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Lord Laming: My Lords, does the Minister agree that the time has come to give priority to the development of a proper system of performance management, so that the work of every doctor and every unit is consistently evaluated against volume, effectiveness and value for money?
Lord Hunt of Kings Heath: My Lords, the noble Lord will be glad to know that we have agreed in principle with the British Medical Association that the new consultants' contract will make annual appraisal and effective job plans mandatory for all consultants
The Countess of Mar: My Lords, is the Minister aware that I am becoming more and more worried about his answers to these questions? It seems that we are setting up an enormous bureaucracy in the National Health Service. Everyone will be expected to fill in bits of paper to justify his or her occupation, stating how many patients are being treated and how many have recovered. Can the Minister give me an assurance that this will not be so and that doctors' priority will be the patients? Can the noble Lord also assure me that clinical directors still have some contact with clinical work? The myth is that they were no "blankety-blank" good as doctors, so they have gone into administration.
Lord Hunt of Kings Heath: My Lords, the whole point of having clinical directors is to enable men and women who are practising clinicians to be involved also in leadership of their particular section of the hospital, or NHS trust. Surely that must be right. The more that people in leadership positions are involved in the experience of dealing with patients and of providing front-line services to them, the more effective those organisations are likely to be. I can assure the noble Countess that we are also very keen to ensure that we keep administrative costs to a minimum; indeed, from a figure of 5.3 per cent of total budget in 1997-98, they fell to 4.6 per cent by April of this year.
Lord Elton: My Lords, will the new arrangements allow for doctors, and others, in the National Health Service to record the amount of time that they spend on filling in forms, as well as on undertaking other activities?
Lord Hunt of Kings Heath: No, my Lords. We need to ensure that we keep bureaucracy to a minimum. We must enable clinical directors not to be administrators or form-fillers, but to lead their colleagues in ensuring that resources are used effectively and that high-quality services are delivered.
Lord Hunt of Kings Heath: My Lords, we are very much involved in that initiative. We have encouraged many individual NHS organisations to develop systems and processes in order to meet those standards. In addition, as I have already said, we expect every NHS organisation to be a good employer. We shall be monitoring that situation most effectively and rigorously over the next few years. If we are to meet the commitments in the national plan and recruit and retain more staff, we must be good employers. We must ensure that staff are dealt with fairly, effectively and in a supportive environment.
Baroness Amos: My Lords, the Department for International Development finances two projects in the Sverdlovsk region, to improve child mental health services and to improve services for vulnerable children. Both are managed by charitable organisations. The DfID has also supported projects run by British and Russian charitable organisations though the Health Small Projects Scheme.
Baroness Cox: My Lords, I thank the Minister for that encouraging reply. I must declare an interest because I am involved in several programmes for orphaned and abandoned children in Russia--programmes that are growing fast due to the enormous dedication of Russian colleagues working in difficult conditions. Is the noble Baroness aware that the funding agencies of the European Commission do not currently support charitable organisations if they have any links with the Russian Government? That is most unfortunate because such links can be extremely helpful in ensuring the effective implementation of programmes, their accountability and their sustainability. Can the noble Baroness say whether Her Majesty's Government would consider asking the European Commission to review its funding criteria on the matter?
Baroness Amos: My Lords, perhaps I may, first, pay tribute to the tireless efforts of the noble Baroness, Lady Cox, as president of Christian Solidarity Worldwide. Indeed, her efforts are well known in this House and Christian Solidarity Worldwide has carried out a range of family-focused childcare projects in Russia.
In response to the noble Baroness's specific question, I must tell her that I am not aware of any such blanket policy on the part of the European Commission with regard to funding agencies with links to the Russian Government. However, I shall be happy to investigate this further. Perhaps the noble Baroness will be good enough to provide me with any further details that she may have.
Lord Archer of Sandwell: My Lords, as my noble friend is aware of the work carried out by Christian Solidarity Worldwide, especially the sterling work of the noble Baroness, Lady Cox, in establishing schemes such as those aimed at providing family fostering and
Baroness Amos: My Lords, I should point out to my noble and learned friend that sustainability is always the key consideration at the outset when we are looking at the kinds of work that we shall be funding from the department. We include at the planning stage of all our projects the issue of sustainability; indeed, we monitor the question of sustainability during the lifetime of our projects.
As regards foster family care, I can tell the House that we now have a health and social care partnership scheme. If there are any organisations planning to do more work in this area, I hope that they will be encouraged to apply for participation in that scheme.
Lord Hylton: My Lords, are the Government fully seized of the scale of the problem facing children in Russia? Are there not some 40 million children growing up in poverty, over 400,000 in very unsatisfactory, old-style institutions and thousands of street children, as well as other children at risk in all the major cities?
Baroness Amos: My Lords, we are well aware of the scale of the problem facing children. In fact, we recently set up a vulnerable children's project, which will be funded to the tune of £750,000. In addition, we are looking at a number of health-related projects that will also have an impact on children and on families.
Baroness Nicholson of Winterbourne: My Lords, I thank the noble Baroness for her excellent earlier reply. I can assure her that not only is there no blanket opposition to funding children's programmes by the European Commisson but that also, over the region, many millions of ecu are being dedicated to NGOs working with children. However, perhaps I may remind the noble Baroness of the great difficulty that we all face in the region in respect of trafficking in children who have been abandoned and are now being neglected--children for sale. I urge her department to put some finance behind that as, indeed, the European Union is now doing.
Baroness Amos: My Lords, I can tell the noble Baroness that we share her concerns about child trafficking; indeed, it is one of the areas that the DfID, with the FCO and the Department of Health, has been considering in terms of protecting children from such trafficking.
Lord Alton of Liverpool: My Lords, has the noble Baroness had a chance to consider the report that I gave recently to her officials relating to street children in Moscow, the 5,000 children in orphanages in and around the Moscow area and, in particular--alluding to the points just made--the trafficking that is now taking place with the selling on of children into prostitution? Is the noble Baroness aware of the
Baroness Amos: My Lords, I can tell the noble Lord, Lord Alton, that we have been looking at the report. We are considering making a detailed response to it in the light of what we are already doing in Russia. I can tell the House that over the past nine years we have spent about £200 million in Russia. Our current expenditure is to the tune of about £27 million per year. On the specific question of the punitive tax regime, I shall take that point back to the department for consideration.
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