NEW CLAUSE.—(Power of local health authority to contribute to expenditure on co-ordination of services.) (Hansard, 21 April 1947)

§ Mr. Westwood
I beg to move, "That the Clause be read a Second time."
One of the chief criticisms of the Government's health service was that it was organised in three divisions, and that we who were responsible for the proposals in the Bill might not secure a fully integrated service. The three divisions are the hospital and specialist services, which are administered by the regional hospital boards and the boards of management; the general practitioner services administered by the executive councils; and the local clinics services which are administered by the local health authorities. We are sometimes asked what guarantee there is that the arrangements made by these three different agencies will dovetail together so that there will be no overlapping or, what might have been even more difficult, no gaps in the facilities offered to patients.
In the Bill as it stands, there are three important factors which will help to make sure that the service works as a whole and not three independent parts. In the first place, the Secretary of State is in a position to secure that the general lines on which the three divisions of the service are administered are in keeping with one another. This the Secretary of State can do through his power to control directly the work of the regional hospital boards and boards of management which act as the Secretary of State's agents. He has to approve the proposals submitted by local health authorities for the discharge of their duties, and he has to control by regulations the activities of the executive councils. In the second place, there is a considerable element of common membership, and there will be, among the various local authorities concerned. The local health authority will appoint a substantial portion of the members of the executive council provided for in the Bill, and it is consulted in the appointment of the regional hospital boards and the boards of management of the hospitals. In the third 650 place, every patient will in future have a right to the services of a general practitioner, one of whose functions will be to see that the patient turns at the appropriate time to the particular part of the health service organisation which can cater for his current needs.
In practice, day to day co-ordination will be secured by close contact between the personnel responsible for administering the three divisions of the service, and to facilitate close liaison the Secretary of. State—I have always had it in mind and I presume any other Secretary of State would be in the same position—will be in the position to encourage the establishment of non-statutory local committees in which representatives of all three divisions of the service would take part. These committees would not have any executive powers but they would meet regularly to discuss the whole field of health service for the area and thus ensure that each division of the service was-constantly in touch with the trends of development primarily affecting the other divisions and that any findings of such a committee would go forward as recommendations for consideration by the responsible executive bodies concerned, the regional hospital boards, the executive councils or the local health authorities as the case may be.
I do not consider it desirable to add to the number of statutory bodies whose creation is required by the Bill when it becomes an Act but I accept the suggestion made to me in local authority quarters—it was particularly strongly represented by the county of Fife—that it would be an advantage to provide some statutory pointer to the desirability of establishing non-statutory committees by voluntary action. So far as the hospital organisations and executive councils are concerned, appropriate provisions can be made by regulations and in regulations. For local health authorities, however, any provision would have to be made in the Act itself. If I inserted a provision in connection with the power of local authorities to appoint representatives to such a committee, it might actually throw a doubt on the power of the local health authority to appoint a representative to other bodies. That is one of the difficulties we always face when we try to pass legislation in this House. We must not put something into an Act of Parliament that may lead to doubts about some other Acts. At the present time the 651 local authorities have the power to send representatives to the committee of management of a nursing association providing services under Clause 25, and so on.
Without specific statutory provision, a local health authority could not make any contribution towards expenditure incurred by a co-ordinating committee. I do not expect that such a committee would incur much. There might be such items as cost of accommodation for meetings and the circulation of documents which could most suitably be shared by the three executive authorities concerned. This new Clause authorises a contribution to expenditure of this kind. It is therefore proposed for insertion in the Bill as the most appropriate provision to give a lead to the establishment of these non-statutory co-ordinating advisory committees. It is necessary to stipulate that contributions towards the expenditure of such bodies should be made only where the body has been approved by the Secretary of State, for such expenditure will rank for grant under Clause 51. With this explanation, I trust the Committee will give me the new Clause.

§ Mr. Henderson Stewart
As the Secretary of State said, the initiative in this case came from Fife. A few of my friends in Fife—the hon. Member for West Fife (Mr. Gallacher) will agree with me—took the view that despite the safeguards the Secretary of State referred to earlier, there is likely to be, at any rate for some considerable time, a tendency for these three bodies to sail according to their own charts. They will want their own individual independence. The history of all bodies of that kind shows that at the beginning, and sometimes for long years afterwards, they tend to exaggerate their own position and are reluctant to cooperate with other people and to recognise that they are just one part of a much larger service. The view of my friends in Fife was that if they had somebody to co-ordinate the activities of these three bodies—not a statutory body but an advisory body—it would be a good thing, and most hon. Members would agree.
The only difficulty we have had with the right hon. Gentleman is over the framing of the actual Clause. The Fife County Council produced one or two 652 alternative drafts which were put to the right hon. Gentleman but he has not thought fit to accept them. We think it strange in relation to a very simple thing—the right to set up an advisory committee—that we have to start off by saying: A local health authority may contribute towards expenditure … But if the right hon. Gentleman is advised by the draftsmen that this is the only way of doing it, I am afraid we must accept it. Personally, I do not mind what the form of words is so long as we secure the object, and if we can provide in Fife and other counties as small body of representative people to watch the activities of these three organisations so that they work together, everybody will be satisfied and great advantage will accrue.

§ Mr. Spence
When the Secretary of State started I had high hopes that he would produce something which I could consider of real value to the Bill. The question of co-ordination throughout this health services scheme is one on which I spoke at several of our Committee meetings upstairs. I had high hopes that the Secretary of State would say that a real committee was being set up locally which would in fact be able to get on with the job. However, as he developed the explanation, it seemed to me that the strength that might have been there gradually faded away. We find a coordinating committee which has no executive power in any way. Something stronger is needed. The Committee needs certain powers in order to get things done. The type of committee which is proposed will not enable us to get much further on than we were before. The recommendation for this committee may have come from one county, but I can assure the Secretary of State that there is strong feeling in other counties that something stronger is needed locally to co-ordinate the three services.
There is implied in the Fourth, Fifth and Sixth Schedules a degree of coordination in the interchange of members of these particular bodies in their committees, but nowhere in the Bill is direction given for these bodies to work together as a team. So far as the Secretary of State has gone, it is a straw in the wind, showing the right direction, but I would like to see a good thick branch instead of a straw.

§ Mr. Niall Macpherson (Dumfries)
The Secretary of State said that it was his intention to encourage the formation of these bodies. He went on to say that there was nothing to involve local authorities in expenditure at all, that is to say, that there are powers within the Bill which would enable such of the bodies concerned, to make the necessary contribution. He then gives local authorities power to contribute, and I think he has done that because of a recognition that the local authority has a vital and necessary part to play in this matter, and that it is ultimately the local authority's responsibility. Although it is not in the Bill as it now stands, I feel we shall come to a final recognition of the necessity for an executive local authority co-ordinating body.
There is one point I would ask the right hon. Gentleman to clear up. The local health authority does not need to contribute to any such body as may be formed; indeed, the safeguard so far as they are concerned is that unless the body is in accordance with their wishes, they will not contribute anything. That is a sound safeguard. I want to make quite certain however, that in no circumstances will they be directed to contribute to such a body that is set up and approved. I would have preferred it, if in accordance with one of the recommendations, the local authority initiated such a committee. It should have been the initiating, coordinating body; it should have been able to put up a scheme to the Secretary of State and, where that scheme of coordination was approved, it should have been authorised to contribute. That is the way it should have been done.

§ Mr. Westwood
May I deal with that point, if it will shorten the discussion? There is no compulsion upon the local authority to contribute because the Clause says "A local health authority may contribute." So it will be left to them to determine whether they will or will not contribute. I understand it has been fully discussed by the County Councils Association representatives, and they certainly were not prepared to take obstructive, negative or positive action with regard to this new Clause.

§ Commander Galbraith
I should have thought that if the co-ordinating body were required—and from what the right 654 hon. Gentleman has said, there does not seem to be much doubt in his mind as to that—it should be something far stronger than he has suggested. I cannot see how a voluntary body of this nature, dealing with three statutory bodies, will be able to exercise any influence whatever. It will have no position, no authority. All it can do is to attempt to argue these three other bodies into agreement. I am all in favour of having voluntary bodies, but I cannot see what chance a voluntary body has of exercising any pressure whatever on three statutory bodies which, presumably, it exists to coordinate. If the right hon. Gentleman really feels that such committees are necessary, he should go further than he has gone.