§ Order for Second Reading read.
§ 11.7 a.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt) rose—
§ Miss Margaret Herbison (Lanarkshire, North)
On a point of order. Before we begin the Bill, Mr. Speaker, I should like to know whether one of the Ministers from the Scottish Office will deal with the Scottish part of it.
§ Mr. Speaker
That is not, from any point of view, a point of order. I want the help of the House in this matter. I want this seeming practice of rising to mention any topic prefaced by the words "On a point of order" not to go on.
§ Mr. Speaker
It is not a point of order, and I am not prepared to hear anything further about it on the basis of a point of order.
§ Miss Herbison
In that case, Mr. Speaker, I wonder whether you can help me in any way. This is a matter of some concern. I took it for granted that one of our Scottish Ministers would be taking part in the debate. Can you help me in any way to find out whether that is the case?
§ Mr. Speaker
I cannot accept any responsibility for the conduct of Ministers, or for their presence or absence, so I am in some difficulty in helping the hon. Lady, at the same time desiring to avoid any conceivable kind of discourtesy towards her. The present position is that the Order for the Second Reading of the Bill has been read, and I called the Minister to move the Motion.
§ Mr. Hector Hughes
Apart from any point of order—may I ask for your guidance, Mr. Speaker? You may have observed that the practice has grown up recently of Bills affecting Scotland coming before the House with no Scottish Minister being present—
§ Mr. Speaker
Order. I do not know on what basis the hon. and learned Member thinks he is addressing me. I have not called him. He is not rising to a point of order. I do not know what he is doing. Miss Pitt.
§ Miss Pitt
I beg to move, That the Bill be now read a Second time.
The shortness of this Bill is not a measure of its importance. It occupies a vital place in the development of the health and welfare services and fits in with all the other steps that are being taken to ensure that their development is on proper lines and puts first things first.
The first priority must be to forestall illness and disability by preventive measures whenever this can be done. It is even more important to foster positive health and social well-being. Where, notwithstanding our efforts, illness or disability or any of the whole range of social difficulties or problems occur, the next priority is to ensure that people are cared for or helped at home and in the community except where they need the special type of care that only a hospital can provide. Without derogating in any way from the work of the family doctor, it is the case that a major part of the burden and responsibility for both of these priorities—prevention and community care—falls on the local authority services. These services cannot function unless they are properly staffed. This means enough staff, and properly trained staff. That is where the provisions of the Bill fit in.
The main purpose is to set up training councils for health visitors and social workers for the whole of the United Kingdom. Health visitors and social workers are two important groups of local authority workers who devote their time to the purposes I have mentioned, of prevention of illness and care in the community. Training for the health visiting service provided by local authorities is, of course, long established, as hon. Members will know. We, with Commonwealth countries who have followed our pioneering work, have been one of the few countries to make use of a fully trained nurse who receives further training to equip her to carry help and advice into every household. The task here, therefore, is to make the fullest use of existing high standards of 1686 training so as to ensure that the health visiting profession is able in numbers and standards of training to make its full contribution to both prevention and community care.
Training specifically for social work in the local authority health and welfare services is new and the challenge here is different; to provide a training outside universities so that existing officers and new recruits may have that background of skill and knowledge that has long been recognised as essential in other fields of social work. We hope that many workers with a university type of training will enter the local authority field; but the bulk of the work in the health and welfare services will fall to workers with the new general training in social work recommended in the Younghusband Report, and it is for this new training that the Social Workers Training Council will be responsible. There is thus great need in both spheres for the imaginative stimulus that a national training body can give. Both the Jameson and Young-husband Reports recognised this.
We have also had very much in mind the complementary roles in the local authority service of the health visitor and social worker. Both these workers do their job to a very large extent in people's homes. In both cases they have to work on their own, though in co-operation with others, in an environment which is personal to the individual they are seeking to help. Each will often have to refer cases to the other because of the nature of the skilled help required, and constant advice and co-operation will be required at every turn. Thus there are many links between them, and it is proposed not only that the two Councils should be set up by the same Bill, but provision is made for them to have the same chairman and some members in common, as provided in paragraphs 2 and 9 of the First Schedule.
The Bill has been prepared after full consultation with the local authority associations, professional and medical organisations, universities and training bodies, and voluntary organisations. The interest has been most encouraging and there is every prospect that its provisions will be welcome to all the interests concerned.
1687 I turn now to the provisions in the Bill. Clause 1 and the First and Second Schedules provide for the establishment and proceedings of the two Councils, which are to be called the Health Visitors Training Council and the Social Workers Training Council, and for an advisory committee to each Council on the exercise of its functions in Scotland. Similar committees may be appointed for Northern Ireland. The main provisions of the Bill extend to the whole of the United Kingdom because the situation it deals with is common to all parts of the United Kingdom and the aims of health and welfare policy are the same throughout.
Clauses 2 and 3 set out the functions of the Health Visitors Training Council and Social Workers Training Council, respectively, very much on the lines recommended in the Jameson and Young-husband Reports. The Councils will have the general duty of promoting training and will do this by encouraging the provision of facilities for training. They will set national standards by approving courses as leading to certificates which they will award.
The certificate of the Health Visitors Training Council should take the place of those issued by the Royal Society for the Promotion of Health and the Royal Sanitary Association of Scotland, who have long set standards for health visiting. The health visiting profession, like many others in the health field, is very much in their debt. Initially the Social Workers Training Council will be concerned with social work in the local authority health and welfare services and in similar services run by voluntary organisations, but under Clause 3 (3) its functions may be extended to other fields of social work.
Social work which involves dealing with individuals and families cannot be separated into watertight compartments and the same body of sociological and psychological knowledge and the same skills, supplemented as necessary for work with particular disabilities, apply to the different settings in which social work is done. The general two-year training recommended in the Young-husband Report is itself based on this view as applied to the health and welfare services provided by local authorities to meet a variety of needs.
1688 The Bill, therefore, does not limit in any way the fields of social work which may become the responsibility of the Social Workers Training Council. It is hoped that local authorities will ensure that some of those whom they appoint to it will have a wide experience of the local authority social work services, and thus facilitate, for example, any eventual extension of the Council's functions into child care. But we have thought it preferable to confine the Council's functions in the first instance to the health and welfare services, since a new training is to be introduced for them to meet a very urgent need for trained recruits. The courses to be provided, however, may well prove eminently suitable for training for social work in other fields, for example, in other local authority services.
Moreover, although it is intended that the Council will, at least to begin with, address itself to the needs of the health and welfare services, we shall, nevertheless, encourage co-ordination between courses for various kinds of social work, wherever this is practicable.
There are encouraging signs of this in the case of the North Western Polytechnic in London where a two-year "Younghusband" pioneer course and a two-year child care course are being run side by side. Clause 4 provides for the Councils to be financed from Exchequer funds. As far as can be estimated they will require about £50,000 annually. The figure will, of course, depend on how their responsibilities develop and on what income they receive, for example, from fees. The sum will be apportioned as between England and Wales, Scotland and Northern Ireland in relation to population.
Although Clause 5 does not deal with the Training Councils the research powers which it provides also follow a recommendation in the Younghusband Report. The Report envisages the need for research into the social needs of particular groups, the proportion of any group needing social work services, and the operation and effective use of case conferences and co-ordinating committees. These are matters which have parallels throughout the health and welfare services and opportunity has, therefore, been taken to provide the Ministers and local authorities with 1689 research powers in relation to the function of local health and welfare authorities where these are missing in present legislation.
The constitution and proceedings of the Councils are set out in the First Schedule. The aims of the provisions for appointment of members are: first, to ensure representation for England, Wales, Scotland and Northern Ireland. Secondly, to provide a broadly based membership; the Social Workers Training Council will have three more members than the Health Visitors Council to cover the greater number of interests concerned. Thirdly, to maintain a balance of interests. The local authority associations will have ten members on each council, whom they will appoint themselves, but the professional and educational interests together will have a slight majority. Fourthly, to ensure that in making appointments Ministers will consult the interests concerned. The interests to be consulted are laid down in the case of all but one of the appointments to the Health Visitors Training Council and all but two of the appointments to the Social Workers Training Council. The exceptions will allow Ministers to appoint outstanding individuals or to make any necessary adjustment in the balance of interests.
We have tried to strike a balance between providing representation for every interest that could make a contribution to the training of health visitors or social workers and keeping the Councils to a manageable size. If the Councils feel the need for ranges of knowledge or experience for which we have made no provision, it is open to them under paragraph 15 of the First Schedule to appoint committees of an advisory character consisting partly of persons who are not members of either Council.
Last but not least, paragraph 2 of the First Schedule provides for the appointment by the Privy Council of one person to be chairman of both Councils. It has already been announced as hon. Members will know, that Sir John Wolfenden has agreed to occupy this key position. I am sure the House will agree that this is a very good send off for the two Councils.
1690 It is rare for so much to depend on so small a Bill. The success of the services for prevention and community care in the future will depend in no small measure on the work of the two training Councils. I think it is no exaggeration to say that without the stimulus to training which the setting up of the Councils will provide, many of the aims of previous legislation will remain unrealised—for example, the Mental Health Acts with their reorientation of care for mental disorder towards care in the community.
I would go further and say that although the Health Service Acts and the National Assistance Act were passed more than ten years ago, the aims of these Acts are not capable of full achievement without the passing of this Measure, and I hope that the House will now give it a Second Reading.
§ 11.24 a.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I am sure that the House will be grateful for the explanation which the hon. Lady the Parliamentary Secretary has given of the purposes of the Bill, although there are some questions which she has left unanswered. For our part, we on this side of the House, with one or two reservations, welcome the Bill which, as the hon. Lady said, is of an importance out of proportion to its length and to its immediate rather limited objective. I should not think of calling it a mouse of a Bill, although it really has not all that much to show for the years that the mountains have been in travail. I reckon that the gestation period of this Measure has been eight years, and, in a sense, thirteen years. Unlike most children, it has not two parents but three, because it really stems from the Mackintosh Committee's Report on social workers in the mental health services, a Committee set up as long ago as July, 1948, and which finally reported ten years ago in 1951.
Almost the only fruits of the Mackintosh Committee was the appointment of two further Committees of Inquiry. So perhaps it would be more accurate to call the Mackintosh Committee not the parent but the grandparent of the Bill. Following the Mackintosh Committee's Report we had the Working Party on Health Visiting under Sir William Jameson. That working party 1691 was set up in 1953 and reported in 1956. Before it reported the Younghusband Committee on the local authority health and welfare services was set up in 1955. It reported to the right hon. Gentleman's predecessor in the spring of 1959, so that a further two and a half years have elapsed between then and now when the Bill is brought before the House. I submit that that is too long, and that the situation which we are facing is too serious and too urgent to justify so inordinate a delay.
The Bill and the social implications behind it certainly reflect a trend of our times, and a very welcome trend, because as human existence becomes more complex, as society in this country, as elsewhere, accepts willingly more and more collective responsibility for its weaker members, for the sick, for the old and for the children, so the need for skilled social work inevitably grows. Equally, as the trend develops away from institutional care for all forms of handicap and towards care within the community, so again the rôle of the social worker, and I include the health visitor, becomes still more important.
These men and women have to provide advice, help and support. They have to assess needs and help to see that those needs are met, where necessary by other social agencies. All this requires not only tact and the right kind of personality but special skills which are acquired only after training and a long experience in the job. The need for more systematic, organised training and for recognised qualifications and gradings in these fields was appreciated many years ago both by the workers themselves and by many of the employing authorities. So I stress again the belatedness of the Bill.
As the hon. Lady explained, the Bill covers two rather different categories of workers which have, however, some features in common. They both enter people's homes, they both have the job of assessing the social setting into which they come and they both have to give advice. But the health visitor is primarily concerned with health education and comes solely within the right hon. Gentleman's orbit, so to speak, unlike the social workers who are responsible to welfare authorities as well.
1692 The health visitors are all trained nurses. I think I am right in saying that they are all women, although I am not sure that this is essential—perhaps this is something at which the Council might look—whereas, on the other hand, among social workers there are a number of men. I think, incidentally, that we want more men in social work than we have at the moment. These differences between the two categories of workers have been recognised in the Bill by the setting up of two separate Councils, and one can see the argument for that. Equally one can see arguments—they may be less cogent—for having a single Council. But here we have got a rather unhappy compromise. We have got two Councils, but it is written into the Bill that they must have a common chairman and some common members. This, I think, is rather pointless.
On behalf of my right hon. and hon. Friends, I have already welcomed very warmly the appointment of Sir John Wolfenden. I am sure that he will chair both Councils admirably. But was it necessary to elevate this common chairmanship into a principle and actually to write it into the Bill? This is one feature which has met with a certain amount of criticism from those affected.
Perhaps I can deal quite briefly with the question of the health visitors. I think that the House may be as surprised as I was to learn that the first health visiting service was established 99 years ago in Manchester and Salford. I certainly thought that it was far more recent than that.
As the Parliamentary Secretary told us, the health visitors already have a recognised qualification and training. I think that it would be true to say that the formal training they have varies in quality. Certainly the courses vary in length from six months to twelve months. The health visitors have a higher proportion of qualified staff working in the local authority services than do the social workers. They have in fact 70 per cent. of qualified staff, but the untrained minority, the 30 per cent., who are called "acting health visitors", are by no means evenly spread over the country as a whole. For example, the county boroughs of England and Wales have only about 20 per cent. of acting health visitors, but in the Scottish 1693 counties nearly two-thirds of the health visitors are unqualified and untrained.
I gather that the profession of health visitors in general supports this Bill. I believe that it has some misgivings about the composition of the Council, and perhaps about the type of institution where training may be established, but I shall deal with those matters a little later.
With social workers the training position is very much worse. A great majority of them have had little or no formal training. As an example, one might take the welfare officers of whom about 60 per cent. of those functioning in local authorities have no qualifications at all. I emphasise that these welfare officers include mental welfare officers—what we used to call the duly authorised officers or the D.A.O.s—workers who have a very responsible, difficult, and occasionally dangerous, job to perform in looking after the welfare of the mentally disordered.
This gap has been filled with untrained, unqualified workers. I readily admit that some of the men, and some of the women, are people of exceptional aptitude who have had a long experience and gathered all the advantages of a long experience in the job, but some who have not been of the right quality, the right personality, for the job may well have done positive harm. To their great credit mental welfare officers have themselves been pressing the Minister, or rather the Minister's predecessors, for many years for the establishment of a recognised training and qualification. They have met with stalling and delay even though there have been bodies perfectly willing—indeed anxious—to provide just the courses that they needed. The Younghusband Report says, in paragraph 226:we cannot but deplore the time lost in the years since the Mackintosh Committee stressed the urgency of the situation.That was ten years ago. The paragraph goes on:Even a series of modest experimental courses in the last two years would have helped newly recruited duly authorised officers and mental welfare officers to undertake the difficult and important work which awaited them, and would also have produced a useful body of experience on which to base recommendations for training. We have much sympathy with the disappointment and frustrations felt by these officers who have waited so long 1694 and done so much to try to bring about opportunities to train in their chosen field of work.It is very regrettable that the Young-husband Report has not been debated in this House. We on this side of the House welcome the main conclusions of the Report. In particular, we welcome the establishment of the general two-year course leading to the national certificate and also the concept of the welfare assistant, who I think will be very necessary.
Before coming to the details of the Bill itself, I wish to say a word or two about this two-year training course, which has already become known as the "Younghusband course." We are glad that the right hon. Gentleman organised the starting of four of these pilot courses in advance of the passing of this Bill, but I am very sorry that three of them are being conducted by colleges of commerce, at Birmingham, Liverpool and Glasgow. Without wishing to say anything derogatory about colleges of commerce, which no doubt are excellent institutions for their own purpose, I should like to say that I do not think they provide the right surroundings for this type of course. The fourth, as the hon. Lady said, is in a polytechnic, which happens to be in my constituency. That is an institution which has a reputation for social studies and quite a considerable social studies department. This course has got off to an excellent start, at least so I have learned from such inquiries as I have made. I think it is a yardstick of interest in this problem of social work training that there were 300 applications for the 15 places available. A great deal of work had to be done in whittling down the short list and getting the 15 best applicants to undertake the course.
I hope that a great deal of thought will be given by the Ministry, and by the Council when it is set up, to the appropriate places for these courses. I do not suggest that they need all take place in universities, although I think that everybody would welcome the university link, but what about colleges of advanced technology? Would not they be suitable places? Is any thought being given to the possibility of establishing them in teacher training colleges? These are workers who will be dealing with people. For that reason we have 1695 to be very careful in selecting the right sort of environment for their training. That is most important.
I come to some of the details of the Bill, on which I have a number of questions to ask and some criticisms to make. If I concentrate on the social workers' aspect of the Bill, that is only because I have heard more doubts expressed about it by social workers than by health visitors. Clause 3 (1, a) lays down the main functions of the Social Workers Training Council. Incidentally, why has the Younghusband title been switched round? Why not "The National Council" or just "The Council for Social Work Training"? That would be less clumsy than "Social Workers Training Council." This is not an important point and perhaps we can talk about it in Committee. The Clause says that the Council should be concerned with:the training of social workers by seeking to secure suitable facilities for the training of persons for such social work as is required in the health and welfare services.Subsection (5) of the Clause defines these services asservices provided by a local authority in carrying out their functionsunder the appropriate parts of the National Health Service Acts and the National Assistance Act—or similar services provided by a voluntary organisation.Subsection (3) of the same Clause provides for the possible extension to cover "other social work". We want to know a little more about what that means, quite apart from what the hon. Lady said. Does it mean services under other Statutes than those mentioned, or services which are not carried out by local authorities or voluntary bodies? Could it mean, for example, services carried out by hospital authorities?
Some people regret that these Councils are at the moment limited to training for the local authority services. The hon. Lady mentioned child care. That was the only service she did mention, but there are many other services which could be loosely embraced in the phrase "social worker" which are anxious to know what the possible meaning of subsection (3) is. Is it intended at a later stage to include social work training for probation officers or prison welfare officers or even officers of the National 1696 Assistance Board? I hope that we shall have a fairly clear indication from the right hon. Gentleman. When he winds up the debate, of the intentions behind this proviso. We are entitled to know, and we are also entitled, I think, to an assurance that no extension will be made without the fullest possible consultation with the professional and other representative bodies concerned.
I come now to the main criticism of the Bill. The services for which the training is organised through the medium of the Bill are all understaffed, and in many cases quite seriously understaffed. The Jameson Report estimated that we needed altogether 11,500 qualified health visitors compared with the 8,000 whole-time equivalent health visitors at present employed in Britain, of whom, I stress, nearly one-third are unqualified. In other words, the Report estimated that an additional 3,500 qualified health visitors are needed.
The Younghusband Report is rather less specific about the need for additional social workers, but it suggests a figure of an additional 2,500—those are workers with the general training—plus a minimum of 1,000 welfare assistants, which may well be an under-estimate. Estimates of the need for psychiatric social workers vary, but at least 500 more of these are needed. We need more almoners and more family case workers. Altogether we need at any rate at least 8,000 additional workers in these two fields of social work and health visiting, and this may be a very conservative estimate. How are we to get them and where are they to come from?
The Younghusband Report recommended in paragraph 878 that when the Council is set up it should concern itself with recruitment. The Report says:We think the National Council would have a most useful function in conducting publicity campaigns on a national level, and in various other ways stimulating recruitment to the services. It might assist in the selection of students.There is no mention in the Bill either of recruitment or of the selection of students. Why this omission? If we compare the position with the two bodies which I think are most closely analogous to the two Councils which are being set up under the Bill—the Central Training Council for Child Care 1697 and the Probation Advisory and Training Board for the probation service—we find that both those bodies are set up directly under Home Office auspices and are both concerned with the recruitment and selection of students.
This brings me to the main criticism of the Bill. Both those bodies administer direct Home Office grants to trainees. Why is there no provision in the Bill for central training grants? Both the Younghusband Report, in paragraph 935, and the Jameson Report, in paragraph 379, recommended that this provision should be made and did so in specific terms. I will not weary the House with their actual words, but it is obvious why they made these recommendations—because this is the only way of getting the recruits we need and bringing local authority staffs along for training. It will be no good relying on the local authorities for grants. We all know that local authorities vary very much indeed; some are good and some bad, some are generous and some mean. There is no conformity and no common policy. We have already had the experience of candidates selected for these four pilot courses having to withdraw because the local authority would not provide them with the necessary training grant.
Another difficulty of the present system is that prospective health visitors can obtain training grants only if they sign in advance a contract of service with an individual local authority. I am told that this has had a very damaging effect on recruitment, because women going into this service want to feel that they have a certain amount of freedom to look around and to consider where they want to go at the end of training, without feeling tied to a particular local authority, of which they may know very little, before they undertake the training.
Not only is there no provision in the Bill for central grants, but the Minister does not even take any reserve powers in case the local authority grant provision on which he is relying fails to work, as we believe it will fail. Indeed, the Money Resolution to the Bill seems to be drawn in such a way as to preclude us from even tabling an Amendment on this point and discussing it in Committee. It does not help for the 1698 Minister to tell us, as no doubt he will, that the local authorities will be helped by the block grant. Just because it is a block grant there can be no guarantee that any additional sums provided under it will be used for this purpose. In the absence of central training grants, I very much doubt whether the Bill will achieve the objective which we should all like to see it achieve. Every organisation which I have come across which is concerned in any way with the Bill has deplored the absence of this provision. We should like to join most emphatically in condemning this omission.
Next, may I say a word about the wider problem of recruitment to these and to similar professions and occupations? What I have to say perhaps does not arise directly out of the Bill, but it is certainly germane to the purposes of the Bill. These services are already under-manned and need to be expanded, and the same is true of many other services, for example the nursing service and the physiotherapy and radiography services. All these have an acute recruiting problem. I know that this is tied up with inadequate remuneration, and that this is perhaps not the proper time and place to discuss it, but it is also tied up with the very limited potential supply—a supply which all comes from the same educational sources, from the same pool of potential recruits, largely, of course, young women, although I repeat that I should like to see more men taking up this kind of work.
All these services are competing with one another, and yet the staffs are nearly all employed by public authorities of one kind or another. Why cannot we have some kind of a manpower and needs survey? I know that it is difficult to get this sort of thing done, because it involves several Government Departments, but surely it is an appropriate job for the Central Statistical Office to do, and we urgently need to have it done. Let us try to see where we are going and whether we are likely to have anything like adequate manpower and woman-power to meet all these needs. We may have to impose some kind of rationing or limitation of recruitment in certain branches, or some quota basis. I hope that serious consideration will be given to this matter. The problem affects the 1699 right hon. Gentleman's Department perhaps more than any other.
I want to say a few words about part-time social work. There is a largely untapped reservoir of experienced and often trained and qualified social workers who have married and left the service but who now, perhaps with children at school, are willing to return on a part-time basis. Yet few local authorities will take the trouble to organise the work to fit in with the convenience of the part-time social worker. I hope that the Training Council will address itself to this problem, that it will arrange the appropriate kind of refresher courses and that it will stimulate, in any way that it can, local authorities to make use of this valuable reserve, largely of womanpower. A body called the Association of Part-Time Social Workers was formed two years ago, and I know that it is only too anxious to co-operate to this end in any way that it can.
The Explanatory Memorandum tells us that these two Councils will cost the Government about £50,000 a year. The hon. Lady did not say how this sum would be divided between them, but let us assume that it will be £25,000 each. This seems to us to be a grossly inadequate amount on any count. The cost of the Probation Advisory and Training Board is £90,000 a year, although it deals with a service only about half as large as the social work service.
The Explanatory Memorandum speaks of the Exchequer meeting any expenses which are not met from "fees etc." What is meant by "fees"? What is meant by "etc."? The fees for the tuition courses will presumably go to the bodies conducting the courses, which normally will not be the Councils. There will probably be fees for examinations, but will they not be swallowed by payments to examiners? I cannot see that that there will be very much net income from fees available to the Councils. I smell some cheeseparing here. I hope that the right hon. Gentleman will not be dismayed and will not force economies on the Councils if he finds that the costs rise substantially above the figure forecast in the Explanatory Memorandum. I should have thought that £100,000 was much nearer the mark. It might well be more than that.
1700 After all, the Minister has already had one lucky windfall in this connection, in that one of the bodies recommended by the Younghusband Committee has already been set up without involving the Exchequer in one penny of expenditure over the next ten years at least. I refer to the National Institute for Social Work Training. This Institute has been set up through the generosity of the Nuffield Foundation and the Joseph Rowntree Memorial Trust, which have set aside £350,000. I understand that this body will fulfil the functions of the staff college which was recommended by the Younghusband Committee, and it is a most important function. I also think that the Institute and the Minister have been extremely lucky in securing the services of Mr. Robin Huws Jones as its first director. The Institute has been in operation barely two months. I am sure that the whole House wishes it well.
There is another rather disappointing sentence in the Explanatory Memorandum. The Younghusband Committee stressed the need for research. It complained that in the course of its study of social work services it often found that there was no information available on important aspects. The Committee argued that much more continuous research and inquiry was needed. It is true that the Bill gives powers to the Council to carry out and assist in research, but the Explanatory Memorandum says:The additional expenditure … on research … will be very small.This looks like little more than a perfunctory genuflexion to the idea of research rather than any serious intention to get down to doing research. I hope that the Councils will completely ignore that sentence.
Over the last twelve months the Minister has made a series of speeches on various Health Service platforms outside the House. The other day one of the medical journals—I think it was the Lancet— did the Minister the honour of suggesting that they should be collected together and published so that they could be studied.
§ Mr. Robinson
I thought that the right hon. Gentleman knew that. I have 1701 read most of these speeches. They are very interesting, at times philosophical, and often stimulating. But I detect what seems to me a contradictory thread running through them. I agree that the right hon. Gentleman wants a better National Health Service. He wants improvements in the Service, but he seems to want to get them for less money. I wish he could forget that he was once Financial Secretary to the Treasury. I know that money is by no means everything in the Health Service, but I think that in the end the right hon. Gentleman will find that there are few economies which can be made, except at the expense of the patient or at the expense of the service which the patient gets. The Government cannot get a tolerable Health Service on the cheap. Reverting to the Bill. I do not think that the Government can expect to staff an expanding community care service with trained, as against untrained, workers for £50,000 a year.
Finally, I have some doubts about the composition of the Councils. We can perhaps deal with these more appropriately in detail in Committee. I think that the two Councils are too large. They are unwieldy. They are unnecessarily large. If they are to function effectively, they will have to do so entirely through committees. There also seems to be rather too much emphasis on the local authority aspect and too little emphasis on the educational aspect. Perhaps this is a corollary of the fact that the right hon. Gentleman is looking to local authorities to provide most of the money. I notice in particular that universities are not even mentioned in the First Schedule, which sets out the composition of the Councils. I am sure that there has been a good deal of hard bargaining here, but the net result is that the list of bodies which have to be consulted and those which have rights to nominate seems to be a little incoherent and perhaps a little too rigid.
Inadequate though it may he in some ways, I recognise that the Bill is an essential first step towards development of a comprehensive community health and welfare service carried out by trained and qualified workers. We hope that the right hon. Gentleman will be able to set our minds at rest when he winds up the debate and that he will 1702 assure us that the Government are a little more serious about this problem than the Bill, superficially at least, suggests. We hope that we shall be able to improve and strengthen the Bill in Committee.
§ 11.56 a.m.
§ Dame Irene Ward (Tynemouth)
I think that I should first apologise to the House, because I do not think that I shall make a very coherent speech. The problem is that it is only within the last few days that many of the bodies concerned with the Bill have put forward their views. One normally likes to have an opportunity of discussing their points of view with them. When this is not possible, it is a little more difficult to express fairly and adequately what they think. I hope that the House will bear with me if my speech is not particularly good and coherent.
May I tell the House that I am speaking for some of my hon. Friends who cannot be here today. I am speaking for my hon. Friend the Member for Manchester, Wythenshawe (Mrs. Hill), who has very wide experience in matters of this kind. I am speaking for my hon. Friend the Member for Plymouth, Devonport (Miss Vickers), who had hoped to be able to make a contribution. I am speaking for Baroness Elliot of Harwood, who also has had a very wide experience in matters of this kind. I am speaking for the Health Section of the Royal College of Nursing, with which I have had consultations. I am speaking for the Women Public Health Officers' Association, which has some strong reservations on the Bill which, its members wish to put forward.
I have had a memorandum from the Institute of Almoners, which has been referred to by the hon. Member for St. Pancras, North (Mr. K. Robinson). I think that I am also in order in saying that the criticisms which I shall offer will not be unacceptable to Eileen Younghusband herself. I have not had the pleasure of discussing the Bill with her, but there are very good grapevines operating in matters of Government Bills. I thought that I should say that so that my right hon. Friend and the Parliamentary Secretary will know that some of the critcisms which are voiced—and, in general, I agree with every word spoken by the hon. Member for St. Pancras, North—are put forward by 1703 people who have a right to speak on this subject.
In welcoming what is, at any rate, a first step in creating this extended trained community service, I want to make one personal observation. As I have moved about the country, as I have listened to many cases on the bench, as I have come across the flotsam and jetsam of life and have looked at all the social problems that arise today, I have always believed, very sincerely and genuinely, that if we had a first-class trained community service operating throughout the length and breadth of the country we should have many happier people, and far fewer problems to face.
Let us take this question of research. I do not blame my right hon. Friend; he may have put up a most gallant fight with the Treasury. I have never been able to convince the Treasury—although I have tried for years to do so—that one should sometimes spend money to save it. It is quite impossible to get that into the heads of either Treasury Ministers or Treasury officials.
That is my complaint here. There is this niggardly, beastly little comment about research—that it will not cost very much. I do not know whether either my right hon. Friend or my hon. Friend the Parliamentary Secretary is a magistrate, but if they were to listen to the pathetic cases coming before the bench—the number of sub-normal people, the number of people who have had no friends, no advice or anyone to turn to—things that one ought to know when discussing a Bill like this—I do not think that they would have agreed to put into the Bill that stupid little phrase that research will not cost very much. If any research is needed, I should like to direct it into the Treasury to find out what is in the brains of the Treasury Ministers and the Treasury officials.
A sum of £50,000 is to be provided. When we are starting to build—and I am sure that is the intention of my right hon. Friend—a trained, skilled service, it is tremendously important that the first people in it should be the top people who can be attracted to it. As has been pointed out by the hon. Member for St. Pancras, North, it is most remarkable that only £50,000 is to be 1704 made available for two Councils—and for the establishment of their offices. What I think the hon. Gentleman forgot to point out is that those running the probation service do not even have to provide for their overheads. Here, we are to be tied down to this £50,000. I have no doubt that the Treasury and my right hon. Friend are once again looking to the kind of people who have a vocation for this sort of work to do it on a cheeseparing level. That is absolutely monstrous.
It is rather regrettable that there is to be no training council for psychiatric workers and hospital almoners. It is, of course, obvious that it would be difficult to fit those people into the framework of this Bill, because they work in a different sphere, and not in the local authority field in quite the same way as those covered by these two training councils. Nevertheless, theirs is a highly skilled occupation. A great deal of new work and new emphasis is being put on mental health, and I should have thought that the brains of my right hon. Friend, which are very considerable, could have been directed to trying to cover the whole scheme by this Bill.
I find in Parliamentary life that if one lets an opportunity go it will not recur for many years. It is most regrettable that this opportunity has been lost. My mind goes back again to all those subnormal people brought before the bench for petty offences; people with whom we cannot really deal but who, if only they could have been put into the hands of trained people earlier in life might never have appeared before the bench at all. The Government have lost a very great opportunity.
I turn to the composition of the two Councils. I am delighted, of course, to pay my tribute to Sir John Wolfenden—he is a very great man and plays a great part in our national life—but I do wish that sometimes my Government would not fix on one person and make him chairman of almost everything that comes along. When I think of what Sir John Wolfenden's responsibilities are, I really wonder whether we could not have appointed someone equally distinguished as chairman of these two Councils. I know that Sir John will not take this amiss, but I think it quite ridiculous to keep on appointing the 1705 same man to I cannot imagine how many jobs. If my Government would like me to supply a list of suitable people, I shall be delighted to do so.
One or two specific points have been made to me by some of these professional bodies. I listened to the amazing simplicity with which my hon. Friend the Parliamentary Secretary so delightfully told the House that there was, of course, always consultation. I can tell her here and now that I think nothing of the consultation that goes on within her Department. I have not thought anything of it for years. I do not accept the simplicity of the way in which this statement is put forward, and, in a moment or two, I should like to read an extract from a communication from the Women Public Health Officers Association on this point.
There is, of course, very great criticism to be directed against the composition of the Councils. For one thing, I do not see why the local authorities should have so many representatives. I should have much preferred there to have been better representation of the professional people concerned, but I have not the slightest doubt that the Association of Municipal Corporations, of which I have the honour to be a vice-president, and the County Councils Association have very good access to my right hon. Friend—very much better access than have these social workers' organisations. We have to fight every inch of the way to get them anywhere at all.
This is what the Women Public Health Officers Association has to say:At discussions with the Ministry of Health officials in the past year or more, the Association has asked for substantial representation of the health visiting profession on the Training Body. We were disappointed with the original proposals for the present legislation, which the Ministry sent us a year ago and which, as far as the Health Visitors Council was concerned gave six seats to representatives of the profession out of a Council consisting of a total of nineteen members.They were disappointed then. This is the result of consultations, or whatever they were, but I notice that only officials and not the Parliamentary Secretary or the Minister were involved. Have the Government any comment to make about the reduced proportion of health 'visitors, since out of 29 people who will comprise the Council only eight will be professional representatives? It continues: 1706We have noticed that the Professions Supplementary to Medicine Act, 1960, provided for the setting up of Boards which are to be responsible for training for the various professions. In each case the 'representative' members of the Board, i.e., the members of the professions concerned, have a slight majority over the total of all other members appointed to the Board. We feel if it is reasonable for Dieticians, for instance, to have a slight majority on their Training Board, it is equally so in the case of Health Visitors.It is obvious, of course, that my right hon. Friend is expecting the local authorities to bear the full responsibilities—financial and otherwise—for this whole scheme. I am sure that that suits the Treasury, and I am glad that I did not vote for the Local Government Act which imposed the block grant. I always held the view that it was an abominable Act. Of course, the local authorities want their price, and in this Bill they have it. They have what they want.
I am not criticising the officials of local authorities. In the main, they carry out their jobs extremely well, and if sometimes their advice was taken by councils we should have made greater progress than has been the case. But the pass has been sold and this consultation is really not worth the paper on which it is written. I hope something will happen about this. I have no doubt that the Financial Resolution is very tightly drawn. That has been happening for many years in this Parliament, but perhaps the other matters will be subject to Amendment in Committee. In any case, I hope that the representation of the professional bodies will be increased and that when my right hon. Friend replies he will give an assurance to that effect. If he does, he will have a wonderfully easy passage for the Bill in the Standing Committee, when, I am sure, hon. Members on both sides will join together so that my right hon. Friend will get the Bill on the Statute Book with greater speed.
I do not wish to burden the House with too many quotations, but I must quote from another important memorandum. It fits in with what was said by the hon. Member for St. Pancras, North and concerns training grants to individual students. It would be rather difficult for the Minister to start a study to find out if permissive powers granted to local authorities by Parliament are used by the local authorities. If my right hon. 1707 Friend did carry out such a study he would get a shock, because the difference between the way various authorities use these permissive powers is tremendous. It is shocking to people like myself, with very good local authorities, to find that some local authorities ignore the permissive powers to the detriment of the human beings involved. This memorandum sums up the position clearly. It states:Perhaps the most serious omission in the Bill is grant aid to students. It is clearly intended that this shall come from local education authorities. Those who have experience in the Universities and elsewhere know the delays and uncertainties of these grants. Very often no final decision is reached until G.C.E. examination results are available in August which means that the colleges of further education, whose terms start in September would be faced with last minutes withdrawals"—which the hon. Member for St. Pancras, North mentioned—while at the same time candidates and their employers would be uncertain as to whether or not they would be able to take a course for which they had been accepted. In addition, some of the older candidates whom it is most desired to attract may have no claim on any local education authority and may be, indeed often are, refused a grant. Both the Probation Advisory and Training Board and the Central Training Council in Child Care themselves give grants for maintenance, tuition and travel. Thus a candidate accepted for training by either of these Councils automatically receives a grant (subject to a means test); he is not required to apply anywhere else; and he experiences no uncertainties or delays. In addition, a salary is paid for candidates already in the child care or probation service who are given leave of abence to train. Already local health and welfare authorities are beginning to say that they will not release staff for training if they have to bear the whole cost of this. The block grant system is likely to make local authorities all the more unwilling to pay the whole cost of training, for which the Bill clearly intends that they shall be responsible. The child care and probation arrangements by which I per cent of the central authority grant is withheld from all local authorities as a contribution to a training fund seems a much more equitable system. The position of general or family caseworkers is particularly unfortunate in that they have no claim on any central Government department and are in fact being trained, when L.E.A. grants are refused, by means of very limited voluntary funds. These variations in grant aid to students are but one example of the many anomalies in social work training at present but this is no good reason for perpetuating them.That is the point. We need an entirely new Bill which will start a new era, clear up anomalies, avoid ineffective 1708 decisions, and, bearing this in mind, it seems difficult to see how in Standing Committee shall we be able to alter the whole of this Bill to put the position right.
I hope that my right hon. Friend will go to the Treasury and explain in no uncertain terms—because we are used to his clear mind—that if the idea behind the introduction of such a new Bill, the philosophy behind it, is put into full operation it will create a great new surge forward. It will save expense in the long term, because although we get a lot of talk these days about the long and short term, it is the short term which involves the expenditure of money. The long term, if properly operated, will save money and will create happier and better families.
It is tremendously important to remember that the health visitors, going about their duties, form a section of the social services which really sees families in their natural surroundings and can talk to them as a unit. They go to homes and perhaps see the father and mother together. Perhaps they have gone there to discuss the problems about their child. Thus the health visitors can do more than many other sections of the social services to turn out good, happy and healthy citizens. They can observe the strains. If they think that the children are not being properly looked after, they can hand on their information to the local education authority. They have a great part to play. If the health visitors want something in this Bill, I see no reason why they should not have it.
The Government could create a great access of good will, if they wanted to, but they have fallen between two stools. Yesterday, as I was reading all these papers—as I say, they came to me rather hurriedly and I have had to make a speech which really should have been made by others of my colleagues more qualified to make it in the House today —I felt that I wanted to criticise very strongly the Minister and the Parliamentary Secretary, but then, of course, my back knowledge reasserted itself and I realised that here was the dead hand of the Treasury again. The bother about this House is that we can never get at the Treasury.
1709 I hope that my right hon. Friend will accept my criticisms in the spirit in which they are made. He is quite a tough operator. I hope that he will not look back to his days as Financial Secretary to the Treasury but will realise that there is here a great human need for the country and, if he sets the Bill off on the right lines, the future for many people who have not had the advantages which we have had will be much clearer, happier and more successful.
§ 12.22 p.m.
§ Mr. Hector Hughes (Aberdeen, North)
I support the Bill. It is good in its intentions, but it has some grave defects, as earlier speakers have pointed out. It deals with a very important and useful profession which badly requires expansion, but it does not deal with that profession in exactly the right way. I want the Bill to be as effective as possible for its noble and humanitarian purposes.
The Second Schedule relates to Scotland. It is right that Scotland should be represented on the Government Front Bench. This point has been made already, and I am glad to see that at long last a Scottish Minister is now present.
§ Mr. Hughes
I submit that the growing practice of Scottish Ministers to absent themselves from the Front Bench when Bills relating to Scotland are under consideration is bad for the particular Bill, is bad for Scotland, is bad for Britain, and is bad for legislation in general. Indeed, I might go further and say that it is contrary to the spirit of the Union between England and Scotland. But, as a Scottish Minister is now present—
§ The Under-Secretary of State for Scotland (Mr. T. G. D. Galbraith)
Since the hon. and learned Gentleman has twice made that comment, I feel I must point out that I have been present during the whole debate.
§ Mr. Hughes
It is right to say that the Scottish Minister was not present at the beginning of the debate when he should have been.
§ Mr. Galbraith indicated dissent.1710
§ Mr. Hughes
However, that point has been dealt with already and I say no more about it.
I have taken a great interest in the purposes of the Bill for very many years. Over six years ago, I devoted the whole of an Adjournment debate to these matters. On this occasion, as I did on that, I declare my interest. I am associated with other organisations which have similar benevolent aims. For many years I have been a member of the board of the Church Army whose noble purpose is to help unfortunate citizens who need help, whose need, incidentally, was greater before the development of the Welfare State than it is now.
On the occasion of the Adournment debate to which I have referred, I received valuable assistance not only from the Church Army but also from benevolent organisations such as the London County Council Health and Welfare Service, the Scottish Council of Social Service, the National Old People's Welfare Committee and the Old People's Homes Committee, the wide experience and statistics gathered by which were put at my disposal. I shall not, therefore, repeat those matters now.
I mention those facts to support my submission that I speak with some experience and authority on this matter, notwithstanding the laughter of the Minister of Health, which seems to me to be quite irrelevant to the subject we are discussing.
§ Mr. Hughes
In addition, I have been fortified by help from Dr. Ian Macqueen, the Medical Officer of Health for the City of Aberdeen, whose wide experience and great human kindness have induced him to study with devotion the problems of the sick, the aged and the needy during many years, to the great advantage of Scotland. Dr. Macqueen has studied this Bill, and he takes the view that, while it is a good and desirable Measure, it has certain defects. I hope that the Minister will carefully consider those defects with a view to their rectification in Committee.
I shall not discuss Committee points which it would be more appropriate to deal with later, but I shall adumbrate certain criticisms of principle which are relevant at this stage.
1711 There are three different classes of worker in this humanitarian sphere which the Bill should embrace and deal with, but, in fact, of those three classes—the health visitors, the social workers and the health visitor tutors—only the first two are dealt with while the third is not. This is wrong in principle. The omission leaves a great gap in the Bill which may be fatal to the effective fulfilment of the purposes intended by it, which, according to the Preamble, relate tothe training of health visitors and social workers".I emphasise the word "training" in its particular relevance to the third class which, in my submission, is completely left out of account, namely, the health visitor tutors.
The omission is evident from the strange, complex and unworkable mechanism to be constructed by a kind of engineering miracle under Clauses 1, 2 and 3 and the First Schedule. This attempted miracle has already been referred to, though not in those words, by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson).
Clause 1 provides for the setting up of two separate Councils, namely, the Health Visitors Training Council and the Social Workers Training Council. Clause 2 deals with the functions of the Health Visitors Training Council and Clause 3 with the functions of the Social Workers Training Council. The First Schedule says that these two Councils are to operate under one chairman to be appointed by the Privy Council and it sets out the composition of the Councils. However, strangely, it proposes that there should be fewer members on the more important than on the less important of the two Councils.
I wish to make a few observations on that peculiar structure which the Bill proposes to set up. First, the two Councils are to have one chairman between them. This seems to present a difficulty in operation which may perhaps be surmounted by the two Councils meeting either at different times or meeting jointly. If they are to meet at different times, why should they not have a chairman each? On the other hand, if they are to meet jointly, why should there be two Councils? In 1712 any case, why should not each of the Councils elect its own chairman from among its own members in the ordinary democratic way?
The next objection to the Bill in principle is that, of the three classes which should be envisaged in the Bill, the third class, namely the tutors, is left out. This is an important point, because the health visitor tutors constitute the cream of the profession. In order to reach that class, they have had to take advanced training in educational psychology and in teaching methods. Therefore, they are in a position to make a very important contribution to the work of the Councils. Their omission seems to me to be anomalous in a Bill which is dedicated to the training—and the word "training" is particularly relevant to my argument—of health visitors and social workers. The preamble states that the training of health visitors and social workers is the purpose of the Bill.
Another objection in principle arises from the disproportionate representation on the Councils. The Health Visitors Training Council is the large and more complex group in this sphere of work. Yet the Bill provides that it should have the smaller membership—29 members as against 32 members on the Social Workers Training Council. Dr. Macqueen, to whom I have referred, is very explicit about these defects, and therefore I venture to quote two extracts from a long letter which he wrote to me. He said:It would seem to me a tragedy if health visiting, which is so important from the point of view of preventing and reducing disease and which is therefore so important to the country both from an economic and from a humanitarian point of view, should be to any extent impeded by its Training Council containing a smaller proportion of professional representatives and in particular a smaller proportion of educationists actually engaged in training for the profession than is the case in respect of the other social workers.Since the fundamental purpose of the Bill is the training of health visitors and social workers, what Dr. Macqueen says should be borne in mind in the construction of the Councils which are contemplated by Clauses 1, 2 and 3 and the First Schedule.
In another part of his letter, Dr. Macqueen states:… a great deal of the progress that has already taken place in the training and in 1713 the work of health visitors has been due to the existence of a profession of health visitor tutors with an obligatory advanced qualification, and to the existence of the Standing Conference of Health Visitor Training Centres. I would think it absolutely fundamental that the new Act should ensure that the Training Council for Health Visitors contains an adequate number of health visitor tutors and that it at least consults the Standing Conference of Health Visitor Training Centres before nominations are made".There are other points about the Bill with which I shall not trouble the House at this moment. Perhaps if I am fortunate enough to be on the Committee which considers the Bill I shall have the opportunity to raise them then. They are very important considerations. I hope that the Bill will not be dealt with in a party way. These are not party matters. It is not being dealt with in a party way, because we on this side of the House are expressing our approval of the Bill in principle but want to ensure that it is effective for the purposes which are intended.
§ 12.37 p.m.
§ Lord Balniel (Hertford)
I feel that by implementing the recommendations of the trio of Reports referred to by the hon. Member for St. Pancras, North (Mr. K. Robinson), the Mackintosh Report, the Younghusband Report and the Jameson Report, and by providing for the training of health visitors and social workers, the Government are initiating a reform almost as significant as the passing of the National Assistance Act, 1948, or, more recently, the Mental Health Act, 1959.
The hon. Member for St. Pancras North referred to the Bill as an important Bill, but in the very next breath he called it a mouse of a Bill. I find it difficult to visualise the "important mouse" of a Bill which has been produced. None the less, I accept that the Bill does not contain any dramatic enunciation of new social ideals. What it does is to put into practice ideals which we have all held but which we have not been able to implement. As the noble Lord, Lord Pakenham, said, what we are doing in the Bill is turninga haphazard occupation into a co-ordinated professionI do not think anyone can speak on the Bill without echoing the tributes which have been paid to the two main 1714 committees in this matter—the Sir Wilson Jameson Committee on Health Visiting and the Miss Eileen Young-husband Committee on Social Workers. I am sure that the Members of the latter will not take it as any denigration of their exceedingly important and valuable Report if I express the hope that in future committees should try to present their reports in a slightly shorter form. Even people with a profoundly deep interest in these matters and involved in public life find it almost impossible to read these Reports in their entirety. This fact diminishes to some extent the value of the work which has been done by this Committee.
In referring to the Jameson Committee, I should like to take up the question of the composition of the Councils, to which the hon. Member for St. Pancras, North and my hon. Friend the Member for Tynemouth (Dame Irene Ward) have already referred. The Jameson Committee clearly recommends in paragraph 374 thatThe general balance of representation should be such that the professional and educational interests—the Health Visitors' organizations, the training centres and the Universities—should together be in a slight majority.It had been my purpose to quote from letters which several of us have received from the Women Public Health Officers Association pointing to the fact that the professional organisations will not be in a majority on these Councils. They point out, as my hon. Friend has already said, that under the Professions Supplementary to Medicine Act the professions have a majority on their training councils. I should like my right hon. Friend the Minister, in replying to the debate, to explain the reasons which have led him to depart from the precedents of the Professions Supplementary to Medicine Act and also to depart from the specific recommendation that was included in the Jameson Committee's Report.
The noble Lord, Lord Pakenham, said that the objective of the Bill was to create a co-ordinated profession. The basis of this co-ordinated profession, for which two Councils are now to provide the training, already exists. There are in the field covered by the Younghusband Report about 3,300 social workers doing an immensely valuable task. Of these, 1715 about 1,100 are in the rather specialised field of helping those who are mentally disordered.
None of us would dream of underestimating the scale of the problems faced by people in these professions and none of us would dream of questioning the immensely valuable work which is being done by these people. Nor do I believe that between any of us in this House there is much difference as to the kind of social ideals which should inspire us in the work. Equally, it would be idle to pretend that these social ideals are being implemented or that they can possibly be implemented until we have established an adequate training system which—I do not say necessarily that it will be—could be provided by the structure which we are setting up in the Bill.
If we look at the existing service, we see that 60 per cent. of the welfare officers, the mental welfare officers and the administrative officers, have received no training. Of the remaining 40 per cent., the majority received their training under the old Poor Law authorities. Indeed, only 8 per cent. of the people in this work have any social qualifications.
Looking at it in a slightly different way, one sees that 40 per cent. of the people engaged in the work are over 50 years of age. I do not say this in any way to denigrate the value of the work which is done by these people—through their experience they are probably the most valuable section of the service—but it brings clearly to our attention the fact that during the next decade we must expect a heavy rate of retirement from this service. We see generally a picture of a service in which recruitment is sluggish and promotion is slow and haphazard and, as we all know from our constituency experience, voluntary and professional services tend to overlap and co-ordination is too frequently inadequate.
I recognise that training is not the criterion of success. We all know that many of our most respected teachers in education do not have the educational qualifications which are now demanded. Particularly in the work which we are now discussing, nothing can compensate for any lack of a sense of dedication or for a lack of a sense of compassion. 1716 These people, many of whom have had no training whatever, have an immense knowledge of human character and personality which a whole lifetime of theoretical training could not give them. They have gained their experience amongst a section of the community which is probably the most difficult body of people to deal with in the country.
Even though I support the Bill wholeheartedly so far as it goes, I admit that it is debatable whether the taking of an examination is any criterion as to the success or failure which a man or a woman might make when working in this field as his career. Today, however, if the social worker is to provide the help which is urgently needed, if he is to channel specific help to a specific family, whether it is voluntary or State help, he requires an encyclopaedic knowledge of the welfare services which are available. Some form of two-year training course seems to me to be necessary. I echo the recommendation of the Younghusband Report that this course should consist of one year in theoretical work and at least one year of supervised practice in the field.
I should now like to turn to the question of grants for students, which has been raised by my hon. Friend the Member for Tynemouth. I find it rather sad that it has not been possible for my right hon. Friend to include some reference to them in the Bill. The Younghusband Report, pointing out that provision exists for grant aid for students taking social science and professional social work courses, states in paragraph 743:We agree with these witnesses that the health and welfare services are at a disadvantage in this respect in comparison with the child care and probation services, where grants for training and maintenance are available to all candidates accepted for training courses. We discuss the present situation … and the absolute necessity of training grants if our recommendations on training are to be implemented, and make recommendations accordingly. Here we need only say that adequate grants are essential if recruitment to the health and welfare services is to be improved.In its recommendations in paragraph 936, the Committee states:we do not think that existing provision, however generously applied, will suffice for training 1717 on the increased scale which we recommend. … We thus regard a national provision of assured grant aid as an essential element in both training and recruitment.Those are strong recommendations from a body which studied this matter in great detail. I hope that, in replying to the debate, my right hon. Friend will also be able to tell us why the Bill does not deal with this extremely important—indeed, possibly critical—recommendation of the Younghusband Report.
Another point which I urge upon my right hon. Friend is the importance of establishing the Councils at the earliest possible moment. As was pointed out in The Times today, the delay has already been quite considerable. Even from the establishment of these Councils, a further period of time must elapse while they study the pilot courses which my hon. Friend the Parliamentary Secretary has established, while they consider what form the courses should take and while recruiting of teachers to the training courses is undertaken; and a further delay must arise before students emerge from the courses. If we are to embark on these two-year courses, not in a piecemeal fashion but in a properly thought-out manner, and if we are to establish a common, national standard of training, and if we are to give social service workers a nationally recognised status, the sooner we undertake this work the better.
I should like also to emphasise another reason for haste, and it is this. We hear in this House frequently, and we read in the columns of the Press, a constant welter of moral condemnation. We hear a constant condemnation of the rates of juvenile delinquency. We hear condemnation of the crime rates and of moral standards amongst young people reflected in the illegitimacy rates and the rates of illegal abortion. We hear constantly about the rates of cruelty to children so often affecting the parents. We read of the racial hatreds which have grown up in a number of our towns; and also we hear this constant welter or moral condemnation of the uneasy social malaise which is bred from apathy and boredom and materialism.
The danger seems to me that out of this welter of moral condemnation, the natural reaction of many people is entirely negative. Out of racial hatreds 1718 one has seen emerge the Commonwealth Immigrants Bill. I shall not discuss that in detail, but no one in supporting the Bill could possibly say that it is anything except a negative confession of failure. Out of the high crime rates there is the negative demand that we should go back on penal reform. Out of the increased awareness of mental disorder in the country we see the negative response of the community to the bringing back into the community of perfectly harmless mentally disordered people. This negative reaction is to me entirely understandable, but I feel that we in this House must match this moral condemnation not with negative reflexes but with care and compassion and research, and here again I am a little sad that in the field of research only such a very small sum of money is apparently likely to be devoted. The danger is that unless we hasten with these Councils, the negative reaction to these social problems will nullify much of our work.
I just want to say a word about the question of recruiting for these services. The present level of recruiting combined with the heavy retirement which we must expect during the next ten years is something which we cannot afford when the whole emphasis in social policies must be on domicilary care. The emphasis in the care of old people is no longer upon Section 21 accommodation: it is upon domiciliary care of old people. In the field of mental illness it is upon domicilary care of the mentally sick, instead of in those large, barrack-like hospitals. Also it should be upon the domicilary care of families who become overwhelmed with their problems before breaking them up in the Section 21 accommodation.
I wonder if, as part of recruiting, it would have been helpful to have seen in this Bill whether we could have undertaken the registration of health visitors. I cannot quite understand why, when we have now registered professions supplementary to medicine, and when we are proposing to establish a common national standard of training, this would not be rather a good opportunity at least to consider the registration of health visitors.
One last point I want to make. The emphasis of the Younghusband Report 1719 throughout is on the co-ordination of social work at a local level and the finding of a happy distribution of effort between voluntary organisations and the professional organisations. As a result of passing this Bill we can, I believe, look forward to an improvement in the co-ordination at the local level, but I think we should take this opportunity to remember the words which were written by Professor Mackenzie in 1958 when doing some research work for Manchester University. He wrote.What is most important is that the social services should be seen as a whole, from the point of view of the recipients … the worst enemy of success in collaboration at the lowest level is departmentalism at the highest level.I believe that when we look on our social service structure today, which, after all, was moulded many years ago now, we see this very fault of depart-mentalism staring us in the face. Inevitably, both we in this House and my right hon. Friends charged with responsibilities for the social services Departments tend to look upon them from the point of view of administration rather than from the point of view of the recipients. Perhaps I could give one single example, and it is in the care of old people.
In this country there is a whole framework of assistance for the care of old people. There is the basic pension cared for by the Minister of Pensions and National Insurance. There is the supplementary pension and there are other National Assistance provisions coming under the National Assistance Board. There is housing for the old people, which is the responsibility of the housing authorities. The wardens in those housing schemes are provided by the county councils; the Section 21 accommodation is provided by the county councils; the hospital treatment is provided by my right hon. Friend. The home help service is provided by the local authorities, but the meals on wheels service is provided by voluntary organisations. Then there are the geriatric services. And, of course, there are the tax reliefs provided by the Chancellor of the Exchequer.
Is it really advantageous from the point of view of the recipients that all these services should be run by different Ministries? Are we absolutely certain 1720 that casualties, in quite considerable numbers, are not falling between these different Ministries? And, indeed—and this is only one example, the care of old people, and I could quote many other examples all of which come within the scope of the Younghusband Report—even if liaison between the Ministries is of a very high order, even if that is the case, how can we thus possibly get a coherent, dynamic policy for the care of old people?
My right hon. Friend with this Bill is in fact taking a great step forward, I believe, for improving co-ordination at the local level. I should welcome this Bill still more if I thought that at the same time a serious inquiry were being made to try to achieve a better degree of co-ordination at the Departmental level, because till we get that coordination at Departmental level some of the work of this Bill for achieving a greater degree of co-ordination at local level will, I think, be nullified.
With those—perhaps rather small—reservations I warmly welcome this Bill which at long last has been introduced.
§ 12.59 p.m.
§ Mr. James Boyden (Bishop Auckland)
In paying tribute to the sincerity of the hon. Member for Hertford (Lord Balniel), and, indeed, to that of the hon. Lady the Member for Tynemouth (Dame Irene Ward), may I say that I think they showed a rather naive attitude towards the general policy of the Government? This is the Government who in the last Session were encouraging drinking. This is the Government who were encouraging betting. I rather wondered whether in the agricultural subsidies there was not perhaps an element of encouraging horse racing. But when it comes to the social services, when it comes to grants for students, there is just half a loaf offered by the Minister of Education. I very much wonder whether in this Bill there is even so much as a slice of bread.
It is not so much the actual contents of this little Bill that I am objecting to. Indeed, one gives it a guarded welcome. It is the failure to adopt a thrusting attitude towards the social services and to provide a comprehensive Measure which will deal with many of the ills to which the two hon. Members have referred.
1721 Last week, I had occasion to ask the right hon. Gentleman a Written Question about taking the necessary steps to find out about the statistical problems of population—the problems which required to be tackled in terms of figures and statistics. I was referring to the recommendations of the Royal Commission on Population, and I asked him what his Ministry, which is responsible for this research, had been doing. In a very guarded answer, he said that they were doing practically nothing.
Yesterday, I received a letter from a very eminent authority who was associated with that Royal Commission and who wrote to me in these terms:I have always felt keen disappointment at the lack of interest shown in the Report"—of the Royal Commission on Population—and its recommendations. As far as I know the only tangible result has been the improvement of divorce statistics, introduced, I believe, in 1952. There has been some addition to the technically qualified staff of the General Register Office and the publication of their series of Studies in Medical and Population Subjects', though the emphasis has been on the medical rather than on the population side, as a glance at the titles will show.My correspondent went on to say that the Royal Commission Statistical Committeerecommended that future appointees to the office of Registrar General 'should normally be persons qualified to deal with statistical issues.' Nothing was ever done about this recommendation, and when a vacancy occurred in 1958, an officer of the administrative class was again appointed.It seems clear from this that the Government and the civil service regard the General Register Office primarily as an administrative department, concerned with running the registration service.Here is one of the fundamental situations which require reform. There is an elaborate machinery for collecting the statistics, but, despite the recommendation of the Royal Commission, which was set up by the Labour Government and which produced its conclusions in 1948, the Government continued to jog along without taking the trouble to make greater efforts to get at the facts.
It is the same line of policy which the Minister of Education follows with the support of hon. Members opposite. When he is challenged about the inadequacy of the teacher supply, he says 1722 that he could not get the figures right and that it is a difficult proposition to get the figures right. But no major effort has been made to grapple with this problem and when we get a Bill of this description it is not surprising that it should be a piecemeal Measure and full of flaws. The cost will be very small, and, to quote the actual words in the Explanatory Memorandum:there may be a small increase in the aggregate of the general grants …As the Parliamentary Secretary said, so much is to depend on so small a Bill. The general keynote is smallness, and that is what I complain about in tackling the whole range of social problems and the training of health visitors and of the other social workers.
How much better it would have been if the Government had brought forward a comprehensive Measure for one social training council which would grapple with the whole problem and which would forcefully put to the right hon. Gentleman and the Minister of Education and other Ministers, including the Treasury, the problems and their answers. A council answerable for the whole problem and co-ordinating the advice and getting the Ministers concerned to deal with the problem at national level is what is required. The hon. Lady the Member for Tynemouth criticises the Treasury, but she takes no effective steps to deal with that Department.
What is required in all these social problems is an assessment of the manpower position and some form of social accounting which can discriminate between one set of needs and another, and an agreed recruiting policy to get people into the right jobs. The Young-husband Report refers to the need for the setting up of this Council, of which we are setting up a bit today, and says that thereafter there must be a recruiting campaign to get people into the work. In paragraph 739, it says:We have considered the possibility of a national campaign to recruit candidates for social work, somewhat on the lines of those recently undertaken for nurses and teachers. We think some such operation desirable, but not until training facilities are available.As my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said, this proposal has been taking ten 1723 years to grind through the mills of government and, even after the Young-husband Report, it has taken two and a half years to set up this Council, and only after that can there be a recruiting drive to meet the problems. The Young-husband Report goes on:As soon as a training programme is sufficiently well-established to absorb additional recruits we recommend that this possibility—of a recruiting drive—should be explored. Any such campaign should be planned to correspond broadly with the period when the greater numbers of potential recruits resulting from the post-war population bulge are available. We hope that local authorities and their associations, appropriate government departments, universities and professional social work organisations would then consider the proposal sympathetically and co-operate in ensuring its success.This post-war bulge has been the most ill-treated of the children who have ever come into the world. There is much talk among hon. Members opposite about how things are improving and about the affluence of our society and so on, but the post-war bulge has been kicked about from pillar to post. The Minister of Education has given half a loaf and is providing some improvement, but the effect, when the bulge in 1965 and 1966 competes for university places, will redound very badly on very many individuals.
It is exactly the same in the social services. One of the basic troubles is the inadequacy of research at a broad enough and high enough level. I again emphasise that there is a great need for planning in social work. It is all very well for the Chancellor of the Exchequer at this late stage to talk about economic planning, but so far there has been no talk about the major task of social planning.
As temporary expedients, one can scratch around and encourage people from secondary modern schools, who have not had the proper facilities earlier, and one can encourage mature students and lay emphasis on recruiting part-time married women and so on. But that does not touch the basic problem of getting the right answers to the problems early. The National Union of Students complains that, with the great 1724 drive for science students, there has not been enough additional money to increase the number of science students, but pressure has been exerted to keep at too low a figure the number of awards for students in the field of social research. Only if the Treasury would support the efforts of the social service Ministers can this problem be satisfactorily settled.
I want to make one other comment about the lack of comprehensiveness of this Council. Surely it would be desirable externally that at some stage people like prison officers should have some opportunity of gaining a certificate in social work, not within the service, but on the Wakefield courses to establish them in the public mind as people engaged in social work. I hope that at a later stage—it obviously cannot be for some years—problems of that sort will be brought before the Council and the whole concept widened to take account of such work.
I very much hope that the Council, supported by the Ministry, will adopt a liberal approach towards the curriculum. My hon. Friend the Member for St. Pancras, North said that he disapproved of having some of the courses run in colleges of commerce. It is very easy to lay too much stress on the vocational nature of the courses. I hope that a knowledge of the whole social system, of the social services, and indeed, a knowledge of the statistics required to give the right answers to social problems, will be acquired to enable the students to arrive at answers which are not based on prejudice.
At Durham University for many years we organised a course for health visitors. My old department still does it. This course was concerned purely with social studies and the use of statistics to understand local problems. When I was responsible for this course it was exciting to see how women who were not particularly well educated responded to a wide and liberal treatment of the problems they were up against. Having been critical of the way in which the Government have gone about this whole matter, I hope that some small measure of satisfaction will be derived from this very small Bill.
§ 1.11 p.m.
§ Mr. Kenneth Lewis (Rutland and Stamford)
The Parliamentary Secretary said that she thought this was a small Bill. The hon. Member for St. Pancras, North (Mr. K. Robinson) said that it was a little Bill. It is a modest Bill, which has been taken on a modest day, with a modest attendance, but it has received a fairly heavy pummelling from both sides of the House.
I support the Bill in the main, though I have certain reservations, not so much about what it contains, as about what it does not contain. It is to be commended so far as it fulfils the objects of the Jameson Report and the Younghusband Report. Also, the fact that we have received this Bill within two years of those Reports is complimentary to the Minister. I do not agree with the hon. Member for St. Pancras, North and the hon. Member for Bishop Auckland (Mr. Boyden) that there has been a long delay in bringing in the Bill.
I am sorry that we have not had an opportunity to debate either of those Reports prior to the bringing in of the Bill, but we so often hear complaints from both sides of the House that Reports are filed away and that no legislation results from them, that at any rate in this case the Minister can say that we have had high-powered action, or "high-Powelled" progress, whichever way he prefers it.
Anyone who knows anything about health services, or about the overall picture of health and social services, will, I am sure, agree that the setting up of training councils for health visitors and social workers is a good thing, because they will improve the qualifications of the workers and enable them to do their jobs better. However, I wonder whether the Bill as drafted is a little premature. I wonder whether we ought first to look at the broad concept of our health and welfare services before bringing in a Bill of this kind.
It might have been better had we had the opportunity to discuss where coordination could take place in our health services before we bogged down the channels of training. I am convinced that in the local government sector there is much opportunity for improving the domiciliary services in such a way that 1726 we can save money on hospitalisation. Co-ordinating these services would also provide a better Health Service as a whole.
I was always under the impression that the Government had declared themselves on this matter, and that they were in favour of putting the weight of social service expenditure where the need was greatest. Some of us have thought for a long time that the Government had decided that that would be the future pattern, and that as a result there would be some redeployment of our social and health services.
I became more convinced that the Government had decided on this matter when I listened to the Prime Minister, or rather read a report of his speech, at the Tory Party Conference at Brighton this year when he said:How can the structure of the social services be remodelled and adjusted to ensure that public resources are concentrated on those to whom they do the most good so that benefits are not dissipated by being dispersed too widely?How best can we adapt our present policies to take account of the growing ability, and. the growing desire, of the individual to make for provision for himself and his family?One also has to take into account what has been said by one other important person in connection with the social services generally. He said:We see a range of existing social services, entrenched to varying degrees in institutional form, reflecting to varying degrees needs and economic conditions which have passed or are passing away. We see new needs, born of newer economic and social conditions, which call to be met. We recognise that logically this demands a transfer of resources and effort from the former to the latter, that in the words I have so often quoted, some social services are 'excessive' and others 'inadequate' …He went on to say:.these resources ought to be redeployed to meet modern realities, and this will not be done without soberly assessing but boldly facing the in-built obstacles to that redeploymentThat was said by my right hon. Friend the Minister of Health. That is why I said we ought to take those views into account when considering this broad policy for the social services.
I should like to examine the relevance of the Bill to the principles stated both by the Prime Minister and my right hon. Friend. To do this one must look 1727 at the work of the social and health workers who are the subject of the Bill, and the development envisaged in the two Reports on which the Bill is based, the Jameson Report and the Young-husband Report.
At the moment we have a number of categories of workers in the health and social services working for, or with, local authorities. We have welfare officers, children's officers, almoners, mental health visitors, health visitors, home nurses, midwives, and home helps. We have all those besides a large number of voluntary organisations who employ their own social workers who may work in any or every one of those branches.
Since child protection duties were taken away from health visitors by the Children Act, 1948, and given to children's officers, health visitors have been concerned mainly with maternity and infant welfare. The 1960 Report of the Ministry of Health, which is the latest available, shows that there were approximately 10 million visits to expectant mothers and to children from the age of one to five. Only 1½ million visits were paid to other classes of patients. That 1½ million includes almost 500,000 cases of tuberculosis, so that there is a concentration upon maternity cases at the moment. In home nursing we find almost exactly the same thing. It is, therefore, obvious that there is scope for the use of health visitors over a much wider field. It is also true that there is a certain amount of duplication in visiting, as between nurses, midwives and health visitors.
My right hon. Friend is concerned about the development of maternity services in hospitals. He has a problem. He must either build more and more hospitals for maternity cases or encourage women to have their babies at home and increase the scope of the domiciliary services. If he uses the domiciliary services he can save hospital beds. I want to impress upon him that it seems to me that a decision must be made on these wider matters, in concurrence with this Bill. He has to make up his mind. Does he want to extend maternity services in hospitals, so that every woman who wants to can have her baby in hospital, or does he want to encourage 1728 women to have their babies at home with the attention of a health visitor, a midwife, or a home nurse?
When a decision of that sort has been made, only then can we determine the kind of training to be given to health visitors, as provided for by the Bill. We must decide what sort of training curriculum the health visitor will have. If the Bill is too early, as it may well be, training could proceed along the wrong lines. The training Councils might find themselves in difficulties when determining what they should train for.
There is a considerable scope, both in health visiting and social work, for domiciliary services for the aged. Old people will become more and more of a problem during the next decade. In this case the Minister must decide, as a matter of major policy, what he will do about this. Will he encourage old people to go into homes, or to stay within the environment in which they have been brought up—in their own homes—attended by domiciliary workers? By spending a little money here we may be able to save a great deal elsewhere. If old people can be given attention in their own homes they will probably be happier, and less cost will be involved. The building of geriatric units in hospitals, which is growing apace, is a very expensive operation.
The Government, not just this Minister, must determine what their policy will be in this matter, since it concerns more than one Ministry. Once they have determined their policy, only then can they decide what kind of training should be given to the health visitors or social workers who will be involved in this work. I repeat and emphasise that without an overall policy decision the training of the workers may proceed along quite the wrong lines.
So with this Bill it seems to me there must come a new look at the whole of our health and welfare services. However, it will take some time before the Bill becomes an Act, and I believe that the Bill itself states that the Minister shall determine the operating date. If, therefore, he can arrive at a date for the coming into force of this Measure and at the same time bring forward proposals for the amalgamation of many of the services in local government which come within the whole scope of the Bill, 1729 set up by the Bill, as the years go by the councils will be able to produce a body of workers trained in the widest possible field, to the greatest benefit of the whole service.
We know that the Minister is taking a great interest in mental health. There is great scope for domiciliary work here. There is also scope for saving money by spending it in this sphere rather than in the mental hospital field. The Minister must make it clear to both the Councils concerned in this work that they should provide qualified persons in mental health. He cannot do that until he has decided what the Government intend to do about mental health, and how much of the mental health work will be domiciliary and how much will be carried out in the hospitals.
Last Session I put down a Question to the Parliamentary Secretary concerning the problem of co-ordinating our health and social services. She told me that I was confused. I may have appeared to be so at the time, but in fact it was at that time—and it still is—as plain as a pit shaft to me that a certain amount of co-ordination was necessary. We have put it off for too long. It is time that we tackled it.
The hon. Member for Bishop Auckland referred to planning in social services. I was glad to hear him suggest that there was a need for this. I had an idea that hon. Members opposite were very anxious to plan in every kind of field except this. Whenever a suggestion is made by an hon. Member on this side of the House that there should be some changes in the health or the social sector, and that those changes should be co-ordinating changes or amalgamations, hon. Members opposite oppose us.
There is a need for a new look. If the Bill foreshadows a new look; if it becomes an Act in a few months' time and before it becomes fully operative the Government have declared their intention to look at the whole of our social services, including the health service, on the basis of providing for need where need is greatest and on the basis of avoiding duplication of effort, the Bill will be a good one. But if the Government fail to do this, then the Bill could become a millstone round the necks of the Government in the future.
1730 Of all Ministers, the present Minister must know perfectly well that Governments frequently find themselves in the position where they cannot make changes in policy because of administrative action taken years before. They find it impossible to move out of a groove, something that, maybe, a previous Government or Minister has put there. The present Minister could find himself in just that position with this Bill unless he is prepared to bring in almost simultaneously Measures which will enable the House to coordinate and even amalgamate many of the local government services which criss-cross one another.
If we start training any profession along fixed lines and allow that method of training to go on for a year or two, then, clearly, it is more difficult to change it afterwards. The profession tends to have a vested interest in a certain curriculum. It does not want it changed and it does not want people to come in from the outside. We have seen this happen in many professions, and we see it in many trade unions today where certain job training is given. The men concerned, quite understandably, are not very anxious to have the training altered or to take on any different kind of work.
I do not want to see this happen with either health visitors or social workers. At the moment, I believe that their training is too narrow. On the other hand, some people think that it is too long. It is a long training, but it is narrow for all that. Over the whole field of local government health and social services there should be great opportunities for the men and women employed as officers to have the widest experience in social work and not be bogged down in one groove.
Finally, I wish to say something about the use of part-time workers. This. I believe—I think the point was made by the hon. Member for St. Pancras, North—provides the greatest opportunity for these training councils. We have now in this country a situation of full employment which has gone on for many years. We have something else, too. We have a situation in which people are working less and less hours. Leisure is becoming greater and wider. I think it would be accepted on both 1731 sides of the House that as far as welfare is concerned, it would, perhaps, be a good thing if we could change the Welfare State into the "Welfare Community ". The Welfare State smacks of the Government doing everything, if not the central Government then the local government. The welfare community means that people are prepared to help each other.
I do not think that we shall get very quickly on a full-time basis the numbers of people envisaged in these two Reports. I think that the Jameson Report said that 3,500 full-time workers were required and that the Young-husband Report suggested 2,500. But there is a great scope for recruiting on a part-time basis. Those who can be encouraged to work in their spare time will find that, from a community point of view, they will gain much out of it, and so will those with whom they come into contact.
As far as social workers are concerned, 1 cannot think that it is other than valuable that there should be people employed in doing this work who are themselves doing another job and are therefore in touch with life. If one is engaged in social work there is a great advantage in not being a bureaucrat but in being in touch with life. This is something which we in this country have not yet begun to explore—the use of people's spare time in jobs to help their fellows.
It may be that some would be paid and some would not. It does not matter very much whether they are paid or whether they give their services voluntarily. I hope, at any rate, that the Councils to be set up under the Bill will so arrange their curriculums that account will be taken of the possibility of employing part-time workers.
I support the Bill, but I should like to see it as only part of a new look at the social and health services. I believe that that is desirable and that it is overdue. In my opinion, any new look would be of great advantage to the nation. It may result in saving money in some directions and in costing money in other directions, but what it will certainly do will be to cut out much of the waste, much of the criss-crossing 1732 of functions which at present undoubtedly take place and which most people, I believe, would agree we ought to deal with.
§ 1.37 p.m.
§ Mrs. Judith Hart (Lanark)
I should never have thought it possible in a debate on a Bill of this kind to disagree with so much of what has been said in a speech as I do in the case of the speech of the hon. Member for Rutland and Stamford (Mr. K. Lewis). I am very tempted to explore all the avenues which he opened up, but I will limit myself to criticising two or three of his comments.
If the hon. Gentleman thinks that he can solve the problem of community care of the mentally ill and of the elderly on the basis of people doing a little voluntary work in their spare time, as he suggested towards the end of his speech, he is wrong. Of course there will be a function, and a very important function, for voluntary workers, whatever system of training of social workers is instituted. But this is not what the Bill is talking about. It is talking about the professional basis for the staffing of social services. Any voluntary work done after another job can only be to supplement, and can never be a substitute for, the full-time work of people in the local authority health and welfare services.
I think that the hon. Gentleman is also under a complete misapprehension about the nature of the professional training itself. It seemed to suggest that, if only the Minister would make up his mind where he is going to carry out economies in the social service field and where he is not, we could have an integrated Bill such as the hon. Gentleman would like to see. He said that we could then ensure that the professional training was related to the kind of services which the Minister had in mind.
This is like saying to those who set the syllabus for the training of doctors that, because certain drugs which are very effective in treating illness are too expensive, and because the Minister does not want to give permission to import them from abroad these must be struck out of the professional curriculum of the doctors. That is exactly what the hon. Gentleman is saying. In relation to professional training for social 1733 workers he is saying that, first, it must be decided what the Minister wishes to do administratively and financially, and then, according to that decision, professional training must be adapted.
§ Mr. K. Lewis
I should have thought that if it were done the other way round the Government would have no control over policy. Policy must be decided by the Government and training and other administrative factors must follow.
§ Mrs. Hart
I am glad that the hon. Gentleman has made his position so clear. That is exactly what I am criticising. Of course professional training must consist of teaching students what is known to be right and what is known to be the most effective way of dealing with this problem through the social services and in a way which will help. It is one thing if then the Minister says, "Although you have been trained to believe that it is right to encourage a mentally ill person to stay integrated in the community rather than to go to hospital, I am sorry, but we propose to change the policy and not to allow you to recommend that because we cannot afford it." When that is done an administrative or financial economy is being imposed on what is recommended by social workers. The content of professional training is not being changed. Here there is an important difference which I beg the hon. Gentleman to understand. The profession of a social worker is the same as the medical or architectural professions or any other profession and the content of its learning is not to be dictated by any Minister of any Government.
One other comment I wish to make before leaving the speech of the hon. Gentleman. He implied that hon. Members on this side of the House were resistant to change in the social services, that we were resistant to planning in the social services. That is not true. We are insistent that any changes should be dictated by the welfare of people and not by the kind of cuts which the Treasury might want to make here and there. This is an important distinction in our attitude towards these services.
My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said that he hesitated to call this Bill a mouse of a Bill. I think it is a mouse of a Bill 1734 and so weak that it is hardly able to crawl out of its hole. It is a pity that the House did not have the opportunity to debate the Younghusband Report before the Bill was drafted. Perhaps the reason was that if the House had debated that Report I doubt whether the Government would have dared to bring in a Bill as limited as this one. We ought to be trying, by means of whatever Bill is introduced, to train social workers and to deal with the kind of desperate situation which exists in respect of the training of social workers and health visitors.
I want to turn to the picture in Scotland where this Bill will be of immense importance or could prove to be of immense importance if it were effective. I remember asking the Secretary of State for Scotland not long ago how many psychiatric social workers were employed by the local authorities in Scotland. I was told that the local authorities employed five psychiatric social workers full-time and one part-time. I believe that number includes the two almoners employed by large burghs mentioned in the Younghusband Report, and so that would be three full-time psychiatric social workers.
The psychiatric social workers have been mentioned before today. There was a suggestion that although they were not covered by the Bill, because they are not the general purpose social workers that the Younghusband Report envisaged, nevertheless their situation is relevant to the consideration of the Bill because we must not forget that the general purpose social worker will work under the supervision of the psychiatric social worker. The psychiatric social worker will be needed in questions of difficult diagnosis where there is particular difficulty in treatment. The general purpose social worker cannot do her job unless the psychiatric social workers' service is fully staffed.
The Younghusband Report revealed that in Scotland there were no other social workers in the after-car service at all. This is for the whole sphere of community care. What about the United Kingdom as a whole? I do not think that these figures have been mentioned before, but in the Younghusband Report we are told that there are 26 full-time psychiatric social workers and 1735 5 part-time, in the whole of the United Kingdom, or were at the time when the Report was made. There were 50 almoners and only 70 other social workers. Fewer than half were qualified, and in the whole of Great Britain there were 15 family case workers employed by local authorities, only 5 of whom had had some training.
The hon. Member for Rutland and Stamford said that he did not think the Bill was long delayed since it was only two years since the Younghusband Report was published. May I mention the Mackintosh Report? It is now over ten years since the Mackintosh Report revealed that there was an acute shortage of trained social workers in every branch of the mental health service. When talking to the National Association of Mental Health Workers, Professor Titmuss, quoting himself from the Mackintosh and Younghusband Reports, said:In 1951 eight psychiatric social workers were employed full-time by the 145 local health authorities. In 1959 there were twenty-six; an increase of 2.25 per year. At this rate it will take another fifty-three years (AD 2014), before someone can say that there is an average of one psychiatric social worker to each authority.That is the picture. What we have to do, presumably by this Bill, is to try to tackle what may be called the slum clearance stage in this programme of providing adequate social workers for the social and health services.
I wish now to deal with a fundamental question which I do not think is a matter of controversy. It is a question which is not clearly understood by many local authorities, the most important bodies in this sphere. It is: why do social workers need training? Why is it not enough to have some well-meaning, kind women with some time to spare to call on people and help them and do what is necessary to explain the social services to them? Why is this not enough? From the history of community life in this country one sees an attitude of condescension towards the deserving poor. The most important part of the history of social service was the break-up of the Poor Law and the attitude it represented. At the turn of the century there was the gentle lady, and the Charity Organisation Society; the C.O.S., which is so changed now and is a voluntary organisation 1736 doing extremely valuable work. It is only within the last 20 or 30 years that social work has become regarded as a professional job needing professional training with an academic content and with a necessarily professional approach.
This is because of scientific developments rather than people. I believe that it is science which has humanised the treatment of individuals and of families which are maladjusted or in some social difficulty. It has given a new knowledge of causes and has established systematic methods of diagnosis and treatment. These have to be acquired. Knowledge of causes has to be acquired as well as knowledge of the nature of systematic treatment and diagnosis. This can be done only through professional training. The present advances in the level of knowledge in these spheres is such that it is just as great a crime to send an unqualified person to a problem family as it would be to place a "Mrs. Gamp" in control of a maternity hospital. I hope that local authorities will begin to realise more and more that under the provisions of this Bill they will have immense responsibility. I hope that they will realise their needs and be prepared to take advantage of the provisions in the Bill.
One of my main criticisms of the Bill is that, as has been said, it makes no mention of recruitment. Where are the people who are to undertake this training? Would it not have been very much better if this had been the responsibility of the Government, as in the case of probation officers and child care officers? Would not that be a more effective way of producing recruits? This is linked with the question of who is to provide the money. I have completely failed to understand this new principle on which apparently the Government are embarking. To say that it must be the local authorities who largely support the training schemes by grants is like saying that local authorities ought to do the same for doctors, dentists or nurses whom they employ, or for architects and surveyors.
It is regarded as perfectly natural that training the experts is a responsibility carried out by the Government through universities, while the using of the experts is a local authority function. Because they use the specialists local 1737 authorities do not at present have the function of contributing towards their training. This is a new principle which seems to represent the most cheeseparing parsimony it is possible to conceive. I cannot imagine that the Government could have produced a Bill which would cost less in trying to pay some kind of lip-service to the proposals of the Young-husband Report.
I wish to reinforce what has been said about the need to try to recruit married women. So many professions, by their nature and history, are prejudiced against the employment of married women. When something like this is set up, however inadequate it might be, it is of the greatest importance, particularly where they can do the job so well, that efforts should be made to bring in married women and give them training. This is a matter on which local authorities will have to be particularly punctilious. By slight adaptation of hours, and especially of the hours of training courses, a whole crowd of married women, who otherwise would be cut out by the insensitivity of local authorities to their needs and perfectly fair demands, can be brought in. They are all prepared and anxious to do a fair job for a fair salary, but they need to be thought of as people with particular problems of their own.
I should like to have some clarification of Clause 3 (3) and the phrase "other social work". What is that intended to mean? I hope that we shall have a clear explanation from the Minister at the end of the debate. I also hope that he will make clear what he means by the provision in Clause 5 thatthe Minister and Secretary of State may promote research ".What use is he proposing to make of this power? How much money is to be devoted to this? Is he to give an annual grant for research? If not, why is this provision in the Bill? Is it in the Bill only to pay lip-service to the Younghusband Report? I hope that the Minister will make the phrase mean something, because there is an acute need for research in this field in which so pathetically little is known in comparison with research in the physical sciences, particularly when two-thirds of Government expenditure on research is related to defence.
1738 On the Schedules, which my hon. and learned Friend the Member for Aberdeen, North (Mr. Hector Hughes) mentioned, what kind of people does the Minister intend to appoint under paragraph 3 (a) of the First Schedule when he appoints 13 to the Health Visitors Training Council and, under paragraph 4 (a), 14 to the Social Workers Training Council? What kind of people has the Minister in mind? Are they to be people from the universities, or will they come under the categories in paragraphs 5 and 7 recommended by the Health Ministers and the Minister of Education? I am reinforced on this matter by a letter I had today from Dr. Ferguson Rodger, Professor of Psychological Medicine in the University of Glasgow. I hope that the universities will be brought more closely into the picture and that that will be done more directly.
There is a need for direct representation from the universities. The Department of Psychological Medicine in Glasgow has done a tremendous job in the last 10 or 15 years in establishing courses for social workers of various kinds—courses for probation officers and other social workers. Now it has established a six-month course for health visitors. A great deal of pioneering work has been done, but under the Bill has it any direct place in saying what should be done through the Training Council? I hope that in Committee the Minister will tell us how he intends to bring the universities into this work very much more directly.
My hon. and learned Friend the Member for Aberdeen, North mentioned criticisms made by Dr. Macqueen, the Medical Officer of Health of Aberdeen. I also had a letter from Dr. Macqueen from which I shall quote one sentence which links with what the hon. Member for Tynemouth (Dame Irene Ward) said about representations which have been or have not been made and consultations which have or have not taken place. The letter says:the Scottish Health Visitors Association (the body which normally represents health visitors in Scotland and which gave written and oral evidence to the Jameson and Younghusband Committees) received no invitation to offer comments and was not officially aware of what was being proposed until the Bill had been printed.That was a remarkable statement. I wish that before now there had been 1739 more direct consultation with the professional social workers. I hope that it will take place now and that the example of the course which was set up at the Scottish College of Commerce—not by the Joint Under-Secretary who is present on the Government Front Bench today, but by one of his hon. Friends—will not be followed. In that case, the professional associations of social workers in Scotland were not consulted. Individuals were consulted, but not the associations. I hope that the Government and the Secretary of State for Scotland from now on will learn the lesson and accept the fact that they have a duty to consult associations before bringing in new Measures of this kind or establishing courses such as those which have already been set up. As far as I understand, that course is a most unsuitable one and certainly it is in a most unsuitable place.
I have referred to the nature of professional training of social workers. That kind of training does not fit in at all with the courses carried out at the Scottish College of Commerce. The only other aspect of human studies covered there is management studies. I would not say, nor would any social scientist say, that this subject had anything at all in common with training for social work in the community. Indeed, management studies represent only a new and clever technique for bolstering up the capitalist system. If one takes training for two such entirely different subjects and puts them under the same roof, although they have no connection, we are bound to be left with this result. This has not been the case with the Scottish Home Department probation officer course, which is admirably situated in a building near to a university so that it has an indirect, but human, link with the university, which is immensely valuable to it.
There are one or two other points which I shall leave to Committee, and one or two rather odd anomalies which arise in the setting up of the Scottish Advisory Committee.
During this summer I spent a few weeks in Russia. When one goes to Russia for the first time, there are some things which one expects to see and which one sees, there are some things 1740 which one expects to see but does not see, and there are some things which one does not expect to see but which one sees. I spent some time looking at the way in which they care for mentally ill people in Russia, around Moscow. I had not expected to find what I did find. My hon. Friend the Member for St. Pancras, North knows a great deal about this; he recently wrote a pamphlet comparing the Russian and American attitudes. But I knew nothing about it before I went there.
I was, therefore, all the more amazed to discover that in Russia they had set up apparently 20 years or more ago the kind of system towards which we are just beginning to move. I understand that their chief medical officer for psychiatric services has given a good deal of help and advice to some of our people, for example, in setting up day-treatment centres. I discovered that they have mental health policlinics in every area, fully staffed, and that the ratio of psychiatrists and workers to patients is very high Attached to each of these is a day-treatment centre, the type of thing of which we are beginning to have a few, and a rehabilitation centre, where they train workers in new skills if it is not possible for them to go back to their old factory jobs. There is also a work therapy centre which is running the whole time and which employs at a reasonable wage those workers who cannot possibly go back to their old jobs but who want to work. This also takes in from time to time slightly chronic cases and gives them pep-up training. This is taken as a matter of course. How far away we are from it!
I merely point this out because, although I knew that other countries in the world are way ahead of us in these matters, I had no idea that Russia was one of them. If we are to move into this kind of system, how many more staff shall we need, how many more psychiatrists, how many more psychiatric social workers, how many more general purpose social workers, how many more health visitors? This Bill, with its niggling £50,000 and its failure to recognise the Government's responsibility for setting up courses and paying for courses and its failure to give any real undertaking about the promotion of research in the social 1741 and health services, is, I feel, holding back the advances of this whole field in this country.
Sometimes society is held up because ideas are not forthcoming and because nobody is doing new things, but in 1961 we have reached a position in Britain in mental health and the social services in which the ideas are brimming over, in which people know what they want to do and all that is needed is positive action from the Government to provide the opportunity for their ideas to be carried out. I am afraid that the Bill does not represent the kind of positive action which will solve the problem. I hope that in Committee the Government will be prepared to make rather more of it than perhaps was their original intention when they drafted it. I hope that in Committee—if I am fortunate enough to be among those on the Committee—we shall be able to persuade the Government to expand the Bill and to take up the challenge of what needs to be done.
§ 2.4 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
In the maim, the debate has been highly critical, highly informed and most constructive. Hon. Members from both sides of the House have entered the debate with a keen sense of awareness of the gravity of the problem and of the importance of doing something radical about training in both the fields with which the Bill deals.
The only contrast which we had was in the contribution by the hon. Member for Rutland and Stamford (Mr. K. Lewis), who spoke between the forceful contributions of my hon. Friends the Members for Bishop Auckland (Mr. Boyden) and Lanark (Mrs. Hart).
The substance of the plea by the hon. Member for Rutland and Stamford was that we must not move too quickly and that the Bill was a little premature, but I think that this argument has been effectively dealt with by the urgency which my hon. Friend the Member for Lanark conveyed to the House when she produced these fantastic figures of reaching the year 2014 with perhaps one trained psychiatric social worker for each local authority. It is in that light, I think, that most of us, including the noble Lord the Member for Hertford (Lord Balniel) and the hon. Lady the 1742 Member for Tynemouth (Dame Irene Ward), if I may say so with respect, have tried to put a little pressure behind the Minister in order to make this little mouse a little larger, even if it would only then be a large mouse.
We welcome the Bill as a step in the right direction, but a number of hon. Members have indicated their doubts about the package deal and why these two Departments should be brought into one training Bill. This is because most of us who are interested in matters which are attached to the National Health Service or to the community service have looked at the National Health Service since its inception and feel that a number of the difficulties which have been encountered arise from its tripartite nature. Some of us feel that the idea of having three separate sections was perhaps a mistake in the first place, and we are always seeking ways and means of greater co-ordination between the three sectors of the National Health Service.
Inevitably, when we find two important sectors being put together, as are the health visitors and social workers, in one training Bill we wonder whether this will lead to difficulties later; whether, if we are to put two into one bed, these are the right two: and whether there are not other ways of co-ordination which would be more effective. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) has pointed to the existence under the Home Office of the Probation Advisory and Training Board established in 1936 and the Central Training Council for Child Care. It seems to me that if the Council for the training of social service workers is to attract fresh people and to become an important force in social service work, inevitably there will be some kind of correlation between the people so engaged and those being trained at the moment in the probation advisory service and the Central Training Council for Child Care. It may be that at some time in the future we should like to see co-ordination between these three rather than a continuation of this situation.
The Parliamentary Secretary gave as one of the major reasons for putting these services together in one body the fact that the people who would be training gave of their services in a domiciliary 1743 fashion and were engaged in work in the homes of people where the need arose. If we accept that as a criterion we shall have an amazing number of organisations which will need to be locked together. I do not agree with the hon. Member for Rutland and Stamford in his idea of a grandiose comprehensive plan to meet the various anomalies in sections of social and community care. The suggestion was that before we move at all we must have a grand comprehensive plan which will take all the anomalies into consideration. I feel that that was a plea not for increasing the amount which will be done under the Bill but rather for deferring it. My hon. Friend the Member for St. Pancras, North and the hon. Member for Tyne-mouth emphasised that in the coming ten years, unless we have first-class training of workers in the community, we shall be continually running into all kinds of difficulties.
This is not just an immediate problem. We have waited a long time for legislation. How long will it be before the Bill becomes an Act? How long will it be after it becomes an Act before we shall see something more than the four pilot courses which have so far been held? If people who are taking on these heavy responsibilities are trained, they will have a status. They will feel competent to deal with the increasingly intricate problems which arise from our increasingly intricate pattern of living.
I join other hon. Members in criticising the Government for allotting only the miserable sum of £50,000 to finance these two important Training Councils. The Government are saying, in effect, that two Dr. Beeching salaries will leave them £1,000 over by the time they have paid for these Councils. If the Government want a man to do something in the commercial field, something concerned with pounds, shillings and pence, they cannot pay him enough. They must pay him £24,000 a year. But when it comes to helping people whose lives have been broken trough some cause beyond their control, or to helping mothers who bring children into the world, the Government say that they must have the Florence Nightingale ideal and work for next to nothing, otherwise they have no sense of vocation. I hope that the Govern- 1744 ment will think again about the £50,000. Perhaps we can deal with this in Committee. It is an entirely inadequate sum. It smacks of cheeseparing. It is not a sufficient sum to give the two Councils the force which they will need if they are to be effective.
Training is inevitably bound up with recruitment. If the two Councils are successful in training people who can do their job in the community effectively, this in turn will affect the number of people who are prepared to enter this service.
If the Government expect people to be prepared to devote their lives to this service, to undergo professional training, and afterwards become professional workers in either of these two fields, they must do something more than hope that a grant will be forthcoming from local authorities. Local authorities have different attitudes towards making grants. I had experience of this some years ago when I tried to get major county awards for people who very often began training after they had started families. They then wanted to change their vocation. They received the call to do something different. They were, perhaps, dissatisfied with what they were doing. A long time after their normal education had finished they suddenly wished to take a further educational course at an adult education college on the lines of New Battle Abbey in Scotland.
I had the task of negotiating with education authorities with a view to getting major county awards for these people. There was the ridiculous situation that a person living one side of the border could approach the county authorities confidently, knowing that he would be received favourably, whereas a person living a mile away on the other side of the border knew that he did not stand an earthly chance of getting an award. This is a haphazard way of trying to save a social service. It throws it on the local authority to decide. In the last analysis the authority can always say, "Yes. We think that the applicant has all the qualities which would make for good service to the community. We think that he is capable of benefiting from the training. We think that it is very laudable that he has come forward and asked for this grant, but we regret that the money has run out. Last year's 1745 estimates have already been completed and equally worth-while and eligible cases have already been dealt with. We advise the applicant to try again next year."
Another difficulty is that the G.C.E. results are not known until August. An applicant must send in his application long before that, because courses at training schools start in September or early October. It often happens that people who have applied to go on a course later find that their G.C.E. results are not as good as they thought they would be. They may find that they no longer qualify for the course.
My hon. Friend the Member for St. Pancras, North argued that, if it is possible for the two bodies under the Home Office which deal with probation and child care to have direct grants available for people undergoing their training, it ought to be possible for a Clause to make this possible in this case to be included in the Bill. Has the Minister made any inquiry about the four pilot courses which have already taken place as a result of the Young-husband Report? The one at the North-West Polytechnic should yield a good deal of information. It will be interesting to learn what type of people join the course and what happened to them.
Why is it that the B.M.A. is always included in the composition of bodies established by the Government if these bodies require medical advice? Social workers and health visitors work in fixed localities. They often deal with general practitioners, whose knowledge and experience in these fields would be very valuable. I cannot understand why the Minister has not selected three general practitioners to serve on the training Councils, because they could make a useful contribution.
If attention is to be paid to the experience of general practitioners, why should not the Government go to the General Medical Services Committee, which is representative of all doctors and all organisations? I hope that the Minister will consider this suggestion. Doctors who are not members of a large body may be members of a smaller body. They often feel that they are being left out of the big battalions, although they may have a valuable contribution to make.
1746 The Minister of Health is not in the position of the Minister of Education, who very often has had to choose between the National Association of Schoolmasters, which was not on the Burnham Committee, and the National Union of Teachers, which was on the Burnham Committee. The Minister of Education has at last resolved this difficulty. However, the Minister of Health is not in the difficulty of having to choose between the two organisations in the medical field, because the General Medical Services Committee is a statutory body elected by doctors serving on local executive councils.
I join with hon. Members on both sides of the House in deploring the small sum which has been allocated for research. Much research will be necessary if advances are to be made. The fact that this limitation has been imposed at the outset, before any research has even been embarked upon, makes me believe that the Government are halfhearted and not seized of the urgency of this problem.
I was a little reassured by the speech of the Parliamentary Secretary, but I am still concerned about the passage which says that services will be available to voluntary bodies if their work is similar to that of local authorities. In the case of many voluntary organisations an exact parallel cannot be drawn. I am not certain whether organisations like the Family Service Units would be capable of participating in this scheme. Are the people who engage in the activities of these units similar or comparable to welfare officers employed by local authorities? I should welcome the Minister's views on this.
The Bill is a step in the right direction. It is a little late, but better late than never. It is important for the Government to have a sense of urgency so that we do not have to wait four or five years until people start emerging from the training machine. I hope that the Bill will have a speedy passage through the House. I hope that the various parts of the Bill which we have criticised today will be further examined by the Government and that there will be a sense of urgency in getting the Measure through the House and the schemes established.
§ 2.20 p.m.
§ Mr. Leo Abse (Pontypool)
I do not wish to follow all the arguments of hon. Members opposite, but it would be wrong to permit without challenge a comment made by the noble Lord the Member for Hertford (Lord Balniel), which seemed to me to be a reflection on the diligence and hard work of the Younghusband Working Party. I understood the noble Lord to reproach that Committee for having produced a lengthy Report.
I followed with considerable interest his explorations into the psychological mechanism within the community which permits people so often to have negative responses. On the other hand, in criticising the length of the Report he appeared to be projecting culpability on those who had worked so hard and diligently so as to establish an alibi for the inertia of himself and others who have not taken the trouble to penetrate into the information and scope of a Report which should receive the highest commendation, and which has, in my view, received scant respect in this paltry, incomplete and inadequate Bill—
§ Dame Irene Ward
If I may say so, with very great respect, the hon. Member is putting quite a wrong interpretation on what my noble Friend said, and his allegation is a little unfair. I am sure that my noble Friend only meant that there would be added point to the Report if it were to be condensed so that more people could read it. My noble Friend reads everything and is very knowledgeable on his own subject, and I should hate that allegation to be made without contradiction.
§ Mr. Abse
I am much obliged to the hon. Lady. I am sorry to have to say this in the absence of the hon. Member for Hertford, but I believe that to be his only adverse comment on the Report and I had a great deal of sympathy with the rest of his remarks.
Perhaps it is because insufficient attention is paid to such Reports that we find ourselves in our present position. For example, we know that the Mackintosh Committee recommended the increased supply and training of social workers in the mental health service. All that resulted was a tepid circular to hospitals 1748 and local authorities suggesting the economic use of such social workers as were available. The stress laid time and time again by the Mackintosh Report on the need for the adoption of a training scheme, to be organised through hospital regional boards under the supervision of experienced psychiatric workers, was ignored.
There followed an interlude of four years before the appointment of the Younghusband Working Party, and we had to wait four years more for its Report. After another two and a half years we now get in this Bill the Younghusband proposals so emasculated that no one can have any well-founded hope that in any reasonable period we are likely to get the trained workers we so urgently need.
The Younghusband Report says that we need 2,200 wholetime mental welfare officers—that is based on the statement in the Mackintosh Report—without taking into account, of course, all the additional commitments consequent on the new Mental Health Act. There are at this moment only 625 full-time officers. Even if we juggle with the figures and speak of a staff expressed in full-time equivalents, the maximum is 1,100. The overwhelming majority of these people have no qualifications except their own good will and experience. The total number of welfare officers, including mental welfare officers, is only 1,800, of whom the Younghusband Working Party said that 1,100 have had no training.
We know the serious consequences of this. There is in the Younghusband Report a vivid account of what happens as a consequence of the present lack of training. One officer said:I am appalled at the total absence of any system of training or selection…I have experienced and observed new appointments to this important post recruited from general clerical grades having no previous experience of any type of social work. Some of those appointed were immature and quite incapable of appreciating the impact of mental illness on an individual, his family or the community around him.It is against that sort of background, I believe, that one must evaluate what I regard as the pretentious nonsense of the Minister's statements when he talks of ridding ourselves of the old mental hospitals and turning the patients out to community care.
1749 We know the importance of the work of the after-care officer. It may be that on his capacity and co-operation depends the happiness of a whole family, desperately requiring help in the emotional problems that can result from having a handicapped member. It depends on the welfare worker whether the discharged mental patient—who, with help, might have remained within the community—deteriorates to the point where re-admission to mental hospital must be arranged.
Until we have adequate and trained after-care we shall continue to have the position so lamentably illustrated in Wales, where almost 48 per cent, of the patients who entered Welsh mental hospitals last year had already been discharged but had again broken down and been compelled to return to the hospitals. In hospitals serving my constituency such as St. Cadoc's or Whitchurch Hospital, serving Cardiff—in the very shadow of the Medical College of Wales, more patients were readmitted in 1960 than there were first admissions to them. Who can doubt—I certainly do not—that these grim figures reflect the inadequacy of the after-care service in Wales? How does this Bill measure up, particularly in Wales, to the task of providing mental health workers?
All the recommendations of the Younghusband Report depend upon a developed tutorial system. Field work under experienced supervisors is a necessary and continuous pant of the general training proposed in it. As paragrah 894 of the Report emphasises, this means supervision of psychiatric social workers attached to the mental hospitals and, as their training continues, by psychiatric consultation. Yet we have heard nothing at all of how the Government intend to provide the psychiatric social workers who will have to be the tutors and supervisors if more mental health workers are to be turned out.
The Mackintosh Report stated in 1951 that 1,500 psychiatric social workers were needed; there were then 331. If I am in conflict with the figures given by my hon. Friend the Member fox Lanarkshire, North (Miss Herbison), it is because I am dealing with psychiatric workers in hospitals as well as those attached to local authorities. The Younghusband Report says that that figure of 1,500 must be 1750 increased. In fact, 50 per cent. more are needed do local authority service than was anticipated in pre-Mental Health Act days. We only have 500, and their geographical distribution is notoriously uneven.
How serious is the position is well illustrated by Wales. We have only one full-time psychiatric social worker attached to the hospital services in the whole of South Wales and Monmouthshire. Nor am I surprised at that. The Medical College of Wales flagrantly advertises its contempt for psychiatry by refusing representations made to it on at least four occasions in more than a decade by the Welsh Regional Hospital Board to set up a Department and a Chair in Psychiatry. How can we hope to attract psychiatric social workers into Wales with such a climate prevailing? I listened with interest to the remarks of my hon. Friend the Member for Lanark (Mrs. Hart) about the work being done in Glasgow at the Department of Psychiatric Medicine. Clearly, Scotland is well ahead. We do not even have a chair or department, despite the wishes that have been expressed by the Minister of Welsh Affairs, and despite the fact that the Minister himself has specifically expressed a desire for it. Further, the Parliamentary Secretary and the Minister of Health have indicated that it is the wish of the Ministry that this should be done.
Since we are now talking about the training of potential mental health workers, we in Wales need all the psychiatric workers we can get. How much longer will the Government permit the present situation in Wales to continue, where there is no possibility of our developing the mental health services to reach a sophisticated level? We cannot drop this problem into the hands of the Training Council any more than we can rely on them being able to recruit people who will be part of the intake required for the number of potential psychiatric social workers needed.
We do not have even one psychiatric social worker in the child guidance clinics of South Wales and Monmouthshire qualified to act as a tutor to aspiring students and because we are inadequate in our number of psychiatric 1751 social workers, how can we possibly in Wales train the needed number of mental health welfare workers?
This brings me to the need for trained home visitors for the handicapped. Just as the training of mental health social workers depends on the existence of psychiatric social workers as tutors, so an adequate supply of trained home visitors for the handicapped depends on the availability of almoner tutors. In Wales and Monmouthshire we have a heavier toll of industrially injured than anywhere in the country. The August, 1961, figures showed that 9,200 people were in receipt of industrial injury benefits. That is more than Scotland, even though Scotland has twice the population of Wales. It is three times greater than the Middlesex and London region, which has three times the population. This is the terrible price that Wales is having to pay for its coal and heavy industries.
It is clear that there can be no region in Britain where machinery is more greatly needed for training home visitors for the handicapped than in Wales. Our problems are made even more difficult by the grim housing and the considerable number of paraplegics. I am referring to the types of houses that are like boxes and that were thrown up a century or two ago. There is no region in Britain with a higher percentage, as the 1951 Census revealed, of houses without bathrooms, flush toilets and even running water. Anyone who has seen the difficulties which are encountered by a paraplegic living in a home lacking these basic facilities is bound to feel the terrible burden that rests on the family with which the paraplegic is living. It illustrates how important it is to have the proper number of trained home visitors for these people. These visitors can often take much of the burden off the shoulders of these families and, in many cases, initiate machinery which can bring bathrooms and lavatories to their houses.
The Report points out that more than half the home visitors for the handicapped have no training at all, and that the number required needed to be doubled. Apparently, there are now 250 and we need 600. The Report also states that 300 almoners are needed to 1752 serve under the local authorities. To get the trained home visitors for the handicapped, those taking the general training course will need almoner tutors, yet we are desperately short of them in Wales. The Younghusband Report pointed out that there was only one almoner employed by a local authority to serve the 2½ million people of Wales. Now there are none. The Report also stated that there were 1,165 almoners in the whole country, most of them in hospitals. But in the whole of Wales at the moment we have the derisory number of twenty-five or twenty-six.
This often results in an appalling tragedy of deterioration and family breakdown. When a person is discharged from hospital after treatment for an industrial accident and is sent home, there is not adequate support being given to him often between operations. A terrible deterioration takes place and in my professional capacity I have seen people, perhaps twelve or eighteen months after the accident, and have noted the grim deterioration that has taken place compared with the first time I saw them.
In the St. Lawrence Hospital, Chep-stow—which the Minister visited when he came to Wales recently and where great work is being done in plastic surgery—there is no resident almoner. Between one operation and another a man may be discharged from the hospital and, while he is awaiting his next operation, goes downhill badly because his whole family may break down through lack of after-care for him. I must, therefore, ask the Government what is being done, because all the work achieved by skilled surgeons can thus be made to count for naught. People are not made of clay. They are human beings and in the event of a bad industrial accident, unless a great deal of psychiatric support is given, deterioration will occur after discharge from hospital. How do the Government intend to deal with the almoner shortage and the maldistribution of almoners? There can be no hope in Wales of training these visitors for the handicapped unless there is an adequate supply of tutorial almoners.
Further, who will act as tutors when those taking the general social workers' course are doing the field work, to equip them to aid the problem families? 1753 The professionally qualified worker is needed for this rôle and the trained family caseworkers are few in number. The Report states that there are about a dozen of these workers in the country, but absolutely none in Wales. What is worse, there are no prospects of Wales producing any. We have no family welfare association or family social unit which is recognised by the Joint Committee on Family Case Workers as a caseworker agency, so no one in Wales can today qualify as a professionally trained family caseworker.
Our difficulties with problem families in Wales are regrettably no less than elsewhere, with the same grim consequences that flow from the existence of these families. Research work done a few years ago by Dr. Harriet Wilson in Cardiff showed that nearly 90 per cent. of boys from problem families in the capital city had been convicted by a juvenile court—many only too often —before reaching the age of 17. Would it not be more intelligent to deploy our social resources so that informed and intensive preventive work is available for these families?
It would, since this argument may appeal to the Government, certainly be cheaper than continually sending these boys—at a cost of £10 or £11 a week—to approved schools, detention centres and borstals. But unless the Government have some plans, as yet undisclosed, to step up the number of professionally trained family caseworkers, we have little hope of the Training Council being able to train the needed officers who will have done the field work to help cope with the social work needed with such families.
The brutal fact is that in some areas like Wales, so primitive are the existing social services that after eleven years of Torydom's affluence, and so chronically short of professionally trained social workers are we, that the training councils will find it well nigh impossible to find tutors for those who may wish to take their courses. As the Young-husband Report states:The shortage of qualified social workers able to undertake field teaching (supervision) is a major limiting factor in any rapid expansion.In Wales, the shortage will not be a limiting factor. The result will be absolutely maiming.
1754 I confess that I am always puzzled by the Minister of Health's hints that social service expenditure may be excessive in some directions and inadequate in others. Considering the social services in Wales which we are discussing today, any suggestion by the Minister that excessive amounts are spent on the social services there shows that he is in cloud-cuckoo-land. As if to add insult to the injury which Wales, in my view, has sustained as a result of the Government's starving of the social services for a decade, the Explanatory Memorandum goes on to tell us how small expenditure on research must be.
I take one subject which the Report has singled out as being in need of further research, the problem of the unmarried father. Every year, so the Report points out, 30,000 to 35,000 illegitimate children are born, and a substantial proportion of these children are born to mothers who are neither married nor cohabiting. We know from our maternity hospitals that almost half of the first-born children born in hospital are conceived extra-maritally. Fortunately, most of the parents are married before the child is born.
More research is needed so that we may find some answer to the question why, each year, about 7,000 or 8,000 fathers, unlike the overwhelming majority, shrink from marriage. The damage caused by their incapacity to assume their responsibilities both in terms of economics and of human unhappiness is considerable. The children's departments of the local authorities, quite apart from the voluntary organisations, take far more than 1,000 of such illegitimate children into care each year.
I have observed, whenever bastardy proceedings are pending, how frequently it is revealed that the fathers concerned have attended at the hospitals, how often they have sent gifts to the hospitals, and how frequently there is, in fact, when the child is born, some concern felt about the future of the child. Unfortunately, perhaps as a result of pressure from the father's home or pressure, often, inside the hospitals as a result of what is done by social agencies which arrange to take the child away even before it is actually 1755 born, all too often the ultimate result is that, yet again, there is no hope of the child having two parents. There is a great opportunity when the woman is in the care of a hospital and the man is at the gate of the hospital to do something to correct such an unfortunate outcome. It is lamentable that often, after pressure from his own mother and a lack of the encouragement and support which could lead to a happy ending, there is a bastardy order made instead of a proper home established.
This subject needs exploration. The Report tells us so. Yet how can the work be done when there is such parsimonious talk about how much should be spent on research? Doubtless, this parsimony is in accordance with the spirit of the Government, who seem to be quite prepared to spend any amount of money provided that they can pursue their megalomaniac desire to possess an independent deterrent while sparing little for research which could lead to the enlargement of life instead of the perfection of the means of mass destruction.
I regard the Bill as inadequate. It dodges the clamorous need to fill the yawning gaps in the social services of our country.
§ 2.42 p.m.
§ Mrs. Eirene White (Flint, East)
It is about thirty years now since I went to Bethnal Green to be trained as a social case worker. At that time, social workers were not only deplorably paid but they were expected to have a certain attitude to life. This was illustrated by the fact that, if one sought employment after one's training, one was expected to wear what was called a social worker's hat, a thing of indefinite hue and indeterminate shape. I decided that that life was really not for me, and I did not continue in social case work, although for most of my life I have been engaged in work which has had some relation with social work in the broader sense. I retain, therefore, a keen interest in the organisation of social work and the training of social workers, although I frankly admit that, in more recent years, I have not been in such close touch and I have not the expert knowledge of some of my colleagues who have spoken today.
1756 I felt that this Bill, which provides for the training of social workers, was, or could have been, a landmark. I apologise to the hon. Lady the Parliamentary Secretary for not having heard the first ten minutes of her speech because I was a little late in arriving, but I must say that I was astonished that she sat down after twenty minutes. It seemed to me that anyone who was really concerned about the recruitment and training of social workers would have taken this as a real Parliamentary occasion affording an opportunity to discuss the whole problem in its widest sense. As almost every speaker has remarked, we have had no debate in the House on the great Repents on which the Bill is based. This debate, which comes at a late stage, should have provided an occasion to discuss the wider issues involved.
I hope that the Minister is feeling thoroughly uncomfortable, because he should be. The Bill has been damned with faint praise by every speaker on both sides of the House. In addition, we have the comments in a leading article in The Times today, the first two sentences of which, I think, would very well exemplify the feelings of most of us:Too much of the history of the post-war social services in Britain can be written in terms of the adaptation of old-model machinery to meet past needs calculated by out-of-date reports using even more anachronistic information. This may not be entirely true of the Health Visitors and Social Workers Training Bill, but it would be a relief to have assurances during the Second Reading debate today that it is not true at all.I very much hope that we may yet have such an assurance from the Minster and that we shall be told that he intends to take a broader view of the whole problem of the recruitment and training of social workers than would appear from the Bill.
The Minister has, it is true, left himself a loophole in Clause 3 (3) in which there is a reference to other social work. One would very much like to know what the Minister has in mind in leaving himself that loophole. As regards social workers, the Bill is based largely on the Report of the Younghusband Working Party, and that body, as it points out in its own introduction, was very much limited by its terms of reference. It was not able to go into the wider field of social work training in general because its terms of reference limited it 1757 to the social workers in the health and welfare services.
In its introductory chapter, paragraph 12, the Younghusband Working Party said:A number of witnesses commented on the difficulty of limiting their evidence to social workers in the health and welfare services, since this would mean considering only certain aspects of the total picture. They pointed out the many situations where the work of these officers impinged on that of other social workers (and of workers in related fields) in regard to family or individual problems. In their opinion, a comprehensive review of the training and employment of social workers in the whole field of the social services was required in the light of experience gained since 1948.It is unfortunate that we have a Bill based on recommendations of an excellent working party, but a working party which was limited by its terms of reference.
My approach is rather different from the approach of most of those who have spoken so far. I approach this matter from the angle of education. I regard the education and trainng of social workers as part of our education services rather than part of our health services. We are concerned with the training of people to do a job and although, of course, their work will be administered by the health and welfare services, the Bill is concerned with training, which is education. Like many other hon. Members, I am much disturbed that the conception of the Minster of this trainng seems to be exemplified by the pilot courses already established in colleges of commerce. Admittedly, one is in the North-Western Polytechnic, which is a very good institution for it. The Minister has been a university professor. Surely he should be considering this matter from the widest angle. He must realise that there is tremendous discussion going on in the sphere of further education about the place of education and training of people for vocations, such as teaching and social work.
I should have been much happier if the kind of experimental training which is taking place was done in establishments attached or close to universities. A great deal of evidence submitted to the Robbins Committee on Higher Education—I know that some of it has been published and that some of it has 1758 not—has been to the effect that there should be a much closer connection between the educational training of people in social work and teacher-training and university studies. I believe that teacher-training colleges should be more closely linked to universities than they are, but that is a matter which is outside the scope of the Bill.
The teacher-training colleges are places in which something of this kind may well be tried. After all, teachers and social workers—not merely the ones referred to in the Bill but the ones who ought to be referred to in the Bill—are concerned with the development of the individual in the community. They are dealing with personal development and child development and with a sphere of human life in which a number of basic thoughts and ideals are common to all. I cannot believe that the sort of training which will be given in colleges of commerce is the best way of tackling the problem with which we are concerned.
I am very unhappy that the Bill, as it it drafted, is limited to certain social workers and has nothing to do with other social workers. People in the probation service, hospital almoners, psychiatric social workers and child-care workers have a great deal in common, and it seems a pity that we cannot have a council for social work training which has some connection with these other branches of social work. It may be said that the Bill is a first step. We all agree that it is acceptable as far as it goes, but it seems to be narrow, niggling, parsimonious—all the things which we hope social work would be no longer.
Another matter which I find deeply disappointing and to which almost every hon. Member has referred is the complete disregard of the most strongly expressed recommendation of the Young-husband Report that proper finance should be available for people wishing to undertake social work training. We are considering a Bill in Committee upstairs, the Education Bill, which makes provision for grants from local authorities for various types of education, some of which I think affects social workers. Those of us who have knowledge about these matters are very much disturbed about the purely permissive parts of that 1759 Bill. It is to rely on the different standards of generosity of different local authorities. For some local authorities, it is not a question of being generous. I am thinking of some local authorities in Mid-Wales and North Wales which have not the resources to give the number of grants that they might well wish to give for training of this kind.
It is absurd in this day and age that the question whether a person is able to obtain a grant to study for work for which he is fitted should depend on the chance of residence or birth. There are no recommendations in the Young-husband Report that I can find which are more emphatic than those on the matter of financial provision. In paragraph 1126, headed "Financial assistance for training", the Younghusband Committee specifically states:We have recommended legislation to enable grant aid from central government funds to be made available to candidates to train for social work in the local authority health and welfare services, as it is already for those who intend to enter the probation or child care services.I cannot understand why the Minister has not realised that without this provision the Bill may prove to be, not a dead letter, but far less effective than it should be.
It is most regrettable that this opportunity to do something of major importance in the training of social workers has been missed. The Minister frequently disappoints me. I expect more from him. I expect him to consider these matters from a wider angle. With his background, he should take a wider and nobler view. However, he does not do this. He is the minimal Minister in this House. It seems to me that, unfortunately, this Bill is, once more, a minimal Bill.
§ 2.56 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
Before I deal with the Bill, I wish to voice the strongest possible protest that no Scottish Minister is to speak in the debate. When we look to find which Ministers presented the Bill, we find reference to the Minister of Health, followed by the Secretary of State for Scotland, the Parliamentary Secretary to the Ministry of Health and the Undersecretary of State for Scotland. I am sure that every Scottish hon. Member, 1760 including, I hope, Scottish hon. Members opposite—not one Scottish Tory Member has spoken on the Bill—
§ Miss Herbison
I am referring to those who represent Scottish constituencies—[Interruption.] I hear the Under-Secretary of State saying that he has heard this speech before. It is because we have had cases like this before that I am objecting so strongly on behalf of Scottish Members and Scotland.
It is a grave discourtesy to the House that Scottish Ministers have shown no interest in a Bill which will be of importance to Scotland. I do not worry a great deal about the discourtesy. What worries me deeply is that it is symptomatic of the attitude of Scottish Ministers to social science and the application of social science in Scotland. I take deeper objection to the Secretary of State's lack of courtesy to and neglect of those two associations in Scotland which were ready to give him advice on these matters and which could have given him advice, namely, the Scottish Health Visitors Association and the Association of Social Workers. It is disgraceful that these two bodies of men and women doing important social work in Scotland should not have been consulted by the Minister or by the Department.
From both sides of the House, the Bill has had a tepid welcome, a welcome with many reservations. It seems to me that the Government decided, because of the importance of the Reports which they had received, that they must do something about this subject. From the provisions of the Bill, it is evident that they have done as little as possible and that they are trying to do even that little as cheaply as possible.
Those of us who know the health visitors and social workers in Great Britain know that they are men and women who give great devotion, care and thought to their work. They deserve better than the provisions of this Bill. If we look towards the future most of us on both sides of the House, have grave fears that the provisions of the Bill will not give us the requisite numbers or the properly trained men and women that we must have in our social services.
The Bill is limited in scope to social workers who work under local 1761 authorities. A number of hon. Members have objected to this. I also object. It is far too narrow a conception by the Minister to have confined the Bill and its provisions in the first instance to those employed by local authorities. I am aware that the Minister takes certain powers later in the Bill, and we should like an answer to the questions which have been asked about this.
That limitation of the Bill excludes far and away the majority of psychiatric social workers and almoners. The great majority of these people work in our hospitals under our Health Service. It is only occasionally that one of these people is employed by the local authorities. Figures have been given by hon. Members and they are to be found in the Reports on which the Bill is based.
There is a desperate shortage of psychiatric social workers. Both England and Wales and Scotland have their Mental Health Acts. I have with me a circular issued a little over a year ago by the Secretary of State for Scotland to the local authorities in Scotland. It deals with the provisions of the Mental Health Act which have to be provided by local authorities and in Chapter 3 the Secretary of State has this to say:It is essential, in the Secretary of State's view, that every local authority should play their part in the prevention of mental illness, in the care and after-care of those who are suffering from it and in the care of those suffering from mental deficiency. It is appropriate, therefore, that local health authorities should now be required to provide the necessary services as a statutory duty.I should accept what the Secretary of State has said, provided that in this Bill he were making it the least bit possible for the local authorities to carry out their statutory duties of, in the first instance, taking steps to prevent mental illness and, in the second instance, of providing the after-care which must be given in mental illness. The provisions of this Bill, however, will certainly not lead to as great an increase in the numbers of social workers or of the psychiatric social workers as we consider necessary.
England and Wales already have their Act dealing with criminal justice. In it, there is provision for compulsory after-care of certain prisoners on release. If we are to have compulsory after-care for a new category of people, 1762 again we will need a greater number of social workers. These social workers may be probation officers—and I want to talk about that a little later—or they may be social workers in other fields, but, whoever they may be, it means that we need a greater increase in their numbers.
For Scotland we have not yet had our Criminal Justice Bill presented, but I have read the Report of the Standing Committee of the Scottish Advisory Council for the Treatment of Offenders and that Report makes the suggestion that when that legislation does come before the House it will contain a provision for the compulsory after-care of certain categories of offenders. It also makes the suggestion that in Scotland, instead of having so many people imprisoned on short sentences, we should have far more of them put in care. That, again, would mean—if that Bill does come, and we are expecting it some time this Session—that there would be much greater need for a greater number of these social workers.
There has been some criticism about the two Councils. Whether a person be a health visitor, or a social worker in many another branch of social work, he is dealing with human beings. The vast majority of the social workers are dealing with men, women and children who have problems, problems which, possibly, will be solved only if they are given the fullest help by the social workers. The young offenders who may be put in care rather than put in prison, the people who are to have compulsory after-care, all these are human beings with very serious problems to be solved.
Although we accept these two Councils for the time being, I hope that they, and particularly the Social Workers Training Council, will do such an excellent job in providing worth-while training and in raising the status of the social workers that the almoners and probation officers and all the others who at present are rather afraid of being brought under one council will eventually desire that there should be one council to look after the training of all types of social workers. That will be achieved only if the Councils which are to be set up under this Bill are able to do the work which we feel must be done.
1763 On both sides of the House the question of the composition of these Councils has been raised, and it has been criticised, and I agree completely with all the Members who have said that on the Councils there is not going to be a sufficiently large representation of the professional people concerned. The Under-Secretary of State will know that at present a very powerful committee is examining what can be done to raise the status of teachers and what place teachers can take in the future on those bodies which deal with education. It seems to me that if in education it is considered important that we should have the advice of the teachers and that, in accepting that, we shall in some way be raising their status, then the Government ought to have realised that, to get the very best advice, there ought to be on both of these Councils a bigger representation of the professional people.
When he replies to the debate, the Minister may refer us to the Schedule and tell us that our fears and those of the professional associations are without foundation, because of the various categories which are laid down in the Schedule. We should be delighted to hear that. But even if we have that assurance, we shall still want to amend the Bill in Committee to provide that professional interests shall have a fair and worthy share of the representation on the Councils.
Like other hon. Members, I am perturbed because there is no specific mention of places for representatives from the universities. As my hon. Friend the Member for Lanark (Mrs. Hart) clearly pointed out, great initiative and help have come from Glasgow University in the social sciences and the training of social workers. The universities have much to give these Councils and it is important that they should have representation on them as a right and that they should not merely be included among the categories of those who may or may not be appointed by the Minister of Health, or the Secretary of State for Scotland.
Whatever the professional work to be done, the type of training for the work is of the greatest importance. The Younghusband Report speaks of three types of social workers—assistant social 1764 workers taking training under a properly trained social worker, a social worker with a general training equivalent to two years' full-time training, and the fully trained and experienced social worker able to undertake case work and problems of special difficulty. I am concerned with the latter two. According to the Report, the third category should have a professional training in social work following a social science or other related qualification.
My hon. Friend the Member for Lanark and my hon. Friend the Member for Flint, East (Mrs. White) raised the question of which institution would be the best for this training. That chosen in Glasgow is certainly not the best. These workers deal with human beings and their problems and they ought to train in an institution where human studies are undertaken. It could be a university—or they could be attached to a university—or one of the colleges of education for the training of teachers. That kind of case could have been made if we had been given an opportunity to debate the Report. The mistake made by the Minister of Health and the Secretary of State for Scotland in three out of four colleges—placing these trainee workers in colleges of commerce—would then not have occurred.
I strongly urge on the Minister of Health and on the Secretary of State for Scotland to ensure that where the service is expanded—and if it is to meet the needs of the country there must be great expansion—the greatest care is taken to choose the educational institution at which the training is given.
I turn now to recruitment. We shall recruit the right type of man and woman for this job—and like my hon. Friend I hope that we shall recruit many more men—only if the training is adequate and the status after training is high. When one looks at the provisions of the Bill, one finds that there is little hope of adequate training being given quickly. If adequate training cannot be provided quickly, we shall not get the status which is so important.
Figures have been given for Wales and for England, and my hon. Friend the Member for Lanark gave certain figures showing the dearth of properly qualified social workers. The figures for England 1765 and Wales are bad, but Scotland is the most backward part of the United Kingdom as regards the application of the social sciences. This being so, the Secretary of State for Scotland will have to get a move on if he is to retrieve our good name.
We are told in the Younghusband Report that if we are to man the services which are considered necessary we shall need, at the beginning, about 550 additional social workers in Scotland. If one compares that requirement with the small number of people in the college of commerce at the moment, one realises just how big our problem is.
I had hoped that at least one of the three Under-Secretaries of State for Scotland would have replied to this debate in which Scottish Members have taken part, particularly as in this field we are so much behind the rest of the United Kingdom.
We are told in paragraph 51 of the Younghusband Report that there is an extreme shortage of trained social workers in the health and welfare services. It goes on to say that recruitment is inadequate, and, what makes the picture even blacker, that more than 40 per cent. of the officers are over 50 years of age. Later in the Report it stresses the need for a national campaign to recruit candidates. Who will carry out such a campaign? Are we to hear something about this from the Minister? Are the Government going to accept responsibility for carrying it out—because a national campaign costs money—or is this something which is to be left to the local authorities to carry out? If it is, it will not be a national campaign.
There was a suggestion that mental health sub-committees should be set up in Scotland. This was before the Mental Health (Scotland) Act, 1960. The Younghusband Report says that of all the county councils in Scotland only one had appointed a mental health subcommittee. Forty-eight had not. Has the position improved since then? Unless, in our local authorities, we have men and women who are seized with the importance of community care for the mentally sick, we shall not have this urge to train and attract workers.
I now turn to financial matters. Poor as the Bill is, everything turns on its 1766 financial provisions. We are told that £50,000 will be provided for the two councils. Presumably that means that there will be about £25,000 for each. Let us assume that there will be £25,000 for the Social Workers Training Council. The values of the Government are wrong. The Minister of Transport told us that we could expect to get a man of the right calibre to put the railways upon a solid footing only if we were ready to pay him £20,000 a year, but when we deal with this great problem, the magnitude of which has been stressed time and again in the House, we are told that the Social Workers Training Council, dealing with the whole of the United Kingdom, will get only £25,000.
My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said that the Probation Advisory and Training Board had £90,000 a year, for England and Wales alone. Scotland has its own allocation for that type of work. But here we are with £25,000 for this work. I agree with many hon. Members who have spoken, from both sides of the House, that an insufficient provision—and this one is just niggardly—will ultimately cost the Government more money. Unless we have a Council with sufficient finance to do the work it must do, we shall not get the right number of social workers and young people who could be saved from entering prison and other people who could be saved from entering hospitals for mental treatment will cost the Government very much more, in money terms.
Apart from that, think of the distress and the number of tragedies that could be overcome or avoided if the social workers were there to do the job. If the Minister of Health—who was previously a Treasury Minister—is concerned about the financial aspect of the problem, I can tell him, as others have told him, that one way of saving money eventually is to ensure that much more is provided for these purposes now.
I now turn to the question of research. This part of the Bill disappointed me most. It would have been far better to leave out any references to research, because hopes may have been raised in some quarters. In the Financial Memorandum we find that:The additional expenditure"—1767 of the various Ministers—will be very small.It is not merely "small"; the Government want to emphasise how small it will be—and it will be "very small." The Memorandum goes on to say:As a result of the research powers given to local authorities there may be a small increase in the aggregate of the general grants …Such niggardliness! If that is the attitude of the Government to this matter it shows that they have not begun to realise the problems facing thousands of our people and every local authority in social work today.
Paragraph 11 of the Younghusband Report says:We were struck, in planning the field inquiries, by the lack of any systematic study of the part played by social workers in meeting needs within the framework of the social services.How are they going to carry out services? How are they going to carry out any research with a Government that puts down in black and white in the Financial Memorandum that they themselves will possibly spend only a very small amount of money and that anything extra in the general grant—there may be something—will also be very small? It seems to me that the Government have tackled this problem in the wrong way altogether.
I have one particular question to ask the Joint Under-Secretary of State for Scotland. We are at present dealing upstairs with a Bill on educational grants. The Younghusband Report again stressed very forcibly that we could not possibly get the social workers that we want if we did not have grants. Certain parts of that Report have already been quoted, but I wish to quote from paragraph 743 which is headed "Lack of training." It states:We discuss the present situation in Chapters 8 and 9, and the absolute necessity of training grants if our recommendations on training are to be implemented, and make recommendations accordingly. Here we need only say that adequate grants are essential if recruitment to the health and welfare services is to be improved.At present in Scotland we have no State scholarships. The local education authorities give grants to university students and to students who go to colleges of an equivalent status. What 1768 is going to happen to those who wish to train in social work? Under the new Bill, the Secretary of State takes the power away from the local authorities. All the grants for university students and for those at higher technical colleges, etc., are going to be paid directly by the Secretary of State. Can we be told whether the Secretary of State will pay adequate grants directly to those who wish to undergo training in social services?
Finally, I say to the Ministers concerned that the Bill, which has been long awaited, is a great disappointment not only to those of us who are interested in these matters but also to the men and women outside who have devoted so much of their lives to these services. I only hope that, despite the tight drawing of the financial provisions, we shall be able, at least in some things, to improve the Bill in Committee and, further, that the case that has been made from both sides of the House today will have impressed the Minister with the need for a much more imaginative and a much more far-seeing Measure than the one before the House.
§ 3.28 p.m.
§ The Minister of Health (Mr. J. Enoch Powell)
I am sorry that it is a disappointment to the hon. Lady the Member for Lanarkshire, North (Miss Herbison) that it should be myself who rises to wind up this debate. However, my hon. Friend the Joint Under-Secretary of State for Scotland has heard almost the entire debate and will, I know, be at the service of Scottish Members of the House in connection with the Bill.
Throughout the debate references have frequently been made to its long period of gestation. I adopt the phrase of the hon. Member for St. Pancras, North (Mr. K. Robinson). Indeed, it has been a period of some nine or ten years in all but this long period has certainly had its advantages as well as its disadvantages.
While I would not go along all the way with my hon. Friend the Member for Rutland and Stamford (Mr. K. Lewis), who said that the Bill was premature, or even with the hon. Lady the Member for Flint, West (Mrs. White), who felt that an even wider examination of the field of social work ought to be 1769 the basis of such legislation, I would point out that if this legislation had come forward as a result of any of the earlier Reports and had not been able to take account of the Younghusband Report, one important result which it does achieve would not have been possible. My noble Friend the Member for Hertford (Lord Balniel) rightly talked of the danger of departmentalisation in all these spheres. At least this Bill brings closer together and links firmly the training of the health visitor and the training of the social worker. I believe that an important gain.
The hon. Member for St. Pancras, North said that it could be argued both ways whether there should be one or two training councils for this purpose. But I think there can be no doubt that the essential work of the health visitor is so firmly in the sphere of social work that we ought to keep the two as close together as we practicably can. I was glad to hear my hon. Friend the Member for Tynemouth (Dame Irene Ward) emphasise this point with such force.
The link between the training of the health visitor and the social worker proposed in the Bill is in the nature of a compromise. But I hope that in practice it will prove not, as has been feared, an unhappy, but a happy compromise; and that the common chairmanship and the partially common membership of these two Councils will not only ensure co-ordination between the training of the two types of workers, but could lead to an even closer relationship in the future between the two lines of training.
I come now to the question of the composition of the Councils and, in particular, of professional representation where, I think, I can remove a misconception. It was suggested that the recommendation of the Jameson Committee that the professional and educational representation should be in the majority had not been followed. In fact, if the professional and educational representation is taken together it will be seen that, as recommended by the Committee, and, indeed, in the ease of both Councils, there is a majority.
The hon. and learned Member for Aberdeen, North (Mr. Hector Hughes) raised particularly the question whether the health visitor tutor would find representation on the Council. I have no 1770 doubt that with the eight members to be appointed to represent health visitors, taken in connection with the members to be appointed after consultation with the bodies concerned with the training of health visitors, it would be strange indeed if the experience and point of view of the health visitor tutor were not represented on the Health Visitor Training Council. Perhaps at this point I may explain something which was asked by the hon. Member for Lanark (Mrs. Hart). The interpretation of the thirteen members to be appointed by the Health Ministers is to be found in the fifth paragraph of the First Schedule, which accounts for all except the one member to which my hon. Friend the Parliamentary Secretary referred.
The local authorities are strongly represented on these councils but I make no apology for that. After all, the local authorities are statutorily responsible for the provision of these services. They are the bodies rendering the services to the public in the first place and it is they who gain the experience and feel the needs in the operation of these services. I think it right therefore that the local authorities should be strongly represented. I agree that this attempt to bring in so much—indeed, if possible, all—of a great range of experience and interests makes a large Council; but if one has to choose, I am sure it is right in starting something of this sort to be over-anxious for a wide representation rather than to take the line that one would like to limit the total membership of the Council.
§ Mrs. White
Before the right hon. Gentleman leaves the composition of the Councils, may I ask in what way he expects Welsh interests to be represented? There is to be no advisory council for Wales as there is for Scotland and Northern Ireland, and there is no specific mention of Wales in the representation. Are we to assume that the Minister himself and local authority organisations will be asked to pay attention to Welsh interests?
§ Mr. Powell
I think the hon. Lady may be sure of that.
Special reference has been made several times—and rightly so, for it is an important feature of the Bill—to the door left open in the description in 1771 Clause 3 of the functions of the Social Workers Training Council. Instances have been given by many hon. Members who have spoken in the debate of other aspects of social work, other professional duties with an important social work aspect, which they would like to see brought, either at once or eventually, under the work of this Training Council. The object of subsections (3) and (4) is precisely to make that possible, but it would be inconsistent with that wish that I should here say exactly what is included and exactly what is excluded by the possibility opened in the subsections of Clause 3.
The hon. Member for St. Pancras, North said, very rightly, that before the field of this Council was extended there ought to be the fullest consideration and discussion with the professions concerned. I agree with him. One cannot force people in under this umbrella even if we believe that it is built to shelter more than those who are holding it up at the moment it follows that this must be a willing accession, something which comes as the work of this Council proceeds and the value and possibilities of what we are starting become evident. So I must be excused from doing something which would inevitably hinder rather than help what I believe the whole House wants to see. My hon. Friend the Member for Tyne-mouth may be reassured that legislation will not be necessary, but that it needs only an Order in Council to extend the scope of the Social Workers Training Council and make any necessary adjustments in its membership.
A great deal has been said about the words in the Explanatory and Financial Memorandum which attempt to offer some forecast—I choose my words carefully and, I believe, correctly—of what might be the annual net cost to the Exchequer involved in the Bill. It is quite misleading to compare this sum in any sense with, for example, the annual cost of the Probation Advisory and Training Board, which has—of course, among many other functions—one object which these Councils will not have: it has itself to carry out training. There is no real financial analogy there, but I shall not Burke the issue of grants.
1772 There is no provision made in the Bill for direct Exchequer grants to those who will take the courses which will be promoted by the Councils which this Bill sets up. The making of grants for further education is basically a function of the local authorities. It would be quite wrong, certainly at this stage of the development of this branch of further education, for that function to be taken away from the local authorities and replaced by direct grants from the Exchequer. As I have previously told the hon. Member for St. Pancras, North, it seems to the Government right that we should see how the normal machinery for grants works in this field before we consider whether it has to be displaced or reinforced.
§ Mr. K. Robinson
Before the right hon. Gentleman leaves the question of grants, as he will appreciate that this may be the last opportunity we shall have of discussing them, may I ask if he ought not to have taken some reserve powers in the Bill rather than wait until the system he proposes to adopt breaks down and then have to come to the House with entirely new legislation in order to get the power to administer central grants, as is done in the case of child care and probation?
§ Mr. Powell
I do not think that we ought to anticipate at this stage and in the framework of this Bill what the hon. Member calls "the system breaking down"—that is what it would mean.
§ Mrs. Hart
May I ask the right hon. Gentleman to clarify a point? Is it the case that the organisations which carry out the training will have to be self-supporting on the basis of the grants received, on the basis of students paid by local authorities, because, if this is the case, then we are departing from a principle, because it is not the fact in other professions in which students take training courses for which they get grants from local authorities.
§ Mr. Powell
As has emerged from the debate, there is not only one form in which the training will be given; but mainly it will be a part of further education and the same financial arrangements will apply to this training and to these courses as to courses of further education generally. But I ought not to say more than that because I should 1773 be prejudging matters which will be for the consideration of the Councils and which it will be their duty to arrange or bring about.
On the matter of research, there is a genuine misunderstanding about the terms of the last paragraph of the Explanatory and Financial Memorandum. In the course of their work the local authorities who administer these services and the central Government Departments come into possession of an immense amount of material which could be made to yield valuable information. They employ people who are directly in touch with the facts and with the circumstances about which we wish to know more. With comparatively little extra expenditure, if the power were there, as it is not at the moment, this information could be tapped by the authorities themselves and also could be made available for academic bodies of all kinds for the research which we all agree is urgently needed.
It is because a very small expenditure in this way, for which the powers will be given for the first time in the Bill, can yield these results that reference is made to these relatively small quantities, but there is no implication that there is any intention on the part of the Government to limit research or to be niggardly in their approach to research. The point is that these powers to promote or assist research will often enable us for comparatively small sums to get big and useful information out of the mass of material which flows from the local authorities and through the central Government Departments.
§ Dame Irene Ward
Will my hon. Friend expand that a little? Does he mean that his Department, if it so desires or at the request of the Councils, will itself start a research project—from the local authority to his Department?
§ Mr. Powell
The power to do that is covered by the words. I cannot imagine that a Department of State which was approached with a worthwhile project would refuse its co-operation or fail to help to secure the co-operation of the local authorities. Up to the present there has not been the power to do so, and any expenditure in doing it would on a strict view not have been covered by Parliamentary sanction. This Bill gives Parliamentary sanction for just that.
1774 Recruitment is a subject which rightly has bulked very large in the debate, but it would be a mistake to think that, because the word is not mentioned in the Bill, therefore recruitment is not part of the function of these Councils. Recruitment in the sense of taking on or seeking to take on an employee is the function of the employing authority, the local authority, but if by recruitment we mean seeking suitable people to take these courses and thus to became qualified, if we mean increasing the flow of potential recruits to these branches of social work, then recruitment in that sense is quite firmly within the functions and duties of the Councils which we are setting up. They could scarcely promote the training of health visitors and make such courses known without taking steps to bring to the knowledge of all who might be suitable to attend these courses the fact that they existed and to what career they would lead.
The hon. Member for Willesden, West (Mr. Pavitt) was courteous enough to tell me that he could not be here for the winding-up because he is attending the opening of a new unit in the hospital service. I adopt the words he used, namely, "that training is inevitably bound up with recruitment." The Councils will not be able to concern themselves with training for these branches of social work unless they also concern themselves with the way in which recruitment for training can be stimulated and recruits obtained. We shall certainly for many years be anxious to get every suitable entrant that we can into these courses and into these professions.
I emphasise the point made both by my hon. Friend the Member for Rutland and Stamford and the hon. Lady the Member for Lanark—I think they both meant the same thing, though they rather missed one another in the dark—about the importance of part-time workers in this sphere. The attention of local authorities has already been drawn to the important possibilities of recruitment of married women for part-time work in these services. Indeed, in some ways part-time workers perhaps have something to contribute which full-time workers may not to the same extent be able to contribute. It would be useful if this possibility were again 1775 emphasised here, because local authorities cannot too often or too fully have in mind the question whether they are doing enough to obtain part-time workers for these services.
The Bill is only a means to an end. The Government would not present it, and I know that the House does not see it, in any other light than as a means to an end. That end is not even the training and employment of increasing numbers of well-qualified and suitable workers in these spheres. The end is to be able to treat, to help, and to support in the community all who can best be helped, treated and supported there. It is as a means, perhaps a small means administratively and mechanically, but, as everyone has accepted, an indispensable means to that end, that I commend it to the House.
§ Mr. Hector Hughes
May I ask the Minister one question? He seemed to imply that, though health visitor tutors are not specifically mentioned in tile Bill, they are in some way either included in or represented by the other classes in the Bill. As health visitor tutors are so important an element in this field of human endeavour, they should be dealt with specifically in the Bill.
§ Mr. Powell
I think I covered the hon. and learned Gentleman's point in my speech. Perhaps he would look at the exact words I used. I would gladly discuss the point with him further if he wishes.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 38 (Committal of Bills).