Sixth report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee D and appendices, session 1956-1957: Running costs of hospitals.

  • Great Britain. Parliament. House of Commons. Select Committee on Estimates
Date:
[1957]
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Licence: Public Domain Mark

Credit: Sixth report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee D and appendices, session 1956-1957: Running costs of hospitals. Source: Wellcome Collection.

    70/448 page 48
    13 February, 1957.] [Continued. from the fact that Ministers have authorised a building programme for the hospitals. That means that there are additional buildings coming into Operation over a period of time, and that additional money has to be provided to start them and run them. 465. That is rather a different cate- gory, is it not? What I want to arrive at is whether you agree that the Treasury is faced with a certain annual bill to which there may be certain inevitable additions springing from rises in cost of living, or whatever it may be, and that you have no means at your disposal to see that the basis on which that bill is compounded is sound? Yes, I think that is so, apart from such lay criticism as we can exercise on the details of this in our usual function of laymen criticising experts. 466. What steps do you take, or can you take, to confound your criticisms? ——aAll we can do is to ask questions of the Ministry and see whether we think the answers are adequate. 467. What sort of questions? ———We should ask whether increases in staff are necessary and on what grounds, what the case is for any expansion element at all in any given year, and we should be told on what it was intended to spend additional money. 468. All your questions of criticism would be related to increases? Yes. Mr. Robinson. 469. How far down the organisational ladder do you go in criticising expendi- ture? Do you take individual Hospital Management Committee estimates, or do you go below Regional Board level in querying the estimates put up to you by the Ministry of Health?———What we have from the Ministry of Health are combined summaries of the Regional Boards’ estimates. We cannot go below that level; we can see what the com- position of the total of Regional Boards’ estimates is by heads of particu- lar kinds of expenditure but that is all. 470. You do not get any further break- down in considering annual maintenance estimates than each Regional Board’s estimate broken down in the sub-heads for the region? We do not see the Regional Board’s estimate. We see a global total broken down by items of expenditure. Mrs. Hill. 471. May I ask what happens with regard to teaching hospitals?———We do not see those separately either. Mr. Robinson. 472. That is also a global sum for all the teaching hospitals? Yes. Chairman. 473. Would you say there is a good deal less control by the Treasury than in the case, say, of the Service Depart- ments?——-Yes, certainly, there is less. 474. Is there any control by the Treasury over virement? No. 475. Is it true to say that an un- economical hospital authority is under no pressure to produce the same standard of service at a lesser cost since it can be assured of being allocated at least the same sum in the forthcoming year as it had in the past year?——It can happen that if a given hospital authority is in a position in which it could make savings and does not it is still possible within our control for it to go on receiving money in the same way. 476. It is very unlikely, in fact, that it will not go on? They have the inducement that if they can make economies within their total funds they can also make improvements in the service out of the proceeds, at any rate within their region. 477. Do you consider that satisfactory that there is no pressure you can exert to make an uneconomically run hospital more economically run? No. I think we should like to see a system under which the maximum possible pressure is put on the hospital authorities to achieve economies within the existing rate of expenditure. 478. Have you any idea what such a system might be? The general policy—I think that the Ministry have already explained this to you—is that having regard to the nature of these authorities it is desirable to proceed to the maximum possible extent by exerting a moral pressure and persuasion on them, rather than by issuing directions. We would like to see, I think, a system developed ‘by which the allocation of the money as between different hospital authorities was, at any rate, influenced
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