SOUTH WESTERN REGIONAL HOSPITAL BOARD

HC Deb 29 April 1963 vol 676 cc861-72

Motion made, and Question proposed, That this House do now adjourn.—[Mr. McLaren.]

10.43 p.m.

Mr. W. A. Wilkins (Bristol, South)

I suggest Mr. Deputy-Speaker, that you will not find my observations so highly technical that you will not be able to understand them, though perhaps you may think that they are a little provocative. This debate arises out of the totally inadequate or unsatisfactory replies given by the Minister of Health to two Questions concerning apppointments to the South Western Regional Hospital Board, which I asked him on 25th March, and two further replies which he gave on the same subject to my hon. Friend the Member for Bristol, Central (Mr. Awbery) on 1st April.

I regret that I shall be compelled to generalise far more tonight than I would wish, but time is limited and I want to give the Parliamentary Secretary to the Ministry of Health adequate time to reply to my observations. These Questions were put down following a letter which I received from the Town Clerk, sent on behalf of Bristol City Council, requesting me to give the utmost support to the representations which were made by the local authority to the Minister of Health in a letter dated 12th March. My letter is dated 14th March. The Town Clerk's letter to the Minister was dated 12th March. I want to read two passages from the Town Clerk's letter which is in substance the point I make about the local authority.

The extracts from the letter headed "Constitution of Regional Hospital Boards" read: The persons nominated by the Council year by year have all had a wealth of experience in public work and local administration, many of them having considerable experience in hospital administration, and it is unfortunate that the experience and public service of these nominees should not be recognised when making appointments to the Regional Board. The Health Committee wish the Minister to be aware of their strong feeling in this matter, and that he should also be aware that they consider that the exclusion of this authority's nominees, over a period of time, from active participation in the affairs of the South Western Regional Hospital Board has debarred them from playing a full part in the operation of the national health service of the Region. I needed very little encouragement to take up the cudgels on behalf of my local authority in this matter because, for some years—and it has been for some years now—I have been not merely greatly disturbed but to some extent embittered by what appears to be a deliberate trend in the composition of the board, its subcommittees and, even more pronounced, the hospital management committees. What is alarming is that it does not now seem to be confined to the South-West. I have had indications from other authorities that the same sort of concern is expressed in different parts of the country.

This is a three-part complaint, and I shall deal with it in that way. First, the regional hospital board. This is the only aspect of the matter with which I shall deal in detail because it gives rise to the basic objection of my council. In 1949, that is, when the first regional hospital boards were constituted, the late Alderman J. J. Milton, a man whose whole life was dedicated to health service work, with thirty-six or more years' membership of the Bristol health committee, quite a substantial number of those as chairman, and with a consequent wealth of administrative knowledge, was appointed a member of the board.

Here I digress to tell the Parliamentary Secretary—I have a very clear recollection of this—that the strongest possible representations were made to the late Aneurin Bevan that this man was the one who should have been appointed the chairman of the regional hospital board at its inception. I well remember my late right hon. Friend telling me personally that it was his great desire to be abundantly fair to all interests and parties, that he wanted to bring in the voluntary hospitals, and that he intended to give absolutely fair representation to all interests, especially those of the voluntary hospitals. He did in fact appoint as chairman—I do not complain about this—a gentleman who was a governor of the largest voluntary hospital in the city. Alderman J. J. Milton, as he then was, was appointed deputy chairman under him.

Alderman Milton completed a three-year term only. In 1950, V. J. Ross, another Labour alderman, was appointed, and he lasted for three years. In 1952, F. A. Parish, another Labour alderman, was appointed, and he served for one year. In 1953, Sir A. H. Downes-Shaw, a Conservative alderman, was appointed and became chairman. He served for six years. So it would seem that at that point the pattern began to change.

Since 1959, no nominees submitted by the local authority have been appointed to the board. Why?

What purports to be an answer to this question is to be found in HANSARD of 25th March, the day when I put my Questions to the Minister of Health. Towards the end of his reply, the right hon. Gentleman said: I have to arrange for balanced representation of all interests and points of view in the whole of the south-western area, and no fewer than 8 of the 29 members are connected with Bristol."—[OFFICIAL REPORT, 25th March, 1963; Vol. 674, c. 932.] We had better have this right, provided, of course, that the information in the South Western Regional Hospital Board Year Book is correct. According to my analysis of the regional hospital board, in the year 1962–63, the board has 28 members, including the chairman—not 29. Seven are connected with Bristol: three are professors, one of whom is a Fellow of the Royal College of Physicians and two of whom are surgeons. I do not criticise this, because, of course. I believe in workers' participation in the work in which they are involved. However, it does leave only two laymen and no local authority representation at all on the board. All right. What constitutes, may I ask, balanced representation? I am here only dealing with local authority members as shown by the year book from which I have just quoted and up to the end of last month.

At that date the local authority representation on the South Western Regional Hospital Board was Wiltshire, one alderman; Gloucestershire, one councillor; Plymouth, one alderman, one councillor; Bristol, no representation for four years. I have not been able to check these figures, but I am advised that the population of Plymouth is approximately 210,000. I know the alderman who serves on the board, and I am quite prepared to say that he is an exceedingly able man, but, nevertheless, there is a representation of two from the City of Plymouth. The population of Bristol is now somewhere about 430,000. It represents the largest single unit of population in the South-West. So the number of people requiring to use the hospital services in a given area is of no account, or so it would seem. It does not apparently come into the consideration of balanced representation to which the Minister referred.

I want to ask the Parliamentary Secretary this. Is the judgment made on the basis of administrative experience? Apart from the medical representation on the board, which appears to be seven plus a nursing representative, I question very much whether previous administrative experience in hospital service counts at all, because if it does, why did not the Bristol authority have a single nominee accepted in the last four years?

I was honoured to serve on the Bristol health committee for ten years. We administered a service of hospitals, clinics, and all forms of medical services which a Manchester Medical Officer of Health—I believe it was Dr. Veitch Clark—described in the Manchester Guardian, as it then was, after a visit he paid to our city, as the finest in the country. We administered six hospitals, Southmead General, Snowdon Road for geriatrics, Ham Green for infectious diseases, Stapleton, now Manor Park, formerly for mental defectives in the main, Bristol Mental, now Glenside, and Hortham, two mental institutions. Of these, very much to my regret, and with no blame attaching to the Minister, Snowdon Road has been taken back by the local authority to be used for its original purpose of a home for aged people.

In the course of the years the present members of the Bristol City Council gained a wealth of experience in running these hospitals and services, and the truth is—at least, I suspect the truth is—that they have too much experience to please the hierarchy. I could go on almost endlessly about these institutions and their administration, but I must curtail my observations owing to time. I want to conclude this part, then, by simply saying that this very fine hospital service, created, built up and paid for in large measure by the ratepayers of Bristol, was a magnificent contribution to the hospital services in the West Country upon nationalisation, but the experience of those who administered it is now completely ignored.

I pass quickly to the second point, the composition of the sub-committees. I inferred in the two Questions which I asked the Minister that people identified with my party—here, of course, I depart from the local authority aspect to deal with the political aspect—are quietly but effectively "winkled out" when the end of their appointment is reached. Not all are treated in this way because that would be too obvious. If one inquires for the reasons, one is told that they are too old or have served for a long time, which is very interesting in view of some of the facts that I have with me which I wish I had time to deploy. As to the question of being too old or too long in service, I—

Mr. Robert Cooke (Bristol, West) rose—

Mr. Wilkins

I will not give way. I could do with two hours to deal with this, and I have only seventeen minutes. I could do with at least one and a half hours.

Or is it to bring fresh minds to bear? Or is it, as the Minister said, that he has to arrange for balanced representation? Or was it the case that one regional board sub-committee wanted to dispense with the services of two of its members but was hard pressed for a good reason and it suddenly decided or found that the only convenient way to do it was to decide to have no further need for co-opted members? An extremely able man was pushed off the mental health sub-committee at that time, one who had spent a long time in mental health work in an administrative and official capacity. These excuses or reasons—if they are alleged to be reasons—would, in my judgment, do credit to a Philadelphian lawyer.

I doubt whether I would have attempted to raise this matter in this way were it not for the fact that year after year at the south-west regional Labour Party conferences, which I have attended for about fifteen years, either by resolution or speech someone will be sure to bring to our notice the dropping off of hospital management com- mittees of people who are identified with our party. I was advised in Taunton only a month ago that three more able people had been removed from hospital management committees. Two were county councillors, still members of their authority and still nominated by that body. They have been replaced by persons with no elected status. I understand that in one case the replacement was by a bank manager. The third person, a lady, was a member of a county council, nominated by that body, but she is no longer a member of the county council, and she was dropped off this year as soon as the opportunity offered. Rightly or wrongly—I do not know—she thinks that it was her outspoken comments and uncompromising stand when she thought it necessary which earned her the displeasure of someone or other in authority. That leads me to ask who does the recommending to the Minister as to who shall be dispensed with or who shall be appointed.

There is also—I regret that I must aggregate this for brevity—the composition of the clinical area committees and the hospital management committees. By my checking there are five clinical area committees. Their total membership, according to the year book which I have quoted, was ninety-two at March, 1963. Ten of these people are known sympathisers with the Labour Party. I can break these figures down if the Parliamentary Secretary requires it. There are thirty-five hospital management committees, and the membership of these committees in aggregate is 585. Those with known allegiance to the Labour Party number thirty-eight.

I can well understand that this is considered to be a provocative statement. When I remember what happened in 1948 and onwards and the immense desire of Aneurin Bevan to see that representation was fair, under the greatest criticism of some of his own colleagues, and when I think what has happened in the intervening period, I feel extremely bitter about what is taking place not only in our area but in other areas as well. Does the Parliamentary Secretary suggest to us that this is simply a coincidence?

I have here a letter from the Secretary of the Western Federation of Trades Councils which was sent to me on 8th April, and he says: … in so far as the Federation is concerned, our concern in this matter is lack of appointments made by the Regional Board, from suitable nominations forwarded to them by me as Federation Secretary. It is many years since we have had fresh appointments made from the nominations submitted by the Federation. Those persons who were originally appointed have from time to time been reappointed and these indeed are few. There are a number of Hospital Management Committees in the area covered by the Federation which have no Federation nominees serving on them. In regards to House Committees the same situation arises. The T.U.C., at its last two conferences, has been bitterly critical of the appointments made to these posts. If the Parliamentary Secretary wants to check up on that he can do so on page 263 of the 1961 report and on pages 141, 142 and 328 of the 1962 report. He will see that the complaints are not confined to one region. The hon. Member for Nantwich (Mr. Grant-Ferris), in a supplementary question following my hon. Friend the Member for Bristol, Central (Mr. Awbery), said that the Minister should bear in mind that the complaint raised by my hon. Friend was shared by some other parts of the country, including his area.

I can see the Parliamentary Secretary looking at the clock and I do not want to deny him the opportunity of replying. With all the facts I have, I would need an hour or more to do justice to my case. But I ask the hon. Gentleman to look again at the speech made by my hon. Friend the Member for Oldham, West (Mr. Hale) on 27th March, when my hon. Friend quoted cases similar to that which I am instancing. He gave chapter and verse in authentication. It was not merely his own view but that of a number of organisations in Oldham that there was a clear case of discrimination. His charges were not answered. I wish I had time to quote from his speech.

Last week a respected former Member of this House came to see me and gave me a year book of the South West Metropolitan Regional Hospital Board and a lot of information. He told me that if I went through the year book and marked the appointments I would find that the proportion in this board was even lower than it was in the South Western Regional Hospital Board.

The hon. Gentleman can also get a photostat of a letter sent to the Minister of Housing and Local Government by local authorities calling attention to the additional expense they are involved in for the Mental Health Service, domiciliary treatment and so on. Local authorities who have to carry the burden of a large proportion of the cost of these services should have the right to one member at least on the regional board. I hope that as a result of what I have said the Parliamentary Secretary will say that he is ready to have an inquiry into how these appointments are made, who recommends them—and what colour of eyes one is supposed to have before one has a hope of being appointed.

Mr. Robert Cooke

I have seldom heard a more political and one-sided argument. That is the only thing I can say now because my hon. Friend is only too ready to reply and I am certain that he will give the answer to the hon. Member.

11.5 p.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

There is very little time left for me to deal with what the hon. Member for Bristol, South (Mr. Wilkins) has been saying, but I will do my best. I will deal first with the question of appointments to the South Western Regional Hospital Board. This board is responsible for the administration of hospital and specialist services in Somerset, Devon, Cornwall and much of Gloucestershire and Wiltshire. It is a large area and because of its elongated nature, as the hon. Member knows well, the board's responsibilities are all the heavier. It is of the first importance that the board should be able to discharge its responsibilities effectively, and to this end it must be constituted, as any regional hospital board must be, so as to embrace within its membership a variety of skills and experience.

Under the Third Schedule of the National Health Service Act, in appointing the members of a regional hospital board the Minister is required to include persons appointed after consultation with the university concerned, in this case, of course, Bristol University, with organisations representing the medical profession, with local health authorities in the area, that is to say, with county and county borough councils, and with such other organisations as appear to him to be concerned. That is laid down in the law.

I must emphasise that the members of regional hospital boards are appointed for the personal contribution they can make to the efficient administration of the hospital service and not as representatives of particular interests or organisations—I am frankly shocked by the suggestion that appointments should be of a political nature. This principle is of the greatest importance to the efficient administration of the hospital service and I should have thought that after fifteen years of the National Health Service it was high time that it was fully recognised.

A regional hospital board is an executive body. It must be large enough to undertake efficiently the manifold tasks which it is its duty to discharge, but at the same time it must not be so large that it becomes unwieldy. The South Western Regional Hospital Board has twenty-nine members—not twenty-eight—and my right hon. Friend and I consider that this number is fully adequate for the tasks that it has to tackle.

These considerations do not mean that my right hon. Friend has no regard to geographical considerations, or the interests of authorities within the area. On the contrary, he endeavours, subject to his duty to appoint an efficient and effective management body, to maintain a reasonable balance in the membership of each regional hospital board both with regard to the interests of organisations and the geographical areas from which it is drawn.

In the case of a region which covers so extensive an area and which includes communities of so diverse a nature as does the south-western region, geographical considerations are perhaps of particular importance, but in considering appointments my right hon. Friend views the board as a whole and in his view the membership is well balanced. It is true that the board does not at present include a member suggested by the Bristol City Council, but of its twenty-nine members eight are associated with Bristol and five are resident in Bristol. In fact, members of the board are drawn from or associated with all the principal districts within the region.

The area covered by the board includes the whole or part of areas of as many as twelve local health authorities—Cornwall, Devon, Gloucestershire, Somerset, Wiltshire, Dorset, Bath, Bristol, Exeter, Gloucester, Plymouth, and the Scilly Isles. There are ten executive councils and thirty-four hospital management committees within the board's area. Seven of the board's members, as it stands today, were recommended by local health authorities. My right hon. Friend certainly has regard to the names submitted to him by all the bodies which he consults, but he cannot bind himself to appoint those recommended by any particular authority and it would be quite impossible to do so having regard to the total number of bodies which he is required to consult and the paramount requirement of producing a well-balanced management team. In short, it is physically impossible to get a quart of recommendations into a pint pot of appointments.

The term of appointment of one-third of the members expires each year, but in deciding on reappointment or replacement the Minister has to balance the value of experience against that of including new elements. Here I must emphasise—because it did not figure at all in the hon. Gentleman's speech—that our prime consideration must always be the efficiency of the hospital service and its capacity to serve the patient. I make no complaint that the hon. Member has made a strong plea on behalf of his city, though a former and distinguished Member for Bristol reminded us that, once elected, a Member must take account of wider considerations. Equally, I am convinced that in this instance my hon. Friend has struck a fair balance. Let us consider the present membership of the board from the point of view of the areas with which members are mainly associated. Devon and Exeter can claim nine, Bristol eight, Somerset four, Cornwall and Gloucester three each, and Wiltshire two. That seems pretty fair.

Looking more closely at the qualifications of those who are associated with Bristol, one is struck immediately by the fact that they are all distinguished people, whose experience and knowledge must be of the utmost value to the board. They would add distinction to any regional hospital board in the country. They include a distinguished obstetrician at United Bristol Hospitals, a professor of jurisprudence at Bristol University, the chairman of the board of governors of the teaching hospital, the Dean of the Faculty of Medicine at the University, who is also a member of the General Nursing Council, a surgeon at Bristol Royal Infirmary, who is also a clinical lecturer in surgery, a professor in child health, a chairman of a hospital management committee, and the secretary of the T.U.C. South West Regional Advisory Committee. That is a very distinguished body of men, and their political colour does not enter into the question of their appointment.

I would add that the appointment of a person recommended by the city council is not the only way of ensuring effective co-operation between the board and the council. The regional hospital board has a joint advisory committee for the Bristol clinical area which includes three councillors, including the Chairman of the health committee.

I now turn to the question of appointments by the regional hospital board to the hospital management committees in Bristol and elsewhere in the south western area. Under the Third Schedule of the 1946 Act, regional hospital boards are required to include in the membership of hospital management committees persons appointed after consultation with the local health authority, with the executive council, with the medical and dental professions, and with such other organisations as appear to the boards to be concerned. These appointments are made by regional hospital boards, and while the Minister has given general guidance on their exercise of this responsibility he has no power to intervene.

Regional hospital boards similarly have a responsibility to ensure that they appoint well-balanced hospital management committees fully able to discharge the diverse functions of management, and in making their appointments they must have this consideration in mind equally with the results of their consultations with the authorities and interested bodies that that they are required to make. The South Western Regional Hospital Board is satisfied that it has carried out the appropriate consultations with Bristol City. I am advised that all of the eight hospital management committees which cover hospitals within the Bristol City boundary include members recommended by the city. I really do not think that there can be any substantial ground for complaint on this score, having regard to the fact that members are appointed for the personal contribution they can make to the efficient management of the hospital service and not as representatives of organisations or political parties.

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at thirteen minutes past Eleven o'clock.