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]

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.

72/448 page 50

$13 February, 1957.] [Continued. service ; they are statutory agents set up to work on behalf of the Minister, and people who serve in them give their time voluntarily. Therefore, we do feel there is a case for dealing with this Service in a rather different way to direct Government expenditure. Chairman. 488. It is the taxpayer’s money just the same, of course? Yes. 489. Does that mean you feel you can deal with it less stringently, or should deal with it less stringently? There is another point I would like to make. There is very great practical difficulty in dealing with this expenditure as if it were a government department, and saying that each Regional Board or each hospital authority must sub- mit an estimate broken down by sub- heads to the Ministry, that the Ministry must reduce those estimates in detail, under each sub-head to a figure they think reasonable, that that must then be put to the Treasury and discussed with them for approval on each sub-head, and that the result must then be put back to the Regional Boards and the Manage- ment Committees for implementation. We do not think we could get that pro- cess completed in the time available between September and the end of January. It is not very easy even now on this system to get a decision taken in time to give the hospital authorities reasonable time to plan their expenditure for the coming year. Vice-Admiral Hughes Hallett. 490. This arose from my question about virement. I would like to continue the subject of virement for a moment. Do I understand from your earlier answer that you attach material im- portance to the fact the Boards are com- posed of people working voluntarily and that has to do with your agreement to allow virement without approval?—— Yes; we think, particularly in view of the nature of these authorities, that we must have a system which it is reasonably practical to work and which enables them to have some discretion, subject to the Regional Board’s approval, to switch money from one head to another within a global total which must not be exceeded. 491. One other question arising from that. Supposing the members of the Regional and Management Boards were paid, shall we say, on the same scale as the Electricity Authority, what would be the percentage effect on the total cost of the hospital bill. Would it be appreciable at all? (Mr. Workman.) I think they would then become servants of the Minister. 492. I am asking what appreciable effect it would have on the bill? I think, as at present constituted, the Minister, previous Ministers of Health and the Government have desired to give a large measure of delegation to hospital authorities so that they can, as far as is consistent with parliamentary control, run their own affairs, and if the unpaid members were transformed into highly paid civil servants they would almost be bound to come under more direct control of the Minister, and the Treasury and the Government would intervene much more deeply in the carry- ing out of the Hospital Service, and there might then be an opportunity to change the financial provision. Vice-Admiral Hughes Hallet.) That was also in my mind, but I still would like to press my question as to whether, in fact, it would have any appreciable effect on the global cost of the Hospita! Service. Chairman.| 1 should like to put an answer into your mouth, Mr. Turnbull, that it would cost quite a lot of money, and is really a policy question outside our terms of reference. Vice-Admiral Hughes Hallett. 493. With respect, one of the reasons given for this very loose control is that we were getting the management “on the cheap”. The point I am trying to make is that the cost of paying the management would be a negligible frac- tion in the sums with which we are deal- ing here? (Mr. Turnbull.) I think that it is a bigger point than getting the management “on the cheap”. We are getting the management by what were thought when the Act was framed to be the right kind of people to manage this service. Chairman. 494. I think that we have to accept the set-up to that extent as it is. I should like to go back to one of your previous answers. You did reply that there might be a slight change of system so that you could exert pressure in individual in- stances, did you not?——Yes.$