HL Deb 28 July 1980 vol 412 cc675-711

3.16 p.m.

Report received.

Clause 1 [Power to make changes in the local administration of the health service in England and Wales]:

Lord WELLS-PESTELL had given notice of his intention to move Amendment No.1: Page 2, line 9, at end insert— ("( ) It shall be the duty of the Secretary of State to ensure that one half of the members of a District Health Authority are appointed from persons nominated by local authorities falling within the area of the District Health Authority concerned.").

The noble Lord said: My Lords, with your Lordships' indulgence, I beg leave not to move this amendment, due solely to the fact that I was late in putting down Amendment No. 8 and in due course I wish to move Amendment No.8. I think it would be for the benefit of your Lordships' House if I were not to move Amendment No.1.

[Amendment No.1 not moved.]

Lord WELLS-PESTELL moved Amendment No.2: Page 3, line 36, at end insert— ("( ) Each Family Practitioner Committee established under subsection (1) or (2) above, shall admit to its meetings one member representative of each Community Health Council whose community or part thereof is covered by the Committee. Such representatives shall have power to speak but not vote and shall only attend that part of the Committee at which the general health services are discussed").

The noble Lord said: My Lords, I think I can take this matter quite briefly. It relates, as your Lordships will see, to the position of the community health councils. As your Lordships know, every district has a family practitioner committee and the responsibility of that committee is to concern itself with two quite distinct matters; namely, with the medical aspects and the medical activities of the family practitioner committee, and also with what one might describe as various matters in the community which are of social importance and which have some medical content.

It is the practice of the family practitioner committee to deal with medical matters as a committee only, and that committee is attended by the medical members. It is also the practice of the family practitioner committee to deal with a number of other matters in a form of open committee which various people are able to attend and to take part in, but not to vote.

We on this side of the House—and I believe noble Lords on the other side—would express some surprise that the community health council, which is a body concerned with the views of the consumer—in other words, the patient—is not represented at that second meeting. It is perfectly true that a large number, but not nearly the majority, of family practitioner committees do, in point of fact, invite a representative of the community health council to attend and participate, but not to vote. But it means that a very large number of the community health councils do not receive such an invitation and, therefore, are unable to be present to express the views, comments and observations of, shall I say? the consumer—namely, the patient. I think that everyone will agree that in view of the tremendous contribution which the community health councils make, they ought to be present. The whole purpose of this amendment is to make it incumbent on the family practitioner committees to have a member representative on each community health council who shall have power to speak, but not power to vote.

I do not know what the noble Baroness the Minister will say, but I should like to draw your Lordships' attention to the document sent out to all local health authorities in the last few days by the Secretary of State for Social Services. I refer to document LAC 80/3, which we discussed in some respects last Wednesday, when a Statement made by the Secretary of State was repeated in this House, and in which he made it quite clear that community health councils: will be retained in the new structure, with one community health council for each district". The Secretary of State went on to say that the Government will issue a consultative paper in the autumn seeking views, for example, on the membership and role of the community health councils. Later on, when it is possible to form a considered judgment of the need for separate community consumer representative bodies to exist alongside the new, more locally-based health authorities, the position will be looked at again.

I hope—and I say this with very great respect—that the Minister will not say that all this will be considered in the future. We know that consultation takes a long time. We know that sometimes consultative documents take a year, 18 months or even longer, before they are printed and before the consultations are able to take place. I hope that the Government will feel able to accept this amendment, if for no other reason than that which I gave a little while ago—that is, the significance and the importance of having the views and observations of the community health councils. I think that that is all I need to say, and I beg to move.


My Lords, the effect of the amendment moved by the noble Lord, Lord Wells-Pestell, would be to enable community health council representatives always to be present at meetings of family practitioner committees. It is an issue which, clearly, has attracted interest, not only in your Lordships' House, but as a Motion that was discussed in another place at the Committee stage. We acknowledge that indeed there are advantages in the admission, to the non-confidential part of the family practitioner committee meetings, of community health council observers. There is also merit in the CHCs' argument that without this they cannot carry out with full effectiveness their statutory duty: to represent the interests in the health service of the public in its districts". Indeed, much has been made of the fact that at present only about half the family practitioner committees admit community health council observers to their meetings. However, the majority of the remainder have other equally effective means of co-operating with CHCs by, for example, regular meetings to discuss issues of common interest with them.

At Ministers' requests the matter of the admittance of community health council observers was discussed at a meeting between officials and representatives of the family practitioner services to consider the merits and the disadvantages of the compulsory admission of observers. From this, it was clear that the representatives of family practitioner committees were themselves persuaded of the value of admitting observers, and they thought that the climate of opinion among family practitioner committees as a whole was indeed moving in that direction.

There remained many, however, who would find it objectionable for family practitioner committees to be compelled to admit community health council observers, and who would argue that the worthwhile, best and most effective relationships between family practitioner committees and CHCs could be achieved in other ways. It was apparent that some goodwill could be lost and some flexible and harmonious relationships could be endangered if, indeed, the admission of CHC observers was made compulsory.

The introduction of enforced admission would, indeed, bring about these difficulties. Indeed, I think I am right in saying that when the party of the noble Lord, Lord Wells-Pestell, was in Government, it also considered this matter and did not think it right then to support the compulsory admission of community health council representatives to family practitioner committees. It was reluctant to do this. We believe that enforced admittance would not necessarily be conducive to improving relations between the two committees. Almost all family practitioner committees had found it possible and even helpful either to admit CHC observers to the non-confidential parts of their meetings, or to arrange some alternative ways of discussing points of common interest.

As the noble Lord, Lord Wells-Pestell, quite rightly said, we have decided to retain CHCs. We recognise their importance and the work that they have done, and there is no division of opinion between us on that matter. As he also rightly said, we shall be reviewing their role in the restructured health service, and we announced in our Statement last week, on 23rd July, that we should be inviting views on this and related questions in a consultative paper in the autumn. In reviewing that, we shall be very glad to look at any suggestions that we receive on further ways of improving the relationships between community health councils and family practitioner committees because, indeed, in these matters it is most important to have the right relationships and to get good co-operation between different parts of the health service, all of which have a common interest in making the health service work as well and as efficiently as possible in the interests of the patients themselves.

As I say, it is not in any way our intention to abolish community health councils, but indeed to look at their future role, and in considering this we shall be considering the point which the noble Lord has raised in his amendment. With those assurances I hope that the noble Lord will feel able to withdraw his amendment.


My Lords, I am not very happy with what the noble Baroness the Minister has said. I made it quite clear in my amendment that I was asking that: Such representatives shall have power to speak but not vote and shall only attend that part of the Committee at which the general health services are discussed". I think that it is a great pity that there is this kind of division, and I am sorry that the Government seem to be supporting it.

The noble Baroness quite rightly said that a number of family practitioner committees readily welcomed and, in fact, invited community health council representatives to be present at that part of the meeting where they were discussing non-medical matters. She said that the Government are under the impression that a number of family practitioner committees would find it objectionable. Why objectionable? Are those family practitioner committees of the opinion that as members of the medical profession they have a complete monopoly of ability? No medical member of your Lordships' House, whom I know very well, would make that claim. But this is the claim that those family practitioner committees are making—that they are self-sufficient; that they do not need any social help, guidance or observations from people outside, working in the same field.

If the noble Baroness the Minister would say, or could say, that the Government would make a point of communicating with all family practitioner committees who do not admit a representative from the community health council and advising them to do so, I should be better able to accept the situation. But I am not really prepared to accept the situation if the Government are going to say, "No, we can't do that; we must await the outcome of the consultations that we are going to have". In my view those will take a jolly long time. If the family practitioner committees are really concerned with coming to grips with the non-medical problems, the social problems, which impinge upon their medical ability and their medical competence, then I think they ought to be asked to include a representative of the community health council. I would hope that your Lordships here would support this amendment.

Baroness YOUNG

My Lords, with the leave of the House, as we are on Report, the point that I was trying to make about the CHC observers at family practitioner committees was that what family practitioner committees would object to was the fact that they would be compelled to admit as observers people from community health councils. It would not necessarily be an objection to the community health councils themselves. There is a difference, and it is a question of whether or not they should be compelled to admit them. I think all of us recognise today that the climate of opinion is for more open government, is to have observers in places and committees where this is possible. I fully recognise that the noble Lord's amendment does say that when confidential matters are to be discussed the observers would not be there; the observers would be there only for general health matters.

This is an issue which we shall certainly be raising with the community health councils in our future discussions with them, and I hope that the community health councils will see it as an earnest of our good intention that we have already accepted the principle that they should continue to exist. They were, of course, brought into existence in the 1974 health reorganisation. They have done good work and we wish them to continue to do so. Among the many matters we shall be discussing is whether they should, by right, attend family practitioner committees, which, as the noble Lord, Lord Wells-Pestell, will know—no doubt better than I do—are committees which are very much concerned with detailed matters to do with family practitioners and are not, in fact, covering quite the whole range of subjects covered by other statutory committees in the health service.

We feel that at this stage we do not want to embark, in any of our constitutional arrangements, on forcing people into

acceptance of policies that we may well be able to get by agreement over this consultative period. As I say, it is not that we have ruled this out. We hope that we shall be able to discuss it and to reach agreement, because it is working quite well, as I understand it, in 50 per cent. of the cases now; and it is just in the other committees where it is not working and where, if this amendment were to be carried, they would be compelled to accept this, that the difficulty would arise. We do not want this kind of difficulty at this stage of this Bill and this reorganisation.

3.34 p.m.

On Question, Whether the said amendment (No. 2) shall be agreed to?

Their Lordships divided: Contents, 49; Not-Contents, 84.

Amherst, E. Davies of Penrhys, L. Paget of Northampton, L.
Amulree, L. Donaldson of Kingsbridge, L. Pargiter, L.
Ardwick, L. Elwyn-Jones, L. Porritt, L.
Aylestone, L. Fisher of Rednal, B. Ritchie-Calder, L.
Balogh, L. Gaitskell, B. Rochester, L.
Banks, L. Gordon-Walker, L. Shinwell, L.
Beaumont of Whitley, L. Goronwy-Roberts, L. Stedman, B.
Birk, B. Hale, L. Stewart of Alvechurch, B.
Blease, L.[Teller.] Hall, V. Stewart of Fulham, L.
Blyton, L. Janner, L. Stone, L.
Brockway, L. Kilmarnock, L. Strabolgi, L.
Buckinghamshire, E. Leatherland, L. Strauss, L.
Burton of Coventry, B. Llewelyn-Davies of Hastoe, B. [Teller.] Taylor of Mansfield, L.
Cledwyn of Penrhos, L. Wallace of Coslany, L.
Cooper of Stockton Heath, L. Lloyd of Hampstead, L. Wells-Pestell, L.
Crowther-Hunt, L. Melchett, L. Wynne-Jones, L.
David, B. Northfield, L.
Addison, V. Drumalbyn, L. Home of the Hirsel, L.
Alport, L. Dudley, B. Hunt, L.
Auckland, L. Dundee, E. Hunt of Fawley, L.
Avon, E. Ebbisham, L. Hylton-Foster, B.
Bellwin, L. Effingham, E. Ilchester, E.
Belstead, L. Ellenborough, L. Kinloss, Ly.
Bessborough, E. Elliot of Harwood, B. Kinnaird, L.
Blake, L. Evans of Hungershall, L. Kinnoull, E.
Burton, L. Fairfax of Cameron, L. Lauderdale, E.
Caithness, E. Faithfull, B. Lindsey and Abingdon, E.
Carrington, L. (A Principal Secretary of State.) Geddes, L. Long, V.
Gibson-Watt, L. Lyell, L.
Chelwood, L. Godber of Willington, L. McFadzean, L.
Cockfield, L. Gowrie, E. Mackay of Clashfern, L.
Craigavon, V. Gridley, L. Macleod of Borve, B.
Cullen of Ashbourne, L. Hailsham of Saint Marylebone, L. (L. Chancellor.) Malmesbury, E.
Daventry, V. Mansfield, E.
de Clifford, L. Hanworth, V. Margadale, L.
De Freyne, L. Henderson, L. Marley, L.
Denham, L.[Teller.] Henley, L. Monk Bretton, L.
Derwent, L. Hives, L. Mowbray and Stourton, L.
Netherthorpe, L. Sandford, L. Sudeley, L.
Northchurch, B. Sandys, L.[Teller.] Trenchard, V.
Nunburnholme, L. Slim, V. Vaizey, L.
Rawlinson of Ewell, L. Spens, L. Vaux of Harrowden, L.
Redmayne, L. Strathcarron, L. Vickers, B.
Rochdale, V. Strathclyde, L. Vivian, L.
Romney, E. Strathcona and Mount Royal, L. Young, B.
St. Aldwyn, E. Stuart of Findhorn, V.

Resolved in the negative, and amendment disagreed to accordingly.

Clause 5 [Power of health authorities, etc. to raise money etc. by appeals, collections, etc.]:

3.42 p.m.

Lord WALLACE of COSLANY moved Amendment No. 3: Page 8, line 21, leave out second ("A") and insert ("An Area or District").

The noble Lord said: My Lords, it will be recalled that in moving the deletion of Clause 5 during the Committee stage I drew attention to the valuable activities of local voluntary groups and the community value of such money raising efforts, quoting a number of examples from personal experience. The purpose of the amendment before the House is to free regional health authorities from fundraising schemes. The areas they cover are large, thus ruling out enthusiastic local involvement, and frankly apart from running large-scale lotteries I fail to see what other activity they could undertake. In any case, regional health authorities have a big enough job to cope with in running an effective and economical service without staff being diverted to fund raising activities.

Many area health and district health staff are voluntarily involved already in activites organised by such bodies as leagues of hospital friends. The amendment will not alter this, and accepts that area and district health authorities can initiate schemes of fund-raising and enlist the aid of hospital leagues of friends in other bodies such as Rotary, Inner Wheel, et cetera. It may of course be argued that fund-raising by regional health authorities would ensure that rich areas help poor areas, but experience shows that in local activities results and enthusiasm are greater in poor areas, probably because there is a greater community feeling in such areas. The amendment is intended to be helpful, and I trust it will be accepted by the Government in the same spirit. I beg to move.


My Lords, I have during the interval since Committee stage had the opportunity to read once again Lord Wallace of Coslany's speeches on this subject both at Second Reading and more recently, and we are well aware of his point of view. In the debates on this clause both here and in another place we have emphasised that we see fund-raising as an essentially local activity, and on that I think we agree. Appeals for funds for local services, where the benefits can clearly be seen by the local people who have contributed, are the ones most likely to be successful. We resisted an amendment in another place which would have required all locally raised funds to be distributed by the regional health authority; this would have destroyed the incentive to local people to contribute. We expect that most NHS fund-raising will be done by area and district health authorities and boards of governors. It is at this level that it is most likely to be successful. The noble Lord, Lord Wallace, told the committee, and the House at Second Reading, of the success which his own local area had achieved, and we should congratulate him on that.

However, there may be circumstances where it would be sensible for a regional health authority itself to become involved—perhaps in co-ordinating an appeal for something which would serve more than one area. We do not think it would be sensible to exclude this sort of involvement, and that is why we have given the power in Clause 5 to all authorities—regions as well as areas, districts and boards. I would stress once more what I stressed in Committee, that this is a permissive power, and it does not have to be used in a mandatory fashion. I hope that your Lordships' House will accept this as sensible and that the noble Lord will feel able to withdraw the amendment.


My Lords, I certainly accept the point that the noble Lord has made. However, having had some battles in the past with regional health authorities—I have been a bit of an anti-regional health authority person in many ways; they seem so remote—I cannot see them getting involved. There is the possibility, as the noble Lord says, that some special appeal might be made—who knows?—and that they would coordinate activities. I think local health authorities, the areas and the districts, would prefer that the region kept out of it, and I do not think they would like to be co-ordinated by the region.

I do not regard this as a major point. I was trying to be helpful, and quite honestly I suppose that the noble Lord in replying has really met my point. He just made the point that possibly regional health authorities might have to come in sometimes. If that is the case I see no purpose in pressing the amendment. I have stated my point, and to some extent the noble Lord has met it. I therefore beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

3.50 p.m.

Lord WALLACE of COSLANY moved Amendment No. 4: Page 8, line 42, after first ("activities") insert ("but excluding major lotteries").

The noble Lord said: My Lords, this amendment raises an important point of principle: should the National Health Service adopt large-scale gambling as a source of supplementary finance? To many people that would be morally wrong. Secondly, if organised by regional health authorities, or possibly by area or district health authorities (it is more likely to be RHAs and therefore not likely to be areas or districts) then, if they were run by RHAs, that would be bound to involve large numbers of staff. Thirdly, if professional outside help were used, that would involve part of the finance raised being used to provide income for professional gambling organisations, which again would be thought by many people to be morally wrong; and there are strong and profound objections to such a course. In any case, the experience of schemes run by local authorities on this basis has revealed a considerable lack of success and increasing apathy.

There have been a number of attempts to float a national lottery, but so far nothing has got off the ground and there has been considerable hostile reaction, mainly again on moral grounds. There is also the risk of legal problems arising. An uneven pattern could also arise with some regions activating schemes and some not, so the only solution would be a national lottery run by the Government, and we know the political problems that would cause. So far, we have had no clear indication of the Government's intentions in this matter. If the Government do not intend to encourage this type of questionable activity, they have a duty to say so and to accept the amendment, which would put the issue beyond doubt. This is not a light matter but one of real moral importance, and I appeal to noble Lords, if I feel it necessary to press the matter to a Division, to give their support.


My Lords, I hope the noble Lord, Lord Wallace, will feel able to withdraw the amendment after I have spoken on the subject. The Government entirely accept his first argument, that it would be wrong if the clause gave authorities power to run major lotteries; but as the Bill stands it does not do so and the amendment is therefore unnecessary. I would draw the noble Lord's attention to the discussion that took place on Second Reading of the Bill in another place in December of last year, when my right honourable friend the Secretary of State said: The words 'casinos' and 'lotteries', as I understand it, do not come within the clause. They would be the subject of legislation from another department. My control would be exercised through the opening words of Clause 4(3):'Subject to any directions of the Secretary of State excluding specified descriptions of activity'".—[Official Report, Commons, 19/12/79; col. 675] My right honourable friend in quoting what was then Clause 4(3) was of course referring to what is now Clause 5(3), and I am sure the noble Lord, Lord Wallace, will have appreciated that. It would obviously be helpful to the House if I explained precisely why that is, in order to get the position quite clearly on the record and, I hope, to dispel any lingering uncertainty.

The relevant legislation here is the Lotteries and Amusements Act 1976, and this was referred to in Committee. This Act distinguishes between two main types of lottery; small lotteries and the larger society or local lotteries, and that is Sections 3, 5 and 6 of the 1976 Act. Small lotteries (a main example of which would be a raffle) may be held subject to certain conditions at what are defined in the Act as "exempt entertainments"—that is, fetes, bazaars, dinners et cetera—and there is no restriction on who may run these small lotteries providing the conditions on their conduct are complied with. The conditions are set out in Section 3 of the 1976 Act and include ones relating to the use of the proceeds (not for private gain) and the types of prizes where there are no money prizes. It is also provided that the lottery must not be the only, or the only substantial, inducement to persons to attend the entertainment. Health authorities are empowered under the new section to organise events which fall into the category of "exempt entertainments" and will be able therefore to organise these small lotteries as an incidental part of such activities. I need hardly remind your Lordships' House that these are a common feature of many a fund-raising summer fete.

I take it that those are not the sorts of lottery the noble Lord is anxious to exclude, but I thought it would be helpful to explain this part of the 1976 Act so far as these lotteries will be allowed. So far as the larger society or local lotteries are concerned—and I assume it is these lotteries that the noble Lord is referring to in the amendment—the position is that under the 1976 Act only certain classes of bodies can run these lotteries. Health authorities are not empowered by the Act to run these sorts of lotteries because they are neither local authorities (who are given a specific power in the 1976 Act to run local lotteries) nor societies capable of running society lotteries. This Bill in no way overrides this legislative bar. The amendment is therefore unnecessary and we hope the noble Lord will feel able to withdraw it.


If that is the case, my Lords, and particularly the last words uttered by the noble Lord, why on earth not say so in the Bill? There is a weakness in the Bill in that the noble Lord said it is not in the Bill, but in subsection (3) "competitions" are mentioned, and competitions could include a sizeable lottery on, say, forecasting the result of a horse-race or a type of football competition which is quite common. Although there may be a provision in the Act about health authorities, it is not in the Bill, and I want to avoid any possibility of problems arising. I am not at all happy with the Minister's reply.


With the leave of the House, my Lords, I should explain that it is not in the Bill because it is already subject to the terms of the 1976 Act. As to whether health authorities should have this power, I explained in Committee that we shall be considering separately whether to give health authorities the power to mount major lotteries. If we wished to do that, it would be achieved by an amendment to the Lotteries and Amusements Act 1976, and the House would of course have the opportunity to debate the proposals.

I mentioned that the 1976 Act was under review following the report of the Royal Commission on Gambling. We have not decided either way on the matter. I will convey any views expressed by noble Lords—and of course any views expressed by the noble Lord, Lord Wallace, who has taken such an interest in lotteries—to my right honourable friend the Secretary of State, who will no doubt pass them on to the Home Secretary at the appropriate time.


My Lords, with the leave of the House, may I say that therefore there is a possibility that the Government will seek power for health authorities to run major lotteries; the noble Lord has said so. I am very concerned about this. Under those circumstances, on the question of principle I shall press the amendment.

4 p.m.

On Question, Whether the said amendment (No. 4) shall be agreed to?

Their Lordships divided: Contents, 46; Not-Contents, 94.

Amulree, L. Fisher of Rednal, B. Pargiter, L.
Ardwick, L. Gaitskell, B. Phillips, B.
Aylestone, L. Gordon-Walker, L. Ritchie-Calder, L.
Birk, B. Goronwy-Roberts, L. Ross of Marnock, L.
Blease, L. [Teller.] Hale, L. Shinwell, L.
Blyton, L. Hall, V. Stedman, B.
Brockway, L. Henderson, L. Stewart of Alvechurch, B.
Burton of Coventry, B. Leatherland, L. Stewart of Fulham, L.
Cledwyn of Penrhos, L. Llewelyn-Davies of Hastoe, B. [Teller.] Stone, L.
Collison, L. Strabolgi, L.
Cooper of Stockton Heath, L. Lloyd of Hampstead, L. Strauss, L.
David, B. McGregor of Durris, L. Taylor of Mansfield, L.
Davies of Penrhys, L. Maelor, L. Wallace of Coslany, L.
Donaldson of Kingsbridge, L. Melchett, L. Wells-Pestell, L.
Elwyn-Jones, L. Northfield, L. Wynne-Jones, L.
Evans of Hungershall, L. Paget of Northampton, L.
Addison, V. Ellenborough, L. Marley, L.
Adeane, L. Elliot of Harwood, B. Monk Bretton, L.
Airedale, L. Fairfax of Cameron, L. Mowbray and Stourton, L.
Alport, L. Faithfull, B. Murton of Lindisfarne, L.
Amherst, E. Gainford, L. Netherthorpe, L.
Ampthill, L. Geddes, L. Northchurch, B.
Auckland, L. Gibson-Watt, L. Nunburnholme, L.
Avon, E. Godber of Willington, L. Orkney, E.
Banks, L. Gowrie, E. Porritt, L.
Beaumont of Whitley, L. Gridley, L. Rawlinson of Ewell, L.
Bellwin, L. Hailsham of Saint Marylebone, L. (L. Chancellor.) Redmayne, L.
Belstead, L. Rochdale, V.
Bessborough, E. Hanworth, V. Rochester, L.
Blake, L. Henley, L. Romney, E.
Burton, L. Hives, L. St. Aldwyn, E.
Caithness, E. Home of the Hirsel, L. Sandford, L.
Carrington, L. (A Principal Secretary of State.) Hunt, L. Sandys, L. [Teller.]
Hunt of Fawley, L. Soames, L. (L. President.)
Chelwood, L. Hylton-Foster, B. Spens, L.
Cockfield, L. Ilchester, E. Stamp, L.
Cottesloe, L. Kilmarnock, L. Strathcarron, L.
Craigavon, V. Kinloss, Ly. Strathclyde, L.
Cullen of Ashbourne, L. Lauderdale, E. Strathcona and Mount Royal, L.
Daventry, V. Lindsey and Abingdon, E. Strathspey, L.
de Clifford, L. Long, V. Stuart of Findhorn, V.
De Freyne, L. Lyell, L. Sudeley, L.
Denham, L. [Teller.] McFadzean, L. Trenchard, V.
Derwent, L. Mackay of Clashfern, L. Vaizey, L.
Drumalbyn, L. Macleod of Borve, B. Vaux of Harrowden, L.
Dundee, E. Malmesbury, E. Vickers, B.
Ebbisham, L. Mansfield, E. Vivian, L.
Effingham, E. Margadale, L. Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

Clause 6 [Provision of public money for, and financial duties of, health authorities, Health Boards, etc.]:

4.9 p.m.

Lord WELLS-PESTELL moved amendment No. 5: 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: My Lords, this amendment was before your Lordships at the Committee stage on 10th July when it was moved by my noble friend Lord Pitt of Hampstead. He wishes me to apologise for his absence today. He is at present in Botswana, where he has been attending the funeral of a very old friend of many of us, Sir Seretse Khama. My noble friend has asked me to raise this matter in the hope that this time the Government will be able to give a more detailed ex- planation than they gave on the last occasion, for resisting the amendment.

Your Lordships will see from the amendment that it deals with the central funding of certain specialist services. As your Lordship know, in certain regional health authority areas there are specialist hospitals dealing with particular medical matters which not only serve the particular regional health authority in which they are situated but also deal with patients coming from a very large area.

I do not want to take up unnecessary time by setting out the large number of specialist hospitals that are to be found in this country; but it is felt by a good many people—my noble friend in particular—that they should be separately funded. I know the answer is that if a specialist hospital is in the area of a particular regional health authority then in assessing the needs of hospitals in that authority's area the needs of the specialist hospital are taken into account. But it is felt by a good many people that, because of the shortage of money, insufficient money is given to the specialist hospital in order that a more liberal amount may be given to some of the other hospitals. It could be argued by the Government—and it could be a very valid argument—that the size of the cake is known, and how it is divided still will not provide any more money. This I accept; but I ask the Government whether there is not a case to be made out for their looking separately at the needs of these particular hospitals. If there is, then perhaps they ought to be lifted out of the usual round of funding and treated quite individually.

I think it is extremely difficult, when a hospital is serving an area which is perhaps the size of half of England, to feel that it is being given a sufficient amount of money to enable it to do that; and many of your Lordships (not only the medical Members of your Lordships' House, but many other noble Lords) know that there are some specialist hospitals that serve pretty well the whole of England at one time or another. Ought they to be treated like any other hospital in a regional health authority, or should they be considered quite separately, with the Government perhaps setting a sum of money aside simply and solely for the specialist hospitals?

I think the argument can be a pretty fine one, but a number of people who are familiar with the tremendous contribution which these specialist hospitals are making share the view of my noble friend. Therefore, I ask the Government whether they can add anything to what they said on 10th July last, either by accepting this amendment or, if they are unable to accept it, by giving a more reasonable and a more encouraging reply to my noble friend Lord Pitt. I beg to move.


My Lords, as was made clear at an earlier stage, the Government do not take kindly to this amendment. We think it is unnecessary because, should the need arise, the Secretary of State is already able, without new powers, to vary the allocation to regional health authorities to reflect particular circumstances; and regional health authorities already can and do take into account such special factors in determining the allocations to the present area (or future district) health authorities.

We also think it is undesirable because it would be a direct intervention by the Secretary of State in the business of planning—that is, managing the health services—a task which is specifically one for the health authorities set up for that purpose. Issuing guidance on general or specific matters is one thing: taking over the functions of the health authorities is quite another; and the Government have repeatedly said that they are in favour of less intervention, not more.

We also think the proposal would be unworkable, because the problem of defining and identifying which services should be specially funded, and by how much, would create a mini-bureaucracy on its own; and I leave it to the imagination of your Lordships what sort of scramble it would provoke to be put on the favoured list. Specialised units ought not to be established in a random manner and funded directly from DHSS outside the normal arrangements for arriving at priorities. They should, we believe, fit into a pattern of need, and, according to their degree of specialism, serve a local, regional or national population. We believe that the correct way to plan the location of such units is through the NHS planning system, which involves the DHSS, RHAs, AHAs and the DHAs to come. It would be the negation of a rational planning system if certain specialised units were formed and funded entirely apart as the result of special pleading by isolated individual enthusiasts. Hospitals exist primarily to serve the needs of their local population. The extent to which they serve wider functions should be a reflection of a planned decision. The planning process will take cognisance of the need for resources.

It is not possible, or indeed justifiable, to seek to place particular services outside the whole complex of competing priorities within a given resource total, as this clause seeks to do. The health service must be looked at as a whole, and it would not be sensible or fair to allow certain services to take up more than a due share to the detriment of others. The Secretary of State and the health authorities are well aware of the importance of the specialist units, and their interests—and those of the patients they serve—are fully taken into account in the system. I feel sure that the noble Lord, Lord Wells-Pestell, knows full well how this is done, after his many years in the DHSS, and I do not think that he himself would perhaps have suggested that we should go away from the system which has been operating and on to this special funding of these specialist hospitals.

It was pointed out in Committee that the amendment is technically defective, since hospitals "have no discrete financial or administrative existence; the Secretary of State can fund only a health authority. I hope the noble Lord, who thought on the previous occasion that he did not get a full answer, will feel that I have given a satisfactory explanation this time, and will be able to withdraw the amendment.


My Lords, I am grateful to the noble Lord the Minister for his reply. He will understand that I stand before your Lordships today as a special pleader on behalf of my noble friend Lord Pitt. It is a question as to whether he, a member of the medical profession, will feel that the Government have given a satisfactory reply. When the noble Lord the Minister said that hospitals exist to serve their local community, I could almost hear my noble friend say, "Yes, but take the Stoke Mandeville Hospital, which is in an area health authority to serve a particular community but which in fact serves the whole country ". That is his point. There can be given to that area health authority only a certain amount of money to cover not only their needs but the needs of every other hospital. The result is that over the years more and more people have wanted to go to Stoke Mandeville; there has been an enormous waiting list and, if I may say so, things came to a head a year or two ago when it was found that the hospital was seriously in need of a great deal more money.

I do not wish to pursue this because it is not my amendment, but I was anxious that the Government should have another opportunity of looking at it in the hope that they could have come forward with a much more sympathetic reply than they did last time and which I find they have not been able to come forward with on this occasion. Nevertheless, I am grateful to the noble Lord, and I beg leave to withdraw the amendment.

Amendment by leave withdrawn.

4.21 p.m.

Baroness YOUNG moved amendment No. 6: Leave out Clause 7 and insert the following new clause:

"Services provided by relatives of doctors providing general medical services

(7. The following subsection shall be added at the end of section 29 of the Act of 1977 (arrangements and regulations for general medical services) as subsection (5) of that section and at the end of section 19 of the Scottish Act of 1978 (which makes corresponding provision for Scotland) as subsection (4) of that section:—

"( ) Regulations shall—

  1. (a) include provision for the making to a medical practitioner providing general medical services of payments in respect of qualifying services provided by a spouse or other relative of his; and
  2. (b) provide that the rates and conditions of payment and the qualifying services in respect of which the payments may be made shall be such as may be determined by the Secretary of State after consultation with such bodies as he may recognise as representing such medical practitioners." ")

The noble Baroness said: My Lords, I beg to move the amendment which stands in my name and in that of the noble Baroness, Lady Masham of Ilton, and the noble Lord, Lord Winstanley, whom I am pleased to see is in his place this afternoon. We had a most valuable discussion in Committee of the question of payments to general practitioners who employ relatives as ancillary staff in their practices. I explained then why it was that this Government, like its predecessors of both parties, had felt unable to allow these general practitioners to claim 70 per cent. reimbursement of the salaries they pay to relatives and which they would be able to claim if the staff were not related to them. The difficulty which has always been seen here is, in a nutshell, how to provide acceptable and demonstrable safeguards for the spending of public money which would be involved.

It was largely because of this financial difficulty that the Government felt unable to accept, as it stood, the clause added to the Bill in Committee, as it appeared to envisage that any of the 22,000 general practitioners in England and Wales employing a relative in the practice should be eligible for reasonable payments without further delay. Nevertheless, as I said to noble Lords on that occasion the Government had every sympathy with the principle involved and the broad intentions of the clause. Indeed, I offered to reconsider the matter on that occasion. With that in mind and in view of the strength of support which the clause received from all parts of the Committee, the Government has accordingly considered the matter afresh to see whether it might be able to accept Clause 7 either in its present or a modified form, in the light of the amendment which was carried on that occasion.

I am glad to be able to say that as a result we have felt able to table the amendment standing in my name and that of the noble Baroness, Lady Masham and of the noble Lord, Lord Winstanley. The new clause we propose to replace Clause 7 does, as the noble Baroness, Lady Masham, wished, put a statutory duty on the Secretary of State to secure that payments are made to general practitioners who employ their spouses or other relatives in respect of qualifying duties. It places that duty in the appropriate National Health Service context—which will require him to consult the representatives of the general practitioners nationally about the way he carries it out. The Secretary of State, of course, already has a power to make such payments. What the new clause would do would be to make that power a duty. It would provide a specific recognition in legislation of the strength and legitimacy, as it were, of the case which the noble Baroness brought before your Lordships, and of the principle involved. It would, we believe, be a notable landmark in the progress towards the objective, which the Government share, of seeing that all general practitioners employing relatives on qualifying duties should be able to get direct financial help as they can when they employ unrelated staff, though the terms and conditions of payment have to differ. I hope that noble Lords generally will welcome, as I do personally, the step forward which this new clause represents.

Perhaps I may explain briefly its effect. It will place a duty on the Secretary of State to make regulations providing for payments to general practitioners in respect of qualifying services provided by a spouse or other relatives. The regulations will also provide for the rates and conditions of payment and the qualifying services in respect of which payments may be made to be determined by the Secretary of State after consultation with the representatives of the profession. This will—as the Government believe is necessary—put it in the hands of the Secretary of State to determine how quickly it will be possible to move towards the objective of direct payments for all general practitioners employing relatives on qualifying duties and to determine what such duties should be and who, for this purpose, should count as a relative.

However, I must make it clear to noble Lords that this clause would not immediately open the door and release new resources for this purpose. It would not oblige the Secretary of State to do more for the time being than he is already doing and beyond which, he does not feel able to go at present. The noble Baroness, Lady Masham, understands and accepts this, although naturally she would have liked to be able to secure more immediate progress on the ground, as indeed, would the Government. The recent agreement with the representatives of the general practitioners to extend the scope of the related ancillary staff scheme will, however, be reviewed starting before the end of 1981 and I am sure that the prospect for further improvement will be most sympathetically considered at that stage. The Government are glad, however, that we have also been able to table this alternative clause, not only in my name but also that of the noble Baroness, Lady Masham, and the noble Lord, Lord Winstanley. I hope this amendment will accordingly commend itself to the House.

4.27 p.m.


My Lords, in commending the noble Baroness's amendment to the House, it would appear that I have already brought upon myself the ire of doctors and doctors' wives who have already written to me, accusing me of being something of a renegade. I would say, in supporting the noble Baroness's amendment, that I have not changed my views one jot or tittle since I expressed them to your Lordships in Committee recently. I believe that this act of discrimination against a small number of extremely hardworking women ought to be removed as speedily as possible. This is an anomaly which ought to disappear. However, I am genuinely persuaded that the means of removing this anomaly that the noble Baroness has brought forward—although it may he in the nature of the inevitability of gradualness—probably offers the best hope of getting the thing done.

There are two points that I should like to make. The first is regarding the point that the noble Baroness has made regarding the financial difficulty and the importance of not burdening the Government with extra financial commitments. It is a fact that the family practitioners have contractual arrangements with doctors all over the country whereby they are under an obligation to repay 70 per cent. of the pay of women or men working in certain approved posts. If all the doctors who at the moment employ their wives or their daughters in a given practice or partnership or group practice should get rid of them and say, "You go and work for another practice!"—and take on somebody else, then immediately the family practitioner committees would have a financial and contractual obligation to repay 70 per cent. That is what some of them will do if there is any delay in bringing forward this measure. I think it right to re-emphasise that we are not here talking about the doctors' wives who wander about the surgery flicking a duster or occasionally answering the telephone; we are talking about professional women doing important, full-time jobs, as receptionists, typists, secretaries or nurses, posts which are approved by the family practitioner committees; and they are really doing a full-time job. If they are replaced by somebody else, the family practitioner committee will have to pay and pay at once. There is no getting out of that.

There is one other point in this amendment which enables the Secretary of State to remove this anomaly and this unfortunate element of discrimination against certain women straight away. He states that he will do this after consultation with such bodies as he may recognise as representing such medical practitioners. There is only one body which represents such medical practitioners and that is the General Medical Services Committee; and that committee's advice to the Secretary of State will be precisely the advice which I gave at an earlier stage of the Bill.

Therefore, it necessarily follows that if there is any delay at all in remedying this injustice and removing this anomaly, clearly the responsibility must inevitably lie at the feet and at the door of the Secretary of State I hope it is to him that the letters of doctors and their wives will be addressed in future rather than to me. I hope that noble Lords on all sides of the House will support this amendment as a step in the right direction.


My Lords, we on this side of your Lordships' House would not dream of opposing the amendment. We would go a long way with the noble Lord, Lord Winstanley, in all that he says. But, on the other hand, we view the conduct of the Government in relation to other matters, where they have shown discrimination against the unemployed—or they will do from this November—and the invalids. Their benefit will be reduced by 5 per cent. We would have found it extraordinarily difficult if the Government had been able to implement this immediately. In the circumstances, we feel that, while it may only be a half a loaf, a half a loaf is better than none at all. We understand why the Government may be reticent in giving any undertaking as to a date when they will implement this in view of the fact that they are penalising many hundreds of thousands of people who are far worse off.


My Lords, as one who did not like the first Clause 7, I warmly welcome this new clause that we are about to pass. It will be welcomed by all spouses, whether male or female, and any relatives who are enabled, because of their qualifications, to help doctors in their practice. I warmly welcome this new clause that my noble friend has brought to this House today.


My Lords, on the Committee stage my noble friend Lord Mottistone spoke in some detail on this amendment. He has asked me to convey his apologies that he is not able to be present. As one who also spoke on Committee, I join him in thanking the Government for at least going some way towards correcting what I think was formerly something of an anomaly. There are problems, as the noble Lord, Lord Winstanley, with all his experience, has outlined. I can only think that the general practitioner will be able to give a much better service to his patients, particularly nervous ones or those who have a distressing complaint. The wife of the practitioner—particularly if she is medically trained—in an urgent case may be able to run off a quick letter rather than waiting for further secretarial help to come along. On those grounds, I should like to thank my noble friend and her department for going a long way to bring in a valuable part of the Bill.

The Duke of ATHOLL

My Lords, I should like to ask my noble friend to confirm that this new clause applies to Scotland as well as England and Wales, as I believe it does.


My Lords, speaking in a purely personal capacity, I should like to add my word of support in favour of this amendment. Many patients recognise the tremendous services rendered by doctors' wives who assist their husbands in a secretarial capacity. On balance, the ultimate consideration ought to be: What is best in the interests of the patient?

General practitioners realise that their wives or near relatives do not always fully measure up to the requirements of the practice; and they should be allowed the widest possible latitude in their choice of assistants or secretaries.

On balance, this decision ought best be left for the consideration, through the Secretary of State, of the local medical practitioners' committee. After the experience that the Government have had during the Committee stage of this Bill, this amendment is one which will commend itself not only to the majority of Members of the House but also to the majority of medical practitioners, who, as we all know, put the considerations of their patients first rather than those of personal gain or loyalty to members of their family. I give my warm support to this amendment.

4.37 p.m.

Baroness YOUNG

My Lords, with the leave of the House, I should like to thank all those who have taken part in this short debate. At the outset I should say that the noble Baroness, Lady Masham of Ilton, has written to me to give her apologies for not being here this afternoon but she is unable to be present. She sent me copies of samples of a great deal of the correspondence that she has had, so even if I was not aware from people who have brought it directly to my attention, I would have had it from the letters which she has sent.

I should like to assure the House and all those who have spoken that there is no division of opinion about the merits of the case. It is, as I said at an earlier stage, a question of the financing of this scheme and how to find a way of identifying the qualifying duties. These are problems which we believe can be overcome. The new clause puts a duty on the Secretary of State to look at this at a future date.

I was therefore very glad to hear what the noble Lord, Lord Winstanley, said on this matter; and I thank him for the generosity of his remarks about the new clause and for his agreement in principle. I recognise that he, like us all, would have liked it to go further; but I am very pleased that he accepts this clause as an earnest of our good intentions in this respect. I am also grateful for the remarks of the noble Lord, Lord Wells-Pestell. He has recognised that the clause goes some way to meet the real criticisms of the Committee. I also thank my noble friend Lady MacLeod for her support and the noble Lord, Lord Auckland.

May I say to my noble friend the Duke of Atholl that the Bill applies to Scotland and Wales? I hope that clears that point. I say to the noble Lord, Lord Segal, that of course we are all agreed on the principle of this. It is a question now of the money to implement it. That said, I appreciate the welcome that has been given to this matter. We have had a useful discussion on it and I am obliged to all noble Lords who have taken an interest and now support this compromise amendment that the Government are bringing forward.

On Question, amendment agreed to.

4.40 p.m.

Lord BANKS moved Amendment No. 7: After Clause 23, insert the following new clause:

("Information on recruitment and training of disabled persons

—(1) Every body to which section 98(1) of the Act of 1977 refers shall prepare and submit to the Secretary of State in respect of each financial year such information as he may prescribe about the arrangements of that body in that year for the recruitment and training of disabled persons and for the employment, training and advancement of disabled employees.

(2) The Secretary of State shall each year lay before each House of Parliament such statement in such form as he considers appropriate of the information obtained by him under this section.

(3) In this section the expression "disabled person has the same meaning as in section 1(1) of the Disabled Persons (Employment) Act 1944; and the expression "disabled employee" shall be construed accordingly.")

The noble Lord said: My Lords, during the Committee stage in another place on what is now the Companies Act 1980, an amendment was moved by Mr. John Hannan, with the support of the the all-party disablement group. This amendment required companies to provide for the Secretary of State each year information about their arrangements during the preceding year in respect of the recruitment and training of disabled persons and of the employment, training and advancement of disabled employees. The Government accepted that amendment in principle and it is being implemented by means of regulations which will be discussed in this House on Wednesday.

This amendment would place a similar obligation on statutory health authorities. Answers given to Questions asked in another place have revealed that health authorities and local authorities have a very poor record so far as satisfying the 3 per cent. quota for the employment of registered disabled people is concerned. No health authority satisfied the quota during the five years 1976 to 1979. In these circumstances it seems desirable that the obligation of reporting action in this field which has been placed on companies should be extended to health authorities so that progress may be monitored and any necessary action by the Government taken. I hope the Government will be able to accept this amendment, and I beg to move.


My Lords, as noble Lords will be aware, we are concerned, as a Government, that all employers in the public and the private sector should accept their proper responsibility for employing disabled people. As one means to achieve this, we consider that employers should be publicising their arrangements for recruitment and training of the disabled. As the noble Lord, Lord Banks, has just mentioned, we shall, on Wednesday, in this House and in another place, be considering regulations being laid under the Companies Act 1980, prescribing the information which companies must include in their directors' reports on the policies they have applied during the past financial year for the employment of the disabled. Information will be required on their policies for giving full and fair consideration to applications for employment made by disabled persons, having regard to their aptitudes and abilities; for continuing the employment of and arranging appropriate training for employees of the company who have become disabled during their employment by the company, and for the training, career development and promotion of disabled employees of the company.

As good employers, health authorities, like other public sector employers, would not, I am sure, wish to lag behind private employers in providing information about their arrangements for recruiting, employing and training disabled people. My right honourable friend the Secretary of State for Social Services will therefore be drawing to the attention of health authorities the obligation being laid upon companies to provide this information, and will be discussing with health authorities in what way they can best meet the Government's objectives. Whether the formal reporting mechanism suggested in the amendment would be the most effective way to publicise health authorities' policies I am not sure: we are bound to look carefully at the detail of any new routine requirement which would place new burdens on health authorities.

Public sector employers are, in any event, well accustomed to following the provisions of legislation without a specific statutory obligation being laid upon them to do so. Indeed, although health authorities are expected to make every effort to comply with the provisions of the Disabled Persons (Employment) Act 1944, they are not, as Crown bodies, bound by it in law.

We therefore think it more appropriate for the health service to take note of the regulations for companies, and to consider its own arrangements informally, without being required to follow a specific statutory procedure on the lines of the amendment now before us. I hope, therefore, that your Lordships' House will accept my right honourable friend's assurance that the Secretary of State for Social Services will draw the new requirements for companies to the attention of NHS employers, and will discuss with them in what way they can best comply with the Government's wish that all major employers should frame and, given their different problems and circumstances, practise effective policies for employing disabled people, and that the noble Lord who is responsible for this amendment will agree to withdraw it.


My Lords, I am grateful to the noble Lord, Lord Cullen, for that reply. I am glad that he expressed the Government's concern in this matter as he did, and I am also glad he said it was the view of the Government that employers should be publicising what they are doing in this particular field. The noble Lord did say that public bodies are accustomed to follow legislation, but I did give an indication in my earlier remarks that the local health authorities had not been successful in doing that, however much they had wanted to, over the past five years. This certainly adds a certain sense of urgency to the discussions, which I am glad to hear are going to take place. Therefore, although I would not say I am entirely satisfied, I welcome the assurance that has been conveyed to us from the Secretary of State, and in view of that assurance I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 1 [Amendments consequential on changes in local administration of the health service]:

4.47 p.m.

Lord WELLS-PESTELL moved Amendment No. 8: Page 40, line 41, after ("district ") insert ("and at the end of (d) there shall be inserted the words "of whom in non-metropolitan areas not less than two shall be appointed by the specified councils of non-metropolitan districts " ")

The noble Lord said: My Lords, I beg to move the amendment standing in my name. As your Lordships will see from the amendment, we are dealing in the amendment with the representation of the non-metropolitan areas on the district health authority. This amendment is one which I think it is fair I should say is of considerable concern to the Association of District Councils. I feel quite inadequate in dealing with this matter, as the President of the Association of District Councils, the noble Lord, Lord Sandford, is in the Chamber. I hope that he will cross my t's if they need it and will not hesitate to dot my i's or to correct me in any way that he feels is necessary.

This amendment provides that two of the four members of district or area health authorities appointed by local authorities under Schedule 5 of the National Health Service Act 1977, paragraph 2(1)(d) shall in non-metropolitan areas be appointed by district councils specified by the Secretary of State. This change would in fact bring about what is proposed by the Secretary of State himself because, if you are familiar with the document, to which I have already referred this afternoon and which the Secretary of State sent less than a week ago to all local authorities, on the structure and management of the new body to be set up by the provisions of the Bill we are considering this afternoon, you will find that the last sentence of Section 11 states: It is the Secretary of State's intention to introduce legislation that would enable two of the four local government members of a non-metropolitan district health authority to be appointed by district councils.

That being the case, I submit with very great respect that there is no good reason why this change should await further legislation. We have the Bill in front of us. It deals with structure and management. I want to suggest that by putting this in it will remove any doubt as to what will be the position. It will be entirely helpful.

The change should be incorporated in this Bill. Otherwise, there is a danger that district councils will lose their existing representation on health authorities, because the total number of local government representatives is being reduced. With the existing statutory provision for at least four members to be appointed by non-metropolitan county councils, there will be room for non-metropolitan district councils only by grace and favour of the county councils.

For example, we have the situation, as I see it, that district councils cannot be individually represented on their new district health authority. In Salop, which has one health district in the county, there are six district councils and, if there are to be only four appointed from the district councils, it will have to be four of the six. In Dorset, where there are two health districts and six district councils, there can again be only four.

I could draw attention to Devon, where there are three health districts plus part of another district and where there will be no fewer than 10 district councils which will be entitled to only four representatives. So it is not an exorbitant number. As I understand it—and I hope that the noble Lord, Lord Sandford, will put me right if I am wrong—it will mean those 10 district councils in Devon getting together and electing four people. This is an entirely reasonable amendment and I hope that the Government will feel able to accept it. My Lords, I beg to move.

4.52 p.m.


My Lords, I should like to rise to support this amendment and to start by thanking the noble Lord, Lord Wells-Pestell, who is a Vice-President of the Association of District Councils, for being kind enough to put it down. The amendment was not received by the association until last week, 24th July, and on that day I happened to be on business in Brussels on behalf of a Select Committee. But I would certainly endorse what he said and just add these points.

The necessity—not the desirability—of having local authorities and district councils in particular represented on the health service is not, I think, in question. If you come to think of their responsibilities for environmental health, housing, planning and the local communities' needs generally, I consider that that goes without saying. It is not in question and, in fact, it has been recognised and achieved in the past.

The arrangement by which district councils have been represented on the health service since 1975 is that they have made nominations to the regional health authority, which has made the appointments. The consultation paper, Patients First, which went out in December 1979, recognised the necessity for the districts to continue to be represented on the local health authorities. But the legislation of 1977 does not make provision, except in the terms that the noble Lord mentioned, though that, in itself, would not be unsatisfactory.

The difficulty comes from the consultation paper which was issued last week. There we have the remarkable suggestion that if the county councils—an entirely different sphere of local government—thought fit to reduce their membership, then room might be found for the district councils. That is a quite intolerable situation. We are not there by favour of the county councils. That was followed by the equally unsatisfactory proposal that the Secretary of State should, in due course, introduce legislation. But, as the noble Lord said, here is the legislation in front of us and here is the opportunity—indeed, the necessity—to make provision in it for the district councils in non-metropolitan areas to be properly represented in the health service. Therefore, I have no hesitation in supporting the amendment, and I have every expectation that my noble friend will be able to accept it.

4.56 p.m.

Baroness YOUNG

My Lords, I am grateful to the noble Lord, Lord Wells-Pestell, and to the noble Lord, Lord Sandford, for raising this important aspect of local authority membership of health authorities. The amendments already made by the Bill to Schedule 5 to the National Health Service Act 1977 merely apply the existing provisions concerning local authority membership to district health authorities. That means that only non-metropolitan county councils, metropolitan district councils, and London boroughs can appoint members directly to health authorities.

As the noble Lord, Lord Sandford, said, there is at present an administrative arrangement whereby non-metropolitan district councils can submit nominations for membership to regional health authorities. Regional health authorities then, in turn, appoint these members as part of their appointments. We believe that new smaller district health authorities should continue to have representation from the grass roots of local government; that is, the non-metropolitan district councils. We therefore have considerable sympathy with Amendment No. 8, which would add non-metropolitan district councils to the list of those local authorities which may be specified in regulations as bodies with powers to make appointments to health authorities, provided that this, like other measures in Clause 1, would take the form of an enabling power only.

The precise numbers of local authority members, and the split of members between local authorities, are, however, different propositions and we need to consider, in the context of detailed restructuring proposals which the regional health authorities will be making in the coming months, which particular local authorities should make appointments to individual health authorities and the appropriate numbers of such appointments. At the end of the day, these rights can be guaranteed and enshrined in subordinate legislation, in precisely the same way as applies to other local authorities which already enjoy appointment rights.

In preparation for the discussion which we would have on this amendment, I looked at the regulations and it is clearly laid down which districts will appoint representatives to the different types of authority. I therefore find that there are difficulties in the way of accepting Amendment No. 8, which goes further than this enabling power to which I have just referred, principally because that amendment would tie the hands of the Secretary of State and the regional health authorities before detailed proposals for district health authorities are agreed and substantiated.

As I am sure the noble Lord, Lord Wells-Pestell, and the noble Lord, Lord Sandford, appreciate, Clause 1 of the Bill is an enabling clause and the details have not yet been worked out. It is difficult to say, at this stage, whether it will be appropriate to have not less than two non-metropolitan district council representatives serving on district health authorities in the shire counties. In the main that may well be a satisfactory solution, but we have no proof at this stage that that formula will apply without exception in all such cases throughout the length and breadth of the country. Therefore, I think it would be wrong to put such a requirement into the main legislation ahead of proven need.

Furthermore, the position of the non-metropolitan district councils would become more special than their local authority brethren, with whom the second amendment seeks to bring them into line. No other type of local authority is guaranteed at least two places in the principal Act. The 1977 National Health Service Act delegates, in effect, to subordinate legislation—that is, the health authority constitution orders—the local authorities concerned, and the precise, the specified, number of appointments which should be made. That cannot be the case under this amendment.

The whole of the provisions already contained in the Bill are expressed as enabling measures, with the one exception of this particular amendment. From the moment that the Bill becomes law, this amendment would apply to a considerable number of area health authorities whose boundaries cover shire counties. The effect would be that these very area authorities which the Government are seeking to replace would be required to contain at least two members appointed by non-metropolitan district councils. I do not think that this is in fact the intention of either the noble Lord, Lord WellsPestell, or, indeed, the noble Lord, Lord Sandford, but I accept the principle of what they are trying to do.

Accordingly, we must oppose the first of these amendments, for the reasons which I have enumerated and which I am sure they will understand. There is difficulty about having something written into an enabling clause in this way. But the overall objective of the amendments can be met, we believe, entirely by the second amendment. That will bring the non-metropolitan districts into line with the other classes of local government body already covered by the 1977 National Health Service Act, a point to which my noble friend Lord Sandford drew our attention right at the beginning of his remarks when he said that it was unusual that they should have been left out of the list of authorities. The second amendment is one which the Government had in fact intended to introduce at some appropriate occasion in the next session. Now that the amendment has been tabled, it seems to us that it should be supported. Therefore, I should like to give an assurance to the House that we would accept Amendment No. 9.

I have tried to explain the situation as fully as I can. I hope that the House will agree that the principle of what the noble Lord, Lord Wells-Pestell, wishes to do and, indeed, what my noble friend Lord Sandford wishes to do is one with which the Government agree. By accepting the second of these two amendments one would make it an enabling measure. Although we accept the general principle contained in the first amendment, which is embodied in the second amendment, we cannot accept that amendment as it stands because it would confer this right of two members of district authorities to be on the, at the present time, area health authorities and at a later date on the district health authorities, when, of course, Clause 1 is simply an enabling power which will enable district health authorities to be set up. Until we know how they will be set up, we think that it would be inappropriate to have this precise number of people from district authorities. With that explanation, I hope that the noble Lord, Lord Wells-Pestell, will agree to withdraw Amendment No. 8. If he moves Amendment No. 9, it is one which the Government would be happy to accept.


My Lords, I am grateful to the Minister for what she has said, but I want to be perfectly frank. I am still a little confused about some of the arguments which the Minister has put forward for not accepting Amendment No. 8. Obviously I shall want to read at leisure in Hansard what she has said. I am sure that the Minister has given very good advice. However, I should like to take advice upon it. I am grateful that, having seen the wording of Amendment No. 9, the Government would be willing to accept it. All I wish to know now is whether the Minister wants me to move it properly or whether I should just move it formally?

Baroness YOUNG

My Lords, the important matter before the House is that the noble Lord should move the amendment so that it can be agreed to.

The DEPUTY SPEAKER (Lord Derwent)

My Lords, is it your Lordships' pleasure that Amendment No. 8 be withdrawn?

Amendment, by leave, withdrawn.


Amendment No. 9. The Lord Wells-Pestell?


My Lords, what I meant is whether the Minister wanted me to justify the amendment. If not, I shall move Amendment No. 9 which stands in my name.

5.5 p.m.

Lord WELLS-PESTELL moved Amendment No. 9: Page 41, line 5, after ("paragraph 5,") insert ("in sub-paragraph (1)(a) after the words "metropolitan district "there shall be inserted the words a non-metropolitan district," ")

The noble Lord said: My Lords, Amendment No. 9 relates to Schedule 1, page 41, line 5. I beg to move.

Baroness YOUNG

My Lords, as I have already indicated, the Government are prepared to accept this amendment.


My Lords, I am very grateful to the Minister. If in future she is going to do something like this, I think that she ought to give me good notice. I am not sure that my constitution would stand too many shocks of this kind! Nevertheless, I am very grateful to her.

On Question, amendment agreed to.