§ 4.13 p.m.
§ Debate resumed.
THE LORD BISHOP OF LEICESTER
My Lords, I must begin, by custom and by sincere conviction, with a word of gratitude to the noble Baroness, Lady Brooke of Ystradfellte, for her initiative in provoking this debate. Obviously someone had to do it at some time, but the decision to embark on the task—demanding, as it obviously did, the mastery of an enormous document and the expression of opinions on many delicate and disputed matters—cannot have teen an easy one. Then I should like to lay my own little tribute of gratitude at the feet of Mr. Frederic Seebohm and his collaborators. They have done, in my view, a remarkable piece of work, and one which will take its place in the long line of reports which stand out as milestones 1199 in the social history of this country. From the Elizabethan Poor Laws to Beveridge was a long pilgrimage (although in my view it was as creditable to take the first steps in that pilgrimage as it was to take the last), and we may surely think that the name "Seebohm" will be associated with the next great event in this series, only to be surpassed in its turn by other developments as yet not visible to our eyes.
I have no difficulty in affording a warm welcome to the main provision of the Report—and an important feature of it is the way in which the whole project is brought into relation to this main provision—that of providing a unified social service department with responsibilities extending far beyond the limits of existing local authority departments. It fell to me to forward evidence to the Seebohm Committee on behalf of the Church of England Board for Social Responsibility. It is naturally gratifying to see the proposals following closely the pattern set out in the evidence we submitted. If I may quote a brief extract from that evidence, it was:After the pruning off of services which are historical anomalies, local authority personal social services should all be gathered up into one department with a committee structure of its own directly responsible to the council and a specialised staff of social service administrators and workers headed up by a chief officer directly responsible to the council through a main personal social services committee.I quote those words not to claim any particular credit for the evidence submitted, but only as an indication that the general trend of responsible opinion, both in the community at large and in the churches, is running in very much the same direction. I may mention that those giving evidence were encouraged by the Committee to cast it in a certain mould, which I think suggested that the Committee had a fairly clear idea at the start what kind of evidence they wanted.
I must say that when the noble Lord, Lord Stonham, was speaking I was struck by the extremely cautious—indeed, cool—reception which, on the whole, he gave to these proposals. It seemed to me as though he was very anxious that we should not attach more importance to this Report than he thought it deserved. In fact, at times I thought he was almost asking us to look at it, so to speak, 1200 through a reversed telescope in order to see it as something comparatively unimportant when set in the midst of all the other proposals that were under consideration at that time.
§ LORD STONHAM
My Lords, if I may interrupt the right reverend Prelate, perhaps I could remind him that one of the first things I said in my speech was that this was a monumental Report which would affect our thinking for decades to come. That is hardly a cool reception, or advising the House that it should be ignored.
THE LORD BISHOP OF LEICESTER
My Lords, nor did I say that the noble Lord suggested that it should be ignored. I merely recorded the subjective impression that I had at the end of his speech. No doubt it was my fault if I did not consider every word that he said. But I was going on to say—and perhaps the noble Lord would not have been so anxious to interrupt me if he had known this—that I do not entirely criticise him for this because I think that a rather cautious attitude on such a proposal as this is absolutely necessary to any Government which has the responsibility of making these very difficult decisions.
I should now like to turn to a number of particular points in the Report on which I wish to comment in slightly more detail. First, I draw special attention to the chapter on Housing, Chapter XIII. The first essential for good family life is a place to live in, a home. Many of the problems with which social workers have to deal arise from inadequacies of family housing. Dealing with housing requirements is therefore central to the concerns which occupied the Seebohm Committee, particularly on the preventive side. Chapter XIII elaborates this concern and recommends that local housing authorities assume responsibility for all aspects of housing within their areas, including the nature and quality of provisions made in the private sector and by housing associations and societies. The homeless family, the large family, the handicapped and the aged should be included. These considerations do not imply that local housing authorities should themselves directly provide all the necessary housing, but that they should exercise general oversight.
1201 Apart from the aged and the handicapped, needy people are frequently both highly mobile and poor. They consequently do not reach local authority lists; nor can they pay the normal rents charged for local authority dwellings. These facts lead to the conclusion that subsidies should be related to tenants and not to dwellings. The really important point made in this chapter is the urgent need for a combined housing advisory service and a housing aid service. Citizens need one central agency in each area to which they can go to with their own housing problem and which is equipped to give them the help they need. It is only necessary to seek to find a way through the maze of housing legislation to appreciate that this service cannot be rendered by the ordinary citizens' advice bureaux. Add to these the Rent Acts, the local authorities' system of housing allocation, the Industrial Selection Scheme, mortgages and bank loans and the fact that family needs and potentialities vary, and it can be well understood that an expert housing advisory service is needed. Linked with it should be a housing aid service to help those who can, with care, purchase their own dwellings. Such people need assistance with savings, mortgages, property assessment and with the law. Both these services require that those giving the advice and help should know about the housing situation in other parts of the country as well as their own.
Add to these reflections the urgent need for a person or a family making an inquiry to secure an answer and not to be told to go to another address (which is often miles away) and it becomes quite clear that all the relevant knowledge and guidance should be concentrated in one place in each local authority area. Such a service can help a lot of people to solve their own problems and can identify those who will need more continuous care.
Shelter, in co-operation with the Catholic Housing Aid Society and the British Churches Housing Trust, is considering the establishment of a housing advisory centre in London. The pioneering work has already been done by the Catholic Housing Aid Society and its experience and that of the British Churches Housing Trust will be available in setting up this new independent Shelter housing advisory centre. The intention behind this proposal is to devise a service which can be 1202 developed all over the country by local authorities and their housing departments. It will provide experience for future local authority action and in the meantime will assist a large number of families whose problems might not otherwise be dealt with.
Before leaving the subject of housing, may I draw your Lordships' special attention to paragraph 403 of the Report. It says that familiesshould not, in any circumstances, be split up on reception into temporary accommodation.It also stresses the importance of privacy for families even in the most temporary accommodation. We have seen some of the unfortunate results of such separation in cases under the control of the Kent County Council; but it is a problem affecting all areas of the country where there is homelessness. I must remind your Lordships that there are on any one night some 3,000 homeless families in England and Wales; and one-third of them being received into temporary accommodation have to be split up. It is strange that society has been so ready to admit the need for food and shelter for each member of a homeless family but has been comparatively blind to the need to keep that family together at all costs.
My Lords, I now turn to a subject in which the churches are particularly interested: the part to be played in the new situation by the voluntary organisations. I stress "organisations", because the part of individual volunteers is a separate question. The paragraphs where this matter is dealt with are paragraphs 211, 495 and 496. The later paragraphs are the more general in their application. Here the pioneering work of voluntary organisations is recognised and a "major role" (paragraph 495) is still envisaged for them. But the same sentence draws attention to the problems which the voluntary societies may offer to the local authorities. Paragraph 496 states:The social service department should play an important part in giving support, both financial and professional, to vigorous, outward-looking voluntary organisations which can demonstrate good standards of service, provide opportunities for appropriate training for their workers both professional and voluntary and show a flair for innovation.Progressive thought among voluntary organisations will recognise the shrewdness with which these conditions have 1203 been listed and will not quarrel with their main import. There may, however, be some lack of proportion in the way that the Report sets out the problem. It might have been better if they had begun by saying that such a vast work is at present being carried on by the voluntary organisations—by the Red Cross, by the W.R.V.S., by the associations for the blind, the deaf and the handicapped—that no scheme could be devised which could rapidly supersede them. But that is by the way.
My Lords, paragraph 211 makes three points about the services for unmarried mothers. It states clearly that there is no intention that the voluntary bodies should be superseded. This is perhaps wise, for the Church of England alone deals with some 30,000 cases a year in this field, has 5,000 cases annually in its residential homes, and arranges some 2,500 adoptions yearly. The Church welcomes the view that there should be:a clear assignment of responsibility to the social service department for ensuring adequate social care and advice for both the unmarried mother and her child.It expects that in many cases, and for a long time to come, the community will be glad to use the voluntary organisations as agents for this community care in view of their unrivalled experience in this field. It has no objection to the request that there should be:a realistic alternative source of assistance to those unmarried mothers who do not wish to approach religious bodies…But if this suggests that religion is to be pushed down the throats of clients in this field, I am sure the view is usually mistaken. When the Diocesan Moral Welfare Organisation in my own diocese had that name—it is now, as nearly everywhere, the Council for Social Work —the girl clients had their own way of secularising it: they just called it "the Welfare". I do not think they worried very much about anything else.
My Lords, may I now address myself to one of the most important chapters in the Report, Chapter XVI on "The Community". This is where the Report really strikes out into new territory. It is here, if anywhere, that it shows some promise of fulfilling the third sentence of paragraph 2 in the introductory summary on page 11, where it says: 1204This new department will, we believe, reach far beyond the discovery and rescue of social casualties; it will enable the greatest possible number of individuals to act reciprocally, giving and receiving service for the well-being of the whole community.This possibility is explored more fully in Chapter XVI. Although the Report rightly says that it is not seeking nostalgically to reproduce small rural communities in large urban areas, it is clearly motivated by a desire to produce some sense of identity, some feeling of belonging, some network of privileges and acknowledged duties not unlike that which has frequently sustained smaller communities, given their members something to live up to, supported them in trouble, and increased their joy in times of happiness and prosperity.
The Report envisages a quite new form of social responsibility for local authority departments, a responsibility to encourage and stimulate forms of community awareness by helping groups of all kind to be aware of the needs of the community and to demand from the community, usually through the authority, the services which they need. For this purpose some areas will be seen to present a claim for special help. It is interesting to see "social development areas" coming into the picture corresponding, in some way, with developing nations on the world scale. Here is place for volunteers, and the Report foresees the appointment of area officers alongside the departmental head with special aptitude for and training in the right use of volunteers. It is impossible here to go into more detail, but I would respectfully urge noble Lords and, of course, the Government, to pay special attention to that chapter. How far a true community sense can be developed from the local town hall without a quite unacceptable new kind of paternalism will appear only with time, but the effort is certainly worth making. It is one in which the churches will be specially interested and where they can undoubtedly make their own distinctive contribution.
My Lords, as I have been, in the main, handing out "chocolate drops" to members of the Seebohm Committee, I hope they will not mind if I end with a few "acid drops". I notice, for instance, that the words "churches" and "clergy" or "ministers of religion" do not appear in the index and I found only one brief 1205 reference to churches in the whole Report. This is strange when one remembers that the churches are the most widely supported form of community activity in the country and that there are 18,000 Anglican clergy alone, most of them in daily touch with people in trouble and distress. With rare exceptions they reside in their parishes and this is unlike anything that can be said of almost any other profession. No individual minister of religion is listed as giving evidence, although I make no complaint at all of the weight given to church organisations. But a man like Canon Norman Power, who has put up such a fight for the actual people involved in the re-housing of the Ladywood area of Birmingham, would have had a lot of important things to say. The churches realise that they themselves have to do a lot of new thinking about the social implications of their work, and in February the Church Assembly will debate an important report on the Church and the social services.
One does get a little tired of the continual harping that the day of charity has passed. The Report says:The day when voluntary organisations could act as vehicles for upper and middle class philanthropy appropriate to the social structure of Victorian Britain is now passed.That is in paragraph 496. Well, yes indeed it is, if anything so anachronistic still exists. But almost every voluntary organisation that I have ever known—and Leicester is exceptionally rich in such organisations—depends a great deal on upper and middle class philanthropy, and it would be a sad day if those who are better off lost their sense of responsibility in these matters. The family service units have pioneered the very form of family care envisaged in this Report, and for their financial backing have relied on the very form of support from professional and business circles which is here relegated to an outworn past. I think we have to face the fact that nature has ordained that strong can help weak. Parents are stronger than children; middle-aged people are stronger than old people, and we can never rid ourselves altogether of the responsibilities of various kinds of hierarchies of strength and resources, not only financial but also personal. But these, my Lords, are very small "flies" in a large pot of very precious ointment, and, having mentioned 1206 them, I end with renewed gratitude to the authors of the Report and an expression of hope that rapid progress nay be made towards the implementation of the proposals.
§ 4.35 p.m.
§ LORD COTTESLOE
My Lords, as other speakers have said, we must all feel grateful to the noble Baroness, Lady Brooke of Ystradfellte, for initiating this debate on a subject of great importance. Like them I join in welcoming this Report. It covers a wide field wind, overlaps and interlocks with that covered by a number of other Reports, notably the Green Paper on The Administrative Structure of the Medical and Related Services to which the noble Baroness, Lady Brooke, referred; the Report of the Royal Commission on Local Government which we eagerly await and that of the Royal Commission on Medical Education, with its recommendations on the administrative structure of the Health Service. The list is not exhaustive. If my remarks stray on to matters not perhaps strictly within the terms of the Seebohm Report itself but closely related to and interlocking with them, I am sure your Lordships will bear with me.
It is the Health Service aspect with which I am particularly concerned. The general trend of all these Reports, except that of the Royal Commission on Local Government which we have not yet seen, is towards unification aid regionalisation. Let me make clear that when I use the word "regionalisation" I mean government on a basis of region, area, district, locality—whatever you may choose to call it. Regionalisation is fashionable to-day. It is part of the same trend of which the desire for Scottish and Welsh self-government are other manifestations. A desire for political and administrative fragmentation is rather curious at a time when, in the world of commerce, mergers are the most striking feature. But in the field of administration regionalisation has a good deal to be said for it, so long as it is not carried too far.
Unification, on the other hand, is something about which, in the field of the social services—and I take that phrase to include, as Seebohm does, housing and education and the health services—is something about which we can a I unreservedly agree in principle. We can 1207 all agree with the recommendation of the Seebohm Committee that the social service department and the housing, education and health departments must be the undivided responsibility of the same local authority; just as we can all agree with the desire expressed in the Green Paper that there should be ideally a single authority for medical and related services in each area.
My Lords, the question is what this really means; how far it can be carried; how far it can in practice be achieved. If it means—I quote from the Minister's foreword to the Green Paper:in each area a new type of local authority such as may be created after the, Royal Commission on Local Government has reported"—and the suggestion is only tentatively put forward by the Minister: if it means that, then those of us who remember the old municipal hospital service would almost unanimously deplore a reversion to anything of that kind. I was myself a member of the old Hospitals Committee of the London County Council and I am not without some little experience of the whole picture of the transition from the municipal hospital service to the national hospital service. I had the good fortune to be for seven years chairman of the Regional Hospital Board. I was for some years a member of the board of governors of an undergraduate teaching hospital, Middlesex, and I have been for twenty years a member of the board of governors of a post-graduate teaching hospital, Hammersmith, of which I am at the present time the chairman. So, my Lords, I have seen this matter from a number of different points of view.
When the National Health Service was brought into existence twenty years ago there were widespread fears, natural enough, that it would result in the levelling down of the service given to the public, more particularly by the hospitals. Those fears have not been realised—indeed, precisely the opposite. So far from there having been a levelling down, there has been almost everywhere a most notable raising of the standards of the hospital service. This has been due not so much to any particular virtue in the setup, which is in many ways open to criticism: if it were not, there would have been no need for the Green Paper nor for those parts of the Seebohm Re- 1208 port which deals with the health services. It has been due in part to the unification of the hospital service under the general control and direction of a single Ministry, and even more to the development, at the instance of that Ministry, of a very much higher standard of consultant staffing.
Speaking broadly, the pattern of the administration of hospitals in a number of large regions—14 in England and Wales—by Regional Hospital Boards under the Ministry seems to work, and, on the whole, to work well. There are, of course, difficulties and frustrations. Some regions are better administered than others, but the local inequalities are far less than in the days of the old municipal service, and the general standard is far higher. We should, it seems to me, be very careful to make sure that we shall have something better before we reorganise the whole affair for the sake of a further unified administration, unified on the basis of perhaps 40 or 50 Area Health Boards covering much smaller areas, such as is envisaged in the Green Paper. It may be right to do so, but we may well in the process lose a great deal more than we gain.
I am particularly concerned with the place of the teaching hospitals in the new pattern for the social and health services that is contemplated in these Reports and especially with the place of the postgraduate teaching hospitals of London. All hospitals have as their prime purpose to serve the interests of the patients in their care, but the teaching hospitals have also a responsibility of no less importance: that of training the doctors and consultants who are needed for the service of the public, both in and outside the hospitals, and also for the great bulk of the research that constantly carries forward the endless battle against the forces of sickness and disease.
The provincial teaching hospitals can, I think, fit without great difficulty, and without detriment to their teaching activities, into a pattern of regional or area administration. They serve as the natural focus on which the health and the hospital services in their area are centred; and they have close ties with their universities. The great metropolitan concentration of undergraduate teaching hospitals, such as St. Thomas's and Westminster, Bart's 1209 and Guy's, the Middlesex and the rest—there are a dozen of them, with world-famous names—present more of a difficulty, owing to their concentration in such numbers in a limited metropolitan area. But if they can work together in groups, as I am sure they can, they too can fit into an area pattern without great detriment to their work, and possibly indeed with some advantage to it.
It is the post-graduate teaching hospitals that do not fit into this pattern. Before I go into the reasons for this I must deal with a common source of misconception, the misconception that is due to a failure to differentiate between two entirely different kinds of post-graduate teaching, a differentiation that is not made at all clear in the Todd Report. There is, first, the post-registration training of consultants and general practitioners all over the country, as it is carried on for the most part in the regional hospitals. A great extension of such further training is desirable, and indeed necessary, and is recommended by Todd.
But that is something quite different from the advanced specialist teaching and research that are carried on by the 14 London post-graduate teaching hospitals. These hospitals are training every year some 3,600 doctors, already qualified, two-thirds of them from overseas, many of whom eventually return to positions of responsibility and leadership in their own countries. The advanced teaching and research carried on in these 14 hospitals is something quite different, in its range and its depth, from the further training of general practitioners, and it is virtually ignored by the Todd Report and the Green Paper.
These post-graduate teaching hospitals are all specialist hospitals, some large and some small, but almost all with the highest international reputation. Hammersmith, indeed, is a general hospital, but it is organised on a basis of highly integrated specialist departments. These 14 hospitals draw to London doctors from all over the world in large numbers and the work they do does much to fertilise the arts of medicine throughout the world. It is said that the Todd Commission were told in evidence that the drawing power of London is losing strength. This evidence, I believe, was directed specifically to the undergraduate medical schools. It 1210 may be that the attraction of the United States is increasing, but the demand for special post-graduate education in London certainly shows no falling off in either the number or the quality of applications from doctors from overseas. The brain-drain of teachers from London to the United States is, however, serious, and it is basically due to inadequate finance—not so much, perhaps, to salary differentials, though they are serious, as to inadequate buildings and equipment This is the aspect of this particular matter which calls for the most urgent attention.
These special hospitals, the postgraduate teaching hospitals of London, cannot from their very nature be fitted conveniently into a regional pattern giving a district service, since they give a specialist service to patients referred from many different parts of the country, and from overseas, too, as well as from their own district. The Todd recommendations and the Green Paper proposals simply do not apply to them. The Royal Commission on Medical Education did not really face this problem at all. They evaded it by recommending the disappearance a these special hospitals as independent entities by their absorption in the London undergraduate teaching hospitals.
Perhaps I am a little off the Seebohm Report, my Lords, but I shall shortly be finished and I hone that your Lordships will bear with me for a few minutes more. A close association with the undergraduate teaching hospitals is indeed desirable, and in most cases already exists; but if the arrangement by which these post-graduate to aching hospitals are administered by boards of governors directly under the Ministry is to he altered at all (and it is very easily understood that the Ministry might prefer not to deal directly with the problems of a number of highly individual hospitals, some of them very small), then they should in my view, with ate possible exception of some of the smaller hospitals that might become integrated into the precincts of general hospitals, be federated as a single and separate group of post-graduate hospitals for the purpose of administration by the Ministry while retaining their separate identities. That is the only way in which they can be fitted into the new pattern without grave detriment to the value of their work in the international field.
1211 It would be quite wrong that such major specialist hospitals as the Maudsley, for example, should, for mere administrative convenience, be administered by a single board with a general hospital. The same applies to Queen's Square, to Great Ormond Street, to Moorfields, to Stanmore, to Queen Charlotte's, the Brompton and others. Even though a close working association of the special post-graduate hospitals with general hospitals is agreed to be necessary, their efficient administration demands boards that are immersed in their particular problems and requirements markedly different from those of a general hospital.
One or two of the small special postgraduate hospitals might well be administered by special committees of the hoards of governors of the general teaching hospitals with which they are associated. But however closely integrated they are with those hospitals, it is as essential that their individual identity as special hospitals, and indeed their names (most of which are known throughout the world), should be retained as it is that the post-graduate teaching institutes that depend on them should preserve their separate identities. What is really required appears to be some arrangement parallel with the British Postgraduate Medical Federation, that extraordinary organism that comprises the teaching institutes of these hospitals, and provides these hospitals with their medical staff. It is a single school of the University of London, with 3,700 qualified doctors from all over the world as students, with nearly 600 recognised teachers, and more than 70 professors of the University—a school that is, incidentally, most happily free from the student unrest that nowadays bedevils so many teaching establishments.
There is one further point to which I must draw the attention of your Lordships before I sit down. Todd recommends that the Ministry should pay for the post-graduate teaching done in hospitals. This may well be appropriate—indeed I think it is right—in respect of the further training of general practitioners and junior hospital staff in regional hospitals; but it would quite stultify the more advanced teaching and research carried out under university 1212 leadership in the London post-graduate teaching hospitals.
I say that for this reason. The British Postgraduate Medical Federation and its institutes in the individual hospitals depend for their revenues, in the main, on two sources. About £2 million a year comes from the University, and more than half as much again, more than £1 million a year, from voluntary sources, in the form of research grants and the like. They also receive from time to time very large capital grants from voluntary sources. Quite apart from the essential need for the closest possible ties with the University of London—ties which happily exist to-day—if this work were to be taken over by the Ministry, or to depend on the Ministry for its finance, it is quite certain that these vital revenues from voluntary sources, and the capital sums also, would dwindle away. Donors will still give to universities for teaching and research who would not dream of subsidising a Ministry. The work of specialist teaching and research in the post-graduate teaching hospitals, which is one of the great success stories of the nation since the end of the last war, would be almost completely stultified, and that is something which we should all agree cannot be allowed to happen.
My Lords, if I have talked perhaps too much about hospitals, I can only say that the service given by hospitals is certainly a personal service. It used to be a local authority service in this country, but I hope that it will not be again, because I am sure that that would be to its detriment. I hope the Minister will be able to tell us that when the Government are considering action on the very complex and difficult issues that are raised in these Reports that we are discussing to-day they will give full weight to the particular aspects that I have raised this afternoon.
§ 4.55 p.m.
§ LORD WELLS-PESTELL
I should like to thank the noble Baroness, Lady Brooke, for giving your Lordships' House the opportunity of discussing what must be one of the most vital Reports that, as a community, we are likely to consider for some time to come. I think I ought to make it quite clear that I approach the matter this afternoon from 1213 the standpoint of someone who worked for many years as a professional social worker, professionally trained, and who has assisted in recent years in the training of social workers. I find myself in some difficulty, because, in principle, I favour the suggestion of the creation of a "comprehensive, community-based, family-orientated, social service" which is to be available to everyone in the community, but instinctively—and I want to make this quite clear—I am apprehensive of the establishment of a monolithic social service department as envisaged in the Report. The idea that there should be one door through which all who are seeking help should enter I find very attractive, but this in itself is no guarantee that those seeking help will, when they get on the other side of it, find skilled, competent and expert service.
I am also concerned that throughout the Report there is—at least, it appears to me to be so—a strong undercurrent of emphasis on the multi-purpose social worker, generic trained for that purpose. In the Report there seem to me to be too few concessions to specialisation at the actual working front level; and if this is so (I admit that I may be wrong in my assumption) it could be harmful to the client from the treatment point of view. At the moment—and let us take some pride in the fact—those of us who have spent a fair amount of time in a number of countries abroad have, I think, always returned to this country profoundly grateful that we have enjoyed here for many years a vast and comprehensive network of social services, statutory and voluntary. And I think we have to face this fact also: that for many years many of them have been providing a marked degree of specialist help. I fear that this may be watered down if there is too great an emphasis on the multi-purpose social worker, who might turn out to be a Jack-of-all-trades and master of none.
It should be recognised that there must—and I want to emphasis the word "must"—be limits to the capacity of the generic-trained social worker; and I find it difficult to believe that even a highly trained social worker could deal effectively with the range of problems envisaged for the multi-purpose trained social worker. These problems include 1214 mental health, adolescent difficulties, social inadequacies, children and families, unmarried mothers, matrimonial problems, adoptions, the educationally subnormal, to mention only a few. I think we have to keep in the forefront of our minds that we are learning more and more about people every day—about their behaviour and their problems s—and if it teaches us anything at all it teaches us that we need great specialisation if we are to understand those problems and to give adequate help to the client. I believe that the generic trained approach could prove to be not only administratively inefficient but in many instances unhelpful to the client.
All this is going to be put at the foot of the town hall authorities. The town hall, which is to be the supreme authority, to be responsible for the social work department, is not everybody's idea of a Mecca, and to many the town hall image leaves much to be desired. I understand it is even regarded by some as the dead hand of precedent, full of political prejudices and revealing too much red tape. If this new social work department is to provide a service for all, then mar y local authorities will have to undergo a change, be less authoritarian and more approachable and more understanding, and be capable of attracting all sections of the community to use its services, and not lust the lower socio-economic group. This will he best achieved if there is recognition of the contribution which is already being made by a number of voluntary societies and by retaining them wherever possible as agents of the local authority, rather than attempting to absorb them in the local government setup. I do not think we ought to encourage local authorities to become empire builders, but indicate to them how to use the various skills outside the town hall, of which there are a considerable number.
I find that the role of the voluntary organisation is not clearly defined in the Report. To put it mildly, I think it would be unfortunate if the local authority social work department attempted to take over all voluntary effort in the field of social service. Generally speaking, voluntary societies in this country are doing a good job. Many of them are open to criticism, but so are a good many of the departments in our local authorities. I 1215 venture to suggest that the majority of our voluntary organisations are doing a very good job. Many are doing it not only effectively but much more cheaply than it could be done by local government. The financial aspect is of supreme importance, for it has been the lack of adequate financial resources which has made it impossible for some local authorities to develop adequately their existing social work responsibility, without taking on more. It is the lack of adequate financial resources that has caused a fair number of local authorities up and down this country to employ social workers who have not been adequately trained.
Paragraphs 495 to 500 of the Report do not make it clear, at least not to me, whether reference is being made to voluntary organisations or to voluntary workers working for statutory agencies. An organisation just because it is a voluntary organisation does not necessarily lack professionalism, either in its approach or in its skill and competence. Many voluntary organisations would have no difficulty whatsoever in meeting the requirements referred to in paragraph 496, of beingvigorous, outward-looking voluntary organistions which can demonstrate good standards of service.There are voluntary organisations functioning in the field of social work to-day with a higher standard of selection and training for their voluntary workers than is given to some full-time social workers employed by some local authorities.
Voluntary social work has always been a part—and, I want to suggest, an important part—of our way of life. I believe we have more voluntary workers in social and community work to-day than we have ever had before. I hope nothing will be done to discourage that vast army by mobilising them to the suggested newly-established social work department, which appears to be the suggestion in paragraph 498, for it states:it will be more and more necessary for local authorities to enlist the services of large numbers of volunteers to complement the teams of professional workers, and the social service department must"—"must", your Lordships will notice—become a focal point to which those who wish to give voluntary help can offer their services.1216 I am inclined to think that there will be a substantial number of voluntary workers who would prefer to make their contribution outside the setting of the local authority rather than within it. The assumption in paragraph 499 that volunteers cannot replace professional workers I believe shows a lack of understanding of what some voluntary workers can do, and are doing at this moment, in the field of social work to-day. Many are already professionally qualified, but they prefer to work without payment for the community through voluntary organisations.
My noble friend Lord Amulree made reference to the Probation Service, so perhaps I have an excuse to bring that in, although in the ordinary way I do not require any encouragement. Although the Committee were precluded from reviewing the operations of the Probation and After-care Service, some of the Committee's recommendations, if carried into effect, would affect that Service. I hope the Government will not be tempted, when framing legislation to implement the Seebohm Report, to change in any way the Probation Service. I recognise that this is not the appropriate time to discuss the future of the Probation Service, but I ask the Government to recognise that the Probation and After-care Service must remain an integral part of the administration of justice and be totally involved in the treatment of the offender. We are moving towards the integration of all those agencies responsible for dealing with offenders, and we accept this as a good and desirable thing, but in view of the very special nature of probation and after-care work I hope that its uniqueness will be recognised, and that it will be allowed to stand apart from the concept of a general personal service. I hope, my Lords, it will not be necessary for me to argue this more fully at some future date.
I acknowledge that the Seebohm Report makes an important contribution to new thinking on the social services and that it reflects a detailed investigation. Nevertheless, I would again say to the Government that I hope they will resist any pressure to introduce legislation too quickly and will not be in a hurry to implement the recommendations of this Report until further consideration has been given to certain proposals.
§ 5.9 p.m.
§ BARONESS SWANBOROUGH
My Lords, I must admit great distress because I can think of no words in which to thank the noble Baroness, Lady Brooke of Ystradfellte, or the Seebohm Committee, in terms different from those which have already been suggested. But as a woman who works very hard herself, I should like to pay tribute to the immense amount of hard work which must have gone into this Report, which in itself is so stimulating and exciting to those of us who work on the ground. This Report is not only a splendid document; it is also of such first-class thought-provoking shape that it should be read and considered by everyone working in the field of social service, and after being read it should come back again and again to one's mind so that one could make certain that one had not only considered but understood the implications of the recommendations made.
To my mind, the objective of a family service is a great move forward because of the principle that lies behind the proposals, namely, that in the future work will be based simply on the family and not on the symptoms. The aim from start to finish in the whole of the Report is to secure an effective family service. I am quite certain, as many other people must be, that this is a gigantic undertaking—much bigger than people realise at first—and that the various services involved will have a great deal of reorganising to do before they are able to meld in anything like a worthwhile degree.
To those who work on the ground, by which I mean within the community with individuals at the local level, the advantages of this breakdown are not only very apparent but extremely welcome. To a woman with a family, a series of different social workers visiting her leave her completely bemused. Her mentality (which often demands the visits) finds it well nigh impossible to distinguish between the social service visitor from the welfare department, the children's officer, the school welfare officer, the probation officer or the health visitor, and so she refers to them all vaguely as "the welfare lady" or "The welfare gent". The advantage of having one person visiting the family, in whom confidence is really felt, would be beyond words, and overcoming all the difficult- 1218 ties and obstacles (which would be many) would be more than worth while.
If in fact, as recommended in the Report, there were to be a complete change of local government machinery in regard to their personal social services, the transition from to-day's workings to to-morrow's methods would certainly entail changes for many responsible persons as well as dislocation of hopes, aspirations and ambitions; and this, I am quite convinced, must be taken into account from the outset. The advantage of ending divided responsibility and the possibility of ultimately developing one adequate career structure should not in any way be under-estimated. The criticism of a monolithic structure can he overcome only by those of good will who believe in real and honest delegation, and who would in every way act with generosity and with wisdom. I am a little afraid that in those local authorities which have not grasped the real value of the recommendations it may be only the clear-sighted and visionary who will he able to grasp these facts, and one must be ready to help those persons who are perhaps more shortsighted.
Recently a senior local authority official is said to have declared that he hated the whole Report from start to finish but he recognised that in his hatred there was a great measure of his own personal feelings and he realised to the full that the man who sat in his chair in some years' time would be operating the scheme with ease and with complete certainty that this was the right way to proceed. I cannot help feeling that we should all aim to speed up this forward-looking approach. Recommendations which simplify complicated and outmoded methods should surely he welcomed, and it is so tiresome that everybody is always ready to accept a change for somebody else but never for themselves. I feel that those who are organising and operating must certainly be deeply aware, from the outset, of the human ambitions and inevitable personal disappointments which will present themselves and may seem to be almost insurmountable obstacles. I am convinced that unless those who steer are of strong character and great understanding, human relationships could wreck many of the recommendations. The hazards must be recognised in order that they may be met and overcome.
1219 As the noble Lord, Lord Wells-Pestell, has said, as a nation we are proud of the welfare that is available to our citizens. But such welfare should undoubtedly make the community in which they reside realise that welfare is more than just available. History has taught us this, and we know that what we are aiming to achieve is not something which can be bought just for cash. Welfare workers are not clock-watchers; they spend themselves unstintingly because of their belief in the work they are doing. And if, by participation—and I mean real participation—local residents can be involved, a great depth of understanding, as well as recognition of true values, can be achieved within the community as a whole. This makes me feel very much in favour of the suggestion that the forward viewing of areas should not be greater than could be undertaken by teams of up to 12 social workers.
The team, as envisaged, is of highly skilled professionals, and the voluntary workers on whom it is proposed they should call could be best forthcoming if, as has been mentioned more than once this afternoon, they were provided by a responsible and trusted body. This means that voluntary organisations should be forward looking and preparing their members to be valuable helpers and, indeed, often (as has been mentioned) "sub-contractors" to the professionals, each clearly understanding—and this is important—their relationship one to the other.
Careful preparation by the responsible organisation would make the volunteer much more worthwhile to the professional, and the fact that someone is responsible for the volunteers will guarantee replacement in the case of illness or enforced absence, and a standard of performance which, as in all other walks of life, has to be watched in order to be maintained. If professionals set out to collect their own volunteers they are either doomed to disappointment and frustration or are embarking on an undertaking which will demand too much of them, personally, away from their professional work, because (as I know from long experience), volunteers, like all other personnel, have to be handled carefully; and that takes time, thought and energy.
While my responsibility (and I declare an interest) is in the field of voluntary 1220 service, my outlook, of necessity, takes cognisance of a much wider field. Many years of work with local authorities has convinced me that if volunteers are realistic and reliable and constant in their work, statutory bodies will use them to the full and encourage them in experimental fields of endeavour. This involves more and more individual interest in the community, and this is surely what we are aiming to get. Work to-day in the whole field of voluntary service is very much more real and practical, for those who care to participate to the full; and I believe that there are more and more people to-day who are ready to make a contribution of their own individual energy, and who will, by that contribution, make their participation within the community a real thing. Greater leisure will provide such opportunity, and if only wisdom could prevail, tremendous good could come to the community, and indeed to the country, through the recommendations of this Report.
The implementation of the Seebohm Report must of necessity be related, as so many speakers have said, to decisions on local government and the Health Service, but if a statement of intent could be made by Her Majesty's Government it should be done as soon as possible, because uncertainty breeds restlessness among all concerned. It is quite obvious that translating so complicated a Report's recommendations into legislation, let alone into operation, must of necessity take time. I would urge that during this inevitable time lag moves forward may be made continuously and with definite purpose; otherwise I fear that much that is supremely good may be lost.
§ 5.20 p.m.
§ LORD SEGAL
My Lords, this debate has already ranged over a very wide field, perhaps wider even than that covered by the Seebohm Report. The noble Lord, Lord Cottesloe, has made out a strong case for a full-scale debate on the Todd Report on Medical Education and it is to be hoped that the date when such a debate may be held is not too far distant. But certainly the complete reorganisation of the social services in conjunction with the existing health services is long overdue.
The proposals of the Seebohm Report have by the general consensus of opinion, 1221 we have heard this afternoon, been warmly welcomed. Many of them are excellent; some indeed are magnificent. But their whole purpose will fail unless the humanising of the National Health Service and the whole structure of our social services is put in the forefront. This point must be rammed home to the people of the country. It is far more important than the efficiency of the services, or the economy of manpower, or the saving of cost. Of course these are vitally important issues in themselves, but far more important is the recognition that it is the patient, the person in need, who counts first and foremost, and that the interests of the patient will be best served by these new proposals.
There are just two or three points, out of what the noble Baroness, Lady Brooke of Ystradfellte, has described as a mine of information, that one would like to single out and stress this afternoon. First, I feel that much more can be done to bring the health services and the social services closer together, both through the hospitals and through the general practitioner. It has been said that the Seebohm Report was given a frosty welcome in certain sections of the medical profession. I do not believe this to be so. I feel that the more the proposals of the Seebohm Report are investigated the more they will receive a generally warm welcome, not only among social workers but also among the medical profession themselves.
I think that many now condemn the endless amount of time that is wasted to-day by highly skilled surgeons and consulting physicians on the various hospital committees. If, as a result of this Report, taken in conjunction with the Government's Green Paper, something can be worked out so that this needless waste of time can be eliminated, and so that all this valuable mass of manpower —perhaps the most skilled in the whole of our social services—can be directed to the purposes for which it was originally intended, it will be worth while indeed. The Area Boards, once they were constituted, would invite representations and advice, and in that way a good deal of this needless waste of time that I have mentioned could be avoided altogether. That would be one of the most desirable results of any reorganisa- 1222 tion of the National Health Service and the local authority social services.
Equally, I feel that a great deal can be done to bring about the closer working of the health services and the social services if the general practitioner himself is brought more closely into the revised proposals. Reference has been made to the existing schemes of postgraduate education. Here I feel that the general practitioner could be given far greater facilities than he new enjoys of closer contact with recent advances in medicine, research in medical work. If some post-graduate courses of instruction were geared more to the actual interests and the welfare of the patients, not only would access to the hospitals be more open and freer to the general practitioner, but the implications of the work of the hospitals in terms of the social services could be brought home more closely to the general practitioner, and great advances would be made in the interests of the patient.
I should like the care and the welfare of patients admitted by the general practitioner into our hospitals to be not less than that of a wealthy patient admitted into a nursing home, who receives the utmost care and attention not only from consultants but from the general practitioner himself. If clinical courses could be arranged specifically on the patients admitted into hospital by the general practitioner, then I think enormous advances could be made to help the patient after his discharge from hospital in terms of rehabilitation and his return as a useful member of the community.
The third point I would stress is the doubts that exist in the minds of so many people that these proposals may result in the creation of a new form of bureaucracy in place of the existing bureaucratic machinery. As we all know, there has grown over the National Health Service a mass of dead wood, accumulated over a period of twenty years. A great deal can be done to-day in terms of not only laying down a clear policy but improving the efficiency of the existing service. I am particularly concerned about the uneasiness that exists in the minds of parents of children who are mentally handicapped and who have to be admitted into a hospital or an institution. These children are cut off from their home surroundings, and from their 1223 parents. Many of the existing barriers have now been broken down. In many hospitals the children can be visited freely; the medical staffs and the nursing staffs are readily available to help the child, to advise the parents, and generally a good friendly relationship has been created. But there are natural fears of the parents that if a new reorganised system is set up, they may be more removed than they are at the present moment from access to the nurses and doctors who are looking after their children. Many of them feel also—and these are natural fears in the case of parents whose children are kept in a hospital over a long period of years—that their complaints are likely to go less heeded in the future than they are at present.
Although we know that these fears may be largely unfounded, I feel that an integral part of any new health structure should be, as envisaged in the Green Paper, the appointment of health commissioners attached to the Area Boards. In the same way as Parliament has seen fit now to appoint a Parliamentary Commissioner, an Ombudsman, so I think a great deal could be done by giving free outlet to the complaints, whether founded or unfounded, of so many parents who are uneasy about the welfare of their children, by the appointment of these Health Ombudsmen. To my mind the essence of a new democratic structure is not the election or appointment of any new officials by democratic means, but the provision of a free outlet for the expressions of opinion and, if need be, of complaints (to the widest extent) down at the grass roots, so that any parents under a sense of grievance have immediate access to an outlet by which their grievances can be redressed.
My Lords, I would conclude as I began. The aim of any new centralised authority must be to humanise the whole system, and the whole approach to these social and health problems from the point of view of the mass of the community, of the ordinary patient, of the ordinary child who is in need. So far from creating a new bureaucratic machine or, as many people seem to dread, a machine in the form of a bureaucratic juggernaut, the Government should seek to stress above all that any reform suggested in the Seebohm Report will be carried out in 1224 order to humanise existing social services.
May I endorse the plea put forward by Lady Swanborough, by quoting these words from the Seebohm Report:Pending legislation, we urge the Government to make a clear statement of their intentions, so that local authorities and any other bodies concerned can start making preparations accordingly.That, I think, is an opportunity which presents itself to the Government at the conclusion of this debate. I would urge upon the Government to make now a clear statement of their intentions and to state categorically that they accept, in general principle, the implications and recommendations of the Seebohm Report, so that any existing doubts in the minds of the medical profession, in the minds of social workers and in the minds of the people of this country, may immediately be set at rest.
§ 5.34 p.m.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I rise with great pleasure to take part in this debate, and to thank the noble Baroness, Lady Brooke, for having initiated it, and also to say that I agree with the general principles of this Report, the Seebohm Report. There seems to have been no reason—it is only historical in fact—for the build-up of our social services in this country in such a departmental and fragmentary way. The last of the committees, the local authority committees, designated to deal with children were, after all, set up only in 1948, and if you study the historical progress of social work, starting in the medical field and spreading right through the community, there seems every reason why now, in 1969, we should try to co-ordinate and make a simpler form of administration for the social services. I say "simpler", but of course nothing is simple and the reorganisation is going to be difficult. Nevertheless, I agree with both Seebohm and the equivalent of Seebohm in Scotland—that is. The Kilbrandon Report—in which my activities take place, that it is a good plan to start now.
I speak with some experience because I have been chairman of two of the committees involved in this type of reorganisation, the children's committee and the probation committee, which in Scotland will form part of the new social work 1225 department. I was asked the other day, and was elected, to be chairman in my own county council of the new social work committee. I have chosen as my vice-chairman (this, I hope, will please Lord Segal) a general practitioner who is a member of the county council. So in the area in which I live we are going to start from the grass roots up. Whether or not we shall succeed, I have no idea; but this is going to be the great challenge and I have agreed to take it on.
Looking back on the twenty years during which I have been chairman of the children's committee and the probation committee, I have many times realised how much better it would have been if the cases with which one was dealing, the family case, the children's case, could have been dealt with by one person or a group of people, because often cases would pass from department to department, and, unless a careful check was kept between one department and another, vital information was not passed on, and quite often muddle took place which might have been avoided had there been a more co-ordinated social service department in which we were operating.
I agree, too, that it is most important to get all the help we can from the voluntary organisations. We in local government have been doing that for many years, and there is no doubt at all that without help from voluntary organisations many of the things we try to do would be far less effective. I support very strongly indeed the proposal to work closely with the voluntary societies. If in the new social work department everything is to work harmoniously (and that is a big "if"), the family, with its many problems, will in all probability need to deal only with one person, and that person will be in touch with many different agencies and types of help.
I agree with Lord Wells-Pestell, when he says that in the voluntary organisations there are many highly skilled professional people who prefer to work in voluntary agencies but whose skill and advice is made available if a local authority asks for it. This, I think, may well be the better pattern of working with voluntary organisations than trying to enrol them as members of a social work department. I am sure we all agree that the important thing in social 1226 work and in the social work department is that we must do as much preventive work as we possibly can. In 1948, when the children's committees were set up under the first Act, we were not allowed to do preventive work; we had to deal only with the care of children when, so to speak, the damage had been done. But since 1963, under the new Children Act we have been allowed to do preventive work. This has been invaluable in preventing family breakdown. In fact in some areas, in my own in particular, preventive work by the children's officer takes far more time than any curative work or treatment which may be undertaken later.
In the new social work departments, if they are really comprehensive, I believe it should be easier to find out the weaknesses in the community and to try and remedy them before a total break up of the family. From the individual's point of view he or she can get in touch with one centre, which should be much easier for them, and easier to contact in any part of the area. Of course there are snags. In setting up the social work department there must not be a takeover bid by one of the existing departments for the other two, and then call his a new social work department. It is not, and it never will be. One is afraid that, because old people's welfare departments are so big, they may make a bid to be transformed into the social work department. I believe this would be wrong. We must not forget that the genesis of the children's work in local authorities came via the Curtis Committee and its Report. That was because in those days children who were homeless and deprived were being housed in Poor Law Institutions because there was nowhere else for them to go; no children's homes or anywhere where they could be taken in.
There are those in the medical profession who think that the health visitors, plus the nursing services or the almoners, can do all the work. I am quite sure that this is wrong. I have the greatest admiration for the health visitors, for the almoners, for the district nursing services and all the rest of them, but this is not social work in the sense in which I believe family social work should be done by a social work department. I am convinced that if this new plan is to work it must start on the level as a 1227 new department and must bring in, again at the same level, the wide range of children's work, old people's work, including home helps, old people's welfare, mental health, and all the other things which are listed in the Report.
The noble Lord, Lord Wells-Pestell, made a very strong plea for omitting the probation service. As you know, the Seebohm Report particularly omits the probation and after care services, but we in Scotland have been given the job of incorporating the probation service through our social work departments. I will not go into that matter now, but that is one of the differences between what is happening in Scotland and what is happening in England. I should like to see the structure of the department consisting of one chief officer and then the other specialist officers—heads of what were all the old departments—working at the same level but under his direction, and in that way there would be no jealousy or takeover attitude among the officials.
Access to the departments will be all-important, and I like the suggestion in the Seebohm Report of decentralised offices where people can take their problems. In a rural or a sparsely populated country district, an area office in a market town would serve the purpose. It might be open only once or twice a week, but so long as people knew that they could go to that office, could find there the answers to their many queries, that would save them travelling long distances perhaps into a central area, because in Scotland many of our rural areas are very scattered indeed. The same situation would apply to the rural counties in England. I also like the suggestion that voluntary organisations in the community should also help to supplement the statutory services and bring in those outside interests to which the noble Lord, Lord Wells-Pestell referred.
What are the problems? The first, I should say, is the lack of trained people. How we in Scotland are to find chief officers to the number of about fifty is really hard to visualise. I hope that women will have as good an opportunity to apply for these jobs—provided that they have had the training and experience—as men. I am sure that 1228 I should have the support of the noble Baroness, Lady Summerskill, were she in your Lordships' House tonight. I also hope that makeshift appointments will not be made—people appointed because there is nobody any better. That would be fatal. It would be much better to carry on as we are than to start a new scheme with the wrong head. If social workers are to be trained for this new orientation of social work, there will have to be a general re-thinking of social work training and social work courses.
Here I should like to draw your Lordships' attention to the Institute of Social Work, which under the able Chairmanship of Mr. Seebohm himself, can be of great help in this matter. In the short time in which it has been in existence, the Institute has provided social works studies, many social works conferences and discussions, books of great value in the social work field, far more than any other institution, not excluding the London School of Economics and other universities. I hope that the Government will look towards the Institute for advice and help in setting up their advisory council, or whatever method they use to extend the training facilities.
Both the Carnegie Trust, which financed the first generic social work training course at the London School of Economics quite a long time ago (I forget the year), and more immediately the Gulbenkian Trust, have made great contributions to the improvement and value of social work training. The Gulbenkian Trust have just issued a Report on Social Work Training for the Community which is of enormous importance. But just as new methods are put forward, new problems arise; and the community problems of my early student days are no longer—as I well know—the problems of to-day. So it is essential to have a body of people—like those in the Institute of Social Work Training—who can work on changing methods and make experiments without disturbing academic syllabuses until changes are proven and can come into effect.
The most difficult thing, of course, will be to find the people with a wide outlook and experience. This is bound to take time. People could be helped by refresher courses and discussions between one specialist group and another, 1229 between different areas. There are those already trained in child care who will have to learn about different social problems. There are those in child care (I speak of this particularly, because it is the thing I know most about) who have been probation officers or have been in the education service, or had other experience, and this learning about each other's specialisations will, of course, have to take place among the officials if they are to work a really satisfactory and successful social work department. Clearly, it will not run smoothly unless it is handled with enormous tact, great care and patience.
I expect that everyone in this House has received the memoranda from a variety of social work agencies and social work groups, all of which have welcomed the Seebohm Report, with some reservations which naturally one is only too glad to appreciate. I think that it is therefore up to the local authorities to consult with these people, with the associations to which they belong, and to work out the best administrative set-up together.
The noble Lord, Lord Segal, has said —and I entirely endorse his words—that we must bear in mind that we are setting up an administration which must be as akin and tuned in to the people who are the users of this service as it possibly can be. He talks about the patient. It is not the patient I am concerned about. I am concerned about the ordinary person, who is perhaps not at all ill but has just fallen on bad times, or got into difficulty. For such a person the help of the social worker is absolutely vital. But it must be help which is easily accessible; it must be help which is understanding and encouraging to the person who is seeking good advice.
I return to where I started. This scheme will not work if one department is allowed to take over another department and then call itself a new social work department; because it will certainly not be that. This has to be a genuine merger into a real social service for the whole community: young, old, mentally handicapped, physically handicapped—anyone who can live in the community with help and assistance. This is our task. It is up to the local authorities, with the help of all those voluntary organisations who are anxious 1230 to help, to carry it out. I only hope that we can fulfil it, because it is a great challenge and will be of enormous benefit in the local authority services.
§ 5.52 p.m.
§ LORD JAMES OF RUSHOLME
My Lords, it would seem only right that I should preface what I hope is going to be a very short speech by a declaration of interest. The noble Baroness, to whom we are most grateful for initiating this debate and for initiating it with so much clarity, was kind enough to point out the fact that my wife was a member of the Seebohm Committee. I can assure your Lordships that no improper influence has been used on me to cause me to modify any views which I might have. I have, alas; even written my own speech. I say "alas" because it would have been much better had she written it. What I have learned from this personal knowledge of the creation of this Report has been to appreciate the quite exceptional and, in my experience unusual amount of hard work and hard thought that has gone into it by the Chairman and his Committee, which, included, as has been said, a distinguished Member of your Lordships' House the noble Baroness, Lady Serota.
There are moments in our social history when one feels that, given the will, the slow piecemeal progress of reform can be rapidly accelerated; when different lines of thought in different fields seem to come together to provide a quite new impetus for a general advance. We have, I believe, now reached such a time. The Seebohm Committee's Report is evidence of a new climate of opinion about some aspects of our social organisation, a climate which, in some ways, the very existence of the Committee has done something to stimulate. There is a new emphasis on the community rather than simply the individual, shown, for example, in the work low starting in certain development areas. There is the new attitude shown by the White Paper, Children in Trouble. The Seebohm Report is perhaps the most comprehensive statement of this new approach and therefore a most profoundly important stimulus to advance in social welfare.
It has obviously two main aspects. The first is administrative. As we all know, and as has been said several times this 1231 afternoon, our social services, admirable though they are, staffed as we know them to be by often devoted men and women, are less efficient than they should be simply because of their fragmented character. If one considers the individual who may need help, say a child or an old person, the variety of provision is bewildering enough. When it is the family that is involved—and it is towards the family and the community that the Seebohm Committee so rightly forces us again and again to look—then even one who is not altogether unfamiliar with the field is baffled by the number of possible agencies involved and by their often overlapping functions.
The very fact that the Committee which we are discussing had to be set up by no less than four Ministries is itself witness to this complexity. The very chapter headings in their Report, covering as they do among other topics the old, the young, the physically handicapped, the mentally ill and certain aspects of housing, all show how diverse the areas they had to cover, and yet that fragmented pattern must be unified if a more positive approach to social welfare is to be achieved, for it is clear how all these elements interact in any given social situation. It seems now the plainest of common sense that the Committee should have reached the conclusion they have reached; that a great body of social services should be brought together both at local authority level and in Central Government.
That such a massive unification can be brought about without some departmental rivalries, some professional jealousies and some comprehensible frictions cannot be imagined. Even our debate this afternoon has occasionally shown evidence of a certain little rustling like the grindings of axes in the background at times. It is not to be imagined that this should not be the case. But I am convinced that it is still less possible to imagine, if one reads the Report, that the Committee could have reached any other possible conclusion. At the heart of those conclusions is the belief that one Ministry must be responsible for the services with which they have been concerned. Some of us would prefer this Ministry rather than that. There is all too much room for argument here, but I myself have come to believe that a 1232 decision as to which Ministry should ultimately be responsible for the unified service is far less important than that the unification should take place and that the decision to bring it about should be taken now.
The second aspect of the Report that makes it a document of quite exceptional significance is that it embodies the new attitude to the social services to which I have referred. It is not simply concerned with social case work; it is not confined to remedial action. Through it there runs a determination to provide for a positive provision for family and community wellbeing which will prevent some of the grosser evils with which we now have to deal and which, one hopes, may generate a greater sense of social participation in the life of the community among our citizens. Let me take one example which has an obvious appeal to me, the strengthening of social services in schools by putting greater responsibilities upon school welfare officers and in other ways. This kind of idea has been urged by some of us in a rather woolly and indeterminate way for a long time. There are some experiments and courses on it already in existence, but when one sees the success of a properly developed service, say in Australia where it has run for years, one cannot but be grateful for the realistic and sensible suggestions made by the Committee on this matter. The provision of such care as part of a family service would help to save many children from later requiring much more elaborate and, incidentally, much more expensive forms of care.
What about the difficulties facing the Seebohm recommendations? The first is that it is clearly so easy to find excuses, many of them specious, for delaying the implementation of those recommendations at all, as the speech of the noble Lord, Lord Stonham, so comprehensively demonstrated. At one point in his speech I thought I heard the phrase "the next century". My heart leapt up, for I thought that here was a firm date and a firm promise! But, in fact, that turned out to be a delusion. It was one of those delightful rhetorical embellishments, and if he were here I should tell him that I would never hold him to the promise that the Government would be doing anything by the next century.
1233 But, to be fair, it is of course true that the whole structure of local government is now under examination by the Committee under the noble Lord, Lord Redcliffe-Maud. Should we not then wait until that report? The answer is, No. This particular argument for delay was clearly very much in the minds of the Seebohm Committee. They are not all that simple-minded and they deal with it quite specifically and, in my view, quite decisively, for they have obviously taken the greatest care to put forward proposals for unification which could be applied to the present structure of local government and subsequently adapted to any proposed reorganisation when it happens. And who knows when that will be? The Government have so far maintained an unbroken silence since the Report was published six months ago, and this in spite of the fact that when the Committee was set up it was urged to report with all possible speed—cost what work it might.
I believe that further delay in announcing their general intentions, still more any suggestion that we should go on "waiting for Maud", would be deplorable, for three reasons at least. The first is that, as we all know, some local authorities are already putting into operation schemes of their own for unification, based on plans which were specifically rejected by Seebohm and which, once adopted, will be very difficult to reverse. In other words, delay may mean that we end with schemes which, under the name of "unification"—and it is a very nice name—go wholly against the considered recommendations of this Report and may well be worse than the present set-up.
Secondly, the effect of delay and uncertainty on the morale of social workers will be lamentable. During the past few months it has been very striking, and even surprising, how warm a welcome the Report has received, not only in the serious Press generally—I remember, for example, one very fine article on it in the Economist—but from most of the various professional bodies concerned. They have welcomed it with few exceptions. The people who will have to work in this new unified profession that is proposed have given it their whole-hearted support. There has built up an impetus of genuine enthusiasm for the changes proposed. If we delay any longer a positive 1234 statement about the future, that impetus will be dissipated in disillusion.
The third reason why delay is deplorable is that the changes proposed by Seebohm cannot, in any case, come about overnight. A unified, and in some cases more skilled, profession of social workers takes time to build up and we have to be encouraged in our efforts to develop appropriate methods of training. Thanks to the inspiration of Dame Eileen Young-husband, we have over the past few years seen a considerable development and improvement in our social work training. But Professor Donnison is expressing a comprehensible fear when he says:The Seebohm Committee say these departments should eventually be headed by someone trained and experienced both in administration and social work. Such people scarcely exist, and we have no systematic procedure for producing them.That is a legitimate fear. In fact, my colleague, Professor Kathleen Jones, is pioneering a course for just such people, but there is no doubt that the extension of such work needs some very positive stimulus.
I am all the more sure that the Seebohm Committee have again made a most important recommendation, when they urge that the University Grants Committee should make available earmarked grants for post-graduate training and research in this field. As the noble Baroness, Lady Elliot of Harwood, has said, the shortage of adequately trained social workers is going to be an inevitable obstacle to the rapid realisation of all the ideals for which Seebohm stands. But that very shortage provides one of the strongest arguments against delay in a general declaration of intent. If a real wave of enthusiasm and a surprising measure of agreement is not to be frittered away, people who might consider further training to become advanced social workers will have to be reassured.
We must know the Government's attitude, the general attitude, to this Report. We must know whether or not the' are going to take or reject this opportunity for a real step forward in providing a new structure for our social services. It will be new because it will be unified; new because positive in its aims and looking towards the overall needs of families and communities. It will be "acceptable, available, accessible and accountable". 1235 Is it too much to ask that the Government should grasp this opportunity for an improvement in the whole quality of our national life, and tell us all that they intend to do so not grudgingly, not reluctantly, not with an endless emphasis on the difficulties, but with some of the practical idealism that has inspired the Report itself?
§ 6.7 p.m.
§ LORD DELACOURT-SMITH
My Lords, I share the sense of indebtedness which has been expressed by a number of noble Lords to the noble Baroness, Lady Brooke of Ystradfellte, for having given us the opportunity of this debate this afternoon. I must express my apologies and regret that a long-standing and inescapable commitment deprived me of the opportunity of hearing her introduce the debate. I share, too, the sense of indebtedness of the whole community to the Seebohm Committee for a Report so outstanding for its humanity, its breadth and its vision. I address myself to it with some diffidence, because I cannot claim to have the long experience of local authority service, nor the deep knowledge of social service work itself, which has been possessed by many who have spoken in this debate or who have commented upon this Report elsewhere. My own work has fallen in a rather different field, but still one in which one is bound to be constantly conscious of the immense range and variety and complexity of the problems of individuals with which the social services, in their broadest sense, must seek to deal.
Nobody who has that consciousness can be unaware of the degree to which the very variety and extent of our social services can lead to frustration and bewilderment, can lead to loss of energy and loss of time, when an individual has to go to a variety of services with different locations, different staff and sometimes implying quite different courses of action on behalf of the person who needs that social assistance. Indeed, it is very often those who are in the greatest need of the support and guidance of the social services who have suffered most severely from their present form of organisation. Of course, we all realise that we cannot combine in one single unified service the whole range of services—some on a local 1236 basis, some on a national basis—which are necessary in a complex community. But I believe that the combination of the personal social services provided by local authorities worked out by the Seebohm Report can lead to that needed humanisation of our social services of which the noble Lord, Lord Segal, spoke earlier, and, further, can provide a focus, a link, by which the whole range of our social services can most effectively be made available to those who are in need of them.
Perhaps I may take as an example the recommendations which are made in the Report in respect of unmarried mothers. Much of what is said, of course, applies with equal force to mothers who are for any reason inadequately supported, whether it be through the death of the husband, through separation, through divorce, through a long period of imprisonment of the father or for any other reason which may have rendered the families fatherless. One feature of this Report, of course, is its general emphasis upon the provision for children under the age of five. Provision for a child born out of wedlock can often best be made in the context of provisions for children as a whole, but the Report makes specific reference to the fact that there should be a clear assignment of responsibility to the social service department for ensuring adequate social care and advice for both the unmarried mother and her child, and also emphasises in the same paragraph that help is necessary in the form of guidance and accommodation, and in ensuring adequate income.
My Lords, many examples could be given of the degree to which the division of responsibility between our social services can lead to less adequate support being given than the services should in the aggregate provide, but at the local authority level, of course, there is in this case frequently a division between the responsibilities of the health department, the welfare department, the children's department and the housing department, to take only those which come most readily and most obviously to mind. I know that those who have been particularly concerned with these matters are of the opinion, for example, that a division of responsibility between the children's department, on the one hand, 1237 and, on the other, the department concerned with housing—the housing department in some cases or, in the case of the homeless family, the welfare department —may itself be responsible for inadequate preventive work which can in fact result in the child in question finally having to be placed in care. Indeed, I believe that illegitimacy is one of the largest, if not the largest, of the causes of children being placed in care. This, I think, is an illustration of the degree to which the perspective must be that of ensuring that our social services as effectively as possible enable people's problems to be dealt with at an early stage, before they become acute to the point of breakdown.
In this particular field, I am sure that the proposed social service department can do much towards providing a comprehensive service of guidance and assistance to each mother in the light of individual circumstances, and can help to ensure that other services outside the social services department itself are mobilised adequately for this purpose, so ensuring for a greater proportion of children born out of wedlock a fairer chance in life, and for more mothers a real choice between agreeing to adoption or continuing to bring up her child on her own responsibility in a way for which our present services do not adequately provide.
My Lords, reference has been made to the important and stimulating Chapter XVI on the setting of the social services in the community, on the part which the community as a whole can play in this regard; and the right reverend Prelate the Bishop of Leicester, speaking earlier, referred to the passage in the Report which speaks, again in this field of unmarried mothers, of the pioneering work which voluntary bodies, and particularly religious organisations, have done. But I believe it is of value that in such cases as these there should always be what the Report callsa realistic source of assistance to those who do not wish to approach religious bodies".My Lords, the question now before us, in the light of this Report is: what are the steps now to be taken? I had intended to say a little upon this subject, but the noble Lord, Lord James, the noble Baroness, Lady Elliot, and the noble Baroness, Lady Swanborough, have 1238 spoken so fully, so convincingly and with such deep knowledge on this subject that there is, I think, very little that anybody can add. However, if I may I should like to add my plea to theirs, that the Government should recognise, and recognise right away, the need for positive action in this field. There are always admirable reasons for delay; there are always admirable reasons for postponing action.
When one looks at the spectrum of our social services and the intimate connection of so many of the most important personal services with the structure of local government, it can no doubt be said that the fact that there is to be a substantial recasting of local government in the next few years makes this an inappropriate time to act. I hope the Government will be very far from taking that view. The matter is an urgent one from the point of view of those who require the assistance of the social services; the matter is an urgent one from the point of view of those dedicated, devoted and experienced people who are employed, whether in a voluntary capacity or in a full-time capacity, in the social services themselves; and I do not think that one can neglect the dangers of the anxiety and uncertainty which proposals as radical as these are likely to bring to many who are actually engaged in this field of employment.
Nor, my Lords, can we neglect the point which was made by the noble Lord, Lord James: that there is the danger of developments taking place in this field which are not truly based upon the concepts and recommendations of the Report. I myself have heard, for example, of the fact that a number of Landon boroughs have established joint departments under the medical officer of health, which seems, at any rate to me, to run counter to the recommendations of the Report. No matter how admirable a man of medical experience and training may be, he is not necessarily the type of person recommended so clearly by the Report as required for the heading of a social service department: someone who is himself, or herself, trained and experienced specifically in social welfare work. But, as I have said, previous speakers have covered the point so fully that I will conclude only by expressing the hope 1239 that the Government will at as early a date as possible declare their unequivocal support for the main recommendations of this Report, will act to work out the guidelines which can be followed by those who want to see these reforms brought into effect, and so ensure that we secure in this country at the earliest possible date the benefits which can flow from this great social document.
§ 6.22 p.m.
§ LORD PLATT
My Lords, it is natural that some of my remarks will be made from a medical angle, but I can assure your Lordships from the very beginning that I am not one of those who scrutinise every new Report in search of the veiled or overt threat to the status of the medical profession. I have given considerable attention to this Report and I am myself convinced that the main recommendation, the setting up of a new local authority social service department, which should, as we all hope, lead to the development of a real family service, is right and that it should increase the effective use of our social services. I also accept fully and unreservedly that the department should not normally be under the medical officer of health.
It is to be hoped that these departments will lead to better collaboration between the social services and our own profession. In this connection I echo the words of the noble Lord, Lord Segal, in hoping that we shall get general practitioners as fully involved as we can. In parentheses, may I say that the noble Lord, Lord Segal, entertained me a little, for after admonishing the noble Lord, Lord Cottesloe, for dealing with the Todd Report rather than the Seebohm Report he went on to take us through the Green Paper on the reorganisation of the National Health Service.
This collaboration with the medical profession, which is so very necessary, has not always been tremendously conspicuous in the past; and this is pointed out in the Report. As a past medical educator, I am hound to think once again that it is the early training of the medical student which makes him less—what shall I say?—interested in broad social questions than in the fascination of the medical or surgical diagnosis and treatment of the individual patient. I think this is 1240 natural to medical students, natural to people who take up medicine as a profession. I think this is primarily what they want to do. Attempts to introduce social medicine departments into medical schools have also not always been conspicuously successful, partly because of the shortage of good teachers in these subjects, partly because their approach is sometimes too academic and statistical and not human and individual enough to suit the average medical student, and partly because the student so quickly becomes bound up in the individual problems of the sick patient in hospital. Of course, one must realise that most of his teachers nowadays have never practised medicine outside a hospital—and you cannot really teach social service, any more than you can teach the full practice of medicine, from an ivory tower.
My Lords, the doctors, if they have been critical of this Report in some statements—although I do not think they have been very seriously critical—have to realise that they cannot have it both ways. They cannot go on ignoring the social services and the behavioural sciences in the education of medical students and then expect to direct how those services should be used. None the less, I think there are some areas in which we in our profession must be very vigilant; notably, I would say, in adult psychiatry, but even more particularly in the field of child psychiatry in which the doctor, even if he does not direct the service (which does not matter so much) must be the head of his own clinic and must take—he and no one else—the final responsibility for the diagnosis and treatment of his patient; and his records must be confidential. I think we must look after those things when the Report is implemented, as we all hope it will be as soon as possible.
Child guidance is perhaps not one of the most successful parts of the Report. There seems to be an incomplete realisation that it is very largely a matter in which psychiatrists, psychologists and highly-trained psychiatric social workers collaborate together; that it is, in other words, something very much more than mere guidance. In this area, at least, I hope that there will be plenty of consultation between the medical profession and the local authorities before any plans are put into action. There is also a 1241 danger in this area of too close a relationship between the services which rely on voluntary collaboration as between doctor, parent and children in a child guidance clinic and those which have an element of compulsion and penal action, such as the management of approved schools, remand homes and so forth.
My Lords, at best, the recommendations from this Report can improve the status as well as the efficacy of social service, and thereby lead to a more attractive career structure and aid that recruitment of good people into social service which is so necessary to build up the numbers which will be needed. I cannot see that this threatens the medical profession in any way. Indeed, the status of doctors who work for local authorities in various capacities could improve if many of them were employed partly in hospital service and partly in the clinic in collaboration with the social workers. Barriers between hospital and community might be broken down a little more.
I was going to refer to the paragraph on the care of unmarried mothers, which I think is tremendously important, but the noble Lord, Lord Delacourt-Smith, has already done this quite fully and eloquently and there is no need for me to go on with it. What alarms me a little—and here I echo other speakers—is that the implementation of the Report may reveal a tremendous shortage of the right kind of people. It would be tragic indeed if departments were set up in which poorly trained or half trained social workers were under the direction of someone who had academic knowledge of sociology and psychology but knew little or nothing of human behaviour from the school of experience. For those reasons there could be merit in proceeding—I will not say more slowly, because I do not want anything I say to interfere with prompt action on the part of the Government—perhaps more experimentally; trying this out where it is known that enthusiastic and highly trained people exist to set patterns for the best type of service as it then later spreads through the country. My Lords, I think that concludes my part in the debate.
§ 6.31 p.m.
§ LORD ILFORD
My Lords, I should like to join with those noble Lords who have expressed their appreciation to the 1242 noble Baroness, Lady Brooke of Ystradfellte, for having selected this subject for our debate. I should like to add to that my appreciation of the manner in which the debate was introduced. In different circumstances I have had some experience of the powers of exposition of the noble Baroness, but I have never heard them used to better purpose than in her speech this afternoon.
My Lords, the personal social services with which this Report deals have come into existence haphazardly, in a fragmentary fashion, without any comprehensive background for their administration. The local authorities will, I am sure, welcome the attempt which this Report makes to set them against some discernible administrative background of their own which will present them as a major local service comparable with the other major services for which local authorities are responsible. For the notable contribution which this Report will make to the ordered, consistent, administrative structure which, as the Report says, the services so badly need and at present so completely lack, the local authorities will, I feel confident, be most appreciative, even if at times they find themselves not in full agreement with the recommendations in the Report.
But, my Lords, there is one recommendation which seems to me to be or primary and fundamental importance. The Report comes down firmly and unequivocally in favour of these personal services remaining services for which the local authorities will continue to be fully responsible. It was not that voices were lacking to put an altogether different plan to the Committee. It was suggested to them that these personal social services should cease to be functions for which the local authorities were responsible and should be administered by the central Government, perhaps with the assistance of some local advisory boards. That was the alternative put to the Committee and that proposal the Committee have most emphatically rejected.
I think that the reasons they give are significant and compelling. Your Lordships will find the whole matter discussed in paragraph 137. The Committee express the view that a high level of what they call "citizen participation" is vital to the successful development of these 1243 services which are so sensitive to local needs. The Committee further express themselves unable to see how at present this participation could be achieved outside the local government system. I need not say that this recommendation gives great satisfaction to the local authorities. It is very gratifying that after the prolonged investigation which the Committee undertook they should have reached the conclusion that the citizen participation so necessary for the success of these personal services can best be found in local government. That, of course, is a view which the local authorities have pressed for many years, usually without much success.
My Lords, I hope that this Report will prove something of a turning point in the matter. Local authorities have passed through a long period of uncertainty and, let us be frank about it, denigration; of indecision and criticism, often not very well informed. It has surprised me sometimes that persons could be found to join local authorities or to enter their service. The forthcoming Report of the Royal Commission will, I hope, mark a change and that the public and, indeed, some Departments of central Government, will come to recognise that local government is an essential part of our political democracy, not to be readily or lightly dismembered.
I hope that the Minister who will respond for the Government will be able to tell us whether the Government accept this part of the Report; and particularly whether the present Minister of Health and Social Security, to whose predecessor the Report was addressed, accepts this part of the Report. It is difficult to reconcile it with certain parts of the Green Paper, where it would appear to be clearly contemplated that some, at least, of these services, if not all, should be administered by some new central authority set up by the central Government—and I suppose consisting of persons nominated. If we cannot get an answer to that question to-night, I hope that the answer will not be too long delayed.
I do not think one can say much in this debate about the operation of these personal services. A number of noble Lords have spoken about the operation of a particular service about which they have special knowledge and experience; 1244 but although the Committee made exhaustive investigations into the operation of the services, notably those for children, and the Report is filled with suggestions for their improvement, the Committee actually made very few positive recommendations. The principal recommendations which they made are in the field of administration and not of the operation of the services; and I therefore propose, in the few moments for which I shall address the House, to turn to the administrative recommendations.
Before doing so I should like to say that the Report presents what is really a new approach and a new view of the place which these services should occupy. Most of these services came into being in order to meet the special needs of a particular class or section of the community, and since then they have been so administered. The Committee present a much wider conception of social service directed to the well-being of the whole community and not restricted to one class which they refer to as "social casualties". This new conception seems to me to be the most valuable, as it is indeed the most novel, aspect of this Report. It leads inevitably to the proposal to group all the services together into a single administrative whole, from which all needs, be they medical, educational, social or domestic, are to be met from within the group. This conception underlies all the Committee's administrative proposals. The social service department must be, in their view, a recognisable administrative unit, administered through a chief officer under the supervision of a social service committee who have no other obligations but the steering and guiding of the social service department. No doubt the single social service department which the Committee recommend will be the pattern upon which the majority of local authorities will reorganise their services.
The single social service department and a single committee are what the Committee recommended and what they desire to see. But the Report goes a little beyond that, and at this point I think the Committee will find that they no longer carry the local authorities with them. The Report goes on to recommend that the social service department and the appointment of a special committee and of a chief officer should be 1245 mandatory. The local authority, whatever the local conditions may be, are to have no alternative but to reorganise themselves on these lines. Mandatory committees have not been a great success in the past. Indeed, Lord Redcliffe-Maud's Report on the organisation of management in local government emphatically condemns them, and recommends that the statutory obligation to have certain committees, such as the children's committee, should now be withdrawn.
I am sure that the modern approach to this question of mandatory committees and mandatory chief officers is that when an obligation to provide a service is placed upon a local authority it is best to leave the local authority to decide for themselves how to carry out that service according to their own local circumstances and conditions, which, after all, they know best. Members of local authorities and their officers are likely to work much more enthusiastically in an organisation of their own fashioning rather than in one that has been forced upon them from outside.
The conception of a single social service department must involve the appointment of a chief officer who will enjoy the status and independence of a senior chief officer. That, I think, is one of the fundamental recommendations which the Committee made. The position of the chief welfare officer to-day varies in different authorities. His functions are sometimes confused with those of the medical officer of health. In some authorities he combines in his own person the functions of the two chief officers. There is no reason why the medical officer should not be the chief welfare officer, if he possesses the qualifications for that post, but he ought not to be at the same time medical officer of health and chief welfare officer.
The importance which the Committee attach to the chief officer in this new service leads them to recommend that the Minister should be consulted on the appointment and that the first appointment should be made subject to his approval. I think that in that recommendation the Committee have gone astray, and I hope that this recommendation will not be persisted in. Local authorities ought to be left to choose 1246 their own staff, without control from the Central Government. A local authority will never settle down under a chief officer who is not their own choice. The Redcliffe-Maud Report recognised that the chief officer appointments should be the responsibility of the local authority and recommended that where there is a statutory obligation requiring ministerial approval, as in the Children Act, it should be withdrawn. That was going a long way, and I hope that this proposal that the appointment of chief officer should be controlled in this way by the Central Government will not be persisted in.
My Lords, it will be some time before these recommendations can be carried into effect or, indeed, before the resources necessary to implement them are likely to be available. But I hope that the Government will be able to tell us before long how much of this Report they will be able to accept. They have been pressed to do so this afternoon from several quarters. Local authorities are already beginning to reorganise their welfare services, some upon the lines recommended by the Report and some otherwise. It is essential, too, that housing functions, welfare functions and the education services should be administered by the same tier of local government. They are not so administered to-day. Local authorities themselves recognise the importance of this change. No doubt the Royal Commission will recommend changes along the lines of this Report.
It is not easy to see how the reorganisation of these social services which these proposals would involve can be planned without some knowledge of what the future pattern of local government is likely to be. This Report, the Green Paper and the forthcoming Report of the Royal Commission ought to be studied and implemented together. Obviously the new pattern of local government cannot be worked out until the recommendations of the Royal Commission are known. The local authorities ought not to be encouraged to begin the reorganisation which these proposals will involve if they may before long have to undertake fresh reorganisation to give effect to the Report of the Royal Commission.
I have no wish to delay the Government in reaching their conclusions about 1247 what the future shape of the social services should be; nor do I see any reason why some delay in the implementation of the new services should do so. I hope that we shall not have to wait too long for the Minister's decision on the principles which this Report raises. I can assure him that he will have the full co-operation of the local authorities in re-planning the administration of these vital services, and I hope that where the local authorities have reservations they will not be lightly brushed aside.
§ 6.49 p.m.
§ LORD MORRIS OF GRASMERE
My Lords, I will not keep your Lordships long at this time of the evening, but I feel bound to say one or two things on the occasion of this debate, for which, like other noble Lords, I am most grateful to the noble Baroness, Lady Brooke of Ystradfellte, for initiating. I should declare an interest in certain aspects of the Report because I am Chairman of the Statutory Council for Training in Social Work and also Chairman of the Local Government Training Board, which is feeling a good deal of concern about the whole situation of training for social work.
As I am coming to the end of a period of six years as Chairman of the Statutory Council, I should like to offer one or two observations to your Lordships on my experiences during those six years. Before coming to training, about which I mainly want to speak, and quite briefly, perhaps I may say a word or two about the timing of decisions. When I decided to refer to this point, I did not realise that I should have the Chairman of the Royal Commission sitting so close to me on my right, but I still propose to say what I was going to say. It is perfectly true that several things are bound up here; and it is also true that in the present state of discussions about the implementation of democracy, about participation, devolution and local government, there are certain basic difficulties of principle which the Government will have to face. Therefore, there is good reason for not deciding anything until you can decide everything. There always have been good reasons for not doing that, and here there are special reasons.
If you look at the difficulties of timing, the Green Paper came out at the same 1248 time. If the Green Paper takes away the local health services from the local authorities, this will, of course, leave the health departments of local authorities with very truncated departments, and each authority will find itself in a complicated and difficult position with regard to its personnel, the chairmen of its committees and its general history of dealing with these problems in its area. It will be subject to all sorts of temptations. The Maud Commission Report also has a bearing on this. If the Commission reports in a direction (and many people think that it may report in this direction) which makes the number of authorities at some tier negotiable—and a number of authorities are referred to in the Green Paper by the Ministry as prima facie suitable authorities for Area Boards, roughly of the order of something like forty authorities—then it is difficult to see how in the main trends of opinion about Governments, about participation, local government and so on, the question will not arise whether the Health Service should go to the local authorities. These things are, therefore, very badly bound up.
I used to be not many yards away from the Chairman of the Maud Commission, a student and a teacher of politics, and I tried to tot up for myself last evening when, if all went well, the Maud Commission recommendations could come into operation. This was a personal effort, but I have heard other people, who should be able to do the sum, tot up to much the same effect. It seems to me that if all goes well it is probable that the main recommendations of the Maud Commission could hardly come into operation before 1974.
There are all sorts of political difficulties about great reforms in local government. Everybody expects that this is going to be a great reform, and it seems hardly possible that this could be done at an earlier date. Those who are working in the social services say (and the Seebohm Committee no doubt heard them say) that they have already been waiting for seven years, and this will be another five years or so. This is pretty difficult. There is a great deal of unsettlement among the social workers, the health visitors and the more specialised kind of workers, like the psychiatric social workers; there is great unsettlement in 1249 the health departments of the local authorities. And great unsettlement, of course, affecting recruitment. I will say a more important word about this in a moment.
There are grave difficulties, and the noble Lord, Lord Ilford, has referred to one of them. The Seebohm Committee think it important (and I agree with them) that this comprehensive committee should be spread over the nation, and should have in hand the control of the administration of the social services. The Committee also attach importance as to who the chief welfare officer should be, and, therefore, while they are moderate about their suggestion, they think that the Minister should have some hand in the appointment of the chief welfare officer. Both those points are of very great importance.
Yet everybody supposes that the Maud Commission are going to say that, probably at present, but above all when local authorities are reformed, there ought to be no nonsense about ridiculous interference on detail—and, indeed, on more than detail—with the authorities when they emerge in the new model. It is of course impossible to rebut that. The swing of opinion is in that direction, it is trying to press Whitehall to recognise that new model authorities, and certainly a great number of old model authorities, are capable of doing perfectly well many of the things on which at the present moment they are still tagged at every detail by the central Department. The pressure of opinion on this point is irresistible, and quite rightly so. On the other hand, it is also true (and this partly for a reason which I shall give again in a moment when speaking of training) that it is of fundamental importance that the Seebohm department for social work should come into existence in authorities all over the country, and that the chief welfare officers should be the right people.
The Government have a problem because there are several things that are not just local difficulties but difficulties of principle. But surely it should not be beyond the wit of a Government with the best Civil Service in the world, and themselves not without experience—the Houses of Parliament are not without experience of this kind of work—to find some way of seeing that these departments are set up; that the initial appointments, above all, are the right appoint- 1250 ments; and that no-one succumbs to the temptation, because of various local difficulties, of showing loyalties and making the wrong appointments. It should be possible to ensure that this change takes place without necessarily offending against the great principles of the relative independence and autonomy of the new model local government authorities. I know that some scholars think—and I believe they are right—that in the past the Ministry of Health have been less forceful in dealing with local authorities than have other great Whitehall Departments that deal with local authorities. The Ministry of Health have been less forceful than Whitehall would have been over education, less forceful than it would have been about almost anything else. But the fact remains that it is of great importance that these departments should be set up and that the right people should be appointed.
It is extremely important that the Government should say something. Surely they must be able to say something. If, instead of beginning to give their minds too much to the question of what in detail the ultimate set-up is going to be, they gave up their minds to the question, "When can we announce so-and-so, and what is the best thing to announce first?", and so on, I cannot help feeling that, even in recognition of these great difficulties of principle, they could say something. It really is important to say something. I feel tempted to remind your Lordships of a story of a friend of mine from this House. He is in India at the moment, so I can borrow his story. It is a well-known, story, I suppose, and perhaps he has not very great proprietary rights in it, but one of the stories, of which we know many, about the young officer who was drilling troops and getting into rather a mess is the one of how he got them into a position where they were heading straight for a precipice and he seemed to be incapable of any further instruction. The sergeant-major got more and more worried, and eventually said, "For Heaven's sake, sir, say something, even if it's only 'Good-bye'". The Government really must say something, even if it is only "Good-bye".
Now my brief words about trailing. In thinking about training, the Council of which I am Chairman, when considering what it ought to say to the Seebohm 1251 Committee—and the Seebohm Committee have agreed with it about this—thought that the basic thing about it was that we are, as trainers, at the present time in at the birth of—or only just after the birth of—a great profession, one of the great professions of the future. The social worker is able to do what he or she is able to do because of modern developments. Some developments we owe to the medical profession, some to the human sciences, and some to the development of politics. Far more is known about society through modern statisticians and sociologists, and all sorts of things are possible that used not to be possible at all. Social work as it now exists, no doubt largely arising out of the work of institutions dealing with criminals and out of the work of the medical profession, is something that is possible only in the modern age. But it will grow.
As the noble Lord, Lord Ilford, said, it is a very important point in the Seebohm Report that we are dealing here with workers. We are not dealing with just the submerged tenth of the population, the most unprivileged, which means, and must mean in general, the poorest part of the population. We are dealing with workers who increasingly are dealing with the whole population. Children's officers are dealing, not with small sections of the social structure; they are dealing very widely, and increasingly widely, with the entire population. Parents are going to schools to look after and bring up their children; they are seeking advice about their families and expecting more of the schools than ever. Of course, the wise middle classes always handed over to teachers their children at the age of eight and then never dealt with them except as guests thereafter. But, of the great masses of the population, more and more are going to the professionals, with all the developments of modern knowledge, about the bringing up of their modern families.
And this is true also of the social worker. More and more people in all classes are going to the social worker. Old people belong to all the classes of the community, and the people who are grateful for the help that they can get from the great social work services in dealing with old people, or with 1252 their physically handicapped, come from a very wide section of classes. I do not say they come from your Lordships' families in very great numbers, but in some cases they do come from your Lordships' families. They certainly come from a very large section of the population.
The social worker is a professional. He or she is a professional in the sense that the doctor, the lawyer or the teacher is a professional. Social workers have to use their own judgment to bring their body of knowledge and training and experience to bear on individual and family problems. They have to go into the family. They have to recognise things that may not be on the surface, and they have to adjust their knowledge, their training and their experience to giving advice; and it has to be taken as personal advice. When I said that this profession had only just been horn, I meant this. As has been mentioned many times in this debate, social workers have come into this great work through a number of different avenues; they have had a number of different titles. But increasingly in the last year, indeed increasingly in the last seven or ten years, they have realised that a great many of them have a lot in common; that they are all brothers in one main work, and that is the social work.
It is true that there are some people with elements of social work in their daily occupations, like teachers and health visitors who will have to stay in the educational services or the medical services. They are taking greater and greater interest in getting together with social work training authorities in introducing that element in their own initial training which has a social work content. But a great number of people with different titles — psychiatric social workers; almoners, as they used to be called; the social workers in the health services; probation officers and many such workers—have been drawing together and saying to themselves, "We are really all part of the same profession". They are gathering together in a national professional body. They have had a great deal of discussion and deliberation in doing this, but they are gathering together in a great national body.
The happiness and welfare of this country will depend a very great deal on 1253 the fortunes of this profession. Bear in mind that a great number of the things its members do will in many cases prevent some people from being ill; and such people will not reach the medical profession and will not reach the hospitals. In some cases action will prevent them from being really very ill. It is the way of society that in the future this is going to be an enormously influential profession, at least as influential as the teachers or, in future, the doctors. On the preventive side, the amount of work that will fall on the prevential workers—whether in the prevention of various kinds of ill-health or of other disasters—will to a very great extent turn on the social workers. Therefore our future depends to an immense extent upon the future of this profession.
In order to feel happy about themselves as a profession its members depend a great deal, of course, on a sound, solid, well-guaranteed and sustained system of training. Training is recognised as essential and enormously helpful to the job. Upon training depends carrying through a large volume of social work of high standard. Also, all the various employers in the services should be able to know where they are about employing people. All this is absolutely essential to the profession.
The Seebohm Committee have put up an immensely strong case for saying that it is absurd that when there is a basic professional training it should be in the hands of a great number of training authorities. Obviously there ought to be a comprehensive training authority. But I would add just one point. I think we have learned a great deal in latter years about the form that training ought to take. Lawyers have contributed to it; the chairmen of local authority committees, medical officers, social workers of great experience and distinction have all contributed a great deal to it. I could speak at some length on all the things we have learned, but I will not do so at this time of the evening.
However, there is another point. A profession which is, after all, a demanding one, and cardinal to the health and happiness of the community, has always tended in this country to seek to ensure that it should be governed by a professional body, and that part of the training and qualifications for the pro- 1254 fession should be under the control of a professional body. Again, one of the great trends of modern opinion is that in these days the country cannot really do, as it used to think it could, with the professions entirely under the control of the professional bodies. Whether or not it will ever think that about the doctors and lawyers, we do not know; but this is another of the great modern trends of opinion.
I believe that the social workers would be perfectly happy—no; "perfectly" is too strong a word: the social workers would be happy—if they felt that the training and establishment of qualifications for their profession were in the hands of a national comprehensive Council with a certain degree of independence. I speak here again with some experience, because the Council of which I have been Chairman is not, as I think the Seebohm Committee said, and as several people have said during the course of this debate, an advisory Council to a Minister. It is a statutory Council set up by an Act of Parliament, which in fact set up two Councils: the Council for Training in Social Work and the Council for the Training of Health Visitors. Its independent Chairman is appointed by the Privy Council. A good many members of the two Councils are appointed by the Minister of Health and some are appointed by other people—in the case of the social workers, for instance, they are appointed by the local authority. This has enabled the people who come under the ægis of the Council to feel that they are entering into the professional heritage, and it has helped them a good deal.
The Council has been a wonderful forum for the discussion of all the main principles that are involved, and it seems to me that, if I am right in thinking that we are in at the birth and early growth of a great profession that is going to be one of the fundamentally important professions in the future, then the comprehensive body which is to be responsible for the training of social workers should have something like the standing that the two Councils to which I have referred, with their special Act, already possess. After all, the workers are not employed by the Government Departments: they are employed by the local authorities, 1255 the hospital authorities, or whoever it may be. And the independent Council seems to me to be a rock on which the future of the profession could be well built.
It has been said that one of the great difficulties—and I am now very near the end of my speech—is the difficulty of finding people. It is of course perfectly true that when a service is expanding greatly it is difficult to find a large number of good, senior people because they only grow up and attain the necessary experience at a certain pace, and with expansion the posts cannot be filled. But it is not true in the social work professions at the moment that it is difficult to attract the right people.
The noble Lord, Lord Stonham, gave the figures for the increase in the training of social workers under the Council for Training in Social Work. The figures are quite impressive. The bottleneck is not the dearth of suitable people. The universities, colleges and schools of this country are turning out plenty of young people who want to work in this area. They are keen to do it, they feel called to do it, they have the intelligence to do it and a great proportion of them—not all, but a great proportion—have the necessary personalities and characters as well as the necessary intellectual ability and previous general education and training. There is a certain shortage of health visitors, but by common acceptance I think the shortage is now considered to be in the health services and not in what we are referring to as the social work department, and I need say no more about them. On the social work side there are plenty of candidates.
In so far as there is a bottleneck limiting the rate of expansion of trained social workers at the moment, it is not because of a lack of suitable applicants but because of the difficulty of finding top people, of good enough supervisors for the practical part of the training. This being professional, the practical part of the training is fundamental.
§ LORD WELLS-PESTELL
My Lords, I wonder whether the noble Lord would give way and allow me to ask him if he can explain the shortage of psychiatric social workers throughout the country, and also the shortage of probation 1256 officers, which is felt particularly in London?
§ LORD MORRIS OF GRASMERE
My Lords, I must not claim knowledge which I do not possess and, of course, the psychiatric social workers have other methods of control of training. But I believe my noble friend will find that it is pretty well accepted that the slowness of the rate at which the numbers of psychiatric social workers are increasing is primarily due to the shortage of places for training at the present time and not to the numbers of people coming forward who wish to be psychiatric social workers. I think my noble friend will find that that is so, but I must not claim to speak with authority on this subject. I can speak with authority about the social workers in the local welfare service.
I was saying that the practical part of the training of the professional workers, such as the bedside training of doctors, is absolutely vital. Just as the bedside training of doctors depends for its quality on the experience of the clinical teacher who takes the students round, so the practical part of the training of social workers depends on the quality of the older, experienced social worker who supervises the work. The danger is now emerging that there may be a certain shortage caused by the educational economies. We do not yet quite know, because there has not been time for this danger to emerge, but there have been signs that some of the colleges running the courses will find they have not got the necessary money, and we may run into a difficulty there. But at the moment the bottleneck is the shortage of supervisors for the practical work.
I want to emphasise—and I had better leave it at this—that the question of the growth of the profession, which matters so much to the community in the coming decades, depends on having the right arrangements for training. I have indicated what I think experience shows to be the very good arrangements for training, but it will be seen also that in the interests of the profession, the growth of the profession, the stability of the profession, the solidarity of the profession, the public spirit of the profession, it matters enormously also that in these departments of social work there shall 1257 be the right welfare officers. Without the right arrangements for training you cannot go on, in spite of the work of the schools and colleges, attracting the right young people into the social work profession.
§ 7.20 p.m.
§ LORD SANDFORD
My Lords, first I should like to add my own humble congratulations and applause to Mr. Frederic Seebohm and his colleagues for this Report. I will not choose quite the same words to express those congratulations as the noble Lord, Lord Stonham did, because when I hear the word "monumental" I think of burial grounds, and when he had finished his speech and I had peered through his various smokescreens and realised just how little he really said in the way of indicating what the Government's response was to be I felt that there was perhaps some slight connection. This is a very workmanlike Report and I think it deserves a more wholehearted welcome than the Government have so far felt able to give it. What I particularly like about the Report, and what I find so commendable and fascinating, is the way in which the philosophical and the administrative and the professional aspects have been woven together throughout.
If there are some criticisms—and I shall have some to make myself in a moment—I think we ought to recognise the very great difficulites under which the Committee have laboured. They have been mentioned during the debate. The first is the dilemma laid upon them in wishing to establish a new local authority service, the dilemma of choosing between strong central control, which I think all of your Lordships would agree is necessary in order to achieve high standards and to make a clean break, and on the other hand allowing that degree of local choice which I am sure is going to be one of the things which the Royal Commission on Reorganisation of Local Government will recommend, so that the whole idea will gain acceptance in local authority circles; it will give scope for variety and will ease experiment, of which there must be a good deal. The other difficulty is that there has been this huge number of bodies investigating and reporting in overlapping fields: the Plowden Committee, three separate committees on various aspects of local gov- 1258 ernment, staffing, reorganisation and management, the Report on Children in Trouble, the two non-Government Reports, highly relevant, the Williams Committee Report and the Aves Committee Report which is still awaited, and then on top of that the Green Paper on the reorganisation of the National Health Service and, for full measure, Lord Todd's Report. All these have a bearing.
In addition, I think their difficulties have been increased by the limitation of their rather awkward terms of reference. They were asked to report on local authority services, and this has meant that they were not able to deal as fully as perhaps they would like with the whole business of income maintenance, which has a very strong link here, or with probation and after-care, which was brought into this field in the case of the Social Work (Scotland) Bill. They were asked to deal with social services, and this has inhibited them from considering and reporting upon health services.
Before leaving the subject of thanks and appreciation, I should like to voice appreciation of the statutory workers already in the field. If these services are not at the moment all that we would desire, the fault certainly does not lie with them. As my noble friend Lady Brooke of Ystradfellte pointed out, it is mainly this splintered, uncouth set-up under which they are trained and in which they have to work, the meagre resources available to them, that are responsible. I believe our thanks are due to social workers for all they manage to achieve in spite of the confused and old-fashioned structures under which they have to live and do their work.
I would turn to the Report itself and reiterate the welcome that it has already received from my honourable friend Lord Balniel, who is the spokesman for the Conservative Party in the other place. The Conservatives have given the Report a warm welcome and urged the Government to implement it. But having done that, I want to go on to voice a mild criticism about the Report as a whole, using words taken from the Report itself. Paragraph 152 says:There is a lack of any clear statement about the aims of social action".And again, on page 180:…a clear and compelling idea of the aims of the new service1259 and of the new department is required. The Committee say that but they do not supply the answer. The nearest we get to a single clear statement of aims is in paragraph 2, where we read:The aim of the new service will be to enable the greatest possible number of individuals to act reciprocally giving and receiving service for the wellbeing of the whole community".I would agree with that statement and hail it as a rather fine one, but it is not reiterated anywhere else and it is certainly not developed. The right reverend Prelate pointed out that this marks a radical departure, as he put it; it strikes out into new territory from all the existing statutory services. This idea of ordinary people being encouraged by the service and through the service to give service is, in my judgment, far too lightly treated in the rest of the Report, with the exception of Chapter XVI where it is treated separately.
Having said that, there is indeed in this Report very much to applaud. I should like to single out an aspect mentioned already by the noble Lord, Lord Delacourt-Smith; namely, the emphasis in Chapter XIV on prevention and early warning, for surely without effective early warning and prevention the social problems of the community, as has already been demonstrated, clearly get out of hand. The whole problem of drug abuse and drug dependence is a case in point. We did not get anything like sufficiently early warning of this problem until it was upon us. I believe that the social service area teams will need antennae dispersed throughout the 100,000 people in the communities they are supposed to serve. Is not this one of the primary roles for suitable selected lay members of the community, people serving as the eyes and ears of the service, attuned for the first signs of trouble in their own street or neighbourhood? Incidentally, in this connection I cannot see how the social service area teams can afford to be without the early warning intelligence of young children in trouble at home that comes the way of the health visitors as they go about their ordinary duties. They must, if not under the same roof, be linked into this service in some direct way.
I believe the Report is right to give a prominent place in the next chapter, 1260 Chapter XV, to research, and it is right to distinguish between central and local research, both of which are needed and right, too, to emphasise that research, to be of any value, has to be a continuing process.
But my special welcome is for Chapter XVI on the community. This, I believe, is an excellent chapter so far as it goes, but the fact that this rather novel aspect is filtered out and treated separately in a chapter on its own is to me a sign that the statutory professional social worker, or at any rate those members who brought influence to bear upon this Committee, have yet to come to terms with the fact which we are constantly reiterating in Conservative social policy, that in caring for those who are lonely, in trouble or in adversity, it is families, neighbours and friends and voluntary bodies who have the greatest contribution to make, and that professional members of the social services are auxiliary and ancillary to them rather than the other way round. I particularly welcomed what the noble Lord, Lord Stonham, had to say on this point, because it convinces me that he, at any rate, shares my opinion. This last point is the truth which is glimpsed in paragraph 2 of this Report, when it claims that this service will enable the greatest possible number of people to act reciprocally, giving and receiving service for the wellbeing of the whole community. My complaint and my criticism is that that is a truth which, after paragraph 2, disappears from sight and is never fully developed. I believe it is this truth which, when it has been carried through to its logical conclusion, will develop our ideas on words from that of a Welfare State which is designed to provide a minimum service for the specially needy on to a Welfare Society, a community giving optimum care for all its members, which is a rather different thing.
May I now turn from the Report as a whole to the specific and particular plan which it proposes for adoption, and give it an unqualified, or very nearly unqualified, welcome? I refer to the plan for a social service department for each local authority and for area teams of around a dozen social workers under one roof, serving communities of about 100,000 people each. It is here where I believe the Committee have done their most workmanlike engineering job, on 1261 merging the various fragmented bodies that are operating at the moment; and it is particularly good when one considers how awkward were their terms of reference.
But acceptance of this plan leaves a number of difficult questions. What about the local authorities in which health and welfare have already been merged for some time? I am not talking now about the various London boroughs and others who have "jumped the gun" and have gone down the course in the wrong direction. I think that is most unfortunate and reprehensible, and I hope it will not be continued. It is that kind of action which makes it difficult to resist the demand from Governments when they come to Parliament and ask for mandatory powers to intervene and correct this kind of situation. No; what I refer to is those local authorities, I believe about one-third of the total number, who have already got their health and welfare departments combined. Are these links going to be broken? I think it would be unfortunate if they were.
The second question is, what is the logic—and here I am following the point which the noble Baroness, Lady Elliot, introduced—of excluding probation and after-care in this scheme for England and Wales, and including it in the Scottish social work department? I fail to see the reason for that. Thirdly, a question has been raised by several noble Lords already: what about the relationships between the area teams and social workers on the one hand, and the general practitioners, health visitors, home nurses, et cetera in the same locality, on the other hand? I think everyone, except perhaps some members of the two professions concerned (and the medical noble Lords who have spoken in this debate are exceptions here) can see how important it is for the patient that there should be this close liaison. But so much of this plan at first sight seems to have the effect of building up local social work departments against the health sections as though they were preparing for battle together rather than joining in the dance. I hope this impression is a false one, because from the patient's point of view I think it is essential that they should work together.
I have a few notes about the implications of the content and nature of train- 1262 ing, but I tremble to deploy them in full in the presence of the noble Lord, Lord Morris. I will take just a few extracts. What I should like particularly to welcome and emphasise is the need to go a stage further and incorporate into these generic syllabuses work with groups, work in residential establishments on the lines proposed by the Williams Committee, teaching and training to give a capability for working in and with communities when the committee under Dame Eileen Younghusband has reported upon that. Coupled with this, I believe, there is more to be taught and learned on how to develop in social workers the skill in building up more fruitful partnership between the statutory and voluntary workers. Here again, we have another Committee, under Miss Geraldine Ayes, which will give useful guidance on this aspect.
But there is still more to be thought about in this generic kind of training, and that is the whole business of community development—a different thing from working in communities, because where we are now creating new towns, building new estates, tacking new housing on to old country towns and villages, there is the whole problem of creating a community, bringing it into existence, before we can start thinking of caring for communities. This requires different skills which have to be taught. Also of this question of training (perhaps I have overlooked any reference to this in the Report, but the noble Lord, Lord Segal, certainly mentioned it) it would seam to me that we shall need something rather special in order to impart to the senior officers in charge of these social work departments a special kind of sensitive touch for managing such delicate departments. This is something I have not read or heard much about, but as one visualises the way in which these departments and area teams are going to have to work, this delicacy in touch seems to be something that needs to be thought about a great deal.
My final point on training is this. I hope that it will not be thought that this single door of the local authority social service department is the only point from which the skills of social workers will be deployed in the community. My hope is that many other bodies—such as, for instance, charitable organisations, the 1263 Churches, voluntary bodies and a whole range, perhaps, of private profit-making organisations—will find their ways of deploying these skills in their own ways, and thus bring further resources of money and of manpower to the service of society. It seems to me that this is the way we shall avoid the danger, which several noble Lords have mentioned, of building up a single, monolithic, bureaucratic statutory kind of paternalism of the worst sort.
Lastly, I come to implementation. We have been faced to-day with the choice of the Seebohm proposals, which might be called the "instant plunge", of an urgent, wholesale imposition of the whole scheme on a certain appointed day, with mandatory powers and all that. On the other side we have from the noble Lord, Lord Stonham, the "never, never" line, with hundreds more Reports which will have to be awaited, read through and so on and so forth, and no indication—certainly we have had none to-day—of any shred of Government policy.
§ LORD STONHAM
My Lords, there is only one Report that has to be waited for, not hundreds. But they have all to be read and considered.
§ LORD SANDFORD
My Lords, seventy answers to the questions you have already asked, and the Maud Commission Report, I thought, was a start.
I think there are grave objections and difficulties to both these plans. I think the chief difficulty to the "instant plunge" is that at this moment there simply is not the cash to do justice to the operation. Secondly, I think there is the logical objection that if you are working for a community-based service you have to put your roots in the community and let the service grow up out of it. It seems to me to be a contradiction in terms to talk about a community-based service and then "plonk" it down from on high. The objection, on the other hand, to the line taken by the Government so far has been eloquently stated by the noble Lord, Lord Morris of Grasmere, when he emphasises how unsettling this is among the professions. It has been emphasised by other noble Lords, who point out that local authorities are "jumping the gun" in various ways and going off in the wrong direc- 1264 tions. I would add that there are growing queues of patients and clients with serious unmet needs, and for this reason I have ventured (and I hope these suggestions will not weary your Lordships) to devise a brief scheme for the consideration of the Government as to what they might do between these two alternatives. The noble Lord, Lord James of Rusholme, provided me with a title when he used the phrase "accelerated piecemeal evolution" because that is what I believe to be perfectly possible at this stage.
These are the things which I suggest could be done. The first has already been eloquently advocated by the noble Lord, Lord Morris of Grasmere: to set up the Central Council advocated in the Report, at paragraph 640, and to do it forthwith, to develop further all the work done by the three Training Councils already in existence, and at the same time provide a focal point at which advanced planning and advice can be brought into one body. The second thing (and so far as I can see this can be done immediately, without waiting for further Reports or having any further consultations is to set up the central inspectorate, which is also advocated in the Report at paragraph 649. In the new Minister of Health and Social Security we have a suitable Minister for bringing that about. As the noble Lord, Lord Amulree, pointed out, this is not an inspectorate to regulate, to ask for a whole string of further statistics and so on, but to get around, to consult and to promote various developments which ought to be under way at this stage.
Thirdly, surely we can give a very warm welcome to the plans, already fairly well advanced, for the unification of all the separate branches of the profession, and also, in passing, a welcome to what I think is known as the "Social Workers' Action Group" dedicated to extracting from the Government some small shreds of policy statements. Fourthly, can we not, without further delay, encourage the National Institute for Social Work Training, mentioned by my noble friend Lady Elliot of Harwood, in co-operation with the Social Work Advisory Service, in getting more of the generic training courses proposed by Mr. Seebohm's Committee actually on the stocks? And could they not be encouraged to bring into this planning the local 1265 government training board, which it seems to me would have a great deal to contribute at this stage, and at this point to take into consideration the probation and after-care service, because that could be done without prejudice to whether they are coming into the area teams and the social service departments?
Fifthly, is it not possible to encourage the establishment here and now, not overall but here and now, and up and down the country, some area teams on the pattern suggested by Seebohm? This again, it seems to me, could be done without pre-empting anything that the Royal Commission on Local Authority Reorganisation is likely to recommend. There must be some places where there is now a willingness among the social workers in the field, and where it would be practicable from the point of view of the buildings and so on, to bring these area teams into being. They could then serve as test-beds for the ideas which are put forward in the Report for universal application. If we were to do that, would it not be possible to apply some of the money which the Government will be empowered to apply through the Local Government Grants (Social Need) Bill to build up area teams of this kind in those areas where there is the willingness to do it, but where nothing practical can be done without the injection of funds from outside? It seems to me that the Bill is drawn sufficiently widely for that to be Possible.
Having said all that, my Lords, I would entirely agree that, for all the reasons which have been deployed this afternoon, it really is not possible to set a "D-Day" for the implementation of the Seebohm Report before the publication of the Maud Report. But surely it might be possible to reach it before that Report is fully implemented. Coupled with these various steps which I believe could be taken in the statutory field, surely it is possible to expect a wide and vigorous response, independent of statutory action, from local voluntary bodies. It seems to me that they can take, and ought to take, a number of steps in order to be ready for the full implementation of this Report. First of all, there should be local directories of who is doing what in the social service field in each locality; a local assessment, by the voluntary bodies acting jointly, of social need; 1266 a local assessment of the resources of voluntary manpower in the Churches, in the schools, on the lines that have already been pioneered by Task Force, and in existing clubs. When that information is available ought it not to be possible for local voluntary bodies, through councils of social service, or councils of churches, to evolve new patterns of co-operation on comprehensive lines and having evolved the patterns to launch them, train the volunteers to work in them and make plans for further development?
I just throw these suggestions out for the consideration of the Government while they are hesitating about the line they ought to take on this Report but before we reach the moment for the plunge which the Seebohm Report points us to in the future.
§ LORD BALERNO
My Lords, before my noble friend sits down may I ask him a question concerning the exclusion of the probation services? I wonder whether he is aware that when the social Work (Scotland) Bill was before the House and was in Committee an Amendment to exclude the probation services was narrowly defeated by the Government. As it was a case of calling in the English to defeat the Scots on that occasion, I must say we were extremely grateful for the support we received from the noble Lord, Lord Wells-Pestell. May I just add that I personally hope that the Seebohm Report in this respect will be followed.
§ 7.49 p.m.
§ LORD KENNET
My Lords, this has been a most useful debate. When the topic for discussion is a document such as the Seebohm Report, covering so many interests and so wide a field, many views expressed are found to focus on some one or two of the many individual subjects covered in the Report, and it is no easy matter to single out for further comment individual points raised in debate. Before I turn to any of these points I ought to say, as other noble Lords have said, how important a field it is that the Seebohm Committee have surveyed for us. Many of us, while well acquainted with individual parts of it, did not know in detail the extent of the many-sided activities included within the personal social services. It is not the least of the 1267 services rendered by the Seebohm Committee that they have given us this valuable and detailed conspectus of them.
I now turn to some of the points which have been raised in to-day's debate. Let me say something on a point of detail which there was not time for my noble friend Lord Stonham to take up in the presentation by the noble Baroness, Lady Brooke. I should like to say how grateful I, too, am to her for having given the House this opportunity of discussing this matter. She mentioned the point about the Social Survey Report on Home-Help and asked when we could expect that Report to be in hand. I expect it to be in the hands of the Department of Health and Social Security in the spring of this year.
§ BARONESS BROOKE OF YSTRADFELLTE
My Lords, may I correct the Minister? That was not a question which came from me; it must have come from somebody else. But I am sure that whoever asked it will be delighted to have the noble Lord's reply.
§ LORD KENNET
My Lords, I beg the noble Lady's pardon for having pinned upon her a question which she did not ask, but I hope that the answer will be useful to somebody. The right reverend Prelate the Bishop of Leicester said that it was a continuous journey from the Elizabethan Poor Law to Beveridge and from Beveridge to Seebohm, and that they were milestones. Every Member of your Lordships' House will agree with this as a fair assessment of the situation. This enormous Report which we have before us to-day is indeed a milestone. I was particularly interested to hear the remarks of the right reverend Prelate about where, geographically, to concentrate the maximum social effort in this field. I hope that what he thinks about this matter will be met by developments in community development projects, about which I hope that an announcement will be made by the Government quite shortly.
A great many points were raised in the debate, and all were valuable. I do not want to jump about to say that the Government agree with this, or that they disagree with that, or that they do not 1268 know what they think about the middle ones, since it would be absurd to attempt to do so.
The noble Lord, Lord Amulree, raised a point about sheltered housing ("sheltered" is the Seebohm Committee's word, which they define), about old people, and about the need not to split up families when, unfortunately, they get into temporary accommodation. On the housing side of the Seebohm Report, the point about sheltered housing is one of the most important with which the Committee deals. As to not splitting up families in temporary accommodation, this is fully Government policy. Central Government at present do what they can to urge local authorities not to do this, and we believe that local authorities now do what they can to assist on this matter. There has been a considerable change in the practice in this field over the last two or three years.
The noble Lord, Lord Cottesloe, made most valuable remarks about the hospital service in general and its relation to the field of personal social services. The noble Lord, Lord Wells-Pestell, spoke about the division between the personal social services and the probation service—that is to say, the personal social services, which were within the terms of reference of the Seebohm Committee, and the probation service, which was not within its terms of reference, although they said something about it. And who shall blame them for that, because it is contiguous.
In regard to the remarks of the noble Baroness, Lady Swanborough, about the advantages of having a unified "welfare lady", that is to say, one lady from the welfare, this is what it is all about. The House to-day, and the Government in the following days and weeks, will attend to what she said with all the deference which is due to somebody with her vast experience in this field.
I think it was the noble Lord, Lord Segal, who first raised, at length and in substance, the relation of the general practitioner to this matter. This was later taken up in the complicated question of how one should relate personal social services to the general practitioner and, beyond him, to the hospital. This is certainly one of the main areas which will have to be taken into account in settling 1269 what to do in the matter which has been under discussion in to-day's debate.
The noble Baroness, Lady Elliot, laid emphasis in her speech upon getting the right people. This has been one of the main threads in this debate. One can easily devise roles for an ideal personality, but it may not always be easy in all parts of the country to find the personality to fit the role. This is a topic which is closely related to the training of people. I was glad to hear the speech of the noble Lord, Lord James of Rusholme, because schoolmasters, and those whose experience is with schools and universities, often seem to me to be held to be somewhat above the battle in the matter of the social services. He made the point as to how much more could be done by the schools as such and the welfare persons associated with schools. I think that this also is a most important matter in the decisions which will have to be reached in setting up the new system which we shall get.
The noble Lord, Lord Delacourt-Smith, was not alone in raising the importance of early warning. This is one of the keys to the whole question. The earlier one can find out that something is going wrong, the more likely one is to be able to prevent its getting worse. The noble Lord, Lord Platt, spoke about the need for people with human qualifications as well as academic ones. This point was related to what the noble Baroness, Lady Elliot of Harwood, said about getting the right people, because in this field nobody is right unless they have the necessary human qualifications.
If I may come to the speech of the noble Lord, Lord Ilford, he felt that it would be wrong to accept the Seebohm Committee's recommendation about the mandatory social services committee, and wrong to accept the recommendation that the chief officer of this committee in each local authority should be a person approved by Whitehall. The House and the Government, in taking up their position, should give considerable attention to the weight of the noble Lord's experience in the local authority world. Of course, to adopt this recommendation of the Seebohm Committee would seem to be going against the recommendation of the Report—which is called in the business "mini-Maud"—on management 1270 of their own affairs by local authorities, which tends away from the idea of mandatory committees and mandatory officers and goes towards the idea of leaving each local authority to carve up its business between committees and officers as it thinks fit.
The noble Lord, Lord Morris of Grasmere, if I understood him aright, seemed to be saying that the Central Government ought to be able to choose chief officers without in fact appearing to do so. I do not know whether I misunderstood him, but that was my impression of his speech.
§ LORD MORRIS OF GRASMERE
My Lords, I certainly did not wish to say that the Central Government should choose officers. Indeed, I commended Seebohm for being moderate in its suggestion as to the way in which the Central Government should take, some part in the process. I wanted to say that it should not be beyond the wit of man to find some way of seeing that all local authorities attach the greatest importance to appointing the right person, perhaps without offending against the principle of freedom to rule in their own house.
§ LORD KENNET
My Lords, I am sorry that I mistook the noble Lord's purpose. It was not quite clear to me. Lastly, the noble Lord, Lord Sandford—and I am sure that everybody would agree with him on this matter—spoke of the reciprocal giving and receiving of service, quoting paragraph 2 of the Report. This is the banner headline which spreads over the whole idea of reforming and improving our local authority personal social services. He spoke also of the delicacy of touch needed in managing these affairs, which I connect with the formulations of other noble Lords and Ladies about getting the right people with human, as well as the other qualifications. Every one of the suggestions which I have mentioned, and every one of those points which I have not mentioned, will be taken into account by the Government from now on in the period—which I hope will not be too prolonged—before the Government can come to a conclusion on this matter.
The right reverend Prelate the Bishop of Leicester said that my noble friend Lord Stonham seemed to be looking at 1271 the Seebohm Report through the wrong end of a telescope. I hope he will agree with me that he was only looking at it with a diminution of focus sufficient to accommodate the two or three other Reports which also have to be looked at through the same lens. My noble friend Lord Stonham said that it would be wise to consider together the topics raised by the Seebohm Report, by the Green Paper on the National Health Service and by the Report of the Royal Commission on Local Government. To this I would add also the former preliminary Report by the noble Lord, Lord Redcliffe-Maud—the one which we call "mini-Maud" as opposed to "maxi-Maud". The debate to-day has amply demonstrated the importance and complexity of the matters with which all these Reports are concerned. I think this emphasises the impossibility of dealing with them separately and attempting to reach conclusions on any one of them in isolation.
I should like to say a word about the timing of the Royal Commission's recommendations. I believe—and the noble Lord, Lord Redcliffe-Maud, will correct me if I am wrong—that his Royal Commission is in fact on the point of completing its Report. After that, printing will go forward as quickly as possible. This stage may take two or three months. It would be misleading of me to offer any precise forecast of the publication date, because the Royal Commission's Report is a bulky one. But the time interval which I have just mentioned is so short as to indicate that the Government should not attempt to reach final conclusions on Seebohm or on the Green Paper until we have all three Reports available for consideration together.
Several noble Lords have spoken in various ways of the possibility that something ought to be done by the local authorities even now before the Government have come out with their view on the matter. I refer to experimentation. Of course, it could be said that it is already going on and that it is in the minds of some authorities, and that where it is going on or is contemplated it is not always on the lines which the Seebohm Report recommended. It is also true, as has been noticed in this 1272 debate, that the Government are planning an experiment in community development on a national co-ordinated level, which I recently mentioned. This would certainly accord with the Seebohm Committee's thinking about co-operation between services and involvement of the people concerned.
But the essence of the Seebohm recommendations, to which these suggestions relate, is that they are about the form of organisation for local authorities' work—the comprehensive social service department. It may well be that some experimentation will prove a sensible way into the complex of problems involved, but the Government need to have some clear idea of the form in which one would like to see this work organised before embarking on or facilitating experiment in formal organisation. This, I think, is my answer to the point made by the noble Lord, Lord Sandford, who asked: why do we not make money available now up and down the country? I think the right way to do this is through the community development project. That is why, as my noble friend Lord Stonham mentioned at the beginning of this debate, the Government have been at some pains to urge that local authorities would be best advised not to "jump the gun" on Seebohm, but to await the Government's conclusions, which we shall make known just as soon as we can.
We have had a most interesting debate and I am sure we must all be grateful, as I said earlier, to the noble Baroness, Lady Brooke of Ystradfellte, for giving us the opportunity to discuss this very large and important Report. There can be no doubt of the vital importance of the topic. Every one of us here and outside must feel a concern about the way in which our community cares and provides for those in need and those unable, for one reason or another, to fend for themselves. With a Report as far reaching in its scope as this, it is very natural that much comment should have been aroused. Not all of it is favourable, of course; the Committee made over 200 separate recommendations and it would be idle to suppose that there are not several important fields in which weighty opinions have been voiced, disagreeing with the Seebohm views. They have been voiced here to-day.
1273 The Government are anxious that there should be the widest and frankest discussion of the Seebohm recommendations. That is well under way and will continue; this debate is part of it. The Government welcome the views that have been expressed to them by the interested organisations in this field, and they welcome particularly the comments that have been made by your Lordships in the course of the debate to-day. I think I may say that we have had a very well-informed exchange of views—it is extraordinary how our House provides, time after time on different topics, people who have spent their whole life in the thick of it; it happened again to-day—and an exchange of views which the Government will consider very closely as they consider what the next steps should be in dealing with the Report.
The noble Lord, Lord Morris of Grasmere, told a story about a sergeant-major marching troops over a cliff top. Actually it was not a sergeant-major; we all know that it is a naval story, but I will not dwell on that. The training noncommissioned officer or petty officer said to the eminent young officer trainee, "Good God, sir, aren't you going to say something, even if it's only, Goodbye?"; and the noble Lord said to the Government, "Aren't you going to say something to the Seebohm Report, even if it is only Goodbye?". I say to it neither "Goodbye", nor, "I embrace you in holy wedlock here and now". What I say to it is, "Stick around for just a little bit longer. There is one more important guest that we are waiting for."
§ LORD ILFORD
My Lords, before the noble Lord concludes his speech, may I 1274 put one question to him which I but earlier in the debate? Is the noble Lord able to say whether the Government have decided that these social services are to continue to be local authority services for which the local authorities are solely responsible?
§ LORD KENNET
My Lords, this is one of all those matters which, in the view of the Government, ought to be considered when we have all four relevant Reports before us. I refer to the first Maud Report, the Green Paper on the Health Services, the Seebohm Committee Report and the Report of the Royal Commission on the future a local government itself.
§ 8.8 p.m.
§ BARONESS BROOKE OF YSTRADFELLTE
My Lords, I am most grateful to Members of this House who to-day have taken part in this debate. The noble Lord, Lord Kennet, referred to it as a most useful debate. I must confess that I shall be prepared to say that it is a most useful debate only when I see what the Government intend to do as a result of it. But I should like to thank those noble Lords who have taken part. We have been here for just over five-and-a-quarter hours and I like to think that perhaps some good will emerge as a result. My Lords, I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.
§ House adjourned at nine minutes past eight o'clock.