Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees.
- Great Britain. Parliament. House of Commons. Select Committee on Estimates
- Date:
- [1951]
Licence: Public Domain Mark
Credit: Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees. Source: Wellcome Collection.
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![25 January, 1951.] [Continued. it? It relates to the very awkward time when alterations have got to be done in hospitals in order to get them done within the budget period. It lays off a ward just at the height of the pneumonia crisis. I think it is a very useful letter. That is the sort of detail that can be covered by your proposals in regard to the block grant?—Putting it another way, we feei from our day to day life in hospitals that there would be less sand in the wheels and more lubricating oil if the finances were put on the block grant system instead of being subjected to detailed scrutiny. Mr. Thomas Reid. 209. What are you suggesting, that when the Minister hands over to an area their block grant he thereafter trusts the local people to exercise due economy and every- thing else?—-That is so. 210. At the same time the Minister is responsible to Parliament. On other sub- committees on which I have served we have found it very mecessary sometimes that the Minister should tighten up his control over expenditure where—I am not talking about the medical service now— waste has been brought to our attention, and yet in this case you are suggesting the Ministry officials should say ““ We hand over the money (in this case to the local committee) and thereafter we wash our hands of it’. That is really what you are recommending?—Well, no, I do not think we go to that extent. I think our feeling as medical men would be expressed if I were to say this. We feel that Ministerial responsibility and scrutiny—and we are much concerned with this principle-—in their branch of hospital work could be dis- charged by a process of inspecting as dis- tinct from day to day contro] and authori- sation. No one suggests that a block grant is given to a certain hospital group and is thereafter lost sight of. It is quite proper that the Minister should inspect its ex- penditure, and if he notices that a particular group is doing things very badly, of course he can step in and stop it. That is a differ- ent matter from day to day scrutiny of small expenditure. It is rather analogous, in other words, with the way in which the State assists in the financing of universities, and rather in the way in which a semi- statutory board before the war gave great financial help to many London hospitals, namely, the King Edward Fund. The King Edward Fund appointed an inspectorate who used to visit all the hospitals to which that Fund gave large sums of money—but those visitors were not controllers. They could report back to the King Edward Fund and if they found money had been expended wastefully or improperly the King Edward Fund peovle would intervene, but otherwise a hospital should be allowed M.B., B.S. free discretion in expending its block grant. Miss Ward. 211.A review should be taken annually really, and efficiency matter judged on the annual results rather than on day to day administration?—On systematic inspection. Mr. Thomas Reid. 212. You surprised me by saying that petty details are interfered with by head- quarters. I cannot understand how head- quarters would wish to interfere in regard to the purchase of a stethoscope or some- thing like that?—(Professor Cloake.) I think what we have to realise is this: the system has been running for two years; it has taken some considerable time to get going, but it has got going in a way which we personally feel—and it is im- possible to speak about this without utilis- ing the knowledge one has about matters which are not all medical details. I am chairman of our medical committee, and many things come to me. I am also a member of the board. If you do not want me to speak about matters of this kind then Chairman. 213. I am sorry I interrupted you before perempiorily. There is no objection what- ever to your using any information how- ever come by, but I think it is important we should not ask you questions, and expect you to reply to them, about matters which do not impinge on the medical profession side at all?—Yes, Sir. Of course the medical profession in hospitals feels that everything concerning the hospital is its concern. We are just as keen to see economy in our Hospital Service as we are in our own affairs. 214. We all feel that as citizens, but from the professional point of view the block grant obviously may affect the activities of your constituents?—The only point I wish to emphasise in respect of what I regard as so much interference with the detail of administration is the fact that gradually the details of administration are being brought further and further into a_ centralised system. The autonomy exercised formerly by the house governor and his finance officer was naturally, under his board, absolute. Local purchases, for example— they had to be purchased by the board— were brought with considerable care for a comparatively small outlay. The Ministry appears to have the idea that economy will be effected by central buying. I personally feel, and many people will agree with me, that central buying is no panacea at all. There are many possible objections to it. It may result in gross inefficiency ulti- mately developing for comparatively small economy, which is offset by the increased](https://iiif.wellcomecollection.org/image/b32182478_0059.jp2/full/800%2C/0/default.jpg)
