HL Deb 28 June 1974 vol 352 cc1741-63

12.7 p.m.

LADY RUTHVEN OF FREELANDrose to ask Her Majesty's Government what progress has been made in setting up community health councils throughout the country; and how names of members are selected. The noble Lady said: My Lords, I am asking Her Majesty's Government the Question about the delay in forming community councils, and the selection or election of members to these councils, because this is a very important subject, and one which worries a very large number of people. It is important, first, perhaps. to the consumer (in other words, the patients); secondly, to the many people who have served on regional boards, hospital management committees or house committees of hospitals; and, thirdly, to the members of the voluntary organisations who have given so much of their time and effort to help the hospitals, the staff and the patients. There has been a great delay in the appointment of these community councils. Very often I have been told. and have also read in the newspapers, that the delay is caused by the Department of Health and Social Service not sending early enough clear instructions on how these community councils are to be set up.

With this, I must profoundly disagree. I have seen and read a document called, 1973 Number 2217 National Health Service England and Wales (Community Health Councils). The instructions contained in this document are, I think, very clear. I have also seen all the documents sent out by one regional authority to their areas and districts; a report of the first meeting of one of their community councils; the names of those individuals, and who and what they represent, and of all the community councils in that region. I have been sent copies of the Department's instructions on the appointment of secretaries, allowances for travelling and subsistence allowances; and also the Secretary of State's statement on the appointment of National Health staff as members of community councils. I feel certain that all regions have received the same letters from the Department, but many regions have not taken immediate action.

I feel certain, myself, that the delay in forming the community councils has been caused by the many other appointments to areas and districts that regions have had to deal with; and also, perhaps, by the fact that they knew so little about the community councils that they put it on one side until they had completed what they thought were more important tasks, whereas in the eyes of many of us community councils would have been the first priority. I know one region which, up until about a week ago, had done nothing even to call a meeting of the people who would like to serve on a community council. Some other regions have just a few community councils going in some of their districts, but by no means all. The Council of Social Services has offered help in many places to assist the regions. As a result in one region that I know they have formed community councils, but, unfortunately, most of the regions have not accepted the offer from the Council of Social Services.

In one region I discovered that a community council had been formed in what I can only call a curiously infantile way. They received applications from well over a hundred people—all from highly respectable voluntary organisations —who volunteered and put forward their names for consideration. This region was so distressed or worried or fussed by the number, and did not know what to do about them that they divided the names into ten packets, one for each district in the region, and drew out the names just like that. It may be a good idea, but it is not exactly what we thought would happen. I make no accusation of neglect against the Department which set out explicit instructions, but against the regions which were too overpowered by the reorganisation and also, in many cases, had no knowledge of the importance of community councils to so many people, particularly to patients.

So in answer to the first part of my Question, I should like to know from the Government, or from the Minister who is to reply, how many community health councils are functioning in England and Wales at this time. I understand that Wales is far ahead of England; they have a community council for each one of their districts. I believe that we have 206 districts in England, but I know that they have not by any means formed as many as 206 community councils. My second question is: how are the members of community councils elected or chosen? I have given one had example and I fear that there are many other regions which do not take much trouble. In 1973 the new Health Act was being discussed in this House. The noble Baroness, Lady White, and I, together with many noble Lords, wanted the councils to be strong, to have teeth and to be carefully selected. I managed later, with the help of many noble Lords from all parts of the House, to get the setting up of the councils transferred from the areas to the regions. I think I suggested the Secretary of State to start with, but the regions were equally good. They would also provide the accommodation, secretarial assistance and finance when needed.

We all felt that an impossible position would arise if community councils were set up and looked after by the very people in areas on whom they were going to report. and I think many noble Lords, were glad when my noble friend Lord Aberdare, who was at the time Minister of State, was able to persuade the then Secretary of State, Sir Keith Joseph, to make the alteration in the Act. I must confess that I am worried by the way the choice of members is made. It varies from region to region. I remember that in our debate in this House in 1973 the question of the members of community councils was raised, and I must confess that I had the temerity to suggest that one-third should be appointed by the local authorities, one-third should be from voluntary organisations, and one-third should be chosen or appointed by the regions. I was defeated in my efforts, and it was left with one-half appointed by local authorities, ten by voluntary organisations and five by the regions.

I repeat what I said so long ago, that there are too many members from local authorities on these councils. I know of one district where two members appointed by local authorities were very elderly aldermen, though I must admit that that was balanced by having two quite young people; but I still think that there are too many of them. I have found in my travels around the country that many appointees of local authorities know little or nothing about hospitals—I emphasise "hospitals", because that is what community councils are to deal with; hospitals and patients in hospitals—compared with the original regional boards, the hospital management committees, the house committees and many of the voluntary organisations, such as the Red Cross, St. John's, the W.R.V.S., the League of Hospital Friends and many others.

I declare my interest in the League of Hospital Friends. We started 25 years ago with 24 groups; we now have nearly 1,000. Though we are supposed to be only money-raisers, and we raise about £1½ million a year, at least 800,000 of our members actually work in hospitals. I feel very strongly that they should be better represented, because it has taken quite a lot of work to get their names on the community councils. I think we have too many appointees from local authorities, and too few of those people who have served on the various bodies which run the hospital service and the voluntary organisations.

My Lords, I have spoken for too long. I did not mean to go on for so long. I am so glad that we have a new Member of our House who is herself a regional chairman, because she will be able to tell us much more than I can. I speak only from observation, from reading newspapers and from talking to various people throughout the country. I have worked for 25 years in the Health Service and I still care deeply for the hospital side of our Service. I hope that Her Majesty's Government will give me reassurances about the methods of the present situation. I know that the Secretary of State regards community councils as a very important part of our new Service, and I hope that the Government will be able to reassure me and my noble friends that setting up elections of members of community council; will be given a priority which, alas, is not the position throughout the country.

12.18 p.m.


My Lords, I rise with great trepidation to make my maiden speech en the Question raised by the noble Lady, Lady Ruthven of Freeland on community health councils, their selection and role within the reorganised National Health Service. Before I proceed I must, however, declare my interest, which has already been mentioned. I am chairman of the South-West Thames Regional Health Authority, and in that capacity the remarks I am about to make are framed basically on my own personal experience within my own region. They do not necessarily represent the views of my fellow chairmen in other regions, nor of the members of my authority.

I should like to begin much further back. Before we consider the role of membership of community health councils in the reorganised Health Service I think it is important to consider what the goals of that Service are. They were admirably expressed the other day in a pamphlet issued by the Office of Health Economics. Without a doubt the fathers of the National Health Service, men such as Beveridge and Bevin, saw it as an instrument for promoting social change and a means of breaking down inequalities within our society. In this I think the Service has largely achieved their aim. However, the most obvious goal of the Service is to deliver adequate health care to the population of this country and the demand for its services has always over the years exceeded the resources available to it.

The current reorganisation of the National Health Service is not a revision of these goals but it changes the means by which we hope to achieve them. I do not believe any longer that the fundamental principles underlying reorganisation—the unification of the three arms of the Service—are disagreed with by anybody, even although we may disagree on whether we should have a two- or a three-tier system. So I think we must consider the present reorganisation as a stage in the development of the Service in this country. The demands on the Service will continue to change as new health problems appear, and a changed social environment will make further demands on the Service we have.

In any process of development one must very carefully consider and try to retain what was good in the old system. In my view, one of the sad things is the reduction by about two-thirds of the "lay" interest in the Health Service through the abandonment of hospital management committees, Boards of Governors and local authority health committees. It can be argued that the old authorities had a dual role to perform—they were both administrators and representatives of the general public—and that the new concept of the unified Service has a more clear-cut managerial responsibility. The introduction, therefore, of community health councils into the unified Service to represent the views of the community and the users of that Service, is one of the most important aspects of the reorganisation and is warmly welcomed I believe by the whole of society.

Here I should like to make a plea for refraining from using the word "consumer" or comparing the community health councils with the consumer councils of the nationalised industries. Most importantly, users of the National Health Service are not consumers. To be a consumer, to me at least, means exercising some kind of choice: for instance, as to whether I heat my house by electricity or by gas (and I suppose to-day, I would choose gas). I do not choose to break my leg, I do not choose to have a mental breakdown, so as to be able to consume the service provided. I am therefore either a patient or a recipient of the service provided. I believe we should refrain from using the word "consumer".

As has already been mentioned, the constitution of the community health councils has been carefully spelled out in the Statutory Instruments and, as your Lordships will know, it provides for half the membership to be nominated by the local authorities, one-third by the voluntary organisations, and the rest to be direct appointments by the Regional Health Authority. In a 20-member community health council, that would allow the Regional Health Authority the appointment of three members. The appointment of members by the voluntary organisations is governed by strict regulations on consultation and, in my own particular region, has been greatly helped by the services of the Council of Social Service. One can imagine the problems of selection within any one district in which there may be 150 voluntary organisations. The problem for them is to decide between themselves who should represent that interest in the community health council. The Council of Social Service has been immensely helpful in getting the organisations together. The number of voluntary organisations in any one district which attended the regional selection meetings has been as high as 60 within my own region.

The few members retained for appointments by the Regional Health Authority are in order to ensure a reasonable balance of interest when the number of members from the other two bodies have already been selected and nominated. The appointment of local authority members has been left to the discretion of each local authority. The only advice given, so far as I am aware, in the Statutory Instrument, is that local authorities may appoint either councillors or those who are not councillors. This has resulted in widely varying methods of appointment. Some councils have made their appointments through the leader on a Party political basis; others have made their appointments on a proportional all-Party basis; and yet others in their right to appoint non-councillors have used the criteria of interest in the National Health Service regardless of political affiliations. Of the three methods used, I very much regret the appearance of appointments on a one-Party political basis. The community health councils, one would hope, should not become a forum for Party politics, but should emerge as an informed body of opinion capable of scrutinising the performance of the new authorities, and acting as a liaison between the authorities and the general public. A tremendous responsibility rests on their shoulders for the success of the re-organisation.

However, in order to exercise their responsibility, they need money, they need to be adequately serviced and financed. That is one of the responsibilities of the Regional Health Authority. But that responsibility has been placed on us with no special allocation from the Department for these expenses. It is a conservative estimate that the minimum cost of servicing a community health council will be between £15,000 and £20,000 a year, which in my own region will amount to £210,000 a year. For the country as a whole it is estimated that the cost will be somewhere in the region of £4 million. And that is only a beginning. That is only to give them the basis to start. Your Lordships may think, as I do, that this is money well spent if it helps to improve the efficiency of the Service. However, it is important r, look at this sum, in the context of the economic situation of the country and having regard to the cuts in public expenditure now being imposed. If this was the only additional demand on the revenue of the new Authorities it would be bad enough. But the highly inflationary times through which the country is passing have created large financial shortfalls in the Health Service budget. It is estimated that the revenue allocations for 1974 and 1975 for each region show a shortfall of between £3½ million and £4 million per region, which, over the country as a whole, at a conservative estimate, is well over £50 million a year.

It is necessary to make sure that it is realised that the shortfall is on the money necessary to maintain the Service as of April 1, 1974. It includes no monies for new development and no money for the implementation of political decisions already taken, such as free family planning or hearing-aid provisions. In my own region the shortfall is £4 million, made up of a 15 per cent. shortfall in the money transferred from the local authority for the maintenance of the former local authority services, plus an additional sum of £1.8 million for the increased price of oil. These figures take no account of possible increases in the remuneration of Health Service personnel, because those sums are especially funded.

At this point I should like to return to the additional £4 million needed for the community health councils. You may call it the straw that broke the camel's back. If no more money can be found to make up for the shortfall a reduction in the service provided is inevitable. If the shortfall is made up by additional monies being allocated, the present Service can be maintained, but no developments can take place. It may be necessary, therefore, to ask the community health councils to function on a shoestring for their first year unless specific allocations are made for this purpose. I feel this would be a tragedy because the first year of the functioning of the community health councils will he by far the most important year. This is the year when they begin to work out the role they are to play within the Service, and this is when they really need more secretarial help than perhaps they will need in the future. I think that it would be a tragedy, and I should like to make a plea to the Government for a special allocation of £4 million initially for the servicing of the community health councils.

I have spent some time discussing the financial situation of the Health Service, as I see it within my own region. I have no doubt that this need for greater financial resources could be voiced and repeated by those concerned in the other major social services as well. Because the resources arc limited, the Government arc confronted with the obligation to establish priorities, and surely the medical and welfare needs of the sick and the aged take precedence in any allocation of the nation's resources.

12.32 p.m.


My Lords, it falls to me, in speaking immediately after the noble Baroness, Lady Robson, to have the very great pleasure of congratulating her upon her maiden speech. She speaks from great authority as the Chairman of the South-West Thames Regional Health Authority, and in this respect your Lordships' House is specially fortunate in having her here to participate to-day in the debate on this Unstarred Question. It is particularly appropriate that the noble Baroness should have spoken from the Benches she occupies because, as your Lordships will remember with great affection and deep respect, it was from those Benches that the late Lord Beveridge also spoke—and it is to him, as its architect and founder, that the Health Service owes the deepest debt of gratitude.

The House is indeed grateful to the noble Lady, Lady Ruthven of Freeland, for bringing forward this Question today since it is the last opportunity for doing so before July 1, and it is a date of special significance in the programming of events. Your Lordships will be aware that community health councils should have been established by April 1, 1974, with a deadline of April 30. It is therefore with dismay that one recognises that not all local authorities have played their full part and not all regional health authorities have been able to carry out their functions in appointing these boards. We look forward to hearing from the noble Lord, Lord Wells-Pestell, the precise numbers of those who have been able to do so.

There is another ground for gratitude to the noble Lady, Lady Ruthven, for having brought this matter before your Lordships to-day; that is, she has persuaded not only the noble Baroness, Lady Robson, to take part but also the noble Lord, Lord Aldenham, who will deliver his maiden speech. We look forward with pleasure and anticipation to his remarks.

I recognise what the noble Lady, Lady Ruthven, said, and I would echo her words that regional authorities have placed this problem on one side. However, I think we should recognise straight away that 1974 has been a specially difficult year. Nevertheless, we should chide those regional health authorities which have been unable to take any action whatsoever. Many of your Lordships will have served in the past on bodies of a kindred nature, as I have, and will know that the approach of local authorities is one which, by its nature, is different from voluntary organisations when they put forward nominations. Here I should declare an interest as a member of the Council of the British Red Cross Society.

I entirely agree with the noble Baroness when she says that no accusation of neglect should be placed against the Department of Health and Social Security. During my very brief period of office I was attached to that Department, and I am specially proud to recollect that it was during this period that Circular HRC/74/4 was produced. In my view, the Department can take pride in this circular, because it makes particularly clear the duties of the Regional Health Authorities; and whereas the language of the Statutory Instrument 973/227, which was referred to by the noble Baroness, Lady Robson, is arcane, to say the least, and only the initiates of Statutory Instrument language will be able at first sight to interpret the precise role, the Departmental circular is a model of what has to be done. Therefore I do not feel that Regional Health Authorities can claim that there is a lack of clarity in instruction on what their duties should be. Indeed, it has been taken to the ultimate degree in Appendix 2, which sets out a summary of the action required on the initial establishment of community health councils. In Appendix 3 can be found the numerical balance to which the noble Lady, Lady Ruthven, took exception. I can quite understand and share her objection. though I do not necessarily go the whole way with the noble Lady. In Appendix 5 there are clearly set out the matters to which the community health councils, when set up, might wish to direct their attention.

I was most interested to hear that it is within the knowledge of the noble Lady, Lady Ruthven, that the Welsh authorities have given priority to this appointment, and it is of special interest because the noble Baroness, Lady White, who took such a prominent part in our discussions last year, mentioned the extreme difficulties facing regional authorities. The noble Baroness mentioned her own area—a county which stretches from West Shrewsbury to the sea—and of course in these large local authorities there has been great difficulty both in communication and also in the reaching of a degree of satisfaction between the bodies concerned. Therefore I think we ought to give the Welsh Regional Authority a very strong pat on the back—


My Lords, I wonder whether the noble Lord would be good enough to give way? My understanding is that no community health councils have been established in Wales as yet. If I am wrong, I hope somebody will put me right. There is provision for 22, but as it is not a Health Authority it becomes the duty of the Secretary of State for Wales. My information is that so far no community health councils have in fact been started.


My Lords, I am very much obliged to the noble Lord for intervening, because naturally this was something not precisely within my own knowledge. I shall leave the matter there. Finally, I should like to draw to your Lordships' attention the financial situation of those appointed by voluntary bodies and those who serve on local authorities. I do not think it is invidious to mention this at the present moment, because your Lordships will be aware that there are two very different categories of members of community health councils. In the first place, the local authority nominees enjoy a special privilege because in addition to enjoying a mileage allowance and a subsistence allowance they also have an attendance allowance which is not enjoyed by the voluntary membership. Therefore the two classes of members who sit together require the services of an especially astute chairman in balancing and drawing together the forces on that Committee in a degree of harmony which I am sure everybody would wish the community health councils to enjoy.

It is the wish of this side of the House that the community health councils should flourish and form an integral part of the Health Service in the future. We look forward to hearing from the noble Lord, Lord Wells-Pestell, what progress has been made in this respect.

12.40 p.m.


My Lords, first, I should like to add my congratulations to the noble Baroness who has spoken to us for the first time to-day. My one regret is that it was not a day when the attendance of your Lordships was commensurate with the importance of her speech. Those who have worked in the Health Service and have a great wish not only to keep it going but for it to go on improving, must realise that we have in the noble Baroness, Lady Robson, a new and powerful ally.

I must also congratulate the noble Lady, Lady Ruthven of Freeland, in having put down this Question to-day. I agree with just about everything she said including her remarks about the composition of the community councils, but it is too late to go into that matter again. I look upon them as an extraordinarily important part of the Service. One could almost say without exaggeration that they might eventually be the most important part in the reorganisation of the Health Service, because so much of it is concerned with improving, as the authors hope, the administration of the Service. It has been much criticised for hardly ever referring to the patient the whole way through. When I have voiced doubts of this kind to people who are more knowledgeable than I am on the actual administrative side of the Health Service, I have been given first of all a number of vague generalisations, and then, "But, of course, the community health councils are what we must rely on to make sure that the needs of patients in the various districts and areas of our country are being met."

I welcomed the setting up of these councils when I read and, to some extent, studied, the reorganisation Act because as well as serving as a doctor in the hospital service I was for many years on the board of governors of a large teaching hospital. I realised that it was labouring under the difficulty of trying to perform two rather different functions; that is, having a much too large membership composed of people of different kinds with totally different interests. In a large community that can be an advantage; there is exchange of knowledge, interest and so on. Of course there were some professional members, like myself, who represented the medical services; there were others who were clearly able administrators—and I noticed the noble Lady's grasp of the financial side of the Health Service—and there were others who represented purely local interests and were solely concerned whether the maternity hospital in some small town was going to be enlarged, and what was going to be done about this and that, and so on.

All these are tremendously important things, but I felt that they lost some potential in being gathered together in one hospital board. I welcomed the setting up of these community councils because I thought that here would be a group of people whose primary interest was in the patients; who would look at the Area Health Authorities and Regional Health Authorities to see what they were doing and criticise them; and, above all, make new suggestions to them where they saw a need to do so. If they work properly, I hope that they will come to find new ways and good ways of finding out what the needs really are. I am very interested in the problem and I hope we shall get a satisfactory reply to the Question from the noble Lord who is to reply.

12.47 p.m.


My Lords, I rise with considerable trepidation to make my maiden speech after 40 years of silence from my family. On seeing Lady Ruthven's Question on the Order Paper I thought I should break my rule. I should like to declare an interest: I am a member of the North-East Thames Regional Health Authority. We attach the greatest importance to the community health councils. "National" health is an unfortunate name because it is really "community" health. It is for the health of the community and not just running an expensive service. That is what it is all about. We have formed our community health councils and six of them have already held their first meetings; there are ten still to do so. We plan to do that by July 15. I do not say that is a record, but we are trying to go ahead as fast as possible.

To illustrate the importance that the region attaches to the community, one or two members of the authority attend the opening meetings of the councils. I have been to North Camden, and I am going to the Harlow meeting next week. The North Camden meeting almost restored my faith in human nature. Many people, some middle-aged, but a great many young, accepted appointments to the community health councils, and were all keen to set up sub-committees to deal with difficult regions or special problems. A lady chairman emerged of great competence, charm and ability. I am full of hope that will be a pattern for the whole region.

We must not think that the National Health Service is to do only with hospitals. I feel that as soon as a patient gets out of hospital and back to the community the better, and the idea of medical centres, which are being set up as fast as possible, is excellent. This is particularly so when one realises that we have a shortfall of beds and a decaying stock of hospitals. The noble Baroness, Lady Robson, mentioned a shortfall of money. I think it is deplorable, and should like to add to her plea for some more money, not only for the councils but also to restore the cuts made by the last Government. We have an ageing stock of 104 hospitals in our region. We are building one new one out of 100-plus. That is deplorable. The average age of the hospitals is older than when the National Health Service began.

The importance of the community councils is enormous. They will have to deal with complaints, but it is important that they should not become complaints centres. They have much more positive things to do. They have to deal with community problems, planning new services and changes in the services. Most important, they will have to deal with closures of hospitals that are at the end of their useful lives. The Department attaches so much importance to the community decision that they have said that when a decision is taken by the relevant community council the Department will not intervene. But there are far more local things we have to deal with: the ratios of doctors to patients of dentists to patients; catering in the hospitals, facilities for children, facilities for mothers to stay in hospital with young children, and again the waiting time for people who need operations or treatment.

There is one other point I should like to make. We have been thrown a small bomb called "democracy in the National Health Service", and the only thing this Government seem to do is to increase the number of people on each of these councils. We have standardised on 24–12 councillors. 8 from the voluntary bodies, and 4 appointed by the regions. We feel that this is as good a mix as we arc likely to get, and to increase the number of councillors, which is what the document seems to suggest, is not entirely relevant. I have never yet heard of a councillor being elected by his fellows because he is expert in the Health Service. Although he may be an excellent man himself, he is not necessarily able to help very much in the community health per se. I would finish, my Lords, by reiterating my plea, that we cannot maintain the Service, even in its present rather shaky state, without more money.

12.52 p.m.


My Lords, it is my great privilege to thank my noble friend Lord Aldenham for his maiden speech here to-day. The two maiden speeches we have heard have given us much encouragement. We have heard from two people who really know what they are dealing with in the Health Service, which is so very dear to the hearts of many of us. I congratulate my noble friend and the noble Baroness—who I still look upon as my boss, although I am no longer chairman of a hospital management committee in her region. I congratulate her most heartily on her speech.

I now turn to these community health councils. I am not happy about half of the vacancies going to local authorities, although I know it is a fait accompli. The reason why I am not happy is that councillors come and councillors go, and continuity is very badly needed. Although the work involved is to a great degree outside hospitals, its main object is to look after the hospitals, to suggest what can be done, and to visit them. So membership continuity is needed in these community health councils. Unfortunately, my hospital management committee, to the best of my knowledge, has not one member either for the Area or in the community health councils. This is not the fault of the noble Baroness; it is the fault of the system, by which so few of those who have given honourable service for so many years can be found places within the Service to-day. This is an important point.

The second point I would make is that, now that we have this fait accompli, with the local authorities having half of the membership of the community health councils. I hope that my small voice will reach them in asking that they will consider carefully who is put on these councils. I hope they will put on the councils those who know and care about hospitals— not just this or that person who wants a job or to whom they want to give another job. I am not in any way deprecating the local councils, and I am sure that this will be done. But it is so vitally important, as I know as one who has worked for many years in hospital management committees and visited the hospitals under my command. Those in the hospitals—the nurses, the doctors and everyone else concerned—want so desperately to know the people who are to look after them in the future. It is not only a question of right; it is a question of morale as well, especially in these difficult times. I hope this point will be remembered.

May I reiterate what was said by the noble Baroness about the importance of not starving these community councils of money. Nothing done to-day can be done without money. These community councils will desperately need staff to help them do of their best. They are vitally important and I hope that what the noble Baroness has said will be carefully considered. Especially in the first year they will have to feed themselves into the hospitals, to become known and understood. My Lords, may I say again what a privilege it has been to hear the two maiden speeches which have been made to-day. They have given me great hope and I thank the maiden speakers.

12.57 p.m.


My Lords, I want if I can to resist the temptation to go down every avenue which has been provided in this debate to-day. In her Question, the noble Lady, Lady Ruthven of Freeland, draws attention to two things, and it is those two things I want really to deal with: the progress which has been made in setting up community health councils throughout the country, and how the members are selected. I hope the noble Lady feels that this debate has been worth while. When this matter was set down to be dealt with on a Friday morning I know she had some doubts as to whether there would be an adequate House to take note of what was said. But the fact that the House may be small in number is not an indication of the value of a particular debate.

In this debate we have been fortunate to have taking part a number of people of great experience. In fact, everyone who has participated brings to this discussion a deep understanding of the problems with which we are faced as a community and of what we are trying to do in the field of the National Health Service. The noble Lady, Lady Ruthven, the noble Baroness, Lady Robson, Lord Grenfell, Lord Aldenham, and I, myself, even if not now, have been for long periods members of boards of governors of hopsitals. The noble Lord. Lord Sandys, has been a member of the Department of Health and Social Security, and has perhaps a deeper knowledge than many other people of what really goes on. The noble Lord, Lord Platt, brings to the subject a lifetime of experience in the Hospital Service.

Having said that, I wonder whether I may add sincerely (because sometimes in your Lordships' House we use words which are a matter of form and are meaningless) to the noble Baroness, Lady Robson, how indebted the House must be to her for the quality of her contribution. The House always likes to hear from people who know. The same applies to the noble Lord, Lord Aldenham, who brings a great deal of personal knowledge and personal experience. I know that we are grateful to them, as my noble friend Lady Ruthven also must feel, for choosing this particular debate in which to make their maiden speeches. As your Lordships know, the new Regional Health Authorities in England have the duty of establishing community health councils in each administrative health district. We have to face the fact that this is a complex task, involving extensive consultations with local authorities, local voluntary associations and a variety of other bodies in the district.

The noble Baroness, Lady Robson, and certain noble Lords who have spoken, have drawn attention to the number of people whom the local authority can appoint. I understand that community health councils are advised, generally speaking, to have not less than 18 and, where possible, not more than 30. On the face of it, this would appear to give a disproportionate number of people to the local authorities. However, I want to stress that the local authorities are not bound to appoint local councillors. They can draw on the experience in the community outside the local authority. It is perfectly true that a large number of local authorities will appoint people as a reward for public service. That was the practice over a period of many years in the appointment of lay magistrates.

There was a time when lay magistrates in this country came from one section of the community, and it took time to alter this. It may well be that this kind of thing will happen in the early years of a community health council, but I do not think that we need feel despondent. When one is setting up something, obviously one tries to do it as quickly as possible, using the people one knows, and one has to face the fact that after a few months or a year many of them are not competent to do what was expected of them. However, it finds its own level eventually, and I am not particularly worried by the fact that there may be a preponderance of local councillors on these committees. The problem will solve itself ultimately.

At this stage I want to turn to the question of finance. This is a point which the noble Baroness, Lady Robson, made with some force and, if I may say so, with some justification. But the cost of establishing community health councils is, as she rightly said, part of the cost of reorganising the Service and Regional Health Authorities are expected to bear this out of their development monies. At the moment we cannot do anything about it. Because I am in at team meetings on matters of this kind, I know that my right honourable friend the Secretary of State personally feels concerned about what the Regional Health Authorities are asked to do. However, we are faced, as every other Government Department is faced, with the problem of trying to lay our hands on enough money to do the kind of job we want to see done. The noble Baroness is concerned about this, but for the immediate future the position will have to remain as it is at the moment. They will have to judge the priority to be given to the community health councils in relation to the many competing claims on their resources. Any special allocation for community health councils would have to come out of the total allocation to the Regional Health Authorities for running the Service. I wish that I could hold out some hope that we shall be doing something about it in the near future, but it would be quite wrong of me to do so.

The noble Lord, Lord Sandys, said something about attendance allowances. I may have misunderstood him, but local authority members of community health councils do not get an attendance allowance from local authorities for attending meetings of community health councils.


My Lords, forgive my intervention but would this not be true if those said members were councillors?


My Lords, I understand not, but perhaps the noble Lord will allow me to look at this point. If I am not accurate in my information, I will write to him on it. Bearing in mind the time scale for the exercise—and it has been a comparatively short one—the considerable administrative burden falling upon regional authorities and the additional factor of local government reorganisation, it is a considerable achievement on the part of all concerned that so much has been achieved in so short a time. We have to take these two factors—the reorganisation of local government, and the time that they have had to do this—into account. When one thinks that there are, or will be ultimately, something like 207 community health councils, and that 117 of them either have had their first meeting or have appointed all their members it is something of an achievement in a comparatively short space of time. I understand that appointments to the remaining 90 councils are not yet complete, but we have information that good progress is being made and the picture will change considerably in the next few weeks.

May I congratulate the noble Lord, Lord Aldenham, who is a member of the North-East Thames Region, because they have pretty well completed their full number of community health councils? However, it is fair to say that out of the 14 districts only about four are seriously and sadly lagging behind. I should like to take this opportunity of paying tribute to the noble Lady, Lady Ruthven of Freeland, because she was among those Members of this House who played an important part in persuading the previous Government to make extensive changes to their original proposals for community health councils, so as to make them more representative of the community.

It is no secret in your Lordships' House that we on this side were also unhappy about a number of aspects of the National Health Service reorganisation, and many of your Lordships will know that my right honourable friend the Secretary of State has made it possible in recent weeks for certain people, who would normally not be eligible for membership of community health councils, now to become members of those councils. While one is in the process of setting up these councils one must bear in mind that there will be certain difficulties which will take a little time to overcome. But, as I have said, 10 of the 14 regions either have completed or are near completion of their membership of community health councils. If any publicity is to be given to this debate, it is important that the public should know that non-councillors can be appointed by their local authority and we hope that this will happen.

I should like to say a word about the selection of voluntary organisations which, as your Lordships know, are to appoint one-third of the members of each council, the appointments being finally made by the regional health authority after consultation with the appropriate local authorities. The Department's guidance circular which has been referred to by two noble Lords, which was issued by the previous Administration, explained that it was intended that organisations which influence policies should be included, as well as those mainly concerned with providing a service to the National Health Service. Under the regulations, the regional authority must advertise in the local Press, inviting voluntary organisations to apply. I have no information at all as to how many regional authorities have advertised, inviting voluntary organisations to apply. But I think it should be known that the various local Councils of Social Service have done a really magnificent job in this field by getting together all the local voluntary organisations in each area, so that they may be informed of what is expected of them, and as a result of this a good deal of progress has been made. Once the list of organisations has been determined, it is for the regional authority to invite those organisations to agree among themselves how the places to be filled by them should be allocated.

We must also face the fact that in almost every area there is a vast army of local voluntary organisations. I was staggered to learn not so long ago, that in some of the new town areas there are upwards of 120 local voluntary organisations functioning. This has been part of the scene in this country, and when there is a limited number of people to be selected it is extremely difficult to decide which of the organisations shall be appointed. I think that the local authorities, the voluntary organisations and the regional health authorities have grasped this point and have made tremendous progress in recent weeks. There are, of course, a great many contenders for the limited number of places available. If the voluntary organisations are unable to agree within a reasonable period—and I say this specially for the noble Lady. Lady Ruthven of Freeland—it is for the regional authority to select the organisations which, individually or jointly, are to appoint members. I understand that in most regions there has been no difficulty at all; hence the progress that has been made.

The appointments of the remaining members, normally one-sixth of each council who are appointed by the regional health authority, should also not be made by the regional health authority until there has been consultation with the appropriate local authorities. This proviso has been put in simply and solely so that the regional health authority can look at the composition of the community health councils, can see which interests in the community are lacking, and, we hope, as the last Administration hoped, and as my right honourable friend the Secretary of State hopes, those three places will then be used to fill the obvious gaps in the community health councils.

The Government believe that the community health councils have a vital role in making local participation in the running of the National Health Service a reality. Many of us have been conscious for a good many years that there has been no real point of contact between what we are pleased to call the, "man in the street", the hospital and those who have been running the hospital. I do not want to spell out the duties, obligations, responsibilities and requirements of the community health councils, because I am talking to noble Lords who have read the appropriate documents. But they have a responsibility to see that the Area Health Authority and the Regional Hospital Authority know what local people are thinking about the service being offered. If we succeed in doing that. we shall have made a considerable step forward in the treatment of people who come within the responsibility of our National Health Service. In the majority of cases, as I have already said, the appointment of local authority and voluntary body members has been made. I understand that the Secretary of State for Wales hopes to make his appointments shortly.

My Lords, the only other point I want to make is that my right honourable friend the Secretary of State for the Department of Health and Social Security is anxious that perhaps in the not too distant future there might be a national body co-ordinating the work and responsibilities, acting in a kind of advisory capacity to community health centres. This is still being thought out. I thought I would mention it because to many of us it seems that if we are to have something in the region of 207 community health councils, there ought to be a body to which they could turn for advice and guidance, with which they could have discussion as to the needs of the ordinary person. As I have said, my right honourable friend hopes that the formation of a national council will be possible in the not too distant future.