§ [2ND ALLOTTED DAY]
§ Order read for resuming adjourned debate on Amendment proposed, [1st April], on Consideration of the Bill, as amended (in the Standing Committee and on recommittal):—
Which Amendment was: In page 61, line 42, at the end, insert:
(3) In its application to Greater London, section 31 of the National Health Service Act 1946 (which provides for Executive Councils for General Medical and Dental Services and Supplementary Ophthalmic Services) shall have effect as if for any reference No the local health authority area there were substituted a reference to one of the areas provided for in the Schedule (Areas, etc. of Executive Councils for General Medical and Dental Services, Pharmaceutical Services and Supplementary Ophthalmic Services).—[Mr. Pavitt.]
§ Question again proposed, That those words be there inserted in the Bill.
§ 3.41 p.m.
§ Mr. G. W. Reynolds (Islington, North):
I had just started to speak when our proceedings finished last night. I had just said that I thought that the House was entitled to more information on the ideas that the Minister had in mind and then sat down to allow the Minister to make an interruption, whereupon he launched a terrific attack on me saying, among other things:The hon. Gentleman cannot say that".and that he could have spelt the matter out in greater detail. I can only say that I did say it, and I will say it again: the House is entitled to more information about the Government's attitude on the creation of health executive committees in the Greater London area.
We are dealing with legislation which, we have been told on many occasions, has been preceded by a Royal Commission's Report, by inquiries which have gone on for many years and by the decisions of the Government taken as a result of the Royal Commission's Report. We have had the Second Reading and the Committee stage of the Bill and we have now arrived at the day on which we shall be asked to give it a Third Reading. Yet 253 the Government still have no policy which they can announce to the House about what they intend to do and the machinery which they intend to set up to keep health executive committees in being in the Greater London area.
This is not good enough. After all the thought which is supposed to have been put into the Bill and into the details of it, one would have thought that, when we reached this important matter, which is not included in any way in the Bill and which will govern the pattern of health executive committees for 8½ million people, the House was entitled to have from the Minister of Health some indication of the sort of pattern which he proposes.
So far, all that the Minister has told us is that he has power under Section 31 of the National Health Service Act, 1946, and under Clause 81 of the Bill and that at the appropriate time will consult the professional and other interests concerned and will decide what has to be done. Enough time has gone by to have enabled the Minister to consult many of the interests concerned and to tell us before we give the Bill a Third Reading what these provisions are likely to be.
I am sorry that the right hon. Lady the Member for Chislehurst (Dame Patricia Hornsby-Smith) is not present, because last night she made a number of assertions about exactly what the Bill would provide and the present set-up of executive committees. I had the temerity to interrupt her on one or two occasions, and she said that she had been Parliamentary Secretary to the Ministry of Health for six years and had dealt with this matter and knew what she was talking about. We are aware that she was at the Ministry for six years, which is quite a long time, but she made three statements which I must correct in case hon. Members are under the impression that they were a correct exposition of the situation.
The right hon. Lady said that there were 25 members and an independent chairman of each health executive committee. There was an independent chairman for the first three years of the Act's operation, hut the First Schedule of the National Health Service Act, 1949, amended that. It cut out the independent chairman and made it possible, after the 254 appointment of the 25 members, for the executive to decide who would be chairman. The right hon. Lady was referring to the Act as it was before it was amended in 1946. I want to get that point straight.
I interrupted the right hon. lady when she spoke about the Minister having power under Section 31 of the 1946 Act to secure the amalgamation of certain local health authority areas. She said that there are only l37 executive councils and that, therefore, there was not one for every county borough and county council. I agree with that. That is obviously a matter of arithmetic. I said that the mergers which had taken place, such as that between Canterbury and Kent and Carlisle with its surrounding area, had been done by agreement. The right hon. Lady said that she thought that I was wrong.
I have checked on this and find that page 193 of the Ministry of Health's Report for the year ended 31st March, 1948, says, with regard to executive councils:There is one for each county and county borough in England and Wales except that in eight cases, with local agreement, orders were made by the Minister combining two areas under single executive councils.I must, therefore, also get that point straight. This is done by local agreement, and it was the right hon. Lady who was wrong in her assertion and not I in the intervention that I made.
The right hon. Lady also said that there was no question of the functions of executive committees being broken up or fragmented into 33 areas under the Bill. I cannot accept that, because Section 31 (1) of the National Health Service Act, 1946, makes it perfectly clear thatThere shall be constituted in accordance with the provisions of the Fifth Schedule to this Act for the area of every local health authority, a council, to he called the Executive Council …We are creating 33 local health authorities, and I think that the assertion which I and my hon. Friend the Member for Willesden, West (Mr. Pavitt) and other of my hon. Friends made that, unless there is further legislation or an order by the Minister, there would have to be under the provisions of the Bill 33 executive councils in the London area. Someone must take action—either this House 255 by legislation or the Minister by order—or there will be 33 executive councils. I wish to make that clear before dealing with the general position.
I do not think that anyone wants 33 executive councils in the Greater London area. I think that we want more assurance from the Minister before we leave the Amendment as to exactly the type of thing which he has in mind. It is not sufficient for him simply to say, "I intend to consult all the interests and I have all the powers that I want under Section 31 of the National Health Service Act and Clause 81 of the Bill to deal with this problem".
We on this side, at any rate, want a definite assurance that there will not be more local health executive councils in the Greater London area than there are at present. There are the present county councils and county boroughs and we want an assurance that there will not be mare executive councils by the time that the Minister has finished, and that he will not create more authorities but that there is the likelihood that the number will be reduced rather than increased.
I also ask that when these authorities are set up each of the 33 local health committees will be given a place on them. The position at the moment is that normally there will be one executive council for each local health authority and eight members of that authority will serve on the executive council. We should have an undertaking from the Minister that all 13 of the local health authorities in the present L.C.C. area will have at least one representative on the executive council. He has power under Section 31 of the National Health Service Act, 1946 to ensure this. He has power to amend the normal number. This would presumably give an executive council of 34 or 35 members instead of the normal 25.
If we create new health authorities, we must ensure that, if the Minister uses Section 31 for purposes which were never dreamt of when it was dealt with in this House in 1946, all local health authorities will have a representative on the executive council when set up.
We have been told that these new London boroughs are, in effect, county 256 boroughs. But a whole number of things are being done to denigrate their status and to make them more akin to metropolitan boroughs than to county boroughs. If they are to be regarded in as many respects as possible as county boroughs, there must be provision for them to have at least one representative on the executive council covering their area. The Minister has power to ensure that under Section 31 of the 1946 Act and Clause 81 of the Bill.
There are 13 local health authorities in London. If the Minister retains the Middlesex executive covering the existing area, there are nine authorities there, including Twickenham, which is astride the river. There would have to be more members on same of these authorities than is normally the case over the country as a whole. We must have an undertaking that these health authorities will all have at least one member on the executive council covering their area.
The Minister also said that he would have consultations—and he is bound under Section 31 of the 1946 Act to consult the existing health executive councils in an area before making an order changing the pattern of the area. Presumably, he will also be able to consult the existing local health authorities—the county councils and the borough councils—within the area. As soon as the Bill is passed, however, there will exist throughout the area joint statutory committees of the boroughs that will form the new local health authorities.
If the Minister is to consult the executive councils already in existence—which, as the Bill stands, are doomed to extinction in 1965 unless he does something about it—as the Bill sets up statutory committees to make preparations for the introduction of the new health authorities, he should, when he has got a little way with the preparation of the scheme, at least give those statutory committees the right to comment on the draft scheme which he is preparing for the area.
I am a little unhappy about the amount of consultations for which some of those statutory committees might have to be called in, because they do not necessarily represent the type of council that eventually may be elected to cover their area. Nevertheless, they are the only instrument to hand which has any connection with the new local health 257 authorities which are being set up. Therefore, those statutory joint committees have a right to consultation, as well as the existing executive councils and the professional bodies involved.
Therefore, I must insist upon rather stronger assurances than we have had so far from the Minister. In asking for those assurances, the Minister will, no doubt, consider that I am in good company, because when Section 31 of the National Health Service Act, 1946, was debated in Standing Committee, Mr. Willink, who was leading for hon. Members opposite, said of the Clause.This is something of a blank cheque for which the Minister is asking with regard to what is carefully laid down …" —[OFFICIAL REPORT, Standing Committee C, 14th June, 1946; c. 1572.]He said that it gave the Minister power to set up new bodies more or less without consultation. According to hon. Members opposite, it was a blank cheque that was asked for in Clause 31 of the 1946 Bill.
In view of what was said on that occasion, I do not feel that we can give the Minister power to fill in that blank cheque when this Bill is passed unless before we part with the Amendment he gives the House an idea of the figures that he will write in. I hope, therefore, that the Minister can give us some or all of the assurances for which I have asked.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
The hon. Member for Islington, North (Mr. Reynolds) must not take it amiss that I responded so hotly last night to his opening remarks. He said that it was asking too much to rely upon the common sense of myself and my right hon. Friend and of my colleagues on this Bench in this matter, which meant that he was not taking seriously a firm assurance that I had given to the House. I would be less than human if I had not reacted to that. I have a high regard for the hon. Member, but I ask him to heed the advice that Norfolk gave to Buckingham, in Shakespeare's Henry VIII:Heal not a furnace for your foe so hot That it do singe yourself",otherwise the hon. Member might encounter the fate of Buckingham.
258 I am, of course, anxious to remove any doubts and uncertainties on this important matter. The hon. Member for Fulham (Mr. M. Stewart) and the hon. Member for Willesden, West (Mr. Pavitt), and, indeed, the hon. Member for Islington, North, are quite right in their assumption that if the Bill were passed and no order were made by my right hon. Friend in regard to the executive council pattern in the Greater London area, then, as from the appointed day when the new boroughs come into existence, there would be an executive council in the area of each of them; that is to say, 32 in all.
It must, however, be within the recollection of the House that I was careful to say that, in general, it would be desirable to avoid having more executive councils in the Greater London area than is administratively necessary. I went on to give a firm undertaking that no decision would be taken by my right hon. Friend in regard to the future pattern without the formulation of provisional arrangements, their discussion and consultation upon them with all the interests concerned, by which I meant the professions, the Executive Councils Association, the local authority associations and any other bodies that would have an interest.
My right hon. Friend has already seen representatives of the British Medical Association, including some distinguished doctors in the London area. There have been discussions at official level with other interested bodies and further discussions will take place. As I said last night, my right hon. Friend will not come to a final decision until he has had the opportunity of consulting the joint committees of the existing local authorities in Greater London, for which provision is made in Clause 83. This will enable him to get the view which is likely to be held by the new local health authorities as from the appointed day. It would, however, be quite wrong, as, I am sure, the House appreciates, for my right hon. Friend to commit himself, or for the House or for local authorities to do so, by inserting a provision in the Bill before the local authorities have had opportunities of expressing their views.
The hon. Member for Islington, North is quite right in saying that local health 259 authorities, like the Minister and the professions, appoint members to the executive councils. Therefore, they have a direct interest in the matter. The answer to the hon. Member's question about representation is that whatever the new pattern proves to be, we would expect all the local health authorities to be represented on the executive councils. When the consultations have taken place, my right hon. Friend will not delay making an order so as to remove any uncertainty as to the future.
Having said that, I do not think that the House would expect me to say in advance precisely what pattern of executive council administration will be laid down, because, to give one elementary reason, to do so would be to make nonsense of the consultations yet to take place. As I explained last night, however, my right hon. Friend does not need additional powers to enable him to do what hon. Members opposite have asked or something approximating to it. He has the power to amalgamate local health authority areas for the purpose of setting up an executive council under either Clause 81 of the Bill or Section 31 of the National Health Service Act, 1946, and he intends to use this power.
My right hon. Friend is well aware of the arguments advanced in the debate last night and of the views expressed by hon. Members, including the hon. Member for Willesden, West, and he has had the benefit already of the view of medical men in London. The House can, therefore, be assured that we shall make our arrangements as speedily as possible in the light of what is best for the administration of the general medical, dental, ophthalmic and pharmaceutical services in the Greater London area and, above all, in the light of what is best for the patient.
I hope that, in these circumstances, the hon. Member for Willesden, West will not press his Amendment.
§ Mr. Laurence Pavitt (Willesden, West)
In welcoming the comments of the Joint Parliamentary Secretary, and although I am glad to know that the Minister intends to use that power, as was obvious to us during the debate on the Amendment last night, I seek still further assurance. I should like the Joint Parliamentary Secretary to bear in mind a number of the points which have been raised during the 260 debate. I welcome his assurance that a decision by his right hon. Friend will not be long delayed, but it would be of great help to the House to have an idea of the possible time lag.
I realise that I could not pin down the hon. Gentleman to a precise date by which he hopes that his right hon. Friend will make up his mind—obviously, that depends upon the time that it takes to consult the various people whom he has mentioned. On the other hand, negotiations can drag on for a long time. It would be helpful if the Parliamentary Secretary could tell us that, the process already having been started, we might expect a conclusion before the House rises before the Summer Recess. This would give time for everyone to consider it. Whilst not wishing to pin the hon. Gentleman down to saying that this will occur in three months, for instance, it would be helpful if he could tell us that this was roughly the period he had in mind.
I am very satisfied that he obviously does not intend to create more executive councils and local medical committees than is absolutely necessary. Two major executive councils are involved in the reconstruction and their areas have not been altered or changed by other provisions in the Bill. These are the Executive Councils of the County of London and of Middlesex. Alterations are being made to Essex, Kent, Surrey and county boroughs, so, obviously, I cannot expect the hon. Gentleman to give assurances about them. Nevertheless, it would be helpful if he could indicate, without committing himself specifically, that in principle he feels it desirable that the London Executive Council and the Middlesex Executive Council should not be greatly changed—provided, of course, that the representations he receives are not so forceful that he feels it necessary to change his view. I am not seeking an absolute undertaking, but am only trying to probe the hon. Gentleman's mind.
Also, it would be helpful, in making up my mind whether or not to press this Amendment, if he could state the approximate number that he has in mind for the Greater London area. I believe that it is better that it should be six or eight or nine rather than a greater number like 15 or 16. Again, I do not want to pin him 261 down to exactitude, because obviously, if he is to have consultations, he cannot go into them with his mind already made up. But in considering the wide range of services these bodies will have to provide, particularly for the family, it would be helpful if we knew the Minister's principles for the future. If the House would permit him, I would be grateful if the hon. Gentleman could reply to these points.
§ Mr. Braine
Perhaps I may have the permission of the House to reply, Mr. Speaker.
First, it is in the interests of the National Health Service and of the arrangements in London to get the future pattern settled as soon as possible. Of course, I give an assurance that my right hon. Friend will, as soon as his consultations are completed—and we shall press on with them—lay his order. I hope that that will meet the requirement the hon. Gentleman is pressing.
In view of what I said a little earlier about the pattern of executive council administration in London, I do not think that I can go any further. Clearly, what will determine the issue is what is best administratively for the Greater London area, and it may well be that a pattern not very dissimilar from that which obtains now will be the answer.
But I do feel that I ought not to commit my right hon. Friend to any precise pattern in advance of discussions which, after all, will not take place in a vacuum, but with the people who are concerned now with the provision of these services in the Greater London area. I am sure that my right hon. Friend will very much bear in mind all the arguments put forward in the debate. I do not think that there is anything further that I can add. My right hon. Friend is fully conscious of the importance of resolving this matter as early as possible and in the best interests of the National Health Service.
§ Mr. Pavitt
In the light of the very firm assurance that the Minister will take action along the lines indicated, and with some confidence that when be discusses this with the people concerned he will reach a favourable 'conclusion, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.