§ 'In section 2 (Health Boards) of the 1978 Act—
- (i) after the words "Secretary of State" there shall be inserted the word "(a)"; and
- (ii) after the words "Health Boards" there shall be inserted—
§ (b) Subject to subsections (1A) and (1C), may by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions under this Act as he may so determine; and those boards shall, without prejudice to subsection (1B), be called Special Health Boards.";
§ (b) after subsection (1) there shall be inserted the following subsections—
§ "(1A) An order made under subsection (1)(b) may determine an area for a Special Health Board constituted under that subsection which is the same as the areas determined—
- (a) for any other Special Health Board; or
- (b) for any Health Board or Health Boards constituted by an order or orders made under subsection (1)(a).
§ (1B) An order under subsection (1)(b) may specify the name by which a board constituted by the order shall be known.
§ (1C) The Secretary of State may by order provide that such of the provisions of this Act, or of any orders, regulations, schemes or directions made under or by virtue of this Act, as apply in relation to Health Boards shall, subject to such modifications and limitations as may be specified in the order, so apply in relation to any Special Health Board so specified."; and
§ (c) in subsection (2), for the word "(1)" there shall be substituted the word "(1)(a)".'.—[Mr. Michael Forsyth.]
§ Brought up, and read the First time.
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth)
I beg to move, That the clause be read a Second time.
§ Mr. Forsyth
The new clause and the amendments are important as they allow the Secretary of State for Scotland to set up a special health board in Scotland. Those powers do not exist in Scotland, and I should explain to the House why my right hon. and learned Friend the Secretary of State would like to have them. This arises out of the review that we have undertaken of health education in Scotland—a review carried out on the Secretary of State's behalf by Touche Ross—and a report that has been produced on the incidence of coronary heart disease in Scotland.
Although in Scotland we spend about 25 per cent. more per head on health than is spent in England, we still have very high levels of coronary heart disease and lung cancer, and life expectancy is still lower in Scotland than it is south of the border. The Government have made health education and the promotion of good health part of their priorities for the Health Service in Scotland. Following the reports that have been made to the Government, it has become apparent that there is a need for a body in Scotland with the status and standing to ensure that our health promotion policies are given the centre-stage position that is required.
At present, health education is the responsibility of the Scottish Health Education Group, which is part of the Common Services Agency. The Secretary of State would 181 very much like to create a new body that would be a special health board with responsibilities for health education and promotion throughout Scotland. That body would have as its purpose the implementation of a policy statement of priorities in health education and would be responsible for achieving the targets set by central Government. It would work closely with health boards.
It is for those reasons that we are proposing the new clause and the amendments. It is our intention to establish the new body and to have it set up and working by 1 April 1991. It is essential that we move with speed. The Public Accounts Committee has drawn attention to the need to focus our health education programmes more effectively, and I accept the advice given and the criticism made in the past. Having said that, I believe that we have made great progress in health education. I make no criticism of those who have worked so hard to achieve that in the past.
I hope that the new clause and amendments will be welcomed on both sides of the House. This is a positive step forward. It is an attempt to meet the SHARPEN priorities, which we set out more than a year ago, in which health promotion and education were given a centre-stage position. I have considerable pleasure in commending the new clause and amendments to the House.
§ Mr. Maxton
The hon. Member for Wirral, South (Mr. Porter) has asked me to declare my interest. I can tell the House that I am a member of the Management, Science and Finance union, but I receive no sponsorship for elections from that union and am not a sponsored member of it. I am not sponsored by any union except very indirectly, I suppose one might say, through the new clause, as the money for my expenses comes from the Labour club, and drinking and smoking provide a lot of its income. But that is another matter.
I think that everybody must welcome this new clause, but the problem that we have with it is that it makes no reference to health education. It is a broad, general clause dealing with special health boards in Scotland. It gives the Secretary of State powers considerably wider than those of health education. Opposition Members are suspicious that it is being done in this way, especially as the new clause was put down on Friday, which meant that the Opposition had no opportunity to table amendments to make it specific to health education. That arouses our suspicions about the Minister's intentions.
The Minister's problem in Scotland is that no one trusts him. He may have the best intentions in the world about this legislation and the new clause, but the people of Scotland, particularly when he takes such wide powers, simply do not believe him. They always look for ulterior motives and other things for which he intends to use such powers.
Increasingly, people in Scotland distrust not only the Minister's intentions, but his competence. One can only assume, as the Prime Minister stayed at the hon. Member's house for the night that she was in Scotland, that he was the person who advised her on her whole trip to Scotland. If he can create that sort of public relations disaster, we have every right to distrust his competence in anything at all, particularly since the Prime Minister went to Ibrox to make the draw for the Scottish Cup. If hon. Members 182 wonder why this is relevant, I will tell them exactly why. Until last year the Scottish Health Education Group sponsored the Scottish Cup; therefore the Prime Minister and the Minister had a direct interest at that time, although they have not now. To advise the Prime Minister to go to Ibrox in connection with the draw for a cup in which Rangers Football Club is no longer involved really takes a bit of beating and could cause considerable distress to many football supporters in Scotland. Her performance on television was appalling. That she should describe herself as a Scot by saying "we in Scotland" all the time takes a bit of believing.
§ Mr. Bill Walker (Tayside, North)
The hon. Gentleman, with his interesting ancestry, is trying to lay claim to a Scottish background and history. He should remember that some of us are real Scots.
§ Mr. Maxton
I do not know whether the hon. Member can make the claim that I can, that both his mother and his father were born in the constituency that he now represents. If that does not make me a Scot, I do not know what does.
The Minister's intentions and competence in this matter make us a bit suspicious and I think that we ought to ask him to explain why he is taking broad powers instead of specific powers. Why did not he simply table a clause to set up a new body in Scotland to deal with health education? What else will he use these powers for? The House is entitled to answers to those questions.
I still do not understand, even from what the Minister said, what exactly will be different in health education compared with what was done by the Scottish Health Education Group, for which I have a very high regard. I criticised it in an article that I wrote in The Runner magazine in Scotland because it did not sponsor enough running but sponsored football. However, a lot of its work in health education led the field not just in Scotland but in Britain, and in some cases in Europe; it was very advanced.
§ Mr. Walker
I did not have the opportunity to read that article, but I am sure that it was interesting, because I have enjoyed reading other things that the hon. Gentleman has written. Does the hon. Gentleman believe that, when one writes articles and is paid for them, one should make a declaration in speeches in the Chamber, particularly if an article has been on Health Service matters?
§ Mr. Maxton
The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) may have an interest to declare. For myself, if the hon. Member for Tayside, North (M r. Walker) knew anything about The Runner magazine in Scotland, he would know that it runs on a shoestring and does not pay contributors anything, so I did not get paid for the article.
§ Mr. Kennedy
The hon. Gentleman should bear in mind that that may be the story he was told when the magazine got his copy.
§ 5 pm
§ Mr. Maxton
That is always possible. However, I know the people who run the magazine and I think it fair to say that they do not have any money. That is taking us rather wide of the new clause.
The Scottish Health Education Group has done good work in Scotland. In his brief speech, the Minister did not give us reasons why the group should disappear and a new body should be established. We need to know more about the relationship between a new health board and the other health boards in Scotland in regard to health promotion.
I shall give one example from my area—the "Good Hearted Glasgow" campaign run by the Greater Glasgow health board. I do not know how effective it is, but it has done well in publicity. Whether it has stopped large numbers of people smoking or eating foods with high cholesterol is another matter. In that respect there is a question mark over health education. Certainly we need to know whether such a campaign would be taken over by the new health board or would remain with the Greater Glasgow health board. If it is taken over by the new health board, where is the division in responsibility? The "Good Hearted Glasgow" campaign is not just about advertising and education; it is also about the provision of screening of blood pressure and so on, particularly of men of a certain age. Will the Greater Glasgow health board continue to do that while the new board takes over publicity? I hope that the Minister will give us more information on that.
When I first read the new clause, before the Minister kindly told me exactly what he intended, I wondered whether it had a relationship to the new Health Service executive which the Minister suddenly announced last week. Does he intend giving the new executive legislative standing by creating a special health board which would have power over all the other health boards in Scotland? That suspicion still remains. The Minister may set up such a body, but I am not sure that it would have great legislative standing under this legislation or under the National Health Service (Scotland) Act 1978. Does the Minister intend to use the new clause later to give that body powers?
The clause is broad enough to allow the Minister to explain to the House exactly who he intends to appoint to the new executive body, how much each will be paid for being a member, what contracts they will have, and the terms of the contract. We have grave suspicions about the body, as we have about Mr. Cruickshank, the chief executive of the Health Service in Scotland. We do not believe that the Health Service can be run as a private business like Virgin Records. It should be run for the benefit of the health of patients in Scotland.
I hope that the Minister will say more about the health education side, how it links with the other health boards and how it will help education in Scotland to have the new body as opposed to the existing arrangement. Will he also say more about the new Health Service executive?
§ Mr. Bill Walker
I congratulate my hon. Friend the Under-Secretary on bringing forward the new clause. He will recollect that in Committee the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and I tried to introduce amendments to the Bill. Because we were not as astute as my hon. Friend and his advisers, we were unable 184 to come up with an amendment that was technically able to do the job. We put down an amendment which gave us the opportunity to speak——
§ Mr. Michael Forsyth
It was discourteous of me not to say, in introducing the new clause, that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and my hon. Friend the Member for Tayside, North (Mr. Walker) raised the matter in Committee, when I undertook to bring forward amendments. The genesis of the new clause and the other amendments was in that debate. I apologise for not having said that when I introduced them.
§ Mr. Walker
I thank my hon. Friend for his intervention. I gathered that that was the logic behind the new clause.
That brings me to the point behind the interesting contribution of the hon. Member for Glasgow, Cathcart (Mr. Maxton). He will have realised that the hon. Member for Ross, Cromarty and Skye and I had difficulty in Committee because, if we had made the amendment too narrow, it would have been out of order. We were grateful to the Clerk of the Committee for his assistance in framing an amendment to which we could speak.
I am pleased that the new board will be able to determine policy. Because of the special health problems in Scotland there should be a positive approach to the promotion of health care. I hope that the new clause will receive support on both sides of the House because we are all united on the prevention of health problems.
The meandering of the hon. Member for Cathcart through Ibrox was an interesting way to consider the promotion of good health care. We should encourage more anticipation in sport. The approach of the hon. Gentleman to health care is a splendid example; I give him that.
§ Mr. Maxton
Almost the only criticism I have of the Scottish Health Education Group is that for so many years it sponsored professional footballers in Scotland and did not put money into activity sports such as running and amateur football, as it should have done.
§ Mr. Walker
I do not disagree with the hon. Gentleman; we should do more to assist amateurs in whatever activity they are involved. Like me, the hon. Gentleman is a great believer in the fact that we can prevent illness by looking after our own bodies, by exercise, and so on.
Because the hon. Gentleman wandered into Ibrox to talk about public relations exercises, perhaps I may refer to the best public relations flop last week when the leader of his party missed the boat to Dunoon. The chap who caught that boat was not the Leader of the Opposition but the vice-chairman of the Conservative party, myself. If it were a question of missing boats, I might draw the attention of the hon. Gentleman to the early-day motion about that, but I would probably be ruled out of order, so I will not refer to it. I am responding to the hon. Gentleman's meandering into Ibrox park. I would never have dreamt of going into Ibrox park until the hon. Gentleman did so. Because of that I had to respond.
This important debate was delayed because of points of order. The reaction of some Opposition Members to a fairly straightforward question, touching a fundamental aspect of the new clause, that when people earn money writing articles——
§ Mr. Deputy Speaker(Mr. Harold Walker)
Order. The hon. Gentleman should address himself to the new clause about special health boards.
§ Mr. Walker
The new clause has been the subject of many interesting articles. I hope that you, Mr. Deputy Speaker, are not suggesting that it is wrong for me to refer to them. The hon. Member for Cathcart made his view clear about the support for professional football of the body that the special health boards will replace. If it was in order for him to do that, it must be in order for me to draw attention to the many articles that have appeared in the Scottish media on that matter. I cannot believe that you are suggesting that I am out of order in drawing attention to those articles.
Many of the authors of those articles are hon. Members and they have been commenting in those articles and have been paid for them. Perhaps the hon. Member for Cathcart would like to consider who is writing those articles. He should read the Glasgow Herald from time to time and he might recognise the names of the authors of articles in that paper. The new clause is very important because it will provide the machinery in Scotland to deal with important aspects of health care.
§ Mr. Robert Hughes (Aberdeen, North)
The only part of the Minister's speech with which I could possibly agree was the reference to the importance of health education. That is hardly surprising since my knowledge of health education was gained when I was convenor of the health and welfare committee of Aberdeen town council. The health officer at the time was the formidable Dr. I. A. G. MacQueen, who was one of the foremost protagonists of health education and the role of the health visitor.
I do not intend to discuss health education at length save td say that when the Health Service was reorganised in Scotland and we moved from the old regional hospital boards to the present health boards there was a great deal of concern that the removal of responsibility for health education from local authorities to the new health boards would lead to health education being subsumed under a huge area of responsibility. We were afraid that it would lose its importance and that the focal point would be lost.
I do not want to criticise the Scottish Health Education Group, but I suspect from the Minister's remarks that there is need for a higher profile, a greater focus and more attention to be given to health education. Over the years, health education has clearly not had the impact that we hoped it would have. The health of the nation is not determined simply by the hospital service or by general practitioners. It is certainly not determined by politicians. The health of our nation is determined by good social and housing conditions.
It is incongruous that we spend a great deal of money on unhealthy practices such as drinking and smoking. If we have to declare an interest in either of those pastimes, I must admit to partaking occasionally of the liquids that come from the vine and the rye and I occasionally indulge in tobacco. I hope that that does not prevent me from participating in the debate.
A good life style and good living habits should be encouraged at an early age and health education is extremely important. I would not quarrel with any of the Government's proposals to improve health education. However, I wonder why it is necessary to have such a portmanteau provision as new clause 74.
186 As the Minister said, the new clause sets up special health boards. However, it states that the Secretary of Statemay by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions".The Secretary of State is taking power here not just to set up special health boards to deal with health education or with HIV; he can also set up boards in particular parts of Scotland.
I hope that the Minister does not believe that the new clause will weaken the comprehensive role of the existing health boards. There has been much discussion and argument about the functions of the new health boards. It was decided that they should cover the widest possible spectrum covering primary health care, secondary health care and community care.
We know that community care is to be removed. Will there be a special health board to deal with community care once it disappears to local government? That would seem to be inconsistent, but it might be a possibility. Will there be special health boards in local areas? Will there be special health boards in local areas to deal with specific functions? Does the Minister believe that if a particular health board is recalcitrant about privatisation—and. I regret to say that Grampian health board is enthusiastic about privatisation——
§ Mr. Hughes
I can see the Minister nodding and smiling, but we will return to that point later.
For the purposes of this new clause, if a health board decided that it would not pursue privatisation for particular services, does the Minister have the power under the new clause to establish a special health board to deal with those areas that he wants to privatise? He must give us a clear answer on why he needs special local health boards. He gave no reasons in his opening remarks. It is not good enough to table such broad sweeping new clauses without providing a clear explanation of their meaning.
I want now to consider the Health Service executive I assume that the Minister has legislative authority over that, although he is not taking such powers in the new clause. What is the legislative purpose of the new Health Service executive? Will it be a special health board under new clause 74?
We need to know how much the executive staff will be paid. I have seen estimates that they may be paid as much as £50,000 a year. What binding contracts will be provided? Anyone thinking of taking up such a contract must be aware that if he is appointed arbitrarily with an arbitrary contract, he will be subject to arbitrary dismissal if there is a change of Government.
The Minister cannot provide five-year or 10-year contracts believing that they will tie staff down, because there will have to be compensation if the executive is disbanded if there is a change of Government. I hope that no one will take such a job under the illusion that he has a fat, juicy contract with £50,000 a year and that he will get compensation if we decide that the executive will not exist after the next general election.
The new clause looks innocuous and it would appear to be a reasonable tidying-up measure. Most uncharacteristically, the Minister introduced it in such a modest and 187 moderate way that it is hardly surprising if we wonder what is going on in his little mind behind his smiling, bland little face. We need more explanation before we accept the new clause, although I emphasise that we support entirely the idea of giving health education a much higher profile and more new money.
§ Mrs. Maria Fyfe (Glasgow, Maryhill)
I begin by declaring an interest in that I am sponsored by the Transport and General Workers Union, although not a penny of that money enters my pockets. It is spent campaigning against Conservative policies in Maryhill—and that is an easy job.
I want more information from the Minister on the proposals for special health boards and health education than he has so far troubled to give us. The Minister has not said anything about how the membership will be decided. We must remember the way in which the composition of the local health boards has been changed over the years, so that more and more people of Conservative persuasion seem to serve on them while fewer and fewer of Labour persuasion are chosen. That makes me wonder how these boards will be chosen. Might trade unionists who are involved in health education find a place or two on them?
What are the Minister's plans for choosing women to serve on the boards? Very few women serve on the public bodies in Scotland—boards of various types—over which the Minister has some influence or control. The proportion is tiny. Women chair only one or two. Generally speaking, those in which women participate in any great extent relate directly to things that are seen as women oriented. I also wonder about the resources that the new health education board will have——
§ Mr. Michael Forsyth
I may have misheard the hon. Lady, but is she suggesting that very few health boards are chaired by women? If so, she could not be more incorrect. If the hon. Lady checks, she will see that a number of health boards are chaired by women, for example, Lanarkshire and Forth Valley. The most recent appointment that we made—in Forth Valley—was bitterly criticised by the Labour party, but it was another example of another woman being appointed to a health board. Others, such as in Fife and the Western Isles, are also chaired by women.
§ Mrs. Fyfe
If the Minister had been listening to what I had been saying, he would have heard me refer to public bodies in general, across the whole spectrum. Few women serve on or chair such bodies. Of course, I do not simply want there to be more women—I want more women of progressive views to be involved, who will want to do something for their communities. Clearly, not all women fall into that category—as is only too obvious in this place.
The Minister has not spelt out whether the new boards will have more or fewer resources than the present health education body. I hate to suggest this to the hon. Gentleman in case I am putting ideas in his mind, but has he any thoughts about the bodies being funded by the commercial interests that would benefit from increased health education, such as Outspan and Jaffa? Who knows, perhaps this is the first time that that has entered the Minister's head. I hope that I have not given him a new idea.
188 I do not see the point of leaving it up to the new boards to determine their priorities and targets. I should have thought that medical advice on the major problems confronting us would be the best way in which they could decide their priorities.
We have enormous health problems in Scotland. Indeed, the Minister identified the problems of heart disease and bronchitis from which we know that Scotland suffers especially. There is not much point in advising people that their housing conditions are unhealthy when they can do precious little about it. Will the Minister run a course in health education for his hon. Friend the Minister for Housing and Planning so that they can do something about achieving the major improvement in people's health that would result if they were removed from the damp-ridden housing that is wrecking their health?
Problems such as drug abuse are widespread in parts of Glasgow. I know that useful work had been done on that, but I should like to know whether special funding will be provided for it. Quite apart from the horrific impact on people's lives if they themselves are abusing drugs and on those of their families, drug abuse creates extremely unpleasant living conditions for their neighbours and those who live in the vicinity. Children in parts of my constituency find needles lying in untended grass on wasteland.
Many health education issues need our attention. I am arguing for women to be involved in the boards not simply on the grounds of sexual equality, but because many health matters affect women especially. Women tend to be greater users of the Health Service, both in their own right and because they bring their children to the surgeries. It would be a pity if we did not ensure that women are involved in those bodies in appropriate numbers, and not only in the tiny minority that is the case now in most of the different boards that operate in Scotland. Obviously, I want women of progressive views to be involved, and not too many Conservative women.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I welcome this important new clause. Any idea that was cobbled together by my hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) and the hon. Member for Tayside, North (Mr. Walker)—an unholy alliance if ever I saw one—must be worth supporting, but perhaps that is going too far.
Since being elected to the House, I have tried to take a particular interest in preventive medicine in its broadest sense because I believe that moving health care in general in the direction of prevention is an entirely good and proper thing, and health education is an important element in that.
The only reason why I am dragged to my feet now is to ask about the independence that the new body will enjoy. I do so because some worrying parallels could be drawn with the situation that arose in 1986 when the right hon. Member for Sutton Coldfield (Sir N. Fowler), the then Secretary of State for Social Services, abolished the health body that was then independent of the Government and established a new Health Education Authority. That provides a parallel with the contents of the new clause. I do not need to remind the House that real misgivings were voiced at that time. When the right hon. Gentleman introduced that change in 1986, he said that he was doing so to deal with the special problems of AIDS. Everyone 189 supported the move for that reason. However, it subsequently became clear that the Government were using undue influence and bringing to bear departmental methods of working and priorities in a way that was not possible before, when the previous English and Welsh body had more independence from Government Departments.
There is a great deal of value in any health education body having an element of independence. If such a body is to be successful, it must operate in areas that are difficult for any Government because they embrace, for example, dietary provision and nutrition. That immediately involves a confrontation with the direct commercial interests of the food industry. I fully accept the difficulties of that. We have had arguments about sugar and about cholesterol-free diets around which many commercial interests have been built up. Similarly, we must confront the difficult area of alcohol abuse in terms of, on the one hand, what is good for the population's health, and, on the other, what is good for the industry that is supplying liquor of all sorts. There are also similar problems with the tobacco industry, about which I have been concerned for some time.
Any health education body worth that description will have to look closely at the impact of the produce and the products that such commercial enterprises are purveying to the public. If that body is under direct Government guidance and control, that puts the Government in a difficult position. I hope that that matter has been properly addressed and that the things that went so badly wrong in 1986 when the Department in England took over the previous health education body for England and Wales are corrected for Scotland in the future.
Following that train of thought one step further, I hope that the voluntary sector will be able to interface closely with the new body that the Minister is setting up. I also hope that funds will be made available so that it can undertake work in some of the sensitive areas with which the Government find it difficult to cope, such as AIDS. I pay tribute to what has been done north of the border in that area. An awful lot more needs to be done. It is valuable to establish a health education authority to look at the specific Scottish aspects of the development of the disease. I am grateful that the Minister is nodding his assent.
I fully understand that for any Government advertising campaigns are necessary to confront the problem adequately. It is difficult for Government Departments to do so. There is a value in having pressure groups and voluntary groups that can work alongside AIDS sufferers and HIV positive patients in a way that Ministers, officials and civil servants never could. That is no criticism of them; it is simply recognising reality. I hope that the new body will have a wide scope, flexibility and independence and will be free from the influence of the Minister's Department. If not, he will be wasting his time and the body will not succeed.
It would be helpful if we could be given a steer about the amounts of money and the resources that might be available to the authority. Is it likely that there will be new money or will budgets have to be trimmed to give the new health education authority an acceptable budget with which to work? I hope that the Minister will consult widely—I mean widely, to the extent of consulting the voluntary sector—before he puts together the membership of the new body. That, too, is crucial. I agree with the hon. Member for Glasgow, Maryhill (Mrs. Fyfe) that we must have more 190 women on all such bodies. We must have a spread of membership to embrace all the difficult matters that must be dealt with if the body is to succeed.
I welcome the initiative. The body has great potential for confronting some of the difficulties that are peculiar to north of the border, such as coronary heart disease and short life expectancy, to which the Minister referred. The body can do so only if it is genuinely free of day-to-day Government interference and control.
§ Mrs. Margaret Ewing (Moray)
I shall be brief because many of the points that I should have made have been touched upon by other hon. Members. The Minister has shown an administrative commitment to the establishment of the boards and we are asking for details to flesh out the ideas behind them. A great deal of importance should be attached to who the members of the boards will be and what budget will be available to them.
We all recognise the great importance of health education. One point that has not been touched upon by other hon. Members is how the boards will interface with our education system. We all recognise that a great deal of health education work has been undertaken in our primary and secondary schools. We owe a great debt to many teachers, particularly physical education teachers, who, through their classes, have made youngsters aware of the implications of diet and habits for their health. Many parents have told me that they have stopped smoking because such an impact has been made on their children during lessons at school that the parents feel guilty arid give up the habit. Perhaps I should have some children who could come home and give me that lesson because, like the hon. Member for Aberdeen, North (Mr. Hughes), I admit to particular vices.
It is important to know how the health boards will tie in with our education system, and use the expertise that is already present in our schools and the information that the Scottish Health Education Group so readily supplies to them. We want that to continue and to be expanded. It will be interesting to hear what interface the Minister has in mind.
§ Mr. Kennedy
As the Minister was either generous enough or grotesque enough to give me joint B-film scripting accreditation on the new clause with the hon. Member for Tayside, North (Mr. Walker), it seems appropriate for me to say a few words. My hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) described that partnership as an unholy alliance. I hope that the House understands that on these Benches we can speak about that term with particular insight.
I echo the question put to the Minister on the structure that he has chosen. The hon. Member for Aberdeen, North (Mr. Hughes) said that, like so much else in the Bill, the new clause opens up fairly wide-ranging powers. Under various clauses, we have heard time and again that the Secretary of State is taking powers unto himself. More often than not, we are told, "Don't worry because he does not intend to exercise them." Some of us fear that from time to time those powers will be exercised. We should never ascribe to this Health Minister some of the mean motives that might be in the hearts or minds of other Health Ministers, but the successors to his office may want to use those powers in a different way. What safeguards are there?
191 The hon. Member for Glasgow, Cathcart (Mr. Maxton) referred to prevention when he spoke about sport. The Health Minister is also responsible for sport in Scotland. He wears two hats. I repeat the point made earlier in this short debate, that over the century the greatest contributors to better and healthier living have been improved housing, water supplies and working and environmental conditions. In that context, and without straying beyond the parameters of the debate, I hope that the Minister will recognise that there are slightly wider social obligations, in terms of broader Government social policy. Much of that resides with the Secretary of State for Social Security. We shall go on to one aspect of that later. Those obligations must be borne in mind as well as worthwhile and valuable initiatives such as the Minister outlined.
Like the two other smoking sinners, and as the third member of that triumvirate in the House, and with national no-smoking day almost upon us, such is the extent to which I am moved by the Minister that I shall have a real go this year to kick the habit once and for all.
§ Mr. Michael Forsyth
I am delighted that, even before the new clause has been accepted by the House, we have at least one convert in the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). If the House accepts the new clause and amendments, when we lay down regulations to establish the new health boards in Scotland responsible for health education, the hon. Gentleman will be able to give us a full report on the progress that he has made in the intervening period.
The hon. Gentleman was kind enough to raise the matter in Committee when I was considering the report that we had received from Touche Ross and the advisory council. The hon. Gentleman said that the Secretary of State was taking more powers. The new clause and amendments do not give the Secretary of State more powers. They enable him to delegate his powers to new bodies. In that sense, the new clause does not increase the Secretary of State's powers but merely allows him to set up bodies that will act as his agents. That is the constitutional position of the health boards. I pointed that out when we first discussed competitive tendering in Scotland.
§ Mr. Maxton
Perhaps the Minister will tell the House in what other circumstances he expects the Secretary of State to use the power to delegate responsibilities. For what reasons would he do so?
§ Mr. Forsyth
If the hon. Gentleman is patient, I shall come back to the point that he raised. I was simply responding to the points raised by the hon. Member for Ross, Cromarty and Skye.
The hon. Member for Ross, Cromarty and Skye also said that housing, water supplies and so on were important for public health. I agree, but he will recognise that both those areas are the responsibility of local government, not central Government. There is certainly much room for improvement in both areas and in local government. No doubt people will take the opportunity in respect of water supplies on 3 May.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) raised several points. He asked why there was no reference in the new clause and amendments to health education and why they were widely drawn. To be 192 perfectly honest, when we were contemplating what steps we might take it struck me as remarkable that the Secretary of State for Scotland could not delegate his powers to new bodies that he might constitute, as my right hon. and learned Friend the Secretary of State for Health can south of the border. We discussed the matter in Committee and it seemed appropriate that we should give the Secretary of State those powers.
I am surprised that the hon. Member for Aberdeen, North (Mr. Hughes) thinks that there is some Machiavellian plot involved in my moving the new clause. There is nothing sinister or underhand going on. The powers in the new clause and amendments mean that the Secretary of State would have to come to the House to make regulations which would be subject to negative resolution. Therefore, the House would have every opportunity to consider the arrangements in respect of this new health education body.
The hon. Member for Cathcart was suspicious and, in line with the hon. Member for Aberdeen, North, suggested that this was all part of putting the management executive, which we have established in the NHS, on a statutory basis. We do not require these changes in the law to establish the management executive. We have been able to do so. Mr. Cruickshank, the chief executive of the NHS, is a civil servant, not a political appointee. I was distressed to hear what the hon. Member for Aberdeen, North said. I take it that he was not speaking for his Front Bench when he suggested that members of the management executive, who are being recruited to get the best possible deal for the patient, would not enjoy job security under a Labour Government. In that respect they would share the fate of many thousands of fellow Scots, if that is what he sought to imply.
§ Mr. Robert Hughes
We must get this exactly right. What is the status of the new executive body? Will the individuals be appointed under normal Civil Service terms and conditions? If so, that is another matter. However, if they are to be appointed on individual binding contracts with high salaries, we need to be told. There is a big difference.
§ Mr. Forsyth
The hon. Gentleman is absolutely right. The appointment of people on fixed-term contracts which are performance related is different. It is also desirable and important. The chief executive of the Health Service certainly is appointed on that basis, as are the general managers of the health boards. That is a great step forward and I am sure that the hon. Gentleman will welcome accountability of those whose function it is to hold the Health Service accountable for the targets which are set in the interests of patients.
§ Mr. Maxton
All of us would be interested to know exactly who the Minister has in mind for these jobs. The newspapers have said that the chief medical officer for Scotland will be one person on the executive. Who will the others be? I appreciate the Minister's remark about Mr. Cruickshank because he was appointed against the Minister's wishes. The Minister wanted Mr. Laurence Peterken from the Greater Glasgow health board. Is not this a back door through which the Minister can put Mr. Peterken on the executive?
§ Mr. Forsyth
What the hon. Gentleman says is completely untrue. The appointment of the chief executive 193 was made in the normal way, on a recommendation from the Civil Service Commission, and was approved by Ministers. The hon. Gentleman should not make such comments unless he is sure of his facts. He is wrong.
The management executive has nothing whatever to do with the new clause. It has come into the debate only because the hon. Member for Aberdeen, North asked me to give an assurance that we do not intend to create a special health board, which is the management executive. I am happy to give him that undertaking which I hope means that we can now leave the matter behind us and look forward to a better managed, better run Health Service. I know that Opposition Members are opposed to that——
§ Mr. Forsyth
In a moment. The Official Report will show that the hon. Member for Cathcart said that we cannot run the NHS like a business, and a business is run in a businesslike manner. A Health Service run in that way will be better able to meet the needs of the patients and those who send us to the House.
§ Mr. Robert Hughes
The Minister should not be allowed to get away with the statement that Labour Members do not want the Health Service run in a businesslike manner. It is utterly untrue. In all the years I have been involved in the Health Service, whether as a councillor, a member of the regional hospital board or a Minister, we have always been anxious to ensure that it is run properly and we get value for money. That is different from what is happening now. The Health Service is being run not on businesslike methods, but to put business the way of the Minister's friends. The way that it has been prostituted for his political ideals is a disgrace.
§ Mr. Forsyth
If the hon. Gentleman is arguing that the Labour Government ran the Health Service well, he will forgive me for pointing out that they presided over a cut in the hospital building programme and a cut in nurses' pay of more than a quarter. The contrast with our record could not be clearer. He may not wish me to go over what is certainly ancient history, because it is so long since we had a Labour Government, but perhaps I may remind him of the Labour party's attitude to the appointment of business men to take charge of Health Service management. It opposed that on the grounds that business men were not appropriate. Yet business methods and a businesslike way of running the Health Service are in the interests of patients.
§ Mr. Forsyth
I have been good in giving way and I should make progress, but I give way to the hon. Member for Aberdeen, North.
§ Mr. Hughes
The Minister should be reminded that the Labour Government set up a special commission to look into nurses' pay. That was done thoroughly. I remember a business man in Aberdeen who was appointed by one of the Minister's predecessors to be vice chairman of the then North-East of Scotland regional hospital board with a 194 view to making it more business-efficient. He became chairman of the finance committee. Within a year he said, "What are those so-and-sos who used to be friends of mine doing to my Health Service?" Business men who are appointed know what is happening. The Health Service is not being run properly in the interests of patients. and the Minister should stop pretending that it is.
§ Mr. Forsyth
If the hon. Gentleman is saying that everything is not perfect in the Health Service, I agree. That is why we are introducing the Bill and providing for the service to be run in a more businesslike way. If he thinks that it is any consolation to nurses that when his colleagues were in government they set up a commission into nurses' pay, he does not live in the real world. The Labour Government cut nurses' pay by a quarter whereas we have increased it by——
§ Mr. Deputy Speaker
Order. This is a long way from the new clause before the House. I hope that the Minister will return to it.
§ Mr. Forsyth
I apologise, Mr. Deputy Speaker, if to speak of the good news in the Health Service is to stray from the new clause.
The hon. Member for Cathcart asked about the "Good Hearted Glasgow" campaign. I appreciate his kind comments about it. It is a good example of a health board being involved in health promotion and doing it extremely well. That sort of campaign would not be threatened in any way by the creation of a new body with national responsibilities for health promotion, as he claimed. We intend to have a national policy statement about health education for which the new body will he responsible. The health boards will work with the new body to achieve that. We particularly want to place more emphasis on the prevention of coronary heart disease. The campaign in Glasgow and that in my own constituency, which is run by the Forth Valley health board, are excellent examples of what can be done in that area.
§ Mr. Tom Clarke (Monklands, West)
Since this seems to be a rather rushed affair, and since the Under-Secretary has referred to the important subject of health education, will he tell the House what consultations he or the Secretary of State have had with people responsible for health education at the moment?
§ Mr. Forsyth
I do not think that the hon. Gentleman was here at the beginning of our deliberations and lie therefore missed what I had to tell the House——
§ Mr. Forsyth
I am surprised, because I told the House that we had asked Touche Ross to carry out a review of health education policy in Scotland. The company spoke to nearly all the interested parties in health education and produced a report which is now in the Library. I commend it to the hon. Gentleman. It sets out Touche Ross's recommendations, which reflect the views that were given as it went around Scotland speaking to interested groups. The report recommends the establishment of a special body, although not of the kind that we are discussing. Having commissioned those reports, we should proceed with all due speed to ensure that the body is up and running by 1 April next year.
My hon. Friend the Member for Tayside, North (Mr. Walker), who is no longer in the Chamber, raised a 195 number of important issues. As the hon. Member for Ross, Cromarty and Skye said, we should give him and my hon. Friend credit for having raised the matter in Committee.
The hon. Member for Moray (Mrs. Ewing) asked me about the detailed nature of the body, who would be appointed and other such matters. Assuming that the amendments are passed, that will be decided by the House. There will be an opportunity to discuss the issue in the House, if the hon. Lady cares to ensure that, because the new clause provides for powers to make regulations which will be subject to negative resolution. I have no doubt that we will get a great deal of advice now that we have made our policy clear.
The hon. Lady also highlighted the importance of health education in schools, and I entirely agree. We shall expect the new body to strengthen links with education authorities and schools. When I was Education Minister I was particularly conscious of the great work that is being done in our schools, particularly on drugs and AIDS, and all credit is due to the education authorities involved in that.
The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) asked me about independence—[Interruption.] Not the kind of independence with which the hon. Member for Moray is concerned. That seems to be becoming less fashionable, if recent polls are to be believed.
The hon. Member for Roxburgh and Berwickshire asked me about the independence of this body. It will be active as the agent of the Secretary of State. I agree that there are times when it is helpful for Ministers to be distanced from some of the campaign that is necessary on a health education fund, for the reasons that the hon. Gentleman outlined. There will be a national policy statement and it will be the job of the board to give effect to it and obviously that will be at arm's length.
I heard what the hon. Gentleman said about the nature of the board, and the composition of chairman and members, and I shall ensure that people with the talent and ability to provide the best possible service will be recruited to the body—as we have done with all the health boards.
The hon. Member for Roxburgh and Berwickshire also asked me about resources that will be deployed. If he looks at the Touche Ross report in the Library, he will see that credit is given for the increasing resources that have been provided. The report points out that this area may have been under-resourced in the past. That was a problem not of funding but of structure. We are determined to commit resources to health education because it is one of our priorities.
The hon. Member for Glasgow, Maryhill (Mrs. Fyfe) asked me about women appointees. I think that we have done extremely well in appointing women to health boards—not because they are women, but because they had the talent and expertise required—and they have done extremely well. The hon. Lady also asked me about funding for drug abuse. She will know that we have made available considerable additional resources to deal with the problems of drug abuse and AIDS. In the space of a little more than a year we have doubled resources. I hope that the hon. Lady will recognise the progress that has been made.
196 I sense that, having given those assurances to Opposition Members, there may be some support across the House for our proposals. The strengthening of health education is a key link in achieving our objectives for a better health service and better health care in Scotland. I hope that I have been able to persuade the House to support the new clauses.
§ Mr. Tom Clarke
I do not think that the Minister should be surprised if some hon. Members feel that we should take up some of his remarks, albeit briefly.
The Under-Secretary of State said that he was not sure whether I had been listening to his remarks about the Touche Ross report, but I do not think that he was listening to my intervention. I clearly asked whether people involved in health education had been consulted. He gave no evidence that they had been consulted on the conclusions and the recommendations of the report. Therefore, there is a great temptation for Opposition Members—perhaps because of the Minister's speech—to have greater doubts about the new clause.
In all honesty, perhaps the only redeeming feature is that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), who was positive at all times in Committee, made some contribution to the new clause. I hope that he and the House will not mind when I say that the Opposition—having heard the Under-Secretary's particularly vague explanation in response to my hon. Friend the Member for Aberdeen, North (Mr. Hughes), who asked a direct question about the legislative purpose of the boards—will judge the Government's real intentions when we deal with the regulations.
I am not convinced that the new clause represents the answer that all hon. Members would wish for in creating a broad strategy for the Health Service in Scotland, and for the major thrust necessary to deal with heart disease, respiratory conditions and the problem of an earlier mortality rate than elsewhere in the United Kingdom. The Minister did not convince us that much time had been devoted to real consultations on health education. I hope he will not mind if I return to the painful subject of what was once the responsibility of the Scottish Film Council. I think he is now able to distinguish that organisation from the Scottish film library. It works closely with the health education unit, which deserves to be congratulated on the way that it has promoted the campaign against AIDS and drugs. The Opposition want to be absolutely certain that the quality of those campaigns will not be diminished but will increase. We are not convinced, by any stretch of the imagination, by the Minister's arguments. Some of us are worried, in view of his speech, that there he was, sitting on the roof of St. Andrew's house feeding the vultures and coming up with even more crazy ideas about what he will do with the Scottish Health Service.
Notwithstanding the Minister's weak arguments, we shall not oppose the new clause. However, we shall look carefully at the regulations that will be laid before the House.
§ Question put and agreed to.
§ Clause read a Second time, and added to the Bill.