§ 5.19 p.m.
§ LORD WINDLESHAM rose to move, That the Draft Health and Personal Social Services (Northern Ireland) Order 1972, laid before the House on July 11, be approved. The noble Lord said: I beg to move the Motion standing in my name on the Order Paper. This Order will provide a new administrative structure for the personal health and personal social services in Northern Ireland. It is based largely on a Bill which had been presented to the Northern Ireland House of Commons, but which lapsed when that Parliament was prorogued.
§ Although the reorganisation of local government in Northern Ireland (discussed in the debate on the last Order) was a factor in the sequence of events leading up to the present draft Order, it was not the main reason for making a structural change of this kind. As in Great Britain, the personal health services in Northern Ireland are at present divided in a tripartite structure. There are the hospital and specialist services; the family practitioner services; and the local authority personal health services. Each of these is administered by separate authorities. There is general acceptance throughout the United Kingdom, however, that the time has come to begin bringing the three branches of these services together into one unified structure, both in the interests of patients and to enable the most effective deployment of resources. A National Health Service (Scotland) Bill, integrating the health services in Scotland, is already before Parliament, and a similar measure in relation to England and Wales will be introduced later. Therefore what is proposed in this Order is broadly in line with the new pattern that is emerging throughout the United Kingdom.
§ There are, however, certain regional differences in each part of the British Isles. In Northern Ireland the most important of these is that the personal social services at present provided by local welfare authorities will be included in the new framework. Because of the reorganisation of local government in Northern Ireland a new base had to be found for these services and it seemed 1543 sensible to take the opportunity to combine their administration with that of the health services. In many fields the health of a community and its social needs are inter-related. The elderly, the handicapped and the mentally ill, for example, are particularly vulnerable groups in need of both medical and social care. The combined administrative structure will enable the health and social services for these groups to be fully co-ordinated. I should add that certain safeguards will be included in the administrative structure to protect the professional autonomy of both services.
§ Consultations and discussions about the restructuring proposals have been going on in Northern Ireland over a lengthy period. A Green Paper containing tentative proposals was published by the Northern Ireland Government in 1969, and in March, 1971, the Ministry of Health and Social Services issued a Consultative Document. These two documents provided the main bases for the consultations with interested parties. When one considers the many interests involved and the radical nature of the proposals, it is fair to say that a most encouraging measure of agreement has been reached. There are, inevitably, some differences of opinion on certain aspects of the proposals, but generally the concept of a unified service has been welcomed. In addition to its reforming character, this Order consolidates into one basic code most of the existing health and welfare legislation, and this should be a considerable convenience for those who need to be familiar with the law in this field.
§ The draft Order brings within the direct responsibility of the Ministry of Health and Social Services at Stormont all the personal health services: that is to say, the hospital services; the family practitioner service; and the school health and other personal health services provided by the local health authorities. Moreover, it transfers to that Department the personal social services functions of local welfare authorities (such as the care of the old and the handicapped) other than those in relation to child care and adoption services which transfer to the Ministry of Home Affairs. The main functions of the Ministry of Health and Social Services are set out in Part II. Article 4 is really the foundation of the whole Order. It 1544 underlines the fact that the health services will be integrated and will be co-ordinated with the personal social services. I should perhaps also mention Article 15. This provision gives the Ministry broad powers to promote social welfare and subsumes the functions of welfare authorities under a variety of provisions in the Welfare Service Act (Northern Ireland) 1971. It also enables assistance to be given to persons in social need who do not come within the specific categories mentioned in that Act.
§ Part III of the draft Order contains important provisions. It provides for the establishment of Health and Social Services Boards to undertake the area administration of services on behalf of the two Ministries. In practice there will be four boards, each of which will be responsible for providing or securing the provision of a comprehensive range of health and personal social services in its area. Membership will be broadly based, and there will be wide-ranging consultations about appointments. As I mentioned in the debate on the last Order, it is the intention that about 30 per cent. of the membership of each area board will be nominated by the district councils in its area; approximately another 30 per cent. will reflect professional interests; and the balance will be appointed after consultation with other interests such as the universities, voluntary organisations and trade unions.
§ It is vital that the boards should be appointed as quickly as possible after the making of the Order so that they can make adequate preparation for the assumption of their functions when they come into effect on April 1, 1973. The management structure of the boards is not detailed in the Order, but in practice there will be a system of district management with each district normally corresponding to the area of one or more of the new district councils—as I mentioned, the 26 new district councils under local government reorganisation from April next year. It is planned that there will be 16 management districts for health and personal social services. The district services will be provided on an integrated basis by district officers appointed by the board and responsible to their chief officers. In order to represent public opinion concerning services at the local level, each board will be 1545 required to appoint district committees, which will have an important consultative and advisory role. Membership of a district committee is likely to include local members from the parent board, district councillors, and other persons in the district with an interest in voluntary service.
§ Moving on to Part IV of the Order, the provisions here are fundamental to the new structure, and concern the future central machinery for the health and personal social services. The Northern Ireland Health and Social Services Council will be established with membership drawn from the boards, the central professional advisory committees to be appointed under the Order, and other interests. The Council's main function will be to advise the two Ministries on matters of major policy, but it will also provide a useful forum for discussion of matters and problems of common concern. Under Article 24, specialist central advisory committees can be appointed for a profession or professions, or for a particular service. For example, under this provision committees will be appointed to replace the existing Standing Medical and Standing Nursing Advisory Committees, and one will be appointed for the personal social services. These committees will give professional advice as necessary to the Northern Ireland Health and Social Services Council and to the Ministry of Health and Social Services. Article 25 further enables the appointment of ad hoc committees to advise on particular matters.
§ Two other important central bodies will be appointed under Part IV. The creation of the Northern Ireland Central Services Agency for the Health and Social Services is a departure from earlier proposals set out in the Consultative Document in the light of comments received from various interests. This agency will provide certain executive services on behalf of the boards and the Ministry which can most effectively be organised on a regional basis. It is the intention that the agency will provide, for example, central legal and supply services, central payments machinery for the independent contractors in the health services (that is the family doctors, dentists, pharmacists and opticians). The 1546 other body to which I referred just now is the Northern Ireland Staffs Council for the Health and Social Services which will undertake functions in relation to recruitment, selection, appointment and training (other than professional training) procedures for various staff in the health and personal social services.
§ In Part V of the draft Order the Ministry is given a number of functions supplemental to its main functions in Part II. Most of these are a restatement of existing provisions. Part VI provides for the administration of the family practitioner services by the Health and Social Services Boards on behalf of the Ministry. Here again, this is a re-enactment of existing legislation: Part II of the Health Services (Northern Ireland) Act 1971 refers, although there are some adaptations to meet the new structure. Part VII recognises the need for close co-operation between the health and personal social services authorities and other bodies, in particular the district councils and voluntary organisations.
§ Part VIII defines the duty of the Ministry of Home Affairs with regard to child care and adoption services, and is complementary to the duties of the Ministry of Health and Social Services under Article 4. I should perhaps just pause here for a moment to explain that the reasons for this division of responsibility in Northern Ireland stem from the fact that the child care services are and traditionally have been related to the functions of the Ministry of Home Affairs, such as the courts and the Probation Service. We intend to see, however, that there is the closest working relationship between the two Departments in the administration of the personal social services. Nor is the door closed to some re-allocation of Departmental responsibilities at a later stage. The issues involved, however, my Lords, are complex and require study before any firm decisions can be taken. It would not be practicable, in our view, to undertake such an inquiry within the very tight timetable of re-organisation to which we are committed by the local government reform programme. Once the new structure for the health and personal social services has been successfully launched, my honourable friend Mr. Channon, who has responsibility for the 1547 Department of Health and Social Services, and myself, since I have responsibility for the Ministry of Home Affairs, have agreed that the Departments concerned should review the situation to see whether any re-allocation of Departmental responsibilities and a greater measure of integration would be justified.
§ Part IX of the draft Order is concerned with the winding up of existing authorities and the transfer of staff, assets and liabilities to new ones. Part X deals with endowments and other trust property. Part XI contains financial provisions; and Part XII a number of miscellaneous and administrative provisions, many of which, again, are modified versions of existing legislation.
§ My Lords, that is necessarily a brief summary of a long Order, although, as I have mentioned, a good part of it consists of consolidating, and in places amending, existing legislation. I hope I have said enough, however, to give an indication of the significance and the range of the changes involved. Undoubtedly this Order will be a landmark in the development of the health and personal social services in Northern Ireland. It will enable a better service to be given to patients and persons in social need. It will help to ensure the most effective use of financial and manpower resources. It is a reform which is in line with the pattern in the rest of the United Kingdom. For these reasons, I commend it to your Lordships. I beg to move.
§ THE LORD CHANCELLOR (LORD HAILSHAM OF SAINT MARYLEBONE)
My Lords, before I propose the Question it might be convenient to the House if I explain that after this item of business I shall be giving the Royal Assent to a number of Acts and Measures under the Act of 1967.
§ Moved, That the Draft Health and Personal Social Services (Northern Ireland) Order 1972, laid before the House on July 11 be approved.—(Lord Windlesham.)
§ 5.35 p.m.
§ LORD SHACKLETON
My Lords, I shall be as brief as I can because I am very conscious that there is a lot of important business before the House in 1548 relation to which the House is in a position in fact to influence matters in a way in which we are not able to with regard to these Orders, except by an actual act of rejection. I should like to apologise to the noble Lord, Lord O'Neill of the Maine. Perhaps I have lost confidence in the Government Front Bench after the disaster over the Scottish Housing Bill, but it is surprising how many noble Lords do not know either the contents of Standing Order 29 or the explanation on page 82 of the Companion. But (if I may have the attention of the noble Lord) having been really rather pompous about the whole thing I feel I must apologise to him because I rebuked him, perhaps incorrectly, when he said that, on the Scottish disaster, the matter was not carried unanimously, which was in fact what my noble friend had said. I am told that in any case this is a term which has no meaning in your Lordships' House, and perhaps, therefore, he was all right, and I apologise to him.
All I would say on this Order is this. I have actually prepared quite a long speech, but it is quite obvious that it is really not much use our discussing this—and again I exonerate the Government. But I should like to make one or two quick suggestions. First of all, the noble Lord's statement, which was of course the sort of statement that would be made on the introduction of a Bill going through Parliament in the normal way, is probably going to be helpful to another place, which I believe has not yet discussed it; but it would be helpful if, during this difficult time, the Government could perhaps (and it sounds absurd) circulate in advance what will be the contents of the Minister's speech. It is very difficult for us to make comparisons with English legislation and before we come on to the new Order, and the vital Order, with regard to proportional representation, it would be very helpful if the Government could publish informally the basic documents, whatever they are, or provide some sort of memorandum referring to them, and give an indication. We are all anxious to co-operate on this, and I think it would save the time of the House on what is going to be a very crucial subject. In fact, we are having to invent our procedure as we go along.
I should have liked, if the noble Lord had had time to answer, to have asked 1549 him how far in fact this Bill (or Order, as I must call it) differs importantly from the proposals in the Consultative Document, because the Consultative Document, like all Consultative Documents, was easier to follow than the Bill itself; and I make no criticism of his explanation. I was not quite clear, either, how much consultation there was. It may be that we will just have to take it that there was the fullest consultation. Again, I am a little bit bothered about the amount of participation by local authorities here as compared with the proposals in the Act, where apparently they have absolutely no power. The district councils, certainly, have no powers at all to speak of; all they can do is to write reports, and this may be right. Here again, the members of the boards are appointed. How far are the boards going to be related? I think the noble Lord said, "in due course in relation to local government reform", and clearly there is no finality at the moment. I was interested in the noble Lord's explanation as to why the dual system with regard to the two Ministries is being maintained. Of course, as he knows well, the Home Office in this country, too, has had a major role to play in children's affairs, and we have altered it. But none the less, I understand the Government have not had time at the moment to set the inquiry in train. I notice one other thing, and that is that doctors do not appear to be members of Area Boards. There is nothing that we can do about this at the moment, but, of course, when the first report comes out there may then be a question of a need for some amending legislation. But certainly we will speed this Order on its way. Indeed, as I say again, there is nothing else we can do about it, and we ought not to pretend that we are giving it proper consideration.
§ LORD BARNBY
My Lords, with regard to this Order I should like to follow the example given by my noble friend Lord O'Neill, in of course giving support to the Order; but it would seem from its title that it would not be out of order to raise a question with my noble friend Lord Windlesham with regard to the administration current in Ireland, which presumably, such as it exists now, will be continued under this Order—and we have to look to the noble Lord as 1550 the line of contact which this House has between Northern Ireland and ourselves. Would he be inclined to make any comment on the widespread reports that have appeared in the Press—presumably in relation to this Order and in the light of a Statement made in the House yesterday that there are areas of Northern Ireland in the control of enemies of the Crown where the authority of the United Kingdom does not appear to hold—that under this Order in future benefits and allowances will continue to be paid as they would have been paid under normal conditions? It would help if the noble Lord could make some comment on that.
Before I sit down I should like to endorse what the noble Lord the Leader of the Opposition has just said: that from our past experience of attempting at Westminster to legislate for Ireland we should not delay too long the setting up of some kind of mechanism for the efficient application of legislation to Northern Ireland where such machinery does not now exist.
§ 5.41 p.m.
§ LORD O'NEILL OF THE MAINE
My Lords, when the noble Lord, Lord Shackleton, floored me at a stroke, I had been going merely to make an observation emerging from the conversation across the Table between the noble Lord and the noble Lord, Lord Windlesham. As I was just about to say, I may not be privy to certain discussions which may have taken place through the usual channels. The observation I was intending to make was as follows. Stormont has been suspended or prorogated for one year. We do not yet know what the future will hold. There was a little discussion on the previous Order about the fact that if another place had come to some determination about how to deal with these matters, we might have found them a little easier to deal with here.
I was going to observe that if, in fact, Stormont has been suspended for only one year (and, at the moment, we are still some way away from the end of that period) is it wise, either for us here or for another place, to produce some elaborate machinery for dealing with Northern Ireland affairs in the Parliament at Westminster, if some new assembly or another will emerge next March? I 1551 should have thought that the Government ought to give consideration to the possibility of deferring any final decision as to how Northern Ireland legislation should be dealt with in the United Kingdom Parliament, until they have themselves made up their minds what they are going to do with the future of Stormont.
My Lords, I am not making these remarks in a vacuum. I am making them in the knowledge that the Alliance Party, which is the only non-sectarian Party in Northern Ireland, is in favour of the reconstitution of some local assembly; I am making these remarks in the knowledge that the S.D.L.P., who (thank God!) yesterday changed their mind and are now willing to have discussions with the Secretary of State, are in favour of having some new assembly re-established; and in the knowledge that Mr. Jack Lynch, in a very notable speech last week, himself suggested that some new assembly should be established in Belfast. In view of all this personal knowledge that I have, I am wondering how wise the United Kingdom Parliament would be, either in another place or here, to produce some new elaborate machinery for dealing with Northern Ireland affairs in the new Session, when there will be only four months before it will fall to the Government to make some announcement as to what they will do with Stormont after next March.
I had no intention of saying any of this until the little discussion over the last draft Order took place across the Table. I am not doing anything other than giving some personal advice and my personal observations to which I hope the Government will give a little consideration.
§ LORD WINDLESHAM
My Lords, in reply to the noble Lord, Lord Shackleton, the Government are willing to make available any information that is helpful to your Lordships in advance of debates of this kind. There is, in fact, an explanatory document published together with each Order in Council. They are widely available in Northern Ireland and are considered by the Commission, as a guide for them, when they go through the Orders. I believe that these are available in your Lordships' House. 1552 Should any more information be required we would consider providing it.
The noble Lord asked about the extent of consultation. I understand that it has been very considerable. A consultative document, a Green Paper, was published in 1969 on the administrative structure of the health and personal social services in Northern Ireland. Debate and consultation took place on the basis of that Paper and it was followed by the consultative document on the re-structuring of the personal health and social services in Northern Ireland. Finally, a Bill was drafted, following the usual consultation with interests concerned. This Bill was presented to the Parliament of Northern Ireland before Prorogation but did not receive a Second Reading. I believe that the main difference between the draft Order before your Lordships and the consultative document is the establishment of the Central Services Agency. This departure from the proposal contained in the consultative document was made in the light of comments received.
The noble Lord, Lord Shackleton, also asked about the powers of the district committees. Here again there was representations from certain interests that these committees should be given some executive powers. But this would have breached an essential principle of the new structure, which is that in Northern Ireland there should be a single tier of management authorities; namely the boards themselves, under the central department. The committees will have an extremely useful function in keeping in touch with local opinion and ensuring that this is done in an efficient and sympathetic way; but the Macrory approach, as explained on previous Orders, is that education and health should be regional services, with area boards—four for health and five for education—covering the whole extent of the Province.
The noble Lord also asked about doctors in regard to membership of the area boards. I understand that the intention is that there will be a number of doctors on the area boards perhaps up to half those representing the professional interests.
The noble Lord, Lord Barnby, asked about social benefits. I do not think this 1553 arises on the Order before your Lordships, but I can tell him that social security benefits, retirement and unemployment pensions are still paid throughout Northern Ireland. Everyone in Northern Ireland has a statutory right to receive these benefits; and legislation will be needed if that position were to be altered.
The noble Lord, Lord O'Neill of the Maine, made a useful and constructive contribution to the earlier discussion we had about our Parliamentary procedures for considering Northern Ireland legislation. I think the right thing for me to do would be to pass on his comments to my right honourable friend the Leader of the House, who for some months now has been considering the question of holding discussions with representatives of the other Parties, so that he may be aware of the most useful views put with such authority by the noble Lord, Lord O'Neill of the Maine. That is a brief reply, my Lords, but I know that other Members of your Lordships' House are waiting to move on to business of some importance and significance. I hope that I have covered the main points that have been raised.
§ On Question, Motion agreed to.