NATIONAL HEALTH SERVICE EXECUTIVE COUNCIL (CROYDON)

HC Deb 25 November 1964 vol 702 cc1411-27

10.10 p.m.

Mr. Frederic Harris (Croydon, North-West)

I beg to move, That an humble Address be presented to Her Majesty, praying that the London Government (Executive Councils) Order, 1964 (S.I., 1964, No. 1771), dated 6th November, 1964, a copy of which was laid before this House on 13th November, be annulled. I am sure that the Minister of Health will be the first to appreciate why we in Croydon want to get this Order annulled. It is because of that part of it which intends to transfer the Croydon Executive Council of the National Health Service from Croydon to the new Executive Council for South-West London and Surrey operating from Surbiton. I would say right at the outset that my Prayer as such has no political content whatsoever. It is brought entirely because of this intended administrative act. In presenting my arguments I am supported by my two Croydon colleagues, the hon. Baronet the Member for Croydon, South (Sir R. Thompson), who, I am sure, will add his weight to the case, and the new hon. Member for Croydon, North-East (Mr. Weatherill), who, as he has not yet made his maiden speech, will not actually take part in the debate tonight.

It was in February last that Croydon Executive Council of the National Health Service first approached myself and my Croydon colleagues about the Minister of Health's proposals to abolish Croydon Executive Health Council as such and place it within the Surrey Executive Council. As can be imagined, this brought about the strongest opposition from Croydon Executive Council in conjunction with the Croydon borough authority and the local medical, dental, pharmaceutical and optical committees. All, of course, were pressing for the retention of a separate Executive Council for Croydon.

The Minister's proposals are entirely based on the ground of avoiding a possible—and I stress the word "possible"—administrative anomaly, but did not take fully into account the effects on the Croydon Health Service or the convenience of the local public, for whose benefit, after all, the health services were originally brought into being. In dealing with this matter I must ask our new Minister of Health why the convenience of the Croydon public is being so blatantly disregarded.

There is no doubt at all that under these present proposals the close co-ordination of work of the local health authority administered by the present Executive Council, built up over so many years, will be lost. Then we have the enforced travelling to Surbiton, which is from Croydon a difficult and very inconvenient journey for the members of the public in Croydon and the medical practitioners, too. All this can only lead to additional frustration and inefficiency.

I reminded the then Minister of Health, as I now respectfully do the new Minister, that we in Croydon have already experienced two years of bitter wrangling on the future of Croydon itself in local government—whether we were to retain our status quo, or whether we were to be pushed into the Greater London area. We all know the outcome of that battle, unfortunately, and so Croydon, plus the urban districts of Coulsdon and Purley, themselves now being severed from Surrey—and I stress that—are joined into one as London Borough No. 20, with a population of about one-third of a million. To us it seems most peculiar that the Health Service should now be reorganised in absolutely direct conflict with the trends of local government which we in Croydon have now had to accept.

Understandably, too, the Health Committee of Croydon Borough Council has been pressing the Minister to receive a deputation. Although I was tinder the impression that this had not been acceded to, I was pleased to learn the other day that the Parliamentary Secretary has kindly indicated that he will now receive such a deputation if the borough council so wishes. I am sure that it will want to take advantage of this invitation, no doubt together with representatives of the Croydon Executive Council.

I am most anxious to make sure that the Minister does not underestimate the very strong feelings held in Croydon about these general proposals. We as Croydon Members of Parliament are unanimously in opposition to these proposals, for we are very mindful of the convenience of our constituents and their difficulties, and all this will add to these problems in dealing with our local health services. The Croydon branch of the B.M.A. is likewise strongly opposed to these proposals.

I should like now to revert for a moment to past history in this matter. We had a meeting at the Ministry of Health, on 6th May of this year, when all the interested parties were present. So, too, were two of the Croydon Members. The then Parliamentary Secretary took the chair at that meeting, and Croydon's case was very well put, notably by the representatives of the Croydon Executive Council. At the end of the meeting the majority of us felt that Croydon's objections to these proposals would be met in full.

Subsequently, however, it went further than that, for I received a letter from the Parliamentary Secretary, dated 21st July, in which he confirmed that after careful consideration the Minister had concluded that there would be an advantage in forming one Executive Council covering Croydon plus a number of surrounding areas, and that consultations to this effect would subsequently take place. That was a clear statement of the Minister's decision, and I presume that it must have been supported by the officials of his Department, and I presume, again, that it was in response to our deputation of 6th May.

The intention then was for the boroughs of Sutton, Bromley, and Bexley to be linked to Croydon. Imagine my disappointment therefore when, early in September, I was advised by Dr. Nunan, the Chairman of Croydon's Executive Council, who had played an active part in all this, that the Minister had in effect reversed the decision and given in to other pressures.

This was subsequently conveyed to me by the Minister himself in a letter of 8th September wherein he stated that the alternative proposals that he had in mind had met with even greater criticism than the original provisional proposals. Although he knew that we in Croydon would be keenly disappointed he felt obliged to revert to his original proposals.

In that letter there was once again the sting which to me is like a red rag to a bull: the Minister hoped that on consideration Croydon would, albeit reluctantly, accept that this was the best solution from the point of view of Greater London as a whole. I stress again this reference to the point of view of Greater London as a whole, for this is exactly the same argument that, in local government, was put forward for pushing us into the Greater London area. Then we were told that we had to give up 1,000 years of proud history and status, all in the interests of Greater London as a whole. Now, completely in the opposite direction, we are expected to agree to the Croydon Executive Council being transferred to Surrey.

Two Departments of the Government are working in completely opposite directions. I am getting sick and tired of being told that the interests and convenience of the people of Croydon constantly have to be subjugated to the interests of Greater London as a whole. Naturally enough, with the election of a new Administration my colleagues and I got together and immediately made a new approach, together with vitally interested parties, to see whether our new Minister would agree to retain the original status quo. The Minister will understand how very disappointed we were to receive his outright rejection, with no cogent reason advanced in support of his decision.

So much can be said about all this that I want to conclude by emphasising one or two points. It must be the unanimous view of all those directly interested in the Health Service in Croydon that it is a great mistake to have the administration of Croydon's general practitioner services mixed up with those of the County of Surrey. The Greater London local government scheme completely changed the whole administrative set-up in the outlying regions, which to my mind—since we have had to accept this change—ought now to be bounded by a great wall, so that the distinction can really be seen by all.

The present proposal runs completely contrary to all this. If the Minister regrettably insists on going ahead with this proposal I ask him whether the facilities are really available at Surbiton to accommodate all that would have to be transferred from Croydon. For instance, there are over 250,000 records which would need to be installed by the operative date of 1st April next. Am I right in assuming that this could not be done for a long time, and that Croydon, in the meanwhile, would be converted into a mere sub-office of Surbiton?

If this is true not only does it add to the irritation of all concerned in Croydon but it makes a complete nonsense of any suggestion that this is being done to streamline the administration. Surely it is better to leave well alone. If my assumptions about the lack of physical accommodation are correct, what is the point in demoting Croydon to a sub-office of Surrey? The Minister must appreciate why Croydon's feelings are running so high in this matter.

I also agree with the Health Committee of our Croydon authority that to administer this new area from Surbiton would be a retrograde step, ignoring as it does the close co-operation that already exists between the three branches of the Health Service in Croydon. I contend that the London Borough of Croydon will be sufficiently large to justify a separate executive council. It will have a population of one-third of a million. Regrettably, the Minister's proposals are obviously based on administrative expediency. There is no regard to the disruptive effect on Croydon's health services or upon the public of Croydon

I sympathise very much with the view of the present Chairman of the Executive Council, Dr. Nunan. He reminded the Minister a short while ago that the reason put forward for Croydon's extinction—namely, that the retention of a separate executive council for Croydon would itself create an administrative anomaly, because the basis of the executive councils in the Greater London area is that a separate executive council for each London borough is undesirable—is completely unacceptable and invalid to Croydon. He also reminded the Minister that if the present proposals were implemented, it would have serious repercussions not only on the National Health Service in Croydon but throughout the whole of the executive council services.

It is the fact that the majority of executive councils in England and Wales cater for the needs of much smaller numbers than at Croydon. It would be surprising if Croydon's experience does not cause them to wonder who will be the next to be sacrificed for this kind of administrative convenience. For all these very strong and practical reasons, I and my colleagues have been forced to pray against this Order.

10.27 p.m.

Sir Richard Thompson (Croydon, South)

I wish to support my hon. Friend the Member for Croydon, North-West (Mr. Frederic Harris) in his opposition to this Order. The sad thing is that these changes are not being brought in for any sound medical reason, or for the benefit of potential patients and people whom we should have in the forefront of our minds. It has been quite clear all along that these changes are strictly administrative. Anyone familiar with the mass of correspondence which has passed between the Ministry and Croydon will have seen that, again and again, the bureaucratic phrase crops up that the continuation of the present arrangements would constitute an "administrative anomaly". To me that seems the wrong sort of approach to this problem. It is not a reason connected with providing better general practitioner dental or pharmaceutical services. It is purely for reasons of convenience.

Services of the kind provided by executive councils, as I think the Minister will agree, are the most personal of the medical services. Many of us manage to get through our lives without going into a hospital. Very few of us go for even a year without calling on a doctor or going to a chemist. Therefore, it seems to me that these services provided under the executive councils are truly the most personal health services obtainable under the National Health Service.

If the pattern of councils, following population and administrative changes, has to be altered, surely the overriding consideration should be the convenience of doctors and patients and not the administrative tidiness which no doubt they are anxious to ensure at the Elephant and Castle. I accept that no change in an established pattern can be made quite painlessly. Clearly, the growth of population and new administrative boundaries must be reflected in the administration of local services. Otherwise, we should get complete stagnation. But when we have new arrangements like this, they ought to fit the geographical facts and provide a better and not a worse situation than the one replaced. As my hon. Friend has said, Croydon has been enlarged from a quarter of a million to two-thirds of a million people which, is surely a big enough unit. It already has a highly efficient Executive Council. Why not let the new boundaries of that council match those of the local authority?

I said that it already had a highly efficient Executive Council, and that is not just a form of words. When I was in the right hon. Gentleman's second chair I had very good reason to know what a good authority Croydon was. It was in the days which the right hon. Gentleman will remember, when poliomyelitis inoculation was a major preoccupation with the Ministry and caused us a great deal of worry. I recall a time when it was necessary to get a very quick piece of information on the feasibility of something connected with the inoculation campaign, and three executive councils in the whole country were selected for this spot check. One of them was Croydon. It was because it had the reputation of being a first-rate body. We knew we would get the authoritative answer and get it quickly. When I say that it is an efficient authority, I am not just repeating the usual courtesies which one would like to say about one's own authority. I really know it to be a fact.

It is a great mistake to establish boundaries for the National Health Service that cut across the major boundaries of the Greater London area. All our experience is that the administration of local public services which does not conform to major local government boundaries is needlessly complicated and inefficient. I should have thought it was rank bad planning, and it would surprise me very much if the present Government, with their strong bias towards planning and organisation, were to produce an answer of this kind. At all costs, I am sure that we should avoid one group of officials or one committee carrying out public duties and discharging responsibilities which overlap major local government regions.

I have here a number of letters from local doctors, dentists and others protesting most strongly against this proposed action. I will not weary the House by quoting extensively from them, but I should like to assure the Minister that the volume of protest is really very large indeed and it is not confined to official bodies, to the Executive Council and to the Croydon Borough Council itself. I have here stacks of letters from doctors and dentists who really feel that this is a thoroughly retrograde step which will impair the service that they can give to patients, and that, of course, is the yardstick by which all these things should be measured.

The fact is that the proposed reorganisation will add to the administrative difficulties and not lessen them. Can one imagine a more chaotic structure for the National Health Service in Croydon than a situation where the local hospitals are controlled by a regional hospital board with its headquarters elsewhere, where the Executive Council which looks after the general practitioners and the dental and pharmaceutical services is controlled by a body conforming to no local grouping tradition or loyalty at all, with its headquarters in Surbiton, and its ambulances—which, of course, form the link between the doctor, his patient and the hospital—now a function of the Greater London Council with its headquarters in County Hall?

Could there be a more carefully contrived fragmentation of local services which all ought to work together—these three entirely separate authorities controlling interdependent sections of the National Health Service, all from different headquarters, none of them in Croydon? Poor old patients!

I appreciate that the Minister inherited these proposals. I am not laying the blame entirely at his door, but I hope that he will show independence, have a fresh mind and a new approach. I hope that he will withdraw them and get out a more rational scheme conformable to major local government boundaries and the realities of providing a really first-class general practitioner service over a densely populated area where a sound and reputable organisation already exists. Let the hon. Gentleman enlarge the area of the former Croydon Executive Council if he will, but he should locate it in Croydon where communications are so very good.

Surely it is true that in a loosely linked largely suburban area with poor lateral communications any choice of headquarters will be inconvenient for some people. I grant that, but, if we grant this, Surbiton has nothing to recommend it from the point of view of convenience or accessibility. If we go through with this reorganisation, why can we not leave the headquarters in Croydon where there is a strongly established organisation and where access is very good, where the premises are capable of handling the extra work and the administration burden which will be involved and also, if I may say so with due modesty, where there is the best reputation of any executive council in the area.

I ask the hon. Gentleman to look at this again. I appreciate his difficulties. Any change would tread on someone's toes and take away responsibilities from some and put them on others. We have a good administration here. It would be far better to redraw the boundary line for this Executive Council in such a way that it would remain based on Croydon and allow it to continue to give the distinguished service it has given in the past. I warmly support the Motion and I hope the hon. Gentleman will take note of what has been said.

10.38 p.m.

Dr. David Kerr (Wandsworth, Central)

It ill behoves me to join battle with the hon. Member for Croydon, North-West (Mr. Frederic Harris). As one of his constituents, I have already some grounds for owing him a debt of gratitude. Some of the political fire of this Prayer has already been drawn both by the hon. Member and more particularly by the hon. Member for Croydon, South (Sir R. Thompson). It therefore seems that we are debating administrative advantages.

However, I would not feel that a Prayer of this sort should be allowed to rest on parochialism or Croydon's stature. I must draw the attention of the House to the fact that the Order deals with the whole reorganisation of the executive council service, not only in the Greater London area but well beyond it. Indeed, I believe that the Minister has more headaches over it than Croydon can provide. There is a great compelling power in the case the hon. Members for Croydon have put before us tonight, but it is somewhat reduced by comparison between the small population which is gathered in the Croydon Borough Council area and the larger population which the London Executive Council has been taking for many years, in fact since the Insurance Act was passed in 1911.

The London Executive Council caters for a population of 3 million. If the arguments which the hon. Members have put before us had the power they wished them to have, those arguments should in equity be applicable to all the newly-established health authorities in the Greater London area with populations comparable with that of Croydon. To the best of my knowledge, the population of Croydon is not two-thirds of a million, as was claimed by the hon. Member for Croydon, South. Either that was an unhappy slip of the tongue, or the Asiatic population explosion has reached Croydon earlier than anywhere else.

Sir R. Thompson

I should have said one-third of a million, the figure quoted by my hon. Friend, and, if I said more than that, I apologise.

Dr. Kerr

I am obliged to the hon. Gentleman.

I emphasise only that, in the very near future, the problem which has been lightly touched upon by the two hon. Members from Croydon will be very much in the forefront of the Minister's thinking. I refer to the problem of collaboration between the general practitioner and local authority services. I do not quarrel with this reorganisation. I do not think that it carries us further away from or any closer to a solution to this great problem of better co-ordinating and integrating these two important personal health services.

In passing, I should say that, contrary to the claims of the hon. Gentlemen opposite, my experience has been that the people who use the general practitioner service have rarely heard of the executive council, and I think that doctors hear of it mostly because it is from the executive council that they receive their quarterly cheques.

I urge that we go ahead with the proposed reorganisation described in the Order, with the defects which the two hon. Gentleman have rightly laid at the door of the Government who reorganised the whole of London's local authority services. This was none of our doing, and we are here faced, in a small way, with the problem of making the best of what was left to us. It was left very late for us to do anything about it. But I hope that the Minister will be able to give an indication of the means whereby he will overcome the imbalance between the present representation of local health authorities on the executive councils which we are now establishing under the Order and the urgent need to bring the doctors and the local health authorities much closer together.

10.42 p.m.

The Minister of Health (Mr. Kenneth Robinson)

I assure the hon. Member for Croydon, North-West (Mr. Frederic Harris) that I do not underestimate the strength of feeling in Croydon about the administrative decision which is embodied in the Order. He and his hon. Friends have left me and my Department in no doubt about it, and they have been ably abetted by the Croydon Borough Council and by professional organisations in and around Croydon. It is on that account that I am grateful to the hon. Gentleman for the moderate, though forceful, way in which he moved the Prayer.

The hon. Gentleman and his hon. Friend the Member for Croydon, South (Sir R. Thompson) have made quite clear that they are criticising a part only of the proposals in the Order, the part which affects Croydon, hut, to put the matter in perspective, I must ask the House, first, to look at the Order as a whole and to consider why it was necessary and what it is designed to do.

The reorganisation of local government in Greater London by the London Government Act, 1963, as the House knows, abolishes the county councils and county borough councils in Greater London and transfers responsibility for the health services provided by local health authorities under Part III of the National Health Service Act, that is, the personal health services, to the new London borough councils.

The Royal Commission on Local Government in Greater London which recommended this change did not consider the consequences in relation to the administration of the general practitioner, the dental, the pharmaceutical and the ophthalmic services under Part IV of the Act, and it did not do so because its terms of reference did not extend beyond local government. But it would not be possible to leave matters where they stand if this Order were to be annulled tonight. Unless we can proceed along the lines which the Order lays down, there would be a most regrettable loss of efficiency in the administration of these four services and an increase in their cost out of all proportion to any possible advantages.

The Order, which covers not only the whole of the Greater London Area, but areas beyond, has followed the most prolonged consultation with interested bodies and professional organisations, the great majority of which accept its pattern. Section 31 of the National Health Service Act, 1946, provides that there shall be an executive council for each local health authority area unless it appears expedient to the Minister, in the interests of efficient administration of the services, to constitute by Order an executive council for the area of two or more local health authorities.

At the inception of the National Health Service the local health authorities were all county councils or county borough councils, and, broadly speaking, the executive council pattern was allowed to coincide with it, except for a few areas mainly where the county town and the adjoining county were combined. In Greater London this meant that in general the executive council services were administered over very extensive areas. I think that this was appropriate for such a closely-knit urban area, and it minimised the number of boundaries which make duplicate or multiple contracts with general practitioners necessary. I will say a word about that in a moment. The three county boroughs, East Ham, West Ham and Croydon, were exceptions, but, because there was no question of dividing the county areas, the additional duplication which occurred was not very great.

The situation resulting from the local government changes which will take place on 1st April, 1965, would be very different. In the absence of any grouping of local health authority areas, there would be 33 executive councils within Greater London and four county areas adjoining—a total of 37 executive councils in place of the existing nine councils. Admittedly, the population of each of the 33 London boroughs would be greater than that of many existing executive council areas in other parts of the country, but the multiplication of boundaries would complicate the administration intolerably. Under the National Health Service Act a general practitioner has to have a contract for services with every executive council in whose area any of his patients live. The more boundaries there are, the greater the number of doctors who have to have contracts with more than one executive council.

Moreover, the movement of population in Greater London is relatively greater than in other parts of the country, and each removal of a patient across a boundary sets in train a simple but time-consuming procedure so that the patient's record can follow him and the doctors' remuneration can be adjusted. The constitution of a large number of executive councils would, therefore, considerably increase the clerical work of executive councils without any benefit to the patient or the practitioner. I would tell the hon. Member for Croydon, South that in drawing up the Order we have been considering the best interests of both the doctor and the other professions and the patients.

Thirty-three executive councils, where there are now five, each requiring 25 voluntary members, and each with a clerk, a finance officer, a registrar, and so on, would be needed within Greater London alone unless we made this grouping. The professions in each would have to set up local professional committees and find members willing to serve on executive council committees. The transitional operation of dividing the patients' record cards and the medical registers—about 16 million cards, 7. million in the London Executive Council area alone—between 37 new councils would be enormous and very costly. Furthermore, corresponding adjustments would have to be carried out in the National Health Service Central Register at Southport.

What would there be to set against all this? The idea behind Section 31 of the National Health Service Act, 1946, was that coincidence of local health authority and executive council areas would facilitate liaison between the local authority domiciliary service and the family doctor service. Hon. Members made that point. This idea was, without doubt, sound in principle, but I do not regard it as of such overriding importance as to swamp all other considerations. From the point of view of the patient, after all, what matters is the degree of co-operation between the family doctor and the health visitor, the midwife and the other members of the domiciliary team, and while this may be facilitated where areas coincide, it can be achieved where they do not.

In our view, the balance of advantage in Greater London lies with grouping and with the reduction of the number of executive councils that would otherwise be required. This Order, therefore, groups the local health authorities in and around Greater London into large executive council areas.

In making his original proposals in February of this year, my predecessor made it clear that he had decided against constituting any single London borough as an executive council area, and he proposed to include the London Borough of Newham with the rest of Essex, and Croydon with the rest of Surrey.

There were objections, and after considering objections from Newham and Essex, and exploring possible alternative groupings, his final decision made last July was to set up two executive councils, one for the new administrative county of Essex, and one for north-east London, comprising the five London boroughs of metropolitan Essex, including Newham. This has been accepted locally, although I accept that there were originally strong opinions in East and West Ham in favour of a separate executive council for Newham.

The House will realise that this alternative grouping of Newham with other London boroughs accorded with the original decision not to establish a new executive council for a single London borough. Unfortunately, the parallel proposal for forming a south-east London area, consisting of the four London boroughs of Sutton, Croydon, Bromley and Bexley, did not meet with the same acceptance. Such a proposal was in fact put forward in July for comment by the bodies concerned, and this was the time when hon. Members received that letter from my predecessor. The present Croydon Executive Council and associated professional bodies and the new London Borough Council of Croydon, while still preferring a separate Croydon area, were prepared to accept this proposal, and two of the three other London borough councils also preferred it, but there were strong objections from the existing Executive Council of Kent and its associated professional bodies, who considered the proposal contrary to all tradition and communications.

There were also objections from the professional groups and the Surrey Executive Council to the inclusion of Sutton in the new group, and even from one of the professional groups in Coulsdon and Purley, at being separated from Surrey. On the one hand, there were objections from Croydon to being grouped with other London boroughs in metropolitan Surrey and the new administrative county, and on the other hand there were objections outside Croydon, mainly from professional sources, to being separated from the areas containing the administrative counties of Surrey and Kent.

While my predecessor would have been prepared to adopt any alternative grouping likely to prove less objectionable, none was suggested, and he felt that, on balance, it was better to revert to the original proposal. After the change of Government, I found myself faced with the same problem, and having carefully considered all the circumstances I came to the same conclusion and I made the Order accordingly.

The difficulties arise because none of the existing executive councils involved wishes to see the existing arrangements altered. The Kent Executive Council and the practitioners in north-west Kent want to preserve the link with the new administrative County of Kent because they see no advantage in disturbing it. The Sutton professional bodies are used to dealing with the Surrey people. Croydon wants a separate council because it has one now.

The hon. Members who have moved and supported the Prayer have put what is, from the local Croydon point of view, a strong case for its continuance as a separate executive council area. They stressed, as they were right to do, the close relations that exist between the Croydon County Borough Council and the present Executive Council and the ease and, possibly, almost the informality with which co-operation between the two domiciliary services in Croydon is maintained. They believe that, merged in a group with the other metropolitan Surrey boroughs and the administrative county, with offices in Surbiton, all this would be lost.

Perhaps at this point I may answer the question put by the hon. Member for Croydon, North-West about whether there will be adequate facilities at Surbiton for the new, larger executive council. I am advised that all that will be required is a small office extension at the Surrey Executive Council offices in order to take in the extra records from Croydon, Staines, Sunbury and Twickenham.

There is no doubt that the present Croydon Executive Council has an effective service. It is perfectly true that, with a population of 250,000 or so, it is dealing with an area larger than many provincial county borough councils. The London Borough of Croydon will have an even larger population. I could win peace for the moment by acceding to Croydon's request, though there might well be objections from Coulsdon and Purley if I were to do so, and then nearly everyone would be able to carry on undisturbed.

But I believe that it would be wrong to do so. Croydon is part of the Greater London area and it cannot be dealt with as if it were an isolated county borough. The arguments in favour of a separate executive council for Croydon are, save as in one respect which I will deal with in a moment, no less applicable to any of the other London boroughs and are, indeed, persuasive if any one borough is considered in isolation.

But the boroughs are not isolated and this is the reason for grouping them for executive purposes. The only difference between Croydon and the other boroughs is that Croydon, or rather the larger part of what is to be the new London borough, already has an executive council for its area.

This may seem to be a significant difference now, but it will not be a convincing reason in two years time when Croydon will be one of 33 London boroughs and its unique position at the moment as the only county borough in the London area south of the river has become a matter of history. The existence of a separate executive council for the London borough of Croydon would then become a strong argument in favour of separate executive councils for other boroughs, and such representations may be made from time to time. Indeed, although the London boroughs have not yet taken over their functions, one has suggested already that there ought to be a separate executive council set up for its area and similar suggestions were made earlier in the consultations by existing local authorities.

What would be the answer in a few years' time to pressure from some of the other London boroughs, with populations as great as, or greater than, Croydon's. As I have already explained, in the context of Greater London and its environs, separate executive councils for each local health authority would lead to a less efficient administration of the service without compensating advantage. It is deeply disappointing for those who are conscious that they are conducting an administrative unit that is efficient, though small, to feel that they are being swallowed up in a bigger organisation. But there is no reason to fear that the larger units are less efficient than the small ones in regard to the essential co-operation and liaison between the services.

Ministers of Health would have had many complaints from both public and the professions alike if these larger units were inefficient or unsuccessful. I am confident that, with good will, the new executive council in the south of the Greater London area will work as effectively and co-operatively as the present councils have done. To annul this Order would be to unravel the whole new pattern of Greater London domiciliary health services which has emerged from many months of consultation and I hope that, in the light of my explanation, the hon. Member will withdraw the Motion.

Question put and negatived.