§ 2.59 p.m.
§ LORD ABERDARE
My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
§ Moved, That the House do now resolve itself into Committee.—(Lord Aberdare.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The EARL OF LISTOWEL in the Chair.]
§ Clause 1 [Reorganisation of National Health Service]:
§ On Question, Whether Clause 1 shall stand part of the Bill?
§ BARONESS SEROTA
Since this first short and seemingly simply clause places the onerous duty of arranging the reorganisation and the unification of the National Health Service in accordance with the provisions of the Bill entirely on the shoulders of the Secretary of State, may I ask the Minister whether he could, at the outset of our deliberations, give the Committee an account of the steps towards reorganisation which have already been taken in advance of the publication of the Bill, and how it is intended to proceed in the coming months? I have already indicated, during our Second Reading debate, that in our view the Bill has come a year too late to give really adequate time to prepare for the major changes which are involved. Although it is admittedly difficult at this early stage to predict when it might receive Royal Assent, even if everyone concerned co-operates to make reasonable progress, as we all agree is necessary to bring to an end as soon as possible the uncertainties which many staff have experienced, it now seems very unlikely that the Bill will reach the Statute Book before the early summer.
Presumably the Secretary of State cannot pre-empt the decisions of Parliament 823 on the nature, the powers and the composition of the new authorities, so they cannot be appointed, I take it, or begin to take executive decisions effectively on the whole range of vital issues involved, including the very important question of senior staff appointments, until the late summer and the autumn. That will be only some seven or eight months, at the very most, before the appointed day. I should be grateful if the noble Lord could confirm this, especially in view of the rumour, referred to during our Second Reading debate, which the noble Lord, Lord Hayter, called "an ugly rumour", that letters are already going out to chairmen of large companies to see whether they have people available to sit on Area or Regional Health Authorities. If this rumour is correct, may I ask the Minister whether the Secretary of State is similarly in process of consulting professional organisations, the universities, the trade unions, staff associations and, indeed, the voluntary movement; and, if not, when he intends to do so?
May I also ask about the situation in relation to the members of the existing authorities who were due to retire this year? Is their period of office being automatically extended to maintain continuity and to reduce unnecessary disturbance at this stage, as is so in the case of the parallel reorganisation of local government? I was very surprised to hear, only last week, of a case locally in which a very long-serving member of a Hospital Board, who was coming to the end of the three-year term of office, was not to be renewed for this further last year, and I know that many noble Lords, particularly the noble Lord, Lord Grenfell, as I recall it, pointed out during our Second Reading debate that the reorganisation will in any event drastically reduce the number of lay people at present involved at different levels of the management of this Service. It would scarcely seem necessary to add insult to injury by making further changes at this time.
I am of course aware, from the circulars which the noble Lord has kindly let me see recently, of the steps which have already been taken to establish joint liaison committees with existing Health Authorities, both at regional and area level, and of the very detailed instruct 824 tions they have received from the Department about how to set about undertaking the initial preparatory work and the consultations which are needed to prepare for as smooth a transition as possible. This in itself will be no mean task for the members of the staff involved, in addition to their normal duties of maintaining the existing services, and I am sure that the burden on them will grow in the months to come. Unfortunately, owing to the delay in coming to decisions about the very difficult issues involved in the organisation of the Health Service in London until mid-November, the joint liaison committees have not yet been set up for that area—the area where the problems will be most complex of all, and where the problems of the changeover will be extremely difficult. Could the noble Lord tell the Committee how and when it proposed to establish joint liaison committee machinery in the Greater London area?
As one who experienced a major reorganisation, serving both on the existing authority and also on the newly formed one, I speak with some feeling on this question of the problems of the transition, and I am only too conscious of what these changes involve, first in terms of preparation and then in actual decision-making in the very short time that will now be available before the new authorities are appointed. Fortunately, as the noble Lord the Minister rightly pointed out in our Second Reading debate, relatively few people will be involved in carrying this operation through over the Service as a whole. For the vast majority of the staff in the Health Service, April 1, 1974 will come and go, and all that will result will be a change in the heading, of the notepaper, at least initially. I therefore do not wish to exaggerate the size of the problem in any way: it is already quite large enough, and will fall very heavily indeed on the shoulders of relatively few people. But I think it would help the Committee, and especially the staff of the Service, if the noble Lord could at least outline the plans that he and his colleagues have in mind for the corning year to fulfil the duty which this clause of the Bill places fairly and squarely on the Secretary of State, and, through him, on the staff of his Department, who undoubtedly will be bearing the brunt of it.
§ 3.8 p.m.
§ LORD ABERDARE
The noble Baroness has raised several matters. She began by asking me about the steps that have already been taken; and I think she knows as well as I do some of the fairly thorough researches, discussions and schemes that are in progress and have been in progress for some time. There is always a difficulty. Some of us would perhaps have liked things to advance more quickly, but, on the other hand, the more quickly they move the less time there is for discussion and consultation. But I think she will acknowledge that we have been doing our utmost to get the widest possible consultations on the new Service. She knows that various training schemes have been in progress—inter-professional schemes. The noble Baroness has herself mentioned the joint liaison committees, which are rapidly assembling the facts so that once the Area Health Authorities come into being they will be at least knowledgeable about the factual matters in the area which is their responsibility; and I can confirm to her that joint liaison committees in London are now in process of being set up.
The noble Baroness knows, as she preceded me in this particular job, the difficulties that London presents. All I can say is that, with the help of all those concerned, we have been having regular meetings and exhaustive discussions about London; and it is my opinion that, although it has taken some time, the expenditure of that time has been well worth while and we now understand each other's point of view much better. We hope that the proposals we put forward for London will prove satisfactory. The noble Baroness referred to what the noble Lord, Lord Hayter, I thought rather unfortunately, called "ugly rumours", but this is one area in which we have also been thinking ahead. Frankly, we have been thinking about the future membership of these bodies, without any commitment anywhere; and we have naturally been talking to all degrees and all sorts of people who might be able to help, including the bodies representing employees, the trade unions, just as much as anybody else.
I am sorry to hear that the noble Baroness has a particular case in mind of someone who is not to be reappointed 826 for the last year. I was surprised to hear that, and I should be very grateful if the noble Baroness could give me details. The Secretary of State is responsible only for the appointments at regional and board of governors level, and certainly at that level, in so far as I have any say in the matter, I have been hopeful that anybody who had only a further year should serve until the end of the present National Health Service scheme. I think I have answered the questions which the noble Baroness asked me, I hope satisfactorily.
§ BARONESS SEROTA
I am grateful to the noble Lord, Lord Aberdare, for his explanation to the Committee. I am sure he will agree that in the coming months the maximum communication, particularly to staff, will be of immense value in this context. I particularly welcomed seeing a copy of the Department's latest journal called N.H.S. Reorganisation News. I hope that copies will go to all staff, so that they are kept fully informed of all developments, and also to members of health authorities. I think that the main area which must continue to concern us, although I am sure that the noble Lord will say that this is a matter for the staff commission, will be the timing of senior appointments at area and regional level. After my London experience, which I have just referred to, where after all we were considering only a very small part of the country, I do not see how someone appointed, say, to a very senior post in Bristol region could continue his work in Manchester and Newcastle for the period of the overlap. But I appreciate that these are points that the staff commission will have to consider in consultation with the Department. I mention them now because I think is is important for us all to be aware of some of the problems which we shall be considering during the progress of the Bill, and particularly those that affect the individual positions of staff in service.
§ Clause 1 agreed to.
§ Clause 2 [General powers and duties of Secretary of State to provide Services.]
§ 3.12 p.m.
LORD STOW HILL moved Amendment No. 1:
Page 1, line 14, leave out ("he considers") and insert ("are").
§ The noble and learned Lord said: I beg to move Amendment No. 1, and if your Lordships would agree I would couple with it Amendment No. 2; and Amendment No. 5, which is down in the names of some of my noble friends, raises the same issue. This is a Bill of major importance and it is far from the intention of my noble friends or myself to raise tiresome, futile, drafting points at the outset. The actual wording to which the Amendments relate is complex, but I expect that the noble Lord, Lord Aberdare, will be able to tell the Committee that the words are the draftsman's method of ensuring that all the powers which within any reasonable ambit could be said to be desirable are vested in the Secretary of State. I say no more about the language, but it was thought by my noble friends and myself that it would perhaps be of value at this very early stage in the debate, for a reason that I will give, by means of these Amendments, designed to be probing Amendments, to invite the noble Lord to state with rather more precision the views of the Government on some aspects of the Bill referred to during Second Reading and of which I should like to remind the Committee.
§ In her stringent criticisms of the Bill during Second Reading, my noble friend Lady Serota pointed out, as the Committee will probably agree quite rightly, that this Bill is in the nature of an enabling Bill. Its provisions are general in scope; they are designed to confer powers to set up new authorities within the ambit of the three-tier or, if one includes the districts, the four-tier system. But, of necessity—this is not a point of criticism—the drafting of the Bill does not fill out in any real detail precisely what the three or four tiers are to do. At any rate, that would be the submission which would come from this side of the Committee. In those circumstances it was thought by my noble friends and myself that it would be useful in enabling the Committee to decide on later Amendments to have an opportunity to think over what the Government intend with regard to these various aspects of the Bill to which I should like to call attention.
§ I apprehend that most of us who have endeavoured to prepare ourselves for this 828 debate, in particular those like myself who have little expertise in these matters, will have made a careful comparison between the second Green Paper published by the last Government and the White Papers published by the present Government in August of this year. There are, of course, very many points of resemblance; but if one tries to isolate the major point of difference between the proposals of the last Government for the purpose of reorganising the Health Service and those contained in the White Paper and now set out in the Bill, and explained in his full and careful speech on Second Reading by the noble Lord, Lord Aberdare, it might be said to be this. The last Government were much more anxious, by the arrangements which they proposed to introduce, to secure that there should be a full measure of cooperation by local authorities in the functioning of the new authorities which were to be set up.
§ Criticism of the Bill during the Second Reading came from this side of the Committee on the basis that little and wholly inadequate provision was made in the Bill for such co-operation by local authorities. I am sure it is a matter on which we are all agreed that in our national social arrangements the work by local government—local democracy, if I may so describe it—is of inestimable value, particularly when one is constructing and seeking to operate an enormously important service of this sort which touches directly every single citizen in the community. Unless there is a strong reason for excluding them, it is desirable in principle in the highest degree to enable members of local authorities to co-operate actively in the formation of policy and taking decisions in so far as it is possible so to do.
I think I am right in saying that the criticism on that topic focused very largely on the composition of the Regional Health Authorities. The first point I should like to put to the noble Lord is this. I should be grateful if he could give us some more detail as to the Government's thinking on the actual place of the Regional Authorities. There are to be 14 of them; their membership is to be prescribed, in effect, by the Secretary of State, after certain consultations. If one looks for a comprehensive statement as to their function in the Govern-
ment's White Papers and in the noble Lord's speech, probably it is most comprehensively summed up by the noble Lord in this passage from his speech:
The region will be responsible for major planning decisions and for co-ordination between areas for the allocation of resources and general supervision of their use, and for the provision of certain services too specialised to be provided by individual areas."—[OFFICIAL REPORT, 4/12/72; col. 12.]
§ The difficulty in which we on this side find ourselves is to try to estimate, with that description, how usefully the Regional Health Authorities can function with the composition of their membership which is proposed by the Bill. We are anxious—and this anxiety was expressed from this side during the Second Reading debate—about whether these Regional Health Authorities which are interposed between the Secretary of State and the Area Health Authorities may become something of what in other contexts is described as an eminence grise. They will be—I do not want to overstate the case—perhaps shadowy, rather remote bodies with (again I do not mean this in any offensive sense) a rather elitist, oligarchical composition. At any rate, that is the risk. They will in due course perhaps become so regarded and one will be faced with, as it were, a third tier not really undertaking its functions and not fully appreciated by the actual patient, the member of the public, who sooner or later in the course of his life must have recourse to this great Service of which we are all so extremely proud.
§ I should be grateful in those circumstances if, as the first request I would put to him, the noble Lord, Lord Aberdare, would be kind enough to elaborate rather more in detail the parts I cited from his speech; and in elaboraing it, so that it will enable us to think over what his answer is, to deal rather more fully with the criticisms that have been made that these bodies may become too remote, too divorced from the life of the average person who participates either as a worker in or a partaker of the benefits of this system.
§ If I try to isolate the other matters on which I should like to request information of the noble Lord, Lord Aberdare, the next I would go to would be the Area Authorities. As I understood from the noble Lord's speech, it was intended that the specific number of local authority 830 appointees in the Area Authorities should normally be four. There are 90 Area Authorities and 14 Regional Area Authorities. Is a membership of four in the composition of the Area Authorities satisfactory? Is it sufficiently large to ensure adequate participation by the local authorities and the public at large? Closely allied with that question, I go to the community health councils on which I should like to put these questions to the noble Lord. As I read his closing speech in the Second Reading debate, I understood him to say that after listening to the debate it was his view that in the course of the Committee stage we could improve the community health councils. I thought that that meant (though perhaps I misunderstood him) that he had in mind the possibility of accepting Amendments in order to counter the broad criticism made that they will be effete and parlous bodies, being, in fact, dependent upon the Area Health Authorities. That is the third point.
§ The fourth point, which I put on the same basis, relates to the Health Commissioner. As I read the relevant Schedule, if it is a question of clinical judgment all inquiry is precluded. That surely cannot be quite satisfactory. There should not be that absolute bar. On this side we accept at once that it would be ridiculous to subject every doctor's decision to possible inquiry by the Health Commissioner; for that would bring the whole system to a standstill almost immediately. We propose nothing of that sort; but the noble Lord will have noticed that we have put down Amendments to the scope of the possible inquiry by the Commissioner which we hope will go, as it were, some way to meet the point I have sought to make of the inquiry being too limited and which will at the same time avoid the danger of unduly inhibiting the proper functioning of the Health Service. Clearly, it must function properly; and, clearly, what doctors decide must not be subject always to the risk of inquiry by an outside body. Nevertheless, would not the noble Lord agree that the present drafting is a little too restrictive and that something on the lines that we propose would be desirable?
§ Those are the questions on which I seek information in the first Amendment. They are probing questions and are put 831 to the Minister in a genuine desire to facilitate the processes of the debate on which we are embarked. That is our intention in putting them down and we shall be grateful for any information which the noble Lord can give. I beg to move.
§ LORD ABERDARE
I must say that I find it difficult to answer the noble Lord. He has almost moved Amendments Nos. 1 to 130 en bloc; whereas I had studied this Amendment and had taken the view that it was a small point, though a very important one.
§ LORD ABERDARE
I will forgive the noble Lord for that. I had better say, while we are on the wording of the Amendment, that we could not accept it as it stands because it would mean that the extent of the Nationalised Health Service would be a matter for potential litigation and ultimate decision by the courts since it would remove the Secretary of State's discretion as to what he wished to do and what he did not wish to do in given circumstances. It would become a matter for legal decision. I am sure that this is very far from the minds of the noble Lord and his noble friends.
But as it is a probing Amendment perhaps it would be less than courteous of me if I did not try to give (necessarily somewhat briefly, because we shall be Going into all these matters in detail in the course of the Committee stage), some overall answer to the four questions that he put. So far as the Regional Authorities are concerned, I hope we shall be talking about their functions in detail later. We believe that the regional tier is necessary. We do not think it would be easy or advantageous for the Secretary of State to deal directly with some 90 Area Health Authorities. We believe that the regional tier has very specific duties, and I gave some account of them at Second Reading. The region is not in any way an eminence grise; it is a very important tier in the chain of responsibility from the Secretary of State to the Area Authorities.
We have based these Regional Authorities on the sort of geographical areas 832 at present covered by the Regional Hospital Boards, because these are accepted entities; they have forward looking plans for future hospital development. That, I think, is the best way of carrying forward a reorganised Service. But we intend that the regions should have specific duties to perform. On the other hand, we have said that the Area Health Authorities will be the main executive authorities and although the devolution of responsibility goes from the Secretary of State, to the regions, to the areas, there is provision in the Bill for the Secretary of State to stipulate certain services which either shall or shall not be reserved to the regions or to the areas. So to that extent we hope that there will be full devolution of the executive services of running the areas.
He went on to criticise the number of local authority members for the areas. We fully value the co-operation of local authorities in the areas. Obviously it is essential when one is running a health service that there should be the closest co-operation with the social services, housing, education and the environmental health services. It was for that reason that, in the first place, we were determined to have Area Health Authorities to correspond exactly with the counties and metropolitan districts; and it was for that reason that, as a complete exception to the normal rule, where we have arranged for the Secretary of State to nominate the members of the region and for the region to nominate the members of the area, we provide in the case of local authorities that they should appoint their own members to the Area Health Authority. We thought, and we still think, that four is about the right number within a total of what will probably be about 15. There will be slight modifications. The reason why this is not in the Bill is to give flexibility, and in certain cases there will need to be more than four local authority members. One case, for example, would be in London, where a number of boroughs have to be combined into an area and there would obviously be a case for increasing the number of local authority members. But as a general guideline, we have felt it right to stipulate that the local authority should have the right to nominate four members to the Area Health Authority.
The noble and learned Lord asked me about community health councils. We 833 shall certainly be coming to a detailed discussion of the community health councils. This is a brand-new concept, and when I said that I hoped that in Committee we should be able to improve on what we have put into the Bill, I was simply saying that, with the assistance of your Lordships' views, we might well be able to make various suggestions that may be thought better than those we have put forward: because we are willing to take any advice on this matter that seems sensible.
On the Health Commissioners, again I think we ought to wait until we can just discuss that matter in more detail. General matters of clinical judgment are excluded from the Health Service Commissioners' remit, as I think, rightly and necessarily. But all matters that may involve doctors, if they are matters of administration and not of clinical judgment, will of course be within the remit of the Health Commissioners.
I hope that I have helped the noble Lord. As I said, his speech came to me as rather a shock, but I hope I have done something to help him forward.
§ LORD STOW HILL
If I may say so, the noble Lord has answered me royally and amply, and I am most grateful to him. I apologise sincerely to the noble Lord for moving the Amendment in a form which he did not quite expect, but in the light of the fact that this is largely an enabling Bill, I thought it would be useful at the outset to ascertain what the Government's thinking was, and the criticisms which were directed to it. I beg leave to withdraw the Amendment.
§ LORD STOW HILL
I did not move the second Amendment, but in accordance with custom and your Lordships' rules, I asked whether I might explain the reasons for that Amendment. I only moved the first Amendment and not the second one.
§ Amendment, by leave, withdrawn.
§ 3.35 p.m.
LORD BROCK moved Amendment No. 3:
Page 1, line 17, after ("other") insert ("lawful").
The noble Lord said: Clause 2(1)(b) states that the Secretary of State shall have power
to do any other thing whatsoever which is calculated to facilitate, or is conducive or incidental to, the discharge of such a duty".
We wish to insert the word "lawful" after the word "other", so that the sentence will read:
shall have power…to do any other lawful thing whatsoever which is calculated to facilitate.
and so on. As it reads at present, anything that the Minister does is lawful. His power is not even limited to doing things which are lawful apart from this Bill. It would seem only proper that he should not be permitted to do things that apart from this Bill are not lawful. In the National Health Service Act 1946 there is no such all-embracing power as "anything whatsoever". These are very strong words. It is noteworthy that there is nothing similar in the National Health Service (Scotland) Act, passed as recently as August 1972. In fact, the Scottish Act refers specifically to powers conferred in the original 1946 Act. Why then does the Bill designed for England propose such all-embracing powers as "anything whatsoever"?
§ I suggest that explanation and amplification is needed. Is it that the English are a ruder and rougher race than the Scots and need greater powers of control or possible disciplining? Is it that Her Majesty's Government think that Scotland will be controlled by a lighter rein than England? Or perhaps it is that later perusal and assessment of the Scottish Act has caused Her Majesty's Government to regret the less severely controlling powers that will apply to that country. Whatsoever be the cause, I suggest that your Lordships should await an explanation of this apparent tougher attitude to what many might think is a softer southern scene and does not merit such a heavy yoke. The insertion of the word "lawful" could serve as a mollifying Amendment and would lessen the severity of the Secretary of State doing anything whatsoever that he wishes to do. I beg to move.
§ LORD DAVIES OF LEEK
Quite briefly, and keeping to the point, I should like to endorse what the noble Lord has said. When he referred back to the Amendment which would be appropriate here 835 as exemplification, under the words "anything he considers", the Secretary of State can do anything that he considers and here do anything whatsoever. We seem to be throwing the pitch so wide that there will be need for about five ombudsmen as this business develops. As we go along with the entire pattern of the Bill, which is to change management, we shall have all management and no services if we are not careful.
Can my noble friend tell me what happens if the Secretary of State does something that is unlawful?
§ LORD ABERDARE
I will try to. This is a complementary general power to do things which are not themselves services. Services come under Clause 2(1)(a). This is a power to provide things which are ancillary to the provision of services, including, for example, the provision of residential accommodation and other facilities for staff, and arrangements for obtaining advice from other statutory sources on the planning and development of the Service. Hitherto it has been implicit that the existing National Health Service Acts confer a power to do these incidental things in the discharge of the Secretary of State's Health Service duties. But this has not been entirely satisfactory, and the clause defines expressly the subsidiary powers in terms similar to those that were used in the Local Government Act.
So far as the Amendment is concerned, it would depend on the interpretation of the word "lawful" which the noble Lord wishes to insert. Although in the last resort this would naturally be a matter for the courts, it appears that it could be possible to interpret it in two ways: either as enabling the Secretary of State only to do what it is already lawful for him to do, without the power that he has now in Clause 2(1)(b), or as limiting his power only to those things which are not expressly unlawful. In so far as the insertion of "lawful" suggests that the power in this clause has to be construed as enabling the Secretary of State only to do what it is already lawful for him to do, this would be objectionable, because it would lose the whole point of the subsection, which is to give him subsidiary powers. In so far as the word is construed as limiting the power to do only 836 such things as are not made unlawful by some other statutory provision or principle of common law, then it is not necessary, because there is an accepted principle of construction of Statutes that when an Act of Parliament refers to a thing being done, it is to be taken as referring to the thing being done lawfully.
As I said, the wording of this clause is based on Section 111(1) of the Local Government Act 1972. That gave a similar subsidiary power to local authorities, but subject to the provisions of the Act or of any other enactment passed before or after the Act. Therefore I hope the noble Lord will feel that what the Secretary of State does will be lawful and intended to help the Health Service by providing additional requirements outside the strict provisions of the Health Service.
§ LORD PLATT
As my name appears on this Amendment I should just like to press the Minister a little further. He has quoted the Local Government Act: I have not looked that up. I am taking no particular side on this issue. I am sure that what we all want is to give the Secretary of State the right powers, and no more than that. Is it really usual in Parliamentary drafting to give somebody the power to do any other thing whatsoever? This power seems extraordinarily wide. But if I am assured that this wording is used in other Acts and that it means explicitly something lawful, I shall be quite satisfied.
§ LORD ABERDARE
This is in fact a legal point and I do not feel altogether competent to explain it fully, but the reason for it is that there is something in law called ejusdem generis which is a principle of construction that where the words "any other" appear between two sets of things, the meaning to be attributed to the second set of things is limited by treating the words "any other" as meaning "any other similar". The draftsman has deliberately avoided the application of this rule by putting the word "whatsoever" after the other things. I hope that that will satisfy the noble Lord.
§ LORD BROCK
I thank the Minister for his reply, but I should like to ask why Scotland is not exposed to this wording.
§ LORD ABERDARE
I will certainly inquire the reason for that from my right 837 honourable friend. I am afraid I cannot say at the moment why Scotland did not feel that this was necessary. As I say, it has always been thought to be implicit in the Health Service Acts that the Secretary of State has these powers. We are trying to make it explicit in this Act.
§ Amendment, by leave, withdrawn.
§ 3.44 p.m.
§ LORD BROCK moved Amendment No. 4:
Page I, line 19, at end insert—
("Provided always that nothing done by the Secretary of State under this power shall limit the freedom of a member of any profession in the performance of his professional duties; and provided also that nothing done by the Secretary of State under this power shall be or authorise any breach of contract or infringement of any right legally vested in any person body or corporation.")
§ The noble Lord said: This Amendment concerns the insertion of a rather long sentence. The first part is intended to protect fully the clinical freedom of doctors, and the absolute desirability of this would be accepted without question by most people. Certainly a patient undergoing treatment would not wish to think that what his doctor advises or proposes to do to help in his treatment should be in any way influenced or modified by an edict from above; that is to say, from administrative or official sources. There is no evidence, intimation or even suspicion that the present Minister has any but good intentions towards the clinical freedom of doctors, but we have to think of a possible successor who might not have such good intentions. It could be that in the future the medical profession might have cause to regret its reliance on good intentions only. For that reason, it would seem wiser to have this assurance of clinical freedom inserted into the Act. The second part of the Amendment really rests upon the same reasons as the desire for the insertion of "lawful" in Amendment 1. I beg to move.
§ LORD AMULREE
I should like to say one word in support of the first part of the Amendment. I am not very interested in the second part of it. I think it is rather important that it should be 838 made clear in the Act that the clinical freedom of the profession should not be interfered with. I am sure there is no danger of that under the present Administration, and there would be none under any Government that one can see in the future. But, after all, this Act will govern things for a very long time and one wants to be sure of what will happen in the far distant future. Therefore I should like to see something of this kind put into the Bill, to protect what is a possibility at some future time.
§ LORD BROWN
First, I should like to make a short comment. When we were discussing scientific research I was a little worried about claims by the medical profession to have such complete discretion over research. This is another emanation of the medical profession, which seeks to ensure that nothing shall be done to limit the freedom of a member of the profession in the performance of his professional duties. Of course, everyone works under constraints, and if this were construed as written it would result in the Secretary of State's being unable to refuse a tenfold expansion of the accommodation required by members of the medical profession, because they would say that unless they had this it would interfere with their professional duties. It would be quite impossible to give anybody complete freedom in the exercise of his professional duties "without limitation". That is what it says, but I imagine it does not mean that; it means complete freedom in his diagnostic and therapeutic responsibilities and within the terms of the resources available—or something like that. The proposal would have been welcome had that condition been there, but it is not there.
Does the noble Lord, Lord Brock, wish this provision to apply only to the medical profession?—because, so far as I can see, it would apply to any other profession, and it is part of the duties of the Secretary of State to provide hospital accommodation, which would involve surveyors, architects and goodness knows what else. I think that the Amendment is defective in this respect.
§ LORD ABERDARE
I agree with my noble friend Lord Hawke on this matter. Indeed, it seems that a member of any. 839 profession could have this provision applied to him, and certainly it would apply to architects, engineers and all those other professional people who are involved in the Service. That is obviously not what the noble Lord is really after. However, I should like to give to him, the House and the noble Lord, Lord Amulree, an absolute assurance that the Secretary of State does not wish to interfere in any way with the clinical freedom of the medical profession in the performance of their professional duties. It was not thought necessary to write this into the 1946 Act, and the principle has never been questioned. Your Lordships will have seen in the Introduction to the White Paper that the Secretary of State confirmed that the Government accepted the clinical freedom of the medical profession to do as they think best for the health of their patients. We think it would be undesirable to accept an Amendment which might leave the Secretary of State open to challenge on questions of general policy or control of the Service in matters not directly related to clinical judgment: and I think that this might happen under the present Amendment of the noble Lord. The Amendment illustrates the difficulty that arises in attempting to provide a definition of "clinical freedom" which can be clearly set out in legal terms in such a way as to avoid ambiguity or conflict over interpretation. The concept of a practitioner's clinical freedom is quite clearly understood, and any problems that arise can, in our opinion, best be sorted out, as they have been in the past, by discussion between the Secretary of State and the professions concerned.
'The second part of the noble Lord's Amendment which relates to contracts and legal rights is not necessary. There is a well-established presumption in the courts that the Legislature does not intend to permit encroachment upon existing rights further than clearly appears from the enactment. There cannot be said to be any clear, unambiguous terms in Clause 2(1) conferring on the Secretary of State any power to break or authorise a breach of contract or to infringe any legally vested rights; therefore it is not necessary for this provision to be in the Bill. So I hope, with that assurance, that the clinical rights of the medical profess 840 sion will indeed be respected, and in view of the difficulty of writing it into legal terms, that the noble Lord will feel able to withdraw his Amendment.
§ LORD BROCK
I thank the Minister for his reply. I should like to take this matter back and consider improving the wording. I appreciate the looseness of the wording that has been pointed out to me. I therefore may return to the matter on the Report stage. In the meantime, I would ask the Committee's permission to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 3.52 p.m.
THE EARL OF MANSFIELD moved Amendment No. 6:
Page 2, line 7, after ("and") insert ("(except in Greater London)").
§ The noble Earl said: I beg to move Amendment No. 6 standing in my name, and, with the leave of your Lordships, it might be convenient if I also spoke to Amendments Nos. 10, 12, 13, 14 and 15 which also stand in my name. Your Lordships will no doubt be relieved to know that they all go to the same subject. Clause 2 places upon the Secretary of State the duty, among others, of providing an ambulance service and, as I am sure most of your Lordships know, so far as London is concerned—and my Amendments really go to London, although they would, if accepted, apply to the rest of the country—the present ambulance service is provided by the Greater London Council. The powers under which this service is provided are derived from Section 45 of the London Government Act 1963. In effect, this section will be repealed in Schedule 5 to the Bill.
§ It is worth noting that the London Government Act 1963 recognised the ambulance service so far as London is concerned as components of a strategic regional service, and the ambulance service was put in charge of what became the Greater London Council, and not in charge of the various London boroughs, the local health authorities for the area. In this time and in these days, when the local authorities are having more responsibility thrust upon them, it is, to say the least, ironic that London is to lose its ambulance service, which for over 841 forty years it has in effect administered so well.
§ LORD ABERDARE
If the noble Earl will forgive my intervention, London is not to lose the ambulance service. I hope he will not go on record as saying that. That the Greater London Council would transfer it to the Health Service is, I think, what he meant.
§ THE EARL OF MANSFIELD
I take my noble friend's point, but I am not sure that it is a valid one, for reasons which I shall come to. London may not lose the service in name but it may well lose it in effect. As I understand it, the ambulance service—and for the moment I shall not call it "the London Ambulance Service"—will be kept intact, administered by one of the four Greater London regional authorities on behalf of all of them, acting as some form of agent. They are, I suppose, one might say, the authorities of Kent or Essex, or Surrey or Hertfordshire, all of which will, as it were, extend into the middle of London. One can imagine—if, for instance, it was the authority of Kent which became the agent—that its preoccupation would extend from the Isle of Thanet to the middle of London. Although I have no doubt that there will be set up arrangements, and probably a committee which will consider all these matters, it is not difficult to envisage that London would come off fairly badly, or at least it would be not as good as it is now, when the affairs of the area were considered as a whole.
My argument starts from the basic premise that there should be no change in an organisation such as the London Ambulance Service unless it is inefficient in itself; or, secondly, that it can be made even more efficient; or, thirdly, that the service can be maintained as efficiently as before but in a more economic form. I do not suppose anybody would allege that the London Ambulance Service is inefficient. But there are cases where, if it is taken away from the care of the Greater London Council, which administers it now, it will lead at least to less efficiency; probably to greater cost—certainly capital cost. One could mention a number of examples of this. The first perhaps would be intercommunication with other services provided by the 842 Greater London Council at the moment, such as the Fire Service. Very close liaison exists between these various London services so that if, for instance, there is an emergency or a disaster or some great accident or fire, all the resources of the Council can be deployed as quickly as possible to help the victims or indeed anybody else who needs help. That, in my submission, is one reason for keeping the status quo.
Another matter, which concerns purely efficiency and cost, relates to the maintenance and the service of vehicles. There are about 1,000 vehicles which require the support of a fully equipped motor vehicle engineering facility—that is to say, 1,000 vehicles in the ambulance service. The Greater London Council has in fact a fleet of very nearly 3,000 vehicles of all kinds and has acquired much experience and expertise as to both maintenance of the vehicles themselves and the design of new ones. So far as I know, none of the present Metropolitan Regional Health Boards maintain any department such as the supplies department of the Greater London Council which is engaged in design; nor do they have these well equipped and highly expert teams of persons who equip and maintain these ambulances. I have no doubt that the same facilities could be set up by other people, by these new authorities, but it would be expensive and it would take time.
Another matter, of course, which can be argued is that if the Minister is in effect to be responsible for the Health Service he should be responsible for all parts of it, including the supply of all ambulances and the capital cost in relation thereto. My answer to that argument. if it is going to be raised, is perhaps twofold. First, ambulances do not necessarily come within the aegis of the Department. Secondly, even if they do, London stands alone: Greater London is by far the biggest conurbation, almost in the world, certainly in this country. The problems presented to an ambulance service, both locally and, as it were, to the area as a whole, are peculiar to London, and in my submission there is no reason why, even if ambulances in other areas are to be nationalised, the London Ambulance Service should not be left on its own.
843 May I finally throw out this point to my noble friend for his possible consideration? If, in spite of all these reasons which I have advanced, it is necessary for the Government, so to speak, to be responsible for the financial running and production of the ambulance service in London, it might well be that some sort of compromise could be reached by which the Greater London Council became, as it were, the agent for the Government in running the London Ambulance Service. By that means, I suggest, the Government would have the control they want yet the Service would continue with the efficiency which it has displayed all through these years; and Londoners, at any rate, as I suggest, would have rather greater confidence in the future. I beg to move.
§ LORD GARNSWORTHY
The noble Earl, Lord Mansfield, has presented a powerful case and, if I may say so, has presented it most persuasively. I must confess that I envy him his powers of persuasion. I hope that what he has said, except for the final part (which I believe if all else fails is the ultimate), the powerful and persuasive case which he has presented, will commend itself to the Minister.
This is not a political matter in the Party political sense. The G.L.C. are under the control of the Government's friends at the present time. I have no doubt that if the Labour Party had been in control they would have been coming forward with a plea to your Lordships' House through one of us to do precisely the same kind of thing that the Committee is now being asked to do. Therefore I believe there is a special case for the Government to give their sympathetic consideration to the major plea that this service should be left with the Greater London Council. There is no criticism of the manner in which the Greater London Council, under both Parties, and the L.C.C. before that, have administered the ambulance service. Both the major political Parties are proud of what they have achieved in this direction in London. Both feel that any change means, not improvement but possibly—and I put it no higher than that—putting at risk a standard which was achieved and a standard which is of the very highest.
844 May I put this further point to the Minister? In the Second Reading debate the point was made—indeed, it is the object of many of the Amendments that have been tabled for consideration by the Committee—that we ought to do all we can to secure democratic control of the service. In the case of the ambulance service in London we have that democratic control, and there is no substitute by way of democratic machinery that I think anybody can advance that is likely to commend itself as an improvement on what now prevails.
The noble Earl, Lord Mansfield, drew attention to the fact that the intention appears to be that London will be divided into four regions, but that the London Ambulance Service, recognising the necessity for keeping it under one head, shall be administered by one of these four regions. I do not know whether I have understood the position (I think I have) in regard to London; I hope I have with regard to the rest of the country. I believe that this will be unique in the country. Therefore I am wondering whether the Government, recognising the necessity for keeping the control for the whole of London under one body and being intent on achieving this throughout the rest of the country, will see that here in London is a unique way in which it may be done, the position having been established that there exists an efficient service. Everybody commends it for its efficiency. As the noble Earl, Lord Mansfield, has said, it is working well; leave it alone.
I cannot see what the Government stand to lose; and financially I think the National Health Service stands to gain. I cannot see that there can be any saving in capital cost if the ambulance service is transferred to the Health Service; I cannot see that there can be any reduction in running costs, unless the Government take up the suggestion made by the noble Earl, Lord Mansfield, in his closing remarks, and use the G.L.C. as, so to speak, an agent. There appears to me little to commend that idea. Without thinking of it further (and I must say the noble Earl took me slightly unawares when he brought out that suggestion), if the Government recognise virtue in that I should have thought it incontestable that they would recognise the virtue of leaving the service with the Greater London Council; letting the G.L.C. continue doing the job themselves, answer- 845 able to the community, the standard of their service being judged, assessed, approved or disapproved of by the community at large.
But may I put to the noble Lord something that does concern me; namely, the question of the reaction on staffs in the London Ambulance Service—because this is not just a matter of drivers? The noble Earl, Lord Mansfield, referred to the manner in which the G.L.C. have been able to cater for the needs of the ambulance service, as it were, in common with the Fire Service and the other services. I think the number of vehicles they administer is somewhat in excess of 2,000.
§ LORD GARNSWORTHY
Well, 2,000 plus the ambulance service—3,000, or whatever the figure is. If the ambulances are taken away, there will clearly be redundant staff with the G.L.C. Is it intended that some of the maintenance staff and the purchasing staff shall be moved over? As I see it, that would call for costly new building, the development of a maintenance service that would call for recruitment of experts, men who are qualified to do the job properly; and the ambulance service is a highly specialised one. What do the Government intend with regard to that matter?
I hope the Government will seriously consider accepting the proposals made by the noble Earl, Lord Mansfield. Perhaps I should say that, so far as I am able to assess the position, if the Government do not concede this they are at least likely to be pressed very vigorously throughout this House and, I would surmise, throughout the other House. I should like to think that this is one of the changes in the Bill for which your Lordships will be able to claim credit.
§ 4.18 p.m.
§ LORD ABERDARE
I have listened with great care and attention to what has been said by the noble Lord, Lord Garnsworthy, and by my noble friend who moved this Amendment with great eloquence. But I cannot say that I am personally convinced, even by his eloquence. It seems to me to go to the root of the whole of the reorganisation 846 that we are seeking to bring about. After all, the underlying object of this Bill is to unify the Health Service, to put an end to the tripartite system of the Health Service which has led to difficulties and a lack of co-ordination hitherto.
One part of that tripartite structure consists of the personal health services, which are at present the responsibility of the local authorities; and these include the ambulance service. No one is criticising these local authority services or is saying that they have been badly run—certainly not the ambulance service, and certainly not the personal health services. All we are saying is that we believe that in the future, for the more efficient use of the skills of those concerned in the health services, these local authority services should be integrated with the others. And we have said—as did the second Green Paper of Lord Garnsworthy's Government before, that the ambulance services should form part of the new National Health Service. Therefore, if that is accepted, what we are really arguing about in my noble friend's Amendment is simply that an exception should be made in the case of London. I feel that that would not be advisable.
I grant that the ambulance service is well run by the G.L.C., but we have no intention of breaking up the present London service. My noble friend was not quite clear—nor, I believe, was the noble Lord, Lord Garnsworthy—what our intentions are. Our intentions are that the ambulance service should remain a London Ambulance Service, covering the whole of London. It will be run by a committee on which will be represented the four London regions over some of whose territory the service will be operating. There is no question of Kent having anything to do with it. Kent will be an Area Health Authority of its own and will run its own ambulance service, because in general the ambulance services are the responsibility of the Area Health Authority. But in this case there will be a joint ambulance service in order to retain the excellent service that there is at the moment.
§ LORD GARNSWORTHY
I am most grateful to the noble Lord for what he has just said: that there will be a committee. But is that going to be put in the Bill?
§ LORD ABERDARE
No. The administrative arrangements for the whole of the Bill, the setting up of the management arrangements, are not included in the Bill, but I can give the noble Lord an assurance that that is what is going to happen. He said that other noble Lords had mentioned that one Regional Health Authority would be responsible. But this, of course, would be for the day-to-day routine management of the Service; the operational management would come under a joint committee. The noble Lord, Lord Garnsworthy, asked me whether that was unique. Not necessarily. It could well be that in other large conurbations there would be advantage in having a single ambulance service—for example for the whole of Manchester or Birmingham. But again these are matters which we can discuss. What we want to do is to find the best ambulance service organisation to cover the various areas of the country. Normally the ambulance service will be the responsibility of the area, but where there are positive advantages in keeping an ambulance service for the whole of a larger conurbation that will be done.
May I say further—and this is an important point also—that although there is no criticism of the way in which the Greater London Council has run the service, we must acknowledge that much of the efficiency of it is due to the Chief Ambulance Officer and his staff, and they will be transferred completely. I am quite sure that they will continue to give the same excellent service that they have done hitherto. At present, the London Ambulance Service meets the emergency requirements of the London area and receives also requests from hospitals and G.P.s to move patients with medical need. It does not play any part in the social services. Some ambulance services do, but the London Ambulance Service does not: it is entirely concerned with health needs and is involved in conveying to and from hospitals and other National Health Service treatment centres. At present, these hospitals and general practitioners making routine demands on the ambulance service have no responsibility or concern for it and its problems. But if we transfer the London Ambulance Service to the National Health Service this will ensure that both those who are making demands on the service and those 848 who provide it are within the same organisation. We believe, therefore, that there will be better opportunities for more effective and co-ordinated management arrangements so that ambulance requirements are met as effectively as possible. In particular, closer working relationships should be possible in the field of hospital admissions and discharges and outpatient appointments. For example, another very particular sphere where it is vital to have the full co-operation of the ambulance service is in the accident and emergency departments.
Those are the reasons why, for the full provision of health services, we feel that the ambulance service has a very vital part to play as part of the unified new Health Service, and we are sure that in the arrangements that we are making the service will remain and retain its present excellent standards and that we shall certainly not upset its present efficiency.
There is one other point that I forgot to mention and that I hope will help the noble Lord, Lord Garnsworthy. Subject to that overall transfer of responsibility, we certainly hope that we shall be able to continue to rely on the Greater London Council for the provision of maintenance and support services in matters such as vehicle maintenance and the provision of radio communications, at any rate for the next few years. Discussions are in train to that end, and I am sure that if my noble friend felt that further conversations on these lines would be helpful, that is something we should certainly wish to continue. But on the overall question of the policy I feel that the ambulance service is a vital part of the health services, and London is just as important in the provision of these services as are other parts of the country. On a point of principle. therefore, we ought to include the London Ambulance Service within the National Health Service.
§ LORD PARGITER
Before the noble Lord sits down, will be say, on the actual cost to the service (it will be wholly chargeable to the National Health Service, but over and above the grant-in-aid which is now paid by the Government), whether the Government want to take more money back? In other words, will they want to take something at the expense of the ratepayer.
§ LORD ABERDARE
I can assure noble Lords that we will not take anything at the expense of the ratepayer.
§ LORD GARNSWORTHY
I am most grateful to the noble Lord, Lord Aberdare, for the very courteous and detailed replies that he has given to questions put to him by me. May I say—and I hope he will not mind my doing so—that while I was listening to him I developed a tremendous sense of sympathy for him in that he is being asked to defend something on which, if he was on this side of the House, he would be taking up much the same attitude as we are doing. I sincerely hope that his noble friend Lord Mansfield will not be over-easily persuaded by the thinking that appears to have gone into the production of these proposals. It seems to me that the main point that the Government are making is, "We want a unified Service". The Amendment of the noble Lord, Lord Mansfield, would achieve a unified ambulance service in London. "Well," say the Government, "that is fine: we give an assurance, although it is not in the Bill, that we will take steps to do this. We will have a committee from the four London regions." What an unnecessarily cumbersome piece of machinery! What an unnecessary piece of machinery at all! If the Government, not with something included in the Bill, but by way of an administrative action, have to go out of their way to set up something to take the place of the Greater London Council, why undertake the exercise'? The noble Lord himself has given a fairly clear indication that there is no criticism whatsoever of the standard of service being given under the Greater London Council. Indeed, he hopes that they will get that degree of co-operation from the G.L.C. that will enable the very same high standard to be maintained. If the G.L.C. are called on to do this but really do not have the responsibility, then when they face the electorate—noble Lords should be under no illusion about this—they will have to account for a service for which they have become responsible but for which they feel that they do not have the power to be responsible at the present time. I very much hope that before this debate continues the Minister, who is usually as helpful as one could expect a noble Lord in his position to 850 be, will indicate that there might be some further thinking on the matter, for it seems to me that this is likely to be one of the big issues to confront the Committee.
§ LORD REIGATE
I apologise for detaining your Lordships at a moment when the Committee may wish to come to a decision on this important series of Amendments. I should like first to congratulate my noble friend on having drawn attention to what seems to be an appalling weakness in the Bill regarding the arrangements which the Government have laid down for Greater London. I had expected that we would advert to this theme later in our consideration of the Bill, but already it has become obvious that the arrangements in London are less than perfect. I thought it was restrained of the noble Earl in moving the Amendment, when referring to the London Government Act, not to draw attention to the fact that the Minister who put that measure through the House of Commons was in fact the present Secretary of State, who might be described as the architect and even the author of Greater London. If London really is to be divided into four Metropolitan Regional Boards and then we are to have a committee to run the ambulance services, it only shows that the basic thinking on the organisation of London is entirely wrong. I would only say, finally, how strongly I agreed with the noble Lord, Lord Garnsworthv, when he said that if a thing works well let it alone. Who am I to quarrel with that impeccable Tory doctrine'?
§ LORD FISKE
May I raise a further small question which I hope it will be possible for the Minister to answer'? I was alarmed to hear that he is still to look to the G.L.C. to do much of the servicing and maintenance. In the servicing and maintenance workshops of the G.L.C.—and of the L.C.C. before it—many of the prototypes of ambulances which are now in common use throughout the country were evolved. In other words, my question is a simple one: what, in these rather mixed circumstances, will become of research into such matters as new engines for ambulances, new fabrics for ambulance bodies, new ways of loading and unloading, new types of wheels and similar considerations? These were the subjects of continuous 851 research by the G.L.C. and the L.C.C. before it. I can only think that in the set-up that the Minister is proposing this work will come to a halt—that is, unless some arrangement has been made to ensure its continuance. If such an arrangement has been made, may we be told about it?
§ LORD ABERDARE
I think that noble Lords are rather neglecting the fact that all that is said about the London Ambulance Service could apply perfectly well to the health departments of the local authorities. Many of them work very well. What we are doing in this Bill is bringing all the health services together and I do not think one could expect to get the full benefits of reorganisation in London for the Health Service unless the London Ambulance Service was an integral part of it. I certainly do not accept the proposition of my noble friend Lord Reigate that this is less than perfect. It is trying to retain the excellent ambulance service that covers the whole of London but to combine with it an integration with those who actually put the demands on it—namely, the doctors, hospitals and patients. These will all be part of the Health Service and it seems extraordinary to suggest that we should leave the Ambulance Service outside this concept and I would find it very difficult to go further than that.
As for the remarks of the noble Lord, Lord Fiske, I take his point and I am sure that it is something that obviously must not be neglected in future. We are simply saying that it would be rather ridiculous to start building new depots, even if we had the time to do so, and start completely afresh on the maintenance side. We would rather, at least at present, make some sort of agency arrangement on that basis whereby the G.L.C. can continue to give the service which it has previously given. On the general principle, however, I find it difficult to be more helpful, although if I could enter into further discussions with my noble friend, if he thought that that would be useful in view of what had been said in this debate, I should be perfectly happy to discuss the matter further with him. As I say, I would find it difficult to concede what is a basic principle of the Bill.
§ THE EARL OF MANSFIELD
I am bound to say that I found my noble friend's attitude less than happy over this matter; I go further and say that I found it disappointing. This is the first major Bill to come before your Lordships' House first—at any rate since I became a Member—rather than going to the other place first. Without being offensive to the movers of other Amendments, this is the first substantial Amendment in this first Bill, and if I may say so my noble friend is behaving as if we were at the tail end of the Session with no time left to consider anything.
My noble friend says that this question of ambulances, and of London ambulances in particular, goes to the root of reorganisation. He goes on to say, "The Committee which will administer the whole new re-organisation of ambulances is not in the Bill but I assure you that there will be one." He then goes a little further and says that he will need most of the staff. I must add in parenthesis that if it is anything like the staff of the Central Criminal Court when it was nationalised, it will desert en bloc. At any rate, he will need the staff and the complicated electronic apparatus to run the whole thing, which is at present administered by the G.L.C., and all of this still goes to the root of reorganisation. I have considered the matter with, I hope, the due diffidence that befits my station in your Lordships' House and I am afraid that I am not prepared to withdraw the Amendment. I will leave it to your Lordships to do what is best.
§ LORD ABERDARE
Before my noble friend decides on that course, may I remind him that I suggested that although I found it difficult to accept the principles of the Amendment, I offered to have further talks with him about it? I slightly resent his imputation that I am pushing your Lordships through lack of time. That did not enter into the issue. We have plenty of time to go on considering these matters. I am simply indicating that in my view this is a fundamental question. It is difficult for me to help my noble friend further, but I am quite willing to go on talking about it if that is what he would like to do.
§ LORD GARNSWORTHY
Is the noble Lord, Lord Aberdare, saying that he is 853 prepared to look further into this matter with an open mind; in other words, that there is no question here of the issue being decided and that the talks which he might have with his noble friend will be really meaningful in that they will take cognisance of the points that have been raised this afternoon in the atmosphere of strong feeling which has attended our consideration of this Amendment? If that is the undertaking which the noble Lord is giving, I feel that it might commend itself to your Lordships. If not, then there are a number of other questions which must be raised because this is a very important matter. We are this afternoon discussing developments in the Service that are not in the Bill and we should not fail to explore them thoroughly before disposing of the issue. If the Minister is giving the kind of undertaking that I have suggested would be reasonable, his noble friend may feel sufficiently satisfied.
§ LORD ABERDARE
I would hope that I had. I cannot go back on what I said, that I think the general principles of the Bill indicate that one should bring all the ambulance services within the National Health Service. But I can give every other undertaking that the noble Lord mentions. I am certainly prepared to discuss it further. The one thing we have got is time. If the noble Earl would like to have further discussions, I should certainly be pleased to do so.
§ THE EARL OF MANSFIELD
In the circumstances, I would be less than generous if I did not ask leave to withdraw this Amendment. May I just say that the noble Lord, Lord Garnsworthy, has put it so much better than I did that I wish it were him doing it.
§ Amendment, by leave, withdrawn.
BARONESS LLEWELYN-DAVIES OF HASTOE moved Amendment No. 8:
Page 2, line 14, leave out from ("service") to end of line 18.
§ The noble Baroness said: I beg to move the Amendment in my name. I think it would be for the convenience of the Committee if we took together with Amendment No. 8 Amendments Nos. 9 and 11; Amendment No. 8, as your Lordships will see, is really a paving Amendment for No. 9, and they hang together, I think well. The purpose of 854 these Amendments is to establish where the responsibility lies for genuine aftercare. The Bill lays down that it will be the duty of the Secretary of State to provide facilities, but we are anxious to know what this really indicates. Does it indicate accommodation as well as services? And we are particularly anxious to know how the local authorities' concurrent powers fit in here.
§ The whole trend of modern medicine is, first, to prevent people from having to go to hospital, and, secondly, when they are there, to get them out and back into the community as soon as possible, but in a way that is satisfactory both to the patients and to the community. Paragraph (e) of subsection (2) deals with people in need of help, like geriatric cases, like recovering alcoholics, like the mentally handicapped. I can remember, very clearly, as a member of a hospital management committee of a mental hospital when the 1959 Act was passed, how we welcomed it, how we felt that this was the great opening up of the mental hospitals. But we were overwhelmingly aware of the almost desperate need for community care, for what nowadays we call halfway houses or hostels, for those people who do not need to be hospitalised but are not able to cope with the realities of life completely and who cannot be thrown back on their hard-pressed relatives, who are often people least able to help them. Then such places hardly existed, and even now they hardly do, and the responsibility fell on the local authorities. They were very short of money, they were very short of staff, and they had to cope with the unpopularity that always exists of providing such places. Hostels for the recovery of alcoholics or mentally handicapped people, open prisons, things of that kind, are always popular in theory but they are never popular in your own town. So we think it right that the Secretary of State should assume responsibility financially for these facilities and also should help to designate where these places should be, always, of course, in close co-operation with the local authorities.
§ There is another consideration which makes it essential that this should be a national service. Most members of the Committee will be familiar with the magnificent work done by the National Association for Mental Health, the Rich- 855 mond Fellowship, and many other voluntary organisations. Indeed the work of the voluntary organisations in this field is almost beyond praise. But they themselves would be the first to agree that what is needed is a general pooling of experience, an interchange of staff, for instance, which would mean better conditions for the staff—an interchange of ideas of all kinds. Of course, what is desperately needed is a central departmental grant to promote the work nationally. It is indeed true to say that there are many patients who would be far better out of hospitals but who have to stay in hospitals because up to now the State has paid for hospital services but not for adequate after-care.
§ The noble Lord, Lord Amulree, on Second Reading of this Bill, said that it appeared almost as though some local authorities were unwilling to spend money from the ratepayers to assist a service that was founded by the State. That is a very understandable sentiment. We agree with the intentions of the Bill to make the provision of these preventive and aftercare facilities the duty and the responsibility of the Secretary of State. We think that these halfway houses and hostels should be part of a national programme and that they need the authority of the Secretary of State and his financial assistance behind them. We have put down these Amendments, first, because we think our wording makes the situation more definite; second, because we should like to know whether there is any national scheme which will provide accommodation and services; and, third, because we hope the noble Lord, Lord Aberdare, can explain to us just what will be the relationship between his Department and the local authorities, both now, in the intervening years before 1974, and afterwards. I beg to move.
§ LORD DONALDSON OF KINGS-BRIDGE
May I say one word in support of this Amendment, taking the analogy of the penal world. Curiously enough—and this is the only way in which this is true—the penal world is ahead of the health world by about ten years. Something like ten years ago the provision of after-care was nationalised, very properly, and ever since it was done, without being very good it has been somewhat better.
856 The noble Baroness is absolutely right in suggesting that this is by far the most important aspect which must be brought into the present time. Most of the treatment, et cetera which goes on in institutions is already highly developed, and it is a question of improving it. After-care for the ill, particularly the mentally ill, hardly exists. People know very little about how to do it. The only way serious progress will be made is, first, by having a national plan, and, second, by having a national slice of the Budget. My noble friend has made these two proposals. I think she is absolutely right, and I have great pleasure in supporting the Amendment.
§ 4.40 p.m.
§ LORD ABERDARE
I must confess I was wondering what these Amendments were designed to achieve. Perhaps I had better say a word as to why the original wording is in the sense that it is, why the words which the noble Baroness seeks to remove are there. They were put there to limit the scope of the powers of the Secretary of State to make charges as closely as possible to the existing powers of local health authorities to charge for services provided under Section 12 of the Health Services and Public Health Act 1968. We did not wish to make radical changes in the charging provisions of this Bill. It seemed inappropriate to do so. Therefore, this particular description of the services was put in for that purpose. That was one of the purposes. Secondly, it provides a pointer as to which facilities of the kind referred to in the paragraph, lines 11 and 12, the Secretary of State might regard as appropriate as part of the health services. The expression used in the subsection,the care of persons suffering from illness and the after-care of persons who have suffered from illness …".is very wide, and includes what are at present and will in future be the responsibility of social services departments of local authorities.
What the noble Baroness is touching on is the very vital subject of collaboration between the social services and the health services, and this is a cause which we share utterly with her. It is one of the guiding principles that has affected the whole of the arrangements that we are making in the Bill. As I said earlier, it is the reason why we believe there 857 should be Area Health Authorities matching the local authorities. It is the reason why we set up various committees to work on the future collaboration arrangements between these two bodies. Like her, I very much hope that we shall achieve improved collaboration and improved services in this field which lies between the two. I am hopeful about the new health care groups within the district management arrangements. These will be groups of practising professional people concerned with patients suffering from a specific sort of illness, for example, there might be a health care group for the mentally ill. These would consist not only of consultants and general practitioners, but also of nurses and other professional people and, indeed, social workers. Again, the community physician surely has a big part to play in this kind of work. He will be associated with these health care groups. We have made it very clear that, although we used to call these groups "patient care groups", they are not directed solely to the needs of those who suffer and are ill, but to the whole community which the district is responsible for looking after. So we are providing preventive services just as much as treating the patient once he has fallen ill.
With regard to the noble Baroness's point about financial arrangements, these are a little difficult because while, in the case of local authorities, we hope to find extra monies for them under the rate support grant—and we have indeed done so—the way in which they spend their money is their own concern and we can do no more than persuade. But the fact that in the Bill there will be a duty laid upon the Health Authority and the local authority to co-operate, and the fact that there will be a committee set up between them to ensure that there is joint planning, will go some way towards meeting what the noble Baroness has in mind. I hope that, as we go through the Bill, we can discuss further examples so that we can ensure the close linking of the social services and the health services. I took careful note of what the noble Lord, Lord Donaldson of Kingsbridge, said, and I am sure there is scope for this kind of halfway house or hostel, or whatever one likes to call it.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
I am indeed grateful for the 858 most courteous way in which the noble Lord has dealt with this Amendment, but I am still a little puzzled. Health care groups and community physicians are admirable in themselves, but I do not quite see how they are to provide actual accommodation and facilities of that kind. I quite understand about the move towards co-operation between the different services, which we shall be discussing when we come to Clause 10; but I wonder whether the noble Lord can be a little more precise about more being done under the new reorganised Health Service than was possible in the past.
§ LORD ABERDARE
I cannot promise any more money under the National Health Service Reorganisation Bill, but what I was trying to say was that with the pressures that should build up to give higher priority to services of this sort, by producing health care groups which will be working on these problems, by having a community physician who will be advising his district or his area as to the priorities, there will therefore be a switch of rather more resources into community care than there has been up to the present moment. That is as far as I can go. I hope that this will turn out to be so.
§ BARONESS SEROTA
I hope that the noble Lord will forgive me for slightly prolonging this debate, but these Amendments were designed—perhaps inadequately, but quite sincerely—to elicit and clarify the intentions of the Government in relation to what we all agree has proved to be one of the most difficult areas of definition of responsibility. The noble Lord, Lord Aberdare, rightly said that when we come to Clause 10 we shall be considering these issues further in terms of the detailed co-operation between the Health Authority and the local authority, but I am still not quite clear. Am I right in understanding from the Bill, as he has explained it, that in future the Health Authorities and the local authorities will have concurrent powers to provide residential accommodation with the Health Authorities providing for those who could leave hospital but are still in need of continuous medical or nursing care, and the local authorities providing social care and support for those who could stay in the community if they had such help. Is that the position as a result of the transfer 859 under Clause 2? Are they both to have concurrent powers? I understand fully what the noble Lord has said about the different methods of financing, and we understand that this is a problem. But we are anxious to discover this afternoon whether the authorities have concurrent powers.
§ LORD ABERDARE
I do not think I should describe them as concurrent powers. They each have powers to provide certain kinds of services. The social services provide for those who do not require medical attention, and the health services provide the sort of homes where medical attention is continuously required. So I do not think that anything in this Bill will change the present division of responsibilities. But of course they come very close together in the middle, and we hope that with the collaboration of the two authorities we shall get greater concentration at that point.
§ BARONESS SEROTA
I am grateful to the noble Lord. We agree not only the fact that they come close together; but that there is this very difficult issue of the overlap. But I must press this point a little further. When the noble Lord said that this Bill does not change the position, did he mean that the present powers and responsibilities of the hospital authorities remain as they have been? I have in mind the difficulties which hospital authorities have had in the past in providing residential accommodation in the community. Many noble Lords will be aware, for example, of the pioneering steps that the Wessex region has taken to provide residential accommodation right in the community and not within the periphery of the hospital. Perhaps they have done that using powers which were not necessarily fully theirs; but they have done it and they have shown the way. I want to be quite sure that, in the future, Health Authorities will be able to continue to make this kind of provision available.
§ LORD ABERDARE
This Bill does not in any way affect the present powers of the hospital service. All that this section of the Bill is concerned with is transferring to Health Authorities those functions which are at present part of the functions of local authorities.
§ BARONESS LLEWELYN-DAVIES OF HASTOE
As very few mental hospitals, for instance, have any very clearly laid down plans for the after-care of patients, and as I am still not absolutely clear about what my noble friend described as the "concurrent powers", I am rather loath to withdraw my Amendment. In doing so, I ought perhaps to warn the noble Lord that we may return to this matter at a later stage. I beg leave to withdraw the Amendment.
§ LADY RUTHVEN OF FREELAND
May I say a word about this matter? I have found that the people who have been doing what we are asking for in regard to a community home or place of residence for those who can be discharged from psychiatric hospitals have been nearly always voluntary bodies and not the local authorities.
§ LORD ABERDARE
I am grateful for those remarks from my noble friend. We appreciate the help of voluntary bodies and they are, in fact, mentioned in the Bill.
§ Amendment, by leave, withdrawn.
§ 4.52 p.m.
§ LORD DONALDSON OF KINGS-BRIDGE moved Amendment No. 9A:
Page 2, line 18, at end insert—
("(f) comprehensive medical, dental and nursing services for Her Majesty's prisons and borstals in place of arrangements of a kind which immediately before the passing of this Act it was the function of the Secretary of State for the Home Department to provide;")
The noble Lord said: This Amendment comes as rather tangential to the main stream of the Bill; but it is none the less important and, I think, none the less directly relevant to the Bill which is supposed to deal with the reorganisation of the National Health Service. As part of that reorganisation (and, we think, a part that for the whole of history has been outside the National Health Service but should be brought into it), I am proposing a complete merger. I am proposing that the Prison Medical Service should become a part of the National Health Service. There was impressive support for this view given over eight years ago when the Gwynn Committee reported on the organisation of the Prison Medical Service; and in fact the Institution of Psychiatry, the National Association for Mental Health, the Royal College of
Physicians, and the Royal Medico-Psychological Association all recommended complete integration. But the Committee, supported by the B.M.A. and the Institution of Professional Civil Servants, decided otherwise. Even so, they made it clear that their decision was not binding for all time and should be seen as a temporary one. I quote their words:
The organisation may well need to be reviewed and adapted in the light of future developments.
§ They say that their recommendations may hold for some time to come ". We think that the time has come and that eight years is about it. We think that this is the appropriate moment and this is the appropriate Bill on which to raise the question.
§ It may be that I owe the Minister an apology for not having raised this matter on Second Reading, but unfortunately I could not get here. My guilt is somewhat assuaged by the fact that my noble friend Lord Davies of Leek referred to the matter in passing and also a good deal assuaged by the fact that when I asked the Minister's colleague, the noble Viscount, Lord Colville of Culross, an Unstarred Question on prison conditions about a month ago, I gave him verbal notice that I was going to raise this point. But I was finally cowed by the ticking of the clock and did not do so. So I have no doubt that the noble Viscount had a neatly docketed brief which he will pass to the Minister and I hope that this is enough apology to cover the situation.
§ In the last eight years a good deal has happened in the penal field, not least of which is that two of the signatories to this Report have changed their minds. I will not go into details; but if the noble Lord wants them I will give them. In any case, the Report is essentially by doctors and administrators about the administration of doctors. The patients are mentioned, and then obliquely, in only three out of the 35 paragraphs. I do not say this as a special criticism because the problem is basically administrative, but its correct solution could do much to help the prisons and it is with that that we must concern ourselves.
§ One of the most arid and agonising things about prison is the pressure to destroy the personality and individuality. It is the business of prison administrators 862 to resist this, to counter this, whenever they see a chance. A man's relationship with his doctor can be and should be a personal, individual and satisfactory one. I confide totally in my own doctor; so do my family. He responds with total confidence in his hopes or fears as to our welfare. This is a personal strength to us and something that I think a man can ill do without. That is why the family doctor must always be the cornerstone of any Health Service. Yet the administrative arrangements in prison are such that the man is most unlikely to find this sort of relationship there. It seems to me that if the doctor he found there were a doctor like any other doctor instead of one of a class apart employed by his "enemies", the prison authorities, something might be done; but as it is, it is a "we—they" situation which gives the man very little chance of forming the kind of relationship we are speaking of and gives the doctor little chance of behaving in the way that he would probably like to behave.
§ The old type of prison doctor in the 19th century, like the old Army "sawbones", was expected to keep malingerers at work and to take their heartbeats when they were being flogged. I hasten to say that there is nothing of this attitude in the modern Prison Medical Service, but the machinery is exactly the same as it then was. It is not surprising that the opportunities for a prisoner to make the kind of relationship with a prison doctor which he would make with his family doctor if he were living at home very rarely exist. Of course, in the end it is the man that counts, and a good doctor under this system is better than a bad doctor under any system into which we may change the present one. But this is the argument used: that excellence is what is required is often used as an excuse for leaving machinery rusty and inefficient; and I do not think we should let this happen.
§ So much for the consumer, for the man I am concerned to benefit. But there are also strong administrative arguments. In particular, there is the wider career structure, the easier exchange of views and information between the minority prison group and their peers, the wider field from which to choose specialists and the elimination of rivalry and jealousies which have certainly existed. The present 863 service is isolated, and in my opinion suffers from isolation. The Gwynn Committee recommended that there should be a beginning in breaking down these barriers by making a number of joint appointments between the two services. In the eight years there have been, I think, only six, which does not look like a very successful breaking down of barriers. The career of forensic medicine will always be one for specialists, as are radiology and the job of those who administer anesthetics so that fact can be no reason why it should not be included within the system as a whole.
§ The balance of administrative advantage is a matter of opinion but the balance of human advantage is overwhelmingly in favour of a change of this kind. I think it may be said that this is a question about which the Butler Committee will surely have something to say. If we leave it open, of course they will: but if we decide it now they will not need to. It seems to me that this Bill is the right place to make a change of this kind. It seems to me that the arguments on the administrative side may be overwhelmingly outweighed by those on the human side. I hope very much that the Minister will feel able to accept this Amendment, or at least that it is of sufficient importance for him to look at it further.I beg to move.
§ 5.0 p.m.
§ LORD GARDINER
I rise to support this Amendment which has been so persuasively moved by my noble friend Lord Donaldson of Kingsbridge. I do so because this is something which I have thought and said for at least 20 years. What I think first interested me in the point was the number of cases I heard where a convicted man was obviously to some extent mental, and where the judge said, "It is said that you need psychiatric treatment. Any psychiatric treatment that you need you will receive in prison."I am quite sure that any judges who said that did not know that that was not true, because had they known it would have been a very cruel thing to say. I think they ought to have known what I knew, which was that there were only two part-time psychiatrists in the whole of the British Prison Medical Service. To obtain their services you 864 had first to get a prisoner transferred to Wormwood Scrubs, and unless he had a really long sentence there was always such a queue at Wormwood Scrubs that it was usually impracticable to get such a transfer.
In the last 20 years, of course, there have been great improvements in the Prison Medical Service, and I should be the first to acknowledge that. Now, quite a high proportion of those in the service have at least a diploma in mental health. But I could never understand why it should not be part of the National Health Service. I suppose that these are the only members of the community who are not entitled to the privileges of the National Health Service. Most of them have been paying their insurance constributions all their lives, and they are very much in the hands of the prison medical officer. I have received complaints fairly recently of the very short nature of the examination in prisons, and there seems to me to be no real reason why the Prison Medical Service should not be part of the National Health Service and, in particular, why a prisoner should be entirely deprived of any independent medical advice. About a fortnight ago I was at a conference which considered conditions of imprisonment, and the committee on which I served was composed mainly of judges, magistrates, probation officers, prison welfare officers and so forth. One of their unanimous resolutions was: "In our view the Prison Medical Service should form part of the National Health Service and prisoners should have a right to independent medical advice." For these reasons I support the Amendment moved by my noble friend.
§ 5.3 p.m.
§ LORD ABERDARE
The noble Lord, Lord Donaldson of Kingsbridge, need not apologise for having introduced this Amendment, though I must confess that I have not had a great deal of time to study it, as it was put on the Marshalled List only, I think, on Friday. But I certainly think it a subject that we should consider most carefully. Of course it would be possible to put the provision into the Bill, but we feel that this represents a fairly major organisational change and that, before we embark on it, we ought to enter into rather more exhaustive 865 consultations and consideration before putting it into legislation.
We believe that in recent years the Prison Medical Service has made considerable advances, and this was acknowledged by the noble and learned Lord, Lord Gardiner. At present it is able to provide quite extensive cover for the medical, dental and nursing needs of the persons in its care. It works in close liaison with the National Health Service and is free to call for assistance when required. The noble Lord mentioned only a few joint appointments but my advice is that many doctors and dentists from the Health Service are employed on a sessional or part-time basis to assist in the prisons. It has seemed to us important that the care of those in prison should be in the hands of persons specially recruited and trained to deal with the additional problems peculiar to the penal situation and to the nature of those in prison. The Prison Medical Service now has 110 full-time medical officers, two-thirds of them with specialist qualifications. They are able to ensure that medical and custodial requirements are met in a humane and acceptable way, with proper regard to modern standards of practice. Similarly, the nursing needs are dealt with by trained prison hospital officers complemented by nursing sisters under the direction of a matron-in-chief. On the other hand, dental services, as the noble Lord will be aware, are provided from the Health Service.
The noble Lord, Lord Donaldson of Kingsbridge, mentioned the 1964 Working Party on the organisation of the Prison Medical Service, which studied the whole situation and made certain recommendations for its future development which have now been implemented. In particular, the posts of consultant, forensic psychiatrists, working between the Health Service and the Prison Service jointly, were initiated with great success. Also a Standing Medical Advisory Committee was suggested and is now in operation. So, while there is no doubt room for improvement, I believe that the Prison Medical Service at present is well staffed, has good morale and, with the increasing facilities for planning provision being made available, is providing effective medical cover. The noble Lord mentioned the work of Lord Butler's Committee on the treatment of the mentally abnormal 866 offender. Obviously this will have implications for the future work of the Prison Medical Service in the psychiatric field, but I should not have thought it right, as I said at the beginning, to introduce a major reorganisation like this without the fullest consultation. Having said that, I must say that I am impressed by what has been said by the noble Lords and perhaps I may be allowed to consider the matter. Obviously, it brings in a Department other than my own, so I think it would be best if I could talk it over further and we debated it at a later stage.
§ LORD DONALDSON OF KINGS-BRIDGE
The noble Lord, Lord Aberdare, has said even more than I hoped he would. I do not think that at this stage one could expect this Amendment to be accepted, and the fact that the noble Lord does not reject it outright is as much as my noble and learned friend and I could hope. I would point out that all previous considerations which have been raised about this matter have been concerned with the convenience of the administration, and the point which I wanted to make, and which my noble and learned friend Lord Gardiner was trying to make, was about the relationship of a doctor to his patients. That has nothing to do with the administration or the institution in which the patient is. It is a personal and intimate relationship. It is that which is lost, and it is that for which we have to try to work. But in view of what the noble Lord, Lord Aberdare, has said I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ On Question, Whether Clause 2 shall stand part of the Bill?
§ 5.9 p.m.
§ BARONESS WHITE
I do not think that we should allow this clause to pass without some reference to another aspect of health care in this country to which I think no reference was made during the Second Reading debate. I refer to something rather wider in its impact than the very important element of health care referred to by my noble friends, Lord Donaldson of Kingsbridge and Lord Gardiner; that is, occupational health. We are at some disadvantage because we have not yet debated the Report of the Committee, under the chairmanship of the 867 noble Lord, Lord Robens of Woldingham, on Safety and Health at Work. I fully recognise that your Lordships' House, together with another place, passed last Session an Act relating to the Employment Medical Advisory Service, which set out a certain pattern for at least part of the care of people at work. But I do not think we should remain silent about a very large aspect of health care in this country.
I have been studying Chapter 12, the relevant chapter in the Robens Report, on the organisation of occupational medicine, and without any disrespect to that Committee I must say that I think they were stronger on safety than on health. I was far from convinced on reading that Report that they had gone adequately into the relationship between health, care at work and general community medicine. One can understand that they may have felt that this was not part of their remit. But it seems to me that they were rather cavalier in their comment in paragraph 380 of that Report, where they said:The argument that occupational medicine should be organised within the framework of the National Health Service is really a secondary issue".Well, from their point of view it may have been a secondary issue. But they went on to admit that:Any fundamental reorganisation of general medicine would provide an opportunity for further consideration of the place of occupational medicine within the administrative structure".It seems to me a little odd that we should have had no reference whatever to that in the introductory speeches and consideration of the Bill that is now before us. There is a strong body of opinion—in spite of what the Robens Committee may have felt—that the place for occupational medicine is within the National Health Service. It is true of course, as they argue, that, whatever system of administration one chooses, there is bound to be what they call an interface between the health and the occupational or industrial aspects of it, and that therefore, however carefully one devised one's administrative system, one would never get a complete identification. This one must freely admit. But, to my mind, there is a strong case for suggesting that if the Government, in the Bill now before us, were capable of taking 868 over the School Health Service, they might at the same time have taken over the Employment Medical Advisory Service. I believe that if they had been prepared to face this we should have had a much stronger position for the staff, both at doctor and at nursing level, because they would have felt that they were much more secure in their professional work as part of the great National Health Service.
We are all well aware that there are departmental problems here. This is one of the reasons why the Prison Medical Service was not included in the Bill: the Home Office do not want to give it up. When one comes to the occupational health service, the same applies: the Department of Employment do not want to give it up. I know perfectly well that in the previous Administration Mrs. Castle did not want to give it up; and she did not. I assume—though I have no intimate knowledge of the present Administration—that Mr. Macmillan does not want to give it up. But that is not necessarily an overriding reason for maintaining the occupational health service as a separate organisation.
We have no specific Amendment down; therefore I should not in the least hold it against the noble Lord, Lord Aberdare, if he did not wish to reply to my remarks now. We felt, however, that we should at least put the Committee on notice that at a later stage when we perhaps have had a little more time for further consultation and when, frankly, the Government Front Bench have had time for further consultation, we may put down an Amendment on this matter so that we can discuss a considerable area of health care which we believe ought at least to be considered in a Bill which purports to reorganise in a comprehensive fashion the National Health Service of this country.
§ LORD ABERDARE
I feel that it would be discourteous of me not to reply to the noble Baroness, who has put her point so lucidly. It is true, as she said, that the Employment Medical Advisory Services have only recently been the subject of an Act of Parliament, and we have no intention at present of providing an occupational health service under the National Health Service. The fact is that the Secretary of State, under his qualified duty to provide medical, dental, 869 nursing and ambulance services, is not limited to a particular place, and therefore this includes the provision of services at a hospital, in-patients' homes, or indeed in any other place. This, for example, covers the scene of a major accident. So if the Secretary of State were to consider it necessary to meet all reasonable requirements, then the duty would also extend to the provision of services at places of employment.
As I say, there is at present no intention of going as far as this. As the noble Baroness knows, the Department of Employment organised the Employment Medical Advisory Services to carry out duties in connection with occupational hazards, such as working conditions and toxic hazards, including some routine medical inspections. Some firms provide privately the equivalent of a general practitioner service—and indeed we have been under pressure to take over responsibility for these services—but hitherto they have been regarded as a duplication of existing National Health Service primary care services, which in this country are provided on a home basis. So it will be a matter for the future to decide on priorities and where medical care is best provided. I listened with interest to the noble Baroness, and we can certainly discuss this subject further.
§ Clause 2 agreed to.
§ 5.17 p.m.
§ BARONESS SEROTA moved Amendment No. 17:
§ After Clause 2, insert the following new clause:
§ Establishment of National Health Service Training Board
§ "It shall be the duty of the Secretary of State to establish a National Health Service Training Board to meet the training needs of the unified service in England and Wales."
§ The noble Baroness said: I am proposing this new clause in the belief that the proposed reorganisation of the Health Service presents us with an excellent opportunity to establish new national machinery to plan and co-ordinate all aspects of staff training and development for the unified Service, other than of course education and training leading to professional qualification. Many of your Lordships are familiar with the various aspects of the staff training arrangements in the National Health Service, which reflect in many ways its historical develop- 870 ment. They have evolved slowly and somewhat eratically over time as new needs have been revealed in a rapidly changing Service. Until comparatively recently, it is fair to say that they have consisted in the main of unco-ordinated, separately organised specialist systems for the different professions and staff interests who are concerned in the delivery of health care services, and they are all rapidly becoming irrelevant in the context of the training demands of an integrated Health Service such as we are seeking to build through the provisions of this Bill. One thinks of Cogwheel, Salmon, Zuckerman, and most recently of the excellent Report of the Committee on Nursing under the chairmanship of Professor Asa Briggs, which have all contributed to the recognition in the White Paper that in future most induction in-service, post-professional, and particularly management, training will need to be of a multi-disciplinary nature in the Service itself and closely related to the local authority social services, with which staff will need to co-operate at all levels to provide reciprocal and complementary services.
§ I believe that there is now a clearly demonstrated case for a major reappraisal of all our existing training programmes and the development of new ones, both for the period of transition, which will certainly last beyond April 1, 1974, and for the long-term development of a truly integrated Service. I therefore welcomed the statement—I believe it was in paragraph 150 of the White Paper—that comprehensive arrangements for all aspects of the personnel function (including training) must be developed. I was also glad to learn from the White Paper that the Department's own resources were being strengthened for this purpose. The White Paper went on to outline the proposals to establish an Advisory National Health Service Training Council, working with a linked series of advisory committees to provide co-ordinated advice to the Secretary of State. I have very great regard for the work undertaken up to now by the National Staff Committee, the hospital administrators, the clerical staff and the nursing staff committee, which are now apparently to be reconstituted on a wider basis as part of the proposed new series of advisory committees and which will move in alongside the personnel staff of the Department.871
§ I also congratulate the Department on mounting these special courses to which the noble Lord, Lord Aberdare, has referred this afternoon, to assist staff to prepare for the period of the transition through the integrated health care management courses and special courses for medical administrators. Perhaps, since I have certain connections with some of the institutions providing these courses, I had better not praise them too highly; but at least I speak with first-hand knowledge of the value that these ad hoc courses have been to the staff who have been able to participate in them.
§ I believe that all this experience and activity in the last year or so will undoubtedly make a very useful and practical contribution to the longer-term training programmes that will be needed. Taken together, they have shown above all the urgent need for a new, vigorous and dynamic National Health Service Training Council, with executive powers of its own and direct responsibilities for developing training programmes over the range of health care staff needs. I see it as being a fairly compact body composed of Health Service authorities, with direct representation from the staff and including people with special knowledge and experience of training and education programmes in the Health and Social Services. Such a council must have real organisational independence and the necessary highly-skilled specialist management if the complex task involved in developing comprehensive training programmes over the whole range of the Services concerned is to be forcefully and effectively tackled.
§ The Advisory Council envisaged by the Government in the White Paper is quite a different kind of animal from the one that I believe to be essential for the development of multi-disciplinary staff training in this critical stage of the organisation of the unified Health Service. I therefore hope that the Government will give serious consideration to this new clause. Its main purpose, after all, is only to strengthen and make real the objectives which we all share in this very special area of concern; namely, to assist staff of all kinds to utilise to the full the new opportunities which the Service will present. I very much hope that the Government will consider this alterna- 872 tive of an independent statutory training council to the Advisory Council assisted by a series of committees which was envisaged in the White Paper. I beg to move.
§ 5.24 p.m.
§ LORD ABERDARE
I can readily agree with the noble Baroness: we share the same objectives, and we are equally keen to see positive personnel policies developing in the Service, and also to give the related training which is so essential to it. The noble Baroness referred to the courses at present provided to enable staff from all three branches of the Service to extend their understanding and develop their expertise; and I should like to express my thanks to her, and to those others who play such a leading part in these very excellent courses. But I hope that, on further consideration, she may feel that we have already provided a fairly extensive system of advisory committees for the future.
We should not like to go as far as setting up a new training board, independent of the Service itself. In fact I can only repeat some words that I used on November 29, 1971, in reply to the noble Lord, Lord Garnsworthy. When we are considering a training council it does not mean that we are looking for something like a new industrial training board, building up a separate organisation of its own. We do not think this would be appropriate to the reorganised Service. In fact we are proceeding on the lines set out in paragraph 150 of the White Paper and in the corresponding paragraph of the Welsh White Paper. A start has already been made on consultations to establish two of the linked staff advisory committees mentioned in those paragraphs—that is, the National Staff Committee and the National Nursing Staff Committee. These committees, with others to be set up later, will co-ordinate the advice given to the Secretary of State on aspects of recruitment, manpower planning, training and career development of staff in the National Health Service.
The National Health Service Training Council, which is envisaged in the White Paper, is to work with those staff advisory committees and thus ensure compatibility of training arrangements. The Training Council will advise on the proper development of staff training and will respect the special needs of professional 873 staff. We do not think it would be right to embody such a Council in legislation, when it forms only a part, though an important one, of comprehensive personnel machinery.
The problem is that there are already a number of statutory and other bodies concerned with training for the major professions in the National Health Service, and their existence would make it difficult to provide additional, all-embracing statutory provision of the type suggested by the noble Baroness. We think that our proposals for a Training Council, which are less formal than what she has suggested, are better suited to the needs of the National Health Service and its staff in the immediate future. I recognise the noble Baroness's sincerity. I hope that she will agree not to press this Amendment and will appreciate that we can achieve our common aims through the existing committees and those which are to be set up in the future, with the new Training Council to coordinate the work of these committees and those other statutory committees that already exist for the various professions.
§ LORD GARNSWORTHY
The noble Lord has referred to paragraph 150 of the White Paper. It was the later sentences of that paragraph which were quoted by my noble friend Lady Serota that encouraged us to think that this Amendment would be welcome and acceptable, in the sense that it gives real meaning to what is said in that paragraph. The noble Lord referred to assurances which he gave to me some time ago, but I think he will be aware that the Stall Side of the Whitley Council have been urging for a very long time that a central training body should be established. The noble Lord, Lord Aberdare, has asked the Committee, and particularly those of us on this side, to accept that what he has said is sufficient by way of indication and assurance that this matter will not be overlooked.
My noble friend asked—and, if we are going to consider accepting assurances, it is important we should have an assurance beyond question on this one—that in regard to any training council or training board that may be set up the staff shall not only be represented on it but shall have the right themselves to 874 appoint their representatives. I put this as something quite distinct from the staff organisations making nominations and the Secretary of State choosing to appoint as he thinks fit. If the staff are to have confidence not only in the training council but in advisory committees (and, if I may, I will touch on advisory committees a little more presently) they will do so only if they have confidence in the persons who represent them. The one sure way of securing that confidence is to leave them to appoint their own representatives.
The noble Lord, Lord Aberdare, says there is a great deal in the Bill about advisory committees. So far as I know, there is not very much in the Bill about advisory committees of the kind which are the subject of these Amendments.
§ LORD GARNSWORTHY
The White Paper. Well, we are concerned with the Bill. I am glad the noble Lord is willing to concede there is little in the Bill about advisory committees of this kind. This is a matter of some concern. There is one weakness of this Bill—it is a weakness recognised by most noble Lords who spoke on Second Reading; it is certainly a weakness which is referred to when one is in conversation with Members of your Lordships' House—and that is its very vagueness; how much is left to the discretion of the Secretary of State; how little is conceded as a matter of right. I would ask the noble Lord, Lord Aberdare, to recognise that the substance of these Amendments is well worthy of most serious consideration by the Government. I have a feeling that, unless some awareness of this problem is shown from the Front Bench opposite, it will remain a problem throughout the passage of this Bill. I should like to feel that we can make a constructive contribution, one that will be satisfying. We shall need the good will of the staffs throughout the piece—not merely at the present time but so far as we can look forward in the future. I hope that the noble Lord. Lord Aberdare, will be able to give further consideration to this matter.
§ LORD ABERDARE
Certainly I will. As the noble Lord has said, it is a most 875 important point. I should like to consider carefully the proposals which he has put forward and perhaps to talk to the noble Baroness later on about our plans for the National Health Service Training Council. If that will satisfy her, I will certainly undertake to carry the matter further on those lines.
§ BARONESS SEROTA
I am always happy to talk to the noble Lord about any subject, and particularly about this one. I must confess to being very disappointed with his reply. It was exactly what I feared it might be, and, as my noble friend Lord Garnsworthy said, it would have been so nice to be surprised. If this is to be the pattern of our Committee stage we shall have a very long Report stage indeed because I am anxious about the organisation and structure of the training arrangements for the Service. I realise that these Amendments went down only last week. Perhaps we have had too short a time between Second Reading and Committee stage. I should like to think that the noble Lord is going to consider my proposal seriously because I am convinced that we shall not have the dynamic training organisation that the Service needs at this moment if we accept the noble Lord's series of linked advisory committees, advising and advisory councils, who then advise the Secretary of State. In view of the noble Lord's assurance, I will not force this Amendment to a vote to-day, but in withdrawing it I would urge him as powerfully as I can to take it seriously. This is a matter of prime concern to the Service of the future, and it is not good enough simply to waffle along as we have done in the past. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 5.35 p.m.
§ BARONESS WHITE moved Amendment No. 18:
§ After Clause 2, insert the following new clause:
§ Establishment of National Health Service Advisory Service
§ ". It shall be the duty of the Secretary of State to establish and maintain a National Health Advisory Service for England and Wales."
The noble Baroness said: I beg to move the Amendment standing in the
name of my noble friends and myself. I do so because it is of importance to all of us in considering the new arrangements for the Health Service to discover what are the Government's intentions with regard to what I think was one of the most successful innovations of my right honourable friend Mr. Crossman, the last Minister of Health; namely, the Hospital Advisory Service. The terms of the new clause indicate that we would hope that under the new dispensation the work of this advisory service should be extended to cover not only hospitals but other aspects of the reorganised Health Service. If I might remind your Lordships, the Hospital Advisory Service was established in 1969 following the scandal at the Ely Hospital for mentally handicapped patients. The shock of the revelations at Ely was particularly close to any of us who happened to be in the Welsh Office as Ministers at the time, and that shock had a very profound effect not least upon the Minister then responsible, Mr. Crossman. He felt that it was essential, if such a situation were to be avoided, that there should be an independent body established, to cover both England and Wales, reporting to the two Secretaries of State concerned—and reporting directly—so that the Ministers concerned could feel that they had independent advice coming to them directly, on the one hand, and, on the other hand. that the Health Service could benefit by professional advice (I stress the word "professional") from persons who were normally engaged within the Service themselves, and that this advice should be not merely critical but in every possible way helpful. The terms of reference, if I might remind your Lordships, were
by constructive criticism and by propagating good practices and new ideas, to help to improve the management and patient care in individual hospitals, excluding matters of clinical judgment, and in the Hospital Service as a whole: and to advise the Secretary of State for Social Services about conditions in hospitals in England and the Secretary of State for Wales about conditions in hospitals in Wales".
Since its establishment the Hospital Advisory Service has published two reports—because, in addition to the detailed reports which go both to the establishments themselves and to the Department, it is part of the duty of the Director of the Hospital Advisory Ser-
vice also to submit an annual report, which is published—and it is quite clear from the two reports which so far have emerged from this service that it is doing absolutely invaluable work in exactly the way in which was hoped and expected of it. If I may quote from the Foreword, signed by the Secretaries of State, in July, 1972, they say:
This report gives us an insight into the sympathetic and effective methods used. These indicate an originality essential to an organisation which sets out not to find fault with performance but much more to promote improvement in any of the numerous factors which may impede it, and they reflect the enthusiasm of all those who take part in the work of this service".
That, after all, from two senior Secretaries of State is quite high praise.
§ The method adopted of working in teams is part of the originality displayed in this organisation, and as the announcement of the appointment of the Hospital Advisory Service indicated, the members of the teams are seconded from their normal employment in the National Health Service. In other words, they are not employed in this particular type of work for life. To my mind, that is a very sensible thing. Admittedly in another sphere, in education, we have a different pattern; we have Her Majesty's Inspectors who, once they have reached that exalted standard, remain H.M.I.s for the rest of their professional lives. But frankly I think that in the National Health Service, and particularly in a Service which changes rapidly in many aspects, it is better that one should have this pattern of those who, for a period, have this very particular duty but after they have done it for maybe one, two, or a slightly longer period of years, then return to their normal professional work, having themselves no doubt learned a great deal as well as having conveyed much to others.
§ Therefore we think that this experiment has proved itself; that the general lines on which it was conceived were right and effective; that it should now be extended to the totality of the Health Service, with any necessary modifications, and that it therefore merits inclusion in the Bill which is before us so that it is given some statutory form. In its present form, of course, it was a purely administrative decision to set it up but the main principles: that is, that it should be independent of both Departments, the 878 English and the Welsh; that it should have direct access to the Ministers and that its reports should be published; that its staff should be mainly on secondment (although I would not necessarily say exclusively on secondment) we believe are all right and proper and we hope that if the proposed new clause is accepted by the Government it will be on the understanding that these principles are maintained. I beg to move.
§ 5.44 p.m.
§ LORD ABERDARE
As the noble Baroness has said, the present N.H.S. Hospital Advisory Service, which operates in both England and Wales and is responsible directly to the two Secretaries of State, is concerned only with the hospital services and at present gives advice on services in psychiatric (including mental handicap) and geriatric hospital services only. It was set up, as the noble Baroness has told your Lordships, by administrative action, and its terms of reference and field of operation can be varied by the Secretaries of State in the light of changing needs and circumstances. I would certainly join with her in paying tribute to the valuable work the Hospital Advisory Service has done, and to her own Government for having initiated the Service.
We fully accept the need to provide suitable mechanisms for assessing the services provided for patients and the conditions in hospitals. A variety of methods will need to be used, related to the needs of the particular aspects of the reorganised Health Service. We do not think it would be appropriate to impose on the Secretaries of State a statutory duty to use one particular method while not mentioning others. They already have sufficient powers under the Bill to provide for services to be assessed and for advice to be given on them, either by a service modelled on the present Hospital Advisory Service or by other methods.
The intention of the Secretaries of State is to maintain the Hospital Advisory Service in its present form until the reorganisation of the Health Service has taken place, after which they propose to discuss its future with the new Health Authorities and the professional interests concerned. This will need to be considered in relation to the other mechanisms for monitoring the services in the 879 reorganised and integrated National Health Service. Therefore I hope the noble Baroness will feel that we are aware of the value of this Hospital Advisory Service, but that, rather than write it into the Bill, we should prefer to leave it to the decisions of the Secretaries of State at a later date when they can discuss it fully with the new Health Authorities who will be directly involved.
§ LORD DAVIES OF LEEK
I am grateful for the speech that has just been made by the noble Lord, but a point occurs to me. It is already sticking out a mile that we are taking the Bill too near to all the White Papers that have been turned out. Things are in a state of flux: I am not saying, this in a derogatory sense, but it is on such a vast scale. It seems to me that in the remarks which have just been made by the Minister there is an idea that the Government will accept some form of words such as my noble friend has moved from the Front Bench. We are going to take this Bill through this Committee, and maybe through the Report stage also, with things not being clear in the minds of the Ministry—and I repeat that I say that in no derogatory sense. I know the noble Lord the Minister is overwhelmed with a large job of work for his Ministry, and I wish him well in it. But I hope that some of these things will be put before this House more explicity than we have had them un to the moment.
§ LORD ABERDARE
I take that point, and I will certainly do my best to make everything explicit. In this case the difficulty is that the Hospital Advisory Service works as well as it does only because it has been accepted by the health authorities, and by the medical profession and others, and it would be quite wrong to perpetuate it in a Bill until an opportunity has been given to discuss with the new authorities and with the medical profession further developments that might be appropriate for it.
§ BARONESS SEROTA
In all the consultations that have taken place in regard to the new legislation has the noble Lord, or any of his Ministerial colleagues, ever entered into consultations with the professions concerned about the possibility of extending the scope of the Hospital Advisory Service?
§ LORD ABERDARE
Not so far as I know. I do not think it has been considered that the time is yet appropriate for expanding the work of the present Hospital Advisory Service.
§ BARONESS WHITE
I am sure the noble Lord will realise the great difficulty in which we are placed in a situation of this kind. It is all very well for him to say that "when the times comes "and" in due course" we shall have consultations with the new authorities. But if one has no anchor point, and if there is nothing whatever in the Statute, even by reference, it means that everything then passes entirely from our surveillance in Parliament. However enthusiastic we may be about the Hospital Advisory Service as it is, and however much we may wish to have it extended, we shall have no occasion whatever to consider it if there is no mention of it anywhere in the Bill or in a Schedule. This frankly worries me.
I can see it perfectly from the point of view of the Minister, but I hope that he can see it from the point of view of Parliament. If one has something, which admittedly was an innovation started by administrative action but which appears to have proved itself to be something of value, and if one then goes and discusses it with the new authorities there is bound to be a certain apprehension that possibly in this hierarchical system, which worries some of us, some over-formalised monitoring system may be proposed which really would not meet the kind of situation for which the Hospital Advisory Service was devised.
I do not propose to press this matter to a vote; this is not the sort of issue on which we really want to vote. I ask your Lordships who are concerned with services of this kind to think carefully between now and the next stage about this type of issue. If we have something which seems to many of us to have been a singularly useful innovation, we should at least seek to safeguard it. I do not mean that we should make it immutable in its present form; and the new clause as drafted is as wide as it could be, leaving immense discretion to the Ministers concerned as to the precise way in which it might be administered. We at least have here a point of reference which I feel is of value, and I therefore ask the 881 Minister seriously to reconsider this matter because we are asking… the Secretary of State to establish and maintain a National Health Service Advisory Service for England and Wales.The clause could hardly be broader than that. It does not seek to trammel Ministers as to the precise way in which it is organised or administered. We would of course hope that the principles so far adopted would be continued, but we do not want to attempt to tie Ministers in perpetuity.
Frankly, I would have thought that the noble Lord could accept a new clause drafted in such broad terms. Although, as I say, I do not propose at this time to press the matter to a Division, I have every expectation that if we do not press it the subject will be raised in another place. This would seem to be an issue on which your Lordships might well give a lead. However, if the Minister dots not feel able to go further, and I appreciate that he may not be able to do so.—
§ BARONESS WHITE
If the noble Lord, Lord Platt, wishes to intervene, I had better wait to seek leave to withdraw the suggested new clause.
§ LORD PLATT
I had intended to intervene immediately following the remarks which the noble Baroness is now making.
§ BARONESS WHITE
If the noble Lord waits till that point, and after I have sought leave to withdraw the suggested new clause, he may find himself in some difficulty in trying to intervene. Perhaps he would care to speak now and I will make some final comments after he has spoken.
§ LORD PLATT
I appreciate that the point the noble Baroness is now making is important, but I suggest with respect that the new clause would not secure the aim she has in mind. Although I am not an expert Parliamentary draftsman, I suggest that the new clause is too wide to achieve any purpose at all. I could not agree to a proposition which simply left the Secretary of State with power to do anything he liked in the way of handling advisory services. The noble Baroness's proposition would not appear to secure the continuation of the very 882 useful Hospital Advisory Service about which so much has been said.
§ BARONESS WHITE
If the noble Lord, Lord Platt, would care to draft a more detailed and specific Amendment for Report, I should be more than happy to consider it. In the present circumstances it seems that I cannot do other than seek leave to withdraw my suggested new clause.
§ Amendment, by leave, withdrawn.
§ Clause 3 [Medical and dental service for pupils]:
§ 5.55 p.m.
LORD GARNSWORTHY moved Amendment No. 19:
Page 2, line 36, at the end insert ("provided that the teachers shall not be required to undertake any duties connected with such inspections, other than the assembling of the pupils.")
The noble Lord said: We come to the clause which deals with medical and dental services for pupils, which in subsection (1) lays on the Secretary of State
… the duty … to make provision for the medical and dental inspection at appropriate intervals of pupils in attendance at schools maintained by local education authorities and for the medical and dental treatment of such pupils.
§ Let me say at the outset that it is important that we get this part of the Bill as right as we possibly can. It is appropriate that we should pay tribute to the tremendously valuable work which has been done over long years by the School Medical Service. Many people living to-day have all too little appreciation of what they owe to this Service for having detected defects and troubles of one kind and another. The Service has probably been under strain in parts of the country in the last few years, but one can say without doubt that generally speaking it has represented a remarkably successful and wonderful job of work on the part of local education authorities throughout the country. As a nation, we should be aware of what we owe this Service. If this Bill becomes an Act the situation will be changed considerably. We hope that we shall get things right. Indeed, I hope that we succeed in securing some improvements. I assure the Committee that the contribution of my noble friends to the consideration of this clause will be as constructive and helpful as possible.883
§ The Amendment is intended to make clear the limit of teachers' responsibilities in regard to medical and dental attendances at appropriate intervals at schools. Teachers have undertaken, and at the present time are undertaking, many duties which, strictly speaking, do not come within their terms of engagement. They go beyond the strict call of duty in many ways, giving help which is time-consuming and which often imposes self-inflicted real burdens. How much individual children owe—indeed, how much society owes—to teachers who have such a tremendous sense of responsibility to their pupils is incalculable. Many people owe an immeasurable debt to dedicated teachers in this as in so many other fields. It is that sense of moral responsibility on the part of teachers which accounts for the support that is most effective, particularly in the medical and dental services, and not least because it is voluntary.
§ I stress that aspect because it is this involvement on the part of dedicated teachers on a voluntary basis that is responsible for so much that is successful by way of tasks that are freely undertaken but which go beyond professional obligation. Indeed, the interest and service that flows from this voluntary involvement is something that legislation cannot ensure and should not attempt to ensure. It is important to recognise limitations in regard to professional obligation. I say this after consulting with what is, I believe, the largest professional body which speaks for teachers, and it is felt by them that this Amendment should be written into the Bill. Looked at strictly in terms of a Health Service, that Service ought to cope with all the clerical work; the organisation of facilities, including parental interest; all the follow-up work; and the making of whatever contacts may be necessary—indeed, the entire administrative process. It may be said that there is nothing in the Bill that lays that duty on teachers. As I said, the largest staff organisation which speaks for teachers feels that the limitation of obligation on the part of teachers in this particular respect ought to be written into the Bill.
§ May I say here, speaking from experience, that I well recall teachers saying how much difficulty there has been in the 884 past in securing the co-operation of parents when John Willie has been seen by the dentist. There has been difficulty sometimes in getting the co-operation of parents when some trouble has been diagnosed by the doctor. Perhaps too easily we would say that any teacher worth his or her salt would recognise that that is something which they ought to do. Left to their own inclinations, as I have said, they do a very great deal that they are not under an obligation to do but, excepting that they may give over and beyond the call of duty, it has been a very difficult matter, even when teachers have been very conscientious, to ensure that children get the treatment which they ought to have. It may be that the noble Lord, Lord Belstead, when he comes to speak on this Amendment will be able to assure us that the Health Service will be able to cope more effectively in future than it has been doing in the past. If he is able to give that assurance it will be welcome, because we are very anxious to get this part of the Bill as right as we possibly can. I beg to move.
§ LORD DAVIES OF LEEK
I am interested in this Amendment because the desired object of the Bill, which is to provide the framework for the new Health Service, is to improve on the past. Keeping myself strictly to the terms of the Amendment without meandering too far out of order, may I say that the purpose here is not only medical but also dental attention, and we are asking that the function of a teacher should be limited to that of assembly. From experience, I believe that it is absolutely necessary after the assembly for a nurse to be present with the doctor. There are all kinds of reasons. There are different stages in the life of a child when the presence of the nurse, and sometimes the parent, creates confidence.
May I point out that so far as the dental and the medical inspections are concerned, specific training is needed today. A tribute has been paid to the Health Service in schools. A tribute has been paid to the dental service. I reiterate and endorse that tribute, but I know that the dental service and the medical service for schools is undermanned. It is the ugly duckling of the profession because conditions and salaries have not been appropriate in relation to those of their 885 colleagues in other parts of the profession, despite the fact that these dedicated men and women in dentistry and in the medical service are making as great a contribution to the men and women of the future as that of any doctor or surgeon who attends to us when, years later, we may have to be in hospital. Consequently. when we are building up this framework at the base of the pyramid of health, as I said the other day, money will have to be spent to get the appropriate recruits, and with those recruits the nursing profession should be brought in and properly rewarded so that the burden does not always fall upon teachers—as it used to do in some of the rural schools in the past—to try to spot deformities or deterioration in the health or condition of the children.
I hope also that in this framework (I do not know if the opportunity for amendment will come) we shall do something about this damnable propaganda all the time which is ruining the teeth of the children of Britain. They are worse to-day generally than they were 20 years' ago through the overt 'hyperbole which is used on television to describe sweets. More sweets per head are eaten in Britain than in any other country in the world, and if the dental profession were asked about the condition of our children's teeth to-day they would say they are probably the worst of any (I do not of course mean of dentistry service) because children are bulging themselves out with masses of sweets.
That is a slight diversion, but it is worth calling attention to it, because we are building up a framework of health, and part of that framework of health is to protect the public and the children—I do not mean in a motherly or paternal fashion—from the ruination of their own teeth. One day we may have the courage to do something about fluoride. I do not say we should add fluoride in the national water supply, but there should be a fluoride provision for the children in school supplies, in the drinking water which the children get at school (as they have with school milk), provided that the teachers agree. Consequently, this Amendment by my noble friend opens a vista in this framework of health. I sincerely hope that the Ministry will agree that the job should be done properly and that every school should have a room 886 where the doctor and dentist can have privacy—not, as I have known, an examination that takes place in the cloakroom, where wet coats have been hanging up, with the doctor or dentist a few yards away having to examine the child there. There should be a surgery or place of inspection in every school where the dentist, nurse and doctor can examine the children in privacy.
§ 6.8 p.m.
§ THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF EDUCATION AND SCIENCE (LORD BELSTEAD)
I am grateful to the noble Lord, Lord Garnsworthy, and to the noble Lord, Lord Davies of Leek, for paying tribute to the school health service. This is one of the things in this country which has been proof positive that we really try to look after children from as young an age as we can. The noble Lord, Lord Garnsworthy, had every right to say that the service has worked; and because it has worked pretty well we ought to pay tribute to it when we have the chance. In this connection, may I make it clear that Clause 3 gives to the Secretary of State for Health and Social Services the same duties and powers in relation to services for pupils as local education authorities have at present. There is no intention that under this clause teachers should be required in any sense to service the school inspection arrangements under the new arrangements.
I should, however, like to pick up what the noble Lord, Lord Garnsworthy, said when he talked about the things which teachers do in a voluntary capacity, for I genuinely believe that this Amendment might prevent them from doing what they, as professional people, might wish to do. So far as the routine aspects of school medical inspections are concerned, certainly one would not expect teachers to do more than see that their pupils arrived for inspection. There are various nursing, clerical and other ancillary staff present at medical inspections and involved in those inspections. On the point made by the noble Lord, Lord Davies of Leek, about facilities, it is stated in black and white in Clause 3 that in this particular case the duty is upon the Secretary of State to provide the treatment and inspection facilities. It will therefore be 887 the people on that side who will undertake such duties as filling in records and screening work and helping with the examination and with the equipment.
But teachers, school doctors and nurses generally attach a good deal of importance to the maintenance of close and continuous ties between the school and the school health services, not just at medical inspections but throughout the year. Teachers, as the noble Lord, Lord Garnsworthy, quite rightly acknowledged may well wish to have the opportunity at inspections to discuss with the doctor or nurse general health questions, or points about an individual child who perhaps the teacher knows a great deal better than anyone else. In this situation teachers in nursery and primary schools and special schools may also wish to be present, at any rate for a few moments, to reassure and help their own children, and to facilitate communication with the doctors or nurses, if they know that difficulties will arise; for instance, if a child is deaf, inarticulate, or is in any way severely handicaped. I am sure the teaching profession would consider that on some occasions they have an important part to play in the inspection process and would regard this as something with which they would wish to be identified.
A further point has to be borne in mind; namely, that the essential feature of the new arrangements is that there should be good co-operation at all levels Section 48(4) of the Education Act 1944 will in essence remain; it provides that every local education authority shall make arrangements for encouraging and assisting pupils to take advantage of the facilities for medical and dental inspection and treatment. The arrangements which local education authorities have been expected to make under this subsection have in fact never been defined; they are for local discretion in the light of particular circumstances. But I suggest that it could be argued that the professional co-operation of the teacher can be in a sense an aspect of the fulfilment by the local education authorities of this duty under this subsection.
I would therefore urge your Lordships not to accept this specific Amendment, but to leave it to the good sense of local education authorities and school and Area 888 Health Authorities and school doctors and nurses to see that teachers are able to do all that is professionally required of them, without this developing into an obligation which goes further than that. May I reiterate to the noble Lord, Lord Davies of Leek, that the Bill makes it clear that the responsibility for inspection and treatment rests on the Secretary of State, and I am sure it would not be the wish of Area Health Authorities or local education authorities that teachers should personally be involved with any of the routine questions to do with medical examination.
I appreciate the reason for this Amendment. What I hope I have communicated to the Committee is that there is no requirement written into this clause which will extend the duties or powers of the teaching profession in connection with school medical inspections, but that in the spirit of section 48(4) of the Education Act 1944, which still in essence stands, I believe this Amendment would be unduly restrictive.
§ LORD AUCKLAND
I have listened with great interest to the proceedings on this debate. This is not an aspect of the Bill with which I am personally very much acquainted. But one thing is absolutely certain; that is that the importance of this clause depends on team work. It is not solely a question of whether or not the teacher should assemble the children; the whole thing boils down to the root source, which is where the parents can help, too. I think it very important that there should be the closest possible liaison between parents, the school doctor, the teacher, and, if necessary, the family doctor. Mention was made of children who are deaf. Of course, many deaf children are at special schools, particularly if they are severely handicapped in this respect.
I hope my noble friend will give further consideration to the Amendment which the noble Lord, Lord Garnsworthy, has moved. I quite see that in its present form it is not perhaps completely satisfactory; indeed, I am not sure that in its present form it can be made to work. But I think there is some substance in it. Co-operation between parents, teachers and all the authorities is essential to make this scheme work properly.
§ 6.15 p.m.
§ LORD GARNSWORTHY
I am most grateful to the noble Lord, Lord Belstead, 889 for the very careful statement—I think it was carefully prepared—with which he replied, and I am extremely grateful to the noble Lord, Lord Auckland, for what he has said. After listening as closely as I could to what the noble Lord, Lord Belstead, said, may I say that I think it needs studying very carefully, because there is a considerable degree of ambiguity about it. He spoke about leaving it to the good sense of the local education authorities and others involved in the service of education to do all that is professionally required of them. We are talking about this particular clause in this particular Bill.
My noble friend Lord Davies of Leek, and I am grateful to him, laid stress on the fact that if this Amendment were carried then it would lay on the Health Service the obligation to ensure that all the things to which the noble Lord, Lord Auckland, so rightly referred, as indeed did the noble Lord, Lord Belstead, himself, were carried out. Teachers can ensure that pupils attend for examination and they can ensure that they attend for treatment. That is a fairly considerable undertaking in co-operation. What is unreasonable is to say, "You may be professionally required", or "there may, by implication, be some professional obligation to go beyond that, to keep contact with the parent ". May I say, and I think probably it meets the point, that usually, if they are bothered about a youngster, head teachers will instruct the educational welfare officer to call at the home. I do not think there can be any question of expecting teachers to go so far as to be quite sure that parents cooperate and do all that they ought to do. It is sometimes difficult to persuade parents that Johnnie ought to be sent to school on the day the inspection is due. There is a difficulty there. If teachers co-operate in assembling pupils for inspection and treatment, they are making quite a contribution.
But I am positive that teachers, of their own goodwill, will do a very great deal more than perform professional obligation. May I say this very frankly to the noble Lord, Lord Belstead—of this he will be as aware as I am and possibly more so—that where teachers are concerned a climate has developed in demonstrating the limit of obligation. I should be very sorry if in the passage of this Bill we failed to take advantage of the 890 opportunity to recognise that they have a limited obligation in regard to what is involved in this clause.
I hope that the noble Lord will appreciate that what I am saying is based on a feeling on the part of teachers. This is an issue where we want no confrontation, but I think the noble Lord could have given a much more satisfactory assurance than lie has given. I should have been prepared to withdraw the Amendment and leave the matter, if his assurance had been complete in the sense that it recognised that there was a limitation to the responsibility of teachers, and if that limitation were in the terms of the Amendment. I should have accepted that without its being written into the Bill. I do not at the moment feel inclined to press the matter to a Division this evening, but I am inclined to return to the matter at Report stage, after giving the Minister an opportunity of thinking further about it. If a similar Amendment is tabled at Report stage, he may be able to give a little better assurance than he has done so far. On the other hand. the noble Lord may now feel that he can give a quite explicit assurance which would meet the principle of the Amendment.
§ LORD BELSTEAD
The noble Lord, Lord Garnsworthy, used the expression "limit of obligation" and said, during his second speech, that a head teacher who is worried about a pupil will often go to the educational welfare officer, who will follow up the case. The noble Lord has touched precisely on the sort of point which worries me very much about this Amendment. It is just possible that this Amendment could preclude that process. It could be said that under this Amendment that is the sort of process which a head teacher either need not or should not follow. What I am saying is that the process which the noble Lord has put forward as being usual for a normal, compassionate head teacher is something which should continue; and if anybody in the teaching profession feels that that profession is being imposed upon there is the joint collaborative machinery between local authorities and the new Area Health Authorities where these matters can be threshed out. I realise that this is not an easy problem, and I am perfectly ready indeed, this is surely the whole point of 891 a Committee stage—to listen carefully and learn from what other noble Lords have said. But I would ask the noble Lord, Lord Garnsworthy, to be so good as to look carefully at the Report of what has been said and, if he feels that we have not got it right, the matter can be returned to at the next stage of the Bill.
§ Amendment, by leave, withdrawn.
§ 6.23 p.m.
§ LORD GARNSWORTHY moved Amendment No. 20:
§ Page 2, line 38, leave out ("may") and insert ("shall")
§ The noble Lord said: Subsection (2) of this clause states that the Secretary of State, in arranging for the medical and dental treatment of pupils, may, by arrangement with any local educational authority or with the proprietor of any educational establishment which is not maintained by the local educational authority, make provision accordingly. It seems to us that the word "may" here indicates a discretion which would be undesirable if it were exercised, in the sense that something which ought to be done might not be done. The word "shall" is much more clear, much more explicit and puts beyond any doubt the duty of the Secretary of State. In a word, it makes it what it ought to be in this connection—an obligatory activity. I beg to move.
§ LORD BELSTEAD
I ventured to suggest to the Committee a few moments ago that the purpose of Clause 3 is to transfer the duties and powers under present educational legislation, without adding to or subtracting from anything which exists at the moment. It will place a duty where a power has existed earlier. On those grounds, I am afraid that I am not in a position to accept the noble Lord's Amendment. But may I ask for guidance from the noble Lord? It seems to me that this Amendment hangs together with some of the other Amendments between Nos. 20 and 26, because, as the noble Lord himself has said, it would place an obligation on the Secretary of State to provide services for senior pupils, for what I call Section 56 children, and also for independent direct grant schools 892 after arrangement with the proprietors. I do not want to appear to be too unforthcoming in saying that I cannot accept the noble Lord's Amendment, and may we know a little more of the noble Lord's thinking and whether he wishes to take any other Amendments with this one?
§ LORD GARNSWORTHY
Not at this stage, although I have it in mind to take some of the Amendments together. But may I say that this has not been an easy matter to deal with, and I should have been obliged if the noble Lord had approached me about it before we met this afternoon. Let me tell him of some of the difficulties which have had to be faced. I did not receive a copy of the Marshalled List until I reached your Lordships' House this afternoon. We are not accustomed to meeting on Mondays, and it would have been impossible to get in touch with a Government Department over the weekend, if one had wished to do so. I certainly have no desire to take up the time of the Committee in moving Amendments separately, but I hope the noble Lord, Lord Belstead, will recognise that we have had a comparatively short period of time in which to work since the Bill was issued. This is the first time that we have taken a Bill of this size before the other place and we really have had a stint on our hands. I shall co-operate as much as I possibly can, but I hope that the noble Lord will be as tolerant of the procedural difficulties which arise as a result of our approach to the matter, as we have been of the very difficult situation in which we have been placed in considering the Bill.
§ LORD BELSTEAD
Perhaps I owe the noble Lord an apology. I am sorry if I appeared to be hectoring in my tone, and I did not wish to be, but I thought it might be for the better understanding of this group of Amendments if they were considered together. Perhaps it is better if we take them one by one, and certainly I shall be guided by the noble Lord. Several times this morning, I attempted to get in touch with the noble Lord and with his noble friend Lady Serota, but I regret to say that I was unsuccessful. I feel sure that it was my mistake, and nobody else's, to put that point to the noble Lord.
§ LORD GARNSWORTHY
I am grateful to the noble Lord. I hope that I did 893 not appear to be resenting any hectoring, because I know that the noble Lord did not intend it. I was trying to explain a very real difficulty. As regards this morning, my noble friend was fully engaged and I was attending court all the morning, but when I arrived home I had no indication that anybody had been ringing my telephone, although someone was there for most of the time. I said at the outset that Clause 3 is extremely important, and I therefore think that we ought not to consider doing anything which would rush our consideration. But, in the circumstances, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 6.30 p.m.
§ LORD GARNSWORTHY moved Amendment No. 21:
Page 2, line 39, leave out line 39 and insert—
("(a) make arrangements with each local education authority for the provision by that authority in the area of the authority of").
§ The noble Lord said: Clause 3(2)(a) calls on the Secretary of State to make arrangements for medical or dental inspection by arrangement with any local education authority. Like so much in this Bill, the words "any local education authority "lack the provision that the circumstances call for. They are vague where they need not be vague, vague where there ought to be clarity beyond question. There can be no question that "any" should be "each". The wording of the Amendment is intended quite seriously to be helpful. Without seeking to demonstrate that at length, I hope it will commend itself to the Government. I hope the Committee will see the virtue in it. I beg to move.
§ LORD BROCK
My interest in this Amendment lies in the words "in the area of the authority of". The medical officers of health are to be moved from local authority employment to the new Health Authority; but the local authorities will still need advice on various matters, as is instanced in this Amendment. It was feared that they might seek to obtain medical advice from other medical sources and it is desirable that they should continue to obtain advice from those from whom they have always obtained it and who will be employed by the Health Authority. Already we see an opportunity being created for local authorities 894 to recruit new medical staff. This will stultify the whole question of the reorganisation of the National Health Service.
§ LORD BELSTEAD
If I read correctly the clause as it would be amended, this Amendment would transfer to the local authorities a responsibility for the Health Service, for senior pupils, for the Section 56 children and for direct grant and independent schools, by arrangement. The Joint Working Party on collaboration was, I think, definite, although there were dissenting voices, that this should not be so. I apprehend that it would really be the opposite of co-operation if certain educational sectors became the responsibility of education and other sectors became the responsibility of health. It is with that in mind that I must say roundly that while I am sorry not to be helpful, it seems to me that if this Amendment were accepted it would completely alter the intention of Clause 3(2)(a) as printed, which proposes that the Secretary of State should have the power to make provision. Moreover, the Amendment would in fact place a duty on the local authority. Your Lordships may wish to debate the principle of this matter later in depth when we come to Amendment No. 27; but at the moment I am afraid that I really cannot accept the Amendment for the reasons given. I do not think I am in a position to give an answer to the noble Lord, Lord Brock, because the Amendment is not mine.
§ LORD GARNSWORTHY
I am grateful to the noble Lord. In the light of what he has said, and since I do not wish to take up the time of the Committee, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ LORD GARNSWORTHY moved Amendment No. 22:
§ Page 2, line 40, leave out ("provision for any").
The noble Lord said: With this Amendment I should like to speak to Amendments No. 23 and No. 23A. The effect of these two Amendments would be that subsection (2)(a) would begin:
by arrangement with any local education authority, make medical and dental inspection and treatment of—
§ It seems to me that this would help ensure that the National Health Service would have an obligation to continue what the local authorities have sought to achieve; that is to say, the need to ensure that the contribution, both direct and indirect, made by the school health service in the educational process is encouraged to continue to develop—which has been, and is, as I understand it, the aim of the local authority associations. The purpose of these Amendments is to further that. I hope the Amendments will commend themselves to the Committee, for I believe their effect is to provide a more explicit wording and help ensure a medical service which will meet all the health needs, not only of inspection but also of treatment of all those young persons whose education may be affected by health defects which ought to be rectified. I beg to move.
§ LORD BELSTEAD
I must apologise to the Committee in that I am not entirely sure that the intention of the noble Lord would be served by the acceptance of these Amendments. The noble Lord said that the intention is that the National Health Service should be, and should be seen to be, continuing the good work of the school health service. I should like to take these Amendments away and look at them, and if the intentions of the noble Lord are achieved by the passage of these Amendments, then, if I can be of any service in accepting them I will do so. At the moment, I cannot see that they achieve this object. I am also not too sure that their insertion would leave the text grammatical.
§ LORD GARNSWORTHY
It would be churlish of me not to say that I am very grateful for that reply. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 6.39 p.m.
§ LORD GARNSWORTHY moved Amendment No. 24:
§ Page 2, line 41, at end insert ("and medical counselling with psychiatric psycho-therapeutic and nursing support of").
§ The noble Lord said. I hope the Committee will be patient with me. I had prepared to move this Amendment separately, but the whole lot will not take over long. The clause as worded provides 896 for medical and dental inspection and/or treatment. Increasingly it is being appreciated that mental health is as important as physical health; and in the world of education, perhaps more than elsewhere. I think it is only to be stated in the Committee to-night to be seen as obvious. One might say that good as is the service of the child guidance clinics at present, a great deal more needs to be done. Earlier this afternoon one or two speakers referred to the difficulties of the school medical service. So far as child guidance clinics are concerned, it has been doing wonderful work. My one criticism would be that it has all too frequently been carrying far too heavy a load. I am thinking of incidents within my own knowledge and experience where young people have needed not only advice but a great deal of help and support because of behaviour problems.
§ Those behaviour problems arise for a variety of reasons. One is tempted to think and to say that the parents ought to accept responsibility and do something about it. I felt that the noble Lord, Lord Auckland, was right when he said that parents ought to be playing a part. It would be much easier if we could rely on all parents doing so. One of the difficulties of ensuring that we get a satisfactory school health service is that children who most need parents with a sense of responsibility do not have them. The parents do not understand all that is involved. They do not understand the handicap imposed on a child because of their failure. I do not think this is a deliberate failure but an unconscious failure, and something to be regretted. This is one of the difficulties and something that I had in mind when I moved an Amendment recently about putting a limit on the obligation of the teacher.
§ I do not know how to secure the cooperation of parents who do not begin to understand. I am certain that we ought to do everything possible to see that the child does not suffer because the parent lacks understanding or is unwilling to accept the responsibility. In my experience the maladjusted child is nearly always the product of a maladjusted home. The fact that the home environment is unsatisfactory is all too often not appreciated until a child has been in trouble. It may be detected when truancy occurs or something a very great 897 deal more serious. There is thus raised the issue of who is to be responsible for giving attention to the maladjusted home. For some years I have been chairman of a school for maladjusted children. It is an expensive specialisation of the service of education. The pupil-teacher ratio has to be very favourable and the care staff of a high standard.
§ If I am going wide in moving this Amendment I hope that the Committee will be patient with me. I am doing my best to bring into play all the forces involved in securing a Health Service which will enable a child to take full advantage of the opportunities made available by the local education authority. Section 48 of the 1944 Education Act, as amended by the 1953 Act, provides for medical and dental inspections, for the oversight of individual children and for advice which may be given to their parents. I think I have it right when I refer to "advice which may be given to their parents". This clause would be strengthened, thus ensuring that the help in overcoming the handicaps of mental illness as much as medical and physical illness would be adequate. I believe that gives effect to the view of the Society of Education Officers who issued a memorandum in which they stated that they wished to put on record the view that there will be a continuing need for local education authorities to run a child guidance service in conjunction with the school psychological service. It would serve to emphasise the role of the local education authorities in relation to child guidance services, and indeed beyond them to older pupils and students. If I have gone a little wide it is only from a desire to be helpful in the sense of not missing out anything which ought to be said about this aspect of the National Health Service as it applies to those in full-time education.
§ LORD AUCKLAND
Since the noble Lord, Lord Garnsworthy, has mentioned my name in this connection may I say that I have a great deal of sympathy with his object in moving the Amendment. I cannot speak with the same experience in education as he can and I am not a justice of the peace. But my wife sits on our local Bench and periodically a child of the type mentioned by the noble Lord appears before the court. I take his point about parents. There are all too 898 many parents who will not fulfil their obligations in this connection. Because of that I think we are in a great deal of difficulty over the Amendment. Psychiatric treatment and the allied forms of treatment are different from the ordinary dental and medical inspection. Here I think is the problem: how far can one make it mandatory for a child to receive this kind of treatment without either parental consent and co-operation or that of the family doctor. That, I think, is the real dilemma.
Clearly, there are children who are in need of psychiatric treatment but in some cases if children know that a companion has received this kind of treatment they will damn the child and probably make the situation worse. I may be talking out of turn, but it seems an important point. Serving as I do on the house committee of one of the several mental hospitals situated in that part of Surrey where I live, I have studied the problem of mental health so far as I can. I hope that the Government will give some thought to the very important implications behind this Amendment, notwithstanding the inherent difficulties which it presents.
§ 6.48 p.m.
§ LORD BELSTEAD
I do not know that I am particularly competent to be drawn into a discussion on the child guidance services. Several noble Lords are, but I do not think that I can be numbered among them. But, as a result of what I have heard, I think I ought to say that I know it is not envisaged that there will be any change in the present child guidance arrangements, other than those which may develop as part of agreement and consideration by local education authorities, Area Health Authorities and social service departments about the most effective ways of organising these services in the future.
The noble Lord, Lord Garnsworthy, referred to maladjusted children. I thought he was going to say more about special education. Perhaps for the Record I ought to say that Sections 33 and 34 of the 1944 Education Act remain on the Statute Book, and local education authorities still have the powers connected with these sections. The noble Lord asked who would be responsible for the homes of the maladjusted children. As I am sure many noble Lords will be 899 aware, Section 111 of the Local Government Act is in force. That gives local authorities power,to do anything which is calculated to facilitate or is conducive or incidental to the discharge of any of their functions.Here again I would imagine that the collaborative machinery comes into play—exactly who is to do what. I should have thought—and I speak off the cuff here—that the kind of things the noble Lord has in mind would very probably be conducive to et cetera and fall within the purview of Section 111. But on this point, in case I have it wrong, I will write to the noble Lord and to my noble friend Lord Auckland.
Finally, perhaps I may just say that, like my noble friend Lord Auckland, I have sympathy with the objective of this particular Amendment. I must, however, give a reply which is often given in Committee, but which I think the noble Lord would be willing to accept; namely, that it is not really necessary. The Amendment is assumed in the terms "medical treatment" or "treatment" which are to be found in the Bill.
I think that the discussion we have had has been extremely useful. I have given an undertaking to the noble Lord and to my noble friend Lord Auckland to write on a particular point, but we will look most carefully at all that has been said on this matter, and if there are revealed any weaknesses on any other points, I will certainly undertake to include them in the letter that I write.
§ LORD GARNSWORTHY
I am grateful to the noble Lord, Lord Belstead, for the sympathy that he has shown in listening and giving consideration to what has been said. I should like to express my thanks to the noble Lord, Lord Auckland, for his support. I am sure the Committee knows of the great interest that he takes in these matters, and I am glad that he has intervened in the way lie has. The noble Lord, Lord Belstead, referred to Section 111 of the Local Government Act. I think the powers given to local authorities there are quite general.
I had it in mind to return to this question on Amendment No. 26, but perhaps I could refer to it while I am now on my feet. That Amendment says: 900Page 3, line 10, at end insert—("and(c) shall direct the relevant Area Health Authority to engage and second to the local education authority all such staff as may be reasonably necessary to enable such local education authority to make such provision")Having regard to what the noble Lord has said, perhaps I ought not to voice all the remarks that I have prepared in connection with that Amendment, which I think has considerable relevance to what he said. I hope his indication that he will look at this present Amendment means that he will look also at that particular aspect, because if the L.E.A.s are to carry out the services to which the noble Lord drew attention, then clearly they will need specialist staff. Will they be engaged; or will they be seconded? I will not press the noble Lord now, but I should be grateful if he will think about this and give some indication in his letter of the Government's thinking on it. It is obviously a matter to which, if necessary, we can return on the Report stage, and for the moment I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
LORD GARNSWORTHY moved Amendment No. 25:
Page 2, line 42, after ("pupils") insert ("and students").
§ The noble Lord said: It seems to me that this Amendment raises a somewhat different aspect of the school health service. The White Paper and the Bill appear to be silent on the question of the provision of free medical treatment for the over 19-year-old students, and the intentions of the Government, so far as I am aware, are not known: they are certainly not known to me. If the Government have intentions, perhaps the Committee as a whole would like to know what they are. So it would appear at this stage to be advisable to get this provision written into the Bill.
§ The primary object is the prevention of educational failure in the sphere of higher education. If left to an Area Health Authority, there is reason to fear that this class of person would not receive the same consideration and priority as should be the case if he or she were catered for within the framework of the service specially designed to meet the needs of those within the responsibility 901 of the local education authorities. If full advantage is to be taken of the educational opportunities offered, it seems logical to do everything possible to ensure the physical and mental well being of students over 19 as of pupils under that age. It is probably unnecessary for me to draw attention to the fact that I am speaking of students who come under the umbrella of the local education authorities; I am not raising the issue of people at university. The Government's intentions in regard to those appear to be reasonably clear, and I think they are as well defined as we could expect at this stage. I beg to move.
§ 6.56 p.m.
§ LORD BELSTEAD
I explained to the Committee at the outset that Clause 3 lays upon the Secretary of State the same duties and powers as local education authorities have at present. I suppose it could be argued that, strictly speaking, it is unnecessary for the obligation which my right honourable friend is accepting towards pupils to be spelt out in such detail, but it was felt that it was only right that in respect of a service which is at present provided by local education authorities it should be made absolutely clear in legislation that it is the intention that this service shall continue. But we have thought it reasonable that the obligations and powers specified in legislation should not go further than those which at present rest with the local education authorities.
This does not rule out the possibility of special arrangements being made in future, under the National Health Service, which are not specifically provided for. As I have already indicated, the Secretary of State's general Health Service powers are pretty broad, and are as defined in Section 1 of the National Health Service Act 1946. Your Lordships will notice that all that is contained in Clause 3 is "without prejudice" to those 1946 powers. The Secretary of State has ample powers to provide services to meet the needs of any group of the population, and he is not prevented by the terms of this clause from looking at the health needs of students. I submit to the Committee that this in itself marks an improvement on the present situation. As your Lordships may know, at present, because local education authorities have health powers in Section 48 which are 902 limited in terms to pupils under the age of 19, there have been limitations on the extent to which L.E.As. could use their general education powers to organise health services for the student population.
Perhaps I may say just a brief word on what I mean by health services for students. Many L.E.A.s have felt that it was appropriate to ensure that provision was available under the general practitioner services for students who were resident away from home. It was also felt that they could see that provision was made for medical advice for their student population. But it has not been possible for L.E.A.s to go as far as perhaps some would have wished to go in providing an integrated service to meet all these needs. As I have tried to indicate in these last few words, the situation after 1974, from a statutory position, will be different. First, as I have said, there will be no statutory inhibition on Area Health Authorities. There will also not be the same inhibition on L.E.A.s. The repeal of subsections (1) and (3) of Section 48 will make it possible—I put it no higher than that—for L.E.A.s to consider the health requirements and welfare of students in so far as they consider that their educational powers enable them to do so.
Your Lordships will remember that these powers, as given expression in Section 111 of the Local Government Act, are wide. That Act makes it quite clear that the local authority—and I quote:shall have power to do anything that is calculated to facilitate or is conducive or incidental to the discharge of any of their functions.Therefore there will be powers for L.E.A.s (who will be concerned with students as students) and for the National Health Service (which is concerned with the health of the students, as it is going to be concerned with all other sections of the community) to come together and decide what services or co-ordination of services are required by students in higher educational establishments, and how these can best be provided.
I hope that that statement will be of some assistance to the Committee. We think it right that there should be this freedom, and that it is wrong that at this stage there should be an obligation imposed for the immediate introduction after 1974 of what would in effect be a new 903 Service. There are a variety of views on the nature of services required by students and on the extent to which they require services different from others in their age groups. There is considerable variation in the various arrangements in any area for the provision of further and higher education, and there will also be different views about the extent to which additional resources should be made available for student health needs as compared with the health needs of other sectors of the community. We are therefore sure that the right approach here is the one for which the Bill provides; that here is an open situation in which the matter can be considered and explored further by Area Health Authorities and local education authorities together, in the context of all the other varying considerations.
§ LORD GARNSWORTHY
I am grateful to the noble Lord for the kindly way in which he has replied and for the understanding he has shown. He has made a statement of some length. My inclination is to see little but virtue in what he has said this evening, but I hope he will understand if I say that I should like an opportunity of reading his speech. I have taken advice from people engaged in education—education officers and others—and in the light of what they said to me I tabled the Amendments. My feeling at the moment is that probably the noble Lord, Lord Belstead, has completely met the point in what he has said; but perhaps we may return to it at Report stage if a reading of what he said indicates that the position is not quite so good as I think it is. I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 7.3 p.m.
§ LORD GARNSWORTHY moved Amendment No. 27:
Page 3, line 17, at end insert—
("(3A) For the avoidance of doubt, and without prejudice to the provisions of section 111 of the Local Government Act 1972, it is hereby declared that every local education authority shall have power to make arrangements for the provision of such facilities (so far as they are not provided by the Secretary of State) for free medical or dental treatment, as they may consider desirable or expedient—
- (a) for pupils in attendance at any school or college maintained by them or at any
904 educational establishment, other than a school, which is so maintained; and
- (b) with the consent of the proprietor of any school or other educational establishment in their area which is not maintained by them, and upon such financial and other terms, if any, as may be determined by agreement between the authority and that proprietor, for pupils (being junior pupils or senior pupils) in attendance at that school or establishment:
Provided that any arrangements made under this subsection in respect of any pupil referred to in paragraph (b) above shall be such as to secure, so far as is practicable, that the expense incurred by the authority in connection with the provision under the arrangements of any facility shall not exceed the expense which would have been incurred by them in the provision thereof if the pupil had been a pupil at a school maintained by them.
(3B) In its application to local education authorities in Greater London the last fore-going subsection shall have effect as if the reference in paragraph (a) thereof to pupils included a reference to any persons who have attained the age of 19 years and for whom full-time or part-time education is provided in pursuance of paragraph (a) of section 41 of the Education Act 1944.")
§ The noble Lord said: I think I can be a little more helpful to the noble Lord, Lord Belstead, on this Amendment and say that in speaking to it I also propose to speak to Amendments 29, 30, 31, 32 and 33. I hope that course will commend itself to the Committee. It may seem that this Amendment covers some of the ground we have already touched upon, but I think it will be appreciated as I develop what I have to say that this is rather different. These Amendments to Clause 3 are intended to deal with a number of points about which the Inner London Education Authority is very concerned—points affecting the school health service generally and the student health service in London in particular. The service at present provided by the ILEA for Inner London schools will be largely transferred to and divided between the four new Regional Authorities, and will be administered by some seven Area Health Authorities, three of them concerned only with Inner London, and four of them with both Inner and Outer London.
§ Clause 3 of the Bill places on the Secretary of State the duty of providing for the medical and dental inspection and treatment of pupils in schools maintained by local education authorities, as has been said previously this afternoon. The removal of an efficiently run service from 905 democratic control is to be regretted; but one appreciates that a wholly independent school service cannot effectively be provided in isolation from an otherwise unified Health Service. Nevertheless, an authority such as the ILEA would wish there to be provision in the Bill for reserve powers, for the avoidance of doubt whether such powers would exist at common law and under the Local Government Act 1972; whether it could make some independent provision of services which were thought to be important and which the Area Health Authority was unable or even, in some circumstances, unwilling to supply.
§ In these Amendments to Clause 3, the suggested new subsection (3A) seeks to enable local education authorities to provide for pupils at all schools and educational establishments maintained by them such facilities for medical treatment as may appear to them to be appropriate, over and above the provision made by the Secretary of State. Examples of the facilities which are currently provided by the Inner London Educational Authority under its present school health service but which might not be available, or available to the same extent, under the reorganised Health Service are facilities for child guidance, speech therapy and recuperative holidays. Recuperative holidays are an aspect of the Service which we have not touched upon so far. Another example of the need for the suggested power is a case where a local education authority might consider that a standard hearing aid provided under the Health Service was not the right instrument for a particular child. In the Inner London Education Authority area, the availability of such facilities might in future vary as between schools and different localities because of the proposals that a number of Regional Health Authorities will each be concerned with a different part of that area. I submit that the Authority ought to be able to secure uniformity of available facilities for pupils throughout its area, notwithstanding differences of approach between Regional Health Authorities who will be concerned with different parts of that area.
§ Paragraph (b) of the suggested subsection (3A) would extend this supplementing power of local education authorities for the benefit of those pupils at schools 906 and establishments not maintained by the authorities for whom the authorities are currently empowered by Section 78 of the Education Act 1944 to provide medical and dental treatment. ILEA have Private Act powers under Section 56 of the Greater London Council (General Powers) Act 1968, enabling them to provide free medical treatment for persons over the age of 19 for whom full-time or part-time education is provided by the Authority. These Private Act powers depend for their effect on Section 48(3) of the 1944 Act, which is scheduled for repeal in this Bill. It is thus extremely doubtful, in the view of the Authority, whether they would have the power in future to provide a student health service. I have taken note of what the noble Lord said earlier, but it is right that the Committee should be aware of the feeling of the ILEA in regard to this matter. They have not come to this view lightly and have done so on the best advice obtainable to them. When speaking on Amendment No. 25 I touched on the absence from the White Paper and the Bill of provision for free medical treatment for the over 19-year-old student, and I do not want to go over that again.
§ The subject matter covered by these Amendments is very much a London one, partly because of the special powers granted to London but also because of the great number of students attending ILEA colleges. The Authority feel entitled to point out the difficulty of getting a number of Area Health Authorities to co-ordinate their plans to develop a comprehensive new service in the first years of their existence; yet there seems to be a need for rapid expansion. It is reasonable to ask for specific powers to be spelt out in the Bill enabling London education authorities to run a student health service. The only alternative, in the view of the Authority as the result of the advice they have had, seems to be to promote a new Private Act of Parliament; but this could not now be done so that it could be enforced by the time the present reorganisation Bill is likely to come into effect. The proposed new subsection (3B) to Clause 3 is based upon Section 56 of the Greater London Council (General Powers) Act 1968; it would enable the authority to provide facilities in the nature of their present student 907 health services, to the extent that these facilities are not provided by the Secretary of State. I apologise if I have taken some little time, though I have a feeling that I have probably sketched over the matter rather more lightly than the Committee will appreciate. I am speaking here this evening after taking counsel with those who speak for the ILEA, and I trust that the content of the Amendments will be acceptable to the Minister. I beg to move.
§ 7.13 p.m.
§ LORD BELSTEAD
The noble Lord, Lord Garnsworthy, has hung both parts of this Amendment on to the particular position of the Inner London Education Authority. May I make just one thing clear to the Committee? We ought to be clear that the first part of the Amendment, which would put a new subsection (3A) into the Bill, would provide powers and duties for all local education authorities concurrent with the National Health Service as they are proposed in the Bill. What I am saying is that if the first part of this Amendment were accepted not only would it leave it open to local education authorities to provide an alternative service; but it would also have the effect that it would not leave the same incentive for Area Health Authorities to take a positive attitude to the responsibilities for the health of their school children.
The noble Lord, quite understandably, drew the attention of the Committee to the particular boundaries difficulty which there may be in Inner and Outer London. He held that the Inner London Education Authority would be at a disadvantage. What I am submitting to the Committee is that the difficulty here is that there is no question that the first part of the Amendment is drawn a very great deal wider than Inner London. In saying that, I am bearing in mind the conclusions which were contained in paragraphs 49 and 50 of the Paper which was put forward as the First Report of the School Health Service Sub-committee of the Working Party on collaboration. The majority view there really was conclusive. It was that the responsibility for school health in a reorganised Service should lie with the Health Service.
I admit, immediately, however, that that Report went on to recommend that 908 legislation should not prevent local education authorities from making direct arrangements in exceptional cases. This view has naturally been taken into account in drafting the Bill, as of course has the view of the Note of Dissent which was appended to that Report. Our view, as it has come out from that consideration, is that Section 111, to which we have already referred, of the Local Government Act 1972 gives wide enough powers to local education authorities when for educational reasons they consider it essential to provide services, without in any way detracting from the overall responsibility of Area Health Authorities.
May I refer specifically to some of the points which were worrying the noble Lord, Lord Garnsworthy? To give just these practical examples: local education authorities' own powers would seem to give them ample scope if they felt that hearing or sight problems were interfering with educational progress, to arrange for the examination or screening of children, and also to take whatever steps they might think necessary to ensure that treatment was provided. I think that education authorities will also have full powers, both under their general educational functions and under more specific functions, to obtain whatever advice, guidance and treatment they consider essential for children who are failing to make progress at school, whether for physical reasons or for reasons that might be associated with behavioural problems or mental disturbance. It is not envisaged, as I have said before, that there shall be any change in the child guidance arrangements.
When the noble Lord referred to hearing aids he made me feel that perhaps I ought to put on record now that the Government clearly recognise that there are special problems with certain hearing aids, and also I think with splinter-proof glasses. These are all problems which the Government are looking into and about which there will be consultation if it seems there may be a case for asking L.E.A.s to continue to make this kind of provision. I do not think, on this particular point, that that should allow the Committee to accept such a very wide-ranging Amendment as this is, but it is important that that should come up under this Amendment as well.
909 My noble friend Lord Auckland spoke about looking on all the new arrangements from a team point of view. Overlying the whole Bill is the range of cooperation which is to be provided. May I remind the Committee that the function of the joint consultative committees will be precisely to examine the needs of each area, the plans of the Area Health Authority and the corresponding local authorities, and to advise on the planning and operation of services in matters of common concern. There are collaborative arrangements to which we shall be coming in the Bill, I think I am right in saying, to provide for the appointment of joint consultative committees between A.H.A.s and local authorities. Your Lordships will have noticed that specifically in the table the Inner London Education Authority is written into the Bill. There will be collaborative arrangements for sub-committees; there will be collaborative arrangements for making reports to the Secretary of State; and the National Health Service of course is under a duty to make staff and services available so far as is reasonably necessary and practicable. I only remind the Committee of this as a backdrop to what we are considering in resisting, as I am afraid I am, the first part of the noble Lord's Amendment.
The noble Lord has come to the second part of his Amendment, which is new subsection (3B). What I have said on Amendment 25, when I spoke at some length, will in future leave it open to Area Health Authorities and local education authorities jointly to consider how the health care needs of students can best be met. What I think I ought to say to the Committee is that there have so far been only very informal discussions between the officers of the Inner London Education Authority, the Department of Health and Social Security and the Department of Education and Science about the future of the services for students which the Inner London Education Authority have just introduced. There is no doubt that these discussions will have to be continued. But the general principle of the Bill is that property held or staff employed wholly or mainly for the purpose of transferred functions will be transferred. There are, however, provisions whereby the Secretary of State can modify this general principle. I suggest that the future of 910 services which the ILEA are making for students will have to be reviewed in relation to these provisions.
May I conclude by saying that I have looked carefully at the second part of the noble Lord's Amendment because I realise that we are talking about something very important; namely, local government powers which Parliament saw fit to agree to. I believe that there is an advantage in this matter of a unified National Health Service. As I said on a previous Amendment, the combined effect of Section 1 of the 1946 Act and Clause 1 of this Bill is that the National Health Service has a duty towards all sections of the community through a unified service. Local authorities and A.H.A.s will be able to discuss a multitude of problems through the joint consultative committees. The local authority voices will be heard on their family practitioner committees and there will of course be local authority representation at area level. This is why the Bill leaves open this particular matter in Inner London.
If an education authority wants to go further into the provision of health services for its students there are, as I have said, Section 111 powers, and if Inner London feels that this is not enough then of course it might be necessary to return to the avenue of a local Act. Your Lordships may say that this reply would nullify the existing local Act powers of the G.L.C. in this respect. This may be so but in the light of a reorganised service, with opportunities for consultation and facilities for transfer of staff and property, it would hardly be reasonable to expect this one exception before the provisions of the Act have been given an opportunity to work.
Secondly, may I just tell the Committee that discussions on a very informal basis have been going ahead between D.H.S.S. and D.E.S. and the Inner London Education Authority and it is the view of the Government that these discussions should be continued.
§ 7.22 p.m.
§ LORD GARNSWORTHY
I am grateful to the noble Lord, Lord Belstead, for the detail of his reply. As always, lie is extremely courteous and persuasive, and because he is so persuasive it is not always a simple matter to separate the wheat 911 from the chaff. I have a suspicion that he has been blowing quite a bit of chaff across the table. There may be some wheat there but it will require a reading of what he has said to discriminate between the good and the not so good; that which can be accepted and that which may be rejected.
The noble Lord seems to query that this Bill will nullify the special powers enjoyed in London. I thought he was raising a question—
§ LORD GARNSWORTHY
The noble Lord was not, and he does accept that in point of fact it will nullify those powers. Good! The purpose of these Amendments is not to ensure that London is left out of the Service but that London enjoys reserve powers. If in point of fact the reorganised Service does not provide what Inner London wants—indeed I think it goes beyond that, because the whole of London is covered at the present time in regard to the enjoyment of powers, but I will return to that in a moment—London will have a quite different kind of organisation from that which existed previously. I do not want to dwell on what was earlier debated in the Committee; that is, the shape of the structure for controlling the service in London.
The Bill proposes four regions. I think it is quite possible that some child, some pupil, some student, somewhere will fall through these four nets. Instead of having a unified service—and we are talking a great deal about a unified service—so far as London is concerned there is going to be a break up of the service. It will no longer be a unified service in the sense that the school health service has been. I quite agree that when the noble Lord speaks about a unified service he is speaking about something different, but I think this is the point of time when we ought to be doubly careful. Everybody is agreed that the health service for the pupil at school and for the student should be as good as we can make it. This is the time to be doubly sure that nobody can fall through the four nets—if I may so refer to the new type of organisation that is to exist.
I stress that this is a request for reserve powers. The noble Lord speaks about 912 further consultation, but if we do not get this matter right while the Bill is passing through this House it will perhaps be too late when it becomes an Act. The noble Lord also spoke about Section 111 of the Local Government Act. I should have checked this, and I hope I may be excused for raising a query which the noble Lord, Lord Belstead, may be able to answer off the cuff. He may have touched on it and I may have missed it, but the situation in London is unique (is it not?) in that we have a local education authority which is itself not the body of local government in the generally accepted sense of the term. Will ILEA enjoy all the powers that flow from Section 111 of the Local Government Act? It may be that the answer is a simple "Yes", in which case there is nothing more to be said in regard to that particular point. I shall be surprised if the noble Lord is unable to answer without difficulty.
In the light of what he has said, and unless he has something further to add, I have the feeling that we shall have to return to this matter at Report stage. For my part, I shall need to take advice from those who understand the law much better than I do. I am very much of a layman, doing my best, but in regard to matters such as this I must depend on the advice of experts.
§ LORD BELSTEAD
I should like to reply to the noble Lord on three points. The first is that I have listened, as I think we all have, very carefully to what the noble Lord, Lord Garnsworthy, has said about falling through the four nets. I should like to be allowed to consider that point; but in fairness to the Government I must just point out that this is not the effect of the first part of Amendment No. 27.
The noble Lord asked me, secondly, whether the Inner London Education Authority would enjoy all the powers flowing from Section 111. I think, off the cuff, the answer is definitely, "Yes". It was under that apprehension that I gave the noble Lord quite a full reply, identifying the deaf, the slow learners, and so forth, who could be looked after by a local education authority. I will check on this immediately, and if by any chance I am wrong I will undertake to let the noble Lord know within the next 24 913 hours. I am sorry that I can only give an off the cuff answer but I am pretty certain that I have the answer right.
Thirdly, it would be wrong, after the talk of the wheat and the chaff, if I did not accent that I have not given the noble Lord satisfaction on the Amendment which he seeks to make to subsection (3). What in essence I have said is that this is something which should be looked at by the new Area Health Authorities in consultation with the Inner London Education Authority because there are ramifications here which go beyond Inner London. If the noble Lord is prepared to accept my reply at this stage, to recognise that perhaps we do not see entirely eye to eye on the whole Amendment, but to give an opportunity for both sides to look at this matter again, perhaps we could leave this Amendment.
§ BARONESS SEROTA
Following on what the noble Lord has said, I wonder whether, when he is looking at the four regional nets to which my noble friend Lord Garnsworthy referred, he will also look at the shape of the area nets that are proposed in the London area. I make this point particularly in relation to the services of the ILEA because, as the noble Lord will be aware, according to the proposed arrangements there will be certain Area Health Authorities in London that will consist partly of an Inner London borough and partly of an outer London one; and in Inner London the borough is not the education authority (in such cases, of course, it is the ILEA), whereas in outer London the position will be different. This is a factor which affects the organisation of the Service and I should be grateful if the Minister would bear this in mind when he is considering the question as a whole.
§ LORD HYLTON
May I ask my noble friend for an assurance that no existing service provided by the ILEA will be dismantled when this Bill becomes law, bearing in mind that it is likely that children living in one health area or region will be going to school in another? This was precisely the reason why the ILEA was invented in the first place. It would be a very unconservative thing to do to take 914 away powers from the ILEA and give them to newly invented Health Authorities.
§ LORD BELSTEAD
As some of your Lordships will know better than I do, there is a provision in an earlier Local Government Act that allows pupils to cross not only boundaries from Inner to Outer London, and vice-versa, but also from counties neighbouring outer London into outer London boroughs. We are therefore talking about pupils who in these cases travel a great deal. I cannot give the assurance for which my noble friend asked—I recognise why he asked it—because this will be a matter for the Area Health Authorities in consultation with the ILEA. This is set out in Clause 10, and it will be for them to consider. It is not for the Government to consider and I think that great umbrage would be taken if the Government were to lay down the law in matters of this kind.
§ LORD HYLTON
Why should any consultation be necessary? Surely an existing service can be preserved.
§ LORD GARNSWORTHY
Yes, and I hope he will read what he said in the OFFICIAL REPORT because if he will concede that, he will concede everything that is sought. However, it would not be fair to catch him on the chance use of a few words in that way. I am sure that the Committee as a whole appreciates the trouble the Minister is taking to try to deal with the points that are being made, though I am not sure that lie is meeting the wishes that are being expressed.
I am grateful to the noble Lord, Lord Hylton, for his intervention. It raises the whole question of follow-up and it is leaving a great deal to chance, bearing in mind that too much is being left to chance. I hope that the Minister will contact his right honourable friend about this issue. London is unique in this country, in terms of the size of population and the type of local government structure. There is a to-ing and fro-ing which does not happen in any other part of the coun- 915 try and that is inevitable in this area. It is usually a matter of choice when it happens outside the Metropolis, but it is happening here all the time and the ramifications are such that the Government are not entitled to say that they can easily be satisfied or that the proposals in this Bill will meet the unique situation in London.
I re-emphasise the point I made earlier—namely, that this is a request for reserve powers. Perhaps a part of the main Amendment is undesirable or the lesser Amendments are not acceptable. I appreciate that the noble Lord intends to give these matters further thought, but I should like to feel that the Government will themselves do some positive thinking about this and appreciate the concern that exists not only on this side of the Committee but on the Benches opposite. I do not believe that this is a Party political matter. When I supported the noble Earl, Lord Mansfield, earlier, I was told by his noble friend Lord Reigate that I had been expounding good Tory philosophy by saying that if something was working well it should be left alone. The noble Lord, Lord Hylton, is putting the matter in a rather different way from that of the Government. He is not speaking as a Socialist from these Benches but is saying from the Conservative side of the Committee, "Here in London we have something that is working well. Why interfere with it at a time when you cannot satisfy us that your scheme is foolproof?". The ILEA are saying, "Please give us reserve powers which will enable us to deal with those who fall through your nets." I do not think that anyone who is in any way familiar with the London service can feel anything but concern lest young people will fall through the nets. That concern is bound to be felt unless the clause is amended.
As I said, we shall read carefully what the noble Lord said, and shall take advice from those who are able to examine this matter and appreciate it more fully than I am capable of doing at the present time. It is to be hoped that the Government will return with something positive on Report. If not, my noble friends and I may wish to return to it, though not, as I say in any Party sense because this is not a Party political issue. For the 916 present, however, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ 7.39 p.m.
§ LORD GARNSWORTHY moved Amendment No. 28:
Page 3, line 18, leave out from beginning to ("to") in line 19 and insert—
("(4) It shall be the duty of local education authorities in relation to county schools and of the managers and governors of voluntary schools in relation to those schools").
The noble Lord said: Clause 3(4) provides:
It shall be the duty of the managers and governors of schools maintained by local education authorities to make available to the Secretary of State such accommodation as is appropriate for the purpose of assisting him to make such provision as is mentioned in subsection (1) of this section for pupils in attendance at the schools.
§ The point of concern is the fact that the managers and governors of schools maintained by L.E.A.s are given the duty to make the accommodation available. In general, this accords with a recommendation made by the School Health Service Sub-committee of the Working Party on Collaboration, except that they proposed that L.E.A.s should make the accommodation available; and that would seem to be more appropriate.
§ I may say that I have discussed this matter with a number of people in the service of education, and I believe I am representing the point of view of the Inner London Education Authority, as well as the point of view of chief education officers who have themselves given a great deal of thought to this matter. I know that the I.L.E.A. feel that they should be involved under the subsection with regard to county schools, that is to say, premises which they have established and maintain, as distinct from those premises which have been established by other persons: voluntary schools, aided, special agreement and controlled schools. That is their view, as I understand it; and it is also the view of a number of other people in other local education authority departments in the country. I do not think this is a matter of great substance, but I should like to feel, as I hope this will be the last Amendment on which I shall be speaking here this evening, that I have given the noble Lord, Lord Belstead, the opportunity to be 917 completely forthcoming and to say, "I am pleased to tell the Committee that I will accept this Amendment". I am quite certain that it would be an improvement. It is pretty meaningless to call on school governors and managers, because everybody knows that, outside the special cases I have mentioned, it is the local education authority which in fact provides the building and has to see that things are done. At this point I propose to sit down, optimistic in the feeling that the noble Lord, Lord Belstead, will enjoy himself and say: "There is no need to talk further about this Amendment. I am pleased to accept it". I beg to move.
§ LORD BELSTEAD
The schools, of course, are already required by the Standards of School Premises Regulations to have suitable accommodation available for medical inspection and treatment of pupils during school hours. It was with that fact in mind that the duty of making this accommodation available under Clause 3(4) was assigned in this Bill to the managers or governors of a maintained school. I would just say this: increasingly to-day there is a wish for more voluntary participation, and one way in which this can be achieved in public life is through the work of managers and governors of schools. After the bricks and mortar have been made available we are talking here about the administrative responsibility of making the premises available.
I must say that, having read the Bill, I felt perhaps we had got it right and that this could have been well handled by managers and governors who would consult with the headmaster or the headmistress concerned. On the other hand, the noble Lord has fastened on to a point. It is true that it is the authorities who maintain the schools. One has to comb through all the articles of government and rules of management to discover the true answer, but I believe it is true, that the majority give oversight of the actual occupation of the premises to authorities themselves. If we are to meet the noble Lord what we shall have to do is to ask the local authority associations what they think about it. The noble Lord says that he knows that some people in local government would very much like to see this, but we shall have to ask local authority associations what 918 they think. I undertake to do this, and if we get a favourable reply, and unless anything else has cropped up to change minds between now and Report stage, I hope perhaps to be able to meet the noble Lord on this Amendment.
§ LORD GARNSWORTHY
I am most grateful Ito the noble Lord. He will appreciate that I did not claim to be speaking for the associations. I hope that he gets the answer I should like him to get. He has been as generous as he possibly can, and if I allowed myself a burst of almost unrestrained optimism, I enjoyed it for the brief moment. I believe that I am entitled to be reasonably optimistic that as a result of my moving this Amendment something may come out of it that will be very much like what this Amendment aimed at achieving. I should like to thank the noble Lord for being so forthcoming and helpful.
§ LORD BEAUMONT OF WHITLEY
Before the noble Lord actually withdraws his Amendment, I wonder whether the Minister would also undertake to consult those bodies such as C.A.S.E. which have a particular interest in strengthening the powers of managers and governors.
§ LORD BELSTEAD
I cannot give the noble Lord an unequivocal undertaking about this, but what I should like to do (the noble Lord and I correspond on various matters educational from time to time) is to look at this. I have given the noble Lord, Lord Garnsworthy, an undertaking but I should like to be able to say to the noble Lord what I feel it is right to do in this case. Certainly I would not brush aside what the noble Lord has said to me. There was the point which I put to the House, that people want more participation, and I believe that this was something with which the noble Lord agreed.
§ LORD GARNSWORTHY
I had no idea that the noble Lord, Lord Beaumont of Whitley, wished to raise that matter or I myself would have gone a little more deeply into the question of how often governors and managers meet and how much they are involved in day-to-day administration. Those of us who know much about it are under no illusion. We know that it is the L.E.A. who will have to do this, if it is going to be 919 done, whatever may be set out on paper. I beg leave to withdraw the Amendment.
§ LORD BELSTEAD
In case noble Lords think that I have simply been blown hither and thither by a wind, may I say that the reason I came down on the side' of saying that I hoped to meet the noble Lord was that when one combs through the articles of government and rules of management one finds that what the noble Lord says is true; the oversight of the actual occupation of the premises is, in the majority of cases, with the local education authorities. It was for this reason that I felt I should try to meet the noble Lord on this Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 3 agreed to.
§ LORD ABERDARE
As we are about to move on to a new clause which is concerned with family planning, and to which a number of important Amendments have been put down, and as we already have further business this evening, I would move, if it is convenient to the Committee, that the House do now resume.
§ Moved, That the House do now resume.—(Lord Aberdare.)
§ BARONESS SEROTA
I very much hope that the Committee will agree to the Motion which the noble Lord has just moved. I hope he feels that we have made good progress to-day. I must say that I am delighted, although it has taken us nearly five hours, that we have ended on a note to an Amendment which for once did not have the heading in capital letters. "Resist".
§ On Question, Motion agreed to, and House resumed accordingly.