§ Mr. Kenneth ClarkeI beg to move amendment No. 43, in page 19, line 3, leave out subsection (1).
§ Mr. ClarkeThis enormous body of amendments arises out of an agreement that has had to be reached between the Government and the Opposition about the Bill's progress in the light of the pending general election. We are dealing with the part of the Bill that concerns the future status of family practitioner committees. That was the issue that most divided the Government from the Labour party—but not, I think, from the Liberal party—during our deliberations. There was a fundamental difference of opinion between us.
The Government wish to give independent status to family practitioner committees, but the Labour party wants to put family practitioner committees and services under the umbrella of the district health authorities and wants them to be administered in closer association with the hospital and other community health services. The Opposition are, of course, perfectly entitled to their opinion, although we differ strongly about it. At this stage of this Parliament's life, the Opposition insisted that they could not facilitate the Bill's passage if the existing 874 proposals for family practitioner committees remained in it. As we had no alternative and as there was no way in which an adequate debate could be held to resolve the difficulties between the two sides during this Parliament's remaining lifetime, we had to agree, with considerable reluctance, to withdraw the bulk of the provisions that we proposed for family practitioner committees.
The Government's opinion has in no way changed about the desirability of making the changes that we proposed. Indeed, the Labour party's insistence on that part of the Bill being removed has led to widespread concern among general medical practitioners and no doubt among those—although they have not yet pursued the matter so closely—in the dental and optical professions. I have received numerous representations from those involved in family practitioner committee work, asking how and why the Government have had to drop the provisions.
Only this afternoon, Dr. John Ball of the General Medical Services Committee came to see me to express the British Medical Association's very strong concern about the way in which the provisions had been dropped. I gave Dr. Ball and others an undertaking, which I gladly repeat to the House today. When the Government return to office it is our intention at the earliest possible opportunity to reintroduce these provisions in a new Bill and to put them on the statute book as quickly as possible. We remain convinced that the family practitioner services would benefit most from being administered by, and under the aegis of, independent, free-standing committees whose sole concern and objective is to develop the primary care services that are the National Health Service's first line of contact with the public. I hope that that reassures the various members of the contractor professions who are worried about the present slight doubt and uncertainty in the Act brought about by the attitude of the official Opposition. That remains the fundamental position. We hope to press on with what we believe to be the desired policy as soon as we are returned to office.
Nevertheless, there are one or two small points which have never been at issue between the two parties. One reason why there is such a long list of amendments on the Amendments Paper is that we are taking the opportunity to preserve small provisions which should not give rise to any difficulty despite the clear policy division between the two sides of the House. First, we wish to put into the Bill the provision that allows for the inclusion in joint consultative committees of additional members appointed by voluntary organisations. This proposal was originally brought forward by Lord Wallace of Coslany in another place on behalf of the official Opposition. The Government welcomed it and indeed a Government amendment put the proposal into the Bill. We therefore propose that in schedule 5(4) section 22(5), as presently drafted, should be retained as new subsection 4 (a). We also propose to retain paragraphs (a) and (c) of section 26. This is important in terms of properly-based financial procedures. The two paragraphs ensure the accountability and possibly the control through audit of the accounts of family practitioner committees.
There follow in schedules 6, 9 and 10 a number of consequential amendments, but we have retained in schedule 9 the inclusion of family practitioner committees within the provisions of the Public Bodies (Admission to Meetings) Act 1960, so that the public, and in particular community health council members, will be admitted to 875 the non-confidential part of family practitioner committee meetings. The right hon. Member for Norwich, North (Mr. Ennals) pressed the views of the community health councils upon us in Committee. There was almost complete agreement between the right hon. Gentleman and myself because we were both anxious to ensure that the community health councils in particular had a proper and close relationship with the new family practitioner committees once they were established. We accept that once the family practitioner committees obtain the independent status to which the present Government are firmly committed at the earliest possible opportunity, they cannot stay outside the requirements of the Act. They should have the same close relationship with community health councils that other health authorities enjoy.
I hope that the Opposition will accept our minor reservations. Otherwise, this great body of amendments honours the agreement that we reached with them in order to get the Bill on the statute book.
§ Mr. Alfred Morris (Manchester, Wythenshawe)I am grateful to the Minister for his courteous and helpful letter about these and other Government amendments to the Bill. The Opposition are glad that the Government have now agreed not to implement their plans for family practitioner committees. In our view, the decision to confer on the Secretary of State the right of appointment of all 30 members of an FPC with the exception only of the vice-chairman was a grave mistake. It would have taken local independence away from FPCs and forced them into accepting the edicts of central Government. Moreover, some recent events have made it clear that the Secretary of State's powers would not have been used either sparingly or non-controversially.
We are also opposed to this part of the Bill because the Government were seeking to achieve what should be inconceivable. They were seeking to make the FPCs into rubber stamps for the Government and at the same time to split them from the rest of the National Health Service.
The Minister admitted in Committee that the integration of primary and hospital care is the major problem to be resolved. Yet the Government's plans for FPCs could only have distanced them from the rest of the Health Service. When combined with the powers of appointment, the Government's policy was, in the view of my right hon. and hon. Friends, nothing less than a policy of divide and destroy.
Following the consultation across the Floor since the dissolution was announced, three small sections of this part of the Bill are being allowed to go through. One of them, as the Minister said, was proposed by my noble Friend Lord Wallace of Coslany in another place. In particular, we warmly welcome the agreement to extend to FPCs the Public Bodies (Admission to Meetings) Act 1960, which has been called for repeatedly by community health councils. They, as I hope is readily accepted on both sides of the House, are a source of advice that all of us should not only heed but respect.
§ Mr. Kenneth ClarkeWe have made one or two acceptable reservations in the otherwise unfortunate deletion of the FPC arrangements. The right hon. Gentleman welcomed the fact that the Government had withdrawn their proposals for the future of FPCs. That is not the case. We have not changed our mind. We have 876 been obliged temporarily to withdraw our proposals because otherwise there would not be the time to get the Bill on to the statute book. But the moment that we are returned to office we shall look for an early opportunity to proceed with our policy and to give the FPCs the freestanding independence that we think they require and deserve.
I realise that the right hon. Gentleman, through unfortunate circumstances, has not taken part in earlier debates on the Bill. I wholly reject his claim that the Labour party objects to the Bill because the Government would appoint all the members of the FPCs. That has been a wholly artificial point throughout our debate. If we give independence to FPCs, that makes them accountable for substantial amounts of public money. As with similar bodies in public service, because they are accountable for such sums of money, there must be a direct relationship between them and the Secretary of State, who is accountable to Parliament. It is unworthy to suggest that the Bill is designed to make FPCs the rubber stamps of Government. That is a parody of a perfectly straightforward constitutional position, and one that would not be abused by a Secretary of State in the present Government or, I trust, any other Government.
The right hon. Gentleman also argued the case for integration between district health authorities and FPCs. I accept entirely the desirability of close relationships. I am sure that all those interested in primary health care also accept that. However, we do not believe it necessary to achieve close co-operation by making the FPCs and the administration of their services wholly subordinate to the administration of the hospital and community health care services that are bound to be the major concern of DHAs because they are the larger part of the NHS budget.
We believe that it is possible to have independent FPCs. The Government propose to take other steps, which I detailed in our debates in Committee and will detail again on a future occasion, to ensure that there is a strong and close relationship between the FPCs and the DHAs so that their independence for administrative matters does not in any way impede the desirable co-operation that should take place between them in caring for the patients.
§ Mr. Alfred MorrisWhat I sought briefly to note was that the Minister and his colleagues accepted that integration of primary and hospital care is the major problem. That was my point. I am glad that the Minister accepts that it was also a point that he made in Committee.
§ Amendment agreed to.