HL Deb 27 February 1973 vol 339 cc526-37

2.47 p.m.

EARL ST. ALDWYN

My Lords, I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the National Health Service Reorganisation Bill, has consented to place Her prerogative and interest, so far as they are affected by the Bill, at the disposal of Parliament for the purposes of the Bill.

THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)

My Lords, I beg to move that this Bill be now read a third time. If I may trespass on your Lordships' time for just a moment or two, it is appropriate to thank your Lordships for the very constructive way in which you have dealt with this Bill. On Second Reading I drew attention to the fact that this is the first time that a major Bill has started its life in this House, and it follows an undertaking given by my noble friend the Leader of the House that he would see what could be done to balance out the spread of legislation between the two Houses. He has discharged that obligation by producing at least this Bill as the first major Bill to start its progress in this House. It has been a unique experience. It has not always been easy and there have been certain difficulties. Not having had a previous sifting of the Bill by the other place has caused a great deal of extra work, particularly for Members of the Benches opposite. But I am grateful to all your Lordships for all the constructive work you have done on the Bill, and I believe that it has been a successful precedent. We have made a great many Amendments to the Bill and most of them are significant improvements. We have made more effective the professional advisory machinery. We have recast the whole set-up so far as community health councils are concerned. We have introduced some important Amendments on the subject of the Health Service Commissioner and with regard to staff consultation. We have also had some useful debates on many other matters of policy arising out of the Bill, especially the linkage between the health authorities and the local authorities, and have had some useful discussions on the subject of family planning, including one major Amendment.

I am particularly grateful to the three Graces, if I may so term them, on the Front Bench opposite, the noble Baronesses, Lady Serota, Lady White and Lady Llewelyn-Davies of Hastoe. Brightness, joyfulness and bloom were the Graces, and the noble Baronesses certainly displayed those qualities as well as being very powerful advocates for their viewpoint, and all of them have had a significant influence on the Bill. Associated with the Graces was the god Hermes—in this case the noble Lord, Lord Garnsworthy. The god Hermes, your Lordships will remember, was a precocious child and the god of eloquence, and certainly the noble Lord was very eloquent in defence of the interests of the staff, about whom both he and I have a deep concern.

I should also like to thank my noble friends on this side of the House. They have not always supported me in the Lobbies; in fact, some of my noble girl friends have been particularly rebellious. But I should like to thank all those noble Lords, especially some of my noble friends who have deep experience of the Health Service—the noble Lords, Lord Grenfell, Lord Reigate and Lord Auckland, Lady Ruthven, Lord Cottesloe, and others. In particular, perhaps, may I thank my noble friends Lord Amory and Lord Brooke of Cumnor, the Castor and Pollux, I think, of our side, for their very constructive assistance and suggestions to help this Bill forward. Others of your Lordships have played a considerable part in the Bill. The noble Lords, Lord Platt, Lord Brock and Lord Amulree have effectively watched over the interests of Aesculapius; and the right reverend Prelate the Bishop of Lichfield, who is an old and valued friend of the National Health Service, has been very helpful, too. Finally, may I thank my two colleagues on this Bench, my noble friends Lord Belstead and Lady Young, for their patience and untiring support in the course of the passage of the Bill? I beg to move.

Moved, That the Bill be now read 3ª.—(Lord Aberdare.)

2.52 p.m.

BARONESS SEROTA

My Lords, I know noble Lords will be very appreciative of the generous and humorous words of the noble Lord, Lord Aberdare, and would undoubtedly wish me, first and foremost, to thank him and his colleagues for the unfailing patience and courtesy, and fortitude, which they have shown consistently throughout our consideration of this major measure. Apart from the sheer physical stamina involved in steering a Bill of this size through the House, the noble Lord, Lord Aberdare, has accepted Government defeats on a number of issues of policy without bitterness or rancour, and without seeking to reverse the will of the House at a later stage. He has also—and we are most appreciative of this—listened to and taken heed of the strength of feeling expressed on all sides of the House, as well as from these Benches, on certain aspects of the Bill, to the point of submitting Government Amendments at the Report stage to meet many of the matters raised during the examination of the Bill by noble Lords who spoke from long experience and direct knowledge of the National Health Service.

In addition to those whom I have learned in the course of these debates to call my noble Health Service friends I should particularly like to thank my colleagues, the noble Baroness, Lady White, Lord Garnsworthy, Lord Stow Hill and Lady Llewelyn-Davies, who unfortunately is unable to be with us to-day, for their invaluable support throughout the examination of the Bill and for all the time, tolerance and effort that their participation in this truly co-operative endeavour has involved. The kind references by the noble Lord, Lord Aberdare, to my noble friends and myself are greatly appreciated and we in our turn would wish to thank the staff of the Department, through the Minister, for all that they have done in these many months, if not years, on the preparation of the legislation, its passage through this House, and the preparation for the transition in which they are now heavily involved. As a result of all our labours I would warmly agree with the noble Lord, Lord Aberdare, that the Bill which will now go forward to another place for consideration and scrutiny has greatly benefited from starting its passage here early in December, and I only hope that this experience, apart from bringing credit on this House, will encourage rather than deter the Government from seeking in future Sessions to balance the burden of the legislative programme in this way.

The Bill still does, however, contain a number of major provisions, particularly in relation to the composition and the functions of the proposed Regional and Area Health Authorities, to which we on this side are as firmly opposed as ever. In spite of all our efforts, the Government have refused to give an inch on the rigid doctrine of absolute Ministerial appointment and control of the new Health Authorities which has determined the pattern of the reorganisation provided in the Bill. They have also completely failed, in our view, to take the opportunity of this first major reorganisation of the Health Service since its inception in 1946 to decentralise and democratise one of the greatest of our social services by allowing the producers of the service—the doctors, the nurses and other Health Service staff—together with the consumers of the service to play a more direct part in the new authorities which will take over in April, 1974. We are also particularly concerned at their refusal to provide for any arrangement to coordinate the strategic planning of health care services at regional level with other major social services to which they relate. I have little doubt that this very crucial question of the relationship of the new Regional Health Authorities with other regional agencies and to local government both now and in the future will be raised in another place. We also welcome the improvements the Government have made to Clause 9. There are still a number of matters in relation to community health councils that could be discussed further particularly in relation to staff and premises. Again, there will be opportunity for these matters to be further considered elsewhere.

My Lords, throughout the consideration of this Bill we have been constantly aware of the need for Parliament to bring to an end, as soon as is compatible with a full and thorough examination of the Government's proposals, the long period future of a Service which depends above ably experienced since the publication of the first Green Paper nearly five years ago. We have therefore refrained from putting down any further Amendments or raising particular issues to-day on Third Reading although we greatly regret that the Bill still does not contain a number of proposals that have been made in the course of our discussions. But I know that my noble friend Lord Garnsworthy and all concerned with the future of a Service which depends above all on those who provide it would particularly wish me to thank the Government, and the noble Lord, Lord Aberdare, especially, for the undertakings that have been given and for the way in which the Bill has been improved in relation to consultations with staff interests in the processes of reorganisations and in the extensive preparations for the April, 1974, changeover which is now gathering momentum. For, in spite of the provisions of Clause 1, the real burden of this major reorganisation will undoubtedly fall on their shoulders while they must continue at the same time in every respect to maintain the level of the existing services to patients. We would therefore want to give them our full support at this time and wish them every success in the difficult months, the all too few months, to come in which they will have to effect the transition once Parliament has determined the final shape of the Service.

Finally, my Lords, I know that there are some noble Lords who genuinely doubt whether this reorganisation will really benefit individual patients or justify the great upheaval that is undoubtedly involved. I am afraid that the dominant emphasis in Government policy on the bureaucratic management and control of the new Service from Whitehall downwards has reinforced these views. For my part, I believe wholeheartedly in the very real advantages which could flow to patients and to the community as a whole from the development of a truly integrated and comprehensive community-based Health Service from which the existing inequalities between Regions, between social classes and particularly between people with handicaps and those without must be eliminated; but such a service, in our view, must be based on democratic principles of participation and control by managing authorities which are truly representative of, and sensitive to, producer and consumer interests from the outset.

Moreover, the new Service must surely be planned and provided at all levels and not merely at Area level in conjunction with the other great complementary social services—housing, education, the personal social services and environmental planning—if the needs of the individual patients are to be more effectively met and if we are to develop health-care services with a stronger emphasis on prevention and real care in the community. Unless this reorganisation succeeds in strengthening the general practitioner and community base of the National Health Service by developing improved local health and social care services to the family doctor and his team we shall not reduce the present demands on the Hospital Service and effect the much needed change in the balance of emphasis between prevention and cure. We shall therefore watch the progress of this Bill with great interest as it is considered in another place and hope that it will be returned to us with even more improvements than we have managed to achieve in this House. Although it is primarily concerned with organisation and struc ture, it is a Bill which will undoubtedly affect the future health and wellbeing of every single citizen and of future generations.

3.2 p.m.

LORD REIGATE

My Lords, may I, too, congratulate my noble friend on navigating this great measure through your Lordships' House? Perhaps I may also be allowed briefly to utter a very slight lament: it is that one of the outstanding changes in this Bill is the abolition of the independent boards of governors of the teaching hospitals. Speaking as one of the chairmen, I think that many will share my regret at the passing of a long and honourable tradition which goes back into the mists of time and has, I think, helped to make British medicine the very great service that it is. Those with whom I am associated in the Teaching Hospitals Association have endeavoured to point out some of the consequences as we see them. My noble friend and the Secretary of State have always listened with kindness, but not always, perhaps, as sympathetically as we should have wished. Nor, I think, have our arguments always been comprehended. However, my Lords, if this is the price of unity, we feel that we must accept the decision although with regret and with some misgivings.

It is fair that I should point out that through all the discussions, through all the long arguments, no one has ever sought to claim that this change is going to improve medical education. It is also fair to point out that the future of the Health Service must in the long run depend on the standards of medical education. Teaching hospitals exist to serve patients first and foremost, but also to serve the medical schools, and it is possible that the medical schools may find that the Area Health Authorities, which have many other irons in the fire and on which the schools will have only a small representation, will not be such sympathetic partners as the teaching hospital boards to whom they have been accustomed. I do not want to indulge in any way in an unnecessary jeremiad but merely to give a warning. After all, my Lords, if there are faults in the Bill, even when it becomes an Act of Parliament they can be remedied in the next National Health Service Reorganisation Bill. If history teaches us anything it should teach us that as the measure of 1949 followed that of 1946, the next measure should be in 1976.

3.5 p.m.

LORD GRENFELL

My Lords, I also should like to congratulate my noble friend on the successful termination of this Bill. I think that we are passing on a far better Bill than the measure that came to us. My noble friend has always been ready to listen to the voices in this House, and that is vitally important. In reorganising the Health Service I am not convinced that the Ambulance Service should remain under the G.L.C. rather than come under the umbrella of the new Health Service, but that has been the will of the House. My hospital management committee felt very deeply that a statutory duty should be put on the community health councils to inspect and report on hospitals rather than merely have access to them. I think that is a sound idea, and I hope that it will be considered in another place. I feel that we have greatly improved the constitution of the community health councils. I would stress very sincerely the real importance of ensuring that no part of the Health Service should be subjected in any way to Party politics. I wish the Bill all success. We shall be be able to judge its effect better and more fully in about two years' time when we see how this actually works. In any case, I feel convinced that all concerned will endeavour to ensure that the patient is always looked after to the best of their ability.

LADY RUTHVEN or FREELAND

My Lords, I should like to add my thanks to my noble friend the Minister of State for what he has done to this Bill. He was most amenable to suggestions from both sides of the House. I suppose that in a way it was rather difficult for him to accept changes in the Bill which were suggested from his own side of the House, but he did it in a charming and delightful manner. As a Back Bencher of his Party, I should like to thank him for all he has done to make the Bill a much better Bill to go to the other House.

3.8 p.m.

LORD PLATT

My Lords, speaking from the Cross-Benches, I must first regret that, having had to attend a luncheon, I was not able to be in your Lordships' House in time to hear the beginning of the Third Reading debate on this Bill. I would add my thanks to the Minister, who has carried the measure through with such courtesy, efficiency and obvious knowledge of the questions involved. I am most grateful to him.

LORD AMULREE

My Lords, I should like to say a word of thanks from these Benches to the noble Lord, Lord Aberdare, for the great care and attention that he has given to this Bill and for the able and competent way in which he dealt with all the various problems involved. I am certain that one of the reasons why we were lucky enough to get the Bill introduced in your Lordships' House was because the Secretary of State knew that the noble Lord would be in charge of it. I should like to thank him for the Amendments which he accepted from us and for the kind and able way in which he conducted the business.

3.10 p.m.

BARONESS WHITE

My Lords, may I add a word or two to those so felicitously spoken by my noble friend Lady Serota? First, I should like to thank the Minister for his charming compliment. In my most dreamlike moments I do not think that I ever cast myself as a Grace. A Muse may be, but not a Grace. However, it was no less agreeable that someone should have thought of me in those terms. I am very happy that we are sending the Bill to another place as much improved as I think it has been by the labours of noble Lords on both sides of the House. There has been a quite remarkable unanimity on certain matters—that is to say, unanimity with the exception of the Minister, but he has been most forthcoming where he rightly felt that the strong feeling of the House was in a certain direction.

I have only two matters which still rather concern me in relation to the Bill. As some of your Lordships who took a close interest in the matter know, I was myself especially detailed to study the community health councils and the provision of an Ombudsman, a Health Service Commissioner. I should like to make the point which I made last week on the race relations debate. I was somewhat concerned at the proliferation of bodies for the protection of the citizen in various directions. We have now had Government support for a special police tribunal for possible complaints against the police; we have the machinery which we are setting up under this Bill, and major local authorities in various parts of the country are also establishing offices for the protection of the citizen including their relationships with the Social Security Department. It seems to me that the time has come when the Government ought to be giving some thought to this proliferation and to ask themselves what the local administration should be and whether we are justified in setting up networks of different bodies to follow up various procedures without interrelationship one with the other.

The other point which concerns me, my Lords, is the fact that the National Health Service Reorganisation Bill does not take cognisance of another section of the health care in this country, the occupational Health Service. I know that we passed a Bill last Session on the establishing of the Employment Medical Advisory Service; that consultations are going on about the Robens Report on Safety and Health and that work and legislation are to follow upon that, but these matters are under the care of a different Department, the Department of Employment, and one would hope that there is genuine collaboration between the two Departments. I have here the circular which was sent out by the Department of Employment concerning the Employment Medical Advisory Service which refers to liaison with general practitioners, hospital staffs, works medical officers and others interested in occupational medicine. It is being established on the basis of nine regions which may or may not have any relationship at all to regions set up under the Bill now leaving this House. Certain National Health facilities, particularly of a diagnostic nature, including a central pathology laboratory in London, are to be put at the disposal of the Employment Medical Advisory Service. This was not discussed in this House in relation to the Bill before us, yet the two things are to my mind plainly closely connected.

I am further disturbed by the comments made by a very highly respected Member of another place, Miss Mervyn Pyke, who was herself a Member of the Robens Committee. In addressing the annual conference of the occupational health section of the Royal College of Nursing recently, she said that the health part of the Robens Report was the woolliest and least satisfactory, and when she was taxed with this by one of the members of the Royal College of Nursing she said: To have gone into occupational health in sufficient depth, the Report would have had to be held up for six or seven months, and we felt we could not afford to lose that amount of time. I mention this because if anything serious is to be done on the occupational health side I hope that there will be the closest co-operation between the Department of Health and Social Security and the Department of Employment. I think I am entitled to raise this plea because one Government after another has refused to face the real problems of occupational health. I do not blame this Government any more than I did my own, but I think it is wrong that we should not take cognisance of the difficulties we have not been able to tackle in this Bill. While we should congratulate all concerned on the Bill we have before us, we should regret that it did not extend to industrial and occupational health.

LORD ABERDARE

My Lords, I should like to thank your Lordships for your very kind personal references to me. I have had the greatest sympathy from my right honourable friend the Secretary of State which has enabled me to meet some of your Lordships' wishes. I recognise that there are still deep divisions between the two sides of the House on the administrative framework of the new National Health Service, but all that is on the Record and it would not be appropriate to re-argue it now.

May I say one word to my noble friend Lord Reigate. We have listened sympathetically to the arguments of the Teaching Hospitals Association. We are all deeply grateful to the members of the Board of Governors for the work they have done over many years past, as indeed we are to the members of all the other Boards and Committees that serve the National Health Service. I can assure him that if we can avoid it nothing we do will harm medical education, and the very fact of integration might well be of great benefit to medical education. I have listened with interest to what the noble Baroness had to say about occupational health and I will certainly study it.

On Question, Bill read 3ª, An Amendment (Privilege) made: Bill passed, and sent to the Commons.