§ Order for Second Reading read.
§ 3.50 p.m.
§ The Secretary of State for Social Services (Mr. Richard Crossman)
I beg to move, That the Bill be now read a Second time.
The Bill implements the key recommendation of the Seebohm Committee, whose Report was published in July, 1968. The Committee was appointed in 1965 jointly by the Home Secretary, the Secretary of State for Education and Science, the Minister of Housing and Local Government and the Minister of Health with the following terms of reference:to review the organisation and responsibilities of the local authority personal social services in England and Wales and to consider what changes are desirable to secure an effective family service.The Committee undertook a most careful and thorough-going review of the services provided by local authority children's and welfare departments and the personal service provided by education and health departments. The Government and, I am sure, the House and everyone concerned with these services must be most grateful to Sir Frederic Seebohm and his colleagues for their comprehensive study of this wide field and their wise analysis of the whole of the problem of securing an effective family service which provides the basis for the proposals we have now brought forward in the Bill.
The services concerned are organised today on the basis of legislation of 1945 to 1948, and looking back on that legislation now we can see that it did four main things. First, it established a National Health Service in a tripartite form, one of the three parts being a local authority responsibility. Secondly, it established an interlocking system of family allowances, national and industrial insurance and national assistance the combined effect of which was to make the central Government responsible for cash benefits generally. Thirdly, it established on a new footing the local authority social services, known as the "welfare" group; that is, the accommodation of elderly people who cannot live alone or with their families, the accommodation 1407 and welfare of the physically handicapped and temporary accommodation of the homeless. Fourthly, and lastly, it concentrated in a local authority children's service the various forms of care for children deprived for whatever reasons of a normal home life with parents or relatives.
This great body of legislation, taken as a whole, finally broke up the old Poor Law and established for the first time a body of national minimum standards for welfare in the widest sense and thereby created what we now call the Welfare State.
In all four of these areas, we are now embarking on, have already started on, or are preparing the way for, radical reforms. First, our recently published Green Paper proposes the unification of the three parts of the tripartite National Health Service. In the second sphere, the National Superannuation and Social Insurance Bill introduces the most radical reshaping of the national insurance system since Beveridge; and, points three and four, we bring forward this Bill to unify, within each local authority, the administration of the personal social services.
I think that it will be convenient to review the Bill against this background of the development of the Welfare State. We can see it best as part of the second wave of the social reforms initiated in the post-war years, or if one likes to put it in this way, as the first action we take in building the second stage of the Welfare State.
The primary objective of the personal social services we can best describe as strengthening the capacity of the family to care for its members and to supply, as it were, the family's place where necessary; that is, to provide as far as may be social support or if necessary a home for people who cannot look after themselves or be adequately looked after in their family. This is not the only objective of the personal social services. They have an important rôle to play in community development, for example. But it has been the idea of forming a "family" service that has inspired the call for a review of the organisation of the services with which the Bill is concerned.
The problem of how best to organise services to deal with the family as a 1408 whole became increasingly important as policy in various different services turned towards measures to help people in their own homes. The aim was to forestall family breakdown and avoid wherever possible moving people to old people's homes, to remove the danger of institutionalising the life of children and to move them into children's homes, foster homes or hospitals.
The Mental Health Act, 1959, gave a new emphasis to community care for the mentally disordered. The Ingleby Report of 1960, which was concerned with child neglect and juvenile delinquency, and properly treated the two as one subject, recorded that a number of witnesses had urged the reorganisation of our existing services into a family service. The Ingleby Committee, considering this outside its terms of reference and recognising the difficulties, urged that further consideration should be given to the simplification of services, so that a family in trouble could have, as the committee put it, "one door on which to knock".
So, when the Government took office in 1964 they immediately took up the problem of establishing a family service, particularly in the context of strengthening the family as the best means of meeting the problems of children and young people in trouble. In 1965, the then Home Secretary, my right hon. and learned Friend Lord Stow Hill, published as a basis for discussion a White Paper, "The Child, the Family and the Young Offender". This announced the Government's decision to appoint an indpendent committee to consider what changes were needed to secure an effective family service; and this led to the appointment of the Seebohm Committee.
The Government decided on an independent committee because they found that, although there was wide support for the idea of a family service, there were very different views as to how this should be achieved. The Government considered that the solution should have behind it the weight of an independent committee to whom all interests would have an opportunity of presenting their views. The wide difference of views represented is illustrated by the fact that the Seebohm Committee, in Chapter 6, noted that it had examined seven different approaches which had been put 1409 before it before deciding in favour of the eighth.
Among those the committee rejected were: the creation of two social service departments, one responsible for social work services for children and families with children and the other for old people and handicapped adults; a proposal that personal social services should be divided between an enlarged children's department on one side and a combined health and welfare department on the other; and the idea that personal social services should be absorbed into enlarged health, or health and education departments.
The committee's recommendation was that in each local authority there should be established a new social services department to be responsible for the services set out in paragraph 168 of the Seebohm Report. What the Seebohm Committee wanted as the services to be brought within this new Department were, first, the present services provided by children's departments; secondly, the welfare services provided under the National Assistance Act, 1948; thirdly, education and welfare services and child guidance services; fourthly, the home help service, mental health social work services, adult training centres, other social work services and day nurseries provided by local health departments; and, fifthly, certain social welfare work currently undertaken by some housing departments.
That was what the Seebohm Committee reported and in the Bill we are implementing the key proposals of its report. But before coming to the Bill itself there is just one of the changes the committee recommends which does not require legislation with which I will deal. The single most important proposal made by the committee outside legislation related to the further development of the training of the various groups of social workers. This is a matter of the first importance. The main recommendation of the Seebohm Committee on this subject is in paragraphs 533 and 534. The committee recommended that there should be one central body to undertake the functions now distributed among various training councils.
The report envisaged that this body would be a training committee of an advisory council concerned with policy 1410 generally. But we have put forward in the Bill a rather different proposal involving the creation of a new central training council, which will be an independent statutory body separate from the advisory machinery. Moreover, we think that it should cover social work training not only for the local authority services in England and Wales, but also for services outside local government and for services in Scotland and Northern Ireland.
We have, accordingly, invited the local authority associations and the professional and other bodies concerned to discuss with us the setting up of a new council on these lines. This can be effected—and this is the convenience for us—under existing legislation with amendments to Clause 11. That is what Clause 11 is about.
I come now to the main substance of the Bill. But, before dealing with it, I ought, first, to meet the objections of people outside the House who have asked, and will ask, why it is necessary to legislate at all on this matter at this time.
During the consultations which we had on the Seebohm Committee's recommendations, while we found that there was general agreement on the principle of drawing together the personal social services, strong pressure was put upon us to defer legislation so that this could be simultaneous with the reorganisation of the National Health Service and the restructuring of local government. It was put to us that this would avoid a whole succession of changes in local government and the awkwardness of an interim period for the present local authority health services. These were serious objections which we had to consider.
However, having considered the objections to immediate legislation, we decided that the need for the reorganisation of the personal social services was so urgent that we could not further delay it, least of all delay it to await the reorganisation of the National Health Service and of local government. It has long been agreed that the present distribution of responsibility for these services is unsatisfactory. For 10 years, or more, different views about the form that the changes ought to take have been urged upon Ministers and local authorities, and the efficiency of the services 1411 has been increasingly affected by uncertainty about their future; and the appointment of the Seebohm Committee five years ago strengthened the likelihood that changes of some kind would be made.
Indeed, experience has not been wanting since the Seebohm Committee reported to show that, even while we were considering and consulting about what should be done, other people were acting de facto and in ways contrary to those which the Seebohm Committee recommended. Representatives of the staffs upon whom we depend for the efficient operation of the services—I think that I met the representatives of each group—seem to be united in support of the Seebohm recommendations and have urged on Ministers in the strongest terms that delay in the implementation of these recommendations is impeding their work. I got the impression that they ought to know what they were talking about.
Therefore, while the Government have thought it right to proceed with legislation now, we do so in the knowledge that this comes in advance of local government reorganisation and anticipates the creation of an integrated Health Service with which the reorganised personal social services will have to be designed to mesh.
I do not mean that this is an interim measure. On the contrary, it carries out an important reform which I hope will endure. But it comes into force in an interim situation while we are in the process of replanning two obsolescent forms of local organisation—the counties and county boroughs—and, at the same time, the Health Service. We have, therefore, deliberately confined ourselves in the Bill to the minimum organisational reforms needed to secure the essence of the Seebohm Committee's recommendations. We have not sought on this occasion to rewrite the whole of the law on the personal social services. However, we think it is wiser to do the minimum in the intervening period and await the structure of the reformed local government and the reformed Health Service.
I come now to the question of Ministerial responsibility. If we have denied ourselves a complete rewriting of the law on personal social services, we have also denied ourselves the luxury of a 1412 final decision on Ministerial responsibilities in Whitehall consequential upon the changes which the Bill will effect at local level.
The changes in Whitehall were not within the scope of the Seebohm Committee's inquiry, but, as the House will be aware, it supported the view of certain witnesses who urged that a single Government Department should be responsible for all the services within the province of the local social service departments. This may well be the sensible eventual solution, but it surely cannot be wise to attempt to reach a conclusion on this matter until we see the final shape of the administrative structures which we are now engaged in refashioning for the Health Service and local government.
It has not, therefore, been thought sensible to make changes in the existing alignment of Ministerial responsibilities in Whitehall. But, to give a unified direction to the new service in this interim period, a joint social work group of officials has been set up within central Government comprising a staff drawn from the three Departments concerned, namely, that of my right hon. Friend the Home Secretary, my own Department, and that of the Secretary of State for Wales. This group has been acting, and will act, under the direction of my right hon. Friends and myself to ensure that there is a properly co-ordinated and unified lead given from the centre in the restructuring of the personal social services.
We propose only an interim solution in Whitehall. I felt that it was important that we got the solution right at the local level because it is at that level that social workers are active and where change is needed.
§ Lord Balniel (Hertford)
The right hon. Gentleman describes this as the luxury of postponing a decision. I should describe it as a failure to make up his mind. Throughout the Bill it is said that the Secretary of State may designate regulations, that he will do this, that and the other. May I ask which Secretary of State?
§ Mr. Crossman
The three of us will work together, and there will be no difficulty whatever. We have a very good social work group and I see no difficulty 1413 during the interim period. I suggest that when dealing with major restructuring—the Department of Health and Social Security was reshaped or created only 18 months ago—it is much better to get things done by stages and, above all, before finalising the decision in Whitehall on the division of responsibility, to see what we are responsible for. We do not yet know the shape of the local government or the health service that we shall have.
These are major matters for which we shall he responsible in four years' time which will be basically changed in that period. Therefore, I thought that it would be sensible, if we are to make this change in the local organisation of personal social services, to do that at the local level and keep the final solution at the centre—it may be that I shall still be there—for those Ministers who will be responsible for the enormous change in two major areas.
§ Sir John Vaughan-Morgan (Reigate)
I appreciate that there may be something in what the right hon. Gentleman says about the Health Service and local government, but may I ask about the children's service? Is there any reason why the right hon. Gentleman should not winkle that out of the Home Department now?
§ Mr. Crossman
I have seen a good deal of the children's service. I see no reason why we should think that its morale or efficiency will be immediately improved by being what is called "winkled" out of the Home Department. My impression is that the children's service works at local level. The real test is what happens at local level. If we can get the personal social services organised at local level under the new social services committee with the new director, the people who do the work in the children's service will be well content.
I have heard no great demand at local level that I should create a dispute in Whitehall about the future while we are all looking at the development of these Ministries. We have four years, at the end of which time we can see what is the best Ministerial responsibility. I find myself in the unusual situation of advising caution and an organic approach to institutions to right hon. Gentlemen opposite.
§ Mr. Christopher Price (Birmingham, Perry Barr)
Does my right hon. Friend agree that the appointment of these directors at local level will be crucial to the development of the service that he has just outlined? If they do not have what I should call unified central advice, but have two kinds of advice constantly coming at them as to what sort of directors they should be, it will not be a very satisfactory situation.
§ Mr. Crossman
I quite agree. It would be deplorable if my hon. Friend assumed that we had not evolved in the Government a very coherent view, before putting forward the Bill, as to what sort of man the director should be. That is why we established a joint work group.
On the official level at Whitehall there is a clear, united view as to how we should be organised. We would not solve the problem by saying that one of the fissionable sections should be allowed to operate in competition against the other. What we need and what we have is a coherent view. My right hon. Friend the Home Secretary and I have discussed this and know what we want and we shall be a united team in making sure that these directors are the right people. That is why we have taken these unusual powers and may well be, or might be, criticised for doing so. If we are so criticised I shall only say that we took the powers because we know what we want.
§ Mr. Martin Maddan (Hove)
If an hon. Member wants to raise with the Government questions arising out of such a decision, to whom will he address his question and who will answer it?
§ Mr. Crossman
The director of the social services department will have under him a number of people who have been brought in partly from the medical officers of health's department and partly from other departments. Such people may well come from the children's department, or from the welfare department. I would advise the hon. Member to address his questions to the Minister 1415 who was responsible for that section of the work.
§ Mr. Maddan
I am talking about the director of the social services department in the local authority himself—the director of all the activities, children, old people and the like. If I want to ask a question about that, to whom do I address it?
§ Mr. Crossman
Me, because my title is, strangely enough, the Secretary of State for Social Services; and I co-ordinate social services in the Government.
§ Lord Balniel
What I think is not absolutely clear is whether the Secretary of State for Social Services is appointing the directors of the social services departments.
§ Mr. Crossman
I was asked about a particular director and whether he would go to the Secretary of State for Social Services on a co-ordinated question. When I was asked how the appointment of the director was made I said that it was made by the three Ministers acting conjointly with an official committee acting conjointly under them.
The hon. Gentleman need not be alarmed. It is a working institution. I can assure him that he will find that it will work well and that we were well advised during a difficult intermediate period of this kind. We have had a lot of changes in Whitehall. I want to reduce the number of departmental changes which take place from time to time. I am surprised at the way in which hon. Gentlemen opposite want to have the maximum number of upsets that they can in Whitehall.
§ Mr. J. E. B. Hill (Norfolk, South)
When the Secretary of State referred to the work group in Whitehall, has he in mind having anyone from the Department of Education and Science, bearing in mind the educational needs of children under 5 who do not come under the jurisdiction of the Department of Education and Science and yet, in various activities outside school need some educational guidance?
§ Mr. Crossman
We have the normal consultations in Whitehall at Ministerial and official level. I do not think that we 1416 would need to have an official from that Department permanently on this interdepartmental committee. I think that this matter will be referred to again. I am sure that my hon. Friend the Minister of State, Home Office, will confirm, that the harmony of mind is as perfect as I have demonstrated.
I come now to the demarcation problems which, compared to what we have been discussing so far, are slightly more controversial, beause I am now dealing with the basic problem which we have to solve in the Bill. That is, defining which are the personal services intended to become the responsibility of the new local authority department, and which are the health services which will ultimately be the responsibility of the new health authority.
As we have already seen, the Seebohm Committee had no doubts on this matter. But however clear-cut the committee's answers were, when I came to discuss this question, especially with some of the doctors, it was plain to me that this was not a matter on which universal consensus had been achieved. Everyone agrees that integration would be a good thing, but everyone wants to integrate everyone else under him.
Therefore, this was the question which I had to resolve before the Bill could be drafted; and it was a question which had to be answered before the Green Paper proposals for the future structure of the Health Service could be finalised.
It was a question which has involved us in long and extensive consultations. I have myself discussed it on many occasions with those most deeply concerned, that is, with the medical profession, the social workers and the local authority associations. Now, in the Green Paper, and in the Bill, we have advanced the Government's firm decision on an issue on which a complete consensus is impossible to achieve.
What was the principle adopted? It was that of organising the services according to the skills required to provide them. As is pointed out in the Green Paper, if organisation according to type of user—mentally handicapped, old person, young child under 5—was adopted as a guiding principle, then there would be a grave danger and a need to have more than 1417 one local service deploying the same skill. We might, in terms of reorganisation, have achieved an area health authority, and the local authority would have to employ doctors, nurses, social workers, residential care staff, and so on. So reorganisation would have meant duplication. In terms of present structures, it would mean that both the health and social service departments would have to do the job. But only by arranging for one agency in each area to deploy professional staff, and not more than one, can scarce professional skills be used to best advantage, and continuity of care by one professional worker of each discipline be assured.
This is, broadly, the proposition and it carries out up to 80 per cent. of Seebohms recommendations. It is accordingly the principle of organisation by primary skill which is the basis on which the Bill has been drafted and Clause 2 is the key Clause here. For the existing local statutory children's and welfare committees it substitutes a single social services committee in each local authority. That committee is also to assume responsibility for social services assigned by the law to the health committee.
That means they take over from the medical officer of health home helps, day care for the under-5s, help for unsupported mothers and social services for the sick and the mentally disordered, including residential accommodation for those who cannot live at home but do not require continuing medical supervision.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
Would the Secretary of State tell us whether in the structure at local authority level he is envisaging a very large number of sub-committees within the local committee? How is it to be arranged?
§ Mr. Crossman
I should have thought that these will be very large local authorities and that they will have functional sub-committees with district devolution. I do not see it all being run by one headquarters in the heart of one unitary authority as big as we conceive it in the Midlands. It will be essential to have a second layer of sub-committees and officials in the districts working at closer levels.
1418 This line of demarcation leaves to the local health committee responsibility for personal health services—health centres, home nursing, maternity, and child health care, health visiting, and ambulance services and other general services where they apply. It is, of course, only temporarily left with the local health committees, because under our proposal they are to be brought under area health authorities with the hospital and family practitioner services. This is the awkwardness of the present proposals—the interim period in which the health committee continues to function and before the medical officer of health becomes the community physician on the other side of the line.
Despite this disadvantage, this allocation seems to the Government to offer the best prospect of vigorous development of both groups of services. The effect of our allocation must be not to separate but to secure the closest operational relationship between them, and this concept is developed in the Green Paper on the Health Service. The period when we are working under the existing authority, and before we get to the new authority, will be an awkward interim period, because the health committee will have a feeling of being deprived of certain services while still only hoping for the future, when its vigour will be revived inside the new social services committee.
I turn now to the principle of the statutory committee. At this time, when a new grouping of services is to be set up, it is necessary, in our view, to provide a statutory committee to ensure that these services are established as a unity. We regard the unification of these functions at committee level as vital for two reasons. First, they are largely concerned with situations within the family, and the measures affecting members of a family must be framed and carried out as a whole. Secondly, in many cases total responsibility for a person's welfare lies in the local authority's hands, even to the extent of measures affecting his personal liberty—for example, in the case of young children and persons in the care of the authority.
It is an essential safeguard in such cases that there should be the clearest chain of accountability for all aspects of 1419 the person's welfare. But, as the Seebohm Committee found, and as we know, it is not accepted everywhere as absolutely a matter of course that these functions should not remain fragmented. We have, therefore, to provide by Statute a form of organisation which we consider essential.
The House will be aware that the Redcliffe-Maud Committee on the Management of Local Government was critical of statutory committees on principle as an undesirable restriction by Parliament on the freedom of a local authority to run it own affairs. Indeed, in the White Paper on Local Government Reform, the Government have accepted that, in general, the statutory requirements for authorities which maintain separate committees for specific purposes are obsolete in that the services in question are now firmly established.
The trouble here is not the number of integrated services we are now trying to bring into being. It is also argued that, when the service has been established, one need not have a statutory committee, or there may be sharp divisions about how the service should be organised. At that point, it seems to me that we have to make an exception. We have to say in this case that, for a period at least—the period of reorganising the personal social services—we need a statutory committee.
That was the central proposal of the Seebohm Committee. I think it knew that it would here come into conflict with others and that it would not be popular with the local authorities. Nevertheless, we have accepted its view. This does not mean that the Government reject the Redcliffe-Maud view for all time as far as the statutory committee for personal services is concerned. Once the newly-integrated service has come to be fully established and the form of organisation envisaged in the Bill comes to be accepted everywhere as a matter of course, the statutory requirement may well be regarded as superfluous and, certainly, it should then be reviewed. I give that as the considered view of the Government.
I come now to the second controversial part of the Bill—the appointment of the director. This is in Clause 6. We propose 1420 the creation of a statutory post of director of social services for the purpose of the authority's social services functions—those which fall within the province of the statutory committee. These include the functions of the present statutory post of children's officer, which is to be abolished. This post is an essential feature of the statutory framework required at this stage of the development of the services.
If it comes to be everywhere accepted as a matter of course, as at present it is not, that these services should be the unquestionable major responsibility of a director—selected for his qualifications—to direct them, then it might well be that statutory provision to that effect would be regarded as superfluous. It is a matter to be judged in the light of experience.
Provision is made for the Secretary of State to prohibit the appointment of an individual candidate whom he considers unfitted for the post, but this procedure will be dropped when it becomes possible to prescribe qualifications in accordance with Clause 6(3). How soon this will be possible depends on the development of training schemes to the point where appropriate formal qualifications are widely held in these services. I say that because I am an old local government man myself and I agree with Redcliffe-Maud about the obsolescence in many areas of statutory committees and statutory appointments. I believe that, if we are to carry out the Seebohm recommendations, we have to use the statutory power for a period, at least until this organisation is as well established as education or welfare or other organisations which we recognise and for which the statutory qualification is unnecessary.
By Clause 13, any Orders or regulations made under the Bill may be in the form of separate instruments for England and for Wales. We have made arrangements in the Bill for Wales in that way.
I turn now to the important Clause 15, about bringing the Bill into operation. We accept the Seebohm recommendation that this change should be made in advance of the reorganisation of local government. If the Bill reaches the Statute Book in its present form, the general plan would be to bring it into force in time for directors of social services to be in post not later than, say, 1421 1st April, 1971. However, it has been suggested to us that a local authority might consider it preferable in the interests of efficiency to retain its existing organisation for the time being, having regard to the implications of local government reform for itself.
I can conceive of an authority which saw the total demolition of its future in three years' time saying that reorganisation would only have to take place all over again. That would not be true in most cases, but it might be the case in some. In most cases one could carry through this reform and see it perpetuated after local government reorganisation. I do not know whether any authority will take the view I have referred to. I hope not, as I want the personal social services everywhere to benefit as soon as possible from the Bill.
But, on this point, local authorities will need time to consider the effect of the Bill alongside the decisions announced in the White Paper on the Reform of Local Government. We must, therefore, treat it as a possibility that a local authority may make out a case on efficiency grounds for postponement of the operation of the Measure in its area, and the Bill provides accordingly. It would be possible, for example, to postpone the operation of Clause 2—establishment of a social services committee—Clause 6—appointment of a director—or Clause 10—revocation of delegated schemes—in any particular area. I make it clear, however, that it is our intention to get the Bill into operation as widely and as soon as possible.
This is not a long Bill. It is confined, as I have said, to the minimum reforms in organisation which are needed to secure the essence of the Seebohm Committee's recommendations in this interim period. But I do not minimise its importance. It represents the first part of an immense movement of structural change which the Government have initiated in the social services. I referred at the beginning to the four interlocking areas in which major social reform was undertaken in the post-war years. When the National Superannuation and Social Insurance Bill becomes law, when the unification of the Heath Service has become an accomplished fact and the restructuring of local government has been carried 1422 through, this Bill will be seen to take a vital place in the radical overhaul of our social institutions to serve the needs of the next generation.
Parliament and the Government are looking to the services with which the Bill is concerned to make a major contribution in areas which contain some of the major social problems of our time—the social welfare of the elderly, the prevention, care and after-care of mental disorder and mental handicap, the support and care of the disabled and measures to protect and help the young and, at the same time, to protect society from harmful behaviour by the young.
There are no tasks more difficult or more exacting. If the services are to develop a capacity equal to these tasks and to tackle them with confidence, we cannot wait for the reform of local government and the Health Service. We must act now. We must end the uncertainty about organisation and provide for these services the statutory framework which an independent committee has recommended and which the Government believe to be the best.
§ 4.30 p.m.
§ Lord Balniel (Hertford)
The fact is so rare it makes the pleasure all the greater when I am able to agree with the Secretary of State in his decision to introduce this Bill. Mr. Frederic Seebohm is one of my most distinguished constituents. I have, therefore, a very special pleasure in congratulating him and his committee on the work which they have completed so successfully and joining them in the pleasure which they must feel in seeing this legislation follow their endeavours.
I would begin not only by congratulating Mr. Seebohm and his committee, but also by expressing our thanks for the help and advice which I certainly had in my constituency, and which, I believe, other hon. Members have had, from people who are working in this most exciting and difficult field of the social services: the guidance we have had from the associations representing the child care officers; the social workers in the mental health field; the social workers in the educational field; the health visitors; the medical officers of health; the representatives of the local authority associations.
1423 The advice and help which we have had from everybody involved has been of a remarkably high quality and of very great value to us in considering this difficult subject.
The only trouble, as was mentioned by the Secretary of State, is that there is a difference of view between some of these organisations. There is a clear, almost unbridgeable, conflict of opinion and the politician has the unenviable task of exercising his judgment as to what he believes to be right. We know that in the decisions we take we cannot command universal support throughout this field. I suspect, just as the Secretary of State could not command in every detail universal support from the benches behind him, that it is possible some of my hon. Friends might disagree in some respects with some of my own comments.
Many of the points which were brought to us by these various social worker organisations are committee points. We will see that they are considered very carefully in Committee. Others will be raised by my hon. Friend the Member for Chelsea (Mr. Worsley) if he catches your eye, Mr. Speaker, and my other hon. Friends who have made a specialised study of the Seebohm Report and of the Bill.
I would begin by giving a general welcome to the major purpose of the Bill, which is to group together the family welfare services of local authorities into one social service department. If one has to accept—and for the purpose even of discussing this Bill I have to accept—the Government's assumption that the National Health Service will be administered more centrally and outside local government, then one has to draw a dividing line somewhere between the local authority services and the national health services. Any dividing line, wherever it is drawn, is bound to have its illogicalities, but somehow in framing legislation a division has to be made between the responsibilities of the area health boards and the responsibilites of the various family welfare services.
On this, I think rather sad, assumption the only conceivable demarcation one can make is the one which the Secretary of State for Social Services has made. It is a demarcation based, 1424 to use his phrase, on "primary skills". It is a demarcation so that on one side there shall be the services which are primarily medical in content and, on the other side, the services which are primarily social in content. I do not think one can try to separate services along the lines of one suggestion, considered and rejected by the Seebohm Committee, some being for children and some being for the elderly. It is the primary skill which is the only conceivable, logical line of demarcation in this field.
I believe that our task in Committee will very largely be concerned with seeing that this dividing line does not become an "iron curtain" between the services. We must see that it does not become a new source of division between the health services and the welfare services.
As the Secretary of State said, the Bill leaves many uncertainties. For instance, there is no defined future for the education welfare service and no defined future for the child guidance clinics. In some ways the omission of the child guidance clinics is an interesting feature of the Bill. Going around the country, as many of my hon. Friends do, we see that the child guidance clinics are usually an outstanding clinical team. There is a tight, interlocking linkage between the different professions: the child psychiatrist, who has medical qualifications; the educational psychologist and the psychiatric social workers. In these clinics they all treat each other as equal, interdependent partners and there is very little of the dependent relationship, which is one of the sources of friction and annoyance to social workers in so many of the other fields.
The contents of the Bill are inextricably interlocked and interwoven with the proposals and future legislation for the reform of the Health Service; they are inextricably interlocked and interwoven with the reform and ultimate legislation of local government. Both are vast and complex issues on which we take rather different views from the Government. It is impossible to have a serious discussion of this Bill without bearing these other issues in mind.
It is a very great pity that the House has not had the opportunity of debating 1425 the Green Paper on the reform of the Health Service before we debate legislalation on the reform of the personal family social services. I have though always said that the Government would be wise to legislate to establish a social services committee without awaiting the legislation on local government reconstruction. I have held this view ever since I read the Seebohm Report—for two reasons.
There is, first, the urgency of the problem which has to be tackled by the social services committee. There is the ineffectiveness of the existing services in some areas. There is the overlapping; the fragmentation; the lack of public knowledge; the confusion which is caused by divided responsibility and the hideous gaps which flow from that confusion, through which the least articulate and the most unfortunate people fall, be they children or elderly persons, be they mentally handicapped or persons who just find the stress of ordinary everyday problems too much to cope with.
If we step back from the scene, the overall picture we see is the need to end the lack of co-ordination of a whole series of services which have grown up piecemeal and which are orientated towards solving specific problems. We need to replace that picture with a structure which can at least give us the chance of developing an effective family service.
When I talk of the urgency of the problem, I believe that it is borne out by experience in our own constituencies. It is also borne out by virtually every page of the Seebohm Report and it is borne out if I give just one statistic taken from the report itself. The committee commissioned a certain amount of research; it discovered that at least one child in 10 at some time before he or she reaches the age of 18 will need special education, or psychiatric help, or help from a social worker.
At present, at most only one child in 22 is receiving such help. Although this is a factual figure, many people regard it as being exaggerated; that is, until they begin to think of their acquaintances in that age group. Hon. Members will readily appreciate this, with their knowledge of the problems that are brought to their attention.
People I think underestimate the special help which must be given to that 1426 age group, if only because parents are often reluctant to talk about the special problems which face their children. Sometimes they feel guilty. Sometimes they feel embarrassed. Sometimes they are aware that their children are already breaking the law and are in danger of being brought before the courts. Sometimes there is a personal, emotional involvement which prevents people from facing the situation.
Another reason why I want to see this new department established, even before the reconstruction of local government, is because I want to see it settle down; establish its own identity; get used to working with the other great departments of local government and begin recruiting appropriately trained managerial social workers before all local government officers become involved in the turmoil which will follow local government reorganisation.
While I emphasise the urgency of this legislation, I am in no way diminishing the value of what has been undertaken in the development of community care help. A personal friend of mine, and one of the most experienced medical officers of health in the country, argued with me persuasively against rushing the Bill through and urged that it should be phased over five or 10 years on the admittedly real grounds of the acute shortage of administratively trained social workers. He gave me some figures which throw an incredible light on the achievements in community care. A century ago one in every four members of the population died from an infectious disease. The average age of survival 100 years ago was 40 years, whereas the average today is 70 for men and 75 for women.
I support the Bill because I cannot see that the structure of local government is adequately geared to provide the unified family welfare services which are acutely needed today. Some local authorities have made valiant efforts and have achieved outstandingly remarkable successes, but they have achieved them against a background of a statutory structure which impedes rather than helps them. It is all the more important that the personal social services should be brought together, for as we look into the future we become aware that many of the 1427 most intractable problems that are growing up around us have the emphasis on social or psychological aspects rather than on the need for medical care.
There are problems with which the Home Secretary is concerned, such as immigration, the assimilation of strangers into our community, the high proportion of immigrant men who leave their families behind in their native countries and the growing number of immigrant children who are having to be taken into care. There are problems such as the growth of drug addiction among the younger generation and the growth of violence and delinquency at a quite early age.
There is the strain on families having to care for mentally handicapped children who, only a few years ago, would have died in infancy, but who will now, because of the great advances in medical science and care, live a long life. There is also the increase in mobility among younger families, with the result that all too often we find the older generation being left behind and deprived of the companionship which is so important to them.
It is beyond question that in society as a whole there is a growing stress which, for many people, is just too much. This is accentuated by what I sometimes consider to be the absolutely calamitous standards of environmental planning and architecture which we have in Britain. The tower blocks that are being built seem to be far removed from the friendly, cosy neighbourhoods which I believe are the wish of the great majority of the population.
The Bill is essentially a piece of administrative and machinery legislation. It requires each local authority concerned to establish a social services committee. It enables the Secretary of State—I do not know which Secretary of State, despite the interchange which has gone on over this—to add functions when he thinks that that is right and it provides for the appointment of an officer. The Secretary of State has power to make regulations laying down qualifications for the director, and all of this comes into force on a day to be appointed by the Secretary of State, who can postpone the appointed day for certain areas. This is machinery which I believe to be right because one of the great advantages of the Seebohm 1428 system is that it provides for the maximum efficiency and humanity in the use of our resources.
The Explanatory and Finacial Memorandum to the Bill reckons that the increase in expenditure will be slight. This is understandable, but there was no indication in the Secretary of State's speech of the blood and sinews—the financial resources—which will make this new committee a living thing.
I will return to the question of machinery shortly, but, first, there are certain aspects on which I must comment. Something more than machinery, however well-intentioned, is needed if we are to solve the social problems in our midst. I refer to resources, action, drive, training, manpower and money. Instinctively, I feel that something over and above these material things is needed. It is something psychological. The Seebohm Report was really demanding both improved services and parliamentary and local government recognition of the social work profession. In layman's language, the Seebohm Report was really asking society to recognise the social work profession as having come of age; of having its place alongside the teaching, medical, nursing and other great professions.
Social worker morale needs a boost and, frankly, I think it a pity to launch this next step forward simply on a machinery Bill. Indeed, this method of taking this step forward on a purely machinery Bill, which will come into operation at an unknown date, is remarkably unimaginative. It lacks a quality of political leadership which should be given. It does not in any way give us the feeling that we are at the point of departure for a major advance in the evolution of social welfare.
The Bill gathers together in Schedule 1 a series of local authority responsibilities which are today spread among the children's department, the welfare committee and the health committee, and puts them, I believe rightly, into the new social services department. I would make it more dramatic. It should not be just a shuffling around of existing functions. It should be more forward-looking. It should not just be machinery. There should be a declaratory clause of this committee's new general duty to promote social welfare in the community.
1429 When one reads the equivalent Scottish Act one gets the feeling of a new impetus forward. I admit that it is not exactly the Declaration of Arbroath. It has to deal with laundry facilities, burial of the dead and some mundane subjects. But the whole impression of the Scottish Act is forward looking and it is better. We as an Opposition will try to add to the Bill some kind of declaratory Clause which is positive, fresh and imaginative. We shall try to breathe life into the dry bones of the Bill, which is singularly uninspiring.
§ Mr. Denis Coe (Middleton and Prestwich)
Having quite rightly paid great tribute to social workers, does the noble Lord suggest that a declaratory statement of that nature would make all the difference to the way in which they are to work?
§ Lord Balniel
I do not think that it would make all the difference, but psychologically it would give a really clear categoric parliamentary exphasis and statement of our intention to move forward the personal social services. This certainly is the view put to me by a number of social workers. We shall try to put forward such a Clause in Committee.
The second main point of difference I have with the Government is that I do not read the Seebohm Report as merely recommending a new administrative framework. Running through that report as a kind of principle is the theme that if we are effectively to help the sick, the elderly, the deprived and unfortunate, we must integrate and harmonise the resources of manpower and money which can be made available. This is a principle which we want to apply in the reform of the health services. Divided responsibility means that no one takes responsibility. That is as true of central government as it is of local government.
Of course, I know the reservations felt by certain social workers. I can imagine the friction between the Secretary of State for Social Services and the Home Secretary—who has, very wisely left before I came to this part of my speech. The Government cannot duck the fact that the Seebohm Report recommended not only a new social services committee, but also that it should come under the responsibility of one Minister. Does the Secretary of State accept that recommendation or not?
§ Mr. Crossman
When I was speaking I said that I thought it should be done, but it should be done on completion of reform of local government and the health services. I think that the principle of a single Minister is correct.
§ Lord Balniel
If the principle of a single Minister is correct, it is my opinion it would be better to include it in the Bill. The present services of the children's department are transferred to the new social services committee but the child care services in Whitehall will be left with the Home Office.
Common sense and logic tell us that if we are to harmonise at the local level we should harmonise at the centre. The Secretary of State for Social Services and the Home Secretary should talk this matter over again. If the right hon. Gentleman's courage fails him, I should be happy to accompany him. My view is that the children's services are more appropriately the case and responsibility of the Department of Health and Social Security.
The third main point is the allocation of resources. The Seebohm Report states, in paragraph 74:Local authority personal social services are not fully meeting needs for which, on the basis of the duties placed on them by statutes, they are clearly responsible. Obvious examples can be derived from the waiting lists for different kinds of day and residential care for the mentally ill, the mentally sub-normal, the handicapped and the aged. There is no doubt also that in many areas domiciliary services like home helps or meals on wheels are falling short of meeting obvious needs which those in the services think they ought to be meeting.Virtually every page of the Seebohm Report, which is a long report, echoes that theme. Community care for the mentally infirm and aged islittle more than a phrase".Services for the physically handicapped arein urgent need of development.The care services for the mentally disordered are, in many parts of the country,a sad illusion and, judging by published plans, will remain so for many years ahead.It is those published plans which worry me most. Many of the improvements in the health and welfare services depend on the rate support grant. The Government have decided that for the current year the increase in spending under this 1431 grant shall be cut to 3 per cent. in real terms from the 6 per cent. which it has been for many years past.
Even more ominous for the future are the figures given in the White Paper on Public Expenditure, Cmnd. 4234, December, 1969. Between 1964 and 1969 the annual average rate of increase in expenditure on health and welfare was 3.9 per cent. at 1969 prices. For the period 1969–72, the figure is expected to drop fractionally to 3.8 per cent. The tentative figures showing the estimated increase in spending on health and welfare between 1971–72 and 1972–73 are 3.4 per cent. and between 1972–73 and 1973–74 they are cut right down to 2.4 per cent. When we look at the growing population of the elderly and see the need to develop community care services we fail to understand how the Government can deliberately plan to slow up development in this field so dramatically.
The Bill is a machinery Bill. Nothing in the Minister's speech indicated that additional resources would be allocated; and all the published figures show that there will be a cut in the growth rate of this expansion.
Finally, I would like to end by wishing the social workers involved in this change every success in the invaluable work which they undertake. I will also like to explain my profound belief that their work must be in partnership with the voluntary organisations. The voluntary organisations have a unique rôle to play in finding problems, bringing them to the attention of statutory authorities and bringing their irreplaceable experience, warmth and companionship to meet so many needs which can never be met by the statutory authorities. My right hon. and hon. Friends and I will wish to amend the Bill in Committee but we are prepared to give the Bill a Second Reading.
§ 4.58 p.m.
§ Mr. William Molloy (Ealing, North)
Normally I would have opened my speech by congratulating my right hon. Friend for at long last introducing this Bill, but a measure of natural Socialist confelicity compels me to compliment the noble Lord the Member for Hertford (Lord Balniel) on the manner in which he presented the Opposition's case. I thought 1432 that at one time he would come right over to these benches for I have never known such an example of a Tory being converted on the road to Damascus. Yet on the road he appeared to have had a touch of the sun when he got to the end of his speech.
I agreed with much of what he said when he spoke of the evils of bad housing. I have been involved in local government for many years and I have found that one of our biggest headaches. One could argue that a great deal of what the noble Lord and my right hon. Friend spoke about this afternoon, and a great deal of what is in the Seebohm Report, could be traced to the effects of evil housing conditions. The right hon. Gentleman was quite right. Those of us who have been involved in London local government and have battled desperately to deal with evils like Rachmanism have often been prevented from carrying out some of the ideals—which I applaud the noble Lord for holding—by some of his predecessors. We had to wait for some of the reforms in housing and social services of this Government.
I was also impressed by his argument about the increase in the life expectancy of ordinary people. Again, he sounded as though he was speaking at a Trades Union Congress conference. This is one of the great achievements of the trade union movement and one of the reasons it was born because people were—through exploitation—dying at an early age. When talking about the evils of that period, he was really applauding the birth of the Labour Party and condemning his own party.
We should pay our respects to the Seebohm Committee, which has become almost a household word in the Labour Party. I have never known an issue to excite so much attention or to be the subject of so much debate in the Labour Party—[Laughter.] Of course they find an issue like this funny. Everything that is miserable and unpleasant for the ordinary people of this country is funny to the Tories—
§ Mr. Martin Maddan (Hove) rose——
§ Mr. Molloy
Not likely: sit down. The hon. Member does not deserve to be given way to when he makes a remark like that. He is dealing with the wrong character when I am on my feet.
1433 This report will be seen as a landmark as great as Beveridge and the first Welfare State which the Labour Government introduced in 1945. I, like both Front Bench speakers and many other hon. Gentlemen, wish to pay my respects to Mr. Seebohm and his committee for their magnificent work. It is not merely a report to Parliament but an examination of the way of life of the vast majority of our people, much of which is frankly unpleasant. They have done a magnificent service in drawing attention to evils and to the remedies which have been implemented but many of which have failed to work, and in presenting proposals which are worthy of examination and which have resulted in this Bill.
One of the striking things about the report is the number of alternatives which were examined. The committee has gone into detail on a number of problems, and only after discussion and examination in depth has it decided on a positive recommendation. This also should be applauded. The quintessence of the Seebohm Report is that it is now time for us to end uncertainty in social services. Inevitably many speeches will take the form of questions. I should have liked a lot more detail in the Bill.
There should be a director of social services in the authorities mentioned in the Bill. I can understand the criticism that, because such an appointment will need the Minister's acquiesence, some people will think that the heavy hand of Westminster will be imposed on local authorities. But in fact, at long last, the status of local authority social services is being raised to that of their many other responsibilities. Over the years, we have passed legislation which permits and legislation which requires local authorities to act. Some local authorities, whether they want to or not, must appoint a medical officer of health, a borough engineer, a town clerk or his equivalent, but director of social services has never been a compulsory appointment. At long last, this is put right.
But surely there must be some Ministerial responsibility to see that the right sort of person with the right experience and approach is appointed to such an important post. I do not say that there should be detailed examination of every appointment, but, since local authorities will have to win the Minister's support, 1434 I think that they will take that little extra care in making appointments.
The director is to have an adequate staff, but I should like the Government to be more explicit about what this means. Those of us with local government experience are always a little suspicious of any Government who talk of providing "adequate" services and "adequate" staffs. Sometimes their interpretation of "adequate" and that of those who work in and serve local authorities are quite different.
No detailed answers can be given, because of the size of the various local authorities, but we have a right to know more than what the Bill says. The answers will enable us in Committee to have some idea of what we can press for and approve or disapprove of without waiting for the actual Clause. It is not a particularly good way to work to wait until the Committee stage to probe and suggest. Perhaps the Government can enlighten us more on this tonight.
I welcome Clause 9 which provides for adequate protection of superannuation and any form of what might be called redundancy pay involved in local authority social services. As we are to have a director of social services in the London boroughs and the county boroughs I hope that the equivalent dignity and status will be afforded to the field officers working under the director. If that does not happen the whole thing will not work in the way that Seebohm or the Bill intends. Success in implementing the Seebohm recommendations and the provisions of this Bill will depend on the calibre of person responsible to the director.
It is important to have constant liaison with the voluntary organisations in towns and cities. I deplore the idea of trying to run welfare services on the basis of a few ladies shaking a collection box on a fine Saturday morning in the spring. I am opposed to those who have much more than anyone else making fat donations to various services as they used to. Not only did they make the donations but they sent their instructions too. We have got rid of this.
There is now growing up, and it is evident in my constituency, a community spirit among ordinary people who wish to aid those not so fortunate as themselves. 1435 It is important that the director of social services should have high on his priority list a liaison officer to work with the voluntary organisations.
I have some sympathy with the arguments put forward for taking the entire child welfare services and putting them into this once and for all. I am not attracted by the argument of leaving them within the Home Office and my right hon. Friend did not go at great length or depth into this point. Has there been a disagreement between him and the Home Secretary? This is an important subject. There is a need to see children's welfare services under the same umbrella as many of the services enumerated in the Bill. Many of us who have been involved with welfare work for many years believe this strongly.
Schedule I of the Bill refers to the Children and Young Persons Act 1933 and under the heading "Nature of functions" it saysProtection of the young in relation to criminal and summary proceedings; children appearing before court as in need of care, protection or control, committal of children to approved school or care of fit persons, etc.This is the ideal thing to come under the umbrella of the director of social services rather than be the responsibility of the Home Office.
Not long ago I was involved in an issue concerning three young children in my constituency. Never at any time have I condemned the magistrates in the Ealing court who had to deal with the problem of these three young children. What happened was that while the magistrates wanted to discuss the matters and reach a sensible conclusion about the children they wished to remand them temporarily. There was nowhere to remand them so they had to be put away while the court thought about them. The magistrates ought to have asked what would happen to the children, but there was no social service director whom they could ask. If there had been they could have asked him to look after the children while they discussed the issue. While it was no fault of the magistrates, but of the system, these children, who had knocked off some goods worth 7s. 3d. were put in a cell below ground and kept there for nearly nine hours.
§ Mr. Norman Miscampbell (Blackpool, North)
To relieve the hon. Gentleman's mind I can tell him that as a result of the Children and Young Persons Act of last year this problem will not occur again and we will not have the difficulties that he has related. I am sure that that will please everyone.
§ Mr. Molloy
I am grateful to the hon. Gentleman for that intervention. Nevertheless this happened and it was wrong. If there had been a director of social services then he, as the senior officer of the council, would have had the responsibility of looking after these children. It is with some reluctance that I have to make this critical point. The children's services are not being adequately catered for. They should come under the umbrella of the Bill.
As has been said many of the voluntary organisations, specialists and others involved with the social services have made their contributions to both sides of the House and I am grateful for some of the information we have had. I would like to draw my right hon. Friend's attention to the criticisms that have been made by art organisation known as the Social Workers Standing Conference. This body discussed the Bill at its conference this month. While it welcomed the Bill it made a number of criticisms worthy of the attention of my right hon. Friend. It said that local authorities need social advice just as they need legal, financial, medical and technical advice. The duties of the director of social service should include giving advice on social issues to the authority he serves and to the authorities in other tiers in the same area. That is an eminently sensible suggestion. It may be that is already the intention of my right hon. Friend and will emerge in Committee.
The other point that is made is the upsetting effect on a small household when the mother or father has to go to hospital. The social workers say that hospital social workers need a base in the social service department from which they could serve hospitals and community health centres centred on general practitioners. They say that hospital social services should be provided by the department from the start and that postponement would prolong uncertainty, depress morale, retard recruitment and damage 1437 the service. There will be serious disappointment that this is not being done.
There has been deliberate misunderstanding of the Seebohm Report by at least one local authority, and it is my duty to bring this to the attention of the House. The hon. Member for Hertford is a champion of the social services, and I wish that some of the Tory members of the council of the London Borough of Ealing had been here this afternoon to listen to his speech—perhaps he will send them a copy of it. The London Borough of Ealing claims, cunningly, that it has anticipated the Seebohm Report, but the opposite is the truth. About a year ago the council merged the health and welfare services under the medical officer of health. The head of the welfare department was demoted to number three in the hierarchy. This move was totally opposed by the council welfare workers and voluntary social workers because it was contrary to the Seebohm Report. Within six months of this disgraceful operation the senior welfare officer and his deputy left the council's employment, and later several other senior officers in the welfare department also left.
In the Southall part of the London Borough of Ealing there is a serious immigration problem, which I give the council credit for tackling as courageously as its Socialist predecessors. But out of the blue the council got rid of the community relations officer who worked with the voluntary organisations. He resigned, I understand, because the new structure was anti-Seebohm, and he has not yet been replaced. Within the last three months the council has decided that the already merged health and welfare departments shall take on the children's department, education and the lettings section of the housing department, all under the control of the medical officer of health, whereas it is the chief welfare officer and his colleagues who should have been gaining experience to enable them to implement the Seebohm Report. When both sides of the House are keen to see the implementation of the Seebohm Report, it is quite wrong that Ealing should be moving in the opposite direction——
§ Mr. Kenneth Baker (Acton)
Part of the London Borough of Ealing is in my constituency, and I should not like to 1438 go unchallenged the tirade of the hon. Gentleman, who is in much of what he says factually inaccurate. The London Borough of Ealing in many ways has anticipated sensibly the Seebohm Report. It has put social welfare, housing and the inspectorate of the health services under the director of social services. I deplore the hon. Gentleman's attack on the appointment of a local government official who cannot answer in the House. The Ealing welfare services are second to none in the country.
§ Mr. Molloy
The hon. Member knows full well that this is big blarney. I did not attack the medical officer of health; he had no option but to accept the appointment. I am attacking the Tory councillors. I am surprised that the hon. Member has the audacity to mention housing. The colleagues he is defending reduced by nearly 90 per cent. the expected provision of houses in the London Borough of Ealing.
§ Mr. Kenneth Baker rose——
§ Mr. Molloy
I have a little more to say. If that annoys the hon. Gentleman, perhaps he will listen to this. The luncheon clubs in his own constituency have asked the local authority for aid to provide more meals for old people, and this request has been turned down. They could not state their case to the community relations officer or the chief welfare officer; they have gone. Everything now comes under the umbrella of the medical officer of health.
The Bill provides that the director of social services shall have no other responsibility than that, and the Opposition agree with this. How then can it be said that he shall, when he has a moment to spare, be borough engineer, general manager, town clerk or medical officer of health, as he is in Ealing? This is an absurdity as the hon. Member for Acton (Mr. Kenneth Baker) knows. If the hon. Member for Hertford meant what he said this afternoon, as I believe he did, I hope he will use his influence with his colleagues in the London Borough of Ealing and persuade them to fall in line with his thinking. Otherwise, the Conservatives at parliamentary level will be telling the nation how they applaud and support the Seebohm Report while at local level they will be working in the opposite direction. They have not the excuse of saying 1439 that they did not know because I have told them.
A Measure such as this should be implemented in entirety throughout the whole of the country. No local authority should have sub-standard social services. The best should be good enough and provided for everyone. Nothing can be more detrimental to the morale of social workers or more irritating to people to know that their area has sub-standard social services compared to the rest of the country. If this Measure is to be a success, and I applaud it as a great step forward, I feel that its ultimate progress will depend on universal application throughout the country.
§ 5.30 p.m.
§ Dame Joan Vickers (Plymouth, Devonport)
I now realise why the speech of the hon. Member for Ealing, North (Mr. Molloy) took over half an hour. He has had to wait for the benches on his side of the House to fill up. We are told that Socialists want a compassionate society and that they care for people. On a Measure such as this which deals with people I am astonished to see those benches so empty.
The Seebohm Report is one of the best reports presented to Parliament in recent years. I add my congratulations to the committee on the fact that its report is clear and concise and its recommendations definite. I should like to add my congratulations to the voluntary organisations. When the report was first produced I called a meeting in my constituency, which was attended by over 40 people representing voluntary as well as statutory bodies. I feel that the Bill before the House is so good because so many parts of it are a result of the splendid efforts of so many outside organisations.
The keynote of the report is that it recommends a new local authority department providing a community-based service that is family-orientated and available to all. I emphasise that it concerns the family since this matter has been neglected in recent days with families often being divided.
I feel that this new Department will reach far beyond the discovery and resources of social casualties and will enable the greatest possible number of indivi- 1440 duals to take mutual action, giving and receiving service for the well being of the whole community. For this reason, I regret that the right hon. Gentleman is not able to say that one Minister will be responsible. Without central direction, I feel that it will be difficult to work since there might easily be conflict in local action.
It will be seen from Clauses 2 to 6, which are based on paragraphs 629 to 636, that if the Seebohm recommendations are to be carried out it is essential to establish a social services committee and to appoint a director of social services. This must be mandatory. It will be most difficult for the local people to serve three masters—it is often difficult enough to serve one.
My particular purpose in rising to speak on this Bill is to point out that certain things have not been included. One is housing and the other is school welfare service. On the other hand, I should like to see left out of the Bill playgroups and nursery schools and infants schools which must come under the Ministry of Education. Paragraph 447 of the report states that the first five years of a child's life is of vital importance and they must be considered as the responsibility of the Department of Education and Science.
In regard to housing, I am fortified by paragraphs 124–125 of the Report of the Supplementary Benefits Commission, which say that a broader view should be taken of local authority responsibilities to allow the family to continue in existence without the disruption caused by a member being taken into care. A clearer liaison should also exist between the work of the housing department and the mortgage loan services operated by local authorities. The job of housing managers or directors of housing will be bigger and more challenging.
Good housing is the key to happiness, as Seebohm recognised in paragraphs 387–426, in which definite recommendations are made. From the moment a child is born its environment begins to affect its life. Cases involving battered babies regrettably are on the increase. There is delinquency because young people cannot stay at home and are probably worse off in their homes than they are at school. They cannot bring their friends home and when they begin to earn money they 1441 spend it all outside. Little notice has been taken of the Central Housing Advisory Committee circular sent out in 1959, and its advice has not been accepted. This is another reason for including the subject of housing in the Bill.
I am glad to see the home help service better placed under the Bill than under area health boards. Another omission is the absence of mention of the school welfare service. At present posts in this service have a lower status and are paid less, despite the fact that these officers are likely to be one of the first to find signs of difficulties in the home. They can also co-operate easily with the parent teachers' associations.
I should not like to see the child guidance service transferred. Circular No. 347, which dealt with the contributions of the school psychological service, the school health service and child guidance school service, in co-operation with the teachers and the school nurses, is the better way to go about the matter. If these were to be taken over it might mean that the education service would be robbed of effective help for children with mixed social, medical and educational psychological problems.
Regrettably the Bill does not give the local authorities the general power to promote social welfare in their areas. In many local authorities there may be a minority of persons who may interpret the proposals in the Bill as being outside their terms of reference. As the Bill stands they may regard the provisions as applying only to the under-18s and people over pensionable age.
Clause 11 deals with the staff development programme and relates to paragraphs 570–572 of the Seebohm Report. The provision relates to newly appointed trained workers who need reorientation in their particular work. I should like to know more about this programme and how it is to be carried out.
Clause 15(4) and (5) relate to the coming into force of the Bill, but no definite date is set out. I am sure that if there were a definite date by which the Bill could be implemented it would then be up to local authorities to arrange implementation. I am not saying that local authorities should be pushed, any more than I feel they should be pushed 1442 into comprehensive education, but a definite date would give them a starting point from which to set up their organisation. I hope that something more will be said about this matter and also the question of newly appointed trained workers.
I hope it will not mean that people with years of experience will be turned away because they are what is termed as "professionally qualified", as has happened in some cases in the education service. A number of these people have a great deal of experience in practical matters rather than just theoretical knowledge. This is an important matter which must be borne in mind.
I agree with my hon. Friend the Member for Hertford (Lord Balniel) in what he said about the financial effects. I do not know whether the Bill is meant to deceive the gnomes of Zurich, but the proposals in the Bill cannot be put into action without adequate funds or personnel in order to carry out the legislation provisions mentioned in the Bill. I hope that the Government will consider including a provision such as that contained in section 12(1) of the Social Work (Scotland) Act, 1968, which I feel would help to improve the situation.
My final point deals with research, planning and administration. Very little has been said on this point. Indeed, the Secretary of State said nothing about it. Paragraph 174 of the Seebohm Report says that some children are receiving inappropriate care because suitable forms are not available. This point is also dealt with in regard to the elderly in paragraphs 130 and 131. If the Bill is to be effective, we need more research. I hope that the Minister of State will be able to deal with some of these matters and say what the Government intend to do about further research, planning and administration.
§ 5.40 p.m.
§ Mr. Christopher Price (Birmingham, Perry Barr)
I want to take up a few of the points which were made by my right hon. Friend in what I felt was an exemplary speech.
The first one which I would mention concerns the appointment of the new directors of the social service departments. As I said in an intervention, this will be the crucial cornerstone of the new 1443 organisations. In passing, perhaps I might support all that my hon. Friend the Member for Ealing, North (Mr. Molloy) said about what the London boroughs have been trying to do in a rush job to anticipate this Bill. In my view, it has been a disgraceful operation, and they have done it all wrong. In Haringey they have even appointed a brigadier to try and run the education service. It is a very serious situation.
The fact has to be faced that exactly the same tensions occur at local level as those which so far have prevented a unified service at national level. We do not have a unified service at national level, because my right hon. Friend the Secretary of State for Social Services and the Home Office cannot agree.
The argument is well known. If the Home Office gave up its precious little Children's Department, it would be dealing with just the police, immigration and prisons. It would he a dull, miserable place. No one would want to go into it, and it would be downgraded from its position as one of the traditional top Departments of State.
That is a very nice argument. However, I do not believe in it. Sometimes the traditional top Departments of State have to be downgraded because matters have to be reorganised. The ultimate of national Government reorganisation will be the abolition of the Home Office. Obviously it was a sensible Department to have when it controlled virtually all home affairs. But now it is sensible to allocate responsibility for them more functionally and, as such, the Home Office ceases to be a functional department.
It is obvious that my right hon. Friends the Home Secretary and the Secretary of State for Social Services have agreed to live and let live. They have chosen peaceful co-existence rather than a merger. I accept that they will work together in harmony and peace.
The same situation exists at local level. In every local authority, there will be only two contenders for this new job. One is the existing medical officer of health and the other is the existing children's officer. However, the two are as different as chalk and cheese. Often the children's officer has social work qualifications and has spent his life in 1444 that sort of department. Although we have some very famous medical officers of health, especially in a number of the smaller county boroughs, traditionally they are not known as the cream of the medical profession. Public health does not have the standing in the profession which the great colleges of surgery and medicine have attained. This has always been the difficulty with medical officers of health and public health departments.
The fact remains, however, that the medical officer of health holds the position of power which the Home Secretary holds in the national Government. In most local authorities, they are on the top salary, sometimes earning nearly two-thirds more than the children's officers.
§ Mr. Tim Fortescue (Liverpool, Garston)
The hon. Gentleman is probably aware that a medical officer of health cannot be fired either.
§ Mr. Price
Exactly. He has a statutory post. However, he can resign. There are more ways than one of killing a cat.
In the appointment of directors of social services it is essential that those who have had a lifetime in social work and who have social work qualifications should be preferred to people with medical qualifications. I say that quite openly. It would be disastrous if, as has happened in Ealing and in other parts of the country, medical officers of health took over jobs for which many of them are totally unsuited.
I see from the Bill that the Minister has power to prescribe the qualifications of the new directors. I am pleased about that. However, I hope that my hon. Friend the Minister of State will tell us the sort of salary these individuals will be offered in terms of the salaries of other chief officers in local government. I have been in local government, and I know how status-conscious it can be with heads of big departments looking down on the heads of little departments.
These new social service departments will not succeed unless their directors have salaries which are as high as those of any other chief officer, apart from the town clerk or whatever new name may be given to the senior officer in any future reorganisation.
§ Mr. Wallace Lawler (Birmingham, Ladywood)
While I do not necessarily 1445 disagree with the hon. Gentleman's recent references to medical officers of health, does he see a situation arising where a local authority might be paying a very high salary to its director of social services, and be obliged still to pay an even higher salary to its medical officer of health who will have greatly diminished powers?
§ Mr. Price
I hope that the hon. Gentleman will have time to develop that point later. The problem is one of the interim difficulties mentioned by my right hon. Friend. After these directors are appointed and before the local health departments are transferred holus-bolus to the new area health authorities, there will be a period during which we shall have a number of overblown managing directors in charge of diminished and undernourished empires. There is little that we can do about that. I wish that local authorities had "top hat funds" from which they could pay lump sums to redundant chief officers and tell them to go. That is one of the more admirable practices of private enterprise. In local government, one tends to be "lumbered" with chief officers simply because they cannot be sacked and will not resign.
§ Mr. R. W. Brown (Shoreditch and Finsbury)
My hon. Friend is not quite right. Any local authority can pay off an officer whom it does not want. However, it is so expensive that no prudent authority wishes to do it.
§ Mr. Price
I believe that where there is a statutory chief officer it is more difficult than in other cases, but I bow to my hon. Friend's long experience.
I hope that we will have more information about these directors' salaries, vis-à-vis those of the other chief officers of the local authority, their status and, more important, their qualifications. I think this will be crucial.
For my second point, I should like to echo what was said by the hon. Member for Plymouth, Devonport (Dame Joan Vickers) about the education service, particularly education welfare officers. The effect of the Bill will put education welfare officers in an even worse position, and they are not in a good position now. They are on as low a salary as can possibly be paid to anyone for the work they do in a local authority. They sometimes do crucial work. Many of them 1446 have grown out of education departments. They have possibly been clerks in education departments who have had the feeling that they would like to be out in the open air doing social work rather than sitting behind desks. Most of them are longing to have training by which they can qualify as proper social workers. Most of them could pass that training if they had the opportunity. But in authority after authority there simply is no opportunity for them to become qualified as social workers or, indeed, to have any career structure. They are all on one flat salary, with perhaps two or three in each local authority on a slightly higher salary. They have no prospects. Yet they are working at one of the most difficult jobs in the community.
If all the other social workers in local authorities are to get a great uplift by being brought together in these social service departments with, I assume in many cases, enhanced salary, and the education welfare service is to be left on one side, it will be very difficult to keep any education welfare service going.
The education welfare service is a vital link between the social services and the schools. I echo what my right hon. Friend said about his hope that these social service committees would not have lots of functional sub-committees so much as local district committees in the enlarged local authorities. If they have local district committees—I hope that they grow and get some de facto power within them—that is the level at which the education welfare service, as well as the voluntary services, can be brought in and given a job to do.
I re-emphasise the point that if something is not done at the same time as this reorganisation to enhance the morale and the salaries of education welfare officers, many authorities will find themselves without a service at all. Social work is not their only function. They do a great deal of census and other vital work for the education departments, many of which could not function without them.
Thirdly, I should like to comment on my right hon. Friend's rather sheepish remark about insisting on it being a statutory committee while Maud and everybody else says that we should not have any statutory committees. The experience of anyone who has been in local 1447 government is that statutory committees are a frightful nuisance. When when law states that there must be a statutory committee, it is often an invitation to bureaucracy, because the committee has to be hedged around with decision-taking powers, which usually mean enormous delays in decision-taking, and the decision-taking is by the wrong people.
I have never understood why, if there is a statutory officer, there must be a statutory committee. I agree that when setting up a new service of this nature it is vital that there should be a statutory officer and that the Minister should have power over vetting the short list and should have the powers that he is taking in the Bill. That is right. But to lay down that there must be a statutory committee is an unnecessary adjunct, and I am sorry that it has been put in the Bill.
§ Mr. R. C. Mitchell (Southampton, Test)
Does my hon. Friend agree that one difficulty that local authorities have faced in trying to set up social service committees in advance of the Bill has been that the children's committee is a statutory committee?
§ Mr. Price
Yes. I should have hoped that we had learned from experience of these difficulties that one of the greatest freedoms that we can give local authorities in future is to put as few statutory restrains of this kind on them as possible. We should put the absolute minimum statutory restrains on them. I hope that the necessity for a statutory committee will be gone into in a very nit-picking way in Committee to try to ensure that, unless it is justified, the Government have another think about it.
Having made one or two criticisms of the Bill, may I say that I give it a hearty welcome. I think that it could represent an enormous advance in the attitude of local authorities to people in the community. The ordinary man in the street often looks on his local authority as a bit of awful bureaucracy, as a housing office, or as a rather grim town hall in which he has to search around to find the right place to go. When he comes with his social problems he is often confronted with someone who is fundamentally a clerical officer.
1448 This is constantly happening in the Birmingham City Housing Department. Birmingham is trying to run a housing department in an over-centralised way. I have a feeling that the hon. Member for Birmingham, Ladywood (Mr. Lawler) will agree with me about this. People who have no social training whatever are having to deal with social problems. I look forward to the Bill changing the image of local authorities and local democracy among the people at large.
We have got away from dividing the poor, as we did in the 19th century, between the deserving poor—those who have worked hard and need help—and the non-deserving poor—those who went on the bottle and should not be helped. In the 19th century it was thought that by refusing certain people help it might actually make them work harder—or work. We have got away from that idea to a large extent. I do not want to make a political speech. Perhaps hon. Members opposite have not got away from it so much. However, local authorities have got away from that idea.
But we have another great revolution to go through which I hope the Bill will hasten along. Many people in local authorities somehow feel that in the 20th century there is some kind of distinction between the deserving poor and the non-deserving poor on what I should call the moral plane, in terms of family planning services, the availability of advice about abortion, how we deal with unmarried mothers and how we deal with minority immigrant groups in the country. I often feel that in all those terms the local authority has a very different attitude to different groups. They hope by ignoring some groups to make people more moral. They hope that by not really tackling the problems of unmarried mothers and the problems of family planning those problems will go away. I very much hope that with a service staffed by trained social workers, who know the facts about this kind of situation, who have been trained to know the sociological parameters in which society works and have studied the evidence, we may change the whole attitude of local authority workers towards the public and make it a very much more civilised and humane society. I believe this Bill goes a long way towards doing it.
§ 6.1 p.m.
§ Mr. Marcus Worsley (Chelsea)
I am glad to follow the hon. Member for Birmingham, Perry Barr (Mr. Price) because I find myself in considerable agreement with him. I thought his remarks on career structure and the education welfare service and on the extent of statutory control over local authorities were very pertinent to this debate. I hope we can follow these points in Committee and discuss them more fully. I, like him, welcome this Bill. One should not claim too much for it. By itself it does nothing to help one single family, but it provides a modern framework within which a more comprehensive social work service can develop.
I believe, that local authorities and social workers between them will respond enthusiastically to that opportunity. As my noble friend said in opening on this side of the House, this is a Bill about machinery. Therefore, it ought to be judged by asking two questions. First, will it make it easier for local authorities to provide a social work service for the family? To that I respond unconditionally, "Yes, it will", because it will end compulsory departmentalisation at local level within the social work service.
My second question is: Will it make decisions about social priorities easier? Here my answer is only a qualified "Yes". It is one of the strange and encouraging facts about this field that the cheapest action is often the best. It is not only better but also cheaper to keep an old person in her home by the use of supporting services. Also, social work can often keep a mentally or physically handicapped person living happily in the community, whereas lack of it means that that person ends up in an institution at much more cost to the community.
I am reminded of the proverb quoted by Dame Eileen Younghusband in her book, "Social Work and Social Change":Give a man a fish and he will eat for a day. Teach him to fish and he will eat for the rest of his days.This, says Dame Eileen, is the essence of social work. It is rather a neat quotation. It is too much to hope that social services expenditure will actually be self-limiting, but the fact that I have outlined, while it would be naive to argue that it will mean a reduction in expendi- 1450 ture, does mean that priorities in this field have a very special importance. It means that decisions on whether to put resources in one field or another have a particular relevance. Certainly, after the passage of this Bill local authorities will find it easier to look at their social services expenditure together and to assess for example, the demands of domiciliary or residential care.
The big question mark to which I would like to draw the attention of the House is: how do we as a community judge when it comes to considering where resources are to go between health and the social services? There is nothing in the Government's plans in this Bill or in the Green Paper which will make it easier to allocate resources between, for instance, geriatric care in hospitals and services for old people in the community. This evening we cannot pursue this aspect too far. We have been promised a debate on the Green Paper soon. But it is a problem which has to be solved. How are we to allocate resources between these two fields? There is literally nothing in the proposals before us to make this decision easier.
For myself, I believe the Government generally are drawing the line between medical and social work at the right place, but that does not alter the point, made by my noble Friend in his speech, that any line is in a sense artificial and a matter of convenience. The whole human problem has to be looked at together in terms of resources. It also has to be looked at in terms of cooperation between different skills. We are abolishing some boundaries in this field by this Bill. We must be desperately careful that we do not create another boundary, between medicine and social work, which would be just as bad.
All these plans have to be seen by the medical side and by the social work side not as a new separation but as a new opportunity for co-operation. Perhaps what I am saying is most obviously true in the field of mental health. Many people have suggested that mental health social work ought to be within the health field. Personally, I do not support this view, but I understand the reason for those who do support it. I feel they are wrong because I believe they are assuming that effective co-operation can only be within one department. The fact is that in mental health, if we are to be 1451 successful, we shall need to have the very closest co-operation between social workers and the health side if anything is to be done. For these reasons, it is important that co-operation should be particularly effective in this field.
I must end, as others have done, with a comment on the extraordinary fact that the Government do not intend to practise what they preach. Both hon. Gentlemen who have spoken from the benches opposite have repeated this theme. The Government are telling local authorities that they must have a single department for social work. Yet the Government do no such thing in central administration, though every argument in the Seebohm Report applicable to County Hall is as applicable to Whitehall as well. The Government are in the position of a bigamist preaching monogamy—and statutory monogamy at that, with no mistresses allowed.
So we have the two Secretaries of State, who earlier were sitting on the Front Bench, competitively introducing the Bill. The Secretary of State for Social Services said that this was a period of experiment and that therefore it was better to delay a decision. It is, of course, true that the Government have created a feeling of chaos in the whole of local government and the health services, but in one area alone a decision has been taken—this area, the social work services. Yet in this area alone, they propose to continue a division in central Government.
Of course, as the hon. Member rightly said, this has nothing to do with the specious arguments of the right hon. Gentleman. This is purely a struggle for power between the Departments. Each is fighting for his own with a tenacity which would be admirable if it were more usefully applied.
Clearly, this will not do. The Government must realise that they must themselves accept the logic of the Seebohm Report. If not, no one will believe that they have a sense of urgency or that they have thought through this matter and understood it. Everything that I have said about priorities, resources and cooperation makes essential a single central Government Department responsible both for health and for social work. For these reasons I end on the hope that the Government will listen to the sense of the 1452 House and that the contest between the two right hon. Gentlemen will be ended in favour of the Secretary of State for Social Services.
§ 6.12 p.m.
§ Mr. R. C. Mitchell (Southampton, Test)
I must first apologise for missing the two opening speeches. Unfortunately, I was meeting a deputation on the subject of teachers' pay. If I could slip in a quick plug, I hope that this dispute will soon be settled and that there will be no need for any more such deputations.
I welcome the Bill as far as it goes. It is a great advance. Like the hon. Member for Plymouth, Devonport (Dame Joan Vickers), I regret the absence of certain housing welfare functions and the school welfare service. If I speak particularly of the child care service it is because I was a member of a children's committee for a long time. What we are trying to do in this whole area is to prevent rather than cure. Section 1 of the Children's Act was designed for this purpose. Unfortunately, many children's committees have not been able to do as much as they wanted because of lack of resources and lack of co-ordination between various social service departments. I can remember one classic case of one family receiving statutory visits from seven different social workers, mostly from the local authority but also the probation service and others. However much we try to co-ordinate locally this is not at all satisfactory.
The second reason why I welcome the setting up of a social service committee is that I believe that it will be more powerful vis-à-vis the finance committee than the individual children's and health committees are at the moment. One of the difficulties I have found is getting the local finance committee to appreciate the importance of one's work and give adequate resources.
This is so, I regret to say, in my local authority at the moment. It was so when my party was in control. We were always having battles with the finance committee over the number of child care officers we wanted. I remember a classic case of an attempt to institute an O, and M. investigation of the children's department. Those concernced concluded that each child care officer should have 1453 such-and-such a case load. The difficulty is that one cannot do a time and motion study of the social service worker. The officer may have to stay in a home for three or four hours one evening to settle one case but may be able to deal with another in five minutes.
The practice used to be for the Home Office inspector to tell the children's department what should be done. The committee would agree, but when we asked for the necessary money, we could not get it. One thing which the Bill should be more precise about is to ensure that the committees and departments have sufficient staff to do the job. A great deal can be done, and in the long run money saved, by doing preventive work at an early stage. It is terribly important that housing should be involved. In my local authority, although it has improved over the years, perhaps the first indication the children's committee had of an impending housing eviction which might have involved half a dozen children was when they were virtually out on the streets.
The career structure in the education welfare service is, frankly, nil. Many officers have not received social work training—through no fault of their own. They would be pleased to do so if such a system could be devised. It is in the schools that one can often pick up and deal with early signs of trouble at home. If one can get these cases early enough, many children can be kept out of care.
I hope that the provisions made in the Bill for sub-committees will not lead to a return of the old system, with separate sub-committees dealing with children and health—in other words, departmentalising each area again. This is very easy in local government.
Another difficulty is the lack of resources of many children's departments. They cannot do many of the things they want. For example, a number of children's departments recently decided to drop their adoption work. I must declare an interest because I have two adopted children, adopted through the local children's department. This work was absolutely invaluable. I regret that many local authorities are dropping it because they have only enough staff for their purely statutory duties, and cannot do many of the non-statutory things as well.
1454 It is very important that the new social service departments should have a closer relationship with the National Health Service and the hospital services. I can think of a number of occasions in the past when old people have come out of hospital without the necessary co-ordination by the local services to ensure that when they come out—and they have to come out because of the urgent need for beds—there are the necessary domiciliary services to help them in their homes. In a number of cases this co-ordination has broken down. I hope that under the new arrangements there can be much closer co-operation.
As to the training of social workers, I think that eventually we may have to get away a little from the departmentalised social worker and try for a more general purpose social worker than we have now. Where should these people be trained? This is a hobby-horse of mine. I believe that the colleges of education have a great part to play. At the moment they are almost entirely restricted to the training of teachers. I think it would be good, not only for the social worker but for the teachers as well, if such colleges could be developed into colleges of social service so that side by side within the same colleges there could be training of probation officers, child care officers, and so on. This would replace the present system where they are attached to the extra-mural or some other department of a university.
Finally, I agree entirely that one weakness in this Bill is that what it says is good for local authorities is not followed in practice by the Government. I believe that it is absurd to have a Ministry of Social Services dealing with one part and the Home Office dealing with another part. How can one separate, governmental-wise, the children's department from the other social services? I thought that the whole purpose of the Bill and of the Seebohm Committee was to provide a co-ordinated social service. If one does it locally I cannot for the life of me see why one cannot do it nationally. I hope that we shall be told that it is not just empire building between the various departments, with the Home Office afraid of losing a bit of its present structure. If it is, it is tragic.
1455 I welcome the Bill, but wish it had gone a little further in certain ways. However, I am sure that its results will prove very beneficial to many people with problems of all descriptions who exist in our society today.
§ 6.24 p.m.
§ Mr. Brian Harrison (Maldon)
When the Secretary of State introduced this Bill he said that it was not a long Bill but that it was an important Bill. I think that the debate so far has shown that people do regard it as an important Bill for the simple reason that it deals with people, and very often people who are not as fortunate as the general run of members of the community.
However, over the last few months or so—in fact, over a year or so—we have had a series of Green Papers, White Papers and other reports on the social services, bringing us to the second phase, as the Secretary of State said, in the development of social services in this country. It seems that we got the best form, or the most practicable form, of social services that we could when we began with our health service and evolved our local authority services. But the time has now come for a rethink, as it were, and there has been a lot of thinking and many thousands of words have been written and many thousands of words spoken between various voluntary organisations, between Government Departments and between local authority departments to try to get ourselves into a shape in which we can deal with the problems that we are facing today.
I welcome the Bill because it is the first piece of legislation which gives us a practical step along the rethought road along which we are now proceeding, and along which we shall find ourselves proceeding at increasing pace over the next few years. The idea of unifying the personal services which affect the individual in local authority areas must appeal to any Member of Parliament who has tried from time to time to find his way through the jungle of different welfare services to discover which welfare service would deal with a case that may have come into his care. But if it is difficult for a Member of Parliament to find his way round—and there are a lot of people who would not agree with this, because we are meant to be better informed 1456 on this sort of matter than the community at large—how much more difficult it must be for the ordinary person who is trying to obtain a little help. Anything that will increase coordination between Departments will be very worth while.
The King's Fund Report "Working Together" said:In the past, fragmentation of services and lack of communication have been two of the greatest obstacles for the provision of an adequate and efficient health service … There is now an increasing realisation of the urgent need for both co-operation and coordination between various departments".As the Bill helps to achieve a better co-ordination between the Departments I welcome it.
I think, however, that we want to make sure that very soon any disagreement—if there is any disagreement—between the Home Office and the Department of Social Services is settled, and that we obtain the right sort of services and a better and less fragmented service to enable us to see more clearly how the resources can be allocated. There is a rather vague reference in the Bill to the appointment of the directors who will be responsible for these co-ordinated services. I notice that the Committee of Secretaries of State, as it has emerged, has a right of veto of the appointment of an officer. But later on the actual qualifications or the job specifications for the post will be announced or worked out.
I hope that this will be done with the absolute minimum of delay because, even if a professional job specification, as it were, is to be provided first, at least we shall be able to get a closer idea of what is required both in relation to the type of person for whom we are looking and also the type of training for future people who will fill these important posts. These directors will not easily be found. But they will be extremely important and will have to be highly trained if the local government welfare services are to work properly.
I hope that, at the same time, both the Government and the directors and the local authorities will be looking at the provision of an adequate number of social workers, because the Bill will not be effective unless, as has been said, there are troops, as it were, on the ground to deal with the cases. We in Essex are 1457 suffering badly from a shortage of health and other social workers. The front-page story in the Essex Chronicle last week-end was that Essex was more than 25 per cent. below establishment and that an appeal was being issued to people with some training, who have retired or have given up the job, to come back for part-time or whole-time work if possible. It is vital that we should get an adequate number of people in order to carry the responsibilities which these new departments will have.
I hope also that sensible remuneration will be laid down for these workers. There has been a suspicion that sometimes the officers have been paid by the number of children they were looking after or were responsible for. I believe this view to be wrong. Very often, the test of a good social worker—this is certainly so in psychiatric work—is that his ability is in inverse proportion to the number of cases he is looking after. This must be the measure of the success of any welfare services for the future rather than the large number of cases with which they have to deal.
However, these are small points and not really criticisms of the Bill as a whole. The King's Fund Report says that, while we are putting through the legislation and waiting for the complementary measures,In the meantime people are born and they die, become ill and recover, and the health and welfare needs of the population increase rather than decrease. Any administrative change on national level is bound to be a lengthy and possibly a painful process. It is vital that there should continue to be concentrated efforts throughout the country to increase still further the unification of the services, irrespective of any further plans on a national scale.It is because the Bill is one of the first steps in the unification of the services and because I feel that it can play a big part in dealing with people and making their lives better that I welcome it.
§ 6.33 p.m.
§ Mr. Arthur Blenkinsop (South Shields)
I, too, must apologise for intervening without having heard my right hon. Friend the Secretary of State for the Social Services. One of our difficulties is that we have other committees and commitments in the House which we have to try to meet.
1458 I intervene because I have in the past had some considerable experience and responsibility in part of this work and know the urgency of the problems. One thing which has pleased me very much and given me a lot of encouragement in recent years has been the greater appreciation of the importance of the role of the social worker, which was far from being the case some years ago.
Like others, I regard the Bill as no more than a stage on the road, and it is easy to see its limitations. I share the view of many others that we would have liked to see something very much more. I understand the criticism, for example, that we are tying down the local authorities as they are today in a rigid way, or so it appears, in the Bill. But I would rather we did this with regard to our existing local authority situation than leave the matter and wait until we are in a position to legislate on the new local government set-up which may emerge in two or three years' time. I would much rather take this intermediate step now, however inadequate it may be in certain regards, than wait for another two or three years until we are able to bring in some final, comprehensive Measure.
I hope that we shall still be looking seriously at how far we can allow greater authority to the new local authorities when they come to be established. I also share the view that it is our deep desire to see an end of this conflict centrally and to see one Minister with the full responsibility. But, again, I would rather get ahead with this Measure even without that agreement than not have anything at all. It must be clearly heard to be the almost unanimous view of the House, however, that we should get agreement on this. Whatever feelings we may have for this part of its work, my view is that it must be taken away from the Home Office, however regretful we may he about it. That is the rational view to take of the future, and I hope that there will be agreement on the matter before long.
Like all who have had experience in this work, I am concerned to see that we establish gradually a close link between the welfare and social workers and those in the health services. I do not disagree with the kind of dividing line that is being suggested in the new Green Paper, which, no doubt, we shall have an 1459 opportunity to discuss at a later stage. We all have to recognise that in nearly every one of our major social services there are health implications, and vice versa, and that, whether we are dealing with old people through the kind of separation of functions outlined here or with the care of psychiatric patients and others, it is inevitable that we must have an organisation that can indeed organise easily between the health and the welfare sides.
My hon. Friend the Member for Birmingham, Perry Barr (Mr. Christopher Price) urged that when it comes to the decision about who should be appointed directors of the new social services committees the choice should not automatically fall on the local medical officers. I urge caution on this matter in the middle of argument all over the country, nearly always on the issue as to who should be appointed to take charge of dealing with social and welfare and health services. In many local authorities these were very often brought together under one head and there were great arguments as to where the balance of advantage lay. To my mind this is not something on which one can give any hard and fast rule; it depends entirely upon the qualifications and ability of the individual concerned.
I would not always rule out the possibility—it would be rare but it might occur—where one would get a medical officer of health suitable to be the director of future services suggested here. I would not want it to be laid down that he could not in any circumstances be an efficient director; it depends entirely upon the individual. In the past there have been extremely good examples of combined services run by the medical officer of health, and other examples where it has proved far more satisfactory to keep the two separate and to run the welfare services separately. The qualifications and the individual himself are of supreme importance.
I welcome the fact that under this Bill there will be a chance of improving the quality of the training available in the future for our social workers. This is of very great importance. Although there has been reference to shortages, the general qualifications of those coming forward for work in this sphere have 1460 vastly improved over recent years. It has been my experience in the areas I know best that there has been a very real increase both in numbers and in quality of those coming forward.
Another aspect about which we have been deeply concerned in the past has been housing. I share the anxiety that housing and housing welfare and advice do not seem likely to be brought into responsibilities of the social service director and the local department. I would have thought this was a sphere which needed to be brought in. If there is an area of advice and welfare which greatly needs raising in quality, it is the administration and running of many of our housing departments from a welfare point of view. Here is an opportunity to raise the standard. It must be a fairly common experience to hear of the bitterness and illwill very often caused in constituents who have been dealt with harshly by staff in housing departments. Assistance to people in our constituencies in this respect is of the very greatest importance.
The shading of problems from actual homelessness through all the ranges of housing problems cannot be separated from the general social service problem. I hope that this is a matter which will be looked at seriously in Committee.
§ 6.45 p.m.
§ Mr. Norman Miscampbell (Blackpool, North)
Like other hon. Members who have spoken in this debate, I would pay tribute to those who have given their advice—conflicting advice at times—help and encouragement to us over the last years when the Seebohm Report has been debated and thought about. We must appreciate the point raised by the hon. Member for Southampton, Test (Mr. R. C. Mitchell) when he said the had had experience on one occasion of seven people going from various welfare departments to one home. It is a scandal that the children's officer may go and the information available to him may not be fully transmitted to the other departments so that they, too, can take steps to ensure that other social difficulties experienced by a family may be helped by the council and by the facilities which are available.
We have gross over-lapping in our local services, and the Bill will go some 1461 way to helping to overcome that difficulty. This, as has been said, is one of the most important problems of our times. The size of the problem is familiar to all of us, certainly to those who hold "surgeries" and interviews in their constituencies. There are the problems of old age and of people growing old in a young family in small homes; the difficulty of looking after such old people within the family; the problem of children to be helped; and the problem of welfare generally. All these are problems brought to our notice regularly week by week. I approve and applaud the fact that they are to be dealt with by one authority.
My hon. Friend the Member for Chelsea (Mr. Worsley) made the point that so often it is much cheaper to try to help persons in their homes or before they are in need of full medical help and attention. He also raised the question of priorities. Will this new system deal with the priorities correctly? He was somewhat pessimistic. I think we are taking one step forward; at least one group of people will be dealing with all the problems. In this way we are likely to get better priorities than we have had in the past.
There are deficiencies. I am sorry to see that further provision is not to be made for local authorities to expand the services. Paragraph 74 of the Seebohm Report made it perfectly clear that on many occasions local authorities are grossly under manned in these areas and need help from the central Government. It would be well to apply the resources that we have—admittedly limited resources—to this problem at this point, because it may be the most cost-effective way of expending our money.
I would raise two points. I appreciate that both of them were subject to promises that they would be reviewed; I was glad to hear this when the Minister spoke. I am somewhat sceptical about legislating for a statutory committee in local authorities which is limited and confined—to be put into a straitjacket as to what it has to deal with.
In my own constituency we have already anticipated Seebohm—as have so many local authorities. We have a social services committee which deals with children, welfare, environmental health—which covers smoke and impure foods 1462 and such matters—and also local health services. That committee, in its present constitution, cannot continue. Indeed, as it is presently constituted, we must make special arrangements because strictly we need a separate children's committee.
Before coals of fire are heaped on poor Blackpool's head, I would point out that we have taken careful steps to get around that difficulty by designating the social work committee to be the children's committee as well. We should not have to take such steps, but this committee was set up before the Government proposals, in which the needs of the town were not considered, and it was thought that these were the things which should go into it.
Each district will have a different set of priorities and different needs. One need only look at the position of different constituencies to see the differences. Mine and that of my hon. Friend the Member for Hove (Mr. Maddan) have a preponderance of retired people. This is a familiar facet of seaside resort constituencies. Therefore, I hope that flexibility will be imported into the Bill and that we shall not be too confined as to what our social service committees can deal with.
The second point is perhaps less important, but it merits consideration. It was raised in part by the hon. Member for Birmingham, Perry Barr (Mr. Christopher Price) who thought that central Government should take the power, as Clause 6 would provide, to vet the appointment of social service directors. I can see his point, and I would deprecate the appointment simply of the medical officer of health to take over this important post, but, if our local authorities are to have an independent life and if we are to give them the trust which I think we should, we should, now rather than later, as the Minister hinted, give them the power to appoint and if necessary fire the social service director.
I appreciate the risks, and we should not close our eyes to them, but we are going shortly to much greater authorities. We shall give our new unitary authorities, however it comes out, a great deal more power. If we mean what we say and are going to give local authorities more power, we should give them the right to make their appointments instead of subjecting them to central Government control.
1463 One plea which has been made and which will be echoed throughout the country is that there should be—I believe that there will be—good co-operation between the new social service committees and the voluntary bodies. Every hon. Member who holds a fortnightly or monthly "surgery" knows the variety of problems with which he can be faced. The one over-riding impression which every hon. Member takes from his surgery is that he can give people advice which they have often had before and he cannot do much more to help in many cases. But the one thing that he can do is to give them encouragement.
This is where the voluntary bodies play a splendid and wonderful part. They can give these people more than what has been called the clerical officer's approach. Local councils often give more than this. But there is a danger. One of the great advantages of this nation, perhaps one of its unique advantages—we so often claim unique advantages that I hesitatae to do so again—is the tremendous depth within our society to which our voluntary bodies penetrate. Almost everybody can be approached by and put in contact with some voluntary body. Although we are now setting up merely the machinery to create statutory bodies which will look after great areas of our welfare services, I hope that the co-operation which has been so marked before will continue, to the great benefit of everyone who can be helped, whether by a statutory or by a voluntary body.
§ 6.55 p.m.
§ Mr. Kenneth Marks (Manchester, Gorton)
I also apologise for not being present for the opening speeches. This was not because of a lack of interest. Those of us who are interested in pensions, social security and education are attending Standing Committee in the morning, visiting schools and colleges in the afternoons and making Second Reading speeches for the second week in succession on educational or welfare matters.
Like most hon. Members, I welcome the Government's acceptance of the main proposals of the Seebohm Report. In dictating to local authorities how to set up their committees, the Government are on this tremendously difficult ground of the borderline between direction by 1464 central Government, whether in education or social services, police or anything else, and what the local authority should do itself.
In this case, as in education, they have got it about right, but what we want to see later on is local authorities with freedom in finance and other matters to build up these departments. We must face the fact that, both nationally and locally, we are attempting the impossible when we say that one department should run all the services which affect the people's welfare. We are finding it difficult nationally, with the work of the Home Office, with the tremendous links between welfare particularly children's welfare, and the future crime figures, and it will continue to be difficult locally with education and with welfare services under this head.
It has been argued that school welfare officers should have been included in the social services department rather than the education department. I can see the Government's difficulties here, because about half the population, certainly 40 per cent., under the Maud reorganisation will be living in areas where the education authority will be different from the one administering personal services. I realise that, as a Parliamentary Private Secretary, I must not stray into local government too much, but, as a former teacher and head in secondary schools, where there were many social problems, I want to talk particularly about children's welfare.
First, I pay tribute to the work of the school welfare officers and the school nurses, who do a great deal of the work in the same connection. They make the first attack on many children's problems because teachers and others who see children every day see that something is going wrong in their lives and want to know about it. The Seebohm Report said:We cannot over-emphasise our view that the role of the teacher is of prime importance. It is he or she who, seeing the child daily in class, is often the first to become aware that all is not well and notes some of the familiar symptoms of disturbance or distress ….It goes on to refer to truancy, a problem which is greatly neglected on a national level and which should be looked at a great deal more at local level. It is in absence from school that the significance 1465 of a child's problems often become obvious. In their submission to the Seebohm Committee, the education welfare officers said:The education welfare officer differs from most other officers in that instead of waiting for information to come which will take him into a difficult situation, he patrols the no-mans-land between home and school. He is as well known there as the baker, the milkman and the postman. All the time he is meeting families in every degree of disturbance and sees the children there. What is more important, he sees them in school.The education welfare officer sees the children in school and talks to the teachers. In a smaller school he talks to the head, but nowadays in bigger schools teachers are specifically trained for this job. This is why I do not worry too much about the fact that the school welfare officer will not be on the social services committee. His job is in the school, and it will become even more vital he will be the link man. As head of a school, I saw all sorts of people connected with children's problems. As well as the school welfare officer, I sometimes saw the probation officer, the children's officer and the school nurse. Here is another who will not come within the ambit of the social services committee, because her work will largely be concerned with sickness or after care, but she is another link between the school and children who will come to school later, for she sees not only children in school but the families. We also saw social workers from the child guidance centres. All these people had different geographical areas of work. One would have perhaps two school welfare officers covering the area and three psychiatric social workers. There was need for co-ordination of their work.
The Government have been right in at least including the education welfare officers. I think there is a case for child welfare generally to be joined to the education service rather than to the social services as a whole. The school provides a base with almost continual contact with the children. This may provide a better base for the department connected with children than would be the proposed new department. I think there is a case for the school itself to be used as the centre for social workers. People say that parents cannot find who to talk to at the town hall and this will be a new department, but they certainly know 1466 where the school is and they often take prolems there, many of which have nothing to do with the children but with the families themselves.
In previous discussions on educational priority areas, Ministers have spoken about family advice centres. I hope that they are not forgetting this. If we are to set up a huge new department by which everyone has to go to a town hall we must remember that some town halls are a long way from where the parents live and the system would not work. We have to have bases in the districts to which people can go to find those trained to discuss their problems and not merely to be at a desk for a period to deal with anyone who comes in. There is a need for district advice centres to be linked with the schools. Indeed they may well be in the schools and they should be linked with voluntary bodies.
Although many of my teacher colleagues and hon. Friends will not thank me for saying so, I think many schools should be used a great deal more than they are. I hope that we shall look at this aspect very seriously in future.
§ 7.5 p.m.
§ Mr. Wallace Lawler (Birmingham, Ladywood)
I join in the welcome given to the invaluable Seebohm Report and to most aspects of this Bill. In opening the debate, the Secretary of State said that one of the main purposes of the Bill was to organise services to deal with the family as a whole. The hon. Member for Manchester, Gorton (Mr. Marks) has anticipated what I want to say about the importance of the establishment within the framework of the Bill of family advice centres. This gap exists in most local authority areas, certainly in areas of large authorities such as that in which I live and which I represent.
It is of primary importance for us to give more attention to seeing that there is opportunity for families to seek the help of trained social workers before tragedies occur. I think particularly of evictions. Often the children's department may know nothing, until the physical tragedy has occurred, about a family with children being thrown on the street. When a family faces eviction, the circumstances should be reported to the social services committee weeks before it is to happen. Every step should be taken so that many social tragedies can be 1467 avoided by sensible advice being offered through the medium of the social services committee which is now envisaged.
The Seebohm Report poses the question of a mother who would prefer to look after her young children at home. It says:This is an issue which must be faced in the context of arrangements for social security benefits … No mother who would prefer to look after her young children at home should be obliged to work for lack of a reasonable minimum income.Those are sentiments which I am sure almost the entire House would agree, but they cannot be applied in the very hard practical, economic situation which exists today. One has to accept that for unforeseeable years ahead hundreds of thousands of mothers will continue to go out to work. Sometimes that is not through their own choice but through economic necessity. It becomes ever more clear as more and more of the male professions, backed up by female professions, make it known that their incomes are inadequate.
We need to look at the whole question of being able to help families to keep together. It would help if considerable relief could be given on family income tax. This should be given as of right to wives who stay at home to bring up their families. We face the situation today, and may do for many years, in which many married women will of necessity need to go out to work. Here is an untapped source. Married women are usually available part-time only, but that source would help to fill the real gap which will arise from the proposals in the Bill concerning trained social workers.
I urge die Government to remember that social workers, like teachers and nurses, come from the same limited pool. It might be as well to give the married woman who finds herself obliged to go out to work the opportunity of part-time residential training for the important posts that will become available in which, if the Bill is to succeed and if the Seebohm Committee's Report means anything, there must be the right people to serve as social workers.
There is another weakness in the Bill. The hon. Member for Plymouth, Devon-port (Dame Joan Vickers) said that good housing is the key to all happiness. How 1468 much I agree with that. Lack of good housing is directly responsible for the increased and most costly impacts we have ever known on our social services.
I should like to ask about the rôle of the proposed director of social services, and I hope that the Minister will deal with it in her reply. What is his role to be? After the social service committees have been set up, the housing committees within most local authorities will still be functioning, from the point of view not only of building houses but of all housing management functions other than the welfare visiting aspect of housing?
How far will the new director of social services be able to go when he can see that the immediate provision of a house would precipitate a new and costly social problem locally? Will he, like some housing officers of public health departments, have to make a formal recommendation to the housing manager, or to the housing committee through the housing manager? Will he have any powers to act? Will any residue of houses be put aside and made available to these important social services committees so that they can act without waiting for other local authority committees, some of which are jealous of their independence, to act on a written proposal? These are important points.
If the director will not be able to satisfy a problem family, or if any real problem will arise because of the lack of provision of a house without reference to a committee, the word "direct" means very little.
It is worth remembering that most housing managers—certainly in the large boroughs—have become laws unto themselves. Therefore, it is important at the outset that we see that there is the utmost co-operation between housing committees —which will apparently continue to enjoy their present autonomy except for one slight amendment about welfare visitors —and the proposed social services committee. I should not be disturbed if there was direct provision for a director of social services to commandeer empty property and assist a family into it. I think that he should be able to use some of the many thousands of empty properties throughout this country, both municipally and privately owned, to help reduce 1469 the social ills that arise because a family has no roof.
I recognise that the task confronting these proposed directors of social services will be monumental. We must give them power, with final reference to the Minister at national level, I presume. Multiple visiting by suitable staff on the part of so many committees within local authorities should be ended. Then a great number of suitable staff would be available for such service through the social services committee. I do not believe that there should be a tremendous expenditure on additional staff. I think that the report suggests this, too.
I also suggest that where, for some reason, supplementary benefit commissions cannot act in time, the director's department should have limited additional power to act—for instance, to be able to produce a little money on a Saturday. Saturday is usually crisis day for many families. Problems often arise on a Saturday morning which do not seem to be solved by officers of the supplementary benefits commissions.
I have come across problems where, £5 expenditure on a Saturday morning has prevented the break up of a family, with all its costly implications to the local and national authorities once the break up has occurred. One of the last cases I dealt with on a Saturday morning concerned a wife and children. The husband, a car worker, having drawn his salary on the Friday, had bolted with a blonde. This was a real problem which had to be met. A wife in desperation can often do something which she will afterwards regret, which will bring about a new set of circumstances involving her children being taken into care.
It is, therefore, important that the new committees should have emergency and additional, if limited, powers to be able to help particularly with problems which arise at weekends. I believe that these new committees could do a great deal to reduce the increasing and tragic toll of broken families that is seen again and again by those of us who frequently move about at local level.
I should like to make one other reference to a financial point which I cannot altogether understand. The Explanatory and Financial Memoran- 1470 dum, in the paragraph under "Financial Effects of the Bill", states:The expenditure of local authorities could be affected by the provisions of the Bill which create the post of director of social services or which may result in the payment of compensation to staff (including children's officers) who suffer loss of employment or loss or diminution of emoluments which is attributable to the provisions of clause 2, 3, 6 or 10. It is expected, however, that few, if any, local authority staff will be affected in this way and that the increase, if any, in expenditure of local authorities will prove to be so slight as not to be quantifiable or to affect the rate support grant payable to local authorities.I find it difficult to reconcile that reference with the remarks made by the right hon. Gentleman today. He said that there would be not only sub-areas but sub-offices with sub-departments and sub-officers. Does that mean that in a large borough there would be, in addition to the central authority, a number of district authorities? How would the new staff be paid? It will be a new and fairly heavy expenditure on the part of the local authority. However desirable many aspects of new social provisions might be, local authorities must bear in mind that they are about to inflict yet another record round of rate increases on protesting ratepayers. It ought to be made clear that if, as the Minister suggests, a fair amount of district provision is planned, careful thought should be given to the expenditure entailed. The Government should make clear how much of any new expenditure would be forthcoming from a national level.
I wish the Bill every success, subject to the reservations I have made. I hope that the local authorities will co-operate with the Government not only in setting up the new committees and social services without delay, but in making, as some authorities have, a trial run with a trial social services committee, thereby precipitating the genuine and praiseworthy intentions behind the Bill.
§ 7.21 p.m.
§ Mr. Tim Fortescue (Liverpool, Garston)
I, too, welcome the Bill, although if all county boroughs and authorities had been as progressive as Liverpool it would not have been necessary. As all hon. Members will know, Liverpool appointed the first medical officer of health in the country, divorced its social services committee from its health committee a long time ago and 1471 has a separate director of social services as is envisaged in the Bill. Once again the great city which I represent has anticipated governmental action, and I am sure that it will continue to stay in the forefront.
If Liverpool can do it, why cannot the Government? Why have three Ministers instead of one? If Liverpool can put all its social services under one director, why cannot the Government put all their social services under one Minister? This has been the theme of the debate, and I urge the hon. Gentleman to convey this to his right hon. Friend with the greatest severity and enthusiasm so that this one criticism of the Bill can be removed.
I want to raise a preliminary point about the position of welfare workers—I use the term in the fullest possible sense—who find themselves on the wrong side of the line, the side of the line on which they would prefer not to be. For instance, health visitors and occupational therapists see themselves as very much attached to the health services and find that they are to be under local authorities. These people are valuable and an essential part of welfare work. I would hate to think that any administrative action would make them unhappy.
In the other direction there are the hospital social workers, who in many cases need a base in the local social services committee. As far as I can see, they will find themselves under the local health authorities. I hope that the feelings of such workers will not be ruffled unduly and that everything possible will be done to meet their point of view so that they do not feel that they are being ridden over roughshod.
The hon. Member for Manchester, Gorton (Mr. Marks), who is not present now, mentioned difficulties sometimes experienced in finding a place for someone in need of welfare care. He pointed out that under the proposed reorganisation of local government the town hall will often be a very remote place—that is, a long way away. He welcomed, as I do, the proposal that there should be district committees.
There will be another extremely valuable aspect of such district committees if they have district centres from which to work. If those centres could somehow 1472 be combined with the offices of the Department of Health and Social Security and possibly also with the employment exchanges, we could bring into care and into welfare a lot of people who at the moment will not go to employment exchanges or to the offices of the Department, thinking that there is some stigma attached to it. If there was one building to which it was perfectly proper to go—it is perfectly proper to go to the other places, of course, but a lot of people do not go because they feel that there is this stigma—there would not be that difficulty. I see this trouble in my constituency, and I am sure that many hon. Members see it in theirs.
My main point is to do with finance, which is not spelled out in the Bill, and about which very little is said in the Green Paper. This is the most important aspect of all. I want to take a particular example and say why I think that an opportunity has been missed in the Bill. It is general knowledge that in the National Health Service hospitals more than half the beds—it is a remarkable figure—are occupied by geriatric patients or mentally disturbed or mentally ill patients. Many of these people went to hospital when they need to: not all did; some went because there was nowhere else to go. Now they no longer need hospitalisation but there is nowhere else for them to go because there is not sufficient accommodation in the old people's homes or community care establishments provided by the local authority. There are long waiting lists for most old people's homes and day centres. Therefore, these patients remain in hospital, at a cost in Liverpool, I believe, of £60 a week and in London, at a teaching hospital, £70 a week.
§ The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)
Perhaps the hon. Member would accept that it is not fair to use those figures, which are for acute beds, when we are talking in terms of the group of patients that he mentions, who are, by and large, long-stay patients and elderly or geriatric patients. He will find that the cost is significantly lower than the figures he has quoted.
§ Mr. Fortescue
If that is right I stand corrected but it was my impression that 1473 the cost is the cost of a hospital bed, of whatever kind.
Let me go to the other side of the story, which is that the cost of a place in an old people's home in Liverpool is about £.13 a week, very much lower. There is nothing in the Bill or in the Green Paper making provision for money to be switched from Health Service building programmes to the building of old people's homes. If this were done, the old people could be looked after by the community at a very much lower cost.
I have done some simple arithmetic and worked out that if half the geriatric patients and half the mentally unwell patients at present in hospital beds could be accommodated in old people's homes or in day care in the community, the saving to the community would be in the neighbourhood of £140 million. Capital expenditure on the hospital building programme this year will be about £100 million.
The conjunction of those two figures leads me to believe that thousands of people could be as adequately, if not better, looked after out of hospital, in homes, and at a much lower cost. If some of that £100 million could be spent instead on building old people's homes, there would be far more places available for old people, the running cost of looking after them would be much lower and, above all, many of the old people would be far happier. They would not be so institutionalised as they are in hospital; they would be in the community, able to go out when they wanted and be among people who are on their feet instead of on their backs.
We are all concerned at the greatly rising cost of the National Health Service. If, now, half the patients who are in hospital are either old or mentally unwell, it is likely that many more people in these categories will be sent to hospitals unless deliberate and urgent action is taken. I know that there are the problems of the rate support grant and coordination between the proposed local health committee and the social services committee. Until there is co-ordination between these two bodies, and until there is one man, or a small group of men, who can decide which way the money should go, I fear that the present system whereby money is wasted on sending to hospital people who neither need nor want to go 1474 to hospital will continue. With those few remarks, I welcome the Bill.
§ 7.32 p.m.
§ Mr. Frederick Silvester (Walthamstow, West)
May I continue the discussion started by my hon. Friend the Member for Liverpool, Garston (Mr. Fortescue) and say a little more about resources. My hon. Friend the Member for Hertford (Lord Balniel) said that the future plans set out in the White Paper on Public Expenditure will make for slightly less growth than the growth to which we have becom accustomed in the last five years. The figures for local authority expenditure, however, under the same plan will be higher, and I take the point that my hon. Friend has been making.
What we are doing, and what is even now envisaged, is a switch from resources currently being spent by central Administration into resources spent by local authorities. The administrative set-up which is likely to result from the Bill will accentuate that pattern. Already local authorities are under a great strain from supporting services of many kinds, and during the passage of the Bill the Government must reassure local authorities that the financial resources they will need to meet the requirements of the Bill will be made available to them; otherwise, the rate burden will become insufferable. The Seebohm Committe spent time not only on the administrative arrangements which are the nub of the Bill but on the need to divert more resources into this whole area.
It will be noted from the Appendix Q to the Seebohm Report that a rough estimate has been made that of 2.7 million children who were thought to be in need only about 628,000 were currently being helped by the services—so the need for expansion is enormous. This is not mentioned in the Bill, but it is crucial to its success and will have to be the subject of discussion during the passage of the Bill.
The motive power behind the Bill comes from two separate sources. One is the desire to use the resources of these services for the better convenience of the consumer; the other is the desire to build up a profession of social services, and these two aims do not always work in harmony. There is an element of conflict to which it is worth paying a little attention. The most obvious source of 1475 conflict is that, in the desire to build up a social services profession, we are of necessity limiting the autonomy of the local authorities, and we should not under-estimate the importance of this. This situation is not limited to the appointment of the director, but is also concerned, for example, with such matters as the Secretary of State forbidding the committee to deal with certain matters which are not covered in the Bill.
We have already been told by the County Councils' Association about services which will not automatically come under the committee and which will have to be referred to the Secretary of State for his approval. We are, at the early stages, giving the Secretary of State some statutory powers over local authorities so as to make sure that the local authorities provide a career structure for the social services profession, but we should not necessarily want this to continue. I accept it at the moment because it is necessary to establish a career structure, but I was glad to hear the Secretary of State say that he regarded it as a temporary matter. I hope that he will be able to estimate how temporary it will be.
The Seebohm Committee recommended that the appointment of the director of social services should be made with the approval of the Secretary of State on the first occasion, but not thereafter. Under the Bill it is possible for the Secretary of State to withhold approval time after time. That is a more strenuous control on the local authorities than was envisaged by the Seebohm Committee.
May I turn to the conflict which may arise between the desire to build up the profession and the need of the consumer. Anyone who was setting up a service would regard the needs of the consumer as paramount and the needs of the people supplying the consumer's needs as secondary. The whole basis of the Bill and of the Green Paper is to concentrate primarily on "the skill rather than on the user". Again, I accept that as something which may currently be necessary, but I doubt whether it is a sensible way of supplying services to the consumer in the long term.
There is likely to be a social content in the work of many services which are not 1476 now to be within the department. This is not a blinding flash of inspiration; it has been said by everyone. For example, health visitors as they go on their rounds may undertake tasks which they regard as being a piece of social service. We may say that they are not particularly well trained for it and so it should not be done by them. But it is wishful thinking to suppose that they will not do these jobs when they arise. There will always be minor works of social service done by such people. The Seebohm Committee recognised this and spoke of secondment. That is all right in the temporary situation, but I wonder whether it is sane in the long term to regard this as a department which is defined by the profession rather than a department which is defined by the user. I can foresee situations in which health centres in the Health Service, hospitals and schools will in the course of time, whether we want it or not, wish to have as part of their set-up somebody trained in the social services. The Bill must not prevent that happening.
§ Mr. Crossman indicated assent.
§ Mr. Silvester
I am delighted to see that the Secretary of State agrees. It is crucial to recognise that, although for professional purposes a separate department is desirable, it must be recognised that there will be a great deal of social welfare work outside that department.
§ Mr. Crossman
I could not agree more. I am delighted that the hon. Gentleman has made that point. Take a person who is a social worker now working in a hospital. In future he would work for a local authority but would be seconded to a hospital and do exactly the same job, but with a different master. It may be said that this is silly, but it is not. It is better to make them feel that they belong together, provided that the two groups work together. It is possible to defend the skill definition provided that the two parts of the service mesh together and work together. I agree that people will overlap in this manner, and they ought to do so.
§ Mr. Silvester
I am delighted to hear that, and it is obvious that the Committee stage will go swimmingly.
I should like to deal with another matter in which there may be some conflict. It arises from the desire to apply 1477 these principles universally. The one outstanding example is the situation in the I.L.E.A. in which already the education department covers a larger area than that of the social services department. Under the Maud proposals this will be duplicated in the metropolitan regions outside London.
The Seebohm Committee quoted a Social Research Unit document which dealt with this matter in London, and which I should like to read to the House:We"—that is the Social Research Unit—believe that the considerable members of children, especially those of secondary school age or at special schools, who live in one borough and attend school at another, make it essential to organise an authority-wide system of school welfare supervision and action. Otherwise there will be a very real danger that children who are recognised by school teachers as displaying difficulties in schools might not be adequately followed into their homes in other boroughs of London.It goes on to say that there is a real danger of losing the services of volunteers.
Seebohm rejected that idea on the ground that the same principles should be applied everywhere. Personally I do not think that to be necessary. One will hope to see the educational welfare officers coming within the new department eventually but in some areas of the country they could be excluded. From the point of view of an adequate career structure the department would be large enough in the I.L.E.A. to have people working within the education departments. Perhaps the right hon. Gentleman could advise the House on that matter.
There is another danger arising from this conflict which will be important in the early stages. This is the possibility of over-training. Obviously there is a desire to use skilled people and to get more of them since they are chronically short. But there are many people who do jobs without necessarily undertaking the full qualifications and who do not need to undertake them. My own local authority makes wide use of people who at one stage have undertaken either voluntary or professional work. For example, they use doctors wives and people who are prepared to undertake part-time work within the welfare department for which they do not need specialised training. This is work that must be done 1478 by somebody and may, for example, involve getting a house ready for somebody who is due to come out of hospital as a sort of first-aid. We must continue to use that sort of person and I shall be sorry if there is a tendency to insist on maximum training in all occupations.
This final point emphasises Clause 11 of the Bill as a matter of crucial importance. The working of the Bill depends on two aspects. One is that there should be enough of the right people and the resources available to undertake the work. The second is that they have sufficient confidence in themselves to be willing to allow other people to undertake other parts of their jobs. I wholeheartedly support the Bill.
§ 7.45 p.m.
§ Mr. Martin Maddan (Hove)
I should like to start by congratulating the authors of the Seebohm Report; indeed, whatever this Bill might be entitled, we should all regard it as the "Seebohm Bill", since there is that stamp of authorship and parentage.
I have a comment rather than a criticism to make of the thread which runs through the Seebohm Report—a threat that may be slightly exaggerated. It is that things need to be changed because at the moment everything is so bad. I do not think they are so bad as one might suppose from reading only the evidence of the Seebohm Report. The authors were trying to make a case for urgent and speedy action. I suppose that is excusable, but I should not like those working on the ground to think that we in this House think that they are dead failures, because that is not true.
I should like to turn to the constitutional organisation proposed under the Bill. There are several things that disturb me in the Bill. One matter involves co-option to the social services committee, which is to be permitted up to the extent of 49 per cent. There cannot be a majority, but there can be co-option up to that figure. I prefer people who are prepared to stand for election to run our affairs than those who spend their public life being quietly co-opted to committees and never having to face an electorate with a risk of failure at an election. I hope that we shall not see too many co-options. However. I should not like to rule them out altogether; but 49 per cent. co-option of 1479 members seems to me to be far too many.
§ Mr. Crossman
There was a special reason why we put that in. It was because of the importance of getting full representation by co-option of the opposite numbers on the health authority and vice versa. There seemed to be that special reason for putting the two together, and it was not thought that we had put in a rather high percentage.
§ Mr. Maddan
If I may say so, that is a good answer. I have some criticism of the health authorities, because they are appointed anyhow. However, this is not the moment to discuss them. The fact remains that I hope that we shall be able to examine this proportion in Committee.
My next constitutional point is that which many hon. Members have raised. It concerns the qualifications of the directors of social services. The Bill says that the right hon. Gentleman can issue definitions of the qualifications required and that, when he has done that, he will no longer exercise his veto powers. He said that he already had a very good idea of the qualifications which were necessary. In view of that, I hope that regulations will be made very quickly so that his veto power is extinguished simultaneously with the Bill coming into force. I notice that the right hon. Gentleman is smiling in a way which leads me to suppose that that sentiment is optimistic. Perhaps I had better pursue the point a little. Will the right hon. Gentleman permit the appointment, for example, of an assistant clerk from the clerk's department who has shown that he has sympathy with the social services department, who has proved his administrative ability and who has the confidence of the local authority? I do not see why such a person should not be appointed to the directorship of the social services department, but I rather fear that the right hon. Gentleman will not allow the local authorities that sort of autonomy.
In my view, the success of a director will come as much from his personality as from his training and background. My concern about the Secretary of State's veto is that he will not know about per- 1480 sonality but only about paper training and background, on which he will be able to check.
I think that the right hon. Gentleman has answered my next question already. I wanted to know to which Secretary of State we should address all these questions. The right hon. Gentleman said to him. We have discussed this undesirable rivalry between the Department of Health and Social Security and the Home Department, and it has been made clear that the Department of Health and Social Security is in the chair in these matters. The history of the Department, whether one has in mind the old national insurance wing or the health wing, has been one predominantly of dealing with appointed boards and committees which have virtually acted as branches of the Ministry. I do not believe that the Department has much experience in the handling of local authorities. The members of councils are elected and have a right of their own to be there. They are not appointed by a Minister. It might be a wrong solution to suggest that the Minister of Housing and Local Government should be responsible for this great enterprise, but the experience of that Ministry in understanding how local authorities work must not be overlooked in setting up and supervising the new social services departments.
One further point that I wish to make concerns the Secretary of State's guidance. We need to be told more about the kind of guidance that is envisaged and how it will be operated. "Guidance" is a word which is best understood when one has read Orwell's "Nineteen eighty-four". It is a word which does not please me. I prefer a situation in which directives are spelled out plainly, laid down and understood on both sides. Guidance always goes on behind the scenes, and it is usually backed by threats of what might be termed secondhand blackmail along the lines of, "if you do not do what we say now, you will find that it is very awkward for you later on." Furthermore, some of the powers now exercised in welfare on a permissive basis by the local authorities should be made mandatory, so that the standards of the best authorities can be enforced everywhere.
So much for the constitutional points. I come now to the medical considerations. 1481 The Bill leaves environmental health under the public health inspectors employed in local government. It must not be imagined that all health matters are under the area boards. As I understand it, the local authorities are to run the port medical authorities. Under this Bill, medical officers of health are virtually superannuated from local government, or will be very shortly, and it occurs to me to wonder to whom the port medical authorities will be responsible. Who is to run them in the absence of the medical officers of health?
In the absence of a medical officer of health in a local authority there is a danger that the Seebohm welfare department will shop round for medical consultancy advice. That would be regrettable. Its members are not medical men, nor are they advised by medical men. They may get advice from peculiar sources. I hope that it will be made clear that any medical consultancy which a social services department requires should be channelled through the community medical officer.
There will be a further awkwardness owing to the absence of medical officers of health from the local authorities. At present, home helps are in very short supply, and they are not always best allocated. General practitioners certify that home helps are needed, and very often that certification may need medical scrutiny in determining priorities for the allocation of home helps. I do not know how that will be done in the absence of medical officers of health from the local authority structure.
Having said that, I acknowledge that a line has to be drawn somewhere in welfare and medical matters, otherwise we shall have one authority running everything from the national creche to prisons, and obviously that would not work. However, it does not make matters easier not to have social welfare and health under the same authority, but with one in the local government scene and the other in the proposed area health boards directly under the Ministry.
I turn now to the activities in the new departments, and I want to concentrate on two points in particular. It is a pity that the war pensioners' welfare service is not to be brought into the social services departments and that the disabled resettlement officers of the Department 1482 of Employment and Productivity also are not to be under them. I raise that point now partly in the hope that it merits some comment, and partly to give notice that it is a matter which might be examined in Committee and about which the Government could be thinking in the meantime.
But the main point I want to talk about in relation to the activities of the new departments is the question of old people. The recent Act calls on local authorities to act positively for elderly people, as they must for the handicapped, but there is the great problem of locating all these people. It is nice to think that as far as possible old people should be looked after by their family. In theory this is very good, but it is not very easy. Present marriage ages often mean that it is not so much that the children will look after the parents, as that the grandchildren will look after their grandparents.
Mobility is another problem. Apart from young people going away from their parents' neighbourhood when they marry and find jobs elsewhere, old people leave the area of their family and go to places like Blackpool or Hove, my own constituency, leaving their families behind them. This mobility of the old as well as of working generations causes great problems because of the splitting up of families.
The Medical Officer of Health in Hove has told me that three-quarters of those who die in Hove were not born even in Sussex. My intention is to see that in my old age I settle as near as I can to at least some of my children in the hope that they will look after me, because however good the Seebohm department may be it will not be as good as they could be.
One problem that the Bill and the health Green Paper will not solve has been referred to by my hon. Friend the Member for Liverpool, Garston (Mr. Fortescue). This is the problem of the relationship between hospitals and old people's homes. There is a policy pursued in my part of the world by the hospital board which I find very distasteful and inequitable. When an old person who cannot look after himself is discharged from a local hospital the hoard makes it a condition that the local authority shall take that person into one of its homes. This is enforced by the board's saying 1483 that it will not take from one of the, authority's homes a patient requiring hospital treatment unless the authority will take someone from the hospital into one of its homes. This is an absolutely wrong method of deciding who shall be in hospital and who shall be in a home. There may well be people on the waiting lists for a place in a home who are in worse need than some of those being discharged from hospitals. This is a very serious and bad situation.
I have seen an estimate that one in five people in residential homes should perhaps return to the community. That figure may be a slight exaggeration, but it might be possible, particularly with the development of sheltered, warden-type homes. The comparison of the cost of people remaining in the community as opposed to staying in institutions has been mentioned. I do not want to go into the figures too much, but I will have a wager with the Parliamentary Secretary that the ratio of expense is about 50 to 1 between institutional care and domiciliary help. That is the comparison of the average cost of maintaining someone in a hospital or home and maintaining him in the community. People can be maintained in the community for a year on what it costs for only one week in an institution. That must underline the point of my hon. Friend the Member for Garston.
We have also discussed housing, which is the basic social service of all. It is not only a question of the amount of housing allocated to elderly people. It is very much the type that matters. A fifth-floor flat for elderly people is very bad, because it causes them to live in isolation.
The welfare authorities' efforts to provide homes for problem families are often made difficult by the lack of co-operation of the housing authorities, which can show itself in many ways. From the social point of view it may be very important that problem families are not gathered together in a sort of ghetto but are spread about in the community, and this applies to council houses as well as others.
One also finds difficulties in co-ordination between the welfare authorities and the housing authorities in having physical adaptions made to council houses for 1484 families who are handicapped. This is not working at all well in many areas. Co-operation of second-tier housing authorities will be absolutely essential from the implementation of the Bill if the social service department is to succeed.
The whole question of delegation to second-tier authorities is difficult. It causes confusion and sharp variations between areas. In the Borough of Hove there is no sheltered warden-type accommodation at all, while in the small urban district of Portslade in my constituency there are two sets of such accommodation, with two more on the way. It cannot be right that there should be that difference.
My own party has ideas about the organisation of local government which were well debated last week. We shall have to take care that in any second-tier restructuring housing allocation is in the same tier as the welfare department.
It may be necessary for the social welfare department to designate social welfare development areas where it must concentrate a great deal of its money because the areas have particular problems of age, poverty and so on. It must be understood that resources do not have to be spread evenly over the whole area for which it is responsible, and that national resources do not have to be spread evenly over all local authority areas.
We have talked a little about cash and supplementary benefits. Certainly the position is not satisfactory, particularly with regard to the long-term chronic sick. In cases of multiple sclerosis, for instance, it is often not possible for the affected mother to feed herself and her family on the supplementary benefit level. If anyone thinks that that is exaggerating, I can tell him of two recent cases where the multiple sclerosis sufferer had to go to hospital merely to get a proper diet.
There are other cases where husbands have given up work to help their wives at home, and enlisted themselves as home helps to earn a little money. But that is a very unsatisfactory solution which destroys the self-respect and standing of the husband. Help could be given by the provision of more home helps or the allocation of cash to enable the family 1485 to make different arrangements. There are not many such cases, but where they exist the need is very real.
It has been stressed how essential voluntary work is if the whole system is to operate properly. I want to stress the need for a proper relationship between volunteers and official welfare staff. It will be most important that the official staff of the social service department feel that their dignity and status are in no way impaired by working with untrained volunteers.
One of the great encouraging signs in this country at the present time is the interest of young people in helping the elderly and the handicapped. That is very encouraging. It exists to a greater extent in this country than in many others, including socially-minded countries like those in Scandinavia. We have to harness this idealism and practical realism in our young generation. Welfare workers, quite understandably, are very keen on increasing the recognition given to them. I suppose among the oldest professions, or perhaps the oldest it is respectable to talk about, is the medical profession. Hypocrates did not start by trying to gain status for doctors. He started by trying to develop standards, and in social welfare there must be exactly the same procedure. Status will not come about because of artificial means to bolster it up. It will arise because of the standards, work and successes of the profession. We must always remember that the new service—and in saying this I am quoting a social worker—is not for the social worker but for the client.
§ 8.10 p.m.
§ Mr. Douglas Houghton (Sowerby)
I must apologise to the House for being taken away for two hours during this debate, to attend a meeting elsewhere in the House, but I heard the speeches of my right hon. Friend and the noble Lord who opened for the Opposition.
I want to take this opportunity of paying my respects to the work of the Seebohm Committee and the outcome in this Bill. Since I was the Minister originally responsible for the setting up of the Seebohm Committee, it was a strange experience as a co-ordinating Minister doing all the work and having all the responsibility for appointing the committee 1486 to find that constitutionally the committee had to be appointed by the Home Secretary and serviced by the Minister of Housing and Local Government. I shall come in a moment to what I regard as a weakness of command still left in the Bill during the transitional period.
The House will have noticed that the committee reported to four Ministers. It seems to me that those Ministers are going to have a hand in the direction of the new social service department in the local authorities; but I wonder whether, during the debate, any reference has been made to the last paragraph of the chairman's foreword. I believe this is a very serious matter. The chairman, Sir Frederic Seebohm, referred to the difficulties of a committee of this kind in functioning and doing the job well and expeditiously, bearing in mind that all the members of the committee will be busy people having other things to do who nevertheless wish to give the best of their services to voluntary work of this kind.
I notice on page 21 of the report a list of the meetings and other activities of the committee. The full committee met on 74 occasions, and 12 of the meetings extended into two days. It visited 17 local authorities in England and Wales. That is a very heavy burden for a committee to bear in the interests of social services and of the nation. I know that the arrangements for servicing this committee to begin with were not at all satisfactory, and I had a great deal to do with Sir Frederic Seebohm in the early days of his great work. I believe that he and his committee are to be applauded and congratulated for having produced such a splendid report. They did a really good job.
The Bill is not quite as good as the report. The report is very good. The Bill is pretty good. The weakness of the central command is an unsatisfactory feature of the Bill. The Secretary of State was questioned quite a lot on this in the course of his opening speech. He gave the impression that the ministerial consortium will work harmoniously with perfect understanding, that there will be no demarcation difficulties, that each Secretary of State will know his place and each one will know what directions to give, and that no confusion can possibly arise. The Secretary of State thought the 1487 imperative and urgent thing to do was to strengthen this work in the field. I agree with that, but central direction at the beginning of this new scheme ought to be equally strong.
I do not pretend to know what the difficulties are though I suspect that my right hon. Friend the Home Secretary wants to stick to his children because otherwise he will be associated with police and crime. He may feel that if he can stick to his children this will give him perhaps a more noble mission in life or a feeling of great well-being. Frankly, I do not feel that the children ought to stay in the Home Office when this new scheme comes into operation. I appreciate, none better, the difficulties of the probation service, but I believe we have the pioneering work in Scotland to guide us in this matter.
Scotland was very fortunate in that not only was it able to pioneer in this field, arising from the Kilbrandon Report, but also it had the advantage of centralised administration under my right hon. Friend the Secretary of State for Scotland, which removed any inter-departmental difficulties when introducing the new scheme of the social work department in Scotland. May I say, in passing, that I believe my right hon. Friend the Secretary of State is absolutely right to propose legislation on this report in advance of either the re-vamping of the health service or the reform of local government.
I believe it was equally right, though difficulties were made at the time, that Scotland should be allowed to go its own way before England and Wales. The Kilbrandon Report was published in April, 1964, and it seemed to me that it was intolerable that Scotland should wait on England when it had already begun its pioneering work. My admiration for Scotland grew in many respects when I was a Minister. I thought that on the whole its law was much more sensible than ours, and the degree of independence and initiative it could show when it was allowed to do so was most refreshing.
I have commented on the central command, which I hope can be looked at again. There is perhaps one feature of the new arrangements that makes the strongest appeal to me following the discovery I made in the course of going round the country looking at what was 1488 actually happening; that is, that there shall be greater association between the social side of housing and tenants, especially of local authorities. I found to my horror in one place that the children's department was unaware of families in which there were young children who were to be evicted from local authority housing. This seemed amazing, but it happened, apparently, because the housing department said that it was the landlord and the children's department had not the necessary liaison with the landlords to know when trouble might come upon families with young children. This will be a great thing.
Clause 7 refers to local authorities exercising their functions "under the general guidance" of the Secretary of State. It seems to be going against the trend to button the local authorities to the Secretary of State's apron strings on a matter like this, but I thought that we were trying to devolve responsibility and push more out from the centre. This will probably come about more noticeably with local government reform. We shall get it in sharper relief still if the Constitutional Commission considers ways of devolving from Whitehall on a bigger scale than ever before. That is a conceivable outcome of that commission's work: it was what it was asked to consider.
I suppose there is some sanction behind Clause 7. Does the Minister say, "You are not acting under my general guidance, so you must be punished."? If so, what is the punishment? Does he withhold funds and thereby throw the social services into disarray? This seems a bit sloppy in an Act of Parliament—that they shall "act under the general guidance" of Big Brother. Surely the local authorities which will have these responsibilities, especially when we have the reform of local government, will be responsible enough to carry out their duties without statutory obligations to do so under the general guidance of the Secretary of State.
It is not one Secretary of State who will guide them but four, and all sorts of mischief could arise if this celestial harmony between the Ministers concerned were disturbed at some time and the local authority played off one against another, saying, "How can I follow your guidance when I have received contrary 1489 guidance from someone else?" No, this is not a right beginning, and my right hon. Friends should sort this out and strengthen the central control of the new system.
I repeat that I believe that the Seebohm Committee has made a significant contribution to social improvement. The smallish House that we have had for this debate indicates not a lack of interest in what we are doing but perhaps a measure of exhaustion from the emotions of the last two days considering the momentous decision on whether we shall enter the Common Market. Members of Parliament are only human after all, and they must be excused sometimes for having exhausted themselves on momentous issues, but they remain keen, although, perhaps, they do not show it enough, on important measures of social reform of this kind.
§ 8.24 p.m.
§ Mr. Michael McNair-Wilson (Walthamstow, East)
I agree with the remarks of the right hon. Member for Sowerby (Mr. Houghton) about Clauses 6 and 7 of this otherwise considerable Bill. He is right to question why the Secretary of State finds it necessary, to interfere in what I like to think will be a local authority matter. It has been said that the Bill is about the machinery by which the Seebohm Report could become a reality. The Bill is shadow more than substance. It will undoubtedly make an administrative neatness where a good deal of muddle exists. But when one hears that three Ministers are to administer it, one wonders whether the neatness got lost somewhere or whether three Ministers wanted to have some part in the whole business of the social services committee.
The Bill is shadow rather than a sub-substance because, having set up the social services committee with its director, it does not meet the point made by my hon. Friend the Member for Liverpool, Garston (Mr. Fortescue), about what finance is to be made available. It says in fact that the Bill is not expected to result in any significant increase in expenditure from public funds. But what the Bill does do and what the Seebohm Report did is to recognise the social worker as a professional person.
This is a long overdue and therefore much to be rejoiced at recognition. The 1490 social worker has a place in the treatment of human beings every bit as important as the doctor. Dame Eileen Young-husband in her 1969 report said that the lack of recognition afforded to social workers in the health and welfare services was one of the main brakes on recruitment. Therefore, one must hope that the new recognition implied in the Bill will help recruitment.
The social worker is emerging as a professional person highly skilled in the science of human behaviour, whereas the doctor is recognised as a professional expert in the science of medicine. Here lies the difference, but the fact that there is a difference does not mean that both aspects are not equally important. I hope that this new recognition of the social worker will help those members of the medical profession who have hitherto looked with some suspicion on social workers as amateurs—gifted perhaps, but no more than amateurs.
On 4th July last year The Times carried a leading article which said:Frequently, there is a simply failure to appreciate the extent to which modern medicine demands that doctors work as a team, not just with other doctors and without an automatic right to the captaincy.What I think must now become the accepted pattern is a doctor and a social worker working hand in hand each appreciating that the other has a special skill and that they would be wise to accept that skill for what it is.
Therefore, I see no reason why mental health should not come under the social services committee. That seems to me perfectly reasonable. By the same token, I see no reason why the director should not be a senior social worker. I think he should.
Having said that and welcomed the Bill and the setting up of the social services departments, I want to deal with my reservations to it. They lie in how the Seebohm Report is to be implemented once this committee is in existence and the social services departments begin to function.
The Seebohm Committee talks about an integrated social services committee within the concept of community care. The report says:The first responsibility of the new departments will be to deploy existing resources more effectively, but additional resources will be needed.1491 The report then goes on to list the main resources, and says that the two main resources which will be needed are manpower and buildings.
It seems to me that without these two essential elements the Seebohm Report and the Bill will turn out to be not much more than a piece of administrative machinery. There is a belief that by setting up a social services committee and lumping all the social workers together one can create a sort of omnibus social workers and thus spread the social workers more thinly. I am suspicious of this concept, particularly when one brings it into the mental health field, because the idea that mental health can be left in the hands of untrained social workers is very far from the Seebohm Committee's idea, and unless we grasp the need that will exist, most of all the need for more social workers, we shall not achieve very much merely by moving this piece of administrative machinery.
I stress this point about mental welfare officers because I think it is important to return once more to the Younghusband Working Party of 1959 and the estimate made by Dame Eileen Young-husband when she said that to make the Mental Health Act 1959 effectively operational would require 2,200 mental welfare officers.
The table in the Seebohm Report shows that on 30th September 1966 there were 1,826 mental welfare officers and assistants—one does not know how many are fully qualified—in the field. That is a shortfall of 400 workers. Yet the figure I originally gave of 2,200 referred to 1959 and not to 1966. Again, the Seebohm Committee's Report says:Many area units covering populations of 50,000 to 100,000 will not inherit even one social worker trained and experienced in psychiatric problems.It is therefore difficult to see how without those skilled mental welfare workers we are really going to make these local authority departments successful.
Indeed, I should like to ask whether it is the intention to use any social worker who is around to do this job on the concept of the omnibus social worker or whether the Minister has some plans to boost recruitment and training. I should like the Minister to tell me what his estimate is of the requirements for mental welfare officers at this moment, 1492 bearing in mind the figures which I have given him. Would he say whether he thinks the Younghusband Working Party figure of 2,200 was too high and whether he is satisfied with the figure of 1,826 which apparently existed on 30th September 1966?
Would the Minister also tell us whether the Government have plans for recruiting more welfare workers in this field? Would he also say whether he has brought the Seebohm Report recommendations of reorganisation of social worker courses in colleges of further education and universities to the notice of the Secretary of State for Education and Science? I hope that he will agree with me that it is not enough to have social workers. What we need are qualified social workers, because quality is infinitely more important than merely counting heads.
The Seebohm concept of community care in relation to mental health envisages—this came out in the mental health debate—that the mental hospital should be a hospital for treatment and that those who can be cared for in the community should be cared for in that way. Therefore, we are thinking of two kinds of community hostels. In one the mentally handicapped—to use the Secretary of State's new phrase—will live under the care of or with a warden and other staff who will look after them. We are also thinking of the group home where the just mentally handicapped can probably live on their own and will require only the surveillance of a mental welfare officer who will visit them from time to time. Both these hostels will clearly require staff—in the one case living in, and in the other staff who visit them. Also they will require buildings. They will require, as Seebohm pointed out, considerable provision to make them successful. This will cost money.
When the Bill says that it is not envisaged that it will demand any considerable sum from public funds, it is difficult to see how the architects of the Bill believe it is going to operate. After all—and again I quote from Seebohm, because it is a warning that we should heed—mental health work requires trained social workers andthere must be no danger that neglect outside the 'hospital replaces the imaginative and 1493 skilful care now provided inside many of them.This comes directly back to the point I want to stress. Unless the hostels are properly run, all we are doing is pretending that we are giving people treatment that we are not giving and have not made proper provision to give.
Having talked about the easing of the bed space problem in mental hospitals, we must also bear in mind—again I refer to Seebohm, because it is such a thorough report that it seems that nothing has been left out—that there are probably more geriatric patients with serious mental conditions outside mental hospitals at this moment than all those in hospital. That is a circumstance we cannot allow to continue, and it must be our task to find out where these people are and get treatment to them. It is also true that the psychiatric cases and maladjusted children who are not receiving treatment are legion. We must accept that the mental health service at this moment is touching only a small percentage of the people afflicted in this way.
Therefore, it seems to me that we are going to need a considerable number of nurses, trained staff and mental welfare officers if we are to bring help to these people. All this costs money. I cannot help feeling that the Bill, which says so little about training, about the provision of buildings and about where the money is to be found while it accepts the implications of what Seebohm wants, does nothing or very little to make that great report a reality that can change the social services.
§ 8.38 p.m.
§ Mr. Edwin Brooks (Bebington)
I, too, apologise for having been detained elsewhere for much of this important debate. If I stray upon territory which has been well traversed already, I shall doubtless receive your deserved reprimand, Mr. Speaker.
I want to begin by saying how much I have enjoyed the speech of the hon. Member for Walthamstow, East (Mr. Michael McNair-Wilson), which was both constructive in its criticisms and cogent in its suggestions. Like him, I was somewhat dismayed at reading in the Preamble to the Bill that implementation is not expected to result in any significant 1494 increase in expenditure out of public funds.
When I first read the Seebohm Report, some considerable time ago now, my view was that it defined a very large range of services for which the existing provision was inadequate. There were difficulties in recruitment, in filling existing establishments, and difficulties, of course, in using rationally such scarce resources as were available to the local authorities. But to imply that by waving an administrative magic wand and simply rationalising the structure of control, however needed that is, we can somehow produce a transformation of the quality of the services provided would really be excessive euphoria.
I regard this administrative reorganisation as the preamble to improvements in the quality of the services, which, as we well know, are in many respects still grossly inadequate. This is ground which has been traversed this evening, and as the debate is now drawing towards its conclusion I would simply touch on two points concerned with the administrative reorganisation which is here postulated.
Both of these points stem from our difficulty in discussing the optimum structure for the personal social services, at a time when very large question marks hang over the future of both the health service and of local government itself. The two illustrations I have in mind will indicate some of my own curiosity and concern.
In the first place I think it was the hon. Gentleman the Member for Walthamstow, East who referred to the Seebohm Report having "covered everything". Certainly it is a report which is as massive as it is erudite but I cannot entirely share his view. As someone who has, during his time in this House, been concerned with the development of a comprehensive family planning service I looked in vain in the index of that report to find any reference whatever to this important personal service. Eventually I tracked down, in paragraph 449, a brief sentence where, right at the very end, reference was made to the 1967 Act which had empowered local health authorities to make arrangements for providing a family planning service. It concluded: "We hope these powers will be fully developed".
1495 I am subject to correction, but I can detect no further reference to this important service anywhere in the whole of the Seebohm Report. This is unfortunate because we are here dealing with a service which for 40 years or so has been provided by a charitable and voluntary organisation. It is still, in many parts of the country, that organisation's responsibility to ensure an effective service. As I have said on numerous occasions, in this House and outside, I regard the financial provision which we have made for this service over many years as lamentably inadequate. I would, in all fairness, congratulate my right hon. Friend for the energy and enthusiasm he has brought to the development of this service (I see my right hon. Friend is leaving the Chamber; I hope I am not forcing him to leave in embarrassment at this unusual praise). Despite the enthusiasm and encouragement he has brought to those working in this sphere, we have still a very great way to go.
This is where an administrative problem arises. As I understand it, under the proposals included in my right hon. Friend's Green Paper on the reorganisation of the National Health Service, family planning, which was clearly envisaged by the Seebohm Committee as remaining within the powers of local authorities, is now to be transferred, or so is the intention, to the new area health executives which will be set up and on which the local authorities will be represented in the proportion of only one-third.
It may well be there are very strong arguments—and this is not the time nor the place to pursue these—in making such a change of authority in the provision of the family planning service. The local authorities are to remain, under the Bill we are discussing, responsible for the generality of the personal social services. Clearly, if we are to take out of the local authorities the responsibility for the family planning service there are going to he problems of co-ordination between the various areas of executive decision-making.
The second query I have in mind involves the future of the education service which, as Seebohm pointed out at length, plays an enormously important part in picking up the casualties of our 1496 society. There are the problems of the under-fives; the problems of the socially-deprived areas—where one cannot separate the lack of educational opportunity from the inadequate family and parental circumstances.
There is everything to be said for bringing together under one roof responsibility for the education services and personal social services. This is spelled out on a number of occasions in the Seebohm Report, notably when dealing with the provision of social counselling, social work in schools and the problems of the educationally subnormal.
I raise this matter tonight because under the proposals for the re-structuring of local government, the new two-tier authorities in the metropolitan regions will have education en bloc transferred from the lower-tier authority to the upper-tier one; from the metropolitan district to the metropolitan region.
I understand that it is the intention in future that the metropolitan district shall subsume all the local authority functions which are discussed in the Bill, so that we shall find a two-tier structure covering a large proportion of the population under which education—presumably this will include primary and secondary education and the provision of nursery education—will be the responsibility of the metropolitan region, whereas all the other personal social services, which Seebohm and Maud point out are integrally meshed with education, will be under another authority.
There may be overwhelming reasons which led the Government to take the decision to remove from the metropolitan district the whole of the education service. However, this is contrary to the informed recommendations of the two major Commissions, Maud and Seebohm, which went into these extremely important matters.
These points are not marginal or peripheral to the problem of the optimum administrative structure for the next generation. Indeed, they are at the heart of it because it is in conurbation areas that the provision of, say, nursery school education can be a most effective therapy to combat all the inherent problems faced by children who live in such areas and particularly under social conditions of deprivation.
1497 While this division of local authority responsibility may not happen, it is worth remembering that, should it happen, it would run counter to the philosophy of both Seebohm and Maud, both of which argue for the closest possible co-ordination in this range of related social services.
These are two examples of several which could be given to show that while we may think that we are here producing a new model which is streamlined, efficient and rational in the way that the old one was not, severe problems of coordination remain between the services. There are others which I do not have the time to discuss tonight. I hope that in Committee we can go more deeply into all these matters.
Although it is inevitable that, when making a contribution at this late stage in a debate, one tends to talk about points on which one holds a critical view, in general both the Seebohm Commission and the Bill are very much on the right lines. I have no quarrel with the general concept and the Government are to be congratulated for having implemented Seebohm to a greater extent than many feared would be the case. We must give deserved praise where it is due.
If it is the Government's feeling that all this will not involve substantial extra expenditure, then I am sure that they will be proved wrong. I hope that they will be proved wrong because, if they are not, it will mean that we will not have the personal social services that this country now deserves.
§ 8.50 p.m.
§ Mr. Kenneth Baker (Acton)
I am impelled to intervene in this debate at this rather late hour because of the speech made by the hon. Member for Ealing, North (Mr. Molloy) who attacked the local authority which serves both his constituency and mine. I cannot allow his remarks to go unchallenged. I regret that he is not now in the House. He is usually a most punctilious attender in debates and speaks when the demands of the party opposite make that necessary. He did well to keep the debate going for three-quarters of a hour when hon. Members of the party opposite were absent from the Chamber attending a Committee.
I welcome this Bill, but with considerable reservations. I think it goes only half-way to the Seebohm proposals. I 1498 should like to have seen a more thoroughgoing reform of local administration than is envisaged by the Bill. I should like educational welfare to be added to the directorate of social services locally. More important, affecting my constituency and the London Borough of Ealing, I should like housing to have been added. I should like the housing manager of a local authority to be made responsible to the director of social services.
In my constituency one can almost put an equation sign between welfare and housing; welfare equals housing and housing equals welfare. In cases I get day after day and week after week, I find myself writing to the housing manager and then copying my letter to send it to the welfare manager, and vice versa. An hon. Member representing a country constituency may not have this experience, but I am sure that those who represent constituencies in the major conurbations of Birmingham and London do have this experience.
A problem which I find particular to my constituency is that of a high proportion of elderly single ladies, spinsters and widows, who are left without companions by the passage of time. Their friends and relatives have died and they are living either in houses which are too large for them or in rooms which are pathetically too small. They are in attics at the top of houses or they are down in wet, mouldy basements. These are not housing cases but welfare cases. The progressive way in which the London Borough of Ealing has handled this matter is to put the housing manager under the director of social services. This is sensible and admirable.
I regret very much that the hon. Member for Ealing, North attacked Ealing Council for doing this. Many councils throughout the country will do the same in the next five or ten years. We cannot divorce these two problems. In the London Borough of Ealing, apart from adding housing to the direct ate of social services, the council has added health. This is somewhat contentious, particularly in view of the Green Paper, because the old health service may be hived of completely into some sort of area inspeotorate.
For the time being, I see no reason why clean air, clean food and environmental health problems should not be 1499 under the director of social services. Under Clause 6(6) a local authority would not be allowed to do this. It is regrettable. The London Borough of Ealing has appointed an administrative officer to coordinate all the field work of the welfare workers. This is very necessary. It has shown in a very farsighted way that we have to back this Bill and the Seebohm Report with additional staff.
My major reservation about the Bill concerns Clauses 6 and 7 under which the Government—Whitehall and the Minister—are saying that they know best about welfare at a local level. Under Clause 6, they must approve the appointment of the director of social services. I object to that power being given to them, because if one believes in local government, if one believes that people should elect local authorities and decide about the problems in their areas, they should be allowed to appoint the director of social services. Why should his personal dossier be sent to Whitehall? Why should the personal dossier of the other people who might be considered be sent to the Ministry to look through it and put its imprimatur on it, and say, "This man we approve of, and that man we do not"? That is the responsibility of local government, and for the Ministry and the Ministers to intervene is another example of the rather fussy, governessy, interventionist approach of Socialism.
Clause 7 says bluntly thatLocal authorities shall…act under the general guidance of the Secretary of State.That is an admirable principle when it is announced in its broad philosophical concept, but how can the Secretary of State know the particular problems of Acton, Ealing, Sowerby, Cheshire, Hertfordshire, Birmingham, or Scotland? Why should such decisions be referred to Whitehall? When we have the confidence to give local government its head we should back it.
While there is to be co-ordination at a local level, while there is to be a director of social services, and while there will be one door through which our constituents can go for help at a local level, these things do not exist at a national level. The director of social services will be partly responsible to the hon. 1500 Lady and the right hon. Gentleman. He will be partly responsible to the Home Secretary and to the Secretary of State for Education and Science. He will have a divided responsibility. This is most regrettable. I believe that one should make a start by transferring responsibility for the children's department from the Home Office to the Department of Health and Social Security.
My last point reflects the point made by the hon. Member for Bebington (Mr. Brooks). It is a little deceptive of the Government to say in the Explanatory and Financial Memorandum that the Bill will not increase Government expenditure very much. There is evidence from Scotland, where Seebohm has been operating for over a year very successfully, that expenditure on these services is going up. I welcome that. This is an area in which I believe—and I am sure that my right hon. Friends on the Front Bench agree—that we can increase Government expenditure. As Seebohm pointed out, if one child welfare officer employed at £1,200 a year manages to keep two children out of care and in the family, he or she has paid for his salary in one year. That is real value for money. I hope that my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) will readily admit that this is an area where Government expenditure will increase, and where we should welcome it.
My local authority, the London Borough of Ealing, has led the way in this respect. I am glad to see that the hon. Member for Ealing, North has returned, because he now has a chance to contradict me if he wishes. The authority has anticipated Seebohm, and gone ahead of Seebohm. I believe that it is the shape of things to come that we shall have at the local level an authority, a directorate of social services, that will deal not just with children and welfare but with housing, education and, for example, midwifery, which is excluded under the Bill. Then we shall be doing a real service. I look upon this as a launching pad for the future. It provides the opportunity for immense progress and I hope that both sides of the House will appreciate this.
§ 9.0 p.m.
§ Mr. Maurice Macmillan (Farnham)
Unfortunately, in some ways, there is no maiden speaker for us to congratulate 1501 today, but I think I could congratulate the hon. Member for Ealing, North (Mr. Molloy) on his well-thought-out and careful contribution to forthcoming local government elections while he was holding the fort for hon. Members upstairs. My hon. Friend the Member for Acton (Mr. Kenneth Baker) dealt with his argument and said, rightly, that he was concerned at how much welfare was really a matter of housing. He might have added that both of us who have experience of work of general practitioners know that many health problems are also a matter of housing.
The debate, as it was bound to, covered the Bill's provisions not only in the context of the total recommendations of the Seebohm Report but also in the light of wider discussions on the organisation of the Health Service generally. Inevitably, therefore, it dealt with the omissions from the Bill, as well as with the criticisms of method.
As my noble Friend the Member for Hertford (Lord Balniel) said, this is a machinery Bill. It is tidying up, or making a start on tidying up, a little corner of a very large area of administrative confusion. One of my hon. Friends said that, in realising how much work there is still to do, we should not imply any derogatory attack on the work which is being done by the Health Service and by welfare services generally. But I do not get quite the same impression of an orderly progression to the second stage of reforming the Welfare State which the Secretary of State gave today.
Looking at the conflicting and sometimes contradictory elements in the various reports which have been put before Parliament—Green Papers, the Redcliffe-Maud Report, the White Paper—I feel more like the Walrus and the Carpenter:If seven maids with seven mopsSwept it for half a year,Do you suppose,' the Walrus said,'That they could get it clear?''I doubt it,' said the Carpenter,And shed a bitter tear.But I congratulate the Minister on at least making a start with one mop on reorganising the Welfare State for the end of this century. That is the potential importance of the Bill, that it is a beginning in bringing up to date the structure and organisation of our Welfare State.
1502 My main argument with the Bill is in its effect on these larger problems, the constraints which it may well put on the reorganisation of health envisaged in the Green Paper and of local government as envisaged in the White Paper on the Redcliffe-Maud Report, and how it may be expected to work out in practice in the light of these documents. So I look forward to the future from this machinery Bill.
There seems to have been very little quarrel tonight with the main provisions of the Bill, with the concept of unification, that there should be one committee and one director of welfare in each local authority, whatever the local authority may be. There was a feeling that perhaps it was not necessary for the committee to be statutory. I share the view of the hon. Member for Birmingham, Perry Barr (Mr. Christopher Price) that there is here an implication that when local authorities have been reformed, they can be trusted to be independent and controls can be relaxed, but that now they cannot quite be trusted.
I am a little worried about this on past precedent and on the words of the Secretary of State. "We take power", he said, "because we know what we want". That is the authentic voice of centralisation. As we know, the flexibility and delegation that are so frequently sought in theory are rather selective when put into practice. What power have local authorities now over the type of education which they provide, and over the health services, where, as proposed in the Green Paper, authority is being removed from the area health authority to the centre? This is happening again with welfare. There is this element of centralisation in all three aspects of the Government's proposals. I am not quarrelling with the principle that some things must be centralised and not everything can be delegated, but I did not, nor did hon. Members on both sides of the House, find the Secretary of State's argument wholly convincing.
I did not find the Secretary of State's argument that it was necessary to legislate now wholly convincing, but I must admit it is a very fine point whether we should go ahead now on Seebohm or wait until we can do more later on. As he said, legislating now under the 1503 Seebohm Report will remove the uncertainties which were causing morale in the welfare services to fall off. But I am a little worried that there may be increasing uncertainty adversely affecting morale in the Health Service, which will see some aspects of its work threatened without realising exactly what other powers are to be entrusted to it.
The Bill anticipates some of the other reforms by keeping the proposals flexible and by the somewhat unusual arrangements for bringing them into effect, which is necessitated by the dilemma of the Secretary of State on whether to legislate now, with all the disadvantages, or to leave it until later.
It is certain that the Bill neither claims to improve nor does improve the social services. It gives an opportunity for them to be improved and no more. The recruitment and training of the necessary manpower is not made any easier, and the Bill in no way increases the resources available for welfare. Neither does the Bill help with the difficult decisions about the allocation of resources and how they can best and most effectively be spent. My hon. Friend the Member for Chelsea (Mr. Worsley) referred to this in some detail. He made it plain that there was a major problem of allocating resources for dealing with much the same sort of difficulties that people get into in the different parts of the service, health or welfare.
My hon. Friend the Member for Liverpool, Garston (Mr. Fortescue) pointed this out in its most obvious form. It is possible to save the taxpayer and the Health Service money by taking old people out of hospital, but it may well cost the ratepayer more money in providing hostels and homes for them to go to. The Bill does nothing to help to resolve that type of problem, except that it may be easier for two rather than three committees to argue the matter—not that it seems to worry the Secretary of State.
The point has been made by one or two hon. Members that the problem of obtaining more resources and allocating them is not affected. My hon. Friend the Member for Acton pointed out that it was possible to save money by spending money and that more effective welfare 1504 in practice reduced the ultimate cost to the State. This is also true in regard to devices to keep people out of institutions which may well be not only more effective and more agreeable for the people concerned but also cheaper for the taxpayer. It is one of the consoling aspects of these difficult problems that frequently that which it is right to do is also the most economical. This is by no means the case in all aspects of government.
§ Mr. Houghton
The hon. Gentleman admitted that this was a machinery Bill. Why is he now complaining that it does not do everything else as well?
§ Mr. Macmillan
I was not complaining; I was merely saying that it did not. So much has been claimed for the Bill. It was described by the Secretary of State at the beginning of his speech as a great step forward. He said that it was stage 2 in reorganising the Welfare State. It is not. That he had dealt with the tripartite health service, when he has not. He said that his Bill had dealt with family allowances and pensions. It does not. It transferred the burden to the contributor and made it very difficult to run private pension services. He said that this Bill dealt with the local authority services and the local authority handling of children. It does not. I am pointing out that what has been said to have happened has not happened.
§ Mr. Crossman
I did not say that the Bill did all these things. I said that the Bill was one of the four things we were doing, and the three others were described in the words attributed to me.
§ Mr. Macmillan
I am glad we agree that the Bill does not do it. I am willing to admit that the right hon. Gentleman did not claim that it did it. He merely said that the local authority services in the welfare group and the local authority services in handling children were the subject matter of the Bill and that the Bill dealt with that problem. I was trying to point out that it was the forerunner of the way of dealing with it and provided a background for dealing with it, as the hon. Member for Bebington, (Mr. Brooks), among others, said.
It is implicit in the discussions on the Green Paper, as much as in the debate 1505 on the Bill, that many people, especially old people, are still having to move from health to welfare and back again. This is behind the anxieties of medical officers of health, health visitors and others who have been in touch with me about this Bill. We all know the reasons and the dilemma about unification. We all agree that health and welfare should so far as possible be unified. But the difficulty is that one cannot take welfare away from local authorities and transfer it to health and one cannot put health matters under local authorities without arousing a great deal of feeling in different parts of the country and among the various professions. This is the reason behind the flexibility described in Clause 3(1).
One of my hon. Friends expressed doubts about the Departments' capacity to act in this connection as supervisory rather than controlling bodies. This flexibility leaves the door ajar for Redcliffe-Maud. It is possible for the Green Paper and the reforms suggested in the White Paper to come either from this Bill putting health under the local authorities or b" separating off the welfare function from the local authorities and merging it with the health function. Either is possible under the arrangement suggested in Clause 3(1).
The composition suggested by the Green Paper admits of this sort of merger eventually taking place, although the manner in which it would happen would have to depend on the final form of local government, whether the health and welfare function was delegated to a committee representing local government and the professions, instead of merely delegating health to a committee which was so representative.
I wish to make one suggestion. Either in the Bill at a later stage or perhaps later on still in a circular, the Secretary of State should lay down some ideas for mutual support between health and welfare in certain specified instances, notably that of old people, and take precautions to see that the divisions which some people fear will be exacerbated by the Bill do not occur in the handling of children and the handling of old people when it comes to hospital beds, hostels, old peoples' homes, housing and the support services, all of which were mentioned by my hon. Friend the Member for Chelsea.
1506 Some anxiety has been expressed about training, which is dealt with in Clause 11. I am not sure what the Secretary of State meant when he referred to training for services outside the local authorities and how it is to tie in with existing training organisations such as that for the training of health visitors. My hon. Friend the Member for Plymouth, Devonport (Dame Joan Vickers) rightly expressed the hope that this would not involve people who had given good service and were effective being dismissed simply because they did not have the necessary diplomas. On the other hand, another of my hon. Friends made the equally valid point that training in social work should be as much the concern of colleges of further education as it was of other training institutions.
I turn now to those parts of the Seebohm Report which are not taken up in the Bill. First, there is education welfare and child training. My noble Friend the Member for Hertford referred to the success that the clinical teams working in child guidance have. Having a slightly partisan health view, I wondered whether the use of the word "clinical" implied that ultimately they should come under the health or welfare aspect of this work.
I understand from the explanation given by the Government that these aspects of the Seebohm Report are awaiting the ideas and decisions of local authorities so that they may or may not be eventually incorporated in the new welfare committees according to how matters work out in practice. It seems that frequently matters are left flexible when it is difficult to reach a decision and taken away from the decision of local authorities when the Government are certain about what they want to do.
Other obvious omissions from the Seebohm Committee's recommendations are those affecting the Government. It is a charming and delightful thought that on one matter in the Bill all right hon. and hon. Members who have taken part in the debate, with the exception of the Government Front Bench, have been unanimously agreed that it was a curious anomaly that Whitehall should have health and welfare under one Minister when they are not to be unified at county hall or at town hall, and, contrariwise, that where welfare now comes under one department at county hall and town hall, 1507 it should not do so at Whitehall. This is a curious anomaly. I referred earlier to Tweedledum and Tweedledee. I remind the Secretary of State that when the storm came they both had to get under the same umbrella. I think that he will find that necessity later.
The Secretary of State argued that the time to make this merger was later when it was clear how matters were developing in this sphere. I do not agree. I remind him of the old proverb that a fish starts stinking from the head. I think it is equally true that when an organisation has to be reformed, the reform should start at the top, not at the periphery. This shows a certain inconsistency of approach which is by no means absent from other aspects of the dealings with health, welfare and social security.
I will give a few examples. We have accepted that the Zuckerman Report requires that scientists in the hospital service should be paid the market rate, but not nurses. We have accepted that there should be one Secretary of State that was admittedly a Tory suggestion originally— but the Green Paper on health and the Seebohm Report still avoid the issue of unifying health and welfare lower down. When it comes to Redcliffe-Maud and the White Paper on Local Government, there is nothing about central control. There is confusion in the Green Paper. Is what is now regional policy to go back to the central Government?
The most serious failure in the Bill is shown in the delegation arrangements, mostly in Schedule 2. The Government's Press hand-out as to what this means states:The Bill also proposes changes to the arrangements under the Local Government Act, 1958, under which 30 county district councils exercise certain health and welfare functions by delegation from county councils. There are no corresponding provisions for delegation of children's services, and the purpose of this provision is to ensure that responsibility for the main personal social services is concentrated under one authority in each area. Those delegated functions which are social service functions as defined in the Bill will, in the period to be prescribed by Ministers, be resumed by the county councils, and no further schemes of delegation will be made.I imagine that "resumed" means that the new unitary authorities will take over 1508 the present functions which are delegated, and that the phrase "no further schemes" means that when the new unitary authorities start operating they will not be able to delegate their welfare functions. But the Green Paper on health implies that area health authorities are too big for real local contact and knowledge. That is why the district committees have been suggested. Surely, welfare is at least as personal to the consumer as health. So there is also a strong implication that the unitary authorities are too big for welfare.
A point which was developed by my hon. Friend the Member for Waltham-stow, East (Mr. Michael McNair-Wilson) and, to some extent, by another hon. Gentleman was that we have here an authority which requires some kind of non-statutory district committee, whether in health or in welfare. I believe I am right in saying that the Secretary of State referred to such a non-statutory district committee. So there is a danger that this Bill in helping to remove one set of barriers may, especially in conjunction with other measures not yet decided, start laying the foundations of another set of barriers.
I see the difficulty which the right hon. Gentleman has to meet. I believe that much of it stems from this piecemeal approach to the problem, which could distort the whole pattern of the future. Perhaps the initial difficulty comes from the fact that the Redcliffe-Maud Report dealt so specifically and in such detail with local government before the Royal Commission on the structure of Government and Parliament generally—the Commission on the Constitution. This seemed to me a cardinal error which is likely to prevent a really radical approach and to produce distortion.
We say we want decentralisation in our local government, especially in health and welfare, and yet in the Green Paper on health we get an area which is too big for contact and too small for the planning function and, as a result of the rather phoney district committees, a resumption of power by the centre. softened by the equally "phoney" regional councils. Why do we have it in the Green Paper? Largely, because we want to keep the health area the same as the local government area, and yet it 1509 seems probable that the local government area is itself rather large for proper contact on the welfare side with the people who need it most; so health is forced into a unitary authority mould with the same defects for health and welfare.
The result could be, and it is very important we should recognise it and take steps to prevent it in practice, to perpetuate this division between health and welfare in a structure which prevents either being handled in a satisfactory unit, because both really need a two-tier system; and we have not faced the problem of fitting a two-tier health or welfare system into a single-tier local government system.
I do not believe that the problem is by any means insoluble, especially if it is looked at in the context of both health and welfare being controlled by committees which are under the ultimate control of local authorities but which are not wholly made up from them and include representation by the professions involved. I should be out of order to seek to discuss this matter, even if there were time to do so, but I hope that in winding up the Minister will show clearly that this division between health and welfare has been taken into account and that it is recognised that this Bill in itself does nothing to solve the difficulty; and perhaps he will be good enough to give the House some idea of where we may hope to go from here. But we do accept that in this Bill the Secretary of State has put forward a platform from which, I hope, it will be possible to advance.
§ 9.30 p.m.
§ The Minister of State, Home Office (Mrs. Shirley Williams)
May I begin by echoing the many praises that have been heaped upon the Seebohm Committee and upon the very great assistance that has been given both by the medical profession and the social workers to those of us who have been concerned with trying to construct the Government's Bill. I am very pleased that my right hon. Friend the Member for Sowerby (Mr. Houghton) is present because as he said, and we recognise what an important thing he set in train, he was the Minister responsible at the time that the Seebohm Committee was set up. While paying very deserved tribute to those who have been involved in the discussions may I 1510 say that the division of opinion between the medical profession and the social workers over the Bill and what should go into it stemmed from two honourable reasons. One was the depth of their commitment to the services in which they work and the second was their very praiseworthy desire to seek more work not less. I would like to put on record the gratitude that the whole House feels, certainly my right hon. Friend and I feel, for their very great assistance and help in the consultations about this Bill.
Let me turn now to what were the four main points that gained general support in the House. First was the principle upon which the division was made by my right hon. Friend. This is the principle that stems from the main skills required for the functions of respectively social work and medicine. This has been the principle which, broadly, has been accepted this evening. The second thing that has been broadly accepted, indeed it is striking how little criticism there has been of it, is the need for a statutory committee. One or two speakers, interestingly enough from either side of the House, cast a little doubt upon this. It is worth pointing out that those of us who have studied Seebohm see quite clearly that what emerges from the report is the requirement for a statutory committee to reunify the fragmented social services.
With respect to my hon. Friend the Member for Birmingham, Perry Barr (Mr. Chirstopher Price), he had, perhaps one illogicality in his otherwise very logical speech, when he began by pointing out the problems that some of the London boroughs have faced in moving in a contra-Seebohm direction and ended up by saying that he was not sure that we needed statutory committees. Perhaps that spells out the very reason why we do.
Thirdly, there was broad agreement upon the timing of the Bill. It has not been easy to get the timing right because of the interdependent matters with which the reorganisation of the health service, the reorganisation of local government and the Seebohm Bill have been concerned. I believe that what has been understood by many people who have spoken has been first that it was important to talk about social services in advance of the upheaval that is bound, 1511 necessarily to be a concomitant of the reorganisation of local government and to try to settle at least this one element of reorganisation in advance. Secondly, there has been the recognition by many that had one area of the country, London, been enabled to go ahead on its own the effects on the staffing and the spread of trained social workers throughout the country might have been such as to thrust back the social services in some parts for a long time.
Fourthly, there has been agreement on the scope of the Bill, that is to say on the general view that the timing under which the reorganisation should take place should as far as possible be early and as far as possible general. Although the Bill allows for some exceptions, it is important to underline that these are exceptions and there should not be many. They will also mean that the authorities which insist upon asking to be exceptions must weigh in the balance the effect on their recruitment policies if they do so without very good reasons.
Having said that, may I follow what was said by the hon. Member for Hertford (Lord Balniel) in the less controversial part of his speech—and this part of my speech is to be equally non-controversial. He had some interesting things to say about the type of burden being put on the community social services, that is the social services at local level, as a result of some of the developments that most of us find encouraging, but which undoubtedly place a strain on personal social services.
These are such developments as trying to keep for as long as possible elderly people out of institutions and within the community. There are developments that flow from the attempt to try to make the stay of the mentally ill in hospital as short as possible and the recognition that their return to the community is part of the business of rehabilitation. There is a great responsibility on the community for such groups. In this I would agree with some of the remarks of the hon. Member for Walthamstow, East (Mr. Michael McNair-Wilson) who indicated the growing demands that young people place on the service. This is both because of the regrettable rise of drug addiction in the last decade in this country and also again because we want as far as possible 1512 to avoid the institutionalisation of young people. So this problem of avoiding institutionalisation throws unquestionable burdens upon the personal social services which they will have to meet in the next few years—and which this House wants them to meet—but they will unquestionably he greater than ever before.
I turn to some of the points of a more controversial nature. In doing so, I should like to say a word to the hon. Member for Acton (Mr. Kenneth Baker), and I am only sorry that he is not in the House when I make these few answering remarks to some of his points. I thought that he made a brave attempt to straddle the Seebohm Committee Report, the Bill and his commendable loyalty to his constituency, and in particular to his local borough. But I am afraid that this is a straddling which is impossible, because the Seebohm Report says clearly that it does not believe that the health and social services responsibilities should be joined together, as they have been in Ealing, and the Committee does not believe that housing should be brought in with the personal social services, for reasons which it made clear, although it indicated that there should be wider responsibility for housing committees. As much as I respect his efforts, I do not think that the hon. Member for Acton can make the two things add up in the way that he wanted them to.
If I may say so—and I am bound to do so—there could be few examples further away from the spirit of Seebohm than the reorganisation which Ealing has undertaken in that part of London.
§ Mr. Molloy
On both sides of the House, we agree that most of the problems which we have been discussing are caused by bad housing. Ealing has slashed back its housing programme and at the same time it has cut down on its welfare services. In short, it has substituted Scrooge for compassion.
§ Mrs. Williams
I shall not follow my hon. Friend the Member for Ealing, North (Mr. Molloy) in that because, important as the Borough of Ealing is, it has perhaps had its fair share of the debate.
I turn to the appointment of directors and the new committees of personal social services.
§ Mr. R. W. Brown rose——
§ Mr. Brown
No. When my hon. Friend refers to the burden on authorities, I am at a loss to understand why the Common Council is permitted to be a separate authority because it houses its people in my constituency and not in the City of London. Therefore, the burden of welfare services is on the Borough of Islington, and why has the Common Council not been joined with the Borough of Islington so that its rates can contribute to the welfare services?
§ Mrs. Williams
My hon. Friend can be a little mischievous and I shall be a little more careful about giving way in future.
Let me make it absolutely clear right away that the veto power which has been objected to by some people—that is the requirement for Ministerial approval—is of course very specifically recommended in paragraph 636 of the Seebohm Report which says:We are all agreed that local authorities should seek the best advice available in selecting the heads of their new departments and that they should be required to consult the responsible Minister about the composition of the short list and to take account of any observations he may make before making the appointment.Therefore I should perhaps suggest to hon Gentleman opposite that their attempts to saddle my right hon. Friend with an excessively governessy attitude towards local councils simply will not do because it is quite clear that this was one of the essential conclusions of the Seebohm Report itself.
I was asked to say a little more about my right hon. Friend's desire, which he made clear in his speech, to get away from personal investigation of people who are put forward as possible candidates for the job to general qualifications. He is anxious as soon as possible to formulate qualifications so that he can give up this duty, but the reason he cannot do so immediately is because—and the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) made a fair point about this—at present some of the outstanding figures in this work are not formally qualified and cannot be because of the very slow build-up of training 30 or 40 years ago, and it would be wrong to lay down quali- 1514 fications such as would make their possible appointment impossible. This is something we do not want to do for the best possible reasons.
The formula in the Bill dealing with the remuneration of the new directors is exactly similar to that which applies to other chief officers of local authorities. It would neither be proper nor in line with precedent for Parliament to endeavour to lay down precisely the remuneration of these officers. I am mildly surprised that some hon. Members who are in favour of greater independence of local authorities should have asked us to do so.
I come now to the question of delegation schemes and the delegation of powers. I did not completely follow the objection of the hon. Member for Farnham (Mr. Maurice Macmillan) on this score. One cannot reunify and give responsibility for personal social services to a single local authority committee under a single director unless one starts by taking back delegated powers, and the delegated powers that would have to be taken back are those of the county district councils. This is part, of course, of the local authority unitary area concept and is essentially part of resting responsibility where it belongs.
Clause 4(2) makes it clear that it is open to any local authority as it wishes to delegate to a sub-committee, just as other local authority sub-committees can have delegated responsibilities from the full committee. In this respect, it would be possible for a local authority to match precisely the district committees proposed in the Green Paper on the Health Services in order to create the unity that the hon. Member seems to have believed has escaped us. Contrary to what he said, there is precise symmetry in this, with the area health authority paralleling the unitary authority with its responsibilities for dealing with the social services and the disrict committee paralleling any sub-committee which the local authority may care to establish. I hope that the hon. Gentleman will forgive me if I do not follow his strictures on that point.
A number of hon. Members argued strongly in favour of there being a general power, and I understand their feeling on the matter. The Government are not dogmatically opposed to doing so but there are difficulties which may or may 1515 not be considered overwhelming. The powers given to the local authority personal social services department in he Bill are very sweeping. I will give the list since I do not think that it has yet been given to the House in the debate.
The list includes the day care of children under 5, regulation of child-minders and nurseries, the care of unsupported mothers, adult training centres and sheltered workshops, residential care of elderly people, residential care of mentally handicapped or mentally ill people not requiring full medical cover, the welfare of the elderly, the establishment of new homes for children, the establishment of children's homes for young children, the continuation of child care and local authority adoption schemes, the service of home helps, the supervision of children found in need of care and protection under the Children and Young Persons Act, 1969, the care of the disabled, the care of the physically handicapped and, in addition, of course, the whole of family case work as we understand the present responsibilities of local health and welfare departments.
If, beyond all that, Parliament wishes to add a general power, that general power can only be meaningful if it carries with it all sorts of careful divisions which show where that power does and does not tread on to the existing statutory power of the central Government. In short, the powers given already are so great to attempt to establish a general power would require with it a whole set of provisions, indicating where that general power would overlap, and therefore cannot be allowed to overlap, with powers in the field of education, housing, social security and so on.
The parallel with Scotland does not hold, the reason being that the Scottish reorganisation carried with it the addition of certain functions which this Bill does not deal with; in particular, the giving of powers over probation and aftercare to the reorganised Scottish committees and therefore the Bill was, unlike this, a Bill that went into function and not only machinery.
§ Mr. Gilbert Longden (Hertfordshire, South-West)
Is the hon. Lady going to say anything, as she is peculiarly qualified to do, about the position of education welfare officers?
§ Mrs. Williams
I did not regard the hon. Gentleman the Member for Hertfordshire, South-West (Mr. Longden) as being impatient, but I will shortly satisfy his request after I have dealt with another paragraph.
The other paragraph concerns the question of training. I am a little sorry the debate did not concentrate rather more on this crucial aspect. Those who said the debate was purely concerned with machinery and not at all with resources had not looked closely enough at Clause 11. Clause 11 brings about a very substantial and important change in the training of social workers. It brings them first of all under the heading of the same council—the new Central Council for Training in Social Work. It gives this Council the power to set professional qualifications and the responsibility for courses in this sphere. It will mean—as implied by that Clause—the establishment of common training schemes in order to provide as quickly as possible an increase in the number of trained staff. A number of speakers, not least the hon. Member for Birmingham, Lady-wood (Mr. Lawler), pointed this out as a crucial element in the success of this new legislation.
It also covers Scotland and Northern Ireland and therefore goes wider than the rest of the Bill. It also covers probation and after-care workers and in this respect also goes wider than the personal social services at the present time. It is worth underlining the importance of this change in the field of training and the capacity it gives my right hon. Friend to increase training to the level that will be required by the additional responsibilities.
I was very interested in a point made by my hon. Friend the Member for Southampton, Test (Mr. R. C. Mitchell) who suggested we should look closely at colleges of education as a possible source of training for social workers. I do not think I need tell him I had, in my previous incarnation in the Department of Education, very considerable sympathy with the idea of widening out the largely monotechnical state of these institutions —but, in saying that, I must point out I am not committing the Government.
I would turn to three points raised on specific issues on which there has been a fair amount of misunderstanding. One was a plea made by a number of hon. 1517 Members that the housing social service should go under the new personal social services committee. Social services given by housing committees are an anomaly and are outwith the advice given by successive Governments. In 1959, the Central Housing Advisory Committee made it absolutely clear housing committees should not seek to duplicate the social work and social advice given appropriately by other committees within local authorities, specifically by health and welfare committees. That advice has been repeated and will be repeated again. This is an issue which affects only a very small number of local authorities. It is not therefore thought by us to be suitable to be brought within legislation. The advice repeated on more than one occasion to both this Government and to its predecessor, when the noble Lord was a member of it, is quite clear.
§ Mr. Lawler
While it is agreed that this advice has been given and has been frequently repeated, is the hon. Lady aware that it has been just as frequently disregarded? Why does she think that it will not continue to be disregarded in future?
§ Mrs. Williams
The hon. Gentleman will appreciate that this represents, nationally speaking, a small number of committees and that there may be more effective ways of dealing with this problem, than by legislation.
The subject of educational welfare was raised by a number of hon. Members, including the hon. Lady the Member for Plymouth, Devonport, my hon. Friend the Member for Perry Barr and my hon. Friend the Member for Manchester, Gorton (Mr. Marks). The problems relating to educational welfare arise from the fact that certain statutory responsibilities are laid down in the Education Acts in respect of school attendance, and this is one responsibility which falls on educational welfare officers.
They have, especially in recent years, developed in the direction of taking on more and more child case work, so to speak. This has been an excellent development in many respects for the reasons given by my hon. Friend the Member for Gorton, such as the close inter-relationship that now exists between the school and the family; the school know a good deal about the problems that children face.
1518 We are open-minded about the possibility of this case work among children coming under the direction of the director of the social services. As soon as the Bill becomes law, a local authority can be made responsible for this element in educational welfare. That can happen without it being made mandatory. After all, we could not mandatorily switch the whole of this sphere to the personal social services without enormous difficulties arising; for example, about the statutory requirements in regard to child attendance.
There will be discussions between the bodies concerned, the local authorities and the professional bodies, about the handover and the distribution of responsibility for this element, with which Parliament is concerned, as is obvious from the comments that have been made on the educational welfare side.
In connection with child guidance, I merely wish to say that there is a good deal of sympathy in my mind with the remarks of the hon. Lady the Member for Devonport. Child guidance is, by its nature, a teamwork activity ranging through the hospitals, the education service and the personal social services. It would be one of the hardest types of service to divorce according to some administrative formula. This is one of those spheres which cannot be tidied lip without, in the end, making it difficult to establish the kind of liaison that is necessary.
The question of Ministerial responsibility created considerable excitement in the House. Speaking for what is obviously the less favoured Department in the eyes of the House—my right hon. Friend did rather better than I in terms of popularity votes—we have a great deal of pride in the Home Office for the achievements of the children's service.
In the last 10 years or so this service has changed greatly. It has an extremely proud record. Its activities over the years have not represented a type of perverse empire building. It all goes far deeper. This service has a sense of tradition, but there is more to it than that. Wherever one makes a division, that division is bound to be artificial. My right hon. Friend pointed out that, in the long run, it may be sensible to have a solution based on putting this service under a 1519 single department, but I point to a difficulty which arises now. It is the problem which arises from the passage of the Children and Young Persons Act last year. The Act attempts to ensure that for as long as possible children who have committed some offence which brings them before the court shall be looked after under the general heading of the children's service. As the hon. Member for Blackpool, North (Mr. Miscampbell) pointed out, it is to delay as long as possible the passage of these children through the normal procedures of the courts and as far as possible to arrange that that shall never occur.
It is this division which is not an easy one between the courts and the probation service on the one side and the children's service on the other which is an artificial division that cuts across human need as much as the division which the House dislikes between the children's services and the rest of child welfare and child care. There is not an easy division. I do not believe it is possible to establish one. I only plead, as did my right hon. Friend, that we should be given time to see how the new organisation works and then look at it in the light of the best ministerial arrangements.
Without any doubt at all we would wish to be judged on the results of the ministerial arrangements which have been made and in particular on the joint committee which has been established. If at any stage the House has reason to feel that the machinery is not working well, that will be for the House to judge, but I ask that the House should not prejudge the situation. I also ask that it should recognise that an attempt to put all the social services under one head —disablement, resettlement, unemployment benefit, housing and education—would be too much even for the broad shoulders of my right hon. Friend, energetic Minister though he be. This was advocated by some hon. Members in suggesting that housing committees should be brought into the social services.
§ Lord Balniel
I would not dream of quarrelling with the hon. Lady's pride in the welfare services, but the Seebohm Report says, and it was repeated con- 1520 tinuously, that there is no use in altering the organisation of local level unless there is a similar reorganisation in Whitehall. We agree with that view and every hon. Member who has spoken in this debate has taken that view. I hope that the hon. Lady will consider it very carefully indeed.
§ Mrs. Williams
The noble Lord perhaps knows the answer that he will get, that reorganisation has taken place and we shall see how it works. We believe it will work well.
My final point concerns the noble Lord, Adroit and charming as he is he suggested, and this was part of the financial adroitness, that in some curious way the effects of this Bill which are said to be slight suggested that the Government are not particularly concerned about the social services. This Bill is not the proper vehicle for increases in expenditure, as he well knows, but for changes in machinery. The part which concerns the financial business of the Bill concerns only those matters which relate to the salaries of the directors of the personal social services.
If that is the horse which the noble Lord wants to run, I shall quote a few figures. Expenditure on the health and welfare services from 1964–65 to 1969 nearly doubled from £80 million to £147 million. The number of mentally disturbed under local authority care hag increased from 153,000 to 185,000 as a result of the extension of local authority care. The number of residents in hostels for the mentally disordered has jumped from 3,500 to more than double, 7,300. The hon. Member for Walhamstow, East (Mr. Michael McNair-Wilson) should take note of that because he was particularly concerned about this question. The number of child care officers has increased from 1,868 when the Conservatives left office, to 3,222 at present. This is the real measure of our concern. The noble Lord knows that it is not by this Bill but by our activities over the whole range that our achievements should be measured.
§ Question put and agreed to
§ Bill accordingly read a second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).