HC Deb 07 May 1962 vol 659 cc152-68

Amendment made: In page 5, line 5, leave out "Health Visitors Training Council" and insert: Council for the Training of Health Visitors".—[Mr. Powell.]

Miss Pitt

I beg to move, in page 5, line 6, to leave out "twenty-nine" and to insert "thirty-one".

The Amendment arises from a promise that I made in Committee. It increases the total membership of the Council for the Training of Health Visitors to provide for two more places to represent professional and educational interests. In Committee hon. Members were concerned at the fact that there did not clearly appear to be a majority for those interests. As those who served on the Committee will remember, I took them through a rather long arithmetical lesson in order to point out that the figures proved that there was a majority representing professional interests, but I promised then both to meet the point that it should be made quite clear and to ensure that there was adequate representation for the General Nursing Council, by putting down Amendments on Report to increase the total.

Amendment agreed to.

Further Amendment made: In page 5, line 6, leave out "Social Workers Training Council" and insert: Council for Training in Social Work"—[Miss Pitt.]

Miss Herbison

I beg to move, in page 5, line 9, after "appoint", to insert: the Chairman of each Council and may appoint". We were very disappointed to find that the Minister had not put down an Amendment to this effect. In Committee a similar Amendment was moved by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), and it was then supported by hon. Members on both sides. When the Parliamentary Secretary replied to the debate, although she did not give a definite promise she seemed to be impressed by our case, and we felt at that time that, on Report, our Amendment or a similar one would be moved by the Minister or the Parliamentary Secretary. Since neither has taken steps to do so, we have put down this Amendment.

We find it very difficult to understand the attitude of the Government on this matter. If this Amendment were accepted the Bill would read: The Privy Council shall appoint the chairman of each council and may appoint one person to be chairman of both councils. That would do nothing whatever to tie the hands of the Minister.

It being Ten o'clock, further consideration of the Bill, as amended, stood adjourned. Proceedings on the Health Visitors and Social Workers Training Bill exempted, at this day's Sitting, from the provisions of Standing Order No. 1 (Sittings of the House).—[Mr. Powell.]

Bill, as amended (in the Standing Committee), further considered.

Miss Herbison

I was saying that if this Amendment were accepted it would in no way tie the hands of the present Minister of Health or any future Minister of Health. It would still leave this matter completely flexible. I hope that because it would do so the Minister will gladly accept the Amendment.

In dealing with a similar Amendment in Committee, the Parliamentary Secretary said that the Government wanted the closest co-operation between these two councils. We also want that close co-operation between the councils, but even if we had a separate chairman for each council it would not militate at all against close co-operation. I am sure that, whoever was Minister of Health, he would always make a point of finding people who were worth while and sensible to be chairmen of each of these councils. Even if there were separate chairmen we could get the co-operation which all of us desire between these two councils.

All of us are very glad that we have such an eminent person who has accepted the chairmanship of both these councils from the beginning. We are delighted about that, but the time may come when the Minister might feel that it would be much better for the work of each council and for the work of both councils that there should be separate chairmen. He envisages, as we envisage, great progress and development in this social work, in the training of health visitors and in attracting personnel to this work and in the training of social workers and attracting personnel to that work.

If one of these councils is extended to take in other work there may come a time when a chairman who had to be chairman of both councils would find the work so heavy that it became intolerable. We are trying to help the Minister in the event of that happening. He would then have the flexibility in the Statute to ensure that if he wished he could at some future date appoint separate chairmen for each council.

If the Minister accepts this Amendment, he and future Ministers in their wisdom could still appoint one man as chairman of both councils. On the other hand, if it were found that for the good of the work and co-operation of the councils it was necessary to have two chairmen, he would not be bound by the limits which are at present in the Bill. I am sure that some thought has been given to this matter since Committee stage. I hope the Minister is able to say that he is ready and willing to accept the Amendment.

Miss Vickers

It may be remembered that in Committee I had a similar Amendment; in fact, I think that mine went a little further than this. I support what has been said by the hon. Lady the Member for Lanarkshire, North (Miss Herbison). We are all delighted to have such a good chairman as Sir John Wolfenden—a man of great experience; and it is no criticism of him or of anyone who follows him that I support the Amendment. But we may find in the working of these two councils that they need to be separated.

There may be several reasons for this. One is that the work may become too onerous. Or it may be found in the working of the councils at some time that there is a need to divide them. We all hope that this will not be necessary, but it would be a pity not to make provision in the Bill for this in case it turns out to be better for both councils that they should have separate chairmen.

It may also be found that one person cannot co-ordinate them sufficiently and that two people getting together, one representing one council and one representing the other, would be able to find a better means of co-operation than if there were only one head. Perhaps two heads are sometimes better than one.

I therefore hope that we shall not lay down in the Bill that there can be only one chairman, because we should be tying ourselves to something which might not be workable in the future.

Mr. Powell

As my hon. Friend promised in Committee, I have directed my mind to the issues which were there canvassed and which are raised by the Amendment. There is general agreement not only, I am glad to say, upon the person of the first common chairman of the two councils, but also upon the desirability of the two councils starting their existence closely knit together, and the intention that they should be closely knit together is expressed particularly by the fact of the identical chairman.

But it seems to me that future development—and we envisage future development, particularly for the Social Workers Training Council—cannot diminish and may conceivably increase the importance of these two councils being closely knit. Upon balance, therefore, it seemed to me that it was better that in the constitution of these two councils as we are setting them up by the Bill, this intention and the present guarantee for its fulfilment which the common chairman represents should be enshrined in the Act, so that there may be no mistake as to the views of the House in launching this development that these two councils not only ought to start together in their outlook but, if anything, should grow closer together rather than fall apart as the years go on.

I admit that this is a matter of judgment and balance, but it seemed to me, and I respectfully advise the House, that on balance there is a greater advantage in spelling out in the Bill that these two councils are to have a common chairman.

Mr. K. Robinson

I am surprised at the Minister's response to the Amendment. We all understand the desirability of a close association between these councils. They get off to a closely associated start by the appointment of one common chairman. All we were seeking to do was not to tie the hands of every successive Minister of Health when faced with the problem of finding a chairman or chairmen for these councils. There may well come a time when there is not an obvious person available who is suitable to be chairman of both councils. Whatever the desirability of closely associating the two councils—and I do not question it—I think that there is a case for some measure of flexibility.

The right hon. Gentleman says that it is a matter of judgment. I should have thought that it is almost a matter of common sense to say that a loophole is left against an eventuality which may probably—or certainly possibly—occur at some future time.

Amendment negatived.

Amendments made: In page 5, line 11, leave out "Health Visitors Training Council" and insert: Council for the Training of Health Visitors".

In line 13, leave out "thirteen" and insert "fourteen".

In line 14, leave out "five" and insert "six".

In line 22, leave out "Social Workers Training Council" and insert: Council for Training in Social Work".—[Mr. Powell.]

Mrs. Hill

I beg to move, in page 5, line 35, to leave out "Of".

Mr. Deputy-Speaker (Sir William Anstruther-Gray)

It may well be convenient to take with this Amendment the Amendments in page 5, line 36, leave out "twelve"; and in page 6, line 5, at end insert: (d) one after consultation with the British Dental Association.

Mrs. Hill

Yes, Mr. Deputy-Speaker, that will be convenient.

I ask that the Minister should consult the British Dental Association with the object of one of the Association's members being included in this professional representation other than the health visitors themselves. The reason is that the health visitors in their work visit a considerable number of families. Their principal work probably is with young families. They therefore see a tremendous number of children in the younger age groups, all of whom could be helped very considerably by their advice. After all, their work is preventive medicine. I feel quite sure that if greater attention were paid to this aspect in the earlier years much suffering and ill-health would be avoided later.

In one city, health visitors can pay 100,000 visits to children in the age groups that at present lack dental treatment. If there were someone on this body who could give specialist direction and advice to the council, to be passed on by it to the health visitors, something really valuable would be achieved. Dental caries is the one complaint whose incidence has not lessened as a result of all our health work. Therefore, this is a very suitable moment to ensure that at least one of these persons should be a dentist of the highest training.

10.15 p.m.

Miss Vickers

I regard this as one of the most important of the Amendments with which we are dealing. At one time, rickets was called the "English disease", but I think that the condition of the teeth is now our major disgrace. The number of children of school age who have false teeth is a great blot on the Welfare State.

As has been mentioned, children get their first proper education in this matter from the health visitors, who advise the mothers on how to bring on the first teeth and see that they are properly cared for in preparation for the second set. It is essential that we should have experts here. Doctors have a great deal of general knowledge, but as the care of the eyes and the teeth is a very specialised matter, I suggest that this is an extremely important Amendment if we are really to look to the future health and welfare of the children.

I have just returned from America, where I was particularly impressed by the excellent dental work done there. I have also been to the West Indies, where the children's teeth are exceptionally good, because the inhabitants have a natural asset. Sweets may be bad for the teeth, but apparently sugar cane is a very good cleanser. In both of those countries the children have better teeth than ours have. We have made a start by having dental school nurses. We have recognised that the New Zealand experiment was worth while, but the service should be extended. I therefore support the Amendment.

Mr. Powell

I entirely accept the object behind the Amendment. I entirely accept that in the activities of the health visitors' council the importance of dental health in the preventive health work of the health visitor should be fully recognised, and should be to the fore.

I give an undertaking that, in one way or another, steps will be taken to ensure that the membership of the council always includes at least one person who has a special interest in dental health and in the place dental health should occupy in a health visitor's training. I think it would be better to secure the result in this flexible way than to write into the constitution a specific member and a specific requirement of consultation.

I have given the British Dental Association the same assurance as I am now giving and I think that it can be taken that the interests of dental health will always be represented on the council and that its importance in the training of health visitors will not be forgotten.

Amendment negatived.

Amendments made: In page 5, line 36, to leave out "twelve" and to insert "thirteen".

In page 6, line 3, to leave out "one" and to insert two".—[Miss Pitt.]

Mr. K. Robinson

I beg to move, in page 6, line 12, to leave out "twelve" and to insert "thirteen".

Mr. Deputy-Speaker

I think that it will be convenient if, with this Amendment, we discuss the next, in page 6, line 13, to leave out "ten" and to insert "eleven".

Mr. Robinson

That will be convenient.

The changes that have been made in the constitution of the Health Visitors Training Council are, as the hon. Lady explained, for the purpose of making manifest the majority of what we might call the professional members will have over what we may describe as the employing members.

In Standing Committee, there were a number of attempts to change the numerical constitution of these two councils. We got into a slight tangle a short while ago over the comparatively simple changes we were making at this stage of the Bill, but the complexity of the Notice Paper in Standing Committee, when three of us were trying to make three different and complicated sets of changes to the Social Workers Training Council, had to be seen to be believed. It was only the ingenuity and persistence of the Chairman of the Standing Committee that got us out of that difficulty.

I have tried to avoid getting into the same difficulty on Report. I think that the House would now agree that the professional majority on the Health Visitors Training Council, as amended a short while ago, is now even clearer than it is on the Council for the Training of Social Workers. I have sought a very simple way of making the professional majority rather more definite and clear. This does not involve any change in either the size of the council, or in the various members who are to be appointed after consultation with various bodies. It solely affects what the right hon. Gentleman called on Second Reading the "swingers"—the members of the council appointed without reference to anyone.

I agree that this is a good principle. While there is one on the Health Visitors Training Council, the right hon. Gentleman, for some reason or other, has chosen to put two on the other council. I thought that if we reduced the number of "swingers" from two to one, bringing it in line with the other training council, we should then just increase from ten to eleven the members who have to be appointed after consultation with organisations appearing … to represent social workers. This is a very simple Amendment. I think that probably one of the "swingers", at any rate, always would be likely to come within this category of the professional representation, but the effect of these two Amendments would really put that beyond a peradventure. I hope the right hon. Gentleman will see fit to accept this Amendment, which would go some way to doing what most of us were seeking to do in Committee in a series of Amendments which I think ultimately were withdrawn.

Miss Pitt

As the hon. Member for St. Pancras, North (Mr. K. Robinson) said, the effect of these Amendments, taken together, is to increase by one the number of members to be appointed by the Health Ministers to the Council for Training in Social Work after consultation with organisations representing social workers or otherwise concerned with social work. It is done at the expense of one of the two members in respect of whose appointment prior consultation was not laid down—or, to use the inelegant phrase which he and my right hon. Friend have found, at the expense of one of the swingers".

The hon. Gentleman went on to say that he thought it quite likely that one of these two might well be representative of the social worker interests, but he wanted to make it certain and he does so by cutting down the two for whom no specific provision is made. I say at once that we recognise that a wide range of interests will have to be represented under paragraph 7 (a), and that is the reason why there are to be ten members here for social workers compared with eight on the Council for the Training of Health Visitors under the comparable provision.

As I have said, it might well be that the Health Ministers would appoint to one of these uncommitted places people who would be nominated under the earlier provision of paragraph 7 (a), but we think that the representation of social work interests should not be increased at the expense of one of the two uncommitted members both of whom might be very important for the future work of these councils. These two "swingers" might both be needed to appoint outstanding individuals who would not become members of the council in any other way.

One example which I might put to illustrate the point is that it might be thought appropriate to make a specific link with hospital management committees, but we think that to allow for the widest possible contribution it would be right to preserve the two uncommitted places and, as I believe that the social workers themselves are adequately covered and they have a majority on the council, I hope the hon. Gentleman will not press this Amendment after this explanation.

10.30 p.m.

Mr. Pavitt

This is a small Amendment, but I should like to support my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) upon it. As a member of a hospital management committee, I have not been tempted by the hon. Lady to alter my view of the prospect that some members of the group may find themselves serving upon this most important council. Hon. Members on both sides have recognised that the Minister has had an extremely difficult job to resist all the pressures placed upon him in trying to get the balance of the council as he would like it, but I think my hon. Friend has made a case for this Amendment.

The council has to carry with it the people actually involved in the work, and if they were to feel they would have a clear majority it would be far easier for the council to work effectively from the word "Go." They may feel that the balance is not too well preserved and they may fear that they may find themselves in a minority. It is only a small point, and a question of only one person, but I hope the Government will accept the Amendment.

Mr. K. Robinson

I am again sorry that the hon. Lady does not find it possible to accept this Amendment, particularly as she gave no explanation why two "swingers" are necessary on this council when one, apparently, is sufficient on the other. However, in order not to prolong unduly the proceedings of the House, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Miss Herbison

I beg to move, in page 6, line 18, at the beginning to insert "Of".

Mr. Deputy-Speaker

It may be convenient to take with this Amendment the next two Amendments in the name of the hon. Member for St. Pancras, North (Mr. K. Robinson), in page 6, line 19, after "Schedule" insert "two" and in line 19, after "with" insert: the Joint University Council for Social and Public Administration, and five after consultation with".

Miss Herbison

These three Amendments do go togethear. If the Amendments were accepted paragraph 8 of this Schedule would read: Of the members mentioned in sub-paragraph (b) of paragraph 4 of this Schedule two shall be appointed after consultation with the Joint University Council for Social and Public Administration, and five after consultation with such universities and other bodies concerned with the training of social workers as the Health Ministers and the Minister of Education think fit. By paragraph 4 (b) seven members of the council are appointed by the Health Ministers and the Minister of Education. We should like to ensure that the seven should be appointed after the appropriate Ministers have had consultation with the Joint University Council for Social and Public Administration. We wish that because this body, established as far back as 1918, has done excellent work, has very great knowledge of the problems which the council may have to meet and solve, and also because on this body there are representatives of local authorities. They are people used to working very closely together to achieve what we hope the council we are setting up will achieve. We feel that, since they have great knowledge, they should be specifically mentioned in the Schedule. The Parliamentary Secretary said in Committee that of course there would be consultation, but we feel that that ought to be specifically stated here in the Schedule. It ought to state that this is one of the bodies, because of its knowledge and experience, with which the Ministers must of necessity have consultation, particularly in the appointment of people to the council.

In some of our universities there may be vice-chancellors, professors and so on who have little or no knowledge of the work we are discussing on this Bill. It seems to us that, where there is attached to the universities a body of people who have experience and knowledge, we ought to take the greatest possible advantage of their expertise. We are not asking for a great deal, and I hope that the Minister will be read to accept the Amendment.

Dame Irene Ward

I support the Amendment. I know that the body concerned would very much like its place in the scheme of things to be mentioned specifically in the Bill, and I am a little surprised that it did not appear to my right hon. Friend that it would be a good idea to provide for the place of this very distinguished and trusted body to be stated by name.

Like the hon. Lady the Member for Lanarkshire, North (Miss Herbison), I should feel much greater confidence if that body were given specific reference in the Bill. As she has pointed out, the Association of Municipal Corporations and the local authorities generally have figured largely in the provisions we have been discussing, being specifically mentioned by name and associated with the training council. It is equally important that this distinguished university body, which is so widely respected, should have its proper place and have its position on the council specifically stated.

Mr. Powell

The object of both the hon. Lady the Member for Lanarkshire, North (Miss Herbison) and my hon. Friend the Member for Tynemouth (Dame Irene Ward) can, I think, be better achieved without these Amendments than with them. The experience and importance of this joint university body is not in question. I assure the House that Ministers would consult the council in making their appointments under the paragraph generally, and there is, therefore, no need—indeed, it would be undesirable to do so—to restrict the appointments in respect of which this council is consulted to two.

It seems inappropriate that one should compartment the education appointments to two and five, assigning consultation in regard to one set to a joint university body and in regard to the other set to universities and other bodies concerned. The joint council would, in fact, be in a somewhat better position to influence by its advice and experi- ence the views and the choices open to the Ministers in making their appointments with the Bill as it stands than with the Bill as amended. It is for that reason, that it would be more effective and appropriate as it stands, that I suggest to the House that the Bill should not be amended as has been suggested.

Amendment negatived.

Mr. Powell

I beg to move, in page 6, line 27, at the end to insert: 10. Of the members of each Council who are appointed by the Health Ministers, one at least shall be a fully registered medical practitioner engaged in general medical practice, and that member shall be among those appointed after consultation with the British Medical Association and the Society of Medical Officers of Health. The object of the Amendment, as it shows, is to ensure that in each of the councils there shall be at least one general practitioner. There is no doubt about the growing importance, and growing existence, of a liaison between the family doctor and the health visitors and the social workers. They are already exploring the almost endless ways in which they can help one another, and it is clearly important that the outlook and the point of view of the family doctor should be represented on both councils.

Therefore, the Amendment provides that each council shall have at least one such and that that member shall be one who has been appointed after consultation with the professional bodies.

Mr. K. Robinson

We on this side welcome the Amendment, particularly because the Minister has decided that it shall apply to both councils. The only criticism I have is embodied in an Amendment of mine which has not been selected.

This is almost entirely a drafting matter, but not entirely, I should have thought. The Minister's Amendment states that one at least of the members shall be a fully registered medical practitioner. This was the point I made to the Parliamentary Secretary in the Standing Committee when she wanted to suggest an Amendment whereby one was a medical practitioner. I said I thought it was a mistake to limit it to one. But if we say one at least shall be a fully registered medical practitioner and that member shall be among those appointed we seem to be assuming that it will be only one, because "that member" is singular.

All I suggest is that if those words were deleted the provision would be far better grammatically and would express the Minister's purpose much more lucidly. The provision would then read one at least shall be a fully registered medical practitioner and shall be among those appointed after consultation with the British Medical Association …". I am surprised that the Minister did not indicate that he was prepared to accept my Amendment. No doubt he will have an opportunity, since this is not a financial matter, of having second thoughts on it. I certainly welcome the principle of his Amendment.

Miss Vickers

I thank my right hon. Friend for the Amendment. In Standing Committee I moved an Amendment to provide the words one of whom shall be a general practitioner. I am grateful to my right hon. Friend for the consideration that he has given to the point, and I welcome the Amendment.

Mr. Pavitt

I also welcome the fact that this provision is being made, though it is not quite what I had hoped for. Like my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), I welcome the fact that it is to apply to both councils.

I should have liked the words "actively engaged" included. The tendency in regard to medical representation from general practice is that only those general practitioners who are able to spare the time from very busy practice serve on committees. This means that there is a tendency for the representatives to be fairly elderly senior partners of groups of practitioners—not group practices but partnerships—and this often means that they are somewhat divorced from the day-to-day working of general practice. It would have been a help to have had the words "actively engaged".

I regret that the consultation is with the British Medical Association and not with the College of General Practitioners. An Amendment of mine which has not been selected dealt with this. The standard of general practice has improved, and the status that the general practitioner is getting by reason of the College of General Practitioners is something which needs to be encouraged. The inclusion of my proposal would have helped general practitioners who are keen about the advance of general practice, the function of the family doctor in the community and the relationship of the family doctor with other parts of the health service. Such doctors could give service on the two councils.

Nevertheless, I am grateful that provision is being made to have general practitioners on both councils.

Amendment agreed to.

10.45 p.m.

Mr. K. Robinson

I beg to move, in page 6, line 41, to leave out "that" and to insert "either".

This is quite a moment, because, so far, no Amendment moved at this stage from anywhere but the Government Front Bench has been accepted, and this is the last opportunity for the right hon. Gentleman to accept one moved by the Opposition. It is a minor matter, but I do not think that Paragraph 14 of the Schedule is necessary. If it is held to be necessary, however, I submit that it is essential that the Amendment should be made.

The paragraph says: A person who is or has been a member of either Council shall be eligible for appointment as a member of that Council. On the face of it, that looks a self-evident proposition, but if it is left like that it will also mean that such a person will not be eligible to be a member of the other council. I am told by my legal friends that it is a basic principle of law that if we specify something we exclude what is not specified. In order to make it clear that anybody is eligible for appointment or reappointment to either council, I think it is necessary to alter the wording as suggested.

Miss Pitt

The Amendment follows a discussion we had in Committee. I have had the benefit of being able to take legal advice on the matter. In tabling the Amendment the hon. Member seeks to remove a doubt, but the legal advice that I have been able to obtain is that the Amendment is not necessary, and that paragraph 14, as drafted, would not preclude the appointment of a member to the other council.

In fact, that should already happen when the councils are set up. The hon. Member will recollect that under paragraph 9 it is laid down that dual appointments should be encouraged, and it is mandatory in the case of local authority representatives that some of them at least should be members of both councils. What the hon. Member desires to happen, therefore, will happen. Under the Bill, as drafted, a member of one council will be eligible for appointment or reappointment to the other. Therefore, I am unable to take advantage of his invitation to be kind at this last opportunity, because it is not necessary.

Nevertheless, I am grateful to him for putting the Amendment down, because it allows me to put something else on the record which I should like to be equally clearly understood. The word "member" includes the chairman. The chairman may be reappointed to the chair, or as an ordinary member. Also, any past or present member may be appointed to the chair. The hon. Member's efforts have not been without avail, therefore, and, having heard my explanation, with the added comment about the position of the chairman, I hope that he will now feel able to ask leave to withdraw the Amendment.

Mr. K. Robinson

In view of that explanation, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.