LORDS AMENDMENT. (Hansard, 6 November 1946)

§ THE LORD CHANCELLOR

My Lords, the first Amendment which we have to consider is that to add to the end of Clause 19 a new subsection, with which your Lordships are all familiar. This was a matter on which I had made up my mind many years ago, but when I hear such a speech as I heard from the noble Lord, Lord Balfour of Burleigh, revealing a complete knowledge of the subject, and a speech which was obviously of the utmost force and sincerity, I always remember a letter which Oliver Cromwell wrote to the General Assembly of the Church of Scotland: "I beseech you brethren, in the bowels of Christ, to think it possible you may be mistaken." Accordingly, I was at pains—as I think the noble Lord knows—to get this matter reconsidered by the Minister and his officials. I will frankly say that in the course of those considerations I rather played the part—I will not say of the devil's advocate, because I was the advocate of the noble Lord, but I was concerned to put forward, so far as I could, the noble Lord's point of view, and to see that it was carefully considered. As a matter of courtesy to him, and to your Lordships, may I tell you very briefly the sort of argument with which I was met and which, I am bound to say, made me come to the conclusion that for once my earlier opinion was right?

The effect of the noble Lord's proposal, which involves that the maternity and 1000 child welfare services, as well as other services, should be dedicated to the borough councils and the City of London, would, of course, destroy the unitary basis and, I think, the efficiency of the local health services. May I illustrate this by considering simply maternity and child welfare? What would be the result? The London County Council are now, and would be under the noble Lord's Amendment, responsible for the domiciliary midwives service. Before the war 25 per cent. of the births which took place in London were attended through these L.C.C. services, and there is no doubt that that figure has substantially increased. To be effective, the supervision of expectant mothers and pre-natal and post-natal care must be closely co-ordinated with the domiciliary midwives service through one authority responsible for all related facilities. Will you consider the case where hospital treatment for maternity patients is necessary? There again, obviously, arrangements by the Hospital Regional Board, or Boards—there may be one or two for London—must be co-ordinated with the supervision of pre-natal and post-natal care. If pre-natal and post-natal care comes under the boroughs and the City it means that the London Regional Board will have to co-ordinate with thirty separate bodies—the L.C.C., 28 borough councils and the City of London. Clearly, that would be impracticable. And if there were more than one Regional Board—which is very probable—it would be still more difficult.

Now, consider the case of infant welfare. The L.C.C. are the education authority, and as such are responsible for the school medical service; that is, for the "over-fives." But the L.C.C. are also running nursery schools for children from the age of three. Before the war there were no fewer than 40,000 children under the age of three attending schools, often in nursery classes. For the health of those children, when attending school, the L.C.C. are responsible. Frequently children between the ages of three and four go to the schools in summer, when their health is the responsibility of the L.C.C., and are kept at home in winter. The borough councils and the City are now, and would continue to be, responsible by the proposed Amendment. To have this divided responsibility would go far to destroy a comprehensive health service.

1001 Then let us consider the doctors. They will be under contract, of course, with the local executive council. They will be increasingly engaged on infant welfare and school medical work, and it is really essential that one authority and not thirty authorities should be responsible for infant welfare, whatever the age of the child. It would be indefensible under the new scheme to separate maternity and child welfare in the health services—they would be a focal point in the new services—from the other domestic and domiciliary services which are ancillary and must be closely associated with maternity and child welfare.

Having said that, I want now to go on to a further point. I had hoped that the noble Lord, Lord Latham, would have been here today. He asked me to express his regret that he is unable to be here. In what I am now going to say I am stating his point of view. The London County Council are fully aware of the necessity of avoiding undue centralization and of securing decentralization locally. They have already declared by a resolution on the 28th May of this year that they will seek the largest practicable measure of local decentralization and will entrust the day-to-day management of the local health services to area committees, to which members of the metropolitan borough councils and the City will be appointed, and also that members of those bodies will be appointed to the Statutory Health Committee of the London County Council.

The metropolitan boroughs and the City will therefore not only have members on committees charged with the day-to-day management of the services but also on the Central Committee which will formulate policy. Those area committees, the noble Lord assures me, will have real and genuine executive powers. Thus the boroughs and the City will be effectively associated both with the making of policy for the whole of London and with the administration of the local services on the spot, and local interest and local touch will thereby be adequately preserved. In settling the areas of the local committees, it will be the resolute endeavour of the London County Council to avoid dividing any metropolitan borough or the City and it is confidently expected this will be possible. The London County Council are fully and sympathetically aware of the great interest and pride 1002 which the metropolitan borough councils have always taken in their health services and, so far as it rest, with them, they will see that there is still ample scope for local interest and local enthusiasm. Accordingly I beg to move that we do not insist upon this Amendment.

§ LORD BALFOUR OF BURLEIGH

My Lords, may I begin by expressing my pleasure at seeing the serried ranks of the noble Lords beside me? If my efforts have done nothing else, they have at least secured a considerable attendance on this side of the House. The argument of the noble and learned Lord on the Woolsack has filled me with admiration. Once again it has demonstrated what a wonderful case can be put up by the skilled advocate on theory. The noble and learned Lord's argument was admirable theoretically, It is in practice that the case demands other treatment. The noble and learned Lord said that this Amendment would destroy the unitary basis and efficiency of the local health services. On paper that may appear to be true. The noble and learned Lord said—and he gave a very cogent example—that in the midwifery service co-ordination is necessary. Profoundly true. What is the position today in the boroughs where these services are so admirably carried out? Midwife is a service which was transferred from the borough councils to the London County Councils only a few years ago, and I took the trouble to ask, when going into this matter, what the position was The position is that a mother in Kensington is unaware what local authority's servant she is dealing with, so well integrated are the services. They all work together so well. The integration is so complete that the mothers who attend these centres, I am assured, are sublimely ignorant of the fact that the midwife is the servant of the London County Council and the health visitors are the servants of the borough councils.

If I may pass for a moment from the argument of the noble and learned Lord, which was so skilfully presented to your Lordships, I should like to refer to the argument used in another place by the Minister, because there I think we can see what the result is going to be if your 1003 Lordships agree to allow this Amendment to go: Under this proposed scheme the metropolitan boroughs would be encouraged to have buildings of their own in which they would give certain health services and alongside in another building the L.C.C. would provide other services. What does the Minister take us for? We have in Kensington all the services provided in the same building and anybody other than an infant in arms would see that that was done. The Minister said: Concerning accessibility of the local authority to the population, I attach the utmost importance to this point. I believe that the local authority ought to be capable of being approached by the citizens, but if, in the future, a citizen has any difficulty about his health he will go to the health centre and not to the town hall. He will go to the health centre and not the town hall! But health centres do not exist yet except in a few places like Kensington where we have the embryo. If the lady who is going to have a baby is going to look for a health centre I am afraid she will have a pretty considerable hunt. Why not leave well alone, at all events until the health centres exist?

As to the statement which the noble and learned Lord made on the authority of Lord Latham, of course, I welcome that as far as it goes, but unfortunately it does not go very far. Lord Latham has given an assurance that he is fully aware of the necessity for avoiding undue centralization, and that there is to be the largest practicable measure of decentralization. In order to secure that, there are going to be area committees set up on which members of the metropolitan councils will be appointed, and also they are to be on the Central Committee. There is no guarantee whatever that any member who knows about maternity and child welfare will be associated, and in any case they can only be very few. It may work; I hope it does, but I am bound to say that the past history of any kind of co-operation of that sort is not very encouraging. Over and over again we have had these Acts allowing the County Council to delegate, and even promises of delegation, but nothing happens. I do not wish to inject any note of bitterness, but this is a thing on which borough councils do feel just a bit sore. Their local knowledge is not made use of, the London County Council take the service over, Acts are passed 1004 giving them power to delegate, but nothing happens.

I hope Lord Latham and the County Council will this time be a little better than their word. I would like to draw attention to Section 166 of the London Government Act of 1939, because if the County Council chose to do what I think would be a sensible thing and delegate to the people who are really doing it well, there is a power in that section. It says: The Minister may, on the application of the County Council or of any association or committee which is in his opinion representative of borough councils, by order provide—

(a)for the transfer to all borough councils of any functions exercisable by the County Council;
(b)for the exercise by any such borough council as may be specified in the order, as agents for the County Council, of any functions of the County Council: Provided that no functions relating to the relief of the poor exercisable by the County Council shall be transferred under this subsection."

There it is if the County Council choose to play the game. There is the power under this Act. Having said so much, I can only say that of course I must submit to the general wish of the House that this is not an issue on which we should insist. I have, therefore, nothing more to say.