NORTHERN IRELAND (HEALTH AND SOCIAL SERVICES)

HC Deb 31 July 1972 vol 842 cc164-87

Mr. Channon

As I was saying a few moments ago, the order deals with the reorganisation of the health and personal social services and many other matters. The reorganisation of local government in Northern Ireland also meant that a new base had to be found for the personal social services at present provided by local welfare authorities—[Interruption.]—and the draft order proposes this.

Mr. Speaker

Order. More silence, please.

Mr. Channon

Health and social services need to be planned and delivered on a co-ordinated basis and this will be facilitated by the single administrative structure. At the same time, care must be taken to protect the professional autonomy, both of the health and the personal social services, and the administrative structure will include adequate provisions to this end.

The draft order effects a radical re-organisation of services and is, I emphasise, the product of consultations and discussions over several years with the many interests concerned. Generally there is firm support for the concept of a unified service, although with so many differing interests one could hardly expect complete unanimity. There is, however, a wide measure of agreement and eagerness to have the new machinery set in motion.

Before I go into some of the details I am sure that I would be expressing the views of all hon. Members if I were at this stage to pay tribute to the doctors, nurses, ambulance drivers and all those associated with the Northern Ireland health and social services for the almost incredible work they have done, in particular over the past three years. Like so many other sections of the community they carried on working regardless of the appalling conditions, and no words of mine can express the appreciation that the country owes them for their work under the trying circumstances in which they have been placed.

Mr. James Molyneaux (Antrim, South)

My hon. Friend refers to the work of ambulance drivers, nurses and so forth. Will he bear in mind the necessity for fair and equal treatment of the various grades of ambulance and transport drivers attached to the hospitals board? Many have not been on what is known as "stand-by" duty and as a result have been deprived of special payments. I should be grateful if these pay scales could be evened out.

Mr. Channon

Perhaps I might look at the point that my hon. Friend raises. I shall write to him about it when I have had a chance to examine the situation. Certainly the work done by ambulance drivers has been remarkable.

I do not think that the House will expect a detailed account of the order and, in view of the limited time available, perhaps it will be best if I highlight those aspects of it which are of special interest. The order brings within the direct responsibility of the Ministry of Health and Social Services for Northern Ireland the hospital services, the family practioner services and the school health and other personal health services provided by the local health authorities. It also transfers to that Ministry the existing functions of local welfare authorities in terms of personal social services other than the child care and adoption services which transfer to the Ministry of Home Affairs. The provisions in Part II of the order indicate the main functions of the Ministry of Health and Social Services. Its general duty as stated in Article IV is the provision upon which everything else hangs.

Provision is made in Part III for the establishment of Health and Social Services Boards which will undertake the area administration of services on behalf of the two Ministries. For what are hoped to be good administrative reasons there will be four such boards. There will be wide-ranging consultations about appointments to the boards, and their membership will be broadly based to reflect the various interests in their areas. About 30 per cent. of the membership of each board will be nominated by the district councils in its area. About another 30 per cent. will reflect professional interests. The balance will be appointed after consultation with such interest as the universities, industry and commerce, the trade unions and voluntary organisations.

The House knows from previous debates that the new administrative structure must come into operation on 1st April, 1973, to synchronise with the dissolution of the existing local health and welfare authorities. This raises problems, in view of the fact that local government elections in Northern Ireland for the new district councils cannot be held for some months. It means that district council nominees to the Health and Social Services Boards cannot be appointed until some time later. Accordingly, paragraph 3(3) of Schedule 1 enables the majority of members of boards to be appointed as soon as possible after the making of the order and to proceed with essential actions which really cannot wait such as the advance appointment of key staff.

Generally speaking, each board will be responsible under the two Ministries for providing or securing the provision of a comprehensive range of health and personal social services in its area with the exception of certain regional specialities such as neurosurgery which can only be provided at one centre to serve Northern Ireland as a whole. They will be required to act in accordance with regulations made or directions given by the Ministries and will have to prepare schemes for the exercise of their functions. It seems likely, for example, that a board's area will be sub-divided into districts for the local management of services. The boards will appoint district officers to operate as an executive team and to be responsible to their chief officers at the board's headquarters.

Apart from the 30 per cent. membership which will be district council nominees, it is important to secure further community participation in the services and to ensure that the boards are responsive to local needs and views. Each board will be required to appoint district committees whose function will be to represent the interests of the public in their districts. Their membership is likely to include local members of the board, district councillors, representatives of voluntary organisations and other people with an interest in the health and personal social services. The district committees will not have executive powers. But they will have important consultative and advisory functions and a vital rôle in energising voluntary effort in their district.

Part IV deals with the central machinery for the new structure. The Northern Ireland Health and Social Services Council will be established to advise the two Ministries on major policy matters. It is also possible under Article 24 to enable the appointment of specialist central advisory committees for any profession or professions or for a particular service. Under this provision, committees will be appointed to replace the existing Standing Medical and Nursing Advisory Committees, and other specialist committees will be appointed as necessary, including one for the personal social services.

Another important feature of the new central machinery will be the Central Services Agency for the Health and Social Services which will be appointed to provide certain common services on behalf of the Ministry and the boards. The functions of the Agency are not detailed in the order but will be conferred by direction of the Ministry. It will provide, for example, the payments machinery for the independent contractors in the health services and will be the base for advisory appointments machinery for senior hospital medical and dental staff. The Common Services Agency to be established under the Scottish Bill is fairly similar in concept.

The essence of the new administrative structure is that there should be a single tier of authorities at area level responsible under the Ministeries for the functions of both planning and management. The creation of the Central Services Agency will in no way be a breach of this principle. It will have no authority over the management activities of the boards. Its membership is likely to be representative of the boards and of the practitioner professions.

A further central body to be established is the Staffs Council for the Health and Social Services. This Council will have functions in relation to recruitment selection, appointment and training—other than professional training—procedures for certain staff in the health and personal social services.

The reason why this order is so long, apart from these measures which I have outlined, is that it also consolidates existing legislation and it will be extremely useful because it will contain the whole legislation in this field.

Part VI of the order provides for the administration of the family practitioner services by the Health and Social Services Boards. This is very largely a re-enactment of existing legislation.

Part VII provides for co-operation between the health and personal social services authorities and various other bodies. Many instances of the need for co-operation could be adduced, but as time is so short I shall refer only to two. The Health and Social Services Boards will be responsible for the general surveillance of the health of their populations. This will include, for example, responsibility for the prevention and control of communicable diseases and for certain sea and airport health matters. On the other hand, the new district councils will be responsible for a wide range of environmental health services such as street cleansing, refuse disposal, the control of air pollution and the enforcement of food and drugs legislation. The boards and the district councils will need to enlist each other's help in these matters. The other instance of co-operation to which I would refer relates to voluntary organisations, and the Ministry of Health and Social Services would be empowered to make arrangements for the provision of services by these organisations or to give them assistance.

Part VIII, which is more controversial, defines the duty of the Ministry of Home Affairs in relation to child care and adoption services. I should mention at this point that there has been criticism by some social work interests of the dichotomy of responsibility for the personal social services as between the Ministry of Health and the Ministry of Home Affairs. This division of responsibility reflects the fact that while, in general, personal social services are closely related to health services, the child care element is linked with functions and services of the Ministry of Home Affairs, such as the courts and the probation service, arising from the legal framework within which child care is provided. I do not think that in practice this should cause immediate difficulties, since steps have been taken to ensure the necessary liaison between the two Ministries in the administration of personal social services.

It has been suggested, however, that there should be a greater measure of integration, both at departmental level and in the field, to bring under one administrative framework a fuller range of personal social services. This is certainly the trend throughout the United Kingdom, but the House will reflect that the different patterns of recent development in England, Scotland and Northern Ireland indicate that the issues are by no means clear cut, and that the extent of such integration needs to be carefully considered in relation to particular services such as probation, hospital social work and education welfare.

I have discussed this problem with my noble Friend the Joint Minister of State and the Departments concerned, and generally we intend to undertake a review which needs to be in greater depth than the timetable of the current reorganisation of local administration would permit. We intend to undertake a review, which can best be initiated when the massive task of implementing the new structure has been completed.

Meanwhile, I should stress that the new boards will be undertaking a substantial range of personal social services, and their establishment will not prejudice any greater measure of integration which may be agreed upon for the future.

I need not deal in detail with Parts IX and X, but if any hon. Members have questions I shall try to answer them. The same applies to Parts XI and XII which contain various financial, miscellaneous and administrative provisions, most of which are based on existing legislation.

I must say something, especially in the presence of my hon. Friend the Member for Antrim, South (Mr. Molyneaux) about the Special Care Service. I have met representatives of the special care committees including my hon. Friend, and they have expressed most forcefully their fears that under this order the special relationship which they have, including the close liaison between the hospitals and parents of patients, would disappear. Nothing could be further from the aim of the order. I have therefore set up a working party of representatives of the special care committees and officials of the Ministry of Health and Social Services to consider how best special care services can be administered under the area board structure set up by this order. I should emphasise that the House agreeing to this order will not inhibit discussion or implementation of the recommendations of the working party.

This is a far-reaching measure which makes fundamental changes in the organisation of the health services in Northern Ireland and, in addition, brings the personal social services within the same framework. I think the House will agree that as medical science advances and as the health and social needs of the community change, it is necessary to have an administrative structure which can quickly adapt to the changing demands and changing needs.

I believe that the proposals in the order will establish such a flexible structure. I also believe and hope that it will enable the best possible service to be provided for patients and persons in need within the resources available. As someone who has had some brief acquaintance with the services provided in Northern Ireland I have a profound admiration for the work that has gone on in these areas.

No one can quarrel with the objectives of the order. It is an urgent order because, with the reform of local government, it is essential that these duties should be regularised in time for next April. I hope, therefore, that after I have tried to answer any questions which hon. Members may wish to put to me the House will agree to approve the order so that the essential element of reorganisation can go ahead and we can, in reasonable time, provide a sensible framework with for the organisation of the health and personal social services, for that, I am sure, is the wish of all hon. Members, and it is certainly the wish of all thinking people in Northern Ireland.

10.18 p.m.

Mr. Merlyn Rees (Leeds, South)

This is a fundamental measure and yet, as I understand it, it has not been discussed at Stormont. I understand that there was a Green Paper in 1969, a consultative document in 1971—a similar pattern to that followed in this part of the United Kingdom—and that the order was debated for 22 minutes recently in another place. I do not apologise for coming back to the question, because I know that the Government are concerned about it. The order illustrates again the nature of the parliamentary problem which faces us as a result of direct rule.

A major measure which would normally have a Second Reading, a Committee stage, and so on, is being discussed for 1½ hours at this time of the night. We accept that the problem arises from the direct rule temporary provisions, but on every occasion on which this happens we must remind ourselves that if this situation is likely to go on for very much longer, certainly in the next Session both sides of the House will have to work out a proper method for dealing with this type of legislation.

The Minister explained that the order is based on the changing pattern and the integration that is taking place in the various parts of the health service. It is also based on local government reform. There is one question that I have to put to the Minister. From discussions that I have had with my colleagues who have shadow responsibilities, I have learned that there is a different system in Northern Ireland from that in Scotland and in England and Wales. It has been explained to me that area health boards in Northern Ireland will also take over the work of the local authority service; that the local authorities in Northern Ireland will not have such, let us say, important work to do as have local authorities in the rest of the United Kingdom. I should like to be given some justification for the different structure. We do not ask for the health functions in Northern Ireland slavishly to follow what is done in England and Wales and Scotland. There must be a short explanation for such differences.

The essence of the order is in the social service boards, of which there are to be four. On the other hand we recently passed an order creating five educational advisory boards. This is something similar to the position even earlier than the 1870s in this country, when there was a proliferation of education boards, highway boards, and the like which were eventually brought into the local government structure. Is it sensible to have one number of boards for education and libraries and another for health and social services? For example, the health and social service boards are responsible for the medical and dental inspection, supervision and treatment of school children, yet education will be under a different number of boards. Why has it been thought necessary to have a different number of boards?

All of us quite properly are given to saying "Hear, hear" when reference is made to the incredible work people in the health and social services are doing in Northern Ireland—the work of the ambulance men and nurses in a wartime situation. We should transfer our concern to some of the real staff problems that exist. The staff need reassurance that there will be no redundancies as a result of reorganisation but rather that career prospects will improve. Can we have that assurance?

I understand that in seeking to maintain status the Interim Staff Commission is reducing eligibility, and therefore competition for posts in the new structure. Is not this unsatisfactory? It has been put to me that the Northern Ireland section of the British Association of Social Workers has completely rejected the salary scales propesed as being too low in comparison with those in other services. I also understand that it is meeting tonight to consider the matter. Since the reorganisation will involve more responsibility all round, will not this be fairly reflected in salary scales?

As with a previous similar order, this order removes the declaration of allegiance. As the Minister will recall, we discovered on that occasion that people taking this sort of post in Northern Ireland not only had to take the oath of loyalty to the Crown but an oath of allegiance to the Government. As we have said before, it asks a litle much in this country for at least 50 per cent. of the population to take an oath of allegiance to the Government. I would not take an oath of allegiance to the right hon. Gentleman the Member for Bexley (Mr. Heath). The hon. Lady the Member for Lancaster (Mrs. Kellett-Bowman) evidently disagrees, but it really is asking a great deal. Would the hon. Lady take an oath of allegiance to my right hon. Friend the Leader of the Opposition?

Mrs. Elaine Kellett-Bowman (Lancaster)

Is it asking a lot to expect more than one of the hon. Gentleman's colleagues to be present for such an important debate? To have only two Members on the Socialist benches seems to me to express complete contempt for a very important concept.

Mr. Rees

The hon. Lady has not been present all day, when we have had a large attendance of hon. Members discussing Ireland. She is the last person who should come into the Chamber and act in that sort of silly way.

Mrs. Kellett-Bowman rose—

Mr. Rees

I shall not give way any more. On the Opposition side of the House we manage Irish affairs in a bipartisan way. Thank God the hon. Lady keeps out of Irish matters.

Mrs. Kellett-Bowman

She is not keeping out of them at present.

Mr. Rees

The order removes the declaration of allegiance. The hon. Lady's Government is removing it. We are thanking the Government for doing so. When on a previous occasion we discussed the education order, we found that the oath was being removed for officers but not for teachers. Does that mean that in dealing with health and personal social services, the oath of allegiance will affect health and social workers and that it is being removed only for officers? We ask again when the Promissory Oaths Act, 1923, will disappear.

I notice that paragraph 5(4) states: The Ministry may permit any person to whom this paragraph applies to use for the purposes of private practice, on such terms and conditions as the Ministry may determine, the facilities available at accommodation or premises provided under this Article". This is the rôle of private practice. Is the rôle of private practice greater or smaller than it is in the rest of the United Kingdom? There are limitations and disadvantages of waiting lists, bed shortages, queue jumping and so on. Does the Ministry pay the costs and pay for the consultant's time, and so on?

I notice that paragraph 7(2), concerning the prevention of illness, care and aftercare states: The Ministry may recover from persons availing themselves of any service provided by the Ministry under this Article, otherwise than in a hospital, such charges (if any) and so on.

Paragraph 8 deals with the care of mothers and young children. The charges are in respect of services. At the time when people need the service a charge is put on them. There are arguments against charges. There are charges on page 14 under the heading "Ancillary services". I do not think that in the rest of the United Kingdom there are charges for ancillary services. Are there to be any exemptions? Why is there a difference—if there is a difference—in Northern Ireland on the question of charges?

Paragraph 12 is concerned with family planning and states: The Ministry shall make arrangements, to such extent as it considers necessary, for the giving of advice on contraception, the medical examination of persons seeking advice and so on. What is meant by the phrase to such extent as it considers necessary"? Is this different from the system in the rest of the United Kingdom?

The Women's Institute in this country is in favour of a full family health service within the National Health Service, referring, as I understand it, to England and Wales. What does the order mean when dealing with family planning in the difficult context of Northern Ireland?

Paragraph 33 raises a question about amenity beds. The paragraph states: which is not for the time being needed by any patient". This is a Utopian situation. Are there beds in Northern Ireland which are for the time being not needed by patients under the health service? That is what it says. What is the situation in that respect?

On page 25 I notice that travelling expenses are paid for not only patients but for relatives visiting hospitals. Does this happen in this country? That may or may not be a good idea. But I do not believe that this is done in this country, certainly for relatives—a term which would need further definition.

I could ask many other questions. I shall understand if the Minister sees fit to write to me on a number of questions, because some of them are esoteric. There is the question of disabled persons on which my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) will no doubt wish to address you, if he succeeds in catching your eye, Mr. Deputy Speaker.

The order will go through, but we must be sure that the arrangements in the future for dealing with such legislation are better than this. The best arrangement is surely to have a Northern Ireland legislature which is supported by all the people of Northern Ireland and which can deal with such matters. Until that time comes we must use this procedure. I make no apology for raising some of the smaller issues which I have raised.

10.31 p.m.

Mr. James Molyneaux (Antrim, South)

As the hon. Member for Leeds, South (Mr. Merlyn Rees) said, this is the first example of inadequate scrutiny and discussion of a major Measure. This order was printed as a Bill just before Stormont was prorogued but it was not considered by Stormont. The order contains no sectarian issues. It is concerned solely with the modernisation of the health and welfare of the people.

Many interests are involved. The customer—the patient—must come first. Then there are the administrators—doctors, specialists, nurses, and welfare workers. All these interests must be taken into account. In the normal parliamentary processes, all these interests would have been safeguarded and their views represented and discussed at various stages of debate. In the normal course of debate, Government Amendments would have been introduced to correct obvious deficiencies. I suspect that the necessity to re-write the Bill as an order provided an opportunity to introduce such improvements.

In all fairness, I pay a sincere tribute to my hon. Friend the Minister of State and the staff of the Northern Ireland Office at Dundonald House for their patience and understanding of the genuine views put forward by interested bodies. If we have not yet succeeded in our various points, at any rate we still travel hopefully.

The most general fear is that the proposed structure will become impersonal and that many people will be estranged from the administration. My hon. Friend indicated that 30 per cent. of the personnel of the area boards will be nominated by district councils. I ask him to look at this matter again to consider whether this is a healthy balance. How will the nominations be made? There has been evidence of rushed decisions. Admittedly, very short notice was given and a short time allowed for nominations. In some cases, hurried meetings were properly convened and decisions properly made. There are other examples of nominations having been put forward sometimes by salaried officers, with very odd results.

One major matter is the protection of the interests of existing staff. These dedicated officers can be relied on to cooperate and to give of their best, but they have legitimate fears for their future, particularly those in the middle and senior grades. They are told that assurances cannot be given at present because parallel legislation is to be introduced and adopted in Great Britain. As this legislation has not been tabled and will be different, and as it will in any case not take effect until 1974, how can it be used as a precedent? In my view, the order should secure for officers of any grade a right of transfer to the new service on lines similar to those embodied in the Health Services (Northern Ireland) Act, 1948.

In fact—this is my reservation—the order appears, first, to deny statutory right of transfer to all officers; second, it gives the right to retention of existing terms and conditions of employment for so long as the Ministry deems appropriate; and third, it appears to exclude from the compensation provisions any officer who is not transferred.

Also, there are important superannuation problems. There will be a special problem for officers in the older age group who will be affected by the reorganisation and regrouping of hospital services, and in many cases they may suffer down-grading.

I am grateful to my hon. Friend for his expressed concern on the question of child care and for his assurance of deeper examination of this complicated problem. I suggest that there is need to move slowly until we see how the new arrangements in Great Britain work out in practice.

My hon. Friend the Minister of State would probably be surprised if I omitted any reference to the Special Care Service. As a member of his working party, I could not with propriety say publicly whether we agree or disagree, but as vice-chairman of a Special Care hospital management committee I may, I hope, at least state our aim. This is simply to prevent any fragmentation of the service. It is interesting that only yesterday the Mind Campaign came out clearly in favour of a unified authority for the mentally handicapped. In my view, only such a unified structure can permit the flexibility which would allow us to switch patients, staff and resources to gain the maximum advantage.

One must remember the all-important need to protect the interests of Special Care patients. Normal patients in a general hospital have their full faculties, and in any case they are there for a comparatively short time. But special care patients are particularly vulnerable and need the protection of people with real authority such as they have at the moment in the hospital management committee. There is an even clearer parallel in education: if it is considered that normal children in a school should nave the safeguard of a school management committee, how much greater is the need for protection of the interests of mentally handicapped children.

We cannot be satisfied with some form of casual visiting committee. There must be a body with real power, and a body deeply involved, including perhaps—indeed, I delete the word "perhaps"— including representatives of parents' organisations.

In the short time at our disposal, we are doing our best, within the straitjacket imposed by the Order in Council procedure. The product will not be perfect. I beg my hon. Friend the Minister of State to give an assurance that this Measure will be regarded as a broad framework within which compromises and modifications will be permitted in the course of recasting the whole structure of the health and welfare services over the coming years.

10.39 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

In comparison with the order on electoral law, this order may appear of minor consequence. In fact, however, it is one of fundamental importance. Unlike other discussions on Northern Ireland, we are concerned here much more with the munitions of peace than with the munitions of war.

The proposal to improve co-ordination of services will be widely welcomed. As the House knows, the division of responsibility for personal health and social services in England has come in for criticism. There was, for example, strong criticism of this division of responsibility at the British Medical Association's recent annual conference in Southampton. The Minister would do well to look at John Roper's report of the conference in The Times of 20th July. He will find much of value in what the medical correspondent of that newspaper had to say about the BMA's deliberations. I accept that the order is well designed to secure effective co-ordination. My principal concern is with the personal health and social services available to the long-term sick and severely disabled. There is no Northern Ireland equivalent of the Chronically Sick and Disabled Persons Act, 1970. It may be argued that the order gives powers to provide all the services for the disabled vouchsafed for the disabled in England, Scotland and Wales by the 1970 Act. The draft order is, however, so much more general than the 1970 Act that it provides nothing like the same degree of encouragement and direction. Apart from the provision of invalid vehicles under Article 30, all other services would have to be provided under the Minister's general duty under article 4(b) …to provide or secure the provision of personal social services in Northern Ireland designed to promote the social welfare of the people of Northern Ireland. This goes nowhere near resembling the force of the very specific provisions of the Chronically Sick and Disabled Persons Act, 1970. Section 1 of that Act imposes a duty on local authorities to draw up a register of the disabled. The detailed listing of what authorities must also do under the Act would inspire them significantly to improve the lives of their disabled people. I understand that the Minister has asked for papers from all Northern Ireland Departments which would have powers under the 1970 Act on provisions for the disabled. He will recall that I have already put to him a number of Parliamentary Questions on the matter. My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) also has taken a very special interest in seeking to apply all the provisions of the 1970 Act to Northern Ireland.

There is, of course, very little time tonight, and very little material, on which to base an informed assessment of the legislation. As Lord Shackleton said in the House of Lords: We ought not to pretend that we are giving it proper consideration."—[OFFICIAL REPORT, House of Lords, 27th July, 1972; Vol. 333, c. 1549.] My hon. Friend the Member for Leeds, South (Mr. Merlyn Rees) recalled that the order was debated for only 22 minutes in the House of Lords. I hope it can be said that at least the House of Commons gave rather more time to a Measure of fundamental importance to the people of Northern Ireland.

Westminster is now in direct control of the policies underlying the personal health and social services in Northern Ireland. May I take it that the Minister will not miss this opportunity to ensure that all the new provisions available to the long-term sick and severely disabled in England, Scotland and Wales will now be made available, as soon as possible, to the long-term sick and disabled in Northern Ireland? I am certain that if he can give that assurance, he will earn the gratitude of hon. Members on both sides.

10.45 p.m.

Mr. James Kilfedder (Down, North)

I echo the words of the hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) whose interest in this subject is well recognised. It is a matter of regret that little time is given to detailed discussion of the order. Indeed, it is regrettable that there is no representative of the Republican parties in the Chamber when we are discussing a Measure which is for the benefit of all people in Northern Ireland.

I intend to make only a brief intervention in order to deal with a constituency matter. There is widespread belief in my constituency that the Ards and Bangor hospitals are to be run down. It is believed that the Ards Hospital will in the long run become largely a geriatric unit. This impression has been created as a result of remarks made by representatives of the hospitals authority at a meeting in Bangor in February, 1971. However, the then Minister of Health at Stormont, in May, 1971, denied there was any truth in these rumours, and he promised that the Ards Hospital would continue as a general hospital providing a wide range of specialities. I should like an assurance from my hon. Friend that the Ards and Bangor hospitals will remain and be allowed to expand, because this is of vital importance to my constituents.

I regret that a large part of County Down has been linked with Belfast under the reorganisation. There are to be four areas in Northern Ireland. Three of them will be made up each of 250,000 people, but the Eastern Area is to be composed of Belfast and the greater part of County Down with a total population of about 750,000 people.

I accept that there are advantages in larger units. For instance, it is easier to get able people to staff the hospitals. In that sense there is justification for linking, for instance, the Ulster Hospital at Dundonald with the Ards and Bangor hospitals. But according to the North Down Area Plan, published not so long ago, my constituency is expected to have 180,000 people within a few years. The local people in North Down have grown up with their local hospitals in Newtownards and Bangor, and it would be a great pity if these two hospitals were diminished in importance as a result of the link up of part of County Down with Belfast. In my opinion, the facilities provided by these two hospitals should be expanded and allowed to grow with the growth in population which is expected in the area. The danger is very real, because in cases of emergency patients would have to be moved from County Down to a hospital in Belfast through the congested streets.

Most of the representatives on the Eastern Area Board will be Belfast-based and Belfast orientated, and I fear they will have an in-built bias against the growth of Bangor and Newtownards hospitals. I should like an assurance from my hon. Friend that this will not be allowed to happen. It must be recognised that there is a real danger of this bias operating because the Eastern Area Board will provide a whole range of medical specialisms for Northern Ireland as a whole. This will concentrate attention on the hospitals in the city of Belfast, draining attention and potential away from the remainder of the area covered by the Eastern Board.

Concern is also felt by people in my constituency who are connected with the medical profession that midwives and nurses as a profession do not appear to be included at the top management level. Can we not have the appointment of a chief administration nursing officer on the same level as the three principal officers? The nurses and midwives represent the largest single group of professional employees on the staff of the area boards, and it is essential that a suitably-qualified nurse should be appointed to the position of chief administration nursing officer. Such a person would be able to help in formulating nursing policy, which is at the very centre of the personal health side of the functions of the area board. There should also be a midwifery officer at area board level, so that the board would always have ready to hand a person it could approach about the many problems that arise in connection with the midwifery services.

That is all I wish to say now, except to emphasise once again to my hon. Friend the fear in North Down that in the long run it will suffer when the life blood of the hospital service in County Down is drained away to Belfast. This must not be allowed to happen.

10.52 p.m.

Mr. Channon

I thank the House for the reception it has been kind enough to give to the order.

I recognise the unsatisfactory nature of the parliamentary proceedings in which we are engaged. I fear that this is an inevitable feature of the present parlia- mentary situation. We are well aware of the unsatisfactory nature of the proceedings, and I note the views of the hon. Member for Leeds, South (Mr. Merlyn Rees), which he has expressed on many other occasions. He will know of the proposals of my right hon. Friend the Secretary of State, which will go some way to ease this very difficult situation. At the same time, the House is good enough to realise that in the present situation it is essential that the order should become law at an early date so that we can go ahead with creating a new structure for the area health and social service boards. Confusion next year would be very much against the best interests of people living in Northern Ireland. That is the last thing that any hon. Member wishes, and therefore I hope the House will allow the order to be passed tonight.

If I do not cover any points raised in the debate, I shall write to the hon. Members concerned about the points in question.

I can assure my hon. Friend the Member for Down, North (Mr. Kilfedder) that there is no change of mind by either the Ministry or the hospitals authority about the hospitals in the Ards and Bangor area. The statement by the former Minister of Health and Social Services still remains the policy of the Ministry of Health and Social Services. I hope that that statement will go some way towards allaying my hon. Friend's anxieties.

The hon. Member for Manchester, Wythenshawe (Mr. Alfred Morris) rightly raised the question of the Chronically Sick and Disabled Persons Act, and reminded me that he asked a Question about it some time ago, as did his hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). In answer to his hon. Friend I gave an undertaking that I would consider whether legislation in Northern Ireland on the lines of that Act was required. I have now had the chance to examine the situation, certainly in relation to the personal social services.

The powers contained in this order will enable anything to be done in Northern Ireland in relation to the personal social services referred to in the Act for which I am, temporarily at any rate, responsible. The bodies responsible for such services will be the area boards, which will be the agents of the Ministry. The difference is that the order does not make the provision of all these services mandatory in the same way as it would be elsewhere under the Act. The boards will be the Ministry's agents and will have adequate powers to provide such services, however, and what I am prepared to do is to give an assurance that I will arrange for directions to be given to any board which is unwilling to provide any service whose provision is mandatory in other parts of the United Kingdom. I believe that this will go some way towards meeting the point put by the hon. Gentleman in relation to the personal social services.

It is true that some services under the Act are not directly the responsibility in Northern Ireland of the Ministry of Health and Social Services and are not therefore covered by this order. I am in close touch with my colleagues responsible for these other Ministries to establish what the situation is and whether it is necessary to promote corresponding legislation in relation to those services. I am examining the matter at present and I am sure that the hon. Gentleman will keep on pressing me about the topic. I hope to be able to give him a firm answer on the other points in due course. But I hope I have in effect met his point about the health and personal social services even if it is being done in Northern Ireland in a slightly different way from the rest of the United Kingdom.

My hon. Friend the Member for Antrim, South (Mr. Molyneaux) rightly again raised the question of special care. I am grateful to him for serving on the working party, to whose report I am looking forward. This is not obviously the time to go into it, since it is a matter for consideration.

My hon. Friend also asked why there is to be only 30 per cent. representation of district councils on the new area boards. This was the lower figure recommended by the Macroy Committee as being within the acceptable range of local council representation. The health service is very different from the education service, where the figure is to be 40 per cent. It is generally recognised that in education there has been a much closer local connection than there has been in the case of the health and personal social services. It was felt that 30 per cent. would not be unreasonable.

Some people have argued to me that this itself is an advance in the amount of democratic representation upon area boards compared with what exists at present. But I note what my hon. Friend has said and I am grateful for his tribute to me—not deserved—and to the staff of the Ministry of Health and Social Services, which is deserved. They have done a remarkable job in getting such a wide range of agreement on all these topics, considering the diffuse and technical nature of so many of them. I thoroughly endorse my hon. Friend's tribute to them.

Mr. Merlyn Rees

Since 3.30 we have been debating proportional representation on the district councils. The question arose of how the district councils' representatives on the area boards are to be selected. As we are, as it were, crossing to the other side of the river now, could the hon. Gentleman assure us that the question of proportional representation on the senatorial rules procedure will he looked at by him, because it will be odd if we have proportional representation on district councils but not for the representation of councils on the area boards?

Mr. Channon

I will look at any suggestion the hon. Gentleman puts to me, but there are difficulties in what he proposes. On many area hoards, both health and education, some district councils will have only one representative. If that is so, I fail to see how we can direct them to proceed by the method of the senatorial system of proportional representation.

I think I am right in saying that it will be up to those district councils that have more than one representative to decide how to choose them. I should have thought that no honourable method would be closed to them, but I shall examine the question. The hon. Member will appreciate that some difficulties are involved.

The hon. Member asked me a number of questions, and I shall try to deal with most of them. First, he asked about staff. It is the intention to deal with staff in precisely the same way as in the rest of the United Kingdom. The standard transfer terms that apply throughout the United Kingdom will provide for officers to transfer to new employing authorities and to enjoy the same terms and conditions of service until they are served with a new contract of service. This will be the same throughout the whole of the United Kingdom, and if the terms were improved throughout the rest of the United Kingdom I see no reason why they should not be improved, if necessary, in Northern Ireland.

There will also be a staff commission for health and personal social services in Northern Ireland. Its terms of reference are, among other things, to advise what steps are necessary to ensure the smooth transfer of staff employed in the health and personal social services to the proposed area boards, and I very much hope that this matter will be resolved in as efficient and friendly a way as possible. It is extremely complex. The staff commission will have an important role to play. The intention is that the conditions of transfer should be the same throughout the United Kingdom. The hon. Member will probably know more than I do about the detailed proposals for Scotland.

The hon. Member also asked why there were a different number of boards for the education and the health services respectively. Having been given responsibility for both Ministries, that was the first question that I asked when I arrived in Northern Ireland and was confronted with these two massive pieces of legislation, much to my dismay. Consideration was given to the possibility of having five boards, in line with the Ministry of Education—and if I read the Macroy Report correctly it would have preferred a parallel number of boards for both services.

To create a fifth area board for health would have meant splitting up the proposed Eastern Board into two, and having a separate board for Belfast and another for North and East Down. My hon. Friend may think that that would have been a happier solution, but there would have been great difficulties. North and East Down contributes to the major Belfast hospitals not merely for regional but for all specialities, and this will continue, because the natural flow of communications from North and East Down is into Belfast. That is why it was decided to have four rather than five area boards in this case.

I shall write to the hon. Member on the question of the rate of salary of social workers when I have had a chance of examining the matter. On the question of private beds, charges, and family planning, by and large these provisions merely repeat the existing law, and in virtually all respects are consolidating. I do not think that there are any new points—but if there are I shall write to the hon. Member. On the question of charges, the situation is the same as for the rest of the United Kingdom. There are no separate rules for Northern Ireland. It is right to say that travelling expenses in Northern Ireland are more generous than in the rest of the United Kingdom. I shall give the hon. Member details of them.

I have explained in relation to other orders that my right hon. Friend felt that there were already sufficient anomalies in relation to the oath of allegiance and he did not wish to add to them. The whole question is exceedingly complex, and highly controversial. In spite of the hon. Member's persuasion I do not think that he would expect me to launch into a series of full-scale pieces of legislation in this matter, which would be highly controversial and not necessarily productive. All that my right hon. Friend is determined to do is not to increase the anomalies, and there are many in this field.

If I have not dealt with the points raised by hon. Members I will certainly write to them. I do not think, in relation to family planning, that there are significant differences from what is proposed in the Scottish Bill. I am told that they are similar to provisions in Clause 8 of that Bill, but if I am wrong, or the hon. Member has a detailed point to raise, I will write to him.

I have dealt with amenity beds charges and with travelling expenses, and with the question of the various boards.

The Macroy Report argued that certain services should be regarded as regional and vested in the Ministries; for example, water, sewerage, arid planning and things like them, and that the development of personal social services should be for the Ministry of Health and Social Services. There are 26 district councils in Northern Ireland and it was thought right that responsibility for personal social services should be vested in the Ministry of Health and Social Services who would devolve functions to the area boards.

The future structure of the Health Service is comparable with that for the rest of the United Kingdom, except that in the situation of the personal social services which is different because of the very different structure of local government proposed in Northern Ireland.

Nevertheless, as I said when I first moved the order and subsequently, what astonished me, coming afresh to the subject, was that, on so complex and difficult a matter, there should be a wide range of agreement—not total agreement on all aspects, but a measure of agreement on, the major restructuring of the personal social services.

This is a major achievement, and I am not sure how well this will be achieved in the rest of the United Kingdom. This reform of personal social services will be of benefit to people in Northern Ireland and of benefit to the further advancement of the personal social services.

In many respects Northern Ireland is ahead in this field, in administrative structure, and in many things, and we should pay tribute to that.

In the light of the discussion and of my undertaking to answer points raised, and in the interest of future progress with these services and of the people of Northern Ireland, I ask to the House to allow the draft order to be made.

Question put and agreed to.

Resolved. That the Health and Personal Social Services (Northern Ireland) Order 1972, a draft of which was laid before this House on 11th July, be approved.