§ 3.24 p.m.
§ LORD SHACKLETON: rose to move, That an Humble Address be presented to Her Majesty praying that the Secretary of State for Social Services Order 1968 be made in the form of the Draft laid before the House on October 16. The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper, which relates to the Secretary of State for Social Services. The proposed merger of the Ministries of Health and Social Security was, I believe welcomed on all sides of this House when I made a Statement about it last week. The Special Orders Committee have examined the Order and reported, and we are now clear to go ahead. I hope, therefore, that this Order, while containing much consequentially of great interest, will not be controversial. Therefore I do not propose to take up much of the time of the House in introducing it, although if any points are raised by noble Lords I will do my best to answer them.
§ I need only say initially that the purpose of this Order is to bring into one Department under a Secretary of State the present Ministry of Health and the present Ministry of Social Security. The new Department will he known as the Department of Health and Social Security and will be placed in charge of the Secretary of State for Social Services, my right honourable friend Mr. Crossman. The Order will take effect from November 1, 1968. The activities of the two Ministries which will be merged are complementary. The Ministry of Social Security provides cash and the Ministry of Health care for the sick, disabled, handicapped, elderly and others in need. Both recognise that adequate income, support, advice and practical services are likely to be important ingredients in maintaining family stability. Both provide short and longer term help and both are concerned with particularly vulnerable groups, such as elderly and the mentally ill.
§ The planning of services and kind and cash benefits should be improved in comprehensiveness and efficiency if carried out centrally within one Department. In their practical operation there is much scope for co-operation at the local level 1546 —that is, between the local staff of the new Department, on the one hand, and the local authority officers and general practitioners on the other. The bringing of responsibility together will not automatically achieve a more effective service, but it will help towards this end. There will also be improved scope for co-ordinated research, including local survey work and the development of new ideas and policies. On October 16 the Prime Minister said in another place, and I echoed it here, that improved co-ordination was one of the main purposes of the reorganisation. I mentioned that at present problems affecting the elderly, the very young, and the long-term sick and disabled cut across Departmental boundaries.
§ In moving this Order, I should like to add one personal note. I think it was noticeable in some of the remarks which were made the other day that noble Lords, as indeed Members of another place, have a high regard for the two Ministers concerned. In particular, the Minister of Health—and what I say about him is in no way to the detriment of the Minister of Social Security—has for several years occupied a very difficult role. I think there is a degree of agreement that he has been a quite exceptional Minister of Health. I am therefore glad that in the course of these postings and personnel arrangements there is another place for him, where I am sure he will discharge his duties with great ability. There is no doubt that he has been a great and valuable Minister of Health. My Lords, I beg to move.
§ Moved, That an Humble Address be presented to Her Majesty praying that the Secretary of State for Social Services Order 1968 be made in the form of the Draft laid before the House on October 16.—(Lord Shackleton.)
§ 3.28 p.m.
§ LORD DRUMALBYN
My Lords, my noble friend, Lord Sandford, welcomed this Order when it was announced, and I hasten to do the same. Indeed, I could hardly do otherwise, since the Conservative Manifesto in 1966 committed us to this merger. In principle, it is of course a very good thing to combine under one Department the responsibility for services to the individual, whether in cash, kind or care, be that individual a child or 1547 an old person, whether he is physically or mentally handicapped or otherwise in need of help. One advantage in particular was to be gained by this. Until now, I think I am right in saying, neither the Minister of Health nor the Minister of Social Security has normally had a seat in the Cabinet. Yet these two Ministers between them were responsible in 1967 for administering over a third of total central Government expenditure.
I looked up the figures and your Lordships may like to have them. Out of nearly £1,300 million of central Government expenditure, the National Health Service is listed in the national income and expenditure return as costing £1,270 million, and expenditure on war pensions, National Insurance, pensions and other benefits, family allowances and supplementary benefits amounted to over £2,900 million—well over £4,000 million in all between these two Ministries. This is a big assignment for any Minister, who has a weight of responsibility covering so many millions of people, quite apart from the hundreds of millions in cash, and this surely merits a seat in the Cabinet.
There have, of course, been overlords—I think there have been three—but overlordship is not, by and large, a satisfactory device. It tends to blur a Minister's responsibility for his own Department. The Conservative Government tried it and discarded it years ago. Generally speaking, surely the person who sits in the Cabinet should have the ministerial responsibility for the Departments over which he has to exercise authority. This has happened in the Defence services and it is logical that it should now be applied to the care of the individual. In this way it should be possible to make better use of resources, both human and financial, and co-ordinate them to the advantage of those whom they are designed to serve.
Of course, mergers ought not to be made unless there is a clear prospect of advantage for those for whom the Ministries exist. Where the Departments to be merged are different in character, there are bound to be difficulties to overcome, and I think I ought to point out the two main differences. The first is this. The Ministry of Health is mainly a co-ordi 1548 nating Department. Unlike the Ministry of Social Security, it does not have a large staff in the field. The Ministry of Social Security has a staff of 2,250 at headquarters. and over 58,000 at Newcastle, Blackpool and in the regional and local offices, plus 300 or so looking after hostels, reception and establishment centres.
To judge from the Green Paper on the administrative structure of the National Health Service for England and Wales, the Government do not intend to build up their own services in the field of health. They have put forward, as a basis for discussion, proposals for area boards which, according to paragraph 20, would take over the functions of the executive councils, regional hospital boards, boards of governors and hospital management committees, and would be responsible for planning and co-ordinating a very wide range of services—health centres, home nursing, health visiting domiciliary maternity services, child health services, family health centres, care of the long-term sick and ambulance services, not to mention postgraduate medical education and preventive medicine.
The present Minister of Health says in his introduction:The central theme of this Green Paper must be the unified administration of the medical and related services in an area by one authority, in place of the multiplicity of authorities concerned in the present arrangements.By amalgamating the Ministry of Health and the Ministry of Social Security, responsibility is being unified at the top for the cash and care services. That is all to the good. I hope that the noble Lord, Lord Shackleton, will be able to say a little more about unifying administration at the ground level. On the one hand, the cart services will be under area authorities in co-operation with the general practitioner. On the other hand, the financial services will be under national authorities with their own network of services throughout the country. I wonder whether the noble Lord can say a little more about the advantages that the Government expect to gain at ground level.
To start with, is it expected that the areas for the two administrations will be the same? This has always been a difficult matter in administration. We 1549 have so many different areas—Post Office regions, Board of Trade regions, Ministry of Labour regions, hospital regions and the like—and I hope that with the consolidation of these two Ministries it will at any rate be possible to bring two sets of regions into line. Of course, the most obvious field "on the ground" is in the case of the physically handicapped, whether at home or in residential accommodation and hospitals, and in discovering and meeting the needs of the aged. I do not know whether plans have been made in advance of this amalgamation for this to be done, and, if so, whether the noble Lord can tell us about them.
The second difference is that the Ministry of Social Security covers the whole of Great Britain, while the Ministry of Health covers only England and Wales, so that you get a rather lop-sided merger. For Scotland, legislation dealing with social welfare services has already been passed this Session in the Social Work (Scotland) Act, and if the Seebohm Committee's recommendations for social service departments in local authorities are implemented there will be a similar kind of organisation in England and Wales. All the same, this seems to leave a problem, and I wonder what the Government envisage in the way of co-ordination between the two Secretaries of State and their Departments for their respective duties in Scoland. I do not know if it has been considered whether, to complete the merger, the Scottish section of the Ministry of Social Security should come under the Scottish Office.
The third question I should like to ask is whether the Government regard this merger as yet complete. If a man loses his job through redundancy there is no co-ordination between the unemployment benefit and redundancy payment, although of course the Ministry of Social Security has a responsibility for the collecting of redundancy payments. I wonder whether the new Secretary of State should not take over responsibility for redundancy payments. If I may introduce a slightly contentious note, he could hardly make a worse mess of it than the Ministry of Labour has done in respect of the cost and the financial control. Next, is it not time that policy and administration for family allowances were entrusted to one Minister and one Department, instead of being shuttled 1550 about between the Treasury and the Minister of Social Security, with the various Secretaries of State—for Scotland, for Education, for Employment and Productivity—joining in?
The noble Lord has touched en one of the sad features about mergers of two organisations, and that is that at least one of the two heads must go. In this merger it so happens that both Departments have political heads of quite exceptional ability, as the noble Lord said, and I should particularly like to pay my own tribute, as he did, to the Minister of Health—a man who has never sought popularity and who is wholly dedicated to his work, as I think all of my noble friends will agree. I wish that perhaps these two Ministers had some more positive assignments than they seem to have been given, but they certainly go to their new assignments with our good wishes.
I shall not ask the Minister how many civil servants he expects to save by the merger, though it is a common enough question. What I ask him is: how many have so far been saved by the absorption of the National Assistance Board by the Ministry of Social Security? This might be as good an indication as he could give us of what is likely to result from this merger. I do not ask this to embarrass the Minister, because I know that in fact the staff increase I by 3,176 in 1967. But part was due to the increase in the number of beneficiaries, and part to the work which the Ministry of Social Security does in connection with the selective employment tax. But if that can be left aside, perhaps the noble Lord could give us an indication of what this merger has meant or an equal basis; that is to say, making allowance for the increase in beneficiaries.
My last point is this. The new Secretary of State will be taking over at a time when both the National Health Service and the National Insurance system are under discussion, not to say under fire. He is credited—if that is the right phrase—with authorship of the Labour Party's scheme for National Superannuation in 1957, revised in 1958 and abandoned in 1960. He struggled on, and in 1963 produced New Frontiers for Social Security, proclaiming a scheme based on graduated contributions related to wages to give retirement pensions equal to half pay to the average worker.
1551 Perhaps in the last six months he has been overlording the long-promised scheme and will produce it with a flourish on November 1. Whenever it is produced, we have been assured that it will also provide for the long-term sick. At the same time we have, or will shortly have, before us not only Mr. Robinson's Green Paper, but the Seebohm Report on Local Authority and Allied Personal Services, and of course, also, the Report of the Royal Commission on Local Government.
In order that all these matters may be considered together within one unified Department, this—and I hope my noble friends will agree—is a propitious time for the two Ministries to merge. High on his list of problems will no doubt be the problem of the wage stop, which still leaves 200,000 children in families living below the level of supplementary benefits—a problem of co-ordination of wage policy and social security policy, and a problem of quite exceptional difficulty. But apart from the immediate advantage that the Minister responsible for the two Departments merged will have a seat in the Cabinet, the advantages lie in the future as potentialities and not as certainties. It is up to the Government to turn them into realities for the benefit of the ordinary citizen, and in doing so they will of course have the full support of this side of your Lordships' House.
§ 3.40 p.m.
§ LORD AMULREE
My Lords, I should not like this opportunity to pass without my saying one or two words about the present Order, because (and this is the point I should like to touch upon first) I have known the present Minister of Health well for a very long time. I have worked in what is his constituency, and I have been very closely associated with him in all sorts of matters not entirely to do with his Department. My impression is that he has been the best Minister that we as a profession have had to work with since the days of Aneurin Bevan—which is saying something—and I am extremely sorry that he is giving up the work he is doing now. But I am sure he will do very well in the job he is going to, and I should like to wish him every success in it.
1552 The other point I should like to raise is this. While I can quite well see the advantage of joining the Ministry of Social Security with the Minitstry of Health, my mind goes back to the time when responsibility for environmental hygiene, and all that was involved in it, was taken from the Ministry of Health and put into (I think it is) the Ministry of Housing and Local Government because, it was said, it was far too big a Ministry and dealt with far too many things to work properly. It has always seemed to me that there was a very close connection between environmental hygiene (which, after all, is the basis of what a great deal of our society has been built on) and the prevention of disease, which is the job of the Ministry of Health at the present time. Therefore, it does not seem to me to be entirely logical to bring together the two Ministries which deal with hardship and at the same time not to join up in some kind of way the two Ministries which deal with the prevention of disease. I am not quite sure how that could have been done, because if a third Ministry had been brought into it I think it would have made far too large a Ministry. Nevertheless, I shall be interested to see whether these two Ministries now joined together do work successfully. If they do, it may be worth while thinking once more about what to do with environmental hygiene.
One of the great points the noble Lord, Lord Drumalbyn, has mentioned is that the Minister in charge of this Department will now be in the Cabinet, and I wonder whether it will be possible once more for us to have in this House a Departmental Minister in charge of health affairs, rather than somebody who does the work extremely well but is not connected with the Department itself. It was a great advantage, I think, when we had in this House a Departmental Minister from the Ministry of Health, and I wonder whether that will be possible in the future when this new Ministry gets going.
My Lords, I should like just to ask one question. I may be wrong, but I had the feeling from the speech of my noble friend Lord Drumalbyn that the Ministry of Health Green Paper was a foregone conclusion. I understand that this Green Paper is 1553 for discussion only, and I should like to have that confirmed because a great many discussions are taking place all over the country on this Green Paper. Perhaps I have got it wrong—I see that my noble friend indicates that I have. But I think confirmation of that would help many of us throughout the country, and we should be grateful to hear that that is so.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I wonder whether I also might ask the Minister a question, concerning the relationships of the local authorities with this new Department—because the local authorities have charge of the administration of certain welfare services. I am thinking particularly of old people, of people leaving mental hospitals and coming back into the community and of a variety of social security matters which, under the old system, have been entirely administered by the local authorities.
Equally, the hospital system in any given area is, of course, nothing at all to do with the local authority: they have nothing to do with the administration of the hospitals. Under the new scheme, will the local authorities still be the administrative bodies for much of the social security work, or will that be taken over and dealt with on the basis of the hospitals? In other words, will it be taken from the local authorities because it will then be linked up with the hospital service? I think this is rather important, since so much of the working, on the administrative side, of the Acts of Parliament concerning social security which have gone through has depended upon its being carried out by local authorities. What is the relationship between the local authorities and the new set-up when it comes into being?
§ BARONESS LLEWELYN-DAVIES OF HASTOE
My Lords, may I very briefly re-emphasise what the noble Lord, Lord Grenfell, asked about the Green Paper? It has been rather distressing for those of us in the hospital world to find that the Green Paper has been rather assumed to have become a White Paper overnight, and we need reassurance on this point before the deliberations which we hope will take place in this House.
§ 3.47 p.m.
§ LORD SHACKLETON
My Lords, I am grateful to noble Lords for turning this into a general, interesting debate of 1554 a kind which certainly would not have been possible on an Order in another place, as the noble Lord, Lord Drumalbyn, will know very well. In this relaxed, end-of-term atmosphere, with the pressures of the Transport Bill and other Bills gone, this has given rise to a number of interesting points on which I hope I shall be able to give some reassurance. Therefore, it is rather important that one is able to have this opportunity. I would first of all say how much I appreciate the remarks of the noble Lords, Lord Amulree and Lord Drumalbyn, about my right honourable friend Mr. Kenneth Robinson. I think we have had an exceptionally dedicated, strong, effective and humane man in that job.
I would say to the noble Lord, Lord Amulree, that I have of course noted his remarks about ministerial representation in this House. This is a subject which, naturally, deeply concerns me. We should like to have a lot of Ministers, but I think I should be straying very far if I went beyond saying that we have noted his remarks. I think, if I may say so, that some of my colleagues do have difficulties—and these will be acknowledged by other noble Lords who have had the experience of being departmental spokesmen without being members of the Department concerned—but they have coped very well in this field. However, I note the noble Lord's point.
Turning now to some of the other issues, first of all I agree with the noble Lord that it is very desirable to have the Minister in the Cabinet. Of course, Departmental Ministers who are not in Cabinet—one is giving away no secret—do turn up when issues of their particular concern are under discussion. None the less, such a vast and important area of government particularly merits representation; and, as the noble Lord says, although one is now and again forced back to having co-ordinating Ministers, the system of overlords is an unsatisfactory one. Indeed, I remember that one of the less enjoyable episodes of my life was when I was twitting the late Sir Winston Churchill on his overlords, a subject on which he was peculiarly sensitive. His colleagues did not like it a bit, and I got the full weight of his wrath, mainly because he misunderstood a reference I made to Lord Cherwell.
1555 So I know all about overlords; and there is no doubt, I think, that what is proposed here is right. It is more difficult to be a co-ordinating Minister than a Minister with executive responsibility. My right honourable friend Mr. Crossman (we shall all be able to watch him on television tonight, though he will not be talking on this area of his interests) has been deeply interested in all these fields, and I am sure that he will bring great imagination and vitality into something which calls for imagination as well as for organising ability.
My Lords, this discussion has started to revolve around the Green Paper. I am glad that the noble Lord, Lord Grenfell, and the noble Baroness, Lady Llewelyn-Davies, raised this matter. It must be stated absolutely firmly that the Green Paper is for discussion; although, naturally, many people take sides on this. I have my own views on the Green Paper; but it has been deliberately put out for consideration. It raises interesting and important issues; but some of the points raised by the noble Lord, Lord Drumalbyn, and that raised by the noble Baroness, Lady Elliot, are matters which really cannot he discussed to-day. It is not only the Green Paper; there is the action that may be taken in due course through Seebohm and, of course, we are waiting for Maud. I am saying clearly that the Government are thinking very hard on these matters and that there are all sorts of plans and ideas under consideration.
The difficulty is that one cannot do everything at once; the Government are taking it in stages. We have no intention of going off at half cock on the Green Paper. It is far too important a matter, as are the relations with the local authorities. Initially, of course, there is no change in the organisation locally. There is co-ordination at the top. There will be, in particular, the development of certain common services both on the establishments side and the social side and there will he room for some rationalisation at headquarters. It is true, notwithstanding the remarks I made about overlords, that my right honourable friend the Secretary of State for Social Services does have a wider concern than merely his Department. He will be responsible for the co-ordination 1556 and, above all, for the development of the co-ordination, over the whole social services field. This will enable him to make sure that measures for environmental health—and I say this to the noble Lord, Lord Amulree, who was on an obviously important point—will be considered along with other health measures. I think therefore that I cannot answer (and I do not think the noble Lord, Lord Drumalbyn, expects me to answer) his questions about areas and whether the area boards will be the same. But, in any case, the policy is not yet settled in certain of these matters.
There were certain other points that noble Lords asked me. I should say that there are no plans for actually integrating the local services of hospitals and general practitioners with the local offices administrating cash benefits. This is the sort of discussion in which at the end one is driven inevitably to the conclusion that everything should be in one large Ministry, that everybody should live in London, preferably all in Whitehall, controlled by one computer which would probably be at Newcastle. One can only do one's best; but I think this is a logical and natural integration from the policy point of view. I do not think I can deal with the question of redundancy payments; nor will I be drawn by the noble Lord into a discussion of whether they are good or bad. I should have thought that they were serving the purpose for which they were intended, which must be not only to protect people who have the misfortune of losing their jobs but, above all, to facilitate the rationalisation and re-organisation of industry. So I will merely say that I do not accept his particular criticism. I am sure that he does not want to go further—
§ LORD DRUMALBYN
My Lords, perhaps the noble Lord will allow me to interrupt him. I was talking only about the financial administration of this, the financial control, which has cost the country very much more than was originally estimated.
§ LORD SHACKLETON
My Lords, I do not see how the noble Lord can expect to see a financial control in relation to something which is determined by numbers and events outside direct control. Nobody has been more worried than the Government, and particularly 1557 the Treasury, about the mounting cost; but they are serving their purpose. I would not say that it is faulty administration. The noble Lord might wish to say that it is faulty government; although I am sure that in his present kindly mood he would not want to say that. It is in my view nothing to do with the control. However, I think perhaps I had better not go any further.
My Lords, I have mentioned that there will be merging of certain Departments. I mentioned establishments, organisation, information and intelligence; but the Ministries will generally go on as before. My right honourable friend will have his principal office at Alexander Fleming House at the Elephant and Castle, and noble Lords may be interested to know that for the time being Mr. Swingler, Minister of State, will have his office at the present Ministry of Social Security building in John Adam Street and will look particularly after the social security side of the new Department. Mr. Ennals will concern himself particularly with the Health service.
There are difficulties. As one who has worked as a Minister within a federal department the Ministry of Defence as it was, I know of these difficulties; but they can be overcome and they will be overcome and gradually one gets this better organised policy. The noble Lord asked me what savings had been made as a result of the 1966 merger. He was kind enough to point out that he already knew that manpower had increased so that it was difficult to point to a saving in manpower; but there has been a major rationalisation. It so happened that, wearing my Civil Service Department hat, I have recently seen some of the work which has been going on. It is of a very advanced kind. If noble Lords want to see the finest application of P.E.R.T. networking they will find it in some of the work done in the co-ordination of the old Assistance side with the Ministry. But there has been extra manpower and cost resulting from the success of the supplementary benefit schemes and the additional task which this Government, I confess, have put on civil servants to perform.
I am glad that no noble Lord asked me anything about the Children's Department. I hope it is clear that there is no change in regard to this at the 1558 moment. Although the Secretary of State for Social Services in his co-ordination role will have an interest in this it is much too early to say what change there will be. On the question of Scotland, again I am sure that noble Lords would not expect that there would be any general change. Things may look lopsided on a chart; but it does not mean that they are not practical solutions. The Secretary of State for Social Services will be responsible for the social security services in Scotland as is the present Minister of Social Security. I do not wish to be drawn into any suggestion of further devolution in that direction at the moment.
My Lords, I am grateful to noble Lords. I believe I have answered practically every point that has been made. I would only say something which I think one should say, since we have been generous in our compliments. Anyone who has worked with officials in the Ministry of Health, and particularly with those in the regions of the Ministry of National Insurance, and in the offices, will know that there you find a most devoted group of people who do not at all conform to the public idea of civil servants. They really are civil servants and they deal with the public as human beings. I am grateful that your Lordships appear likely to approve this Order.
§ VISCOUNT BRIDGEMAN
My Lords, before the noble Lord, Lord Shackleton, sits down, may I ask whether he realises how relieved were those of us who are members of county councils to hear what he said about the position regarding the Green Paper? Does he realise that it confirms us in the view that the Government not only wish the Green Paper to be discussed by county councils but are prepared to keep an open mind until the results come up? Does the noble Lord realise how important that is, seeing that the local authorities have not only to form considered and serious opinions on the Green Paper but also on the Seebohm and Maud Reports, as the three things are related?
§ LORD SHACKLETON
My Lords, I am much obliged to the noble Viscount.
On Question, Motion agreed to: the said Address to be presented to Her Majesty by the Lords with White Staves.