HL Deb 11 February 1970 vol 307 cc899-903

3.48 p.m.


My Lords, with the permission of the House, I should like now to repeat a Statement which is being made in another place by my right honourable friend the Secretary of Stats for Social Services about the Green Paper which he has published today on The Future Structure of the National Health Service. Copies arc available in the Printed Paper Office.

The Paper records three decisions which the Government have reached on the health services in England. First, they have decided, as already announced, that the National Health Service will not be administered by local government. Secondly, the Government have decided on the administrative boundary to be drawn between the National Health Service and the public health and personal social services which will continue to be run by local authorities. The health authorities will be responsible for those personal services where the primary skill needed is that of the health professions, and the local authorities for those where the primary skill is social care or support. This boundary will be further defined in the Bill to be published tomorrow arising out of the Report of the Seebohm Committee. Thirdly, they have decided that, in order to achieve better co-ordination than is at present possible, the number and areas of the area health authorities should, in general, match those of the new local authorities proposed in the White Paper on Local Government Reform in England; that is to say, the unitary areas and the metropolitan districts outside London. There will be special arrangements for London.

In the light of these three decisions the Paper puts forward revised proposals for the future structure of the Health Service. Apart from the three decisions, the Government are not committed to the proposals. These are all open to comment, and they will of course be fully discussed with interested organisations before firm decisions are reached. That is why we are publishing a further Green Paper.

Our basic purposes are:

  1. 1. to unite the National Health Service and to integrate its separate services locally;
  2. 2. to co-ordinate the National Health Service and the local government public health and social services;
  3. 3. to involve local communities in the running of the National Health Service district services and in general to decentralise responsibility to the maximum extent compatible with the retention by the central Department of its proper function of ensuring maximum value for the resources spent on the Service.


My Lords, I am sure that my noble friends on this side of the House join with me in thanking the noble Baroness for having repeated this Statement which has been made in another place. I think that this House may congratulate itself that it has as one of its Members the Minister of State for the Department of Health and Social Security. It is difficult to comment before seeing the Green Paper, but I wonder whether the noble Baroness would answer two questions. First, are not the Government creating an awkward interregnum period for local authorities by legislating this Session on the Seebohm recommendations and not legislating until some unknown date in future on the local health services and local government boundaries? Secondly, could the Minister tell us a little of the Government's proposals for the special problems of London? Will they affect the position occupied by the teaching hospitals, their boards of governors and their endowment funds?


My Lords, I also should like to thank the noble Baroness for repeating this Statement, which covers a great many complicated matters. I do not propose to comment on them now, but I should like to make one suggestion for the future. This Statement is based upon the Green Paper. Would it not be more satisfactory in such cases if the Green Paper (or whatever colour the Paper might be) referred to could be made available one day before a Statement is made, so that noble Lords interested in the matter could have some idea of what Ministers were talking about? At the present time a first Statement makes it extremely difficult to follow what is going on. I am certain that it would save a great deal of time and anxiety, if we could make some change in procedure in the future. Nevertheless, I thank the noble Baroness for repeating this Statement.


My Lords, can the noble Baroness, when she replies, give us an assurance that the House will have an early opportunity of discussing this important Paper, which none of us has yet seen?


My Lords, may I deal first with the point raised by the noble Lord, Lord Amulree, and say that naturally we will bear his suggestion in mind, though I think that its adoption might present certain difficulties, of which he will be as well aware as I am. In reply to the noble Lord, Lord Cottesloe, a debate would of course be a matter for discussion between what are known as the usual channels, and, knowing your Lordships' great interest in this area of the social services, I should not be surprised if you felt that you wished to debate the matter.

The noble Baroness asked whether the Government's decision, on the one hand, to put forward the Green Paper proposals in relation to the reorganisation of the National Health Service and, on the other hand, to present to Parliament a day later a Bill implementing the main recommendations of the Seebohm Committee will not cause an awkward interregnum. The need to consider the reorganisation of the health services and their close links with the personal social services was the reason why, in a series of Statements in reply to Questions from noble Lords opposite, and from elsewhere, the Government said they could not make a statement on the recommendations of the Seebohm Committee until they had looked at the proposals for the reorganisation of local government, following the Report of the Maud Commission, and their own proposals for the reorganisation of the National Health Service.

If the noble Baroness will read the Green Paper against the Bill which will be presented in another place tomorrow for its First Reading she will see that we are conscious of the problems of an interregnum and equally anxious to see these overcome. I would also say to her that the need for urgent legislation on the main recommendations of the Seebohm Committee Report arises from the anxiety in the professions concerned about change and their desire for change. The timing here has created certain problems, as the noble Lord, Lord Cottesloe, will be aware. The Seebohm Committee reported some eighteen months ago, and in view of the situation the Government have decided to legislate on the main recommendations in advance of local government change. I have no doubt that when the House comes to debate these matters, we shall be able to consider them fully.

With regard to the noble Baroness's second point, the situation in London and teaching hospitals, so many of which are concentrated in the London area, I would tell her that there is a short Appendix to the Green Paper (which is very green) dealing with the possible grouping of the present London boroughs to form area health authorities, but within them the position of the London teaching hospitals clearly will remain unchanged. Administratively, the universities will be represented on the area health authorities whose areas contain medical schools. The noble Lord, Lord Cottesloe, will be glad to know that we are very conscious, as a result of consultations with the Teaching Hospitals Association, that it will be necessary to take into account the special needs of teaching and of research in considering the position of the area health authority within whose area a teaching hospital lies. I hope that, with that assurance, the noble Lord's mind will be somewhat more at rest than it has been in the last few months, and that when we come to debate these matters it will be possible to deal at greater length with specific items.


My Lords, may I ask the noble Baroness what were the objections to producing a Green Paper and putting it in the Printed Paper Office so that we should be prepared for this Statement, particularly in view of the fact that the Bill is to be introduced tomorrow? I find it difficult to understand what is the purpose of this particular piece of machinery?


My Lords, I hope that my noble friend is not under any misapprehension. She mentions the Bill to be presented tomorrow. It is not a Bill to reorganise the National Health Service, but a Bill to reorganise the personal social services. When she comes to read the Green Paper, particularly the Foreword, she will find the dividing lines which the Government set out between the personal social services and the health services. I did not say that there necessarily would be difficulties in meeting the point raised by the noble Lord, Lord Amulree. He led me into details and problems of Parliamentary procedure in laying Papers with which I am not sufficiently familiar to give an opinion. All I said was that it might raise problems though it is a matter at which we could look.