§ Dr. Stuttaford
I beg to move Amendment No. 26, in page 15, line 34, at end insert:'and the local authority shall establish a special committee of the authority, not being the committee established under section 2 of the Local Authority Social Services Act 1970.1429to administer the said services and to employ the necessary persons'.This amendment is proposed at the request of the medical profession and the nursing profession—indeed, everyone involved in medicine other than administrators. Ever since 1970 when Seebohm divided the medical service people away from one another there has been anxiety about the liaison between doctors and social workers. More recently this anxiety has become much more pronounced. It has involved not only social workers working outside the health service but medical social workers within hospitals and psychiatric social workers.
There has been increasing anxiety because these people who are in the hospital service are in many ways almost the elite of the social worker service. They are people who have had long training, and many have a degree, and for many years they have been part of the medical and surgical teams within the hospitals. No ward round is ever complete unless we have had the opinion of the almoner. She not only helps the patients in hospital but follows them up after they leave. The psychiatric social worker is a link—it is a woman—between the hospital and general practitioners. She is a woman of influence—enormous influence, not only with doctors but the patients and their families.
These are people who have been largely neglected and deserted. We learned with horror that they are paid less than other social workers, and their terms of service are less good. The Council of the British Medical Association has been anxious for an amendment so that these workers should remain part of the National Health Service, and should not, at any rate without some safeguards, be transferred to local authorities. So there has been put forward this idea that there should be this committee.
The explanation of how it will work is better than anything I could dream up:The council—of the British Medical Association—'urges that the NHS Reorganisation Act should require every local authority to establish a special committee to administer the social services for the area health authority. The latter should be strongly represented, by right, on this committee, and the social workers concerned with the NHS should be employed by the special committee, not by the local authority: in much the same way as con-1430tractors are to be in contract with the family practitioner committee, not with the area health authority.In this way it is hoped that there will be close liaison between doctors and social workers, that the social workers working within hospitals will be integrated as they are today into a medical or surgical team as well as into the work outside and that the divergence between social and medical work will cease.
That divergence is entirely artificial. The social problems of the patient are every bit as important as are the medical problems; the two cannot be divided. One cannot say where the doctor's province ends and the social worker's begins. We are dealing with the patient in the round, his physical and mental condition, whether he is diseased or healthy, his background and his family. These divisions cannot be made. They should never have been countenanced in 1970 and we want this retrograde step to be taken no further.
§ Sir K. Joseph
My hon. Friend the Member for Norwich, South (Dr. Stuttaford) does not have to persuade me. I understand the concern of the medical profession and I share its view that there should be the minimum possible division between the social workers and the medical, nursing and other workers. I quarrel only with the particular proposal embodied in the amendment and the need for it.
With the best intentions, the effect of the amendment would be to create a further division. Instead of the health world on the one hand and the social service world on the other, the social service world would be divided into two, with the director of social services employing the staff serving two committees possibly giving conflicting instructions.
I will not spend time describing the damage that will be caused because I want to comfort my hon. Friend with the proposals contained in the Bill and those which will be covered later by regulation. There will be in every area health authority and every local authority joint consultative committees on which the area health authority and the local authority will place members. Those joint committees will be designed to see that the health, social and other local authority services do their planning and implement 1431 their services together. The authorities will be required to produce statutory reports through which any failure to agree on joint plans and implementation will be ventilated to the public and the Minister.
As for the social services within the health service, my hon. Friend and the House will be aware that social workers will be transferred to the local authorities, subject to a number of safeguards. The safeguards are now being worked on in detail by a joint working party which consists of representatives from local authorities and health authorities and includes social workers.
The safeguards will include a requirement that no health service social worker in post on the eve of 1st April 1974 will be required to leave work as a social worker in the health service without his or her specific agreement. The safeguards will include a requirement on the local authorities to staff the health service with the social workers required.
The directors of social services are enthusiastic to improve the social work services in the health service. I assure my hon. Friend that the safeguards and provisions in the Bill and those that will emerge from the working party and be embodied in regulations achieve the purpose that he and the Government share much better than does the amendment. I entirely understand the object of the amendment and sympathise with it but its effect would be damaging.
I hope that my hon. Friend will withdraw the amendment and communicate to the British Medical Association the assurance which I have given.
§ Mr. Pavitt
May I say that this is about the only part of the right hon. Gentleman's Bill on which I can say that I am in entire agreement with him?
§ Amendment, by leave, withdrawn.