HC Deb 16 October 1973 vol 861 cc161-72

10.0 p.m.

Dr. J. Dickson Mabon (Greenock)

I want to raise tonight the question of appointments to the Scottish area health boards as they are presently constituted.

I do not do this in any personal sense in the nature of raising the appointment of this or that person. One could argue a case about the Government's behaviour towards, for example, Mr. William Taylor, who was once the chairman of Livingstone Development Corporation and who was treated very shabbily by the Government. There have been complaints, for example, from my hon. Friend the Member for Stirling and Falkirk Burghs (Mr. Ewing), who has said that there has been a vendetta conducted by the Secretary of State against Sir John McWilliam in relation to appointments on the ports authority. That may be an allegation against the Secretary of State which could be unfair for the allegation should be against the Minister for Transport Industries. There may be complaints, too, about the way in which the Highlands and Islands Development Board appointments have been made over the last three years.

But I am not raising tonight specific names, specific instances and specific boards. Tonight I am raising the question generally of how the 209 appointments to the area health boards under the new Act have been carried out.

I have somewhat serious allegations to make. I should like to justify them. I repeat that I am not talking in terms of any particular people. I am talking in terms of the generality of the people who should be appointed.

The first thing that I readily agree with the Secretary of State is that members of health boards or, for that matter, of any other boards, ought to be selected for their individual contribution rather than for the fact that they are representatives of any particular interests or areas. Having been a Minister at the Scottish Office, I know what that means. It means that while Ministers pay attention to that as a principle and accept the fact that there are certain other guiding principles which we have to respect, I have been often enough, as a Labour Minister, criticised at party meetings about appointing Conservatives to these boards. I have defended that on the ground that it is essentially a British system that we appoint people of merit while taking into account the obvious political interests and other interests that they have.

There is nothing wrong with the fact that someone in public life is a Conservative, or a Socialist or a Liberal. It is all to the good that they should be so interested in public life and willing to identify themselves with the interests of the major parties that they are still able and willing to come forward and to serve. These are not arguments against them. On the contrary.

At a given time a Minister, whatever the colour of the party he represents, ought to be able to appoint people fairly from all parts of the political spectrum. I warn the Secretary of State that if he is about to lay down, as I think he is beginning to lay down, the rule which is applied, as I understand it, in some parts of the United States, the rule that it is "all in, all out", he cannot blame us if we adopt the same procedure when we achieve office.

I would deplore that. It is very wrong that a Minister should be obliged not to appoint a Conservative just because he is a Conservative, or should shy away from a Liberal because he is a Liberal, or should have to appoint a Labour man who is available when the Minister knows that he may not be the best man. This is an essential part of British democracy. I hope that I carry all hon. Members with me when I say that it is wrong when we seem to depart from this principle. My complaint is not based just on political discrimination but on other facts.

Mr. Ian MacArthur (Perth and East Perthshire)

Based on a lot of baloney.

Dr. Dickson Mabon

No, it is not. I take as an example the nurses. No one could say that nurses are politically biassed, all affiliated to the TUC, paying their dues to the Labour Party, solidly Socialist in their views and, therefore, a suspect body in the eyes of the Conservative Party. All hon. Members have received complaints about the way in which nurses have deliberately not been appointed to the boards of management or, for that matter, to the area health boards. The argument that the Secretary of State has used against them has not been applicable to the situation in England. In England nurses have been or are to be appointed to these bodies, I understand. The same applies in Wales.

But the Secretary of State for Scotland has quite wrongly hidden behind the concept that managerially nurses should not be on these boards or on the boards of management of individual hospitals. Maybe there is force in that argument, but is it not possible for nurses to be appointed who are not in the employment of a particular hospital or area health board and who might serve on the board even though they do not work within that area?

The Royal College of Nursing and all the other health service bodies such as the Confederation of Health Service Employees and others could provide acceptable candidates to serve as nurses interested in the wellbeing of nurses generally and in the health service. Doctors do that and I am not against doctors being appointed in the health service. Naturally I declare my interest in this matter. It would be bad for the health service if doctors did not continue to serve in all the governing bodies as presently constituted.

But it is outrageous that while doctors are given that preference nurses by definition are specifically denied representation on these bodies. Therefore I complain bitterly that it is wrong that one of the finest services, namely nursing, of the health service is denied representation on these governing bodies. For the life of me I do not understand how the Conservative Party can possibly resist the appeal that is being made to it by the nursing profession on this issue.

These days we are most anxious to ensure that women are properly represented in these governing bodies. If we understood the Prime Minister and his colleagues correctly at their recent conference, they intend to announce in the Queen's Speech a Bill which deals with unfair discrimination against women. The Government are to make a plea that we should be fair to women and that we should give them the same rights and privileges as men.

Women in Scotland, as in England and Wales, constitute more than half the population yet of the 209 appointments presently made to area health boards, only 45 are women, according to information given in HANSARD. Frankly, I cannot accept the argument that the available quality of personnel is such that only 45 women out of 209 possible appointments are eligible to be appointed in this respect, and that, may I tell the hon. Member for Perth and East Perthshire (Mr. MacArthur), is not baloney. The Secretary of State has made a great mistake in appointing this small number of women. They must be entitled to three or four times as many appointments to the area health boards. My comments on nurses and women generally are not political.

I will not go into the matter of representation from industry. The Minister in reply should tell us about that and say how many of the 209 appointments have been made from the CBI and the employers' associations. I do not know the answer but I know the figures for the trade unions. It is often argued that appointments should be made equally from the employers and the employees, but the employees vastly outnumber the employers. The trade union figures are that on the Argyll and Clyde board, with 12 members, there is one trade unionist; in the Ayrshire and Arran board, three trade unionists; in the Borders, one; in Dumfries and Galloway one; in Fife, two; in the Forth, two; in Glasgow, two; in Grampian, one; in the Highlands, one; in Lanarkshire, one; in the Lothians, one; in Orkney, one; in Shetland, one; in Tayside, two and in the Western Isles, one. There is a total of 21 nominated trade unionists out of 209. It is absolutely unbelievable.

Not all of these trade unionists are necessarily Socialists and at least two of them, to my knowledge, are not in the Labour Party. But in terms of trade unionists we have this tiny number. Is it not terrible that on these public boards we should have such a small number of personnel from the trade union movement? Therefore my allegation is, first, that quite strongly, there is discrimination against nurses; secondly, that there is unfair discrimination against women; and thirdly, that there is wrongful discrimination against trade unionists. I now come to the political content—

Mr. MacArthur

Nonsense!

Mr. James Hamilton (Bothwell)

That is not nonsense. It is a fact of life.

Mr. MacArthur

That is chasing shadows.

Mr. Speaker

Order. This is a very exciting Adjournment debate, but hon. Members should not make sedentary interruptions.

Dr. Dickson Mabon

I am very much obliged for your protection, Mr. Speaker, because he is a very rude Member and he ought to be put in his place from time to time. I dare say that he will get more excited by what I shall say now. The Government may protest that they have innocently made errors about the nurses and they might want to recoup themselves about that, but how they will do it I do not know. They may be very sorry for what they have done to women and very sorry, too, for what they have done in discriminating against trade unions. But let us come to the political parties. The Liberal Party in Scotland and other parties are also aggrieved, but naturally we, as the largest party in Scotland, must necessarily feel more aggrieved at the present situation.

It is perfectly true that of the 15 chairmen three are Labour appointments. Incidentally, they are very good appointments. The fact that Mr. Simpson Stevenson has not only been appointed chairman of the Glasgow board but has also just been appointed chairman of the Common Services Agency is a matter of considerable pleasure to many of us. He is a very competent man. He is a Socialist and one naturally assumes that he is a competent man, but even in the eyes of the Conservatives he is a competent man.

But the appointment of three out of 15, even when two of them are on the largest boards, is not a sufficient argument to say that therefore the others are necessarily the proper choices.

Let me look at the membership of the boards. I must go through them very carefully, because I want this written into the record. The Argyll and Clyde board has 12 members, of which one is a trade unionist and two are lady members. There are three Labour appointments on that board, which is a very high number compared to the rest. Ayrshire and Arran has four out of 15; in the Borders not a single Labour appointment has been made out of 15; in Dumfries and Galloway there is one out of 15; in Fife there are three out of 15; in Forth—a predominantly Labour area—two have been appointed out of 13; in Glasgow, overwhelmingly Labour, there are about five out of 18; in the Grampians there are three out of 16; in the Highlands there are two out of 15; in Lanarkshire there are four out of 14; in the Lothians there are six out of 18; in Orkney there is one out of nine; in Shetland there are two out of eight; in Tayside there are four out of 16; and in the Western Isles there is none out of 12. That is the position for Labour and those are identified persons. They are not nominated as members of the Labour Party. They are people who have served in local government as Labour councillors. Or there is Mr. Ryan who is in the Argyll area who is also a dentist and a Labour councillor. So that there are all kinds of qualifications even on these boards.

Mr. MacArthur

I must interrupt, and I apologise for speaking earlier from a sedentary position. The hon. Gentleman has identified certain members of area boards as Labour supporters, and he admits to the House that he cannot identify the political affiliations of other members of the boards. Will he not agree with me that political affiliations do not count one whit in this matter? What matters is the ability and experience of people appointed to the boards. They may be Labour or Conservative, but that is not what matters. There may be others he has not mentioned, who have Labour affiliations which are not readily identifiable. But in relation to the point before the House, what matters is the ability and experience of these people and the contribution which they can make to the management of the health service in Scotland. That is what matters; not their political interests.

Dr. Dickson Mabon

I know as well as the hon. Gentleman who so far—I emphasise "so far"—has not served in the Government that many nominations are produced by the Scottish Office civil servants who are very fair. They put the nominations before Ministers, and the Minister in the last analysis make the judgment. It has been the custom of Ministers over many years to be fair. When a decision has to be made between X and Y they look at the political balance of the board and, although X may be a very good man, they may decide to nominate Y because otherwise the political balance would be upset. That has always been the case.

If the present Government are now propounding a new theory, that regard should not be had to preserving a political balance, we, too, will observe this new rule and no longer shall we regard political balance as valid. The Cooperative Union in Scotland submitted 42 nominations for 209 places. Not one of those 42 was appointed to any of these boards. I cannot believe that they are all second-rate people none of whom deserves to be appointed. This is a terrible discrimination against many men and women—particularly women—who serve in the Co-operative movement, some of them political and some not political.

Of course, this is not entirely spilt milk. Not all of the appointments have been made. I ask the Under-Secretary of State to tell us how many more appointments are still to be made to the area health boards. I also ask him to take into account the criticisms which we are making about the way the Government have behaved. Will he seek to redress the adverse balance which has arisen from these badly balanced appointments? The Minister has been unfair to nurses, to women, to trade unionists, to co-operators and to the general public in the way that this cockeyed balance has been achieved. He has only been over fair and over-generous to the Conservative Party in Scotland, and he ought to be ashamed of himself for what he has done.

10.17 p.m.

The Under-Secretary of State for Health and Education, Scottish Office (Mr. Hector Monro)

I am not in the least bit ashamed of myself. I am only sorry about the most unreasonable speech of the hon. Member for Greenock (Dr. Dickson Mabon). He began with totally outrageous comments on my right hon. Friend the Secretary of State, implying that he had made appointments which were unfair to boards in Scotland. He spoke about the ideas of the Secretary of State of "all-in, all-out" for appointments. This is absolute rubbish and he knows it. I am sorry that a former Minister of State at the Scottish Office should utter tripe like that to the House.

Then the hon. Member dealt with "Mabon's law" on the theory that everybody who he does not know personally is a Socialist, is automatically a Conservative. I would be delighted if that were so, but he must know that this law of his is inaccurate. Let us be serious about this serious matter.

I very much welcome this opportunity to dispel some of the misconceptions which have arisen in connection with the appointments which my right hon. Friend has made to the health boards in Scotland. These are important appointments because the massive reorganisation of the Health Service to which we are committed will not achieve the results we all hope for, in terms of improved patient care and greater efficiency, unless members of the health boards are properly equipped to discharge the functions laid upon them by the Act.

My right hon. Friend is fully aware of the importance of these appointments and has taken considerable care to select men and women with the appropriate experience and personal qualities. The hon. Gentleman knows that the Act requires that appointments will be made only after consultation with local authorities, universities having an interest in the provision of health services within their area, teaching hospitals' organisations representative of the medical and other health care professions and such other organisations as appear to the Secretary of State to be concerned. Invitations to submit names for his consideration were sent to over 200 representative organisations. These consultations resulted in the submission of over 2,500 nominations from which we have so far selected about 200 names and on which—on the total number—my right hon. Friend will draw when he comes to make further appointments later this year. In round figures there will be appointed four or five to each board, depending on various considerations.

Our choice was therefore large and we are greatly indebted to the organisations for the trouble they took to sift out and nominate suitable candidates. I emphasise once again that my right hon. Friend was concerned to find men and women whose personal qualities and experience fitted them to make an effective contribution to the work of the board to which they were appointed, although he has naturally taken account of geographical and other considerations. The start which the boards have made is most promising.

We had to ensure, in order to maintain continuity, that each board contained a nucleus of members with experience of administering the three parts of the health service as it is operating at present, including persons with local government experience. It was clearly desirable to include men and women who had a professional interest in the provision of health care in the community, whilst excluding those who would themselves be employed by the board in a direct management relationship with any of its chief officers. My right hon. Friend has sought to achieve a reasonable balance on the boards between professional and what might be described as lay members.

The hon. Gentleman has quoted a number of figures purporting to demonstrate in his view the unrepresentative character of the appointments. I emphasise again that they are appointed for their personal qualities and experience and not as spokesmen for a particular organisation or professional group.

I shall quickly give one or two figures. It is extremely difficult—and I am sure the hon. Gentleman will agree with me—to be sure or even to have an idea of the majority of appointments which have a political involvement. However, we can take a view about the 60 local authority councillors because many of them stand as representatives of the Labour Party, the Conservative Party or the Liberal Party. I have been able to discover by looking at the newspaper—I have not made other enquiries—that 19 local authority members are Socialist, three are Conservatives, one is a Liberal and three others are progressive or ratepayers. There are 34 independents. I have no idea to which party they belong.

Mr. James Hamilton

How many are Conservatives?

Mr. Monro

The hon. Member for Bothwell (Mr. James Hamilton) seems to be under the same misapprehension as his hon. Friend the Member for Greenock. If everybody who is apparently not a Socialist is a Conservative, I am delighted to be given that information. Hon. Members must not give way to the temptation to talk about something of which they know nothing.

The hon. Member for Greenock wanted to know from what nominations people were appointed. The CBI has had seven members appointed, the STUC has 18, the local authorities 44 and the professions 82. I emphasised how important it was in getting the boards off the ground to have professional advice. There are 14 members from the universities, 38 nominated by the executive councils, 31 from the regional hospital boards, 74 from the boards of management and 52 from all other organisations, including the Red Cross.

Dr. Dickson Mabon

What about nurses?

Mr. Monro

If the hon. Gentleman leaves me enough time I shall get to nurses. That is an important issue. For that reason, I will not go over the occupations of the 210 people appointed, although I can let the hon. Gentleman know them later. I do not think that the figures he gave were in the least bit relevant to the situation. I am sorry that he should have tried to improve his case by quoting completely wrong figures.

I ask the hon. Gentleman to bear in mind that the local health councils will be appointed in due course and the local authorities have a right to appoint members to them. No doubt the affiliations of the authorities will have their effect on their appointments.

The hon. Gentleman raised the very important issue of the nurses. Like him, I have the highest regard for the nursing profession in Scotland. My right hon. Friend takes the view that a person directly employed by a health board and working in a direct management relationship with a chief officer of that board—or any of the chief officers themselves, for that matter—should not be eligible for appointment as a member of the board.

This, applies not only to nurses although their representations have naturally attracted a great deal of publicity, but also to other professional staff, including, for example, specialists in community medicine, dentists in the school health service and staff of various other categories who are officers of a health board.

Hospital consultants and general practitioners are in an entirely different situation, since they will not be in a line management relationship with any of the chief officers of health boards. Unlike the nurses and other professional staff employed by health boards to whom I have referred, general practioners and consultants are engaged under a contract for their services. They are not professionally or clinically accountable to the chief administrative medical officer. The appointment as health board members of a limited number of consultants and general practitioners is accordingly consistent with our policy.

I want to assure the hon. Gentleman that we have appointed seven nurses to various health boards. They are not, of course, involved in direct line management and we shall bear in mind the representations made in relation to future appointments.

The hon. Gentleman has previously asked me, but did not bring out in his speech, about appointments that have to be made. In the majority of cases the chief officials have now been appointed, but a number of appointments, particularly in the dental profession, still have to be made and will no doubt be announced after Christmas. Most of the boards have made their principal appointments.

I want to stress the value of the contributions which the nursing profession can make to the administration of the National Health Service and to bring to the hon. Gentleman's notice another point he did not bring out—the importance that the area nursing and midwivery committees will have in the working of the boards. They will have direct access to the chief area nursing officer and the boards themselves. So there is no question that the voice of the nurses will not be heard in the future development of the health services in Scotland.

Mr. William Hannan (Glasgow, Maryhill)

Which boards have the seven nurses been appointed to, and who are they?

Mr. Monro

I will write to the hon. Gentleman.

The hon. Member for Greenock has not helped his case by chuffing away all evening from a sedentary position when we have been talking about a serious issue. He has completely misjudged the feelings of most people in Scotland about the constructive appointments made to area boards, and I have every confidence that they will fulfil their work in future extremely well indeed.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.