COMMUNITY HEALTH COUNCILS (Hansard, 12 June 1973)

§ Mr. Alison
I beg to move Amendment No. 17, in page 10, line 34, leave out 'appointment of a chairman of a' and insert 'election by members of a Council of a chairman of the'. The effect of the amendment is to secure that the chairman of a community health council is elected by the members of that council.

§ Mr. Arthur Blenkinsop (South Shields)
I beg to move Amendment No. 18, in page 10, line 37, at end insert: 1422 '(provided that no regulations made in pursuance of this paragraph shall permit the staff, premises or expenses of councils to be provided by or shared with any Area Health Authority)'. I feel a certain chill wind blowing through the Chamber both physically and, I suspect, intellectually. We on this side have clearly expressed our dislike of the community health councils. We do not think that they are an adequate means by which public opinion should be expressed about the health service, but still we battle on in a manful way to try to get modest amendments made, to make the Bill less disagreeable and to improve its provisions.
So this modest amendment is brought back before the House at this disgraceful hour of the morning because we were so dissatisfied with the treatment afforded to the proposal in Committee. When this issue was discussed the Minister seemed to make the case that our amendment was attempting to limit the ability of the new councils to appoint such staff as they wished because there was this limitation included in the amendment. If the Minister had made it clear that he was willing to agree to write in his own amendment giving full power to the councils to choose their own staff, premises and so on, none would have been happier than we, but he did not. I put down amendments that would have achieved that object, but they were not selected, so we cannot discuss them. If the Secretary of State would say that he is willing to substitute the same proposals, even with a manuscript amendment, giving the new community health councils authority to choose their own staff and premises, we should be very pleased.
2.15 a.m.
This is a much more modest proposal that merely tries to avoid the major disadvantage under which it would be possible that the staff and premises might be those of the area health authority, in which case we believe there would be a complete loss of any real sense of independence. This is very much the view of the local authorities. I have had a further communication from them in which they repeat that they very much dislike the present provisions. They would prefer to see local authority staff premises used. They particularly dislike 1423 the proposal that the body that is to be, as it were, investigated might provide the staff.
I have heard not only from the Association of Municipal Corporations but from the National Council of Social Service, which confirmed the same anxieties about the present provisions and asked for an amendment.
I do not understand why the Secretary of State cannot accept the amendment or comparable provisions bringing the position somewhat nearer to our view. We regret that after the discussions in Committee he has not made any proposals of his own on Report. We should have understood if he had made definite proposals himself, but he has not. I hope that even at this stage he will agree to the modest provision that we propose, which would go some way to meet not only our anxieties but those vigorously expressed by the local authorities and such a body as the National Council of Social Service.

§ Mr. Mayhew
My hon. Friend the Member for South Shields (Mr. Blenkinsop) was very right to move the amendment and to show the concern that is widely felt at the balance of power between community health councils and the area health authority. Many of us have felt this for a long time, but today I feel a new concern, having learnt of the Secretary of State's intention not to call for nominations for the community health councils until next April. I did not realise the implications before. Is this so? Is it the right hon. Gentleman's intention that the area health authority and the regional health authority should begin operations without any community health council to check them? For how long are we to have area and regional health authorities operating without any kind of accountability or watchdog function or democratic control?
It behoves us to press amendments of this kind in efforts to make more powerful the position of the community health councils. I do not know whether it is the intention of my hon. Friend the Member for South Shields to press the amendment to a Division, but we should have from the right hon. Gentleman an explanation and a reassurance that he does not propose to launch the area and 1424 regional health authorities without any form of watchdog or democratic supervision.

§ Sir K. Joseph
The hon. Member for South Shields (Mr. Blenkinsop) has invited me to go over ground extensively covered in Committee. The substance is that the Government and the Opposition believe that community health councils should make their own decisions on staff and, subject to what I am going to say, on premises. I do not see that as limiting their freedom of decision. It makes sense that they should be allowed to consider the staff offered to them by the regional authorities; if they do not like that staff, they will say so. It also makes sense that they should consider the premises offered by the authorities; if they do not like those premises, they will say so.

§ Mr. Blenkinsop
If the right lion. Gentleman takes that view, why does he not put down an amendment to specify precisely that?

§ Sir K. Joseph
Because this sort of thing is spelt out in regulations and I am asserting that that is our intention. I am also asserting that we think that the right staff should be culled or chosen from people who are in the NHS as a career. That will normally be the position because the community health councils will be best served by people who know their way around the NHS, understand the statistics and can make effective use of the information necessary to the community health councils and their decisions.
We assert, and I repeat, that the community health councils will be able to say "We do not want that person but someone else." The same will be true of premises. From time to time, a council will no doubt choose to share premises with an area health authority because that is more sensible. I do not see why we should take away the freedom of the councils to make up their own minds. We share the desire to see the community health councils independent within this framework.
The hon. Member for Woolwich, East (Mr. Mayhew) is right that our date for having community health councils in operation will be 1st April 1974. But, unlike the regions and the areas, we do not have to have them in operation in 1425 shadow form or in substantial form long before in order to prepare the management of the new service. They will be called into action when the new service begins. I hope the hon. Gentleman is reassured.
I hope that the hon. Member for South Shields will not press the amendment. If he does, I must ask my right hon. and hon. Friends to reject it.

§ Mr. Pavitt
The right hon. Gentleman's explanation is totally unsatisfactory. He knows the argument well. The amendment seeks to set up a watch-dog, not a kept poodle. The amendment aims to get the whole organisation from under the control of either area or regional authority. Without the assurance of this amendment we have no guarantee that the regulations will contain what we seek.
In the Grey Book it has been made plain that officers of the community health council will be a part of the career structure within the area health authority. Full-time officials serving community health councils will, if they are looking for promotion, be reluctant to get at cross purposes with the area or region. This is the point of the amendment. We have to keep officers, premises and so on independent of those over whom they are supposed to be watching. This is the only way they can effectively perform the function which the right hon. Gentleman envisages. The right hon. Gentleman ought to assure us that when he frames his regulations he will have second thoughts and include this guarantee.

§ Sir K. Joseph
I undertake that in the regulations, when they are made, I will seek to embody the assurance I have given to the House. I cannot go further.

§ Mr. Mayhew
I beg to move Amendment No. 19, in page 11, line 29, leave out 'and'.

§ Mr. Deputy Speaker (Mr. E. L. Mallalieu)
With this we can also discuss Amendment No. 20.

§ Mr. Mayhew
These amendments would prevent overlapping of membership between community health councils on the one hand and regional and area health authorities over which they are supposed to he watch-dogs on the other. 1426 It is self-evidently sensible, and I challenge even the Secretary of State or the Under-Secretary, who are well known for their ingenuity in these matters, to find good reason for not accepting the amendments.

§ Sir K. Joseph
The hon. Gentleman has almost stimulated me to find a reason for rejecting the amendments. Such is the spirit of co-operation at this hour that I will tell the House that it was the Government's intention to do exactly as the hon. Gentleman suggests in regulations. It would make sense to accept the amendments.

§ Mr. Alison
I beg to move Amendment No. 21, in page 11, line 38, at end insert: '(5A) The Secretary of State may by regulations— (a) provide for the establishment of a body—

(i) to advise Councils with respect to the performance of their functions and to assist Councils in the performance of their functions, and

(ii) to perform such other functions as may be prescribed; and

(b) make provision as to the membership, proceedings, staff, premises and expenses of the said body; and the Secretary of State may pay to members of the said body such travelling and other allowances (including compensation for loss of remunerative time) as he may determine with the consent of the Minister for the Civil Service.'. This amendment discharges the undertaking given in Committee to consider amendments moved by the right hon. Member for Deptford (Mr. John Silkin). Its effect is to give the Secretary of State power to provide by regulations for the establishment of a national body which would advise community health councils with respect to the performance of their functions, and perform such other functions as may be prescribed.
The Secretary of State will also have power to make provision as to the membership, proceedings, staff, premises, and expenses of such a body and to pay to members of the body such traveling 1427 and other allowances as he may determine with the consent of the Minister for the Civil Service.
The hon. Member for Woolwich, East (Mr. Mayhew) will recall the intervention he made in my speech during Second Reading. He suggested that a national organisation of community health councils might be a good idea. This is the end product of the germinal idea which he sowed in the minds of hon. and right hon. Members at the time.