§ 3.5 p.m.
§ Further considered on Report (according to Order).
§ Clause 45:
§ Local health authorities
§ 45.—(1) Subject to section 19(2) and (3) of the National Health Service Act 1946 (which relate to joint boards and health committees of local health authorities) and subject to subsection (3) of this section, the local health authority for each London borough shall be the council of that borough and for the City shall be the Common Council.
§ BARONESS SUMMERSKILL moved, in subsection (1), to leave out "subsection (3)" and insert "subsections (3), (4) and (5)." The noble Baroness said: I beg to move this Amendment. I have on other occasions spoken on matters which are related to this clause, and I would ask your Lordships to forgive me if now and then I emphasise certain points that I have raised on other stages of the Bill. The object of this series of Amendments is to provide that the Greater London Council should assume responsibility for the local health services of the inner London boroughs and the City for a five-year period from April 1, 1965. I said to the noble Lord, Lord Newton, yesterday, that we recognise that the great principles which are involved in this Bill have been debated and that when we have gone into the Division Lobby my noble friends and I have been defeated, although we always feel that we have achieved a moral victory. The time has now arrived, surely, when we must discuss these details and combine together to achieve a working administration.
§ It is for these reasons that I am asking in this series of Amendments for an interim period of five years during which the best possible service can be established in the boroughs. I think this would provide an adequate period during which the services could be delegated to the boroughs in an orderly fashion. The extent of the work which must be accomplished in the short time provided by the Bill can be appreciated only when it is realised that a wide variety of services is involved. On the Committee stage I gave a whole list of services, and I will not weary your Lordships with 655 them all again. I would, however, remind your Lordships that these services include maternity and child welfare, problem families, tuberculosis, after-care, mental health and domiciliary midwifery. I went into some detail on many of these services, particularly with regard to the midwifery service, in order to illustrate the volume of work which will be called for in this short period of a little over a year provided by the Government in the Bill.
§ The personal health services in London are administered by nine divisional officers of the L.C.C., but the midwifery services have been developed on a much wider basis, because all babies are not necessarily born within these nine divisions. Perhaps only a small number of babies are born in these divisions, and it is necessary for the London County Council to have a central authority whereby they can be assured that, if there is a call for help for a maternity case, there is a group of midwives, a hospital, doctors, or some part of the service which can be used immediately. Therefore, central control has been necessary in order to cope with these emergency calls, whether they arrive at night or during the weekends. That is what I am asking for at this stage: to maintain the central control for five years before we establish these new authorities, which will have to start from scratch.
§ Let me remind your Lordships, with regard to midwifery, that the maintenance of a 24-hour service is essential in London, because we have a floating population. We have girls coming over from Ireland; and we have girls who come on ships arriving at the South coast who always make for London. A girl may come to London to have an illegitimate child—and let me not dismiss that part of our maternity services. The illegitimacy rate in London is very high—higher than in any other part of the country—partly due to the fact that here a girl can remain anonymous. She can get lost in this vast crowd of people, and she can be assured of a safe confinement. Therefore it is necessary to maintain a 24-hour service and supervision in London. The calls on the London County Council headquarters come from doctors, police, individuals, relations and the general public.
656§ If the proposals in this Bill are carried out to the timetable which is envisaged in the Bill, there will be a risk of the breakdown in the local health services in inner London. Although, of course, it can be disguised, there must inevitably be a deterioration in the service, because this wonderful service cannot be transferred in a very short time. I would remind your Lordships of what has to be done. These new boroughs which will take over will have to provide not only the services but also the whole pattern of standing orders and establishment structures. We discussed the establishment structures yesterday, and I think the whole House recognised what a tremendous amount of work there is to be done. If the provisions in this Bill are left unchanged, the problems flowing from transfer will take some years to clear up and in my opinion the risk could best be avoided if central control were maintained for an initial period. I beg to move.
§
Amendment moved—
Page 63, line 21, leave out ("subsection (3)") and insert ("subsections (3), (4), and (5).").—(Baroness Summerskill.)
§ LORD NEWTONMy Lords, the noble Baroness has moved Amendment No. 147. Linked with it are Amendments Nos. 148, 149 and 150, and I take it that it will be convenient if I discuss them altogether. They are all part of the same plan. I appreciate the remarks of the noble Baroness to the effect that we have quite lengthily at earlier stages discussed the principles of this Part of the Bill and, therefore, it is a good thing, perhaps, that your Lordships should concentrate rather more on the details than on the general principles. I certainly agree with that, and so I will accept the implicit invitation not to say too much in reply. Towards the latter end of her remarks, the noble Baroness expressed a fear that if the Bill remains unchanged there may well be a breakdown of the personal health services in London, or a reduction or diminution in their quality. I think that was the gist of her remarks. I cannot agree about that. I do not think there will be. If I did, I would not be commending the Bill to your Lordships.
May I say something about the question of midwives, which the noble 657 Baroness has discussed to-day, as she did on Committee? The position, as I see it, is that the number of widwives needed when this Bill is passed—as I hope it will be—will depend on the number of births, subject only to the fact that the staff of any one authority cannot be allowed to fall below a certain minimum if there is to be sufficient cover for such things as leave, night duty, emergencies, and so on. The number which the new boroughs will need, and will have, on present L.C.C. staff-population ratios should, in our judgment, be ample to provide this cover. County boroughs outside the London area with staffs of a similar size have little difficulty in providing the necessary cover from within their team or teams of midwives, and though the staffs needed by different boroughs in inner London will vary according to local needs and circumstances, they should, in our opinion, be large enough for flexible deployment.
I do not think, therefore, that there is any reason to believe that the change to the new pattern of borough administrations which this Bill provides in the London area will in itself result in any need for an increased number of midwives. Even if I were wrong about that—and I do not think I am—the conclusion I would then draw would be this. There should not at any time be delegation of the personal health services to the London boroughs. I should not conclude that there was a case for delaying transfer—and that is, after all, what this series of Amendments provides. It provides for delay and eventual transfer of these personal health services to the London boroughs.
Perhaps I can summarise quite quickly the other and broader reasons why these Amendments are unacceptable. The first is that, in any event, it is inevitable that the officers of the existing authorities will be anxious about their future. This anxiety will be increased the longer the period taken for the changes in administration. Therefore, one is bound, I think, to conclude from that that transfer should take place as early as possible. In the Government's view, it is practicable to make the transfer on April 1, 1965. This is what the Bill provides, and indeed we have had several debates on that theme. In particular, on Amendments to Clause 3 during the Report stage 658 of the Bill, my noble friend Lord Hastings argued the general case against delay in making the change.
The joint committees which are to be set up under Clause 85 will be able to do much preparatory work before the new boroughs are elected in May, 1964. I would emphasise again to-day, as I did in Committee, that the new boroughs will not be faced with the need to start new services entirely from scratch. They will take over the existing services as going concerns, and that is surely a very material point. If the Amendments with which the noble Baroness is concerned were accepted, the situation would be very complicated administratively. There would have to be a lengthy form of negotiation between the Greater London Council and the boroughs over the schemes and stages for the delegation which she proposes. With both the Greater London Council and the boroughs concerning themselves with the administration of the health services—as they would have to do—I should have thought that it would be very easy indeed for friction to arise during the transitional period. If that happened, it would quite obviously be detrimental to the development of the services in the interests of their patients actual or potential, which is surely what we want to avoid more than anything else.
Again, under the Amendments of the noble Baroness it would be possible for the various personal health services to be transferred piecemeal, one by one. If that were to happen, there would be fragmentation of the personal health services, and various parts would be split one from the other and from the welfare service, from the child care service and from housing. I do not believe anyone who is interested in health problems, as is the noble Baroness, would think that that would be a good thing.
Finally, under these Amendments there would be considerable staffing problems, because both the Greater London Council and the boroughs would need their own health departments with their own system of administration and headquarters. There would inevitably be duplications at the more senior levels with the future of the Greater London Council headquarters staff remaining completely in suspense. I do not think, administratively, that would be a good thing. For all those reasons I 659 must again, as I did at Committee, advise your Lordships not to accept this Amendment.
§ EARL ALEXANDER OF HILLSBOROUGHMy Lords, I have not intervened very often in the detailed discussions of Amendments of this kind, and I appreciate the courtesy with which the noble Lord has replied, but I must say that I fail to be convinced by his arguments. Here is an existing very successful scheme, which is under one authority. It has no difficulties about the different boundaries between the areas to be covered by the services. It covers them all from one central headquarters. As has had to be pointed out on many other points of discussion earlier in this debate you are breaking up this service under twelve additional authorities; it has previously been carried on by one. Yet the noble Lord thinks that the best case he can put up is that it would be most inconvenient for the anxieties of officials if it were not done urgently. The actual considerations which my noble friend Lady Summerskill has put up with regard to the people who have to be served, treated and looked after come as a secondary consideration.
§ Really, when one considers the addition which is made to the problems of reorganisation by rushing this matter, one is bound to feel that the answer of the noble Lord has completely failed to deal with the very important and critical comments which my noble friend Lady Summerskill has made. I hope, therefore, that the Government will look at this matter again. The statement that the noble Lord makes, that there is already in existence a practical health organisation in every one of the new areas now to be given the responsibility of the existing central authority, does not seem to me to answer the question at all. Can they at once, or within a reasonable period, have such a separate organisation for their particular boroughs as to give adequately the same service for the whole area, without interruption, as is given now by the central authority? It seems to me that that is quite impossible, and I hope, therefore, that my noble friend will not see fit to withdraw her Amendment.
§ 3.23 p.m.
§ On Question, Whether the said Amendment (No. 146) shall be agreed to?
§ Their Lordships divided: Contents, 28; Not-Contents, 65.
659| CONTENTS | ||
| Addison, V. | Henderson, L. | Rusholme, L. |
| Alexander of Hillsborough, E. | Latham, L. | Shackleton, L. |
| Amwell, L. | Lawson, L. | Shepherd, L. |
| Attlee, E. | Lindgren, L. | Stonham, L. |
| Burden, L. [Teller.] | Listowel, E. | Summerskill, B. |
| Burton of Coventry, B. | Longford, E. | Uvedale of North End, L. |
| Champion, L. | Lucan, E. [Teller.] | Walston, L. |
| Chorley, L. | Macpherson of Drumochter, L. | Williams, L. |
| Crook, L. | Morrison of Lambeth, L. | Wise, L. |
| Douglas of Barloch, L. |
| NOT-CONTENTS | ||
| Aberdare, L. | Gage, V. | Middleton, L. |
| Ailwyn, L. | Glentanar, L. | Milverton, L. |
| Ampthill, L. | Goschen, V. [Teller.] | Molson, L. |
| Balfour of Inchrye, L. | Grantchester, L. | Monsell, V. |
| Carrington, L. | Grenfell, L. | Montgomery of Alamein, V. |
| Chesham, L. | Hailsham, V. (L. President.) | Newton, L. |
| Cholmondeley, M. | Hanworth, V. | Ogmore, L. |
| Clwyd, L. | Hastings, L. | Robertson of Oakridge, L. |
| Colyton, L. | Home, E. | St. Aldwyn, E. [Teller.] |
| Craigton, L. | Howard of Glossop, L. | St. Oswald, L. |
| Cromartie, E. | Howe, E. | Salisbury, M. |
| De La Warr, E. | Iddesleigh, E. | Salter, L. |
| Denham, L. | Jellicoe, E. | Sandford, L. |
| Derwent, L. | Jessel, L. | Somers, L. |
| Devonshire, D. | Lansdowne, M. | Soulbury, V. |
| Dudley, L. | Lloyd, L. | Spens, L. |
| Eccles, L. | Long, V. | Strathclyde, L. |
| Effingham, E. | Lothian, M. | Suffield, L. |
| Ferrers, E. | Mancroft, L. | Swinton, E. |
| Forster of Harraby, L. | Margesson, V. | Twining, L. |
| Fortescue, E. | Massereene and Ferrard, V. | Waleran, L. |
| Freyberg, L. | Merrivale, L. | |
| Resolved in the negative, and Amend ment disagreed to accordingly. |
§ 3.30 p.m.
§
BARONESS SUMMERSKILL moved, after subsection (3), to insert:
(4) In its application to the area of the inner London boroughs and the City, and so far as it relates to the care or after-care of mentally disordered persons, section 28 of the said Act of 1946 (which enables a local health authority to make arrangements for the prevention of illness, and the care or after-care of persons suffering from illness) shall have effect as if for any reference to the local health authority there were substituted a reference to the Greater London Council; and so far as concerns the duty imposed on that Council by virtue of this subsection—
The noble Baroness said: My Lords, once more I would ask your Lordships to reconsider the administration that is provided for in this Bill and to consider whether it would not be better to maintain a central authority. Some of the arguments which I propose to adduce on this Amendment are very similar to those I have already used.
§ First of all, one should consider the mental health service of to-day. The Mental Health Act was in this field revolutionary. It calls for a re-orientation regarding mental health, for we are rapidly moving away from institutional care, which in the nineteenth century was considered normal, to care and treatment within the community. This, of course, calls for an adjustment of the ordinary family to a new way of life for the psychotic—though perhaps to use the word "psychotic" is too dogmatic. I should remind your Lordships that, of the patients who go to see their general practitioner to-day, one out of three has some mental disability, ranging from a neurosis to a psychosis. The noble Lord the Leader of the Liberal Party asked just now what effect noise had on the community. The answer, of course, is that nobody can assess it. But they have assessed roughly that one out of three patients has some degree of mental disability. Bearing that in mind, the mental health services to-day clearly assume a 662 greater importance in the field of the social services.
§ The mental health service in London has been divided among the nine divisional health officers which I mentioned on a previous Amendment, yet there is still central control; and there is central control in the mental health services for the same reason that there is central control in the midwifery services. A person may be seized with some mental defect very suddenly, and there may be an emergency call. If there is an emergency call there must be some central authority to answer—and these calls, of course, come outside office hours, during the week-end, and at times when the ordinary worker in the office of a local authority is not working. For this reason alone, surely the argument that there should be some centre to which these calls could go must be accepted.
§ The noble Lord, Lord Newton will ask why the boroughs should not do it. In my opinion it would be extremely wasteful for each borough to provide such a service, for in most cases an emergency officer would be unemployed for much of the time. Although, as I have said, there is a great deal of neurosis and mental disability, the proportion of psychotics is, of course, small, and therefore if an emergency officer were on call the whole time—during the week-end, during the nights—it may be that a week or two or or more would pass without his being employed. That rather wasteful approach would be avoided if we had a central authority.
§ One must recognise, too, that the medical approach to mental ill-health has changed. We have all kinds of treatments. We have day hospitals where a patient who has been discharged from a mental home can go and be treated, can stay there just for a day for treatment. We have day hospitals where a patient who has not been to a mental home of any kind can go to have treatment and go home to his own home, in the same suburb perhaps, at night. This is a new approach to mental health. We have to take into consideration the short-term and long-term treatment, and for this reason hostels, training centres, day centres, all kinds of institutions which are concerned with the treatment of mental patients, have been established. But they are unevenly distributed throughout the 663 county. Every noble Lord knows it is difficult to get accommodation in London, whether it is a house or for a factory or an institution, and therefore those who are looking for this form of institution must look everywhere. Curiously enough, we find more places in the south-west of London, but nevertheless they are unevenly distributed even in the south-west of London, and the best use has to be made of any suitable site or building wherever it becomes available. The noble Lord accepts that.
§ What do the Government propose to do? They propose to break up—the word "fragment" has been used so many times—these services which I describe, which have been administered from the centre, and give each borough the right and the duty to establish their own institutions. Perhaps the noble Lord will tell me this. Here we have in the southwest of London a number of these training centres, hostels for the mentally sick. Are they going to remain? Are the boroughs going to use them in the southwest of London, or is there still going to be central control? He told me just now—and he was rather glib, if I may say so—that the boroughs will take over the institutions. It took a long time to establish the existing institutions. It has taken time to find the sites and the buildings, to staff them and then to direct them from the centre. And, of course, mental instability does not afflict a person because he happens to live in a certain borough. It may be that in one part of London there is a higher proportion than in others. Again, for that reason, because this is widespread but not necessarily controlled by the frontier of a borough, I suggest we should have central control. These institutions have been established by the L.C.C., and they have been planned to serve wide areas. Nevertheless, the demand for these services is not so great that it would justify every borough in having their own training centre, hostels and all the ancillary services.
§ For all these facilities which bear no relation to borough boundaries, in my opinion, one central authority is sufficient. If we are to look at this simply as a piece of wise administration, a piece of local authority business which calls for economy, which calls for understanding, 664 which calls for the sympathetic approach—if these are the considerations, then I believe we should press for a central authority, and not allow the wonderful mental health service which has grown up in the London County Council to be broken up into small pieces. I beg to move.
§
Amendment moved—
Page 64, line 17, at end insert the said subsection.—(Baroness Summerskill.)
§ 3.41 p.m.
§ THE EARL OF LONGFORDMy Lords, I feel sure that even at this stage, when the minds of so many of us are becoming dulled by argument and a certain amount of repetition, noble Lords will have followed closely the speech of my noble friend. Some noble Lords are under instruction as to how to reply to it, but I hope that the noble Lord, Lord Newton, will feel that she has brought forward arguments that are difficult to meet. I look around the House and I realise that there are noble Lords whose mental independence is most marked. There is the noble and gallant Viscount, Lord Montgomery of Alamein. No one ever calls him a "yes-man". Is he going to take a firm Government directive? We are told that in this House the Whip is just a summons to attend. He has complied. He has done all that duty asks. He has come here. That is all the Whip involves.
§ VISCOUNT MONTGOMERY OF ALAMEINMy Lords, I did not receive a Whip to be here to-day. I came here because I am interested in learning about local government, which I do not know much about. I am learning a great deal.
§ THE EARL OF LONGFORDMy Lords, I do not know why the noble Viscount has not got a Whip. There seems to be something wrong with the Whips' Office. I do not know whether we ought to get some guidance. Is a noble Lord who does not receive a Whip entitled to sit among the Conservatives—a sort of sheep in wolf's clothing? Is this permitted at all?
§ VISCOUNT MONTGOMERY OF ALAMEINMy Lords, I used to sit down there and then I thought I would move and nail my colours to the mast. I might have gone to the Liberal Benches—there is plenty of room there; but I thought it better to come up here.
§ THE EARL OF LONGFORDMy Lords, I hope the noble and gallant Viscount will feel able to un-nail his colours. As he has not been given the Whip, the Party are not doing much for him. I do not think he is under any obligation. However, he is a student of efficiency, and surely he will agree—if he came here entirely free, as I believe he has done to-day—that the case presented by the noble Baroness needs a great deal of argument. It is really inconceivable, I am sure, that anybody who was interested solely in mental health and in efficient provision for mental health, would think that the proposals of the Government were best for mental health. I do not think we shall be told that, but we are told that they fit in with some Governmental theory. I do not know whether the noble Earl, Lord Arran, who for some reason has averted his face from me, would agree—I understand he is listening; I hope that my words will carry to him. I do not regard him as such an expert on efficiency as the noble Viscount, Lord Montgomery of Alamein, but I regard him as a great expert on humanity. And from the point of view of the children, I cannot believe that he will feel that this plan of the Government is going to help the children.
The noble Baroness has explained this in detail; she has explained the difficulties in detail. I think she has made plain the two great inconveniences that will be bound to occur in the transitional period while an attempt is being made to unscramble the eggs. But I think our argument goes further, and suggests that in the long run, even after the transitional period, an inefficient arrangement will be promoted by this sort of Government plan. I challenge the noble Lord, Lord Grenfell, to say that the plans of the Government are going to be good for the children. I do not expect him to answer that because I know that his sincerity would make it impossible for him to give an answer which was compatible with his Party views. But I would challenge him, as possibly the noble Lord closest to this problem, to say that the plans of the Government can possibly help the mentally afflicted children.
I am not going to add a great deal to what the noble Baroness has said, but may I just present general arguments? We are told that this is part of a scheme of the Government, something on the 666 lines of the Royal Commission's Report. But the Government have departed from that when it suited them. We are told that they have got a theory and the children must fit in with the theory. May I present three special reasons why it is particularly cruel to proceed with the Government's theory in this case. In the first place, these are the most helpless children. I am talking specially of the mentally handicapped, but my arguments also apply to all the mentally afflicted.
With regard to the mentally handicapped—I was Chairman of the National Society for Mentally Handicapped Children until the other day when I had the honour to hand over to my noble friend Lord Stonham—they are the most helpless of children. They cannot speak for themselves. They never will be able to speak for themselves in all their lives. That is a feature which is, I am afraid, unique to them, unless you have in mind that there are old people who have reached the age when they cannot speak for themselves. These children will never be able to present their own case; and therefore it is particularly brutal to use them as the guinea-pigs on which to carry out an experiment in local government administration in pursuit of some theory provided by a particular Royal Commission. That is one aspect.
Also, there is the fact alluded to by my noble friend that we are going through a revolution in mental health. No one is quite sure what will come out of it. To use an expression borrowed from the noble Viscount, Lord Montgomery of Alamein, the nation has nailed its colours to the mast of community care. We have decided to call on the community to assume a completely new and much enlarged responsibility for the mentally handicapped. We have announced the revolution, but we have not yet carried it far. It is in the middle of the revolution, when nobody knows what will come out of it, that the Government propose to conduct their own peculiar political experiment.
Finally—and this is a point which I do not think the noble Baroness alluded to, but I think she probably would have done had she spoken at greater length—there is no field in the social services where the variations between the advanced authorities and the backward ones are greater than in this one. There 667 may be difficulty in proving which are the most advanced authorities. We are given accurate figures which show, broadly speaking, which are in the top class and which are in the bottom class. Nobody would deny that London and Middlesex are in the top class. There is no comparison between the services that they render to the mentally handicapped and those rendered in some of the counties. I am afraid that my own county of East Sussex was in the bottom class for a long time, until the noble Lord, Lord Grenfell, called attention to their backwardness. I supported him, and now they have made a lot of progress. But there are these tremendous variations between authorities.
What the Government will do here, if they get their way, is to take two of the best authorities, authorities as good as any in the country—you may say that Leeds and Oldham are good, but they are no better than London, the L.C.C., and Middlesex—and break them up in pursuit of a theory. I must ask the House to believe that some of us regard this particular scheme as utterly heartless, and I hope that the House will support this Amendment. I cannot believe that anybody who cares for the children could go into the Lobby with an easy conscience in support of the Government's proposals.
§ 3.50 p.m.
§ LORD STONHAMMy Lords, I should like to add my word to what my two noble friends have just said. I have been connected with the voluntary organisations for mental health for the last twenty years, and it is a tragedy that, for reasons which I think are totally invalid and wholly unsound, the Government should contemplate disrupting this particular organisation for the mentally afflicted in London. My noble friend Lord Longford asked your Lordships to consider this not in accordance with any real or imagined instructions you may have received or requests as to the way you should vote, but to try to look at it from the point of view of the service which is being given in London to mentally afflicted people which unquestionably will be impaired unless this Amendment is accepted.
A few days ago I met a consultant friend of mine, and somebody happened to say that I had recently become 668 Chairman of the National Society for Mentally Handicapped Children. This eminent doctor then revealed that he and his wife were the parents of a retarded child. He wrote me a letter only this morning. It is a long letter, and I do not propose to read it all, but he makes some extremely valuable suggestions. His letter gives an idea of the suffering of parents and their children when the services for the children are so hopelessly inadequate, and it shows how necessary it is for us to preserve those that exist. He says:
We, naturally, as anxious parents seeking help and advice, helped our little girl through numerous interviews with much of the pediatric service, but got nowhere, and we are obliged to learn by trial and error ourselves. We were told that she was mentally retarded, but there the information finished. No advice as regards possible schooling was given, and I regret to say not one person mentioned the National Society for Mentally Handicapped Children. We received nothing but evasions, shaking of shoulders, and on one occasion even the greatest cruelty from a top so-called pediatrician who rounded off the interview with the words: 'Well, you will just have to take her home and make the best of a bad job.' Once in a very big London hospital to which she was admitted because of fits we found her and two other little ones tied to the foot of the bed on the floor. This is a shameful and inexplicable way to treat a docile little child, and we recall it with horror."—as indeed any parent would if that had happened to a child of theirs or any child that they knew. But, unfortunately, there are thousands of such children. The point I am trying to make is that with the care of the mental health services being within the County of London it has, of course, its defects. It is still growing; and great improvements are needed. Nevertheless, it is a good and comprehensive service, and is in the hands of people who know and care.My Lords, what we are confronted with under this Bill, unless it is amended, is that these services—and the noble Lord cannot deny it—are going to be broken up. He has alleged, and he will again no doubt say, that it will be broken up into twelve convenient components, so that each is of itself able to provide a satisfactory service. If he is going to say that, I must say in advance that it is manifest and demonstrable nonsense. It just is not physically capable of being broken up in that way, and nobody who has examined it can think so.
669 My noble friend Lady Summerskill gave examples of the geographical distribution within the County of London of the present service, and there is no doubt that the service is greater in some parts of the County of London area than in others. That is beyond dispute. It means that when it is split up some boroughs will be adequately—even more adequately—catered for in relation to the needs of that borough, others less, and some will not take over any provision at all in the shape of buildings and accommodation. I put to the noble Lord, Lord Newton, an analogy with which he is very familar—the emergency bed service. In that service 'one has a central organisation which is in almost instant communication with all the hospitals of London and Greater London. Within a matter of minutes perhaps as many as a dozen hospitals can be applied to so that an emergency patient or physically sick patient can be got into one of those hospitals. The noble Lord will appreciate that that is a central organisation in contact with hospitals which is manned all the time. I think he will agree that that is a true picture. That is for sick people and emergencies.
When we come to this domiciliary and hospital mental service in London at the moment we have a central organisation manned all the time, even at week-ends. If, however, it is broken up, there will not be such an organisation manned all the time. Therefore it will be impossible during week-ends and at holiday times to get an urgent mental case into institutional care or treatment through the medium of a central organisation. So that what proves invaluable in regard to the emergency bed service and that kind of organisation does at the moment exist in London for mental health. I submit that unless this Amendment is accepted, if the Government persist in their present intentions, inevitably that will be done away with. There will be no central organisation to network out cases of this kind. I think that is going to be a very tragic thing.
Finally, I should like to mention the position of the day clubs—those run by the Institute of Social Psychiatry—and the clubs which are now beginning to come along with the assistance of the London County Council, grant-aided by the Psychiatric Rehabilitation Association, of which, as the noble Lords knows, 670 I am President. Those clubs are not yet all over London, but exist only in some parts. It is impossible to see, therefore, how the benefits of those clubs can be made available all over London; and it is extremely unlikely we shall get more clubs if we have to depend on boroughs with obviously less resources individually than the County of London now have. They cannot carry on unless they are grant-aided—they are largely voluntary, but they are to some extent grant-aided. They will not be able to expand unless this happens, and, as the noble Lord is aware, they link up in the catchment area with mental hospitals some 25 miles away, like Long Grove, Bethnal Green, and there is that kind of set-up. I just do not see how, under the Bill as it stands, these clubs for the mentally afflicted can carry on, and certainly they will not expand. I hope that when the noble Lord comes to reply he will deal with the points I have raised.