HL Deb 24 February 1972 vol 328 cc677-86

3.35 p.m.

BARONESS TWEEDSMUIR OF BELHELVIE

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.—[Baroness Tweedsmuir of Belhelvie.]

On Question, Motion agreed to.

House in Committee accordingly.

[The EARL OF LISTOWEL in the Chair.]

Clause 1. [General duty of Secretary of State.]:

On Question, Whether Clause 1 shall stand part of the Bill?

BARONESS TWEEDSMUIR OF BELHELVIE

Perhaps it would be for the convenience of the Committee if I took this opportunity, which seems to be the right moment on whether the clause shall stand part, particularly having regard to the words effective provision of an integrated health service", to make a brief statement about a Health Service Commissioner in Scotland, because, as has been made clear in a Statement by my noble friend the Secretary of State for Social Services in another place and my noble friend the Minister of State here to your Lordships, the Government have decided that there should be a Health Service Commissioner as part of the arrangements for dealing with complaints in the National Health Service. So far as Scotland is concerned, the present Bill provides a suitable opportunity to include the necessary provisions. These will take a little time to prepare and it will therefore be our intention to introduce new clauses when the Bill reaches another place.

LORD HUGHES

I am grateful that the noble Baroness has taken this early opportunity to make that statement, because, as she will recollect, it deals with one of the points I raised on Second Reading. Having read only Press reports of what was said about this subject, I cannot say that I am happy about the way in which the references to the Commissioner are being circumscribed. But I have no doubt that if these clauses are to he introduced in another place we shall hear a great deal more about them and shall have something to work on when they come back to us for reconsideration in due course. I am glad that, in whatever form the Health Commissioner's function may be carried out, the Government have reached this decision in time for it to be incorporated in the Bill.

Clause 1 agreed to.

Clause 2. [Provision of accommodation and medical, etc., services]:

LORD HUGHES moved Amendment No. 1: Page 1, line 25, leave out ("or") and insert ("and").

The noble Lord said: My first Amendment refers to Clause 2(c) which reads: medical, nursing or other services, … In the 1947 Act the reference was: medical, nursing and other services … This may seem a small point, but Parliament and its draftsmen are very particular about the meaning of "and" and "or" and I wondered whether there was any significance in the change of wording on this occasion. I must say that the use of the word "and" in this connection is preferable, because there can be cases when all the services are needed. The use of the word "or" almost connotes that there would be a choice and that one might be provided instead of another—a nursing service might be provided instead of a medical service or some other service might be provided instead of a medical or nursing service. It ought to be made perfectly clear that the duty of the Secretary of State is to cover the whole range: I think there is no doubt on that point. May I say at this early stage that in putting down Amendments to this Bill I have not, with one solitary exception to which I shall refer in due course, sought to make any political points whatever. All the Amendments are Amendments which can be discussed on their merit and for which support will not necessarily fall upon one side of the House or the other. This is a typical example, and in moving this Amendment I should be glad to hear what the noble Baroness has to say in reply.

BARONESS TWEEDSMUIR OF BELHELVIE

Perhaps the noble Lord will be glad to hear that I think his Amendment is an improvement on the present situation, and I am very glad to accept it.

On Question, Amendment agreed to.

3.40 p.m.

LORD HUGHES moved Amendment No. 2: Page 2, line 5, leave out from ("as") to end of line 5 and insert ("may be prescribed").

The noble Lord said: That is a very good start, but I am very suspicious of good starts. It is much better to get a "No" on the little things and to get a good answer on the things that really matter. I hope the noble Baroness will continue with the good work. Perhaps it would be for the convenience of the Committee if I spoke to Amendments Nos. 2 and 3 together. This Amendment is that in page 2 we should leave out from "as" in line 5 and insert the words, "may be prescribed". Subsection (2) concludes: … shall be made available for those services on such terms and conditions as the Secretary of State may determine. The Amendment which I am moving would make that subsection read: shall be made available … on such terms and conditions as may be prescribed. Noble Lords will recollect that on Second Reading I referred to the fact that this Bill was largely a skeleton and that in due course there would follow many regulations and orders. All the regulations which are made will be subject to Parliamentary procedure, mostly by Negative Resolution procedure but, in a few cases, by the Affirmative Resolution procedure; and some of the orders will be subject to Negative Resolution procedure. The great majority of the orders which are to be made under the Bill will not be subject even to the Negative Resolution procedure.

When I queried this position, I was informed—and I did not disagree with what the noble Baroness said—that the Parliamentary procedure was being reserved for what could be regarded as the more important of the orders. The benefit of orders being made, even though they are not subject to Parliamentary approval one way or another, is that Members of both Houses can be made aware of what is taking place. I am not certain that it is nearly so easy for Members either of another place or of your Lordships' House to become aware of things which the Secretary of State may determine. My reason for moving this Amendment is that these are important decisions which may be made. It is right that Parliament should be made aware of what is being done so that if someone is not satisfied, or does not have sufficient knowledge about the position, they will be in a position to ask a question in Parliament about it, although they will not be able to debate the order itself; whereas, if it is as laid down in the Bill at the present time that the Secretary of State may determine it, quite a long time might elapse before any Member of either House of Parliament knew anything about it.

These are important points and it is right that when we legislate in this skeleton form as much as possible of the subsequent decisions should come automatically to the attention of any Member of either House who is interested in the matter, and he should not have to go ferreting out what the Secretary of State might quite legitimately have determined but which, in the ordinary course of events, would not come to the notice of Parliament. The next Amendment follows exactly the same lines. I beg to move Amendment No. 2.

BARONESS TWEEDSMUIR OF BELHELVIE

I appreciate the point which was made by the noble Lord on Second Reading. I am afraid that he was right in that I cannot accept all his Amendments. I suggest to the House that the reasons why these two Amendments are not suitable for the Parliamentary procedure which the noble Lord had in mind are these. The provision by means of a determination for charging for the use of National Health Service premises has already been precedented in Section 15(5) of the 1947 Act. This deals with the availability of facilities at health centres for family practitioners to carry out Part IV services. It provides for charges to be fixed by the determination of the Secretary of State. The same arrangements apply under Section 15(6) of the 1947 Act which deals with the use by practitioners of health centre facilities for private practice. Over the years—and it is a long time now—these provisions have not given rise to any difficulty. There are a considerable number both of regulations and orders in this Bill as a whole which are subject to Parliamentary procedure; but we feel that the purpose of the Bill overall is to simplify the administration. The terms and conditions which have already arisen for use by general practitioners of particular premises which have not already been subject to any difficulty in the previous Act, and where there is no issue of principle, would only add to the complexity of the Bill. I hope that on reflection the noble Lord will feel that this is so.

LORD HUGHES

I cannot say that I am absolutely convinced on this matter at the moment. I should prefer to study what the noble Baroness has said when I read it in due course in the Report of these proceedings. In view of what I have said, I do not want to add needlessly to the complexities of the legislation, but I want Parliament to have the fullest opportunity of considering important matters. I therefore beg leave to withdraw the Amendment but I may come back to it at the next stage.

Amendment, by leave, withdrawn.

Clause 2, as amended, agreed to.

Clause 3 [Provision of medical, dental, etc., services]:

On Question, Whether Clause 3 shall stand part of the Bill?

LORD HUGHES

Clause 3 is a simple and short clause about which my noble friend Lord Hoy commented on Second Reading. I have a number of points to raise and it will become apparent to members of the Committee that I have come under the influence of the noble Lord, Lord Conesford, because I am querying points of language rather than points of law. This matter might well come into this category. The clause reads: It shall be the duty of the Secretary of State to secure the provision of general medical, general dental, pharmaceutical and general ophthalmic services … Reading this, the thought occurred to me why the word "general" should be used in regard to three of the services but not of the fourth. I have no doubt at all that this will be precedented in the 1947 Act, and I have no doubt at all that there is a sound reason for it, but quite honestly I do not know what it is.

It will be perhaps for the convenience not of the Committee but the noble Baroness if I continue my remarks for a few minutes longer so that her colleague may furnish her with material which will enable her to make a suitable reply, provided that it does not take too long to work out the answer. The longer it takes to find the answer the more doubtful I shall be about the reason for it being there at all. I must apologise to the noble Baroness, I cannot keep speaking any longer; but I see that the noble Lord is on his way back.

BARONESS TWEEDSMUIR OF BELHELVIE

Happily I can observe that under Part IV of the National Health Service (Scotland) Act 1947, from which this particular clause is modelled, it is described as "general medical and dental services, etc."

LORD HUGHES

That I have no doubt about. What I want to know is why it is not necessary to talk about "general pharmaceutical services". I thought that that was the answer that the noble Lord, Lord Aberdare, would be bringing back to the noble Baroness.

BARONESS TWEEDSMUIR OF BELHELVIE

If I may speak again, I suppose that the noble Lord is correct. One could say—and it may be better language—"medical, dental, pharmaceutical and ophthalmic services". The only reason why "general" is in the Bill is, as I have said, because it is modelled on the 1947 Act which, if I remember rightly, was the responsibility of the Party opposite.

LORD HUGHES

But we are discussing a Bill after 25 years of operation of the Act and we are agreed that there are certain ways in which even that wonderful Act can be improved by 1972. I cannot therefore accept that in those cases where an answer is not readily forthcoming the obvious one is that in 1947 perfection was achieved and we cannot do better. I will let the point rest at that, but it makes better sense—or it removes undue suspicion—if there is not an apparent differentiation against the pharmaceutical services; and I shall put down an Amendment for the next stage, which I hope the noble Baroness will either accept or give good reasons for rejecting.

Clause 3 agreed to.

Clause 4 agreed to.

Clause 5 [Care of mothers and young children]:

3.51 p.m.

LORD HUGHES moved Amendment No. 4: Page 3, line 2, leave out ("to meet all reasonable requirements").

The noble Lord said: This is a probing Amendment. The clause as it stands says: It shall be the duty of the Secretary of State to make arrangements, to such extent as he considers necessary to meet all reasonable requirements … and so on. I do not think words should be in legislation unless they serve some useful purpose and, quite frankly, I cannot see what is gained by adding the words "to meet all reasonable requirements", particularly as that phrase follows the words "as he considers necessary". Presumably if the Secretary of State, having looked at the matter in his nice room in St. Andrew's House, or in his equally nice room in Dover House, has come to the conclusion that it is necessary to do something, no one, in Scotland at any rate, would suggest that the Secretary of State was considering it necessary to do something which was not reasonable or was intended to meet unreasonable requirements. For that reason, it seems to me that the words are quite needless, and if there are fewer words to print it must at the end of the day contribute to a certain amount of economy in all the subsequent reprinting. I therefore beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

This particular form of words is used elsewhere in the Bill and is precedented. However, I am always anxious to try to improve the English of Bills and am therefore glad to thank the noble Lord for his contribution and shall be glad to accept his Amendment.

On Question, Amendment agreed to.

Clause 5, as amended, agreed to.

Clause 6 [Medical and dental inspection, supervision and treatment of pupils and young persons]:

On Question, Whether Clause 6 shall stand part of the Bill?

LORD HUGHES

On Clause 6 I wish to raise two points which might be termed "Conesford points". The noble Baroness will probably be able to give a satisfactory explanation on the first. The Bill refers to: medical and dental inspection, at appropriate intervals, and for the medical and dental supervision …". I am wondering exactly what are the differences between "inspection" and "supervision". It seems to me that in the ordinary use of language either of these words would cover the whole field. One possibility of course is that "inspection" refers to the actual work on an individual child or a number of children, whereas "supervision" might be general overseeing arrangements. If an explanation of that kind applies, then I am not unhappy about it.

With regard to trying to put into Bills language of the kind people will understand when they read them, I wonder why, when we read the proviso, we find this language: if the parent of any child or young person gives to the authority notice …". Who on earth would ever speak or write like that—"gives to the authority notice"? Why cannot it be the more simple, ordinary, everyday language: "gives notice to the authority"? It does not make a ha'penny worth of difference which way it is done, but over and over in the Bill we find phrases such as this. I know that it is not always possible in legislation to put matters in ways which are immediately understood by people: a matter may be complicated and some form of legal wording may be necessary. But this seems to me to be a case of being awkward for the sake of being awkward. Perhaps the noble Baroness will tell me what she thinks of these two points.

BARONESS TWEEDSMUIR OF BELHELVIE

I would agree with the noble Lord on the second point concerning the words "gives to the authority notice", which I must confess I had not particularly picked up. But the phrase is copied from Section 61 of the Education (Scotland) Act 1962. On the noble Lord's first question regarding the difference between "inspection" and "supervision", this wording also is used merely because it replaces the relevant provisions, Section 58(1) and (2), of the Education (Scotland) Act 1962.

LORD HUGHES

I take it that if at the next stage I seek to tidy up the language relating to the second point the noble Baroness will be able to make another early start in accepting an Amendment from me. On the first point, it seems to me that it is not necessarily the best way of going about things just to go to the old Act with a pair of scissors and a pot of gum, and to cut out the bits and paste them into new legislation and say, "Well, we now have the start of a new Act." There is something to be said for trying to achieve the results in fewer words. However, I am not certain in my own mind that "supervision" and "inspection" are in every case identical, so I will not come back on that point. But I will put down an Amendment on the other point, and I am grateful to the noble Baroness for her indication.

Clause 6 agreed to.

Clauses 7 and 8 agreed to.

Clause 9 [Educational and research facilities]:

On Question, Whether Clause 9 shall stand part of the Bill?

LORD HUGHES

I have another point in connection with language. Clause 9 states: It shall be the duty of the Secretary of State to make available such facilities, in any premises provided by him under the Health Service Acts, as appear to him to be reasonably required for undergraduate and postgraduate clinical teaching and research and for the education and training of persons providing or having it in contemplation to provide …". Who on earth thought up that phrase, "having it in contemplation"? First of all, what is "it"? Why cannot the phrase be "providing or comtemplating to provide services under those Acts"? It seems to be an absolute nonsense to use a phrase such as that in the Bill, and I am quite certain that if I put down an Amendment to alter the words here, or if the noble Baroness herself will do so, the Committee will be happier about Clause 9.

BARONESS TWEEDSMUIR OF BELHELVIE

May I say to the noble Lord that I am most grateful to him for his points concerning the English language. Perhaps we can get together afterwards and see whether we can improve it.

Clause 9 agreed to.

BARONESS TWEEDSMUIR OF BELHELVIE

May I move that the House do now resume, to hear a Statement.

Moved accordingly, and on Question, Motion agreed to.

House resumed.