LORDS AMENDMENT (Hansard, 24 July 1978)

§ The LORD CHANCELLOR
My Lords, I apologise that I have not caught up with the excellent pace of these proceedings. I beg to move that this House doth not insist on their Amendment No. 87, to which the Commons have disagreed, and doth agree with the Commons in their Amendment No. 88 to the words so restored to the Bill. With the leave of the House, I shall speak also to Amendment No. 89.
740 Amendment No. 87 is concerned with the terms and conditions of service of the Health Service staff. This is a subject which has been discussed at great length both by your Lordships and in another place. It is the Government's policy that matters relating essentially to the remuneration of Health Service employees, general medical practitioners, opticians, dentists and pharmacists should be excluded from the competence of the Assembly, but that the terms and conditions of service not related to remuneration should be devolved. I do not think that your Lordships dissent from that. However, the complexities of the relevant legislation make it very difficult to separate matters of remuneration from other terms and conditions of service, so the Government adopted the device of devolving the relevant functions in the National Health Service Act 1977 and then making the exercise of those functions by the Assembly subject to directions by the Secretary of State. That allows the Secretary of State to determine the regulations he considers affect remuneration and related conditions, leaving the Assembly those related to other matters.
The relevant provisions in the Wales Bill had a somewhat complicated journey through your Lordships' House. As a consequence, when the Bill left this House for another place, its effect was to devolve outright the terms and conditions of service of all Health Service staff. That is not in line with Government policy nor, I venture to think, with the wishes of those of your Lordships who took part in our earlier debates. Accordingly, I urge your Lordships to accept the disagreement of the other place with Amendment No. 87. That will ensure that the Secretary of State's directing power is restored to the Bill in respect of general medical practitioners, opticians, pharmacists and dentists, and, in consequence, the remuneration of the staff can be determined by the Secretary of State rather than by the Assembly.
I also commend to your Lordships Amendment No. 88 which was made in another place. That will extend the Secretary of State s directing power to cover employed staff such as hospital doctors as well. So, the policy of reserving all matters relating to remuneration will be achieved.

§ Lord PORRITT
My Lords, I should like to say a few words and make a faint plea—I am sure that it will be a fruitless one and your Lordships will be glad to hear that it is a final one—for a last consideration of these Amendments. As I believe the noble and learned Lord has allowed himself to consider Amendments Nos. 87 and 89 at the same time, perhaps I may also do so. I am not talking about detail and I completely agree with him about the intense complexity of the legislation.
We are, in fact, as I see it, very comfortably now back to square "A" —back to where we were during the Committee stage, when a simple Cross-Bencher had the temerity to query the considered opinion of the noble and learned Lord the Lord Chief Justice. However, as I see it, these two Amendments mean that medicine—and I speak of medicine in its wider sense—will be administered differently, or at least will be under acute risk of being administered differently, in Wales and in the rest of the United Kingdom. We must remember that we are dealing with standards of appointment of consultants and with the pay, remuneration and conditions of service of doctors—a wide spectrum of medicine.
As I see it, medicine is international and not national. Therefore, in many ways what we are trying to do with these Amendments is not sensible. I suggest that the more divided one makes medical administration, particularly if it is done as the result of political intervention, the less is the patient likely to get advantage from it and that, after all, is the aim and object of every good doctor.
In my view, these Amendments seem, first, unnecessary; secondly, dangerous, and, thirdly, simply a method of finding something medical to devolve. That opinion is held to exactly the same extent by the British Medical Association both at its headquarters in London and at its headquarters in Wales. The headquarters in Wales, as I mentioned on a previous 742 occasion, represents 90 per cent. of the profession in Wales. So, not only is the proposal unnecessary and dangerous, but it is also unwanted by the profession. It is surely not a very happy way of starting off the devolution of medicine in Wales that it should be forced on an unwilling profession.

§ Lord SANDYS
My Lords, I should like from these Benches to support all that the noble Lord, Lord Porritt, has said on behalf of the profession. Perhaps it is particularly a matter of regret that the Bill, as originally introduced into another place, was in a form which the medical and other cognate professions found much more acceptable. The Government have proceeded along their course, but unhappily the Amendments of which the noble and learned Lord the Lord Chancellor has reminded your Lordships in the Motion, were introduced at a much later stage. The device which the noble and learned Lord referred to is one of particular misfortune, and I think that it has been said again and again on this Bill that administrative complexity will always give rise to friction. Such is the case here.

§ The LORD CHANCELLOR
My Lords, I take note of what the noble Lord, Lord Porritt, has said. if the Amendments are inserted, my information is that pay for consultants will be totally devolved. I see that the noble Lord, Lord Porritt, shakes his head, but I understand that that would be one of the consequences. The powers of the Secretary of State are ones of regulation and direction. He does not himself act as employer; that function lies with the authority concerned. As I understand it, the Wales Bill does not change the structure of the provision of the 1977 Act, so that there will be no change in the employing authority unless there is some major restructuring of the National Health Service. The Assembly will not, therefore, itself make appointments of National Health Service staff. The regulations made under paragraph 10(1) do not, I am advised, lay down the standards or qualifications required by consultants, only the appointments procedure.
Appointments in Wales are made by Area Health Authorities, which are advised by committees convened for the purpose 743 by those authorities. The members of committees are nominated by the health authority itself, the Welsh Medical Committee, the Welsh National School of Medicine and the Royal Colleges. It is up to these committees to determine the standards they wish to apply for each appointment and to decide whether the candidates are suitable for appointment to particular posts.
There are, therefore, no statutory standards at present. The qualifications for any particular post are decided by the committee advising a health authority; they select the person they think most suitable, and this will continue after devolution. I hope that those assurances and that information will provide some satisfaction to noble Lords who have raised the points on the Amendments. I understand that there is acceptance of the view that remuneration should not go to the Assembly. I hope that in the light of what I have said, what I mentioned initially will prove acceptable.

§ Lord PORRITT
My Lords, I thank the noble and learned Lord for his explanation, which is interesting but does not really take my point. One has never thought that the Assembly would appoint doctors, but one has thought that perhaps the Assembly would direct the boards which do so. However, I realise that it is too late now and I apologise for taking so long.