§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Legh.]
§ 10.0 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)Tonight, I am raising the question of the appointments to hospital management committees and, in so doing, I want first to thank the Minister for coming here personally to answer this short Adjournment debate. I know it is somewhat unusual, and I know it imposes an extra burden on him. I am, therefore, all the more grateful that he feels this subject, as I do, of sufficient importance to deal with it himself.
It is well known that this question of appointments to hospital management committees has been a matter of a good deal of argument and criticism ever since hospital management committees were set up. These hospital management committees have given extremely good service. They are manned by many thousands of voluntary helpers, and nothing that I want to say tonight should be taken as any criticism of their efforts in their own work. We are extremely grateful to them.
In point of fact, we cannot tonight discuss any wider questions of how management committees as a whole should be elected, or how hospital boards should be elected. This is a matter that is laid down in the Act, and, clearly, all we can discuss tonight is the administration of the Act.
But, on that question, it is important that we should still be clear as to the provisions of the Act itself. The Third Schedule of the Act lays it down that it is the responsibility of the regional hospital board to appoint hospital management committees. In so doing, the Schedule lays it down that there must be certain consultations. In the first place, now that the management committees have all been set up, there must be consultation with the management committees themselves. There must be consultation with the health executive councils; there must be consultation with the local health authorities; there must be consultation with the senior medical and dental staff in the hospitals being 455 served by the management committee, and there must be consultation with—a nice round vague phrase—other organisations.
It is in the working out of these consultations that most criticism arises. Presumably, the object has always been to secure both efficient committees and committees that will have an effective contact with the local community. That has been expressed more than once in circulars sent cut by the Ministry.
We need to look at the question that there has been far too much secrecy about this matter. It is quite unnecessary so far as I can see. It is true that very few people in the country understand how this works. One of the first things I want to ask the Minister is whether he does not think that regional hospital boards themselves should make rather more clear in their own area what their practice is.
Obviously, practices vary very much throughout the country. There is no good reason, so far as I can see, why the regional hospitals boards should not let people know more about what they do and roughly what approaches they make before selecting members for management committees. A good deal of the criticism might well be overcome if there was more knowledge of just what went on. Whenever anything appears to be done in secret there is always a natural feeling that something wrong has happened.
The second point is to what extent should the Minister himself give advice to the regional boards about how they should carry out their responsibilities under the Act in this respect. What proportions are desirable in culling members from the different bodies which regional hospital boards are expected to consult? It is expected that they will consult local health authorities. We all agree that it is most important that there should be members on hospital management committees with a wide current experience of local government work. The question is what sort of weighting should be given to their representation. Is there any advice which can be given to the regional boards about that, and should at least one of the members from the local health authorities be a medical officer of health?
456 Some might have said that all medical officers of health should serve on hospital management committees somewhere, but that is quite impracticable. Hospital management committee areas often cover a number of local authority boundaries, and in practice it would not be possible to do that. However, every encouragement should be given for a reasonable number of medical officers of health to have this closer contact with hospitals many of which they previously administered.
Then there is the question of the health executive councils. There the problem arises whether, in consultation with health executive councils the regional hospital boards should encourage the appointment of general practitioners. Many take the view—certainly the British Medical Association take the view—that there ought to be more representation from general medicine. It will be interesting to hear the Minister's view about that.
One of the more difficult questions is what sort of representation should be given to the senior medical staffs. Here the criticism has been made that there is too much medical representation already on the hospital management committees. This is one of the problems. It is suggested that hospital management committees essentially should be lay bodies and that the medical advice should come rather from medical advisory committees than from members of the committees themselves. The Act lays it down that there shall be this consultation and it is obvious that there should be representation of the senior medical staff, but to what extent should that representation be on the committees?
On more than one occasion the Ministry has sent out notes of advice to regional hospital boards suggesting that they should limit the medical representation on management committees and emphasising that in the view of the Ministry at that time these committees should be lay committees to ensure their proper representation of the people in the area. I want to know whether the Minister now takes the same view or whether he has been inclined to increase the professional representation.
Then we come to the general question of in what way should the regional hospital boards interpret their responsibility to consult other organisations. It is here that there is the most variety in 457 practice. Some boards invite a wide variety of organisations to submit suggestions and names on every possible occasion. Other boards do not invite any organisations to submit proposals. They say that they welcome any proposals from wherever they may come but they do not invite them. They do not send out any notes to different bodies to invite representation.
It is a difficult problem to know how far one should go. It seems to me that it might be possible to offer some advice, to try to secure a little more uniformity than at present. I agree that if we want to get a membership representing the community living in the area of the hospital being served, we do not want to enforce a general national pattern—at any rate not too strictly. But we seem to have gone to the other extreme. If one looks at the figures the Minister gave, following inquiries I made of him earlier this year, it is clear that there is an extraordinary variety in the arrangements made by regional boards.
Among the bodies which have lost representation in these last few years would appear to be the trade union organisations generally. While we have always insisted that this should not be a matter of political representation as such, I think that the Minister would agree that the trade unions represent a large proportion of the community with whom we are anxious to establish a close link. It is therefore important that the sort of background which they offer should be fully and properly represented. The suggestions I receive create in my mind the feeling that there has been a considerable change in that part of the representation in recent years.
Apart from any wider proposals which we cannot properly discuss tonight, I should like to know whether it would be possible to have an annual delegate conference called by hospital management committees to which they would invite representatives from voluntary organisations of all kinds. This is already done in a few, areas, but not many. From such a conference one could select quite a number of people who showed a keen and active interest in hospital work and who could give valuable service to management committees.
I suggest to the Minister that he might do more to encourage that type of annual 458 contact with the general public. It should not be in the form of ordinary public meetings, as experience suggests that they are not particularly helpful or successful. Rather, it should be in the form of a delegate conference and a real effort should be made to get as many responsible voluntary organisations as possible to send representatives. The representatives should be induced to put forward proposals beforehand. The management committee might issue a short report and general financial statement and give some indication of the way in which local voluntary bodies could assist the hospitals in the coming year.
The small amount of experience which we have had of this type of conference suggests that here is a way in which we can bring together the more active part of the community and the local hospital. I hope that the Minister—who, I am sure, is as anxious as we are about securing the most effective link with the local community—will not allow his mind to dwell solely on the importance of major changes, which I hope that we shall have a chance of discussing at some other time, but that he will also examine the possibility of establishing a more active contact than exists at present.
I think he would agree that there has been quite a lot of criticism upon this issue over quite a long period, and if we can get him to do anything to still that criticism., first, by advocating greater general publicity and an understanding of what is happening, and, secondly, by adopting more new methods and recruiting mew members to management committees, it would be of great value to the hospital service. We ought to pay a real tribute to all those who have been doing so much hard work, and who have sometimes been rather frustrated, on hospital management committees since they were set up.
§ 10.15 p.m.
§ The Minister of Health (Mr. Iain Macleod)When I saw that the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) had put down this subject for the Adjournment debate, I thought that he would have great difficulty in keeping in order, because, as he very fairly said, the Schedule to the 1946 Act, which we are really discussing, 459 could not be amended without legislation, which we cannot discuss. That Schedule lays it down that the Minister has no standing in the question of hospital management committees.
But he left the larger questions to another day—and no doubt we shall come to them in due course—while raising some matters of the very first importance, in which, even if I have no direct responsibility, I am bound to have a considerable interest, and a duty to see that the Act is carried out. Most of the hon. Member's comments centred round the fourth of the different bodies mentioned in Part II of the Third Schedule, that is, the vague phrase—as he said—
such other organisations as appear to the Board to be concerned.It is quite true that there have been many complaints about appointments to hospital management committees. It would, indeed, be a very odd thing if there were not, because about 10,000 people are involved in these appointments, and not all of them could please everybody. It is, however, of some interest that in so far as the complaints coming to me are political in origin, I receive roughly the same number from hon. Members of this House complaining that people of Labour sympathies have been moved as I get from hon. Members complaining that people of Conservative views have been moved.To them all I give the same answer, and I am afraid that, in part, it must be my answer tonight. It is that I must point out that this responsibility is laid by the Act upon the regional hospital boards. It is, therefore, their business, and not a matter in which I would interfere in individual appointments. But I entirely accept what lay behind the hon. Member's very reasonable speech, namely, the suggestion that I should satisfy myself from time to time—and this debate is a very good means of answering questions upon the matter—that the Act is being properly implemented.
As a result of the approach which the hon. Member made to me, and conversations which we had in the summer of this year, I got out for him details of the consultations that were carried out by boards. As he said, they show a most extraordinary variation, and I think I might very quickly mention those bodies which 460 are most consulted, because it is a matter which ought to go on record. There are, 14 boards in England and Wales, and only one body is common to them all, namely, trades councils.
Twelve of them consult the Royal College of Nursing; 10 consult hospital contributory schemes; eight consult women's institutes; seven consult the British Red Cross, and local medical committees; six consult the St. John Ambulance Brigade, and business and professional women's clubs; five consult chambers of commerce and trade, branches of the B.M.A., women's standing conferences, the W.V.S., and women's Co-operative guilds. Then, a whole variety of bodies, many of very great importance, such as the leagues of hospital friends, are consulted in what would appear to be, looking at the matter nationally, rather a haphazard way.
Perhaps I may quote from the document which I sent to the chairmen of the regional boards for one of their periodic meetings. It is an important part of what I have to say:
The Ministry has no desire at all to interfere with the discretion of Boards in this matter, but chairmen may care to consider whether greater uniformity, and in the case of some of the organisations concerned, more widespread consultation would not be of advantage.I agree that, on the face of it, it does not look wholly satisfactory, but one must remember the infinite variety in the regions, and in the problems that confront them.A region like East Anglia, for example, has very little in common with, say, the Manchester region, and the Sheffield region has very little in common with the Welsh region. If we take the Welsh region itself, it is not only a collection of counties, but a whole country in itself, with infinite variety between the heavy industry in South Wales and the extremely thinly-populated counties in mid-Wales and North Wales.
Therefore, it seems to me that it would be wholly wrong to try to enforce uniformity of consultation, because, again to take the same example, it would be absurd, and indeed impossible—because they would not exist in many towns in South Wales—to attempt to consult admirable bodies such as the women's institutes, just as in Merioneth it would be extremely difficult to make effective 461 consultation with the townswomen's guilds. Therefore, these matters have to be left very largely to the regional boards.
I should like to take up some of the individual points which the hon. Gentleman made. First, on the question of secrecy, by and large, I am all for allowing the Press to be present Whenever we possibly can. There are inevitably, in medical affairs, when the condition of individual patients has to be discussed, or disciplinary action is involved, discussions from which the Press have to be excluded, but, on the whole, the more information that is given and is available, the better.
If there be any suspicion, and there may well be, about appointments to the hospital management committees, one of the best ways of dispelling it would be to let the local Press know exactly what methods are used. It is rather interesting, in connection with that point, to note that only today I received a survey covering the last three years from the North-West Metropolitan Regional Hospital Board, which deals with some of these points.
It also includes, in its appendix, a full list, not only of all the bodies which it consults—and it consults all the bodies in the document which I have quoted, which I have no doubt is a tribute to the hon. Member for Tottenham (Sir F. Messer), and to his brilliant work on the Board—but also shows from whom it had received names and the numbers of those names finally recommended for appointment. I should have thought that this admirable precedent might well be followed by some of the other boards. Many of them do this, but perhaps there will be a further improvement.
It is also interesting to quote from this particular Board, as the hon. Gentleman raised the question of doctors, on which I shall say a special word later, that of the medical and dental staff, it received 91 names, of which 51 were appointed, local health authorities suggested 39 names, of which 15 were appointed, and other local authorities 180 names, of which 68 were appointed. These seem to me to be reasonably consistent as between the numbers sent and the numbers appointed.
Another point to which the hon. Gentleman directed my attention was the 462 representation of doctors. He was quite right in saying that in the time of the previous Government a number of circulars was sent out—natural enough at the beginning of the scheme—to give advice on this matter. They laid it down that any implication—I think that I am quoting exactly—that the hospital management committee was a body more likely to be concerned with the interests of the staff than with those of the community would be most unfortunate.
The hon. Gentleman asked me if I did not incline to increased medical representation. There, again, my answer must be that it is not for me to increase medical representation, though it might well be for me to become concerned if the medical representation seemed unduly high or unduly low, because, of course, we must not look at it from only one side. I have issued no circulars, and none has been issued since 1951. The position remains that I have had no evidence that appointments of medical staff to hospital management committees have been excessive in any way. It seems to me to be essentially a matter which one ought to leave to the boards themselves.
The hon. Gentleman then made a very interesting suggestion about widening the contacts of the hospitals with voluntary bodies in the area, and with local people. I do not think that I wholly agree with him that public meetings have proved of little value. One can really only speak of these things as they concern hospitals in one's own town, but certainly in Enfield, where public meetings are held, and where representatives of many varied voluntary organisations attend, and where a recently formed League of Friends is doing very fine work for hospitals, I personally think that they are of great value indeed.
I am quite certain that the problem here—and I am entirely with the hon. Gentleman in trying to get the hospitals more in touch with local people, and local people more in touch with hospitals—is essentially not one for solution by circular, but for ordinary human relations. Perhaps the most important human, personal relations to get right are those between the local Press and the secretary or the chairman of the hospital management committee concerned.
I would suggest that whether the approach comes from the local Press or 463 from the hospital, those people should get together. I am sure that the Press will find that they are delighted to have them, and, on the other hand, that the hospitals will find that the Press are of infinite value to them in spreading to all local people a knowledge of the work that is being done.
It may seem that the answer which I have given is, on the whole, a negative one. In a sense, it is, and, in a sense, the hon. Gentleman knew that it was going to be, because when he was at this Ministry, Ministers of the day gave exactly the same answers that Ministers give today, that they have no standing in the matter, and that they do not intend to question the discretion freely laid by the 1946 Act upon the regional hospital boards to take into account all bodies which they think are concerned when they make appointments to the hospital management committee.
464 But if that answer is negative, it does not follow that this debate is unhelpful. I think that it is of great value, and I am grateful to the hon. Gentleman for raising it, because I am certain that secretaries of regional hospital boards will call this debate to the attention of their chairmen and boards. That will be done with the added authority that comes from the matter having been raised by somebody who had a responsibility when the Socialist Government were in power. I have no doubt that they will consider everything that has been said, and that they will look again at their own arrangements in the light of the points made to see whether they are carrying out—as I am certain they are trying to carry out—the responsibilities which the 1946 Act laid upon them.
§ Question put, and agreed to.
§ Adjourned accordingly at Half-past Ten o'Clock.