§ The Second Deputy Chairman (Mr. Bryant Godman Irvine)
We now come to Amendments Nos. 521 and 545—
§ Lord James Douglas-Hamilton (Edinburgh, West)
On a point of order, Mr. Godman Irvine. I ask for a Division on Amendment No. 545, which will be taken with Amendment No. 521, after the debate that is judged to be necessary.
§ Sir John Gilmour (Fife, East)
I beg to move Amendment No. 521, in page 48, leave out lines 1 to 4.
§ The Second Deputy Chairman
With this we may take Amendment No. 545, in page 48, line 3, leave out "Family planning Abortion."
§ Sir J. Gilmour
The amendment seeks to leave out all of the words in Group 1 of the schedule. I move the amendment because many of us have received representations from the Scottish branch of the British Medical Association. It has been suggested that it would be right to take out of the Bill the whole of that group.
In previous debates we have discussed matters that affect Scotland where Scotland has especially different circumstances. We can be sure that the circumstances of having adequate health and hospital services are unique and the same throughout the country. Travelling in outlying districts is the only difference that comes to mind.
The BMA wishes the terms and conditions to remain on a United Kingdom basis. It is worried that if there is the devolvement incorporated in the Bill the "United Kingdom basis" will be prejudiced. It is true that the National Health Service in Scotland already has a considerable measure of devolution—for instance, we have our own home and health department. It would seem to be an advantage if the financing of the Health Service were outside the block grant. For that reason I believe that the amendment is well worth considering.
There are one or two other matters that arise not from Part I of the schedule but from Part II, on page 50. It is headed "Matters Not Included In The Groups". It sets out:Control of drugs, medicinal products, biological substances and food.1766 Although the health requirements are devolved, those matters are kept under United Kingdom control.
There is a further point. Paragraph 22 of Part II refers to theTerms and conditions of employment and related statutory rights and duties of employmentof those employed by the Scottish Office or in another way.
Paragraph 23 refers toAny matter relating to the right to prosecute any offenceas not being a devolved matter. I wonder whether that is included in Amendment No. 545, to which my hon. Friend the Member for Edinburgh, West (Lord James Douglas Hamilton) is about to refer, which relates to family planning and abortion. Perhaps the Minister will tell us about that.
Another matter that the British Medical Association is anxious to draw to our attention is the fact that, in the event of the devolution of the National Health Service and the non-devolution of the universities, the four medical schools in Scotland may face problems involving separate academic and service components. The education of medical students and the training of doctors require resources beyond the fulfilment of the service component involved, and such resources are not the responsibility of the University Grants Committee. If medical education and training in Scotland are to remain at their present high level—our medical schools are probably second to none and have a higher reputation than anywhere else in the world—they will require finance out of all proportion to the needs of the population of Scotland, because Scotland is now and will remain for a long time an exporter of trained doctors.
I hope that the Under-Secretary of State, who I imagine is to reply, will be able to give the Committee some of the answers to these questions. I hope that the underlying fear expressed by the BMA—that by devolving this responsibility we shall have two separate standards operating in the medical profession in the United Kingdom—will be unfounded.
§ Mr. Robert Hughes
It is true that within the medical profession there is considerable concern about what might happen to the National Health Service as a 1767 result of devolution. The hon. Member for Fife, East (Sir J. Gilmour) was correct to point out that this matter is to a great extent concerned with remuneration, conditions and standards of service.
This view of what might happen to the NHS goes beyond the medical profession. One dilemma in discussing legislation such as this is that at times one must put aside one's overall view about the need or the desirability for devolution and consider the practicalities of the proposals. The Committee knows that I am not an enthusiast for devolution. I should have been much happier had we not started on this whole business. But, as it is, we have to look at the logic of the NHS being devolved and whether it is altogether bad that it should be devolved.
I accept that, generally speaking, there should be a uniform provision of health care throughout the whole of the United Kingdom. There ought not to be differences in the provision of health care. Because of the way in which the hospital service has developed, some hospitals in England have specialised in particular areas of health care, such as heart surgery and kidney transplants. Because of the size of the population or the expertise available, a similar level of service has not been developed in Scotland. That does not necessarily mean that there is anything wrong.
For example, if someone in Scotland requires an operation or specialist care which is not immediately available in a hospital in Scotland, there are adequate and good working arrangements to enable such a patient to go to London if that is where the treatment is available, and it often is. Indeed, there are arrangements to assist with travel facilities, the payment of fares for relatives to visit, especially if a child is involved, and maintenance for such relatives whilst they are in London or any other part of England.
I had always assumed, until a few minutes ago, that those arrangements would not be interfered with. I hope that I am right in assuming that nothing in the Bill which devolves the administration of the NHS will deny to any citizen, either in Scotland or in Wales, the facility of moving across the border to obtain necessary health care and hospital treatment in any part of the United Kingdom. Indeed, someone living in England 1768 might wish to move to Scotland to get special medical care which is not available immediately in England. I assume that the ability of any citizen to obtain medical treatment anywhere in the United Kingdom will in no way be diminished. In other words, if the prognosis of a patient's illness demands that he should go outside Scotland to get the necessary care that he requires, I hope that will still be available without difficulty. I am sure that will be so, because we are concerned only with the devolvement of administrative functions.
There is nothing wrong in any area of social policy with advances being made in one part of the country as opposed to to another or of administration in one part of the country being different from another.
Let us consider the whole history of social services in the United Kingdom. In many respects, because of its size, Scotland has been able to make imaginative progress, especially in social welfare, before it has been possible for such advances to be made elsewhere. One outstanding example is the Social Work (Scotland) Act 1972, which is far-reaching in its effects and is being copied in other parts of the United Kingdom. Scotland has made greater advances than have been made in other parts of the United Kingdom because of its size and its separate administrative arrangements.
Scotland has almost always had separate legislation covering the National Health Service. The NHS in Scotland was set up under legislation separate from that for England and Wales. Scotland has a separate and distinct NHS. Indeed, there was separate legislation for Scotland when the reorganisation of the Health Service took place a few years ago. The result is that Scotland's administrative setup for running its health services is different from that which operates in England and Wales. That different set-up has not led to a lower standard of health care for people in Scotland. Therefore, it is reasonable that the Health Service generally should be devolved to the Scottish Assembly.
The Scottish Assembly will have to do a job which is done at present very largely by the Scottish Home and Health Department, in conjunction and consultation with the area health boards. It has 1769 to consider the priorities of spending, whether greater emphasis should be put on mental health, for example, where new hospitals should be built and whether major hospitals covering all kinds of specialities are required or whether the cottage hospital approach is preferable.
I concede immediately that the general development of health policy in the United Kingdom, despite the fact that we have always had separate legislation—except in one area that I will come to later—has been evolved, as the hon. Member for Berwick and East Lothian (Mr. Mackintosh) said, by "gentle discussion and co-operation" between the health departments in England and Wales on the one hand and Scotland on the other. There has always been close co-operation and a cross-fertilisation of ideas.
What worries me about devolution of the Health Service to the Assembly is the possibility that the cross-fertilisation of ideas and the close co-operation, which have benefited both administrations, civil servants and the medical profession, will be affected. This has been a two-way traffic and if, as a result of devolution, the cross-fertilisation of ideas is stemmed completely it will be a bad thing for Scotland and for England and Wales.
Although there are some worries about this, by and large I take the view that there is nothing wrong with the devolution of administrative functions and legislation in the health services to Scotland. I enter this caveat: if the Scottish Assembly were to take major policy decisions contrary to the general view held throughout the country as a whole, there could be difficulty.
There are only two ways of dealing with such a position. For example, if on the emotive issue of pay beds the Scottish Assembly decided that it wanted to go against the general trend of reducing the number of pay beds and perhaps even increase them and give a greater place to private medicine, it would be very serious. There are two answers to that. The people of Scotland would just have to lump it. If we are to have devolution, the message must be driven home to the people time after time that not every decision taken by the new Assembly will be 1770 according to the will of the majority. If there are swings and roundabouts, these will have to be accepted. People cannot come forward afterwards and complain that they are being treated differently from England. They will just have to accept it.
§ Mr. Dalyell
My hon. Friend has had ministerial experience in the Scottish Office, so I shall put this question to him: supposing that a Conservative Government were in office in Edinburgh and it took this action on pay beds, and supposing that my hon. Friend were still the Labour Member for Aberdeen, North and one of our right hon. Friends was in office at 10 Downing Street, would he not feel an irrepressible urge to knock on the door of 10 Downing Street asking the Prime Minister to do something about the Government in Edinburgh and to stop them from pursuing a policy that was basically against the deepest political beliefs of the Westminster Government? Does he not believe, as I do, that therein are the deep seeds of conflict?
§ Mr. Hughes
Yes. My hon. Friend is reinforcing the second point that I wish to make. If a view is taken by any number of people who then make representations about it to me as their Member saying that they believe that the Scottish Administration is going contrary to the public will as they see it, it is not a question of an irresponsible urge. I make no secret of the fact that I would make no attempt to repress the urge. I would go straight to No. 10 to make the point that I believed that the Assembly was going contrary to the general public good of the United Kingdom as a whole, and of the people of Scotland in particular, and I would lose no time complaining about it.
However, I would complain on the basis of the services being provided and not on the basis of devolution. We have the seeds of conflict if people claim that the differences are caused by devolution. That is why I say that if decisions are taken which are believed by some to be contrary to the general wishes of the Scottish people they will have to accept that the differences are a result of different styles of Government. They will have the opportunity of turfing the Government out at the next election.
1771 Of course there will be conflict, but since I still hope that there will be communication between the health departments of Scotland and of England and Wales, and because social policy relating to medical treatment has advanced greatly in the past decade and even more since the establishment of the NHS, I believe that the possibility of major changes taking place in the Assembly over health matters is unlikely. Therefore, I certainly would not support the particular amendment.
This is one of the areas in which we have to accept that the balance of probabilities for social policy and medical treatment, and administration generally, will follow a similar pattern. We cannot guarantee it, of course, but my experience is that the National Health Service, despite criticism, has a general ethos of providing free treatment, especially in hospitals, and this will be accepted by almost every person involved in the discussion of health matters. It is so clear cut that I do not see any tremendous difficulties.
I am in slight difficulty because the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) has not yet moved the amendent on family planning and abortion. He must make his own case, but I shall put my point because these amendments are being discussed together. In relation to Amendment No. 545 I do hope that the Under-Secretary, the Minister of State and, indeed, the Leader of the House do not have closed minds. If I recall rightly, they have not yet accepted any amendments to this Bill. This will be a good place to start. The amendment is very reasonable.
I do not take the view that family planning and abortion are not contentious matters. Certainly they are to a greater or lesser degree. The fact that there is a great deal of political controversy surrounding family planning and abortion and that they generate a great deal of heat, discussion and passion does not disqualify their being devolved and discussed in the Assembly. Indeed, some hon. Members might be glad if these issues were removed from our debates.
These are areas which have not been dealt with by separate Scottish Bills. Legislation on abortion has been carried out on a United Kingdom basis. Almost alone, it falls out of the pattern of matters 1772 that have previously been under the control of the Secretary of State. There is no logical reason to include it as an administrative area that has previously been dealt with almost wholly in Scotland.
This is one area where it is imperative that we ensure that we have a policy for the whole United Kingdom and decisions that are carried out on a United Kingdom basis. Otherwise, we run into the difficulty of cross-border services. I do not think that such matters as specialist treatment would be affected by devolution, but family planning affects the day-to-day lives of women and there are enough problems in the general United Kingdom framework of ensuring equality of treatment in family planning and abortion not between Scotland and England or between Wales and Scotland, but between different administrative areas within the National Health Service. This is because of the policies pursued by consultants in charge of gynaecology and obstetrics in different parts of the country. Some women have to go a fair distance to get an abortion because of the practice in their areas.
As this issue affects people so much, it should be dealt with on a United Kingdom basis. There should be no question of women having to leave the Scottish Health Service and cross the border to get an abortion or family planning assistance. There is a possibility that major differences of approach might be adopted in these areas. It is essential to have a general approach, especially on family planning. It is possible that we might end up with the sort of situation which existed between Northern Ireland and Eire, at least until recently. People from the South had to cross the border to buy contraceptives and then smuggle them back into the Republic. I know that this is not an exact parallel, because there are customs posts in Ireland, but in matters of ordinary human welfare there is a great deal of sound sense in having broad social policies dealt with in the United Kingdom as a whole.
§ Lord James Douglas-Hamilton
I congratulate the hon. Member for Aberdeen, North (Mr. Hughes) on having spoken so ably on Amendment No. 545. I should like to put on record the position of the British Medical Association. The hon. Member for Aberdeen, North said that he 1773 was not enthusiastic about devolution, but that if we accept the logic of the Bill some form of devolution of health services must be taken for granted.
The BMA does not like devolution as it affects the medical profession, but being realistic, it recognises that there should be a fall-back position in case Group 1 is not removed. The association wants family planning and abortion to be dealt with on a United Kingdom basis.
The association accepts that there is already a substantial measure of administrative devolution in health matters. There was a separate Act of Parliament setting up the National Health Service in Scotland. This is administered by the Scottish Home and Health Department. The BMA is concerned lest the arrangement whereby separate services, such as housing, education and roads, have to compete for shares in the block grant allocation, and that this may lead to an inadequate share for the continuing development of the Health Service.
As my hon. Friend the Member for Fife, East (Sir J. Gilmour) said, the BMA wishes to ensure that terms and conditions of service remain uniform throughout the United Kingdom, the review body of the General Medical Council being the main part of the machinery in recent years.
On general medical standards the BMA thinks that the following subjects should be dealt with on a United Kingdom basis: drug standards, quarantine regulations, vaccination requirements and other aspects within the whole field of community medicine. There are other areas which it thinks can work really effectively only if the law remains uniform. This applies particularly to family planning, abortion, transplant surgery, private practice and the control of nursing homes, which it would like dealt with on a United Kingdom basis.
The BMA thinks that standards of health here and entitlement to benefit should be uniform throughout the whole United Kingdom. It says that the relationship between the Health Service and the health administration in Scotland has been particularly good recently, and it very much hopes that this will continue.
1774 On the specific subject of abortion, the BMA's fears—I really cannot say whether they are well grounded—are that there may be a different law on abortion in Scotland from that in England, and that this may cause serious problems from a practical point of view. It is making objections not on moral grounds but on the practicalities. The BMA says that there may be a flow of patients across the border. There is no way of telling whether there is anything in this fear, unless it is tried out. Only then would evidence be available.
If there were cross-border traffic and a shift of cases to the most advantageous part of the United Kingdom, the BMA thinks that this could lead to an upheaval in health services in Scotland. It does not want to see fees varying from one part of the United Kingdom to another as doctors cross the border every day. It thinks particularly that this might impair the free movement of doctors from one part of the United Kingdom to another.
The hon. Member for Aberdeen, North said that it would be most undesirable if anything were done which harmed cross-fertilisation of ideas. What the BMA feels most strongly about is that one of the best features of the medical professional has been the relative ease with which doctors can move from one part of the United Kingdom to another and throughout the EEC in order to secure employment. It believes that this has helped substantially to improve the quality of research at Scottish universities. It feels that it would be much better to have one law on family planing and abortion in the United Kingdom.
I could go on at some length in mentioning the point that if the majority of Assembly Members voted one way on abortion and the majority of English Members of Parliament in the House of Commons voted another way, and it was a narrow vote, we might find that the Scottish Members of Parliament turned the balance if they voted in a different way. We might find that that would cause a certain amount of resentment. It seems that it would be more satisfactory to deal with this particular subject on a United Kingdom basis.
There was considerable force in the words of the hon. Member for Aberdeen, North when he said that these matters 1775 had in the past been dealt with on a United Kingdom basis, which reinforces the case. As the hon. Gentleman will recall, he was the Minister dealing with the Children Bill for most of the time two years ago. That is the kind of subject that I should have thought should still remain a United Kingdom subject.
I sincerely hope that the Minister will look very carefully again at the form of words used. I look forward to his reply.
§ The Second Deputy Chairman
It may be for the convenience of the Committee if I indicate now that I shall be prepared to accept a request for a Division on Amendment No. 545.
§ Mr. Gerry Fowler (The Wrekin)
I shall be very brief. I very much hope that the first of these amendments will be withdrawn or, if pressed to a Division, rejected. It seems to me that devolution of health services is of the essence of devolution. If one is to have devolution at all, one cannot retain on a United Kingdom basis so domestic a matter.
My hon. Friend the Member for Aberdeen, North (Mr. Hughes) said that in Scotland there could be a different standard of provision from that which obtained in England, but there is already a varying standard of provision between various parts of the United Kingdom, and I doubt very much whether the devolution of the health services will make the situation significantly different.
Of course, the nub of the argument is precisely what the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) touched on when he was talking about the fears of the BMA. He said that the BMA feared that the allocation of resources between housing, education and health might be made in a way which was damaging to the health services in Scotland after devolution. That is what devolution is all about. If one has to have devolution at all it must be the right of the Scottish Assembly and Executive to decide on their priorities at a particular time and to put more resources into health, housing or education, within a finite total. The Assembly will be disposing a finite total of resources, as does the House of Commons.
The whole argument concerns the question whether decisions about priorities are taken within Scotland or Wales or by the United Kingdom. I strongly believe that 1776 such priorities should be decided by the Assembly. Perhaps the Assembly would take the view that its priority, at least for a period, was to invest in housing and social welfare because it believed that that was the most effective way of raising the standard of health for the people of Scotland. It may well be that bad housing and poor social welfare services cause many of the problems with which the health services have to deal. To prevent is better than to cure. If that were the Assembly's view, it would be right. To say that the Assembly should have no power to control the health services, while it has power to control housing and welfare, would make very little sense.
§ Mr. Dalyell
Can my hon. Friend recall, when he was Minister, whether it was put to him on behalf of the medical profession that it feared that the Assembly would set up a health committee which would take over the responsibility of the regional hospital boards and therefore make medicine in Scotland rather less expert? What did my hon. Friend feel about that when he was a Minister?
§ Mr. Fowler
I have heard that argument. If the Assembly had a health committee I do not believe that it would seek to interfere in matters that were within the professional competence of doctors. Not I alone believe that a little more democracy in the control of the Health Service throughout the United Kingdom would be no bad thing. One does not wish to stray on to the ground of interfering with the experts, but there are areas of health administration, controlled by qualified medical practitioners, which are properly within the sphere of interest and responsibility of the general public through their elected representatives. I do not share the fears of my hon. Friend the Member for West Lothian (Mr. Dalyell).
The hon. Member for Fife, East, who moved the amendment, suggested that there might be difficulty for the medical schools. The Government are not proposing that there should be devolution of the universities. Hence, they are not proposing that there should be devolution of the university medical schools. One reason for that is that Scotland is an over-producer, not only of highly qualified medical personnel but of highly qualified personnel in general. Scotland 1777 is an over-producer in proportion to its population.
Scotland exports the products of Scottish universities mainly from its medical schools. For that reason it is important that we should not devolve the universities or medical schools. I do not anticipate any more difficulty in collaboration between the medical schools and the remainder of the health services after devolution than one has at the moment, not least because even now one is talking about collaboration between UGC-financed institutions and services financed by the Scottish Office. Even in terms of the development of medical schools, one is talking about what is a UGC responsibility, but a UGC responsibility exercised in collaboration with the appropriate health department, whether in Scotland or in England, because developments in medical schools take place only after detailed consultation with the appropriate health department. I imagine that that will continue after devolution. It is merely that the health department will have changed somewhat, because it will be responsible to the Assembly rather than being part of the responsibilities of the Secretary of State, responsible to this House.
I hope that the first amendment will be withdrawn, but I have considerable sympathy with the second. There is a special case about abortion in particular. My hon. Friend the Member for Aberdeen, North touched on it when he said that it was not simply because this was an area of political contention. It is one in which passions ran high. That is part of the difficulty. Nobody fears that in Scotland or in the United Kingdom there will be separate legislation on the possibility of obtaining an appendectomy or tonsillectomy. It is inconceivable. There is no passion about it, and there is no legislation about it.
However, it is conceivable that at some time, were this to be a devolved subject, the law in Scotland and the law in England and Wales might get out of step. It could happen either way, but that is irrelevant. What would happen is that Scotland or England would become an abortion haven. My objection is exactly the same as my objection to the type of proposition that we shall 1778 debate later this evening on an SNP amendment concerning finance. One cannot envisage a situation in which England or Scotland becomes a tax haven for the residents of the other. Equally, one cannot envisage a situation in which either country becomes an abortion haven for the residents of the other.
The case on family planning is perhaps less strong, but we do not want to get into the situation that so long obtained between Northern and Southern Ireland. We would not have customs posts, at least as long as we kept the SNP out of power in Scotland, but it would be absurd if people were crossing the border, one way or the other, for family planning advice or to obtain contraceptives.
I am not notorious for being opposed to the Government on the Bill, not least because I largely devised the White Paper that lies behind it. Therefore, it is unlikely that I would oppose the Government on many issues. However, I very much hope that Amendment No. 545 will be carried, because it is one of the more sensible and more important amendments.
§ Mr. Hector Monro (Dumfries)
I am surprised at the hon. Gentleman's conclusion. I thought he shared my view that we should not accept the amendment. I am not in favour of the present type of Assembly, but if we are to have an Assembly it is essential that the health services are devolved to it for consideration and responsibility.
We in Scotland are justly proud of our medical services, of the whole history of medicine in Scotland, its independence and its leadership throughout the world in terms of services, skill and practice. Therefore, it is right that we should not be afraid that we should reduce the standards of the medical services in general if the Assembly is set up, approved by a referendum, and becomes responsible for the health services.
The hon. Member for Aberdeen, North (Mr. Hughes) and I were on the Front Benches opposite each other during the passage of the National Health Service (Scotland) Act 1972. It was as harmonious a passage of legislation in this House as I can recall, particularly in a Scottish Committee. This was because, basically, it was a non-partisan framework of legislation, supported by the 1779 major parties. It was a constructive measure. It set up the single-tier authority which has proved so practical as compared with the two-tier system for the National Health Service in England, which has attracted criticism. The legislation was set forth on as reasonable a basis as one could wish.
The health services in Scotland are, of course, short of money, but bearing in mind the restrictions of the past three or four years, since the Act came into force, the authorities have done a remarkably good job, not only in the setting up of the area health boards, and in everything flowing from that, but in now establishing local health councils. It seems to be inconceivable that the right to look after the health services in Scotland should be exempted from devolution to the Assembly and operated from the United Kingdom Parliament.
Honourable Members have rightly touched on the co-ordination of the health services in Scotland with those in England and Wales. I am sure that that co-ordination would continue to be first-class. Nowhere is such co-ordination more important than in my area, since some of its medical services are supervised from Cumberland and Carlisle. There is there a perfectly satisfactory relationship, which has gone on for many generations, and there is no reason why it should not continue in the future.
I want to emphasise the exceptional standards of the services in Scotland. We have particularly Scottish services such as the Mental Health Commission, which has been an outstanding success over a long period. I cannot conceive that we should lose control of it from within Scotland. In the same way, we have our own Scottish ambulance service, which works very effectively. It has always been under Scottish control. It has never been a United Kingdom operation.
If we are to have a devolved Assembly, that is where the continuation of responsibility for these services must lie. The same is true of the pharmaceutical and dental services. They are Scottish services, and I am proud that they have been so successful for many generations and under successive Governments. We must, though, watch the position of the university medical schools. The universities 1780 may be a United Kingdom responsibility, but the health services in Scotland will be locally controlled by the Assembly. If this is the set-up that we are to have I do not see why there should be any difficulty over the medical schools continuing their extremely close affiliation with the teaching hospitals. We should note that we must not let any difficulty arise.
There is a broader issue here. I have always felt that social work should be a Home and Health Department responsibility rather than a responsibility of the Education Department. In local terms, I felt that social work should be a district responsibility rather than a regional one under the education services. I never got much help on that from the Scottish Office.
§ Mr. Monro
I am glad to know that I have not been batting alone. I felt that all social work and health and housing matters should be a district responsibility and social work in the Home and Health Department of the Scottish Office, entirely devolved from Scottish education. This is not in direct conflict with anything in the Bill. It is a desirable change which I hope we shall see in the near future. There must be close co-operation between the agencies dealing with health, housing and social work.
I come now to the amendment relating to family planning. The family planning issue, and such things as vasectomy, was in the National Health Service (Scotland) Act 1972. These matters are, rightly, to be controlled by the Assembly. The only contentious issue relates to abortion. Here we are treading on difficult ground. All hon. Members who have spoken have rightly said that there must not be any significant difference between the interpretation of the abortion legislation in England and in Scotland. There must not be any kind of haven created. This problem arose on divorce and was eventually ended when the two countries adopted roughly the same position, although there was a three-year interval before that took place.
§ Mr. Monro
It seemed to be a shorter period of time, but I know that the hon. 1781 Gentleman was closely involved in hurrying along what was eventually decided in Scotland. No one has said where he believes the haven might be, in Scotland or England. Harking back to the original abortion legislation, my recollection was that it was felt that there would be a tendency for there to be more resistance in Scotland to making abortion easier than would be the case in England. There were more Members of Parliament from Scotland resisting the social clauses in the abortion legislation than there were English Members. I doubt whether the situation would arise when abortions would be easier to obtain in Scotland than in England. We must make certain that this legislation is operated on a United Kingdom basis. The Assembly and the United Kingdom Parliament must keep in close touch.
§ Mrs. Audrey Wise (Coventry, South-West)
Is the hon. Gentleman aware that historically the position is that the law relating to abortion in Scotland meant that abortion was easier to obtain there than in England? Therefore, when people say that they do not know where the haven would be they are being strictly accurate in a historical sense. Any views held at the moment may be quite temporary. We have to bear that in mind, too.
§ 9.0 p.m.
§ Mr. Robert Hughes
I was not going to make a point. Prior to 1967 it was a question of the interpretation of the Act. It was not a question of having a clear-cut statute. At the moment, there is nothing to prevent someone from Scotland coming to England to receive treatment of a specialist nature that is available in England but not in Scotland, but if there is a legislative difference which makes it much more difficult to get an abortion in Scotland than in England it must be much more difficult for health authorities in England to deal with that kind of problem 1782 because those concerned are seeking to evade a statute.
§ Mr. Monro
I take the hon. Gentleman's point. He was closely involved with and is knowledgeable about the situation in Aberdeen. As those hon. Members who were here when the Abortion Bill was being considered know, I was reluctant—and I still am—to accept the social clauses, but I always accepted the medical reasons for abortion. One does not want to get involved in the details of the Act as it might affect England or Scotland, but we must continue on parallel lines in interpreting legislation and not deviate from the present position.
I shall resist the amendment because if, as I reluctantly fear, there is to be an Assembly, it is essential that the Health Service in Scotland is the responsibility of the Assembly.
§ Mr. Dalyell
Until recently, most of the medical profession in Scotland comfortably and safely assumed that devolution would never get off the ground and therefore they need not bother themselves too much about it. Like their English colleagues, their complaints have become more vocal over the past decade concerning matters that are common to the profession on both sides of the border. Now that they have come to know more about things, they are concerned about how they will be affected.
That is the sorry story of the Bill. As soon as people know what affects them, they become less than enchanted. As examples of that we have the forestry people, people from the inland waterways, the Law Society and chambers of commerce writing to complain, and the same is true of other groups, including doctors.
Scottish junior doctors working, in hospitals sometimes complain that they tend to earn less than their English colleagues. This results from better staffing levels in Scotland. Although junior doctors there might earn roughly £320 a year less than their English equivalents, they can console themselves with the fact that, on average, their working week is about seven hours shorter because of better staffing. However, that has not prevented nationalist politicians from exploiting the pay differential.
1783 Now that the Scottish Assembly has become a real possibility, doctors in Scotland are proving to be as hostile as many other groups. Doctors, like some of the more perceptive teachers, are worried that their salaries might suffer, but what worries them even more—and this is very much the subject of the amendment—is the possibility of the Assembly setting up a health committee which, in spite of what my hon. Friend the Member for The Wrekin (Mr. Fowler) might say, will insist on taking over the responsibilities—or some of them—of the regional hospital boards and interfering to an unacceptable extent, to the disadvantage of the doctors and their patients.
I am as keen on democratic control as anyone else. But let us face the fact that the regional hospital boards system, with its mixture of elected members from local authorities and medical expertise, is working very well. Ministers have time and again rebuked me for suggesting that the Assembly will be a super local government. They say "No". They say that local government will continue to carry out local government functions. The Minister will, of course, say that the regional hospital boards will continue to carry out their functions. I do not doubt that he will be sincere in saying that, but I believe that the Assembly health committee will find itself extremely short of things to do.
We shall have probably 150 full-time Assemblymen. What on earth will they do with regard to health unless meddle with the work of the regional hospital boards? They cannot be passing laws the whole time. One cannot be chopping and changing and for ever discussing licensing and other such things. In fact, if they are to be part of a legislative assembly, as the Government would have us believe, either they will be seriously unemployed or they will meddle. It is one thing or the other.
The truth is that as medicine becomes increasingly specialised, co-operation between hospitals and research centres un and down the country becomes much more essential. Any disruption of the present system could be detrimental to the workings of the NHS. To take two examples, hepatitis and tropical disease patients from the North of England are normally treated in Edinburgh while 1784 many of those from the Lothian area and the Borders go to Newcastle should they need renal transplants. My hon. Friend the Member for Aberdeen, North (Mr. Hughes) knows that there is a considerable connection between Newcastle and Scottish medicine and, equally, between the North of England and the distinguished specialised services in Edinburgh.
I am told by my constituent, the distinguished neuro-surgeon, Dr. Clifford Mawdsley, that still more serious would be the disruption and fragmentation of research, particularly in the highly sophisticated and expensive frontiers of medicine. This is a man who speaks with full authority although, incidentally, he speaks from Labour Party platforms during election times. I make that point because some of my colleagues think that doctors are simply some kind of Tory organisation, which is not quite true.
§ Mr. Dalyell
I agree with my hon. Friend. It is no good dismissing the doctors as some kind of anti-Assembly reaction organisation. I am talking about doctors who have supported us, and whose considerable professional opinion is that this is damaging with regard to a number of their professional concerns.
The Scottish Health Service compares favourably in terms of staffing and provision with that of many regions in England. Scottish health activities are largely centred in the concentrations of population in which the four medical schools play an important rôle in determining the pattern and quality of health care. Edinburgh, Glasgow, Dundee and Aberdeen train graduates whose numbers perhaps far exceed the medical services in Scotland.
The Royal College of Physicians pointed out in an official submission to the government in January 1976 that any change in the Scottish Health Service which could give rise to the production of what is called "peculiarly Scottish doctors" would operate to the disadvantage of Scottish medicine. The college's concern was that it was important to maintain standards which would ensure that the health services in Scotland were no less efficient, no less well financed 1785 And no more encumbered with administrative bureaucracy than other parts of the United Kingdom.
§ Mr. Harry Gourlay (Kirkcaldy)
Is not my hon. Friend basing his argument on an independent Scotland rather than devolved powers to Scotland?
§ Mr. Dalyell
I am basing it rather carefully on a devolved Scotland, because what we are talking about is a separate system of medicine. This is the whole argument. The doctors expressed concern at the proposal of a health committee of a Scottish Assembly the members of which will offer suggestions to oversee the work of the Executive department and when elected along political lines will advise the Assembly on legislating for and financing the Health Service in Scotland with a wide remit to cover policy on such matters as family planning, transplant surgery, abortion, private practice and the control of nursing homes.
Since this committee would have responsibility for health boards and other nominated bodies, the physicians say that the effects of such changes would be to introduce an additional politically biased tier into the administrative structure of the Scottish health services. They say that it isnot apparent how such can do other than detract from their efficiency especially when they have yet to settle, following the major reorganisation of 1974.Having had in this decade one major reorganisation, Heaven help us if we have to undergo another. Since then the new health boards have been formulating their policies to suit best the composite health needs of their areas and the requirements of the four Scottish medical schools in collaboration with the health Department, and in a pattern correlated with that of the United Kingdom National Health Service. The superimposition of a policy-making body whose aim will be to promote Scottish as distinct from United Kingdom interests must surely complicate many administrative considerations, and the uncertainty of added directives to ensure purely Scottish aspects of health care may well result in the Scottish people receiving a less efficient system than they presently enjoy.
1786 That is the view of the college. In conversation by telephone in Aberdeen Mr. Kyle, who represents the Scottish section of the BMA and is probably well known to my hon. Friend the Member for Aberdeen, North, authorised me to say that his body was collectively concerned about another layer of interference. The College of Physicians express concern that the conditions of service in Scotland could conceivably become different from those operating elsewhere in the United Kingdom. For example, say the physicians, if family planning, transplant surgery or private practice, most of which are potentially emotive issues of political confrontation, were to be the subject of alteration of policy by the Assembly, a situation could arise in which the pattern of health care for 5 million Scots might differ radically from that for the remainder of the United Kingdom.
That is precisely the situation that my hon. Friend the Member for Coventry, South-West (Mrs. Wise) and others have been concerned about, whether it operates in the direction that she wants, or in the direction that others want. It is no more satisfactory one way or the other. They go on to say:The conditions of service in Scotland could thus be materially changed, and could prove less attractive to the quality of professional staffing which the Scottish health services have long enjoyed.What many doctors realise is that in order to justify themselves, and their existence in a Scottish Assembly, members of the Royal High School will try to change conditions for the sake of change. This, after all, is what some of them regard as being their raison d'être, the idea of a changing State. They will not be able to resist the temptation to meddle.
§ Sir David Renton
In addition to that, will there not be another temptation, and that is to become ultra-Scottish, disregarding all other considerations?
§ Mr. Dalyell
The right. hon. and learned Gentleman, who was a member of the Kilbrandon Commission, knows that one of my many objections to this proposal is that it plays into the hands, against the wishes of my hon. and right hon. Friends, of the Scottish National Party in creating this feeling of Englishness. Anything 1787 along these lines creates this feeling which goes down the road that the SNP wants to travel. This is a difference of judgment between hon. Members who think, as I do, and some Members of the Government Front Bench. Therefore, I agree with the right hon. and learned Member for Huntingdonshire (Sir D. Renton). This whole system of creating this kind of institution just pushes us along a road down which some of us are determined not to go. The British Medical Association registered its protest.
I am glad to see that my right hon. Friend the Member for Greenock and Port Glasgow (Dr. Mabon) has joined us. He will remember the statement made in January last by the British Medical Association, which he adorns. On 17th January 1977 the British Medical Association made clear its views. I quote from The Scotsman:Devolution of health matters to a Scottish Assembly would add to political involvement in the provision of health care. In these more turbulent circumstances, the service and the patient would require additional protection from decision making on political grounds. This problem can best be dealt with by the formation of a Scottish Health Services Board. The council say: 'The introduction of a Scottish Health Services Board with clearly identifiable areas where the Minister can overrule the board and in a form in which the Scottish Health Services Board would be permitted to publish, would provide the buffer which the profession see as in the best interests of patient care.
§ Mr. Robert Hughes
There is a lot of merit in what my hon. Friend has said, but I should like to put this question to him. Why is it that the medical profession, of all the professions in this country, is so scared of "political" interference? My view has always been that we as politicians, as Members of Parliament, give to the medical profession far too much status and symbolism of status, and that we are frightened to discuss aspects of medical care. If the Assembly were to come into operation and to give this House of Commons a lead in this respect, might not that be a bonus which we did not expect?
§ Mr. Dalyell
I only put it forward as part of the answer. At this moment the medical profession in Scotland is concerned because it sees that decisions in certain areas, rightly or wrongly, will 1788 be in favour of housing, and this means taking resources away from other areas, be it education or health. Rightly or wrongly, this is its fear. But, of course, there is an additional proposition in this whole argument—and here I would hope to have the sympathy of my hon. Friend the Member for Aberdeen, North. It is not only a question of marginally shifting resources in Scotland from health to housing, as an Assembly would be entitled to do. The medical profession knows—as some of the rest of us suspect—that when it comes to public expenditure the total cake will be less than it has been.
Yesterday I produced figures at some length of the total identifiable public expenditure in Scotland, which was substantially higher than the figure for England. I think it was roughly 22 per cent. higher. I gave all the figures, and I will not repeat them. We are probably on common ground when we say that, in the circumstances of an Assembly, and given the nature of the devolutionary juggernaut, as soon as it has established a Scottish Consolidated Fund, there will be hawk-like English Members of Parliament who will make sure—as they never did before when the United Kingdom was clearly a unity—that the Scots get neither more nor less than our share. Once there is that kind of scrutiny, my hon. Friend and I know very well that the total of cake will be substantially reduced. I am sure that the doctors know and understand this very clearly.
§ Mr. Robin F. Cook
My hon. Friend will be aware of the acute political anxieties and stresses caused within England and Wales by the redistribution of resources within the health services which are administered by the Ministry responsible for those services in England and Wales. Those stresses have not been felt in Scotland, nor has any question of bringing the Scottish share of the health cake into distribution ever been entered into, because there is at the present time a separate Ministry. But once English Members are invited to vote on the share of the cake, through the block grant going to Scottish health, could they ignore the fact that that share is higher than many of their own health regions will get, particularly at a time of political stress and anxiety over that share?
§ Mr. Dalyell
They will not be allowed to ignore it by their constituents. One result is that English Members of Parliament will become far more inquisitive than ever before about public spending in Scotland. I see that my hon. Friend the Member for Coventry, South-West is attending our debates. In future, I would not be surprised if she looks rather carefully at what the Scots are receiving per head in public expenditure. When we see that the Scots are receiving £850 and those in Coventry £680 per head, it will be unlike my hon. Friend not to begin asking questions.
§ Mr. Robert Hughes
I must come to the defence of my hon. Friend the Member for Coventry, South-West (Mrs. Wise).
§ Mr. Robert Hughes
I know she can speak for herself, but she might find it a little embarrassing to put this point. Good Socialist that she is, I do not believe there is one Socialist who would argue that Scottish money should be cut off, but I am sure she would argue that the amount of the cake allocated to Coventry should be increased.
§ Mr. Dalyell
I wish my hon. Friend good luck when she makes that application to the Chancellor of the Exchequer. These pressures will arise, and my hon. Friend will be told by her local Labour Party "If you do not ask these questions, you will be failing in your duty as an English Member of Parliament."
§ Mr. Robert Hughes
I am sorry to intervene yet again, but my hon. Friend must not fall into the trap of describing my hon. Friend the Member for Coventry, South-West as an English Member of Parliament, or anybody else as a Scottish Member of Parliament. We Labour Members of Parliament are dedicated to the Socialist concept. We do not associate ourselves with the idea of English or Scottish Members as such. I do not regard my hon. Friend the Member for Coventry, South-West as an English Member of Parliament, and I hope that she does not regard me as a Scottish Member.
§ Mr. Dalyell
I must not fall into that trap or into the other trap of speaking for too long.
1790 I return to the subject of the BMA. I have an official statement by Mr. Kyle, speaking on behalf of Dr. Faulkner and other members of the BMA, which reads as follows:Scottish doctors do not think the Bill will bring any improvement to the health care of the people of Scotland. Over the years the profession has had an amicable working relationship with the Scottish Home and Health Department and there does not appear to be any need for further devolution on health matters. Moreover, the intervention of a Scottish Assembly could well delay progress in the health field.… We have now discussed the Scotland Bill. An amendment has been tabled with a view to maintaining the status quo regarding the present situation of determining terms and conditions of service for doctors on a United Kingdom basis.Dr. Kyle is then reported as saying thatthe doctors would watch the progress of the Bill carefully. It was hoped another amendment would be tabled which would have the effect that matters of health—prevention, treatment and alleviation of disease or illness, including injury, disability and mental disorder, family planning and abortion—would continue to be funded as at present on a United Kingdom basis.I wish that in the Christmas Recess my hon. Friend the Under-Secretary of State for Scotland had had another meeting with Mr. Kyle and his colleagues. I know that my hon. Friend holds many meetings and works very hard, but I believe that he was a little remiss in not holding such a meeting. I received a recent letter from the Minister and he did not mention the fact that the doctors have asked for a current meeting with him. I do not have a copy of that letter with me at present because I did not know that the debate would come up so soon, but the general point was made that the doctors, including Mr. Kyle, had had meetings with my hon. Friend 18 months ago. The attitude taken is that those meetings still hold good.
As we all come to know more about the proposals, the situation appears to become a little different as these matters appear in our in-trays. When these were first put forward as vague proposals, many of us felt that it would be a good thing for us to have a greater say in our own affairs. That is all very well as a general proposition, but when we get down to the nitty gritty of the actual situation, I believe that it behoves the Government, their Ministers and every one of us to consult once again the interest groups, whatever those groups may have said in an ever-receding past.
§ Sir David Renton
I listened with great interest and with some admiration to the hon. Member for West Lothian (Mr. Dalyell). The hon. Gentleman has made many valuable speeches in debates on the Bill, but the one that he has just made was, from a purely practical point of view, one of the most telling that we have heard. The Government should take serious note of the hon. Gentleman's remarks.
It has been said that there is already a separate Scottish Health Service, and a pretty satisfactory one. The service comes under the Secretary of State. I am the first English Member to be speaking in the debate on this amendment. Perhaps a minor reason or entitlement for my doing so is that I am the son of a Scottish doctor — a Scotsman who obtained his academic qualification at a Scottish university and his clinical training at a London hospital. My father practised in England.
In England we are worried about our Health Service. I confess that I voted for the 1972 Act that brought about the reorganisation of the National Health Service. However, I have been worried by the way in which it has worked out. The service has been kept very short of funds even under the present Government, who have been fairly free with public expenditure. Under our present set-up, where we have a United Kingdom Government and a United Kingdom Parliament, even though the Health Services are separate there is a degree of co-ordination, co-operation and liaison. There is not uniformity, but enough common thought is given to the common problems to make sense and to prevent the sort of dangers that have been mentioned by my hon. Friends with such clarity when moving the respective amendments. It would be dangerous and a pity if we abandoned that system.
If, as proposed in the Bill, the Scottish Health Service were hived off to the Scottish Assembly as a devolved subject, the Assembly could go its own sweet way, as the hon. Member for West Lothian so eloquently pointed out. I get on very well with the hon. Members who occupy the SNP Bench, but if by some electoral freak they found themselves with a majority of seats in the Assembly, even though they had not a majority of votes in Scotland, I think that they would be competing 1792 with all and sundry to try to make everything in Scotland far more Scottish than it needs to be. Let me say straight away that I am proud of my Scottish blood. However, inward-looking nationalism could do immense damage to the Scottish Health Service. The Scottish section of the British Medical Association has naturally and properly pointed out its fears.
There are important health matters that should continue to be dealt with on a broadly United Kingdom basis even though the two Health Services are separate. Reference has been made to standards of health care and entitlements to benefit. Notwithstanding all the confusion of the Bill, I hope that those entitlements will remain the same, but I am not convinced that they will. There would be opportunities for making variations within the aegis of the devolved Health Service.
The negotiations on doctors' remuneration and conditions of service are carried out on a United Kingdom basis now. It would be a great pity if there were a parting of the ways in that respect.
The next question concerns the control of medical training and the standards of qualification required of doctors. Surely it is better that we should take no risk in such matters. We maintain very high standards, and Europe and, indeed, the world know that we do. It would be a pity if there were any variation from those high standards.
§ Mr. Dalyell
The difficulty is that Scotland over-produces medical graduates, and that is part of the United Kingdom pattern. This system would upset the United Kingdom pattern.
§ Sir D. Renton
I entirely agree with the hon. Gentleman. I can give first-hand evidence from my father. He was one of the many more doctors than were needed in Scotland, or, at any rate, he thought that it would be interesting, adventurous and perhaps profitable to go to England to try his skill. That he did. He had very high qualifications, and he used them in England.
Scotland has always kept sufficient doctors, but this movement away has been of benefit to Scotland because there have not always been opportunities for the high quality of professional people that: 1793 that country produces. England, as the hon. Member for West Lothian pointed out, has benefited, as have the Commonwealth and many other parts of the world, from the excellence of Scottish medicine and the training provided by Scottish universities and hospitals. Much of the great pioneering work in medicine, and even more in surgery, has been done by Scotsmen who did not always remain at home.
I turn now to family planning and abortion. The points have been so well made by my hon. Friend the Member for Edinburgh, West (Lord James Douglas-Hamilton) that I need only underline them.
As some hon. Members know, I have a great interest in this subject. I have always admired the way in which the city of Aberdeen, on the advice of its former chief medical officer, undertook great pioneering work in family planning. As long as we keep the law and the methods broadly in line, there is scope for local initiative on family planning. But we must ensure that the law and the methods do keep broadly in line. The best way of ensuring that is to leave with the Secetary of State for Scotland and the Secretary of State for Social Services their present responsibilities which, after all, are co-ordinated here at Cabinet level and, in respect of law-making, by legislation in the House of Commons.
The question of abortion has been lightly touched upon by the hon. Member for The Wrekin (Mr. Fowler) who, while pointing out the dangers, said that we did not want an abortion haven. This country did become an abortion haven for Continentals after the passing of the Abortion Act 1967. A very sorry sight was presented when that occurred. But the situation has settled down now and the question of abortion in Scotland is not a matter that gives rise to any kind of anxiety at present. Let us keep it that way.
This is the kind of matter in which, if one makes changes, one always runs risks. These matters are very delicate and difficult to organise from the practical point of view. They are matters in which legislation is not only controversial and cuts across party lines, but in which there are difficulties of definition and practical application.
§ Mrs. Wise
As the right hon. and learned Gentleman has said, these matters of family planning and abortion are very delicate. They also involve deep religious and moral feelings, and feelings about freedom. To devolve these decisions to smaller units of population could be very divisive within those smaller units, and very destructive. This would not be helpful even to those who are keen on Scottish nationalism or any other form of nationalism. We must remember that these are matters which arouse strong religious and moral passions.
§ Sir D. Renton
I never thought that I would ever be so grateful to the hon. Member for Coventry, South-West (Mrs. Wise) for an intervention in a speech of mine. I disagree with her on so many things, but on this matter I am exceedingly grateful for the force and clarity with which she has underlined the point that I was making much less adequately.
§ Mr. Russell Johnston (Inverness)
Before the right hon. and learned Gentleman expresses complete agreement with the hon. Member for Coventry, South-West (Mrs. Wise) will he say whether there is any evidence to suggest that the fact that the Danes, the Norwegians or the Dutch, with their smaller populations, have control of abortion has proved in any way divisive in those countries?
§ Sir D. Renton
The hon. Member is rather naughtily putting words into my mouth that I have not in any way expressed. I think that we have this business of abortion across the border just about right at present, so let us leave it that way—[interruption.] The silly laughter that so often emanates from the charming people on the Scottish National Party Bench does not help our discussions in any way. I do not think that the Scottish nationalists are really interested in the Bill. They are not prepared to face the realities of the administrative, financial and functional problems arising here.
§ Mrs. Winifred Ewing (Moray and Nairn)
Why, in the earlier part of his speech, did the right hon. and learned Member for Huntingdonshire (Sir D. Renton) find it so difficult to consider the possibility of the party that I represent ending up with a considerable number of votes in Scotland, fairly and 1795 squarely under any system of election? Does he not think that there is something illogical in the history of his own party's case in relation to Scottish votes over the past few years?
§ Sir D. Renton
I dare not answer that intervention, because it is totally irrelevant to the Health Service. It is nothing whatever to do with what I have been saying—
§ Sir D. Renton
I shall try to revert to the main theme of my speech. I am not opposed to change. Goodness knows, I have proposed many changes in the House and we must always keep an open mind about change. However, when making such a fundamental change as this, let us make sure that it is necessary and wise, and let us not ignore the vivid warnings from hon. Members on both sides of the House. If we make the change in the face of these warnings and all the practical difficulties, it will be a great disservice to the Scottish people.
§ Mr. Gourlay
I have not been surprised by the last two speeches, since both speakers are bitter opponents of the principle of devolution and are only too ready to call in aid any organisation or limited idea which might help in their arguments against devolution. However, I was surprised that my hon. Friend the Member for West Lothian (Mr. Dalyell) should call in aid the British Medical Association which fought so bitterly against the introduction of the National Health Service and which compelled the then Labour Government and the Minister of Health, Nye Bevan, to agree to private beds in hospitals as a condition to the introduction of such a service. I am surprised that my hon. Friend should call in aid the BMA's help in trying to delete certain devolved powers.
The majority of professional associations and industrialists in Scotland are trying to undermine the principles of the Bill because, like many other Scots, including myself, they are afraid of complete independence. However, I support the principles in the Bill. The Health Service in Scotland is different from that 1796 in England. We have our own NHS Act. I believe that it is right to devolve control of our service from the Secretary of State to an elected Assembly. To the last two speakers I say "Oh ye of little faith in democracy". We are taking powers from the Secretary of State and passing them to an elected Assembly of Scotsmen who have a record second to none in producing the finest surgeons and physicians in Britain, many of whom have been exported to England and the rest of the Commonwealth. Even if we had the disaster of a majority of SNP members in the Assembly, I do not believe that they would try to reduce the standards in the medical departments of our universities.
§ Mr. Teddy Taylor (Glasgow, Cathcart)
As the hon. Gentleman is the first supporter of the Bill to speak on the amendment, will he say what benefit devolution will have in relation to the Health Service in Scotland? He talked about democratic control, but what will a Scottish Assemblyman be able to do about the Health Service which the hon. Gentleman, as a Member of the United Kingdom Parliament, is not able to do? Scottish health laws come before this House and, as an hon. Member, he is entitled to ask questions about the NHS in Scotland in exactly the same way as an Assemblyman would be able to do.
§ Mr. Gourlay
That is a simple intervention to answer. We have the right to question Scottish Ministers but we do not have the right or the time to go into a detailed investigation of the Health Service. That is the whole purpose of devolution. That is what the hon. Gentleman is opposed to. He is not prepared to give his Scottish colleagues and the people of Scotland the right to determine for themselves what they want to do in the Health Service. He wants it done here, where there is a limit on time. It is because of the limitation on time that in some cases we have not been able to correct faults in the reorganisation of the Health Service in Scotland.
For example, many of the people who are members of area health boards in Scotland are now very dissatisfied with the present set-up, because in setting up the new area health boards, executive groups made up of the principal officers of the area have been set up. They are putting 1797 forward propositions to the health boards merely for rubber stamping. In some cases, when members of these boards have challenged the reasons for the decisions of an executive group, they have been politely told "We are in a better position to know than you, as lay members, what is good for the Health Service in this area".
Therefore, from that point of view alone, there are many reasons why an elected Scottish Assembly, particularly if it is run on the committee system, as proposed, could devote a great deal more time to finding out what is wrong and what improvements can be introduced into the Health Service in Scotland. That is only one aspect.
I am rather afraid that the hon. Member for Fife, East (Sir J. Gilmour) has not consulted as widely as he might have done some of the members of the health board in Fife and in other areas to discover whether they are satisfied with the present system. As a former member of a board of management, and having consulted some present members of the area health board who were also members of the previous boards of management, I know that they, too, find that they are not able to become involved in as much detail as they were previously, and the policy is being dictated very largely by the executive groups. In itself, that is a very good reason why this power should be devolved to a Scottish Assembly.
On the second amendment, which deals with family planning and abortion only, irrespective of which views one may hold on most of the aspects, I do not think that there is any danger in those two items being put under the control of the Assembly. I think that the hon. Member for Glasgow, Cathcart (Mr. Taylor) would agree that we in Scotland have always regarded ourselves as being much more enlightened than many of our English counterparts. Therefore, I think that a Scottish Assembly would see that these two items were administered in accordance with the wishes of the majority of the people of Scotland.
After all, the Assembly will have 150 Members. It will be widely representative, even more representative than we 71 Scottish Members of Parliament can be at Westminster, and it will have much 1798 more time to devote to these particular aspects. Therefore, I am not in the least afraid. I have a much greater faith in the Scottish people determining in an Assembly that which is better for them than in that being done by the 635 Members of Parliament at Westminster.
The right hon. and learned Member for Huntingdonshire (Sir D. Renton), who has now left the Chamber, said that he was afraid that the service would become far more Scottish than it would need to be. I do not know what he meant by that, because in all instances the Scots themselves want to have the best possible service that they can get for the money that is being paid. Whether that makes it more Scottish, more English or more Catholic, I do not know, but at least it is what the Scots want. Therefore, it is right that they should have it.
The question of control over medical training and standards is one of the reasons why the BMA does not want to see a devolvement of control of the Health Service. However, again, that is a worry that the BMA may have but I cannot see any valid reason for that worry.
§ Mr. Dalyell
For reasons of time, I concentrated on the BMA, but my hon. Friend will accept that some trade union members, such as Jim Strachan, and John Lambie of NUPE, are very concerned for similar reasons.
§ Mr. Gourlay
I accept what my hon. Friend says about certain trade union leaders, but they are not the holders of all the wisdom in the United Kingdom. Many of us who have discussed these matters over many years are convinced that there is nothing in the powers that are to be devolved to the Assembly that will do anything detrimental to the National Health Service in Scotland, to medical training, or to anything else. I fully support the Bill as it stands and I am opposed to the amendment.
§ Mr. Russell Johnston
I agree with practically all the remarks made by the hon. Member for Kirkaldy (Mr. Gourlay), with the possible exception of when he referred to the hon. Member for Glasgow, Cathcart (Mr. Taylor) as a beacon of progressive thinking in Scotland. The hon. Member for Kirkaldy stumbled there. Apart from that I agree with him.
1799 The hon. Member said that the nub of devolution is discretion and choice and that that is why we have engaged in this exercise. At the beginning of the debate the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) quoted from remarks made by the BMA. Subsequently the hon. Member for West Lothian (Mr. Dalyell) expressed the BMA's fear that an Assembly might spend more money on housing and education than on health. That is no reason for not devolving that power. It is an expression of doubt of which political aspect might dominate a devolved Assembly. It is not a reason in itself.
Medicine is full of choice as it is. We have a whole range of difficult choices to make and it is increasingly difficult for hon. Members, since we are the holders of the purse strings, to make the right choice between the professional advice that Governments are given. That advice is often difficult to understand for the non-professional. It is often difficult to determine the right priority, particularly in the treatment of rare diseases. One cannot guarantee that the United Kingdom choice will be better than a Scottish choice nor can one guarantee that a Scottish choice will be better than a United Kingdom choice. That argument is not significant.
If one accepts the principle of devolution, one accepts that it may produce a greater degree of sensitivity, but one does not know for certain that it will. One accepts that an Assembly will have a greater sensitivity to the problems, a greater degree of knowledge and an equivalent degree of responsibility in the exercise of the job that has to be done.
The hon. Member for West Lothian produced a formidable array of bogies. I am sorry that he has temporarily left the Chamber. One of the arguments that he advocated on behalf of the BMA, with which he appeared to be in accord, was that the Assembly might establish a health council. The hon. Member said that such a health council might—and this is all supposition and doubt—interfere with the regional hospital boards "to the disadvantage of the doctors and their patients."
Is the hon. Gentleman seriously suggesting that a Government of any political complexion would, as a matter 1800 of determined policy, approach the Health Service with the objective of acting to the disadvantage of the doctors and their patients, the patients being the commonality of all the population? I appreciate that the Assembly is as likely to make mistakes as this place is, but that it should pursue a conscious policy of lowering standards is difficult to contemplate as a serious argument.
The hon. Member for Aberdeen, North (Mr. Hughes), in an intervention in the speech of the hon. Member for West Lothian, expressed his doubts and reservations, which I share, about the repeated view of the British Medical Association that "decisions on political grounds" are terrible, that they are interference and a danger. That is not a view that I hold. There is a profound and wholly justified public interest in these matters.
It is all very well for the hon. Member for West Lothian to say of the BMA that "rightly or wrongly, it fears" that this that and the next thing will happen. We cannot legislate on the basis that somebody or other is rightly or wrongly afraid of something. That is not a basis on which one can make any improvement.
Therefore, I cannot accept the first amendment. It is wholly contrary to the concept of devolution and its principle as embodied in the Bill.
The second amendment is perhaps more difficult. The hon. Member for Aberdeen, North felt that what he described as broad social matters should be treated in an equivalent way throughout the United Kingdom. He said that with reference to the amendment on family planning and abortion. One of the mistakes made by the hon. Member for West Lothian is to confuse assertion with logical demonstration and proof. Every day he treats us to assertions clad in the guise of logical argument. Here I admit before I start that probably I, too, am guilty of assertion when I say that in the matter of family planning and abortion it is a question of the acceptance of a community's right to determine matters in its own way. That is what devolution is primarily about—the Assembly's capacity to create within Scotland a domestic environment in tune with what the community in Scotland thinks. It is more a question of that than of the pros and cons and rights and wrongs.
1801 Let me take family planning first, as it is perhaps the easier of the two. One does not want to spend a great deal of time on the subject. We have heard of the smuggling of contraceptives in Ireland. One cannot argue that that is immensely disruptive of the commonweal. One may take the view that it is wrong that contraceptives are not freely available in Eire. One may take the view that it is right. But it cannot be argued that the carrying of contraceptives across the border in brown paper packages has a serious effect on the balance of the community one way or the other. I do not think that that is a matter which is tremendously serious—at least with regard to disruption.
§ 10.0 p.m.
§ Mr. Johnston
I am not denying that. I was trying to avoid expressing my own opinion on the matter. The hon. Lady may be assured of that. What I am arguing is that in this matter the idea that a different policy would be pursued in Scotland, which is what people are worried about, which would have a serious and disruptive effect on the Health Service throughout the United Kingdom, does not stand up. One might disapprove of it, and perhaps rightly disapprove of it, but that is a different question. It would not result in the problems which abortion undoubtedly might result in.
The cases with abortion is much more sensitive, important and difficult. I do not think it can be refuted that what the hon. Member for The Wrekin (Mr. Fowler) described as the possibility of abortion havens could, in certain circumstances, happen. I do not think that one can deny that, irrespective of whether it would happen in Scotland or in England. It could happen if different policies were adopted because of public pressure or democratic decision in either place. The question is what one should do about this.
§ Mr. Robert Hughes
I am not as much concerned as is my hon. Friend the Member for The Wrekin (Mr. Fowler) about abortion havens. I am concerned about 1802 the possibility that the legislation would get out of kilter, in that in one part of the kingdom legislation on abortion might be stiffer than in other parts. Whereas at the moment it is possible for people to obtain an abortion in England or Scotland, depending on administrative arrangements, it would be much more difficult if legislation in one part of the country were stiffer. How could one then argue that one was making a freely-available service?
§ Mr. Johnston
I do not deny that the situation is difficult, but I fall back in the end on the question of the approach to the principle of devolution. I think that democratic decisions can be unfortunate and inconvenient and, in some cases, immoral. I am not here specifying a view on abortion, but it is possible for a group of people to take a decision that is wrong. But that can apply to a large community as well as to a small one.
We see this, for example, in South Africa. In South Africa, there is the operation of democracy for the 3 million white people who are taking a series of immoral and wrong decisions. But they are still democratic decisions in the strict sense of the word. But I think that, in the end, the strength and durability of democracy evolve towards general standards such as the hon. Member for Aberdeen, North commented on in relation to the Health Service in general and the attitude towards it now compared with the attitude in the late 1940s. That attitude has changed fundamentally and, I think, lastingly. It is not to be seriously contemplated that a different basis would now be introduced in Scotland as a consequence of devolution. Democracy has worked its way through to acceptance of a general standard for the Health Service.
I do not think that one can or should be afraid to risk the existence of differences, because, in the end, it is the suppression of differences which can be most damaging to democratic progress. It is not a matter that can be proved, that there is much likelihood of the two getting out of kilter, to use the expression of the hon. Member for Aberdeen, North on the subject of family planning or abortion.
In a democratic community we ought to be able to contain a certain measure of difference and disparity. Once we 1803 separate the two there may be a possibility that, until a certain moment when a general standard will be accepted, there will be a forward movement which may not proceed at quite the same pace. That must be recognised and accepted. It would not be a good thing, in working out a humane and democratic answer, if the majority of people in Scotland wished to restrict abortion or to increase the availability of abortion but the opposite policy was imposed by Westminster. I would be prepared to accept the risk of difference in pursuit of the principle of democratic devolution.
§ Mr. George Thompson (Galloway)
Following the speeches of the hon. Members for Kirkaldy (Mr. Gourlay) and Inverness (Mr. Johnston) I am tempted to take a leaf out of the book of the hon. Member for West Lothian (Mr. Dalyell), but to move in an opposite direction, by making a speech which would consist of a very loud "Hear, hear." There are one or two matters to which I ought to give my attention although I am as anxious as my hon. Friends to get on to the interesting amendments which are to follow.
The hon. Members for Inverness and The Wrekin (Mr. Fowler) have emphasised that the point about devolution is that it is meant to give the Scottish people, through the Assembly, the chance of making choices in certain areas. One such area is health. We all know, from being alive, that the result of making choices is that there is always an element of risk. Things can go wrong, but, equally, they can go right. The right hon. and learned Member for Huntingdonshire (Sir D. Renton) spoke about inward-looking nationalism, quite forgetting to advert to the fact that it is possible to have outward-looking nationalism. That is the sort of nationalism in which I am interested.
The right hon. and learned Member also referred to the training of doctors. How many times in the House of Commons have I pointed out that because Scottish doctors are trained in what are effectively general hospitals they have a much greater social commitment to the general community than have doctors trained in England? How often has the British Medical Association, even in Scotland, striven to move us in the direction of more private practice, not because 1804 there was very much of it in Scotland but because the BMA dog in London was wagging the Scottish tail in the direction London wanted it to go.
The right hon. and learned Gentleman took the view that in certain areas the Scots must be kept under the tutelage of a nurse. That might be all right if we were under the tutelage of a nurse who was always of the character of Florence Nightingale. There is, however, always the possibility that we may be under the tutelage of a nurse something like Mrs. Gamp. What the Scottish people need to do is to get away from being nursed and to undertake their own responsibilities, making their own choices and facing the possibility that there may well be risks—but certain in the knowledge that they have within themselves the means to counteract those risks and, if they should eventuate, the power to take measures against them.
The hon. Member for West Lothian belongs to the group of Scots who are always afraid of change. They always take it that change must be for the worse and never for the better. This is sad, because it seems to be a characteristic of people who are old and done that they almost always look to the past and never to the future. I suggest to the hon. Gentleman and his laughing hon. Friends, and those hon. Members on the Conservative Benches who think that that is funny, that they sit down and exercise their minds on the subject instead of merely indulging in laughter.
§ Mr. Dalyell
I was laughing because I thought that some of my hon. Friends on the Front Bench might wish that I were done.
§ Mr. Thompson
I am not in a position to make a prognosis on behalf of the Under-Secretary of State about the condition of his hon. Friend, either mentally or physically, but the House would be a poorer place if the hon. Gentleman were not here to admonish and encourage us as we go through the Bill.
The hon. Member for The Wrekin said that, because there might be different major medical problems in one country as opposed to the other, the two countries might make different choices and adopt different solutions. I think that that is true. Why should we worry if a Scottish 1805 Assembly, in its wisdom, thinks that more money spent on housing would have a valuable effect in the medical field? We in Scotland are well aware that good housing helps the medical condition of our people. It will be for the Scottish Assembly to weigh up matters and come to decisions on them, and I do not fear that happening.
I think that differing situations in the two countries might lead to cross-fertilisation, as the hon. Member for Aberdeen, North (Mr. Hughes) said, and even to healthy emulation between the two countries. Medical learning is international and therefore I see no reason why these matters should not remain, as the Government intend, within the devolved field.
I cannot understand why the hon. Member for Aberdeen, North should fear that a Scottish Assembly will reintroduce pay beds. That does not seem to be in accordance with what I know of the Scottish people or of the Scottish medical profession.
§ Mr. Robert Hughes
I said that I did not think it was likely that the Assembly would make that change, but that if it did one would have to accept it.
§ Mr. Thompson
I am grateful for that clarification.
The amendment is curious in that it lacks the imprimaturs of the Shadow spokesman on devolution and the Shadow spokesman on Scotland. It remains to be seen whether, when we come to the end of our debate, it is a lightweight amendment in terms of the signatories or a heavyweight amendment to propel its signatories into the Lobby, or even to propel the Tory Party en masse into the Lobby. No doubt the Division lists will show what happens.
It is clear to me that the Bill as it affects the Health Service is a logical development of what we already have in Scotland. We are to move from administrative devolution in certain health matters to the possibility of Scottish legislative devolution in health matters and responsibility for Scottish health will continue to lie in Scotland. It is merely a step forward, and again is not one to be feared.
The Scottish Health Service has excellent standards. All of us in Scotland 1806 are proud of that excellence, and I for one do not believe that in these matters the Scottish Assembly will be more meddlesome, in a mischievous way, than is the House or the Scottish Grand Committee.
§ Mr. Dalyell
If the Assembly is not to be meddlesome, what will it do? Spend its time on legislation? For example, what kind of legislation would the hon. Gentleman and his colleagues like to see the Assembly and its committee undertake?
§ 10.15 p.m.
§ Mr. Thompson
It would perhaps help the hon. Gentleman and avoid my getting into trouble by being out of order if I were to send him a copy of my party's health policy so that he can study it at leisure.
I do not accept as an absolute necessity that because we have a legislature it must legislate from New Year's Day to Hogmanay every year. If we have a health committee I do not accept that it need necessarily sit on every day from New Year's Day to Hogmanay churning out reports or advice. We could probably do with a reduction of these things rather than an increase.
The Scots, being parsimonious, will perhaps apply their parsimony even to a legislature and to oversight. What we are asking for the Scottish Assembly is not a series of privileges to be conveyed to it by the House but a set of responsibilities to be given to it by the House. We believe that as much should be devolved as can be devolved within the limits of what the Government are prepared to offer, unless we can persuade them to offer further things by our advocacy of further amendments, We want the Assembly to be responsible for all those matters that Conservative Members are seeking to persuade us to take out of the Bill.
I do not look upon the Assembly as anything but a staging post on the way to full Scottish self-government. By devolving to the Assembly responsibility for important sectors of Scottish life we shall be giving it, its officials and the people of Scotland valuable training against the day when we take over full control of all our affairs.
§ Mr. Teddy Taylor
The hon. Member for Galloway (Mr. Thompson), in an agreeable speech, said that we should not be scared of change. He chided the hon. Member for West Lothian (Mr. Dalyell) and others for being scared of change.
In this schedule, which my hon. Friend is seeking to amend, there is a major change. It is a change in the structure of the Scottish Health Service and almost all of the health responsibilities of the Secretary of State for Scotland. I accept that we should not be scared of change in itself, but we have had no justification for it so far. I hope that in his reply the Minister will give some idea of the benefits which he believes will accrue to the people of Scotland from this change.
It is a major change. Speaker after speaker, including the hon. Member for Galloway, the hon. Member for Inverness (Mr. Johnston) and my hon. Friend the Member for Dumfries (Mr. Monro), have stressed that we have extremely good health services in Scotland administered from St. Andrew's House on the basis of laws largely determined by Scottish MPs. I hope that the Minister will give some indication of what benefits he believes will come from this legislation.
I hope the Minister will also give an indication about the views of those in the health services with regard to this change. The hon. Member for West Lothian and my hon. Friend the Member for Fife, East (Sir J. Gilmour) pointed out that the BMA was concerned about the change proposed. Many people who work in the health services and people who have representative bodies such as trade unions, trade associations or professional organisations are concerned. Can the Minister give an indication about the general views that have been expressed by the doctors, dentists, consultants, nurses and those engaged in other activities within the health services?
In addition, as this is the first of a number of proposals for devolution that we shall consider, perhaps the Minister will answer one or two specific questions? First, is the division of responsibility clear? Part I of the Schedule contains proposals with regard to health which should be transferred to the Assembly. In Part II we have those health responsibilities relating to the Secretary of State 1808 for Scotland which are not to be devolved. These include:Control of drugs, medicinal products, biological substances and food.At present both devolved and non-devolved matters are handled administratively by the Scottish Home and Health Department. In this case, as in others to which we shall come where some of the Secretary of State's responsibilities will be devolved and others will not, there will be a division in the work of civil servants. Is the Under-Secretary satisfied that there is a clear division between devolved and non-devolved responsibilities?
Will guidance be given to those unfortunate civil servants who will go through this difficult time as to the priority they should give as between devolved and non-devolved responsibilities? For example, some of the work of the Scottish Home and Health Department will be devolved and some will remain with the Secretary of State. Suppose that a committee of the Assembly demands the attendance of the principal civil servant in the Department at the very time that the Secretary of State wants that civil servant to attend on him with advice, and where both the committee and the Secretary of State regard the matters as urgent. What advice will be given to senior civil servants who have responsibilities in both spheres about the priority they should accord to them?
§ Mr. Dalyell
Suppose that there was a Conservative Government in London and a Labour Administration at the Royal High School, and supose that the hon. Member for Glasgow, Cathcart (Mr. Taylor) was the Secretary of State for Scotland and my hon. Friend the Under-Secretary was the Scottish Prime Minister. Would it not be difficult for the same civil servants to give advice to the two parties on sensitive issues?
§ Mr. Taylor
Yes. Even though the Under-Secretary is an agreeable person, as I am, it is quite possible for there to be a dispute between us on an important issue of policy—for example, whether some aspect of health responsibility was devolved, or whether some proposed action of the Assembly would cause trouble for one of us. We should both be seeking advice from the same civil servants while holding conflcting views. What priority will the civil servants give? 1809 The Under-Secretary may say that we should avoid the situation with good will and understanding, but there will be occasions when the civil servant will be asked for advice by the two sides.
We are considering devolving part of the health responsibilities. How is payment from the block grant devolved sums to be calculated when there is an addition to the complement of the staff in the Scottish Office and when only some responsibilities of the additional staff will be devolved? How do we work out the accounting procedures for the devolved and the non-devolved responsibilities respectively?
§ Mr. Dalyell
There is an added complication concerning accounting officers and the responsibilities in this very field of a Scottish Comptroller and Auditor General, who is responsible to the Public Accounts Committee of the House.
§ Mr. Taylor
There will be three days available on Report stage when we can discuss this and other matters, but it is a very important question. What is the accountancy procedure in relation to that part of the Civil Service which is looking after devolved civil servants? I hope that we may have advice on this.
There are a number of other issues arising out of the speech made by my hon. Friend the Member for Fife. East. I hope that the Minister will give us guidance on these issues and also say whether there will be any change in the structure of pay negotiation.
Unfortunately, we were not able to discuss Clause 41, but that is only one of the many clauses which we have not been able to discuss. This was meant to give some kind of guidance as to how Schedule 8 would operate. It covers doctors, dentists, and so on. Will the Minister give us some indication whether the pay of doctors, dentists, consultants and nurses will be subject in all cases to the approval of the Secretary of State? Is any change envisaged in the pay structure and conditions of those involved in the health service?
My hon. Friend the Member for Fife, East was absolutely right in emphasising the real fear among those engaged in our excellent health service that the creation of a Scottish Assembly and the devolution 1810 of the health services might result in separate standards. It would be very difficult indeed if taxpayers paying British taxes were to find that perhaps the level of service was different as between areas north and south of the border.
Will the Minister give us some indication whether there will be any change whatsoever in the present arrangements whereby people can get, without complication, health services both north and south of the border, and particularly hospital services? The hon. Member for Aberdeen, North (Mr. Hughes) was right in saying that there is a movement of patients across the border. They are getting treatment in the hospitals which can give them the best possible service. I hope that the Minister will be able to confirm that there will be no change in this respect.
On the other hand, will the Minister say something about the financies involved? The Scottish Assembly will be working to a block budget, and this will be a limited amount. If the situation arises that a far larger number of English patients are being cured in Scottish hospitals than the number of Scottish patients being attended to in English hospitals, and a considerable amount of money is involved, will there be any change or alteration made in the financial arrangements? If so, who will pay?
Will the Minister tell us whether the clause as it stands, or Group 1, would enable a Scottish Assembly, if it so desired, to alter arrangements for pay beds and for Health Service charges? Could a Scottish Assembly, if it so wished under these devolved arrangements, introduce charges for beds or alterations in pay beds, or introduce Health Service charges under these arrangements? I feel that my hon. Friend the Member for Dumfries was absolutely right in saying that it is very difficult indeed to see why the administration of the health services should not be devolved.
My hon. Friend the Member for Edinburgh, West (Lord James Douglas-Hamilton) mentioned the important question of abortion and put forward an extremely good argument on the need to maintain the present arrangements whereby the law on abortion was fixed on a United Kindom basis. I accept that there are arguments on both sides, 1811 but I hope that the Minister will at least accept that my hon. Friend has made a very good point.
Is there a possibility of the law on abortion being different on each side of the border? This is probably the one area in which there is a greater chance of a change in the law than perhaps on any other issue. There have been two Bills, introduced to amend the abortion law, and they have been passed on Second Reading by a substantial majority of Members. For one reason or another, however, neither of them became law. No doubt the Leader of the House could give some indication of the background to this matter, but it would probably not be in order to discuss it. There have been two votes in the House of Commons in favour of changes in the abortion law, and therefore there is a real chance of a change taking place.
I am sure that the Minister accepts that if there were a difference between the law on abortion in Scotland and that in England it could involve substantial problems for Scotland's health services. At one time thousands of foreign women, despite the long and expensive journey, wanted to come to the United Kingdom for abortions. That occurred because of the major difference between our abortion laws and those on the Continent. The Minister should not underestimate the problems that could arise if differences were to arise between the abortion laws of Scotland and those of England. Moral issues are also involved in maintaining separate laws on both sides of the border. The Minister may say that there are differences on both sides of the border in the law on homosexuality, but even so the law on that matter is not being applied in Scotland at present.
The Minister may also say that United Kingdom law in these respects would have spending implications for the Scottish Assembly. If the House of Commons were to listen to those who wish to bring in a law to give abortions on demand, that would have serious expenditure and moral implications for Scotland. It would mean that the Scottish health services would have to spend more on providing abortion services. The Minister no doubt could point to differences in other respects. In a devolved situation one could have 1812 differences in the school-leaving age on each side of the border.
I appreciate that there are arguments on both sides, but I hope that the Minister will reply to the convincing case which we have advanced. I repeat that serious problems could arise in the Health Service if different abortion laws apply in Scotland and south of the border. Therefore, I hope that the Minister will consider it appropriate not to include the subject of abortion within the subjects to be devolved. The family planning matter may not be so difficult to deal with. It might be possible to include that matter without creating confusion, but certainly the subject of abortion will create many problems. Therefore, I hope that between now and Report the Minister will re-examine the position on abortion and will consider whether there is a case for removing it from Group 1.
§ The Under-Secretary of State for Scotland (Mr. Harry Ewing)
There are three propositions before the Committee. One is the general proposition of the hon. Member for Fife, East (Sir J. Gilmour) that the Health Service functions should be reserved and should not be devolved in any shape or form, and the other two propositions relate to family planning and abortion. The hon. Member for Edinburgh West (Lord James Douglas-Hamilton) claimed, no doubt inspired by the BMA, that those functions should be reserved. I shall take the various subjects rather than deal with the points made on them in the various speeches because in that way I hope to avoid answering each point three times over. I think that will be the most coherent way of dealing with this debate.
Let me deal first with the proposition that the Health Service should be not devolved but reserved. It is worth noting that the Health Service was the one function that was concentrated on by the Royal Commission on the Constitution and was specially selected as a good example of a function that should be devolved. It was selected for the specific reason that decisions on health matters affect people in very personal ways. It was for that reason that the Royal Commission, as the right hon. and learned Member for Huntingdonshire (Sir D. Renton) knows, selected the Health Service as a prime example of the sort of function that should be devolved.
1813 I realise that in deciding to devolve the health services we set up various fears. These fears have been expressed by my hon. Friend the Member for West Lothian (Mr. Dalyell) and by almost every hon. Member who has spoken in the debate. I do not blame the BMA in Scotland. I have good relations with it. I meet it from time to time. I cannot remember a meeting at which there has been any ill feeling. I find its members a reasonable group. I do not want to give the impression that we are dealing with unreasonable people. I understand the fears. The apprehensions that have been outlined by the BMA in Scotland require to be answered.
The medical schools that are part of the four universities in Scotland that teach doctors are not to be devolved because the universities are not to be devolved.
The medical schools obtain their finance in two ways. That is because they have two functions to perform. There is the obvious function of academic teaching, and there is a service function. Even when students are training they do some work in the health services. Therefore, the schools obtain their finance in two ways. One way is through the normal university channels and the other is from the money voted to the Scottish Office for health services purposes in Scotland.
In future under the devolution proposals the schools will still obtain their finance in two ways. They will still obtain the element of finance related to the academic function through the normal university channels. They will obtain the other element of finance from the Assembly because of the in-service work that they do for the health services and, therefore, for the Assembly.
There is no danger to the teaching schools. I am sure that the BMA and all who are concerned about this matter will accept tht assurance. I have been perplexed by the feeling throughout the debate that somehow the Assembly will go for lower standards. That argument does not bear examination. It is not true. It may go for different standards, but it definitely will not go for lower standards. If it goes for different standards, that will be because since time immemorial we have had different standards in Scotland as the needs have been different. For example, the mortality 1814 rate has been much higher in Scotland than in other parts of the United Kingdom.
The health needs of the people of Scotland have been different through the years. That is why the present allocation of resources is different. The needs of the people are different, and most of the things that we do in Scotland in the health services are done differently from the way in which they are done in England and Wales, especially as regards administration.
In Scotland we provide more in-care for patients. We have more patients per head of the population having treatment in hospital rather than as out-patients. That is because of the traditional medical needs of the people of Scotland. We continue to work hard to solve many of the health problems with which we have been beset over the years.
§ Mr. Dalyell
I do not doubt my hon. Friend's sincerity in saying that the Assembly would not want to go for lower standards, but is it not a fact that there might be less money available for health matters? Righly or wrongly, the Assembly may make a decision that there will be a good deal more money available for housing, and, therefore, whether we like it or not resources for health will be less.
§ Mr. Ewing
I am coming to the point about housing. I do not want to be unkind to my hon. Friend, because he and I are the best of personal friends, but I have the feeling that if we go from now until doomsday I shall not convince him on any aspect of devolution. It is as well to approach my reply to the debate from that standpoint. Indeed, I am not being unkind when I say that my hon. Friend is here not to be convinced but to argue against the principle of devolution.
There has been a mistaken impression in the debate that housing and health are not linked. Decisions on housing are often taken on the basis of health, not housing, need. There is a link between housing and health. It is not right for Members of Parliament to separate housing from health in the defined manner that has been evident in the debate. Decisions on housing—whether to demolish and to build new houses or whether to upgrade houses—are often as much 1815 related to health as to the standard of housing that we want people to enjoy.
My hon. Friend the Member for West Lothian struck the heart of the matter as did all hon. Members who brought up the question of the allocation of resources between housing, health, education, roads and various other devolved functions. I repeat, that is what devolution is about. We should not back away from it. There is no point in anyone, from this Dispatch Box or from other places, trying to disguise the fact that devolution is about choice and differences. If the Assembly decides to allocate more resources to housing or to education than to health, it will have to answer to the Scottish electorate. There should be no apprehension about this matter.
The control of the profession is, as the hon. Member for Fife, East recognised, a reserved matter. The General Medical Council will continue to operate and be responsible for all the disciplinary procedures, control mechanisms, registrations, and so on, that it operates and is responsible for now.
The hon. Gentleman referred to the prosecution of an offence committed in a devolved area. Again, there is no difficulty about that aspect. Although prosecution is reserved, the procurator fiscal—the authority who prosecutes crime—will, as at present, on the basis of a crime having been committed and reported, proceed accordingly. Although prosecution is a reserved matter, there will be no difficulty in prosecuting a crime that takes place in a devolved area. I hope that I have been able to reassure the Committee on that matter.
Many questions were asked about the negotiations relating to salaries, conditions of employment and various related matters. The main body for negotiating consultants' contracts and conditions is the Review Body. The Review Body will continue to exist. However, I should not want to mislead the Committee into believing that separate machinery would not be set up in Scotland. That is a possibility. As a result of devolution, it is possible that the BMA in Scotland and the Assembly will get together to set up their own negotiating machinery. I do not think it is probable, but it is possible.
Consultants' contracts, conditions of employment and remuneration are subject 1816 to ratification by the Secretary of State for Scotland. That is clearly defined in Clause 23 and Schedule 4. Therefore, the Secretary of State for Scotland, whoever he or she may be at the time that the Assembly is set up, will have what I suppose the Committee would want to call an override on the question of consultants' contracts, conditions of employment, and so on.
The Government recognise that it is very important to maintain uniform training standards in order to achieve uniform standards in the profession. We do not want a situation in which doctors or consultants working in the health services are forced to work continually in one part of the United Kingdom. We want to maintain a situation in which a doctor feels free to move backwards and forwards to various parts of the United Kingdom. This can he done easily if training standards are uniform, and all those other matters within the ambit of the General Medical Council are kept. They are reserved subjects. I hope that the BMA, which seems to require some reassurance on this point, will now feel reassured.
I shall refer specifically to one or two of the speeches made tonight. I hope that I shall not appear discourteous if I do not refer to all the speeches, but I thought it better to divide my reply to the debate into subject matters. My hon. Friend the Member for Aberdeen, North (Mr. Hughes) referred to the question of family planning and abortion—
§ Mr. Robert Hughes
Before my hon. Friend comes to that, will he answer the question whether people will be able to move freely from Scotland to England or from England to Scotland for medical care after devolution?
§ Mr Ewing
I was coming to that point. My hon. Friend said that he had fears about the possibility—he put it no higher than that—that people might not be able to move back and forth between the various health authority areas in the United Kingdom. There is no possibility that they will not be able to do so. For example, those who come to the National Heart Centre in London may continue to do so. We are able to deal with large numbers of incoming patients from foreign countries without any problems, 1817 so there is no reason why patients from Scotland should cause any difficulties. I hope that this will reassure both my hon. Friend and the hon. Member for Glasgow, Cathcart (Mr. Taylor) who also expressed anxiety on this point.
My hon. Friend the Member for Aberdeen, North also raised the question of family planning and abortion. He said that these matters always had been administered on a United Kingdom basis, and that policy had always been decided on that basis as well. Technically that is not correct. The family planning aspect comes under the National Health Service (Scotland) Act 1972, but the abortion aspect is on a United Kingdom basis.
I do not intend to become involved in the merits of the argument about abortion. My views are well known, and are beside the point, in any case, but it seems rather strange that the hon. Member for Cathcart should ask me to look at this again between now and Report. It would be dishonest for me to say that the Government view was likely to change between now and Report. There is no point in leading the Committee down this path.
It would be both strange and dangerous to devolve to Scotland all the other child-bearing functions—family planning, all aspects of maternity, obstetrics and gynaecology—and hold on to abortion. I hope that the Committee, on reflection, will consider that it is right to deal with matters in the way that we are proposing and devolve abortion as well.
We have always regarded abortion as a matter of conscience, and the people of Scotland are just as much in possession of conscience as people in other parts of the United Kingdom. That will always be the case. There are no dangers involved in devolving abortion, but I do see dangers in reserving it.
§ Mr. Robert Hughes
The Minister said earlier that my hon Friend the Member for West Lothian (Mr. Dalyell) was not here to be convinced. I hope that Ministers are here to be convinced on specific issues. When divorce law was different in Scotland and England, someone living in Scotland could not get a divorce in England. When Scots law was in advance of English law, a person 1818 living in England could not get a divorce in Scotland. Residence north or south of the border affected one's ability to get a divorce.
If the law on abortion becomes different in Scotland and England, how will that affect the ability of people living each side of the border to get a therapeutic abortion? My hon Friend said that treatment will still be available to people moving between different health authorities, but is there not the possibility of differences in abortion law taking away individuals' rights to therapy? There is a substantial point of law involved here.
§ Mr. Ewing
I do not intend to go into the merits of abortion. There are major differences in laws, including those moral laws relating to divorce, abortion and other aspects of marriage. I refer to these as part of the moral law and to other legislation as the criminal and civil law. There will always be major differences in various aspects of the law between England and Scotland. We have been able to live well with that fact. Even under the present Abortion Act, a number of people come from Scotland to England in order to obtain abortions and probably one or two go from England to Scotland.
§ Mr. Gerry Fowler
My hon. Friend has not yet understood the crucial point that if there were differences in abortion law between Scotland and England it is possible that women would move across the border in order to evade the law in their area of residence. They could not do that when there were differences in divorce laws unless they changed their residence. There is a crucial difference here to which my hon. Friend must address himself if he is to satisfy the Committee.
§ Mr. Ewing
It surprises me that we are prepared to accept differences in aspects of family planing and maternity, yet on this one aspect of child bearing—and I am not making light of this serious matter—we say to the people of Scotland that they cannot be trusted to formulate their own approach to this matter. If we are not saying that to them, what are we saying?
§ Mrs. Wise
The matter of trusting Scottish or English people is not the point 1819 —nor is the question of difference in marriage laws. As long as one is resident in an area of the United Kingdom, one knows under which law one is living if there are differences in the law.
The point about abortion is that a woman can visit, take her problem with her and solve it in one part of the United Kingdom where the law is different. This is the difference between abortion and the law relating to divorce and other matters concerned with child bearing. No one in England or Scotland could change the law about how to have babies, but they could change the law about abortion.
§ Mr. Ewing
I am tempted to answer my hon. Friend's last point, but I shall not do so. The point about divorce is the same as the point about abortion. It was not the House of Comons that stopped divorce law reform in Scotland for very many years. It was the attitude of the people of Scotland. Running through the whole argument about whether we ought to devolve abortion matters is clearly a fear in the minds of my hon. Friends and others who are in favour of retaining them that somehow or other there will be a change in the abortion law in Scotland. If there is no fear, there is no need to get worried about devolving the law on abortion. If there is a fear, my hon. Friends are quite right to be worried.
§ Mr. Robert Hughes
I am concerned about therapy for the individual patient. At present, for everything else one can get treatment north or south of the border, irrespective of anything else, but if the law relating to therapy, either north or south of the border—it could happen either way—is different, how would that affect the availability of the NHS generally to the patient? I beg my hon. Friend not to close his mind but to look at this matter again, not from a moral point of view but from a therapeutic point of view.
§ Mr. Ewing
I am looking at it not from a moral point of view but from a practical point of view. It is simply not practical politics to devolve the whole of this part of the Health Service and to hold on to this one aspect of it. I say in all sincerity to my hon. Friends that we shall not be able to convince people in Scotland that the reason we held on to these particular aspects of family planning—call it what one will— 1820 at Westminster was other than that we were afraid that they would not handle it in the way in which some hon. Members want it handled.
§ Mr. Ewing
No, I do not want to give way. I have only another four minutes, want to finish this matter tonight.
I am aware that what I have said may not have satisfied some of my hon. Friends. However, I am convinced that it is right to devolve this aspect of the health services. I can only allow the Committee to decide the issue when it is put to the test, as the hon. Member for Edinburgh, West no doubt intends to put it to the test.
I have dealt with the question of the health service in general and with the question of family planning and abortion.
The hon. Member for Cathcart, raised the question of the Civil Service. There is really no problem concerning that, because there will be no question of civil servants or a civil servant working both to the Scottish Assembly and to the Secretary of State. The civil servants will work for one or the other; they will not work for both. It will be a unified Civil Service. They will all be members of the same Civil Service to allow for United Kingdom recruitment, promotion and movement of civil servants. But they will work in Scotland for either the Assembly or the Secretary of State, not both.
Therefore, the kind of conflict that the hon. Gentleman suggests, and which, to a certain extent, my hon. Friend the Member for West Lothian suggests—he ought not to frown, because I am coming to a good comment about him—
§ Mr. Teddy Taylor
I want to put an example to the Minister. To whom will the principal civil servant in the Scottish Home and Health Department be responsible—the Secretary of State or the Assembly? If it is the Assembly, can the Minister say who will be the principal official in the Scottish Home and Health Department who is answerable to the Secretary of State?
§ Mr. Ewing
If the Secretary of State has health functions, he will have a civil servant who works for him in relation to 1821 the health functions. The Scottish Assembly will have its health functions and will have a clearly defined civil servant who works to the Assembly in health matters. There is nothing complicated about that.
I do not think that it would be to the benefit of the Committee if I continued the debate into our next Sitting, whenever that may be. It would be better if we resolved these points tonight.
One of the lasting impressions left with me from the debate was the tribute of the hon. Member for Galloway (Mr. Thompson) to my hon. Friend the Member for West Lothian. It will look brilliant in my hon. Friend's election address that the SNP says that the House of Commons will be a poorer place without Tam Dalyell. I do not know how the hon. Member will explain that to Billy Wolfe. When my hon. Friend prints it in his election address, it will be worth a great many votes.
§ It being Eleven o'clock, The CHAIRMAN left the Chair to report Progress and ask leave to sit again, pursuant to Order [16th November].
§ Committee report Progress: to sit again tomorrow.