Lords Sitting of 23 January 1973

Preamble
Reassembling after the Christmas Recess, the House met at half past two of the clock, The CHAIRMAN OF COMMITTEES on the Woolsack.
Prayers—Read by the Lord Bishop of Coventry.

WESTMINSTER ABBEY
LORD GLADWYN: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government when the exterior of Westminster Abbey is likely to be cleaned; and whether they are prepared to take any steps to assist its cleaning.
THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF THE ENVIRONMENT (LORD SANDFORD): My Lords, since the cleaning of Westminster Abbey is a matter for the Dean and Chapter, it is not for me to say when it will be carried out, but I know that they are deeply concerned not only in regard to the cleaning but also about repairs to the stonework of the Abbey. They hope to be able to start this year what is sure to be a long-term programme. We are at present considering whether the Government can and
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should make a contribution towards the cost of this work.
LORD GLADWYN: My Lords, while thanking the Minister for that moderately encouraging reply, may I ask him whether he does not agree that the present condition of the exterior of our greatest national monument is something in the nature of a national disgrace? Do not the Government think it is possible to proceed with at any rate some of the cleaning, without embarking on a long and costly process of repair work?
LORD SANDFORD: My Lords, I can assure the noble Lord and the House that this is a matter with which my right honourable friend and I, and the Dean and Chapter, have been concerned for some months. We have looked into it thoroughly.
LORD SHEPHERD: My Lords, would not the noble Lord agree that visitors would regard it as strange irony that the Treasury should be cleaned up by taxpayers' money while the great fabric of Westminster Abbey, which is an important tourist attraction, remains not only uncleaned but obviously with the structure of the stonework breaking away? Is it not true to say that it would be better to spend the money now than to wait for another twenty or thirty years when the cost will be infinitely greater?
LORD SANDFORD: My Lords, I am grateful to the noble Lord for that very useful point.
LORD DERWENT: My Lords, is my noble friend aware that we do these things better in York?
LORD SANDFORD: My Lords, I am certainly aware of the great things that have been done in York.

PHOTOGRAPHIC ARCHIVES
2.37 p.m.
LORD STRABOLGI: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they will consider the establishment of a National Photographic Archive.
THE PAYMASTER GENERAL (VISCOUNT ECCLES): No, my Lords. Photographs are best collected in a number of archives with special objectives. I am, however, considering whether it would be practicable to set up some form of guide to collections.
LORD STRABOLGI: My Lords, while thanking the noble Viscount for that reply, may I ask him whether the Government would consider providing funds to erect a central register of existing photographic archives, with a comprehensive catalogue?
VISCOUNT ECCLES: My Lords, we are considering where such a register—of course it could not be complete because there are far too many photographs; but a comprehensive guide—could best be established. It may be that the British Library is the place to take charge of this project.
LORD HALE: My Lords, has the noble Viscount seen the letter in The Times from the Director of the Oldham Museum, which incidentally, was opened by me just three months ago as a special museum of local interest with a substantial collection of photographic material? Will he bear in mind what an ideal centre this would be in the North? And will he also visit it? Indeed, now that the Government have turned Socialist, he might, while he is there, look in the Labour Party offices for a cup of coffee.
VISCOUNT ECCLES: My Lords, it is a pure accident that we have been thinking about the amenities in Oldham; and I am glad to hear about the new museum.

PARLIAMENT: BUILDING WORK AND PEERS' AMENITIES
LORD INGLEWOOD: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what is the estimated cost of the building works now being undertaken, or that are in an advanced state of planning, above and below ground, on both sides of Bridge Street, in order to improve the facilities and amenities of Parliament; and whether they will state which of these works will be for the benefit of the House of Lords.
LORD SANDFORD: My Lords, the estimated cost of building works now being undertaken or in an advanced state of planning is approximately £4·43 million. Of this sum, £1·2 million is for the benefit of your Lordships' House. This includes the extension to the Peers' Dining Room; additional accommodation to be provided by infilling; improvements in the Moses Room; and a closed circuit television annunciator system for this House. This estimate does not include the proposed new Parliamentary building in Bridge Street.
LORD INGLEWOOD: My Lords, while thanking the noble Lord for that reply (and also paying tribute to our improved telephone system, which was not mentioned by the noble Lord), may I ask whether Members of the House of Lords are likely to get any benefit from the large and expensive underground car park or the building on the other side of Bridge Street.
LORD SANDFORD: My Lords, that will be a matter for discussion between the appropriate committees of each House.
LORD INGLEWOOD: My Lords, does the noble Lord mean that this money was spent before any such discussion took place?
LORD SANDFORD: No, my Lords, What I mean is that it is up to the

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appropriate authorities of each House to decide matters of this kind.
THE EARL OF LAUDERDALE: My Lords, can the noble Lord hold out any hope that as a result of the development on the other side of Bridge Street noble Lords in this House may have access to some reasonable office accommodation, and thus set aside the thought, commonly widespread, that we are second-class Members of Parliament?
LORD SANDFORD: My Lords, the original Question relates to works in hand or in an advanced stage of planning. The proposed new Parliamentary building is in an early stage of planning, and I do not think that at the moment that question arises.
THE EARL OF LAUDERDALE: My Lords, since it is in its early stages, perhaps the noble Lord can give us some encouragement.
LORD LEATHERLAND: My Lords, I should like to ask what are possibly two helpful questions. Can the Minister give us a clear guarantee that, as a result of the works being carried out in New Palace Yard, Big Ben will not one of these days come tottering down? Secondly, does he not think that the Government have already done enough in undermining Parliament politically to do away with the task of undermining it physically as well?
LORD SANDFORD: My Lords, all these trends are being carefully monitored. As to Big Ben, it has been about eight to nine inches out of true for most of its life, and the movements have not been a result of the work that is going on at the moment.
LORD GLADWYN: My Lords, bearing in mind the Leaning Tower of Pisa, would not the noble Lord agree that this would be a great tourist attraction?
LORD SANDFORD: My Lords, it already is.

MENTAL HEALTH: RESEARCH EXPENDITURE
2.42 p.m.
BARONESS BROOKE OF YSTRADFELLTE: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what was the total expenditure of the Medical Research Council in the year 1971–72; and out of this total how much was spent on research into all types of mental disorder.
THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF EDUCATION AND SCIENCE (LORD BELSTEAD): My Lords, the Medical Research Council's total expenditure for the year 1971–72 amounted to £23·469 million, of which £2·079 million was devoted to research into all forms of mental illness. The Council's expenditure in this field has risen steadily over the years, having increased nearly six-fold since 1961–62; the proportion of the Council's total budget so allocated has risen from 6½ per cent. to nearly 9 per cent. over the same period. Special efforts are being made to expand the Council's programme on mental illness, in particular by encouraging biochemical studies in psychiatry. During the past year two new research establishments concerned with the biochemical aspects of the problem have been set up and the Council have awarded four long-term programme grants and some 35 project grants in this field.
BARONESS BROOKE OF YSTRADFELLTE: My Lords, while thanking the Minister for that encouraging report on development in the forms of moneys made available for research, may I ask him what amount was spent by the Medical Research Council in the year 1971–72 on research directly aimed at finding the causes of schizophrenia and what amount was spent on general research with relevance to that objective?
LORD BELSTEAD: My Lords, I am told that the difficulty is that biochemical studies in progress in the field of mental illness may relate to the knowledge both

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of schizophrenia and also of mental disorder in general; and that the same applies to the neuro-biological studies on the functions of the nervous system. It is for this reason that I do not think I can give the noble Baroness a figure relating only to schizophrenia beyond what I said in my original Answer.
BARONESS SUMMERSKILL: My Lords, in view of the fact that 50 per cent. of the hospital beds in this country are occupied by patients suffering from some degree of mental disability, does the Minister think that the small proportion which he mentioned as being allocated to research is adequate?
LORD BELSTEAD: My Lords, the figures rose from £368,000 of M.R.C. expenditure on mental health in 1961–62 to £2,079,000, and those are out of total budgets of £5,572,000 in 1961–62 and £23,469,000 in 1971–72. The respective percentages are 6·0 per cent. and 8·86 per cent. As the noble Baroness will know very much better than I do, there is other research which goes on in this field as well.
LORD MAYBRAY-KING: My Lords, is the noble Lord aware that the voluntary bodies who care for spastics, autistic children and spina bifida children are keenly interested in research into the causes, the treatment and—some day, please God!—the cure for these handicapped children? Is there a link between the work which his own Department is doing and the work done by the voluntary bodies?—because the voluntary bodies are hampered above all by lack of money.
LORD BELSTEAD: My Lords, when I referred the noble Baroness, Lady Summerskill, to other research which is going on in this field I was thinking particularly, among other things, of the Mental Health Research Fund, the National Association for Mentally Handicapped Children and the National Association for Mental Health. I think the link which the noble Lord is asking about is really between the Department of my right honourable friend, the Secretary of State for Social Services, and those bodies. I know there is a link certainly between the Government and the second of the three organisations I mentioned.
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Perhaps the noble Lord would allow me to look at this point a little more closely and get in touch with him.
BARONESS SEROTA: My Lords, I wonder whether I might refer to the point raised by the noble Lord, Lord MaybrayKing, and take it a little further. He asked the question specifically in relation to the voluntary organisations who are concerned with various forms of handicap. May I ask the noble Lord, Lord Belstead, whether the figures he has just given to the House on research into mental disorder include research into mental handicap, or whether this is money found from an entirely different Vote?
LORD BELSTEAD: My Lords, no; as I understand it, this refers to mental handicap as well but does not necessarily include the cost of work done by any of the voluntary bodies. If I am wrong on that point I will certainly write immediately to the noble Baroness. But, as I understand it, what I said to her is the case.

BUSINESS: DELEGATED LEGISLATION
2.47 p.m.
EARL ST. ALDWYN: My Lords, your Lordships will have noticed that the Business for tomorrow includes a Motion on delegated legislation in the name of my noble friend the Leader of the House. A number of your Lordships have indicated that they would like to speak on this subject, and therefore it has been agreed through the usual channels that the debate should be postponed until Tuesday, January 30, when it will take place after the debate on the Robens Report standing in the name of the noble Lord, Lord Avebury.

INDEPENDENT BROADCASTING AUTHORITY BILL [H.L.]
THE MINISTER OF STATE, HOME OFFICE (VISCOUNT COLVILLE OF CULROSS): My Lords, on behalf of my noble and learned friend the Lord Chancellor, who I am sorry to say is indisposed, I beg leave to introduce a Bill to consolidate the Television and Sound Broadcasting Acts 1964 and 1972.

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I beg to move that this Bill be now read a first time.
Moved, That the Bill be now read 1ª.—(Viscount Colville of Culross.)
On Question, Bill read 1ª, and to be printed.

MATRIMONIAL CAUSES BILL [H.L.]
VISCOUNT COLVILLE OF CULROSS: My Lords, again I rise on behalf of my noble and learned friend the Lord Chancellor, to move that this Bill be now read a second time. It, too, is a Consolidation Bill but it gives effect in addition to the recommendations of the Law Commission in their Report (Cmnd. 5167) that was laid before Parliament last month.
The Bill consolidates most of the surviving provisions of the Matrimonial Causes Act, 1965, the whole of the Divorce Reform Act, 1969, the greater part of the Matrimonial Proceedings and Property Act, 1970, the whole of the Nullity of Marriage Act, 1971, together with certain other provisions relating to matrimonial proceedings. The Law Commission's more important proposals—and there are quite a number of them—are designed to improve the rule-making powers, particularly relating to parties to a matrimonial cause, to clarify a respondent spouse's right to have her financial position considered before being divorced and to remove a possible doubt about the right to remarry after decree absolute. With the permission of the House, I will not go into the details of these changes at this stage, because they will go to the Joint Select Committee on Consolidation Bills; and I would also remind the House that the Law Commission's recommendations can be debated and discussed in this House after the Bill comes back from the Joint Select Committee. Therefore perhaps I may leave the matter there to-day. My Lords, I beg to move.
Moved, That the Bill be now read 2ª.—(Viscount Colville of Culross.)
On Question, Bill read 2ª, and referred to the Joint Committee on Consolidation Bills.

NATIONAL HEALTH SERVICE REORGANISATION BILL [H.L.]
2.50 p.m.
LORD ABERDARE: My Lords, I beg to move that the House do again resolve itself into Committee on this Bill.
Moved, That the House do again resolve itself into Committee.—(Lord Aberdare.)
On Question, Motion agreed to.
House in Committee accordingly.
[The EARL OF LISTOWEL in the Chair.]
Schedule 1 [Additional provisions relating to new authorities]:
BARONESS SEROTA BARONESS SEROTA moved Amendment No. 45:
Page 49, line 9, leave out ("appointed by him as he thinks fit") and insert ("being not less than fifteen and not more than twenty-five of whom one-third shall be appointed jointly by local authorities for each county and each district and by the Area Health Authorities wholly or partly within the region of the Regional Health Authority or in the case of Greater London jointly by the London Boroughs and the Area Health Authorities wholly or partly within the area of the Authority and by the Inner London Education Authority, one-third to be jointly appointed by persons representative of the following categories, namely

(a) the medical practitioners of the region

(b) the dental practitioners of the region

(c) the nurses and midwives of the region

(d) the registered pharmacists of the region, and

(e) the ophthalmic and dispensing opticians of the region, and

one-third by the Secretary of State.")
The noble Baroness said: I beg to move Amendment No. 45, standing in the names of myself, my noble friend Lady White and my noble friend Lord Garnsworthy. The Committee may recall that during the consideration of Clause 5 of the Bill on the second day of the Committee Stage I indicated some of our basic objections to the proposed nature and functions of the Regional Health Authorities. Now we come to consider their proposed membership, as set out in bare outline in paragraph 1 of Schedule 1. As at present drafted, this gives the Secretary of State the ultimate decision as to numbers and choice in the appointment of all the members of the

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proposed Regional Health Authorities as he thinks fit, after consultations with the interests specified in paragraph 1(2) of the Schedule—in fact just as he does now in the case of the 14 Regional Hospital Boards.
I am sure that members of this Committee, above all, recognise the great contribution, both past and present, that members of the existing Regional Hospital Boards have given through their time and energy to the development of the Hospital Service in the past 25 years. Many of your Lordships have served on these Boards and are familiar with the responsibilities involved. It is equally fair to say that the most frequent criticism that has been made of the Boards is that they are far too remote from the people that they serve. This Bill, unfortunately, utterly fails to meet this criticism by taking the opportunity of reorganisation to make the new Regional Health Authorities more representative, both of the professional and of the public interests that are directly involved. We see this as a particularly retrograde step at a time when we are removing from democratic local government the whole range of community health services which have been locally administered ever since the beginnings of local government itself.
Judging from certain Amendments to the Schedule which follow on the Marshalled List, it seems that other noble Lords share some of these views in principle, although we may differ a little about the numerical balance of interests that should be included in the Regional Health Authorities as of right, rather than leaving their numbers and composition entirely to the absolute discretion and choice of the Secretary of State after the consultation specified in the Schedule. I am therefore glad that we are to have a general debate on this group of Amendments as a whole on the understanding that this will not preclude further consideration of the individual Amendments themselves, or prevent us from putting questions to the Minister on any or each of them as we proceed.
Broadly, the effect of the Amendment that I am moving will be to limit direct ministerial appointments to the new authorities to one-third of their total membership
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after consultation with the interests specified in paragraph 1(2). In Amendment No. 49B we are seeking to amend sub-paragraph (2)(d) to include specific reference to the trade unions and voluntary organisations instead of the present vague reference to "other bodies". The Amendment would provide that the local authorities, jointly with the Area Health Authorities within each health region, would have the right to nominate up to one-third of the membership of the new Authority; and the main health professions, as specified in our Amendment, would be responsible for providing and nominating the remaining one-third.
The Amendment is put forward in the belief that the contribution and participation of all these groups is essential to the development of co-ordinated health service policies which are truly sensitive and adaptable to consumer and professional needs and interests in the localities that they serve. The case for reflecting Area Health Authority knowledge and experience in the membership of the new Regional Health Authorities was to be the subject of a separate Amendment which was formerly down on the Marshalled List in the name of the noble Lord, Lord Reigate. Unfortunately, I understand that he cannot be with us to-day. According to the Grey Paper on management arrangements in the National Health Service (with which most noble Lords are now familiar), the areas are to have full planning and operational responsibilities for providing comprehensive health services in their areas, and it is difficult to see how they can be completely excluded from the regional planning process at member level and only allowed access to the Regional Authority through the bureaucratic chain of command. Nor do I believe that there can be any question of the direct concern of the relevant local authorities within each health region in the overall planning provision and coordination of health services with the great range of social services that they themselves provide directly for the public living in their areas, since Clause 10 of the Bill places a clear statutory duty on local authorities of every kind, and Health Authorities generally, which presumably includes Regional Authorities as well as Area Authorities, to co-operate in the exercise of their respective functions to secure reciprocal and complementary

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health and social services that are required to advance the health and welfare of the people of England and Wales.
Although Clause 10, subsection (2), of the Bill provides for statutory consultative committees of members for this specific purpose at area level, there is no comparable recognition in the Bill of the need for some form of joint planning at regional level where strategic planning decisions are to be taken. The only recognition that I can trace in the many documents that have been issued on the reorganisation of the Health Service is a reference in the first report of the Working Party on collaboration suggesting that the region is to be represented at area level at joint consultative committee meetings. Can the Minister confirm this? If this is the intention, can he say who is to fulfil this particular function? Is it to be an appointed member of the Regional Authority, or is it to be an official? I find it difficult to see how the Area Health Authorities or the local authorities can effectively fulfil the general statutory duty under Clause 10 if they are not included in the regional planning process through members of the Regional Authorities as of right. If this is not acceptable to the Government I hope that the Minister will be able to tell us in the course of this debate how they see this essential relationship working in practice.
With regard to the proposals in our Amendment that the health professions should be directly involved in the work of the region by providing one-third of the membership, I already explained on Second Reading that we on this side of the Committee have no great love for Clause 8 which groups and isolates the health professions in parallel but separate advisory committees which then have to be recognised by the Regional Health Authorities. We believe that they too should pay their full part, contributing their skills, their knowledge and their experience to the planning of services, which after all they so largely provide, by participating directly in the policy decision-making process of the Regional Health Authority itself. The separate professional advisory machinery which the Bill provides, and was foreshadowed in paragraph 100 of the White Paper, envisaged building into the new structure, to ensure that the health professions exercise
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an effective voice in the planning and operation of the Health Service at all levels. We do not see the advisory committees as any real substitute for this; and I was interested to see in subsequent Amendments on the Marshalled List that we shall shortly discuss that the medical profession in particular is not fully satisfied that the proposals as at present designed will really achieve this. Presumably the nursing profession, which is so vital to the Health Service, would be among the "other professions", as they are described in the Bill, that would appear to the Secretary of State to be concerned in the terms of paragraph 2. They are not even mentioned, and I hope the Minister will be able to confirm to-day that it is the intention of the Secretary of State to include them, too, as of right in the health professions other than the medical profession that he intends to consult.
The Committee will see from the Amendment that we are also concerned about the proposed size of the Regional Health Authorities; and a subsequent Amendment on the Marshalled List, No. 59, relates to the one I am now moving in that it provides a device for, if necessary, joint appointments between the relevant authorities to the Regional Health Authorities. We are anxious that the Bill should provide for greater flexibility than is apparently intended at the moment in the size of the regional authorities up to a limit of, say, 25 members and beyond the figure of 15 suggested as the likely norm in the White Paper to cater for those situations where, for example, in Region 14 (the Lancashire and Greater Manchester local Government regions) and Region 12, which includes the counties of Hereford, Worcester, Shropshire and the seven Metropolitan Districts that will make up the West Midlands Region, there will be as many as 11 Area Health Authorities and 11 matching local authorities operating within the boundaries of the health region. While fully appreciating the desire of the Secretary of State to keep the new Regional Health Authorities relatively compact, there must be, surely, some recognition of the range of interests and different kinds of areas they are catering for, quite apart from the very important question of seeking to lighten the heavy burdens that will fall on this small group of 15 members who, apart

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from their chairman, will be giving voluntary, unpaid service to the Health Service without even, apparently, the kind of attendance allowances which their colleagues in local government will be receiving under the provisions of the new Local Government Act.
Perhaps I might also take this opportunity, as we are having a general debate, and to save time later on, to make specific reference to our Amendment No. 49B, which refers to the inclusion of trade unions and voluntary organisations in the lists of organisations in paragraph 12 that the Secretary of State must consult before he appoints the Regional Health Authorities. The case for this is so self-evident that I feel I need scarcely take up the time of the Committee to make it. Perhaps the Minister could tell us whether it is intended to include them and, if so, whether the Government are prepared to accept an Amendment which I think should commend itself in all parts of the Committee, remembering as we do the contribution of both the voluntary organisations and the trade union movement to the National Health Service.
Throughout all the previous lengthy debates on the reorganisation of the Health Service and on the proposed membership of the new health authorities the Government have until now refused to listen to those both inside and outside Parliament and from all parts of the political spectrum, and to those even within the Service, who are opposed to the rigid distinction which appeared first in the Consultative Document, then in the White Paper and the Grey Paper, and now apparently in the Bill—or, rather, in the order-making powers in the Bill, which seek to establish a rigid division between the management functions of the new Health Service authorities which are to be exercised by members entirely appointed by and accountable to the Secretary of State and any form of democratically elected consumer or direct professional participation in the policy-making processes in the Health Service, except of course for the proposed inclusion of four local authority members at area level suggested in the White Paper. I, for one, still cannot accept that any element of democratic participation and efficiency are by definition incompatible in a public social service such
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as the National Health Service which, above all, must be publicly acceptable and especially flexible and sensitive to consumer need and to public reactions to the services provided. Nor can I understand how the Government can speak with two such different voices on the same subject almost at the same time. This House and the other place spent a long time last Session in considering in great depth, and indeed at great length, how to improve and strengthen democratic local government which provides almost all our other major social services: education, housing, environmental planning and the personal social services. Now we are being told that the representative function and efficient management are incompatible in one body and that it is inappropriate, if not dangerous, to allow any form of representative interests in the administration of the unified Service.
These Amendments are submitted to the Committee in the firm belief that the local authorities, Area Health Authorities, the health professions and trade unions and voluntary organisations should be included as of right in the new regional authorities, which we would still prefer to see as regional councils for the reasons I have already given in our debates on Clause 5. Since other noble Lords have further Amendments to this Schedule, and the same part of the Schedule, I would only conclude with the hope that the Government really will be prepared to listen to-day and to take heed of the general debate we are now to have on the composition and on the methods of appointing the regional authorities. I beg to move.
3.8 p.m.
LORD BROWN: In discussing the Amendments before us we are very much concerned with matters of principle. I start with the suggestion that it is a proven fact that if one is appointed to a role, then one is accountable to those who appointed one. That means to say, in contradiction to my noble friend on the Front Bench, that if you do not keep separate the management structure and what one might call the representative structure, then you have on one and the same body people who are diversely accountable to different bodies. One of the principles which we are debating is

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the principle that you must keep management, on the one hand, and representation of those affected, quite separate. Amendment 45 would bring about a mixture of persons on the Regional Health Councils: people responsible to local authorities and others, on the one hand, and people responsible to the Secretary of State, and eventually to the Government, on the other. This would be to the grave detriment of the efficiency of the Health Service, and as a result patients would suffer, money would be wasted and the services would not be as complete as they would otherwise be.
There are many who continue to think that by excluding representatives of employees or representatives of patients, and so on, from management functions you are being undemocratic. My own experience convinces me that it is only by keeping them separate that you really get a fair share of what we regard as democracy. It is the individious position in which representatives are placed when they are given accountability to higher authority, apparently, as a result of their being put upon a management body, and are also held simultaneously responsible to those who have appointed them—perhaps the consumer or the employee—that really loses the essence of the democracy which people seek to achieve by this process. So I have certain criticisms to make. I suggest that Amendment No. 45 is not sound, for the reasons I have given, because it produces on the Regional Heath Authority a mixture of people accountable to the Secretary of State for the management of the Health Service and other people accountable to local authorities for representing the views of the community as a whole.
Turning to the Area Health Authority, I criticise the Bill because in Schedule 1, paragraph 2(1)(d), referring to those who shall be members of the Area Health Authority, it calls attention to the fact that it shall be:
"the specified number of members appointed by the specified local authority or local authorities."
So if the Government resist Amendment No. 45 they can scarcely support the maintenance in the Bill of paragraph 2(1)(d) in Schedule 1 to which I have just referred, because in principle they are both moving in the same direction.
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Personally, I should prefer to see paragraph 2(1)(d) removed and the whole of the Area Health Authorities appointed by the Regional Health Authorities or by the Secretary of State, always, of course, after taking soundings among the various bodies as to who would be suitable appointees.
In this Bill the interests of the patients and the community at large and the local health authorities are looked after, first, by Parliament itself and its servant, the Secretary of State, second, by the Commissioner (a most important innovation), and third, and perhaps most important of all, by the community health councils in each district. The powers of these councils are extensive. They can call for reports, they can insist on visiting hospitals, and so on. The powers are set out quite clearly. But the extraordinary thing is that if one looks at the way in which these community health councils are to be formed one is left with the impression that instead of being elected by local authorities, or even by elections in the towns and districts, they are apparently to be appointed. So one has the extraordinary situation in this Bill that here is my noble friend on the Front Bench moving in a direction which would put upon the Regional Health Authorities a mixture of representatives and managerial personnel, which no doubt the Government will resist. There are clauses in the Bill which, as they stand, insist that this mixture shall obtain on the Area Health Authorities, and when one comes to the community health councils one finds that whereas one would expect to follow through the principle that they are to look after the interests of local authorities and of the patients, apparently they are to be appointed by the Area Health Authority.
LORD ABERDARE: I hesitate to interrupt the noble Lord, but we shall soon come to the subject of the community health councils. I think he has it slightly wrong; at least half the community health councils will be nominated by the local authorities.
LORD BROWN: I note what the Minister has said, but the word "nominate" does not satisfy me. It is true that the local authorities can nominate, but who decides whether these people shall become a part of the community health councils?

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I am deploying my comments on the community health councils not because I particularly want to start a debate about them at the moment but in order to draw attention to the inconsistencies that arise in this Bill and the inconsistencies in some of the Amendments which we are discussing. I will close my remarks by suggesting that it is essential to keep representative persons and bodies quite separate from managerial bodies and that by so doing one will get more efficient management and more efficient representatives of local authorities, of patients and all the rest of it. Immediately one mixes these things one puts everybody on these mixed bodies in an extremely difficult position. I believe it is true to say, although I have no personal experience, that the hospital management committees have sometimes been confused because some of them have construed their role as being to represent the interests of the community in which their group of hospitals exists and some of them have presumed that they are there to represent the Health Service itself. I believe there is no question but that they are there for the latter function rather than the former. But this is a confusing situation and personally I have little doubt that it has led to some unfortunate situations in the Hospital Service which were probably attributed to personalities. So I have risen merely to draw attention to what I think is an extremely important principle which should be represented in every clause throughout this Bill which deals with management personnel or, on the other hand, with representative personnel.
LORD BROOKE OF CUMNOR: I could hardly disagree more with the noble Lord who has just spoken. It seems to me to be an extraordinary doctrine that on an executive body one should never have any representatives of the general public or the consuming interests, and that if you do have them there they will have divided loyalties and therefore will become ineffective. We must surely grant that there are people who are capable of rising above these difficulties and doing their duty as they see it. I simply cannot accept the idea that representatives of the public should be excluded from executive bodies which have to provide a service. This may be so in the
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provision of gas or electricity, but the subject we are discussing now is far more sensitive than either of those, and far less uniform. I cannot accept the idea of having the National Health Service run by a body of managerial technocrats with no dilution whatever.
I warmly welcome the idea that we should have a general debate on the composition of the Regional Health Authorities and then of the Area Health Authorities, because I believe—and I hope the noble Baroness, Lady Serota, will agree with me—that what we want to do most of all is to elicit from the Government what their own ideas are for the membership of both these types of bodies. My principal anxiety in putting down my Amendments was to give the Government an opportunity to make clear what sort of composition of Regional Health Authorities in the first instance they were aiming to produce by this Schedule, because the Government would be the first to agree that it is not absolutely clear simply from reading the Schedule. Then we shall be in a position to discover whether there is a fundamental difference between the Government, on the one hand and those who are seeking to amend this Schedule. Frankly, I do not know.
The Government appear to me to visualise a Regional Health Authority as a small group of experts in management who, somewhat mysteriously, can be relied on to know what the public want, or ought to want. On the contrary, I visualise a Regional Health Authority as being ideally a rather larger body of people—rather larger than fifteen members—with a lot of practical and financial good sense, wider understanding and (if I may venture to put it this way) more compassion than experts sometimes have, and with a built-in channel of communication between itself and the public that it exists to serve. The main purpose of my Amendment is to keep that channel open.
The Regional Health Authorities will have responsibility for some health services which are now administered by elected local authorities. The Government will no doubt have noted that there is nothing in the Bill which ensures that there should be any local authority representatives at all on the Regional Health Authorities. If my Amendment were acceptable, that would be put right. I

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am not yearning to move my Amendment or to press it to a Division; indeed, I have no intention of doing that to-day. I hope that between now and later stages of the Bill the Government will take into consideration the points that are being made from both sides and will produce their own plan in more explicit form; it may be better than the original Bill and any of these Amendments. I am not asking, as is the noble Baroness, that one-third, one-quarter or any other particular fraction of a Regional Health Authority shall be local authority representatives. I am merely seeking that at least five shall be, whereas in the Bill as it stands there is no guarantee that there will be any.
I repeat in passing that the suggested figure of 15 members on the Regional Health Authority is surely too small. The principal criticism of the Regional Hospital Boards has been their remoteness, and they were larger than 15. I do not see how the members of the Regional Health Authority can do their job unless they are able to make themselves reasonably familiar with what is going on in the National Health Service throughout the region. They will certainly have some social functions to perform. That is inevitable. They will certainly have some problems of local difficulties, tensions and conflicts to resolve. I should have thought therefore that a body of 15, even with a salaried chairman, would not be large enough to enable the members to know enough personally about the hospitals or other local health services throughout their region and to do all the other duties which will inevitably fall upon them. That is why I fear that these Health Authorities, while I agree with the Government in giving them executive rather than advisory powers, may be regarded as even more remote than the present Hospital Boards.
It may be that in the view of the Government that will not matter so long as they are successful management technocrats. But supplying the National Health Service is not on a par with supplying ordinary commodities. It is necessary that they should be sensitive to public opinion, and I would say that it was essential, if they are sufficiently to commend themselves to the population of the area for which they have responsibility, for them to include a material
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number of elected local authority representatives.
I have no desire to bind the hands of the Government in these matters. I realise that an all-wise Minister might very well produce a Regional Hospital Authority better than any of us could contemplate, even though he had to carry out a certain amount of consultation. But it seems to me that we are leaving a great deal to the Secretary of State, and I should be most grateful if my noble friend would indicate whether he and the Secretary of State really are contemplating management expertise as being the first requirement of every member of the Regional Health Authority. If so, then although they may satisfy the noble Lord, Lord Brown, I do not think they will satisfy the general public; and it is because the general public is always anxious to ensure that there is somebody on the executive body who has the qualifications to understand local problems that I press these matters.
LORD BROWN: It is quite clear that before these appointments can be made by the Secretary of State he will, and rightly so, consult all kinds of local authorities, trade unions I hope, and the rest. There is absolutely no reason why people who have some knowledge of;management—who are competent and mature managers—should not also be familiar with local problems. The noble Lord, Lord Brooke of Cumnor, has suggested by inference that either one has people with knowledge of management or people with knowledge of local problems. He has suggested that it is not possible to combine both in the same person. With great respect, he is not right.
LORD BROOKE OF CUMNOR: I was not seeking to establish anything of that kind. I have been worried about statements emanating from the Government that managerial expertise will be the primary qualification for these people. I spent more than twenty years in local government and I met many people there whose managerial expertise was high but was equalled, if not surpassed, by their sensitivity to local public opinion. I shall be only too happy if the Government will make it clear that they want a substantial number of people on these Regional Health Authorities who will

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amply fit in with the definition that the noble Lord, Lord Brown, has just given.
May I ask my noble friend Lord Aberdare to say what will be the likely attitude of the Secretary of State towards those who are at present serving on Regional Hospital Boards and hospital management committees. Is it likely to be the desire of the Government to get rid of all of those people unless they have medical or managerial qualifications? Or, after all the consultations that are laid down by Statute have taken place, is their attitude likely to be that they will seek to retain in the service of the National Health Service those who have fully justified themselves by the work they have done on Regional Hospital Boards and management committees? I am aware that the new responsibilities will go much wider than has previously been the case with these bodies. But I would have thought that there exist a considerable number of those people who are not professional people but who nevertheless would be of great value in the new régime.
My Amendment speaks of local authority members, but my main purpose is to ensure that there will be a sufficient number of people on these Regional Health Authorities who are not there simply because of their professional qualifications. I believe that these bodies should be a well judged mixture between the amateur and the professional. I should be fearful indeed if these Regional Health Authorities were to consist wholly of untried amateurs, but I should be even more frantic if I thought that they would consist entirely of medical or other professionals.
LADY RUTHVEN OF FREELAND: I rise to speak in support of something said by the noble Baroness, Lady Scrota, and repeated by my noble friend Lord Brooke of Cumnor. The noble Baroness spoke of "voluntary people" in the National Health Service. I think that by that both she and my noble friend had in mind those who have served on Regional Hospital Boards and hospital management committees. In my view, their knowledge of the Health Service is very great indeed and it would be the greatest pity if they were excluded from membership of the new Regional Health Authorities simply because they did not
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have the technical qualifications that appear in the Bill. If they have given a number of years' good service to the consumer, the patient, they should not be forgotten when the constitution of the regions and areas is arranged.
3.30 p.m.
LORD LEATHERLAND: I should like to say a word in support of the Amendment moved by my noble friend Lady Serota. I believe that on the whole this is a very good Bill. It is undeniable that the Health Service, having run for so many years, is in need of some kind of overhaul, but we must be careful to ensure that the overhaul is conducted on the proper lines. It may well be that every word in my noble friend's Amendment is not beyond question or dispute, but if the Government could come forward with an undertaking that something in the nature of the spirit of that Amendment will be incorporated in the Bill then I should be quite content. I have a nasty feeling, which has been growing in recent months, that this country is tending more and more towards the corporative state of Italy. Democracy is being squeezed out and bureaucracy is being injected at various levels of our administration and government, and if there are Services that ought not to be run by a bureaucratic machine, surely they are the Hospital and Health services.
As the noble Lord, Lord Brooke of Cumnor, with his long experience of local government has said, the representatives of the people in local government are very much closer in touch with the feelings and the aspirations of the ordinary people than are the people who are closeted in their offices administering the machinery of any particular piece of legislation. I sincerely hope that local government representatives will be brought in at all stages of this new Bill. I know that they are in at some stages already, but also it is essential that they should have a voice in the Regional Authority.
My noble friend Lord Brown is a recognised national and international expert on management science. I take off my hat to him in that respect. The thesis that he has put forward this afternoon would be admirable if we were planning to set up a factory. But we are not discussing nuts and bolts and pipes and tubes: we are discussing

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people; we are discussing patients; we are discussing their families; and we are discussing the facilities that are available to all those people should their health break down. My noble friend rather criticised the idea of there being a mixture of people, a mixture of views and a mixture of attitudes on these authorities. Surely a mixture is desirable; it leads to argument; it leads to proposals being hammered out on the anvil; and it leads ultimately to a respectable and proper decision being arrived at.
LORD BROWN: Would the noble Lord mind if I interrupted him?
LORD LEATHERLAND: Of course not.
LORD BROWN: The noble Lord is misquoting me. I have no objection to a mixture of attitudes, views or anything else, and I have never said anything that could possibly be inferred to suggest that I object to it. I simply suggested that to have a mixture of people on one body, differently accountable to different other bodies, is unsound. I am not even suggesting that they all should have managerial expertise or should all be managers or should all be all so sufficient, but to have a body accountable to the Secretary of State for running the Health Service and to have that body composed of people separately accountable in both directions is to put them in a very difficult position.
LORD LEATHERLAND: I am glad of my noble friend's brief interruption. He objects to mixtures! We have a mixture here, and it works. One side says one thing and another side says another thing; sometimes the two sides become a mixture in themselves, but ultimately we try to arrive at a consensus which may be right or wrong. Decisions are not always right in this world. I am quite sure that a mixture on this Regional Health Authority would be very healthy indeed. I am afraid that my noble friend, with his great expertise in matters of management, has come unstuck in one particular—a board of directors does not manage, a board of directors gives directions which are then handed down to professional managers who manage. The same kind of thing happens in local government. Aldermen and councillors sitting around a table do not profess to be managers (they are fools if they do,
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and they do occasionally); they indicate the direction in which the policy of their particular council is to move and then they instruct their officials, who are the technical, professional, expert managers, to get on with the management and the implementation of that particular policy.
I know it is suggested in Clause 10 that at certain stages there shall be some kind of co-operation between local authorities and these professional, bureaucratic boards. But it is only a consultative committee that is being suggested, even at that level. I shall not call it an executive committee because that rather tends to get into the management level, but it is not a committee which will be able to give directions as to the line and the general attitude which is to be taken by that Health Authority. What is wrong with the principle of having elected people directing our public affairs? We have them in the Cabinet. That is one of the very foundations of our democratic system of government in this country. I dislike the particular complexion of this Bill which seems to have a mania for professional management and which seems to squeeze out the democratic attitude of mind. When all is said and done, during the last two and a half years I have not been especially enamoured of the management ability of Her Majesty's present Government. In this Amendment and those other Amendments touching on this same question which are to come later this afternoon, let us see that we do not say to the ordinary democratically elected people of the country: "The time when you can serve the community is gone. You have to make way for bureaucrats."
VISCOUNT AMORY: I should like to say how strongly I agree with everything that my noble friend Lord Brooke of Cumnor has said and with almost everything that the noble Lord, Lord Leather-land, has said, including perhaps his remarks on the Italian corporate State. One thing I would say is that perhaps his analogy with this House was a little strange, because looking round, to my knowledge, I cannot see any of your Lordships who have been locally elected. But my noble friend Lord Brooke of Cumnor at the beginning of his speech administered the stick rather sharply to the noble Lord, Lord Brown, for expressing the doctrine that there was no place for

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locally elected representatives on a managerial, executive, directorial body. I have become so accustomed to acclaiming all the utterances of the noble Lord, Lord Brown, that I own I was shocked at the necessity for this reproof. But there are some occasions when the stick is justified—particularly when wielded with such a humane hand as that of my noble friend Lord Brooke of Cumnor—and this was one of them.
The case advanced in these Amendments is a powerful one. The fact that the principle behind them is supported by all four of the main local authority bodies I hope will lead my noble friend to attach appropriate weight to them. There is apt to be a danger inherent in this kind of authority and council, and that is the remoteness from the people they serve. The noble Baroness, Lady Serota, made this point and said that there is criticism of this remoteness even in the existing circumstances. Here I must own that I myself am not familiar in detail with the National Health Service having never sat on any of the bodies concerned, except on the county council side of the picture. Because of that danger of remoteness, every possible method must be adopted when passing legislation to make sure that the danger of this remoteness is reduced to the minimum. In the case of the proposals in the Bill, this danger seems to me particularly conspicuous. For reasons which no doubt the Government feel are good ones the organisation they are proposing is really a very hierarchical bureaucratic one. Power and authority are imposed from the top downwards. The Minister appoints almost everyone and approves almost everything. That in practice means that he does so on the advice of his officials. It will be an organisation run from the top and from the centre. Those of us who served in another place will remember the invariable reaction of Ministers on these occasions: "You need not worry; Ministers will exercise their power reasonably, after consultation." I think the noble Lord, Lord Brown, mentioned the point about consultation, but we know that when we are passing legislation we must not have our fears calmed down by that assurance.
Up to a point I think it is not unreasonable, when one remembers that the money is to come from central funds and
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that a great deal of public money is involved, that the Secretary of State should keep reasonably tight hold on the purse strings and take an active interest in his responsibilities for accountability. But this is not a unique constitutional problem. The central difficulty confronting legislators in a Bill such as this is how to reconcile the responsibility of the Minister to control the public funds which have been allocated to the Service with the vital contribution which can and ought to be made to the administration by the democratically expressed voice of the users of the Service. It is the considered view of the local authority bodies —all four of them, I think—that in the proposals put forward in the Bill there is not enough democratic participation to be effective.
The noble Baroness, Lady Serota, made the point about the sharp distinction which the Government appear to draw between managerial responsibility and local representation, and if that distinction really were as sharp as they appear to think, it would be a very poor look-out for local government as a whole; I think it would be a very sad situation indeed. We believe that the arguments that have been adduced (and they will also, I am sure, come from other sources) do call for an amendment to the proposals in the Bill in respect of the Regional Authorities, the Area Authorities and the community councils—though at the moment we are debating only the Regional Authorities. That these Regional Authorities should be entirely composed of Government appointees I cannot believe is right or necessary.
It is true, as the noble Lord, Lord Brown, said, that appointments will be made by the Minister after consultation, but the choice of the members remains that of the Secretary of State. As regards the representation of the democratically elected members, the views of many of us in local government rather differ from that of Ministers, as we understand it. I think Ministers probably accept that the work of the Regional Authorities in certain particular matters, such as planning, will be of interest to local authorities, and therefore certain links are required, in particular perhaps between the Regional Authorities and comparable local authority services, so far as some aspects overlap. But many of us

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look at it rather more widely than that. We believe that elected members of local authorities could bring to bear on the work of the Regional Authorities most useful knowledge and experience of what people want in general ways. That is to say, it will not be purely a technical view of one committee of the local authority about one matter, but will cover a very broad front. That seems to me rather a difference of outlook. I would urge the Ministers to try to check whether their view is not a rather narrow one in this respect. We feel that some local authority members will be a valuable element on all these decision-making bodies in the work of their decision making. We believe, therefore, there should be some minimum representation of local government on all these Authorities. Surely a sensible apportionment of the representation could be worked out. I strongly support the principle that runs through these Amendments, and I would urge my noble friend to look at them very carefully. If he finds something which will alleviate the anxieties we feel and give effect to that principle in a better way than any of these Amendments do, I am sure we shall be very grateful to him and shall be willing not to press our particular Amendments.
LORD INGLEWOOD: I should like to make only one point, which I believe has not yet been made in this interesting debate. In the arguments in favour of ensuring that there is full and proper local authority representation on all these bodies there is one point which I believe is very important. It is from these local authority members that originality is likely to flow. My experience of appointments made by Ministers is that they are very sound and capable men but all too often are safe men, because no official is going to recommend to his Minister that he should appoint someone who is going to be a nuisance. If anyone wants to make a career of Ministers' appointments on these and other bodies he must prove that he is competent and that he is safe. That sort of situation is not going to produce the originality of thought that an organisation like this must have at all levels. It can of course be said that some local authorities may send their awkward squad on to a body like this. But it is a risk that I think the Minister
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must take, that there should be occasional local authority members who do not understand what it is about and who will perhaps press their own King Charles's heads. None the less, it is from the local authority members that this very important originality of thought is likely to come.
LORD VIVIAN: Before the Minister replies, may I say that I feel that the Amendment moved by the noble Baroness, Lady Serota, would be of help in improving the Bill. All noble Lords in this House know of, and are deeply grateful to the noble Baroness for, the tremendous amount of work which she herself performed for the National Health Service when in office as a Minister in this House. During that time I approached the noble Baroness on several occasions with regard to the position and standing of medical practitioners; and I received the greatest courtesy and encouragement from her on this and on several other matters concerning national health. I shall certainly listen to what the Minister, the noble Lord, Lord Aberdare, has to say, but I hope that when he replies on behalf of the Government he will very carefully weigh up the reasoning of the noble Baroness. I believe that if the noble Lord, Lord Aberdare, and the noble Baroness got together they could work out some measure that would be acceptable to both sides of the House and of benefit to this Bill. It is therefore my hope that the Minister will not turn down this Amendment but will take it away and look at it again to see whether he can meet the noble Baroness.
LORD DAVIES OF LEEK: I apologise to the Minister for having come in late, but due to the fog I could not make it earlier. Consequently I will be brief but shall try to be cogent. I should like to support the request of the noble Lord who has just sat down. I sincerely hope that the Minister will take this back and look at it. I was reading with interest of the World Health Organisation symposium which was held in Stockholm in April, 1970. The title of the symposium, and the papers from medical experts and others, was Stress and Disease in Society; and it dealt with The Psychosocial Environment and Psychosomatic Diseases in man. We know that

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90 per cent. of all National Health Service patients first of all come to the base of the pyramid, the "P.B.I." of the Health Service, the general practitioner. He is down at the base. I think that it was Gould who wrote an article in the New Statesman a few months ago saying that we should get rid of the concept of "cottage medicine". We still have the general practitioner working in medicine like those in the old cottage industries before we had the Industrial Revolution in Britain.
I think he should have his place, and in view of the fact that 90 per cent. of the National Health Service depends on that pyramid I believe that he should have his say in the set-up of the Health Service. When using the phrase "cottage medicine", we must think of more and better health centres. May I appeal for a more democratic approach? God forbid this apotheosis of management! There is more in life than efficiency; there is living for the love of life. Nature is not just efficient; nature is erratic, with its abundance when it is producing. It is only man, through his ideas of efficiency and management, who thinks that he is making a better world. He is mismanaging his environment, so much so that probably 70 per cent. of the diseases we have today are psychosomatic: diseases of the mind and neuroses.
May I now quote from an article headed "The Human Factor—And The Inhuman", and say first, anent the symposium in Stockholm, that this kind of organisation is building up the inhuman side of it:
"When man becomes maladjusted to his physical, social and psychological environment, the blame is usually placed on 'the human factor'. Implicit in such criticism is the idea that the human organism, evolved more than 500,000 years ago, is now outmoded. Much of today's medical activity is concerned with the diseases induced by man's present environment and by his unsuccessful adaptation to it. Much less attention is paid to 'the inhuman factor', by which is meant environmental conditions, often arising from modern civilisation, that induce disturbances of a medical and/or social nature even in a perfectly normal biological organism."
I will finish there because I do not want to trespass on the time of the Committee after having made my apology for coming in late for this important debate. I finish with this remark, without going into
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it in depth because there is so much knowledge in this Chamber: this Part of the Bill is where all the power is concentrated. Even if a man were a genius and had the finest soul on earth, it would be too much power in one focal point. Therefore, I hope that after this debate —and I have heard quite a fair amount of it—the Minister, having heard from both sides of the House, will be good enough to reconsider this clause as it now stands.
3.54 p.m.
LORD ABERDARE: I have listened with great interest to this debate, and we have had some notable speeches in the course of it. If there is one thing that has got slightly under my skin it is the complete misrepresentation of the sort of people that we hope to see on the Regional Health Authorities. I must say to my noble friend Lord Brooke of Cumnor that when he referred to "managerial technocrats" and to a "small group of experts in management" it was the most unkind cut of all. I felt like howling out, "Et tu, Brookie!". That is not our intention in any degree at all. Perhaps the simplest thing to do would be to read out, for those of your Lordships who may have failed to read the passage, paragraph 96 of our White Paper.
"The work to be done by the members calls for general ability and personality. They will need to be interested in the NHS; to have an unbiased, questioning yet constructive approach and good judgment; to set high standards and provide vigorous leadership. A diversity and a proper balance of relevant ability and experience are also called for. These needs can best be met if, in the main, members are chosen for their personal qualities after appropriate consultations, not elected as representatives reflecting the views of particular interests."
There is nothing in that paragraph that mentions management, or managerial technocrats, or anything of that sort.
BARONESS SEROTA: Would the noble Lord allow me to interrupt for one moment? It is not really for me to defend the noble Lord, Lord Brooke of Cumnor, but I must point out to the Minister a sentence that appeared in the Consultative Document, when it said quite categorically:
"The authorities will be kept small and management ability will be the main criterion for the selection of members."
LORD ABERDARE: It is no good quoting the Consultative Document, because that is what we were consulting about. We have now put down in the White Paper what we are going to do, and that is much more relevant to what we are discussing now.
May I turn to the Amendment itself? I dislike the Amendment, and I am sorry to say that I could not possibly advise your Lordships to accept it, first of all on the grounds of principle and secondly because I do not believe that it is practicable. Schedule 1 proposes that appointments to Regional Health Authorities should be made by the Secretary of State after consultation with interested bodies. The Amendment would have the effect of making the Regional Health Authorities bodies representative, in the main, of local authorities and of some of the health care professions. I would ask your Lordships which approach is the more likely to enable these Regional Authorities to carry out effectively the important functions that they will have entrusted to them.
They will be responsible for the expenditure of many millions of pounds; some of it for allocation to the Area Health Authorities in their region, and some of it on the provision of regional services and specialties. What we are looking for is a good mix of people from various walks of life, but all united in the one aim of providing a comprehensive Health Service and putting the available resources to the best possible use. We believe that this will be best achieved if the Secretary of State is free to make the appointments to the Regional Health Authorities, just as he does now to the Regional Hospital Boards—and they are bodies that represent all sorts of different interests. They are all appointed by the Secretary of State and I know of no serious criticisms of what they do at the moment, although there has been mention by the noble Baroness, and I think my noble friend Lord Brooke of Cumnor, of their remoteness. But under the set-up that is proposed in the Bill, the Area Health Authorities will be much closer to the people who are using the Service, and these authorities will come between the Regional Health Authority and the hospitals and health centres themselves. Therefore, that remoteness, I suggest, will be of slightly less importance.
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I found a good deal of sense was spoken in the words of the noble Lord, Lord Brown. I certainly do not think that one wants only people of managerial capacity. I think that one wants to have a body at regional level who have one aim in mind. There were at one time two alternatives for the new Health Service. It could have been organised under the local authorities, but that was not the solution accepted by the last Government, nor is it the solution accepted by this Government. But those who criticise the proposed organisation on the grounds that it pays insufficient heed to the needs of the patient would be the first to accuse the Secretary of State if those needs were not being met. He is responsible under this Bill for the provision of the Service. How can we hold him responsible, unless he has at least the necessary powers to run the Service for which he is responsible?
The Amendment which we are considering would allow him to appoint only one-third of the members of the Authority which is his principal agent. I do not see how he could be held responsible for the Service if he appointed only one-third of the members at the Regional Health Authority level. I can see the dilemma in which members might be placed if disputes arose at some point between their appointing bodies and the Secretary of State, and it seems to me wrong to build tensions of this sort into the Regional Health Authorities. I believe that the Secretary of State must be able to determine the choice of people who are to be his direct agents in the National Health Service for which he is responsible, although I agree that he must consult wisely before making his choice. He will certainly appoint members of Regional Health Authorities from the local authorities and from the professions, but the Amendment would weaken the Authorities' accountability since no single appointing source could make changes in membership sufficient to remedy weaknesses in performance. Each group would be a distinct entity and, in effect, it would be a collection of minorities rather than a team and no one could be held responsible.
As for the practicalities, I very much doubt whether what is proposed in the Amendment could work. It would require

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one-third of a total membership of between fifteen and twenty-five to be appointed jointly by the local authorities and the Health Authorities wholly or partly within the regional boundaries. What would this mean in one of the larger regions, such as the present Sheffield region? Between five and eight members would have to be chosen by all the Area Health Authorities, provincial counties, metropolitan counties, metropolitan districts and non-metropolitan districts. In Sheffield, that would be a total of some fifty separate authorities competing for from five to eight places. How would they make the choice? How would a balance be struck between members from the Area Health Authorities and members from local government? How would the separate categories of local authority determine their total and separate shares? I know that later the noble Baroness has down Amendment No. 59, to provide a means for resolving disagreements, but I really cannot see it working and I can only think that under Amendment No. 59 we should come back to the Secretary of State making all the appointments because the others could not agree.
Then the Amendment calls for one-third of the members to be appointed jointly by six of the health care professions—doctors, dentists, nurses, midwives, pharmacists and opticians. If we take the Sheffield region again, there are about 25,000 people from those professions: and how are they to select their five, six, seven or eight representatives? Further than that, would each profession choose a specified number of candidates? If there were only five places, this would seem to mean just one place per profession, if one put the nurses and midwives together. And would the doctors be satisfied with only one place on the Authority? There are also other professions providing health care which may not feel happy about the set-up. So I really feel that the Amendment as it stands at the moment is muddled and impractical.
But on general grounds of principle, I do not feel it to be right that for the Regional Health Authority, which is the main agent of the Secretary of State for the running of the Health Service with which he has been charged, the majority of the members should be
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appointed by interests other than himself. I fully recognise the tremendous contribution that can be made by local authorities and, as I have said, there will be members of local authorities appointed to the Regional Health Authorities by the Secretary of State after consultation with them. But we have built into this Bill the closest possible relationship with local authorities at the Area level. It is there that we have the most intimate working arrangements with local authorities, and deliberately so. One of the main reasons for having Area Health Authorities was to link in as closely as possible with local authorities.
But there are certain aspects of the composition of the Regional Health Authority which have been mentioned this afternoon, which I certainly wish to look at and think about again. My noble friend Lord Brooke was on to an important point when he mentioned its size and I shall certainly look at that aspect, because we want to keep it small and manageable. We do not want large committees which are very often unwieldy but there is nothing rigid about the figure of 15. I am equally convinced, as is my noble friend Lord Amory, that there is a great contribution to be made by local authority members and we see this coming at Area level. Again, I have no reason for not thinking very carefully about this aspect in relation to the Regional Health Authority.
May I make one point in answer to the question which the noble Baroness, Lady Serota, asked me about participation and collaboration arrangements between local authorities and the Health Service? First of all, the joint consultative committee of the Area Health Authority and the local authority will consist of members, although it will be supported by a group of the appropriate chief officers of the authorities. The proposal is that the Regional Health Authority should be represented in the Area Health Authority's membership of the joint consultative committee, so that they would partake with the appropriate Area Health Authority in consultation with the matching local authority. I think I have given the reasons why I am afraid that I find this Amendment unacceptable, both in principle and in practice. But I have said that there are certain points with regard to the composition

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of the Regional Health Authority that I will look at, if I may, and in those circumstances I would ask the noble Baroness whether she is prepared to withdraw this Amendment.
4.10 p.m.
BARONESS SEROTA: I must first apologise to the noble Lord, Lord Aberdare, if I have been both muddled and impractical this afternoon. I have been seeking only to ventilate some of the issues of principle which I think all Members of the Committee are anxious to consider, before we come to any final conclusions on what we regard as a very important part of the Bill.
May I say straight away that I welcome the offer of the noble Lord, Lord Aberdare, to look again at the size of the Regional Health Authorities; and I was also glad to hear his, I thought, somewhat qualified undertaking that he might possibly consider including some element of local authority membership. That part of his reply was not quite clear, and I should like to have something rather more categoric from him before we come to a decision on some of the issues involved. Until now the Government have not been able to accept any element of this kind in the membership of the authorities, and before coming to a decision I think we should be a little clearer in our minds as to what is intended here now.
I should also like to make it quite clear—and I think I can say this on behalf of all noble Lords who have spoken in the Committee to-day and who believe that the representative function and the directional management function are not incompatible—that we all of us, on all sides of the Committee, are just as concerned with the good management of the Health Service as those who take the other point of view. Indeed, on the contrary, our anxiety to see efficient management and the most effective use of resources in so vital and expensive a Service as the Health Service is such that it inclines us even more to the kind of proposals we have been putting forward as regards membership than to the proposals put forward by those who have been determining the policy of the Government.
It is strange that the only ally that the noble Lord, Lord Aberdare, has found to-day is in the powerful support of my
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noble friend Lord Brown. So far, in three days of Committee stage, my noble friend is the only person who has supported the Government positively in this definition and delineation of the role of the manager and the role of the consumer, of the professional and the public service interest in the policy-making processes of the Health Service. Like my noble friend Lord Leatherland, I too fully recognise the long experience of my noble friend Lord Brown as a practising manager in the engineering industry; his great concern with the social organisations through which the manager works; and, above all, the value of the action research studies which he has undertaken in co-operation with Professor Elliot Jaques. But that does not mean that one must agree with all the experts in the field of organisational theory. Indeed, they very much differ as between themselves; and I take the view—and I think those noble Lords who have spoken to-day hold a similar view—that the major factors which affect the management of the engineering industry (such as development, production and sales) are not quite the same as those with which we are concerned in a social service like the Health Service.
There is, I think, a growing concern that lies behind much of our thinking—and I tried to make this point on Second Reading—that as organisations increase in size and complexity the needs of society and of individuals within it should not become subservient to the needs of the organisation, and that loyalties to organisational goals—and I felt this particularly while reading through the Grey Paper—should not supersede loyalties to social goals; again, above all in a service like the National Health Service. What we are trying to say to the Government to-day, I think, is that social services and their organisational structure must react to information that feeds through from the environment, from the consumer and from the public if they are to provide truly sensitive social services.
The noble Lord, Lord Aberdare, was quite right: there are very deep differences between us on this matter. There are deep differences of principle and there are deep differences of approach, although I welcome the offer that he has made in relation to the size of the authorities and to the possible inclusion of

39
local authorities. But these differences exist, and I think it would be unwise in a Committee stage debate to attempt to paper them over. Indeed, I hope the Committee will be prepared to express its views on this particular Amendment in the light of all the cogent arguments that have been advanced. I am not going to pretend for one moment that the wording is perfect. I take some of the points that the noble Lord, Lord Aberdare, made, although I am not sure that I quite agree with the numbers that he gave the Committee. This is Committee stage, and if your Lordships were to accept the principle I would be more than willing to come together with other noble Lords, and indeed with the Government, as the noble Lord, Lord Vivian, has suggested, in order to produce a better, a more practical and a less muddled answer. But the principle is important, and I very much hope that the Committee will support it.
LORD BROWN: Perhaps I may make a comment to my noble friend Lady Serota. I am very much obliged to her for the generous references she made to me, but I wonder whether the Committee fully realises the implications of this Amendment. There are very many Government services, and I do not know of one which adopts the principle that is involved in this Amendment; because all these Government services are in the last analysis responsible to some Minister who is indeed accountable to Parliament itself. If this Committee were to put on a Regional Health Authority a majority of people who are not appointed by the Secretary of State, and if that majority of people were to decide to do something with the resources which did not meet with the approval of the Secretary of State, then the Secretary of State would cease to be accountable to Parliament. So that in effect this Amendment could interfere with the accountability of Ministers to Parliament. This is not a question of opinion: this is a question of fact. I think the Committee ought to be fully aware of what they are doing before they move in this direction if they are going to vote on this Amendment, because it is a very serious principle indeed.
Great emphasis has been laid on the democratic results which would flow from this Amendment. Perhaps I may point
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out that Parliament itself is a democratic assembly, and that Members of Parliament can raise issues about the Health Service quite freely, that members of the public can raise them with the Commissioner and that they can raise them with the community health councils. They can do all these things. I really think it would be a great mistake in principle to put a Regional Health Authority in a situation the result of which would be that the Secretary of State himself could not be held accountable by Parliament.
LORD BROOKE OF CUMNOR: Before your Lordships come to a decision on this matter, may I be allowed to say two things? I could not support the Amendment of the noble Baroness, Lady Serota. I do not think that this tripartite method of appointment is the right one. I prefer, in general, what the Government have proposed, though I do not think that that is ideal, either. But I certainly hope that the Amendment moved by the noble Baroness, Lady Serota, will not be carried. I am grateful to my noble friend Lord Aberdare for what he said in reply to me. He very aptly quoted paragraph 96 with an implicit suggestion that I had not properly studied that paragraph. I think I had, but I had been influenced, I confess, also by paragraph 106 of the White Paper, and I hope he will give further consideration to that between now and the next stage of the Bill, because in that paragraph it says:
"The expression of local public opinion can be catered for in one of two ways. It can be done indirectly by including in the membership of the health authorities local people serving in a representative capacity. Or it can be done more directly through bodies specially set up for this purpose, with direct links to the authorities. The Government prefer the second course. It allows each of the interests—management and the community—to concentrate on its own special function".
et cetera. From that I certainly gained the impression that those who are members of a Regional Hospital Authority are to concentrate on management and are to await the reactions of the community health councils, the local authorities, and so forth, to represent to them the interests of the public. I think the interests of the public must be represented from the very start on the executive body. That is what I am seeking to establish. I hope that the Government will withdraw from the somewhat rigid position that they have taken up in paragraph 106.
4.20 p.m.
BARONESS WHITE: Before we leave this point, I should like the Government to consider the strategic planning functions of these Regional Health Authorities because it is extremely important that anyone undertaking this particular function of theirs (and I know they have others) should be very well aware of what is in the minds particularly of the major local authorities. Elected regional authorities may possibly come about, but we do not know, out of the Kilbracken deliberations. When we are going to receive their report, Heaven knows! But in default of that, surely the noble Lord, Lord Brooke, is right, that there should be some correlation between the great local authorities who are responsible for all the other social planning in their areas and the Regional Health Authorities. If one does not have some provision for that there will be difficulties in having common thoughts on these matters which affect the totality of social planning in the areas of which health planning is one part.
On the point made by my noble friend Lord Brown which, from what he has said, I am quite sure is much in the mind of the noble Lord, Lord Aberdare, and certainly is in the minds of the Treasury—this business of the accountability of the Minister to Parliament if persons appointed to these bodies are not all appointed by him or are even necessarily predominantly appointed by him—if the Minister through the Treasury is the source of supplies, of course he has one very simple sanction. If he thinks they are acting improperly he can withhold the supplies. It is unlikely that such a situation will be reached; but as a matter of political theory one ought at least to keep in mind that the Minister does have the whip hand in so far as ultimately he is the person who finances the service concerned.
Therefore no matter what such an authority might wish to do, they know that ultimately the Minister has this overriding sanction of finance. I do not feel that we should be unduly frightened by that in the way suggested by my noble friend Lord Brown. Had the Government decided that this was a completely reprehensible doctrine, I assume that they would not have included paragraph 106
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in their White Paper; because they put it in as a reputable alternative, but one which on balance was less desirable than the one they proposed. I do not think the Committee should be frightened by the figure of a Minister who will be completely helpless at the hands of a body that he has not entirely appointed himself.
LORD GARNSWORTHY: Before the Minister replies, may I say that I have listened to the debate and have been impressed by the fact that with one exception there appears to be unanimity on the part of those who have spoken. I have the feeling that they have considerable support in the Committee that the Bill is not right and that the Government are showing too little inclination to give consideration in depth to the views that have been expressed here this afternoon. The Minister in his reply indicated that he would give some further thought to what the noble Lord, Lord Brooke, had to say. I wonder whether he could go further. I am sure that we on this side do not want to divide if that can be avoided; on the other hand, if we are forced, we may have to consider that course. Would the Minister indicate that he would have consultations with those who can speak in representative authority? The noble Viscount, Lord Amory, for instance, knows very well the views of the county council associations; the noble Lord, Lord Brooke, knows the views of the A.M.C., and my noble friend Lady Serota is recognised by everybody as an expert in this field, not only as a consequence of Ministerial office but from a lifetime of service in the public field. Would the noble Lord, Lord Aberdare, go so far as to say that he would be willing to have a meeting before Report stage, to see whether it is possible to reach some compromise which would give some satisfaction to those who have spoken so strongly and who feel as deeply as they have indicated?
VISCOUNT AMORY: My noble friend may be able to respond to Lord Garnsworthy's suggestion in some way because it will be a pity if we have to divide on this Amendment about which I think many of us have some worries—worries about the wording and about some of the proposals, though not about the most important part.
LORD ABERDARE: I am quite ready to go ahead to try to help the Committee if I can. I am completely convinced that the Amendment is wrong. I cannot accept that the Secretary of State should appoint only a minority of the main agents in a service which is necessarily centrally organised. I do not agree with the noble Baroness, Lady White, that the financial sanction is really a valid one because the Secretary of State will be giving them a large budget and you cannot expect him to fine them because they have done something he does not approve of. It is more normal where a Minister is responsible for a service for him to have a majority on the agency which is responsible to him.
So far as the strategic planning functions go, the difficulty is that there is no corresponding local authority that embraces the same area as the Regional Health Authority. I have no doubt that the Regional Health Authority will wish to be in the closest possible touch with the strategic planning of the local authorities within its region. But there is no reason thereby to say that of right those local authorities should have their members on the Regional Health Authority. Two bodies can co-operate satisfactorily, I should have thought. But I am impressed, and always have been impressed, by what my noble friends Lord Amory and Lord Brooke say. I will certainly see whether I can help in any way to satisfy them and to satisfy noble Lords opposite who have expressed the need for closer co-operation at regional level with the local authorities. If we could have conversations on that point I will certainly see what I can do. But I am afraid that I cannot accept the Amendment as it is.
BARONESS SEROTA: The Committee has given a considerable amount of time to this issue which I only opened up on Amendment 45. I am grateful to the noble Lord, Lord Aberdare, for the way in which he has received the comments made on what I realise is his "baby" which we have been, so to speak, tearing to pieces in public in front of his eyes. I know that for Ministers this can be a painful process. I hope that he will appreciate that we believe we are doing this in the most constructive way possible. In view of what he has said, and subject
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to the agreement of my noble friends who have also put their names to this Amendment, I should be inclined to withdraw it at this stage on the basis that we can talk between now and Report stage and come back with other proposals. I, myself, do not move one inch from the general principles that I have enunciated. I accept that there are drafting difficulties with this Amendment and that from some of the views put forward it would be helpful to come together for talks. On that basis I am prepared to withdraw the Amendment. I hope that my noble friends who have put their names to it will agree that I should do so.
Amendment, by leave, withdrawn.
4.30 p.m.
LORD BROCK LORD BROCK moved Amendment No. 47:
Page 49, line 9, at end insert ("and not less than one-quarter of these other members shall be medical practitioners").
The noble Lord said: I beg to move Amendment No. 47 which is in my name and the names of my noble colleagues. With the permission of the Committee, I should like to take with it Amendment No. 50, as the two Amendments are essentially similar. They are concerned with ensuring that there is adequate medical representation on governing and advisory committees of the new Administrative authorities. There is nothing in the Bill to limit the number of doctors even to a quarter, but the White Paper suggests that the number of doctors could be quite small. For example, on page 23, paragraph 99, it is stated that the professional members will not be prescribed and may indeed differ from area to area, but it implies that the format could be, or need be, only two doctors in a committee of 15. The Amendment prescribes that such a committee should have double that number.
The medical representation should be at least as strong as it is on the present authorities of the National Health Service. The present practice is that on the board of governors of a teaching hospital a quarter are medical, and on a Regional Hospital Board one-fifth are medical. This, therefore, is a good and acceptable precedent; but it is not in the Bill. The proportion of medical members dates from the Guillebaud Report of 1950 which recommended it then, and has been

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adhered to since. I hope the Minister will be willing to insert some prescription of the proportion of medical members on governing and ordinary committees.
LORD PLATT: My noble friend Lord Brock has made the purpose of this Amendment perfectly clear and there is nothing difficult to understand, so I will not elaborate it. I should like to point out one thing, though I am sure that it will not have escaped the noble Lord, Lord Aberdare. It is that this Amendment does not dispute the principle of the appointment by the Secretary of State, which Amendment No. 5 would have replaced by another mechanism, because its place, if accepted, would be after the words which give the Secretary of State the appointment of such other members as he thinks fit.
LORD ABERDARE: I appreciate the reasons that actuated the noble Lords to move this Amendment but it does not appeal to me very much because I would reiterate that what we want at the Regional Health Authority level is a number of people of different backgrounds, different interests, different talents. Although these will certainly include medical practitioners we feel that it would be wrong to tie the hands of the Secretary of State to appointing a specific proportion of the Regional Health Authorities from medical practitioners. It is not true that in the case of the present health authorities there is a requirement that there shall be a minimum of 25 per cent. medical practitioner membership. The present position is that in 1956, in Hospital Memorandum 111, it was announced that the Minister would not normally appoint more than 25 per cent. doctors on to a Regional Hospital Board, and he asked the Boards to follow this same practice in appointing their hospital management committees.
The boards of governors have one-fifth (I think the noble Lord said a quarter) of their members appointed after consultation with the senior medical and dental teaching staff. Executive councils with a membership of 30 have eight members appointed by the local medical committee, and this will continue to be the practice with family practitioner committees; and of course, local health authorities do not necessarily have any medical members on their boards,
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although doctors may be elected as councillors in the normal way. But the Regional and Area Health Authorities will not be the same as the present hospital authorities. They will have wider responsibilities and functions and will be composed on a different basis. We believe that it would be wrong to specify a particular number of medical practitioners on either the Regional Health Authority or the Health Authority, although we give the assurance that there will be doctors on both bodies.
I should like to make clear that in this Bill we are bringing the doctors even closer into the management, into partnership, with the Service than has ever been the case before. I have said that there will be doctors at both Regional and Area Health Authority level. At all levels, regional, area and district, there will be strong medical advisory committees. I am sure the noble Lord will know that we are in close consultation now with the medical profession and discussing just how those medical advisory committees can best be set up to ensure that essential medical advice is available at all levels.
Under the management study proposals the regional and the area medical officers will be members of the regional and area teams of officers. At district level, the district management team is to contain two elected members from the district medical committee, one being a consultant and one being a G.P., as well as the district community physician; so that will be three doctors out of a total of six on that team. We are also confident that doctors will play a full part in the proposed health care planning teams studying various aspects of the Health Service within a district. I do not think that anyone can accuse us of not having taken due account of the need for doctors to be an integral part of the proposed management structure. But, just as I have been trying to defend the position that we do not want to allocate specific numbers of places on the Regional Health Authority to the, local authorities, I equally hope that it will not be thought wise to specify a certain number of places on the Regional Health Authority for the medical profession. I would ask your Lordships to leave it in the hands of the Secretary of State to make sensible decisions on how the Regional Health Authorities should be constituted, taking

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into account the fact that there will be medical members after consultation with the profession.
LORD BROCK: I thank the Minister for his reply. I do not wish to divide the Committee on a matter such as this. I must trust to the good sense of the Secretary of State, and that he will pay attention to the inevitable value of the medical profession in the various committees and consultations. I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
BARONESS SEROTA: I beg to move Amendment No. 49B, if only to ask the Minister to reply to the question that I put to him on this part of the Schedule when I spoke earlier. I realise that he was then concerned with the wider issues of a major Amendment but I hope that this will give him an opportunity to tell the Committee that the Government are prepared to accept this Amendment.
Amendment moved—
Page 49, line 25, after ("bodies") insert ("including trade unions, and voluntary organisations").—(Baroness Serota.)
LORD ABERDARE: Yes, I am sorry; I meant to answer that matter earlier, but perhaps it will be more convenient to do so now. It is certainly our intention that the Secretary of State shall consult the Trades Union Congress rather than trade unions as referred to in the Amendment. It has been the practice hitherto that Regional Hospital Boards consult the T.U.C. (and I hope that the noble Baroness would think that the right thing to do in the future) and voluntary organisations before making appointments to Regional Health Authorities. The reason why these bodies are not specified in the Schedule is simply that they are one of a number of organisations which will be consulted, such as the C.B.I. for example. It seemed invidious to mention some but not all bodies, yet to attempt to mention all would import a certain rigidity. The Scottish Act certainly makes no such provision. However, I agree with the substance of the Amendment. I should not like to accept it as it stands, because I would rather see "T.U.C." than "trade unions". If the noble Baroness will allow me to consider it, I will see whether before the next stage
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of the Bill I can find some wording that will satisfy what she has in mind.
BARONESS SEROTA: I am grateful to the noble Lord for his offer, and without taking up any more time I will ask leave to withdraw the Amendment, looking forward to hearing further from the noble Lord at Report stage.
Amendment, by leave, withdrawn.
4.41 p.m.
BARONESS SEROTA BARONESS SEROTA moved Amendment No. 51:
Page 49, line 43, leave out from beginning of line 43 to end of line 8 on page 50, and insert—
"(b) the Chairman or a member of the Family Practitioner Committee for the area of the Area Health Authority;
(c) a specified number of members, which shall be not less than one third of the total number of members, to be jointly appointed by all the local authorities for the area of the Area Health Authority;
(d) a specified number of members, which shall be not less than one third of the total number of members to be jointly appointed by persons representative of the following categories, namely:

(i) the medical practitioners of the area of the Area Health Authority;

(ii) the dental practitioners of the said area;

(iii) the nurses and midwives of the said area;

(iv) the registered pharmacists of the said area, and

(v) the ophthalmic and dispensing opticians of the said area;

(e) as to a specified number, members appointed by the Secretary of State, after taking into account recommendations made to him by the relevant Regional Health Authority after consultation by that Authority, except in prescribed cases, with the bodies mentioned in sub-paragraph (2) of this paragraph; and
(f) a specified number of members to be appointed by the Secretary of State on the nomination of the university or universities specified as being associated with the provision of health services in the said area.")
The noble Baroness said: I beg to move Amendment No. 51 standing in my name and those of my noble friends Lord Garnsworthy and Lady White. I know that my noble friend Lady White is most anxious to speak to this Amendment, particularly because of the views that she holds about the proposed composition of the Area Health Authorities. As she appears to be elsewhere at the moment, I wonder whether I might begin

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the debate, which of course affects a number of other Amendments that appear on the Marshalled List, by making special mention of the proposal in the Amendment which refers to the inclusion of the chairman or a member of the family practitioner committee as a member of the Area Health Authority as of right. That is a matter that we touched on at Second Reading. I hope, having put the Amendment down early, that the Minister, when he comes to reply, will be able to say something about this proposal.
As the noble Lord knows, there has been criticism of the appearance that we are creating not an integrated Service out of our present tripartite Service, but one that will integrate the hospital and the local authority services, leaving the vital contribution of the community-based general practitioner services separate from the other two parts. We are fully aware of the thinking behind the Government's proposals to establish through the Bill the special statutory family practitioner committee to preserve the independent contractor status of the general practitioner; but we believe that there would be a danger of their working in isolation if they were too rigidly segregated in that committee, and we are most anxious that they should participate in the wider policy planning and the day-to-day provision of service considerations of the Area Health Authority. That was the reason behind the inclusion of the chairman or a member of the family practitioner committee on the committee of each Area Health Authority. As I have said, I hope that when the noble Lord comes to reply he will let us know the Government's reaction to this suggestion. As I said at the outset in moving this Amendment, I know my noble friend Lady White wishes to speak to it in Committee, and therefore I will sit down to enable her to put forward her views. I beg to move.
BARONESS WHITE: I think my noble friend Lady Serota has put clearly the kind of considerations which we had in mind. We are concerned to some degree with the same sort of considerations as arose on the previous Amendments in relation to the Regional Health Authority. We recognise that the Area Health Authorities have more specific local functions, and we are anxious, as the Amendment plainly indicates, that the
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other parts of the local health services, namely, those which will come under the family practitioner committee and those which are now being taken over from the elected authorities, should all be drawn together and that those working in the services and in similar capacities professionally should have some say in the working of the services. We are also much concerned, as we were previously, as to the kind of consultation which may take place, including consultation with trade unions and voluntary organisations. I have another Amendment down later on which applies only to Wales, but I think that we should take it as a separate Amendment and I will not elaborate on it now.
Before we press this Amendment further, I think it would be desirable to hear what the reaction of the Government is to these propositions. Not a great deal is said in the documentation that we have in the White Paper and so on about the principles on which the Government propose to order the membership of the Area Health Authorities. We in Wales, again, are in a particularly sensitive situation, because we shall not have a Regional Health Authority to carry out the function of appointing the Area Health Authorities: we shall be directly dependent upon the Secretary of State for Wales. Therefore, for us, I think there is a particular interest in the composition of the Area Health Authorities. We want to be doubly certain that the various elements at area level are adequately included in the proposed membership. If, in making his comments, the noble Lord, Lord Aberdare, is able to say something further about our particular Welsh concerns, in addition to the important but minor one in Amendment No. 57, I and others who have Welsh interests shall be particularly obliged.
LORD BROOKE OF CUMNOR: If it is acceptable to the noble Baroness, Lady Serota, and to my noble friend Lord Aberdare, I think it might save the time of the Committee if I were to speak to my Amendments Nos. 54 and 55, thus widening the debate on this Amendment into a general debate on the composition of the Area Health Authorities, rather than to move those Amendments separately, because there is a certain amount of overlap. There are two

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separate points made in my Amendments. The first is that there should be not less than five local authority members appointed by the local authorities to the Area Health Authority. Even on the Government's plan, I think that at least five will be needed, because the Government look on these people as making links with the local authority services. In paragraph 98 of the White Paper the Government say:
"Because of the need for close decision-making links with the local authority services, local authority members who are active in the management of the personal social services, education and other relevant services, should have places on the Area Health Authorities and four members of it will therefore be appointed by the corresponding local authority."
I do not quite follow that word "therefore", because if in fact these people are to be active in the management of the personal social services, education and other relevant services, at least five will be required: there are at least three other relevant services. In addition to the personal social services and education, which are mentioned here, there are planning, housing, and environmental health; and you could not gamble on the possibility that any one of the local authority people would be adequate as links with more than one of those services. So it seems to me, on the Government's own argument, that there should be at least five local authority people on the Area Health Authority. I would say again, if I may, that the number of 15 will prove to be too small in the normal case for the membership of one of these authorities. I know that the Area Health Authority can co-opt to committees and so forth, but it will be the members themselves who will need to be seen visiting hospitals and other units, as described in paragraph 95. That in itself will be a considerable burden on the small number of members of the Area Health Authority. I cannot see any reason why one should not have an efficiently-composed membership and yet go somewhat beyond the figure of 15. I am not pleading for a particular percentage to be local authority nominees; I am anxious that there should be more than four, which it seems is the figure chosen by the Government.
My second Amendment raises a different point. It does not accept the
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argument in the Government White Paper that the need for having local authority people on the Area Health Authority is not because they will be representative of the public but because they will establish links with the relevant social services of the local authorities. I do not think one can have local authority nominees confined to this sort of function. If you are elected to a local authority, you may become interested in a particular service and become highly knowledgeable about it, but you cannot put away from you the fact that you have been elected and that you are a representative of the view of the public.
I do not want to repeat the speech that I made on the previous Amendment, but really find it very hard to accept that representation of the views of the public should be kept away from these health authorities. I appreciate the Government's argument that there will be quite enough of them in the community health council and that the Area Health Authority will do its work more quickly, sensibly and effectively if it does not have representatives of the public on it. That is a view that I cannot accept and that is the purpose of my second Amendment. If my second Amendment were accepted by the Government, it would mean that these local authority representatives on Regional Health Authorities would not be confined in their work there to one particular function; that is, acting as links with the relevant local authority services. They would do that, but in addition they would be an extra channel of communication of local opinion to the Area Health Authority. I cannot help thinking, despite the rigid views of the noble Lord, Lord Brown, that the Area Health Authority would be the better for it, provided that the representatives are sensibly chosen—and I think one must assume that in general, though there may be mistakes, the individuals will be sensibly chosen.
The purpose of my two Amendments—and, as I say, I will not take up the time of the Committee by moving them separately—is, first, that there should be at least five local authority representatives on the Area Health Authority; and, secondly, that they should be there in their own right as people representing the views of the public and not simply in the more technical sense as links with the services

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of the local authority with which they are particularly familiar.
THE DEPUTY CHAIRMAN OF COMMITTEES (LORD CHAMPION): In putting Amendment No. 51 I ought to have indicated that in the event of that Amendment being carried I would not be in a position to call Amendments Nos. 54 and 55.
VISCOUNT GAGE: I am sorry that I missed the beginning of my noble friend's speech. I feel, as my noble friend does, that there are two reasons why local authority representatives should be on these area committees. I do not pose as an expert on this matter, but I should like to give the experience I have had with a small hospital which I know well. It is well equipped for minor operations, though not for major ones. These small hospitals are, I know, a bane of the hospital administration; they have been trying to close this particular one for some years. But public opinion is very much roused on this matter, not only among the lay public but also among the local doctors. Local doctors have formed a society of friends of this particular hospital and have collected something over £12,000 so that this hospital may be properly equipped and maintained. This may be the sort of story that has nothing unusual about it, but it seems to me somewhat extraordinary that the hospital administration should want to close a hospital without, apparently, any reference to local opinion, and that only when local opinion develops and there is a row do they withdraw and change their policy.
My noble friend Lord Aberdare said he did not think it so important that the area committees should be liaising, as it were, with those committees of ordinary local government that were not concerned with medical services. But I think it is important that they should so liaise Take the question of the old I have always understood that the health of the old depends a good deal on the sort of accommodation they have. If they live in purpose-built accommodation with their own belongings round them, they live very much longer in much happier circumstances than if they are herded together in geriatric wards, or even in Part III homes. The position under this Bill is somewhat different, but hitherto
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in rural areas these old people have come under three different authorities, according to their condition. If they were fit they would come under the district council as the housing authority; if they needed care and attention they would come under the county council, and if they were in need of medical services they would come under the hospital board. The system has worked in a sense, but only because, fortunately, we have a number of very sensible people in this country—sensible representatives, sensible doctors, and sometimes a sensible civil servant. But the system itself is not one which leads to proper liaison. It will be somewhat different under the present dispensation, because the people in need of care and attention and of medical care will come under the same authority. I am not saying that this whole question can be solved just by having on the area committee some representatives of the local authority, but I think it will go some way to helping with that liaison. I am quite certain that without it there will be a number of people who will suffer from being, as it were, nobody's child. I hope that this idea may appeal to my noble friend Lord Brooke.
LORD HYLTON: I should like very briefly to support my noble friends Lord Brooke and Lord Gage. It has been notorious for many years that because of the very great shortage of purpose-built accommodation for the very elderly it is difficult to discharge elderly patients from hospital when they have recovered. I feel that if there are local representatives on these Area Health Authorities they themselves will be brought face to face with their own responsibilities, and this will be most helpful.
LORD GRENFELL: Before my noble friend replies, may I say that I feel, as with the last Amendment, that we need to be rather careful of being too specific about the different people who will have powers of appointment. In all different areas you will probably find that the medical practitioners will be carefully chosen. But if we are going to give a power of appointment to the dental practitioners, the nurses and midwives, the registered pharmacists, and the opthalmic and dispensing opticians, we shall get into rather deep waters, because in smaller areas this will be difficult, and in larger

55
areas they will be fighting each other as to whom is to represent them. Let us keep it as open as we can. We have discussed the question in principle; my noble friend has said that he will watch to see whether he can find sonic way round the principle of these Amendments. Let us be careful not to be too rigid with those who will have the power of appointment.
VISCOUNT AMORY: The case my noble friend dealt with in his Amendment is to a large extent in line with the discussion we held on the Regional Authorities. I should like to add one or two words. Looking closely at this organisation, one feels that the area level is perhaps the most important of all inasmuch as the decisions reached there will most strongly reflect on the local users of the Service. So that seems to be the level where it is most important that there should be locally elected members of local government authorities, and where they will have most to contribute. Therefore, whether the provision for representation in the Bill is adequate or not is important.
In discussions that I have had with people who are very knowledgeable about the Health Service one of the fears that is felt is that under the organisation proposed there will be proportionately too much emphasis placed on the clinical and remedial treatment as against preventive and safeguarding measures—that is, on treatment of illness as against the safeguarding of health. Under the new organisation there will be no one who is quite as independent as are the existing medical officers of health. The School Medical Service is an aspect which is of vital interest to local authorities. The joint consultative committees may be effective and useful—and we hope that they will be—but they will be only consultative and advisory. Several speakers, including myself, when discussing Regional Authorities, mentioned that the considered view of all the local authority bodies is that a sufficiently strong representation of elected local representatives on the area committees is absolutely essential, and they should participate fully in the policy decisions that are reached. I should like to support the Amendment proposed by my noble friend Lord Brooke of Cumnor.
5.4 p.m.
LORD ABERDARE: I am grateful to your Lordships who have spoken in this debate, and to my noble friend Lord Brooke for having included his Amendment in it. It has made the matter much tidier and more comprehensible. Many of my objections to the main Amendment that we are discussing, Amendment No. 51, are similar to my objections on the previous Amendment with regard to the setting up of the Regional Health Authority. In my view it would be wrong at this second level for the Regional Health Authority, in turn, not to appoint a majority of its agents on the Area Health Authority. On the other hand, so far as concerns the Amendments of my noble friend Lord Brooke and those who have supported him, we are much nearer together, because we have made specific provision for the appointment by the local authority of members of the Area Health Authority. I will justify that to the noble Lord, Lord Brown, in the course of my remarks.
The Area Health Authority will be the major operational tier of the new Service. We see it, like the Regional Health Authority, as a relatively small body of about 15 members. This is not a magic figure; we want a small body which will not be too unwieldy to take decisions. But in the case of Area Health Authorities we recognise that there may well be particular areas where we shall have to have more than 15 people. This will arise, for example, where there is a teaching hospital, because we have already undertaken to put extra people on the Area Health Authority in that case. It will arise in London in areas where there is more than one London borough in the area. We have suggested that there should be more local authority representatives on those Area Authorities so that each borough has a member of the Area Health Authority as a representative.
At the same time we hope that none of the 15 or so members will feel themselves to be representative of particular interests, because we wish them to take a comprehensive and unbiased view of the total health requirements of the area. That would be the way in which we should hope to meet some of the points which have been put by my noble friend Lord Amory regarding the need for total

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health care for preventive medicine, and community care, which my noble friend Lord Hylton mentioned. That does not mean that its members will not include people from the local authorities, or from the main health care professions or relevant universities. On the contrary, we suggest there should be four members directly appointed by the matching local authority; that is, the authority administering the services complementary to the health services provided by the Area Health Authority, particularly personal social services and education. We think it is this link with the matching local authority which needs particularly to be reflected on the Area Health Authority, and not the less intimate link which there will be with other local authorities in the area.
As to the professions, we suggest there will be doctors and at least one nurse or midwife on each Area Health Authority. In addition there may be other members, drawn from other of the health care professions. As I said regarding the last Amendment, the particular strength of the role of the professions in the new structure will lie in the advisory machinery which we are anxious to be sure is strong, and which will be in a position to bring their views forcefully to the Area Health Authority, just as we see it right for the community health councils to bring the views of the users of the services to the Area Health Authority.
BARONESS WHITE: Before the noble Lord leaves that point, could he, in order to clarify the position, say whether it is still the intention of the Government that those persons from the health professions should not be active within the area of the authority?
LORD ABERDARE: I know what the noble Baroness is getting at.
BARONESS WHITE: There are two quite different conceptions between our proposals and what we think are the Government's proposals. We should like to be quite clear about this matter.
LORD ABERDARE: Our view is that it would be wrong for members of the Area Health Authority to be in the employment of that Authority. The noble Baroness said "active". There is no reason why they should not be active
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in the area. We think it would be wrong, if they are in the employment of the Authority, to be, at the same time, members of it. So far as sub-paragraph (f) is concerned, we have provided in the Bill for a university member, or members, to be appointed by the Regional Health Authority on the nomination of the university.
The noble Baroness, Lady Serota, asked me about the family practitioner committee. We have met, I think, her basic point in requiring the Area Health Authority to appoint at least one of its members to the family practitioner committee. It is not quite the same as having the chairman of the family practitioner committee necessarily on the Area Health Authority, but it is the fact that there will be one member of the Area Health Authority on the family practitioner committee. However, we do not feel it would be right if two-thirds of the members of the Area Health Authority were appointed by local authorities and some of the health professions. These are very important bodies. They will be handling budgets of some £14 million and upwards per annum, and they will be accountable to the Regional Health Authority. We do not believe that the accountability could be effective unless the majority of the Area Health Authority members were appointed by the Regional Health Authority.
The noble Baroness will perhaps not wish me to go into all the practical problems set by this Amendment, just as they were by her Amendment on the Regional Health Authorities. They are less serious and less daunting, but there still would be grave difficulties in rationing out the shares of the various local government members and various professional members as proposed in the Amendment. Our plans are based on an ideal. We want to inspire the Service with enthusiasm for a new approach. We see great hopes for better results in an integrated National Health Service, but as well as unification there must be leadership. I am sure we are all agreed on the need for integration, and we are agreed that there must be a more conscious choice between health in the community and in health institutions. We believe that a new impetus is required from smaller, more positive management bodies at the A.H.A. level, properly advised by professional committees,

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properly advised by the representatives of the local community, yet still free to take positive decisions for the better health care of the citizen. That is why we see the Area Health Authority being established as we have suggested with the chairman nominated by the Secretary of State and the members appointed by the Regional Health Authority.
If I may turn for a moment to the Amendments of my noble friend Lord Brooke of Cumnor, I think we are pretty close together, except that we have suggested four local authority members on the Area Health Authority—4 out of 15, which is just over 25 per cent.—and my noble friend is suggesting 5, which is a little more. I do not say that there is any great significance in one more or less, but I would emphasise (this is what I was going to say to the noble Lord, Lord Brown) that our proposal is not altogether illogical. Naturally, we want to find bodies that will be effective and give a lead, and take the right decisions on priorities. But above all it was borne in upon us that, so far as we were able, we must not allow there to be any lack of liaison and co-operation between the Area Health Authority and the matching local authority. It was for that reason that we have established innumerable bodies. We have had Working Parties. We have laid it down statutorily that these two Authorities must co-operate; we have laid it down statutorily that there shall be a joint consultative committee, and we have gone so far as to concede, in this case only, that the local authority should nominate at least four members of the Area Health Authority. It may not meet my noble friend's pure management doctrine, but I think that in practice it really is an essential if we are to get the right sort of co-operation between the two bodies.
I found myself in some difficulty when my noble friend Lord Brooke of Cumnor was talking about the functions of these four or five members. It certainly would not be our idea that they should be in any sense confined to the function of being the links with the social services or the other particular services of the local authority. We would think it right that, of the four (or, as he suggests, five),
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there should be those who have experience in the very relevant opposite matching services—the social services, and maybe education. But what our wording tries to establish is that they are there as members of local authorities—as my noble friend Lord Brooke says, as elected members—who will give that link with the relevant other services who will also, I am sure, speak as representative of the people who have elected them. But what we want to avoid, if we can, is anybody on the Area Health Authority actually representing a specific interest. We hope that the doctors will not represent just the views of the doctors; we hope that they will be people with medical experience looking at the problems of the health position in the area. Equally, we hope that members who are drawn from the local authority will not just be putting the view of the local authority but will be people with experience of local authority work, who have been elected by their constituents and who will contribute to the overall solving of health problems that present themselves in the area.
There is only one other point that I would briefly mention to my noble friend. There are many pressures upon us, of course, for the right to appoint members of Area Health Authorities. The noble Baroness's own Amendment is one example where other bodies—the medical profession, for example—are brought in and given the right of appointment. Obviously, we must find the right balance of membership. We believe that there is a very special exception to be made in the case of the local authorities, but if one is going to raise their representation from just over 25 per cent. to what might be 33⅓ per cent.—or, at any rate, 5 out of whatever the number may be—it may mean that other bodies will feel they should equally have strong representation. Then we should move away from what we want, a single-minded Area Health Authority applying its mind to the problems of the area, and we should find it again made up of a number of different representative members.
So I very much hope that the noble Baroness will withdraw her Amendment. I hope that I have satisfied her to some degree. I hope my noble friend will

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withdraw his Amendments. I am certainly prepared to think further about the matter; although here again my difficulty is my fear of upsetting the balance of membership and my own belief that four members actually nominated—and they are the only ones to be nominated—on the Area Health Authority probably ought to be able to bring the necessary skills and experience to the work of the Authority.
5.18 p.m.
LORD BROOKE OF CUMNOR: If I may speak before the noble Baroness, I am grateful to my noble friend for what he has said, and assure him that I am not going to press my Amendments; indeed, I shall not move them. I am quite certain that it is more effective if we can have a general debate of this kind on a group of Amendments and give the Government something to think about between now and later stages of the Bill. I still hope that my noble friend will reach the conclusion that four is too small a number of local authority persons (I avoid the word "representatives") on the Area Health Authority. I am glad to have his assurance that these persons will not be confined in the work of the Area Health Authority to representing the linkage between the Health Authority and the relevant local government services. I am sure that everybody who has served on a local authority and is trained in that hard school will realise that in public affairs he is not speaking just for a local authority, but is speaking for the public in general whose views may or may not be channelled through a particular local authority.
My real difficulty, and the point that led me to table my second Amendment, was the troublesome sentence in paragraph 106 of the White Paper which I have already quoted. The Government wish to avoid
"a confusion between the direction of services and representation of those receiving them…"
I do not really see how local authority people appointed by local authorities to an Area Health Authority can stop short of making representations for those who are receiving the services. If those words are allowed to stand in the White Paper and that is to be taken as the principle, then what my noble friend has said cannot stand because it is contradicted by
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those words. The more I think about the whole subject of the composition of these bodies the more I believe that the trouble—and, it may be, the misunderstanding of the Government—have flowed from that sentence in paragraph 106. I know that that sentence gives pleasure to the noble Lord, Lord Brown, but it gives very little satisfaction to anybody else on either side of this House and I hope my noble friend and the Secretary of State will consider matters from that point of view when they are reviewing all that has been said from two different quarters in these two debates.
BARONESS WHITE: We have great sympathy with the sentiments expressed by the noble Lord, Lord Brooke of Cumnor. I must confess that when we first saw his Amendment No. 55 we were a little dubious about "representatives" because it could have meant "delegates" who might be mandated, and I am sure that none of us wanted that sort of relationship. But as the noble Lord properly pointed out, there is of course an inconsistency in the phrase in paragraph 106 of the White Paper compared with what the noble Lord, Lord Aberdare, has stated to be the philosophy of the Government in relation both to the area and to the regional bodies.
In all the circumstances, I think the sensible thing for us to do would be not to press our Amendment at this stage but to hope that in the discussions which the noble Lord, Lord Aberdare, promised on the Regional Health Authorities, any points we have to raise on the Area Health Authorities might be subsumed in those discussions. On that understanding, with which I gather the noble Lord, Lord Aberdare, is in agreement, on behalf of my noble friend I beg leave to withdraw the Amendment.
THE DEPUTY CHAIRMAN OF COMMITTEES: I think the mover of the Amendment must seek permission to withdraw the Amendment herself.
BARONESS SEROTA: On the basis of the conditions which my noble friend Lady White has just stated to the Committee, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
5.23 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 57:
Page 50, line 19, at end insert ("but including, in Wales, the Health Committee of the Welsh Council.")
The noble Baroness said: I beg to move this Amendment which stands in the name of my noble friend Lord Watkins and myself. As the Committee will appreciate, in Wales, because there is to be no Regional Authority, the appointments to the Area Health Authorities will be made directly by the Secretary of State for Wales. Plainly, he will wish to consult a number of bodies in the Principality but in Wales we have the Welsh Council, which is different from any body that exists in England, and this Council has a health committee, or health panel as I believe it is more normally called.
LORD ABERDARE: It is in fact the Health and Social Services Panel.
BARONESS WHITE: That makes it all the better, because one has there a body of persons in Wales who are closely interested in and concerned with policy in the field of health and social services, and we feel that it would be entirely appropriate in our conditions in Wales that the Secretary of State should be under some obligation to consult. He would not necessarily have to take their advice, but we hope that normally he would do so. In any case, we feel it only right that people who are asked to serve on this all-Wales body in relation to health and social services should have some say in making suggestions, at any rate, as to persons who might well be appointed to the Area Health Authorities in Wales. This seems to us to be entirely reasonable.
The Welsh Council itself, as at present constituted, is of course appointed by the Secretary of State for Wales. Many of us hope that the time will come when it will be an elected body. We cannot foresee exactly what will happen because, as I said at an earlier point, we still do net know what the recommendations of the Crowther-Kilbrandon Committee may he and we do not know what developments may ensue. But, whether or not the Council remains, as it is at the moment, an appointed body or, desirably, an elected one, we still feel that in Wales
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it is a body of some consequence and ought quite specifically to be brought into the consultations which will be held under the provisions of the Bill by the Secretary of State before he makes his appointments to the Area Authorities. Accordingly, I beg leave to move this Amendment.
LORD ABERDARE: The noble Baroness will know with what sympathy I look upon a Welsh Amendment, but I am afraid I am not able to accept this one. I believe it would be invidious to single out the Welsh Council for mention in a provision under which other important bodies will be consulted. For example, the T.U.C.'s regional advisory committees for North and South Wales; the Council for Social Services for Wales and Monmouthshire, the Welsh Council of the C.B.I., and a number of Welsh bodies representing the major voluntary organisations—for example, the National Society for Mentally Handicapped Children. Obviously, it would not be practicable to list them all in the Bill and it would be invidious to single out the Welsh Council alone. There is also the point that the noble Baroness herself made: that whatever the future may be, the present situation is that the Welsh Council is a non-statutory body set up administratively by the Secretary of State for Wales and it would be most unusual in legislation to require consultation with a non-statutory body by name, as opposed to generically. But it would be even more odd to require statutorily that the Secretary of State should consult a body which he had himself appointed at his own discretion.
However, I can give to the noble Baroness the absolutely firm assurance that the Secretary of State for Wales will consult the Welsh Council, among other bodies, some of which I have mentioned, before making appointments to the Welsh Area Health Authorities. I think the noble Baroness will probably agree that it would be more appropriate to consult the Welsh Council and then to leave it to that Council to refer to the Health and Social Services Panel. I hope that, with that assurance, the noble Baroness will feel able to withdraw this Amendment.
BARONESS WHITE: We have the assurance on the Record, which is the object of the exercise. I appreciate the

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point about the Welsh Council not being at the moment a statutory body: we hope that it will become so. In any case, I think the Council is in a different position from the more sectional organisations referred to by the Secretary of State, important as they may be. It is an all-embracing body, on an all-Wales basis, and does not represent sectional interests. However, as we have had the assurance from the noble Lord, which I am sure will be observed by his right honourable friend and his successors, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
5.30 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 60:
Page 53, line 27, after ("including") insert ("attendance allowance or")
The noble Baroness said: The purpose of this Amendment is to make it possible for the Secretary of State to pay attendance allowances as well as travelling expenses or compensation for loss of remunerative time—for "loss of earnings" as it is more usually expressed. We feel that this is a very important Amendment because it is not long since we had in this House a Bill regarding local government. As we know, the basis of allowances for members of local authorities was changed in that Bill from what it had previously been. In earlier days the basis for payment to members of local authorities was the same as is now proposed in this Schedule for members of the new Area Health Authorities, but it appears to us that the same considerations which apply to allowances as of right to members of local authorities when they attend for official duties apply to the new Area Health Authorities which we are setting up under this Bill.
It is not always the loss of remunerative time involved in service on bodies of this kind that is important. Service is likely to be extremely onerous, not so much at the regional level, although the work there will be of great importance because it will include the allocation of resources—a task which, if conscientiously done, will involve a great deal of work—but at Area Authority level. It is plain, from the work which will fall to be done at the Area Health Authorities level, more particularly if the members of those
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bodies are restricted in number to the 15 or so proposed by the Government, that the members of those authorities will have a very heavy task to perform.
Included on the Area Health Authorities, as we have been discussing, will be at least four persons—some of us hope more—who are themselves members of local authorities. When they are doing their work on local authority committees they will be remunerated in one way. If, on the other hand, they are performing their duties as members of Area Health Authorities they will be remunerated on a different basis because, presumably, they will be remunerated as members of Area Health Authorities and not as members of the local authorities by whom they are nominated. I feel that there is bound to be dissatisfaction among people who, having moved under the Local Government Act to a new basis of remuneration, find that although they are nominated by their local authorities for public duties on Area Health Authorities they do not have the same sort of right to an attendance allowance; and this seems to me in itself to be unsatisfactory.
There is another matter which I have raised before in your Lordships' House, and that is the position of women. Women who serve on these Authorities can often not legitimately claim compensation for loss of remunerative time for the simple reason that many of them are not remunerated for all the work they do.
BARONESS LLEWELYN-DAVIES OF HASTOE: Not even by their husbands.
BARONESS WHITE: My noble friend is absolutely right. Thus, if they are not in full-time paid employment (I believe I am correct in saying that one has to be in full-time paid employment before one can claim loss of remunerative time) and are only in part-time employment, or are working in the home, then according to these arrangements they may not get adequate compensation for the indirect expenditure which may fall on them and for which it is almost impossible to account.
Women in public life know very well —I see the noble Baroness, Lady Young, smiling in an understanding way—that we are put to all sorts of expenses in our domestic lives for which one cannot possibly account. After spending a very

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long day at an Area Health Authority meeting—and when I think of the distances one will have to travel in Wales it will be a very long day indeed—one usually comes home to a husband and family who expect to be looked after; and we know that it is very much quicker to cook the more expensive meats and fish than the cheaper varieties. It is quicker to use the so-called convenience foods, and these are much more expensive. This is something for which one can never account in any acceptable way, but we all know how important an aspect it is.
Similarly, if arrangements are made to pay for domestic help—for example, to look after children if the mother is not certain whether she will be home in time to meet them from school—if it happens to be on that direct day, then I believe that there are arrangements whereby she can claim something. If, however, she rearranges her domestic life in such a way that she does not have domestic help at the actual moment when she is engaged on the work of the Area Health Authority or regional body, she will not be in a position to claim because the accountants in the Department will say, "You cannot prove that the fact that you had domestic help on Monday had a direct connection with the meeting you were attending on Wednesday." Nevertheless, one knows from experience that there is in fact a direct connection, and therefore it was of tremendous advantage to women members of local authorities when the Government decided to change the basis of remuneration for attendance at local authorities and to give an attendance allowance by right and not simply payment in terms of loss of remunerative time. We are anxious that if the fullest range of people is to be available for service on these bodies, what has been accepted as right and proper for service on local authorities should also be accepted as right and proper for service on Area Health Authorities.
I am aware that there are some differences, so far as local authorities are concerned, between elected members and people who are co-opted on to certain committees. However, I do not believe that that difference is in the least relevant where service on these Area Health
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Authorities is concerned. As I say, they are major bodies in the National Health Service structure and are taking very great responsibility—quite as great within their own fields as any in local authorities—and we therefore wish to press our belief that there should be the possibility included in the Bill of paying attendance allowance and not only, as we understand it, compensation for loss of remunerative time. I beg to move.
5.40 p.m.
BARONESS YOUNG: The Government have given very careful attention to this important point about allowances and the present system of reimbursing members in the National Health Service, but feel that they cannot accept this Amendment. It is the intention of the Government to continue the present practice, which is that members attending Area and Regional Boards should receive travelling expenses, subsistence allowances and the financial and other loss allowances. The precedent was set over the National Health Service (Scotland) Act when it went through your Lordships' House last year, and the Government consider that this principle is right. A special exception has been made in the Local Government Act to pay allowances to the newly elected members of the new local authorities, and their position will be much more nearly comparable to that of Members of Parliament. The new allowances, as Lady White has said, will not apply to non-elected members of local authorities. They do not apply now to non-elected members of Development Boards and Councils, and this distinction between elected members of local authorities and non-elected members of Boards has been drawn.
The noble Baroness raised a number of quite specific points about women members, and as I felt that this matter might well arise on this Amendment, I re-read what was said at the time of the Scottish Bill. I think it is fair to say that the question of financial loss allowances for women members, which is a very real point, has been quite generously drawn, and the Department have agreed that the allowances should be paid where, for example, expenditure has been incurred on, say, baby-sitters while a woman is at a meeting; in special circumstances for home helps. In this way some of the very basic and necessary expenses that

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many women members will have to meet when attending these area board meetings are covered. It is for these reasons that the Government feel unable to accept this Amendment.
BARONESS WHITE: I can only say that that is a very unsatisfactory and—particularly coming from the noble Baroness —extremely disappointing reply. On the Scottish Health Bill the noble Baroness, Lady Tweedsmuir of Belhelvie, was the spokesman for the Government, and we now have the noble Baroness, Lady Young. If I may say so, I think both are traitors to their sex, because they both know perfectly well that the kind of allowances which are given do not fully cover the situation. In any case I have always thought that service on the Health Authorities as they now exist is grossly unfair. We have the Regional Hospital Boards, for example; some of the chairmen put in a tremendous amount of work and receive no remuneration at all. It is true that in this Bill some remuneration is now to be offered to chairmen. But one can be a part-time member of a new town corporation, for example, and one can be a member of an advisory body on gas, electricity, or what-have-you, and it is taken for granted that some payment will be made, because it is said: "We could not get businessmen unless we did". But when it comes to something really important, like the Health Service, the labourer is not considered worthy of his hire.
Coupled with this Amendment is my feeling that the social services have been exploited in this way by comparison with any public service which is even remotely connected with industry and matters of that kind. I watched this very particularly when I was the Minister responsible for some of the health administration in Wales, and I felt that it was grossly unfair that someone who served part-time on our mini new town corporation, for example, had remuneration. There are various other people I could mention. For example, the Chairman of the Welsh Committee of the Countryside Commission gets paid. But when it comes to somebody who is going to serve on a Health Authority compensation for loss of remunerative time is all that is considered necessary for service of this kind.
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This is an important principle. As I say, the Goverment took a great step forward so far as the local authority members were concerned in their own Local Government Act. Some of us were extremely dissatisfied with the response we had on the Scottish Health Service Bill. We are equally dissatisfied with the response we have had so far from the Government on this point, and I would ask my noble friends at least—and I would hope also for some sympathy and support from Members on the other side of the House and on the Cross Benches—to support us. What is good enough for the new local authorities should be good enough also for the new health authorities.
BARONESS EMMET OF AMBERLEY: I feel that I must support the noble Baroness on the Opposition Bench. I do not think that this matter has been sufficiently thought out from the male point of view so far as women members are concerned. There is a very real case here for re-considering the matter.
LORD AUCKLAND: May I also say a word supporting the opposite sex. It seems to me essential that we should get women of high calibre on these committees. After all, women are very closely involved with the National Health Service. In any case, the Schedule is rather vaguely drafted and I was not quite certain from my noble friend's reply who would get the allowance for baby-sitters, and so on, and who would not. It seems that the whole matter is rather vague and I am quite sure that the Treasury could afford to pay proper compensation for this very vital work.
LADY RUTHVEN or FREELAND: I should also like to support this Amendment because having served on a Regional Board and on a number of hospital management committees I have seen the amount of time given up by people, particularly, as my noble friend Lord Auckland said, the women who serve on those committees. It is true that they were coming from their homes and therefore had no claims to make, except for travelling, but it is most unfair that other organisations set up by the Government should be allowed to get this attendance allowance yet not the Health Service. I entirely support the Amendment.
LORD ABERDARE: Before the noble Baroness decides what to do on this Amendment, may I point out one or two difficulties that have not emerged in the debate. There would be repercussions. If you pay an attendance allowance to members of these authorities, there may well be voluntary members of other authorities who equally feel that they should also be entitled to the same treatment. There is also a very real tax difficulty. I daresay the noble Baroness is aware of this. It is frightfully complicated, as are all income tax matters, but if an attendance allowance is paid to a member of a Health Authority that would mean that his or her travelling expenses were taxable, whereas at the moment he or she gets his or her travelling expenses free of tax. It is not as easy as it appears on paper.
BARONESS WHITE: May I interrupt the noble Lord to ask what happens to the expenses of the local authority members?
LORD ABERDARE: The local authority members are looked on differently because they are said to have not only a place of work in the local council offices, but also a constituency place of
work where they live. Therefore their travelling expenses are free of tax for that reason, just as an M.P.'s are. This is a real difficulty. We have studied this matter extremely carefully because all of us are very conscious of the amount of work put in by our members of Health Authorities. It is a very tricky subject. If the noble Baroness likes, we could look at it again, particularly from the point of view of the woman member but for the reasons I have tried to explain it is not easy. Also, we should be out of line with Scotland.
BARONESS WHITE: Scotland could catch up with us, but that does not worry me! I recognise that there may be some difficulties about tax, but I do not believe that they could not be overcome somehow. I should like to get on the record that in principle we believe that something of this sort should be done, and therefore, on this occasion—we have been very cooperative so far—I must ask for an expression of opinion.
5.50 p.m.
On Question, Whether the said Amendment (No. 60) shall be agreed to?
Their Lordships divided: Contents, 71; Not-Contents, 61.

CONTENTS

Addison, V.

Hayter, L.

Ruthven of Freeland, Ly.

Amulree, L.

Henderson, L.

St. Davids, V.

Archibald, L.

Hereford, L. Bp.

Serota, B.

Ardwick, L.

Hoy, L.

Shackleton, L.

Arwyn, L.

Hurcomb, L.

Shinwell, L.

Auckland, L.

Hylton, L.

Slater, L.

Avebury, L.

Inglewood, L.

Somers, L.

Bacon, B.

Jacques, L.

Stocks, B.

Beswick, L.

Janner, L.

Stow Hill, L.

Blyton, L.

Kennet, L.

Strang, L.

Brock, L.

Leatherland, L.

Strange, L.

Brockway, L.

Llewelyn-Davies of Hastoe, B. [Teller.]

Summerskill, B.

Champion, L.

Taylor of Mansfield, L.

Chorley, L.

Lloyd of Hampstead, L.

Vivian, L.

Clancarty, E.

Macleod of Borve, B.

Walston, L.

Davidson, V.

Maelor, L.

Wells-Pestell, L.

Davies of Leek, L.

Masham of Ilton, B.

White, B.

Diamond, L.

Milford, L.

Williamson, L.

Elliot of Harwood, B.

Northchurch, B.

Willis, L.

Emmet of Amberley, B.

Peddie, L.

Wise, L.

Evans of Hungershall, L.

Platt, L.

Woolley, L.

Foot, L.

Popplewell, L.

Wootton of Abinger, B.

Gaitskell, B.

Rhodes, L.

Wright of Ashton under Lyne, L.

Gardiner, L.

Roberthall, L.

Garnsworthy, L. [Teller.]

NOT-CONTENTS

Aberdare, L.

Berkeley, B.

Brooke of Cumnor, L.

Albemarle, E.

Bessborough, E.

Brooke of Ystradfellte, B.

Amory, V.

Bethell, L.

Coleraine, L.

Balerno, L.

Bradford, E.

Colville of Culross, V.

Belstead, L.

Bridgeman, V.

Conesford, L.

Cottesloe, L.

Gowrie, E.

Monck, V.

Courtown, E.

Grenfell, L.

Mowbray and Stourton, L.

Craigavon, V.

Grimston of Westbury, L.

Orr-Ewing, L.

Cranbrook, E.

Hailes, L.

Pender, L.

Daventry, V.

Jellicoe, E. (L. Privy Seal.)

Rankeillour, L.

Denham, L. [Teller.]

Killearn, L.

Redesdale, L.

Drumalbyn, L.

Lauderdale, E.

Rowallan, L.

Dudley, E.

Limerick, E.

St. Aldwyn, E. [Teller.]

Dundonald, E.

Lloyd, L.

Sandford, L.

Eccles, V.

Lothian, M.

Sudeley, L.

Ferrers, E.

Mansfield, E.

Swansea, L.

Fortescue, E.

Massereene and Ferrard, V.

Templemore, L.

Gage, V.

Merrivale, L.

Tweedsmuir, L.

Gainford, L.

Mersey, V.

Windlesham, L.

Gisborough, L.

Milverton, L.

Young. B.

Goschen, V.

On Question, Motion agreed to.

Resolved in the affirmative, and Amendment agreed to accordingly.
5.58 p.m.
LORD GARNSWORTHY LORD GARNSWORTHY moved Amendment No. 61:
Page 53, line 39, after first ("regulations") insert ("(after consultation with the staff representative body)").
The noble Lord said: Paragraph 10(1) of Part III of Schedule 1 enables a Regional Health Authority, an Area Health Authority and a special health Authority to employ officers "on such terms as it may determine in accordance with regulations". Amendment 61 would require those authorities to consult with the staff representative bodies. If one is asked what is a staff representative body, I have endeavoured to set that out in Amendment 124 to Clause 54, which we shall be coming to somewhat later. It surely is desirable that this consultation should take place before these authorities exercise their powers.
I think that at this stage I need not take very much of your Lordships' time, because it seems to me that this is a very sensible Amendment and one that ought to commend itself to the Government. I appreciate that these authorities are anxious to do what they can to meet the staff organisations and see that the role they play in the National Health Service is recognised in the Bill. I very much hope that the Minister, when he replies, will say that he is able to accept this Amendment, which does not seem to me fundamentally to alter anything in the Bill.
6.0 p.m.
LORD ABERDARE: The principle behind this Amendment is one that we touched on before Christmas when we
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were discussing Amendment No. 42. It was then that the noble Lord, Lord Garnsworthy, suggested, in effect, that the Statute should make it plain that the Government attach great importance to their relations with the staff interests, and recognise the necessity of consulting them fully. Since then, as I undertook to do, I have taken a second look at this matter, and I should like to make it clear once again that the principle of consulting staff interests on all appropriate matters is fully accepted by the Secretary of State. Certainly in the circumstances of Amendment No. 42, as in the circumstances of this Amendment, staff interests would most certainly have been consulted.
Although the inclusion of a statutory duty is not necessary from a practical point of view, we have concluded that in order to make our intentions perfectly clear we should accept the principle of this and various other Amendments standing in the name of the noble Lord. As I said when we were considering Amendment No. 42, we are not particularly happy about the phrase "staff representative body" and its definition in a later Amendment, and in the Government Amendment which I will put down at a later stage concerned with consultation we shall be proposing a rather different approach. This definition of the body to be consulted would allow the Secretary of State, if necessary, to sound out staff interests generally on the question of what would be the most appropriate channel of consultation in any particular case. This would accord with the practice that has been successfully followed in the past, and I hope therefore that the noble Lord will be prepared to accept my undertaking. In its present form the Amendment, as drafted, is ambiguous on the question of which

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activity should be the subject of consultations, and I am afraid that I cannot accept it exactly as it stands. However, I give the noble Lord an assurance that I will introduce a Government Amendment at a later stage to cover this most important point.
LORD GARNSWORTHY: I am most grateful to the Minister. I moved the Amendment with brevity because we have had an earlier discussion, as the noble Lord, Lord Aberdare, has said. May I thank him for the full reply that he has given and say that I fully, and indeed gladly, accept the assurance that he has given. With your Lordships' permission, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
6.5 p.m.
LORD GARNSWORTHY LORD GARNSWORTHY moved Amendment No. 62:
Page 53, line 45, after ("experience") insert ("and in the case of an authority, being an Area Health Authority, to employ, after consultation with the relevant Local Education Authority, a medical practitioner, a dental practitioner and a person engaged in the nursing service, being in each case of senior status and having experience in the provision of school health services, who shall serve as whole or part-time officers of the authority and be available to advise the relevant Local Education Authority and to undertake such executive and administrative functions for the purposes of the school health services in the area of the authority as they may be reasonably called upon to undertake.").
The noble Lord said: I beg to move Amendment No. 62. This Amendment is of a somewhat different nature, and would write into the Bill firm guarantees that Area Health Authorities would not only employ particular categories of officer but would ensure consultation with local education authorities with a view to securing people of the calibre and quality likely to fit in with the service of education.
The noble Viscount, Lord Amory, touched on the extremely important consideration of the continuance of the school health services. I think that it may be helpful if we remind ourselves of the role that the medical service plays in the field of education. First of all I mention the assessment and management of handicapped children. This covers a very wide range, and it is extremely important that local education authorities,
76
in dealing with and providing for the needs of handicapped children, have at their disposal all the expert advice and assistance that they may require. There is the issue of subnormality. Assessing an educationally subnormal child is not a purely educational matter. The medical man needs to come in, and local education authorities are accustomed to having the advice of senior medical officers in this field, as they are in regard to maladjusted and handicapped children. The medical officer is of assistance not only in regard to the advice and help that he gives to the local education authority regarding the educational needs of the child or children, but is of tremendous service in helping to counsel parents. Without question, the doctor is an essential member of the staff of a local education authority. May I make the point that the early assessment of a child's needs is not the only matter of concern. Assessment is a continuing process, and the local education authority needs to have continuing consultation and to receive continuing advice from the medical officers who are needed if the work is to be properly undertaken.
I could go on instancing where the medical officer comes into the area of the education service, but I hope that I have said enough to persuade your Lordships that this really is a vital role and that adequate provision ought to be made for it in the Bill. The Amendment lays it down that these officers would be available not only to give advice and fulfil executive functions and administrative duties for the running of the school health services such as may be reasonable to expect, but that they would be there constantly, readily available as and when the need for consultation arose. It seems to me that the Amendment is in line with paragraph 60 of the White Paper, and I trust that the Minister will be able to indicate in his reply that the Government take a sympathetic view with regard to it. The Amendment may not be too well drafted, but that is a difficulty that the Government, if they accept the principle, could quite easily put right. I beg to move.
LORD BELSTEAD: May I say, in reply to the noble Lord, Lord Garnsworthy, that it was only to be expected that noble Lords opposite would put down an Amendment to this effect.

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In fact, I welcome it, because it presents an opportunity for the noble Lord to point out to the Committee the importance of the medical advice and the medical administration which local education authorities will continue to expect to receive, so that the good work of the school health service shall in essence continue. Paragraph 21 of the Report of the Working Party on Collaboration stated that it did not envisage an exact replica of the current usual pattern, whereby the principal school medical officer is also the M.O.H. with a full-time deputy or senior medical colleague responsible for school health. That Working Party recommended that a senior doctor with appropriate experience and training should be appointed, with advisory and executive responsibility for the transferred school health service.
The Report went on to describe the Working Party's expectations of the coordinating role of an area chief dental officer and an area chief nursing officer, but I think it is fair to say that that Working Party on Collaboration did not recommend that such arrangements ought to be put into legislation, and, clearly, sub-paragraphs (1) and (2) of paragraph 10 of Schedule 1 provide ample scope for administrative guidance to be given by regulations. There is a genuine difficulty over this Amendment. If the noble Lord, Lord Garnsworthy, sought to press it, I should have to point out that there are other fields—for instance, social services and environmental health—where the Working Party on Collaboration regarded it of the utmost importance that there should also be arrangements for seeing that the health skills and staffs of the Area Health Authority were available to the local authority, and I understand that these recommendations are still the subject of consultations.
May I outline the intentions of the Government which lie behind sub-paragraphs (1) and (2) of paragraph 10 of Schedule 1? Under sub-paragraph (1)(b) of paragraph 10, an Area Health Authority could by regulation be required to appoint officers having prescribed qualifications or experience to perform prescribed functions. Obviously, these functions could be to advise a local education authority and to undertake other specified tasks on its behalf. Incidentally, I can give a specific assurance to the
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noble Lord that it most certainly is intended either to make new regulations or to carry over the existing regulations, which prescribe qualifications for those medical practitioners who examine children for the purpose of deciding whether special education is required. Then, in accordance with sub-paragraph (2) of paragraph 10 of Schedule 1, professional officers now employed by local education authorities for the purpose of the school health service will be transferred and available to the Area Health Authorities. As stated in another place on July 13 by the Secretaries of State for Social Services and for Education and Science, staff in the school health service will continue with their present work after reorganisation, and it is intended that each Area Health Authority will have on its staff a senior doctor and a senior dentist advising the local education authority as the principal school medical and dental officers do now, and similar arrangements will be made for nursing staff.
The Government recognise, as does the noble Lord, Lord Garnsworthy, the importance of the school health service and the essential need to ensure its continuity and further development. They also recognise the important part to be played by professional officers, doctors, dentists and nurses experienced in that service. I assure the Committee that guidance on the professional staff arrangements for child health and the school health service will cover this. Consideration will be given to the need for prescribing relevant qualifications and experience. Although I am resisting the noble Lord's Amendment, I hope that what I have said gives him the assurance which he is seeking.
LORD GARNSWORTHY: I am grateful to the noble Lord, Lord Belstead, for his lengthy reply to the case which I put very briefly and, perhaps, inadequately. I hope he will not be too surprised if I tell him that he is encouraging me to think of putting down Amendments about social services generally, since he has drawn attention to the fact that they might as easily have been tabled as this Amendment about the school health service. However, that is something for further thought. I am indeed grateful for what the noble Lord has said about this

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Amendment, but both he and the Committee will appreciate that since he has spoken at some length there is need to study very carefully what he has said. I have no wish to press this Amendment for the sake of having a Division. I am much more concerned with getting recognition of the need at all times to have full-time specialists in all the fields where a doctor is essential, if the service is to provide for the needs of all children, particularly those who suffer from any form of handicap. Again may I say that I appreciate what the noble Lord has said and, while reserving the right to come back at Report stage if it is thought that the position is not satisfactory, I do not wish to press this Amendment. But I hope the Committee will feel that, having got the noble Lord's statement on the record, at least some service has been rendered by the discussion on this Amendment. I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
6.17 p.m.
LORD GARNSWORTHY LORD GARNSWORTHY moved Amendment No. 63:
Page 54, line 29, at end insert—
("(6) No officer shall be transferred and no employee placed at the disposal of another authority, under or by virtue of the foregoing provisions of this section, except with his consent")
The noble Lord said: This Amendment is concerned with paragraph 10(2) in Part III of Schedule 1, which would permit the making of regulations for the transfer of officers from one authority to another, and for the secondment of officers. It is intended to ensure that no such arrangements would be implemented without the consent of the officer concerned. When the Local Government Bill was going through this House, we spent some time discussing Amendments which were somewhat similar to this one in their intention. I was present yesterday at a meeting where there were a number of representatives of people in the service of local government. Many of them are at present working in health departments, and I wish I could convey to the Committee the anxiety which some of them feel. It may well be said, again and again, that nothing unreasonable will
80
be done; but these men and women are in a situation which they themselves have not brought about, and they feel threatened in a way which they never anticipated. I should like to feel that we shall at least get something on the record indicating that they will receive a degree of consideration sufficient to allay their anxieties. That my Amendment would do. I doubt whether it will be acceptable to the Government, but I hope that when he replies the Minister will go as far as he possibly can to accept the principle.
May I say that I have been talking to some representatives of a very small group in the Health Service who are worried about being transferred from the hospital service to local government. They drew attention to subsection (5) of Clause 18 of the Bill, and it is interesting to see how that reads. If the noble Lord, Lord Aberdare, is going to tell me that it applies equally in reverse, again I think it will be useful to have this statement. The subsection reads:
"A person transferred by virtue of the preceding subsection to the employment of such a body as is mentioned in that subsection shall not be required in the course of that employment to perform duties otherwise than at or in connection with a hospital unless he has consented to perform such duties."
It would give a great deal of satisfaction to many people who have anxieties if that could be put in reverse. Personally, I do not see how it can be put in quite that form in reverse, but I may be wrong about that. However, may I say that the people who have drawn my attention to this safeguard, as it were, are not satisfied that it goes as far as they would like it to go because they do not want to be transferred. But in regard to people who are being transferred from local government to the hospital service, I feel that at the moment nothing has been said that indicates that they will have quite the degree of consideration that Clause 18(5) seems to indicate will be meted out to those who are being transferred the other way. If I am wrong, I shall be very pleased indeed; I have no wish to be proved right on this one. But I hope that if in reply the Minister says that he cannot accept the Amendment, he will, as I say, be able to go sufficiently far to allay some of the anxieties of those who undoubtedly are extremely disquieted at the present time. I beg to move.
LORD ABERDARE: Again, I can well appreciate the noble Lord's interest in staff matters, and I share them with him. The Secretary of State would certainly wish to consult fully with staff and other interests about the arrangements for staff transfers or secondments envisaged in this subsection, and procedures would be fully discussed with staff interests. But I have to say that the service to the patient is paramount, and one cannot exclude the possibility of occasional situations in which there might be difficulty in securing the full consent of an officer whose services in a particular post were of importance to the public interest. The arrangements for consultation have, however, been looked at again since we discussed this matter in December last, and again I propose to put down an Amendment at Report stage to the effect that no regulations or directions would be made under this subsection without suitable prior consultation. In the case of arrangements concerning the movement of individual members of staff, we feel that we should follow the precedent, which the noble Lord himself has mentioned, of Section 113(1) of the Local Government Act, on which we both spoke not so very long ago. This does not go quite as far in obtaining individual consent as the noble Lord himself would wish, but I hope that what I have said and the Amendment which I propose to put down at the next stage of the Bill will, as he asks, allay most of the anxiety that is understandably felt by certain members of staff.
The noble Lord made reference to subsection (5) of Clause 18. I am sure that we shall have a debate on that when we reach it. He is quite right, of course, in saying that this is a very special case; and it refers to the transfer to local authorities exercising functions under the Local Authority Social Services Act 1970 of staff of prescribed descriptions employed wholly or mainly for the purposes and functions which stand referred to social services committees by Section 2 of that Act. The noble Lord will appreciate that this is a very special case. It is one with which we are all deeply concerned, and it is one where we hope that at least this concession will help on this difficult problem that we have to resolve. But I do not think this special pleading should determine the general rule. I hope, therefore, that the noble Lord will
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feel that I have gone some way to meet him, and will see his way to withdrawing the Amendment.
LORD GARNSWORTHY: I am grateful to the noble Lord, Lord Aberdare. I think he made a very fair point with regard to the use that I made of subsection (5) of Clause 18. But I used it to try to lend emphasis to the case I was endeavouring to make. I am grateful to him for what he has had to say, and perhaps I may say that I have the feeling that it will give satisfaction to those who speak for the people who are most concerned in the subject matter of this clause and of this Amendment. What he said will be studied with interest. I am pleased to withdraw the Amendment.
Amendment, by leave, withdrawn.
LORD ABERDARE: Amendment No. 64 is a small drafting Amendment. The word "so" in this context can be construed only as referring to the opening words of paragraph 11, which refer to regulations, and it is not desired that the bodies to be approved should have to be specified in these regulations. I beg to move.
Amendment moved—
Page 54, line 45, leave out ("so").—(Lord Aberdare.)
Schedule 1, as amended, agreed to.
Clause 7 agreed to.
6.28 p.m.
Clause 8 [Local advisory committees]:
LORD BROCK LORD BROCK moved Amendment No. 66:
Page 7, line 28, leave out ("a Regional Health Authority") and insert ("the Secretary of State").
The noble Lord said: This Amendment deals with local advisory committees, and I should like the Committee to take with it the consequential Amendments, Nos. 67 to 70 and No. 72. Section 32 of the 1946 Act says:
"Where the Minister is satisfied…"
The recognition is the function of the Minister. Section 16 of the Scottish Act says:
"…the Secretary of State is satisfied…",
and the recognition of local consultative committees lies with the Secretary of

83
State. The English Act should say the same. Yet again we have this unexplained differentiation, to which I referred on an earlier occasion in this Committee, between England and Scotland. If the medical representation on the new Health Authorities is to be less than hitherto, as appears probable, it becomes all the more important to have a strong medical element on the advisory committees. A Regional Health Authority or Area Health Authority might well be influenced by some non-medical factor; for example, a purely political factor. It is suggested that the Secretary of State should be the one in whom the ultimate authority rests, and not the Regional Health Authorities or Area Health Authorities. Unless there is some satisfactory explanation for the differentiation between the mode of recognition in England and Scotland, the same mechanism should be followed and the ultimate authority should rest with the Secretary of State. I beg to move.
LORD ABERDARE: We have great sympathy with the noble Lord's intentions in his Amendment, but we feel that to accept it as it is at the moment would result in a very unnecessary centralisation of work which would lay an impossible task on the Secretary of State. Moreover, if the advisory machinery is to be fully effective there must be confidence between the Authority and its committees. It would provide a poor basis for such mutual trust if the Authorities, which have such wide responsibilities, cannot be entrusted with the functions under this clause. Certainly, the local bodies (the Regional Health Authorities and the Area Health Authorities) are in a much better position to assess whether a committee is fully representative than is the central Department. However, if I correctly understand the noble Lord's intentions, he wishes to give the Secretary of State ultimate control of recognition arrangements. We think that there are merits in this proposal.
As subsections (1) to (4) of Clause 8 are drafted the Secretary of State is given no standing in the matter of dealing with this matter and could not issue a directive to an authority about it; he could not intervene directly if there were disagreement between the Authority and the profession. We should expect that if the
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proposal were accepted the Secretary of State would very rarely use the power of direction in this sort of way, and then only in the most exceptional circumstances. But it may be that such a power would, nevertheless, provide a safeguard for the profession against the possibility of arbitrary action by a Health Authority, however unlikely that may be. However, we cannot accept the Amendments as they stand; they have certain technical defects. If I may, I shall be pleased to consider this point further on the lines that I have indicated.
LORD BROCK: I thank the Minister for those encouraging words. Perhaps he will find a way of improving the situation. I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
6.32 p.m.
LORD PLATT LORD PLATT moved Amendment No. 71:
Page 8, line 42, at end insert ("and it shall be the duty of the Authority to consult with the committee on such occasions and to such extent as may be prescribed;").
The noble Lord said: I should like to speak to Amendment No. 71. It might be thought that the wording of the Amendment is unnecessary, but even if it is proved to be unnecessary it seems to me to be desirable, which is a slightly different thing. I propose it with a certain amount of assurance because these words are incorporated in the original Act, and the very wording used here occurs in Section 16(7) of the Scottish National Health Service Act. I beg to move.
BARONESS SEROTA: I should like to support the Amendment moved by the noble Lord, Lord Platt. Earlier in our deliberations the noble Lord, Lord Aberdare, was concerned lest we should be ahead of Scotland. In this particular situation Scotland is ahead of us. I hope that he will agree that we should put the matter right.
LORD ABERDARE: I never like to be behind Scotland and I certainly hope that I can assure the Committee that we will try to help with the point put by the noble Lord, Lord Platt. As I have said previously, we attach the greatest importance to strong professional advisory machinery. That is why Clause 8 provides for

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the statutory recognition of advisory committees. It is essential that the Authority should develop a close working relationship with their advisory committees if this new machinery is to work properly. We do not think that such a relationship can or should be controlled by legislation. We think it would be wrong, therefore, to list in detail all the matters on which the advisory committees should be consulted. This would not only be wrong in principle but in practice it might lead to argument and delay where urgent action was required, and could lead to doubts about the vires of an Authority's action.
With regard to the imposition on the Authority of a general obligation to consult the advisory committees, these objections do not apply. I am aware that the medical profession attaches great importance to provisions of this kind and, as the noble Lord has said, there is a precedent in Section 16(7) of the Scottish Act. Therefore, if the noble Lord will withdraw this Amendment I will undertake to move an Amendment on Report stage which will put a general duty of consultation on the Authority.
LORD PLATT: I thank the Minister for his reply and I feel sure that those of my colleagues who have subscribed their names to the Amendment will allow me to propose that it now be withdrawn.
Amendment, by leave, withdrawn.
Clause 8 agreed to.
LORD ABERDARE: Perhaps at this moment, since we have made excellent progress, as we are about to embark on Clause 9 and as there is other business for the House to tackle, it might be convenient for me to move that the House do now resume.
Moved, That the House do now resume.—(Lord Aberdare.)
House resumed accordingly.

NATIONAL THEATRE AND MUSEUM OF LONDON BILL
Message from the Commons that, in pursuance of the Parliament Act 1911, they have directed that Section 1(1) of that Act shall not apply to the Bill.
SEA FISH INDUSTRY BILL
Brought from the Commons, endorsed with the Certificate from the Speaker that the Bill is a Money Bill within the meaning of the Parliament Act 1911; read 1ª, and to be printed.

NORTHERN IRELAND (BORDER POLL) ORDER 1972
6.38 p.m.
THE MINISTER OF STATE FOR NORTHERN IRELAND (LORD WINDLESHAM)THE MINISTER OF STATE FOR NORTHERN IRELAND (LORD WINDLESHAM) rose to move, That the Draft Northern Ireland (Border Poll) Order 1972, laid before the House on December 14 be approved. The noble Lord said: My Lords, I beg to move the draft Order standing in my name on the Order Paper. Noble Lords who took part in the debates before Christmas will remember that the Northern Ireland (Border Poll) Act 1972 provides for the holding of a poll to enable voters to say whether they want Northern Ireland to remain part of the United Kingdom or whether they want it to be joined with the Republic of Ireland outside the United Kingdom. My right honourable friend the Secretary of State for Northern Ireland subsequently decided that the most appropriate day for the poll would be Thursday, March 8. This date was selected following the advice of the electoral advisory committee and the under-sheriffs, who in Northern Ireland act as returning officers in Westminster elections. March 8 was the earliest practicable date for the poll, bearing in mind the necessary administrative arrangements and particularly the introduction of the new electoral register which comes into force on February 16. The object of this Order is to seek the authority of Parliament for this date and also for the rules on which the poll will be conducted.
The Border Poll Act itself provided that the poll should be conducted so far as possible along the lines of an election to the Westminster Parliament, and the Order has therefore been designed to spell out in detail those parts of the existing electoral law which are to be applied or modified for the purpose of the poll. The

87
form of the questions to be put was also contained in the Border Poll Act and is not therefore part of this Order. I am afraid that this has resulted in a rather technical document, but the alternative would have been to have a self-contained Order, and we were advised that this would necessarily have been considerably greater in length and would not have served its purpose so well.
It is of course important that those who have the responsibility for organising the poll should be quite clear which parts of the existing law are to be applied and modified. Article 4 of the Order provides for the hours of polling to be from 8 a.m. to 8 p.m. This compares with 7 a.m. until 10 p.m. for a General Election. The slight reduction in the number of hours for polling is adopted with the agreement of the returning officers; it will enable the majority of voters to vote in the hours of daylight (lighting-up time in Belfast is expected to be about 6.45 p.m. on polling day), and will also make it easier to recruit staff for the manning of the polling stations. We do not expect the reduction in hours to affect the number of votes cast, particularly in view of the provisions for postal voting which I shall explain in a moment.
My Lords, I have mentioned that the under-sheriffs for Northern Ireland are the returning officers for the poll. There are six in all, one for each county, and they are already engaged in preparatory work. Article 5 of the draft Order is precautionary. It provides for the Secretary of State to employ substitute returning officers if for example an existing holder of the post was prevented from acting by illness.
Postal voting is dealt with in Article 6. Any elector may apply to vote by post if he gives an address in the United Kingdom to which the ballot paper may be sent. This is an extension of the normal provisions for postal voting and could result in a considerable proportion of the electorate voting by post. The form of application is shown in Schedule 3 to the Order. These forms will be available shortly at local authority offices and post offices in Northern Ireland or by postal application to the appropriate registration office.
Article 7 enables the Secretary of State to appoint observers to attend at the issue of postal ballot papers at polling stations, at the opening and verification of returned ballot papers and at the central count. Since there are, of course, no candidates for the Border Poll there can be no counting agents, or polling agents, in the ordinary sense of the word, in this instance. However, it is the intention of my right honourable friend the Secretary of State to invite members elected for Northern Ireland constituencies at Westminster and in the Northern Ireland Parliament to nominate observers who will have broadly similar functions. In addition, my right honourable friend has accepted an offer from the Department of Political Science at the Queen's University, Belfast, to conduct a research project into the Border Poll. It is intended that members of the project team will visit polling stations all over Northern Ireland and also that they will be present at the central count. They will later report to my right honourable friend, and I am sure that this will be a most useful exercise.
Article 8 deals with the arrangement for the central count. My right honourable friend the Secretary of State has appointed the Under-Sheriff for Belfast and Antrim to be in charge of the central count. As I explained in the debate on the Border Poll Bill, the result of the poll will be declared for Northern Ireland as a whole and not by constituencies or any other geographical area.
My Lords, the remainder of the Order is taken up with the Schedules setting out those provisions for electoral law which are applicable and any modification which needs to be made to them for the purposes of the Border Poll. That, I think, is all I need say by way of introduction to this Order. We have of course already debated the principle of it when the Bill was before your Lordships' House and before it became an Act of Parliament before Christmas. But if there are any points which have caught the eye of any noble Lord I will do my best to provide a fuller explanation. I beg to move.
Moved, That the Draft Northern Ireland (Border Poll) Order 1972, laid before the House on 14th December, be approved.—(Lord Windlesham.)
6.46 p.m.
LORD SHACKLETON: My Lords, as the noble Lord, Lord Windlesham, has said, we have already debated the principle of this poll and my views on the subject have not changed. I suspect that, privately, the views of the Government may not have changed; namely, that they are committed to the poll but that it will contribute nothing to peace in Northern Ireland. Indeed, the situation now is rather more worrying than it was a few months ago. The result of this exercise is foregone. It is inevitable that there will be a majority for remaining with the United Kingdom; and we know all this already. The Government have decided that the votes will be counted centrally. There will be no possibility of deriving useful information about the feeling in counties like Fermanagh and Tyrone where, just conceivably, the result might be not entirely as expected; where it is possible that, in a secret ballot, some of those who might otherwise be expected to be nationalists might vote to remain with the United Kingdom. But this we shall never know.
I was interested in what the noble Lord had to say about the research team from the Queen's University. I take it that the team will not themselves be in a position to investigate the make-up of the various voting boxes. The fact is that the Government have got a commitment and I appreciate that, in the light of some rather dangerous news in the last day or two, they feel that it would be more dangerous to cancel the poll than to go on with it. At this point I would not wish to say that the Government have any choice other than to go on with it, much as I regret that we are having it.
I should like to ask the noble Lord one or two questions. First, I take it that in this very sensitive situation he is still not in a position to announce when the White Paper with the proposals for Northern Ireland is to be published. Many of us have argued that it would be desirable that it should be published before the poll. I realise that this is an exceedingly difficult judgment and, as the noble Lord knows, he and the Secretary of State have my full sympathy. Therefore I am very reluctant to be critical. But I would say from outside Northern Ireland—and this is a fact we all have to remember: that we are outside that
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troubled part of the world—my inclination would still be to publish the Government's proposals before the Border Poll.
The noble Lord explained, rather briefly (I have no complaint about that because he made clear that it was an introductory speech), the arrangements for the conduct of the poll. If I understood this correctly, it is being conducted under what I believe are sometimes called the Westminster Rules, based on the 1969 Act and the 1949 Act, but with such modifications as are considered to be appropriate in Northern Ireland, and particularly for what is a most unusual and indeed almost unprecedented event, namely, a plebiscite. This has led to certain consequences which have meant that the Government have rightly tried to take steps to replace some of the machinery of an ordinary election. As I understand it, the nominated observers will take the place of what we sometimes call polling agents.
Here I would ask the noble Lord, who is going to authorise these polling agents? The noble Lord may have had the good fortune or misfortune of having to fight an Election, but in any event he will know that those who are appointed as candidates by polling agents have to give certain undertakings, and certain people have to find some sort of identification. Will this be done by those who are entitled to appoint them? When one looks at the Order here, there seems to be quite a wide choice. I can imagine some rather dangerous situations in which people might well be appointed who could seek by their mere presence to influence the poll in a way that is unknown in this country: that could happen from either side. I appreciate the Government's dilemma in this matter. They want to be as fair as possible, but polling agents could be appointed who are members of the Provisional I.R.A. or the Ulster Volunteer Force, who could by their mere presence produce some intimidating factor. That is all part of the difficulties with which the noble Lord, Lord Windlesham, is far more familiar than I am. Is there any restriction as to who can be a polling agent or an observer? Must he be a citizen of the United Kingdom? I do not think this is spelt out in the Order. But then the Order inevitably draws on a large number of other provisions in sections of the

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relevant Acts, and it may be that this matter is taken care of there.
The noble Lord then went on to the subject of postal voting. Any noble Lord who knows the Irish situation (and nobody knows it better than my noble friend Lord Longford, who was here, but obviously dislikes the Order so much that he has disappeared) will know that voting in Ireland has an historical significance of a kind that is not known in this country. That is about as anodyne a phrase as I could find. It appears that there may be quite a lot of postal voting. Here again there is a real danger—and this is part of the security aspect—that some of these postal votes may be purloined or stolen, or the carrier may be menaced. I wonder whether the noble Lord can say anything on that subject. I appreciate that here again the Government have been seeking to pursue liberal policies and it is difficult to sustain them in the face of some of the threats of violence. I mention this only to show an awareness of the difficulties and the possibility that there may be some real arguments, and indeed scandal, in relation to postal voting.
I notice that those citizens of Northern Ireland whose address is now in the United Kingdom will be able to apply for a postal vote. This again suggests that the postal voting provisions are rather wide. They are not confined simply to people who are away on business, as I understand it, and if people have transferred in ordinary circumstances (my recollection is uncertain on this) their vote can be transferred. I should like to ask what is the position of people who are not living in Northern Ireland—people who are registered, but who are living, say, in the Republic. It may well be that the Government feel that it is not possible to recognise postal voters in the Republic; or maybe they can be provided for in other ways, or they can vote by proxy. That brings me to another point. I take it that there will be a number of former Servicemen who were in Northern Ireland at the date when the last registration took place in September and who may be eligible to vote. One would not wish to suggest that the results could be affected—I am sure they will not be—by United Kingdom troops Service votes, but I take it that they will be able to vote by proxy.
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If I may make one other point, my Lords, I should like to know whether the Government can say anything about the procedures in relation both to canvassing and to the use of cars. In an ordinary Parliamentary Election it is the Parties and the candidates who organise their cars and their canvassing. I take it that cars can be used. In a Parliamentary Election there are certain restrictions. If I remember rightly, you cannot just hire cars—but it may be that I am out of date. I remember the time when one was severely rationed as to the number of cars one could use; but that has gone. Meanwhile, I take it that the political Parties will be able to canvass for votes, but whether they will have committee rooms and seek to bring the voters out as in a Parliamentary Election, I find it difficult to say.
I do not want to make difficulties for the Government, but this is the sort of question that people in Northern Ireland will be asking. It is not possible for the Government to spell out everything. They are undertaking a difficult operation in which, since they are committed, they deserve the support and help of us all; but I think there will need to be a great deal of explanation to the political Parties. We do not need to explain to political Parties in this country, or for that matter in Northern Ireland, how to run an Election, but when it comes to running this unfamiliar animal, a referendum, then some further guidance will be needed. It may well be that the sort of questions I have asked will be asked by others. I can only repeat the support and sympathy that I have for Her Majesty's Ministers who carry this responsibility, and for the troops, probably in large numbers, who will have the unenviable task of keeping the peace during this poll.
6.59 p.m.
LORD WINDLESHAM: My Lords, I do not need to go back over what I said in the debates we had in December about the reasons why the Government believe it is absolutely essential to hold this Border Poll. It is a prerequisite to the possibility of obtaining a settlement. It is as important as that on the Protestant side. Those of your Lordships who read the leading article in The Times this morning will have seen this point clearly stated.

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The noble Lord the Leader of the Opposition has asked me a number of detailed questions about the way in which the Border Poll will be organised. I did indeed fight a Westminster election some years ago. Both of us are probably a little rusty on our electoral law, but I can reply to some of the points which the noble Lord put. If I do not answer all his questions it is because I want to study them more carefully in Hansard, and I will write to him fully covering any points that I have not been able to deal with. The noble Lord asked whether the Queen's University research team would be able to analyse the votes by the areas in which they were cast. The answer is that they will not have access to votes for that purpose. I might add, in parenthesis, that I personally believe that this will be a very useful piece of political research by a team under the leadership of Professor Lawrence, of Queen's University, Belfast. Professor Lawrence has been good enough to act as chairman of the Electoral Advisory Committee which was set up to advise the Secretary of State on the Border Poll and also on other electoral matters in Northern Ireland. There is a shortage of hard facts, although many assertions are made, about how elections have been conducted in the past in Northern Ireland. What we need is more information, and I am sure we shall be able to obtain considerable benefit from the findings of the University research team when they have completed their work.
The noble Lord also asked whether persons who are on the new register—that is the one coming into effect in February—hut who at the date of the poll are living in the Republic would be able to vote. In those circumstances they would be entitled to vote by proxy, since they are outside the United Kingdom and cannot vote by post. The postal voting facilities are very much wider than is normally the case in United Kingdom Parliamentary elections. As the noble Lord will remember, there are a small number of defined categories in the Representation of the People Acts which give entitlement to a postal vote. But they are narrowly defined: physical incapacity; unavailability because of the nature of service or occupation; the necessity of making a journey by air or sea; or religious observance. What
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we are saying is that anyone who is on the register, and who can satisfy the returning officer that he is the person he says he is, and has an address in the United Kingdom is entitled to a postal vote. Therefore if people are apprehensive about voting, for whatever reason—perhaps intimidation—or are not happy about going to a particular polling station, they can get a postal vote.
LORD SHACKLETON: My Lords, this is going to take a great deal of organising. As the noble Lord will recall, postal voting tends to be organised by the political Parties. The Conservative Party in this connection, with their greater resources, usually get their postal votes all lined up before the election and the Labour Party hurry to get theirs lined up in the course of the election. Who is going to tell people about this? I do not believe that without the political Party system and in the absence of candidates with a deep vested interest things Will happen in the same way in this instance. Will steps be taken to inform every voter how this is to be done? I rather gathered that the noble Lord was saying something like that.
LORD WINDLESHAM: My Lords, I do not have the details before me, but we are absolutely at one with the noble Lord in agreeing on the need for the maximum publicity, by way of explanation and guidance, to be given to voters as to their rights under this Order. The Order has first to be approved by Parliament, but we will certainly endeavour to make sure that the facilities for postal voting are widely known.
The noble Lord also asked who would authorise the polling agents. The agents will be appointed by the Secretary of State and will be sworn to secrecy by the returning officer in the normal way. The Secretary of State will rely on the sense of responsibility of those nominating them—that is, the Members of Parliament at Westminster and Stormont. I understand that the Secretary of State wrote to the noble Lord yesterday to give him details of the scheme my right honourable friend has decided upon. It is clearly desirable to try to find some way of enabling the political Parties to provide observers; but since this is the first time there has been a plebiscite of this kind in Northern Ireland, or indeed in

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the United Kingdom, we have to devise appropriate measures to meet the circumstances. Members of Parliament who represent Northern Ireland constituencies at Westminster, or who were Members of the prorogued Parliament of Northern Ireland at Stormont, cover a very wide range of political Parties. What will probably happen is that the political Parties will provide lists of observers in the normal way and a Member of Parliament will then ask for them to be appointed as observers. There should be a reasonably wide range of observers from Parties who are willing to support the poll. We hope that as many political Parties as possible will encourage their adherents to vote in this particular Border Poll, although it is not of course a matter for the political Parties as such.
LORD SHACKLETON: My Lords, may I say that I am very grateful to the Secretary of State for having written to me. I did not refer to this point because the noble Lord more or less covered it in his opening speech. I am not in disagreement. Quite clearly, the Government are doing the best they can and are using their brains on this. I would only say that if people are going to be sworn in, if I remember rightly, this can be done by any justice of the peace locally. He says that they have to be sworn in before him by the returning officer and I believe there is a senior returning officer and a limited number. I mention this point only because one of the fears one has is that there will be some awful trip-up of the "nuts and bolts" organisation, and I just offer that as a further complication.
LORD WINDLESHAM: My Lords, I am grateful to the noble Lord for drawing my attention to these points. I hope that I have answered most of them; hut. as I said earlier, I will check back in Hansard and write to the noble Lord later. It is useful to have this opportunity to debate the provisions contained in these regulations, because it is the first time a poll of this sort has been carried out, and we are determined that it shall be conducted in an orderly and efficient way. The security forces will make sure that polling can take place at the polling stations, and at the same time the Administration must ensure that it is all properly and efficiently organised.
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I have already paid tribute to the assistance we have had from the Electoral Advisory Committee, the members of which are people experienced in this field, and this also applies to the returning officers who are the under-sheriffs. In this respect there is a slightly different procedure for Northern Ireland compared with the rest of the United Kingdom. These officials have been working in a most admirable way, closely together with the Northern Ireland Ministry of Home Affairs. We are greatly in their debt. My colleague, Mr. Howell, will be introducing this same Order in another place later this evening. Since there are a number of Northern Ireland Westminster Members who will have a direct interest in appointing observers and so on, we shall have the benefit of their comments, which we can then pursue in discussion with the returning officers in the weeks remaining before the poll takes place.
[The Sitting was suspended at 7.9 p.m. and resumed at 7.40 p.m.]

NATIONAL HEALTH SERVICE REORGANISATION BILL [H.L.]
LORD ABERDARE: My Lords, I beg to move that the House do again resolve itself into Committee on this Bill.
Moved, That the House do again resolve itself into Committee.—(Lord Aberdare.)
House in Committee accordingly.
[The VISCOUNT HOOD in the Chair.]
Clause 9 [Community Health Councils]:
BARONESS WHITE BARONESS WHITE moved Amendment No. 73:
Page 10, line 5, leave out ("each Area Health Authority") and insert ("the Secretary of State").
The noble Baroness said: We now reach what will be generally agreed is one of the most important and controversial clauses in this Bill, because it deals with the community health councils, on which we had considerable discussion at Second Reading. It would be

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fair to say that on that occasion the Government did not have a friend in the House. There are different views as to the ways in which these councils might be constituted, and different views as to the scope of their functions. What is plain to all the world except, so far as one can understand, those at Alexander Fleming House, is that if one is to have a body whose business it is to act as a watchdog on the operations of the Health Service, then it simply passes comprehension how one can suppose that it can be an effective watchdog if it is to be appointed by, staffed by, possibly housed by, and its expenses met by the body which it is its business to watch. This is the simple proposition. If the Government are in earnest in this matter, and are sincere in their protestations that they genuinely wish community interests in the operation of the Health Service to have an effective voice, it appears to noble Lords in every part of the Committee that the propositions in the Bill as it now stands simply could not bring about that desired state. Therefore some Amendments to this particular clause of the Bill are imperative if we are to have effective community participation in the Health Service.
In our earlier discussions to-night on the managerial structure of the Health Service the point was made by the noble Lord, Lord Aberdare, that the Government were standing by the philosophy of keeping management and representation separate, except for the anomaly (if one might suppose it to be that) at the Area Health Authority level of having at least four persons nominated by local authorities. The corollary to having the hierarchical and self-contained managerial structure which is proposed in the White Paper and in the Bill is that public participation, if it is not to be brought in at management level, must have an effective vehicle alongside or out-with the management structure. It is for that reason that we have literally pages of Amendments proposed to this clause. It is going too far to follow The Times, which made a very good start to the year on January 1 by referring to the proposed structure as a "bureaucratic monster". That was going a little too far. When the article, which no doubt the Minister has read, went on to say that arrangements for giving the public an effective voice were hopelessly inadequate
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there we have reached common ground.
I find it difficult to suggest precisely how we can proceed with this debate because, in the nature of things, the three main groups of Amendments are scattered throughout the clause, yet they each have a consistency within themselves. The Amendment I am proposing, which is the opening Amendment, would substitute the Secretary of State as the appointing person for the Area Health Authority. A number of otherwise rather obscure Amendments which follow are consequential on this proposition, and try to express in the later parts of the clause what would have to be written in were one to accept this particular principle.
For the assistance of noble Lords, may I say that, in addition to the Amendment I am now moving, one might fairly suppose that Nos. 74 to 80 and Nos. 83 and 84 all hang together with this initial Amendment. Amendments Nos. 81 and 82 are separate, and so are Amendments Nos. 85, 86, 89 and 91 which stand in the names of my noble friends and myself. I will come back to the substance of the Amendments in a moment. The other two main groups of Amendments, as is plain from the Marshalled List, are those standing in the names of the noble Viscount, Lord Amory, the noble Viscount, Lord Bridgeman, and my noble friend Lord Pargiter, on the one hand. Those Amendments, broadly speaking, represent the views of the local authority associations. The other Amendments, standing in the names of the noble Lady, Lady Ruthven of Freeland, and the noble Lord, Lord Amulree, which are not so numerous, deal with one or two very important matters. The Amendments standing in the names of my noble friend Lord Garnsworthy and others are separate issues of great importance to the functioning of the community health councils, but do not go into the root matter of who is to appoint, who is to pay for and who is to staff these bodies.
I should make it plain that we are not necessarily wedded to our own proposition that it should be the Secretary of State throughout. When we considered this matter and began our consultations, which we have been pursuing during the Recess, with various interested organisations outside the House, and particularly those concerned with consumer matters,

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we reached the conclusion that everybody wanted to delete the Area Health Authority—there seems to be no dubiety at all about that in this context—as the body responsible for appointing the community health council. We did not find a single person who was in favour of the Area Health Authority appointing the community health council, financing it or staffing it. Those who have considered the matter were also generally of the opinion that, so far as practicable, such a body should be housed separately from the health authority that it was meant to be supervising—not in the managerial sense of supervising, but supervising in the interests of the general public.
There is far less agreement as to what should take its place. It is for that reason that I hope that in this long series of Amendments we may have a broad discussion of the possibilities which are open to us if we accept as a guiding principle that we do not want the Area Health Authority to be responsible, as is provided for in the Bill. I shall listen with particular interest to the propositions put forward by the noble Viscount, Lord Amory, and his friends because, while we may not go all the way with them, we feel there is substance in their proposals. The more one thinks about the functions of the community health councils the more one wants to be certain that they are linked with the community and are not just appendages of the Health Service.
Our own Amendments start, as I say, by substituting the Secretary of State as the appointing authority; and from that would flow that he should also meet the expenses of the body concerned. It is open to argument whether he would attempt to do this directly or by using the Regional Health Authorities, but certainly not the Area Health Authorities—that, I think, would be clear to most of us. The other Amendments which we have put down are in some respects germane to those of the noble Viscount, Lord Amory, in so far as we believe, as I said on Second Reading, that if the real purpose of the community health councils is to express public opinion, there is much to be said for trying to adjust their areas to coincide with those of local authority organisation under the revised scheme. I believe (and one of our Amendments is addressed to this point,
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and I have found a good deal of support for this view in the discussions we have been having) that it should at least be possible under the Bill for there to be direct elections. I gathered from the comment that the noble Lord, Lord Aberdare, made on Second Reading that this procedure does not necessarily commend itself to the Government, but the way in which we have worded this Amendment would, as I say, make it possible rather than mandatory. I think one cannot solve some of these problems (this is the one point on which I agree with my noble friend Lord Brown) on this side of the Health Service without an element of direct responsibility to people, if one is going to presume to speak for the people. But all these matters will be taken in due course as we reach them. I thought it was proper to point out the elements in our policy.
I expect the Government to say that they are not necessarily much enamoured with the idea of making the Secretary of State responsible for the appointments to what we grant will be a pretty large number of community health councils—I think, in round figures, about 200 is the order of magnitude so far as England is concerned. One fully recognises that this might be a difficulty. One of the problems which have arisen in our discussions is that, whereas in the Bill it is proposed that half the membership of the community health councils shall be from the local authorities and the other half from the voluntary organisations, the voluntary organisations themselves are not certain just how they wish to proceed. I do not know whether there are other noble Lords in the Committee who can give some further guidance on this matter, but we have done what we could in the time available to consult with, for example, the National Council of Social Service, National Organisations Division, and other groups who have been meeting to discuss this particular matter. Their strong wish, as I understand it, is that the voluntary organisations should be able to select from among themselves their own representatives on the community health councils. But when one puts to them precisely by what mechanism they think this would be brought about, there is a good deal of uncertainty.
I have before me a letter from the National Council of Social Service, dated

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January 12, in which they say that they would very much wish to be able to select the membership representing the voluntary organisations, but
"the mechanics of this would not be entirely straightforward and would take some while to work out".
They go on to suggest that for an initial period of three years the appointments should be in the hands of the Secretary of State and that that time should be used so that not later than the end of the first two of those three years schemes might be put forward for dealing with the representation of voluntary organisations on the community health councils. I have no doubt the Government will be making their own contacts with the people concerned and I shall he very much interested to know what is their view on this matter.
I think there has been a general feeling that a 50/50 division is not entirely satisfactory. Again, we feel that one-third/one-third/one-third is a better proportion: in other words, one-third from local authorities, one-third from voluntary organisations, and we should like the other third by direct election, but there are alternative Amendments in the names of other noble Lords which suggest that the community health councils might co-opt persons whom they thought desirable. There are other propositions that the Secretary of State might himself nominate names from persons who were not put forward by the voluntary organisations which have a direct concern with the Health Service but might nevertheless be persons active in other walks of life who would make valuable members of such bodies. We ought to discuss all these proposals because what we are trying to do in what is a departure front the existing pattern in the Health Service is to try to lay down guidelines, at least, as to the most effective way of giving real voice to public concern with the way in which the Health Service is run at the community level in the localities.
I repeat that if the Government are taking the attitude which in general they are taking on the managerial structure, then it really behoves them to make certain that this particular vehicle of expression for public interest and public concern shall be as effective as it possibly can be. No one looking at the Marshalled
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List could suppose that it is satisfactory as it is now, because if it were we certainly should not have this very large number of Amendments. The earlier Amendments deal mainly with the composition, method of appointment and financing of the community health councils. There are one or two later Amendments, including that in the name of my noble friend Lady Llewelyn-Davies of Hastoe, No. 90A, and several others, which are more concerned with functions. But if we could get the appointing authority and the method of financing these councils clear in our minds first, then we might be in a better position to consider functions. Accordingly I beg to move the Amendment standing in the name of myself and my noble friend so that we may open the discussion on this extremely important clause.
LADY RUTHVEN OF FREELAND: The noble Lord, Lord Amulree, and I did not move Amendment No. 58 as it appeared to be more appropriate for discussion when we came to Clause 9, where there are many Amendments on the setting up of community health councils, but I should like to draw the attention of the Committee to the fact that there is nothing in the Bill about the composition of the community health councils. If they are to play an important part in the new National Health Service in representing the consumer (in other words, the patient) this omission ought to be rectified. That was what I had intended to try to put over in moving our Amendment No. 58, and the Minister has kindly allowed me to intervene in order to say what I had then intended to say.
Our Amendment No. 58, accepted the suggestion in the White Paper that there should be not less than twenty or more than thirty persons on each council and that the councils should appoint their own chairmen, but we think that the local authorities can provide sufficient expertise with fewer than half the members. Therefore we propose that they should make do with one third of the members. We suggest that three members might be co-opted by the councils themselves or appointed without consultation by the Secretary of State, the remainder to be appointed by the Secretary of State and not by the area (as the White Paper says) after consultation

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with bodies interested in health matters. In the last line of our Amendment we indicated the sort of people these nominees should be. We thought that really it was the voluntary organisations that had actually worked in the hospitals—speaking for my own association, the League of Hospital Friends, and there is also the W.R.V.S., the British Red Cross and the St. John Ambulance and many others who actually have worked in the Hospital Service with the patients and with the staff—who should make nominations. We are particularly anxious that those people should be considered, and we thought appointment should be by the Secretary of State.
We did not agree with some of the Amendments on how the people should be appointed. We think the councils ought to correspond with the health districts and not with the local authority districts, which are different. We do not see that the councils will be any more independent as the creatures of the local authorities than they would be if they were the creatures of the Area Authorities. We feel most strongly that the councils should be set up by the Secretary of State with only a few nominations from the local authorities. That is what I meant to say if we had moved Amendment No. 58 and I am glad to have had the opportunity of saying it now.
LORD AMULREE: I should like to say a few words in support of the noble Lady, Lady Ruthven of Freeland. I am sure it is important that the community councils should not be thought to be in any way dependent upon or really connected with the Area Health Authority, and I should like to support what the noble Lady has just said. I hope that when the Minister replies he will be able to give us not only a friendly answer but also an understandable answer that we shall be able to accept.
8.4 p.m.
VISCOUNT AMORY: I think we are all grateful to my noble friend Lord Aberdare for welcoming the idea of a general discussion on the various proposals covered by the Amendments dealing with the community health councils. I am afraid he may feel a little impatient with us for continuing to plug this one
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aspect of local democratic participation, but the reason we are doing it is really because of the structure of the Bill as it is at present drafted.
If I may, I should like to speak to the Amendment standing on the Marshalled List in the name of myself and my noble friend Lord Bridgeman and the noble Lord, Lord Pargiter, No. 73A. There are many other consequential Amendments: Nos. 77A and 78A, 80A, 81A, 81B, 82A, 82B, 86A, 89A and 91A. In fact, the Amendments set down in our names seem to proliferate over the next two pages of the Marshalled List. It looks as though we have tabled every Amendment that has not already been pre-empted by the noble Baroness, Lady White, and my noble friend Lady Ruthven of Freeland. The aim of all these Amendments stems from the same basic cause. We think it important that the proposed community health councils should be given and should have, and should appear to have, a clearer independence than they have under the Bill at present. The proposals in these Amendments are supported, once again, by all four local government associations who have given great thought to this matter and I hope that this fact will lead my noble friend to think carefully about this matter.
We recognise that the intention behind the proposals for these community health councils is a worthy one: to afford an opportunity for advice from local users to the Area Authority, and criticism of them when the need is felt. But the proposal that half of the council members should be appointed by the Area Authorities, that the staff should be appointed and paid by the Authorities, and that accommodation should be provided by the Authorities—those same Authorities whose work will be subject to the council's criticism—surely cannot be right. The importance of these bodies being at arm's leneth from the organisation whose operations they are ready to scrutinise has been recognised in the Report of the Select Committee on the Nationalised Industries and also in the White Paper on the nationalised industries' relations with the public. It seems astonishing that this principle does not seem to be given effect to in this case. Local authority members, because of their own responsibilities for personal social

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services, and because of the knowledge they have of local needs and wishes, will have a deep interest in the work of these councils. The principle behind all these Amendments is the same: to ensure that the council shall be seen to be as separate as possible from the Area Committees whose operations they are going to scrutinise.
The Amendment standing in the name of the noble Baroness, Lady White, provided, as I understand it, for the councils to be set up by the Secretary of State rather than by the Area Authorities, and for the expenses to be paid by the Secretary of State, the local government members being elected by local government. The Amendment standing in the name of my noble friend Lord Bridgeman, the noble Lord, Lord Pargiter, and myself proposes that the members should be appointed by the local authorities and that the staff should be appointed and paid by local authorities. We believe, again, that the voluntary organisation members should not be chosen by the Area Authorities, but should be chosen in some other way by the voluntary bodies concerned. One thinks particularly of those voluntary organisations such as my noble friend Lady Ruthven, who knows so much about these things, has mentioned to us. I believe that these Amendments would render the councils entirely independent. It is this principle of independence that seems to be so essential, and I hope that if my noble friend does not like the precise proposals put forward in our Amendment he will agree that the principle of independence, and clear independence, seen to be there, requires to be enshrined and to be safeguarded in the Bill, and that he will make some proposals of his own to that effect.
Clause 9(4) says that membership shall be prescribed by regulations, whereas it seems to us that the Bill should itself provide specifically that district councils should appoint members, as is provided in the case of Area Authorities. It also seems to us that it should be laid down that every district in an area that is covered should have a representative. While we agree that the majority of the members should certainly be appointed by districts, we see possible advantage in one or two of them perhaps being members of county councils; apart from the value to the community council, it
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would be of value to a county council to have one or two of its members able to speak from first-hand knowledge of the working of the Health Service.
As regards districts, it seems to us that there is probably some difficulty in ensuring that these districts for this purpose should coincide with the local government districts; so that we feel that the Health Service districts might be the best guiding factory, provided that every local government district has a member on the council which covers any part of its area. Here we are a little out of agreement with the Amendment proposed by the noble Baroness, Lady White.
We know from our experience of other legislation that these sort of consultative bodies and bodies for channelling complaints can fail and be ineffective. They represent in a way a second best alternative to the principle of direct participation in executive decision-making. But if the Government are as determined as they seem to be to keep to a minimum direct participation by elected local government members on executive bodies, we really must press them to adopt some means of stressing the absolute independence of these community councils. I suggest to my noble friend that any reluctance to do so must be interpreted as confirming still further the fears that some of us mentioned at an earlier stage in the discussion to-day—the fairly widely held fears that the proposed set-up will be hierarchical, bureaucratic and insulated against the democratic expression of local opinion and need. The appointment of members and staff by anyone else seems to be preferable to their appointment by Area Authorities.
I trust that my noble friend will look favourably on the principle behind these Amendments and will accept, as I am sure he will, that we are not out to wreck the efficiency of this Service in any way but are anxious to make it still better. If he accepts that principle and looks favourably on it, I hope that he will choose some way of giving effect to the principle.
LORD ABERDARE: I do not wish in any way to curtail the debate or to prevent any noble Lord who wishes to speak from doing so. I feel from what I have heard so far that it might be useful if I

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were to say something now about how our thoughts have moved since we discussed this matter on Second Reading. It seems that the Committee is being a little difficult over this.
SEVERAL NOBLE LORDS: Oh!
LORD ABERDARE: Where it is appropriate that the Secretary of State should make the appointments to management bodies we are being told and advised that other arrangements are preferable. Now, when we are talking about appointments to community representative bodies, the noble Baroness's Amendment seems to indicate that the Secretary of State should make these appointments. I should have thought that that was the very last thing he should do. There would be grave difficulties if that were to happen. The noble Baroness made a most realistic and entirely helpful speech about this. We are all trying to tackle this problem in the same spirit, namely, that of finding independent community health councils. However, as she said, there will be some 200 of them, and it would be an impossible burden to lay even on Alexander Fleming House to have to appoint these 200 local representative bodies which must, one would have thought, be appointed with the utmost local considerations in mind.
BARONESS WHITE: I hope that the Minister will forgive my interrupting him at this point. He will appreciate that in the course of my remarks I tried to indicate that if our suggestions were accepted one-third would in fact be local authority nominees, and therefore the Secretary of State would not have to worry unduly about them; and we should like one-third to be directly elected, so that he would not have to worry about them either. The voluntary bodies would like to choose their own but they are not sure how to do so. They regard the Secretary of State, as it were, as an interim person, one holding the line until they have worked out their own mechanism for doing this job, which means that in the end the Secretary of State would not have to worry about any of them. Nevertheless, we appreciated that something about this matter needed to be put in the Bill.
LORD ABERDARE: That would be on the assumption that we accepted all
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the other proposals of the noble Baroness about direct elections. The important matter on which we are all agreed is that the community health councils should be representative of local opinion; and it has been our thought hitherto that it would be easiest and more effective if the appointments were actually made by the Area Health Authority—although we are open to suggestions about this—simply because within the Health Service, which is the body in which these community health councils will be engaged, this is the most local body we can find who will know the local conditions.
Having said that, may I put on record some of the thoughts we have had since Second Reading because it is clear to me, as it has been to others, that these proposals are not universally approved of. To begin with, we accept the proposal of my noble friend Lady Ruthven of Freeland, that provision about the composition of community health councils should be in the Bill rather than in regulations. That point was also made by my noble friend Lord Amory. We will put forward Amendments on Report in the light of the further discussions we may have to-day on what the composition should be.
Secondly—and I am including in this Amendment No. 58, which my noble friend Lady Ruthven of Freeland and my noble friend Lord Amory did not move—we would prefer to leave the number of members of the community health council flexible rather than lay down a figure in the Bill. This would allow for local circumstances.
So far as the composition is concerned, we intend that not less than one-half of the members should be appointed directly by the district councils or by the London borough councils. We also intend—this will meet the point made by my noble friend Lord Amory—that each district and each London borough council concerned should be represented on the community health council. This immediately means that the Area Health Authority cannot have a majority of members on the community health council—because of this 50 per cent. minimum representation by the district councils, and we chose the district councils because they were the nearest to the ground in relation to the local authority council.
LORD INGLEWOOD: Did I hear the Minister aright? Did he say that 50 per cent. of the members would be appointed or elected by district councils and not by Area Authorities?
LORD ABERDARE: That is correct. That is why I would ask the Committee to consider carefully whether they really mean that the Area Health Authority should not be responsible for making these appointments, because the appointments, as I shall go on to explain, will all be nominees of other bodies: 50 per cent. of them by the district councils.
LORD GARNSWORTHY: Did the noble Lord use the words "a minimum of 50 per cent. by local authorities"? Could he enlarge on that? Does he really mean that it will be a minimum, and that there is a possibility that there will be a majority who are not appointed by the Area Health Authority?
LORD ABERDARE: Yes, that is what I am saying. If the noble Lord will listen for a little longer, that is what I am trying to explain. I have already said that 50 per cent. will be appointed on the nomination of the district council. We go further and propose that of the remaining 50 per cent., two-thirds should be those nominated by the voluntary bodies. I appreciate, as does the noble Baroness, the difficulty of the voluntary bodies doing this themselves, so what we were suggesting was that the Area Health Authority, which knows its area and knows which voluntary bodies are most active in its area, should obtain from them the names of people they would like to see serving on the community health councils. A further two-thirds of the remainder would be those people who would be nominated by the local voluntary bodies. That means that one-third of the total would be drawn from people on the nomination of local voluntary bodies. Taking the whole of the community health council, that leaves a further one-sixth, and we were proposing that these again should be appointed by the Area Health Authority, which knows its locality, after consultation with other local bodies—for example, the churches, and perhaps former members of present hospital management committees. What we have in mind—and I am only covering for the moment the composition of these bodies—is that the Area Health
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Authority should make the appointments, because it is the nearest to the ground that we can get on the health side and because these bodies will be operating directly to the Area Health Authority, but that the composition will be such that the Area Health Authority itself will really have very little say in who the members are because 50 per cent. will be local district members, two-thirds of the remaining 50 per cent. will be voluntary body nominees, that is one-third, and one-sixth will be other local people from various organisations with interests in the Health Service. I thought I ought to put that on record.
LORD GARNSWORTHY: I realise that the noble Lord has a difficult task. This is a long job of work he has in hand. When I rose earlier he asked that I should be patient. I have listened very carefully to what he has had to say and as I understand it—and it is important that we should get the picture clearer—what he has said since my earlier intervention is that 50 per cent. are to be appointed by the Area Health Authority. That a proportion is to be nominated by voluntary bodies is neither here nor there at the moment; they will be appointed from a list of nominees put up by voluntary organisations. That is the only possible meaning to be given to what he has to say. So when he referred to a minimum of 50 per cent. representing local authorities and appointed by them, the word "minimum" has no significance whatsoever because it would appear to me to be a maximum. If I am incorrect I hope the noble Lord will put me right.
LORD ABERDARE: The point I am trying to get over is that the Area Health Authority itself will not be putting on its nominees. It will have 50 per cent. of the names from people put on from the local district. The difficulty is, who else is going to appoint from the voluntary organisations? I do not think it is right that the Secretary of State should make appointments at district level to a community health council. It makes nonsense of it. If your Lordships' Committee can find some other suitable way of finding one-third of community health councils from among the voluntary bodies, I shall be the first to listen to it. We do not look at the Area Health Authorities as quite such an ogre as some noble

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Lords opposite do. We think that they will be perfectly responsible. They will go to the voluntary organisations such as those which the noble Lady, Lady Ruthven of Freeland, represents and others, and say, "There are so many places on our community health council, will you please suggest names for them?" And they will accept those names.
BARONESS SEROTA: May I ask the noble Lord, Lord Aberdare, whether the Government have had consultations with the voluntary organisations on these proposals? It seems to me, and particularly the bodies which the noble Lady, Lady Ruthven of Freeland, has mentioned, that they are quite adult, mature and grown-up. Some would almost say that they are too stable for this kind of activity—and I am sure the noble Lady, Lady Ruthven of Freeland, will understand me when I say that. Have there been consultations? If so, has it been put to the voluntary organisations that they themselves are mature and stable enough to elect their own representatives. I should not have thought it was beyond their ability to come together and elect as from among themselves.
VISCOUNT BRIDGEMAN: I agree very much with what the noble Baroness has said. It occurs to me that there is more machinery available for this purpose than anybody has said so far in this debate. What is the National Council of Social Services for; or the community councils in every county? I know the disadvantage: that they are sponsored by the Department of the Environment. That, of course, would be a very serious disadvantage in the eyes of a civil servant. But having said that (and no doubt my noble friend will come back to that in a moment), while I am on my feet I wonder whether I can say more about what my noble friend has said in reply to the various suggestions. Nobody who has listened to this debate can have failed to notice that there have been three different methods of approach, three different ideas of what should be done to get this right. But, unless I am wrong, there is complete unanimity about what should not be done; that is, that the Area Health Authorities should have the ultimate control of the community councils and should have the servicing of them.
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That is a point which I thought was very clearly made not only by other noble Lords and Ladies, but by my noble friend Lord Amory. That is a point which, so far, my noble friend Lord Aberdare has not met in any way, because my noble friends and I in putting down this group of Amendments felt very strongly that the community councils should be, by constitution, entirely independent of the health councils and that in order to achieve that they should not have the nomination nor should they be responsible for the servicing, because the damage that can be done to the effectiveness of a council by secretaries who send things out too late has to be seen to be believed. If my noble friend could include that aspect, rather more positively than he has done up to now, in the points which he is prepared to listen to and talk about between now and Report, I think that noble Lords who are associated with me in this group of Amendments would be very pleased. But unless we can feel that, I do not think we shall feel satisfied that our point has been mot; and we feel it as strongly as ever.
LORD INGLEWOOD: I do not want to take up much time but I was very pleased when I heard my noble friend say that a large proportion—I believe it was 50 per cent.—of the members were to be nominated by members of local councils. May I follow that up by asking him whether the provision to be made in regulations will say that they "shall be" so appointed or that they "may be" so appointed, because that is important. We are here dealing only with the first stage. Its actual implementation comes when the regulations are laid before Parliament.
My second point, which I think is worth considering between now and Report stage, is that when it comes to overcoming some of the difficulties of finding appropriate members from the hierarchy of the voluntary societies my noble friend should consider the social services committees of the county councils or their successors, who are in fact in touch with all these bodies and have very close contact with the work which we all have in mind. I do not recall having heard him refer to the social services committees of the county councils during the whole course of this debate. As they

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are, as it were, in the middle of the road, their help may very well be valuable to him when he is thinking how he can modify these proposals before Report stage.
LORD HYLTON: May I support my noble friend who has just spoken? During Second Reading debate the noble Lord, with his great experience of the borderland between health and welfare, explored this subject at some length very fruitfully, and I feel it is really most important that the county councils, as the social service and welfare authorities, should be represented on the community health councils.
BARONESS HYLTON-FOSTER: There seems to be some confusion about the voluntary organisations. I would suggest that the people who really know what the voluntary organisations do in the appropriate locality are, first of all, the director of social services, for the community work, and the organisers of volunteers in hospitals. As obviously from district to district—and I mean from district to district—the work of the various voluntary organisations will vary, they are the people who would be most capable, in my view, of recommending to whoever they are to recommend to which voluntary organisations could give the best service on the community councils.
LORD GARNSWORTHY: The noble Viscount, Lord Amory, said that these councils should be seen to have greater independence. I think that what is wanted is that they should be seen to have complete independence of the A.H.A.s and the R.H.A.s That is the point that needs putting across and that the Government needs to grasp. A situation should at no point be seen to exist where the A.H.A.s could be suspected of choosing who served. The councils ought to be independent in the manner in which they are appointed. They ought to be quite independent in regard to finance and the appointment of officers serving them. If community health councils are not going to be so independent then they might as well be forgotten, because the public will have no confidence in them. If the Government would give a little of their time to thinking out how these councils might be appointed, taking into account the views that have been
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expressed here this evening, I think they would be spending their time more wisely and to better purpose than in thinking out why they cannot meet the points of view expressed here to-night.
The pity of it is that those who have put Amendments down on this matter have not had a meeting and consultation before this debate took place, because there is an underlying unity of purpose so far as the movers of the various Amendments are concerned. I should have thought that the Government would appreciate that they are coming up with an answer that is completely unacceptable to this Committee and I believe unacceptable to public opinion—certainly unacceptable to the local authority associations. I should have thought that they would have welcomed the opportunity to call together those who have concerned themselves with these Amendments this evening, so that the way forward might be found to ensure that these community health councils were in fact, and were seen to be, completely independent. If they are not so independent, then the Government are wasting everybody's time in proceeding with their appointment.
LORD GRENFELL: I have had some experience of this subject and I am deeply worried about one situation. I think one can put these community health councils in the category of a hospital management committee without teeth; in other words, they have no monetary teeth; they have to get through everything by the charm of their hearts. They have the right of entry, and the right of entry can be a very dangerous thing. You call it a right of entry, but that immediately labels you as a snooper. We want to avoid that to the best of our ability They must work as a team. If they are nominated by the local authority or by the Secretary of State, they then get further and further away from the hospital, or whatever it is; they are more aloof, and they have to find their way in to the chairman of the Area Authority. Having regard to what my noble friend has said, that 50 per cent, of them will come from the local authorities, would it not be wise for at least the chairman or some of the members to be nominated by the Area Authority, who will know them and who will know the district? I cannot help feeling that the more remote we make these

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people the more difficult their job is going to be. These are not people who can go in and say, "You will do this and do that". They can only come in and say, "Please, we have noticed so-and-so", and the Area Authority under the Bill must take notice of what they say. But please do not let us make them too remote. Otherwise, I fear they will be out on an island of their own and find it very difficult to get in with the team.
LORD HAYTER: I was taken to task at Second Reading for doubts I expressed about the whole of the administration of this new Bill. I think it is true to say that some of those doubts have been expressed by others, particularly in relation to these community health councils. Before we come to a decision, if indeed we can do so at this stage, it is good to ask ourselves what we expect the community health councils to be doing. Some light is shed on this in the White Paper. It is said:
"The council's basic job will be to represent to the A.H.A. the interests of the public…".
One asks how are they going to do that.
"Councils will have the right to visit hospitals…and will have access to the area authority and…its senior officers."
How are they going to do that—a body of 20 or 25 people? Conversely the Area Health Authority is expected to consult the community health councils on plans and variations of plans, new services, the closure of hospitals and the closure of departments. How is an Area Health Authority going to do that in relation to this community health council? There is a delightful phrase: that they are going to meet once a year, all together. I like that. The White Paper goes on to say that this is in addition to the regular less formal meetings between the Area Health Authority and its officers on the one side and the community health councils on the other. How is that going to be organised?
The point I should like to make is that we must devise, in addition to the constitution of the councils, a method of communication between the Hospital Service and the community health council. For my own part I should feel much happier if I knew that one member of the community health council—it may well
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be the chairman—would sit on that Area Health Authority. At least he would be privy to some of their thoughts, and they would know what the community health councils thought about the Area Health Authority's affairs.
My second point is one that has been running right through this debate: that the community health council must not in any circumstances be appointed by the Area Health Authority. I have written down a note, "If anything, rather the other way round". My business instincts prompt me to think that the shareholders should elect the directors rather than the directors elect the shareholders. My last point on the finance side is that, as I understand the Department's views at this moment, there seems to be an impression that, in addition to the finance which naturally has to be provided to these community health councils, the best person to be the staff representative would be somebody from the Department itself or from the National Health Service. This strikes me as being absolute nonsense. Again, when it comes to the question of the offices which these community health councils are to occupy there seems to be a suggestion that these would be in the Area Health Authority's offices. This, too, would be nonsense. For anybody who had a grouse or a grumble to complain to the community health council about some element of the hospital service and then to find that the very telephone number he rings up is that of the Area Health Authority would make him extremely doubtful of what was going on.
My last point—and I imagine that here I shall be on common ground with the Minister—is that I do not think that there should be any direct responsibility at the community health council for complaints. Once such a position got under way in a serious context we should feel that these community health councils were nothing but grousers. I feel that the community health councils are, in effect, a citizens' advice bureau, but to be a good and efficient citizens' advice bureau they must know what is going on in the hospital world. The difficulty at this moment in this Committee stage is that it is very easy to turn to each of the individual thoughts that have been expressed here and say, "Since it is difficult to put into effect what noble Lords

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are trying to achieve, why not leave it as it is in the Bill?" I am sure that that attitude is wrong. There has not so far been one person who has spoken in favour of the Area Health Authorities' making these appointments. We must find another way. We must ensure the independence of the community health councils; and, at any rate to start with, we must leave a flexible situation that can be improved on as time goes by. Personally, I shall not be content until I hear the Minister say that the Area Health Authorities have nothing whatever to do with the election of the members of the community health councils.
8.43 p.m.
LORD ABERDARE: It has been interesting to hear your Lordships' views on these matters. I can certainly undertake to do what the noble Lord, Lord Garnsworthy, seemed to think I had not already undertaken to do; that is to listen to this debate and see what comes out of it. I think I said that at the beginning, and I was rather surprised that he turned such a hostile face towards me and thumped the table.
LORD GARNSWORTHY: I do not want the noble Lord to misunderstand me. I said that it was a pity that we had not had conversations before those Amendments were tabled. I am sure that the noble Lord, Lord Aberdare, is one of the last people towards whom I should want to adopt a hostile attitude, because he is always as conciliatory as he possibly can be and unfailingly courteous. I should have thought that it was clear that I was suggesting that the Government might invite all those interested to come together to find a positive answer to a very difficult problem, and a problem to which the Government themselves do not have a satisfactory solution.
VISCOUNT AMORY: May I say that I was sitting immediately behind my noble friend and I was looking full at the noble Lord, Lord Garnsworthy, and I could not see any hostility in his face at all. It looked to me extremely benign.
LORD ABERDARE: I am very glad to hear that. I am sorry if I imputed the wrong motives to the noble Lord, but he was rather banging the box and I thought that that was an indication of his wrath. I am certainly open to any
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sort of persuasion. Although I have been plugging the Area Health Authority as the appointer, it has been only within the restriction that they would be appointing people nominated by others, so that they would not be able to appoint a majority of people on to the community health council. If there should be another suggestion that we can seriously look at and that makes sense, I am all for considering it.
I do not think it has emerged from this debate as to who is going to make these appointments. I can assure the Committee that we have been in touch with several voluntary bodies but have not yet come up with an answer. The Director of Social Services was mentioned: well, we could think about that. The noble Baroness, Lady Hylton-Foster, mentioned the organisers of volunteers in hospital, but I dare say that it would be thought to be too prejudicial if they were given a say in what people should be put on the community health council. If the local authority were to do it I think there is a danger that they would be dominating this body to too great an extent, just as the other objection is that the Area Health Authority would be dominating, although I do not think that that case has been fully made out. However, I shall certainly think very hard about this matter. We have our own stages to go through, and the Bill has still to go to another place, and I am sure that in the end we shall emerge with a solution that is sensible and that meets your Lordships' wishes.
VISCOUNT AMORY: Could my noble friend say a word about finance?
LORD ABERDARE: I was rather sticking to the composition at the moment. May I say one more word about the composition to my noble friend Lord Inglewood. The question of the appointment by the district council will now form part of the Bill. The constitution will come in a new clause in the Bill, so it will definitely be written into the Bill.
Finance, premises and staff are again matters which we wish to look at. I think we have not got those quite right at the moment. I certainly cannot accept that the Secretary of State should pay the expenses of the community health council. Again we are putting him into a

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difficult position in dealing with local bodies, and we again would have thought on the lines of the Area Health Authority as being the local body best charged with this responsibility. We foresee a fruitful partnership between the community health council and the Area Health Authority.
When we come to the matters of staff and expenses in general, I am not sure that the Bill is flexible enough at present with staffing and premises, which all need consideration in the light of local circumstances in each district. I will undertake to ensure that the regulation-making power is in wide enough terms to enable a variety of arrangements to be made both on staffing and premises according to local wishes and circumstances. If an Amendment is needed to secure this flexibility I will move it at Report stage. So far as accommodation and staff go, I think that it would be a pity to forbid the use of Area Health Authority staff, because that would be very inflexible. The staffing and accommodation of individual councils needs consideration in the light of local circumstances in each district. Again I will undertake to ensure that the regulation-making power is in wide enough terms to enable a variety of arrangements to be made according to local wishes and circumstances. I feel that it is best if we think about what has been said in the course of the debate today, and see whether we can meet some of the points that have been made by your Lordships. Perhaps as we go through the Amendments there may be more detailed points that will arise on them.
BARONESS WHITE: All I can do is to extend my deepest sympathy to the noble Lord, because it is clear to all of us that he is batting on a fairly sticky wicket. He has made one or two promises, that there shall be more specific provision in the Bill and that we shall not leave everything to regulations: but, on the other hand, towards the end of his speech he said that matters should be left flexible so that a variety of arrangements could be made according to local wishes. And by "local wishes", I presume he means the wishes of the community health council.
LORD ABERDARE: Yes.
BARONESS WHITE: I am sorry to have to press the noble Lord on this point, but if we do not get at least some sort of declaration of principle at this stage, we shall be in difficulties when we reach Report stage because, while we are all entirely in sympathy with the view that we are not in a position to reach finality on details—I would not for one moment deny that— I feel that we ought to attempt to go through the intellectual exercise of getting our minds a litttle clearer on what seems to be the best possible way of dealing with at least the major points.
We have been having a little private consultation on our Bench while the debate has been proceeding, because we were considering very carefully the point made by the noble Lord, Lord Aberdare, that, according to his doctrine, the Area Health Authority would not really be doing anything in the way of effective interference, because its choice as to two-thirds of 50 per cent.—if I have his statistics correctly—would be limited to nominations made by voluntary organisations connected with the Health Service, and it would have consultations with other bodies unspecified, except so far as the churches are concerned, about the remainder. If the Area Health Authority is not to be a deciding body and is only to take nominations, that is something one can contemplate with greater equanimity. But surely there will be more nominations than places, and therefore the choice will be made by the Area Health Authority. I find it very difficult to envisage any other situation. Thus, the Area Health Authority will be doing what we are all objecting to, and choosing its own watchdog. It will have a limited pack from which to choose its watchdog, because it will be depending on nominations by various bodies but it will nevertheless be making the effective choice of individual persons. So I am very much afraid that the suggestion put forward by the noble Lord really does not meet the objections which have been voiced from all quarters of the Committee.
We have been trying to transfer this situation, as described by the noble Lord, Lord Aberdare, to Amendment No. 73A

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in the name of the noble Viscount, Lord Amory, and his friends, in which they suggest that a specified local authority (this might be one of the new county councils; obviously, the district councils already have very much say and would need to take a somewhat broader view if they were dealing with voluntary organisation nominations) might have the responsibility of choice. On the principle put forward by the Minister, that the choice would be limited to a selection from the nominations of groups of organisations, would it not be desirable to put this responsibility on to a specified local authority? The noble Lord spoke of the possible domination of the local authority; but the local authority is not the institution that is being criticised. This was the whole gravamen of the criticism of the noble Viscount, Lord Amory, and of the noble Viscount, Lord Bridgeman, that we cannot have people setting up their own jury to try their own cause. But if this responsibility is circumscribed in the way outlined by the Minister, so that they would not have a completely random choice but would be as much or as little confined as the Area Health Authority in the area from which they would choose individual persons, then it seems to me that a democratically elected body, which, after all, is responsible for the welfare of the community in its area, would not be inappropriate for this purpose. Such a body would have just as great a local knowledge as, and possibly somewhat wider than, the Area Health Authority of people who should represent public opinion, which is, after all, the function of the community health council.
In the light of all this, and after consultation with my noble friends, we are prepared to withdraw our Amendment No. 73 in favour of Amendment No. 73A. It was not our original intention to do this, and we have been persuaded by the weight of argument in this debate. We ourselves proposed the Secretary of State partly, as I tried to explain, as a sort of holding operation, because we felt that the voluntary organisations were not fully ready to come forward with the sort of scheme for self-selection which I think they would, on balance, prefer. But there is no reason why they should not work out some self-selection scheme and put forward their nominations
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to the local authority, if they are able to do so. On balance, I think that, of the possible ways of dealing with what is admittedly a difficult matter, Amendment No. 73A is the most satisfactory, because it contains a genuine democratic principle and is also circumscribed, in the way described by the Minister, as to the area of choice that would be open to the local authority.
In those circumstances, if the noble Viscount, Lord Amory, is prepared formally to move his Amendment (which he has not yet done because we have been discussing the earlier Amendment), I shall be happy to beg leave to withdraw our Amendment. But until I have heard from him about what his intentions might be, we must reserve our position.
LADY RUTHVEN OF FREELAND: May I ask a very stupid question? I do not know what is meant by the term "local authorities". I have read everything on this subject, but I cannot find out who they really are. Who are they and where do they come into the National Health Service?
VISCOUNT AMORY: May I refer my noble friend to Amendment No. 91A for the answer to her question?
8.58 p.m.
LORD ABERDARE: I am attracted by what the noble Baroness, Lady White, has just said. It offers possibility of finding another body which might appoint those drawn from voluntary bodies, and it meets the objection that they should not even be appointed mechanically by the Area Health Authority. So I should very much like to think about it. I hope that my noble friend Lord Amory will not press his group of Amendments from No. 73A onwards this evening, because there are various bits and pieces which we ought to think further about. We must think very carefully about which of the various local authorities should be charged with this duty. It seems to me that there might be difficulties with the district, which is already nominating 50 per cent. of the community health council, but we might have found the answer in leaving it to the county authority to deal with the other 50 per cent. of nominations from local voluntary bodies, or in adopting some such way as that. I am extremely grateful to the

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noble Baroness, Lady White, for putting forward that constructive proposal, and to my noble friend Lord Amory. I hope, however, that he will not press his Amendment, because I shall look very sympathetically at the position in the light of what has been said.
VISCOUNT AMORY: My noble friend has been very patient with us, and he has had to play a very lone hand indeed. I think that not one single speech which has been made has come out other than strongly against the Area Health Authority having anything to do with this matter at all. I think my noble friend will feel it is probably significant that not only my noble friends and I but the noble Baroness, Lady White, and her noble friends think, on consideration, that there may well be weight in the method which has been suggested here.
BARONESS WHITE: May I interrupt the noble Viscount for one moment—and I must apologise to the Committee; I should have made this clear. It is the definition of a local authority which is contained in Amendment No. 91A with which we are concerned—at that level. That is what we are really working towards. The districts put up their own people, but the others should be selected by the authorities mentioned in No. 91A, which are the non-metropolitan counties, the metropolitan districts, the London boroughs, the Common Council and so on. It is that group of authorities.
VISCOUNT AMORY: I accept that that is the noble Baroness's point. I am quite sure that my noble friend will not fail to point out to his right honourable friend the views which have been expressed, if only the negative one we have expressed, which is that the Area Health Authority really must keep its fingers out of this matter altogether and have nothing to do with it. I am sure my noble friend will look at this broadly to meet the view which has been expressed by everybody who has spoken in this Committee; and while I do not want to introduce any element of threat at this stage, (though really, I suppose, that is what I do want to do) I would leave my noble friend in no doubt that if he is unable to find a way of taking the Area Health Authorities out, then those of us who have been
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responsible for these Amendments would have to set up a kind of ad hoc, temporary consultative council together, with a view to producing an absolutely terrifying Amendment, so formidable that it will unquestionably receive the approbation of the Committee or, if it is at the Report stage, of the House. But if, as I think is the case, my noble friend is going to set out to try to find some way of meeting our main point in this matter, then I should be willing not to move at this stage the Amendments which stand in my name and those of my noble friends.
BARONESS WHITE: We are in a great difficulty, because we are very much worried at having to wait until Report stage before getting any declaration of opinion as to something on which I think the vast majority of us are agreed. Naturally we take in absolute good faith what the Minister has said to us, but I must confess that we should be much happier if the noble Viscount, Lord Amory, would move his Amendment. After all, if something better turns up we can drop his Amendment on Report and adopt the better proposition. We can have our consultative council, by all means; we should be most happy to join the noble Viscount. But it seems to us rather a pity to leave this Committee stage without having any firm declaration of the view of your Lordships. I wonder whether the noble Viscount would reconsider this matter, on the full understanding that if, on further consideration, the Government come up with anything which appears to both of us preferable, he would then not object if this particular Amendment, if we adopted it now, were then eliminated in favour of the something better. Could the noble Viscount not consider that?
VISCOUNT AMORY: The course of action which the noble Baroness proposes is very tempting, but I feel in this case that my noble friend has gone as far as he probably can go this evening in giving us the assurances we want, and that he has taken on board our views. I believe he will come forward with the answer, but if that does not happen then I think the course is clear before us. But I personally should like to give him the chance now to produce the answer which he thinks would meet the views which

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have been put forcibly in so many parts of the Committee.
BARONESS WHITE: May we perhaps have a further assurance from the Minister? I know it may not be easy for him to give this, but we are in a difficulty. We shall have a reasonable time—and I am not in any way complaining—between Committee and Report, but if an Amendment by the Government is not put down until nearly the end of that period it gives us little chance to consult either with other Members of your Lordships' House or with organisations outside with whom we are in contact. We have put pretty clearly to the Government a possible way out here. We have thought about it carefully, and we have been persuaded, in a way rather against our earlier thoughts, that in all the circumstances this is probably the best thing. I am wondering whether the Minister could assure us—it obviously cannot be any kind of binding agreement, but a gentleman's agreement—that he will make this an urgent priority in his own Departmental consultations and with his Ministerial colleagues, so that we have fair play on this one, which is really a very important thing. We should like to have a reasonable period before we actually reach the Report stage, which I understand is likely to be on February 12 or so, so that we shall not be, not by evil intent but just by effluxion of time, caught short on an Amendment of such importance.
VISCOUNT AMORY: I should like strongly to support what the noble Baroness has said there. I am sure my noble friend will not run this up too tight, but will enable us to take what action we think fit if it becomes clear that my noble friend has failed in what I am sure he will try to do, which is to produce something which is acceptable. If that does not happen, it is quite clear we shall want time to consider what action we take.
LORD ABERDARE: Of course I will do my best with what urgency I can. But these are very difficult subjects, and certainly none of the Amendments on the Order Paper is perfect. Therefore I have gone as far as I can in saying that I will look at it, and I hope that your Lordships will accept that. I really will go and look
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at it. I do not think I can do very much more.
BARONESS WHITE: In all the circumstances, I think the only course open to us is to ask leave to withdraw Amendment No. 73, but I hope that from the exchange which has taken place all the occupants of the Government Front Bench appreciate that this subject is something of real seriousness, and that we must have a genuine alternative put before us in reasonable time. With that understanding, to which we have witnesses all round, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
9.8 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 81:
Page 10, line 14, leave out from ("includes") to ("parts") in line 15.
The noble Baroness said: Without prejudice to what may happen later, I think that on Amendments Nos. 81 and 82 we ought to draw attention to a point which, though perhaps not of major importance, occurred to us in studying the Government proposals. As we understand the Bill as drafted, if it were left without these Amendments it would be possible for a community health council to cover not only the area of one area authority but part of another area authority. What I want to ask for clarification upon is whether this is what the Government really mean: because if these community health councils are to be the grass roots organisations surely it should not be possible under the terms of the Bill for a community health council to cover the area of the Area Health Authority plus some extra territory. This is our reading of it—though we may be mistaken. But if it is so, I am sure the Minister will appreciate that this would not he our conception of a community health council if it covered such a large territory. I wonder whether the Minister may care to comment on this.
LORD ABERDARE: I had some doubts as to what the noble Baroness had in mind; but the position is as she says. The idea is to make provision where there is an overlap situation between two Area Health Authorities. It could happen in certain cases that an Area Health Authority was made up of one health district only, with one district

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general hospital. May I say that it does not even have to have a district area hospital? I am thinking of Solihull, an area of Birmingham, which does not have a district general hospital and depends on another district general hospital for its health provision. Therefore there will possibly be an overlap arrangement which links the district general hospital in Birmingham with the area of Solihull. In that case, if there is to be a community health council which matched that district it would cover not only Solihull but part of Birmingham as well. In other words, where you get a health district which is, as we have defined it, coterminous with a health district, it may overlap two A.H.As, and in certain cases may include the area of one A.H.A.
LORD INGLEWOOD: I should like to support my noble friend. It is a good provision that there should be some recognition of this overlap. It may be that people living in one area are more likely to go to hospital in the next area than in their own. In those cases it is important that the community health council of the area where they go to hospital should include representatives of the area from which they are drawn, provided that the number likely to come from this area is significant. There is one area in the north of England where that happens; and I am told (though I have not checked it) that there is an area either in or near Somerset where that could happen in a big way.
Taking the matter further, I imagine that as the Bill is drawn if there is an overlap between England and Wales there would be no difficulty in appointing a member from one side of the Border to sit on a community health council which lies on the other side of the Border. But the England/Wales Border is not the only line; there is another between England and Scotland. Scotland is not mentioned very frequently in this Bill. Germs might find it no more difficult to cross the Border between England and Scotland than to do so between England and Wales. I hope that, before leaving this clause, my noble friend will tell us how he proposes to deal with this particular problem as regards the overlap in an area between England and Scotland.
LORD ABERDARE: I think my noble friend is anticipating his Amendment No. 93A; but if I may, I would rather leave this until we reach his Amendment. As I think was made clear when the Scottish Act was passing, there are good liaison arrangements which crossed the EnglishFrench—I mean the English-Scottish boundary, and these will certainly continue.
BARONESS WHITE: That was a nice "Freudian slip". We have not got that far yet—thank goodness! These Amendments were really probing Amendments. The point we wanted to make was that in one's anxiety to fit these councils to suitable district hospital responsibilities one should not make the areas so large that they lose the real "grass roots" character. I do not want to press the Amendment. We felt that it was a point which ought to be made. In the circumstances I beg leave to withdraw Amendment No. 81 and I do not propose to move Amendment No. 82.
Amendment, by leave, withdrawn.
9.15 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 85:
Page 10, line 28, after regulations") insert ("separately for England and Wales").
The noble Baroness said: Here we come to a point where I hope that, for once, the Minister may be ready and prepared to meet us. We are asking here that if so much of the provisions in this Bill are to be dealt with ultimately by regulation—I think that this will still apply even if, as the Minister has indicated, we do have something rather more specific in this clause—we should have a possibility of separate regulations for the Principality. After all, the administration of the Health Service in Wales is separate. The Secretary of State for Wales is responsible for its administration in Wales. The people concerned are answerable to him for administration and not to the Secretary of State in London. And there are certain different conditions not the least of which is that we have no regional tier in Wales. The Secretary of State for Wales and the Welsh Office under him will have a far greater part to play, relatively, in Wales in the administration of the Health Service than the Department of Health and Social Security will have in

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the direct administration of the English system. Therefore regulations which might seem appropriate in the English context may not be entirely satisfactory in the Welsh context. In addition to that, in the other place there are only 36 Welsh Members out of a total of more than 600, and as we know very well regulations cannot be amended; they can be accepted or rejected.
In those circumstances, we do not think it would meet the very natural democratic desires of the Welsh people that if there is something that concerns them particularly it should be so completely decided by a majority of people who are not concerned with the affairs of the Principality. I hope I need say no more to convince the Committee that this concession in the Bill would be much appreciated in Wales. I cannot see that it could cause any serious difficulties for the Government, in the light of the fact that the administration of the Health Service in the two countries is different in certain important respects and is carried on separately. So I hope very much that this Amendment will be accepted.
LORD ABERDARE: Under Clause 55(4) any power to make regulations or orders or schemes may be exercised so as to make the same provision for all cases, or different provisions for different cases or different classes of cases. I am advised that there is no doubt that the provisions of Clause 55(4) would permit regulations under Clause 9(4), which we are now considering, which made separate provisions, in whole or in part, for community health councils in England and Wales. So I think that the point the noble Baroness is making is already met under the present provisions in the Bill. But, of course, community health councils are intended to serve the same purposes in England and Wales, and in most, if not all, respects the provisions for them should be the same in the two countries. There might be differences if they were to take account of different circumstances, and any particular differences could usually be dealt with satisfactorily in a joint instrument for England and Wales. I suggest that it would be somewhat cumbersome to be obliged always to make altogether separate regulations. Nevertheless the power is there.
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The noble Baroness made some very interesting suggestions about community councils in Wales during the Second Reading of the Bill. At the moment we have not found any way through this aspect. There are 1,000 community councils in Wales and we have not found a way satisfactorily to associate them with membership of the community health councils. But in a case like that, were there to be a separate provision for Wales, one could have separate regulations.
9.20 p.m.
BARONESS WHITE: I am aware that it is possible under the Bill, but what we are suggesting is that in this particular area, which is a sensitive area from the point of view of public opinion and public representation, a gesture might be made to Wales. The Minister is well aware that there were considerable complaints that Wales did not have a separate Bill. That, I agree, certainly in your Lordships' House, would have been a cumbersome procedure, and we have not made a great point of it. But there has been considerable feeling about this. Circumstances in Wales, as the Minister has recognised, are not in every respect the same as they are in England. I should have thought that it was well worth while making a gesture in this particular area. We are not asking for regulations throughout the Bill to be subject to this procedure. This Amendment deals only with community health councils and, as we have already decided to-night, this is a particular area of the Bill in which public feelings are engaged.
I am not now an elected Member in the Principality, as I was for many years, but I know enough of public opinion in the Principality to realise that the Government would do themselves nothing but good (I offer them some free advice on this) if they showed in this respect, which I do not think would be cumbersome, that they were taking account of the fact that the Secretary of State for Wales does have particular responsibility for the Health Service in Wales. I should have thought that they might give way on this.
Again, I do not like putting everything off to the Report stage, and it seems to me that this is something that might easily be accepted without great difficulty. If it were to apply to the entire

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Bill, then I should have some sympathy with the noble Lord's point of view, because there could be circumstances in which it might be cumbersome all the time to have separate regulations. That I think would be against common sense. But where you are dealing with community health councils and with the expression of opinion of the people, and with nothing else—because they do not have executive functions of any kind—then I do not see what harm would be done; and, as I say, it would be a welcome gesture in the Principality if the Minister could agree that under this clause we should have an opportunity of discussing our own regulations. I think this would be a sound thing to do and, as I have said, it would do the Government no harm politically.
LORD ABERDARE: If I thought there was anything very important in this I would certainly look at it again, but there are so many regulations that are made jointly for England and Wales on matters which concern them both that to make an exception in this case, where one is dealing with regulations that might be entirely similar, seems rather an empty gesture. I would rather make more handsome gestures where they are important.
BARONESS WHITE: I would not reject any handsome gesture that comes this way. The Committee may wish to negative this Amendment, but I am not prepared to withdraw it, because I know what the feeling is and what the response will be in the Principality. On this I must stick to my guns.
On Question, Amendment negatived.
9.25 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 86:
Page 10, line 29, after second ("the") insert ("election by local government elections for the related district or the").
The noble Baroness said: I really had hoped for a concession on the last Amendment. I should very much like to suppose that there might be one on this, but I recognise that the Minister has made it fairly clear that the Government are not prepared, at this moment of time at any rate, to come out in favour of direct election. Nevertheless
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I very much hope they will look carefully at this Amendment, because it is permissive only. If it were mandatory it would be in line with Government policy to resist it, but it is very carefully drawn in such a way as to make it possible at some future stage to have direct elections for the community health councils. If a Government at that stage did not approve of this provision then they would not have to exercise their permissive power. But we all know that a measure of this nature is apt to remain substantially unaltered for many years. It is very difficult to get amending legislation of this kind, except by regulation—and this would not be a suitable matter for regulation without some authority in the main Bill. Therefore what we are really asking is: let us not tie our successors. Even if the present Government do not see eye to eye with us on the desirability of some proportion of the community health council members being directly elected, let us not make it impossible for future Parliaments or Administrations to provide for direct election if they think fit, without going through the full process of amending legislation.
We hear a great deal of talk about public participation in one way or another. I believe that direct election is the most satisfactory form of public participation for many purposes. I think it is very salutary if members have to report back and to answer to the people whose interests they are representing. If they are not directly elected it is very easy to coast along and perhaps carry their responsibilities a little lightly. I have always found it a very healthy experience to have to go back to my constituency and explain what I have been doing, or not doing, as the case may be. Similarly, I still believe there is a great deal to be said for having some members of the council—not necessarily all of them—in a situation where it is their duty to explain to the public what they are trying to do to improve the Health Service, what the genuine difficulties may be in the way of such improvements and how they have been dealing with any complaints from the public as to the way in which the Service was being conducted.
In addition to that, of course, the great advantage of election is that the person

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concerned becomes known as someone to whom people may go with problems. One of the difficulties one has had sometimes with various consultative bodies—for example, those concerning the nationalised industries—is that people simply do not know whom to approach. If they go to the local post office or the local council office and ask, they can usually find out; but the relationship with an elected councillor is quite different because the councillor elect has to circularise his or her constituents and say. "I am putting myself forward for election: these are my qualifications and my aims." Therefore he or she becomes known in the locality. I believe that we should be taking a very serious step if we did not make it possible under this Bill for such a process to take place.
If the present Government do not feel this is desirable, that is for them to decide. But do not let us tie posterity. That is what this Amendment is really about. The last big National Health Service Bill that we had was many years ago, and it will probably be many years before we have another one. A subject of this kind is not one which Governments normally bring forward as amending legislation on a minor scale, so one might have to wait many years, if it were not made possible in this Bill, if and when the time came that it seemed desirable to be able to carry these things out. I repeat, there is nothing to force the present Government to adopt this policy if they do not want to do so; but it would make it possible for future Governments or Parliaments, if they wished, to make regulations which could embody this principle. Though I fully understand that the noble Lord, the Minister, does not agree with this, and that his colleagues do not agree with it as a matter for action now, I am pleading with him to leave the field open for our successors in case they came to the conclusion that this was a sensible wav of dealing with matters. I should have thought that on that basis this Amendment might well be accepted.
LORD ABERDARE: The noble Baroness said, I think, that we should be taking a very serious step if we did not make it possible for our successors to have recourse to direct election to the community health councils. I take the view that we should be taking a very
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serious step if we did, because there are two points of some importance. The first is that direct popular elections are limited at present in the United Kingdom to Members of Parliament and local government representatives. The proposal represents an important departure from this rule and would require very careful consideration of its possible constitutional implications. It might mean the introduction of Party politics into a field which most of us would agree should not be connected with Party politics.
Secondly, a matter of this kind, affecting local government election machinery, is not suitable to be dealt with by regulations under a Health Service Act. It is for these two principal reasons that I cannot advise your Lordships to accept this Amendment which was so persuasively moved by the noble Baroness. It would require very careful study before an innovation of this sort was introduced, and we should have to consult with a great many interested organisations. I am not sure about the merits of the scheme. It has certain attractions in the way mentioned by the noble Baroness, of enabling people to find their local representative and making sure that everybody knows who he is. But just how much enthusiasm there would be locally for these elections in view of the fact that local elections are sometimes not well patronised, I am not sure. I could not advise the Committee to accept the Amendment on the principal grounds that it has considerable implications which it would be wrong to accept lightly.
BARONESS SEROTA: I am not surprised, in some ways, that the Government should react rather cautiously to this Amendment. I must confess that when the noble Baroness discussed this matter with me when she was considering putting the Amendment down I, too, found this a very novel idea. Nevertheless, it is very difficult for the Government to plead that it would be an innovation and that at the moment the only direct elections that we have are for local government and Parliament. The Government have created a totally new kind of authority or council in the form of the community health council to represent public opinion to the National Health Service. This has prompted the thoughts that my noble friend has put forward and which I myself now, after fairly

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long consideration, have found to be not quite so revolutionary as they might sound at first consideration. I should like the Government to think about this matter. It is clear, from what the noble Lord. Lord Aberdare, said, that they have brushed it aside and are not prepared themselves to accept what might be a possible consequence of their own actions. By taking the representative function out of the administration of the Health Service and isolating it in the community health council they themselves have made it necessary to think of ways of creating truly independent councils which every member of this Committee finds essential to the workings of the new system. This is not quite such a "way out" idea as it might have seemed at first glance, and it is something to which serious consideration should be given for the future, in the permissive sense in which my noble friend put it forward and not necessarily for implementation to-day.
VISCOUNT AMORY: I think, as my noble friend has said, that the proposal has some attractions in itself, and the noble Baroness in her vigil way has put it forward with great moderation. But I find myself persuaded by what my noble friend has said. At this particular moment, at any rate, when local government is being reformed and it is all important that the electorate should be clear about the elections they are being asked to take part in—it is of great importance for parish councils, district councils, county councils, et cetera—it would be a serious mistake to introduce this innovation. It would take people's eye off the ball a little and encourage people who are inclined already to say: "I get so confused about all these elections. I don't really know who I'm voting for, or why." I do not think the case is strong enough for putting such a proposal in the Bill, as it were, to be kept in stock against some future use. So personally I find myself persuaded by the reasons my noble friend has advanced against the acceptance of this Amendment.
BARONESS WHITE: My democratic spirit does not allow me to withdraw this Amendment because I feel passionately, having been an elected member, that there are certain essential values in it. I
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still think this is an area to which those values should be extended. So I am not going to ask your Lordships for leave to withdraw my Amendment, because I believe in it.
On Question, Amendment negatived.
9.39 p.m.
LORD GARNSWORTHY LORD GARNSWORTHY moved Amendment No. 87:
Page 10, line 32, at end insert ("such regulations shall make provision for the appointment to the Council of representatives of the Education Service, including teachers").
The noble Lord said: We have been discussing matters of considerable importance. The Amendment has some bearing on them, but I should not want to exaggerate its importance as compared with the larger issues with which we have been concerned. Nevertheless, we have on a number of occasions during the Committee stage of this Bill recognised the importance of the school health service. The noble Viscount, Lord Amory, himself said earlier to-day something to the effect that we must get that right; and a number of other noble Lords have indicated agreement with that view. The position of teachers in regard to the Health Service may very properly be limited in terms of statutory function. I had hoped at an earlier stage in the proceedings that the Committee might have agreed to define that function, to show its limitation, but the Government were not minded to accept that. There can be few who would question that community health councils would be the more representative and the better equipped to perform their function if there were on them representatives of the education service, including teachers; and because of the vital role of the School Medical Service I think there is indeed a strong reason for asking for special representation here.
The teachers, members of the education service, become aware very quickly when there is a breakdown or a failure at home. They acquire tremendous knowledge of local situations for they are indeed the recipients of many confidences and complaints, if only by way of reading the occasional diaries kept by pupils in the primary schools. I am told by friends in the teaching profession that it is quite amazing how much information teachers glean from these entries. As I

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have said before, teachers give service far beyond the limits of their professional obligations.
I hope the Committee will agree that their experience and their knowledge qualify teachers to bring understanding and a sense of public duty to this particular field. I have tabled the Amendment in the knowledge that its acceptance would be appreciated by those most concerned. I am not a teacher and I have no obligation to teachers, except that as a layman I have been concerned with education for a great many years; but I have considerable contact with them and with some of their professional organisations and I can say that it would be very much appreciated by those who speak for teachers if the Government were minded to accept this Amendment—or at least, if they do not like the wording of the Amendment, to accept it in principle and to bring forward something that would meet the situation. I should like to feel that if the Government were difficult about it the Committee might say that they really ought to do this. I take the view that if the Amendment were carried it would also encourage close co-operation (and we cannot have too much of that) between the services of education and health—if I may put it this way—at "grass roots" level, and if co-operation is going to be worthwhile, if it is going to be really fruitful, we ought to get this "grass roots" level of co-operation in this particular field of the Service.
I hope that the noble Lord, Lord Aberdare, will appreciate that I am trying to be constructive and that I am putting the Amendment forward in the friendliest way, with no degree of hostility whatsoever. I trust that in the circumstances he will have no difficulty in accepting it, at least in spirit. I beg to move.
9.45 p.m.
LORD ABERDARE: The noble Lord will know well the importance that we attach to the School Health Service and the efforts that we have been making, in conjunction with the local authority bodies, to ensure that we have the best method of co-operation in future. The noble Lord's Amendment would require the community health councils to include representatives of the education service, including teachers, and it seems to me that as the councils are intended to
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represent the public as consumers of the Health Service, it would not be right to add to them specifically representatives of any other interests.
I fear that if one were to give this right to teachers in this matter, there might well be other people who would feel that they, too, had something to give to the community health council. Certainly there is no reason why members of the public who are teachers should not become members of this body. I would have thought that they could well be among those to be nominated one way or another, but I do not think they should be there as representatives of the education service. If they are worried on the School Health Service side, there are plenty of other channels open to them for bringing their complaints to the notice of the Health Service; direct from the teacher to the doctor, from the local education authority to the Area Health Authority or through the joint consultative committees which there will be for that purpose.
So far as the community health council itself is concerned, I believe that we should stick to the proposals which I am hoping to bring forward on Report and which will be limited to the district council representatives and to people from local voluntary bodies and other organisations. However, if in our future consideration of who should be nominating the other 50 per cent. it were the county council dealing with this matter, maybe they would wish to include a teacher among those nominations; but I should not like to see it written into the Bill that teachers must be members.
LORD GARNSWORTHY: I am grateful to the Minister for those comments and I will not take up too much of your Lordships' time at this hour. It is somewhat difficult at the moment to appreciate what the Government will come up with on Report. The Amendment was of course tabled against the background of the Bill as drafted. If the proposals of the Government on Report—I took the Minister to give a definite indication that we shall be getting Amendments covering the points that have been made—seem to meet the situation reasonably well, I am sure that everybody concerned will be content. It would, however, be foolish to overlook the fact that many local education authorities are concerned

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at what is happening in that the School Health Service is being transferred or taken from them. I am sure that they will give as much co-operation as they can possibly give in this instance.
It would go some way to meet the position if at this level there were provision ensuring a link making it clear that teachers will be able to play a valuable part. Perhaps the proposals of the Government on Report will completely meet this point; I hope they will. I stress that teachers are in a somewhat peculiar position as members of the community. I would not for a moment suggest that they should be there to represent teachers. I am suggesting that they have good service to give in that they have an understanding of what is happening in the community. They become more quickly aware of it than do many others and it would be a good thing to take advantage of this ability. I will not press the Amendment at this stage. Remembering that it is a matter to which we may have to refer on Report, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
THE DEPUTY CHAIRMAN OF COMMITTEES (VISCOUNT HOOD): Amendment No. 88.
LADY RUTHVEN OF FREELAND: The noble Lord, Lord Amulree, and I do not propose to move this Amendment or Amendment No. 90, because my noble friend the Minister spoke on these points earlier in the debate and said that they would be considered when we came to the full consideration of how the community councils are to be set up.
9.50 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 89:
Page 10, line 34, leave out from ("Councils") to end of line 36.
The noble Baroness said: Again, in view of our earlier discussions, I do not propose to press this Amendment, but perhaps I might take advantage of this occasion to say just a word or two about the question of staff, because one is disturbed at the thought of the Government which is being communicated in this House, and also to certain organisations outside the House, that the most satisfactory staff to service the community
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health councils would be persons from within the Health Service. I do ask the Minister to think again about this, because it goes back to the philosophy of the independence of the community health councils.
A number of noble Lords pointed out on Second Reading that if someone had to depend for his career prospects and his future promotion on his superiors within the Health Service, he was not at all likely to be over-critical of any defects or maladministrations falling within the interest of the community health councils. That is one of the reasons why I was interested in some of the local authority proposals. With the reorganisation of local government, for example, there may well be persons who know their localities extremely well, who could be effective officers servicing community health councils and who, incidentally, if they have been in one of the local authorities which at the moment provide an element of health service, probably know a great deal about it.
Therefore, without pressing the Amendment itself, I wish to stress the point that many of us are extremely apprehensive of what we take to be the Government's attitude on this matter: that the community health councils should be staffed from within the Health Service. We believe that they ought to be free to appoint their own staff but that there should be suitable arrangements—because of the limited opportunities offered by the community health councils from the point of view of career prospects and advancement—as there could easily be, for interchange with either Health Service or the local authority services, with a preservation of pension rights and so on. But the councils should be free to choose their own staff, and there should be adequate budgetary provision so that they can have at least one—probably not more than one—really experienced and sufficiently senior person on their staff as their main official in order to make their work effective.
VISCOUNT AMORY: I am sure that there is force in what the noble Baroness has just said. My noble friend has said that he will look into all these matters and I am sure that he will look at this one among them. I take comfort from

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the fact that he said just now that he did not feel that the Government have got the present proposals in respect of staff quite right.
LORD ABERDARE: I accept that. What we must find is some flexible arrangement. There may well be places where, as the noble Baroness said, there is a perfectly acceptable person who is not part of the National Health Service but is able to take on the work of being secretary of the community health council. In another area, however, as she says, it may be difficult to find somebody because there is no career structure there; and in that case it may be better to second somebody from within the Health Service. I must say it has not been my experience that people seconded from one organisation to another have been any less keen in the way in which they perform their job. I do not think this problem would necessarily arise. However, I have said that I should like to look at it, and I think perhaps all of us feel that what we really want is a flexible system which allows the community health council to have the sort of services it is seeking.
BARONESS WHITE: In view of the Minister's remarks, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
9.56 p.m.
BARONESS LLEWELYN-DAVIES OF HASTOE BARONESS LLEWELYN-DAVIES OF HASTOE moved Amendment No. 90A:
Page 11, line 8, at end insert ("in particular, arrangements for advice to be made available to patients in the health service to enable them effectively to suggest improvements in or to pursue complaints regarding the operation of the service and for the council itself to pursue the suggestion or complaint if it thinks fit.")
The noble Baroness said: I beg to move the Amendment standing in my name and the names of my noble friends. Although the hour is getting late, I think it is rather important that I explain to the Committee what we mean by this Amendment. We have had a very remarkable debate, and there can be no doubt at all that the feeling of the Committee is that the community health councils should be a really positive part of the National Health Service. There is no doubt that in all parts of the House there is this belief that it is vital that they should play a positive part. What we have asked for is that arrangements should be made for
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advice to be available to patients in the National Health Service who would like to suggest improvements. I should like the noble Lord, Lord Hayter, especially to notice that we have put "suggest improvements" first, because we feel that this is just as important as complaints. Many people are too inexperienced and lacking in detailed knowledge to be able to suggest improvements themselves without advice. We believe that a lot of valuable suggestions for the Health Service—and I do not mean simply the hospitals but the whole Health Service—might well be lost without some form of expert advice. Although the noble Lord, Lord Hayter, did not care for the idea about complaints, in fact where complaints are concerned it is probably even more important, because it is often those people who most need help in this direction who find it most difficult to formulate for themselves just what the particular difficulty has been and are therefore unable to suggest things which will help patients who come after them.
What we want to ensure by this Amendment is that the responsibility for dealing with individual suggestions and complaints lies fully within the community health councils. The noble Lord, Lord Hayter, referred to citizens' advice bureaux. Noble Lords in all parts of the House know that there has been a tremendous multiplication of local authority advice services. Indeed, the right honourable gentleman—whose exact title I have forgotten; I think it is the Minister for Consumer Services—Sir Geoffrey Howe, has himself referred to this and to the necessity for some kind of rationalisation. If our Amendment is accepted, there should be people who would be capable of having a proper liaison with citizens' advice bureaux and organisations of that kind. Indeed, if necessary, they should have some form of training, perhaps even some minor form of honorarium, so that they would be available to maintain a two-way flow of information and assistance between those advice services which exist already and the new and quite vital ones which will need to be established when the community health councils come about.
It is always very difficult to discuss community health services without in some way getting into the sphere of the Ombudsman. I have heard it said that

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this kind of thing might conflict with his functions. We believe that this particular Amendment would in fact assist the Commissioner, because it would in a way divert from him to the community health councils matters which individuals could not always handle by themselves; and with the expert help of the community health councils a better result might well be achieved.
What we want to establish by this Amendment, and what we hope that the Government will accept, is the principle that if an individual made a suggestion which the councils thought had great substance, they might themselves have the right to pursue the idea, or the complaint, in a general sense with the expert advice that they would have at their disposal. We not only think this important in principle, but we think it important for a different reason: we must, and indeed do, believe that the Government really want these community health councils to succeed; but they will only succeed if they are composed of really first-class people. You are not going to have people coming on to these councils, sitting once a year, as the noble Lord said, unless they have adequate, vital and important jobs to do. It is no use thinking that someone who has served on an active hospital management board, or a board of governors, is going to look at this kind of work unless there is some substance in it. I am sure that the Government would like to have that, and we feel that this Amendment, which is not very complicated, will go a long way towards achieving what the Government themselves are after.
10.2 p.m.
LORD ABERDARE: If I may say so, I very much welcome the constructive view of the functions of the community health councils which the noble Baroness has expressed. She made one point just now when she said that the community health councils should be ready to take up ideas that might be mentioned by individual patients, or indeed complaints of a general nature that also emerge from their contact with patients; and we fully accept this. This is one of the functions that the community health councils will have. However, these are all matters that will be covered within the regulation-
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making powers provided in Clause 9(4)(g), which are quite wide enough to cover arrangements of the kind that she envisages. We propose to issue guidance in due course in the form of a sort of check list of the matters to which councils should pay particular attention. I think that this is the sort of matter which that sort of guidance should certainly cover. In fact, in the White Paper we specifically proposed that community health councils should, on request, provide information about complaints procedures to patients in hospital, and that members should act as a patient's friend where one is needed.
Of course, it is an important function of community health councils to seek ways of making the Service run more smoothly and efficiently, and they will certainly be able to take into account suggestions made to them by patients, and follow up general complaints with the health authorities. We feel that the community health councils themselves should be allowed to decide in the light of local circumstances exactly how they carry out the general duty imposed on them in the Bill, and we do not feel that we should write this particular Amendment into the Bill, although I will certainly take it into account when we come to the guidance to be issued to the community health councils.
We are talking here primarily of hospital patients; the situation is rather different for users of the Health Service in the community, who have access to various sources of information and help. The Davies Committee on Hospital Complaints Procedure is expected to report later this year and will make recommendations about the handling of hospital patients' suggestions and complaints; and this report may well carry implications for the role of community health councils. That is another reason why it would not be desirable at this stage to write into the Bill too rigid a provision which could possibly conflict with that Committee's views when they are made known. I think it would be wiser to wait and see what the Committee say, and then see what should be done to ensure that what they recommend fits in with the role of the community health council The Bill does not have to be amended to achieve the noble Baroness's objectives. As the clause stands, it already

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provides powers for regulations to be made covering the points referred to in the Amendment. I hope, therefore, that she will agree to withdraw this Amendment, on the understanding that her approach to the matter is fully shared by the Government.
BARONESS WHITE: Before my noble friend speaks again, may I ask the Minister for clarification? In paragraph 110 of the English Blue-White Paper, there is a reference to a "patient's friend", but for some peculiar reason there is no such reference in the Welsh Red-White Paper, and this has caused some comment. It is probably inadvertent, but it is a little odd that the English community health councils are expected to provide patients' friends where required in pursuit of difficulties or complaints, whereas the Welsh, apparently, are to get on without one. I wonder whether the noble Lord can comment on that.
LORD ABERDARE: I am afraid that the noble Baroness has caught me out on that point. I know that the Welsh are very competent and hardly need the assistance of a friend, but may I please be given a little time? I will certainly let the noble Baroness know the answer.
BARONESS LLEWELYN-DAVIES OF HASTOE: Between the Red Queen and the White Queen, I feel rather inadequate. The noble Lord is, as always, very disarming and I should like to thank him for the way in which he has looked at—I cannot say accepted—our Amendment. But it is precisely because we did not think that paragraph (g) gave the powers which we wanted community health councils to have—and I took the very best legal advice from behind me—that we put down this Amendment. We all know that if you have two lawyers you have four opinions, so we could not be too sure about that. But if the noble Lord feels that we are so right in spirit, he might have gone a little further and accepted the Amendment. We are disquieted that he should say that he would not wish to have an obligation on all community health councils because some of them would not wish to exercise the powers. It is precisely for that reason that we wish to have this written into the Bill. As the noble Lord has accepted the principle that it is the function of the community health councils themselves
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to pursue these matters, we think it is essential that they should know from the Government themselves that this is so. So I should like to plead with the noble Lord. I cannot see any reason why he should not accept our Amendment, since he accepts the spirit of it. If we have to wait any longer for Davis, we shall never get this Bill through. Can we beg the noble Lord just this once to give in?
LORD ABERDARE: I am sorry, but I have made my position as clear as I can. I can give the noble Baroness the assurance that what she wants can be covered in the regulations. Whatever her legal advice is, my legal advice is the opposite and I hope she will accept that.
BARONESS LLEWELYN-DAVIES OF HASTOE: As my legal advice seems to be sitting silently, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
10.9 p.m.
BARONESS WHITE BARONESS WHITE moved Amendment No. 91:
Page 11, line 17, after ("Authorities;") insert ("districts in relation to a Council shall be coterminous with one or more districts in a non-metropolitan county, or ward or ward; in a metropolitan district or London Borough;").
The noble Baroness said: I recognize that this is a difficult point, because the Government's plan under this Bill is that there should be Health Service districts centred as far as possible upon district general hospitals; in other words, to meet solely the needs of the Health Service. However, in dealing with the community health councils we are not dealing simply with the Health Service but, as I said on an earlier Amendment, with an expression of public opinion, and with the connections between the Health Service and the other community services, where there is, as we all recognise, a considerable overlap of interest.
Had the Health Service been organised under elected authorities, the situation would have been different; but it is not, and therefore one is particularly concerned with other local authority functions on the social welfare side—the housing side, education and so on, which have all been touched upon in the course of our discussions. It was for these reasons that it seemed to us that for this function,

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that of the community health councils as opposed to the administrative function within the Health Service itself, we would be well advised, for this purpose only, to adopt the districts or the wards, as the case might be, which are the pattern for local government functions. We think it would be a very much tidier way of doing things in this particular field, and of course might also fit in better with the propositions, which have been put into cold storage for the time being, of the noble Viscount, Lord Amory, and his noble friends.
I realise that this is not an easy matter. I took counsel with the local authority associations, and I think that they themselves are in a rather indeterminate state about it. The Area Authorities, as we know, are coterminous with local authorities: it is only at the district level that one gets into this difficult situation. I still believe that it will be more satisfactory for this purpose to be able to fit in the work of the community health council with that of the local government organisation. As the noble Lord, Lord Aberdare, mentioned, in Wales, for instance, we shall be having, among other things, the community health councils, and so on, which will be within the context of our reformed local government. The English pattern may not be quite the same, but I think that some of the same reasons for this Amendment might apply there.
I am not proposing at this late hour and at this stage of the Bill to press this Amendment, but I would ask noble Lords who are interested, and particularly those who are concerned with the local authority associations' point of view on all this, to give it perhaps a little further thought to see whether we are not right in our instinct; namely, that for this purpose the local government boundaries are more appropriate than boundaries which are legitimate for the administrative functions of the Health Service itself but are not necessarily, in our view, the best for the functions which we understand are ascribed to the community health councils. I beg to move.
10.14 p.m.
LORD ABERDARE: Of course it would be ideal if the two districts, the health district and the local authority district, were to coincide. Unfortunately,
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they do not, and we have to face this problem. We certainly long ago looked very carefully at what the noble Baroness is now putting forward as a possibility, when we were thinking first about the constitution of community health councils; but we came to the very definite conclusion that it would be wrong, and that the community health councils would be much more effectively organised on the boundaries of the health districts. After all, the health district is the lowest unit of the Health Service which is capable of providing most of the health services, including the hospital service; and the important thing is that at that level the health services should be integrated, both community and hospital services. Therefore, to have a community health council at that level is very important because they will be able to watch over from the community point of view and see that there is proper provision in all types of health provision, both hospital and community. This sort of one-for-one relationship between community health council and the district management team will be of immense importance; because, as the noble Baroness, Lady Llewellyn Davies, was saying when talking about ideas from patients, the community health council should be responsive to ideas from the patient and should then talk about them with the authority. The authority in that first instance will be the district management team and then they could report back to the area. The first point of contact would be the district management team and the one-to-one relationship is right.
While the solution that the noble Baroness put forward would avoid having community health council boundaries cutting across local government districts, it would often result in several community health councils relating to one health district. This would bring grave difficulties. There are instances where you might have five or six local government districts relating to one health district. I do not think this would be a satisfactory way of operating if all had access to the hospital—five or six different community health councils. I think there would be grave difficulties. Of the two choices, we believe there would be difficulties in the way of the suggestion by the noble Baroness and that there are positive advantages in relating community health councils to

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health districts. I hope I have persuaded the noble Baroness, and I think my noble friend Lord Amory agrees with me on this occasion.
VISCOUNT AMORY: I think that on balance I agree. But the local government bodies had, to start with, the hope that it might be possible to work out a scheme where the boundaries would be coterminous with local government districts. At first sight that had attraction. We became conscious of the difficulties of doing it, and I think that our deliberations finished pretty well in agreement with the views that my noble friend has just expressed. We will give the matter further thought to see if there is any reason why the point of view of the noble Baroness may not be the right one. But, rather regretfully, we feel that at present the difficulties would be too great.
BARONESS WHITE: As I said at the outset, this is not an Amendment that I proposed to press. The converse of what the noble Lord has said can occasionally be true. I am thinking of the local authority of Powis, in which I shall be residing. The difficulty is that there is there no hospital in sight, so to speak, and therefore that local authority will have to deal with the whole ring of surrounding health authorities—which will also be very confusing. In view of what the noble Viscount, Lord Amory, has said, as well as what the noble Lord, Lord Aberdare, has said, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
Clause 9 agreed to.
LORD ABERDARE: I beg to move the House do now resume.
Moved, That the House do now resume.—(Lord Aberdare.)
On Question, Motion agreed to, and House resumed accordingly.

ASHDOWN FOREST BILL [H.L.]
CITY OF LONDON (VARIOUS POWERS) BILL [H.L.]
DERBY FRIAR GATE CHAPEL BILL [H.L.]
FORWARD TRUST BILL [H.L.]
HARWICH HARBOUR BILL [H.L.]
KING'S LYNN CORPORATION BILL [H.L.]
MEDWAY PORTS AUTHORITY BILL [H.L.]
MERCANTILE CREDIT BILL [H.L.]
METALS SOCIETY BILL [H.L.]
QUEEN MARY COLLEGE BILL [H.L.]
RHONDDA CORPORATION BILL [H.L.]
SALFORD CORPORATION BILL [H.L.]
SLOUGH ESTATES (UTILITY SERVICES) LIMITED BILL [H.L.]
UPPER MERSEY NAVIGATION BILL [H.L.]
Presented, and read 1ª.