§ (1) A local health authority being a county Council may, on the application of the council of any borough (including a metropolitan borough) within the county by agreement delegate to the council of that borough either with or without restrictions or conditions, any of the functions of the authority under the provisions of Part III of this Act relating to the care of mothers and young children, the employment of midwives, health visiting, home nursing, vaccination and immunisatior, ambulance services, the prevention of illness, care and aftercare, and domestic help.1735
§ (2) If the council of a borough who have made an application under the preceding Subsection are aggrieved by the refusal of the local health authority to delegate functions, or by any conditions or restrictions which the authority propose to impose, the council of the borough may make a representation to the Minister and the Minister after consultation with the local health authority may by order direct them to delegate to the council of the borough, either with or without restrictions or conditions, such of the said functions under Part III of this Act as the Minister thinks proper, and the local health authority shall comply with any direction so given.
§ The Minister may at any time by order revoke an order previously made by him under this Subsection.
§ (3) Any expenses incurred by the council of a borough in the discharge of functions delegated to them under this Section shall up to an amount not exceeding such sum as may be fixed by the local health authority or on an appeal by the Minister be repaid to the council of the borough by the local health authority.—[Mr. Lipson.]
§ Brought up, and read the First time.
§ Mr. Lipson
I beg to move, "That the Clause be read a Second time."
This new Clause provides for delegation by the local health authority—in this instance, the county council—to one of the boroughs within the county, of certain powers which the local health authority has under Part III of the Bill. These authorities have exercised these powers in the past. They have exercised them well, and it is desirable, in the opinion of many of us, that they should continue to do so. They can be given this power of delegation either by agreement with the county council itself, if the county council itself is satisfied that these powers should be delegated; but if there is a difference of opinion on this matter between the non-county boroughs and the county councils, then the matter is referred to the Minister for decision. The Minister did raise as an objection to this, the point that it would cause controversy between the county council and authorities within their areas, and that he did not want to be asked to intervene in quarrels of that kind. But differences of opinion are bound to arise. I do not see why the Minister should object to controversy. Controversy of the right kind is healthy. There can be honest difference of opinion on the right way of doing a thing, and I do not see why the Minister should hesitate to accept the responsibility of mediating between the authorities when there is a genuine matter of dispute. I hope he will not press that objection this 1736 time. The Clause also provides that the Minister shall have power to revoke any Order which he has given, after mediation, for a county council's powers to be delegated to the smaller authorities. If the county council, in the first instance, is satisfied that it is desirable that these powers should be delegated, why should there be objection? If the county council is not satisfied, but if the Minister is satisfied, that these powers should be delegated, why should these powers not be delegated?
Let me show what these powers actually are, because I think that when hon. Members hear what the; are they will realise that the case for delegation to a smaller authority is very strong. They are powers relating to the care of mothers and young children; the employment of midwives; health visiting; home nursing; vaccination and immunisation; ambulance services; the prevention of illness, care and after care; and domestic health. I submit that all these services are personal services; they are human services; they are services best administered locally, and, very often, so far as some of them are concerned, they are services which require quick and immediate attention. Emergencies may arise, particularly in connection with the midwifery services; and, therefore, it is important that they should be administered by the smaller local authorities, with whom citizens can obtain immediate contact. Most people know their own local town hall. They knew their local officers. But the county administration, to a great many people, is very remote, and it is not easy for them to get at it. The people who will be affected by these services have not all got telephones; they have not all got motor cars in which to go out to make representations with regard to the services that they require.
There is, also, the question of people in the locality being able to keep a proper check on the administration of these services. With all due respect to the county council, it does not meet anything like as frequently as the smaller authority. The smaller authority meets once a month, whereas the county authority meets only four times a year. Therefore, I emphasise most strongly, that it is in the interest of those who will be affected, that these services should be administered locally, because people will be able to get into more immediate contact with 1737 them. But the taking of these powers from the smaller local authorities does create a much bigger issue. I hope that we shall not be told today, as we have been on previous occasions, that the desire to retain existing powers by smaller local authorities is due to the vested interests of those authorities, or the vested interests of town clerks. Something much bigger than that is involved.
What is really involved here is the future of local government in this country. I maintain that local government is the successful machine that it is, because there has been a spreading of responsibility through the various grades, and because more and more citizens have been brought into the administration of affairs in their areas. We are endangering this democratic form of government if we try to take away the powers of these smaller local authorities. No one can believe for a moment that the position will rest where the Minister is proposing to leave it. I ask the Minister to be more sympathetic towards this proposal than he has been on a previous occasion. The argument has been that by delegating these powers he will be cutting at the very root of the proposal in the Bill, which is to put all these health services under one authority. Surely the real merit of the service is not whether it is under one authority or under another, but whether it is under the authority which can administer it best.
I believe that the Minister is putting too many powers on the larger authorities. The larger authorities, in many instances, would welcome the power to delegate to smaller authorities, because they feel they are unable to give the time and attention which are required by some of these matters. If the Minister persists, it will mean that the administration of these services will rest largely in the hands of officials. Speaking as one who has been associated with local government for many years, and has a high respect for the ability of our local government officials, I would point out that while they may be good servants they are bad masters. It is necessary to maintain the control of the locally elected representatives over all these matters. For these reasons, I ask the Minister sympathetically to consider this new Clause. This is no party issue. This Clause has the support of Members in all quarters who realize 1738 the value of the work done by some of these smaller authorities, and the need to retain as many powers as possible for them. We shall not be able to retain the personnel of the smaller authorities unless we give them work to do. If we constantly whittle their work away and diminish the services they can render, we shall be doing a great deal of harm. It is because I believe it to be in the best interests of those who will benefit, and in accordance with our democratic traditions of local government, that I move this Clause.
§ Mr. G. Lang (Stalybridge and Hyde
I beg to second the Motion.
I do not wish to detain the House with a repetition of the arguments which the hon. Member for Cheltenham (Mr. Lipson) has so cogently and effective:y made. I should be wrong if I did not once again protest against the steady stripping away of the powers of smaller local authorities. A good deal of that has happened already since this Parliament was elected, and I do not think it makes for good and effective government or good and effective administration. These are particularly humane services, and they are best administered on the spot by people who understand. There is another point, and that is the unwillingness of people, especially at times of illness and anxiety, to go away. Many of them are anxious if they have to see a doctor. We all know that when there is illness among some poorer people there is this fear, and that often they wait far too long, because they are too nervous to see a doctor. They only go as a last resort. If these people have to deal with bodies which are remote, much of the effectiveness of the Bill may be lost.
I have the honour to represent three non-county boroughs, and I know the splendid work which is being done by them. People forget their differences of opinion and cooperate in various ways in a real attempt to lighten the burden of their less fortunate fellows. I do not believe that under the Bill in its present form that can be done. I hope that this Clause will be accepted to make this Bill, which is a magnificent instalment, far more effective. It is a good thing to have the good will of these non-county boroughs. These smaller authorities are apt to be disregarded, and to be trampled under foot. One by one they are losing 1739 their powers, but they are still very effective. I hope that my right hon. Friend will find it possible to give sympathetic consideration to these proposals. No one is more conversant than he with the needs of the poorer people, and no one is more conversant with the way in which these people are nervous of authority, and especially remote authority. All the propaganda in the world will not remove these feelings. I hope therefore that I can go to my three non-county boroughs and tell them that at long last it is not quite hopeless, and that they are not going to lose everything there is except their Member.
§ Mr. Bevan
I believe that it would be convenient if I replied immediately, in order to apprise the House of the point of view which the Government have formed about this Clause. Hon. Members on this side of the House, and also I imagine hon. Members on the opposite side, will not need me to assert my desire to foster good local government in this country. I have been a member of local authorities for more years, probably, than a good many hon. Members in the House, and I have served on almost every kind of local authority. I am as aware as most people of the invaluable services of local authorities in the government of this country. It would certainly be a mutilation of our Constitution and of our inheritance, if we did anything which would gravely undermine local patriotism, and the interest local people take in the management of affairs in their areas. I can assure hon. Members that nothing I have done in this Bill has been done with a view to undermining the structure of local government. I would remind hon. Members of what I said on Second Reading, that in framing these proposals, I have kept in mind one consideration and one consideration only, and that is the welfare of the patient—not the interests of local government, or the interest of anyone else. I know that there are a good many local authorities who identify the preservation of their own privileges with the welfare of their citizens, but quite often the welfare of their citizens would be promoted by the diminution of their privileges.
§ Mr. Pickthorn
Is the right hon. Gentleman suggesting that that tendency is limited to local authorities?
§ Mr. Bevan
It is probably shared by a good many, but Mr. Deputy-Speaker would stop me from throwing my net any wider on this occasion. The consideration, therefore, which I had in mind was how to provide the best kind of health service for the people of this country, and the sort of local authority through which it could be expressed.
This new Clause is an exceedingly important one. If it were accepted, it would fundamentally change the Bill, and not only change the Bill but, in my submission, wreck it. I will try to prove that. In the first place, the hon. Member for Cheltenham (Mr. Lipson) spoke about the non-county boroughs. Why has he not mentioned the urban districts? There are a large number of urban districts that are far larger and more important than many non-county boroughs. In fact, some of the non-county boroughs are woefully unable to discharge their existing functions, so small are they; and although they are ancient, and have great pride, and maintain the full pageantry of their historic lineage, nevertheless the discharge of their functions is woefully behind.[Interruption.] I know that the hon. Gentleman would extend chaos even further. He would include urban district councils—but where would one stop? Some of the rural authorities are even bigger than the urban authorities, and more important. Would he include them? Why stop there? Why not the parish councils?
It is always possible, in every Measure which is brought before the House, to say that there are borderline cases. There are local authorities which, by population and by area, have reached a stage when they ought to be promoted. But that is not a matter for me. That is a matter for the Boundary Commission. There is a Boundary Commission concerned with them, and a case can he cited. I would point out to hon. Members that we should be getting into an administrative morass if, after bringing this great scheme into being, I was asked to arbitrate, as a Minister, between the respective claims of the different local authorities on what they should do under this Bill. The Minister would be put in a wholly impossible situation. In fact, he would be asked to discharge empirically, under the terms of this Bill, precisely the responsibility which the House has given to the Boundary Commission. That is an 1741 impossible thing to ask the Minister to do. I, therefore, resist it on those grounds alone.
Furthermore, I would have to do that at the very time when the main administrative task of launching this scheme was under way. I assure hon. Members that if the principle of delegation has to be considered before the public health authorities, before the county and county boroughs, are able to present their schemes to the Minister, we would not get this scheme started in April, 1948. It would not start before 1949 or 1950. Arbitration and hearings would have had to take place. Every non-county borough, every urban authority, and, maybe, other local authorities could make its application. It would have to be heard, properly considered and arbitrated upon before any single health authority could start its schemes under the Bill. Where do hon. Members think we would get to? Is that in the interests of the patients or people of Great Britain? It is in the interests of the non-county boroughs, not of the patients.
Under this Bill, very important functions are being put upon the county and county boroughs. They are to prepare schemes for the health centres. They will have to prepare schemes for the supervision and organisation of the general practitioner service. They could not start because they would not know whether they had the functions or not, or the areas over which they had to preside. Every one of these difficulties would be created. In the meantime, the poor Minister of Health, whoever he might be, would find himself bombarded by a series of delegations, accompanied by their Parliamentary agents. All these would be putting forward the parochial considerations which led them to make their application. We would have departed entirely from the principle of functionalism and landed ourselves straightaway into parochialism. I ask hon. Members seriously to consider this before they support proposals of this kind, at this late stage. This matter has been considered twice in Committee, and it has been examined exhaustively. It was also examined on Second Reading, and has been examined as the scheme itself has been assembled.
There are other considerations even more important. One of the criticisms levelled at this scheme, as a whole, is 1742 that it is not a complete unit, and all the health services are not integrated in it. One of the health services not integrated is the educational health service—the school health service. That point was made on Second Reading in some parts of the House. I admitted it, but I pointed out that the local health authority is coterminous with the local education authority. As the health service develops, the educational authority service will be assimilated into the National Health Service, leaving the medical inspectors where they are, because they perform very important preventive functions. Surely, it is admitted on all sides of the House that we ought, at the earliest possible moment to destroy these discontinuities in the service. It is not reasonable that a child before it goes to school should be under one doctor and when it goes to school be under another doctor, and when it leaves school be under yet another doctor. It has been argued, and I have accepted the argument, that it is desirable that the child should be under the care of the same doctor and that the same therapeutical service should be available for the child in school, as well as out of school. Otherwise it would mean that there would be a complete separation between the health service and the educational service and that at no point would we be able to assimilate them into the same service.
I think that hon. Members will see that, when they start asserting the claims of a particular unit of local government, and do not keep before their minds all the while the welfare of the citizen, in fact, before long they would get themselves into serious trouble, and find themselves supporting all sorts of authorities and interests, and the welfare of the individual would he left very far behind. I agree that what we must do is to try to keep the supervision of the health service itself, particularly the maternity and child welfare service, as local as possible. Provision is made for that in the Bill. Provision is made for county and county boroughs to have sub-committees on which the local authorities in the area would be represented. That is the reasonable way in which there would be kept local touch throughout. In Part II of the Fourth Schedule hon. Members will seeThe health committee of a local health authority may, subject to any restrictions imposed by the local health authority, estab- 1743 lish such sub-committees as the health committee may determine, and any sub-committee established under this paragraph shall be constituted in such manner as may be determined by the health committee, and at least a majority of every sub-committee shall be members of the local health authority or of a local authority for any area forming part of the area of the local health authority.
§ Mr. Bevan
Every local authority has to submit schemes to the Minister, and I shall see that there are local sub-committees on which the areas would be represented. It is necessary that one should have local touch in these matters, and, therefore, any scheme should provide for these local committees. I should be distressed and dismayed at having to carry out the administration of this great scheme if this new Clause were added to the Bill. I am certain that soon I should be faced with an administrative breakdown. Instead of simplifying the administration, we should make it infinitely complex. In the case of the child welfare services we have followed the new education authorities and the new Education Act, because again we shall be concerned with the education authorities. I do not want to be guilty of an indiscretion, but I doubt very much whether on reflection the House now would establish those executives. There we in the last Parliament surrendered, but to what did we surrender? To the ex parte claims of local government. I have had to follow these education authorities. The last Government, in my view, ought not to have yielded to them, and I am not now going to yield to this pressure, because if I yielded to this pressure, we should have more confusion.
I have spoken at some length on this subject, because I know hon. Members attach very great importance to it, and I attach great importance to it myself. It is not true that we are undermining local government in this country. The functions of local government are undergoing considerable changes, and local government must be restated from time to time in terms of the needs of the situation and in terms of new principles of administration. Local government is not abolished by restatement of its functions. It may be we shall have a considerable reorganisation of local government in 1744 this country, but the reorganisation of local government which adapts it to the needs of the situation vitalises local government. What devitalises local government is to maintain a structure wholly out of accord with the needs of the situation, and many of our local government authorities are out of touch with the needs of the situation. Many of the local authorities for whom the hon. Member for Cheltenham speaks are very important housing authorities, and it is noteworthy that some of the authorities mentioned in the Clause are backward. If hon. Members look at the latest housing return they will see that some of the non-county boroughs are the most backward in Great Britain in discharging their existing functions. The most advanced are often rural authorities, and the next are the county boroughs but the most backward are some of the non-county boroughs, because they are great historical institutions, too small to be able to afford to make a proper start. Their rateable value is too restricted, and their revenues too meagre. We do not increase their revenues by giving them new jobs. The hon. Member said they were unable to obtain efficient staff because their functions are being taken away, but what is really undermining the local administration is that their burdens have transcended their own financial power. Therefore, we do not improve the situation by giving them new functions. I plead with hon. Members in all parts of the House not to make at this stage a change in the structure which would be fundamental, and, in my view, would be administratively impracticable to carry out.
§ Sir H. Lucas-Tooth
I desire to support this new Clause, though I am bound to say that as it stands on the Order Paper it is particularly wide in effect. It would, I think, enable some of what the right hon. Gentleman describes as the more backward local health authorities to delegate some of their powers without anyone being able to step in and see that the situation was such as this House obviously intends. I think that the right hon. Gentleman has perhaps not read through the Order Paper and seen that there is another Amendment, one to Clause 20, which links up with this new Clause. That Amendment provides that any scheme of delegation would require, first, to be submitted, and, secondly, to be approved by the Minister before coming 1745 into effect. In other words, it would not be possible for a local health authority merely to come to an agreement with a subsidiary authority to delegate without any supervision, for any delegation would require to be in accordance with a scheme, which would no doubt be most carefully vetted by the Ministry of Health before being approved. It would be approved only in accordance with some general principle.
I represent half of a non-county borough with a population of somewhere between 150,000 and 200,000 people. It is, I suppose, one of the largest if not the largest non-county borough in England, and, if I may say so, can hardly be compared with some of the small authorities which will be constituted local health authorities under this Bill. Most of the duties in Part III of the Bill are, in fact, at present being carried out by the borough of Hendon, and very efficiently carried out, too. I doubt very much whether they are more efficiently carried out anywhere else in the country. If these duties are to be transferred from the borough of Hendon to the county of Middlesex two things would result. There would be a serious temporary disorganisation of services and a permanent loss of efficiency.
I hope I may be able to give some concrete examples to show that this is indeed the case. I am not arguing for this new Clause simply because of the fact that I represent a non-county borough. That borough has interests, what I think the right hon. Gentleman has described as vested interests, and it has asked that this Bill should be amended in other particulars in accordance with those interests. I have not thought fit to press for such Amendments, but I do press for the acceptance of this Clause because I think that it can be supported with cogent arguments. There is, for example, a health centre at present run by the Borough of Hendon. That health centre is part and parcel of the town hall. It is used for maternity and child welfare work, and I think I am right in saying it is exclusively used for that purpose. Hendon is authorised by virtue of a scheme under Part III of the First Schedule of the Education Act 1944 to exercise on behalf of the county council functions relating to primary and secondary education.
1746 6.30 p.m.
By virtue of Clause 23 (4) of this Bill the borough will, presumably, remain responsible for the care of children from the ages of 0–5, and also for the care of school children from 5–16, as we hope it will be in the near future, under the Education Act. If this Bill becomes law as it stands, without this new Clause, the borough will be responsible for the care of these children coming to the health centre, but will have no responsibility for the mothers. I do not know how that position can be sorted out. You will have to split up the rooms within the health centre, split up the services of those who are working in the centre, so that some of them will be available for the children on behalf of the borough, and others for the mothers on behalf of the county. I do not know how the right hon. Gentleman thinks that he can make a division of that sort work.
I would like to give another example, perhaps more striking, of the benefits which, I believe, delegation involves. The borough of Hendon is now responsible for immunisation against diphtheria. That is one of the services which will be transferred, under this Bill, from the borough to the county. In the exercise of its powers in respect of immunisation, the borough has been most progressive. It has linked this work with maternity and child welfare work, health visiting and school medical services generally, and, as a result, it has managed to secure, by means of the intensive propaganda it has been able to build up, that very nearly 100 per cent. of all children attending welfare centres have been immunised against diphtheria. For the last complete year, 1945, there have been only II cases of diphtheria within the whole borough. One was in the age group 0–1, another in the age group 1–3, another in the age group 3–5, another in the age group 5–10, another in the age group 10–15, and six, more than half the total, were over school age. It can be truly said that as s result of carrying out its immunisation service the borough of Hendon has virtually reduced the diphtheria rate to nil. Further, the cost of the campaign has been trifling.
There is an example of the way in which a non-county borough can carry out duties which are to be taken away from it by this Bill. If the Bill goes through in its present form, it will be 1747 almost impossible for a health authority, however efficiently it does its work, to do this sort of thing, because it will no longer control the other services with which the immunisation service is linked. There will be a complete disruption of these services, which it is our desire to see integrated. I have given practical examples of what necessarily must happen if no power to delegate is given. I ask the right hon. Gentleman to reconsider the matter, and see whether some power to delegate can be put into the Bill. It may he that he will wish to modify this Clause for the reasons he has given, but I ask him to say that a case can be made out for proper delegation to the great non-county boroughs who have done their work splendidly in the past, and who, if these powers are taken away, can only be left with a sense of frustration.
§ Mr. Messer
Does the hon. Gentleman expect different work on the county council from what he gets on the borough council?
§ Sir H. Lucas-Tooth
I am grateful for that question, because that is the point I was trying to make. I am not for a moment suggesting that the county council will not attempt to do this work with the same energy and good will as the borough council, but if you divide the powers, if you prevent delegation with the result that some services have to be carried out by the borough and others by the county, you cannot possibly have that degree of efficiency which we have reached in the case of Hendon.
§ Mr. T. J. Brooks (Rothwell)
The main authority with which I am concerned is an urban district council. It is very jealous about these services being taken away, because it was working maternity and child welfare services five years before the 1918 Act came into force, long before the county council. The mortality rate has been reduced by something like 100 during that time. Also in my constituency there is part of a non-county borough which is trying to get a new maternity home, and it is doing its job very well. I appreciate my right hon. Friend's intention in not wanting to accept this Clause, but when he said that it would wreck the whole Bill his language seemed very strange to me. Surely, the people who are very zealous of the services they pro- 1748 vide ought to be given some consideration. I have a letter here which was sent to the Ministry of Health from the Rothwell Urban Council, in which it makes it clear that it has very much better services than the county. The letter says:My Council at present administer their own maternity and child welfare services, and they are of the opinion that they can provide a service far superior to that provided by the County Council, in neighbouring districts, and are desirous that the service should be continued at its present level. I am instructed to ask the Minister of Health to insert a Clause whereby the authorities administering maternity and child welfare services should be afforded delegated powers. It is noted that there was a clause to this effect in Command 6502, which was presented to Parliament in February, 1944. My Council desire that a similar clause should be inserted in the present Bill.I have proof beyond doubt, that my town council has very much better services than the county council. I do not, however, propose to take up time by going into the details, which I have here, but merely to deal with general principles. Many of the county councils are reactionary bodies. There is need to retain local touch with the people. I appreciate that perhaps the school medical services and the maternity and child welfare services should be together, but when it is suggested that they should be under one doctor, I say that we shall not get them all under one doctor. There will be overlapping, but that difficulty can be overcome. In some local areas there are very efficient services. In my own town there is a maternity home which has been in existence since 1928. The county council has only two maternity homes in the West Riding.
Some of the local authorities have shown the way very clearly. I do not want to argue against progress, but there is a very definite fear in some parts of the West Riding that they will not be as well served when they go over to the county council. That applies to many little towns of 24,000 or 25,000 inhabitants, such as the Rothwell urban district area. If the Minister will not accept the new Clause, will he, in the case of the authorities which have done excellent work in regard to these services during the last 30 years, agree that if the health authority is prepared to delegate powers, he will have no objection to that happening, and if it will not delegate powers, will 1749 he intervene in cases where he knows that the services in a local area are better than those of the county council?
§ Brigadier Peto (Barnstaple)
I was not fortunate enough to be a Member of the Standing Committee which considered this Bill. I intervene in support of this new Clause because, like the hon. Member for Rothwell (Mr. Brooks), I represent a very scattered agricultural area in which there are two non-county boroughs. The tendency of this Bill is to overcentralise in widely scattered areas. I think that the Bill is probably excellent for towns, but not for widely scattered agricultural areas. In North-West Devon the county council might as well be in London as where it is, from the point of view of getting into close contact with the people. The county council is 60 miles from some of the parishes. Nobody can pretend that one can get as efficient service from a county council 50 or 60 miles away as from a local borough which has the welfare of the people at heart and full knowledge of each family in its own borough. That is one reason why I support the Clause. There is perhaps a loophole, as was suggested by the hon. Member for Rothwell, for the delegation of powers in certain areas. I notice that in Clause 31, provision is made for variation in certain areas. Subsection (3) reads:Where it appears to the Minister that owing to the special circumstances of the area for which an executive council has been or is to be constituted under this section it is desirable to vary the constitution of that Council, he may by order provide for such variation.If the Minister may do that in connection with the executive council, why should he not go a stage further and allow for variation, in other respects, in widely scattered agricultural areas? Finally, I dislike the tendency in the whole of the Bill to place extraordinary power in the hands of the Minister. Throughout Parts III and IV of the Bill, one finds that "the Minister may direct,"or" with the approval of the Minister,"or" if directed by the Minister," somebody shall do certain things. To my mind, too much power of direction is given to the Minister, and this will be at the expense of time and efficiency and at the expense of local bodies, even of county councils. Therefore, I support the new Clause, which I hope will be pressed to a Division.
§ 6.45 p.m.
§ Mr. Piratin (Mile End)
As I have a similar new Clause on the Order Paper, I feel it is my duty to support this new Clause. It does not give me very great pleasure to support a Clause which is under the names of hon. Members opposite, although the name of the hon. Member for Cheltenham (Mr. Lipson) is also attached to it. I sometimes have doubts about some of the Opposition's motives. On this occasion, however, we can discuss the matter irrespective of party. Many of us on all sides of the House have experience of local government and can speak on this matter with intimate knowledge. If it should be claimed that, for that reason, we speak from the point of view of having a vested interest to defend, let me absolve myself from that accusation immediately, for although I am on a local authority, I am at the moment on the minority side. Therefore, I have not a vested interest.
The Minister said, quite rightly, that we are concerned with the patients. I believe that some hon. Members on both sides were affected by the Minister's eloquence, and I think there are four points which ought to be recalled in order that his eloquence should not overawe us. First, we are concerned with guaranteeing to the public the best treatment that can be given; second, we are concerned that that treatment shall be convenient to them; third, that the treatment shall be such that there is sympathy and understanding in the way in which it is administered; and, fourth—a thing with which, I am sorry to say, the Minister does not seem to be very much concerned—that there shall be democratic control by the public close to these authorities and not remote from them. I would like to say a few words on those four points and on the remarks of the Minister.
I agree with the Minister that a rich authority could certainly provide better treatment than a poor and small authority. Nevertheless, the Minister is recognising in other fields that it is the smaller authorities which require to be helped by the central authority, precisely because the present rating system is a bad and inequitable one; and until such time as the rating system is adjusted, we have to recognise facts as they are, and press the need for granting subsidies, in this respect, in the same way as the Minister recognises it in other fields. Therefore, 1751 we have to bear that in mind as a question of convenience; and I think that even a greater authority would also bear in mind the fact that it required to spread its services as much as possible. I am, however, not very much concerned with that and think that it will work out whichever way it is approached.
The third point, and one about which I am very much concerned, is that in answer to the hon. Member for Acton (Mr. Sparks) the Minister referred to the fact that he would insist that the local health authorities appointed sub-committees. I am a London Member and have experience of sub-committees. In London, the present social welfare service has a number of divisions or so called subcommittees, and if ever there was an epitomisation of bureaucracy and Bumble-dom it is to be seen in them. London is an exceptionally vast authority with a population of 4,000,000——
§ Mr. Speaker
I am sorry to interrupt the hon. Member, but he will recollect that there is another Amendment which deals with London and therefore London is not really to be dealt with under this Amendment.
§ Mr. Piratin
I accept your Ruling, Sir, but I would point out that if I am to give an illustration it must be from my own intimate experience, and, with respect, I hope that you will allow me to continue to use London for the purposes of my illustration. I was dealing with the point I have made about understanding and sympathy and whether it could be provided when the authority in question was of the size of London or, for that matter, of Lancashire. That is the point I am dealing with, and my illustration can only be based on London. The Education Act, to which the Minister referred, is another case in point. London is one education authority—it was before the new Act and still is; and the Metropolitan Boroughs were not given their various responsibilities. They were not given an opportunity of being accepted, and therefore we have here also sub-committees in London. My opinion, which I believe is shared by many who know something about the matter, is that this is not satisfactory. I have mentioned these illustrations to show that the Minister does not appear to appreciate this point of sympathy and understanding in the provision of treatment.
1752 My fourth point is that of democratic control. Let me take Lancashire, although I do so only from book knowledge and an occasional visit to that county rather than from personal experience such as I have of London. In Lancashire we shall have the anomaly that there are 18 or 19 county boroughs—I speak from memory—and that over and above these county boroughs, some of which are the size of Manchester, for example, there is the whole expanse of Lancashire to be covered by one local health authority, which will administer the whole county.
§ Mr. Piratin
Yes, because we remove the county borough and the only other health authority responsible is the county council; and as the 18 or 19 county boroughs are scattered throughout Lancashire the only authority left is the county council. I am sure that the hon. Member will grant me that. Other hon. Members could give more details of the population and so on than I can, but there will be one local authority for the whole of Lancashire which, from one end to the other, covers some 140 miles. Here and there in between there is the anomaly of the county boroughs, but will anyone suggest that there is the possibility of democratic control in such an authority? There is no such possibility. We shall have sub-committees, and on those subcommittees there will no doubt be a proportion of councillors, who will be county councillors, and also a proportion of representatives of local authorities—in that case councillors of the urban district councils, municipal councils and so on. But they will have no authority; the authority will rest higher up. All that they will be able to do will be to refer matters higher up, which is the kind of experience I have had in London on social welfare and education where matters are referred to County Hall. I do not believe that any Minister or any hon. Member would suggest that that will really make for the democratic control which we wish to achieve adequately in our time.
There are other anomalies, but I want to pass on. It seems to me that the House, on this occasion as on other occasions, is being treated to a very interesting manœuvre. The Minister of Health is not responsible alone, and there seems to 1753 be an underlying policy here. The Education Act, which was introduced years ago, was not the responsibility of the right hon. Gentleman or of the present Government. Gradually, through each different Bill which this House approves, we have an acceptance of responsibility on the part of given local authorities without ever reaching the stage where we are going to discuss the structure of local government at all. At some time, "Maybe this year, maybe next year" as the song goes, we shall be introduced to a Bill dealing with local government. The Parliamentary Secretary to the Ministry of Health is reported in today's Press as having made a speech in the country this weekend in the course of which he said that within the next ten years there will be a revolution in the structure of local government. He may not have said "revolution," although I like that word, but perhaps he used some similar term. He knows about it, and I have no reason to doubt that the Minister knows about it, and that they have in mind what they propose to bring in in due course, but we do not know about it.
What will happen? If I were the Minister, this is the argument I should use when that local government Bill was being introduced. I should say, "Surely this House must see the logic of what I am proposing in 1948"—or whenever it may be—" for we have an Education Act where the local authorities responsible are the county councils, and we have a Health Act where the local authority responsible is the county council "—by that time no doubt there will be one or two other Acts which will conform in the same way—" and surely the local government proposition which I am now introducing must be accepted, otherwise there will be more chaos." The Minister likes the word "chaos" and the argument would be perfectly true because there would be even more chaos then. I am all in favour of resolving as soon as we possibly can the question of our local government structure, but I think that we are leading up to a stage where one day we shall be presented with what will almost amount to a fait accompli and have to accept a Bill which confirms the local government structure which is gradually being introduced by one Bill after another.
I do not believe that the Minister can really uphold this argument, for when he 1754 was making his case before, he said, in reply to an intervention by the hon. Member for Cheltenham, if the hon, Member wanted boroughs why not urban districts, why not rural districts, or why not even the parish councils? All right, but what about the anomaly we have in our system? What about the London County Council, with a population of four million, and the Welsh or Scottish county councils with 50,000? What about the example given by the hon. Member for South Hendon (Sir H. Lucas-Tooth) of the Hendon Borough Council, and what about the fact that in Middles-3x there are authorities like Hendon and others with well over 100,000 population? The whole of Middlesex will be the local authority, whereas in Essex, by the freak of some circumstance of the past when, some 50 years or so ago, the local authority of that area requested that it should become a county borough, Southend is a county borough. East Ham and West Ham are also county boroughs, and the Essex County Council will be an identical authority with these county boroughs and urban district councils. Does the Minister approve of that? He cannot. He has an orderly mind, as he has told us so often. I accept that.
We want to see this thing working in an orderly way, but we have to accept the facts as they are. These are the facts. The Minister may say, for the sake of showing that he considers the logic of the argument used by the hon. Member for Cheltenham wrong, that he does not accept this, but I think he must acknowledge the logic of the existing system. Let us acknowledge that there are anomalies in the system of local government, and that there will be——
§ Mr. Speaker
This is not the occasion, I would remind the hon. Member, for discussing the future of local government.
§ Mr. Piratin
I will not dispute your Ruling, Sir, but I would say that it is not my intention to discuss the future of local government. You will observe that I have not put forward my proposals on the subject, although I have some good ideas. I am only, as you might say, speaking around the subject. In due course, the Minister may give 'me an opportunity of speaking more fully, if a 1755 Bill is brought in on the subject of local government. I will then put forward my proposals, provided you will give me the opportunity. I am about to close my speech, anyway.
I have given some points to strengthen the case for the Minister to give way on this matter. I would draw attention to the fact that an Amendment of mine, which was not accepted, referred to major and minor local authorities. I have heard the Minister's answer on this matter before, but on this occasion, if he and the Parliamentary Secretary had listened to the arguments, I am sure they would have taken the view that this matter is worth reconsidering. The Minister has stated before that this proposal would upset the whole Bill. I do not think so. We have reached a stage of history when a number of things will have, for a while, to be a little bit piecemeal until we find our true level in government and so on. Under the Labour Government we shall gradually find it, because there is a greater degree of good will than there has ever been before. There must be some measure of give and take and I, therefore, hope that the Minister will now see his way to giving way on the point.
§ Sir H. Morris-Jones
I feel sure that the House will agree with me that if the Communist doctrine were always to show itself constructive as the hon. Member for Mile End (Mr. Piratin) has shown himself in his speech it might gain a new adherent every time he spoke in the country for every one lost when the hon. Member for West Fife (Mr. Gallacher) gets up in the House. The Minister gave us a very full description of the consequences of accepting the proposed new Clause, and he included a very fine eulogy of local authorities. I know that he himself has been a very diligent member of a local authority for a number of years. The right hon. Gentleman said that certain changes were fundamental to improvement of local government. Why then, is he refusing to accept the proposed new Clause or some proposal on the same lines? The right hon. Gentleman is by means of this Bill making fundamental changes in the structure of local government, and he is doing it here and now, before any Commission has been set going at all. He is practically annihilating a largo number of responsible authorities, 1756 from the point of view of health administration. As one reason for rejecting the proposed new Clause he said that there were a rather large number of poor local authorities. He particularly mentioned non-county boroughs. He proposes to penalise at the same time first-class local authorities, some of whom were pioneers in this matter of health administration long before county councils were thought of. By not accepting the proposed new Clause the right hon. Gentleman is taking away a vast field of health service from those authorities and transferring it to bodies far removed from them.
I cannot speak of London, which other hon. Members know much better than I do, but I do know about county councils in my part of the country. By means of the Bill, one of the best local authorities in my county will be rendered nugatory, although it has one of the best records in this work. Great lack of interest in the subject will result from their functions being transferred to a body far away. The authority I have in mind has 25,000 people, many of whom do not know at the present moment who their county councillors are, although these will be the men on the health committee, to carry out the new functions of the county council. I ask the Minister to find some via media, some way out, and not entirely to pension off these authorities by transferring these functions from them. Many of these authorities are autonomous bodies, very compact in character. They know their own people very well and they have carried out health services with a great body of opinion, as well as of effort, behind them. If the Minister transfers their functions to unknown members of the health committee of a county council, he will take away a cornerstone of the edifice which he is claiming to build by this Bill.
§ Mr. Anthony Greenwood (Heywood and Radcliffe)
In rising to make my second speech on this Bill I propose to criticise it from one aspect. The Bill will do much for the welfare of many people in this country, but I feel bound to support the new Clause proposed by the hon. Member for Cheltenham (Mr. Lipson). We would all accept the principle laid down by my right hon. Friend the Minister, I think, that the vital consideration in this matter is that of the individual patient, and not any vested 1757 interest of a local authority. None of us would differ from the Minister on that point. What is worrying us is how we are to improve this machinery by drawing this wholly artificial distinction between county boroughs and non-county boroughs. I regard it as indefensible to say that because a local authority is a county borough, partly through an accident of history, it must be efficient and competent to carry out the duties required under the Bill. It is equally indefensible to say that because an authority is a non-county borough, it is not suitable to discharge the functions required by the Bill.
We are not suggesting that all non-county boroughs should be empowered to discharge these functions. The Clause is a purely permissive one. Nobody would suggest that the boroughs of Eye, with a population of less than 2,000, and of Winchelsea, with less than 1,000, should discharge the functions referred to in this Bill, but we do suggest that there are certain local authorities which by their experience and record have proved themselves to be capable administrators of the kind of function which the Minister has reserved in this case solely for the county boroughs and county councils. We are prepared to see the county boroughs and county councils keep the rights which the Minister is giving them, but other local authorities ought to have an opportunity to prove that they are equally able to discharge these functions under the Bill. The point is that the standard to be maintained must be laid down from above, but that the maintenance of that standard in everyday running, should be left to the men and women on the spot. So far as I understood the Minister, he criticised the non-county boroughs partly because they were old. He did not think that was, in itself, sufficient justification for our argument, and I am in agreement with him, but he went on to say that they were too small and that their rateable value was not great enough to enable them to discharge these functions. Other hon. Members have pointed to the illogicality of that observation. What the Minister is proposing is this: that the county borough of Canterbury, which has a population of less than 20,000, should be empowered to perform functions which are denied to the non-county borough of Willesden, which has a population of 150,000. Rut- 1758 land is to be allowed to perform functions which the Minister refuses——
§ Mr. Greenwood
I am grateful to my right hon. Friend for the intervention. If anything, it strengthens our case. If it is possible to discriminate against county boroughs, it should be equally possible to do so in the interests of non-county boroughs.
I have said that it is illogical to draw this distinction between county boroughs and non-county boroughs. I refuse to believe that there is an optimum size for a local authority unit. There are four tests one should apply. The first is that the local authority should be of a compact and convenient geographical area. Secondly, it should have a population roughly in proportion to its size. Third, it should have adequate financial resources at its disposal. Like my hon. Friend the Member for Mile End (Mr. Piratin), I shall await with interest the proposals of the Parliamentary Secretary at a later stage for the reform of local government finance. The fourth test—it is the most important of all—is that a local authority should have behind it a tradition of local pride and civic consciousness. The Minister, with the great reputation which he enjoys in local government, knows as we do how difficult it is to rouse interest in local government. We shall find it far more difficult to arouse interest in our non- county boroughs if the centre of government is removed to a more remote place where the county authority has its seat.
The hon. Member for Rothwell (Mr. T. J. Brooks), like myself, is a Yorkshire-man. I am sure that on that ground, if on no other, the Minister will acquit us of any desire of trying to base this argument on grounds of emotion. But there is one side of the argument which is essentially a human problem. In the Minister's proposal, the responsibility for maternity and child welfare is to be taken away from the non-county boroughs and given to the county authorities. I am sure the Minister will agree that maternity and child welfare are not only matters of chromium 1759 and white enamel and of vitamins and cod liver oil, valuable as those are, but that there is an important psychological factor. The people who administer the service have to know the local conditions in which the mother and child live, and their family circumstances. Those are important considerations. Although I appreciate that the Minister is going to set up local committees, I do not believe that these local committees will take the place of a good local authority where the members of the council know and love every man, woman and child in the ward they represent.
If the Minister persists in the course laid down in this Bill, we shall produce two results in local government. First we shall overburden the county authorities. It is well known that service on a county authority like the London County Council requires a member to devote an average of two days a week to the work, and yet we are proposing to add to the heavy duties which already fall on the county councils. Secondly, by taking away the powers from the non-county boroughs we shall take away their responsibilities and make it far more difficult to attract into local government service, whether as paid officials or as members of the councils, the right type of men and women. Unless we get the right type of men and women, we shall lose one of the most important factors in producing an efficient local government service.
The first time I spoke in this House I complimented the Minister on the adaptability and spirit of compromise which he had shown. I appeal to him tonight not to disappoint the high hopes that a new Member formed of him, and to give the non-county boroughs an opportunity of continuing the great work which many of them are doing at the present time.
§ Mr. Keeling (Twickenham)
I support this Clause not as a member of the Westminster council but as Member of Parliament for a non-county borough in Middlesex. The Minister said that the remedy in the hands of a non-county borough who desired to exercise these powers was to apply to be made a county borough. That remedy is not open to any borough in Middlesex because it has been the policy of this and previous Gov- 1760 ernments not to create any county boroughs in Middlesex. Unless the Minister is prepared to say that he will use his influence to reverse that policy, his argument cannot be applied to Middlesex. Why should powers which are given under this Bill to a county borough, however small and whatever the inefficiency of its health services, be refused to every non-county borough of Middlesex, whatever its size and however efficient it has proved itself to 'be in administering these health services? The Minister said that some non-county boroughs were backward, and talked about the chaos which would be introduced if this new Clause were accepted, but hon. Members have only to read this Clause, to see that that argument is not really relevant because it is left entirely in the hands of the Minister whether to grant these powers or to refuse them. If the borough is backward, when the council applies for delegation of powers he can refuse it, and so avoid the chaos of which he is afraid.
My second point is this. The Minister said that if he had to wait until an inquiry had been made into the possibility of delegating powers under this new Clause, it would delay the operation of the Bill. I suggest that as these powers are already being exercised, either by the county council or by the borough council, it is open to him to leave them where they are until he has considered whether any change should be made. I say that it would create much less chaos to leave them for the time being in the hands of a borough council which is already exercising them efficiently, than to transfer them at once to the county council.
The right hon. Gentleman must have been both impressed and embarrassed by the degree of support given to this new Clause from the Benches on his own side of the House, especially as those speeches in support of the Clause were very excellent ones. I therefore want to suggest to him the possibility of a compromise. He referred to the powers given under the Fourth Schedule. If hon. Members will turn to page 67 of the Bill, they will see these words in the last paragraph, paragraph 7:The health committee of a local health authority may, subject to any restrictions imposed by the local health authority, authorise any sub-committee to exercise on their behalf any functions of the health committee.1761 It seems to me that if the Minister would say that he wanted that paragraph to be used, and that he was willing to consider that the sub-committee to whom those powers were delegated might, in appropriate cases, be either the health committee of the non-county borough council, or the non-county borough council itself, there would not be very much between us. Clause 21 requires every local health authority—in this case the county council—to submit a scheme to him, and he has it in his power to modify any scheme so submitted. I suggest to the Minister that he should give an assurance that he will consider sympathetically any suggestion from a non-county borough council that the scheme should, in appropriate cases, include a delegation by the local health authority to the borough council or to the health committee of that borough council. If he would accept that proposal, I should be in favour of this new Clause being withdrawn.
§ Mr. John Freeman (Watford)
When this Debate started, I had made up my mind to support the Clause and vote against the Minister, but I am bound to say that, having listened to the speeches, and in particular, to the Minister's speech, I have changed my mind and I shall support him on grounds which are perfectly simple. In view of the warning he has given the House about the chaotic situation that would be created if this Clause were accepted, it would, I think be irresponsible on the part of any hon. Member who really wants to see this Bill on the Statute Book in the interests of the people's health to vote for this Amendment at this stage. Therefore, I propose to support the Government on this point.
Having said that, I want to give the Minister one word of warning, if I may be so presumptuous. The fears which many hon. Members, including myself, have had on this point are not doctrinaire fears. Moreover, they are fears which are intimately related to the wellbeing of the patient. We have talked a great deal in the last couple of hours about the structure of local government. What we should be considering is how the patient is to be treated. I assure the Minister, speaking in perfectly concrete terms, about the county of Hertford, and, in particular, my own constituency of Watford, that I have a certain fear at this moment that under the Bill as it is drawn at present, 1762 some of my constituents will be less well treated than they would be if it were drawn slightly differently. Notwithstanding that, I think the Minister's argument is overriding and I shall support him. But the onus is on him, if we support him on this, to scrutinise with the utmost care the schemes which the local health authorities put forward, to make certan that major local authorities, which are not county boroughs, are not put in a ridiculously weak position by a reactionary county council such as we fear the Hertfordshire County Council might in certain circumstances prove to be.
§ Mr. Eccles
We have had many interesting speeches from the Benches opposite in support of this new Clause. I thought none more agreeable than the spirited defence made by the hon. Member for Mile End (Mr. Piratin) of democratic local government against Socialist centralisation. I hope he will continue in that way. The Minister began by paying a tribute to local government in general, and went on, also in general, to use rather contemptuous words about non-county boroughs. The truth is that there are some good and some bad authorities in all types of local authorities. There are some big ones and there are some small ones.
§ Mr. Eccles
I may be mistaken, but my recollection is that the right hon. Gentleman said that non-county boroughs have privileges and pageantry and very little enthusiasm for progress.
§ Mr. Bevan indicated dissent.
§ Mr. Eccles
Well, we shall read it in the OFFICIAL REPORT tomorrow, but I think I am correct. There are certain local authorities exercising health functions—which will be taken away—and exercising those functions well. There is no doubt about that, and the question we have to ask is: Is it worth taking away functions which are being well exercised from a certain number of local authorities for the sake of administrative tidiness? I think it comes down to that. I am very sorry that the hon. Member for Swindon (Mr. T. Reid) is not in his place because I was 1763 going to appeal to him on behalf of the county of Wiltshire. There you have a town tucked up in the North-East corner of Wiltshire, a very long way from Trowbridge. There is no easy way to get to Trowbridge, where the county council sits. It is a town dependent on railway works, with its own character and which, under Part III of the First Schedule to the Education Act, has become an accepted district for carrying out education. Now, under the Minister's proposals, if he does not accept this Clause, the health services in connection with the children which will he looked after from the educational point of view by Swindon town council, will be taken away and put under the Wiltshire county council 45 miles away.
§ Mr. Eccles
The care of the health of the mother is certainly taken away. The services that would look after the mother are taken away and put under the Wiltshire county council. I do not think that is a good thing. Here is a town which has its own character and its own tradition, and I believe that the patients, that is to say the people of Swindon, would be better looked after if their health services continued in the hands of the local people. I suggest that the only solid argument given by the Minister for refusing this Clause, was that it would as he said produce an administrative morass. Will it produce an administrative morass? I do not wish to go over the ground which my hon. Friend the Member for Twickenham (Mr. Keeling) traversed. He showed clearly that there would be less chaos if these services were left where they are now, subject to the Minister's sanctions. The Minister said that chaos would be caused because all sorts of small authorities would, presumably, fix up with county councils that power should be delegated to them. Then they could come to the Minister for sanction for that delegation, and he would be bombarded by these smaller authorities. I do not think that would happen. They would only come when there was really good cause.
§ Mr. Bevan indicated dissent.1764
§ 7.30 p.m.
§ Mr. Eccles
Under the Education Act an accepted district is defined, under two methods of calculation, by population. Could not something similar be done here to give a limit to those who have a right to apply? I think the Minister is going to throw away services which are being well run for the sake of something which is not going to be more worthwhile, and I hope he will think again. If he cannot do it exactly in the terms of this Clause, I hope he will see that the matter is put right in another place.
§ Mr. Sparks (Acton)
I am glad to have an opportunity of saying a few words on this new Clause. I also hope my right hon. Friend the Minister will think again about this matter. It is a very important principle, and one which deserves the earnest consideration of all hon. Members. Those who may be in favour of or against the new Clause cannot be accused of wanting to barter the welfare of the citizen in favour of any specific type of local authority. It has been said, and the Minister has heard this, that county councils are the most reactionary councils in the country.
§ Mr. Sparks
I agree up to that point, but I cannot understand my right hon. Friend believing that the county councils are the best administrative authorities for this purpose. I have had about 15 years' experience of a non-county borough, and some experience of the working as between county and non-county boroughs. My hon. Friend the Member for South Tottenham (Mr. Messer) is not here at the moment, so I may say now that I have never been enamoured of the way in which the Middlesex county council has functioned. It is growing to be an overburdened, top heavy kind of burcaucratic organisation.
§ Dr. Morgan (Rochdale) rose—
§ Mr. Sparks
My hon. Friend will have his chance later. I believe my right hon. Friend by taking away these local functions from non-county boroughs, and centralising them in the county councils, is clogging the machine. He is clogging it with matters which are important, but which could quite usefully be performed by the existing non-county boroughs.
1765 I would like to emphasise some illustrations which have already been mentioned. The Minister said in regard to non-county boroughs that there was opportunity for them to secure county borough status. But that is not so in Middlesex. There can be no county boroughs created in Middlesex; that is established by Statute. In Middlesex, there are 15 non-county boroughs carrying out these local health functions in an efficient and up-to-date way. The largest municipal borough in Middlesex is Ealing, with a population of 155,580, and a rateable value of£1,870,000. Ealing, a non-county borough, is larger in population than any one of 63 county boroughs. I do not propose to enumerate them, but it seems rather remarkable that 63 county boroughs less in population and in rateable value, should be entrusted with the responsibility of being local health authorities under this Bill, while a non-county borough which is larger shall have its functions taken away, and centralised in the Middlesex county council machine. Ealing is also larger than any one of 21 county councils. If it can be argued that the county councils may be entrusted with the responsibility of the functions of Part III, I cannot understand why a large municipal borough like Ealing should have these functions taken away.
My own constituency of Acton is a municipal borough, one of the 15 in Middlesex. We are third from the bottom in population and rateable value. We have a population of 59,400 and a rateable value of£862,061. Yet Acton is a non-county borough larger in population and rateable value than any of nine county councils and larger in population and rateable value than any of 10 county boroughs. How can we reasonably expect a non-county borough such as those I have mentioned to accept the position that it must be deprived of the powers enumerated in Part III, in favour of counties and county boroughs very much smaller in population and rateable value? It is difficult for me, and it will be difficult for the Minister, to put up a convincing argument on those lines.
I conclude with a reference to what is specified in the various Clauses of Part III of the Bill. Clauses 22, 23, 24, 25, 27 and 28 provide for functions which are to be transferred to the county council. But the most annoying part of the whole thing is that the Minister is providing for 1766 consultation with voluntary organisations and giving power to county councils to hand over their functions to voluntary organisations. If it is considered wise that voluntary organisations shall have these public health functions delegated to them, why cannot the functions be delegated to non-county boroughs who are already doing this work very efficiently? I listened very carefully to what the Minister said, and I should be prepared to accept his judgment of the value or otherwise of accepting the Clause. He obviously knows more about the Bill's working than I do. If he feels compelled to reject the new Clause, I ask him, before the final stages are reached, to have another look at the matter to sec whether he cannot give to the non-county boroughs the same functions as he allows to be given to voluntary organisations. I feel quite sure that far from wrecking the Bill, that would help it, and make it more effective. To take away these functions from the 15 non-county boroughs in Middlesex, and place them in the hands of half a dozen officials in London, who are isolated from the locality, is crowding the county council machine with a lot of detailed local matters. That, in my view, will not be advantageous.
§ Mr. E. P. Smith (Ashford)
This Clause carries a number of names from all parts of the House attached to it; in fact, it seems a non-party Clause, but I am about to strike a rather discordant note from this side of the House in suggesting that it should be rejected. I have the honour to represent, amongst a very large rural area, three non-county boroughs. They are full of vital history and honourable traditions; and they have a great local pride in civic government. But I have received no representations from them to vote in favour of this Clause, and they are not usually backward in sending me their views. In fact, I am inclined to think that they would be dismayed were this Clause carried into effect.
§ Mr. Smith
I am quite well aware that the faculties in this Clause are permissive; but if the hon. Member for Cheltenham (Mr. Lipson) knew as much about ancient and rural boroughs as I do, he would soon realise that there would be a stream of competition to get in and to manage these health services, perhaps not always with 1767 the best results, because the borough councils have not the machinery. They have not even the personnel for the task. They have quite enough to do to get on with their housing jobs. I think that the Minister has, on the whole, taken the right course in vesting the power in the county councils, which are not reactionary bodies—at least from my experience I can say that the Kent county council is not reactionary, though of course Kent is always a righteous exception. I believe that the solution of this problem is that proposed by the Minister, in having plenty of specific local representation on his regional committees.
§ Mr. Willink
In my view there are blemishes in this Clause, but on its main principle I shall not be content unless the Minister indicates he will look at this matter again. As I understand the Clause, it would enable a county council to delegate its powers to any non-county borough, and leave the Minister without control of that operation. I doubt whether the Minister could accept that position. Nor do I feel that it is quite appropriate for dealing with the County of London. But the Minister must have gathered that there is a very wide feeling throughout the House that some flexibility in this matter is most desirable. I feel that the Minister's attitude to this Clause discloses exactly the opposite to what he has claimed for this Bill on so many occasions—that it will be flexible to meet the circumstances in the appropriate way. It also discloses what I did not expect to find in the Minister, a certain lack of courage in dealing with decisions that might have to be made if this flexibility were to be improved.
It will be a serious thing if the Bill removes the health functions which come within the range of this part of the Measure from every local authority which is not a county council or a county borough. That is the position under the Bill as it stands. How much wiser, surely, was the procedure of the last House in the matter of education, when a population figure down to 70,000 was decided upon as appropriate for an excepted district. Who can say that it is either logical or satisfactory that all the little Welsh counties and some quite small county boroughs of between 50,000 and 100,000 people should have these im- 1768 portant but most human and personal local functions, while non-county boroughs, which may not succeed in or may not be qualified to make applications for county borough status, because they have a population of only 80,000 or 90,000 are not to have them. As has been forcefully pointed out by some hon. Members representing Middlesex constituencies, all those large non-county boroughs in the county of Middlesex are to be quite certainly and irretrievably deprived of these functions.
I feel that the Minister is falling into the state of rigidity which he has claimed to avoid. It should be possible for him to limit the administrative complications in the next two or three years by a comparatively simple step. This course would necessitate our consequential Amendment, under which the claims proposed by local authorities would include proposals for performing functions themselves or for delegating them, but the Minister would then have the power of approving, or disapproving, or modifying those proposals. He should intimate in advance, after consideration of what has been said today, and of other circumstances, what his general approach to such proposals would be. I, and many others, at any rate, would understand the great difficulty that exists in view of the fact that there are urban districts and rural districts as big as some county boroughs. This and other factors make the duty of the Minister of Health in this matter very difficult indeed, but he cannot doubt what is the mind of the House today, namely, that big responsible boroughs such as those in Middlesex, and others, with over 60,000 or 70,000 population—to imitate the Education Act—would properly administer these services, if the county agreed, and the Minister thought it was appropriate, or even without the agreement of the county.
I ask the Minister to look into this matter again. He said that he had considered in these proposals nothing but the interests of the patient. But he should do every one of us the credit of attributing to us exactly the same intention. A great many of us believe that the patients will be better served, in this personal service, by authorities more local than county councils. We believe that on a review of the matter the Minister would agree, if he searched his own conscience, that he 1769 was merely resisting the whole of this because of the fear that he would be involved in an argument. Let him take his courage in both hands. Let him announce that he will not give these powers to boroughs with less than 50,000 or 70,000 population—whatever, on consideration, he thinks right—but that some measure should be introduced into the Bill which would not make it impossible to leave with thoroughly efficient authorities the services they have at present.
There is a great deal in what was said by the hon. Member for Acton (Mr. Sparks). There is the risk of a county such as Middlesex becoming as overburdened with functions as is the L.C.C. The same will happen with other county councils. The administrative changes involved in this Bill are great. Let the Minister not add to them unnecessarily. I fear that if the Minister proceeds along these lines, it will create the impression in the minds of the people of this country that what he means by local government is local government on a very large scale, with bodies very remote from their constituents. No Minister of Health wants to go down to history as one who is not a friend of local government. This Bill leaves these services to counties and county boroughs. Everything is becoming more remote. I beg the Minister, because I think that is the wish of the House, to consider the matter again.
§ Mr. Key
So far as I have heard this Debate, nothing new has been stated following on our discussion of an exactly similar proposition upstairs in Committee. We are covering the same old ground over and over again. I yield to nobody in this House in my interest in local government and my championship of the small local authorities, but it is not the vested interests of local authorities which must weigh with us in this business; it is the interest of the service that we are out to provide for the people.
§ Mr. Key
When people talk of taking out of the various county areas, first, the non-county boroughs and then the large urban districts, they seem to forget that this would leave the county authority with a remnant area, and without the necessary centres of operation for the services which must be provided. That makes almost impossible the carrying out 1770 of a competent service in the area. This is not merely a question of the cost of the services involved; it is a question of the capacity which will remain to employ the necessary competent and highly qualified staff, to provide these services in the area which is left. It appears to me that to the extent to which one robs the county area of the necessary functional centres, and the capacity for providing competent staff by taking away the non-county and large urban areas, to that extent one makes it far more difficult for the county to provide the services required.
§ Mr. Keeling
The Minister has twice referred to taking urban districts out of the county. There is nothing in the Clause about urban districts; it refers only to boroughs.
§ Mr. Key
I am aware that it refers only to boroughs, but once we have admitted the small non-county boroughs of 10,000 and 15,000 population, in comparison with urban areas with a population of over 100,000, we are up against a proposition which it is impossible to maintain. Moreover, there is nothing in the composition of the non-county borough, compared with the highly competent urban district council, which makes it necessary that they should have these powers. The point I want to emphasise is this would make it possible for a large number of authorities—even if it never extended beyond the non-county boroughs—to bring in questions of delegation of powers, which would postpone indefinitely the time when this Bill could come into active operation. It is because we have a great administrative task to face that I am certain that any attempt to do this would jeopardise the interests of the people and the successful effect of this Bill. To my own friends on this side of the House I say that in this matter they have to show that they have confidence in the Minister and his administration and their intention to see that efficiency is maintained in the instrument which is chosen to carry out the services in the interests of everyone. I hope this Clause will be resisted.
§ Several Hon. Members rose——
§ Mr. Speaker
I hope that the House will now come to a decision. In view of the long discussion which took place on the Committee stage, I almost had doubts about calling this Clause at all. We have 1771 now had a very long discussion on Report. I, therefore, hope the House will come to a decision.
§ Question put, "That the Clause be read a Second time."
§ The House divided: Ayes, 115; Noes, 218.1773
|Division No. 262.||AYES.||7.57 p.m.|
|Agnew, Cmdr. P. G.||Hare, Hn. J. H. (Woodb'ge)||Nutting, Anthony|
|Amory, D. Heathcoat||Harris, H. Wilson||Orr-Ewing, I. L.|
|Assheton, Rt. Hon, R.||Headlam, Lieut.-Col. Rt. Hon Sir C||Osborne, C.|
|Astor, Hon. M.||Herbert, Sir A. P.||Peto, Brig. C. H. M.|
|Baldwin, A. E.||Hinchingbrooke, Viscount||Pickthorn, K.|
|Beechman, N. A.||Hogg, Hon. Q.||Pitman, I. J.|
|Bossom, A. C.||Holmes, Sir J. Stanley (Harwich)||Prescott, Stanley|
|Bower, N.||Hurd, A.||Raikes, H. V.|
|Boyd-Carpenter, J. A,||Hutchison, Lt.-Cm. Clark (E'b'rgh W.)||Ramsay, Maj. S.|
|Braithwaite, Lt. Comdr. J. G.||Jeffreys, General Sir G.||Rayner, Brig. R.|
|Bromley-Davenport, Lt.-Col. W.||Keeling, E. H.||Reid, Rt. Hon. J. S. C. (Hillhead)|
|Buchan-Hepburn, P. G. T.||Lambert, Hon. G.||Renton, D.|
|Butcher, H. W||Lancaster, Col. C. G.||Roberts, Emrys (Merioneth)|
|Byers, Frank F.||Langford-Holt, J.||Roberts, Maj. P. G. (Ecclesall)|
|Carson, E.||Legge-Bourke, Maj. E. A. H||Sanderson, Sir F.|
|Challen, C.||Linstead, H. N.||Shepherd, W. S. (Bucklow)|
|Clarke, Col. R. S.||Smiles, Lt.-Col. Sir W.|
|Clifton-Brown, Lt.-Col. G||Lloyd, Maj. Guy (Renfrew. E.)||Stewart, J. Henderson (Fife, E.)|
|Conant, Maj. R. J. E.||Low, Brig. A. R. W.||Strauss H. G. (.English universities)|
|Lucas-Tooth, Sir H.||Stuart, Rt. Hon. J. (Moray)|
|Corbett, Lieut.-Col. U. (Ludlow)||MacAndrew, Col. Sir C.||Studholme, H. G|
|Crosthwaite-Eyre, Col. O. E.||Macdonald, Capt. Sir P. (I. of Wight)||Taylor, C. S. (Eastbourne)|
|Cuthbert, W. N.||Mackeson, Brig, H. R.||Taylor, Vice-Adm. E. A. (P'dd't'n, S.)|
|Darling, Sir W. Y.||McKie, J. H. (Galloway)||Thomas, J. P. L. (Hereford)|
|Dodds-Parker, A. D.||Maclay, Hon. J. S.||Thornton-Kemsley, C. N.|
|Donner, Sqn.-Ldr. P. W.||Macpherson, Maj. N. (Dumfries)||Thorp, Lt.-Col. R. A, F.|
|Drayson, Capt. G. B.||Maitland, Comdr. J. W.||Touche, G. C.|
|Drewe, C.||Manningham-Buller, R. E.||Wadsworth, G.|
|Dugdale, Maj. Sir T. (Richmond)||Marlowe, A. A. H.||Walker-Smith, D.|
|Eccles, D. M.||Marples, A. E.||Watt, Sir G. S. Harvie|
|Eden, Rt. Hon. A.||Marsden, Capt. A.||Wheatley, Colonel M. J.|
|Fleming, Sqn.-Ldr. E. L.||Marshall, D. (Bodmin)||White, J. B. (Canterbury)|
|Fletcher W. (Bury)||Marshall, S. H. (Sutton)||Williams, Gerald (Tonbridge)|
|Follick, M.||Maude, J. C||Willink, Rt. Hon. H. U.|
|Gage, C.||Mellor, Sir J||Willoughby de Eresby, Lord|
|Galbraith, Cmdr. T. D.||Molson, A. H. E.||Winterton, Rt. Hon. Earl.|
|Glossop, C. W. H.||Morris, Hopkin (Carmarthen)||Young, Sir A. S. L. (Partick)|
|Gomme-Duncan, Col. A. G.||Morris-Jones, Sir H.|
|Grimston, R. V.||Morrison, Rt. Hn. W. S. (Cirencester)||TELLERS FOR THE AYES|
|Hannon, Sir P. (Moseley)||Nicholson, G.||Mr. Lipson and Mr. Lang|
|Adams, Richard (Balham)||Clitherow, Dr R.||Foot, M. M.|
|Alexander, Rt. Hon. A. V.||Collick, P.||Foster, w. (Wigan)|
|Allen, Scholefield (Crewe)||Collins, V. J||Freeman, Maj. J. (Watford)|
|Alpass, J. H.||Colman, Miss G. M.||Gallacher, W.|
|Anderson, F. (Whitehaven)||Cooper, Wing-Comdr. G.||Ganley, Mrs. C. S.|
|Attewell, H. C.||Corbet, Mrs. F. K. (Camb'well, N.W.)||Gibbins, J.|
|Austin, H. L.||Corlett, Dr. J.||Gibson, C. W.|
|Ayles, W. H.||Corvedale, Viscount||Glanville, J. E. (Consett)|
|Bacon, Miss A||Crossman, R. H. S.||Grey, C. F.|
|Balfour, A.||Daggar, G.||Grierson, E.|
|Barstow, P. G||Davies, Ernest (Enfield)||Griffiths, D. (Rother Valley)|
|Barton, C.||Davies, Harold (Leek)||Guest, Dr. L. Haden|
|Battley, J. R.||Davies, S. O (Merthyr)||Gunter, Capt. R. J.|
|Belcher, J. W.||Deer, G.||Guy, W. H.|
|Bellenger, F. J.||Delargy, Captain H. J||Hale, Leslie|
|Bevan, Rt. Hon. A (Ebbw Vale)||Diamond, J.||Hardy, E. A.|
|Bing, G. H. C||Dobbie, W.||Harrison, J.|
|Binns, J.||Dodds, N. N.||Hastings, Dr. Somerville|
|Blenkinsop, A||Donovan, T.||Haworth, J.|
|Blyton, W. R.||Driberg, T. E. N.||Henderson, A. (Kingswinford)|
|Bottomley, A. G.||Dugdale, J. (W. Bromwich)||Henderson, Joseph (Ardwick)|
|Bowles, F. G. (Nuneaton)||Dumpleton, C, W.||Herbison, Miss M.|
|Braddock, Mrs. E. M. (L'p'l, Exch'ge)||Dye, S.||Hewitson, Capt. M|
|Braddock, T. (Mitcham)||Ede, Rt. Hon. J. C.||Hobson, C. R.|
|Brook, D. (Halifax)||Edwards, Rt. Hon. Sir C. (Bedwellty)||Holman, P.|
|Brown, George (Belper)||Edwards, John (Blackburn)||Holmes, H. E. (Hemsworth)|
|Brown, T. J. (Ince)||Edwards, N. (Caerphilly)||Horabin, T. L.|
|Bruce, Maj. D. W. T||Edwards, W. J. (Whitechapel)||House, G.|
|Buchanan, G.||Evans, S. N (Wednesbury)||Hoy, J.|
|Burden, T. W.||Ewart, R.||Hughes, Hector (Aberdeen, N.)|
|Burke, W. A.||Fairhurst F.||Hughes, H. D. (W'lverh'pton, W.)|
|Chamberlain, R. A.||Farthing, W. J.||Hynd, H. (Hackney, C.)|
|Champion. A. J.||Fletcher, E. G. M. (Islington, E.)||Irving, W- J.|
|Jeger, G. (Winchester)||Parkin, B. T.||Thomas, Ivor (Keighley)|
|Jones, P. Asterley (Hitchin)||Paton, Mrs. F. (Rushclifle)||Thomas, I. O. (Wrekin)|
|Keenan, W.||Paton, J. (Norwich)||Thomson, Rt. Hn. G. R. (Ed'b'gh, E.)|
|Kenyan, C.||Pearson, A,||Thorneycroft, Harry (Clayton)|
|Key, C. W.||Perrins, W.||Thurtle, E.|
|Kinley, J.||Popplewell, E.||Tiffany, S.|
|Lavers, S.||Porter, E. (Warrington)||Titterington, M. F.|
|Lee, F. (Hulme)||Porter, G. (Leeds)||Tolley, L.|
|Lee, Miss J. (Cannock)||Pursey, Cmdr. H,||Turner-Samuels, M.|
|Leslie, J. R.||Randall, H. E.||Ungoed-Thomas, L|
|Lewis, A. W. J. (Upton)||Ranger, J.||Usborne, Henry|
|Lindgren, G. S||Rankin, J.||Vernon, Maj. W. F.|
|McAdam, W.||Rees-Williams, D. R.||Viant, S. P.|
|McGhee, H. G||Reeves, J.||Walkden, E.|
|McGovern, J.||Reid, T. (Swindon)||Walker, G. H.|
|McKay, J. (Wallsend)||Richards, R.||Wallace, G. D. (Chislehurst)|
|Maclean, N. (Govan)||Ridealgh, Mrs, M.||Warbey, W. N.|
|McLeavy, F.||Robens, A.||Watkins, T. E.|
|MacMillan, M. K. (Western Isles)||Roberts, Goronwy (Caernarvonshire)||Wells, P. L. (Faversham)|
|Mallalieu, J. P W.||Rogers, G. H. R.||Wells, W. T. (Walsall)|
|Manning, C. (Camberwell, N.)||Shackleton, Wing-Cdr. E. A. A.||Westwood, Rt. Hon. J.|
|Manning, Mrs. L. (Epping)||Sharp, Lt.-Col. G. M.||Whiteley, Rt. Hon. W.|
|Marshall F. (Brightside)||Shawcross, Sir H. (St. Helens)||Wigg, Colonel G. E.|
|Mayhew, C. P.||Shinwell, Rt. Hon. E.||Wilkins, W. A.|
|Messer, F.||Shurmer, P.||Willey, F. T. (Sunderland)|
|Mikardo, Ian||Silverman, S. S. (Nelson)||Willey, O. G. (Cleveland)|
|Mitchison, Maj. G. R.||Simmons, C. J.||Williams, D. J. (Neath)|
|Moody, A. S.||Skeffington, A. M.||Williams, J. L. (Kelvingrove)|
|Morgan, Dr. H. B.||Skinnard, F. W.||Williams, Rt. Hon. T. (Don Valley)|
|Morris, P. (Swansea, W.)||Smith, Ellis (Stoke)||Willis, E.|
|Mort, D. L.||Smith, S. H. (Hull, S.W.)||Wills, Mrs. E. A.|
|Moyle, A.||Smith, T. (Normanton)||Wilson, J. H.|
|Nally, W.||Snow, Capt. J. W.||Wise, Major F. J.|
|Naylor, T. E.||Soskice, Maj. Sir F.||Woodburn, A.|
|Neal, H. (Claycross)||Stamford, W.||Woods, G. S.|
|Noel-Buxton, Lady||Stewart, Capt. Michael (Fulham. E.)||Yates, V. F.|
|Orbach, M.||Stross, Dr. B.||Zilliacus, K.|
|Paget, R. T.||Stubbs, A. E.|
|Paling, Rt. Hon. Wilfred (Wentworth)||Taylor, H. B. (Mansfield)||TELLERS FOR THE NOES:|
|Paling, Will T. (Dewsbury)||Taylor, R. J. (Morpeth)||Mr. Collindridge and Mr. Hannan|
|Parker, J.||Taylor, Dr. S. (Barnet)|