HC Deb 12 June 1973 vol 857 cc1393-405

12.45 a.m.

Mr. Lamborn

I beg to move Amendment No. 131, in page 4, line 22, leave out 'and the said regions'.

Mr. Deputy-Speaker (Mr. E. L. Mallalieu)

With this amendment we can discuss the following amendments:

No. 132, in page 4, line 25, at end insert: '(2) The areas for Area Health Authorities in England shall be the same as the areas for which the local authorities are—

  1. (a) in Greater London, the Council of a London Borough (except in the case of the City of London which shall be included in the Area Health Authority for such adjoining London Borough as the Secretary of State may determine);
  2. (b) in Metropolitan Counties, the Council of the Metropolitan District Council; and
  3. (c) elsewhere the County Council'.
No. 133, in Clause 10, page 12, line 24, column 2, leave out 'each district wholly or partly' and insert 'the district'.

No. 134, in page 12, line 31, column 2, leave out 'each London borough wholly or partly' and insert 'the London borough'.

Mr. Lamborn

In putting forward two amendments earlier today—or, rather, yesterday—having special reference to the London area, I was met with the steadfast opposition of the Under-Secretary to any suggestion that London should be treated in a manner different from the rest of the country. In this amendment I am seeking to have London treated in the same way as district councils throughout the country.

The White Paper outlining the proposals for re-examining the health service stated that It is crucially important for the citizen requiring help of both the health and social services that collaboration between the two should be firmly established. This points to the need of identity between the health area and the local authority responsible for the personal social services. That is true—and it is as true and as valid for the London area as for the rest of the country.

Let us consider the proposed composition of the area health authorities in the London area. We have 16 authorities for the area covering 32 London boroughs. Four area health authorities have an area corresponding with the area of the individual London borough, eight authorities cover the area of two London boroughs, and the remaining four area health authorities each have three boroughs in their areas.

The London Boroughs Association advised me—and I have no doubt that it advised the Secretary of State—that the 32 individual boroughs in the London area have strongly represented their view that their areas should correspond with the areas of the health authorities. That would meet the Secretary of State's view that the areas of the Social Services Department and the area of the health authorities should be similar. It would also mean that the boundaries of the local medical committees, which are themselves established on the basis of the borough boundaries, would coincide with the boroughs—and, of course, if the amendment were accepted, with the area health authorities.

The only reason I have heard advanced in favour of the hotchpotch arrangement that has been conceived in the Bill is the difficulty of relating the hospital catchment areas to the borough boundaries. That situation would arise whatever boundary were established for the area health authorities, because the catchment areas of the hospitals have been built up quite independently of the boroughs. They serve a different area, and will continue to do so whether we juggle about by having one borough, or by putting two boroughs together or three boroughs together.

I want to refer to my area, where the area health authority is established to serve the boroughs of Lambeth, Lewisham and Southwark, joined together to form the area of one area health authority. Of the hospitals within it, King's College draws 85 per cent. of its patients from the area of the three boroughs, Lewisham draws 74 per cent., St. Thomas's draws 61 per cent. and Guy's draws as little as 48 per cent.

Mr. F. P. Crowder (Ruislip-Northwood)

Within the borough of Hillingdon, being Ruislip and Northwood, to what extent and in what form has representation been made?

Mr. Lamborn

I have received representations from the London Boroughs Association, which advises me, as I said earlier, that each of the boroughs has pressed within the association for the boundaries of the area health boards to be coterminous with the individual boroughs.

Mr. Mayhew

I wonder whether my hon. Friend is properly informed on that point. I am sure that my borough is happy to have a single area health authority for itself and for Bexley.

Mr. Lamborn

I can only say that my hon. Friend is misinformed. I was talking to the Chairman of the London Boroughs Association only yesterday evening. It was made clear to me that all of the 32 boroughs which the association represents wish that the boundary of the area health board should be coterminous with that of the borough.

The point that I was making earlier was that however one drew the boundary of an area health board one could not get it to coincide with the boundaries of the hospital catchment areas. The individual boroughs, however, will continue to provide the supporting social services for their areas. They will be providing for services for the same people in the same areas as they are at present, so there can be no case for departing from the principle which applies outside London. Outside London the areas of the area health boards and the borough boundaries, and those of the organisations established by general practitioners for their local medical committees, work together in unison. The hospital catchment area will continue to deal with patients from an area different from that of the area health board, however that area is established.

The constant and basic factor is the borough boundary, which is known to those in the area who know that the supporting services they will require come from that area. What is true for the rest of the country—that the collaboration between the social services and the area health boards can best be established by their operating within the same boundary—is equally true in London.

Mr. Michael Shersby (Uxbridge)

Is the hon. Gentleman speaking particularly of inner London boroughs or of outer London boroughs? I have had no representations from the London borough of Hillingdon which is the local authority encompassing my constituency of Uxbridge. We have no problems of this kind.

Mr. Lamborn

I cannot be responsible for the liaison which individual hon Members have established with the local authorities in their area. I move the amendment at the behest of the London Boroughs Association which advises me that all the London boroughs would prefer that the boundaries of the area health boards coincide with those of the individual boroughs.

Mr. Michael Barnes (Brentford and Chiswick)

Is it not the case that no representations have been made by the London borough of Hillingdon because that borough is very well satisfied with the fact, as I understand it, that it is to be a single area or borough health authority?

My borough—Hounslow—is very unhappy at the decision that it should be part of a three-borough area health authority together with Ealing and Hammersmith. Some London boroughs are very upset about this. I do not understand what the hon. and learned Member for Ruislip-Northwood (Mr. Crowder) and the hon. Member for Uxbridge (Mr. Shersby) are protesting about on behalf of their borough, because their borough has got what it wanted. I only wish mine had.

Mr. Crowder

It really will not do for the hon. Member for Southwark (Mr. Lamborn) to make a speech of the type he is making in the House if it has not been looked into carefully on behalf of the boroughs concerned. It is typical of the incompetence of the Labour Party. If there is a point to be made, let it be made firmly and squarely. To bring our borough into this—

Mr. Deputy Speaker

Order. Is this an intervention or a speech?

Mr. Crowder

As I have been asked a question, may I put it on the basis that——

Mr. John

On a point of order, Mr. Deputy Speaker. I realise that the hon. and learned Member for Ruislip-Northwood (Mr. Crowder) comes to the House infrequently, so he may be a little unfamiliar with its practices, but is it in order for him to stand at the same time as my hon. Friend the Member for Southwark (Mr. Lamborn)?

Mr. Deputy Speaker

That is not normally in order, but I had called the hon. and learned Gentleman.

Mr. Crowder

I am obliged, Mr. Deputy Speaker. It is unfair for the borough which my hon. Friend the Member for Uxbridge (Mr. Shersby) and I represent to be dragged into this argument when it has not even been consulted.

Mr. Lamborn

I repeat that I cannot be responsible for the liaison that the hon. and learned Gentleman has with his borough. What is suggested is in line with what I have told the House.

1.0 a.m.

I am advised by the London Boroughs Association that it is the view of the London boroughs that the health board boundaries should be conterminous with the boroughs. If the hon. Member's borough already has a boundary which is conterminous with the area health board that does not in any way detract from the fact that all the London boroughs want their boundaries to do the same. That is the representation that has been made to me. It was the representation made to the Secretary of State in correspondence and in meetings and it is the representation which I on behalf of the London Boroughs Association am making in respect of the Bill.

I end on the theme on which I started. There is no case for saying that London should be treated differently from the district councils outside the London area. I agree entirely with the sentiments in the White Paper that it was desirable that the areas of the individual boroughs should coincide with those of the area health boards, and I hope that the Secretary of State will consider the position and see that London is treated the same as elsewhere.

Mr. David Waddington (Nelson and Colne)

I apologise for intervening in a debate which on the face of it would appear to be of concern only to hon. Members with London constituencies. However, I could not for one moment support Amendment No. 132 because it would remove entirely the possibility of the Secretary of State deciding in a special case that there should be more than one area health authority in a non-metropolitan county. I refer, of course, to paragraph (c) of the proposed amended clause. I know that the White Paper envisaged that there should be only one area health authority in each non-metropolitan county but the Bill as drafted leaves the door wide open for the Secretary of State, if he wishes to lay an order providing that there could be even six separate area health authorities within the boundaries of a non-metropolitan county.

I want my right hon. Friend when he comes to laying orders concerning the non-metropolitan county of Lancashire to consider carefully the possibility of providing for more than one area health authority within that county. This is an important matter for North-East Lancashire. I shall not canvas all the arguments tonight because there may be another opportunity to do so. However, many representations have been made to the Secretary of State by local authorities in North-East Lancashire and by the Burnley District Hospital Management Committee. The local authorities in North-East Lancashire feel strongly that the county is too large an area to be served by one area health authority. They want local representation on the area health authority but they fear that on an area health authority of that size local interests might not be sufficiently well represented. The new Lancashire county is a very large area. It includes a population of 1.34 million.

The people in my part of the world are inclined to doubt the logic of a proposal—I refer to the proposal in the White Paper—which provides for area health authorities within the metropolitan areas covering populations of 200,000 or 300,000, whereas in the non-metropolitan county of Lancashire one area health authority would be required to serve the needs of 1.34 million people.

I will not develop the arguments further. I merely say that it would surely be wise, when all these issues of such great importance to the people outside London have been raised with the Minister, to leave the door open so that he could so provide, if, having considered the matter further, he decided that there was a case for more than one area health authority in a non-metropolitan county.

I want to see the door left open. Perhaps unwittingly the hon. Gentleman would be closing that door if he were successful in having this amendment carried.

Mr. Barnes

I support the amendments of my hon. Friend the Member for Southwark (Mr. Lamborn), which are designed to create single-borough area health authorities in London.

I should like to cite the example of my own borough, Hounslow, to show that this is the best arrangement for the London area. Under the present proposals Hounslow is to be part of a three-borough area health authority comprising Hounslow, Ealing and Hammersmith. This will be a vast area of 700,000 inhabitants, whereas Hounslow, with a population that is increasing quite quickly—it is now 206.000 and rising—meets all the criteria which the Secretary of State has laid down for single-borough area health authorities.

Let us take first the criterion of the hospital catchment area. The majority of the patients treated at the West Middlesex Hospital are residents of Hounslow, and the remaining patients will still attend the hospital no matter what area health authority boundaries apply.

The services that make up the other criteria—community nursing, social services, education services, environmental health service—are based in the London borough of Hounslow, and the new civic centre now under construction is to be within a few hundred yards of the present health centre in Hounslow. The Hounslow health centre is one of the most revolutionary centres of this kind, certainly in this country and possibly in the world. General practitioner services, local authority health and social services, a mental health day centre, child guidance clinics, dental services, and family planning services are all provided under the same roof. The centre would make an obvious and ideal headquarters for a new area health authority based on the borough.

In addition to that Hounslow health centre, there are four health centres in operation in the borough and a further two in an advanced stage of planning. Experience at them has been that the liaison between general practitioners and the local health authority has been very good and effective.

Hounslow is a very good example of why the London boroughs are very suitable to be single-borough area health authorities. Hounslow is a model health authority, and could easily become one of the new area health authorities with the minimum of change and disturbance. I believe that the same applies to every London borough. That is why I support my hon. Friend's amendments.

Mr. Marcus Worsley (Chelsea)

I hope my hon. Friend the Under-Secretary of State will resist the amendment. I could not help wondering whether the hon. Member for Southwark (Mr. Lamborn) would apply the same argument to education. I should be surprised if he wanted to dismantle the Inner London Education Authority on the same principle.

The problems of many of the social services in the London area, particularly in central London, are different in particular. It would be the height of folly to have such a rigid system whereby we could only have area health authorities and boroughs conterminous. My borough would be in a difficult position if it had to be an area health authority. It is much better grouped with its neighbour, the City of Westminster, where there are so many teaching hospitals.

Mr. Pavitt

The case for the Inner London Education Authority is a very different set of arguments from those which apply in the case of the area health authorities, and that case was accepted in 1963 by the Secretary of State for Social Services himself when he was Minister of Housing and Local Government and introduced the London Government Act. The Conservative Government of the day saw the force of the amalgamation.

I support the amendment. The Committee understood the problems and difficulties the Department has had in trying to solve the problem of boundaries and areas. What fitted in one way did not fit in another. But I regret that, in the final analysis, when the pros and cons of why there should be amalgamations in the London area for area health authorities have been considered, the predominant reason for the solution proposed in the Bill was that the right hon. Gentleman rested on the requirements of the organisation and administration of the hospital service.

The Bill is an attempt to get co-ordination between domiciliary and institutional care. That is one of its main purposes. The effort is being made to shift the present preponderance of resources from the hospital service into family service and community care. At present 67 per cent. of the total resources go to the hospitals. The amendment seeks to redress the balance.

The social services reorganisation which took place after the Seebohm recommendations caused enourmous upheaval in London. The changeover has led to a tremendous growth in most areas, particularly in Brent, my own borough, in the whole provision of social services.

The big problem which the Government have failed to solve in the Bill, and one of their greatest mistakes, is that with regard to divorcing the social services from medical care. In London this problem is becoming more acute because of the greater population and the disparities between the areas. We have had the Seebohm upheaval; now there is to he another.

At present, the director of social services and his department at the town hall or civic centre are cheek by jowl with the community physician, but now that normal kind of contact is to be taken away. It will be all right in my area, because we arc to marry Harrow, but I am afraid that Harrow will be dispossessed because it will not have the same kind of contact. There are great problems in marrying two areas with services already in existence.

1.15 a.m.

Of course the hon. and learned Member for Ruislip—Northwood (Mr. Crowder) is not worried. Hillingdon has got out OK. Incidentally, may I say how I admire the sheer insensitivity of the hon. and learned Member. Some of us have been sitting in the House since 2.30 this afternoon and he slides into that bench for a few minutes and makes an interjection which is recorded in HANSARD just like the rest of our speeches. I admire his skill but I resent it very much as one who has sat here since 2.30 p.m.

The London Boroughs Association has had all the arguments put to it and has had representations from all of the 32 boroughs, including Hillingdon. Hillingdon was in on the discussions which took place.

Of course the Under-Secretary will put forward opposing arguments, especially about the difficulty of the alignment of other responsibilities which will fall within the comprehensive administration of what was a tripartite administration. The right areas are the local government areas because it will help when the next Labour Government turns this bureaucracy into democracy. London contains 8 million people, and if we could do this at this stage it will save the next Labour Secretary of State for Social Services a lot of headaches in dealing with a large section of the population. The next stage will be that much easier.

Mr. Mayhew

I warmly support the amendment moved by my hon. Friend the Member for Southwark (Mr. Lamborn) in respect of 31 out of the 32 London boroughs. I must disagree with him about my own borough. He tells me with great conviction that my borough has made representations to the effect that the area health authority should coincide with its own boundaries. I must assume, therefore, that since I spoke about this with the town clerk and the leader of the council and since I read the minutes of the council proceedings my local authority has changed its mind.

This is the only possible explanation I can give for my hon. Friend's insistence. If this is so I can only say that I think my local authority is mistaken if it has changed its mind. The disposition of the hospitals in Bexley and Greenwich make it a convenient area health authority. In addition, we have the special problem of the new town of Thamesmead being built partly in Bexley and partly in Greenwich. I would like to see this new town under a single health authority and not divided. With great respect to my hon. Friend, I support him in respect of 31 out of the 32 boroughs.

Mr. Alison

As the House is aware, the Government attach the greatest importance to securing, where possible, that the boundaries of the new area health authorities should match those of the new social services department authorities. This would best achieve the purpose of trying to integrate on the health side the old tripartite components of the National Health Service—the GPs, the hospitals and the local authority health services, and, having integrated the health side, to secure the closest possible interface with the local authority social services departments.

The House will be encouraged to know that in the plans for implementing reorganisation the matching of health and local social services authority boundaries which the amendments seek to secure has been achieved in all but one of the areas outside London. A one-to-one match would be our uniform objective in London, the exception to the rule, if it were practical. There were a number of factors which led us to the conclusion, after the most careful and extensive consultations, that this would not be the pattern that would best enable the new authorities to discharge their responsibilities of identifying health needs, collaborating with local government services and providing facilities in support of medical education.

I take here the point made by my hon. Friend the Member for Chelsea (Mr. Worsley). There are some very special factors in London. In November last my right hon. Friend announced the proposed area boundaries for London so that joint liason committees could be established to prepare for reorganisation. The pattern, as the hon. Member for Southwark (Mr. Lamborn) reminded us, consists of 16 areas: four comprising three London boroughs, and in one case also including the City; four areas consisting of single boroughs, and a number of hon. Members have expressed appreciation that they have come within this fortunate group; and eight areas consisting of two boroughs. The provisional proposals in Appendix 1 of the Green Paper emanating from the previous administration were for different individual groupings but also contained a combination of three-borough and two-borough areas and single boroughs. The last administration found the same dilemma as we found.

This pattern of areas was designed to strike a balance between unavoidably conflicting considerations in the London context, and, taking the needs of one borough with another, to give the greatest overall advantage to the National Health Service and the local authority service. It was arrived at after the most careful study and very wide consultations. In February my right hon. Friend considered very carefully strong representations made to him by the London Boroughs Association at a conference which he attended, and in writing to him afterwards. He went thoroughly over the ground which had been covered by the London Practice Group, so called, chaired by the Minister of State, following in the footsteps of his predecessor, Baroness Serota. After considering again all the arguments, including those on behalf of the health service authorities, and representations of the local authorities and family practitioners who made suggestions for larger areas, not smaller ones, my right hon. Friend concluded that the right course was to adhere to the pattern which he announced in November.

It will, of course, be possible to adjust the boundaries in the light of experience—I hope the House appreciates this—and in the light of changing circumstances, but at the inception of the service the boundaries which my right hon. Friend announced will, we believe, best serve its needs. The clause is flexible enough to enable alterations to be by order; we are not laying down a statutory pattern.

Mr. Nigel Spearing (Acton)

I did not quite catch the allusion to the larger area. Did the hon. Gentleman say it was the hospital requirement which militated against the grouping of three, to which my hon. Friend the Member for Brent-ford and Chiswick (Mr. Barnes) referred? The London borough of Ealing is one which is in a unit of three. If the hon. Gentleman is now saying that after review there might be change it would be good to know it was on the basis of the hospitals rather than the general practitioner service.

Mr. Alison

I said the local authorities wanted smaller areas. There was contrary advice from authorities responsible for health services, including the general practitioner service in London. They preferred to have larger groupings of boroughs rather than smaller ones.

As I said, the Bill does not lay down a pattern; it gives powers to make orders and thus gives real flexibility. So the die is not finally and irrevocably cast, but this is the pattern my right hon. Friend decided on for the inception of the service. There is no ideal pattern for organisation of the health services in Greater London. Whatever we do people will be free to cross any boundaries we create and to use the services they want to use. It is a question of striking a balance, the least damaging compromise we can arrive at. Against this background the amendment would mean rigidity, inflexibility, which, in our judgment, would be unacceptable. I must regretfully ask the House to reject the amendment the hon. Member so eloquently moved.

Mr. John Silkin

My hon. Friends and I in Committee pointed out the enormous difficulties and ludicrous situations that arise from the whole concept of the proposed reorganisation of the health services. This is another example of the stupidity of the proposed reorganisation. The Under-Secretary of State called it the least damaging compromise—the least damaging of several damaging compromises, I suppose. The House will soon have to return to this when another reorganisation takes place

What inevitably flows from this is the total divorce of the health services from the social services at local level My hon. Friend the Member for Woolwich, East (Mr. Mayhew) may well be right when he considers Greenwich and Bexley in the context of hospital location, but he will be wrong when he comes to consider the local social services, after reorganisation, including his pet love, the treatment of the mentally handicapped.

I beg the House to consider this and to watch developments carefully. I am fearful of what will happen in London perhaps more than anywhere else in the country.

Amendment negatived.

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