LOCAL CONSULTATIVE COMMITTEES (Hansard, 26 July 1972)

§ Mr. David Steel
I beg to move, Amendment No. 12, in page 9, line 4, leave out 'shall' and insert 'may'.

Mr. Deputy Speaker
With this Amendment it would be convenient to consider the following Amendments:

§ Mr. Steel
The Under-Secretary moved an Amendment to leave out "may" and to insert "shall"just now, and said that it was traditional. I hope I shall not be thought to be against tradition in seeking to move the opposite.
This is purely a paving Amendment to a whole series which appears to have puzzled a number of hon. Members.
1996 12.15 a.m.
Basically, a simple point is involved in this complicated series of Amendments. As I said in the Second Reading debate, the Bill makes provision for the setting up of professional consultative committees within each area. As drafted, it suggests that the Secretary of State shall recognise particular medical consultative committees—a medical committee, a dental committee, a nurses' and midwives' committee, a pharmaceutical committee and an optical committee is suggested. In subsection (4) the Clause provides that if they want to these disciplines can get together and form a joint or omnibus committee, crossing the disciplines, and that if the Secretary of State thinks that that is a good thing he may recognise them also.
I think that that is putting it the wrong way round. If we are moving towards a comprehensive service we should discourage these harsh demarcation lines and encourage in new legislation as much cross-disciplinary consultation as possible between the different professions. I therefore suggested in the Second Reading debate that the Clause should be redrafted. I do not challenge the main intention behind it, but I believe that a multi-disciplinary consultative committee, representing the different branches of the medical profession, should be the body that the Secretary of State "shall" recognise, and that he "may" then recognise individual discipline committees set out underneath—such as a dental sub-committee of the consultative committee. It would have been better if the legislation had been framed in that way.
I ended my Second Reading speech by saying that I should be interested to hear the Secretary of State's immediate reaction. I was then—and I still am—because I did not get a reaction from the Minister in his summing-up. I therefore thought it right to attempt the redrafting that I have suggested. I do not stand by the details, but quite an important principle is involved in what I have attempted to put forward. It would be an improvement if the Bill were redrafted in this way. It should still be interested to hear the Government's reaction and the defence of the way in which they have drafted the Bill.

§ Mr. Monro
I appreciate the approach of the hon. Member to this series of 1997 Amendments. I also appreciate the thinking behind them—the idea of a multi-disciplinary committee. The hon. Member explained in the Second Reading debate that this arrangement seemed to work well in the Border region, with sub-committees for medical, dental and other services within the health service.
I accept that it works well in the Borders and may work well in other areas with comparatively small populations and, therefore, small health service resources, but it seems to the Secretary of State and to me that many practical difficulties would arise in the larger health board areas where committees have to be set up by statute as a mandatory source of advice. First, it would be difficult in the larger areas to decide the right proportional representation. I know that we would get expert advice from the hon. Member on proportional representation, but it might not be so easy to get that advice from the profession.
It might be unacceptable to any of the major professions to find that the advice they had decided upon after careful consideration in a sub-committee was modified by a multi-disciplinary group before submission to the health board. It would mean a great deal of self-discipline by the professional sub-committees to accept the overall decision of a multi-disciplinary professional group, particularly if they were doctors or dentists or other closely-knit professions.
Subsection (4) does not prevent a multi-disciplinary committee being set up if those in the area so wish. I expect it to happen in the Borders and perhaps the Western Isles, Orkney and Shetland and possibly other regions. We are in no way preventing it. I agree that the Bill does not give a positive lead in this direction, because of the practical difficulties that we think over-ride the ideas the hon. Gentleman put forward. I think that when he has given thought to what I have said, particularly in relation to the larger areas, such as the West and Glasgow, he will see that, while his idea may be attractive in theory and may work well in practice in some of the smaller areas, it would not work in the bigger areas.
We have given careful thought to the hon. Gentleman's view, but I cannot accept it. Perhaps on reflection he might be prepared to withdraw the Amendment.

§ Mr. David Steel
I recognise that there is always a danger in arguing from the particular to the general, and I immediately accept the Under-Secretary's point that we cannot necessarily apply to a large region arguments based on experience of something that works well in a small region. The hon. Gentleman said, in a revealing remark, that the Bill did not prevent the formation of a multi-disciplinary committee. It should go further, and encourage it. At the very least, as a traditional Scottish gesture, the hon. Gentleman might have accepted Amendment No. 19, to substitute "shall" for "may" in subsection (4), which allows for the formation of such a multi-disciplinary committee. The Bill should allow for regional variation. Where a multi-disciplinary committee is set up, the emphasis in the legislation should be that it is something the Secretary of State will regard as being of prime importance, if it is appropriate to the area, and that he will recognise it. He should not have a discretionary power to recognise it if the spirit so moves him. The emphasis in the Bill continues to be on the individual specialist committees. Perhaps in another place a minor Amendment on the lines of Amendment No. 19 might be considered. It would have been a friendly gesture if the hon. Gentleman had accepted that Amendment at this late hour.
I beg to ask leave to withdraw the Amendment.

§ Mr. Monro
I beg to move, Amendment No. 20, in page 10, line 2, at end insert ',and may appoint to any sub-committee persons who are not members of the committee'. The Amendment makes it clear that local consultative committees may appoint sub-committees which include co-opted members as well as members of the parent committee. Legal advice is that as subsection (8) is drafted co-option to sub-committees would not be possible. That is an undesirable and unintentional restriction. The main committees will undoutedly wish to co-opt persons with relevant background or experience to specialist sub-committees, such as a general practice sub-committee of the area medical committee.
1999 The BMA has been consulted, and has confirmed that the specific inclusion of the power of co-option is essential for doctors to organise their professional advisory machinery along the accepted lines.