Lords Sitting of 10 July 1980

Preamble
The House met at three of the clock (Prayers having been read earlier at the Judicial Sitting by the Lord Bishop of Bradford):
The LORD CHANCELLOR on the Woolsack.

HEATHROW BUS SERVICE
Baroness BURTON of COVENTRY: My Lords, 1 beg Lave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether, following further inquiry, they are in a position to make a statement about the possible development of a bus service to Heathrow Airport from the West London Terminal area.
The PARLIAMENTARY UNDERSECRETARY of STATE, DEPARTMENT of the ENVIRONMENT (Lord Bellwin): My Lords, I fear there is nothing I can usefully add to the statement made by my noble friend Lord Trefgarne last month.
Baroness BURTON of COVENTRY: I am sorry, my Lords, I was taken by surprise; would the Minister kindly repeat that?
Lord BELLWIN: Yes, my Lords, of course. I fear there is nothing I can usefully add to the statement made by my noble friend Lord Trefgarne last month.
Baroness BURTON of COVENTRY: My Lords, I can. Knowing how reasonable the noble Lord is and that he has connections with Leeds, as I had in the past, may I ask him whether he is aware that what I am really after is getting recognition of the fact that people going out to Heathrow Airport would welcome a bus service from the central area to all three terminals, one for which they would be perfectly willing to pay? They do not
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want a free service and they do not think that the airlines should run it. if I may move on from that, may I ask the Minister whether he regards it as unreasonable that passengers and families going on holidays should have luggage? So long as that luggage is within the limits imposed by the airlines would he not agree, as I am sure his noble friend Lord Trefgarne would agree, that it was really wrong of the noble Lord, Lord Trefgarne, in his spontaneous statement on 12th June, to say that people with luggage should take a car or a taxi?
Lord BELLWIN: My Lords, of course people who travel are expected to have luggage with them, and everyone recognises the problem that there is in this whole situation. I suspect that no one knows more of this than the noble Baroness, Lady Burton, herself, who has pursued the matter so assiduously for so long. I am sorry that I am not able to give her the kind of assurances about the services that I know she would like, but I think it would be fair to say that this is a problem which is now exercising everyone's mind, perhaps not least because the noble Baroness herself has pursued it so vigorously; and without my being able to make promises or commitments at this stage, I hope that there may be a solution to this problem before too long.
Baroness BURTON of COVENTRY: My Lords, without being too much of a nuisance, may I ask the noble Lord, Lord Bellwin, whether I could talk this over with him privately? Is he aware that I am not concerned as to who provides this service, whether or not it is the local authority—I presume that is the GLC—but that it should be paid for? Perhaps I could come and see him about it and try to soften him up on that point?
Lord BELLWIN: My Lords, of course I shall be delighted to talk to the noble Baroness about it.
Lord FERRIER: My Lords, in the absence of the noble Baroness, Lady Macleod of Borve, who asked a supplementary question last time, may I ask the noble Lord this question: Does the noble Lord agree that as well as holidaymakers, the infirm, the handicapped and the elderly also have a problem with regard to luggage?
Lord BELLWIN: My Lords, of course I agree. Who would not agree with that? The problem is not to accept that there is in fact a problem but to decide the best way of coping with it.
Lord MONSON: My Lords, would the noble Lord, Lord Bellwin, not agree that if British Airways did not propose to waste large sums of money on the ridiculous idea of painting out the word "Airways" on the sides of all their aircraft there would doubtless be ample funds available for reviving a coach service from Cromwell Road?
Lord BELLWIN: My Lords, I am sure the noble Lord does not really expect me to comment on that, although there may be many who have sympathy with the point he has made.

HELSINKI FINAL ACT: MADRID CONFERENCE
3.5 p.m.
Lord CHELWOOD: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they will give an assurance that the Madrid Conference in the autumn to review the Helsinki Final Act will discuss fully those clauses renouncing the use of force against any state, and those promising respect for human rights and fundamental freedoms and the self-determination of peoples; and that disarmament (apart from confidence-building measures) will continue to be discussed mainly in the proper forum.
Lord TREFGARNE: My Lords, it is our firm intention that the Madrid meeting should review comprehensively the extent to which all principles and provisions of the Helsinki Final Act, including particularly those to which the noble Lord refers, have been implemented or disregarded. Although disarmament will doubtless be raised, it remains our view that it is most appropriately discussed in other fora.
Lord CHELWOOD: My Lords, I am most grateful for that reply. Is my noble
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friend aware that his reply will greatly reassure many people who are highly critical of the French President's suggestion that disarmament should feature very prominently at the Madrid Conference, specifically called to review the working of the Helsinki Final Act?
Lord TREFGARNE: My Lords, I am glad that my Answer reassured my noble friend. Certainly the most important aspect of the Madrid review conference will be to consider the implementation up to now of the Helsinki Final Act.
Lord GORONWY-ROBERTS: My Lords, will the British delegation be led by a Minister or by an ambassador? Secondly, will there be the most effective co-ordination among the western countries represented there covering their attitudes and proposals in regard to the preparation of the agenda and agreement to the procedures of the conference, and the proceedings of the committees and the plenary conference itself? Also, in particular, in view of our experience at the Belgrade meeting in 1978, will there be the closest co- ordination on this occasion with the United States delegation?
Lord TREFGARNE: My Lords, final decisions in respect of the leadership of the British delegation to that conference have not yet been taken, but I can assure the noble Lord that British participation will be at the highest appropriate level. I can also assure the noble Lord that we shall be discussing these matters very closely with the western delegations.
Lord GORONWY-ROBERTS: My Lords, including in particular that of the United States of America?
Lord TREFGARNE: Certainly, my Lords, including the delegation of the United States.
Lord JANNER: My Lords, while thanking the noble Lord for the statement he has made today and the manner in which he and his colleagues have acted in respect of these particular problems, may I ask him if he will keep in mind, first, the kind of action that is being taken at present by the USSR in arresting some 300 people before the Olympic Games and in driving out of the

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city some 60 other people? Secondly, will he also keep in mind that now an attempt is being made to prevent Jewish students from entering universities, and in fact in regard to the Moscow University itself practically no Jewish mathematics students are allowed to go into the university in order to study mathematics in spite of the remarkable success of those who have previously been there?
Lord TREFGARNE: My Lords, I agree readily that the Soviet implementation of their Helsinki undertakings is, to say the least, highly unsatisfactory. On 2nd July my honourable friend Mr. Blaker made a detailed report to the other place on the recent implementation of the Helsinki Final Act, or failure to implement it, and, with your Lordships' permission, I will arrange for that report to be circulated in our Official Report.
Lord GORONWY-ROBERTS: My Lords, I crave your Lordships' indulgence for speaking again but this is an extremely important matter. Can we take it that there has been an independent review of the performance of the Helsinki agreement, including the vital point made by my noble friend, similar to the review conducted with the support of, but not controlled by, the Foreign Office two years ago, before the Belgrade meeting?
Lord TREFGARNE: My Lords, during the period of this Administration, and I think also of the previous one, the Government have made reports to Parliament at six-monthly intervals and that is the document to which I referred just now.
Following is the report above referred to by Lord Trefgarne:

HELSINKI FINAL ACT
FURTHER REPORT ON SOVIET AND EASTERN EUROPEAN IMPLEMENTATION OF THE HELSINKI FINAL ACT FOR THE PERIOD DECEMBER 1979 TO JUNE 1980
General
1. The period since the last report has been over-shadowed by the Soviet invasion of Afghanistan and by the continued occupation of that traditionally neutral and non-aligned country by substantial Soviet military forces.
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Soviet troops have been directly engaged in attempting to crush Afghan popular resistance to their occupation and have inflicted appalling suffering on the Afghan people. This action violates all the norms of international behaviour including the provisions of the UN Charter and the Principles of the Helsinki Final Act. It has been condemned by an unprecedented majority of members of the United Nations and by the Islamic world. It represents a most serious set-back to the pursuit of genuine détente and international cooperation which can only develop on a global basis and on a foundation of trust and mutual confidence. In CSCE terms the most regrettable consequence of the invasion has been to demonstrate the vulnerability of the CSCE process if certain signatories choose to take advantage of détente in Europe to pursue narrow national advantage elsewhere.
2. More or less coinciding with their aggressive action in Afghanistan, the Soviet authorities have similarly shocked world public opinion with an intensified campaign against political dissenters within their own borders, of which the banishment to Gorky of Academician Sakharov has been only one of the more widely publicised instances. Such actions are clearly intended to silence protest against Soviet infringements of human rights, and in particular of the Helsinki Final Act, and appear to have been timed partly with the opening of the Olympic Games in mind (and possibly also the approach to the Madrid meeting). The denial of certain basic human rights and of the freedom of the individual to monitor the implementation by governments of the Helsinki Final Act has continued in a number of other countries in Eastern Europe, notably Czechoslovakia.
Basket I—Security in Europe: Principles guiding relations between participating states; Confidence-building measures and certain aspects of security and disarmament
Principles
3. The Soviet invasion of Afghanistan, carried out under the guise of an "invitation" from a government whose leader was murdered shortly after the arrival of his "guests", violates a clear

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commitment by the signatories of the Final Act to conduct their relations with all other states in the spirit of the 10 Principles. These include the Principles of sovereign equality, territorial integrity of states, inviolability of frontiers, equal rights and self-determination of peoples, refraining from the threat or use of force and non-intervention in internal affairs. The last of these specifically states that signatories will refrain from any intervention in the internal or external affairs of another participating state "regardless of their mutual relations". Soviet action cannot possibly be claimed to be consistent with respect for these Principles. The Soviet authorities have, moreover, sought to distort the meaning of the Principles by claiming their own action to have been justified by alleged but unsubstantiated intervention in the internal affairs of Afghanistan by other countries. The reaction of Eastern European governments to the Soviet invasion was slow, uneven and generally unenthusiastic. The Soviet Union's allies have tended to argue that developments in Europe should be regarded as distinct from those elsewhere and that the latter should not be allowed to affect the CSCE process. The underlying assumption in such a position that détente is "divisible" is unacceptable.
4. The leaders of the seven Warsaw Pact countries none the less reaffirmed their adherence to all ten Principles of the Final Act in a Declaration issued after their meeting in Warsaw on 14th and 15th of May. The main focus of their interest, however, continues to be the promotion of what they term "military détente", the military aspects of security. To this end, the Soviet Union and its allies continue to call on CSCE participating states to sign a treaty on the non-first use of nuclear or conventional weapons, and affirm their support for a wide range of loosely-framed arms limitation or disarmament measures of a largely declaratory nature (from a world treaty on the non-use of force, to a cut in the major powers' military budgets). More specifically, the Warsaw Pact states have proposed that the Madrid Review Conference should endorse Warsaw Pact ideas on the holding of a multi-stage conference on military détente and disarmament
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in Europe, for which the Polish Government has offered Warsaw as the venue.
5. Ministers of the countries of the North Atlantic Alliance, in the communiqué issued after their meeting in Ankara on 25th and 26th of June, noted that the Soviet military intervention in Afghanistan had seriously affected the confidence necessary for progress in CSCE and stated that it was a matter of particular concern that the Soviet Union had acted and was still acting in Afghanistan in a manner violating the Principles to which it had committed itself at Helsinki at the highest level. Ministers agreed that allied representatives should engage in a thorough review of implementation at the Madrid meeting and that they should also continue to develop a balanced group of proposals and remain prepared to discuss concrete proposals which might be advanced by other participants. But Ministers also noted that the prospects for progress at Madrid and in particular for the consideration of new proposals would be influenced by the course of the review and would depend on the international situation at the time.
6. The deterioration in the implementation of Principle VII—human rights and fundamental freedoms—already noted in several countries in the last report—has continued. In the Soviet Union, a systematic campaign of searches, arrests and trials directed against advocates of human, religious and national minority rights have evidently been launched. Some 100 people are known to have been arrested or tried since October. The administrative and evidently illegal exile of Academician Sakharov on 22nd of January removed one of the dissidents' major links with the outside world Sakharov's present isolation has given rise to fears for his and his wife's health and safety. In addition to the Helsinki monitoring groups in Moscow and in the Ukraine, several of whose members were sentenced to long terms in camps and internal exile, including most recently Malva Landa and Viktor Nekipelov, the main targets of the drive to sweep dissidents out of sight have included the publishers of samizdat material, unofficial Christian groups such as the Reform Baptists, dissident

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Orthodox priests and believers and a body investigating Soviet political misuse of psychiatry, three of whose members, A Podrabinek, V Bakhmin and L Ternovsky have recently been arrested. After 5 months' detention, Father Dmitry Dudko was produced on Moscow television on 20th of June to confess to and renounce his errors including consorting with correspondents and other foreigners, and allowing his "anti-Soviet" and "slanderous" works to be published abroad.
7. Whereas a record number of 50,000 Soviet Jews emigrated from the Soviet Union in 1979, the rate of emigration has declined from a level of over 4,000 a month in November to some 2,200 in April and May this year. In several areas, the emigration authorities are refusing permission to emigrate on the grounds that the prerequisite invitations from abroad are from relatives with insufficiently close kinship. Emigration from other ethnic groups (Armenians, Germans, Greeks and Spaniards) continues to run at a lower and variable level. In recent months, a small number of dissidents have also been permitted to emigrate, or been forcibly expelled, as in the case of Vladimir Borisov.
8. In Czechoslovakia, the appeal of 6 members of the Committee for the Defence of the Unjustly Prosecuted (VONS) sentenced on charges of subversion, was dismissed in December, despite a petition said to be supported by over 700 Czechoslovak signatories and official representations of concern in the West. Western lawyers were prevented from attending the appeal, and several who had travelled to Prague were expelled. The remaining 4 members of VONS arrested in May 1979 were released, but are still under investigation. Harassment of an active group of Catholics in Bohemia and Moravia has continued. Another target of police and judicial action is a small group calling itself the Independent Socialists, whose leader Rudolf Battek has repeatedly been detained and now awaits trial on a charge of assaulting a policeman.
9. More recently the Czechoslovak authorities have gained further notoriety in the West through their
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campaign to disrupt unofficial philosophy lectures organised by Dr. Julius Tomin, a Charter 77 signatory. Academic seminars held in private flats have been broken up and participants detained for a day or two at a time. On at least six separate occasions, foreign visiting lecturers (including the Master of Balliol College, Oxford, in April) were prevented from delivering their contribution, detained and subsequently expelled. So far there has been no satisfactory explanation of which Czechoslovak law the visitors had broken.
10. Under the amnesty declared in the GDR to mark the country's anniversary, just under 22,000 people were released by mid-December. Of these, it is estimated that some 2,500–3,000 were "political" prisoners, who are thought to remain under supervision, to have little choice of employment and to have to report regularly to the police. There is so far no confirmed report of any prosecution under the tighter public order legislation introduced in the course of 1979, with the apparent object of deterring certain dissident intellectuals from communicating with foreigners. Following the expulsion of Huebner and Bahro, several more writers critical of the régime have been permitted to leave for the FRG (some apparently with the option of returning to the GDR).
11. In Poland, whose record on human rights has been better than that of most of the countries in Eastern Europe, there has been an uncharacteristic increase in police activity against dissidents, in the period leading to the Party Congress in February and the parliamentary elections in March. Leading dissidents were detained on the eve of unauthorised anniversary demonstrations in November and December (and 4 were subsequently sentenced to 1–4 months' imprisonment). Reprisals in the form of sackings were taken against a number of workers in Gdansk in February for commemorating the December 1970 food price riots. Members of the "Flying University" (which organises private lectures on subjects not covered by the official curriculum) came under increased police pressure, and 2 are known to have been fined. The editor of Robotnik, the journal of

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the unofficial Committee of Social Self-Defence, was sentenced in March to 3 years' imprisonment and a very heavy fine, for various alleged criminal offences, while Miroslaw Chojecki, director of the unregistered Nowa publishing house, was detained for over a month, released, and then tried on charges of stealing a state-owned duplicating machine. He and one co-defendant were fined and given prison sentences of 18 months each, suspended for three years; two other defendants were fined and given one-year sentences, also suspended for 3 years.
12. In Romania, no new incidents have been reported. However the activities of SLOMR, the Free Trade Union of Romanian Working Men, have effectively been suppressed. It is believed that its leaders and Father Calciu, the dissident Orthodox priest, remain in prison.
Confidence-building measures
13. The Soviet Union recently gave notification of an exercise involving some 30,000 men of the Soviet Group of Forces in the GDR in mid-July. As on most previous occasions of this type, observers are not being invited. Apart from this, no major military exercise had been notified by the Soviet Union or its allies under the terms of the Final Act since last July. There is no reason to suppose that any notifiable exercise has in fact taken place in any of the Warsaw Pact countries.
14. In December, the Warsaw Pact Foreign Ministers collectively endorsed the additional confidence-building measures put forward for consideration by President Brezhnev last October. More recently, Warsaw Pact leaders have stated that it would be appropriate for the further development of confidence-building measures to be considered during the first stage of a conference on military détente and disarmament in Europe, after discussion at the Madrid Review Conference. In this connection, NATO Ministers meeting on 25th and 26th of June recalled their agreement last December to work towards the adoption during the Madrid meeting, as part of a balanced outcome, of a mandate for further negotiations
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under the aegis of the CSCE as proposed by the Government of France, on militarily significant and verifiable confidence-building measures applicable to the whole of Europe, including the European part of the Soviet Union. They expressed the hope that circumstances would permit concrete results in this respect at the Madrid meeting and agreed to continue their common efforts in this area whilst recognising that these same circumstances required NATO countries to evaluate developments on a constant basis.
Basket II—Co-operation in the Field of Economics, of Science and Technology and of the Environment
15. There has been no change in the factors (including shortage of hard currency) which increasingly incline Eastern European countries towards counter-trade policies in defining their import requirements. This continues to he a serious constraint on the development of trade relations with Eastern European countries; in increasing measure, counter-trade and buy-back provisions have been a determining element in major contracts (particularly in the GDR and Romania).
16. Two recent developments, which have still to be tested in practice, may ultimately have a beneficial effect on trade by simplifying administrative procedures and authorising new forms of international economic co-operation. In April, the Czechoslovak Minister for Foreign Trade outlined measures that would enable certain Czechoslovak production enterprises to conduct foreign trade directly, without passing through foreign trade organisations. In March, a Bulgarian decree provided for various forms of partnership between Bulgarian organisations and foreign firms. Hungarian interest in developing new aspects of co-operation, including joint manufacturing and marketing, was reflected in an Anglo/Hungarian seminar on co-operation in third markets held in Budapest.
Business contacts and facilities
17. In general, there has been little change in the practical circumstances governing the day-to-day activities of firms operating in Eastern European

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countries. Despite the provisions of the Final Act, firms trading with the Soviet Union generally still have inadequate access to end-users and continue to suffer delays, inconvenience and uncertainty arising from dealings through the intermediary of designated foreign trade organisations. These difficulties are reflected in the unduly protracted course of some negotiations, and also in the delays experienced by some firms in securing accreditation. Practice in Eastern European countries is not uniform and is generally better in Poland, Hungary and Czechoslovakia. Firms seeking to establish representative offices still face problems of accommodation in all countries, though the pressure is easing as new hotels or trade centres come into service. Rents, payable in hard currency, for office space or converted hotel suites tend to be high and in certain countries are rising fast.
Economic and commercial information
18. There has been no development in the general quantity, quality or timeliness of economic and commercial information, either published or made available in response to specific inquiries. There has in fact been a further deterioration in the amount of detail in the published statistics of the Soviet Union and GDR for 1979. Elsewhere the range of performance previously noted has been maintained, with Hungary and Poland generally more forthcoming than others in releasing information necessary for making a realistic market analysis.
Basket III—Co-operation in Humanitarian and Other Fields
Human contacts
19. In general, the modest improvements noted in previous reports in the handling of applications for family visits, family reunification and binational marriages have been maintained though the procedures are protracted, expensive and in some cases require repeated applications.
20. Czechoslovakia and the GDR were reported to have reduced their backlog of exit applications for binational marriages and family reunification at the end of last year (though
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none of them involved travel to the UK). In Czechoslovakia, the time taken to process applications for family visits has been reduced from 3–5 weeks to a matter of days. Exit visas for short absences are normally obtainable if the visitor is financially supported from abroad; but difficulties arise if any family member is recorded as an "illegal" emigrant. The cost of an emigration passport varies (from a small sum up to about £1,000) according to age and educational status. In the GDR, as previously noted, 90% of the successful applicants for family visits to the UK (136 cases) are pensioners. There has been no progress in the case of a British subject refused permission to visit her children and grandchildren in the GDR, and one long-standing bi-national marriage application has still not been approved.
21. Soviet performance continues to be disappointing: only three of the 23 outstanding personal cases in lists submitted to the Soviet authorities last year have been favourably resolved. In recent practice, the Soviet wives of British subjects have generally been permitted to emigrate within a few months of marriage; but there are currently a number of cases where marriages have been prevented through the denial of an exit visa to a Soviet woman, or of an entry visa to a British fiancé. In Poland, there are few serious problems in this area. Of about 8,600 private Polish applications for UK entry visas over 6 months, some 5,000 are estimated to have been for family visits (higher than the total for all the other countries put together). Emigration passports (mainly for wives of British subjects) are normally granted within four months (at a cost of about £70, plus in some cases a refund of education costs); two recent applications have, however, been refused.
22. There has been no substantial change in the practices of Hungary (with some 500 family visitors to the UK over six months), Romania (with 73) or Bulgaria (with 101).
23. Although the rationing of foreign currency allocations for private journeys is clearly a limiting factor, there has been no overall reduction in the number of tourist visits to the UK from Eastern

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Europe. Tourism in the opposite direction is normally encouraged as a valuable source of hard currency, and the services offered by state tourist organisations have expanded correspondingly over the years. In recent months, however, there has been a disturbing series of incidents involving British (and other Western) visitors to the USSR. The Government has protested to the Soviet authorities in Moscow and to the Soviet Ambassador in London about particular cases of assault, intimidation and harassment of British visitors, some of whom appear to have been singled out for such treatment as a result of their having made contact with Soviet citizens.
Information
24. There has been no improvement in the situation described in earlier reports as regards the availability of Western press publications. Except in Poland, where limited quantities of Western publications are to be found on sale at normal outlets, Western non-communist newspapers and periodicals are not available to the public. Token quantities can occasionally be found in hard currency hotels and airport kiosks, basically for sale to foreigners. Western communist newspapers are generally available at normal outlets.
25. There has been a further welcome increase in the number of British books on sale to the Soviet public, and in the number of bookshops selling foreign books in Moscow and in the provinces. Demand is brisk, despite the relatively high rouble price and the limited range of titles.
26. In Romania, the official party daily and other journals have for the first time reproduced material from Panoramic Britanic, the British Government's official Romanian-language information magazine.
Improvement of working conditions for journalists
27. Working conditions remain professionally uncongenial for journalists in most of the countries, though instances of actual harassment declined
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in comparison with some earlier periods.
28. The Czechoslovak authorities remain both hypersensitive to the contents of Western press reports and unhelpful in their dealings with Western journalists. They withdrew the accreditation of the BBC Central European correspondent in December 1979, as a mark of disapproval of his material. They have also recently impeded the normal operation of news agencies by restricting the type of work undertaken by their Czechoslovak support staff. In principle, however, accredited correspondents and visiting journalists are free to travel throughout the country (under varying degrees of surveillance).
29. In contrast, a British journalist in the Soviet Union has recently experienced difficulties in visiting Tallinn and Kurgan, two cities ostensibly open to foreigners.
30. The regulations concerning foreign journalists and the public order legislation introduced in the GDR in 1979 continue to circumscribe the activities of accredited foreign correspondents. Correspondents from some Western countries find that applications to interview GDR citizens are processed excessively slowly. Restrictions on the information activities of diplomatic missions arc as strict as ever.
31. There are no British journalists permanently accredited in Hungary, but visitors (including some of Hungarian origin) are rarely refused entry, and have reasonable freedom of movement and access to sources. Romanian officials are normally helpful to visitors, including television film crews; but the Government has recently had occasion to protest over the treatment of a British journalist working for the Observer, who, on being refused an entry visa on arrival at Bucharest airport, was detained for two days and nights while awaiting a suitable departure flight. During this time he was denied access to British consular officials before being expelled. Another journalist, the Guardian correspondent resident in Belgrade, was the object of very close surveillance during a visit to Bucharest in May.
Culture and Education
32. Following the Soviet invasion of Afghanistan and the banishment of Academician Sakharov, Anglo/Soviet cultural exchanges declined sharply, as planned visits and concert tours were cancelled or postponed on both sides. Bilateral cultural, educational and scientific exchange programmes with Eastern European countries have not been adversely affected. There are in fact welcome signs of expansion in this area despite financial stringencies. One disappointment is the continuing difficulty experienced in educational exchanges with Romania, including the organisation of high-level academic events.
Science
33. In accordance with the relevant provisions of the Helsinki Final Act and the decisions of the Belgrade review meeting, a Scientific Forum involving "leading personalities in science from participating countries" took place in Hamburg from 18th of February to 3rd March. The meeting brought together distinguished scientists from the participating states as individuals rather than as representatives of governments. Many Western scientists considered the meeting to have been of only moderate value in strictly scientific terms. However, the atmosphere generated by the Soviet invasion of Afghanistan and the exiling of Dr Sakharov in January 1980 meant that the meeting had a particularly political flavour. Western scientists were forthright in criticising the Soviet Union's treatment of many of its scientists and the difficulties experienced in establishing direct contact with them. The final document of the Forum duly noted that "respect for human rights and fundamental freedoms (Principle VII) by all states represented one of the foundations for significant improvement of their mutual relations and of international scientific co-operation at all levels".
Conclusions
34. The CSCE process cannot be divorced from the general course of world events. Soviet action in Afghanistan and increasing violations of human rights in the Soviet Union and certain other Eastern European countries are an affront to the spirit and letter of the
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Helsinki Final Act. Such events have altered drastically the political conditions in which next November's Madrid Review Meeting will now take place and considerably reduced the chances of making progress. At the same time the Government believes that the significance of the Madrid meeting has if anything increased, since it will provide a necessary opportunity for East and West to take stock of the causes of the current state of their relations.
35. The Government remains attached both to the CSCE process and to the promotion of genuine détente. But this can only be on the basis that the participating states abide by the norms of international behaviour. The Soviet Union cannot continue to act as in recent months and expect the Madrid meeting to confirm that business is as usual in Europe. It is for this reason that priority must be given at Madrid to a full, frank and thorough review of implementation focusing particularly on the shortcomings of those concerned as measured against the commitments undertaking in the Final Act. The search for genuine détente and the CSCE process itself would suffer were this responsibility to be evaded.
36. The prospects for the development of new proposals at Madrid are not encouraging in present circumstances. The introduction of new proposals where agreements already reached are not being honoured would severely strain the credibility of the CSCE process. The Government is none the less prepared to do business at Madrid on a realistic basis provided that the rules of international behaviour are respected. We will, therefore, be ready to make progress, but only on the basis of proposals which are substantial in content and capable of producing real and tangible benefits. The worth of new proposals must be decided on the basis of their substance and their appropriateness will depend on developments both before and during the Madrid meeting.
37. It is in this spirit of realism and pragmatism that the Government, together with its partners in the Nine and in NATO, will approach the final stages of preparations for the forthcoming review meeting in Madrid.

RITUAL SLAUGHTER OF ANIMALS
3.10 p.m.
Lord DUNLEATH: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they approve the ritual slaughter of animals whereby the throats of cattle are cut without any form of anaesthetic having previously been administered.
The MINISTER of STATE, MINISTRY of AGRICULTURE, FISHERIES and FOOD (Earl Ferrers): My Lords, the Slaughterhouses Act 1974 provides that animals shall either be slaughtered instantaneously by means of a mechanically-operated instrument in proper repair, or be subjected to stunning, effected by means of a mechanically-operated instrument or an electrical stunning instrument in proper repair, and instantaneously rendered insensible to pain until death supervenes. The only exemptions from this requirement, which have been granted by Parliament, concern the slaughter of animals by the Jewish and Moslem methods for the food of Jews and Moslems, and this must be without the infliction of unnecessary suffering. These exemptions have featured in our law for a very long time. The position is similar in Scotland and Northern Ireland.
Lord DUNLEATH: My Lords, in thanking the noble Earl for his reply, may I ask whether he is aware that the RSPCA have produced a report or statement in which they describe the ritual slaughtering of animals as being horrific and, according to veterinary evidence, have shown that the animal can remain conscious after slaughter for an average of 90 seconds? Is he of the opinion that this suffering is unnecessary, in view of the fact that, according to a statement made in a press report by Dr. Abul Siddiqui, the President of the Ulster Islamic Centre:
"Moslems have no objection to an animal being stunned first before its throat is cut"?
Would the noble Earl, therefore, urge his right honourable friend in charge of
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the Department of Agriculture to make an order that the animals should be electronically stunned before their throats are cut?
Earl FERRERS: No, my Lords; I regret that I cannot do that, because it would require a change in the law in order for that to be done. I am aware that the Royal Society for the Prevention of Cruelty to Animals has issued statements of its views. They are entirely entitled to hold what views they wish. Parliament has discussed this matter on a number of occasions, but the debate has always been inconclusive, and as a result of that it has been decided by Parliament that these exemptions should be made for the killing of these animals on religious grounds and for religious convictions. That is the law as it stands, and must remain so until Parliament decides to change it.
Lord JANNER: My Lords, may I ask the noble Earl to point out that the Jewish method of slaughter of animals has been very carefully considered? I myself have visited, with a Member of Parliament, a slaughterhouse at which the animals are slaughtered. That Member of Parliament withdrew an objection to the exemption after he had seen it and stated that it was clearly an instantaneous and effective method of killing an animal. In those circumstances, will the noble Earl assure the noble Lord who raised the question that, in so far as the Jewish method is concerned, there is no doubt at all, because there is ample evidence to show that the animal is instantaneously killed?
Earl FERRERS: My Lords, in so far as the noble Lord, Lord Janner, asks me to be a postbox for his views to the noble Lord, Lord Dunleath, I am happy to undertake that facility. What I would say to the House is this. I realise that people have many views on this. But this is a religious matter. Parliament has always taken account of people's religious feelings and that is the reason why the situation is as it is. I would tell the noble Lord, Lord Dunleath, that my right honourable friend announced on 4th December that the terms of reference of the Farm Animal Welfare Council have been extended to include welfare at the places of slaughter, and I understand

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the Council will be turning their attention to this subject and will be considering all slaughtering practices, including religious methods.
Lord BROCKWAY: My Lords, as a member of the delegation appointed by another place to witness these slaughters, may I ask the Minister whether he is aware that I and my colleagues came to the conclusion that the Jewish method was no more cruel than the gentile method? But is it not possible to prevent these cattle from suffering in this way by an anaesthetic before they are turned upside down when their throats are cut?
Earl FERRERS: My Lords, that is a possibility in so far as CO2 has been used, but that only on pigs—and of course that does not help the Moslems. With regard to actually injecting an animal with an anaesthetic, of course that would leave a taint in the meat, which again would not be in accordance with Moslem wishes.
Lord JANNER: My Lords, may I ask the noble Earl to consider again what I have just said? Will he agree that precautions are taken, not only to have an anatomical expert to kill animals by the Jewish method but also in having a casting machine, which gives no anxiety to the animal itself? In those circumstances, will he consider that any creation of attempted difficulties should be avoided?
Earl FERRERS: Yes, my Lords; the situation as it is is that these animals have to be slaughtered by a method which has to be approved by my right honourable friend.

ANGOLA: SOUTH AFRICAN MILITARY ACTIVITIES
3.17 p.m.
Lord HATCH of LUSBY: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what steps they have taken to persuade the South African Government to cease their military invasions of Angola and put into effect the United Nations resolution on Namibia.
Lord TREFGARNE: My Lords, the Government are working to solve the problem of violence in and around Namibia at its roots, through the United Nations Plan. Together with our Western partners, we have told South Africa that we are deeply concerned at their military activities in Angola, and that we hope that all sides will exercise restraint. We will continue to use our influence with South Africa in favour of the Secretary General's recent proposals for solving outstanding problems.
Lord HATCH of LUSBY: My Lords, would the British Government agree that this is a naked invasion of a sovereign state which has been taking place since 8th June, and would they consider applying the same kind of publicity for their views to the invasion by South Africa of Angola as they have—and it is the same principle if not the same extent—to the invasion by the Soviet Union of Afghanistan?
Lord TREFGARNE: My Lords, I think the noble Lord is mistaken if he seeks to compare those two events. The situations are very different indeed. In any event, there is now conflicting information on the position in Angola. South Africa maintains, and indeed have so informed Mr. Waldheim, that all their troops have left Angola, although the Angolans deny this.
The Earl of SELKIRK: My Lords, could my noble friend say whether the Government have brought any pressure to bear on the Government of Cuba, or whether the United Nations Secretary General has brought any pressure to bear on the Government of Cuba, to withdraw their troops from Angola?
Lord TREFGARNE: My Lords, I think that is a very pertinent supplementary, if I may say so, although I do not have any information on it.
Lord AVEBURY: My Lords, is it not a fact that if there are any foreign troops from Cuba in Angola, they are there at the invitation of the Government and not for the purpose of carrying out hostilities against the people of Angola? Could the Minister say what is the status of the prisoners who were taken by the South African military when they invaded Angola

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18 months' ago and who have been held in detention ever since, and whether these prisoners are covered by the Geneva Convention? Is the noble Lord aware that the Red Cross recently obtained the permission of the Administrator General of Namibia to visit these prisoners? Further, what report has he received about their welfare and the allegations of torture of prisoners which have been made by several authorities?
Lord TREFGARNE: My Lords, at the outset of his remarks, the noble Lord referred to the "invitation", as he put it, for the Cuban troops to enter Angola. I have come to be very suspicious of that type of invitation after what happened in Afghanistan, when the alleged invitation was apparently issued by someone who had been shot the day before! As regards the condition of the prisoners, to which the noble Lord referred, he will know that this matter was raised when Dr. Viljoen came to London recently and the answers that we received were satisfactory.
Lord BROCKWAY: My Lords, I should like to ask about that last sentence with reference to the putting into effect of the United Nations' resolution on Namibia. Are not the Government of South Africa now defying both the United Nations and the United Nations mission which has been acting in Namibia? Are they not so doing by recognising a puppet government not recognised anywhere else in the world; by their raids into Angola; by their refusal of a demilitarised zone and by their refusal to agree to the confinement of forces to bases?
Lord TREFGARNE: My Lords, the attitude of the South African Government in this matter and the policies that they have pursued do lead us to make representations to them, as I have already described. But, some of the assertions made by the United Nations in this matter leave us with some doubts as well.
Lord BARNBY: My Lords, reverting to the original Question, is it not a fact that all these incursions by South African troops into Angola have been provoked by acts of violence from north of the border? While having great respect and admiration for the noble Lord who asked
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the original Question—and not believing that if he were, with his personality, heavily struck, his inclination would not be to hit back—is it not a fact that the incursions from south of the border have probably been far less frequent than the great number of incursions, with the intention of violence, from the north to the south, into South-West Africa?
Lord TREFGARNE: My Lords, the South African Government certainly maintain that they are striking back legitimately when they make these incursions into Angola. None the less, we feel that these actions are, to say the least, unhelpful in the present circumstances and we hope that they will stop.
Lord GORONWY-ROBERTS: My Lords, is it not a fact that for a long time now the whole policy of the South African Government has been to thwart the intentions of the United Nations in regard to Namibia; to be in default of the unanimously adopted resolution relating to that country; to prevent the creation of a democracy and a free state in Namibia and thereby to imperil the very hopeful example of Zimbabwe; and to place the future peace of Southern Africa, as a whole, in grave jeopardy?
Lord TREFGARNE: Yes, my Lords, there is more than one UN resolution on this matter. The latest one, Resolution 475, contained extreme language envisaging sanctions against South Africa and, indeed, we abstained on that resolution. However, although, as I have said, we certainly believe that these last incursions were highly regrettable, none the less there is a little light at the end of the tunnel in this matter and we are hoping to advocate a more constructive policy in future.
Lord HATCH of LUSBY: My Lords, I should like to return to the noble Lord's original Answer to my Question. Would he agree—and remember that I specifically used the word "principle"—that in principle the invasion of Angola is in the same category as that of Afghanistan? If that is so, why was it that the British Government abstained in the Security Council when the Security Council, with the exception of the United Kingdom, the United States and France, condemned that invasion?
Lord TREFGARNE: My Lords, as I said earlier, these two situations are in no way comparable. To begin with, the South Africans have now largely withdrawn from Angola, although I agree that there is room for more than one view as to whether they have completely withdrawn. In any event, the South African position on some of the other matters is rather more constructive. For example, responding to the Secretary-General of the United Nations on 12th May their communication contained some positive elements, including commitment to international settlement and the demilitarised zone concept and other matters.

BUSINESS
Lord DENHAM: My Lords, it may be for the convenience of your Lordships if I announce that dinner will be available this evening at the usual time.
The Committee stage of the Health Services Bill will be adjourned at approximately 7 o'clock for about an hour.
The European Communities (International Railway Tariffs Agreements) Order and the New Bus Grants Order will be taken during this adjournment.

GREATER LONDON COUNCIL (MONEY) (No. 2) BILL
Read 2ª

HEALTH SERVICES BILL
3.27 p.m.
The MINISTER of STATE, DEPARTMENT of EDUCATION and SCIENCE (Baroness Young): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
Moved, that the House do now resolve itself into Committee.—(Baroness Young.)
On Question, Motion agreed to.
House in Committee accordingly.
[The LORD ABERDARE in the Chair.]
Clause 1 [Power to make changes in the local administration of the health service in England and Wales]:
On Question, Whether Clause 1 shall stand part of the Bill?
Lord WELLS-PESTELL: Clause 1 is designed to undertake a fundamental reorganisation of the National Health Service, and we on this side of your Lordships' Committee have not put down any amendments because we are broadly in agreement with what is set out in that clause. Clause 1 gives the Secretary of State powers to make changes in the local administration of the Health Service. As we understand it, district health authorities are to be set up in place of area authorities, and I should like to ask the noble Baroness the Minister whether she is in a position to say how many district health authorities there will be. As I understand the situation at present, there are 90 area health committees and something like 209 district authorities. Is the noble Baroness in a position to say what the organisation will be, because in my submission, clearly there are unlikely to be 209 district health authorities and, obviously, because of the size of the area health authorities, there must be more than 90?
I am wondering whether the noble Baroness the Minister is in a position to give the Committee some indication of what the pattern is likely to be. At present, the boundaries of the area health authorities fit in very nicely with some, if not all, of the local authority boundaries and it makes administration of medical services and co-operation with the local authorities very much easier. I wonder whether the setting up of the district health authorities will take into account the areas of the local authorities. Although I recognise that it will not be possible to fit them in completely, will they ensure that if a district health authority has to cover more than one local authority, as far as possible it takes in one division or two divisions of another local authority so as to keep the administration as simple as possible? Can the noble Baroness the Minister say how many hospitals are likely to be closed under this new arrangement when it comes into being?

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Bearing in mind that the changeover will take some considerable time—I have heard it said that it will take one year, two years, and even four years; I am quite certain that a reorganisation of this magnitude could not possibly take place in one year—is the noble Baroness in a position to say how long it will take, and is it the Government's intention that all area health authorities will be designated district health authorities? The Bill does not seem to me to be as clear on this as I had hoped. I should like to refer to the Notes on Clauses, at the top of page 6, where it is said:
"Subsection (1) enables the Secretary of State by order to establish health authorities for districts as well as or in substitution for the existing AHAs".
Therefore, it rather suggests that some area health authorities may remain, and I thought that that was contrary to the idea of the reorganisation.
I should also like to ask the Minister whether there is any implication of all this on the regional health authority. In what way will the regional health authorities in the country be affected, and will there be any change in their responsibilities? Further, I should like to ask the noble Baroness what sort of saving will be achieved. I understand it has been said that something like 10 per cent. will be saved, but I am not clear—perhaps I ought to be—of what it is 10 per cent. of. I notice that in another place it was mentioned that there would be a saving of about £30 million, or perhaps even more. I should like to know on what basis this 10 per cent. figure is given.
Furthermore, is it right to assume that the £30 million saved will result from the loss of jobs on the part of a good many at present working in the area health authority, or will it result from some other cause? So far as I can work out, having regard to the number of people employed, if the saving of £30 million is to be made as a result of a reduction in staff, it will mean that the jobs of about 3,000 employees will be terminated. If the figure is more than £30 million, presumably the number of people who will lose their jobs will be greater.
There is only one other matter which I should like to raise, and I hope that on this the noble Baroness the Minister can
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give some sort of comforting reply. We, on this side, have a strong feeling that the Government wish to bring to an end the community health councils. I cannot imagine that anybody who is familiar with the work done by community health councils could possibly come to the conclusion that their usefulness had come to an end. Notwithstanding that our hospitals deal with millions of people every year as out-patients and an enormous number as in-patients, and millions of people see their doctors and so on, the only watchdog that the consumer has—and in this particular instance the consumer is the patient—is the community health council. I should like to take this opportunity—in case I do not get one later on during the Committee stage of this Bill—of paying tribute to the work of the community health councils. I know that some area authorities, some regional hospital authorities, have found them to be a nuisance. But it is part of their rúle to be a nuisance in the sense that it is part of their responsibility to draw to the attention of the various medical committees, the area health authorities and the regional health authorities matters that are happening that ought not to be happening. We really ought not to be afraid of it. We ought to be glad that there is such a body of people, because the National Health Service is, as I said, an enormous concern dealing with tens of millions of people every year. It cannot always hope to do the right thing; it cannot always expect to do it. There are bound to be difficulties.
I believe that the community health councils have rendered the community —particularly those who are in contact with doctors and hospitals—a very valuable service. I hope that the noble Baroness the Minister will be able to say that it is not the intention of the Government to seek to do away with the community health councils. I apologise for putting so many questions to the noble Baroness, but I thought it was better done under Clause 1 than to try to bring them in elsewhere.
3.38 p.m.
Baroness YOUNG: I think that the whole Committee will be grateful to the noble Lord, Lord Wells-Pestell, for giving us an opportunity to look in some detail at Clause 1 and for the way in which he

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has introduced his remarks. It gives us a chance to look at the very many matters which come under this very important Part of the Bill. I am also grateful to him for giving me notice of a number of the points that he wished to raise. It is important for the Committee to recognise that Clause 1 is purely a permissive clause. It enables the Government to carry out the changes proposed in our consultative document, Patients First, if, in the light of the responses to the document, it seems right to do so. Therefore, it may help the Committee if I give some indication of the tenor of the responses that we have already received to this document.
There has been, particularly from within the National Health Service itself, a widespread welcome for the Government's broad objectives; these objectives are to simplify the structure of the NHS and to strengthen management at hospitals and community services level. Equally encouraging, there has been a welcome for the Government's specific proposals to achieve these objectives. In the context of this clause, that means the possible abolition of the area tier of health authorities.
There is a fair measure of agreement within the service that the major structural weakness of the 1974 reorganisation was the establishment of the multi-district area. The concept of the statutory authority at area level with its own team of officers administering an area divided into two or more non-statutory health districts, each with its own team of officers, has not worked as well as had been hoped. Lines of accountability have become blurred; there has developed an over-complex bureacracy; staff and patients have seen the authority as remote and impersonal.
If your Lordships approve this clause it will be possible to establish a general pattern of smaller unitary authorities based broadly on existing health districts, each with its own clearly accountable and simplified management structure. Your Lordships will note that the clause is so drafted as to permit a gradual change. This is an important point. There will be no one appointed day when the entire service undergoes an upheaval. We envisage that that change, if change there is to be, should be within an overall time
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scale and should come at an evolutionary pace to minimise any disruption as far as possible.
I should say right away that the Bill does not compel change at the level of the regional health authorities—this is one of the points that the noble Lord asked—nor indeed at departmental level. This does not imply that we regard the scope for change as existing only at the local level, but we propose no immediate change in the size, membership and functions of regional health authorities. I think it would be helpful to clear that point.
May I now turn to the detailed points that the noble Lord asked. He asked how many district health authorities there might be, and whether there would be the same number as area health authorities at present. The answer is that it is not possible to say precisely how many district area health authorities may be established if our proposals are implemented. We estimate that there might be between 150 and 180 such authorities, some 70 to 90 more than the existing 90 area health authorities. But decisions about this have not yet been taken, and I would draw the noble Lord's attention, on the point about links with local government and as to whether or not the district health authorities are coterminous with local government boundaries, to page 6, paragraph 5, of the Notes on Clauses in which he will see:
"Subsection (2) enables the Secretary of State to determine that a district may correspond with an existing area. In these cases the existing area health authority may simply be reconstituted as a district authority and renamed accordingly.
"Decisions on these points have not yet been taken, and therefore there is considerable flexibility about it at this stage".
The noble Lord then went on to ask about the time-scale. I hope I have said enough for him to recognise that we are not going to have one day on which this will happen. It will be a gradual process, which I think everybody will come to believe is a much wiser and more sensible way of going about this. If the proposals in Patients First are confirmed we shall be asking regional health authorities to conduct reviews of structure at area and district level and to make recommendations to the Secretary of State.
We envisage that many changes could be effected by mid-1982, but that might

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not be possible for all. Our present aim, as set out in Patients First, is that all structural changes should have taken effect by the end of 1983. The timing of changes to management arrangement will depend first on the date of establishment of new authorities who it is proposed will carry responsibility for these reviews, secondly on the availability of suitable officers, and third, on the possible need to negotiate changes to Whitley agreements.
The noble Lord asked me about the savings that we anticipated. Our judgment on this matter is that after the initial years when transitional costs will have to be met, the implementation of our proposals would result in a reduction in management costs of up to 10 per cent. I think that is where he has the figure of 10 per cent. At current prices we should expect this saving to be of the order of £30 million.
On the question of the numbers of jobs that might be lost, it is difficult to estimate a figure until the reviews, both of the structure and the management arrangements, have taken place. But we can say that there are at present 251 separate area and district headquarters organisations, and if our estimates of between 150 and 180 district health authorities prove to be accurate there would be a reduction of between 70 and 90 of these headquarters organisations with some consequent loss of posts. I see from the further amendment that the noble Lord has down that we shall be looking at this whole area of questions about redeployment, and so on, and I think it would be helpful if I left the rest of my remarks on that subject until we come to debate that particular amendment.
Finally, the noble Lord asked me about the future of community health councils. I recognise the force of what he has said, and I am sure that there are many people who recognise the valuable work that community health councils have done. I should like to confirm that my right honourable friend the Secretary of State for Social Services will announce his decision on this matter when he makes his general policy statement on the structure and management of the service later this month. I hope, having answered these specific points and given our background to the thinking on this clause, that the Committee will feel that it is an
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essential part of the Bill and that we have taken account of the views that have been expressed to us on a very wide scale. We are, of course, still receiving information on the consultative document and we shall be proceeding gradually over the implementation of these proposals.
3.46 p.m.
Baroness PHILLIPS: I hope that the Minister will heed the plea that where possible the area health authorties will be coterminous with existing authorities. One of the things that people suffer nowadays is that they have hardly got used to the name of the authority before it is changed. Certainly it is possible to be in one area for health, another area for education, another area to pay your electricity bill, another one for the Post Office, and so on. We add all the time to the complication of life to a number of very simple people who, in the end, really do not know where they go for the particular services they demand. This has never been more noticeable than in the health services.
If this change can be effected with as little complication as possible, I am sure that the Minister will see that this happens, even if we have to have a change of name yet again. That is in itself a confusion. But if the area could at least run counter to some of the areas that people already know, this would make life a little easier for the people who have to use the services.
Lord WALLACE of COSLANY: Following on Lady Phillips's remarks about areas and having a name to cover a whole series of services, I would put a point to the noble Baroness for the Government to consider. I am not here to put forward any political criticism at all. I think that the noble Baroness and the Committee will agree that some reorganisation of areas covered by regional health authorities is in fact necessary. The most outstanding example is London and Greater London—the GLC area.
The present situation is chaotic in London with its divisions into sections controlled by a number of RHAs covering not only parts of the GLC area but large areas of rural and semi-rural districts with interests and problems completely different from the metropolitan area. In fact, the diversion of funds to outer areas by RHAs

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has enforced debateable economies in the GLC area, and led to hospital closures and other cuts against the needs of Greater London residents and also the needs of commuters travelling from the favoured outer areas who need and get treatment in London hospitals.
St. George's Hospital, as we know, has been closed, and Westminster is under threat because the proposed closure of the medical school will mean a drastic reduction in beds and reduction of service, albeit with a financial saving which seems to me the basic reason behind it. Apart from this, many thousands of medical cases are sent to London hospitals from all over Britain for investigation and very often treatment. I think it is an accepted fact that London has become a very important centre of medicine with a world-wide reputation.
The case for a regional health authority for London covering the GLC area is overwhelming, not only because of its density of population but also because of its unique position as a centre for famous teaching hospitals, and also taking into account the tremendous daytime increase in population through workers employed in offices, shops, factories, markets, et cetera, together with visitors for business and pleasure, and travellers in transit by air, rail, and road, all of whom present demands on the metropolitan health services, and hospitals which are not fully met or covered by the present piecemeal set-up of the regional health authorities.
One regional health authority for London would provide better liaison with the GLC and its associated London boroughs, providing, as they do, social services closely allied to the health service. It seems to me to be unthinkable that the country's capital, with its special needs, has been divided up so far in such a fashion, which has seriously eroded its medical needs. Here I attach blame to all the Governments who have handled the health service since its inception. In conclusion, may I say this: The Government must think seriously about this situation, which must surely be remedied, and in this I feel sure they would have the support of the Greater London Council and the people the council strives to serve.
Baroness MASHAM of ILTON: I should like to support what the noble Baroness, Lady Phillips, has said. Corning from a rural area, I should like to tell the Government that their health district is served from Northallerton and the social services from Harrogate, which is in a totally different health district. It would be very much easier for health and social services to co-operate if they came from the same district and people knew each other. The poor old patient just does not know where to go or who to contact.
Baroness ROBSON of KIDDINGTON: Obviously, I was very interested, because of my interest in a regional health authority, to hear the noble Baroness express a desire that the change that is coming should be as evolutionary as possible. I believe in that myself, but only to a certain extent, because I think we have got to balance very carefully the feeling of uncertainty that will hang over a large number of National Health Service staff if the change is too evolutionary. I think it is essential that we set a deadline, for instance, for the appointment of chief officers to the new districts and that we should try in all regions to stick to that deadline as far as humanly possible.
I would hope that the noble Baroness the Minister implied in her reply that the reorganisation and the appointed day within a region would still remain the responsibility of the regional health authorities. But there is one thing that worries me enormously about the whole of this change. That is the responsibility left on regional health authorities to keep financial control during the period of change. That is another reason why I do not want the evolutionary change to be too elongated, because it is going to be very difficult to keep financial control during this period. There are many areas in this country which have created centralised finance offices for more than one district. It does not take a great amount of imagination to see what will happen when the chief officers of that area authority apply for the district finance officer's post. They have to safeguard their future; they are looking to where they are going in the future. The problem of dividing that finance office into three different finance offices, while at the same time keeping financial control, is not going

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to be an easy task, and the longer that period is the more difficult it is going to be.
Baroness YOUNG: I and my colleagues are grateful for the general welcome that has been given to this clause and the very helpful and constructive suggestions that have been made by all those who have spoken. The noble Baroness, Lady Robson, raised a very important point about not allowing the reorganisation to go on too long. Can I reiterate what I said at the beginning in answering the noble Lord, Lord Wells-Pestell, about the time-scale of this? We hope that all the structural changes will have taken place by the end of 1983. This should give time for some evolution, but clearly not an indefinite length of time, for precisely the kind of reasons the noble Baroness herself has made clear, particularly about staff appointments.
The noble Baroness, Lady Phillips, and the noble Baroness, Lady Masham, both raised important points about coterminosity of local authority areas and possible district health authority areas. We recognise that coterminosity is important, but it is not necessarily the overriding factor in the structure of the NHS. We very much take the point about the value of coterminosity and will certainly emphasise its importance in any guidelines that we issue, taking account of the very practical point that the noble Baroness, Lady Masham, has made on this matter. But it may well be that health service considerations such as the numbers of patients in one particular place or the siting of major hospitals might argue against coterminosity in some places. Practical effects as to where one actually has a hospital and whether it can, in fact, fit in with the local authority must also be considered. However, we take this point very much and I am quite sure that my right honourable friend the Secretary of State will take note of the points that have been raised, because they are ones with which we are broadly in sympathy.
The noble Lord, Lord Wallace, raised a point about reorganisation in London. As he probably will know from a number of Questions asked in your Lordships' House on this very point, quite recently we have been considering once again many of the problems of London. What is needed now is not really a further inquiry
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but some action, and my right honourable friend the Secretary of State has established a London advisory group to help him reach decisions on London. It will be advising on major health service issues in London and it has been asked to give priority to considerations of the pattern of acute hospital services in London and to the new structuring of the health authorities. We did in fact have some discussion on this very point in a parliamentary Question not so long ago, and I am quite certain that the right way of proceeding is to wait until this committee has given its advice on this matter. But, again, this is a matter on which no decisions have yet been taken because we are waiting for the result of this particular report.
I should say in conclusion that I realise I did not answer the question asked by the noble Lord, Lord Wells-Pestell, about hospital closures, but at the start of our deliberations I should like to confirm that we are not talking about hospital closures at all in this Bill. The reorganisation of itself will not lead to any hospital closures; that is an entirely different issue.
Clause 1 agreed to.
3.58 p.m.
Lord WELLS-PESTELL Lord WELLS-PESTELL moved Amendment No. 1:
After Clause 1, insert the following new clause:
Health Service Staff Commission
(".—(1) It shall be the duty of the Secretary of State to appoint, within one month beginning with the date of the passing of this Act, two Commissions to be called the National Health Service Staff Commission and the Welsh National Health Service Staff Commission; and the Commissions—

(a) shall consist respectively of such persons as the Secretary of State may from time to time appoint as members of the Commission after consulting the bodies appearing to him to represent persons employed in England, or, as the case may be, employed in Wales who are liable to transfer in pursuance of section 1 of this Act and any other bodies appearing to him to be concerned with transfers of such persons in pursuance of that section; and

(b) shall in the case of the National Health Service Staff Commission exercise its functions in relation to England and in the case of the other Commission exercise its functions in relation to Wales.

(2) It shall be the duty of each Commission—

(a) to keep under review the arrangements made by relevant bodies in recruiting and

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engaging employees and the arrangements made in transfers in pursuance of section 1 of this Act and to give advice to the Secretary of State and the relevant bodies with respect to the arrangements;

(b) to consider and advise the Secretary of State on any matter which he refers to the Commission as being a matter which in his opinion arises in connection with persons liable to transfer in pursuance of section 1 of this Act;

(c) to consider and advise the Secretary of State on the steps required to safeguard the interests of persons liable as aforesaid; and

(d) to arrange for the consideration of representations made to the Commission by an employee transferred from the employment of one health authority to that of another objecting to such a transfer and for the giving of advice to such employees by the appropriate Commission;

(e) shall so advise health authorities that no officer employed by a health authority at the date when the Commissions are appointed shall be deprived of employment within the National Health Service in consequence of this Act save with his express consent freely given to his employing health authority and the appropriate Commission in writing;

and each Commission shall have power to take any steps which it considers are appropriate for the purpose of selecting and recommending to Regional or Area District Health Authorities and special health authorities persons whom it considers are suitable for employment by any of those authorities.
(3) The Secretary of State may—

(a) give directions to each Commission with respect to its procedure;

(b) give directions to relevant bodies with respect to the furnishing by them of information requested by the appropriate Commission and with respect to the action to be taken by them in consequence of advice given by that Commission;

(c) pay to any member of either Commission such remuneration as the Secretary of State may determine with the approval of the Minister for the Civil Service;

(d) defray any expenses incurred with his approval by either Commission in the performance of its functions; and

(e) wind up either Commission in such manner and at such time as he thinks fit;

and it shall be the duty of a body to which directions are given in pursuance of this subsection to comply with the directions.
(4) In this section "relevant bodies" means bodies from and to whose employment persons are liable to be transferred by virtue of section I of this Act.").
The noble Lord said: I beg to move the amendment standing in the names of myself and my noble friend Lord Wallace of Coslany. The purpose of this amendment
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is to establish a health service staff commission, and the amendment sets out clearly the scope and function of the health service staff commission which we on this side of your Lordships' Committee recommend and hope to see. I am going to assume that all noble Lords have studied the amendment very carefully, and therefore I do not propose to deal with it line by line, but just to speak to it in a general way. In the last analysis—and I think this is confirmed by what we have heard from the noble Baroness the Minister and others who took part in the discussion on Clause 1 standing part—the reorganisation of the National Health Service as envisaged in the Bill will be a tremendous undertaking and we must not close our eyes to that fact.
Not only will it be a tremendous undertaking, it will affect a large number of individuals, and in many cases—and we must not run away from this—it will affect a large number of jobs. The best estimate—if "best" is the right word to use—is that it may result in the loss of 3,000, or possibly more, jobs. The Minister was right not to attempt to give a figure because it is extremely difficult until the thing gets rolling to know what will be the outcome. Thus, a large number of people will be threatened with dismissal, and it is therefore important to keep the human factor in the forefront of our minds.
I do not want to repeat what I have said on other occasions, but we are in danger of thinking of unemployment as a statistic. It is not a statistic to the individual who finds himself or herself without a job. It can be the most traumatic experience of any experience, and in moving the amendment I am not unmindful of the duties and responsibilities of the Whitley Council. The nature and size of the reorganisation is such that my noble friends and I are strongly of the opinion that there must be a health service staff commission. I hope the amendment will commend itself to the Government, and as a similar clause was embodied in the National Health Service (Reorganisation) Act 1973, there is nothing new in this; it has been done before, seven years ago, when the health service, which we are discussing today, was reorganised. In the circumstances, I hope the Government will

1321
not be opposed to the idea in principle, even though they may say there were difficulties on the last occasion.
Any major reorganisation—and, as I have said, this is one—is bound to affect a large number of people, and those who are likely to lose their jobs must have every protection and consideration. Noble Lords who remember the reorganisation of the health service in 1973 will know something of the morale of the employees and the shattering effect it had on them. I believe that to some extent—I cannot say to what extent—it had a lasting effect. From 1973 to 1980 there have been many difficult periods in the history of the health service and a number of unfortunate incidents, and there has been a great deal of turmoil in the NHS in the last seven years. That turmoil undoubtedly affected the service which the hospitals were able to give, and it undoubtedly affected many thousands of patients. We cannot allow that kind of thing to recur and we must do everything we can to prevent it. It is not unfair to say that this Government—and I am not out to make political points—are not very good at industrial relations. We are much better at it, so they should take our advice.
We have before us a Bill which will soon become an Act, yet no word from the Government as to what is involved or how the problems arising will be tackled. If I had not been raising the matter this afternoon, I do not suppose for one moment that anybody on the Benches opposite would have raised the question as to what will happen to so many people at present in the NHS. If the Government are aware of the magnitude of the undertaking and problems involved, now is the time to tell your Lordships what they propose to do. I hope they will say that they will deal with it by adopting the amendment. In the other place, the Secretary of State was not forthcoming on this subject in Committee. If, therefore, the Government will not accept the amendment, then I must ask for a clear and reasonable explanation as to how they propose to deal with the chaos which is bound to arise.
We are glad to see the reorganisation, but let us face the fact that it will throw
1322
up many problems affecting individuals, and they must have somebody to look after and watch their interests. I can say that a NHS staff commission is wanted by the staff side and by the unions—I think the noble Baroness, Lady Young, will take my word for that—and that is a desire coming not just from these Benches or from certain people who are sometimes awkward; it is the desire of the staff and unions. The unions connected with the Whitley system have been involved in reorganisation, not only in the NHS but in other public services—I have in mind local government reorganisation, new towns and a number of other bodies—and in all those instances staff commissions were established and greatly assisted in the smooth transition of the reorganised services.
I have referred to the size of the task facing the Secretary of State and his department, a task which, it is thought, could take up to the end of 1983, three and a half years from now, to achieve. But whatever the time taken, it will cover a very wide field of interests taking in a large number of people, and to embark on such a reorganisation without a staff commission will militate against a trouble-free reorganisation. It is not only that we want the reorganisation to go smoothly—nobody would gain anything from it being otherwise—but we must speak of this as employers, for I suppose that every one of us in your Lordships' House, as Members of Parliament, stands in that kind of relationship with everybody employed in the NHS, if not legally then certainly morally. The Secretary of State must carry the staff with him, and acceptance of the amendment would assure that, because, as I have said, it is what they want.
I ask the Committee to bear in mind that several groups of different disciplines will be seriously affected by the reorganisation. I understand that they include—and the Minister was perfectly frank about this—the managerial side, but we are thinking of nurse managers, works officers, senior catering staff and several other groups, managerial people who will not find a job very easily in the present or future circumstances at the age they will be if they are deprived of their employment. We must bear in mind that they have given excellent service and have made improvements arising from their own skills. Let

1323
us pay tribute to the people in our employ. By their skill and competence they add to the general efficiency and smooth working of institutions and organisations, and now many of them will lose their jobs. I am sure that the Government are aware of that.
We on this side of the Committee hope that the reorganisation will be achieved in the shortest possible time. My noble friends and I share the view of the noble Baroness, Lady Robson of Kiddington, in this matter. We hope that those who will be displaced will be considered in such a way as to be able to seek employment perhaps elsewhere in the National Health Service, should an opportunity present itself. Those who do not succeed in retaining their jobs should be able to obtain all the advice and help they need. Redundancy and similar matters have to be considered, and in my view and that of my noble friends a staff commission is essential. The staff must know that there is an independent body looking after their interests.
I hope that on this occasion the noble Baroness will show some understanding—I do not mean that unkindly, though I realise that it may sound unkind—because I believe this matter to be of supreme importance. Bearing in mind that we are dealing with flesh and blood, with human beings, I hope that the rest of your Lordships will feel that there must be set up the kind of organisation that we propose which would be in evidence and would give help to those who need it. I beg to move.
4.12 p.m.
Baroness YOUNG: My Lords, may I say at the outset that this is a very important issue that the noble Lord, Lord Wells-Pestell, has raised. It is most useful that at the start of the Committee proceedings we should be debating the whole question of a staff commission and the arrangements that we are proposing for the staff. We accept just as much as does the noble Lord the importance of maintaining the confidence of the staff during this period of reorganisation. The noble Lord asked for a clear and reasonable explanation of what is to happen to the staff, and I very much hope that I shall be able to answer the questions that he has raised and to reassure the Committee on these particular points.
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My right honourable friend the Secretary of State for Social Services has made it clear on several previous occasions that the Government's view is that national staff commissions for the purpose of any National Health Service reorganisation which follows decisions taken on the document Patients First are unnecessary. However, I wish to emphasise that that in no way implies that we are unsympathetic to the understandable anxieties of health service staff, simply because we do not believe that staff commissions will necessarily smooth the path of reorganisation, from the point of view of either management or staff. In fact, the proposed new clause does more than seek the establishment a national staff commission or commissioners; in one particular respect it seeks to determine what advice they shall give to authorities. I shall return to that point.
I recognise that the proposed new clause reflects the wish of NHS staff side representatives that staff commissions should be established, and I take the word of the noble Lord, Lord Wells-Pestell, that that is the wish of the trade unions as well. However there remains the question: are the commissions necessary? No one has argued convincingly that a staff commission should, as the 1974 English commission was, be involved in the actual appointment of individual officers—that is, by shortlisting. Indeed, I have heard criticisms of the 1974 commission's role in this respect and fears lest complex arrangements of that kind should apply again.
So we come to the procedures for appointing staff. For the 1974 reorganisation, the staff side were consulted by the staff commission, following which the procedures were laid down. On this occasion, the staff side have told us that they wish procedures to be agreed between management and staff sides; and we have accepted this. The staff side have argued that discussions and negotiations over the whole range of staffing issues should take place within the ambit of the General Whitley Council. Again, we have accepted this, and taken action accordingly. This leaves only the question of appeals, and all along we have said that we accept the need for an appeals mechanism, if necessary with an independent component.

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In short, I do not think that a convincing case has been made for the need for staff commissions of the kind that have been described. However, I think that the respective positions of those who do and those who do not want staff commissions are not necessarily irreconcilable. There is some middle ground, and we must find it, perhaps by building on the recognition —shared, I believe, by both management and staff interests—that an effective appeals mechanism will be needed to ensure that everyone is treated fairly. Perhaps agreement can be reached in this direction. If members of your Lordships' Committee, and in particular the noble Lord, Lord Wells-Pestell, or the noble Baroness, Lady Robson of Kiddington, wish to give advice on the form that that mechanism might take, I should be very happy to convey it to my right honourable friend as a matter of urgency. The advice could be given in the course of the Committee proceedings, or noble Lords may care to write to me, or perhaps discuss the matter between now and the next stage of the Bill.
now wish to turn to that part of the amendment that would require a commission to advise that there should be no compulsory redundancies, and to confirm straight away that we are anxious that these should be avoided if at all possible. Indeed, there are a number of proposals which are either specifically, or at least in part, designed to see that compulsory redundancies are reduced to an absolute minimum; and if that minimum proves to be nil, then it will be all to the good. First, we think that any reorganisation should be spread over a period of time—and I have already indicated the timescale: this is in part to help with the problems of the staff. That, with sensible recruitment policies in the meantime, will mean that we can count on natural wastage to take care of much of the expected reduction in posts.
Secondly, there are proposals for a premature retirement scheme. Again, I believe that this will have a very significant effect on the picture and, as with natural wastage, will take care of a significant number of posts. Of course, natural wastage and premature retirement are, in a sense, negative ways of avoiding redundancy, and we believe that we must
1326
be positive, as well. There may be people who, because of the changing needs of the service, have certain skills which are no longer needed, but they may have a depth of background knowledge of the service which we would do ill to ignore. In such cases we should use to the maximum any opportunities that there may be for redeployment, and, if this can be helped by retraining, we should see that this possibility is fully explored. I believe that if these measures do not entirely rule out the need for compulsory redundancies they will very much reduce them. But at this stage I cannot give a guarantee that there will be no compulsory redundancy. What I shall say is that terms that we shall offer to anyone who is made compulsorily redundant will be fair, and we are quite ready to discuss them with the staff side.
What is now important is that we should quickly get down to joint management/staff side discussion of these important issues: how posts are to be filled; protection of pay; the terms for premature retirement; and, in the last resort, redundancy. A joint mechanism for these discussions has now been agreed with the staff side—a committee of the General Whitley Council. Offers have been made to the staff side and the first joint meeting of the committee has been held. We have a duty to allay the natural anxieties of those staff whose posts could be affected by reorganisation, by reaching and publicising firm agreements on all these matters.
The Committee may wish to know that, with the exception of pay, which will remain a matter for the functional Whitley Councils, negotiation of the whole range of staffing issues will take place in a special committee of the General Whitley Council. This committee has held its first joint meeting, and is to meet again later this month.
I hope that by setting this out very fully I have said enough to assure the Committee that we do understand the points put so well and so clearly by the noble Lord, Lord Wells-Pestell, and the anxieties of the staff; that we have got agreement about these procedures with the staff side; and that the committees are meeting. I hope he will feel that we have met what I think are the quite natural anxieties as to the proposals that we are making.
Lord WELLS-PESTELL: It is always difficult to take in what people say, and I should like to look at Hansard tomorrow and read carefully what the noble Baroness the Minister has said. But may I ask her whether I am right in thinking that when she says, "We will see" and "We will offer", she means that the Secretary of State, through his representatives, will consult with the staff side of the Whitley Council on all matters relating to staff—the transfer of jobs, the loss of jobs, redundancy or whatever may result from the reorganisation?
Baroness YOUNG: Yes.
Lord SHINWELL: Before the noble Baroness replies in detail, may I say that one listens to a debate such as this without having much knowledge of the subject; but I am bound to say that although the noble Baroness expressed sympathy and understanding and replied to almost every one of the points raised by my noble friend, the one point to which she did not reply, and which concerns me as a listener, is whether my noble friend was justified in asserting that as a result of this reorganisation probably 3,000 people associated with the National Health Service will be made redundant. The noble Baroness said that it was not the intention to institute compulsory redundancy. That is all very well, and she did refer to the possibility of wastage. But the question which really concerns one in a matter of this sort is whether, as a result of reorganisation —and reorganisation, no doubt, is essential —3,000 people are going to have their services dispensed with. I think that question ought to be answered, because I am bound to say that if it is not answered satisfactorily, although it is not my business (I am not on the Front Bench and do not decide matters of this sort) I should like to vote against the noble Baroness.
Baroness YOUNG: I hope that I shall be able to reassure the noble Lord, Lord Shinwell, on the point that he raises. In answering the first debate that we had, on Whether Clause 1 shall stand part of the Bill?, I tried to answer the very question that his noble friend Lord Wells-Pestell put about the numbers of people who might be affected by the reorganisation. The figure which has been quoted is 10 per cent. of management costs; that
1328
is the amount of savings. But the fact is that we cannot give an estimate of the number of jobs which might be lost until we have the reviews of both the structure and the management arrangements, and these have not yet taken place. What I have said is that we do not intend that there should be one appointed day when the new arrangements will come into force, and one of the reasons for this, of course, is to allow time for consultation and for redeployment, and to meet the obvious staff problems that will arise and which, quite rightly, cannot be settled very quickly.
We have therefore, with the agreement of the staff side, set up the joint management-staff side discussions; and I should like to confirm to the noble Lord, Lord Wells-Pestell, that the kind of issues they will discuss are how posts are to be filled, the protection of pay and the terms of premature retirement and, in the last resort, redundancy. I should like to confirm that should there be compulsory redundancies we shall be looking at the compensation arrangements, and in the case of anybody who might be made compulsorily redundant the matter will be discussed with the staff side; and the staff side has agreed to these arrangements. What we want to do is to try to avoid any redundancies, but there will be all sorts of other matters that I think can be discussed, negotiated and agreed. We believe that the time lag between now and the end of 1983 should make a lot of these difficulties somewhat easier, because it gives us time to consult concerning staffing arrangements and to redeploy, and, of course, for there to be some natural wastage, which will also make the situation much easier.
Lord HOWIE of TROON: I am particularly interested in the turn which this short debate has now taken. In answer to my noble friend Lord Shinwell, when he asked how many jobs would be lost and if it were right that perhaps 3,000 would go, the Minister made a reply which related not to the precise question but to the savings in management costs; and I think I am right in saying that she thought there would be a 10 per cent. saving in these. I may be wrong, but it strikes me that part of the saving in management costs presumably relates to the reduction in manpower and

1329
relates to such items as wages, compensation, redundancies and all that kind of thing.
I am really now wondering what thought we can believe has been given to this estimate of 10 per cent. if we cannot be told how many jobs are to be lost. If the number is 3,000, the saving from wages and so on will be £x; if the number is less than 3,000, it will be less than £x, and if it is more than 3,000 it will be more than £x. At any rate, there must be some relation-ship—it may not be precise, but there must be a relationship of some kind—between the savings in management costs, said to be 10 per cent., and the number of jobs lost. I know that the number of jobs lost is only one part of the total savings, but I think the noble Baroness the Minister should go a little further in replying to my noble friend Lord Shinwell.
Baroness YOUNG: I am not sure whether the noble Lord, Lord Howie, was in his place when I was answering the first debate, but at the risk of repeating myself let me say that I do not know where this figure of 3,000 has come from. I have not given it, and so far as I know it is not based on any estimate at all. I am not trying to conceal anything from the Committee; I am giving the Committee all the information at my disposal, and should I find that I have any more information that I can give I will of course come back at a later stage. When I was asked by the noble Lord, Lord Wells-Pestell, how many jobs I thought might be lost, I said that we cannot give an exact figure, but what we can say is that at present there are 251 separate area and district headquarters organisations, and, as we believe that after our proposals there will be between 150 and 180 district health authorities, this means that there will be a reduction of between 70 and 90 headquarters organisations; and it is on that estimate that the figure of 10 per cent. is based.
How many redundancies there might be is quite a different matter, and really would be impossible to calculate for the reasons I have given, because a number of things will inevitably take place in the intervening time while all this is worked out. The assurance I want to give is that we are doing everything we can to
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minimise individual hardship and difficulty: we are giving the extra time in order to help these procedures along; and we have got agreement over this joint cornmittee, which I hope will prove to be successful.
Baroness ROBSON of KIDDINGTON: May I come in at the end of this debate? I probably should have spoken a little earlier. May I say that, personally, I have great reservatons about a national staff commission. I have reservations because I lived through the last re-organisation of this service, when the national staff commission, the shortlisting and the national advertising of the jobs of all the top officers created really enormous problems and, I believe, great hardships for the staff involved in the National Health Service. So I would hope that we would not have a staff commission which undertook duties of that kind. I should have thought that it might be necessary for each regional health authority to have an appropriate organisation within each region to look after the interests of staff and to deal with appeals machinery within the region.
If we are to avoid an enormous up-heaval, we must keep these changes on a regional basis. What worries me is what the noble Baroness said in reply to the question of redundancies; that there would be a 10 per cent. saving, a saving of roughly £30 million. I agree that the figure of 3,000 is a figure that cannot be justified. Until we have carried out the reorganisation of the management structure within each district, we do not know what it will be; but my understanding of the reason for the reorganisation is that it is not to save 10 per cent. on administration, but to create a better-managed health service. I believe sincerely that there will be hardly any redundancies, because we need to strengthen the management at unit level—which is going to take care of the people who in the past re-organisation were pulled up to the top and were not close enough to the decision-making process. Taking account of natural wastage, if we are to reorganise the service so that it is managerially more efficient I do not believe that we are going to have a great many redundancies. We might have a few. Each region should set up its machinery to deal with the problems thrown up in that way.
4.32 p.m.
Lord GIBSON-WATT: Following what the noble Baroness has rightly referred to as her view of the future of the reorganisation—and I speak as one who was closely embroiled in the last reorganisation in the 1970s—I agree with what she says of the unforeseeable difficulties in this particular line that we ran up against after that reorganisation. I do not think that figures mean a great deal, when we are talking about 10 per cent. or 30,000. I would agree with her that that is not the core of the argument. I listened carefully to the excellent speech of the noble Lord, Lord Wells-Pestell, voicing, rightly, the deeply-felt understanding of those who work in the health service. I myself believe that what my noble friend has said about the appeals mechanism is really the core of the matter. I look forward to hearing more from the Government on how this will work out. I would hope very much, so far as Wales is concerned—for that is my particular interest—that there will be a separate appeals mechanism operating in Wales for the seven areas health authorities that exist there. But I believe—and I stress the point made by my noble friend—that when talking about a period of three and a half years, we will have automatic wastage whether or not we like it; we all grow older. The important thing in this, as she has said, is that every single case which is a problem and which could lead to any redundancy should have very special consideration by the special committee of the Whitley Council and by the appeals mechanism to which she referred. I repeat that I look forward to hearing more about that in the future.
Lord AUCKLAND: I rise to support what the noble Baroness, Lady Robson, has just said. I well remember speaking on the 1973 reorganisation Bill in this House—and speaking on it in a highly critical manner. Having served until then on the house committee of a large mental hospital, I have some experience of the problems up to that time and of the problems that have ensued since. This particular clause, as my noble friend has said, is the core of the Bill. The amendment which we are discussing, although it has some shortcomings, is one which I hope the Government will consider further; because the disruptions and the disputes within the health service over both
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Bills have arisen very largely as a result of reorganisation. The hospital management committees were wound up; we had the very large authorities, which undoubtedly served as best they could, but communications within the authorities and within the hospital staff (were they nurses or administrative staff) were not of the best.
I think the main problem of the noble Lord's amendment is this. This commission will presumably cost a fair amount of money to set up. We do not know how many people will serve on it; we do not know how much they will be paid for, presumably, they will have to be paid. Such savings as one hopes there will be as a result of the Bill may be eaten up in the setting up of a staff commission. One wonders how one is going to get over the problem of looking after the industrial relations side during this period of reorganisation. Although I agree that there should be no flexible appointed day, nevertheless I hope, for the sake of the staff and for the sake of the National Health Service as a whole, bearing in mind how much reorganisation there has been, that the period is not over long.
Lord WALLACE of COSLANY: 1 should like to intervene, first, to say that there will be some very agonising decisions to be taken by those responsible for deciding between one officer and another. It is not a pleasant task and I am thankful that I am not involved this time as I was last time. I do not agree with the noble Baroness, Lady Robson, when she says that there will be practically no redundancy. I do not speak from the regional health authority angle, but from the area health authority angle in as much as I was a member of an area health authority for some time. In the present set-up (and some noble Lords will appreciate this point) there is almost a complete duplication, from top to bottom, of the area health authority staff and the district authority staff. That is one of my objections to it. If one takes that into account, even allowing for wastage, there is bound to be considerable redundancy. I am not prepared to put a figure on it. Nobody can. But I would forecast a far higher figure than any of those already given. This is inevitable, due to the structure of the service at the present time.
4.40 p.m.
Lord WELLS-PESTELL: I think the Government must know more than the noble Baroness the Minister is telling us. I have a shrewd suspicion that she is drawing a veil over this. The noble Baroness referred to 251 management teams. I do not know the exact number of staff in a management team, but it is very substantial. She says that at the very most there will be 180 district health authorities, and perhaps as few as 150; but that around 70 to 90 management teams will go. I do not know the size of a management team. It would require only 30 people from each of those management teams to be discharged, and there would be the 3,000 I have been talking about.
I know that there is no point in arguing this matter any further because I am sure that we shall get no more information out of the noble Baroness the Minister. But I do not think that we ought to allow ourselves to be lulled into a sense of false security, supported, if I may say so, by the noble Baroness, Lady Robson, who says that the figure cannot be justified. I am sure that she is not in a position to say it cannot be justified; she can only say that she would be very surprised if the number was as large. I am relying upon the figures that the Government have given: the 251 management teams will be reduced to between 150 and 190. I say that that will mean a very substantial number of people losing their jobs.
4.41 p.m.
Baroness YOUNG: I should like to confirm again that the object of this Bill —certainly this clause—is not to save money. I was grateful that the noble Baroness, Lady Robson, made this point quite clear, because our whole objective in this connection is to get a simplified management structure with better accountability. We believe this is something which will be welcomed by the public and it comes about as a result of our consultative document Patients First.
We have become drawn into the question of costs and savings, quite rightly, because the noble Lord, Lord Wells-Pestell, raised it. Having said we think there will be some savings, that suggests that is the purpose of the Bill. I assure the Committee that is not the case. I should like
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to reassure the noble Lord, Lord Wells-Pestell, that I am not hiding something from the Committee. I wish that I could give the information that he would like. Perhaps I can try another explanation and say that there is no direct relationship between the 10 per cent. figure that I gave of reduction in management costs and reductions in manpower, which is a very important point to make.
The reason why I say this is that the 10 per cent. reduction in costs is in fact our judgment of what we think can be saved as a result of the reorganisation. The fact is that the precise amount will depend on a whole host of local decisions taken within overall national parameters, but on local decisions about the grading of staff and the like. We cannot possibly judge now at this stage what reductions in manpower there might be. For the reasons that I have given, I do not believe that it is a very profitable exercise to go round saying that thousands of people will be made redundant. The noble Baroness, Lady Robson, quite rightly made the point from her great experience in hospitals that there will be a lot of redeployment into more effective organisations. I was glad to have her support that we could well manage our affairs within the structure that has been agreed rather than by having a staff commission.
My noble friend Lord Gibson-Watt made the important point about the appeals machinery. This is a matter on which I have asked the Committee for their views because we have no determined policy on this matter. This is something on which I hope very much noble Lords opposite, the noble Baroness, Lady Robson, or my noble friends Lord Auckland and Lord Gibson-Watt, with their experience, may have something to say. That would be helpful.
Regarding regional mechanism, which was referred to by the noble Baroness, Lady Robson, I agree that there should be regional appeals mechanisms. Indeed, we want as much as possible to be handled at regional level. As I said earlier, we should be grateful for advice on the precise form that this might take. Only when regional mechanisms cannot resolve disputes would we see matters needing to come to some form of national appeal. This is very much in line with what the noble Baroness hoped. Perhaps I might

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confirm that we propose that there should be a minimum of national rules, and that flexibility should be given to regions to apply those rules by local agreement in the way which best meets the needs and circumstances which apply locally. We accept entirely that any variation from the national rules or guidelines should be the subject of agreement of the staff side interests; and, furthermore, that an effective appeals mechanism should be available for anyone who felt that he had been unfairly treated.
I think that I have given to the Committee all the information I have. I should like to give the assurance that if there are other matters they want to raise between now and the next stage, I shall be happy to write to them or meet them and discuss these issues. I should like to get as much agreement as I can over this important matter of staff. We believe that our approach is one that has been accepted by the staff side and therefore
will work helpfully. I should like to reiterate that on this one area of the appeals mechanism on which we have not reached any decisions we would be very glad to hear from noble Lords any ideas they may have. I hope that with those assurances the noble Lord will feel able to withdraw his amendment.
Lord WELLS-PESTELL: I am grateful to the noble Baroness. It is comforting to hear her words. This must be the first Bill that has been introduced into the House of Lords in the past 12 months where somebody on the Government side has said: "The object of saving money is not the purpose of this Bill". I cannot accept what has been said, and I must test the Committee on this particular amendment.
4.47 p.m.
On Question, Whether the said amendment (No. 1) shall be agreed to?
Their Lordships divided: Contents, 57; Not-Contents, 105.

CONTENTS

Aylestone, L.

Hatch of Lusby, L.

Ross of Marnock, L.

Balogh, L.

Henderson, L.

Sainsbury, L.

Beswick, L.

Houghton of Sowerby, L.

Sefton of Garston, L.

Blease, L.

Howie of Troon, L.

Shinwell, L.

Blyton, L.

Hughes, L.

Stedman, B.

Boston of Faversham, L.

Irving of Dartford, L.

Stewart of Alvechurch, B.

Bowden, L.

Jacobson, L.

Stewart of Fulham, L.

Brockway, L.

Jacques, L.

Stone, L.

Brooks of Tremorfa, L.

Kaldor, L,

Strabolgi, L.[Teller.]

Bruce of Donington, L.

Leatherland, L.

Strauss, L.

Collison, L.

Leonard, L.

Taylor of Mansfield, L.

Cudlipp, L.

Listowel, E.

Underhill, L.

Davies of Leek, L.

Llewelyn-Davies of Hastoe, B.

Wallace of Coslany, L. [Teller.]

Elwyn-Jones, L.

Lloyd of Hampstead, L.

Gaitskell, B.

Lovell-Davis, L.

Wells-Pestell, L.

Galpern, L.

Oram, L.

Whaddon, L.

Gordon-Walker, L.

Pargiter, L.

Wigg, L.

Goronwy-Roberts, L.

Parry, L.

Wootton of Abinger, B.

Greenwood of Rossendale, L.

Peart, L.

Hale, L.

Ritchie-Calder, L.

NOT-CONTENTS

Ailesbury, M.

Brock, L.

Ellenborough, L.

Airey of Abingdon, B.

Caithness, E.

Elliot of Harwood, B.

Alport, L.

Chelwood, L.

Elton, L.

Amherst of Hackney, L.

Clitheroe, L.

Faithfull, B.

Ampthill, L.

Clwyd, L.

Falkland, V.

Auckland, L.

Colyton, L.

Ferrers, E.

Avon, E.

Cork and Orrery, E.

Ferrier, L.

Balfour of Inchrye, L.

Cottesloe, L.

Fortescue, E.

Banks, L.

Craigavon, V.

Fraser of Kilmorack, L.

Barnby, L.

de Clifford, L.

Gainford, L.

Barrington, V.

De La Warr, E.

Garner, L.

Beaumont of Whitley, L.

Denham, L.[Teller.]

Gibson-Watt, L.

Bellwin, L.

Derwent, L.

Gisborough, L.

Belstead, L.

Dormer, L.

Glenkinglas, L.

Berkeley, B.

Drumalbyn, L.

Godber of Willington, L.

Bessborough, E.

Dundee, E.

Gore-Booth, L.

Gridley, L.

Marley, L.

Selkirk, E.

Hailsham of Saint Marylebone, L. (L. Chancellor.)

Masham of Ilton, B.

Sempill, Ly.

Merrivale, L.

Skelmersdale, L.

Hampton, L.

Montgomery of Alamein, V.

Soames, L. (L. President.)

Hanworth, V.

Morris, L.

Spens, L.

Henley, L.

Mowbray and Stourton, L.

Stamp, L.

Holderness, L.

Murton of Lindisfarne, L.

Stanley of Alderley, L.

Hunt, L.

Norfolk, D.

Strathcarron, L.

Hylton-Foster, B.

Northchurch, B.

Strathclyde, L.

Kilmarnock, L.

Nugent of Guildford, L.

Swinton, E.

Kimberley, E.

Orkney, E.

Trenchard, V.

Kinnoull, E.

Orr-Ewing, L.

Ullswater, V.

Lauderdale, E.

Porritt, L.

Vaux of Harrowden, L.

Lloyd of Kilgerran, L.

Redmayne, L.

Vickers, B.

London, Bp.

Renton, L.

Vivian, L.

Long, V.

Robson of Kiddington, B.

Waverley, V.

Lyell, L.

Rochester, L.

Winstanley, L.

Mackay of Clashfern, L.

Rugby, L.

Young, B.

Macleod of Borve, B.

Sandys, L.[Teller.]

Mancroft, L.

Savile, L.

Resolved in the negative, and amendment disagreed to accordingly.

Clause 2 agreed to.
Schedule 1 agreed to.
Clause 3 agreed to.
Clause 4 [Power to make grants towards expenditure on services of common concern to health authorities etc. and local authorities]:
Baroness ROBSON of KIDDINGTON Baroness ROBSON of KIDDINGTON moved Amendment No. 2:
Page 5, line 22, leave out from ("which") to end of line 26 and insert ("in the view of the Area Health or District Authority in consultation with the local authority will benefit or assist the public health, health education and welfare of the population within the local authority concerned;").
The noble Baroness said: I rise to move Amendment No. 2 and at the same time I should like to speak to Amendments Nos. 3, 4, 5, 6 and 7 because they are really consequential. I will address my words to Amendment No. 2 but, subject to what happens to that, the rest follows, I believe.
I welcome very much the fact that Clause 4 of the Bill makes joint financing statutory and that it extends its provisions to Scotland. I also welcome paragraph (b), which extends the use to which joint financing can be put to district councils in relation to their responsibilities under the Residential Homes Act 1980. All those things I agree with and, as has been said before, we are here discussing an enabling Bill, which, in the light of the outcome of the consultations on Patients First, will become the basis of reorganisation of the health service.
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To me, the whole ethos of that document, Patients First, is about a return of he maximum of power of decision-making to the local community. This is something with which, as has already been said, all noble Lords in this Chamber agree.
What I am attempting to do in substituting the words in 28A(1) under Clause 4 is to proceed along exactly those lines, to give greater power to the local people and to the communities to decide how they spend their joint financing. I am perfectly aware that a large number of different uses can be made of joint financing under the present legislation, but I am concerned that there seem to be what I think are unnecessary restrictions on its use in relation to local social service authorities. One of these, for instance, is in the field of health education. Health education is perhaps one of the most important things that we should undertake, because it is only by first-class health education that we will prevent unnecessary illnesses and perhaps be able to make sure that the NHS can meet all the demands of the community. Human beings themselves have got to do something to keep fit, and health education is one way in which we can help people to lead more healthy lives.
At present—this happened as a result of the last reorganisation—health education is the responsibility of three separate authorities; the education authority, the environmental health department and the NHS; and probably the largest chunk of it is carried on by the NHS. I believe it is essential that we should bring together in some form these three different authorities. We can do that by using joint

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finance to create something similar to a health education team, and thereby help to pool the resources of the three bodies and achieve a more effective result. If one thinks back to the medical officer of health's department in local authorities, that was more or less what happened.
It would also help to overcome the very fine line between the responsibilities of those various three authorities. This is something on which we cannot use joint finance at the moment. I should, therefore, like greater freedom for local authorities to take decisions themselves on how to use the limited funds that are at their disposal for joint financing.
In my view, joint financing will become increasingly important, because almost everyone now admits that with our desire to try to keep people out of hospitals, to keep them out of long-stay institutions and to keep them out of geriatric homes, we are moving more and more towards community care, and it is in community care where the interaction between local authority social services and the health services is very great.
Our aim should be to keep people in the community. For instance, there are schemes afoot so that attached to a Part III accommodation we might build a small nursing wing, which would enable social services personnel, community nurses, district nurses and health visitors to have a bed to which people, who normally lived in their homes, but who, for some reason or other, needed pure nursing care for a period of time, could be taken.
Under present legislation for joint financing, we can use joint financing money for putting that kind of wing on to a Part III accommodation. But, amazingly enough, under the legislation we cannot add it to a health centre; we can do it only if it is called a hospital. There are a great number of these small, niggling restrictions on how joint financing can be used, which is quite wrong. But they will always exist as long as the rules and regulations on how to use joint financing are laid down from upon high.
The Government are committed to returning power to the community. Here is a perfect example of where, if the joint consultative committees, on which
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both local authorities and health services are represented, feel that a scheme is justified, and they consider that they should use joint financing, that should be enough. Therefore, I sincerely hope that the noble Baroness the Minister will be able to accept my amendment. I beg to move.
5.4 p.m.
Baroness YOUNG: I am sure that the whole Committee has listened with great care to what the noble Baroness, Lady Robson, has said, in speaking to Amendment No. 2 and to the series of amendments. I am glad of the general welcome that she has given to Clause 4 on the joint financing arrangments. The amendment that she has proposed would have the effect of extending the scope of joint finance beyond the personal social services to a broad range of functions, some aspects of which lie outside the responsibilities of local government. Indeed, she herself argued her case on extending the area for joint financing schemes. However, the intention behind Clause 4 is to give legislative expression to the present well-established arrangements known as joint financing.
The purpose of joint financing is to enable health authorities to grant-aid personal social services projects that are likely to be of value in the overall provision of care in the area; thus, incidentally, benefiting also the health services. The words that the amendment seeks to remove contain the statutory definition of the personal social services.
The funds for joint finance are part of those voted for health and personal social services, and the Secretary of State for Social Services is responsible for both. That is one reason why the Government believe it is appropriate for the National Health Service to help fund joint schemes in the social services field, but consider it would not be appropriate to extend the use of NHS resources in the way that has been suggested.
Perhaps I might take the example to which the noble Baroness referred of health education, which, indeed, is singled out in this amendment. In addition to the activities of the Health Education Council and those of the health authorities themselves, both of which are funded by the Department of Health, aspects

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of health education are carried out by local education authorities, the Department of Education and Science, the Department of Transport on such matters as road accidents, the Department of Employment regarding safety at work, the Ministry of Agriculture, Fisheries and Food on various nutritional matters, the Department of the Environment on health education with regard to sport and so on. It would be difficult to accept that National Health Service funds should be used for all of these matters.
The position in the public health field is that collaboration between local authorities and health authorities is already very close. The functions previously exercised on behalf of local authorities by the medical officer of health are now, following the reorganisation of local government in 1974, generally undertaken by an officer of the health authority appointed for this purpose by the local authority—usually a community physician.
Legislation specifically requires the Secretary of State for Social Services to make available the services of staff and facilities to enable local authorities to discharge their functions relating to public health. In these circumstances, it seems unnecessary to have to consider depriving the social services of any of the limited joint finance available to them.
The trouble with the term "welfare", which is included in the amendment, is that it does not have a generally agreed definition and could embrace a variety of matters, including social security. It is, however, often used to mean the personal social services and in so far as it does the clause, as it presently stands, enables joint finance to be applied to those services.
Even restricting consideration to matters which are specifically the responsibility of local government, there are clearly many fields with a health dimension where the health services can benefit from joint planning and collaborative effort. Such collaboration has increasingly been a feature of the work of the joint consultative committees, and we very much hope that this will continue and expand.
However, acknowledgement of such interdependence is not a convincing reason for using National Health Service and
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social services resources to fund the responsibilities of others. I think that the Government's position on this amendment is aptly summarised in paragraph 2.7 of the Report of the Royal Commission, which said
"The National Health Service cannot cover the whole field".
It may be helpful to the Committee, if I add that we recognise that joint finance, provided with a statutory basis as it is by this clause, has a very useful part to play in assisting the continued development of the personal social services and in enhancing collaboration at local level. In recognition of this, my right honourable friend has said that the amount allocated to joint finance will be gradually increased over the next few years.
5.10 p.m.
Baroness ROBSON of KIDDINGTON: I am very grateful to the noble Baroness for her reply. When I suggested that the use of joint financing should be extended, I apologise if I gave the impression that I thought it should be extended to all the fields which the noble Baroness mentioned. I thought that freedom to use joint financing should be extended, so long as there was agreement by the JCC. The JCC consists of representatives, members and officers of the health authorities and representatives, members and officers of the local authority. I should have thought that the knowledge that members of a health authority have of the limited funds available would mean that the way in which they would agree to money being used for the improvement of health education and welfare—I agree that "welfare" is a difficult word to define—within their local community was in safe hands.
I was hoping that, somehow, in the introduction to this Bill we could remove many of the restrictions that hamper people when they are trying to perform services to the community. I am sorry that the noble Baroness cannot accept the amendment. I shall read with interest exactly where I went wrong and perhaps will move a similar amendment on another occasion. In the meantime, I withdraw it.
Amendment, by leave, withdrawn.
The DEPUTY CHAIRMAN of COMMITTEES (Lord Derwent): I take it that the noble Baroness is not moving Amendments Nos. 3 to 7?
Baroness ROBSON of KIDDINGTON: No, 1 am not.
[Amendments Nos. 3 to 7 not moved.]
Clause 4 agreed to.
Clause 5 [Power of health authorities, etc. to raise money etc. by appeals, collections, etc.]:
On Question, Whether Clause 5 shall stand part of the Bill?
Lord WALLACE of COSLANY: We oppose Clause 5 as we feel that it is completely and absolutely unnecessary. Considerable fund raising activities are being carried out all over the country by voluntary bodies such as leagues of friends and other organisations. There is evidence that such efforts are extending into the field of providing not only comforts at Christmas and so on but also—and this is very important—urgently needed equipment. Because of the financial limits imposed upon health authorities, they are not permitted to spend money on such equipment at this time. Why encourage health authorities to engage in efforts to raise additional finance when, let us face it, their major duty is to ensure the efficient administration of the health service? This work is being carried on by voluntary effort, at no cost to the health service. Therefore I repeat: why engage officers, and it may be quite a number, in fund-raising efforts when their primary duty and obligation to the health service is to see that it is managed efficiently?
Furthermore, and this needs extremely careful consideration, the effect of fund raising efforts organised by officials of a health authority could be to dampen down voluntary effort. The great value of leagues of friends, apart from their fundraising value, is the involvement of many people in the community and the creation of a relationship not only with the hospital but also with the staff and patients.
I mentioned this point during my Second Reading speech, and I invited noble Lords to come along to a fête in
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which I had a certain interest. I can say that the result of that fête, on a rotten, wet Saturday afternoon, was a net profit of over £4,200. My experience at that fête was remarkable, considering the weather. There were happy crowds of people at the fête. When I say "happy", I mean that I did not meet a miserable person. What is more important, the staff—the nurses and others—were running stalls and taking part in the effort, bringing some of the elderly patients around in wheelchairs. Most sensational of all, I found a chamber orchestra performing most beautiful pieces of music. When I inquired of the senior nursing officer where they came from she said, "They are our medical staff". This was a completely happy relationship.
May I put it this way: I doubt whether rank-and-file hospital staff would cooperate if it were a fund-raising function organised by officials of the health service and the hospital. Nor do I think that we should get the same community commitment and the involvement of so many people.
I appreciate that the Government intend the provisions of the clause to be permissive, but it is, in a sense, an encouragement direction. We are given a very vague indication of the sort of money raising activities that are envisaged. I think it was the noble Lord, Lord Cullen of Ashbourne, who gave us a list which was reminiscent of a little function run by the Mothers' Union—the sort of stuff that is part and parcel of friends' activities. And they do much more than was mentioned.
This is a very important point. What are the officials going to be involved in? We have to be very careful, and there has been a request for guidance. All the guidance that we have had so far has consisted of extremely vague assurances from Ministers, both here and in another place. We have had a vague assurance that there will be no striptease dancing—and that, I am pretty sure, will disappoint some noble Lords. There will also be no topless go-go dancing. I have no idea what go-go dancing is, but I have a vague idea of what "topless" means. There are many other things like that. Apparently, there will be no pop music; we do not know for sure, but this is what we are vaguely told.

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There are other important things which should be included in the guidelines. Let us suppose that the district health officials decide that there should be a fête. That is all right, but there is nothing here to indicate that the Government must insure the fête, otherwise public money may be wasted in organising it. But when fêtes are organised by volunteers, they take that in their stride. It is beyond my capacity, with so many lawyers in this noble House, to explain in detail the legal complexities, but what about all the legal complexities of running fund-raising schemes? We do not want a district health official to be pinched and brought before the courts for having contravened a certain regulation, simply because the Government want him to indulge in fund raising.
I am not joking about this. These questions have to be thought about, and quite clearly the Government have not given thought to this. It is a great idea to start fund-raising to help the health service but it is already being done in a better spirit than it will be done by officials. I am serious about these guidelines. If the clause is passed, then these guidelines must not only be published and made available but they must also be approved by both Houses. They must be made available to every authority before they start so that they know where they stand. If not, there will be plenty of dangerous pitfalls ahead.
The clause refers to encouraging the gift of money or property in trust. How will this be done? Again I am not joking, because this is quite a possibility. One can foresee some enthusiastic official getting posters done and put up in hospitals on these lines:"Have you made a will? Don't forget your hospital". A nice sort of greeting for someone coming in for a major operation! The noble Baroness laughs, but some enthusiastic official might do just that, or something very similar. So that is the sort of thing that we must be careful about.
How will these gifts of money and other property be encouraged? What is in the Government's mind (if anything) and is it really necessary, when already considerable numbers of people and families are doing this by means of their wills and gratitude gifts are not unknown. In fact
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they are common, for the saving of a life or the birth of a child. At a maternity unit with which I have had very close connections (my grandson was born there) and which is a very important place to me because I have fought for it over many years the staff are suggesting to people who wish to make a present—always when a baby is born everyone seems to be happy and there are usually boxes of chocolates and so on for the nurses—"If you want to say 'thank you' give us a donation for the new foetal units which we are trying to purchase". These are units which can preserve a baby's life and ensure that it lives a healthy life, even before it is born. A number of people in my area have already donated considerable sums of money towards this end, although I do not know whether it is approved by the department, we are encouraging parents and grandparents of new born babies to give something towards these units.
I really cannot understand this proposal. The point is that this is already going on. Is it not beneath the dignity of the National Health Service for this system of special pleading, officially directed, to be included in Government legislation? I really do not like it. People are willingly responding to voluntary effort, and I am pleased to see it because whatever official direction there is of any Government service, be it the health service, education or anything else, voluntary effort is a very good ally to have, and the health service already has it, as the noble Baroness Lady Macleod of Borve said, in Bethnal Green and in a wealthy area that she knows. The enthusiasm is there: do not negative it by bringing in official schemes when the officials should be otherwise engaged.
Let us face it, official money-raising does not get the same result as voluntary effort. I quote the example of local government lotteries, which are not included in this clause; at least we have had some vague indication although nothing official. But they have been an absolute flop. The clause has many subsections which are not necessary in any case. The use of the health authority land, for instance, for fund raising; that already happens. We had our fete on hospital land last Saturday week. It goes on everywhere—why put it in the Bill? It is absolutely useless. Then there is

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property and money held in trust. Good Heavens! That has been going on for years. One of the problems of re-organisation is the passing over of trust funds. Why burden legislation with the useless and the unnecessary?
This clause is wrong in principle; it would be wrong and divisive in practice. It is vague and indefinite; it is completely unnecessary, it is completely useless and should be withdrawn from the Bill.
Lord WINSTANLEY: It may be helpful if, before the noble Baroness the Minister replies, I make it clear that we on these Benches have no very special fears about Clause 5, although I take the point made very clearly by the noble Lord, Lord Wallace of Coslany, with regard to the possible effects of official action on voluntary activities by friends of hospitals and people of that kind. I share that possible anxiety although I cannot go with him in his fears that the area health authorities might dream up highly imaginative schemes and launch into extreme eccentricities with regard to strip shows, and so on. Indeed, if I had any fears it would be that they would be perhaps too little imaginative rather than too much!
Lord WALLACE of COSLANY: I did not say that. What I said was that vague assurances had been given in another place that there would be no topless go-go dancing and no striptease shows. I am sorry; the noble Lord might be interested, I am not.
Lord WINSTANLEY: Let me move on. I have risen before the noble Baroness replies merely because there is one point on which I should welcome a reassurance. This is a matter which was raised at Second Reading and it is one on which I think fairly positive reassurances were given. Nevertheless, I believe it would be helpful to your Lordships' Committee if we could be reassured again on one particular point. I should not like to think that there was any possibility whatsoever of a health authority that was particularly successful in raising money by these means later being penalised because consideration of its finances was taken into account by Government in allocating resources of another kind.
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It would be helpful if we could have reassurances on that specific point before we dispose of this clause.
Baroness MACLEOD of BORVE: I must apologise to the Committee for not being in my place when the noble Lord, Lord Wallace of Coslany, started to speak. I must tell him that the annunciators in the dining-room were not working and as I was having my first meal of the day I had no means of knowing that he was speaking.
In 1948 when the appointed day came and the Minister brought into being the National Health Service he said quite categorically that no officials of any sort were to help in any way with fund raising. Over the years that prohibition has been relaxed more and more until now the Leagues of Friends—as the noble Lord has said, I have the honour to be national chairman of the 1,080 leagues of friends—nearly all have an official of the hospital on the board. They have a matron, if there is a matron, or otherwise perhaps a No. 10, or they have the Administrator. They have somebody from the official side of the hospital, so inevitably when the subject of fund-raising comes up those people help. From those people down to the nursing staff, they now all help to raise money, as the noble Lord has said.
However, when it comes to the vast sums of money which this Part of the Bill will enable the authorities to ask for, in my view that is a very different thing altogether. For instance, it is within my knowledge that two of my friends happen to be chairmen of very large hospitals which need a great deal of money; so much so that each one of them is attempting to raise £5 million. There is no way in which an ordinary small league of friends, however hard it worked, could possibly provide that shortfall. Therefore I certainly support Clause 5, because it will enable people, whatever size of hospital they support, to be backed up by the authorities in the hospital.
One thing I should like to stress is that, with the network we have built up throughout the country of very good voluntary work, such as has been spoken about by the noble Lord, Lord Wallace, it would be a thousand pities if the authorities did not consult with, take

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notice of and act in co-operation with, the voluntary bodies in their neighbourhood. Of course, I speak primarily for the League of Hospital Friends, because they are specifically for hospitals, but there are many other voluntary organisations within the ambit of the local hospital who would like to come in if the authorities asked them to do so. As we all know, money is not easy to get, but I think that if they work together and never oppose each other then the health service can be enhanced by this clause. I am quite certain that the Minister is right and I would go so far as to say is very imaginative, in my view, in putting this clause in. I think it will be welcomed by everybody, certainly, as I said, on my side, so long as the good will of voluntary people—who work so hard to provide amenities of all sorts, from bedsocks to chapels, from lifts to golf courses, for psychiatric hospitals; everything for their hospitals—is not in any way dampened. I am quite certain it will not be dampened by this clause, and I certainly support it.
Lord PARRY: Before the noble Baroness replies, could she assure us that there will not be competition with existing large charity organisations which fund such activities as those of the Spastics Society and other bodies, and that we shall not see competition on a fairly grand scale for such funds as might be available?
Lord AUCKLAND: I approach this clause with some misgivings, although I think, broadly speaking, bearing in mind that we are living in an inflationary era, nationally and internationally, that the clause is necessary. But in the last analysis it is the voluntary effort, the voluntary contribution, which not only raises the funds but raises the morale. My noble friend, Lady Macleod, mentioned the leagues of hospital friends, of which she is the very distinguished national chairman, and I know from experience what excellent work the leagues of friends do, particularly in the long-stay mental hospitals. They provide teas for long-stay patients and parents and other relatives on Sunday afternoons. In fact my wife and I have in the past helped out in these various functions. So I think it would be a great pity if the voluntary spirit of raising funds was lost. At the same time, as my noble friend Lady Macleod said, very often the matron or
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the chief nursing officer is on the committee of the league of friends. This is certainly true of the hospital with which I used to be associated. Indeed the hospital secretary comes along and helps.
So already one has teamwork between what one might call the voluntary side and those who are remunerated. Provided there is this spirit of co-operation, I do not think that the fears of the noble Lord, Lord Wallace of Coslany—who has had, I know, vast experience in this field, and his speech was one of the greatest importance—should really materialise. For example, to take another sphere, again in the hospital with which I was associated and of which my noble friend Lord Grenfell, so revered in this House, was a very respected chairman of the hospital management committee, Queen Mary's Carshalton, there were cricket matches every summer between the patients and the staff and the hospital officials, the hospital boards; there was nearly always a raffle or something. They raised funds and they certainly gave pleasure to all concerned.
We hear a lot of complaints, I think quite rightly, about the entertainment of very important persons at hospital functions which have to be borne at the expense of the hospital and ultimately by the National Health Service. Particularly in the hospitals in the grey areas where there may not be the funds available, where the league of friends with all their efforts perhaps will not be able to raise the money; let there be (and clause 5, as I read it, will enable this) co-operation between the league of friends and other voluntary bodies and the secretary and officials of the hospital, if I may use that rather dogmatic term. This would fulfil the needs of this clause, about which I must say I am not happy, chapter and verse. I think the principle of the clause is right, in that at a time when raising money by voluntary means is far from easy it will enable albeit a relatively small sum of money to be raised in some areas. Provided it is properly supervised, provided it is kept within the ambit of the law, it will help the financially ailing parts of the National Health Service.
Lord SANDYS: We have had a very interesting debate on this important clause. I should like to begin my remarks with a reference to the speech of my noble friend

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Lady Young at Second Reading, in which she said that as we originally saw this provision it was one of the more minor ones, important but not as important as other clauses in the Bill. She pointed out that authorities already have power to receive, hold and administer trust funds. This point was referred to by the noble Lord, Lord Wallace. These include unsolicited donations and expressions of good will, and the noble Lord referred to gratitude gifts by patients, the results of the work of Leagues of Friends and similar bodies. Although this income is small in relation to central funds, my noble friend suggested that these contributions have an importance out of all proportion to their relative size. Even small sums or items of equipment can be of great value at local level. Fund raising also brings the local community closer together with its hospital. This point was constantly referred to by noble Lords on all sides of the House.
I should like to point out that although the noble Lord, Lord Wallace, ended his remarks by saying that the clause was useless and unnecessary, he paid considerable currency to the value of fund raising in its present context. The Government's contention is this. It is a permissive power, and I think the noble Lord agreed with it. He also agreed that there was no sense expressed in the Bill that local health authorities would be compelled by pressures of one sort or another to make use of it. The Government's contention is that it is supplementary and I think that as such it is a very useful supplement.
The new power is a modest extension of existing ways in which the NHS can draw on voluntary funds. The reaction to this clause—or as we see it, from the Government's point of view the overreaction—of the Party opposite in another place in Standing Committee probably illustrates, better than any other part of the Bill, the differences between us. However, I think that the discussions in your Lordships' House have been of a more fruitful nature. This debate has demonstrated that we all want to see the NHS thrive. The difference between us is the means by which that should be done.
Although the Party opposite remains opposed in principle, noble Lords opposite
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have been rather more restrained than some of their more vocal colleagues in another place, remembering of course, that discussions in Standing Committee "G" occupied a considerable part of the procedures. I have spent considerable time examining this matter and I shall refer to one particular passage later.
There are two main reasons why we are giving authorities power under this clause. The first is to enable the NHS to supplement its existing resources; the second is to allow authorities to make better use of the present voluntary funds. I should like to refer to the speech by my honourable friend the Parliamentary Secretary in another place at column 569 of the Official Report for Standing Committee "G" on 13th March. My honourable friend Sir George Young said:
"A main reason for giving authorities a direct say in fund raising is to enable them, if they need, to deflect appeals for ordinary funds away from glamorous appeals for equipment for acute services. But it is not sensible to restrict their discretion to use the power only to assist with any of their functions. That would be cumbersome. We must allow authorities the maximum flexibility".
That is the Government's intention. We believe that in that sense authorities will be able to make better use of funds and to avoid the problem referred to in Standing Committee; namely, the problem of the purchase of white elephants.
I am sure that noble Lords have seen in the Official Report of the Standing Committee the particular examples that were given, and I need not go into that matter any further. At a time when public expenditure is necessarily being curtailed it would be foolish to do otherwise. As my honourable friend the Parlimentary Secretary said in Standing Cornmittee "G" at column 739:
"The demand for health care is infinite and resources are not. No Government ever has been or ever will be able to find all the resources to meet the needs of the Health Service. Voluntary funding is a useful supplement to central resources".
We recognise the reality of all this, and this clause is a modest measure designed to help the NHS close the gap between resources and demand. It in no way undermines our commitment to see the NHS properly funded. On this point I can do no better than once again to quote my honourable friend in Standing Committee when he said, at column 542:

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"We hope that substantial sums will be raised, but that in no way undermines our commitment to see the NHS properly funded, any more than the present power to accept and use voluntary contributions has undermined any previous Government's commitment to the NHS".
Nor will the raising of funds under this power be used to reduce centrally allotted funds. Here I come to the point made by the noble Lord, Lord Winstanley, and I was very glad that he raised the point.
In his closing speech on Second Reading, my noble friend Lord Cullen of Ashbourne reiterated the categorical assurance given by my honourable friend Sir George Young in another place that money allocated from the centre would not be reduced by amounts raised under this power. I should like to repeat that assurance. The precise reference, for the noble Lord, Lord Winstanley, is column 710 of the Official Report for Standing Committee "G", where it says:
"I would make it absolutely clear that I, the Minister of State and the Chancellor of the Exchequer have no intention of reducing the amount of money allocated to the Health Service by the amounts raised under this new power".
I feel sure that that will satisfy the noble Lord.
It would clearly be completely counterproductive to make such reductions. There would be no incentive if it were known that for every pound raised by voluntary means a further pound was taken off by the centre. The power is there if local health authorities want to use it: no one, as I said earlier, will compel them to use it. We are merely saying to authorities: if you want to draw directly on local good will then you are free to do so.
Much of the discussion on this clause has centred on the activities in which authorities are likely to engage when they use the power. There was some wild speculation on this matter in another place which I would not dream of dilating or digreesing upon. Perhaps I may draw your Lordships' attention to particular aspects which have been raised in your Lordships' House. The question of lotteries was raised, and I think that the noble Lord, Lord Wallace of Coslany, would like some guidance on this matter. Perhaps it would be more useful if I were to begin by mentioning that the Government will be issuing guidance to health
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authorities regarding the exercise of their fund-raising power. I can give the noble Lord, Lord Wallace, the assurance that guidelines are currently being prepared and will be made available to the House in due course. I can give noble Lords an indication of the subjects to be covered. The guidelines will explain our intention behind this provision, emphasising our belief that voluntary funds are a valuable supplement to Exchequer funds and we think that health authorities should have power to engage in voluntary fundraising using the usual types of methods adopted by fund raisers.
The guidance will set out very clearly what fund-raising activities are permitted, and that will cover advice on three main types of activity: first, those not included in the type permitted in the clause—that is to say, moneylending, property speculation or trading activities; secondly, those such as large-scale lotteries, bingo evenings and gambling which are barred by other legislation—and I shall come to that aspect in a moment; and thirdly, those which, although they do fall within the general type set out in the Bill, are considered unsuitable for the NHS. Where there are difficulties they are likely to occur in relation to the third category. But whenever an authority is in any doubt about the legality or suitability of any activity, we shall suggest that it consults us or legal colleagues. The Secretary of State's reserve power to prohibit any activity which he considered unsuitable will be explained. I do not know whether your Lordships would like a lengthy explanation on lotteries. I shall certainly give such an explanation if the noble Lord wishes.
Baroness PHILLIPS: Before the noble Lord moves to that matter, does he know whether these activities would be subject to all the other restrictions which other people have to undergo; for example, having to pay VAT on tickets for an entertainment? There is also the question of produce. If they are going to sell jams in order to raise money for the hospital, that may be condemned by the public health authorities. But I suppose that that may be one way of stimulating customers in the hospital. The matter is not simple at all. Any of us who indulge in money-raising know that you suddenly run into many different regula-

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tions and, indeed, laws. One wonders whether, because this is an official authority, they will be subject to the same problems. Perhaps the noble Lord does not know, but it is a very valid point for anybody trying to raise money.
Lord SANDYS: I am glad that the noble Baroness, Lady Phillips, has raised these matters because they are very practical and important matters. In general terms there will be no exemptions because, of course, much prior legislation covers the matters which she has raised. A question was specifically asked in your Lordships' House—and I do not have the reference under my hand—in regard to jam, which I think my noble friend Lord Cullen of Ashbourne answered a short time ago; he dealt with that important matter.
With regard to lotteries, I think that it would be useful at this point to say this. We shall be considering separately whether to give health authorities power to run "large" lotteries. The main legislation is the 1976 Act, and if health authorities were to have this power, it would be done via amendment to this legislation, the House having the opportunity to consider it in the proper context. The Home Secretary already has the operation of the Lotteries and Amusements Act 1976 under review, following the report of the Royal Commission on Gambling, which the House debated on 29th October 1979. This is a complex Act, and it seems right that its scope should not be extended while the review is in progress. Health authorities may, of course, benefit from the proceeds of lotteries organised by hospital leagues of friends and other bodies who may register as societies under the 1976 Act. I should like to pause in my argument on lotteries and thank my noble friend Lady Macleod of Borve for all her remarks on behalf of the league of friends of which she is, of course, the national president.
Baroness MACLEOD of BORVE: I am the national chairman.
Lord SANDYS: Of course, I beg my noble friend's pardon. It is very important that all the comments made by the leagues of friends in this regard are taken into account. I should like to turn
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to bingo and gaming, because this has been mentioned both here and in another place. The clause would permit bingo and gaming machines only where these were merely a small part of a larger activity or entertainment and not the main attraction. These activities or entertainments are what are defined as "exempt entertainments" in the Lotteries and Amusements Act 1976. One of the main conditions for bingo at exempt entertainments is that it is not the only or only substantial inducement to persons to attend. We can see no objection to bingo in these circumstances.
This Bill does not, therefore, give authorities power to instal fruit machines en masse or permanently to run bingo evenings. Health authorities and statutory authorities can only do that which the legislation allows. The legislation which deals with gaming and bingo requires those who want to do either to form themselves into societies or clubs and then apply for a licence. In other words, it corroborates my earlier remark that the normal restrictions apply.
I have dealt with gambling at some length, and I hope that I have clarified, to a limited extent anyway, the queries raised by noble Lords. We shall also give clear advice on the potential pitfalls in fund-raising; in particular we shall emphasise the unsuitability of any sponsorship of events by companies concerned with cigarette manufacture. Reference was made earlier to strip-tease dancing and go-go topless dancing. I do not know whether the noble Lord, Lord Wallace of Coslany, would like me to say a little more on that subject.
Lord WALLACE of COSLANY: Please do not. It is highly embarrassing. I do not want to be involved with it. I was just pointing out that in another place the Minister gave great assurances, which I am sure will upset some Members, although they will not upset me.
Lord SANDYS: I hope that the assurances were clear. In the case of strip-tease dancing, perhaps I may say that this activity will not be used either directly or indirectly by health authorities or by agents acting on behalf of health authorities as a method of raising funds

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or as a method of attracting members of the public to attend fund-raising activities. Perhaps I have said enough in that regard.
The guidelines will deal at length with the question of National Health Service staff involved in fund-raising. I think that that point was raised by the noble Lord, Lord Wallace, who felt that officials might be spending time, either unnecessarily or time which could be better used in other spheres. We shall make clear that while preparation of fundraising events may become part of the normal functions of some staff, no member of staff should be under any obligation to participate in fund-raising activities as such. We shall also advise on the need for tact and discretion in any involvement of patients or their relatives. Activities such as ward collections will not be permitted. There was a reference to that in another place, which I think caused some anxieties, and I should like to give that assurance now.
The guidance will explain in detail the technical provision relating to the raising and administration of funds. It will emphasise the need for the aims of any appeal to be clearly stated at the onset, along with any secondary purposes. This should give a clear indication of the use to be made both of any excess funds raised and of funds raised should the appeal fall short of the amount needed for the main purpose.
I hope that my reply has been sufficiently full. Equally, if it has been too full, I apologise to those whom I have wearied among your Lordships, but in view of the interest expressed in it in another place and in your Lordships' House, I think that it was justified.
Lord PARRY: As the noble Lord is about to sit down, despite the fact that his full reply was very full, may I remind him that he did not give an assurance that the Government had considered the efforts of major fund-raising sources which are already making contributions to the health service. I am sure that the reply he has given has assured my noble friend, Lord Wallace, that his fate will not become a fate worse than death. I should appreciate an answer to my question.
Lord SANDYS: In reply to the noble Lord, Lord Parry, I am afraid that I can-
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not give him the assurance he seeks because competition will almost inevitably take place between fund-raising activities undertaken by health authorities and other bodies. As he will well know, it is very difficult to co-ordinate both dates and events within a pattern within the existing structure. Very often national charities are concerned with quite different purposes, other than hospitals. I agree with him in the particular case that the need for some local liaison or co-ordination would be highly desirable, but I cannot give him the assurance he seeks.
Lord WINSTANLEY: I should like to press the noble Lord a little further on the point I raised with him and to which I know he referred. In quoting Ministers in another place, I understood him to say that there was no question whatever of funds allocated to the National Health Service being reduced in respect of funds raised in this way. That I fully accept. My question was a rather more specific one. If an individual health authority is unusually successful and raises a large amount of money itself as a result of its own initiative or the generosity of the people who live in the area, is there any question whatsoever that that particular health authority might be penalised in its requests for funds out of the gross allocation to the National Health Service? This is a slightly different and much more specific point.
Lord SANDYS: It is clear that the situation as I have described it is fulfilled. The noble Lord may be referring to the activities of the Resource Allocation Working Party in this particular context. I think I can give him the assurance that money raised in the particular context we are discussing under Clause 5 will be sacrosanct.
Lord PLANT: Could the Minister give us an assurance that very specific guidelines will be issued to hospital management committees and local authorities who are running lotteries that they should not put undue pressure on patients, and in particular patients in emergency wards or out-patients, to purchase tickets and to make subscriptions to these money raising funds?
Lord SANDYS: I do not know whether the noble Lord, Lord Plant, was in your

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Lordships' House when I mentioned this particular aspect. I apologise to him if I did not make it sufficiently clear. I am quite sure that the guidelines will be sufficiently specific for his purpose and will express those sentiments.
Baroness MACLEOD of BORVE: May I ask my noble friend to specifically tell us that the Minister will also issue guidelines to authorities asking them specifically to consult all the voluntary bodies when they are asking for local money?
Lord SANDYS: The noble Baroness made her case with the adverb "specifically" twice. I will certainly pass on her suggestion to my honourable and right honourable friends and hope that this will give satisfaction.
6.2 p.m.
Lord WELLS-PESTELL: The only thing I can say about this clause is that in my view it is a most unfortunate one in this particular Bill. I understand it—by that I mean that I understand its inclusion, because it follows and flows from the philosophy of the Government. The philosophy is that if you can get money in order to reduce expenditure, then do so by all means.
I know that the noble Lord has said that his right honourable friend the Under-Secretary of State in another place has given an assurance that in no circumstance will any money obtained from any activity that one finds mentioned in the clause be used in such a way as to—shall I say?—cause the Government to give less money to the particular authority. But I must remind the noble Lord that we cannot trust the Government. We cannot trust the Government's word. The Government, before the election, were going to increase child benefit. They were going to do a whole lot of things which they have not done.
Baroness YOUNG: I am sorry, but that is not true. The Government are going to increase child benefit from next November.
Lord WELLS-PESTELL: But we are talking about last November. We are talking about last April.
Baroness YOUNG: If I may return to the question of child benefit, which is rather wide of the Bill, it was increased in the April immediately preceding the time when we came to office in the succeeding May, and the increase in child benefit of 19 per cent. will keep up with the rise in prices.
Lord WELLS-PESTELL: That was done by a Labour Government. If the noble Baroness will look at some of the election promises, she will find that there was a promise made that it would be increased either last November or last April. That promise was not fulfilled. It was not the only one. If I am a little sceptical about the assurance that has been given by the noble Baroness's right honourable friend in another place, then have every reason.
However, it is not so much that which concerns me. It is that we, on this side of the Committee, believe that this should be the responsibility of the people, as personified by the state. The health service should be provided by the people through the Government. I see in this, if not immediately, an attempt to make local hospitals, not self-supporting—they will never be that—but to some extent contribute eventually towards their own support. It may well be that it is not the intention of the Government to do so immediately, but that is the intention and we shall be moving backwards to the time of the voluntary hospitals, as this country has gone back to the 1930s since we have had this Government. This provision will lend the opportunity to do so.
I want to deal with one or two specific points. First, if health authorities are going to raise money for special types of equipment, who is going to lay down what those special types of equipment should be? We know that a number of local hospitals are raising enormous sums of money to buy scanners. This is perhaps a highly desirable thing to do. But what they forget, or what they do not take into account, is the enormous upkeep of a scanner; the amount of money that has to be found to maintain it and work it in the course of the year. It is not so much buying the initial machine, it is its upkeep. I want to know who is going to lay down what kind of equipment can be bought.

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There is a tendency these days for hospitals to want to enter the field of some kind of dramatic surgery. When I was appalled to find how few consultants who are specialists in rheumatology have merit awards, and yet there are probably far more people in this country suffering from one form of rheumatism or another than from any other disease. It is not one of these dramatic things. It is not one of these things which bring you a lot of advertisement. There is no glamour attached to it. I am concerned about who is going to lay down the type of equipment that is bought and who will make those decisions.
I am concerned also about another side of it. I was glad that the noble Lord went at great length into the question of lotteries. He said that there will be no intention of putting in a large number of fruit machines. The implication of that is that the Government will approve of some being put in.
Lord SAN DYS: I wonder whether I could just quote what I said, and put the noble Lord right here. What I said was that this Bill does not therefore give authorities power to install fruit machines en masse or permanently run bingo evenings.
Lord WELLS-PESTELL: It does not give the health authority power to put in fruit machines en masse, which by implication means it can put in some. There is a serious principle here, and that is the whole question of gambling,with which the Government ought not to be associated. It is one of the worst possible social evils that we have in this country today.
A noble Lord: Bingo!
Lord WELLS-PESTELL: I did not say bingo; I was talking about gambling and, in particular, fruit machines and the like. It is highly undesirable that the Government should allow themselves to enter that particular field. When they come to consider what they will permit and what they should not permit, they certainly ought not to permit anything which can really come under the term of gambling as it is understood at the
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present moment. I am not talking about buying five tickets for a shilling for a bottle of whisky. I am talking about the more serious forms of gambling, with which I do not think the Government ought to be associated.
Another point is this. What if the income from trusts and lands and that kind of thing is so great that it mounts and mounts? Have the Government thought of that? Hospitals may be situated in fairly well-to-do areas, where people may leave a tremendous amount of money on trust to them, and a good deal of property that brings in a fair amount of money which cannot be spent. That situation could well arise and the money accumulates and accumulates. What happens to that? I am not saying that the income will ever exceed the needs of the hospital, but it could provide a colossal sum of money. Are we to understand that the Government will not step in and say, "Well, this was raised on behalf of the National Health Service, albeit for your hospital, but as there is so much money to spare and it will not be needed, then it goes into some central pool?"
I hope that the Government will look very carefully at this clause, because I believe there are more difficulties associated with it than would appear on the surface. I believe there is a very serious and important principle involved here in the Government associating themselves with some forms of what I would call pernicious gambling.
Lord SANDYS: Of the two points the noble Lord has raised, first of all I should like to clear up the question of the administration of trust funds. In my opening remarks, I quoted my noble friend Lady Young in this regard, because in her speech on Second Reading she pointed out that authorities already have power to receive, hold and administer trust funds; so this would be handled in the normal way. In regard to the special types of equipment, I made a specific reference to the problem of unsuitable purchases and I mentioned white elephants. One reason why we are giving power to authorities is because it is they who know whether they can afford the consequences of their purchase. In this context, the noble Lord, Lord Wells-Pestell, mentioned the cost of maintaining a scanner. As I have said,

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this will avoid white elephants, and I think it is an important point that expensive equipment should lie idle, collecting dust. I am very glad the noble Lord raised this matter. We believe that it is catered for. There will be no specified list of equipment. The authority itself will decide what to appeal for, and we believe it will be the best judge of what is needed, what it is best able to look after and how best to adjudicate between conflicting claims in this context.
In reply to the very serious strictures which the noble Lord made in regard to bingo and gaming, I would point out that I said in my remarks that bingo and gaming machines will form merely a small part of a larger activity or entertainment. These gaming machines will form only a part and will not be the main attraction, and I think it is important to mention it in this context. Also in this context, in reply to the noble Baroness, Lady Phillips, I said that the existing legislation would apply.
Lord WALLACE of COSLANY: As I moved the deletion of the clause, I think in common fairness and respect to the Committee I should reply. Noble Lords need not look surprised; that is how I see my duty. We have had a very good debate on this; it has been a very useful debate. We take this very seriously. I will make no reference to another place. They have their own peculiar customs, particularly in Committee stages, as some of the former Members of another place know. I see a former Chairman of Ways and Means facing me at the present time. Now that we have had this debate, I am more convinced than ever that the clause is ridiculous. I would call it a "silly-billy" clause if there were such an expression to use. The noble Baroness, Lady Macleod, spoke about some large sums being obtained from wealthy people. She said that people were donating large sums of money.
Baroness MACLEOD of BORVE: I hope I did not quite say that. What I did say was that chairmen of large hospitals are asking for large sums to keep their hospitals going. They have not been given them yet, but with this Bill they will have the power to do so, which they have not had so far.
Lord WALLACE of COSLANY: They have the power, and money is still being given. The Bill does not make any difference so far as that is concerned. If there is a wealthy businessman here who wants to give a large sum to a hospital, there is nothing to stop him; so it can be done now. That is my point. All these things that we have been talking about can be done now, except, of course, the provisions for bingo, et cetera. I want to point out to the Government that it is already evident from the ministerial replies that this clause lays a minefield of difficulties and risks for the future. There is no doubt about that. It is proved by the fact, which I welcome, that the Government are to provide guidelines. They will certainly need them, and they will want some very good legal advice in the preparation of those guidelines. I hope the Committee will give them thorough consideration.
One very important point was made by the noble Lord, Lord Auckland, when he pointed out—and I entirely agree with him—that officials, including senior nursing officers and so on, sit in with leagues of friends now; there is no doubt about it. They spend much of their spare time, such as they have, doing it willingly and happily; so why disturb that? The other point is about the white elephant business. This happens with the friends that I know. Before a league of friends purchases equipment, it consults first of all with the consultants, who are always demanding something extra special, and then with the officials, not only of the hospital but usually of the district health committee as well. They come to a conclusion about what is the best thing to buy with the money they have available. Then it is done, with all the questions of maintenance taken into account.
What worries me today—my noble friend Lord Wells-Pestell has also stated this—is the possibility of the Government probably taking powers for larger lotteries. The little bit of gambling that goes on at the present time in connection with leagues of friends is nothing, but larger lotteries provide a tremendous problem. In a sense, this is a moral problem. It will offend a lot of decent, progressive people who think that it is wrong that we should introduce gambling in order to safeguard people's lives in a

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hospital. They are right in thinking that. I think it is a dangerous thing for the Government to get involved in, especially involving area health authorities, regional health authorities and so on. I believe we have to think again about this; we have got to think about it seriously. This clause was said to be a minor list of things, a minor clause. It is not; it is a major clause of principle. I will not divide the Committee. We have had a very good debate, and it may be that some of us might be able to provide some amendments to the clause at another stage.
In conclusion, I should like to thank all the noble Lords and noble Baronesses who have spoken on this. The clause is far more important in its moral effects than some people think, and for the sake of the voluntary services I hope that no precipitate action will be taken by officials to upset the spirit of voluntary service that still exists, and must exist. Thank God it does exist, because it has a great effect in the community.
Clause 5 agreed to.
Clause 6 [Provision of public money for, and financial duties of, health authorities, Health Boards, etc.]:
Lord PITT of HAMPSTEAD Lord PITT of HAMPSTEAD moved Amendment No. 8:
Page 12, line 35, at end insert—
("(d) to hospitals which carry special clinical units agreed with the medical profession sums allotted or further allotted by him to those hospitals to enable them to provide those agreed special clinical services in that year.").
The noble Lord said: The purpose of this amendment is to introduce into the debate the question of central funding for certain special services. During a recent debate on the NHS I instanced the cost of the haemophilic unit at the Royal Free and said it was absurd that such costs should fall on the North Camden district. I gave that illustration then, but it holds good for most kidney units and organ transplants and for things like bone marrow transplants, and it will hold good if all the suggestions about Interferon turn out to be right.
The Government should accept that certain forms or treatment agreed with the medical profession should be centrally
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funded, not through regional, area or district authorities. This would have an advantage from the Government's point of view in that it could be rationalised. My view is that all forms of treatment that are available and known should be available under the NHS. They cannot all be available at district hospital level; certain forms of treatment are specialised and can only be given in specialised units. It is my view that those specialised units should be centrally funded, and it is in that spirit that I beg to move.
Baroness MASHAM of ILTON: I support the amendment because had the National Spinal Unit at Stoke Mandeville been nationally funded, it would not now be in its state of ill-repair and be nationally funded by the voluntary sector. Many people who have worked in and been patients at Stoke Mandeville Hospital's spinal unit—which, after all, has served most of the country and all the services, including many people from overseas—would have benefited had national funding been available. We must consider closely whether we are to have a regional or a national health service. National funding for centres of excellence would save money and, as the noble Lord said, it is too expensive to have a specialised service in every region.
Lord MACKAY of CLASHFERN: It is quite plain that the ultimate source of the money for the specialised services to which the noble Lord, Lord Pitt of Hampstead, and the noble Baroness, Lady Masham of Ilton, have referred is with the Secretary of State, and the question is whether it should go directly to a particular specialised unit or come down through the regional authority. The difficulty is that people concerned with a specialised unit have concern that they should get what they consider that unit requires. Local managers and authorities, on the other hand, have pointed to the fact that you can get too many costly specialised units which are difficult to control and which tend possibly to interfere with other priorities; and, accordingly, to get a balance between spending on specialised services and spending on more general services, you must, in our view, have proper local decision-making.

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That does not, of course, mean that decisions about individual projects should not be influenced by what takes place at the centre. The important thing is that the money which is allotted from the centre takes account of the balance of the specialised services. Our view is that the present system, from that point of view, is desirable, because the method of calculating regional shares of resources already makes allowance for services serving populations from one or more other regions or for existing specialties. To take the example given by the noble Lord, Lord Pitt, although ultimately the money comes out of the North Camden district, the money which goes to the North Camden district takes account of the fact that the money will go out from there to the specialised unit, and accordingly our view is that for these practical reasons this is the better system.
There are some what might be looked on as legalistic difficulties about the amendment which perhaps go deeper than mere legalism. Hospitals as such cannot receive funds; they would have to go to some authority. Whether a hospital should establish or continue to house some specialised clinical service is a decision not for the Secretary of State to agree with the medical profession; it is for the health authorities to reach decisions on such matters within agreed national planning machinery. The medical profession—although I think we all recognise what it is—is not a very precise term in this context.
Who is it with whom this agreement is to be made in relation to a specialised unit? We would say that decisions of that kind are better taken by the authorities, of course within a national planning framework, Accordingly, it looks as though the amendment, put into effect, would make it extremely difficult to make the necessary calculations to enable this form of funding to go through, and, indeed, create a special bureaucracy to deal with this aspect. Accordingly, while I entirely understand the concern which has been expressed, our view is that the better system is the one presently proposed, and I invite the Committee not to accept the amendment.
Lord PITT of HAMPSTEAD: I regret that the Government are taking a negative
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view about this subject and I beg them to think again about it. There would be from the Government's point of view several advantages which they have obviously ignored. The first is the one I mentioned, that of rationalisation. It is not possible to have, say, haemophilic units everywhere in the country, and therefore when such a unit is established it must serve several regions.
I do not think that, if there was central funding, the Secretary of State would be presented with any difficulty in having discussions with representatives of the medical profession, because the Government are frequently in conference with such representatives. I recognise that the noble and learned Lord the Lord Advocate, being a lawyer, sees legal loopholes, but I do not think that he need be so legalistic about this point, bearing in mind what I say about the Government frequently being in conference with representatives of the medical profession. This is common practice.
I always thought that the amendment might need to be more tightly drafted, and I am not too bothered about that. I hope that Members of your Lordships' Committee also will not be too bothered about that. If the amendment needs more careful drafting, I hope that people more capable at drafting than I am will do that. I should like the Government to think again about this question on that score.
I do not agree with the noble and learned Lord about the difficulty of calculating. If it is agreed that the country should have a certain number of units to deal with certain types of illness or to provide a certain type of treatment for a common illness, then it would not be too difficult to decide where these units should be located. In fact, usually such a question solves itself. At this moment, for example, most of the advanced treatments are carried out by hospitals through specialists receiving trust funds. The selection takes place in that way. All that my proposal would entail would be the Government agreeing to take on and fund this role as part of the National Health Service. That is all I am asking for.
I know that in the allocation of funds to regions, areas, and districts the question of special expenditure is taken into

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account. But this question of taking into account special expenditure—and in the eyes of those who have to do the job it is not quite being taken into account—has caused some of our problems. Putting aside the question of whether funding regionally and locally is a better method, the central funding of the special projects would be a marked improvement over the present situation and would prevent some of the problems that have arisen so far.
I never intended to divide the Committee on this amendment. I had hoped that the noble and learned Lord who replied for the Government would see that they gave it careful study. I am still asking for that. I am not asking for more than that, but I shall return to this question at the Report stage, because I regard it as of the utmost importance. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
On Question, Whether Clause 6 shall stand part of the Bill?
6.34 p.m.
Lord WELLS-PESTELL: We come to a rather important clause, which deals with the provision of public money for, and the financial duties of, health authorities, health boards, and so on. I wish to confine myself to one aspect of the clause, relating to the Government's intention to impose cash limits on health authorities. If I understand the clause correctly, not only will the Government impose cash limits on health authorities, but the limits will be legally binding. This matter exercises my mind rather more than do some of the other aspects. If the limits are to be legally binding, I would ask the Minister how the requirement will be enforced. How does one set about legally enforcing the cash limit if a health authority overspends? What are the penalties? I am not being facetious about this. I really do not know how this situation is to be dealt with.
It is reasonable to expect the Government to be in control of public expenditure. We may disagree with the Government about how they do that, but we suggest that, if measures need to be taken against a health authority that has overspent, it would be much more acceptable if they were taken in an administrative, rather
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than a legal, manner. I am not unaware of the fact that in the past some health authorities have run into financial difficulties, and have overspent. I am also aware, as will be other noble Lords, that the present Secretary of State took what some of us felt was unnecessarily drastic action against one authority when instead he could have used existing powers.
I regard the clause as most unsatisfactory because it suggests a course of action without giving any indication as to how it is to be implemented. It is one thing to look at the scope, function and responsibility of a health authority from the remote situation of the office of a Secretary of State, or an office in the department. On the other hand, it is almost impossible for a health authority to make arrangements in advance to cover every financial crisis, contingency, or emergency likely to arise. There are day-to-day problems on which decisions must be made, involving the spending of money, and one makes such decisions because one thinks that they are right.
I remember that when I was at the department a situation arose relating to the City and East London Area Health Authority, which was likely to be overspent by about, I believe, £600,000. Given its problems, the authority was finding it very difficult to comply with the requirements of its budget. Such a situation is not at all surprising. Many area health authorities have such experiences. On that occasion my right honourable friend Mr. Roland Moyle, the then Minister of State, after much discussion came to the conclusion that the right thing to do was to allow the AHA in question to carry the amount into the next financial year. That was done, and I believe that the matter was satisfactorily resolved.
I can well understand that it may not be possible to take action such as that on every occasion. However, I do not like the recourse to some form of legal action. Surely the Government realise that if we are to have an efficient National Health Service, there must be co-operation and understanding between the theoreticians at the top and those people who are providing the service and coping with the day-to-day issues. I do not think that the kind of sanction proposed in the Bill is likely to foster the kind of relation-

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ship which should exist, and which I am sure the Secretary of State himself would want to exist, between him and those doing the day-to-day work.
As I said a short while ago, I think this clause is really very unsatisfactory. In our view it will result in concealed cuts, because you could get a situation where a health authority, fearing that it might run into the red, that it might overspend, will underspend continuously throughout the year in order to avoid overspending and therefore will perhaps finish up with not having spent the money that it was given to spend in the first instance—and, if I may say so, we have had underspending. I think this could affect the services; that we could find it a threat to the services; in other words, that it could result in a cut in medical services.
It would also give rise, I think, to a lack of flexibility, and it is not now possible to run a large concern unless there is a measure of flexibility. So I feel that this threat of some legal action may cause inflexibility; I think it will cause some sort of under-spending; and, of course, it must cause a great deal of uncertainty on the part of those people who are administering the health authority. I do not know whether the noble Baroness the Minister will feel that anything can be done about this. Perhaps I ought to content myself with some kind of explanation as to what is meant by legally enforceable "or" legally binding", and I should be grateful to have that information.
Baroness YOUNG: I am sorry that the noble Lord, Lord Wells-Pestell, should feel that this is a very unsatisfactory clause, but I can assure him that in this we are not seeking any new, draconian powers. Health authorities have always been expected to conduct their business within the financial resources allocated to them, and the introduction of cash limits on public expenditure required us to change our methods of financial management. It might be helpful if I explained in a little more detail why the new procedure is necessary.
The vast majority of health authority funds are money voted by Parliament to the DHSS. Like all other Government departments, the DHSS must not exceed
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the sums voted by Parliament; and this, obviously, is a basic rule. Under the existing provisions of the 1977 National Health Service Act, the Secretary of State has a duty to advance to health authorities such sums as they need to meet approved expenditure. As the Minister for Health explained in Standing Committee in another place, it is clear that we have a mismatch here. Health authorities are to be judged by how much they expend: the DHSS by how much it advances. As he said, authorities could legitimately build up their stocks or reduce the amount they owe to creditors, and still keep within the approved expenditure ceiling; but the DHSS could, as a result, overspend because, by the letter of the law, it had to advance the cash to finance these transactions.
This situation began to cause problems only when the previous Administration introduced cash limits. Before then, the DHSS could seek supplementary estimates to adjust the relationship between approved expenditure by the NHS and the actual cash requirements on the DHSS that this expenditure would generate. Cash limits, however, placed a ceiling on the amount which could be sought by way of supplementary estimates, and eliminated this sort of adjustment. Noble Lords will therefore see that it is necessary to relieve the Secretary of State of his duty to advance sums needed to meet approved expenditure and replace it with one to make a predetermined quantum of cash advances. This is what is achieved by the new Section 97.
As I have indicated, the old system of approving expenditure involved the submission of estimates for approval. We believe this is now unnecessarily bureaucratic, since the distribution of resources is now guided by the RAWP mechanism. However, the Secretary of State has no formal machinery for ensuring that certain money is spent according to national policy. The Minister quoted joint financing as a example where, as a national policy, we (the Government) earmark part of health authority funds for this purpose. To cover this, we have provided that in place of calling for, approving or modifying estimates, the Secretary of State should have a simple power of direction relating to the application of funds by health authorities in the new Section 97(3).

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The noble Lord asked a quite specific question about how a cash limit can be legally enforced, and I would try to explain in this way. If a cash limit is overspent in year 1, the overspending will be taken off in year 2. This happens at present. But if the authority persistently overspends, we must embark on our RAWP powers on the ground that it has not complied with its duty. This is the new duty imposed by this clause.
I hope that this makes it quite clear, but perhaps I should say, further, that if a health authority ask for more money because they have over-committed themselves, the Secretary of State can obviously say only either "No" or"Yes", with the DHSS as a consequence exceeding the estimate voted by Parliament and having to answer to the Public Accounts Committee. To avoid this sort of situation, the new Section 97A places a duty on health authorities so to conduct their business as not to exceed their income. Such a statutory duty on health authorities is rather a blunt instrument. Overspending can occur because of inadequate financial control as well as by deliberate act. The new Section 97A(4) introduces a power of direction relating to this duty. This will enable us to prescribe minimum standards of financial control, budget arrangements, et cetera.
I hope that as a result of this explanation the noble Lord will feel that this is a sensible provision. It is the kind of provision which I think would have become necessary—and he would have recognised it—once cash limits were introduced, as they were, of course, under the previous Administration, when he himself was a member of the Government; and he will perhaps have had experience of the kind of difficulty that might have arisen. It is included in this Bill, not to raise any fundamentally new principles but to enable us to have tighter financial controls because of the cash limits, obviously, as the name implies, on National Health Service spending. I hope I have made the position clear. If, on reflection or on reading anything that I have said, the noble Lord would like any further explanation, I should of course be very happy to write to the noble Lord on it.
Lord WELLS-PESTELL: I do not want to press the noble Baroness the Minister tonight; I really want this for my own information. As I understand it, cash limits can be legally enforceable. I merely asked, in what way? The noble Baroness said that if they did it a second year then action could be taken. I want to know what kind of action is possible under the clause. In point of fact, what would that action be, and what would be the penalties? I know this matter is very complicated, and I will not press it tonight. I do not know whether the noble Baroness feels that I could get a specific answer to this by letter before the Report stage, but I should be quite happy about that.
Baroness YOUNG: I shall try to give a more detailed answer, and then, if it is not as full as the noble Lord would like, I will of course write to him further. He is probably thinking how the new powers that we have in this Bill would have avoided the situation last year, when a health authority overspent its money. There is a power for the Secretary of State in the proposed Section 97A(4) to issue directions to ensure that authorities comply with their new duty. We anticipate making general dirctions under these powers. One such direction will specify that area health authorities should submit to regions a profile of their expenditure for the forthcoming year showing how much they expect to spend each month and in total. If the profile submitted is more than the sum allotted plus other income, then, if reason does not prevail, the region can ask the Secretary of State to issue a specific direction to the area health authorities seeking a reduction in forecast expenditure to the required level. Similarly, general directions will provide for actual spending to be reported and compared with the profile. If the trend of actual expenditure exceeds that forecast on the profile, then, failing reasonable explanations, the regional health authority may wish to ask the Secretary of State for a specific direction requiring the rate of expenditure to be reduced.
Once specific directions with time scales have been issued but not complied with, it will be clearly possible for the Secretary of State as a last resort to invoke the default powers in Section 85 of the Act. I should make it quite clear that we hope

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it will never be necessary to issue specific directions to authorities. It is quite alien to the tradition of relationships between DHSS and health authorities under successive Governments for recourse to be had to the law. Nevertheless, if we are to discharge our financial duty to Parliament, we believe that this power must be there in the background.
Lord WELLS-PESTELL: I will not trouble the noble Baroness to write to me. I should like to read this and perhaps raise the matter with her privately if necessary.
Clause 6 agreed to.
6.52 p.m.
Baroness MASHAM of ILTON Baroness MASHAM of ILTON moved Amendment No. 9:
After Clause 6, insert the following new clause:
("Provision for payment of dependants of doctors for work done in the practice
—(1)The Minister shall make regulations under section 29 of the Health Services and Public Health Act 1968 (Regulation of financial arrangements of hospital authorities and other bodies) to provide that payment may be made to—

(a) the wife; and

(b) any dependent

of a doctor or of one of his partners in a general practice for work relating to the medical practice performed on behalf of the doctor.
(2) Claims for payments under subsection (1) above shall be submitted to the Family Practitioner Committee which shall determine, after consultation with the local medical committee where necessary, whether the payments are reasonable having regard to the nature of the work performed.").
The noble Baroness said: I beg to move the amendment standing in my name and in that of the noble Lords, Lord Winstanley and Lord Pitt of Hampstead. During the Second Reading of the Health Service Bill, I brought to the notice of your Lordships the question of the provision for payment of the dependents of doctors for the work done in the practice. Before explaining the present situation and what this amendment sets out to do, I should like to say that it has all-party support. The noble Lord, Lord Hunt of Fawley, told me that he would support this amendment but he cannot be present today; he is in Newcastle being awarded the gold medal of the British Medical Association, one of the Association's
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highest honours. The noble Lord has made an outstanding contribution to the improvement of general practice.
At the moment general practitioners are reimbursed for the major part (70 per cent.) of the expense of employing paid ancillary help. It applies only to staff directly employed and paid by the doctor, the partnership or the group. It does not apply to the wife or other dependents living in the residence of the doctor or of his or her partner. A single doctor can employ a secretary or receptionist and be reimbursed. If he marries her, he can still employ her but he is no longer reimbursed. This seems to me to be discriminatory against wives. Doctors and their wives in the rural areas feel very strongly about this injustice. It is important to raise the morale and to give the dependents of doctors the chance to work for the practice as there is now a great deal of frustration. I think that this applies mainly to the practice where the doctor is single-handed or where there are only two partners. I should like to quote from a letter that I received from a doctor in Kent yesterday:
"I practise from my own house in a rural partnership running an appointment system so that my wife is working not only for me but for my partners. I am the only resident doctor in the village where we have lived for over 30 years. The obvious step would appear to be for my wife to resign as secretary-receptionist but it is quite simply impossible to find anyone to take her place. For the appointment system to run efficiently, the telephone is in almost constant use from 8 a.m. to midday and again from 4 p.m. to 8 p.m. These are what I would call office hours and are the basic times for which my wife would claim payment".
When a doctor is on call, so is his wife. If he is out on a call and someone telephones or calls with an emergency, it is the wife who in most cases has to take the message or deal with the patients. Primary health is so important that the telephone may ring at any time at night or in the early hours. We do not want to lose the goodwill of doctors' wives; they can make all the difference especially when dealing with distressed and anxious relatives or patients. I understand that doctors can now be reimbursed for employing their wives if they are trained nurses. It can often be more difficult to find good and reliable secretaries, especially in rural areas.
In the second part of the amendment, there is a safeguard should doctors and

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their wives try to abuse the system. Payments would be submitted to the family practitioner committee which would determine, after consultation with the local medical committee, where necessary, whether the payments are reasonable having regard to the nature of the work performed. I understand that Members of Parliament as of right (and, in many instances, in practice) employ their wives as their secretaries for parliamentary purposes. Is it not a convenient and sensible thing to do in some cases? To me, this seems to be a similar situation to doctors employing their wives or dependents. I am also told by a right reverend Prelate of this House that Bishops and vicars can take advantage of this, too. I hope that this amendment will be considered with care. I think that it is the first time that this subject has been before your Lordships for a decision. I hope that the Government will accept it and, if not, that your Lordships will support it so that Members have a chance of discussing it in the other place.
Lord WINSTANLEY: Perhaps I may be permitted, before the noble Baroness, replies, to say a few words in support of the noble Baroness, Lady Masham, who moved this very necessary amendment. Perhaps I may say a few words about the history whereby we have arrived at this absurd, well-nigh Gilbertian situation under which a doctor or a group of doctors or a partnership can employ a receptionist or secretary or nurse and can now gain something like 70 per cent. reimbursement of expenses of that employment from central funds. But if one of the doctors displays an interest in that receptionist beyond a professional one and finally, as the noble Baroness has said, marries her, then suddenly the practice must pay the whole of the cost. That is an absurd situation.
Noble Lords will recall that, going back, we had a situation under which the general practitioners were remunerated out of a pool on a capitation basis and they paid all their own expenses. That necessarily meant that the doctor who gave the best service and employed a receptionist, a secretary, a nurse or whatever, was inevitably worse off than the doctor who provided an inferior service. In order to encourage doctors to employ ancillaries and to provide a better service
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for patients, arrangements were made whereby doctors could obtain reimbursement of necessary expenses if they incurred them. But the person left out was the wife. That person is still left out. It really is an absurd situation.
Briefly, we are not talking about arrangements whereby a GP employs his wife to answer the phone at home—an arrangement about which he can persuade the Inland Revenue to accept that she is employed. We are talking about a person doing a full-time active job for which often there is a training course run by the family practitioner committee, a post over which there is ample supervision. This is not for a nominal employment of a wife, but a wife working very long hours doing a very real job. If the receptionist is not the wife of the doctor then he gets reimbursed as to 70 per cent. of the cost. If the receptionist becomes the wife of one of the doctors, then suddenly the practice or the partner has to pay the lot. That is a situation which should end and end quickly.
Lord WALLACE of COSLANY: I should like to support the amendment of the noble Baroness. There is a parliamentary precedent for this: Members of another place employing their wives as secretaries get an expense allowance. Apart from that, the case put by the noble Baroness for the rural areas is a strong one. I know there are difficulties, but it is a case that deserves careful consideration and support.
Lord AUCKLAND: This is an important amendment. There are many wives who are first-class secretaries. They can deal with patients who may be nervous about seeing the doctor. The wives can give comfort, help and assurance which often a receptionist—no matter how qualified she may be—may not have the skills to do. She may not be as mature as the wife who may have a family of her own. I never realised—and I do not suppose many Members of the Committee realise—until I saw this amendment, that this anomaly existed. It seems to me—and I, like many Members of the Committee, have a wife who is a fully qualified secretary—that such people could do an excellent job and improve substantially the quality of a doctor's practice and be of enormous help. This is one of the most vaulable amendments to the Bill.
Viscount BARRINGTON: I know very little about this matter. I am not a married man, I am not a doctor, and I am not a politician. With great respect, although I would have voted against many of the previous amendments, if this one is put to the vote I am inclined to vote for it on the grounds that it seems to me unfair that if I had a secretary or assistant to whom I was already married I would not be entitled to financial reimbursement. This would also apply if I later married my receptionist or secretary.
I am sure that the noble Baroness will have arguments against this; but this seems to be a reasonable amendment which could do no harm and could do good. Speaking as a bachelor, a non-doctor and a non-politician, who therefore does not have a wife (who has learned shorthand in order to be of assistance), I am in favour of the principle of this amendment.
7.4 p.m.
Baroness YOUNG: I recognise the strength of the feeling of the Committee and it is an issue, as the noble Baroness quite rightly said, which she raised during the Second Reading debate. I say right away that the Government recognise the case which has been put most forcefully this evening that many GPs are assisted in their practice by their relatives, particularly by their wives, and that some are employed in this way on a regular basis. There is no legal impediment to this. The Government are also keenly aware of the strength of feeling among GPs and relatives working with them about their exclusion from the reimbursement arrangements for non-related ancillary staff employed by GPs. This exclusion is of long standing—it goes back to the start of the ancillary staff reimbursement scheme in 1966, which was agreed at that time with the representatives of the medical profession.
Under that scheme, a GP can claim 70 per cent. of the cost of employing ancillary staff on approved duties—these are secretarial, receptionist, clerical, nursing and dispensing duties—up to a maximum of two whole-time equivalents per doctor. It was not thought possible to include reimbursement of salaries paid by GPs to wives or other dependants because, in their case, the need for GPs to meet 30 per cent. of the cost would not be an
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adequate restraint on the demand for the payment from public funds—a risk was seen of excessive salaries being paid and that the normal safeguards which ensure that employees work their contracted hours would be less effective. This exclusion of wives and other dependants has been a matter of concern to the profession and to successive Governments since 1966 but no satisfactory way has been discovered of bringing them into the scheme on the same terms as non-related staff.
As an alternative approach, in 1978 an experiment was begun under which single-handed general practitioners in rural areas became eligible for payment of an allowance where they satisfied a visiting team from the family practitioner committee and local medical committee that they employed their wife or other dependant relative on at least a half-time basis. This arrangement—known as the related ancillary staff scheme—has worked reasonably well and has been recently extended for a further two years. More importantly, the Government have also recently announced an agreement with the representatives of the profession that the scheme should be significantly widened so as to bring in any GP where the wife or other dependant relative he employs is a qualified nurse undertaking some nursing duties. They recognise that this will still leave outside the scheme some wives who are doing valuable work in the practice. But I hope the Committee will realise it is a step in the right direction and there are severe financial limitations on the rate of progress the Government can hope to make in this as in other fields where they would like to see much more done. There will be a further review of the position with the profession in 1982, when no doubt the possibility of further extension will be considered.
The noble Baroness and the noble Lord, Lord Wallace of Coslany, mentioned the allowance for Members of Parliament. There is a difference between the allowance which a Member of Parliament receives for his secretary and when he uses his wife as his secretary and what would be allowed for doctors in this situation. The chief difference between a Member's allowance and the ancillary staff scheme is that the Member's allowance has a maximum ceiling on payment,

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whereas under the scheme reimbursement is at 70 per cent. of whatever the GP actually pays.
The difference is, of course, that there is a ceiling on the expenditure that is given for allowances to Members' wives, and the difficulty in this situation is that there is not a ceiling on the amount that the general practitioner pays. Therefore, if he is reimbursed at 70 per cent., there is no ceiling on the 30 per cent. that he would have. In these circumstances, I hope that the Committee will realise that there is certainly no disagreement between us about the desirability of trying to right what must appear as an injustice to many wives who act as secretaries, and who are not getting the money. I hope that the noble Baroness will see that we have tried to move step by step under successive Governments to meet this particular case.
The difficulty about this amendment— to which I am very sympathetic, as are my colleagues—is that it involves a further expenditure of money. That is the difficulty here. At the moment, we have not the resources to say that we would bring it in. I have given an assurance that we shall be looking at this position again. We hope that we shall be able to do this in 1982 and review the position with the medical profession. I hope very much that when that time comes we shall be able to extend the provisions in the way that the noble Baroness and the noble Lord, Lord Winstanley, would like. In the meantime I think I have gone as far as I can in trying to explain the position, but I am afraid I cannot accept the amendment.
Lord UNDERHILL: Before the noble Baroness sits down, could she explain this to me? She mentioned the possibility of extra cost, and therefore there must be a limitation; but if general practitioners employed secretaries who were not their wives apparently there would be no difficulty in paying the costs. Is that so?
Baroness YOUNG: The difficulty is that at the present time a general practitioner who employs someone who is not his wife is reimbursed by 70 per cent., and there is this 30 per cent. Because of this contractual relationship with somebody outside who is his employee, it is much easier to keep a check on what is
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actually happening. It is much more difficult, when it is a relative or a wife, to prevent abuse. That is why there is the possibility of considerably larger amounts of money being spent. This is not an absolutely insoluable problem and it is one that we hope we shall be able to resolve, but the noble Lord, Lord Underhill, will recognise that if the scheme is extended it will inevitably involve more public expenditure, and that is the difficulty in this particular case.
Lord DONALDSON of KINGS-BRIDGE: Before the noble Baroness finally sits down, could I ask what the objection is to the opportunity presented by this Bill of inserting a ceiling? I see no problem whatever except the will.
Baroness YOUNG: I am sorry if I may not have fully understood the point made by the noble Lord. The problem is that it would involve increased expenditure.
Lord DONALDSON of KINGS-BRIDGE: So the reason is not that there is not a ceiling but that, even if there were, you would have to pay up to that ceiling—is that the problem? In other words, the doctor's wife is not to be paid at all on any basis. I understood the noble Baroness to say that they could not do this because there was no ceiling, whereas with M.P's wives there is a ceiling, quite properly in my view. This seems not to be the case. Would the noble Baroness kindly explain it again?— because I do not understand it, on what has been said.
Baroness YOUNG: I am sorry: I will try to explain it again. As I understand the position, a GP can employ someone as his secretary and claim 70 per cent. of the cost. What such a person pays for his help will vary inevitably from one part of the country to another. That is quite unlike the M.P's secretarial allowance, which I believe is related to what is, as it were, the going rate in London, which he would have to pay. Therefore, as I say, there would be variations between one part of the country and another. There is no ceiling on this because, clearly, what is required in one part is different from what is required in another part, but it is perfectly possible to keep a check on the total

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amount of money that is spent. I am assured that if we were to extend the scheme further than it is now and bring in another group of people it would inevitably involve more public expenditure. At the moment this is not something that we could consider. I am not unsympathetic and I am not trying to put difficulties in the way, because I think we all agree that it is desirable that we should meet what is widely felt to be an injustice to wives who act as secretaries to their husbands in this particular way. But it would mean extra money and, for that reason, we cannot accept the amendment as it stands now.
Lord DONALDSON of KINGS-BRIDGE: I do not want to go on too much about this, but the noble Baroness seems to be saying that the whole argument about a ceiling is entirely irrelevant. The Government are not prepared to pay it, ceiling or no ceiling. I think it was misleading—I know not whether deliberately or not deliberately—that that should have been brought in as an argument.
Baroness YOUNG: I am sorry: I did not wish in any way to mislead the Committee. The noble Lord, Lord Donaldson, practically suggests that I was "pulling a fast one" to mislead the Committee about this. I was asked why we could not do what is done for M.Ps' wives. In that case there is a ceiling on what can be spent, because the amount of money given is related to secretarial allowances in London. There are two issues here. There is the question of a ceiling and the accountability, because, as I understand it, the amount of money varies from one part of the country to another and it would inevitably involve more expenditure. Therefore the two things are different; but the whole case does not rest on the analogy with M.Ps' wives. In fact, in the case of the scheme that we recently brought in—and it could apply, I think, to the case raised by the noble Baroness, Lady Masham—under the related ancillary staffs scheme there is a ceiling because there is an allowance system; but we cannot widen that scheme right away for financial reasons. That is ultimately the difficulty about accepting the amendment.
Lord MOTTISTONE: Do I understand from my noble friend that if the doctors do not marry these girls, their secretaries, and so on, the Government will pay happily? In that case, the Government are not really saving money but encouraging the doctors and their girls to live in sin! And they cannot guarantee they will save money because perhaps the doctors may not want to marry their secretaries. So, if I may say so, it is a ridiculous argument.
Lord PITT of HAMPSTEAD: I must say to the noble Baroness that there is already a ceiling. The regulations say that you can employ the equivalent of two-full time people. That is a ceiling. The ceiling is there, and whether or not one of them is the doctor'swife is irrelevant. Therefore the argument that there is no ceiling really does not hold water.
Another point I wanted to make is this: the noble Baroness has already sold the pass, so to speak, in terms of this question of control by accepting that if the wife is a nurse she can be so employed. If you cannot control her when she is a secretary you cannot control her when she is a nurse, and if you can control her when she is a nurse then you can control her when she is a secretary. So those arguments really are no good, and I would much rather the Government decided to look at this matter again. What is happening at the moment is that the profession feels there has been discrimination against the wives of doctors who are not nurses. That is a grievance and it is one that should be remedied.
Baroness YOUNG: I would agree with the noble Lord, Lord Pitt, that there is a discrimination against wives and that they have a legitimate grievance about it, but, as I understand it, what has happened is that gradually the amount of money that has been allowed for people employed by G.Ps has been increased. The noble Lord, Lord Winstanley, took us through this step by step. First, certain categories of people were allowed for quite specific elements of help. Then the provisions were extended to allow a wife who is a qualified nurse to receive the benefit. What has not happened—and I quite see that it may sound very odd to my noble friend Lord Mottistone, but I think there is a difference—is that the wife who is not a qualified nurse but who helps her

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husband in his practice, as many wives do, does not get this payment. No one is pretending that this is either right or perfect. What I am saying to the Committee is that it does involve increased expenditure of money and I think the Committee must recognise that it is for that reason that it is not being extended now.
In view of the strength of feeling that has been expressed on this matter I will certainly take it back and have another look at it, but I must make it clear that it is most unlikely that I can satisfy your Lordships at a later stage because it does involve more Government expenditure. I will take advice on exactly the amounts of money we are talking about, in recognition of the very strong feelings of your Lordships. But I never like to pretend to people that I can deliver something which will be difficult, and this is going to be very difficult as it involves increased Government expenditure.
Lord WINSTANLEY: As the noble Baroness, without any undertaking or commitment, has undertaken to look at this subject again, might I ask her to look at one particular point while she is doing that? She said that efforts are being made to assist in rural areas where a GP is on his own and his wife is the only person he can get to help him. Would she bear in mind that, not only in rural areas but in cities and urban areas, the vast majority of doctors work in groups or partnerships and in such groups or partnerships there is inevitably a very firm discipline exacted by the other members of the group or partnership as to how much is paid to the wife of any particular doctor? This is a discipline which exists and I think it should be borne in mind. In the vast majority of cases, if doctors employ their wives, they are people doing full-time jobs on behalf of a group of doctors. If the person happens to be married to one of the doctors, the whole practice is penalised by not being able to claim reimbursement. Will the noble Baroness look at that factor and bear in mind that a fairly firm control is exerted by the other people in the partnership, who will not allow an individual doctor to overpay his wife merely because she happens to be his wife, when she is just one of a number of employees of that practice?
Lord PITT of HAMPSTEAD: May I, again, say to the noble Baroness that there is a fallacy in this argument about increased expenditure. As things are, every doctor is entitled to employ up to the equivalent of two people. If one of them is his wife, then he employs somebody else. If she is a nurse, that means that he can employ only one other person. If the noble Baroness agrees that if she is a secretary she can be accepted, then he can still employ only one other person. So the argument about increased expenditure is a hollow one.
The Earl of SWINTON: I wonder whether, if my noble friend is taking this matter back, she can consider this at the same time. I have obviously been under a strong personal lobby for the past few weeks about this point, and I still feel, at the end of this debate, that doctors are doing jolly well out of this. I am thinking of rural areas, where there is perhaps a clergyman and a solicitor, who does a lot of work under legal aid. They do not get a 70 per cent. grant for having a secretary. Would it not remove discrimination entirely if we did away altogether with the 70 per cent. grant, and then the wives would be in the same position as everybody else?
Baroness YOUNG: I do not think I am going to follow my noble friend down that line of argument. However, I will take note of the point which the noble Lord, Lord Winstanley, and the noble Lord, Lord Pitt, have made. I will certainly draw it to my right honourable friend's attention and consider this matter between now and the next stage.
Baroness MASHAM of ILTON: I should like to thank all noble Lords for their support. I am a little worried, because the noble Baroness did not give very great hope that, if she does take it back and look at it again, she will be able to say anything different. I think, in my heart of hearts, I know that the noble Baroness will not be able to give us any more hope at the Report stage. I am a little sad that the Government do not consider that the family practitioner committee and the general practitioners are a highly responsible body of people. We are not dealing with irresponsible people here. We are dealing with very responsible people.

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I may not be here at Report stage, because my children are on holiday and I have to look after them. Also, I know that there is so much frustration among the general practitioners' wives in rural areas throughout the country. They have waited for years and years. I think that there is probably enough support in the House, if noble Lords would look very carefully into their minds and ask themselves whether their GPs and
Resolved in the affirmative, and amendment agreed to accordingly.
Baroness YOUNG: I beg t the House be now resumed.
Moved accordingly, and, on Question Motion agreed to.
House resumed.
their wives are responsible people. Do they need support and are they helpful to them? With that, I think that I should like to divide on this amendment.
7.24 p.m.
On Question, Whether the said amendment (No. 9) shall be agreed to?
Their Lordships divided: Contents, 71; Not-Contents, 41.

CONTENTS

Ardwick, L.

Glenamara, L.

Phillips, B.

Auckland, L.

Gordon-Walker, L.

Pitt of Hampstead, L. [Teller.]

Aylestone, L.

Hale, L.

Barrington, V.

Hall, V.

Ponsonby of Shulbrede, L.

Beaumont of Whitley, L.

Hatch of Lusby, L.

Ritchie-Calder, L.

Bernstein, L.

Henderson, L.

Robson of Kiddington, B.

Bessborough, E.

Irving of Dartford, L.

Rochester, L.

Blease, L.

Janner, L.

Ross of Marnock, L.

Boston of Faversham, L.

Leonard, L.

Savile, L.

Brockway, L.

Lindsey and Abingdon, E.

Stamp, L.

Brooks of Tremorfa, L.

Listowel, E.

Stanlev of Alderley, L.

Caithness, E.

Llewelyn-Davies of Hastoe, B.

Stone, L.

Chelwood, L.

Lloyd of Kilgerran, L.

Strabolgi, L.

Collison, L.

Lovell-Davis, L.

Swinton, E.

Croft, L.

McGregor of Durris, L.

Taylor of Mansfield, L.

Davies of Leek, L.

Macleod of Borve, B.

Tweeddale, M.

Diamond, L.

Marley, L.

Underhill, L.

Donaldson of Kingsbridge, L.

Masham of Ilton, B.

Vaux of Harrowden, L.

Donnet of Balgay, L.

Monson, L.

Wade, L.

Dormer, L.

Morris of Kenwood, L.

Wallace of Coslany, L.

Ferrier, L.

Mottistone, L.

Wells-Pestell, L.

Galpern, L.

Mountevans, L.

Whaddon, L.

Gisborough, L.

Newall, L.

Winstanley, L. [Teller.]

Gladwyn, L.

Oram, L.

Wynne-Jones, L.

NOT-CONTENTS

Abercorn, D.

Ferrers, E.

Margadale, L.

Alport, L.

Fortescue, E.

Mowbray and Stourton, L

Avon, E.

Gainford, L.

Murton of Lindisfarne, L.

Bellwin, L.

Godber of Willington, L.

Northchurch, B.

Belstead, L.

Gowrie, E.

Nugent of Guildford, L.

Blake, L.

Greenway, L.

Orkney, E.

Craigavon, V.

Gridley, L.

Renton, L.

Denham, L. [Teller.]

Hanworth, V.

Sandys, L. [Teller.]

Dundee, E.

Harvington, L.

Selkirk, E.

Ellenborough, L.

Hornsby-Smith, B.

Strathclyde, L.

Elliot of Harwood, B.

Hylton-Foster, B.

Trefgarne, L.

Elton, L.

Long, V.

Westbury, L.

Faithfull, B.

Lyell, L.

Young, B.

Falkland, V.

Mackay of Clashfern, L.

EUROPEAN COMMUNITIES (DEFINITION OF TREATIES) (INTERNATIONAL RAILWAY TARIFFS AGREEMENTS) ORDER 1980
7.32 p.m.
Lord MOWBRAY and STOURTON: My Lords, I beg to move that the draft European Communities (Definition of

1389
Treaties) (International Railway Tariffs Agreements) Order 1980, which was laid before this House on 19th June, be approved.
Although the detail of this matter is somewhat complicated, the essentials are fairly straightforward and I shall try to present them as simply as I can. When Britain joined the European Economic Community in 1973 there was in existence an agreement between the six members of the European Coal and Steel Community, made in 1955, regulating the carriage of coal and steel products by rail within the Community. In addition to this original agreement there were two supplementary amending agreements on points of detail; and the requirements of the 1955 agreement were extended to traffic between the Community and Switzerland and Austria by separate agreements made in 1956 and 1957 respectively. The draft order which is before the House resolves the long-standing difficulty which the United Kingdom has had in conforming with the terms of these agreements.
This difficulty arises because the 1955 agreement assumed the existence of published internal rail tariffs—for which there was (and still is) no requirement in this Kingdom—and because it did not recognise the existence of sea crossings in its provisions relating to the calculation of charges, or indeed in any other way. In the period leading up to accession, Her Majesty's Government were led to believe that a substantial revision of the 1955 agreement was imminent and that the new version would contain provisions designed to accommodate our situation. It was therefore decided that the United Kingdom's inability to comply fully with the original agreement should not be a bar to our accession to the Communities. British Rail at that time carried internationally a very small quantity of steel traffic (only some 3,000 tonnes with the European Coal and Steel Community countries) and no coal.
After our accession it became clear that there was opposition from several members of the Community to any fundamental revision of the 1955 agreement which might result in higher charges for the transport of coal and steel products. For a long time proposals to incorporate in the agreement provisions dealing with our situation made no progress because they
1390
were linked with proposals to increase charges. However, while discussions on the necessary amendments which we required continued, although British Rail were unable to formulate tariffs which met the requirements of the agreement completely, with the aim of complying so far as possible with the spirit of the agreement they introduced, in April 1975, a tariff for the international carriage of steel products. As British Rail did not carry international coal traffic, similar action for coal was not required. The British Rail steel tariff was accepted informally by the other participating railways and the Commission agreed that it met the spirit of the 1955 agreement.
I mentioned at the outset that in 1956 and 1957 the six members of the then Community negotiated agreements with Switzerland and Austria extending the provisions of the 1955 agreement to traffic with those countries. Although those agreements preceded the accession of the United Kingdom to the European Community, unlike the 1955 agreement they were not automatically binding upon us when we joined the Community, and it was necessary to negotiate separate protocols providing for the accession of the new member states to the 1956 and 1957 agreements, to which we were committed by Article 4(2) of the Act of Accession. These protocols were eventually concluded in October 1974. They contained a requirement for the member states to notify the Swiss and Austrian Governments that the conditions necessary for their entry into force had been fulfilled in accordance with domestic law. This presented the difficulty for us that, for the reasons which I have explained, the provisions of the 1955 agreement were not wholly compatible with our law and practice relating to international rail traffic. The Government at the time delayed giving the required notification in the hope that a suitable revision of the 1955 agreement would first be negotiated.
However, a position was eventually reached in which it became clear that no further progress could be made towards such revision to meet our position until we had given the necessary notification under the Swiss and Austrian protocols to which we had been a signatory. It was contended that for this purpose reliance could be placed on the fact that the Government had secured substantial compliance

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with the requirements of the base agreements through the informal tariff introduced by British Rail in 1975. The British Railways Board in March 1978 gave a formal undertaking to continue to conform to the three agreements (that is, those of 1955, 1956 and 1957) "in the manner currently observed", on the understanding that the 1955 agreement was intended to be revised "to make the agreement compatible with the conditions under which the transport of European Coal and Steel Community goods takes place between the United Kingdom and the Community"; and Her Majesty's Government subsequently gave the required notification later in 1978.
Negotiations for a revision of the 1955 agreement then resumed, and the Fourth Supplementary Agreement, meeting the position of British Rail, was approved and formally signed by the member states of the Community meeting in council on 6th December last. This in effect formally legitimises the practice which British Rail have been following since 1975, by allowing them to calculate charges "by analogy" and by providing for a separate charge by sea crossing.
The British Railways Board, on 19th May, gave a new undertaking to comply with the original agreement as now amended, and the way is thus at last clear for these interrelated post-accession agreements to be specified as Community Treaties under the European Communities Act of 1972, so that their provisions may be relied upon directly by virtue of Section 2(1) of that Act. I hope the order will commend itself to your Lordships. My Lords, I beg to move.
Moved, That the draft order laid before the House on 19th June be approved. —(Lord Mowbray and Stourton.)
Lord UNDERHILL: My Lords, I should like to thank the noble Lord for that helpful explanation. He has elaborated far beyond the Explanatory Note in the order, which is very helpful. From what the noble Lord has said it would appear that the matter is thoroughly satisfactory from the standpoint of British Rail and all we can hope is that as the carriage is of coal and steel it is one way only, and that is exports.
On Question, Motion agreed to.

NEW BUS GRANTS (EXTENSION OF PERIOD AND REDUCTION OF RATE) ORDER 1980
7.41 p.m.
Lord MOWBRAY and STOURTON: My Lords, I beg to move that the New Bus Grants (Extension of Period and Reduction of Rate) Order 1980 be approved.
New bus grant is currently paid at the rate of 50 per cent. of the approval capital expenditure on a new bus intended wholly or mainly for stage use. The policy on the grant has been largely bipartisan. A Labour Government introduced it in 1968, then at a rate of 25 per cent. and in 1971 the Conservative Government increased the rate to 50 per cent. and extended the period of the grant from seven years to 12. The last Labour Government concluded in their 1977 White Paper on Transport Policy that there was not sufficient justification for maintaining the grant at its present level beyond this financial year and that it should be phased out by 1985. My Lords, to put it simply, we agree—and although we have brought phasing-out forward by one year, it has been left to this Government to implement the decision. This is the purpose of the draft order which is now before the House.
I hope that your Lordships will find the order a simple one. It does two things. The first is to extend the eligibility for grant, which would otherwise expire after 31st August this year, to 31st March 1984. The second is to provide for progressive reductions in the rate of grant payable during this phasing-out period, starting from 1st September this year.
I would like to explain briefly why we think the grant should be gradually run down and ended in 1984. The foremost consideration was not the cutting of public expenditure—nor I think, to be fair, was it our predecessors'. While expenditure constraints obviously make it difficult to argue a case for retaining the grant, there are positive reasons for actually bringing it to an end. First, successive Governments have always regarded this grant as one introduced for temporary and limited objectives. The most important was the rapid introduction of

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buses suitable for one-person operation, that is with passenger entrances at the front rather than the rear, as was then more common. Because single manning was probably the most significant contribution to greater cost effectiveness, the grant was intended to encourage operators to equip their fleets quickly with such vehicles even ahead of normal replacement. Other objectives were the modernisation of operators' fleets, the improvement of passenger comfort and a measure of vehicle standardisation.
These objectives have largely been achieved. In the 12 years the grant has been in existence, single manning has increased from levels of around 10–20 per cent. in 1968 to typically 70 per cent. and even 100 per cent. with some operators now. Further advances are dependent more on operational considerations than the availability of suitable vehicles. And by 1984 when the grant ends, most operators will have completely replaced their fleets at least once since the grant was introduced.
This leads to the second main reason for phasing out the grant. It was never envisaged as a permanent subsidy for normal replacement of life-expired vehicles and there is some danger of it becoming just that. Running at a current rate of 50 per cent., it tends to distort judgment about the best balance between capital and maintenance expenditure by making buying new an artificially cheap option.
Of course we accept that there are socially necessary bus services which need financial support to survive. But we want help to be given in the most cost-effective way and where it is most needed. An indiscriminate capital subsidy is not the best way of achieving this. We believe that assistance should be channelled through local authorities because local people are best placed to assess the needs and priorities of their areas. Local authorities have power to make grants to bus operators and their expenditure on revenue support is eligible for transport supplementary grant.
Obviously financial assistance of this order of magnitude—it is currently running at just over £70 million a year—cannot be taken away without its impact being felt. That is why—notwithstanding the need to
1394
reduce public expenditure—we agreed with the last Government that it should be phased out over a period (rather than end on 31st August this year) in order to allow time for the industry to adjust to the changed circumstances. The draft order therefore provides that the eligibility for grant should be extended until 31st March 1984, almost four years.
It is not for me to predict how bus operators will make this adjustment. But we do not accept that the only way is for them to raise fares. While the industry has already made considerable progress towards greater cost-effectiveness through such measures as single-manning, which I have already mentioned, there is still room for improvement. I have in mind such measures as the market analysis project studies currently being undertaken by the National Bus Company, which have already achieved substantial economies by matching bus services more closely to demand. In addition, the relaxation of the road service licensing provisions, now enacted in the new Transport Act, will encourage smaller operators with lower costs to provide alternatives to the services which the large public sector operators can no longer sustain. And, of course, removal of this very high capital subsidy will lead to a more realistic assessment of the economies of refurbishing older vehicles.
This brings me to the second part of the draft order which is concerned with the way in which the grant is to be phased out between now and 1984. The total amount of money available for the grant in the Government's public expenditure plans reduced progressively from this year to the year 1983–84. In line with this reduction, the order provides that the rate of grant, now at 50 per cent., should be reduced to 40 per cent. starting on 1st September this year and then to 30 per cent., 20 per cent., and finally 10 per cent., on 1st April 1981, 1982 and 1983 respectively. This gradual reduction in the rate of grant should mean that every new bus brought into use before 1st April 1984 will get grants, albeit at a reducing rate. Clearly that statement depends on our calculations of what buses operators will buy in the next few years. But out calculations are related to forward figures of bus orders and deliveries provided jointly by bus operators and

1395
manufacturers, so I would suggest to your Lordships that they are well-founded.
I hope your Lordships will accept the twin purposes of this order: to avoid the abrupt termination of new bus grant at the end of next month by extending the period of eligibility to March 1984, and to pave the way for its eventual ending on that date by progressively reducing the rate of grant payable. My Lords, I commend the order to your Lordships and beg to move.
Moved, That the draft order laid before the House on 24th June be approved. —(Lord Mowbray and Stourton.)
7.51 p.m.
Lord UNDERHILL: My Lords, again I would like to thank the noble Lord for his very detailed explanation. Naturally, we on this side of the House welcome the first part of the order, and, as the noble Lord says, it was stated in the Labour Government's own White Paper in 1977 that the bus grant should be phased out by 1985. Naturally, we are very happy with the decision of the Government to ensure that it will continue until 1984. But we are not happy with the second part of the order which is to phase out the whole grant by 1985. Perhaps I should elaborate a little on that.
A great deal has happened since the Labour Government's White Paper of 1977. First of all, the Select Committee on Nationalised Industries recommended in 1978 that the bus grants should not be abolished, that they should be continued indefinitely at what was then the current rate, which I think was 50 per cent. In addition, we have had the effect of inflation and increased running costs. The Secretary of State stated in another place as recently as 25th June that fuel and oil costs had increased by 50 per cent. over the previous 12 months.
Noble Lords will have seen reports about the United Counties Bus Company, which is Northampton based; it is a subsidiary of the National Bus Company. It is facing a £1 million deficit, according to the reports. Some 100 workers are likely to be made redundant. From the reports it appears that a total of some 700 drivers and conductors are to ballot on a trade union proposal for a voluntary
1396
£30 a week reduction so as to safeguard the jobs. Apart from the possible loss of 100 jobs in that particular undertaking, which covers a number of counties, if the jobs could not be saved it would be a very serious outlook for the bus services in that area, because undoubtedly the undertaking would have to cut; it would cut the least profitable services, and once again rural areas would find themselves hit very hard. I mention that as an example of what is facing the bus industry in various parts of the country.
In addition, with the pressure by the Government on local councils to reduce expenditure, and cash limits, there will undoubtedly be some tendency by some county councils to reduce the transport grant to operators. If this is to be a growing tendency, and the bus grant is to be gradually phased out, this will place an increasing burden upon bus passenger transport. Inflation means that the cost of replacing buses is increasing, and if the grant towards bus revenues is to be reduced then the future prospect of transport, particularly in rural areas, will become very depressing. As was said in this House in the debates on the Transport Bill, if the networks are to be faced with increased costs and possibly reduced revenue grant, fares will be increased. Undoubtedly some services will be cancelled or restricted. Bear in mind that the Secretary of State also stated on the same date that over the last 12 months bus fares rose by some 28 per cent.
Noble Lords should note that the transport supplementary grant for England for 1980–81, compared with the previous year's, is cut by 5·3 per cent. in real terms based on 1978 prices; with the various categories of acceptable transport expenditure on which the TSG is based it is actually 5·7 per cent. down, even before taking account of inflation. For Wales in real terms the TSG is reduced by 14·7 per cent. So apprehensions of possible lower revenue grant are based on a considerable amount of substance. So, with rising operating costs, possible cut-back in revenue grant, the decrease in the bus grant will be a serious blow to the bus transport industry and also to the travelling public. This will affect all operators of stage bus services.
I have been looking, as no doubt the noble Lord has, at the 1979 accounts of

1397
the National Bus Company. I have them here. This is our important bus network covering England and Wales. The accounts were published on 17th June, only two days before the Transport Bill was to receive Third Reading, and 1 did not receive my copy until just afterwards. In 1979 the National Bus Company purchased 1,394 new buses at a total cost to the company of £52 million, which was 15 per cent. up on the previous year. The new bus grant to the NBC was nearly £24 million in their last year. If this order is approved it will mean that the National Bus Company will lose about £5 million in 1980, approximately £9 million additionally in 1981, £19 million in 1982 and the full £24 million in 1983, with, of course, possible increases due to inflation that may be prevalent during those years. I have been looking also at the Scottish Transport Group, the national bus network for Scotland. That group purchased 458 new vehicles in 1979 and their position is proportionately the same as that of the National Bus Company. Other operators are going to be similarly affected. In 1979–80 the total bus grants paid by the Government to all the operators amounted to £65 million.
While appreciating what has been a policy of both the Conservative Party and the previous Labour Government, I would say that the situation has changed considerably since 1977. For safety reasons, and bearing in mind the facilities required by the public, I think it would be generally agreed that there should not be any slow-down whatever in the replacement of buses. While the noble Lord the Minister refers to the fact that it is undesirable to have these sort of firm revenues going into bus undertakings, I am certain that no one at this stage would suggest any cancellation of the reimbursement of fuel duty costs, which again is a most valuable asset for the bus operators.
For all these reasons we feel that the order is one that should not be approved at the present time. Naturally, it is pointless for us to decide to divide against it, because there are only six noble Lords who know what I am talking about; it would be a sheer waste of time. But I would like to know the views of the noble Lord the Minister on the points I have made, which I believe are constructive,
1398
because with all the consideration of the present position and the change since 1977 it could well be important that the bus grant should be continued. The bus undertakings are going to find this an additional heavy blow. We do not want to get into arguments on the Transport Bill but, whatever else it will do, the Transport Bill will not help the big networks, and the big networks are the people on whom our passenger transport to a great extent relies. It is not only the networks which will suffer as a result of the cancellation of the bus grant, but all operators, in replacing their essential buses.
8 p.m.
Lord MOWBRAY and STOURTON: My Lords, I do not know whether I am quite so grateful to the noble Lord, Lord Underhill, this time as I was for his kind words last time. However, I accept that both he and I are not addressing a very wide audience tonight. On the matter of general principle, I do not think that there is much between us. At the end of the day the noble Lord's party and my party want to see a successful bus operation. We differ as regards the method, the means by which to go about achieving that.
The noble Lord asked about the decline in new vehicles, and I think I answered that point in my first statement. I suggest that the question which arises is whether demand should be maintained at a level higher than necessary to meet operational requirements. Stage mileage operated services seem likely to continue to decline in the foreseeable future—I do not say that that is a good thing; I just say that it is a fact—partly because of decline in patronage and partly because of service reviews to match provision more closely to needs. Operators should not be encouraged to purchase more vehicles than they need, or the manufacturing industry to plan for a higher level of demand than can be economically sustained.
We on this side of the House in particular are always very susceptible to any suggestion as regards transport in rural areas. We have traditionally always had a great wish to help rural areas. But I suggest that in effect most grants go to benefit urban areas because that is where

1399
most buses are used. Indeed, it is common sense, because most of our population lives in urban areas. However, the Government are highly alive to the needs of the rural areas—for example, in the last TSG settlement we favoured revenue support in shire counties.
However, support for conventional bus networks is not necessarily the best use of resources in thinly populated areas. Cars, minibuses and sharing schemes can often provide services more effectively. The Transport Act which we have recently passed makes it easier to organise such services, and we shall continue to encourage experiments with help and with advice. The noble Lord, Lord Underhill, is a very good man. He wants to see the community helped to the best advantage and those people who do not have cars helped to get to the shops and so on. I have the same views as he has on this matter. Believe me, we are trying to do our best. I suggest that noble Lords opposite have tried to do things their way but I do not say that they have had a 100 per cent. success. Let is try now to do things our way. I do not suppose for one second that we shall have a 100 per cent. success, but let us see who has the better balance of the argument.
We are entering a new phase. Let us give the Transport Act a chance to work. This order is mainly something about which both the Government of the noble Lord, Lord Underhill—which has just been phased out—and our Government are in agreement. I take his point about the second part not being quite so agreeable to him, but the intention on both sides is to make it workable. Therefore, I hope that the noble Lord, Lord Underhill, will not hinder the passing of this order because, at base, we both want the same thing.
On Question, Motion agreed to.
[The Sitting was suspended from 8.5 to 8.15 p.m.]

HEALTH SERVICES BILL
8.17 p.m.
House again in Committee.
Clause 7 agreed to.
Clause 8 [Repeal of provisions relating to withdrawal of pay beds and dissolution of Board, etc.]:
Lord WELLS-PESTELL Lord WELLS-PESTELL moved Amendment No. 10:
Leave out clause 8 and insert the following new clause:
"Establishment of Health Services Protection Board
(8. —(1) There shall be established a Board to be known as the Health Services Protection Board, which shall consist of a member nominated by the Trades Union Congress, a member nominated by the British Medical Association and an independent chairman with legal qualifications.
(2) The Health Services Protection Board shall have the duty of considering all evidence submitted to it including oral evidence in so far as it relates to an authorisation which could have been granted under Part Ili of the Act of 1976 and report with its recommendations to the Secretary of State and it shall be the duty of the Secretary of State to give effect to the Secretary of State to give effect to the Board's recommendations forthwith.
(3) In reporting to the Secretary of State under this section the Health Services Protection Board shall, in considering each individual application for an authorisation which could have been granted under Part III of the Act of 1976 and in addition to the matters which Part [If of the Act of 1976 authorised the Health Services Board to consider, be under a duty to ensure that health services provided within relevant hospital premises shall not exceed those services as they exist on the commencement date with an addition of a further number of beds with supporting services, employees, accommodation and equipment equivalent to the number of beds in the National Health Service authorised for the use of private resident patients on the commencement date.
(4) It is the duty of the Secretary of State and of any individual or body corporate having ownership or control of any premises within or without the National Health Service to furnish the Health Services Protection Board upon its request with such information as a Board may require or the discharge of its duties under this section.").
The noble Lord said: I beg to move Amendment No. 10, which stands in my name. Clause 8 deals with the establishment of a health services protection board and we, on this side, have put down the amendment because we note that the Bill will end the activities of the Health Services Board. We believe that, because of the importance of that Board and the contribution it has made, there should be something to take its place.
I am not unmindful that Clauses 9 and 10 have some relation to Clause 8, inas-

1401
much as they deal with the treatment of private patients in the National Health Service, but I am mainly concerned with the effects of Clause 8. I think it would be helpful if I were to quote from the Notes on Clauses, which admirably set out the intention of Clause 8. I do so by quoting what the Notes on Clauses have to say at page 47 about Clause 8:
"This clause lifts the restriction on the Secretary of State's power to authorise, under sections 65 and 66 of the Act of 1977 and sections 57 and 58 of the Scottish Act of 1978, the use of health service hospital facilities for the treatment privately of patients and repeals the provisions relating to the withdrawal of such authorisations (and consequential matters). It also, together with Schedule 2, abolishes the Health Services Board and its Scottish and Welsh Committees, and transfers the functions of the Board and those Committees to the Secretary of State or to persons appointed by him".
I suggest that this clause really does cause us some concern.
Your Lordships are familiar with our views on the matter of pay beds and private practice: it is a ground that we have been over time and time again. If I restate our views briefly I would say that we wish to see the complete separation of private practice from the health service but the right of the individual to be able to choose. That is important. Secondly, we have expressed ourselves from time to time on the unfair queue jumping, and, thirdly, on the large number of pay beds that are never used.
I move this amendment because the last Government made a genuine and sustained attempt to find a real solution to this problem. I believe that the last Government succeeded. Through the good offices of the noble Lord, Lord Goodman, who managed to find a compromise between the medical consultants and the Labour Government, we set up a Health Services Board. The responsibility of the board was to phase out the pay beds from the National Health Service and to regulate the development of private hospitals so that they did not pose a threat to the National Health Service hospitals.
The composition of the board is probably well known to most noble Lords. Its chairman was the noble Lord, Lord Wigoder. If anybody ever proved and established that he could be independent, it certainly was the noble
1402
Lord, Lord Wigoder. He served this committee and the department, if I may say so, extremely well. He had on the committee two members nominated from the British Medical Association and two from the trade unions. It has always been a source of amazement to me that he managed to get agreement among all four. So far as I know, there was no difficulty at all. During the time they functioned, the number of private beds in National Health Service hospitals was reduced from 3,444 to 2,553. That does not take into account the 1,000 pay beds which were withdrawn by my right honourable friend David Ennals when he was Secretary of State and had the power to do it before the setting up of the Health Services Board.
A great deal was in fact achieved. What was achieved was done by agreement of the members, which, in itself, was no mean achievement. What was even more important, their decisions were binding on the Secretary of State. I want to emphasise that because I wish to come back to it. Their decisions were binding on the Secretary of State; in other words, the then Secretary of State who agreed to this procedure—in fact suggested it—having done so, left no doubt in people's minds that he himself was not responsible. It had been left to an entirely independent committee. That is important.
Clause 8 of the Bill puts an end to all that. If your Lordships read it you will see what the position is. We regard it as essential that if the Secretary of State is sincere in wanting to preserve a proper balance between the private sector and the public sector of medicine, then the Health Services Board should be allowed to continue its work; work which was done to the great credit of its members. Does it seem fair in the sense of being just, and does it seem right that the Secretary of State—and I refer to the present Secretary of State, wedded, as I think he is, to the private sector—should have the final word on the place of private beds in our National Health Service and the development of the private sector? I am sure that we shall be told that the Secretary of State will appoint some committee or other to advise him on these matters, but the fact remains that he will have the making of the final decision, and the procedure for deciding these

1403
matters was much fairer, in my submission, under the previous Government. I ask the Minister to consider whether the present Secretary of State would not be well advised not to have the final decision, when we all know his views on the private sector.
I believe that the Government have stated that services for private patients should not prejudice services for the National Health Service patients. I hope that the noble Lord the Minister will confirm that. I believe that the Secretary of State has in fact come to a six-point agreement with the medical profession on this matter. I have not seen it published; I have not seen it advertised. I do not know whether the noble Baroness will want to tell us about the six-point agreement which the Secretary of State has come to with the medical profession.
I gather that the Government are of the opinion that pay bed authorisations are expected to remain roughly at their present level. I would ask the Minister whether she could say on what basis that statement was made. If the Secretary of State does appoint a committee to advise him, I would expect it to be entirely independent with a broadly based membership. If he agrees—and I do not suppose for one moment that he will—he could do no better than reappoint the Health Services Board, which has shown itself beyond any doubt to be completely impartial and independent.
In considering the private sector I would remind the Minister of the comments of the Royal Commission on the National Health Service, and I shall quote from paragraphs 18/28 and 18/37 of their report:
"Private practice does not pay the full share of the costs which are incurred in their sharing National Health Service premises".
This seems to me to be quite disgraceful. If we are going to have, as I am sure we are—and I accept the fact that it is probably inevitable—the private sector working to some extent alongside the public sector, then I feel that there has to be exercised in the future, as in the past, a control of pay beds.
There has to be also a control of private development in terms of private clinics and private hospitals. I think that the records show that the private sector has
1404
developed beyond anyone's wildest dreams. Nevertheless, the Health Services Board was able to control the development because the cardinal principle was that not too many private hospitals should be allowed to be erected near a National Health Service hospital if they were going to prove a threat to the public sector. If they are allowed to develop haphazardly, then they do pose a threat. Obviously they must get their nursing staff locally. They must get a good deal of their other staff locally. So far as the medical staff are concerned they could be by various salary scales and so on seduced from the National Health Service. We are told that the Government want to see an effective National Health Service, able to cope more effectively than at the moment with those who want medical services. I suggest that it is impossible to do this unless there is rigid control.
I do not know whether the noble Baroness the Minister can say what the Secretary of State is prepared to do in this matter. In the Bill there is a reference to his power to appoint a committee or committees. I should like to know quite definitely, because he ought to have made up his mind by now. This Bill has passed through the Commons and it is pretty well half-way through your Lordships' House, and he ought to have made up his mind what sort of set-up he is going to have to advise him about the development of the private sector and pay beds. I would have hoped that it was possible—although I do not think it is possible—to persuade the Secretary of State to give consideration to what we are asking. We feel it is essential to have a health services protection board and my justification for that is the unqualified success of the previous Health Services Board. I beg to move.
8.31 p.m.
Lord SANDYS: Before we move further, I should like to clarify this amendment. There are really two amendments here. One is that Clause 8 stand part, and the other is the amendment the noble Lord has moved. Before I reply I should just like to point this out to the noble Lord, Lord Wells-Pestell.
Lord WELLS-PESTELL: Yes, leave out Clause 8 and insert the following new clause. It is part of this amendment.
Baroness YOUNG: I wonder if the Lord Chairman could help us. This is really a procedural point, to know how we should best proceed. We have not yet had the Motion that Clause 8 stand part, and the amendment would be to take out Clause 8 and put a new one in. I think it would be helpful to know how we should proceed on this.
The DEPUTY CHAIRMAN of COMMITTEES (Lord Alport): My only instructions on this are that if Amendment No. 10—that is this one—is agreed to, it is necessary to put the Question that the new clause stand part of the Bill. Therefore, as I understand it, this is a substitution for the existing clause. A decision having been made on that, I then confirm that by inviting the Committee to agree that the new clause stand part of the Bill.
Lord SANDYS: I hope we are in order, and with the assurance of the noble Lord the Lord Chairman I will now proceed.
The noble Lord, Lord Wells-Pestell, referred to the compromise which the noble Lord, Lord Goodman, produced on the scheme. My first comment upon the argument of the noble Lord, Lord Wells-Pestell, is this. Of course, it is perfectly true to say that a major achievement in negotiation was achieved by the noble Lord, Lord Goodman, but in our submission it was in no way true that the compromise was for a neutral consideration. We believe that from the very beginning it was assumed that the board had a particular task to perform and it performed it in the way which he described. I do not think he can claim other than the very excellent performance by the noble Lord, Lord Wigoder—a claim of impartiality on behalf of the board. Of course, its members performed their task in an exemplary manner.
I should like to begin my remarks by drawing your Lordships' attention to two things. The first amendment would delete the whole of Clause 8 and the second would provide a new body proposed by the noble Lord to deal with applications made under the 1976 Health Services Act for the development of large private hospitals. It was not very clear from what was drafted precisely what the noble Lord, Lord Wells-Pestell, had in mind,
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and I am grateful to him for clarifying the position. However, whatever the precise arrangements would be, one thing is very clear from the second amendment; that is that what is proposed is an overall ceiling on the level of provision of services for private practice. This is a very important policy step on the part of the Opposition. It goes far beyond anything in the present legislation. I shall come back to this in a moment. First, I would like to deal briefly with the provisions of Clause 8 which the noble Lord would have us omit.
Clause 8 serves as an introduction to the following six clauses of Part II—Clauses 9 and 10, which deal with private practice in the NHS, and Clauses 11 to 14, which deal with the private sector developments. It is the foundation for what follows. Under it, the provisions of the 1977 Act, and their Scottish equivalent, which provide for the compulsory phasing out of existing pay beds, are repealed and the restriction on the Secretary of State's power to authorise new pay beds is lifted. Clauses 9 and 10 build on this. Clause 9 tidies up the legislation to make sure there is no duplication of powers to allow private practice in the NHS. It also removes the provisions which allowed for private patients needing specialised treatments to continue to use NHS facilities. With the restoration of the main power to authorise pay beds these are clearly redundant. Clause 10 provides for restrictions on the restored powers. Clause 8 also abolishes the Health Services Board, as the noble Lord himself has mentioned. One of the Board's functions is to propose revocations of pay beds. Its other function is to exercise the powers in Part III of the 1976 Act. The noble Lord quoted from Notes on Clauses, but this is placing the explanation in a slightly different context. Clause 8 transfers these powers to the Secretary of State. Here, too, the clause paves the way for Clauses 11 to 14, which amend the transferred powers. This is a complicated situation but I hope that my explanation has been satisfactory.
I think we should look at Standing Committee G to reassure the noble Lord in regard to the question he put to me over the six principles which were enunciated by the Secretary of State. The noble Lord may know that my honourable friend the Minister for Health, Dr. Gerard Vaughan, sent them to the health authority

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chairmen in March of this year. He will be aware that the principles were referred to in Standing Committee G, and perhaps I might be permitted to quote the Parliamentary Under-Secretary of State's comment on them, because it is very interesting in this context. It comes at column 822. He said this:
"The six principles are designed to ensure the equitable operation of the National Health Service private practice, both as an end in itself and as a way of helping to ensure that the continued presence of private practice does not cause unrest among other staff. The agreement should go a long way to reassuring those who genuinely believe that private patients prejudice NHS patients. The profession's acceptance and public endorsement of the principles is seen by us as clear recognition by the profession that it accepts the pay bed privileges have associated responsibilities.
"These principles are a clear statement of our view that it is totally unacceptable that the treatment of an NHS patient who is seriously ill or who needs urgent medical care should be in any way prejudiced because priority has been given to a private patient in less need".
I could quote further from what was said on that occasion, but I think it would be more valuable to place on record what the six principles are, and at the risk of wearying the Committee, I will enunciate them because I do not think they are on public record.
The six principles are as follows: first, the provision of accommodation and services for private patients should not significantly prejudice non-paying patients; secondly, subject to clinical considerations, earlier private consultation should not lead to earlier NHS admission or to earlier access to NHS diagnostic procedures; thirdly, common waiting lists should be used for urgent and seriously ill patients as at present and for highly specialised diagnosis and treatment. The same criteria should be used for categorising paying and non-paying patients; fourthly, after admission, access by all patients to diagnostic and treatment facilities should be governed by clinical considerations. This principle does not exclude earlier access by private patients to facilities especially arranged for them if these are provided without prejudice to NHS patients and without extra expense to the NHS; fifthly, standards of clinical care and services provided by the hospital should be the same for all patients. This principle does not affect the provision on separate payment of extra amenities,
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nor the practice of the day-to-day care of private patients usually being undertaken by the consultant engaged by them; and sixthly, single rooms should not be held vacant for potential private use longer than the usual time between NHS patient admissions.
Those are the six principles about which the noble Lord asked me, and I hope I have satisfied him that they have been in the hands of the health authorities. They were discussed at some length in Standing Committee G, and the noble Lord may have seen references to them in other official documents. As for private sector developments, the proposals for dealing with applications for private sector developments were set out in a letter by the DHSS on 31st January and that was made available to Members of the Standing Committee. It proposed that the Secretary of State would need independent advice to advise him on applications, and I will, with permission, quote paragraph 17 of that letter:
"From time to time, the Secretary of State will need independent advice in dealing with applications for increases in pay beds or for authorisation of private sector facilities. This would be necessary where applications raise unusually difficult or contentious issues which the Department is unable to resolve. It is proposed that an expert panel be appointed, from which individuals could be drawn to advise the Secretary of State as and when necessary; the members of committees to hold public hearings could also be drawn from the panel. The panel would include a range of various types of expertise; covering medical, nursing and other NHS staff, health authorities and the private hospitals. It is felt that a panel of this nature would give a greater measure of flexibility than a permanent committee with a fixed membership, and would enable advice to be readily available".
I hope the noble Lord, Lord Wells-Pestell, is reassured on this matter.
The amendment seeks to overturn the basis of the Government's policy which I have attempted to set out, and of course the policy was stated in our manifesto and was explained to your Lordships' House and to another place and elsewhere on many subsequent occasions. Perhaps one of the best occasions of this was when the noble Lord, Lord Hunt of Fawley, initiated a debate on 19th March this year, and the noble Lord, Lord Wells-Pestell, will be well aware of that occasion. In that debate, Lord Hunt quoted two very eminent authorities in the medical profession. If Lord Wells-Pestell does not pay much attention to my statements,

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here we had the president of the Royal College of Physicians, Sir Douglas Black, being quoted by Lord Hunt, who said:
"The president of another, the Royal College of Physicians, Sir Douglas Black, supports the continuance of a strong private sector which, in his own words, 'makes a most valuable contribution to medical care in this country … it is no kind of threat to NHS standards'".
The noble Lord a little later quoted another eminent authority, no less a person than the president of the Royal College of Surgeons, Sir Reginald Murley, who had said:
"The private sector is an encouragement to raise standards of personal service, as well as proper costing and economical use of resources". —(Official Report, 19/3/80, col. 221.)
Those two quotations are of real value because those very eminent medical authorities, widely accepted in this country, stand right outside the political field, and I hope that adds reassurance to the noble Lords that the Government's policy is on the right lines.
Our policy on pay beds is quite simple. We believe it was wrong to phase them out and we shall allow them where they are wanted, subject only to their not interfering with services to NHS patients. I think the six principles make that clear. To ensure this, we have a statutory provision, and the six principles to which I have referred have been agreed with the medical profession; and this we shall no doubt discuss when we come to the amendment to Clause 9 standing in the name of the noble Lord, Lord Wells-Pestell.
Apart from the argument of principle on pay beds, they also are a very useful source of income. No less than £45 million is expected to come from this source in 1980–81. I believe that, as a source of income, it is a growing one, because on 19th March, when the noble Lord, Lord Hunt, referred to it, he spoke of an income of £30 million. So if the rate of progress from this source of income is possibly to be anticipated, I think it will be a real source of satisfaction to medical provision in this country.
Lord WELLS-PESTELL: I am grateful to the noble Lord, Lord Sandys, for his contribution. I am aware of what is in the Bill and I am familiar with what the clause intends to do in relation to the Secretary of State's statement about the appointment of committees or a panel.
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The noble Lord said that the amendment seeks to overturn the Government's intention. That is precisely why it has been put down and is now before your Lordships' Committee. I am not impressed by the quotation from two learned members of the medical profession. That was precisely what I should expect them to say. I should imagine that they are both—no, Sir Douglas Black is a scientist, if I remember rightly, not a member of the medical profession.
Lord SANDYS: Sir Douglas Black is president of the Royal College of Physicians.
Lord WELLS-PESTELL: I should be very surprised if people who make that kind of utterance are not themselves very heavily involved in private practice. I would go so far as to say that if they were Members of your Lordships' House, speaking in your Lordships' Chamber, they would have to declare an interest before they spoke. So I am not at all impressed by that aspect.
I raised the question of the six principles because no mention had at any time been made of them in your Lordships' Chamber; there may not have been an opportunity. I am familiar with them. I have a copy of them in front of me. Since the noble Lord has been good enough to bring them out into the open, so that they will be recorded in Hansard, I hope that noble Lords will read them, and read them very carefully. What worries me about the first principle is that it says that the provision of accommodation and services for private patients should not significantly prejudice non-paying patients—which surely implies that it will, but not very much. What does "significantly prejudice" mean? If it is not going to prejudice, there is no need to say "not significantly". It is obvious that it will do. The Secretary of State, I grant, was being honest. What he was saying in effect was that it will prejudice, but not very much—
Lord SANDYS: Perhaps one should look at the total number of beds in National Health Service hospitals. The noble Lord quoted the reductions, and the Committee will be grateful to him for doing so. The present total of beds in question can surely amount to a proportion that is little more than 1 to 1½per cent. of

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the total number of beds in the care of the National Health Service.
Lord WELLS-PESTELL: The noble Lord misses the point. There is a point of principle here so far as we are concerned. It is not a question of a ratio; it is a question of principle. Let us get back to the principles. The fourth principle states that after admission access by all patients to diagnostic and treatment facilities should be governed by clinical considerations. This principle does not exclude earlier access by private patients to facilities especially arranged for them—I emphasise the phrase "especially arranged for them" —if these are provided without prejudice to National Health Service patients without extra expense. I think that that is contradictory in that it permits for private patients treatment that would not he available to National Health Service patients. What facilities was this clause intended to cover?
Baroness YOUNG: Will the noble Lord give way for a moment? On the first point of the six principles that have been agreed, I believe that we are talking somewhat at cross purposes, because the first is in fact a statutory safeguard. The statutory safeguard in the Bill is that the Bill retains the legislative provision that pay beds will be authorised only where this does not significantly prejudice National Health Service services. That is the reference in the first of the principles, and this is provided under Clause 9, which links the sections in the Act referred to, which provide for authorisation of facilities for private patient use with Section 62, which contains this restriction on the use of the power. We shall discuss this matter under Clause 9. But that is the reference, and it is a legislative one.
Lord WELLS-PESTELL: Yes, but it does not alter the fact that the word "significantly" is used.
Lord SANDYS: The noble Lord has twice made this point and perhaps he would like a rendering in regard to the word "significantly". I understand that "significantly" is taken from the noble Lord's own party's 1976 Act in relation to private sector developments and Section 59 treatments. The word is used
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in Section 62, which stems from the 1976 Act.
Lord WELLS-PESTELL: I should have to look at the Act; but, after all, noble Lords opposite have always said that the Labour Party was wrong. I see that there is no point in pursuing these six principles. I think that on the whole there has been something of an achievement, but I do not think that the principles are as good as noble Lords opposite make out. I take the view that the fourth principle suggests that certain facilities are not available to National Health Service patients, and the fifth principle makes it clear that private patients will be able to monopolise the personal time and expertise of their consultant. One point that irritates many of us—and I have spent very long periods in hospitals—is that where there are private beds, the consultant spends an inordinate amount of time looking after the patients in those beds, while his registrar or houseman comes along and looks after me and other National Health Service patients. I am not quarrelling with that situation, because in my experience the consultant popped in occasionally, so that I did not forget him. But the fact remains that this has been one of the complaints of junior doctors—
Baroness ROBSON of KIDDINGTON: May I ask the noble Lord whether it would not be worse if the consultant was functioning in a private hospital, miles away from the National Health Service? In that case he would not even be on National Health Service premises while looking after his private patients, whereas otherwise if there is an emergency in the National Health Service section while he is attending his private patients, then at least he is on the same premises and is therefore more easily available.
Lord WELLS-PESTELL: If the noble Baroness is to argue along those lines, I, too, shall argue on the same lines by saying that if there was no private practice, we should have more consultants and doctors in the public sector. But neither argument is of very great value. I do not want to say anything more, other than to add that I move the amendment.
Lord WALLACE of COSLANY: Before the question is put, there is one

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point that I should like to address to the Minister. We are talking about private beds, but what is the position about amenity beds? Amenity beds still exist in hospitals and are to some extent different from private beds. Do the Government have amenity beds and private beds in mind in relation to the same purpose in the Bill, or are amenity beds still being kept separate?
Baroness YOUNG: To the best of my knowledge, the amenity beds will remain as they are now within the National Health Service. If I should add something further to that, I shall let the noble Lord know later in the proceedings, or write to him.
On Question, amendment negatived.
The DEPUTY CHAIRMAN of COMMITTEES: The Question is that Clause 8 shall stand part of the Bill?—and if my noble friend Lord Sandys is in doubt about this procedure, I would call his attention to page 13 of the Deputy Speaker's guide.
Clause 8 agreed to.
Schedule 2 agreed to.
Clause 9 [General power to make accommodation and services available]:
8.55 p.m.
Lord WELLS-PESTELL Lord WELLS-PESTELL moved Amendment No. 11:
Page 20, line 5, at end insert—
("( ) Section 65 of the Act of 1977 shall be amended by the insertion after the second "and" in paragraph (a) of subsection (1) of that section the words "in particular he shall direct a health authority to admit private resident patients to a health service only if he is satisfied that—

(i) all potential private resident patients have been placed on the same waiting list as comparable National Health Service patients in the care of the same consultant and that the consultant concerned is ensuring that all patients selected by him for admission to such a hospital and all patients on the said waiting list are being so admitted for treatment and moved along the said waiting list in accordance with common criteria;

(ii) in applying such common criteria the consultant concerned is applying social criteria where such criteria are relevant among others to admission to hospital and to progression along the waiting list but not to such an extent as may give either the class of private patients or the class of National Health Service patients
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an advantage in terms of the length of time on the waiting list over the other class of patient;

(iii) a potential private patients' place on the waiting list is being determined by the date upon which he was first referred to a hospital outpatients clinic or for a private consultation by the patient's general practitioner;

(iv) the District or Area Health Authority is ensuring that the provisions in subparagraphs (i), (ii) and (iii) of this section are being properly applied and that statistical monitoring has been instituted by the relevant health authority to ensure that paragraphs (i), (ii) and (iii) above are being so applied;

(v) sub-paragraphs (i), (ii), (iii) and (iv) above are being applied to diagnostic and other medical services; and".")

The noble Lord said: I beg to move this amendment to Clause 9, which deals with the treatment of private patients in National Health Service hospitals. The amendment seeks to lay down certain stipulations. It is a simple amendment, expressed in very simple language, and we ought not to run into any difficulty about it. It seeks to lay down that all private resident patients in National Health Service hospitals should be placed on the same waiting list as National Health Service patients, and should move along the waiting list in rotation. It will be for the consultants to see that their patients take their turn. This will eliminate queue-jumping, which has been a bone of great contention among the public. The amendment also seeks to make certain that neither class of patient would be at an advantage over the other.
The new sub-paragraph (iii) states that the place on the waiting list, whether private patient or National Health Service patient, shall be determined by the date that the patient was referred to the hospital out-patients' department or, in the case of a private patient, when he or she was referred to the consultant by the patient's GP. The new sub-paragraph (iv) places a responsibility on the District Health Authority or the Area Health Authority to see that these conditions are complied with in regard to reference to the National Health Service for diagnostic and other medical services. The same procedures apply.
This is a sincere attempt to overcome misuse and unfairness by the private sector when using National Health Service hospitals. No one on this side of the Committee would want to deny National

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Health Service facilities to the private sector as and when necessary. The National Health Service already provides many facilities, as was recognised by the Royal Commission on the Health Service, and I should like to ask the Minister to confirm that the Government have changed the policy with regard to private patients using National Health Service beds to include capital charges for pay beds. I should also like to ask whether it is the Government's intention to extend that to the other services involving particular equipment where capital costs and maintenance are high. This, I believe, is not being done at the moment. I accept that some contributions that are asked for from the private sector meet certain expenses, but not all expenses take in the overhead expenses. I beg to move.
Baroness YOUNG: The effects of this amendment would be to provide for statutory common waiting lists for all National Health Service and private patients, and for local monitoring of the arrangements. The Secretary of State would be required to direct a health authority that private patients could be admitted only if he was satisfied that the authority were operating on this basis. I assume that the amendment is designed to instigate a debate on the whole question of "queue-jumping" and common waiting lists, and the Government's own six principles, which we have already discussed.
The amendment seeks to provide for common waiting lists for all National Health Service and private resident patients. It is argued for on the basis that without it private practice leads to abuses. We do not accept this argument, and therefore we cannot accept this amendment; but perhaps it would be helpful if I reiterated some of the points that we have already made about the way in which we have provided that pay beds do not operate to the disadvantage of other National Health Service patients.
As your Lordships will know, our policy is to encourage private practice, both within the National Health Service and outside. For the National Health Service that means allowing private patient use of facilities. As I have said, we are concerned to ensure that this is not at the
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expense of National Health Service patients. We said in the consultative letter which the Minister of State sent out shortly after we came into office that we were concerned that the arrangements for private practice in the National Health Service should operate, and should be seen to operate, fairly, and we have kept that promise.
There are two safeguards, one statutory and one non-statutory. The statutory safeguard, as I have already indicated on the previous amendment, is that the Bill retains the legislative provision that pay beds will he authorised only where this does not significantly prejudice NHS services. This is supplemented by the non-statutory safeguards—that is, the agreement that the Secretary of State has reached with the medical profession on the six principles, which we have already discussed.
The noble Lord asked a question about matters of urgent treatment, and I would say to him that we have extended common waiting lists, where they are needed, to include not only those who are seriously ill and/or those who are in need of urgent treatment but also those requiring highly-specialised diagnostic or treatment facilities. We do not believe, however, that it is objectionable that a patient who has chosen private treatment should be admitted earlier (or later, for that matter) than he otherwise might have been as an NHS patient provided that—and I cannot emphasise this too strongly— he does not thereby prejudice the position of NHS patients who are in need of urgent or highly specialised treatment or diagnosis.
This is the extra provision that we have made about which, I think, the noble Lord was concerned. I hope that that answers the question that he has raised, and has explained our general policy with regard to common waiting lists.
Lord WELLS-PESTELL: Is the noble Baroness the Minister in a position to give any indications as to how in fact these things are monitored? Who has the responsibility to see that they are in fact properly applied? That, of course, will also go for the six principles when they come into being, if they have not already come into being.
Baroness YOUNG: So far as the question of monitoring is concerned,

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there will be no formal monitoring system of the sort provided for in this amendment. I think I must say that. The main check will be by medical colleagues—what has been called the peer group. Health authorities will be asked to ensure that private practice is conducted in accordance with the principles. I hope this explains how we would see this operating.
Lord WELLS-PESTELL: I am bound to say, on what the noble Baroness the Minister has said, that I think it is highly unsatisfactory and open to a good deal of abuse.
On Question, amendment negatived.
Clause 9 agreed to.
Clause 10 agreed to.
Baroness ROBSON of KIDDINGTON Baroness ROBSON of KIDDINGTON moved Amendment No. 12:
After Clause 10, insert the following new clause:
("Charge on private health hospitals
. The Secretary of State shall require private health hospitals annually to levy a charge upon themselves to be fixed after consultation between the Secretary of State and the hospitals for use as a contribution by the private health hospitals for the education and training of medical, dental, and nursing staff within the National Health Service")
The noble Baroness said: I am aware of the fact that an amendment was moved in the other place at Third Reading attempting to achieve what my Amendment No. 12 is attempting to achieve here. It was moved as a new Clause 8 in another place, and I have chosen to put it in as new Clause 11 because I believe that it follows naturally in the arrangement of the Bill since the preceding clause deals largely with the responsibilities that the NHS has towards the private sector. I am the first to agree that, having private sector medicine in this country as well as the NHS sector, it is very necessary that we co-operate for the benefit of all the patients; but it appears to me that the Bill itself concentrates rather too much on the responsibilities of the NHS towards the private sector rather than the other way round. I was also very concerned at hearing the Minister of Health's recent statement that he foresees the possibility of private medicine growing until it accounts for 25 per cent. of patient care in this country.
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Today, private medicine accounts for less than 5 per cent. of patient care, but nevertheless the drain on NHS-trained staff is already appreciable.
In the debate on the preceding amendments, somebody mentioned that the NHS benefit to the tune of £45 million income from private patients. It sounds to be a large sum of money. Can I try to tell your Lordships something of the cost of training staff for the NHS and the private sector?—because the NHS is basically the only training ground for the staff that services private medicine as well as its own. So far as I know, there are only five private hospitals which carry on a limited amount of nurse training. There are one or two voluntary and private hospitals which give training facilities to one or two registrars and senior registrars. Apart from that, on the whole the training for health service personnel, whether private or NHS, is done by the NHS.
To give some idea of the kind of burden that this places on the NHS on its limited budget, I can tell your Lordships that the cost of training undergraduate medical students on the SIFT formula in my region—and I have only one teaching hospital in my region—is £6,069,000. That is the sum required to train 324 medical students and 157 dental students; and that is the cost for one year. The cost to my region of re-training and bringing back into service married women who had left because they have had a family is half a million pounds a year. The cost of training nurses in my region is £3,235,000 per year. The cost of postgraduate training for nurses is £274 million a year, and the cost of postgraduate medical and dental education is £458 million a year. I have not totalled those figures but one can do that on reading Hansard tomorrow. It gives one some idea, if one multiplies the total by the 14 regions in England and Wales, plus whatever happens in Scotland, of the cost of training medical personnel for the use not only of the NHS but also of the private sector.
I have put forward an amendment in quite different terms from the amendment which was put forward in the other place. I have done this deliberately, because I believe that it leaves the possibility of working out on what basis a levy should

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be charged to the private sector towards the cost of education. I have talked to many people involved in the provision of private medicine in this country and they are fully aware of the debt that they owe to the NHS. I do not believe that there is any resistance on behalf of the private sector to helping with the cost of education of nurses, doctors and dentists. If we pass an amendment which leaves to the Secretary of State and the representatives of the private hospitals, the working out of the procedure, I believe that we might achieve something worth achieving. I believe that the private sector would feel better about carrying out their responsibilities and that the NHS would benefit enormously. The idea is not a new one. In most industries that deal with both the private and the public sector we have industrial training boards to which everybody pays a levy. I believe that if we did that, the relationship between the private sector and the NHS would be immeasurably improved. I hope that the noble Baroness, the Minister, can accept this amendment. I beg to move.
Lord WALLACE of COSLANY: I should like to support the noble Baroness. This is an eminently sensible and just amendment. It will be attractive to the Government because it will bring finance into the National Health Service. I am sure that the Government, who are so keen to save money, cannot but accept the amendment. We have been discussing private beds. The noble Baroness is quite right: we train in the National Health Service people who become consultants. I think that I am correct in saying—and I have sat on one or two appointment boards—that we appoint consultants. It is the consultants who, in the main, benefit from private pay beds. There is every element of justice in this. It is an attractive amendment for the Government and they will be throwing money down the drain if they do not accept it.
Baroness MASHAM of ILTON: I, too, should like to support this amendment. It seems only fair that these hospitals which cater for people on insurance schemes pay their contribution to the National Health Service. For example, the long-term sick and disabled are not accepted by insurance schemes. They have no choice. But
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when they work they contribute to the National Health Service. They feel that these hospitals which are outside the Health Service should contribute.
9.16 p.m.
Baroness YOUNG: It is very helpful that the noble Baroness, Lady Robson of Kiddington, has raised this matter so that we can discuss it fully in the Committee. The question of the private medical sector's contribution to staff training has been discussed both in our House and in another place on a number of occasions in the past months. It was raised during our own debate in March. It was first raised by my right honourable friend the Secretary of State for Social Services during the Second Reading debate last December in another place. The Secretary of State said then that although the State trained many people who then went to work in the private sector—and there was an argument that there was no reason why the private medical sector should make a contribution to training—there was a good case for saying that in the case of health personnel the position was different. Where the NHS was short of qualified staff, and where the training was expensive, then the private sector should help by training more of its staff to meet its own needs. The Secretary of State mentioned that there already was some private sector staff training; the Government thought there could be more and their policy was to help the private sector increase its contribution. This was in effect a challenge to the private sector to do more.
We believe that the private sector has accepted this challenge and the responsibility for doing more to meet a greater proportion of the training costs of its own staff. That was a point made by the noble Baroness, Lady Robson of Kiddington. She said, quite rightly, that the private sector would like to help in this matter. To help them see what the possibilities are the Department of Health has had a number of meetings both with individual private sector groups and with a sub-group of the joint liaison committee for independent health care. Next week my honourable friend the Minister for Health will be discussing this with the joint liaison committee itself. So far discussions have concentrated almost ex-

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clusively on nurse training, but there is no reason why they should not go wider than this at a later stage. I think the Committee will agree, however, that nurse training is the most important area on which to concentrate. I think the noble Baroness made this point herself. Good progress has been made. We now have a much clearer idea of the amount of staff training which already takes place in the private sector. This is often provided in collaboration with the NHS. It takes the form primarily of in-service and developmental training, but there are a number of formal nurse training courses, both basic and specialist, provided in private hospitals.
We have also got a clearer idea of some of the problems in the way of a larger contribution. The cost of setting up a basic nurse training facility in the independent sector would not only be very expensive; but, more important perhaps, there are also problems in finding the necessary teaching and clinical experience. These problems are exacerbated by the fact that the private sector, unlike the NHS is made up of a number of very different groups, varying in size, services provided and staffing needs. These differences will affect individual hospitals' degree of involvement in a training programme. Basic nurse training within the private sector is of course not the only area where a contribution can be made. I think that the noble Baroness, Lady Masham of Ilton, made this point. In our discussions with the private sector we are looking at other areas where a contribution would be just as valuable.
If I might indicate just briefly some of the possible options, there is a sponsorship of existing NHS basic and post-basic training. This would be done by sponsoring places in nurse training schools both in NHS and independent hospitals. Alternatively, students from independent hospitals might be sponsored or seconded to attend training schools. There is also the question of direct financial contributions which might be made to support and expand existing training facilities, again in both the NHS and the private sectors. There are also a number of universities which are offering nursing degree courses and students on such courses are funded by local education authority grants, as are other undergraduates. These courses
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provide graduate nurses of a high calibre for the common pool of nursing staff. Resources might be injected into those courses by the independent sector by the endowment of professorial chairs ch lectureships. These are just some of tht. options we are exploring and I give them only as examples of what might be pos sible. I have mentioned some of tilt: difficulties and particularly the difficulties in the way of more basic nurse training but, as noble Lords will appreciate, these are not things that can, or should, be done overnight. They will take some time.
I hope I have said enough to indicate that there is general agreement between us on the principle of this and that we are looking actively at it. In view of what I have indicated and the discussions which are currently taking place, I may say we have not ruled out completely the idea of a voluntary levy. During the Report stage in another place, when a similar amendment was tabled, the Minister of State said that we did not have a closed mind on the idea of a levy and thought that some form of agreed rate of voluntary contributions to a central pool might be made. We do not think that an amendment to this Bill at this stage which would introduce a compulsory levy would be very desirable in view of the discussions we are having. Before we did introduce a compulsory levy we would have to think it through very carefully indeed. For example, the levy would be imposed in all private hospitals and it would be completely non-selective and there would be implications of this. Would there not be any exemptions?
As this amendment stands, unless the definition of a hospital was carefully drafted, it could embrace such premises as those looking after the terminally ill. It would include voluntary and religious hospitals where many of the patients are admitted without any charge at all. I do not in any way use these arguments as a debating point, but I would say quite simply that it would be difficult to accept the amendment on the levy as it stands, because it needs thinking through. I give the assurance to the Committee that, as a matter of principle, this is something that the Government are looking at.
I hope I have said enough to assure your Lordhips that we are looking at a series of propositions with the private

1423
sector and meetings are currently taking place. If I have any further information available by the time we reach the next stage of this Bill, I will of course give it to your Lordships. In the meantime, I hope that I have given enough reassurance so that the noble Baroness may feel able to withdraw her amendment.
Lord WELLS-PESTELL: It is gratifying to hear the noble Baroness say that her right honourable friend the Minister of State is considering this matter with the private sector, but, bearing in mind that the private sector is going to exist for some years on people who are already trained—that is, nursing staff, medical auxiliaries and doctors—and that they have been trained at the expense of the State, does her right honourable friend the Minister of State rule out the possibility of getting some kind of levy for the staff they have already got?
Baroness YOUNG: No, we do not rule that out as a possibility. I hope I made that clear: this is one of the things that are being discussed.
Baroness ROBSON of KIDDINGTON: I thank the noble Baroness very much for her reply and for her open-mindedness on this question. I have some reservations. The noble Baroness said it would be very expensive for the private sector to set up a training programme of their own. I realise that, and that is why there is no hope that this will happen. That is why I have introduced an amendment for some levy to be paid by the private sector.
The noble Baroness also referred to the problems of different hospitals, the size of hospitals, terminal care and all kinds of difficulties that might occur in raising a levy from the private sector. This is exactly the reason why I have left my amendment so wide, and why I say that consultation will take place between the Secretary of State and the private sector. All it says is that, as a basic principle, a levy should be charged. I should be quite happy to accept the result of consultation between the Secretary of State and the private sector, and I hope that this will be kept in mind when the consultation proceeds along the lines that the noble Baroness has suggested.
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In view of her statement on the consultation, I am happy to withdraw the amendment today. But I will re-table it on Report, because I do not accept that this is not the time or the Bill in which to introduce it. I believe that this is exactly the Bill in which to introduce it. Having read the report of what has been said in reply today, and after consulting my colleagues, I might easily re-introduce the amendment on Report, but today I beg leave to withdraw it.
Amendment, by leave, withdrawn.
Clauses 11 to 14 agreed to.
Schedule 3 agreed to.
Clause 15 agreed to.
Schedule 4 agreed to.
Clauses 16 to 24 agreed to.
Schedule 5 [Amendments of the Act of 1977 and the Scottish Act of 1978 relating to exemptions from charges for certain services and appliances]:
9.27 p.m.
Baroness ROBSON of KIDDINGTON Baroness ROBSON of KIDDINGTON moved Amendment No. 13:
Page 54, line 33, at end insert—
("After paragraph 1 of Schedule 12 to the National Health Services Act 1977 there shall be inserted the following paragraph—
"1A. No charge shall be made under section 77(i) above in relation to the supply of any drug, medicine or appliance to any person who is in receipt of Invalidity Benefit.".")
The noble Baroness said: I very much regret that my noble friend Lord Winstanley is not here to move Amendment No. 13, but unfortunately he had to leave in order to catch a train. As your Lordships know, the amendment deals with the exemption from prescription charges for all people in receipt of invalidity benefit. To look at the case for this, we have to look at the figures of those to whom it applies. I believe that at 3rd June 1979 there were 557,000 people in this country who were in receipt of invalidity benefit, and of those about 80,000, or 12 per cent., were exempt from prescription charges, because they were over retirement age or receiving supplementary benefit. Then there are a large number of people who are in receipt of invalidity benefit, and who are

1425
exempt because they have a specified condition. Those conditions include cancer, heart disease, spina bifida, cystic fibrosis, multiple sclerosis, mental illness, chest disease and arthritic condition.
In the discussion on this Bill in the other place on 9th June 1980, it was stated by the Under-Secretary of State, Sir George Young, that information was not available for any of the other exemption categories; in other words, the number of people who are exempt under those categories. But there is evidence that many people who would be exempt under those categories do not apply, because either they do not want to go through a means test or they are not aware that they can apply.
The argument of the present Government is that somebody who is in need of repeated prescriptions can get a season ticket, but for somebody who is in receipt of invalidity benefit this can cause quite a lot of hardship. If you are to get the maximum benefit from buying a season ticket, you ought to buy it on a yearly basis—it costs £12 at the moment, and in future it will cost £15—but it will be very difficult for somebody who is caught in the poverty trap (and many of the invalidity beneficiaries are) to have to pay out that sum of money, particularly since they will say to themselves: "I may not be in need of prescriptions for the whole of the year; it may be only in the winter that I shall need a great number of prescriptions".
Neither the Government nor anybody else has been able to tell me how many people are not exempt now. All we know is that 80,000 people are exempt on the grounds of age or because they are receiving supplementary benefit. We do not know how many people are exempt because they suffer from a specific disease. The Government estimate that the cost to the health service if we introduced exemption from prescription charges for invalids would be £21½ million, based on the average prescription per person, and that, taking into account that an invalid would perhaps need more prescriptions than the average person, the maximum cost would be £4 million. These people are already suffering from the abatement of their benefit and from other measures contained in the Social Security (No. 1) Bill and the Social
1426
Security (No. 2) Bill. I believe that it is incumbent upon us to make certain that people in this category are entitled to free prescriptions.
There is one extra point to be made. Very often general practitioners prescribe a drug or a medicine to make the life of an invalid pleasanter and better in some way, although it is not necessary for his physical health. They will refrain from doing this because they will know that the invalid will have to pay the extra prescription charge. The saving to the nation is so small, that I believe this to be one of the meanest things that we are trying to do. Therefore I hope that the Committee will agree to accept this amendment.
9.33 p.m.
Baroness MASHAM of ILTON: I spoke on this point at Second Reading. As old age pensioners and war pensioners are exempt, it seems to me to be reasonable that invalidity pensioners should be exempt if they become yet another category. Already there are six categories. I would not agree if they were to take the place of some of the people in the six categories. I believe that the very severely long-term sick and disabled should be exempt. They include people with muscular dystrophy, spina bifida, multiple sclerosis, kidney disease, continual skin disease like psoriasis, heart disease, chest disease—all sorts of disease.
I have discussed this with the noble Lord, Lord Campbell of Croy, who is himself war disabled. He tells me that it is quite simple for the medical profession to categorise severely disabled people. Therefore, I implore the Government to look again at this category of severely disabled people. It really does seem appalling that this country cannot help these severely disabled and long-term sick people, some of whom have cancer and who may be going to die. Only last week I heard of somebody who has cancer who has hesitated in taking up her season ticket because she feels that she may not live for a whole year. It really is an appalling situation. In fact, as I meet so many disabled people and I really see them at this level, I feel that the country should do something about this situation. Since Second Reading I have discussed this with many members of the public, and they were appalled because they did

1427
not realise that these very badly disabled people were not exempt.
Lord WELLS-PESTELL: I do not want to prolong this debate, but this is a matter which is causing considerable concern to the people who are working in the field of those who could be described, to a large extent, as being deprived. It has imposed a very severe burden on them. I do not want to go over the same ground as that covered by the noble Baroness, Lady Robson, because she has done it in such an excellent manner. What I want to ask the Minister is this. Is it true that the Department of Health and Social Security has already investigated the possibility of granting exemptions to more groups with specified illnesses, but that this was rejected because it was unacceptable to the representatives of the medical profession because of the risk of argument between doctor and patient?
Lord SANDYS: I think we have had a very useful debate on this most important subject, and I am sure that despite the fact that the noble Lord, Lord Winstanley, has been unable to be with the Committee on this occasion the amendment so ably moved by the noble Baroness, Lady Robson, has interested the Committee very much. I think it would help the Committee if I were to go over in a little greater detail the present arrangements.
Your Lordships may or may not be aware that the present exemption arrangements are based broadly on medical and financial need. Exemption on medical grounds is based on the fact that all persons suffering from one of the exempt medical conditions are virtually certain to require prolonged continuous medication. This is not necessarily the case with all invalidity recipients, many of whom may not require a lot of prescriptions. Exemption on grounds of financial need is given to recipients of supplementary benefit, family income supplement and to others, whether working or not, whose financial resources are not much above supplementary benefit levels. Invalidity benefit is not a means-tested benefit; therefore many recipients will not be in financial need.
While recipients of invalidity benefit as a whole do not qualify for exemption
1428
from prescription charges, many of them do not in fact have to pay for prescriptions as they qualify for exemption under the present arrangements; that is, because they are suffering from one of the specific medical conditions or because they are in receipt of supplementary benefit or family income supplement or because their income falls below a certain level. The qualifying level for low income exemption was raised when prescription charges were increased in July 1979 and on 1 April this year, thus extending entitlement to more people. As was explained in another place, the existing exemption arrangements will continue when the prescription charge increases to £1 on 1st December this year. The low income qualifying levels will again be raised at that time.
The noble Baroness referred to figures in June 1979, and I am a little mystified about them because the figures quoted in another place at col. 90 were 130,000 recipients of invalidity benefit—that is for Great Britain, in 1978—who were known to qualify for free prescription on age grounds or because they were in receipt of supplementary benefit. I regret information is not available for any of the other exemption categories.
In June 1978 recipients of invalidity benefit totalled approximately 708,000. This figure includes those in receipt of contributory invalidity benefits, non-contributory invalidity pension and housewives' non-contributory invalidity pension. I have not been able to reconcile the noble Baroness's figures. I am sure they are very accurately quoted, but I have had insufficient time to reassure myself as to their particular source.
The cost of exempting invalidity benefit recipients would be, for those who are not otherwise exempt from the present 70p prescription charge, in the region of £2·5 million. Apart from the cost there are conflicting claims of the various groups including people who suffer from serious medical conditions, such as cystic fibrosis, glaucoma, chronic bronchitis, emphysema, multiple sclerosis and muscular dystrophy, who in terms of prescription needs and numbers would seem to have a much stronger case. Some other examples of people who feel that the exemption categories should be extended to them include people involved

1429
in early retirement, dependent wives of pensioners and widows.
I re-read with interest the speech of the noble Baroness, Lady Masham, on Second Reading at column 1407. She was of this opinion—I quote her words:
"All I am asking the Government to do now, as prescription charges are going up, is to extend the exemption to some more categories who are severely disabled and need prolonged treatment by the use of any drug, medicine or appliance".
The noble Baroness slightly varied her argument this evening, but I think we can take it the two are not inconsistent with one another.
In the present circumstances I think it would be profitable to take up another point raised by the noble Baroness. She specifically mentioned the problem of a particular case of a sufferer from cancer—and I am sure the House was much moved by it. I think the noble Baroness mentioned that the sufferer did not think it would be worth her while purchasing a season ticket, a certificate for 12 months, at a cost of £12. I would remind the House that there is another option of taking up a four-monthly certificate at a cost of £4.50, which would entitle the holder to obtain as many prescriptions as he or she needs during the four-month period. I think there is a point here. By introducing the four-monthly certificate, to replace the previous six-monthly one, the Government hope to have made it easier for people who have to budget carefully, to find the money to buy a prepayment certificate. A prepayment certificate is currently worthwhile for anyone who needs more than six items on prescription during a period of four months, or more than 17 items during a period of 12 months.
When the prescription charge increases to £1 per item on 1st December 1980 the cost of certificates will also be increased. This increase will be less, proportionately, than the prescription charge increase and thus make the purchase of a prepayment certificate a more attractive proposition. The new prices will be £15 for an annual certificate and £5.50 for one for four months. Certificates issued with a starting date before 1st December will remain valid for their full period. I hope that that information may assist the noble Baroness and I hope that I have answered the questions of noble Lords.
Baroness MASHAM of ILTON: Before the noble Lord sits down, I should like to thank him for what he said about the season ticket which can be paid by four-monthly instalments. There are many people who do not know about it and it would be good if the Government could give it some publicity. That would be very helpful, especially to cancer patients. Having said that, I still think that the very sick and disabled should be exempt.
Baroness ROBSON of KIDDINGTON: I am grateful for the reply that has been given, but I am not happy about the answers because I feel that there are such grave doubts about what the Government are trying to save by not allowing this amendment. What worries me is that the noble Lord who replied cannot tell me the number who are already exempt. However, despite that we have a statement saying that if we exempt everybody it will cost £2·5 million, or maybe £4 million. It seems to me to be a very vague statement and that we need more concrete facts.
It also seems to me that someone in the state of physical health which qualifies one for an invalidity benefit is someone who should be entitled to free prescriptions, especially as the saving to the nation is something about which we are not quite certain—the cost might be very much smaller than the amount stated. However, I shall ponder the subject and decide what to do on Report. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness ROBSON of KIDDINGTON Baroness ROBSON of KIDDINGTON moved Amendment No. 14:
Page 55, line 14, leave out paragraphs 3 and 4.
The noble Baroness said: I seem to be working overtime. I have tabled this amendment to Schedule 5 to leave out paragraphs 3 and 4 on page 55, line 14. I followed with interest the debate that took place in another place when in this schedule the qualifying age for free dental treatment was raised from the age of 16 to 18, whereas previously the exemption age was 21. I realise that there can be an argument for saying that somebody aged 18 now has the right to vote, he or she is an adult human being and there is no reason why we should carry on with this particular benefit.
However, in my view it is absolutely wrong at present to stop treating young people free. The economic situation of this country is such that a mass of our young people are leaving school and not earning any money. They arc in the unemployment queue. I am one of those who believe that it is desperately important that people should look after their teeth up to the age of 21; because if we do not look after the teeth of the young people in this nation, we shall only cause ourselves greater expense looking after them later in life. Healthy teeth have an impact not only on the teeth themselves; they have an impact on the whole health of a person.
We in this country certainly have a rotten record over healthy teeth, which is perhaps only surpassed by the people North of the Border. I happen to have been born in a country where teeth are considered to be important; and we take a pride in keeping our teeth to the age of 70, 80 or 90, or of dying with them. I think that we should have that same principle in this country. I believe that it is very dangerous for a young person who, for the first time probably is on his own, or who leaves his family also to have the added disadvantage of having to pay to go to his dentist. If the treatment were free, we might persuade that young person to get into the habit of going to the dentist every six months to ensure that his teeth are in order. He would have had a year or two before reaching the age of 21 in which to get into the habit. I do not believe that the cost of carrying this out would be enormous, and I believe that it would do an enormous amount of good for the young people of this nation, particularly until this Government, with the last Administration, get down to sorting out who has the ultimate responsibility for putting fluoride into our water supply. This is a problem that has not been solved at all. Until we solve it, at least let us look after the teeth of the young people until they are 21 years of age. I beg to move.
Lord COLWYN: I should like to support this amendment. I am very much aware of the financial problems of the National Health Service and also of the directives from the Treasury. I am also aware that the dental profession has been
1432
successful in already having had Schedule 5 of this Bill amended, changing the age for charging for dental treatment from 16 to 18, and I think that that is a good thing.
Although there is no dental significance attached to the age of 21, it is a fact that between the ages of about 15 and the middle 20s there is a higher incidence and often an onset of many of the aspects of dental disease. My colleagues and I feel that any discouragement to seeking treatment at this age may have far-reaching effects which may ultimately cost the National Health Service much more.
However, I was at the centenary celebration this morning of the British Dental Association, and was delighted to hear my right honourable friend the Secretary of State announce the setting up of a dental strategy review group to look into the future management of dental services and to report as early as the spring of 1981. I was most encouraged to hear that one of the points of reference will be an investigation into the basis of patient contribution towards the cost of dental treatment. It is my hope that the present fixed charges—whether they be payable at the age of 18 or 21—will be reviewed in some way so that the actual charge towards the cost of treatment will bear some relationship to patient co-operation with preventative measures and a commitment to a programme of continued care.
Lord SANDYS: I am sure that the Committee was very glad that when the noble Baroness introduced her amendment she spoke with such feeling from her native country on this interesting subject. The Committee will be grateful that my noble friend Lord Colwyn, a practising dentist himself, was able to add such a weighty contribution to the debate.
The Government, I regret, oppose these amendments which would have the effect of reducing the planned revenue from patients' charges and causing difficulty over the implementation of the proposed extension of the exemption arrangements for appliance charges. May I deal with the revenue point first. Paragraphs 3 and 7 of Schedule 5—which of course this amendment refers to—provide for the upper age limit for exemption from dental treatment charges to be

1433
reduced from 21 to 18 in the case of young people who have left school. It is estimated that this will produce increased revenue from patients' charges of some £7½ million in 1981–82 in Great Britain at Survey 79 prices. The amendment provides, however, for the status quo to continue, with, of course, a consequential loss of planned revenue which the Government would have to make good in some less acceptable way—probably by other increases in NHS charges or by reductions in services. In our view this is undesirable.
In framing Schedule 5, we have endeavoured to ensure that we get the balance of exemptions right. We have had regard, for example, to the arguments put to us that it would have a damaging effect on the dental health of young people to reduce the age limit for exemption below 18 (noble Lords may recall that our original intention, outlined in the latest expenditure White Paper, was to lower the age limit to 16). My noble friend Lord Colwyn referred to this a few moments ago. Similarly, we have provided for full-time students to continue to be exempt until the age of 19. Those patients who cannot afford to pay charges will be able to claim remission on low income grounds, as they can now. The existing arrangements for free dental examination also remain unchanged, as do the exemptions for expectant mothers and those who have borne a child within the previous year. With all these safeguards we do not feel that young people's dental health need suffer as a result of the provisions of paragraphs 3 and 7 of Schedule 5.
Turning now to paragraphs 4 and 8, the definition of qualifying full-time education is required not only for the implementation of paragraphs 3 and 7 but also for paragraphs 1, 2, 5 and 6. What we are doing in these paragraphs is to remove the anomaly whereby the existing exemption arrangements for dental and optical applicances and for appliances supplied to hospital out-patients are restricted to young people under 16 years of age or receiving "full-time education in a school". It is the phrase "in a school" which creates the anomaly because, as many noble Lords will be aware, the pattern of secondary education in many parts of the country is now such that a considerable number of young people follow A ' level and other comparable courses not in schools but in
1434
colleges of further education or similar institutions which do not fall within the statutory definition of the term "school". As a result, students at these educational institutions are denied the exemption to which their counterparts in schools are entitled.
Schedule 5 removes this anomaly by extending the exemption arrangements so that they include all those under 19 years of age who are pursuing a course of full-time education. The interpretation of "qualifying full-time education" in paragraphs 4 and 8 is a necessary part of this extension of the exemption arrangements. I hope that my reply, if it has not satisfied the noble Baroness, will at least have explained the Government's position.
Baroness MASHAM of ILTON: Before the noble Baroness, Lady Robson, replies, may I say that she has a very interesting amendment? My country of birth is Scotland, where I think we have the worst record for teeth. I wonder whether she could tell us what they do in Sweden, which I think is her country of birth. Perhaps we can learn from her.
Baroness ROBSON of KIDDINGTON: That was a very searching question, considering that I have not lived in that country for some time now and 1 am not 100 per cent. up to date on the legislation in that country, but in the days when I was a young person we did get free dental treatment up to the age of 21. But I am not certain, and I should not like to say, that this is so at this moment. I shall have to check up, and I will let the noble Baroness know when I have checked with the Swedish Embassy. What worries me in particular about the noble Lord's reply is that he implied that by levying charges we should receive an income of £7½million.Did I understand that correctly?
Lord SANDYS: Yes.
Baroness ROBSON of KIDDINGTON: That is correct. I presume this is on the assumption—and this is what worries me about the schedule—that all these young people went on and had their six-monthly check and looked after their teeth. What concerns me about it is that I do not believe they will. These are young people who are let out of their family surround-

1435
ings; perhaps their mother and father are no longer there telling them to go to the dentist. If they are short of cash because they are not finding suitable employment, the last thing they are going to spend money on is a visit to their dentist. I believe that it is a short-sighted measure, and I hope the Government will have another look at it before we come to Report stage. But I withdraw the amendment for the moment.
Amendment, by leave, withdrawn.
[Amendments 15 and 16 not moved.]
Schedule 5 agreed to.
Schedules 6 and 7 agreed to.
Clause 25 agreed to.
House resumed: Bill reported with the amendment.

WRITTEN ANSWER

  THE KHARTOUM CONFERENCE ON REFUGEES
  Lord BROCKWAY Lord BROCKWAY asked Her Majesty's Government:
  What were the conclusions of the conference at Khartoum on the maintenance of half a million refugees from neighbouring countries in the Sudan, and what contribution the United Kingdom made.
  The SECRETARY of STATE for FOREIGN and COMMONWEALTH AFFAIRS (Lord Carrington): The Conference approved a two-part resolution. Part A commends the policy of the Sudanese Government in coping with the influx of refugees and indicates a need for 280 million US dollars to finance necessary projects. Part B appeals to Governments and other organisations to contribute generously through a National Refugee Fund, through the United Nations High Commissioner for Refugees or by any other means; it also asks the United Nations High Commissioner for Refugees to draw international attention to the appeal. The conference secretariat will issue a summary of proceedings in due course, a copy of which I shall be pleased to forward to the noble Lord.
  My honourable friend the Minister for Overseas Development represented Her Majesty's Government at the conference and pledged a United Kingdom contribution of £850,000 for the financial year 1980–81. This was the largest contribution announced by any Government. The European Community have pledged a sum equivalent to £1·83 million, of which the United Kingdom's share is £342,000.
  House adjourned at three minutes past ten o'clock.