mine. GP fundholding carries a huge burden of increased bureaucracy. Management costs are as high as £80,000 per practice. A recent NHS executive report comments that GP fundholding carries a significant administration tail, which, in a number of places, is excessive.
In addition, hospital trusts are being financially hammered by the costs of administrating fundholding contracts. The NHS executive report states:
"GP morale being at its lowest ebb for many years",
and warns that that is
"stifling innovation and the further development of patient services in many practices."
A 1992-93 survey of GPs' work load showed that the reported average weekly time spent on practice administration associated with the provision of general medical services had increased by 85 per cent. since 1985-86.
"Income from fundholding for most Trusts is between 5 and 10 per cent. of the total revenue . . . yet most employ at least twice as many people to support fundholder contracts . . . as they employ to support the Health Authority contracts."
The amount of paperwork generated by many individual contracts is astronomical.
| Next Section
| Index | Home Page |