CLAUSE 12.—(Functions of Boards and Management Committees.) (Hansard, 22 July 1946)

§ Mr. Willink
I beg to move, in page 14, line to, to leave out from "area," to the end of line 18, and to insert: and for that purpose the Board may appoint such officers as may be necessary. (2) It shall be the duty of the Hospital Management Committee of any hospital or group of hospitals generally to manage and control the hospital or group of hospitals in accordance with regulations and such directions as may be given by the Minister, and in particular:—

(a)to appoint officers, required to be employed at or for the purposes of the hospital, except specialists;

(b) to maintain any premises forming part of or used in connection with the hospital;
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(c) to acquire on behalf of the Minister and to maintain equipment, furniture and other movable property required for the purposes of the hospital;

(d) to appoint for each one of the hospitals in a group a House Committee to which they may delegate any of their functions for the control and management of each such hospital."

The matter raised by this rather long Amendment is, as the Minister will no doubt remind the House in a moment or two, something that has already been discussed. I shall not repeat what was said in Committee, but it is a question of importance. It is the question of whether the Minister will get the best hospital and specialist service, if everybody who is employed in that service is in contract with the Regional Hospital Boards, which, in some cases, will be very remote from the place where such a person is serving. We did urge, and this Amendment in its present form would urge again, that all except specialists should be in contract with the hospital management committees. We believe, for instance, that in the case of the nursing profession, the real loyalty of most nurses is for the hospital in which they work; and as regards other health workers, the same is true. The Minister has said that he is most anxious to facilitate and enable movement for the sake of promotion. On the other hand, we do not wish, and I do not imagine that he wishes, to frighten people off, on the ground that they are to become members of an enormous service, and may be moved about more than they want to be moved. They may say to themselves, for instance," Subject to promotion, we want to work in the hospitals in Manchester, and we do not want to he sent to hospitals in Liverpool." That is the human attitude.
I appreciate that the Minister is not likely to accept the Amendment in these terms, but I would like him to consider this possibility, because in certain areas we may turn out to be right and he may turn out to be wrong. Will he consider inserting in the Bill powers under which, in certain appropriate circumstances as appear good to the Minister of Health, there may be parts of the service in which people can serve their local hospitals, and not in every case be servants of the Regional Boards? The Minister will realise that I am greatly reducing the scope of the Amendment and giving 1816 greater latitude in the organisation of the service. We are advised by competent people that it would be to the advantage of the service that there should be this alternative, in certain parts of the service, in the sphere of the nursing service and of domestic staff. We are advised that recruitment will be much easier if recruitment is to a particular hospital rather than to this very impersonal and novel unit of administration; it has not much of the human element about it, compared with the name of a well-known hospital. We hope that the Minister will consider inserting in the Bill, these additional powers which will enable him where he thinks it right, to have persons in the employment of and in contract with the hospital management committees.

§ Mr. Bevan
As the right hon. and learned Gentleman knows, I am sympathetic with the intentions which lie behind the Amendment. I believe however that all the purposes he has in mind can be discharged by leaving the structure of the Bill as it is. I do not want to insert the actual functions of the hospital management committees, because that will be done by regulation, which is a more flexible method and enables us to amend the situation, as from time to time, appears necessary. I also agree that in the recruitment of nursing and domestic staff it is desirable to maintain a close and sympathetic link between the nurses and particular hospitals, and that the Regional Boards should be in the background. That, I think, will be achieved, because, apart from the senior officers, all the rest of the staff would be appointed by the hospital management committees. A nurse is much more concerned about who appoints her and with whom she is in daily contact, than she is with the person with whom she has entered into formal contract. The reason for entering into contract with the Regional Board is to provide for greater opportunities of promotion. This is a point to which the trade union movement attaches great importance. As things are, the possibilities of promotion are far too limited. People are in contact with a small hospital unit, and have no opportunity of moving outside. Therefore, I think we have ingeniously satisfied both purposes, by having the appointments made by the hospital management committees which preserves the esprit de corps of hospitals and identification of the 1817 staff with hospital management committees, and also having a formal contract with the Regional Boards which provides reasonable opportunities for promotion.

§ Mr. Linstead
While not dissenting from what the Minister has now told us about his intentions with regard to the interpretation of this Clause, I think that we ought to place on record the fact that the Clause, as drafted, puts the emphasis on a different spot from that which the Minister has indicated. As the Clause is drawn, it concentrates in the Regional Board a great deal of detailed responsibility for the day to day work of the hospitals. The Minister has explained that that is not intended, but, all the way through this Bill, we have found the situation arising that the Bill says one thing and the Minister tells us that when he comes to exercise his powers under the Bill he proposes to do something quite different. This is a typical example.

§ Mr. Bevan
I think the hon. Gentleman has shown that it is always necessary to preserve in all such services the hierarchical responsibility. First, the responsibility of the Minister to parliament; secondly, the responsibility of the Regional Board to the Minister; and, thirdly, the responsibility of the management committee to the Regional Board. When it comes to the Regional Board, as one is dealing with greater particularity, it is necessary to deal with that by regulation, and it is not necessary to put on the face of the Bill, one part as emphasis against another.

§ Mr. Linstead
I entirely accept the intention which the Minister has stated, but that does not alter the fact that the Bill could have preserved the hierarchical principle, to which the Minister attaches importance, without having twisted the whole conception of the service in the way that is done here. As the Bill is drawn, it is the duty of the hospital board, to look after the repairs of furniture and the engagement of charwomen. We know that that is not contemplated for a moment, but still I cannot help feeling that this Clause, had it been drawn in the form towards which the Minister's mind is now apparently moving, could have been brought very much closer to what he wants to do.

§ Mr. Bevan
It is precisely the language which one must use when persons are 1818 in fact, under contract with the Board. There is no other way of stating it. If all the detailed functions of the hospital management committee were precisely stated on the face of the Bill, the Bill would be five times as large as it is.

§ Mr. Linstead
I think that the Minister has moved considerably from the position which he occupied when this Bill was first drafted. I have felt, during the progress of this Bill through Committee, that whereas it was originally intended that the Regional Hospital Board would be the effective guiding body of a hospital system, that has receded under pressure into the background, and the hospital management committee has come to the forefront as the effective local body in the day to day management of the hospital.

§ Mr. Messer
One of the complaints of hon. Members opposite was that this system was not already in practice. But a large county council—such as may administer the terms of this Clause—does not appoint every office boy and nurse. They set up committees for that purpose. There are the management committees of the hospitals. Every nurse taken on in a hospital is a member of the hospital staff and, if she gets her training in that hospital, when she goes from it she has the reputation of that hospital behind her. That is the system already in existence, and I understand that the Bill does exactly the same thing.

§ Mr. Willink
In view of what the Minister has said, I hope that he will consider again what I believe to be our common objectives, and put them into the Bill not only technically but as they would appear to the ordinary reader. I beg to ask leave to withdraw the Amendment.