HL Deb 02 May 1974 vol 351 cc263-86

6.31 p.m.

LORD REIGATE rose to move, That an humble Address be presented to Her Majesty, praying that the National Health Service (Transfer of Social Services Staff) Order 1974, laid before the House on March 7 last (S.I., 1974, No. 318), be annulled. The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper. I feel that I ought to apologise or begin by apologising to the noble Lord, Lord Wells-Pestell, who has had a rather arduous day. This Motion relates to an Order which has been made under the National Health Service Reorganisation Act 1973. Your Lordships may recall that the issue I am going to raise was discussed in your Lordships' House on January 25, 1973, and I regret very much that I was not present to be able to take part in the debate on that day. The present Order that I am praying against, it might interest your Lordships to know, was signed by Sir Keith Joseph on February 28 which was, of course, Election day. It was laid before Parliament on March 7 and was effective from April 1.

This is an abstruse and complex issue affecting some 750 National Health Service workers—a tiny minority, if you wish, but a very important minority. I hope that I may be allowed to redeploy the case which was made so ably by others on the Committee stage of the Bill, just for the Record. The main purpose of the reorganisation was, of course, to unite the three branches of the National Health Service, the hospitals, the general practitioners and the public health—an admirable ideal which we all support, even if we are critical of some of the details. The purpose was unity, but I must confess that I think that this Order is, in fact, divisive. It is against the will of the majority that these social workers who are now in the National Health Service are to be transferred to the local authorities.

These social workers of whom I am speaking are the medical and psychiatric social workers, known in the jargon phrase as M.S.W.s and P.S.W.s, who are now working in the hospitals. Once upon a time they used to be called almoners—a very honourable name—and even lady almoners, but since those days the name has been changed and the profession has radically changed its duty; and as it now is the medical and psychiatric social workers are important members of the clinical team in the hospital: the consultant, physician, surgeon or psychiatrist, the nurse, the social worker and, of course, the administration as well. They are concerned with the total care of the patient, and it was the hope of many of us that the wonderful service which they give in the hospitals would, in the reorganised Health Service, be extended more widely in other hospitals and also to the general practitioner as well. It is in the nature of their work that they have close liaison with local authorities, but to achieve close liaison you do not have to be under the command of the local authority. The prime duty of the M.S.W.s and P.S.W.s is to the patient and to the clinical team of which they are part, and they have, I think, played an important role in the last 25 years in completing the care of the patient.

If I may quote from a letter which I received, which I thought was very telling: Modern medicine has become too disease-orientated and can easily overlook the personal and emotional problems of the patient. The medical and psychiatric social worker brings the humanising element. If the medical social worker was employed outside the hospital it is feared that her influence on the medical profession would diminish. There was an endearing postcript to the letter, which I will quote, which said: We are not just a group of elderly ladies afraid of changes for ourselves". I can vouch for that. They are social workers who, I think, have welcomed the challenge of the National Health Service reorganisation and the wider opportunities that it will give to them. They know the nature of their own work as, if I may say so, no remote planner can possibly do. I was reminded of a quotation by, I think, Edmund Burke who said of a not dissimilar proposal, that, these philosophers consider man no more in their experiments than mice who are the recipients of mephitic gas, which I think sums up for all time the attitude of the practical man to the theorist. The special nature of their work has, I know, been recognised by the Department of Health and Social Security and, I believe, by Sir Keith Joseph in person who gave an assurance that they would not be removed from the hospital environment, which makes this change of employer, if I may so put it, even more peculiar and unnecessary.

I have tried very hard to understand the reasoning behind this change and I have read what was said in the debate. I read the reports of the various Working Parties. I think that there is an element of bureaucratic tidy-mindedness which is the work of someone with no knowledge of the work that goes on in a hospital, and I am quite certain that the noble Lord, Lord Platt, will be able to amplify that particular point. It seems to me that the argument runs something on these lines: any social worker is a social worker for all purposes, "and that's that", and social work is a local authority function because the Local Authority Social Service Act of 1970 says so. In one section it says that the after-care of the sick is a local government function—Q.E.D. M.S.Ws and P.S.Ws come under the same umbrella as all other social workers.

If I may quote my noble friend Lord Aberdare, he said, most succinctly: … health skills should be deployed from a National Health base and social work skills from a local authority base."—[OFFICIAL REPORT, 25/1/73, c. 293.] That is very simple, but who is really going to say that the M.S.Ws and the P.S.Ws do not in fact have medical skills? It is very much a part of the role that they have to play. If I am being unfair in my analysis of the situation, no doubt the noble Lord, Lord Wells-Pestell, will correct me, but I ask him in particular to consider whether he would support probation officers being put under local authorities. I believe it has been done in one part of the United Kingdom but I have yet to hear that it is welcomed as a great success.

The other reason given, again by my noble friend Lord Aberdare, on January 25, was the maldistribution of medical M.S.Ws. He put it this way—and there is a slight misprint so I will quote a little more: … an important factor which has been ignored in the case presented by the hospital social workers is that social work support is at present very unevenly spread in the hospital service, and that for many hospitals the need is not to safeguard existing standards but to provide a service. It is of course quite true that social work is better developed in what I might call the "higher grade hospitals", partly for historical reasons, one of which is that the National Health Service has never had a statutory obligation or duty to employ social workers as part of the hospital team. But what will the position now be when the Order is made effective? We shall have M.S.Ws employed by the local authorities, apparently—if the promise is correct—working in the districts (that is to say, in the hospitals) dependent on the Area Health Authorities both for accommodation and for staff, which again does not seem to me to make very good sense.

Here I should like to interpolate one small but vital point. The reports by the M.S.W.s on patients are kept in the social service department of the hospital or, if the consultant has called for a report, with the patient's file. These are very confidential documents and they are by law the property of the hospital. Whose property will they be now? Will the social service department of the local authority own them? Will it have access to them? Will it retain them? How easy it would be for patients to lose confidence in medical treatment if the files were available outside the hospitals. I do not think anyone with a knowledge of the social work of local authorities could relish the idea that some of the details of patients' cases should be available for other purposes in—let us call it the town hall for short.

I should like to have a slight interlude here in order to point out some other change which is being made. Many hospitals have "special clinics", which is the refined name given to the clinics for the treatment of venereal diseases. In these clinics social workers are employed on what is known as "contact chasing", which is quite obviously seeking out those who are transmitting the disease and persuading them to come in for treatment. This is essentially work in the community and is not actually relevant to the clinical team. Hitherto by tradition they have been employed by the local authorities but now—and, on the whole, quite rightly in my view—they are being transferred to the service of the Area Health Authorities. So it is a two-way traffic, but it seems rather irrational if the unification of social workers is the reason behind it.

Others will be able to speak more fully than I have of the work of these social workers and I want to end by pointing out one or two things. As I have said, this Order, Statutory Instrument No. 318, is effective from April 1. When the matter was last discussed in your Lordships' House on January 25, 1973, my noble friend Lord Aberdare said this: I would reiterate that we have not yet made a decision, and I would also point out that the provisions in Clause 18(4) are permissive; they do not provide for transfer on the day appointed for other Health Service staff, but for transfers to be on such day or days as may be determined by or under the order. In effect, they were transferred on exactly the same day as the other staffs; namely, April 1, 1974, in theory, although not necessarily in practice.

In the Order it also states that notice of transfer is to be served on the transferred worker as soon as possible, but I understand that on May 2—that is to-day —many have not yet received that notice and it seems only reasonable that the Order should have been delayed until that could be done. Furthermore, I should like to comment on the fact that in Section 6 there is a right of appeal against transfer.

This is quite frankly valueless. If you are an M.S.W. and you find yourself being transferred to a local health authority which is—unless the Government change their mind—100 per cent. to be your employer, you are not likely to engender much good will if you appeal against that transfer. There is a not unnatural fear of victimisation.

The more I study this matter and the more I read of it, the more convinced I am that an error is being made. I do not want to accuse anyone of any malign intentions; there may be a touch of "empire building" latent in the proposal but there is certainly nothing sinister and I am sure it is done with the best intentions. But I think—and I know that other speakers to-day will support me in this—that a mistake is being made. It is of course my hope that the noble Lord, Lord Wells-Pestell, will announce that the Government are going to withdraw the Statutory Instrument. After all, it is not their Order so they would lose no face if they did so.

Noble Lords will be relieved to know that I do not propose to divide the House, although I have a feeling that if I did we might even win. If I may say so to the noble Lord, no harm would be done by delay. The reorganisation of the National Health Service is, to say the least, a little confused. If the Government, in their wisdom, chose (to make a non-political point) to stay their hand, they could issue a standstill Order to the local authorities delaying the transfers pending consideration. After all, they are considering pensions under the Social Security Act and this is a much smaller matter. It would also give them an opportunity for reconsideration. Also—and this is a most im-important matter—it would enable the newly-constituted Regional Health Authorities and Area Health Authorities to give the matter proper consideration and make their recommendations now that they are in the saddle.

I am sure the noble Lord will have been told by his officials that everyone has been consulted, that the British Association of Social Workers supports the change, and that only a small minority concerned with this matter do not support it. I am sure he will also be told that before this is done everyone should be consulted, including the Joint Liaison Committees, and everyone else. I will not say that there has been a state of chaos in the Health Service, but most of us now think that they have all been working under appalling pressure in the last two years, increasing towards the appointed day, and that pressure still continues. In this very small matter I feel that the new authorities have a very real right to be consulted afresh. I therefore beg to move.

Moved, That an humble Address be presented to Her Majesty, praying that the National Health Service (Transfer of Social Services Staff) Order 1974, laid before the House on March 7th last (S.I. 1974 No. 318), be annulled.—(Lord Reigate.)

6.52 p.m.


My Lords, I should like to support the Prayer of my noble friend Lord Reigate, and I do so most willingly and with great feeling because when the Amendment was moved in January, 1973, by the noble Lord, Lord Amulree, I spoke in support of it and I have not changed my views since. I can only repeat what I said in January last year; that the medical and psychiatric social workers are truly part of a clinical team. They play a very important part in the diagnosis, treatment and rehabilitation of the patient. If they are not readily available in the multi-disciplinary team, there is a very real danger that a crisis may develop which needs attention from the social, medical or psychiatric social worker. If this crisis is not met, it may result unfortunately in a lack of what one might call "on-the-spot help", and far more serious problems for the patient might develop.

My Lords, while I fully accept the good intentions behind the transfer, I cannot agree that it was necessary to develop and improve liaison and good communications between social workers. Provided the interests of the client, as they are now called (although I still prefer to think of these people as patients) are of primary concern, I am sure all the social workers would work together towards this, whoever was their employer. To ensure that all patients (including a large number who have no need of help from local authority social service departments) get the help they need at the time they need it, I am sure it is essential that the Health Service should employ its own social workers.

I would support the statement made by my noble friend Lord Reigate, and point out that a number of functions which used to belong to the local authorities are now the responsibility of the Health Service. My noble friend mentioned one, and there are a number of others which I could state, but I will not delay your Lordships' House. Should not these have social work cover as an integral part of the care and treatment of patients?

6.54 p.m.


My Lords, briefly I wish to support the Motion which has been moved so cogently by the noble Lord, Lord Reigate. I do so for two reasons, first because it was I who moved the Amendment in January last year that the medical and psychiatric social workers should not be transferred to the local authority. I do not want to repeat at any great length what I said at that time, but I should like to put forward one or two points in support of what I am saying, because the psychiatric and medical social workers are really more medically and psychiatrically trained and experienced than the ordinary social worker. They really do know more about the medical side of what they are doing than the average social worker who comes from a social service department. Their work is extremely specialised and requires a great deal of training and experience. Here I can talk with a good deal of experience gained from working with these people, because for 19 years I worked in the closest proximity and liaison with one or two medical social workers. If they had not given me their support in the way they did, it would not have been possible for me to do my work during those 19 years. I am quite sure there will be trouble if they are transferred to the social service department of the local authority.

My Lords, I would put forward these questions. Will the clinical side be able to get the social workers they require at the time that they require them? Will the social workers they get from the local authority be of the same training and experience they expect to get now? These are very important points, because as both the noble Lord, Lord Reigate, and the noble Lady, Lady Ruthven of Freeland, have pointed out, the medical social worker is part of the clinical team taking care of the patient. There is very little, except the unfortunate change of name from "almoner" to "social worker", to tie them in with the modern idea of a working department called a local authority. The welfare of the patient in question may well depend on the work of an expert, trained medical social worker or psychiatric worker being present when required and being able to work closely with all the other members of the team looking after the patient. So I would support what the noble Lord, Lord Reigate, said, in making a plea that the implementation (if I may call it that) of this Order may be postponed so that further consideration may be given to all the enormous problems involved.

6.59 p.m.


My Lords, the noble Lord, Lord Reigate, with his usual skill and clarity, has presented all the arguments. I rise only to make a few remarks in support. I have worked in various capacities in hospitals since 1921, I am ashamed to say. Some of us have considerable concern as to how much reorganisation of the National Health Service will really help the patient. But however we may think of that, we are mostly agreed, as the noble Lord, Lord Reigate said, that what seems to be a very good aim in this reorganisation is to bring the various branches of the medical and allied professions together under one authority, under one roof as it were, whereas now they are divided into what has been called the tripartite system.

If it is a good thing for general practitioners and medical officers of health, the hospital doctors, consultants and juniors all to be under the same authority, surely their chief aides—perhaps I should not call them that because there are many other very important aides such as the technicians—the medical and social workers should also be under that same authority. I feel quite sure that it is the wish of most of them (although I know they are a little divided on this) to be with the medical people and to be regarded as part of the medical team, as indeed they are. The noble Lord reminded us that they started as almoners, and, as he said, even lady almoners. If I may lighten the proceedings for a moment, that brings back a memory of the early 'twenties when I was a very junior hospital doctor. We had one lady almoner who was an enormous woman whom we used to call "the battleship", and it was therefore no surprise to me when a rather ignorant patient said to me one day, "Doctor, I have just seen the lady Armada". At any rate in those days one of their duties was, of course, to see how much patients should be encouraged to pay towards their treatment. Those days are now over and I suppose since they no longer have that function they are no longer called almoners.

All I can really say in support of Lord Reigate—and I do support him very strongly; I cannot see the arguments on the other side at all—is that it has been my own personal experience that these people are of the greatest value, and they like to be part of the medical team. In any good medical unit they are part of the medical team. In a teaching hospital they also have a special function in bringing the social side of a patient's difficulties to the notice of students. In my medical unit in Manchester we always had our medical social worker at our weekly conferences when we went through a number of cases of particular difficulty or importance, patients presenting particular problems. Sometimes the problems were brought to our notice entirely by the medical social worker. At any rate, I need say no more than to tell your Lordships that I am convinced that she—it usually is she—is a very important and integral part of the medical team, and I cannot see why she should be employed by a different authority.

When the noble Lord, Lord Amulree, brought up his Amendment on January 25, 1973, he was—against my will, I should say—persuaded to withdraw it largely on the grounds that the Government had not made up their mind and were going to think again. We never got a guarantee that we should be able to discuss this matter when they had thought again, and we never even heard that they had thought again. I am bound to confess, and it may be because I am not careful enough in my reading of Parliamentary affairs, that the next I heard of it was that it was all cut and dried and set down; and then the next I heard—and I was very pleased to hear it—was Lord Reigate's determination to move this Motion this afternoon, which I strongly support.


My Lords, I wish to associate myself with emotion with the Prayer which the noble Lord, Lord Reigate has so eloquently proposed. It is difficult for many of us to comprehend the reason why the problem arose. He has presented gut so efficiently that it would be redundant for me to say more or to enlarge on the proposition, except to emphasise the importance of retaining the relevant case histories and clinical and social notes with the hospital team; this will follow provided the social workers are retained within the National Health Service.

7.4 p.m.


My Lords, I hesitate to speak after such distinguished medical opinion, but I would nevertheless like to support the Prayer of the noble Lord, Lord Reigate, for two reasons certainly not raised by the medical speakers. After the reorganisation of the social services, it is common knowledge, or it must be common knowledge to any of your Lordships who have their ear to the ground in these matters, that while in some areas the reorganisation went through smoothly and satisfactorily, in a number of areas it was followed by great confusion and distress. I have evidence, in some cases, of a deterioration in the service given to the people who need social services, and this, after all, is what this is all about.

The noble Lord, Lord Reigate, spoke of the question of confidential files. I know of one case in which previously confidential files following reorganisation were left in an open office in which a large number of unqualified persons were able to have access to them. I do not say this was anybody's intention but I think we ought to grasp that reorganisation has by no means everywhere been a success.

The time will come when the objectives of that reorganisation will be generally achieved, but, in my view, that time has not yet come. This in itself is a very good reason for delaying this transfer until we are more satisfied of the standards that have been achieved or that will have been achieved after reorganisation.

Of course, it is not only that there was disturbance, and in some cases deterioration, in service to clients after re-organisation; that situation was compounded by the fact that the re-organisation of the social services took place before re-organisation of local government. I have never been able to understand, when everybody knew that the re-organisation of local government was coming, why it was considered appropriate to re-organise social services prior to re-organisation of local government. I can quote a case in which, following the reorganisation of the social services, a considerable amount of disturbance was created; and that whole situation has been put in the melting pot because the boundaries have been redrawn and people's responsibilities have been further confused. Is it sensible in this situation to stir the matter up once again by bringing about yet further reorganisation by introducing the medical social services into the local authority departments?

I should like to make one further point from the point of view of the client; and I repeat that it is not the panels, it is not the authorities, it is not even the social workers, it is the people who need their services that we ought to be considering in this matter. I know that re-organisation of the social services is based on the tidy idea—and I detest tidiness—that it is better that all the social services should come under one authority. Why? I have never been satisfied by the arguments in support of that doctrine. If you are in need of social services you are by definition at a disadvantage; you do not go there for fun or exhilaration. It can very easily happen that an individual client can get across the authority. It may not be the authority's fault. I believe it is highly desirable that there should not be only one source of social help, and if a client has got across the authority he should know that there is some other source of social help open to him. I do not like monopoly, and I do not like monopoly in the social services. The transfer of the medical social workers into the local authority, in my view, is a further step in the direction of monopoly in the social services, the last place in which it should occur.

7.9 p.m.


My Lords, perhaps I might just say a brief word at this stage, before I leave it to the noble Lord, Lord Wells-Pestell, who has far more expert advice available to him than I have, to say something about the reasons why this decision was taken. There is just one implication, at least, in the remarks of my noble friend Lord Reigate that I should like to put right. He suggested that perhaps this decision had been taken in a rush or under the stress of great pressures at the time of the re-organisation of the National Health Service. That most certainly was not so in this case. The then Secretary of State took a personal interest in this particular matter, on which the arguments on both sides are very finely balanced.

To-night we have heard all the arguments for leaving the medical social workers and psychiatric social workers within the hospital service, but there are arguments on the other side which I tried to put in the debate we had in January of last year. When my right honourable friend was Secretary of State he paid the most tremendous heed to the representations made to him by the hospital social workers. Indeed, both he and I have as high a regard for the work they do as anyone in the House. In fact, their views were put to us very forcefully. I think that practically every hospital social worker in the country wrote a letter to the Ministers at that time. We took their views into account. We also took into account the view of the British Association of Social Workers, whose opinions were different. In particular, the whole matter was gone into carefully by the Working Party on Collaboration, on which the local authorities were represented as well as the National Health Service.

One has to sympathise with the position that some of the hospital social workers find themselves in as a result of this reorganisation. I have great personal sympathy, but the whole of any reorganisation necessarily must be designed for the future. When the noble Baroness, Lady Seear, criticises what has happened in certain cases in the reorganisation I am not in the least surprised. To reorganise the entire National Health Service and not have one or two little difficulties is being too idealistic. There will be things that go wrong. The whole idea behind the reorganisation is to improve matters in the future. I would have thought, and I suggest, that looking to the future there are serious arguments why the coming together of all social work, be it in hospital or in the community, under one employer has advantages both for the services that benefit and also from the point of view of the career structure of people who are working in this service in the future.

I should not like it to be thought that the case made on both sides had not been seriously considered at that time. As my noble friend mentioned, although he did not think it was a very useful provision, Section 18(5) was put into the National Health Service Reorganisation Act specifically to protect those hospital social workers who wished to continue to serve in the hospitals and not become part of a wider profession. I would not go so far as he did in saying that this is a useless protection. I think that it is valuable. I shall leave it to the noble Lord, Lord Wells-Pestell, to carry the case further.

7.14 p.m.


My Lords, it has been suggested by the noble Lord, Lord Aberdare, that I may have some advice to give to your Lordships on this matter. It has always been a dictum of mine that all advice is bad, and good advice is fatal, so I do not propose to give the House any advice at all on this matter. What I should like your Lordships to know at the very outset is that there is more than just a certain amount of sympathy with regard to the situation which the noble Lord, Lord Reigate, has set forth so clearly. I myself deliberately spent some years as a full-time professional social worker. I know it from that side. From there I went on to training social workers, and finally did a certain amount of lecturing in the social sciences.

I am not unaware of what must be the feelings of some people to-day with regard to this particular change. I think that it is a pity that perhaps this matter was not raised much sooner. The Order was laid before Parliament on March 7; it is now May 2, and I think that it would have been possible to have put this Motion down much sooner, and perhaps to have had the discussion on it before April 1. I think that would have been possible. If we had done that, the discussion would have been more meaningful, but I do not think that it can be very meaningful at the present moment.

The noble Lord, Lord Reigate, referred to the Probation Service being incorporated into the social services in Scotland and implied that that had been a failure. There is nothing between the noble Lord and I on this matter, but the real difference here is that the medical social workers in the hospitals concerned are protected. Nobody is saying that they have to give up being medical social workers and join the generic social worker that one so often finds in the local authority. This is not said, and it is not even suggested. The Act goes so far as to say in Section 18(5): A person transferred … 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. So their position is protected. This is the important thing. We are talking about the present several hundred medical social workers, and I say that their being responsible to the local authority is not going to affect their normal daily task.

It is customary in your Lordships' House—a custom of which I do not altogether approve—to always thank a noble Lord for raising a matter. I do so on this occasion with very real sincerity, because it is quite right and proper that the noble Lord should raise this question of the future position of hospital social workers so that it may be fully discussed and so that I can indicate the attitude of the present Government to the questions that have been raised this evening. I think that this debate will be of value to hospital social workers, and in indicating, as I shall, that we support the same line of policy as our predecessors, I hope to make it clear that even though we consider the apprehensions of the social workers mistaken, we fully understand the considerations which have given rise to them, and we hope that the statements already given by the Working Party on Social Work Support for the Health Service, and the further suggestions which they will be issuing shortly, will go a long way towards providing the much needed reassurance.

The National Health Service (Transfer of Social Services Staff) Order 1974 provided for the transfer of National Health Service social workers to the employment of local social services authorities; for the transfer of local authority doctors, nurses, speech therapists and staff in the professions supplementary to medicine—I do not want to take up time setting up the various categories—to the employment of the new health authorities, and for various safeguards and means of appeal for those persons.

The Order was made by Sir Keith Joseph, the previous Secretary of State for Social Services, under Section 18(4) of the National Health Service Reorganisation Act 1973, which was introduced by the Conservative Government. These transfers were based on the proposal, first formulated by Mr. Crossman when he was Secretary of State, that the new health authorities should be responsible for all services where the primary skill needed was that of the health professions, while local authorities should be responsible where the primary skill was social care or support. The basis for this proposal was that only in this way could scarce and valuable skills be deployed to the best advantage of the service needed by every citizen. So far from weakening or reducing the quality of the social work services provided to patients undergoing Health Service treatment, the change to provision from a local authority base should open up a much wider range of forms of social support and care which can be made available according to the needs of each person.

I think one has also to face the fact—and this is a matter which concerns me primarily—that if we have a fragmentation of social work groups it will be difficult to provide the in-service, the ongoing and further training which all groups of social workers need. I think it can best be done in a local authority set-up, although I am not unmindful of the difficulties which local authorities are experiencing at present. At the same time, like our predecessors, we do not wish to underrate the problem.

The organisation of services according to skills poses great problems of co-operative working if the organisation and delivery of services is to be properly responsive to the needs of individuals in the many different situations. In the case of hospital social work, there is much concern among some hospital social workers and among health care staff that the change to local authority employment for the social workers will adversely affect the quality of service received by hospital patients from social workers. But in bringing about this change, the Government, like their predecessors, have a responsibility to see that arrangements are made which will preserve and enhance the standard of service which the public rightly expect, and I do not see any difficulty bearing in mind that the medical social workers at present employed in our hospitals will be allowed to continue there, or any reason why this should change at all.

It was with such considerations in mind over the whole field of the Health Service and related local authority services that Sir Keith Joseph set up a Working Party on Collaboration between the National Health Service and local government to consider ways in which the new authorities should collaborate in the delivery of the services. Among the recommendations of that Working Party was one that a further Working Party should be established on Social Work Support for the Health Service, and I propose to return later to its recommendations.

Hospital social workers represent a very small group when compared with the total of local authority employed social workers. Social work is developing and expanding rapidly, and there was a danger that if hospital social workers had been left as a small autonomous group within the Health Service they would have become isolated from the mainstream of development. Time and time again, both in the field of voluntary social work and in the field of professional social work, we have seen groups working—and I do not mean to be offensive—in splendid isolation. This is what we have to avoid.

Despite the growing number of social workers generally, they are still a very scarce resource and there is advantage in all social workers joining together to provide a comprehensive service for all those at risk in a local authority's area, whether they are living in the community or happen for a time to be in hospital. Social work, whether practised in a local authority or in a hospital setting, rests on a common core of professional theory and practice, supplemented by specialised training which is important, and experience. The type of service needed by the client will depend upon his circumstances and whether he is in local authority residential accommodation, in his own home or in a hospital. Social workers have particular interests and develop particular skills in helping particular client groups, and this applies, among others, to social workers in hospitals.

If I may again reminisce for a second, there is probably nobody in your Lordships' House at the moment who over the years has spent as much time as I as a patient in hospital, and I know from personal experience the tremendous psychological fillip that a good medical social worker can give. In the circumstances of their transfer to local authority employment the Act provides protection—and I repeat this because I want people to understand it—for hospital social workers, not only in regard to their terms and conditions of service, but also with regard to their place of work. No social worker transferred to local authority employment on April 1 may be required to perform duties other than at or in connection with a hospital unless he has so consented. So not only are they protected, but the quality and the kind of service is maintained, which is precisely what everybody wants.

I recognise the special position of the hospital social worker as a member of a clinical team, although not all hospital social workers are so employed, and there is nothing in the transfer to the local authorities that need disturb that relationship. That will be determined by the medical members within the hospital, the clinical team and the medical social workers. The local authority will have no jurisdiction or authority at all over that matter. The Working Party on the Social Work Support for the Health Service, which Was set up to consider the practical problems of the transfer, has recommended that social workers should continue as members of clinical teams and, indeed, that their position should be strengthened and developed. Local authorities have been asked by my right honourable friend the Secretary of State for Social Services—and I quote— To ensure that the duties of social workers in hospitals are not changed in any way which could be detrimental to the level of service they provided before transfer or which would prevent any social worker from remaining a full member of a clinical team, without full consultation with the health authorities and the social workers concerned". I do not see how one can safeguard the position any more. It is a kind of direction from my right honourable friend, and it could not be better.

The main safeguard for hospital social work, however, will be the Joint Consultative Committees to be set up under the National Health Service Reorganisation Act by the Area Health Authorities and for their matching local authorities. These Committees have been strongly advised to set up sub-committees specifically concerned with collaboration in the provision of social work support for health service. Such a Committee will be closely supported by committees of officials drawn from both authorities who will deal with any day-to-day problems of collaboration that may arise.

From my own experience as a professional social worker, I appreciate the fears and uncertainties of hospital social workers about their transfer, and I regret that through pressure of time the Department has been unable, until fairly recently, to issue all the advice and guidance that we would have wished. I think this is a pity. Perhaps it should have been set out more clearly, and sooner. This lack of information has undoubtedly given rise to some misunderstandings about how social work is to be provided in hospitals in the future. There has been a fear that social workers would be withdrawn from hospitals into the local authority departments, and would cease to be members of hospital clinical teams. I hope I have dealt with that point to the satisfaction of your Lordships.

Many of these misunderstandings have, I think, now been cleared up by the issue of the interim report of the Working Party on Social Work Support for the Health Service. The Working Party is broadly based, and includes hospital social workers and hospital consultants having social workers in their clinical teams. I understand that the interim report, which dealt with the organisation and management of social work support, was agreed unanimously by the members of the Working Party, and that they hope to issue a second and final report very soon. If the recommendations of the Working Party are followed by the local authorities, as I am sure they will be, I believe that social work in hospitals, far from being destroyed—that does not arise—will be considerably strengthened. The hospital social worker will in future have the support of the much larger local authority organisations and the right of access to their resources—and they are getting more and more resources in regard to raising the whole standard of social work in this country. I believe also that by harnessing the resources of local authorities social work will be extended into the many areas of the Health Service where it is now deficient or totally lacking.

I do not want to take up much more of your Lordships' time, but I want now to return to the Motion moved by the noble Lord, Lord Reigate, in which he prays for the transfer Order to be annulled. I would advise the noble Lord—and I do not do this at all with any sense of impertinence—that if this Motion is agreed to it will have the reverse effect to that which I believe he intends. The transfers of staff have now taken place. The annulment of the Order cannot affect this situation; it is too late. All it would do is remove from those transferred their rights of appeal and the safeguards as to their terms and conditions of service provided in the Order; and I think this would be a pity from their point of view. I would remind noble Lords of the Statutory Instruments Act 1946, which at Section 5(1) states—and I want to quote again: … if either House, within the period of forty days … resolves that an Address be presented to Her Majesty praying that the instrument be annulled, no further proceedings shall be taken thereunder after the date of the resolution, and Her Majesty may by Order in Council revoke the instrument…". But the section goes on to say—and again I quote: … so, however, that any such resolution and revocation shall be without prejudice to the validity of anything previously done under the instrument or to the making of a new statutory instrument". The transfers have now taken place, and neither the National Health Service Act nor this Motion can alter that fact.

My right honourable friend the Secretary of State for Social Services will be keeping a close watch on how the new arrangements are working, and will give further guidance to local authorities or take any other action that may be necessary to ensure that hospital social work is not only maintained at its present level but is developed and improved. We recognise the value not only of the contribution being made to-day by medical social workers, but the importance of that contribution to the patients. There are bound to be teething troubles—and I would say this to the noble Baroness, Lady Seear. There are always teething troubles, as she knows probably better than anybody in your Lordships' House, when one makes changes, when one passes from one thing to another. This always happens in any reorganisation. But I hope that all concerned with these services will work together to overcome them and see how best they can organise the services in the best interests of the clients. This is what is important. I hope the noble Lord, Lord Reigate, will not proceed with this Motion. If he does—and, I repeat, I hope he does not—I hope your Lordships will feel that it will be quite right and proper to reject it.

7.35 p.m.


My Lords, I understand that it is in accordance with the procedure of your Lordships' House that I have the right to make some comments. I must confess that there are a good many passages in the speech of the noble Lord, Lord Wells-Pestell, which, if I had heard them before I said I would not press this Motion to a Division, would have made me press it to a Division with alacrity. The thought that my action might thereby force him to obtain an Order in Council to put it all back again is too tempting for words. I have a shrewd feeling that, if he had had to do that, he would have had second thoughts, and his Secretary of State would have had second thoughts, and would almost certainly have cancelled this Instrument anyway. Because the transfer has not taken place. The whole gravamen of most of my speech was that the majority of these 750 workers have not received their notice of transfer. They are sitting in the hospitals where they have been working wondering what is going to happen to them.

A good many of the noble Lord's remarks, I think, are common ground to us all. We all want the Health Service to work; we all want more social work. I never said the contrary, did I? I am sure not. The whole point is to have an expansion in this field; everybody wants it. The simple issue is: who commands the authority of the medical social worker who is most of the time occupied in the hospital? The fact is that when the noble Lord says that they will have all the resources of the local authorities open to them, in the majority of cases they have them now. Furthermore, the noble Lord entirely forgets that very many hospitals, perhaps even the majority, deal with more than one local authority, anyway. They are used to this; it is part of the pattern of their work. Why put them under one? Why not leave them under the Area Health Authorities, whose boundaries are, by and large, more likely to coincide with their clientele than the the others?

My Lords, I am most grateful to those noble Lords who have supported me, particularly the two noble medical Lords, whose testimony, I think, we all value very highly. I do not think they will be satisfied, and I do not think any of the consultants in the Health Service will be satisfied, if this situation continues. I think that this is something which will be brought up again. I do not think anybody is satisfied with the rather (if I may say so) bland and almost emollient phrases which the noble Lord used. I would have hated it if he had been aggressive, although I was a little aggressive myself; but it is not quite good enough to speak like a White Paper. This is a very human problem. There are 750 people who are very concerned about, not their own futures—they can all go out and get better jobs (yes, better jobs!) under local authorities than those they have in hospitals now—but with the patients.

If I may make one other point, I was rather sorry for my noble friend Lord Aberdare. I thought that he did very well, and I am quite certain that he has some sympathy, as I think the noble Lord, Lord Wells-Pestell, has, with the point of view which I was trying to put. I was not suggesting that this had been done in a hurry. Good heavens!—there has been enough consultation. I was trying to point out that the timing of it was such that the people with whom he was consulting, apart from the British Association of Social Workers, of whom only a small minority are affected, were health authorities, who were going out of existence, and local government authorities who were also in the process of reorganisation. I cannot believe that the matter can have had the proper consideration it should have been given.

If I may make one final point, the noble Lord, Lord Wells-Pestell, said that it would all have been a little different had I brought my Prayer earlier. I think, with respect, that is a little unfair. This matter was not drawn to my attention—I am neither a Minister, nor a Front Bench Peer—until comparatively recently. I must also point out that I do not think that Election day is a very good day to sign an Order of this nature. Parliament did not meet again until March 12 and there has been a Recess since then. The whole purpose of giving 40 days for a Prayer is that you have 40 days in which to pray—and this is the 39th. There seems to be an implication that if I had brought up this matter at an earlier time the noble Lord might have been more sympathetic. I do not believe he would have been: if I may say this without discourtesy, I do not think he would have been allowed to be more sympathetic.

At the end of the day, my Lords, I am very glad to have raised the matter and I am very grateful for the support that I have received. The noble Lord has not heard the last of this matter, because one aspect I have been most careful to exclude from my remarks concerns the appalling anomalies which happen in the pay structure. I mentioned the social workers in the V.D. clinic: they are coming over from the local authorities at local authority rates of pay, which are higher than those of the National Health Service social workers. The National Health social workers are being transferred to local authorities at their lower rates of pay, while new entrants will be paid at the higher rates. I am sure that no noble Lord would call that justice, and the matter is therefore going to be brought up again, I can assure your Lordships. So, despite the noble Lord's emollient and bland approach, I can assure him there is still a great deal of trouble ahead. I beg leave to withdraw my Motion.

Motion, by leave, withdrawn.