NATIONAL HEALTH SERVICE (SCOTLAND) BILL [H.L.]

HL Deb 24 February 1972 vol 328 cc691-755

4.10 p.m.

House again in Committee.

Clause 10 agreed to.

Clauses 11 and 12 agreed to.

Clause 13 [Health Boards]:

On Question, Whether Clause 13 shall stand part of the Bill?

LORD HUGHES

There are a number of questions that I should like to ask about this clause on which I think it would be appropriate for the noble Baroness to elaborate. This is the clause setting up Health Boards. The White Paper gave certain indications as to what the Secretary of State's thinking was in this matter, the number of Boards which might be set up and the size of the Boards. I wonder whether the noble Baroness is in a position to tell the Committee if it is still the Secretary of State's intention to set up the number of Boards with, roughly speaking, the boundaries which were indicated in the White Paper last year?

Secondly, there has been a certain amount of disquiet about the proposed size of the Boards. I recognise that in this matter there are difficulties in both directions. If you make a Board with the wide range of responsibilities that these Boards are going to have sufficiently wide to enable all the sorts of interests that might reasonably expect to have a right to be included in the membership of the Boards, there is a danger that they may be too unwieldy. On the other hand, if you want to make them very workable Boards with a number that makes for smooth working in what will be a very important and sometimes difficult task, then it becomes terribly difficult to give the breadth of experience that is desirable on the Boards. I think a figure of a possible membership of 15 was mentioned. Having looked at the proposed areas in the White Paper, with some of the Boards I think a membership of 15 would be very suitable looked at from almost any point of view. But there will be others, particularly in some of the more populous areas, where a Board of 15 would be unduly small. I would like the Minister, if she finds it possible, to give us some indication of the kind of variation in size of the Boards that the Secretary of State might have in mind.

Finally on Clause 13, subsection (6) reads: Regulations … may make provision requiring Health Boards to submit to the Secretary of State a scheme for the exercise of their functions, and enabling the Secretary of State to approve, with or without modifications, any such scheme and to make such a scheme in the event of the failure of any Health Board so to do. Can the noble Baroness give us some idea of what kind of scheme the Secretary of State has in mind should be put forward by the Health Boards, the kind of things which these schemes would cover? I have put down no Amendments to this clause because on the face of it it seems to be reasonable, but whether or not anything needs to be done would depend to a certain extent on what the noble Baroness has to say in reply to the questions that I have put forward.

BARONESS TWEEDSMUIR OF BELHELVIE

In answer to the noble Lord's first question, if he will look at the Appendix to the White Paper he will see that the 14 proposed Health Boards there set out give an estimated population in thousands in each area, and they are also compared with the corresponding local government regions and districts. The noble Lord spoke particularly of the very populous areas. Taking Argyll and the Clyde, Glasgow, Lanarkshire and Ayrshire and Arran, those four Board areas are part of the proposed West Region in local government. We have tried in this very populous area to divide up the numbers more than was proposed under local government, and I will not go into the reasons why the Western area under local government is so very large.

But I would take this opportunity to say that we propose now to have a fifteenth Health Board and this will be in the Western Isles. This is because since the White Paper on Local Government was issued—and we had considerable consultations, as the noble Lord will remember—we announced last December that for local government purposes the Western Isles would be given "most-purpose" status, and for these reasons we feel that the balance of advantage lies in giving an extra completely separate Health Board to the Western Isles. We have already proposed that there should be a separate Health Board for the Orkneys and Shetland, and both those and the proposed Board for the Western Isles will have smaller populations and Health Services resources; a Western Isles Health Board will need to keep close links, like the Orkney and Shetland area, with a large mainland Health Board. From comments received on the White Paper, this decision to create a fifteenth Health Board is, I understand, likely to be very acceptable to local interests.

On the second point which the noble Lord raised, subsection (6) of Clause 13, we have recently circulated discussion papers—and I think he has received a copy—to all those concerned on area and district management structures, and until we have had comments on those papers I do not feel I can say more here. They are very long and considerably detailed, and we feel that we should have the advice of those who are likely to have to manage these particular schemes.

LORD HUGHES

The noble Baroness has, I think, jumped from point one to point three; she referred to my point three as the second point. My second point was the number of members on the Boards. May I take it that her reference to the creation of a fifteenth Board for the Western Isles means that as at present advised it is the Secretary of State's intention to proceed with Boards along the lines indicated in the White Paper, because there is nothing in the Bill to indicate that? I take it that this means that the scheme which will go forward in due course will be for 14 Boards, plus one, with the necessary amendment, the creation of that fifteenth Board.

I should like to have some information about the range of members, because in the case of the last Board, for instance, it might be a little difficult to find 15 suitable members for a Board for the Western Isles. I hope that remark does not get undue prominence in any paper circulating in the Western Isles or I shall be in difficulty. However, finding 15 members could be a very different proposition in one of the four Boards in the Western Region. Therefore, could the noble Baroness say something about that?

BARONESS TWEEDSMUIR OF BELHELVIE

I regret that I did not refer to the second point that the noble Lord raised on the number of members; I was concentrating on the number of Health Boards. We said in the White Paper that so far as the number of members on the Health Boards is concerned we would propose that it should be of the order of 15, but I believe I also said on Second Reading that the number would obviously vary according to areas. As the noble Lord rightly said, in the Western Isles, for example, there would probably be fewer, while in a highly populated district there could be more. "Of the order of 15"as to give some kind of indication.

LORD HOY

May I raise one point with the noble Baroness in regard to subsection (6), under which Health Boards have to submit schemes to the Secretary of State who may approve them with or without modification? In the concluding lines it says: and to make such a scheme in the event of the failure of any Health Board so to do. Could the noble Baroness tell us why this is necessary? I have no doubt that she will say that this provision was included in the 1947 Act or the 1962 Act, but if that is so then she will be able to tell us on how many occasions the Secretary of State had to resort to these powers. There may be some good reason for it, but I simply cannot see it, because I cannot imagine that any Board would refuse to submit to the Secretary of State a scheme with regard to their functions, and carry their refusal to such an extent that the Secretary of State had to impose a scheme on them. I should be grateful to know the reason for this provision's inclusion in the Bill.

BARONESS TWEEDSMUIR OF BELHELVIE

It is really only what one would call a "default power". I should think it would be very rare indeed—in fact, probably never—that a Health Board would not produce a scheme. As the noble Lord rightly said, it is based on previous legislation about these schemes. I think it is merely a default power, and if it were not included it would probably not be necessary, but it is put there just to make it sure and definite that under the Bill a scheme must be submitted.

Clause 13 agreed to.

Clause 14 [Local Health Councils]:

4.23 p.m.

LORD HUGHES moved Amendment No. 5: Page 7, line 25, after ("with") insert ("a local authorities in or for the area or district concerned and")

The noble Lord said: The Bill brings forward this concept of local health councils, something which is new to the National Health Service and which is perhaps a necessary thing in view of the concentrating of executive control in these new bodies called Health Boards. It seems to me that in the concept of these local health councils the Government, in the way the Bill is framed, appreciate the fact that local authorities are the sort of bodies who are going to be particularly interested in membership of these local health councils.

The first Amendment on the clause which I make is at line 25, and if my Amendment were incorporated it would read: Where, on representations made to him by a Health Board, the Secretary of State is satisfied, after consultation with local authorities in or for the area or district concerned and with such interests as appear to him to be concerned, … It seems to me to be of particular importance that if the Secretary of State is going to accept the position that in any particular Board it is not necessary to have a health council, he should be under a particular obligation to have asertained the opinion of the local authorities in the area, because I am quite certain that if they are concurring in the arrangements, whatever form they may take, which would make it unnecessary to have a health council, he will not be in any difficulties with anybody else in the area. But if he accepted that there was not a scheme and the local authorities had not in fact been consulted, it might cause a lot of needless trouble. I am quite certain that the Secretary of State would not deliberately fail to consult all or any of the local authorities in the area, but it has been known to happen that when somebody is looking at a piece of legislation, by mistake someone can be omitted. I do not say that if my Amendment were inserted it would ensure that everybody who ought to be consulted would be, but it would at least make it certain that none of the local authorities concerned would be omitted.

While this Amendment is going against the general trend of my Amendments so far, which has been to exclude unnecessary words, I do think that it is a useful inclusion. If it did not do anything else, it would at least get the health council off to a good start with the local authorities concerned, because by putting it in the Bill the fact that it was the intention of Parliament that local authorities in the area should have a special interest in these health councils would be emphasised. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I would agree with the noble Lord, Lord Hughes, that it is most important that the local authorities should be brought into consultation on these matters. The effect of the noble Lord's Amendment would be to ensure that local authorities were always consulted. If he looks at the following subsection he will see that as some of the members of the local health councils will be appointed by the local authorities, it is difficult to conceive of the present obligation to consult not being held to apply to those authorities. On the other hand, I agree with him that it is very important, and perhaps is reassuring to people, that they should know that this really is the intention of Parliament. Therefore I have great pleasure in accepting his Amendment.

On Question, Amendment agreed to.

4.28 p.m.

LORD HUGHES moved Amendment No. 6: Page 7, line 34, after ("prescribed") insert ("such number being not less than two thirds of the total membership,").

The noble Lord said: This Amendment relates to the next subsection to which the noble Baroness has just referred. The subsection which we have just amended deals with the situation where a local health council was not to be appointed. This subsection (3) deals with the case where local health councils are to be appointed. I have stressed the importance of local authorities in this field. The difficulty is that the way in which the Government have decided to go ahead with these bodies means that they are not elected bodies. None of these bodies is elected. The Health Boards themselves are going to be creatures of the Secretary of State and will all be appointed by him. On the other hand, the health councils are going to include people who, though not elected and not chosen by the consumers, in so far as they are local authority members are the next best thing; they will be members chosen by the elected representatives in the area. I think it was the position in previous legislation that in certain directions a minimum number was laid down, and a maximum number laid down in others. In regard to the Regional Hospital Boards, for instance, I remember that it was laid down that the number of medical practitioners should not exceed a certain part of the total membership of the Board. I have suggested that it would be reasonable to include a minimum proportion in the composition of these Boards and my Amendment calls for two-thirds. I would not necessarily die in the last ditch for two-thirds, but it is perhaps reasonable that at least half of the membership of these councils should he chosen by local authorities in the area. But in the context of the job that these councils will have to do, I think that two-thirds is perhaps the reasonable figure. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I regret having to say to the noble Lord that I do not really feel that I can accept this Amendment. The effect of it would be to limit the freedom of tile Health Board in appointing other members of the local health council; for instance, after consulting voluntary bodies such as patients' organisations, the Red Cross, the W.R.V.S. and groups which represent special interests in a certain area. Under the Amendment, membership reflecting such interests would need to be outnumbered at least two to one by local authority appointees. I accept what the noble Lord said about two-thirds perhaps being too high but, as I tried to make clear on the previous Amendment, the importance of local authority appointment of some members is simply not in question. That is why subsection (3) states that local authorities, as elected bodies, will have an obvious job to do in providing members who are in touch with local opinion. It is for that reason, and because it is necessary to recognise the interests of both regional and district authorities when a local health council is formed, that the number of places to be filled by them will be given formal expression in regulations, but will not necessarily be tied to a certain proportion. But of course their importance in nominating is without question, and in order to leave them with some freedom of action I hope the noble Lord will consider withdrawing his Amendment.

LORD HUGHES

I should like to make it quite clear that this is a field of activity where we ought to be trying to proceed as much as possible by agreement, and it is certainly not my intention to-day to divide the Committee on any of the Amendments which I have put forward. I should be content to withdraw this Amendment if I could get an assurance from the noble Baroness, not on any figure of membership, but that the Secretary of State accepts that a major part, or perhaps I should say an important part, of the membership of these councils would come from the local authorities. It is reasonable that such members should be in a majority, but there might be cases where bodies are small and even to give them a majority might be to exclude somebody from the Red Cross, the W.R.V.S. or some such organisation, who could serve a very useful purpose in a certain area, not merely because of the body from which he comes but because of his own suitable qualifications for being on a council of that kind. If the noble Baroness will assure me that the Secretary of State accepts that, in the ordinary course of events, the local authority field is the most important to which he would look for membership of these health councils, I shall be content and will not only withdraw the Amendment but will not feel it necessary to come back to it.

BARONESS TWEEDSMUIR OF BELHELVIE

I always hesitate to use words like "major" or "important" because that often leads to a considerable debate on their interpretation. But I can certainly give the noble Lord an assurance that it is quite clear, as indeed is stated in subsection (3), that the local authorities will have very important work to do. But I think we want to leave freedom to vary the membership of these councils from area to area for the reason which he himself gave; that in some areas there might be more voluntary workers with much to contribute, while in other areas there might not be such people. But certainly local authorities are very important.

LORD HUGHES

I can envisage the noble Baroness moving the Amendment which I have moved if the Election had gone the other way, and I can equally envisage myself giving the answer which she has just given. For that reason, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

4.36 p.m.

LORD HUGHES moved Amendment No. 7: Page 8, line 1, after ("for") insert ("additional expenditure incurred or").

The noble Lord said: On Second Reading the noble Earl, Lord Cromartie, and my noble friend Lady White raised the question of women serving on committees, and mentioned the difficulties in which they might find themselves because they were not entitled to compensation for loss of remunerative time. This Amendment proposes to make subsection (6) read: … including compensation for additional expenditure incurred or loss of remunerative time". I believe that this is a form of words which exists in relation to local government. It does not go so far as the noble Earl or my noble friend wanted, but at least it goes a little further forward and by using a form which is similar or identical to local government procedure it at least keeps in step. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

While I naturally wish to see as many married or single women as possible taking their part in the National Health Service, I am afraid that I cannot accept this Amendment for the very good reason that it is unnecessary. If the noble Lord will look at the words in subsection (6) immediately preceding those which he wishes to amend, he will see that they make possible the payment of "other allowances", of which compensation for loss of remunerative time is only one example. This wording is precedented in Section 37 of the Health Services and Public Health Act 1968, which provides for the payment of allowances to members of the present health authorities. It also provides for … any additional expenses to which he"— or, in this case, she— would not otherwise have been subject being … incurred by the member for the purpose of enabling him"— or her— to perform his duties". I am glad to say that the power would cover—as it does in the Local Government (Scotland) Act—expenses for baby sitters and, where absolutely necessary, for home helps. Therefore the same arrangements would continue in the future. Because of the way subsection (6) is drafted, I hope that the noble Lord will withdraw his Amendment.

LORD HUGHES

I find that a completely satisfactory explanation, and I am very happy to beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 14, as amended, agreed to.

Clause 15 [University Liaison Committees]:

On Question, Whether Clause 15 shall stand part of the Bill?

LORD HOY

May I ask one question in connection with Clause 15? Under present legislation we have medical education committees, but under the proposals in this Bill these committees will go out of existence and will be replaced by university liaison committees. I understand that with this change the terms of reference of the new committees will be somewhat wider. I would be grateful if the noble Baroness could explain to us just why the change has to take place and what in fact the widening of the terms of reference really means.

BARONESS TWEEDSMUIR OF BELHELVIE

There was a Working Party which recommended the procedure which is set out in Clause 15. This clause should also be read with Part II of Schedule I to the Bill, which perhaps gives a rather better idea of the sort of members who would be appointed to these committees. They will concern not only those who are in the medical schools but also, for instance, Strathclyde University, which is bioengineering. For that reason, the arrangements which now exist are, of course, widened.

Clause 15 agreed to.

Clause 16. [Local Consultative Committees.]:

4.42 p.m.

LORD PLATT moved Amendment No. 8: Page 10, line 2, leave out from ("Committees") in line 2 to end of line 3.

The noble Lord said: In proposing this Amendment I should like to assure your Lordships that there is nothing particularly sinister about it. It is not the thin edge of any wedge, or an attempt to have the Health Service ruled by the medical profession. But it seems to me that the words on page 10, in lines 2 and 3, which I suggest should be omitted, are unnecessarily restrictive, have no particular purpose and could be a considerable nuisance. Your Lordships will know, of course, that Clause 16 deals with the recognition by the Secretary of State of certain area committees, of which one, of course, is the medical committee, though others are no doubt of equal importance. It seems to some of us that the area medical committee might, for instance, consist of seven or eight doctors of different kinds—perhaps from health services, from preventive medicine and public health, and from general practice—and that it might be wise for such a committee to have a sub-committee on, shall we say, general practice. Subsection (8) allows such a sub-committee to be formed, but then says that this subcommittee should be composed as to a majority of members of the committee". That is of the main committee. That seems to me unnecessary. As I say, it might be a fairly small committee on which there are only perhaps three general practitioners, and if you want a sub-committee of general practitioners containing perhaps seven or eight you are not allowed to do it because of these rather unnecessary words. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I would say to the noble Lord, Lord Platt, that we have had representations on this matter. In fact, only last week the reservations which the noble Lord has put before your Lordships' Committee were given to us very explicitly. On further consideration of the matter I think that perhaps there is substance in what the noble Lord says, and I would be glad to accept the Amendment.

LORD PLATT

I am grateful to the noble Baroness.

On Question, Amendment agreed to.

On Question, Whether Clause 16, as amended, shall stand part of the Bill?

LORD HUGHES

Subsections (1) and (2) of this clause deal with the setting up of five different consultative committees, and then subsection (3) goes on to say: Where, after consultation … a committee formed … is representative of any other profession engaged in the provision of care … I do not see a definition of "profession" anywhere in the Bill. I think noble Lords will be aware that the use of this word "profession" is more widespread now than it used to be. The word "profess-fession" was once used within a comparatively narrow range. Shall I say that 20 or 30 years ago it would not have been accepted that nursing was a profession, whereas no one would dare to dispute that to-day. The committees listed—the medical committee, the dental committee, the nursing and midwifery committee, the pharmaceutical committee and the optical committee—seem to cover all the very obvious professions, and it may be that the Secretary of State is just playing safe when he talks about the possibility of "any other profession". But if there is not some sort of indication of what is meant by "profession" we might get into certain difficulties. For instance, I am quite certain that, say, the domestic or catering staff could make out a very strong case that they have interests which might be represented. But would anyone suggest that the domestic staff was a profession? It might be argued that the catering staff was. It might even be argued that the domestic staff was a profession. But either we ought to have some indication of what other possibilities are in mind or, alternatively, we ought to have some attempt to define a profession.

BARONESS TWEE DSMUIR OF BELHELVIE

If the noble Lord will look at the subsection (3), he will see that it says that the persons concerned must be engaged in the provision of care or treatment under the Health Service Acts … That is designed to narrow the definition down to such professions, as I think one would now call them, as radiographers or physiotherapists, but it would in fact exclude, for example, the engineers in a hospital. It is those who are engaged directly in the provision of care or treatment, and the two particular professions of radiography and physiotherapy were what we had in mind.

LORD HUGHES

I am rather surprised that at this particular period of history the noble Baroness should use that one. We are all very conscious of how uncared for we are during periods of electricity cuts, when we have no heating. It cannot he said that the engineers responsible for the heating of a hospital have nothing to do with the care of the patients. In fact, if they made a mess of their job everybody else might be wasting their time completely. One of the things which was so often raised during the miners' strike was the special problems of hospitals, and the need to ensure that they were adequately heated, and so on. But I did not have those particular people in mind. I was thinking of those people who assist when there is a shortage of nurses. There are so many duties which fall on other people now who are in the category of assistants, and so on. It may be that that counts as part of the nursing profession; I do not know. But take, for example, the people who keep the hospitals clean. It certainly could not be said that they are not concerned with the care of the patients, because if the places were not kept clean the patients would very soon be uncared for. This, I think, points to the very difficulty that I have been referring to: the absence of some sort of guidance does not automatically limit it to people like physiotherapists and the like.

I will not press the matter because I know that perhaps the unfairest way in which one can deal with a Minister is by raising points on the Question, Whether the Clause shall stand part?, when they have had no previous oppor- tunity to investigate the matter; and there is a limit to the comings and goings from one part of the House to another in the transmission of information. I would be content to leave it that the noble Baroness might have a look at the matter. In the interval before the next stage she might care to drop me a note on this point. I am not quite happy about the way it stands. If she were not going further than she is at the present time, I might find it necessary to put down an Amendment at the next stage. But I do not want to do this if it can be avoided.

BARONESS TWEEDSMUIR OF BELHELVIE

May I perhaps clarify another point on subsection (3). I agree with the noble Lord that anybody engaged in the hospital is helping in the "care or treatment". Where does one draw the line? This is the point that he was putting before the Committee. But subsection (3) begins: Where, after consultation with the Health Board concerned, the Secretary of State is satisfied … The Health Board may say, for example: "We feel that radiographers should come into this category." So there is, in the subsection, a kind of double check that the people concerned are directly, absolutely directly, concerned in the "care or treatment".

Clause 16, as amended, agreed to.

Clause 17 [Scottish Health Service Planning Council]:

4.52 p.m.

LORD HUGHES moved Amendment No. 9: Page 10, line 26, leave out ("after consultation with") and insert ("with the agreement of")

The noble Lord said: Amendments Nos. 9, 10 and 11 stand together and I attach perhaps a little more importance to these than to some other Amendments. This clause deals with the Scottish Health Service Planning Council and, as so often is the case with bodies of this kind, it lays down that they shall produce an annual report which the Secretary of State will lay before Parliament. The clause makes provision for the Secretary of State to exclude part of such a report when he lays it before Parliament. A question on this point was posed by Lord I Hoy and in answer the noble Baroness said that there may be subjects referred to in the report which it was not in the public interest to disclose—for example, a dispute with a contractor (which is the sort of thing that one sees at the present time) details of which it might not be in the public interest to disclose. That, I think, could well justify the exclusion of references of that kind from what is placed before Parliament. But I cannot envisage any circumstances in which it could be considered reasonable that a report annually placed before the Secretary of State by such a body should be suppressed in its entirety. I cannot accept that that is a reasonable thing to do.

So far as exclusion of part of the report is concerned, the Bill as it stands provides that the Secretary of State may suppress the whole or part of the report after consultation with the body which has made the report in the first place. I do not think that that goes far enough. I am conscious of the fact that I am using an emotive word in "suppressed" rather than "deleted" or "not published"; because once a report which is ordinarily published is made, and once you decide that part of it should not be published, then you are deliberately deciding to suppress—though perhaps for excellent reasons in certain cases.

The Amendments oblige the Secretary of State not merely to consult with the Scottish Health Service Planning Council about the deletion of part of the report but also oblige him to get their consent. After all, it is their report. I do not think that it is good enough for the Secretary of State to say, "No, I am not going to let Parliament know that you have said such and such a thing." I am quite sure that a body of this kind would never refuse to delete from the published version of their report something which it would not be in their interests or in the public interests to have published; but I cannot believe that any self-respecting body of this kind would ever agree that it was in the public interest to suppress the whole of their report. In circumstances of that kind they should never have made a report of that nature in the first instance; they should have written a letter marked "Confidential" and then have produced a lot of innocuous material for the annual report. The three Amendments therefore serve the double purpose of obliging the Secretary of State to get the consent of the Council to the deletion of part of the report and so to make it possible for part of the report to be left out, but to make it impossible for the whole of the annual report to be suppressed.

LORD PLATT

Before the noble Baroness replies, may I say that I should like to support the noble Lord, Lord Hughes, very strongly on this Amendment. I was going to ask what was the purpose of the lines and whether there was a very important reason for leaving them in; and even to suggest that they might be looked at again and deleted. But I think Lord Hughes has suggested a way round which is wiser than either leaving the words in as they are or deleting them altogether, which is what I might have suggested. I think that his wording, "with the agreement of", is very wise and I hope that the noble Baroness will accept his Amendment.

BARONESS TWEEDSMUIR OF BELHELVIE

I understand that we are discussing Amendments 9, 10 and 11 together. Both noble Lords have asked me why these words are here at all. Once again the explanation is that they have been copied from the National Health Service Scotland Act 1947, Section 2(5). Over all these years, these words have never caused any difficulty; but I must say that so far as we are aware the powers of the Secretary of State have never been used. I have given some considerable thought to these questions and I should like to say to the Committee that I do not feel I can accept Amendment No. 9, because the Secretary of State who has the final responsibility must himself take that responsibility and of course must he prepared to justify it subsequently in Parliament.

On the other hand, I should like to accept the following Amendments, Nos. 10 and I, which make it quite clear that the report must be laid before Parliament but that the Secretary of State may himself take the decision that a part of the report should not be laid before Parliament. This is for the reason I gave on Second Reading. It is true that such instances are rare, but there might, for example, be a case that was the subject of litigation and it would not be advisable to publish it. I feel that the final responsibility must lie on the Secretary of State because he must justify it. I am glad to accept the last two Amendments.

LORD HUGHES

I am grateful to the noble Baroness. She has accepted the most important part of the Amendments. I am quite satisfied in my own mind that if the Secretary of State did consult the Council about leaving out a part of its report which they felt strongly should be kept in and if, nevertheless, he went ahead with the publication omitting that part, it would be a very strange world and very strange circumstances in Scotland if it did not leak out that there had been disagreement of this kind. I am prepared to accept that the first few words should remain, and therefore beg leave to withdraw my Amendment No. 9.

Amendment, by leave, withdrawn.

LORD HUGHES

I beg to move Amendment No. 10.

Amendment moved— Page 10, line 28, leave out ("any such report or").—(Lord Hughes.)

On Question, Amendment agreed to.

LORD HUGHES

I beg to move Amendment No. 11.

Amendment moved— Page 10, line 30, leave out ("report or").—(Lord Hughes.)

On Question, Amendment agreed to.

Clause 17, as amended, agreed to.

Clause 18 [National Consultative Committees]:

5.0 p.m.

LORD PLATT moved Amendment No. 12: Page 11, line 1, leave out subsection (3).

The noble Lord said: Clause 18 deals with consultative professional committees, and again they are not executive committees. As we see in subsection (1), the Secretary of State must be satisfied that a committee which has been formed is representative of some or all of the professions engaged in the provision of care or treatment under the Health Service Acts, and that it is in the interests of the health service to recognise the committee… It would seem to be quite reasonable that, having been so satisfied, he should accept the committee and that there should not be appended a sort of postscript, which is subsection (3), saying that he can appoint additional persons, unnumbered—they may number twice as many as are already on the committee—if he so wishes. A good many acts of faith are required in this Bill on behalf of the professions. A great deal of power is left in the hands of the Secretary of State. A great many decisions are left to him, and I think this is a case where a little faith should be displayed on the other side; and that a committee of reasonable people whom the Minister has accepted as representative of their profession might be allowed to elect their own members. This would not in any way preclude a friendly Secretary of State from saying to such a committee, "Would it not strengthen your commitee to have so-and-so or such-and-such added to it?" But, as I say, to add this kind of postscript seems to me undesirable and unnecessary.

BARONESS TWEEDSMUIR OF BELHELVIE

I was aware before the noble Lord, Lord Platt, put down his Amendment of the feelings of members of his profession on this matter, as they had made representations. Perhaps I should explain why subsection (3) appears in the Bill in this form. It is left to the profession to decide whom they wish to have on this committee, but it might be helpful if the Secretary of State had the power to appoint, for example, someone—for whom I personally would have great sympathy—such as a member of the nursing profession or a consultant for a particular issue. I should have thought the power would be rarely used. I do not feel able to accept the Amendment to delete the whole of subsection (3), because I think it would be valuable to the committee were it possible for the Secretary of State to have the power to appoint one or two members. On the other hand, if the noble Lord will leave the matter with me, I should like to consider whether we could redraft the subsection and include the words, "after consultation with the profession" or something of that nature. I understand what the noble Lord has in mind, and I hope that he will understand what the Government have in mind. If he will leave it like that, I will reconsider the matter.

LORD PLATT

I think that will go a long way towards meeting the difficulties of the profession. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Clause 18 shall stand part of the Bill?

LORD HUGHES

We have had Clause 11 dealing with local consultative committees and Clause 18 dealing with national consultative committees. I wonder whether the noble Baroness could give us some further information about these committees. To a certain extent there is a possibility that the same sort of things may be discussed at local and also at national level. What sort of field of activity is contemplated? Is there some automatic way of saying that one matter shall be discussed locally and another nationally? Obviously, certain things have only a local connotation. They may refer to a particular hospital or to services in a particular area, which would be a matter to be discussed at a local committee. There are other matters which are obviously of a national character and would be for consideration at a national consultative committee. But there are so many things which do not fall neatly into either one category or the other. Is it to be left to the good sense of these committees at local and national level to work out the way to do things? Or does the Secretary of State have in mind giving some sort of guidance, particularly to local committees, about the field of their activities?

BARONESS TWEEDSMUIR OF BELHELVIE

Regarding national consultative committees, the idea was on the lines of a report of a working party on medical integration which was called Doctors in an Integrated Health Service and which was published in July, 1971. I prefer to call it a united Health Service. The working party considered the means whereby a national structure could be evolved apart from the local professional committees. The functions of a national committee would be to advise the Scottish Health Service Planning Council on the provision of health services with which that Committee was concerned, but it would not concern itself with questions of remuneration or conditions of service. The Council, on its part, would be obliged to consult the committee. There are some matters which I think are much better described in the national context than they are locally, and it is because the Secretary of State is most anxious to have professional advice that we have created both local and national committees.

Clause 18 agreed to.

Clause 19 [Common Services Agency]:

5.10 p.m.

LORD HUGHES moved Amendment No. 13: Page 11, line 34, leave out ("shall have power to") and insert ("may by order").

The noble Lord said: This clause, setting up a Common Services Agency, is a major departure from the present system. I incline to the view that it will be a change which, generally speaking, will be advantageous for the working of the Health Service in Scotland and I do not dissent from it at all. But just because it is such a major change I think it absolutely essential that Parliament should be made aware of what has taken place. This Amendment and the succeeding Amendments to the clause merely have the effect of ensuring that Parliament is made aware of it; because they require that the orders should be made. I do not even suggest that these orders should be included in those which should be subject to Negative Resolution procedure. They will be in the category of those which Members of Parliament or noble Lords can follow up if they feel inclined to, but they will not automatically be brought before them for consideration.

The one thing I was not quite certain about on Amendment No. 13 was whether it was the right procedure. I know it is perfectly correct for the Secretary of State to make an order when he is referring to functions that are carried out by other people. I am not certain whether it is correct Parliamentary procedure for the Secretary of State to make an order when it is his own functions that are involved. The first Amendment refers to the fact that the Secretary of State may transfer to the Common Services Agency certain functions which are carried out by him in a central department and controlled by his own civil servants. If it is not a permissible procedure, then we are stuck with the way it is in the Bill: "shall have power". But if it is possible to make an order on this particular part of it, then this case is particularly important, because there are certain services for which the Secretary of State has been responsible and which he has operated out of monies provided by Parliament. In that case, in one way or another Members of another place in particular have a direct opportunity at different times of the year of querying what may be done. Once the functions are transferred to an outside body such as the Common Services Agency, it is not quite the same thing. I think it would be better to have an order made by the Secretary of State rather than for the Secretary of State just to take a decision. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I think the noble Lord is addressing himself only to the first Amendment, No. 13, and not to all of them together.

LORD HUGHES

I can assure the noble Baroness that I will talk to Amendments Nos. 14 to 23 together.

BARONESS TWEEDSMUIR OF BELHELVIE

I thank the noble Lord. Therefore, while Amendment No. 13 has been moved, we are in fact discussing the principle behind Amendments Nos. 13 to 23 inclusive.

LORD HUGHES

No, not really. I deliberately addressed myself only to Amendment No. 13 because that referred to the Secretary of State's functions. The other Amendments relate to functions which are carried out by Regional Hospital Boards, boards of management and so on. The doubts that I expressed about the correctness of the procedure certainly cannot arise in connection with the other Amendments, and I should like to talk to them separately.

BARONESS TWEEDSMUIR OF BELHELVIE

I thank the noble Lord for clarifying the situation. I can quite understand his wishing that Parliament should be aware of the actions of the Secretary of State in delegating to the Agency some of the functions under the Health Service Acts, but I think it is more suitable that the Secretary of State should have power to delegate than that he should do it by order. Perhaps I should say what kind of function it is thought that he might delegate. Under subsection (2) there would be, for example, those matters which come under health education. It is not a fact that just because a matter is not brought before the House by order, even without the Parliamentary procedure of the Negative Resolution, Parliament is not aware of what is happening, because of course there is the annual report, and the Secretary of State has to be accountable to Parliament for his actions in this respect. I should have thought, therefore, in view of the large number of regulations and orders that there are already, that in this Bill we should consider it wise not to tie the Secretary of State down to take this action by another order.

LORD HUGHES

I should like the noble Baroness to have another look at this matter. It is an important part of a new procedure. While it is undoubtedly quite correct that the Secretary of State could be questioned in Parliament about it, it would be after an interval of perhaps more than a year, whereas if the order were made the subject might be raised in Parliament, not when it was old but when it was fresh. Having regard to the enormous number of regulations and orders which are going to be made under this Bill once it becomes an Act, I would very gently suggest to the noble Baroness that if she can swallow the camel that she herself is creating my few little gnats are not going to cause her much inconvenience. When one thinks of the number of orders and regulations required by the Bill, there is really no comparison between them and what I am suggesting.

I feel quite strongly on this subject. I do not propose to divide on the Amendment; I prefer to act on the basis that Divisions should be left to another place if we cannot reach accommodation with each other on these matters in this House. But I am quite certain in my own mind that in another place they would not be content to let the matter go on the basis that an order should not be made on an important matter of this kind just because the Secretary of State was already making a number of orders in other directions. It might well be that we could suggest other places where he could better do without them than in this case. I think it is right that at this stage I should withdraw the Amendment, but I intend to re-table it at the next stage of the Bill, and I ask the noble Baroness to consider the matter further in the interval because, as I say, I attach importance to it. If I do not get a satisfactory answer on the next stage I may think it appropriate to register disagreement then, but not today.

BARONESS TWEEDSMUIR OF BELHELVIE

Perhaps I can assist the noble Lord in his consideration of this matter before the next stage. I suggest to the Committee that when we are considering whether to make new procedures under this Bill subject to order we should also consider those matters which are not subject to order. I hope that this will not give the noble Lord ideas, but if he will look back to Clause 13 (1), for example, he will see that the Secretary of State has to determine by order a considerable number of matters concerning the Health Services, and that the Common Services Agency is really acting collectively. If the noble Lord has accepted that the Secretary of State is entitled to determine without a formal statutory instrument what functions may be handled by a Board, I should have thought that he would also be entitled to determine, after consultation of course, what functions could be conferred not on individual Boards, but on the Agency which acts for them in a collective capacity. I think that this perhaps might be borne in mind when the noble Lord is considering this matter later.

LORD HUGHES

Yes, I certainly will take that into account, but I am afraid that what the noble Baroness is accusing me of is an error of omission rather than commission. I will certainly look at the point to which she was drawing my attention. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

5.21 p.m.

LORD HUGHES moved Amendment No. 14: Page 11, line 39, leave out ("may")

The noble Lord said: There are three sets of Amendments which are identical: 14, 15 and 16; 17, 18 and 19; and 20, 21 and 22. The form of wording gives what is necessary to ensure that the Secretary of State proceeds by making an order rather than that he may direct. I feel that this Amendment is just as important as the previous one and if I may just talk generally about my ideas on this it will save my making another statement at the end on the Question, That the Clause stand part.

We have not had a really exhaustive statement on the kind of services which may be transferred to this central agency. Sonic things have been mentioned, for instance, the Blood Transfusion Service and the Drug Accounts Committee: those are obvious matters for handing over to the agency. There was reference to major building projects. This is a field where it is terribly important that everybody should have the best knowledge at the earliest opportunity of what is envisaged. Each of the hospital boards at the present time has its own architectural and engineering staffs and these staffs are sufficiently highly qualified to undertake a very wide range of services for their boards and for the hoards of management at, I think it almost goes without saying, a great deal less cost in fees than if the services had always to be put out to private consultants. There are a number of projects where they do not do the whole work (for instance, the Ninewells hospital project at Dundee was put out to a very distinguished architect), but even so there were very considerable functions falling to the regional architect, the regional engineer, and so on, in these matters.

If everything of importance in this direction is going to be handled by the Common Services Agency, the matters which are left may be of such comparatively trifling importance that it would be almost impossible for the Health Board to recruit staff that would serve any useful purpose. Yet it is quite obvious that the whole of the activities to be carried out which would require architectural or engineering supervision are not going to be carried out by the Common Services Agency. These are two examples: one where it is obvious that the services will go to the central body, and the other the extent to which they would be taking over functions which have been carried out over the last twenty-five years by the staffs of the Regional Hospital Boards and boards of management and also, in the same way, by the staffs of local authorities in so far as they relate to the health functions of local authorities which will be taken over. I think that public opinion, and certainly Parliamentary opinion, would be happier about this clause of the Bill if it was quite clear from the beginning that whatever was decided was going to be put in an order which could be placed before Parliament. I toyed with the idea of putting in another Amendment on this point and I have not finally made up my mind on the matter. But this should be one of the orders which should be subject to the Negative Resolution procedure, because I do think it is a very important part of the Act. At the moment, I am certainly confining my attention to suggesting that it should be an order instead of just directions. If I may offer a little bait to the noble Baroness, it may well be that if it were accepted in this form here, it might be found acceptable when it gets to another place. But if it leaves here in the form in which it appears in the Bill I doubt very much whether my colleagues in another place would proceed in the modest way which I am doing in these matters. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I hardly dare to speak after having given the noble Lord ideas on Clause 13(1). I have listened with care to what he said about this question of orders. I think that what he said about Clause 13(1) is relevant because in fact the Agency will derive its functions from a very wide range of sources such as the Health Service central bodies, Regional Hospital Boards and the Scottish Home and Health Department. It will need to be available, as necessary, to help the new Health Boards which themselves will have very different levels of resources in specialised management skills such as work study. We know that from the earlier discussion we had on the range and size of Health Boards; and I would suggest to the noble Lord that we really need a great deal of flexibility here.

Paragraphs 33 to 38 in the White Paper, which concern the Common Services Agency, contain I think a pretty clear description of the kinds of matters which will become in fact the responsibility of the Common Services Agency. Now if we were to give a rigid definition of the functions—because it would be more rigid if you have an order, and even more so if it were subject to Negative Resolution procedure—I think that Health Boards would tend to undermine what is perhaps one of the main objects of the Agency, which is to make it possible to vest substantial local authority management in Health Boards which need not themselves be self-sufficient in all management matters.

The Committee might be interested to know that we are about to circulate a discussion paper on the functions and organisation of the Agency and also that there will be a separate discussion paper on the building division of the Agency. As I think I explained on Second Reading, there will be such matters, as is made clear in the White Paper, as the Dental Estimates Board, the Drug Accounts Committee, the Central Legal Office for the Hospital Service and some of the functions of the ambulance and blood transfusion services. There might be most of the work of the Department's Research and Intelligence Unit, for example. I therefore feel, as I expect the noble Lord has gathered from the tenor of my remarks, not very anxious to accept his Amendments because we need a great deal more flexibility. I did not entirely accept what he said earlier, that one had only to wait for an annual report, for example, for Parliament to discover what was happening. I think all of us know the ease with which Members of another place are able to put down Parliamentary Questions, and indeed very up-to-date Parliamentary Questions. Therefore there is always recourse to Parliament to try to find out the extent of what is happening. However, I think that if we are to make the best of the Common Services Agency—which I am sure is what the noble Lord wishes to do—I suggest to him that we do not want to tie it down too much to have everything done by Order.

LORD HUGHES

I must confess that I do not at all follow the reasoning of the noble Baroness. It is too early nowadays to talk about "this late hour", so I cannot give that as an excuse. There is no question about making an Order requiring less flexibility. Let us look at what is contemplated in the Bill. The Secretary of State may direct that certain things may be done. Surely it is not being suggested that the Secretary of State flips lightheartedly into the office one day and says, "We had a brief talk yesterday about the Common Services Agency doing certain architectural works. Let us issue a direction about it". If the requirement was for an Order, the Secretary of State would say, "We have to consider this matter seriously over the next two or three months to decide what we are going to put into the Order". I suggest that there is nothing in an Order-making procedure that in any way inhibits the Secretary of State's need for flexibility in these matters. I accept that there is need for flexibility. What from the Parliamentarian's point of view the noble Baroness says in defence, is that if it is done in the way suggested in the Bill there is nothing to prevent the Member of Parliament, by stealth or cunning, finding out what has taken place instead of it being directed to his notice by the publication of an Order.

It seems to me that this is not a matter in which we should rely on the leakage, proper or improper, of information to Members of either House of Parliament, but that it should be openly dealt with. Therefore I cannot accept the argument of the noble Baroness. She has been helpful in certain directions and has persuaded me in others; but I am afraid in this case she fails most lamentably. I hope she will give the matter consideration. Unless she does so I am afraid I will have to pursue it further.

LORD BALERNO

I find it difficult to follow the argument of the noble Lord, Lord Hughes. The whole tendency of modern legislation is to have too many Papers and too much bureaucracy arising from the time taken for the consideration and the drafting of Papers. When these Orders come to Parliament whoever reads them? Whoever discovers what they have in front of them? How many of your Lordships study the lists of the Orders as they are issued? If they see something about Scottish health, and they are interested in Scottish health, how often do they remember to ask for the Order at the Printed Paper Office? If they were to get the Order, because it was written in "orderese", they would find it rather difficult from the jargon of the Order to discover what the Order was all about. I am all for a simple approach so that alterations are carried out on the initiative of the Secretary of State, who can be trusted not to suddenly think up an idea such as, "Let us have a change in the plan to-day and issue an edict of some kind", but who would ensure that it would come up through the Department. I am all for making the simple approach and having the maximum flexibility that comes from it.

LORD HUGHES

I do not understand hat for one moment—this must be my dim afternoon. What the noble Lord is saying is that because some noble Lords may not read the Orders and, when they do read them some noble Lords may not understand them, that this is a good reason for simplifying things. The best way of simplifying things is not to tell anybody anything. That is a very good reason for not coming here at all. We could simplify the whole matter in its entirety by staying at home and leaving it to half a dozen people on the Government Front Bench to rush things through. Instead of yesterday being the extraordinary procedure, it could become the normal procedure of Parliament. The Front Bench opposite could sit for three weeks and then rise for the rest of the year. I have never previously heard such a suggestion ever being made: "Let us simplify things by not letting people know what is happening, because if we let them know they will not read it, and if they do read it they will not understand it." I am quite certain that the noble Lord has not consulted his son in another place, because when he was in Opposition he did not treat Orders made by the previous Government in the lighthearted way that the noble Lord is prepared to deal with them here. I think I will let the matter rest at that.

THE DEPUTY CHAIRMAN OF COMMITTEES (BARONESS WOOTTON OF ABINGER)

The Question is, That this Amendment be agreed to? As many as are of that opinion will say, "Content"; to the contrary, "Not-Content". I think the Contents have it. Clear the Bar.

Tellers for the Contents not having been appointed pursuant to Standing Order No. 51, a Division cannot take place. I therefore declare that the Not-Contents have it.

Amendment negatived.

5.39 p.m.

LORD HUGHES

May I say that it is not my intention to move Amendments Nos. 15 to 23, and it was not my intention to have a Division.

Clause 19 agreed to.

Clause 20 [Co-operation between Health Boards and local authorities]:

BARONESS ELLIOT OF HARWOOD moved Amendment No. 24: Page 12, line 36, after ("another") insert ("and with adjacent authorities in England").

The noble Baroness said: I rise to move this Amendment on behalf of my noble friend Lord Inglewood, who is not here. I do so because I live absolutely on the edge of the Border and on many occasions I have noticed in connection with health services that if one lives, as I do, in Roxburghshire, or in, say, Dumfriesshire, it is important that there should be some co-operation across the Border with, perhaps, Carlisle or Northumberland. This question covers the use of hospitals, ambulance services, accident services, infectious diseases and so on. I hope that we may somehow or other get into this Bill a phrase—I do not know whether the noble Baroness can accept the wording of Lord Inglewood's Amendment—to cover a method of cooperation between the Border counties and the English counties. Often events take place which have a bearing on both, and if there are water-tight compartments and a frontier which is never crossed a lot of time can be wasted and occasionally the result can be very unsatisfactory. Therefore I should like to see the words, "and with adjacent authorities in England" added to Clause 20 in Part IV of the Bill.

LORD FERRIER

I should like to support what the noble Baroness, Lady Elliot of Harwood, has said. Had she not spoken for my noble friend Lord Inglewood, who is engaged up in Cumberland, I would have done so instead, and would have been referring to the Second Reading debate, which the noble Baroness on the Front Bench will recollect. I believe there is good substance in this proposal and I hope that she will give it favourable consideration.

LORD HOY

I should like to say a word on this particular Amendment. I had some discussion with the noble Lord, Lord Inglewood, about a similar proposal which dealt with animals in relation to the Agriculture (Miscellaneous Provisions) Act and the treatment of the disease of brucellosis. It was accepted there that of course there should be cross-Border consultation as between counties North and South of the Border. I do not know, however, that this Amendment puts the matter in quite the right way, and that is why I should like an explanation. The clause reads: In exercising their respective functions, Health Boards, local authorities and education authorities shall co-operate with one another"— and then if we put in the words of the Amendment the provision will continue: and with adjacent authorities in England in order to secure and advance the health of the people of Scotland. I should have thought that that was rather strange wording and that it was obvious that this Amendment did not fit into this Bill. But I thought it only right to say that I see the intention behind what the noble Lord, Lord Inglewood, was attempting to achieve; and it may well be that, even without having such an Amendment in the Bill at all, the noble Baroness, Lady Tweedsmuir, can give us an assurance that what is sought by the Amendment is in fact taking place.

BARONESS TWEEDSMUIR OF BELHELVIE

For the exact reasons which the noble Lord, Lord Hoy, has adduced from reading the Bill, I am afraid that I cannot accept this Amendment, although I certainly accept the spirit behind it and the reasoning of both my noble friends Lady Elliot of Harwood and Lord Ferrier. Happily this Amendment is unnecessary, because in fact co-operation between health authorities over the Borders takes place quite considerably. It is really a matter of administration. If there was ever any real difficulty the Secretary of State could in the last resort use his powers of direction. However, to give some examples, there is a co-ordinating committee covering the relevant areas of the Newcastle region and Dumfries, and the senior administrative medical officer of the Western Regional Hospital Board is a member of this committee. In 1969, the last year for which figures are available, around 400 persons from Cumberland and Northumberland received in-patient treatment in Scottish hospitals. Therefore, there is co-operation. It is for this reason, and because Clause 20 is specifically designed, as the noble Lord said, to advance the health of the people in Scotland, that I hope that the noble Baroness, Lady Elliot, will withdraw the Amendment.

BARONESS ELLIOT OF HARWOOD

I have much pleasure in asking leave to withdraw the Amendment. I am glad to hear that the noble Baroness believes in co-operation over the Borders.

Amendment, by leave, withdrawn.

5.45 p.m.

On Question, Whether Clause 20 shall stand part of the Bill?

LORD HUGHES

I do not intend to say very much about this clause. It seems to me. however, that this is just one of these pious declarations which do not mean anything at the end of the day. The clause says: In exercising their respective functions, Health Boards, local authorities and education authorities shall co-operate with one another in order to secure and advance the health of the people of Scotland. No machinery of any kind is laid down for co-operation and there are no penalties. If any local authority does not pay any attention to this provision it does not make the slightest difference, unless we can be told that the Secretary of State would direct. What was said in relation to the Amendment which was withdrawn was helpful, because the noble Baroness, Lady Tweedsmuir, was able to point out the degree to which co-operation existed and the extent to which the Secretary of State might exercise powers if necessary. But there is no question, apparently, of any powers in relation to this provision. It is just an expression of something which is right. It is right to say that people should co-operate with each other in order to further the health of the people of Scotland. But will it go any further than that, or is there any means of ensuring that this provision becomes operative, rather than being simply something which ought to be operative?

BARONESS TWEEDSMUIR OF BELHELVIE

This provision is put in the legislation in order to draw attention to the imperative need for co-operation. We have a joint Working Party comprising officials of the Scottish Office and members who are nominated by the local authority associations, dealing with three main areas in which co-operation is necessary: public health, social work, and school health. The Working Party were glad that this particular provision was put in the Bill because it lays a duty on those concerned to co-operate and it is not just left to practice, although it is true that the relationship between those concerned is usually very good. This provision does make it a statutory duty.

Clause 20 agreed to.

Clause 21 [Designated medical officers]:

LORD HUGHES moved Amendment No. 25: Page 13, line 2, leave out ("designated").

The noble Lord said: At the last stage the noble Baroness referred to the fact that one of the unfortunate factors about this co-ordination and joining together of services was that the long-established and highly respected title of "medical officer of health" would disappear. I cannot say that I am happy with what the Government propose to put in its place. In Clause 21 there are a number of references to the man who will be the successor to the medical officer of health, and he is to be known as the "designated medical officer". It is only a year since the Government brought in another piece of legislation to get rid of the nonsense which had persisted for half a century or more of having a sheriff called a "sheriff substitute", and in the end they took out the word "substitute" and the sheriff is now known legally, as everybody has regarded him as being throughout the years, as "sheriff". To call a man a "designated medical officer" is just to introduce another of these terms. It is almost as if one were saying, "He is not the real thing. We do not have it now, but he is a man whom we shall call a medical officer. He is the 'designated medical officer'." I do not think that that would be proper. My first intention was to table an Amendment along the lines that any such medical officer shall be known in any enactment as "the medical officer of health", just to preserve the old title; but it seemed to me that perhaps it was wrong because the job is not the same as it was before and the medical officer of health at the present time has duties which hear no relationship to what the medical officer of health might have done 25 or 50 years ago. However this is a major change and I think it is perhaps regrettably necessary that the title should be dropped, but I can see no reason for giving the man what in effect is an insulting title and calling him the "designated medical officer of health". My Amendments numbered 25 to 29 and a subsequent consequential Amendment are designed just to leave out the word "designated" so that this officer shall be known as the "medical officer". I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

If only the noble Lord, Lord Hughes, had known, I seized on the word "designated" very early on because I agree with him that it is an unlovely word and I asked why it was used here. As the noble Lord has rightly said, the traditional medical officer of health will alas! disappear under this Bill and the reason why the words "designated medical officer" are used to identify clearly the officer concerned is not only because of this Bill but, as subsection (2) of Clause 21 makes clear, for the purpose of any enactment, and Part II of Schedule 5 of the Bill inserts references to the "designated medical officer" in a variety of Statutes which are mainly in the field of public health; and merely to leave the term "medical officer" I suggest would cause a great deal of confusion. For instance, a medical officer is defined in the Education (Scotland) Act 1962 as "any duly qualified medical practitioner employed by an education authority". Therefore we need a precise definition.

While I cannot accept the noble Lord's Amendments at the moment because they merely delete the word "designated" and leave the words "medical officer", if he or any other member of the Committee can suggest a better name I would consider such an Amendment because I think it would be a big improvement. I cannot accept the Amendment as it is now.

LORD HUGHES

I think I can offer right away in manuscript form a simple alteration which would meet the purpose; namely, to leave out the word "designated" and move the inverted commas from in front of the word "medical" to in front of the word "the". There is quite a difference between "the" medical officer and any medical officer, because this specialises him. If that is not acceptable then I would submit that the noble Baroness has conceded the point that the title suggested in the Bill is objectionable and ought not to persist. She has at her disposal resources very much greater than mine. Their imagination is just as fertile as mine and I would suggest that in this case they apply their fertility to an effort to produce something lovely instead of something which is the very reverse. If the noble Baroness will give me an undertaking that she will find an alternative I should be quite content if she tables an Amendment at the next stage. But if she comes along to me two or three days before the next stage of the Bill and says, "We are at our wit's end; we have not been able to think of a suitable alternative", then I will endeavour to assist her.

BARONESS TWEEDSMUIR OF BELHELVIE

I think that is a very fair offer, but I must leave the word "designated" in the Bill at the moment because I must have a precise definition of this particular medical officer and of the duties that he will have to perform. I will certainly look into the matter because I do not like the name myself. I do not say that it is wrong because in fact it achieves its purpose. I will "have another think", but I cannot promise to be successful.

LORD HUGHES

May I make another suggestion for consideration? While it may be that in any enactment he should be known as the "designated medical officer" could there not be added some other forms of words for the purposes of the Health Boards, or whatever it may be, such as "the such-and-such medical officer" or simply "medical officer"? I can see the need for this wording in relation to other Acts, and that I do not mind because people will not go round with copies of the Act showing that they are called "designated medical officers". What is important is that they should have a title which would be in every day use and would be recognised by the Statutes. However, I now beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 21 agreed to.

Clause 22 [Supply of goods and services to local authorities, etc.]:

On Question, Whether Clause 22 shall stand part of the Bill?

LORD HUGHES

In subsection (1)(a) of Clause 22 there is provision for purchasing and storing, and so on, such equipment, goods or materials as may be prescribed". The first question I want to ask is whether the Minister can give some indication as to what sort of equipment, goods or materials are contemplated as having been provided under the law as it stands at the present time and pressumably would be continued, and to whom they are to be supplied?

Secondly, coming back to a "Conesford" type of point, what is the need to talk about "goods or materials"? In what way do they differ from each other? I should have thought either one of these words would serve the same purpose. Having started on this track my curiosity led me into this clause and I wondered why it was necessary to put it in three words instead of in one.

BARONESS TWEEDSMUIR OF BELHELVIE

The equipment, goods or materials described in paragraph (b) of Clause 22(1) are such things as disposable sterile syringes, needles (which must continue to be supplied to family doctors) or any other item where central purchasing may save expense. This is where "equipment" has been added to this provision and I should perhaps say that only prescribed items can be supplied and the regulations here would, in terms of Clause 53, be subject to Negative Resolution.

LORD HUGHES

What about the goods and materials?

BARONESS TWEEDSMUIR OF BELHELVIE

Materials, for example, would consist of bedding; and goods would consist of needles or disposable syringes.

LORD HUGHES

Could not the noble Baroness just as easily put it the other way round? I do not think it matters. Could not all the items which she has described be classified as goods or materials? Presumably none of them comes into the category of being spiritual.

LORD CAWLEY

I think the noble Baroness has forgotten the Mechandise Marks Act, where all those items are defined as goods.

LORD HUGHES

I doubt whether the noble Baroness has ever even heard of it.

BARONESS TWEEDSMUIR OF BELHELVIE

I really must refute that suggestion.

Clause 22 agreed to.

Clause 23 [Assistance to voluntary organizations]:

On Question, Whether Clause 23 shall stand part of the Bill?

LORD HUGHES

Clause 23 deals with assistance to voluntary organisations, and I think was generally welcomed at Second Reading. It makes provision for assistance, by making available furniture, vehicles or equipment (whether by way of gift, loan or otherwise)". The thought occurred to me why does it not go the whole hog? Why are the voluntary organisations not given the opportunity, which might well be a useful way of assistance, of being given goods, and even materials?

BARONESS TWEEDSMUIR or BELHELVIE

This is exactly what this clause is designed to do. For instance, the W.R.V.S. would be a particular voluntary organisation that could have furniture, vehicles or equipment, either by gift, loan or otherwise—"otherwise" being a commercial transaction—and it is in order to help the voluntary organisations that this clause is here.

LORD HUGHES

The noble Baroness has missed my point. Why should they not be eligible also to receive by way of gift, loan and so on, goods and materials? Furniture is a special type of thing; vehicles are a special type of thing. "Equipment" is not intended to include goods and materials, because in the previous clause equipment is mentioned in addition to goods and materials. It seems that as Clause 23 stands an organisation can be given furniture, vehicles or equipment; but it might well be that the best way of helping a voluntary organisation at a particular time would be to give them certain articles which could not come into any of these three named categories. It seems to me this may have been an accidental omission, rather than a deliberate intention to confine assistance to those particular items. I wonder whether the noble Baroness would like to have a look at this point, if she is not in a position to answer to-day.

BARONESS TWEEDSMUIR OF BELHELVIE

I can say why the goods and materials in which the noble Lord is interested are not included here. It was because it was thought unlikely that there would be any need for the Secretary of State to have a general power to supply goods and materials for voluntary organisations. But he has power under Section 32 of the 1968 Act, as amended by paragraph 36 of Schedule 5 to this Bill, to supply generally goods produced by him in the course of providing health services. He could do it, but not actually under this clause.

LORD HUGHES

On that basis he could provide them with the furniture and vehicles and equipment also. Why, if he can do this under the other power referred to is it necessary to specify them here? It seems to me that it is not going to mean a general supply of furniture, vehicles and equipment to voluntary organisations; some of these organisations will get nothing of this kind. It is only an enabling power that may be exercised, and it seemed to me there was no reason why goods and materials should not be included. I shall probably put down an Amendment at the next stage along those lines, because I cannot imagine that the Secretary of State would not want to have this power. There is nothing to compel him to exercise it. An Amendment to this effect would carry what is otherwise a very admirable clause in relation to voluntary organisations the whole way along the road instead of stopping when 90 per cent. of the journey has been accomplished.

Clause 23 agreed to.

Clause 24 [Dissolution of Boards, etc.]:

On Question, Whether Clause 24 shall stand part of the Bill?

6.4 p.m.

LORD HUGHES

Clause 24 deals with the dissolution of existing bodies, and I will read a note on the point which has been drawn to my attention: Executive Councils concerned with general practitioner services are to be dissolved and the powers transferred to the Health Boards. In earlier consultations the Regional Hospital Boards were given to understand that it was unlikely that the same procedure would be followed as proposed in England; that is, that a separate committee for the purpose of considering general practitioner matters would be set up within the Health Boards. There is little or no reference to this in the Bill as it stands, but the adjustments and amendments referred to in the Schedules do not make it clear that the provisions in the 1947 Scottish Act dealing with the affairs of general practioners are being repealed. Consequently, it would still be possible under regulations for a General Practices Committee to be instituted. I must admit that I do not know anything about this subject. This is a representation which has been made to me. I wonder whether the noble Baroness would care to comment on that extract I have read from a letter which I have received.

BARONESS TWEEDSMUIR OF BELHELVIE

In actual fact the Scottish Medical Practices Committee will remain as an independent body, and that is why it is not referred to in Clause 24, which concerns the dissolution of various bodies that are named. Perhaps I should also mention, to clarify the matter, that the Scottish Dental Estimates Board will also remain, as will the National Health Service Tribunal.

Clause 24 agreed to.

Clause 25 [Rights and liabilities of Regional Hospital Boards and Boards of Management]:

On Question, Whether Clause 25 shall stand part of the Bill?

LORD HUGHES

This clause deals with transfer of property rights and so on. I am also looking at Clause 26, and I am seeking information. Clause 25 transfers the rights and liabilities of a Regional Hospital Board or Board of Management to the Health Board. Clause 26 transfers all interests in property, heritable or moveable, and all rights and liabilities of Executive Councils to the Secretary of State. I wondered about the omission of property from Clause 25. Is it the case that the Regional Hospital Boards and the Boards of Management do not in fact exist as owners of any property? Is the property at the present time of Regional Hospital Boards and Boards of Management in its entirety already the possession of the Secretary of State? Is that the position?

BARONESS TWEEDSMUIR OF BELHELVIE

The position is that all hospital property is already vested in the Secretary of State, and that is why it is not included.

LORD HUGHES

I am grateful to the noble Baroness.

Clause 25 agreed to.

Clauses 26 and 27 agreed to.

Clause 28 [Staff Commission]:

On Question, Whether Clause 28 shall be agreed to?

LORD HUGHES

Clause 28 refers to the setting up of the Staff Commission, and this follows the practice that has already been followed in connection with other Acts of Parliament. May I have some information as to the sort of body which this Staff Commission will be? From what sort of people will its membership be drawn; and what size of body is contemplated here? I must admit that if I had more time I probably could have obtained the answer by finding out about other Staff Commissions, but time did not permit. I thought that many people would be interested in this point, and perhaps the noble Baroness can answer it. It would be useful to have it on the Record.

BARONESS TWEEDSMUIR OF BELHELVIE

It is thought that the body, like other similar bodies, would be quite small, probably with about three persons. As we are discussing it on the Motion, That the clause stand part, I should like to take this opportunity to say that the great majority of staff will continue to perform the same duties as before in the same place, and that the united service (or integrated service, to give it its correct name) will, I think, also give a chance for many officers to develop and perhaps to hold more senior posts later on. I wanted to say this because I did not want there to be any feeling of unease. We are taking a great deal of care over the whole question of the position of staff, and this is why the Staff Commission is being established.

Clause 28 agreed to.

Clauses 29 to 31 agreed to.

Clause 32 [Transfer of staff employed for purposes of public health]:

On Question, Whether Clause 32 shall stand part of the Bill?

LORD HUGHES

In Clause 32(5) we read: In this section, 'public health functions' means the functions specified in Schedule 4 to this Act, and 'local authority' means a county council, a town council or a port local authority. In other clauses of the Bill there is a reference to a local authority in or for the area or district concerned", which seemed to me to be a rather useful way of referring to local authorities, because it could cover the authorities that exist at the present time, such as county councils or town councils, but it would equally cover the new authorities which may be set up if the legislation for the reorganisation of local government takes effect. It would cover a regional council, or a district council, under whatever name they may become known, and there would not need to be any subsequent amendment. I wondered why in this particular connection a local authority is defined in terms which can apply only to an existing one. The answer that has occurred to me is that this is a once-for-all thing. This transfer will take place before reorganisation comes about, and therefore any change in local government that may take place in the future has no effect on this clause at all. Am I right in assuming that that is the way it has been done? Having said that, I now know I am right, because of the nodding in the Box as I was asking the question.

BARONESS TWEEDSMUIR OF BELHELVIE

The brief answer to that is that the noble Lord is correct.

Clause 32 agreed to.

Clauses 33 and 34 agreed to.

Clause 35 [Supplementary order making powers]:

6.13 p.m.

BARONESS TWEEDSMUIR OF BELHELVIE moved Amendment No. 31: Page 21, line 1, after ("Any") insert ("direction or").

The noble Baroness said: I beg to move Amendment No. 31. It might be for the convenience of the Committee if we could discuss Amendments Nos. 32, 33, 34, 35 and 36 together. These are drafting Amendments to Clause 35, which empowers the Secretary of State to make supplementary provision for various matters in connection with the transfer of staff from existing health authorities to the employment of Health Boards or the Common Services Agency. Matters of this kind are the determination of questions about the work on which a member of staff is wholly or mainly employed in the preservation and continuity of service for pension and other purposes. As at present drafted, such supplementary matters are to he covered in an order made under Clauses 29 to 34. There is, however, no order-making power under Clause 29, which provides for the transfer of hospital staff, or Clause 30 which provides for the transfer of Executive Council staff. In both cases the Secretary of State's relationship with the authorities concerned seemed to make it better to confer a direction-making power. That being so, the supplementary matters for which Clause 35 makes provision will, in these cases, be dealt with by a direction. It is therefore for this reason that it is necessary to refer to "direction or order" in Clause 35, and the Amendments add references to direction at the correct points in the clause. I beg to move.

LORD HUGHES

The noble Baroness has been helpful from time to time, and I look forward to favours yet to come, so I will not be awkward on this.

On Question, Amendment agreed to.

BARONESS TWEEDSMUIR OF BELHELVIE

I beg to move Amendments Nos. 32, 33, 34, 35 and 36 en bloc.

Amendments moved—

Page 21, line 6, after ("the") insert ("direction or").

Page 21, line 7, ("Any") insert ("direction or").

Page 21, line 8, at end insert ("direction or").

Page 21, line 12, after ("any such") insert ("direction or").

Page 21, line 16, after ("the") insert ("direction or").—(Baroness Tweedsmuir of Belhelvie.)

On Question, Amendments agreed to.

Clause 35, as amended, agreed to.

Clause 36 [Compensation for loss of employment, etc.]:

On Question, Whether Clause 36 shall stand part of the Bill?

6.18 p.m.

LORD HUGHES

Another part of the letter which I have received from the Regional Board refers to Clause 36, the compensation arrangements. I think it would better serve the purpose if I were to read the relevant part of the letter. An invitation has been extended to Regional Boards to comment on the proposed compensation arrangements to he utilized in connection with the National Health Service reorganisation, which it is understood is to be dealt with under the conditions of the Crombie Code. The Crombie Code is applied generally to public service bodies in matters of compensation, but the Regional Board is representing to the Secretary of State that while such a Code may be reasonable in application to persons found redundant in a specified sphere of occupation, it may be unfair to certain employees in the National Health Service where they may be called upon to accept a post elsewhere than in their present Region, failing which they may jeopardise their entitlement to compensation. This may particularly be so in the case of architectural and engineering staff whom it is at present proposed to place under the Central Services Agency sited in Edinburgh. Although some of the staff may well remain in their present locality others may be offered posts elsewhere beyond their present Region and if, for their own good reasons they do not accept, their rights to compensation may be prejudiced. It is contended that such officers entered into a contract of service providing for their employment within a Region, whereas they may now be required to enter into a National Service with employment beyond their present boundaries. The Regional Board feels that special consideration should be given to officers placed in this position. I wonder whether the noble Baroness would care to comment on that.

BARONESS TWEEDSMUIR OF BELHELVIE

We hope that Clause 36 makes it clear that we are being very careful over the whole question of compensation. The regulations which on compensation will be made will be subject first of all to the Negative Resolution procedure. Perhaps I should say here that in practice most staff will be transferred with their present jobs, and we hope there will be hardly any redundancy at all. It is true that some people, particularly in the administrative posts, may have alterations, either upwards or downwards, in their duties or in their grading.

That is why this clause makes provision for compensation, and it follows the provision made by Section 35 of the 1968 Act for persons affected by executive council or hospital board reorganisations within the present structure. It is not possible to fix the final staff establishments or to assess compensation by the appointed day, and that is why power is given to make the regulations retrospective, because we are determined that no individual shall suffer adversely. I hope that that assurance will give some assurance.

LORD HUGHES

So it would be possible for full consideration to be given to the position of an individual who, for reasons which were very good from his personal point of view, did not wish to accept a post which meant his travelling to another area altogether. He would not necessarily suffer in his compensation terms, through leaving the Service rather than taking that other appointment. It that the posiion?

BARONESS TWEEDSMUIR OF BELHELVIE

Yes.

LORD HUGHES

I am grateful to the noble Baroness.

Clause 36 agreed to.

Clauses 37 and 38 agreed to.

Clause 39 [Transfer of Rights held under the Hospital Endowments (Scotland) Act 1971]:

6.21 p.m.

BARONESS TWEEDSMUIR OF BELHELVIE moved Amendment No. 37: Page 23, line 11, after ("of") insert ("rights in relevant").

The noble Baroness said: This is a drafting Amendment. Clause 39 is concerned with the transfer of rights in certain endowments from existing hospital authorities to Health Boards. These endowments were transferred by virtue of the Hospital Endowments (Scotland) Act 1971 to the Scottish Hospital Trust which will manage the capital and distribute the income to hospital authorities. Existing hospital authorities technically therefore hold rights in such endowments but not in the endowments themselves, and the opening words of Clause 39(1) recognise this fact. However, subsection (2), which deals with the case where areas of existing hospital authorities are divided between one or more Health Boards, ought to refer similarly to "rights in relevant endowments". The reference to "income" is however correct, because income (including accumulated income) becomes the property of the hospital authority. I beg to move.

On Question, Amendment agreed to.

Clause 39, as amended, agreed to.

Clauses 40 to 44 agreed to.

Clause 45 [Extension of definition of infectious disease]:

On Question, Whether Clause 45 shall stand part of the Bill?

LORD HUGHES

The rubric to this clause is, "Extension of definition of infectious disease. 1889 c. 72." It seems a wholly unexceptionable clause apart from its length, which is probably necessary, but I wonder whether we can be told what it means. What is the extension?

BARONESS TWEEDSMUIR OF BELHELVIE

Clause 45 substitutes a new provision for the present Section 7 of the Infectious Disease (Notification) Act 1889. This enabled a local authority in their area to apply the Act to a disease other than those which are specifically listed in the Act as infectious diseases. As local health authorities will disappear with this Bill, it is necessary to re-allocate the function of adding to the list of infectious diseases. That is the aim of this clause.

LORD HUGHES

It has arisen only from the creation of the new bodies? The title appeared to mean that some diseases which at the present time are not regarded as infectious are going to become so. But I understand that that is not the position, and that it is simply a question of the new structure.

BARONESS TWEEDSMUIR OF BELHELVIE

That is correct.

Clause 45 agreed to.

Clause 46 [Power of Secretary of State in an emergency]:

On Question, Whether Clause 46 shall stand part of the Bill?

LORD HUGHES

Clause 46 seems to be giving a very extensive power to the Secretary of State, although it may be a very necessary power. It states: If the Secretary of State is of the opinion that an emergency exists, and thinks it necessary in order to secure the effective continuance of any service under the Health Service Acts, he shall have power to direct that any function conferred by or under those Acts on any body or person shall, during the period of the emergency, be performed by such other body or person as he may specify in the direction. That is a very wide power indeed. It enables him to supersede any of the arrangements which are being made in the Bill for the carrying out of the health services. I am not prepared to say that it is not an essential part of a Bill such as this, but I should like to ask what sort of emergency might call into being the exercise of a power of this description?

LORD PLATT

Before the noble Baroness replies, may I say that I was going to ask whether this clause is really necessary, because I suppose that any Secretary of State has powers for a time of emergency and that they can be very widely used. I assure your Lordships that, with slight reservations, I have implicit faith in the wisdom of the Secretary of State, but I do not like giving my assent to what I think is absolute nonsense. Speaking as a legal layman, it appears that the Secretary of State can direct an engineer to perform an operation for a hernia or something of that kind. I do not think that is really what it means, but if that is what it means I do not want to vote for it. That is all.

BARONESS TWEEDSMUIR OF BELHELVIE

The reason for this clause is to try to fill what is at present a gap in the powers of the Secretary of State. Under Section 56 of the 1947 Act, which is being kept with some modification, he has power after an inquiry to declare a Health Service body to be in default or to authorise any person to act in its place until a new body is appointed. We felt that this was really much too blunt and unnecessary, and in that respect I have sympathy with the noble Lord, Lord Platt. But the Secretary of State has no power, for example—and this is the reason behind the clause—to take quick action where health services are temporarily in danger of break ing down. The noble Lord, Lord Hughes, asked me to give an example. It is very difficult to foresee a certain kind of emergency, but, alas!, one which comes to us sometimes is a major civil emergency caused by widespread flooding, which we have had in Scotland. In such a case it might be necessary to put all the National Health Service rescue services under the control of a particular body or persons, or to put some of the services run by a small Health Board under the control of a larger one. Or following a breakdown in communications, perhaps after a serious fire with destruction of buildings, it might be necessary to transfer control of an ambulance depot from a common services agency to a Health Board. Obviously, we hope that this power will never need to be used, but we feel it is necessary that the Secretary of State in a reformed National Health structure should have this power only for an emergency.

LORD PLATT

Is it not a fact that, under conditions of emergency, the Secretary of State could act in that way without Clause 46? If it is not a fact and if some such clause must be put in the Bill, may I make a plea that it should be re-worded, so as to make it mean some sense instead of nonsense?

BARONESS TWEEDSMUIR OF BELHELVIE

I shall look to see whether it needs rewording. It seemed to me that it was fairly clear, but I will take into account what the noble Lord has said.

LORD HUGHES

May I ask one other question in connection with this matter? Assuming that a situation arose of, say, the kind which unfortunately we have had on at least two occasions in the North of Scotland, of extensive flooding which has interfered with the ordinary and smooth operation of services, presumably the cause would be of such a nature that the Secretary of State would be making a Statement about it anyway in Parliament, and if this were the case he would presumably be making a reference to any such action that he was taking under this clause. I would prefer, as the noble Lord, Lord Platt said, if it were worded a little better than it is. Perhaps it is rather unfortunate that we should be considering this at a time when we have been invoking the awesome machinery of Regulations under the Emergency Powers Act 1920. Obviously it is not that kind of thing which is in mind, but something which is perhaps a halfway house towards it, perhaps with the same seriousness but only in a particular area. I would prefer a better form of wording if it were possible to make it a little clearer what is meant, rather than the suggestion of a wholesale collapse, or even the dreadful thought which occurred to the noble Lord, Lord Platt. What did not occur to him and what might be even worse is if a surgeon had the job of trying to stoke the boilers. The results might then be even more disastrous. In any event, I assume that the least we can expect is that there will be confirmation of the fact that, if such powers were exercised, it would not be done by stealth but would he the subject of part of a Statement which would be made, in the course of which the Secretary of State would refer to what he was doing by virtue of the powers given by Clause 46.

Clause 46 agreed to.

Clauses 47 to 52 agreed to.

Clause 53 [Regulations, orders and local enactments]:

6.33 p.m.

BARONESS TWEEDSMUIR OF BELHELVIE

This Amendment is to correct a minor misprint in the Bill. I beg to move.

Amendment moved— Page 30, line 30, leave out ("39(1)") and insert ("39(2)").—(Baroness Tweedsmuir of Belihelvie.)

On Question, Amendment agreed to.

On Question, Whether Clause 53, as amended, shall stand part of the Bill?

LORD HUGHES

I have a feeling that I ought not to be asking this question because, as a former Minister, I ought to know the answer—but I do not. I have often wondered about it, but have never asked it before. Subsection (5) of the clause reads: Any power to make regulations under this Act shall, if the Treasury so direct, not be exercisable except in conjunction with the Treasury"— the sort of thing which is the bane of all Ministers' lives. What exactly does "the Treasury" mean in this connection? Does it mean tile Chancellor of the Exchequer or a financial official? Or does it mean the denizens of some building who issue instructions, and more frequently embargos, from time to time? Who are "the Treasury" in legislation?

BARONESS TWEEDSMUIR OF BELHELVIE

I think that everybody would like to know who are "the Treasury", but in actual fact this is an exactly similar provision to that which is contained in Section 73(3) of the 1947 Act, which was of course designed by the noble Lord opposite. It is a formal expression which is always used in such a Bill.

LORD HUGHES

I know. It has appeared in hundreds of thousands of Bills: but what does it mean? Are they Ministers or are they officials? We all take it for granted. Every time it appears we say, "Yes, it is always there; we have seen this before, and we shall see it again and again". But I have never spoken to anybody who could tell me exactly what it means. Perhaps it is unfortunate that my noble friend Lord Diamond has gone, although I did not tell him that I was going to ask about this.

BARONESS TWEEDSMUIR OF BELHELVIE

As I understand it, when it says that it must be exercisable in conjunction with the Treasury it is perfectly clear that it could not be just officials, because the decision as to whether these shall be public expenditure is of course a decision made by Ministers. Therefore, virtually it is the Chancellor of the Exchequer, or his Ministers acting on his behalf.

LORD HUGHES

I am grateful to the noble Baroness. I wonder whether she would carry it a little further. Would she in due course write to me, giving a very nice explanation of the answer to this point in writing so that in due course, when other people ask me, I shall be the only person other than herself who can give the answer?

LORD CAWLEY

I think I must call attention to this subsection. It is the most terrible piece of "gobbledygook". What it ought to have said is: Any power to make regulations under this Act shall not be exercisable except with the leave of the Treasury. What on earth this is all about—"if the Treasury so direct"; "not be exercisable"—I do not know. It seem to me that you could say it in half the number of words.

BARONESS TWEEDSMUIR OF BELHELVIE

I am always willing to listen to an improvement of English, but this was in fact taken out of the 1947 Act, as I think I explained.

LORD HUGHES

That does not alter the fact that it might have been wrong and bad in 1946.

Clause 53, as amended, agreed to.

Remaining clauses agreed to.

Schedule 1 [Health Boards and University Liaison Committees]:

6.37 p.m.

LORD HUGHES moved Amendment No. 40: Page 33, line 10, at end insert ("and of these other members not less than one third shall be members of local authorities in or for the area or district concerned and not more than one third shall be medical practitioners").

The noble Lord said: If we insert the words printed in this Amendment, it would mean that the paragraph would read: A Health Board shall consist of a chairman appointed by the Secretary of State and such number of other members so appointed as the Secretary of State thinks fit and of these other members not less than one third shall be members of local authorities in or for the area or district concerned and not more than one third shall be medical practitioners". It was laid down in the 1947 Act that not more than a certain proportion of the members of a Regional Hospital Board should be medical practitioners, and that is the reason why I have included that particular provision, but I must admit that my main object was to ensure that a specified part of a Health Board should be members of local authorities. There have been very considerable representations (as the noble Baroness will know because she met the local authority associations there) that should have the right to nominate members of Health Boards. This I think was the second line of attack or approach from the local authorities, because the first idea was that Health Boards should be elected bodies. For reasons that I need not go into, I do not think any- body regarded that as a point seriously to be pursued having regard to the other bodies being elected and other bodies which may fall to be elected if reorganisation takes place.

The second point—and this was particularly stressed, I think, when she met the Counties of Cities Association—is that the four cities were all strongly of the view that they should have the right to name a member or members of the appropriate Health Boards. I have never disguised the fact that I do not agree that the Secretary of State should be obliged to accept nominations of membership from particular bodies. These Boards in some cases will cover wide areas and may include in their memberships a large authority and a number of smaller authorities. All the experience of the past goes to show that where there are rights of appointment to bodies, they nearly all fall to the big authorities, with the smaller ones either getting no share or figuring in the list only once in a very long time. Yet the noble Baroness knows as well as I—and it would be invidious to mention names—that some of the most effective members of the present Regional Hospital Boards come from small authorities. They are there really by virtue of the service they have given to small local authorities; and this is what has brought them to the notice of the Secretary of State in the first place. If they had had to depend upon getting a nomination from the Local Authorities Association then almost certainly they would not be members of the Regional Hospital Board.

I think it better that the Secretary of State should receive from local authorities nominations to be considered for membership of these Health Boards so that he should have the widest possible choice. But I think that we can go a certain way to meet what I believe the local authorities undoubtedly regard as a legitimate position for them to adopt. If we do not give them the right to name the actual members we should make it quite certain that a specified part of the membership will come from local authority nominations. I have suggested one-third. I am certain that if I had consulted the local authorities about this matter they would probably have argued for a much higher proportion. While my own experience shows that some of the most effective members on a body of this kind are undoubtedly those with local authority experience, the fact remains that there are also some exceedingly good members from other bodies.

I should not like to tie down the Secretary of State to the position that even a half of the membership should come from local authorities; but considering that a membership of fifteen may be the average for these Boards (the figure might be between ten and twenty) this means that from four to six members would be local authority members. Almost all the organisations cover an area with a fair number of local authorities in them, county councils and town councils, at the present time, regional councils and a number of district councils; so it would be difficult to stipulate what would be considered an adequate membership from the local authorities. I do not want to use the phrase "adequate representation" for they are not there as representatives of their local authorities. A figure of less than one-half does not circumscribe the activities of the Secretary of State in any unreasonable way; but I think that it will give an assurance to the local authorities which they at present do not have. We must remember that this is not just a case of switching from Regional Boards, boards of management and executive councils to the new Health Boards but also of transferring some of the oldest functions, and some comparatively new ones, of local authorities to these bodies. I think it would be helpful if they could be satisfied that when the new bodies were set up, while they would not know who the members were going to he and had no right to say that "X", "Y" or "Z" should be a member, they should know that a given proportion of the membership would be people elected to public office in the area; so that, indirectly perhaps there would be people who in some way might be held to be in the public eye. It does not always work like that; people do not always associate Councillor "X" with membership of another body; but sometimes they do.

For that reason I want the first part of this Amendment to be accepted. The second part is just a continuation of the existing procedure; because these bodies are engaged in so wide a field of activity concerning the general public. One speaker during the Committee stage said that one of the extraordinary things about this Bill is that nowhere in it does the word "patient" occur. After all, the Bill is for the purpose of the patients; not for the doctors and the nurses. If the patients were not there we should not be needing the legislation. It was felt in 1947 that these bodies (the Regional Hospital Boards, for instance) should not be dominated by the medical profession. It should be made equally clear in this case that the same position exists. A Bill of this length may possibly contain a restriction to that effect which perhaps is carried over from the old Act. If so, I apologise for having raised the matter; but I have not seen it. I think it desirable that there should be these two figures, one laying down the number of local authority people who should be in and the other restricting the number of medical people who should be in.

LORD SEGAL

Before the noble Baroness replies, can she clarify the position where one of the elected members of the local authority happens to be a general practitioner? It has occurred quite often. One hopes that it will not entail his prior removal from the medical register. Would it not be more in keeping with the intention of the Amendment if it stated that not more than one-third shall be nominated medical practitioners?

LORD PLATT

I hope that we shall not agree with this Amendment. I am sorry to say this to Lord Hughes. On principle, I am against all this laying down that "there shall be three" or "there shall be four" or "there shall be two-thirds". What about half the Health Board being women?—nobody has suggested that yet. If we go on from Paragraph 2 to Paragraph 3 of the Schedule we see that the Secretary of State makes these appointments after consultation with the county councils, the town councils, the universities, the nurses' profession and other professions that he considers appropriate and such other organisations. If at the end of those consultations he has to fill at least one-third of the places with local authority people, his hands are being tied. What is more—I do not know what happens in Scotland and perhaps I have no right to talk about; but I do know something about what happens in England—most prominent citizens in many English towns are not members of local authorities at all but are citizens in various walks of life—in the law or, for that matter, in medicine.

As to the second part of the noble Lord's Amendment, in general I would hope that a Health Board would have no more than one-third of its members as medical practitioners. I do not think it is the intention behind the Bill or the original National Health Act that a Health Board should consist largely of medical men. For the same reason as I am against saying that at least one-third of the members should be local authority people I am against saying that not more than one-third should be medical men. If we leave this to the Secretary of State I think that we shall get a much better result. Having read this clause and found that there is no duty on the Secretary of State to appoint a single medical man to a Health Board I would ask the noble Baroness for some assurance that there will be some likelihood of adequate medical representation; and that is almost the opposite of what the noble Lord, Lord Hughes, seems to desire.

BARONESS TWEEDSMUIR OF BELHELVIE

I am very grateful to noble Lords who have spoken. I thought that the noble Lord, Lord Platt, exactly described the reason why I fear that I cannot accept the Amendment of the noble Lord, Lord Hughes. Our White Paper on The Reorganisation of the Scottish Health Services stated in paragraph 17—this specifically refers to our thinking on the appointment of members of the Health Boards: Although members will be appointed for their personal qualities and not in a representative capacity, it is clearly desirable that they should be drawn from a wide range of experience including the health professions and local government. Therefore I can say to the noble Lord, Lord Platt, that certainly there will be representatives from the health professions and from local government. The noble Lord, Lord Hughes, in a discussion on an earlier Amendment, said that he realised that in certain parts of the country there would be difficulty in getting sufficient members from, for example, local government. But we have made a firm commitment to include as members persons with experience in local government and with the right personal qualities for this job. I suggest to the Committee that we should leave the flexibility as it is now in Schedule 1, because I am sure that in the end it would be in the interest both of the local authorities and also those representing the professions.

LORD HUGHES

I must admit that I am disappointed, particularly as in this case the Government are leaving out of the new Bill something which is in the present legislation. There is a limit on the number of medical practitioners who may be members of a Regional Hospital Board. I think it equally important that they should not even begin to give the impression of being professionally dominated bodies. Obviously, I must agree that it is inconceivable that any of these Boards would he appointed without a medical man on them, and even more inconceivable that they should be appointed without any members of local authorities on them. That was not the situation I sought to guard against. I wanted by the Amendment to ensure that every Board would include a reasonable number of local authority people as members. We expect that just as a Member of Parliament is the person most in touch with what is going on in national affairs—and a good Member of Parliament is also in touch with opinion in his constituency—the elected member of a local authority is generally the person in the best position to know about the feelings of the general public in matters of this kind. It does not follow that he will always do what the public want. Sometimes what is being proposed is the best thing to be done, but not the popular thing. Sometimes these Boards will do things which the general public may not want done at that time, and it would, I think, be more helpful if there was a fair sprinkling of local authority people in the membership.

I have no intention of pressing this Amendment any further, either at this or the next stage in the progress of the Bill in your Lordships' House. But because of the many representations made on this point—and undoubtedly they will continue to be made—and as I did not agree with the main point that local authorities should have the direct right of naming members of the Boards, I felt that I should state the extent to which I think it reasonable that the Secretary of State should be bound. The noble Baroness will not be surprised if I say that although I am not pursuing the matter further in your Lordships' House, that does not mean the end of the matter. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

6.57 p.m.

LORD HUGHES moved Amendment No. 41: Page 33, line 22, leave out ("and") and insert— ("( ) the Scottish Trades Union Congress and").

The noble Lord said: This is a simple Amendment. Page 33 of the Bill gives a list of bodies which should be consulted. It includes local authorities, universities and various professions and such other organisations as appear to the Secretary of State to be concerned. I have suggested the inclusion of the Scottish Trades Union Congress. The other bodies are national bodies or types of bodies which appear throughout the whole country, such as county councils, universities and the professional bodies. The S.T.U.C. is always consulted. I want to make that perfectly clear. I know that even if this Amendment is not made it is most unlikely that the Secretary of State would fail to consult the S.T.U.C.; but because it is a body so representative of a very large section of the organised community, I think it would be a good and a right thing specifically to include it among the bodies which must be consulted. I readily concede that I do not expect that the omission of the name would stop the S.T.U.C. from being consulted if past experience is a guide, even though I would not go so far as the noble Lord, Lord Platt, who said that he would not disagree with the wisdom of the Secretary of State except in a very modest way. I would enter a heavier reservation in that matter, but it would be a political point and the noble Lord. Lord Platt, was not expressing a political point of view. I have no reason to believe that a future Secretary of State would not consult the Congress. But after all, we have known previous Secretaries of State; we do not know who are to be Secretaries of State. It may be that the worst may lie ahead rather than in the past. I hope therefore that the Minister will accept the Amendment.

BARONESS TWEEDSMUIR OF BELHELVIE

I am afraid that I must disappoint the noble Lord, Lord Hughes. I do not think it would be wise to accept this Amendment, nor do I think it necessary to do so. I suggest that it would not be wise, because if you include yet another interest (if one may put it that way) there could be endless demands for further interests to be included formally in the body of the Bill. But as the noble Lord himself recognised, the Amendment is unnecessary because the S.T.U.C. is among those organisations which are at present consulted in connection with appointments to Regional Hospital Boards. They would qualify, in particular, under paragraph 3(d) of Schedule 1, which is now under discussion, as among such other organisations as appear to the Secretary of State to be concerned". I should like to give a definite assurance from this Dispatch Box that it is certainly intended that the S.T.U.C. will be among the bodies to be consulted about Health Board appointments, as indeed they have been in a different capacity up until now.

LORD HUGHES

The noble Baroness undoubtedly disappoints me, but I will give her the consolation of saying that she does not surprise me. I am happy to accept the assurance that has been given, and beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

7.2 p.m.

LORD HUGHES moved Amendment No. 42: Page 33, line 34, after ("chairman") insert ("and members").

The noble Lord said: The schedule as it stands gives the Secretary of State discretion to pay the chairman of the Board. It says: The Secretary of State may pay to the chairman of a Health Board such remuneration as he may, with the approval of the Minister for the Civil Service, from time to time determine. This is not a mandatory thing. As the noble Baroness said on Second Reading, while it has not yet been finally determined that the chairman of the Health Board should be paid, having regard to the nature of the duties it was felt right to take the power to pay him if it should ultimately be determined that that was the right thing to do. In my opinion there is no doubt at all that the decision will have to be taken to pay the chairman of a Health Board, who undoubtedly will be carrying out functions at least as onerous, and perhaps even more so and more responsible than, say, the chairman of a New Town development corporation or the chairman of a nationalised organisation in Scotland, such as the Electricity Board or the Gas Board.

In view of the fact that this is merely a power which is being taken, I think it would be right that the power should be taken to pay the members of these Boards as well as the chairman. I think it will speedily be found that membership of these Boards will make a much greater claim upon the time of the members than has been found in any of the bodies presently functioning under the Health Service. The noble Baroness on Second Reading listed the numbers of bodies that are going to be replaced by these 14, now 15, area Boards: five Regional Boards, a large number of boards of management, a considerable number of executive councils and the health functions of some 30-odd local authorities—to be carried out by 15 people, more or less. I know that matters of this kind will be governed by whatever decisions are ultimately to be made in connection with the reorganisation of local government. One could not divorce the one from the other. It may well be that the same arguments could apply to the development of a new regional authority.

I certainly should not be prepared to move that the members of these Boards must be paid, any more than I should be prepared to move at this stage that the chairman of the Board must be paid. I am quite certain that the chairman will be paid, and am almost certain that the time will arise when the members of the Boards also will be paid. As it is a permissive power, I wish to extend it so that the Secretary of State should have power, in consultation with the Minister for the Civil Service, to pay all the mem- bers of the Board, if that should be found to be desirable. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

I quite appreciate that these Amendments are designed merely to give the power, and cannot confer payment on the members of the Board as well as the chairman, but I fear that I cannot accept the Amendment because, although I agree that the work of a member of a Health Board will certainly be important, if the Boards are to be effective it will be necessary for members to leave a good deal of the detail to officers and to concentrate on the important matters of policy and planning. If they are to do this, it seems that it will not be necessary for them to spend a sufficient amount of time on the work to justify the payment of a salary. This does not apply to a chairman, and that is why, after further thought, we have taken power to pay a chairman, if necessary. No doubt the noble Lord will have noticed that under paragraph 3 of Part III of the Schedule members will be eligible under the Bill for travelling and other allowances, including allowances for loss of remunerative time, which I suggest is important. There is another matter which is of importance; namely, that if these members of a Board were paid like the chairman, it would disqualify about 200 prominent people in Scotland from standing for the House of Commons. Surely the noble Lord cannot wish that.

LORD HUGHES

I do not know why the noble Baroness should have any fears about my wishing to disqualify certain people. I can think of a lot of people in Scotland whom I should cheerfully wish not to have the right to stand for the House of Commons. But that was not the purpose of the Amendment, although it might be an incidental by-product of it. The noble Baroness said that she did not think that the duties undertaken by members would justify payment because so much of the work would be done by officials. But I have been a chairman of a New Town development corporation; and I have been a member of a board of a nationalised undertaking. No one can argue that in these bodies the work is done by the members and that they are not served by an efficient and extensive body of officials, who give them the necessary help when they need it in exactly the same way as it will be given to the membership of a Health Board.

Looking back on my own experience, I cannot imagine for one moment that the work of a member of a New Town development corporation, which carries a salary, could possibly be regarded as more onerous and more worthy of remuneration than membership of a Health Board. It was never regarded as an argument against paying members of New Town development corporations that it would disqualify them from membership of the House of Commons. That seems to me to be a facetious remark, thrown in for good measure. If the noble Baroness cares to look at it, I am certain that she cannot possibly argue that the work to be done by members of these Health Boards is going to be less onerous, less important, or to call for less time than the work of some of the bodies which have had paid membership ever since their inception.

However, I do not intend to pursue the matter. This is the sort of Amendment which obviously involves the expenditure of public money and can be more appropriately pursued in another place. But I want to emphasise as strongly as I can that the Government are mistaken if they feel that they will get the sort of service they need by the repayment of travelling expenses and compensation for lost working time, which, from experience, I know always falls far short of what many people have to undergo in actual loss. Having said that, and in the confident expectation that this is not by any means the last that will be heard of proposals of this kind, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

7.10 p.m.

LORD HUGHES moved Amendment No. 44: Page 34, line 11, leave out paragraph 10.

The noble Lord said: When I was speaking to the first Amendment I said that with one exception I did not think that any of the Amendments I was proposing would be regarded as in any way political. This exception is the one that I am now moving, and it is to leave out paragraph 10 on page 34 which reads: Regulations under paragraph 8 above shall not contain a requirement that all consultants employed for the purpose of hospitals shall be employed whole-time. The Health Service has been in existence for 25 years, and at no time during that period has any attempt been made to require the service to be a full-time service. But if this Bill, when it becomes an Act, serves as useful a purpose as the 1947 Act, we should not be having anything other than an incidental amendment of the Health Service for some years ahead. I think it would be wrong for an embargo of this kind to be laid down for the future.

I do not expect, if this paragraph were taken out, that there would be in the immediate or even the foreseeable future any provision to make the consultancy service a whole-time one. There are still a fair number of people who work on the 10/11ths basis, which is virtually whole-time but which protects their right to private practice. I am not moving the deletion of this paragraph in the expectation that there will be any desire to make a change in the immediate future, but if we are in fact legislating for twenty years or so then I think it is wrong to have such a restriction in the Bill. I therefore beg to move that this paragraph be omitted.

LORD PLATT

May I say a word about this matter? Here again I must disagree with the noble Lord, Lord Hughes. I should like this paragraph left in. I may say that I have not discussed this with any member of my profession. I have always believed that there should be some people who do not spend their whole time in hospital practice and who have the wide and enormously valuable experience of private practice, perhaps in all parts of the world and with people from all parts of the world. If my memory serves me aright—and I have not looked this up at all—the profession was very keen that a paragraph of this kind should be inserted in the original Act so that the principle that one need not be entirely whole-time in the Health Service could not be swept aside by some subsequent Government without the matter coming again for debate before Parliament. I think that is the reason for this paragraph and I would vote for its inclusion.

BARONESS TWEEDSMUIR OF BELHELVIE

I am grateful to the noble Lord, Lord Platt, because I understand that this particular provision is one which means a very great deal to the profession, and that is why I cannot accept the Amendment put forward by the noble Lord, Lord Hughes. This provision is based on the terms of Section 12 of the National Health Service (Amendment) Act 1949. It was inserted by the then Labour Government because of fears of the medical profession that a full-time salaried service would be introduced by regulations made under the National Health Service Acts; and the 1949 Act contained an exactly similar assurance in respect of general practitioners. I may say also that the provision was inserted after long negotiations with the profession following a pledge given by the then Minister of Health, Mr. Bevan, that a full-time salaried Service was not contemplated. It is of course no part of this Bill to change what are really very long-standing arrangements. A proposal to delete this provision was not put forward either in the late Government's Green Paper or in our White Paper: and as a matter of fact even if one did delete paragraph 10 it would not prevent the Secretary of State from continuing the present agreement with the profession but it would remove the statutory assurance. As I know that the profession attach great importance to this, I am afraid that I cannot accept the Amendment.

LORD HUGHES

I did indicate that I regarded this as a political Amendment, and therefore I am not surprised that the noble Baroness has not accepted it. Before withdrawing the Amendment I wish to say a few words more. The noble Lord, Lord Platt, said that it had always been accepted as desirable that a number of people in the Service should be on a part-time basis. I agree that it is desirable and that it has been found very aceptable. I do not expect, as I said earlier, that in the immediate or even the foreseeable future there will be any need for change; but I am not prepared to say that this position will remain for all time. This is what the profession want, and there would have to be an Act of Parliament to change the position.

If we were legislating for only a few years, then I would not quarrel with that, but I do not think it is right that we should continue to act on the basis that it was very necessary in 1949. At that time there was a completely new Service being introduced. The medical profession generally were exceedingly suspicious of it in many ways and there were many things which had to be done in order to ensure their co-operation. But I know that many of the fears which were very genuinely held in 1947, 1948 and 1949 are not held to-day, after 25 years' experience of the Health Service, and what was then a very necessary safeguard from the profession's point of view is not necessarily of the same essence to-day. However it is obviously a point upon which there would be major disagreement, and having expressed these views, I do not feel that it would be right to do anything other than ask leave to withdraw the Amendment.

LORD PLATT

Have I the right to say something since I have been quoted by the noble Lord, Lord Hughes? I should like it recorded for historical purposes that I disagreed with most of the medical profession on their strictures at the time of the introduction of the Health Service.

Amendment, by leave, withdrawn.

Schedule 1 agreed to.

Schedule 2 [Scottish Health Service Planning Council]:

7.20 p.m.

LORD HUGHES moved Amendment No. 48: Page 35, line 35, leave out ("such") and insert ("six").

The noble Lord said: There are two Amendments of this kind, one to Schedule 2 and one to Schedule 3. I should like to speak briefly to both of them. The first one concerns page 35, line 35 and refers to the membership of the Scottish Health Service Planning Council. The Bill says that one member should be appointed by each Health Board, one member by each university in Scotland which has a medical school and not more than six officers of the Secretary of State appointed by him and such other members, not being officers of the Secretary of State, as may be appointed by him. I have suggested that instead of the word "such" in this and in the succeeding Schedule, there should be the word "six". This seems a reasonable Amendment; it is one which was suggested to me and I am happy to adopt it. I beg to move.

BARONESS TWEEDSMUIR OF BELHELVIE

The present provision in the Bill which refers to such other members as may be appointed by the Secretary of State has deliberately been left unspecific because it may be useful from time to time to add to the Council one or two members from industry with management and commercial experience, or at some future date there may be other special kinds of experience which might be valuable. It is unlikely that one would want to add as many as six extra members. Therefore while it would be possible to add six members in the terms of the Schedule as it now stands, I suggest to the noble Lord that one may only want to add one or two members, and perhaps he would think that it is better to leave the Schedule as it is at present drafted.

LORD HUGHES

I do not say that it is necessarily better to leave it, but I do not feel all that strongly about it. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

LORD HUGHES had given notice of his intention to move Amendment No. 49: Page 36, line 10, at end insert: ("( ) The Secretary of State must pay to the Chairman of the Council such remuneration as he may, with the approval of the Minister for the Civil Service, from time to time determine.").

The noble Lord said: I will not move this Amendment, but may I briefly say that for the reasons which I mentioned in connection with the payment of membership of the other bodies it will prove in practice to be reasonable to pay the Chairmen both of the Planning Council and the Common Services Agency and to make provision that they may be paid in the same way as is being done for the Chairmen of the Boards. I should think that the reasons which the noble Baroness advanced against payments to members of the Health Board will be the ones that she will equally advance against the pay- ment to the Chairmen of either of these two bodies. Suffice it to say that I think that in due course the Government will prove to have been wrong and will probably return to this point in future legislation.

THE DEPUTY CHAIRMAN OF COMMITTEES (BARONESS EMMET OF AMBERLEY)

Amendment No. 49 is not moved.

LORD DENHAM

That is out of order.

LORD HUGHES

Then I beg leave to move the Amendment, and if the noble Baroness does not wish to reply, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Schedule 2 shall stand part of the Bill?

LORD HUGHES

I have one point to raise on this part of the Bill. It arises from the letter which I received from a Regional Hospital Board. I believe that the noble Baroness will be able to give a satisfactory answer to this point. The Schedule talks about one member being appointed by each Health Board. I have no doubt that that reference is to the member of the Planning Council—one member of the Planning Council to be appointed by each Health Board. But the fear has been expressed that this may be interpreted as meaning that only the members of a Health Board would be eligible for appointment and that an official could not be appointed. I do not think that that is what is intended, but is it possible that this present wording could be interpreted as precluding an official of a Health Board from being the appointee of the Health Board?

BARONESS TWEEDSMUIR OF BELHELVIE

It would not be possible. One member could be appointed and it could include such an official.

Schedule 2 agreed to.

Schedules 3 and 4 agreed to.

Schedule 5 [Minor and consequential Amendments of Enactments]:

BARONESS TWEEDSMUIR OF BELHELVIE moved Amendment No. 52: Page 56, line 36, after (""Board") insert "or a joint committee of Health Boards."").

The noble Baroness said: This Amendment to paragraph 154 of Schedule 5 brings under the supervision of the Scottish Committee of the Council on Tribunals service committees of joint committees of Health Boards. I beg to move.

On Question, Amendment agreed to.

Schedule 5, as amended, agreed to.

Remaining schedule agreed to.

House resumed: Bill reported with the Amendments.