HL Deb 09 December 1982 vol 437 cc282-357

4.40 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Lord Trefgarne.)

On Question, Motion agreed to.

House in Committee accordingly.


Clause 1 [Joint financing of community services in England and Wales]:

Lord Winstanley moved Amendment No. 1: Page 2, line 43, leave out (" and ").

The noble Lord said: I beg to move Amendment No. 1, standing in the Marshalled List in my name and the names of my noble friends Lady Robson and Lord Banks. Amendment No. 1 is merely a paving amendment for Amendment No. 2 and therefore I think it might be for the convenience of your Lordships' Committee if, in moving No. 1, I speak to No. 2. So far as Amendment No. 2 is concerned, it is a fairly simple matter. It merely seeks to add a further subsection (2)(f) at line 19 on page 3. This subsection, as your Lordships will see, enables the managers of a public transport undertaking to meet the cost of fare-free or concessionary transport which is provided for users of particular community services which are authorised by this Act. This would enable joint financing money to be used to subsidise patients' transport to the various services provided. In some cases, that could well enable people to receive care in the community rather than in hospital, and that is surely the main object of this Bill. In addition, perhaps it would move in the direction of seeing that the ambulance service is not used as a taxi service or as a public transport service, because it would facilitate the use of public transport for patients who are fit and able to use it at concessionary rates, or even free, in order to attend for the various services as authorised under the Act. I think the amendment is a fairly simple one and we believe it would be helpful. We shall be very interested to hear what the Government have to say about it at this stage, and I beg to move.

Lord Trefgarne

I believe I can instantly allay the fears of the noble Lord in this matter because the powers in the present Section 28A and in subsection (2)(a) already permit the health authority to give financial support to the local authority towards assisting with such transport costs. The provision of transport or assistance with transport costs in connection with the use of personal social services is a matter for the social services committee of a local authority, and it is neither necessary nor even perhaps appropriate for additional powers to be given to health authorities to make payments direct to public transport undertakings. I hope the noble Lord will be reassured by what I have said and will not wish to press the matter further.

Lord Winstanley

I am most grateful for what the noble Lord has said, but it will not have escaped the notice of the noble Lord or of others in your Lordships' Committee that there have been certain impediments placed in the way of transport authorities providing concessionary rates for transport. Therefore it is very welcome to hear the noble Lord's assurance that for these particular purposes obstacles will not be placed in the way of such concessions. I will read the noble Lord's words with care, but so far as I have understood them they seem to be entirely satisfactory. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 2 not moved.]

The Deputy Chairman of Committees (Lord Murton of Lindisfarne)

I have to inform your Lordships that if Amendment No. 3 is agreed to I shall not be able to call Amendment No. 4.

Lord Winstanley moved Amendment No. 3: Page 3, line 23, leave out subsection (4).

The noble lord said: I beg to move Amendment No. 3, which seeks to leave out subsection (4) on page 3 of the Bill. A major problem which impedes the whole strategy of getting patients out of hospital and into the community—which surely is a strategy that we all wish to see prosper and succeed—is caused by the old, large, institutional, mental hospitals. Those large hospitals are managed by one health authority, but traditionally and in practice they take patients from a very large number of different health authorities. The clause requires that a health authority making a payment for a joint funding scheme should be represented on the joint consultative committee recommending the payment.

The implication of that is that any health authority managing such an old hospital should be represented on a very large number of joint consultative committees. It has seemed to us that would indeed be a very substantial administrative burden. Moreover, in view of the strict definition of joint consultative councils provided on page 45 of the Bill, the Secretary of State would have to be asked to make a very large number of variation orders. Those are described on page 46 of the Bill. The amendment simply seeks to remove this particular impediment. I would imagine that the Government would not wish such an impediment to exist to a strategy on which we are all agreed, and it may well be that they have in mind other methods of dealing with this particular problem. If so, I shall be very grateful to hear what they are.

In the meantime, I regard this amendment as a probing amendment, pointing to an administrative difficulty—indeed, almost an administrative absurdity—which could arise from the strict application of this particular subsection. I shall be very interested to hear what the Government have to say about other means of dealing with this particular problem, and I beg to move.

Lord Trefgarne

I must confess that when I was considering exactly what the noble Lord had in mind regarding this amendment the precise difficulty he had in mind did not occur to me. However, may I refer to some of the problems that did occur to me and then I can add further remarks at the end in accordance with the speech of the noble Lord?

The arrangements for health authorities to make payments to local authorities and voluntary organisations which we are revising in this clause have always been seen as an integral part of the arrangements for health and local authorities to collaborate in the planning and operation of services of common concern. The development of such collaboration has been greatly helped by the availability of finance in this way. This subsection is designed to ensure that social services schemes are supported through joint finance as part of the wider joint planning between the authorities and that such schemes have the support of all the authorities concerned. It repeats subsection (3) of the present Section 28A, except that it now permits payments to be made to local authorities or voluntary-organisations outside the locality of the health authority. A health authority would thus be able to make payments towards enabling hospital patients to return to their home districts, wherever they might be.

As I said, the immediate problem the noble Lord has drawn to our attention is not one that I have considered in great depth. I should like to do so, and if the noble Lord will be good enough to withdraw his amendment I will give the point careful attention. I will write to him between now and the next stage and then he can take it further if he wishes to do so.

Lord Winstanley

I am most grateful for the noble Lord's assurance that he will look at this point. I do assure him that it really is a serious point and that we have no quarrel with the basic intention behind this part of the Bill but we really feel that so far as these old hospitals are concerned, taking patients from a very wide area, there can be some very serious administrative problems. On the noble Lord's assurance that he will look at that and perhaps produce a remedy for it. I should indeed be glad to seek the Committee's leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4.50 p.m.

Lord Wallace of Coslany moved Amendment No. 4: Page 3, line 28, at end insert— ("Such joint consultative committees shall include representatives of appropriate local voluntany organisations.")

The noble Lord said: The proposal of the Government, to include these joint consultative committees, increases their importance. In the past, they have not met very frequently and have played only a very small part in planning and co-ordination. But if local schemes are to reflect the innovatory ideas of voluntary' organisations, it is very important that voluntary organisations should be included in such committees and their importance should be enshrined in legislation.

I want to make the further point that it is quite clear that the Government are looking forward, more and more, to voluntary organisations taking part in their scheme of things, so far as social and other services are concerned. I do not have the slightest objection to that, because they do very valuable work. In view of that, it is only right, fair, reasonable and to the advantage of the services concerned that these organisations should have representation. I beg to move.

Baroness Faithfull

I rise to support the noble Lord, Lord Wallace of Coslany, because my Amendment No. 7 is practically the same and the wording of this amendment is very much better than mine. One cannot plan facilities in a local authority without consultation with the voluntary organisations concerned, including the people supplying private housing, particularly for the elderly. Therefore, I very much support this amendment and hope that the Government will be able to accept it.

Lord Trefgarne

I hope your Lordships will agree that, in discussing Amendment No. 4, we may also discuss Amendment No. 7, set down by my noble friend Lady Faithfull. My right honourable friend the Secretary of State for Social Services already has power to authorise or, indeed, require the appointment to joint consultative committees of persons who are not members of the authorities, and he most certainly could use this power in relation to voluntary organisation representation. However, we see difficulties, both of principle and of a practical nature, in such a step, given the large numbers of voluntary bodies in each health district, their differences of organisation and the fact that, at most times, the joint consultative committee will wish to have access to specialist knowledge, rather than generalised knowledge, about voluntary activities.

We do not therefore consider that direct membership of the consultative committee is the most effective way of involving the voluntary sector more closely in the provision of community care. What is needed is a voluntary sector voice at working level. Our forthcoming circular on Care in the Community will contain guidance on involving voluntary organisations more closely in the work of the joint care planning teams, and will ask authorities to invite local ' voluntary organisations to meet them and discuss ways of carrying forward the Care in the Community initiative.

But, as I said at the beginning, my right honourable friend has power to direct the appointment of such people to JCCs in appropriate cases, and he will certainly do so. I hope that in the light of this position, which I think is better than having it compulsory, as the noble Lord seeks in his amendment, he will see fit to withdraw it and, also, that my noble friend will not wish to press her amendment when we get to it.

Lord Wallace of Coslany

I cannot quite see the point. There are committees in the health service to which voluntary organisations are asked to nominate a representative. Most of these voluntary organisations have some degree of co-ordination between themselves, and there is not the slightest difficulty in appointing a representative. If the Minister has the powers—albeit, powers which he is, apparently, very reluctant to exercise—why on earth not put it in the Bill? It will be to the advantage of everyone concerned. I see no problem and I do not think that any Member of the Committee who is involved with local organisations, and with the general set-up in the community, will see any difficulty either. The Government are making a mountain out of a molehill.

I shall not press the amendment to a Division. I do not think that that would be advisable at this stage, considering that it is Thursday and a time when many noble Lords are trying to catch trains, some of which are not running. Therefore, to use a colloquial term, I am "using my loaf". With the permission of the noble Baroness, Lady Faithfull. I shall beg leave to withdraw my amendment.

Baroness Faithfull

I am not quite sure of the procedure. May I speak again?

Lord Trefgarne

Yes, as often as you like.

Baroness Faithfull

I am not clear on one point. My noble friend the Minister said that the Secretary of State can appoint somebody. What happens if there is a disagreement between the Secretary of State, a voluntary organisation and the consultative committee, if it is not written into the Bill?

Lord Trefgarne

I have no doubt that my noble friend was addressing that question to me. The difficulty is that the amendment seeks to make this compulsory in every case, and I argue that there will be a good number of cases where it clearly is not appropriate. I suspect that where there is a disagreement between my right honourable friend and the bodies concerned, the view of my right honourable friend will prevail, and so it should. But, of course, my right honourable friend will be very reluctant indeed to impose his views on anybody in these circumstances. No one knows better than I the difficulties of imposing views of any kind on voluntary bodies, because they, understandably, resent that very much. I am certain that my right honourable friend will want to go to the greatest lengths to avoid that. In the meantime, we are considering the amendment, which seeks to make this compulsory in every case, and that is the proposal which I ask your Lordships to resist.

Lord Wallace of Coslany

The noble Lord said that his right honourable friend is a very reluctant person. I entirely agree about that. My view is that he has been far too reluctant on far too many issues. However, I shall not waste the time of the Committee now, because we still have the Report stage. We shall not give up this point. At this stage, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4.57 p.m.

Lord Winstanley moved Amendment No. 5: Page 4, line 18, after ("question") insert ("or have been endorsed by the authority making the payment and the authority receiving the payment in the knowledge of the advice given by the joint consultative committee;").

The noble Lord said: This simple amendment seeks merely to expand, and perhaps liberalise, paragraph (a) of subsection (8) on page 4, by inserting the words on the Marshalled List. It is not unreasonable to envisage a possible situation which could arise where the health authority and one local authority, represented on a joint consultative committee, wish to make a payment, but where other local authorities—and there may be local antagonisms and jealousies—together with a minority of health members of the joint consultative committee, block the scheme.

Had she been able to be present, my noble friend Lady Robson would have moved this amendment. She has great experience in this area of the administration of the National Health Service. Unfortunately, she has had to absent herself from your Lordships' Committee to attend the funeral of a very close relative. But had she been here, she would have recalled an incident in a district in south-west Thames, which comprised a piece of Surrey and a very tiny piece of Hampshire. In my noble friend's words, the tiny part of Hampshire rarely got anything at all.

Notwithstanding this, it might be in the best interests of the patients for a scheme to go through in this minority area, if the two authorities principally involved agree, without the whole of the joint consultative committee necessarily supporting the arrangement. This amendment would allow this, provided that both the authorities concerned took their decision in the knowledge of the conflicting advice. I am sure that this is a provision which would very rarely be used, but it might be a worthwhile one to be inserted into the Bill. I shall be most interested to hear what the Government have to say about it. I beg to move.

Lord Trefgarne

The paragraph to which this amendment relates repeats one of the provisions in paragraph (3)(a) of the present Section 28A in requiring that the conditions relating to the payment accord with the advice given by the joint consultative council in making that recommendation. Since the arrangements for the joint financing of social services activities are part of the wider aspects of joint planning between health and local authorities on which the JCC has a statutory responsibility to give advice to the authorities represented on it, it seems entirely appropriate that payments by health authorities under the arrangements should accord with that advice. This requirement is one of the safeguards ensuring sensible and effective use of the National Health Service funds involved.

I have listened to the scenario of the noble Lord who pointed to a somewhat unusual circumstance. I fancy I recognise the district to which he refers, since I happen to live in it. Be that as it may, I do not live in the deprived area to which the noble Lord referred. I do not believe that in reality this will be a difficulty. On reflection and having listened to the assurances I have been able to give, I hope that the noble Lord will see fit to withdraw his amendment.

Lord Winstanley

I shall most certainly reflect upon what the Minister has said and will also consult my noble friend Lady Robson of Kiddington, who takes a great interest in this area and who has experience of problems having arisen. We shall most certainly consider carefully what the noble Lord has said and will then decide whether or not to ask your Lordships' House to return to the matter. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

5.2 p.m.

Baroness Faithfull moved Amendment No. 6: Page 5, line 4, at end insert— ("( ) The work of a joint consultative committee shall be reviewed every three years by each Health and Social Services Department jointly in England and Wales and a report of the review shall be submitted* to each local authority, to the District Health Authority and to the Department of Health and Social Security.")

The noble Baroness said: This is a probing amendment. So often we pass good laws but, because the joint consultative committees have not been monitored and surveyed and because reports have not been made and submitted both to the central Government department and to Parliament, work has not been done. The amendment recommends that the work of the consultative committees should be monitored: that reports on the work of the joint consultative committees should be made to both the social services committee and to the health committees and that these should be amalgamated at national level by the Department of Health and Social Security, so that every few years it will be possible to see what work is being done by the joint consultative committees. Unless we monitor the legislation which we pass we shall not know whether it is working successfully or whether it is being implemented. I beg to move.

Baroness Trumpington

I support my noble friend's amendment. It seems to me that a great deal of this work is probably already being done. It would merely be a question of letting interested members of the public know the facts. I cannot see that it would cause unnecessary work. Indeed, I believe that it would be a valuable exercise.

Lord Renton

I, too, would like to support my noble friend's amendment. I assume that we may refer also to Amendment No. 7 which is closely allied to Amendment No. 6. It seems to me to be unthinkable that the voluntary organisations should not be fully represented on the joint consultative committees. Unless that is so, I do not see how the committees could do their work.

Lord Davies of Leek

I should like Members opposite to know that we on this side of the Committee believe this to be a constructive amendment. It will keep people informed about this important organisation. I shall say no more. The nub of the argument is so clear that I have pleasure in supporting the amendment moved by the noble Baroness.

Lord Kilmarnock

I, too, wish to add my name to the chorus of support. I believe that the noble Baroness has shown great restraint in specifying three years. Parliament is criticised for requiring too many reports from the bodies which it sets up. A period of three years seems to be very reasonable. It will be of great interest to learn how the new joint consultative arrangements are working.

Lord Wallace of Coslany

May I also say that I support the amendment moved by the noble Baroness.

Baroness Masham of Ilton

Since I am concerned with very many voluntary organisations of which I am president, I, too must support this amendment.

Baroness Faithfull

Can we be quite clear which amendment we are speaking about? We are speaking about Amendment No. 6, the subject of which is not the voluntary organisations.

Lord Lyell

It might be for the illumination or enlightenment of the Committee (I am grateful to my noble friend for providing additional ministerial illumination) if I tried to clarify the difference between Amendment No. 6 and the voluntary organisations which are the subject of Amendment No. 7. I am sure that the Committee will be interested to hear that my right honourable friend the Secretary of State for Social Services already has powers by order to require the authorities who are represented on these joint consultative committees to make reports to him on the work of the committees and their sub-committees. There seems to be no need for additional legislation. Our view is that the planning process in the National Health Service already provides a satisfactory means of monitoring (this is as far as we would go) the development of joint planning, whenever this seems appropriate. At present, particular attention is being paid to joint planning in the regional reviews which culminate in the meetings which take place between Ministers and the regional chairmen. We are considering setting up a research study into joint planning and into collaboration in this field. After this brief attempt to illuminate Amendment No. 6, I hope that my noble friend will be similarly illuminated.

Baroness Faithfull

I am not very happy about my noble friend's reply. However much good work goes on within the confines of the Department of Health and Social Security, it is important that from the point of view of the National Health Service and from the point of view of the voluntary organisations and the public, what is being done and what is going on should be known at local government, district and regional level. The Court Report called for a triennial report on the work being done, but it was felt that this was not possible. This report would, however, be available to parliamentarians and to the public at large. If reports, however good, remain within the Civil Service and local government, the public know nothing about them. Having said that, although I am still worried, I should like to think again about the amendment. At this stage, therefore, and only at this stage, I beg leave to withdraw it.

Amendment, by leave, withdrawn.

The Deputy Chairman of Committees

Does the noble Baroness wish to press Amendment No. 7?

Baroness Faithfull


[Amendment No. 7 not moved.]

Clause 1 agreed to.

Clause 2 agreed to.

Lord Wallace of Coslany moved Amendment No. 8: After Clause 2, insert the following new clause: ("Payments to voluntary organisations. .The following shall be substituted for section 23(6) of the National Health Service Act 1977 (6) The Secretary of State may, if he thinks fit, make payments to a voluntary organisation towards expenditure incurred or to be incurred by the organisation in connection with the provision of any service under the Act.".").

The noble Lord said: On behalf of my noble friend Lady Jeger and myself, I beg to move the new clause. My comments will be brief. The Government's consultative document Care in the Community proposes that voluntary organisations might receive direct funding from the Department of Health and Social Security for joint finance purposes. That proposal has not been incorporated in the Bill. It is desirable that it should be and the new clause therefore incorporates it. I beg to move.

Lord Trefgarne

As the noble Lord, Lord Wallace of Coslany, has explained, the effect of this amendment would be to enable the Secretary of State to make payments to voluntary organisations towards expenditure incurred by them in the provision of health services. My right honourable friend the Secretary of State for Social Services already possesses the power to give assistance to voluntary bodies providing health services and personal social services by virtue of Section 64 of the Health Service and Public Health Act 1968. The amendment will not give my right honourable friend any new power and so I hope that the noble Lord will agree to withdraw his amendment.

If I may add a personal reflection. Section 64 is a provision which we use quite widely in the department. I myself have responsibility for authorising some of the grants which we make under that section of the Act. The noble Lord may be interested to know that in the 1981–82 financial year we made grants to no fewer than 250 organisations under that power, totalling some £8,881,000. Therefore, I hope that the noble Lord, Lord Wallace of Coslany, will be satisfied that not only do we have the power but we use it and use it widely, and that he will therefore see fit to withdraw his amendment.

Baroness Masham of Ilton

Before the noble Lord, Lord Wallace of Coslany, decides what he will do, I should like to support him, because I see no reason, if the Government have this power, why it cannot be written into the Bill.

Lord Trefgarne

It is already in another Act.

Baroness Masham of Ilton

Then would it not be easier if it were in this Bill as well? I should like to say to the Minister how grateful are voluntary organisations to the Government for the help that the Government give, because it enables them to keep going. I would also like to ask what the Government would do if it were not for these voluntary organisations, because, if one thinks about the Sue Ryder Homes, the Cheshire Homes, and all the other voluntary homes, I do not believe the Government would be able to cope if they all packed up.

Lord Trefgarne

If I may just intervene again to answer the noble Baroness, I am grateful for the words of appreciation she used for the Government's efforts. Of course, it is not the Government's money that we dish out with such largesse; it is the taxpayers' money. I believe the taxpayers get good value for the money we issue in this way, and I take note of what the noble Baroness has said. But I do believe that there is a considerable objection to adding another provision designed to achieve the same purpose as the earlier one. The Section 64 provision to which I have referred has worked very well for a long time and I hope that the noble Lord, Lord Wallace of Coslany, will be happy with that.

Lord Davies of Leek

In respect of Section 64 of the 1968 Act, the Explanatory and Financial Memorandum States that Part I of this Bill, make further provision, in relation to Great Britain, with respect to the financing of community services". What further finances are the Government making available if they are not prepared to explore at least the suggestion made in this amendment? This worries me when I look at the Green Paper on Income During Initial Sickness: A New Strategy. With all due respect, and without being malevolent, the new strategy takes a line opposite to that of Beveridge. The Green Paper states on page 2: Further, the fact that many employees receive the equivalent of full pay during sickness … is a curious and unintended outcome. Successive Governments have acknowledged that it is indefensible, but until now no serious attempt has been made to remedy it. We believe that when people are sick the maximum amount should be given to them. Again without trying to make a party political point, I believe that the new strategy is a little too harsh. There are voluntary services all over Britain outside the scope of national grants, such as the Women's Institute and the people who provide meals on wheels. There is a vast amount of voluntary money put in by ordinary people in helping out our social security schemes, and I feel that that should have a little more recognition.

I do not want to speak longer. This is an important Bill and we do not want to act stupidly and keep the House talking unnecessarily. I believe we should think in a little more depth about this amendment before it is withdrawn.

Lord Wallace of Coslany

I am not withdrawing the amendment at this stage because I cannot understand the Government here. The Government put into the consultative document Care in the Community a proposal on the lines of that which appears in the amendment I am moving. If the Minister has these powers—which one may find surprising, but they may exist—why on earth can they not be in the Bill? They will not do any harm; the taxpayers' money will not be dragged from the taxpayers and they will not have to pay more than is necessary because the amendment states quite clearly that, The Secretary of State may, if he thinks fit, make payments to a voluntary organisation", so there is no reason at all why this provision should not be in the Bill. I believe it ought to be in the Bill and I am not going to withdraw the amendment.

5.16 p.m.

On Question, Whether the said amendment (No. 8) shall be agreed to?

Their Lordships divided: Contents, 71; Not-Contents, 87.

Airedale, L. John-Mackie, L.
Ardwic, L. Kagan, L.
Avebury, L. Kaldor, L.
Aylestone, L. Kilmarnock, L.
Balogh, L. Leatherland, L.
Banks, L. Llewelyn-Davies of Hastoe, B.
Beswick, L. Loudoun, C.
Birk, B. Lovell-Davis, L.
Boston of Faversham, L. McGregor of Durris, L.
Bowdcn, L. Masham of Ilton, B.
Briginshaw, L. Mishcon, L.
Caradon, L. Molloy, L.
Collison, L. Northbourne, L.
Cooper of Stockton Heath, L. Oram, L.
Cudlipp, L. Phillips, B.
Darcy (de Knavth), B. Ponsonby of Shulbrede, L.[Teller.]
David, B. [Teller.]
Davies of Leek, L. Porritt, L.
Donaldson of Kingsbridge, L. Richardson, L.
Elwyn-Jones, L. Ross of Marnock, L.
Ewart-Biggs, B. Rugby, L.
Fisher of Rednal, B. Ryder of Warsaw, B.
Foot, L. St. Davids, V.
Gladwyn, L. Serota, B.
Gormley, L. Shinwell, L.
Hampton, L. Sleadman, B.
Hanworth, V. Stewart of Alvechurch, B
Harris of Greenwich, L. Stewart of Fulham, L.
Hatch of Lusby, L. Stone, L.
Hayter, L. Strabolgi, L.
Hooson, L. Taylor of Blackburn, L.
Hunt, L. Tordoff, L.
Hylton-Foster, B. Wallace of Coslany, L.
Ingleby, V. White, B.
Jacobson, L. Winstanley, L.
Jeger, B. Wootton of Abinger, B.
Abercorn, D. Eccles, V.
Ailesbury, M. Ellenborough, L.
Alexander of Tunis, E. Elliot of Harwood, B.
Ampthill, L. Elton, L.
Avon, E. Faithful, B.
Belhaven and Stenton, L. Ferrers, E.
Bellwin, L. Ferner, L.
Beloff, L. Forbes, L.
Bessborough, E. Fraser of Kilmorack, L.
Burton, L. Gardner of Parkes, B.
Campbell of Alloway, L. Gibson-Watt, L.
Cathcart, E. Glenarthur, L.
Coleraine, L. Hailsham of Saint Marylebone, L.
Colwyn, L.
Cullen of Ashbourne, L. Harvington, L.
Dacre of Glanton, L. Henley, L.
Davidson, V. Hornsby-Smith, B.
De La Warr, E. Kemsley, V.
Denham, L. [Teller.) Lane-Fox, B.
Dilhorne, V. Lauderdale, E.
Drumalbyn, L. Long, V.
Lyell, L. Seiborne, E.
McFadzean, L. Selkirk, E.
Mackay of Clashfern, L. Sharpies, B.
Mancroft, L. Skelmersdale, L.
Marley, L. Somers, L.
Merrivale, L. Spens, L.
Mersey, V. Stanley of Alderley, L.
Milverton, L. Stodart of Leaston, L.
Montgomery of Alamein, V. Stradbroke, E.
Mottistone,, L. Strathcona and Mount Royal, L.
Mowbray and Stourton, L.
Murton of Lindisfarne, L. Strathspey, L.
Norfolk, D. Swinfen, L.
Nugent of Guildford, L. Swinton, E. [Teller.]
Orkney, E. Teviot, L.
Pender, L. Teynham, L.
Pennock, L. Thomas of Swynnerton, L.
Plummer of St. Marylebone, L. Trefgarne, L.
Trumpington, B.
Portland, D. Ullswater, V.
Renton, L. Vaux of Harrowden, L.
Rochdale, V. Vivian, L.
St. Just, L. Wakefield of Kendal, L.
Salisbury, M. Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

5.25 p.m.

Lord Banks moved Amendment No. 9:

Before Clause 3, insert the following new clause:

("Amendment of s. 3 of Child Care Act 1980.

The following section shall be substituted for section 3 of the Child Care Act 1980

"Amendment of s Child Care Act 1980. 3.—(1) Where a child is in the care of a local authority under section 2 of this Act the local authority, if satisfied that one of the conditions in the following subsection is satisfied and that it is in the best interests of the child, may bring the parent or guardian of the child before a juvenile court.

(2) The conditions referred to in subsection (1) of this section are—

  1. (a) that his parents are dead and he has no guardian or custodian; or
  2. (b) that a parent of his—
    1. (i) has abandoned him, or
    2. (ii) suffers from some permanent disability rendering him incapable of caring for the child, or
    3. (iii) while not falling within subparagraph (ii) of this paragraph, suffers from a mental disorder (within the meaning of the Mental Health Act 1959), which renders him unfit to have the care of the child, or
    4. (iv) has so persistently failed without reasonable cause to discharge the obligations of a parent as to be unfit to have the care of the child; or
  3. (c) that a care order under paragraph (b) of this subsection is in force in relation to one parent of the child who is or is likely to become a member of the household comprising the child and his other parent; or
  4. (d) that throughout the three years preceding the application for a care order the child has been in the care of a local authority under section 2 of this Act, or partly in the care of a local authority and partly in the care of a voluntary organisation.

(3) On an application by a local authority under subsection (1) of this section the court may make one of the following orders—

  1. (i) a care order,
  2. (ii) a supervision order, subject to the conditions laid down in subsection (5) of this section.

(4) In determining whether or not to make a care order the court must be satisfied that one of the conditions in subsection (2) of this section exists at the time of the hearing and that the order is in the best interest of the child.

(5) Where the court is satisfied that condition (c) or (d) of subsection (2) of this section exist in relation to the child but the court decides not to make a care order, the court may make a supervision order if satisfied that such an order is in the best interest of the child.

(6) Before considering what are the best interests of the child the court must be satisfied that the local authority has fulfilled its duties under section 18 of this Act, and that the plans made by the local authority for the future care of the child are in accordance with the said section.

(7) Where, after a child has been received into the care of a local authority under section 2 of this Act, the whereabouts of any parent of his have remained unknown for twelve months, then, for the purposes of this section the parent shall be deemed to have abandoned the child.

(8) In the circumstances of subsection (2)(a) or (7) above and any other circumstances where the parent does not take any part in the proceedings before the Court, a guardian ad litem under section 7 of this Act shall be appointed for the purposes of the proceedings.

(9) Where an application for a care order in respect of a child has been made by a local authority under this Act it shall be an offence, punishable under section 33 of the Magistrates' Courts Act 1980 to remove the child from the care and control of the local authority except with the authority of a Court, or under authority conferred by an enactment or on the arrest of the child.".").

The noble Lord said: I beg to move Amendment No. 9. I think this amendment covers a substantial issue. I would like also, with permission, to speak to Amendment No. 150, which is consequential. The main effect of this amendment is to remove from local authority social services committees the power to take away the rights of parents over children who are in the authority's voluntary care. The amendment gives these powers instead to the juvenile courts and allows the parent to be heard and represented. The background to the amendment is this. The Poor Law Children Act 1889 gave the Poor Law Guardians the power to assume parental rights over any child in their voluntary care if they were satisfied that the parents were irresponsible. The law was passed in response to evidence that parents were placing children in the workhouse and then removing them when they were aged 10 and able to work. Ninety-three years later these powers now rest with the social services departments, who are still able to remove a parent's rights by administrative means. The principle is enshrined in the Children Act 1948 as re-enacted in the Child Care Act 1980.

Local authorities are able to receive children into care to meet a family crisis, such as illness, homelessness or the inability of the parent to cope. At the moment approximately 50,000 children are in care under these voluntary orders. The parent can remove the child at any time during the first six months of care or by giving one months' notice after six months have elapsed. However, the local authority can by administrative procedure remove a parent's rights over the child. They can do that at any time.

The procedure is relatively simple. If a social worker believes that a parent ought not to have his or her child back, a report stating the reason is prepared for the social services committee. The social worker must in theory satisfy himself or herself and the social services committee that one of several grounds is proved. This committee usually confirms any application for a parental rights resolution, but it may refer the matter back to the department. Neither parent nor child has the right to know that the resolution is being considered, let alone the right to be consulted beforehand or to be represented at the committee meeting. The local authority must, therefore, act as witness, counsel, judge and jury in its own cause. The parent may object and therefore be heard at any juvenile court, but must do so within 28 days. In many cases the parent may be asked to consent to the resolution in advance, and in doing so forfeits the right to object.

A study which was carried out by the National Council for One-Parent Families shows that the procedure in practice is heavily weighted against the natural parents. During the early part of this year workers from that body examined procedures in 30 different local authority areas. This revealed that no parent was heard by the social services committee, and only one of the social workers discussed the issues with the parent before a decision was taken; of the others, half either wrote or visited the parent before the resolution was taken, explaining that it was going to happen, and the others wrote or visited afterwards.

In some boroughs this letter was sent by a solicitor or the chief executive and the social worker followed it up with a visit. In other areas the letter went from a solicitor and no visit occurred. Many clients claim that they were given wrong information. The committee proceedings themselves varied. The case was usually put by the assistant director of social services or by the legal department. In some authorities the legal department was very involved, but in others not consulted at all. In only two authorities did the elected members challenge social work representatives at the committee. In some authorities the case worker was not present at the committee but was represented by a senior member of the department who had no direct contact with the family. A quarter of the parents were put in touch with lawyers and received legal advice. Of the rest the majority received none at all although a few managed to get in touch with pressure groups.

The rights resolutions themselves were taken for several different reasons. Some local authorities used the resolution as an absolute last resort after all rehabilitation had failed or where the parent had almost lost contact with the child. Others, however, saw it as a means of expediting long-term fostering plans and took the resolutions very quickly on the child coming into care. In five cases the resolution was taken in under three months and in one it was taken on the same day. Few parents actually understood the implications of the resolutions. In fact, several people actually consented, thus losing their right to object, while not in a fit state to do so. One mother, for instance, signed while she was an in-patient at a mental hospital. Others were told that if they did not consent their rights would be removed anyway.

Even if the powers were always used responsibly—that is, as a last resort after attempts at rehabilitation had failed—the procedure would still remain fundamentally unjust. The present system puts the social workers in an invidious position in that they are forced to act for all parties during the procedure. Neither parents nor child has a right to appear before the committee or have access to the social services department to put their point of view. Neither the parents' nor the child's case is presented legally at any time during the procedure. The committee members themselves have little training and very often act as a rubber stamp. They are advised by their own officers and act as judge and jury with the officers being the only witnesses.

The number of resolutions has increased from 12,400 in England and Wales in 1973 to 18,400 in 1980. At least 2,300 resolutions are taken each year in Great Britain. It is against this background that the amendment seeks the abolition of parental rights resolutions and the substitution of juvenile court orders for these resolutions. The proposed amendment abolishes parental rights resolutions and places on the local authority the responsibility to take the parent to court if it wishes to obtain the care and control of a child already in its voluntary care. The decision will be made by the court in possession of all evidence and opinion.

I understand that this proposal has the support of the family sub-committee of the British Association of Social Workers, the National Association of Probation Officers, the Magistrates' Association, the National Council for One-Parent Families, and other organisations intrested in child care. As we all know, there have been some horrifying cases of children suffering through not being brought into care, but mistakes are made in the other direction too, with suffering of a different kind. All of us agree that, unfortunately, there are cases where parents must be deprived of the responsibility for their children. The amendment seeks to ensure that the procedure for doing that where children are already in voluntary care, is fair and just. I beg to move.

Lord Hayter

On these Benches we find ourselves in some difficulty on this Bill because we do not understand the supernatural powers of the local authorities. How could they bring the parent or guardian of the child if, under subsection 2 (a) of the new clause; the parents are dead and there is no guardian? We do not understand that.

5.34 p.m.

Lord Avebury

I am sorry; I was distracting my noble friend when the noble Lord was putting that question.

I intervene briefly to pay tribute to my honourable friend Mr. David Alton, who introduced a Bill during the last Session in order to achieve the objectives that my noble friend described and who has fought a number of cases in this respect. I refer particularly to the case of Caroline Pritchard whose child was taken away from her but who, after an enormous struggle, succeeded through the courts in having the child restored to her care. I shall mention the sort of steps that she took. She even went so far as to write to various organisations throughout the country and to the Prime Minister, to whom she appealed as a mother to assist her in her fight for her parental rights. In that letter she told the Prime Minister how she had been through Liverpool Crown Court and lost and had paid out enormous sums of money in legal fees but had discovered in the end that parents had no chance of winning their child back especially, she said to the Prime Minister, if they have no money. I think this is an important point that we should bear in mind. If a parent has plenty of money she can obtain proper advice. She can go to the lawyers and resist the attempts by the social service committee to assume parental rights in the month that she has available to do that. Otherwise she may lose control for ever and not be in a position to get legal aid for the purpose of bringing actions in the courts. In any case, if she lets the month go by it is too late.

I draw the Committee's attention to an article about a particular case written by Polly Toynbee in The Guardian. In this article she says: To tell a mother that she is unfit is to strike at the most fundamental part of herself, and tell her she has failed in the most devastating way imaginable". This article is concerned with a young mother called Susan who had a baby daughter when she was very young, at the age of only 15. It was never suggested that she was incompetent to look after the child. She was extremely fond of it, but problems arose because Susan was living at home and she had rows with her mother and stepfather. In the end. Miss Toynbee writes, in a fit of depression she brought the child into the council's care and in describing why she did this afterwards she said: I wanted a couple of weeks to sort out what I felt, and what I should do". Her parents were absolutely appalled, but her mother realised that she did this as a kind of cry for help. There was no question of her being financially unable to look after the child. It was a good house and the stepfather was in work. Unfortunately, the daughter had friends who were a bad influence on her and at times the mother and the stepfather had rows. That was the background. But to the horror of the whole family what happened then was that four days after Susan had handed the baby into care she was told that the council had deprived her of all her parental rights. Susan and her parents had been given no warning that this was to happen and there had been no discussion with the social worker, no hearing, no court and no magistrate was involved, as my noble friend has described. Susan's social worker simply went round to the house and instructed them that the social service committee had made the decision on his advice. Later on the committee wrote formally saying that notice was given that the council had passed an assumption of parental rights resolution under Sections 3(1) of the Child Care Act 1980 on the grounds that you are of such habits and modesof life as to be unfit to have the care of the child". It told Susan that she had a month in which to object to the order.

She was so upset that some nights later she threw a stone through a shop window and stole a bottle of vodka. Of course, she was had up for that offence and the solicitor who represented her advised her that she ought not to object to the council's decision to take away her parental rights because if she did so it might affect the case against her for malicious damage. Having been given that advice, she omitted to take the one step which was absolutely essential in the whole process if she was going to contest the decision of the social services committee. She forfeited any rights over the child whatever through having let the month slip by.

It is almost unbelievable in this day and age that a parent can be left with no power whatever to assert her rights when the social services committee has made a decision behind closed doors and only one month has elapsed from the date of that decision. As my noble friend has said, since the few cases like this one have arisen, anyone who has come to consider the matter says that the law is wrong and that it should be amended. In these days when the Poor Law, thank goodness! has disappeared, we should take a completely different view of the relative rights of parents and the successors of the Poor Law guardians. I very much hope that the Committee will see fit to accept the amendment, because I am certain that it will not only give enormous hope to parents throughout the country who are affected by it, but it will be in accordance with the views of almost every expert who has studied the matter and in accordance with the views of all the national organisations that my noble friend has mentioned.

Lord Davies of Leek

With the permission of the Committee I should like to ask the noble Lord, Lord Hayter, for some clarification. I only want to hear what the noble Lord said. He put a point of which nobody seems to have taken any notice.

Lord Hayter

It is very kind of the Committee to allow me to clear the matter up. The new Section 3(1) which appears in the Marshalled List says that the local authority has to be satisfied, that it is in the best interests of the child". to bring the parent or guardian of the child before a juvenile court if one of the conditions in the following subsections is satisfied. One of the conditions is: that his parents are dead and he has no guardian or custodian". I could not understand how the two phrases were linked together. Maybe there is some drafting mistake?

Lord McGregor of Durris

Since its inception, the national Poor Law imposed a separate and special system of family law upon those within its care. Patches of that family law still survive, as noble Lords have pointed out. The people in the workhouse under the 1899 Act, whose children had been removed from them on the grounds that they were irresponsible, share many of the characteristics of those affected by this system today. Nowadays most of them, or at least about two-thirds of them, are lone mothers—one parent families. They are often the least educated, the worst informed and the least literate of our fellow citizens. Not only do they suffer all those disadvantages, but in this particular system they are stripped of their parental rights in circumstances in which, as noble Lords have pointed out, many of them have no understanding of the procedure under which it is done or the purposes for which it is done. This seems to me not so much an issue of social policy as an issue in the realm of what the fashionable rhetoric describes as "human rights". It is not creditable to a society that prides itself on possessing a judicial system which dispenses justice to all citizens on equal terms and gives all citizens equal access to that justice.

Manifestly, in these circumstances such women and such men—there are fewer men than women—have no access to justice. I can think of no grounds—and if there are grounds I hope that the noble Lord, Lord Trefgarne, will state the Government's view of what they are—on which it would be reasonable to resist transferring this administrative procedure into the courts. I can think of no circumstances, not even the death of a child, which would cause a greater shock or deprivation to a parent than having a child removed and being unable to get the child back. Let us change this procedure from being an administrative ukase to a matter of judicial determination.

The Marquess of Salisbury

I rise to support the amendment having had some experience of a similar case—one already mentioned by the noble Lord opposite. In that instance a family was deliberately broken up as a result of administrative action, although there appeared to be no real reason for assuming that the parents were incapable of looking after the children. In fact, the mother was a state registered nurse. I think that they were misled, as has been pointed out by the noble Lord who has just spoken, and did not understand the position. The case was taken up by two local magistrates who told me that they considered that it was a gross miscarriage of justice.

As I see it, as the law stands there are two factors which need amending. One is protection from the administration which, as the noble Lord, Lord Banks, has pointed out, is judge, jury and prosecutor. The other is that they should have an opportunity of being looked after. It, therefore, seems to me that if they have a right to go before the courts that would cover the injustices that exist at present.

Baroness Ewart-Biggs

I also would like to support the amendment and particularly to support what the noble Lord, Lord McGregor of Durris, has just said. At the same time I should like to bring out what to me is a really staggering statistic. It is thought, although estimates vary a little, that between 50 per cent. and 70 per cent. of the children in voluntary care come from one parent families. That is an overwhelming fact. It is true that children from single parent families are the most vulnerable. That is the case for varying reasons, one of which is that a single parent family would clearly suffer very often from a lower income and from poorer housing. However, the main reason is that the child would suffer from the anxiety felt by single parents who are trying to bring up their children alone and who have no one with whom to share their anxiety.

Therefore, it seems very likely that a single mother who is more often in a state of depression, anxiety or stress, and therefore more often in a state where she cannot make a rational decision about something, would fall into the trap of losing her child without having thoroughly understood the implications of the procedure. So from the point of view of the single parent family, I think that they need all the help that they can get. These families now number nearly 1 million in the country and I believe that this proposal would help them greatly.

Viscount Hanworth

I should like briefly and very strongly to support this amendment. First, the point I want to emphasise is that the existing system is not working well. It seems extraordinary that the safeguards rigorously applied elsewhere are almost totally absent in committing children to care. The social services committees seldom question their social workers' recommendations: nor are the possible methods of appeal by parents likely to be known by them and used. It appears that hardly, if ever, has a parent's point of view been put before the social services committee. Secondly, I believe that most social workers would welcome shifting some of the very invidious and difficult decisions to a juvenile court. I venture to think that the unfortunate mistakes which are given wide publicity are in part at least due to a reluctance by the social worker to take the major step of taking a child away from his or her parents. We all know that this is, per se, undesirable and a last resort.

Baroness Faithfull

I particularly wanted to speak last. I support this amendment but with sadness and misgiving. With sadness, because there are many single parent families with whom social workers work and with whom they have a very good relationship, and they should have a good relationship. They are able to talk to the mother and put the point of view to her: would she rather a Section 2 resolution be taken out, or would she rather the case goes to court? In the many cases with which I dealt under Section 2 of the Children Act 1948 a large proportion of mothers did not want to go to court.

Secondly, we should realise that if the social worker is a well-qualified, well-trained and understanding social worker, he will want to reunite the child with the parent despite Section 2, and it is perfectly possible to rescind the Section 2 right. The third point I should like to make concerns committees. I do not know the kind of committees about which the noble Viscount spoke. I can only say that when I worked in Oxford my committee certainly never accepted just like that anything that I said. Very many of the committees for which I have worked questioned everything very clearly.

I support the amendment, but I feel sad about it because I think that where a good relationship is established between the mother and the social worker, it is not necessary in all cases to go to court, and the decision should lie with the mother. However, the figures given by the noble Lord, Lord Banks, are so overwhelming, and the speech made by the noble Lord, Lord McGregor, so powerful, that I am convinced that this amendment must go through. Therefore, despite my misgivings and despite my sadness, I support this amendment.

Baroness Jeger

I hope that the Committee will support this amendment tonight. I must say that I share the confusion of the noble Lord, Lord Hayter, about some of the wording of the Bill, but it is not unusual for wording which is brought forward as an amendment at this early stage to be dealt with later, and I am sure any verbal misgivings can easily be put right.

Briefly, I think that an unanswerable case has been made. One reason I support the amendment is that those of us who have been involved in local government for a long time are very well aware of the difference between committees in various parts of the country, of the extraordinary range of ability and practice. In fact. I understand that the one-parent families carried out a review of the practices of 30 local authorities and found practically 30 different methods of dealing with these cases. In some areas neither parent was heard by the social services committee. In some cases the matter was put through the legal department and a document was sent out which was very difficult for a parent, especially a parent in trouble, to understand. In other cases a quarter of the parents were put in touch with lawyers and received some legal advice. Cases were quoted from other areas where no real attempt seemed to be made at contact or at advice, or at bringing the matter to fruition in a way in which the noble Baroness, Lady Faithfull, I am sure would have done whenever she faced these difficulties.

However, I am not talking about the best social workers or even the worst social workers; I am talking about the system. As has been said, it is a system which puts the social worker in an invidious position. It is a system under which neither the parent nor the child has a legal right to appear before the committee or to have access, as of right, to the social services department. I am sure that it happens in some authorities, but we are talking about rights which we want these parents and children to have, and we want them written into the statute. Very often neither the child's case nor the parent's case is presented legally, and, with all the sympathy in the world, there is a great disadvantage built into this system. The noble Baroness may say that it works well in some cases, but I am glad to hear that she will also support the amendment.

I am very influenced by the fact that this amendment is supported by the Magistrates' Association, a body of wise and experienced people. It is supported by the British Association of Social Workers and by many other experienced voluntary committees. Therefore, I look forward to hearing the Minister say that, apart from the help I am sure the Government will give in tidying up any contradictory wording, he will accept the principle of this amendment.

Lord Milverton

I should like to support this amendment, which seems a very reasonable one. I hope that Her Majesty's Government will be able to accept it.

Baroness Masham of Ilton

Before the Minister speaks, may I ask him how many such cases as are covered by this amendment arise each year? I have received many representations from outside bodies, as have most other noble Lords.

Lord Trefgarne

First, I very much appreciate the work of the noble Lord, Lord Banks, in bringing forward this amendment, and I appreciate that noble Lords who have spoken are motivated by a concern for the welfare of divided families and their children. I am sure that noble Lords will accept that we are equally concerned about this vulnerable group. We have, of course, been aware for some time of the representations which have been made by a number of groups and individuals about the law and procedures which are the subject of this amendment. We have also been considering the findings of research commissioned some time ago by the department.

I propose to address myself to the intention and the effect of this amendment rather than to the drafting details and the technicalities. The effect would be to do away with the power of local authorities, in certain specified circumstances, to pass a resolution taking over parental rights and duties in respect of children who have been placed in their care.

It would also do away with the right of a parent to agree to such a transfer of parental rights. Every case would have to be referred to the court, instead of only those cases where the parent objected to their rights being transferred. It has been argued that this would achieve consistency with the situation where a local authority is seeking a care order. There is no doubt that the law relating to children is very complicated and fragmented, and, partly for historical reasons, there are inconsistencies. I am bound to say, however, that the two situations—the seeking of a care order and the transference of parental rights—do not seem to me to be entirely similar; in the latter case, for example, the local authority will have been carrying out many of the responsibilities and duties of a parent for some time. Moreover, I am not convinced that the problems can be wholly resolved by a change in the law. It might be simpler if that were the case. But there is a need to find a balance between the interests of the child and the rights and wishes of the parents—I do not think we can ignore the fact that these sometimes conflict—and the need for a constructive and sensitive social work practice.

We have been looking at the present procedures and they are not, I agree, ideal. But it is clearly the intention of the law, it seems to me, that the decision about parental rights should always be referred to a court when the parent objects; and there are substantial safeguards designed to ensure that wherever a parent is not content with the local authority's proposal to take over parental rights he, or she, is given every opportunity to contest that proposal and to put their own case. We believe we must aim in the first instance to make sure that this intention is not frustrated because the procedures make it likely that parents will let their rights and opportunities go by default. This is where good administration and good social work practice come in, and this cannot be achieved by legislation alone.

We intend to explore with those who are responsible for providing social services, and with other groups who are concerned with the welfare of children and their families, the possibility of drawing up a code of practice for the operation of Section 3 of the Child Care Act. Such a code would provide a framework which would ensure that at every stage parents are given the information and advice which will enable them to take the fullest advantage of their rights under the Act, and would also encourage good social work practice with children and with their families.

Of course parents must have the right to a hearing in court and access to legal aid and advice, and of course they must be given all reasonable assistance to exercise these rights. But I believe we must consider whether the best interests of either children or parents are best served by exposing them to unnecessary court proceedings, when there may be scope for agreement between local authorities and parents about what is best for the child; or whether the parent's right to give a considered and informed consent and reach such an agreement with the local authority should be denied; or whose interests will in fact be served by proceedings when there may be no conflict between the authority and the parent, or when the parent has abandoned the child or disappeared and does not choose to take part in the proceedings. It does not seem that the court, in any of these circumstances, would have any alternative but to confirm that the local authority should exercise parental rights.

There are also practical considerations which we cannot ignore. We estimate that there may be up to 3,000 resolutions made each year—which is the answer to the noble Baroness. We do not know how many of these cases go to the magistrates' court, or to appeal. But there would undoubtedly be a significant increase in cases going before the courts, and it has been put to us that some of these cases might be lengthy. There would be significant additional costs to be met by local authorities and by the legal aid fund; and this at a time when there is important legislation on the statute book—I refer to the Children Act 1975—which we are anxious to bring in, and which I know noble Lords and some of my noble friends are anxious should be given priority. These are all matters which we have to consider. I do not wish to suggest that we believe there is any room for complacency about the present position, or that we have ruled out the possibility of any changes. We intend, in addition to the consultation exercise I have mentioned about a code of practice, to consider carefully whether any changes are needed, and we may conclude that changes or further safeguards are necessary. If that is our conclusion I have no doubt we shall want to use the opportunity of this Bill to bring forward proposals in another place.

I have taken careful note of everything that has been said tonight, and your Lordships have my assurance that we shall certainly bear those views carefully in mind. But in the light of the general assurances that I have been able to give—namely, that we accept that there are some difficulties, that we are considering the matter very carefully and that we will, if we can, bring forward proposals in the other place—I hope the noble Lord will feel able to withdraw his amendment.

Lord Banks

I should like to express thanks to all noble Lords who have supported this amendment—and as your Lordships have seen, it has been supported from every part of the Committee. There is clearly some strong feeling that there is here a need for reform. I think the noble Lord who raised the question of drafting had a point. There is some room for improvement in the drafting. The intention is clear, that in certain circumstances the local authority should have recourse to the juvenile court; but perhaps the wording could be improved. That could always be done at a later stage.

I sympathise with the noble Baroness, Lady Faithfull, and understand her reluctance, but the fact that she, with all her long experience in social work, came to support this amendment is significant. I am sure she would agree that the fact that the family subcommittee of the British Association of Social Workers have supported it is also a significant fact. I appreciate that the noble Lord, Lord Trefgarne, was endeavouring to take a helpful attitude in the matter; and I am glad that consideration is going on beyond the term of the passage of this Bill through Parliament. It would seem, unfortunately—and I regret it—that the Government do not feel able to take action at this particular point of time. If we are to remain with the old system then a code of practice would no doubt help, but I doubt very much whether it would eradicate all the faults in the present arrangements to which noble Lords have referred.

While it is true that a parent may protest within 28 days and the case goes to court, not many parents are aware of that. Many are not aware of it and do not understand that they have this right, but that it must be taken within that time, and that if it is not taken I within that time then they lose the right altogether. I feel there has been so much support expressed for the amendment that we ought to test the feeling of the Committee, and that is what I should like to do.

6.9 p.m.

On Question, Whether the said amendment (No. 9) shall be agreed to?

Their Lordships divided: Contents, 65; Not-Contents, 84.

Airedale, L. Kaldor, L.
Ardwick, L. Kennet, L.
Avebury, L. [Teller.] Kilmarnock, L.
Aylestone, L. Lauderdale, E.
Banks, L. Llewelyn-Davies of Hastoe, B.
Belhaven and Stenton, L.
Beswick, L. Lovell-Davis, L.
Boston of Faversham, L. McGregor of Durris, L.
Bowden, L.
Briginshaw, L. Masham of Ilton, B.
Caradon, L. Milverton, L.
Collison, L. Mishcon, L.
Crowther-Hunt, L. Molloy, L.
Darcy (de Knayth), B. Northbourne, L.
David, B. Ponsonby of Shulbrede, L.
Davies of Leek, L. Rea, L.
Diamond, L. Ross of Marnock, L.
Elwyn-Jones, L. Salisbury, M.
Ewart-Biggs, B. Serota, B.
Faithfull, B. Shinwell, L.
Gibson-Watt, L. Stedman, B.
Gladwyn, L. Stewart of Alvechurch, B.
Gormley, L. Stewart of Fulham, L.
Hampton, L. Stone, L.
Hanworth, V. Slrabolgi, L.
Harris of Greenwich, L. Strathspey, L.
Hatch of Lusby, L. Taylor of Blackburn, L.
Hooson, L. Wallace of Coslany, L.
Irving of Dartford, L. White, B.
Jacobson, L. Winchilsea and Nottingham, E.
Jeger, B.
Jenkins of Putney, L. Winstanley, L. [Teller.]
John-Mackie, L. Wootton of Abinger, B.
Kagan, L.
Airey of Abingdon, B. Mackay of Clashfern, L.
Ampthill, L. Mancroft, L.
Avon, E. Marley, L.
Bellwin, L. Massereene and Ferrard, V.
Bessborough, E.
Birdwood, L. Merrivale, L.
Brougham and Vaux, L. Mersey, V.
Burton, L. Mottistone, L.
Campbell of Alloway, L. Murton of Lindisfarne, L.
Carrington, L. Nugent of Guildford, L.
Cathcart, E. Onslow, E.
Chelwood, L. Orkney, E.
Coleraine, L. Pender, L.
Cullen of Ashbourne, L. Platt of Writtle, B.
Dacre of Glanton, L. Plummer of Saint Marylebone, L.
Davidson, V.
De La Warr, E. Porritt, L.
Denham, L. [Teller.] Portland, D.
Digby, L. Renton, L.
Drumalbyn, L. Rochdale, V.
Eccles, V. St. Just, L.
Elliot of Harwood, B. Seiborne, E.
Elton, L. Selkirk, E.
Ferrers, E. Skelmersdale, L.
Ferner, L. Slim, V.
Fraser of Kilmorack, L. Somers, L.
Gardner of Parkes, B. Spens, L.
Glenarthur, L. Stanley of Alderley, L.
Greenway, L. Stodart of Leaston, L.
Hailsham of Saint Marylebone, L. Stradbroke, E.
Strathcona and Mount Royal, L.
Harvington, L.
Hayter, L. Swinfen, L.
Henley, L. Swinton, E. [Teller.]
Hornsby-Smith, B. Teynham, L.
Hunter of Newington, L. Thomas of Swynnerton.
Hylton-Foster, B. Trefgarne, L.
Kemsley, V. Trenchard, V.
Killearn, L. Trumpington, B.
Lane-Fox, B. Ullswater, V.
Lawrence, L. Vaux of Harrowden, L.
Long, V. Vivian, L.
Lyell, L. Wakefield of Kendal, L.
McFadzean, L. Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

Clause 3 agreed to.

6.18 p.m.

Baroness Faithfull moved Amendment No. 10:

After Clause 3, insert the following new clause:

("Children's regional planning committees.

. The following section shall be substituted for section 32 of the Child Care Act 1980

"Children's regional planning committees. 32.—(1) Notwithstanding the responsibilities given to local authorities in section 3(1) of this Act. where at least two-thirds of the local authorities in a regional planning area (as established by order of the Secretary of State under this Act) agree to retain or re-constitute a children's regional planning committee for that area then it shall be the duty of the local authorities in that area to establish such a committee for the purposes stated in subsection (3) below.

(2) The provisions of Schedule 1 to this Act shall have effect in relation to any children's regional planning committee established pursuant to subsection (1) above.

(3) The purposes for which a children's regional planning committee shall be established under subsection (1) above are—

  1. (a) to prepare and approve plans for the provision by local authorities and voluntary organisations of community homes oflering special facilities intended to meet the needs of other local authorities in the planning area;
  2. (b) to approve any changes in the planned provision of community homes offering special facilities provided under paragraph (a);
  3. 306
  4. (c) to provide information and advice to assist local authorities and voluntary organisations in the planning area to carry out their child care functions and responsibilities.

(4) Where a regional plan prepared pursuant to subsection (3) above includes provision for a community home offering special facilities to be provided by one of the relevant local authorities it shall be the duty of the local authority concerned to provide, manage, equip and maintain that home.".").

The noble Baroness said: This amendment concerns regional planning committees. As your Lordships will know, under the Local Authority Social Services Act 1970 England was divided so that the various regional planning committees could decide the work of the areas in relation to residential care and shared facilities. This Bill makes it possible for regional planning committees to be done away with, and I agree with that; there are many such committees which do not serve a useful purpose. Under the amendment, however, if a regional planning committee wishes to continue, and two-thirds of the members wish to continue, then it shall be able to do so.

Secondly, smaller authorities in particular are unable to supply—and it would be impracticable for them to do so—a wide range of specialist interests for the different types of children in care who need specialised types of treatment. If the regional planning committee in that area, at their wish, continues, then they will be able to share the facilities as between the local authorities.

Thirdly, where there is offered a specialist facility of a residential establishment for a particular type of child, it could not be closed unilaterally. One authority might want to close it, but the other authorities might want to use it. Therefore, I move the amendment so as to ensure that in those areas where the regional planning committees are serving a purpose, they may continue to do so. I beg to move.

Lord Trefgarne

I can well understand the purpose of the amendment, and I certainly appreciate the strong feelings, at least in some quarters, that have inspired it. None the less, I hope to be able to persuade my noble friend not to press the amendment. The effect of accepting the amendment would be to enable a majority of local authorities in any of the existing regions to impose their wishes on the minority and deprive them of the devolution of powers and duties, which is the main purpose of Clause 3.

There is nothing in the Bill which would prevent any grouping of local authorities from getting together to plan and provide residential services for children. Indeed, there is nothing to stop any existing children's regional planning committee from continuing in existence, if the local authorities concerned so desire. What the Bill proposes, and what the amendment would negative, is that a statutory requirement to plan residential provision for children in this way should no longer exist.

Co-operation and joint planning will certainly be necesssry in the future as in the past, but the Government are proposing that each local authority be allowed discretion as to how it fulfils its statutory requirement to provide adequate residential accommodation for children in its care, and related welfare provision. The Bill opens the way to new and more flexible forms of co-operation, better suited to local circumstances. It imposes no duties on local authorities in this respect. I would suggest that a duty to co-operate imposed on an unwilling party would be ineffective and self-defeating. It is for those reasons that I hope that my noble friend will not press her amendment.

Baroness Faithfull

Not unnaturally, I am disappointed by the reply of my noble friend the Minister, because the situation could work the other way. The amendment provides that if two-thirds of the membership of a regional planning committee wish it to continue, it shall continue. Taking into account what the Minister has said, it seems that the minority can control the majority. I have personal experience of this kind of situation arising from when, in a voluntary capacity, I was responsible for setting up a small hostel for very difficult boys. Local authorities which had used it did not continue to support it. They withdrew their boys, and so we had to close the hostel. One of two boys who had been in the hostel for three years is now serving a prison sentence of nine years, and the other is serving a sentence of five years. I would dare to suggest that had the hostel remained open, those boys would not be in prison. However, I shall not press the amendment at this stage, but I hope to discuss it with the Minister and, if necessary, I shall bring it forward again at Report stage. I beg leave to withdraw the amendment.

Lord Davies of Leek

Before the Minister answers the noble Baroness, will he help to clarify my mind? Under the Criminal Justice Act 1982 RPCs are required only to prepare a plan for submission to, and approval by, the Secretary of State for the provision and maintenance of community homes, including voluntary homes designated by the plan as controlled or assisted community homes for the accommodation and maintenance of children in the care of local authorities. The abolition of the statutory requirement makes it necessary to place these or similar duties upon local authorities. What has been put in the place of the statutory duty that hitherto existed? Is not the position nebulous and unclear? What constructive answer can be given to the amendment of the noble Baroness?

Lord Trefgarne

If I have the permission of the Committee to speak again, since my noble friend has I think sought leave to withdraw her amendment, I shall briefly answer the noble Lord. We do not really see that the function that the noble Lord describes would be advanced by imposing upon unwilling authorities an obligation to plan together with others. It might be thought that that kind of mandatory arrangement would effectively prevent some local authorities which provide homes with much-needed facilities from withdrawing them. But it is most unlikely that such authorities would not continue to make available spare places in their homes for other authorities, since this is the obvious way to keep down the running costs and maintain viability. I am of course also dealing with the point that my noble friend raised. I think that I should be trespassing unduly on the patience of the Committee if I were to continue further, but I think that the noble Lord's fears are unfounded.

Lord Davies of Leek

I thank the noble Lord.

Amendment, by leave, withdrawn.

Clause 4 [Closure of controlled or assisted community home]:

6.26 p.m.

Baroness Faithfull moved Amendment No. 11:

Page 9, line 10, at end insert— (" ( ) Before taking a decision to close a controlled or assisted community home, a local authority shall give priority to the special needs of children being fulfilled by a particular controlled or assisted voluntary school or home and shall consult with the voluntary organisation concerned.")

The noble Baroness said: Had the previous amendment been passed, this amendment would have applied in the case of local authorities where there are no regional planning committees. A worrying situation is at present evolving in the country concerning facilities for children who need a particular service: for instance, diabetic children and dyslectic children. A number of voluntary organisations run community homes or assisted homes, in particular for the severely maladjusted child. These are specialist homes. Because they are under financial pressure, many local authorities are withdrawing their children and are not using these specialist homes that children most need and that are run by voluntary organisations. The local authorities are withdrawing the children in order to keep open their own homes, in their own areas, and maintain their own staff. That action is quite understandable, but what is important is the welfare and well-being of the child. Where there is a specialist home providing a service that the local authorities cannot give, the local authorities should not give up using the home in order to use their own homes. I beg to move.

Lord Trefgarne

I fear that my noble friend's amendment gives me a little difficulty. If I correctly understand her intention, it is that before a local authority sets in motion the procedure to close a community home, it should first give consideration to the special needs of any children that are being fulfilled by the home, and by consulting the voluntary body concerned ensure that alternative arrangements are made. If that is indeed my noble friend's purpose—as, from what she has just said, I think it is; and I have to make certain deductions from the amendment as drafted—then I am happy to assure her that the Government are in sympathy with it. Moreover. I can show that the worthy objective that she seeks will in fact be achieved through statutory safeguards in the primary legislation and indeed those proposed in this Bill.

First, however, I ought to point to the ambiguity of the amendment as drafted. It is not really clear what duty would be imposed on a local authority by it. The authority is asked to "give priority" to children's special needs, but the amendment does not indicate what the object, or the effect of doing so, would be. Nor does it indicate the object, or the effect, of the second duty—that of consulting the voluntary body. For that reason, I fear that the amendment is technically defective.

However, putting that to one side, I would draw my noble friend's attention to the new Section 31 of the Child Care Act 1980, which Clause 3 proposes to insert. This lays a duty on local authorities to have regard to the need for ensuring the availability of accommodation of different descriptions, and suitable for different purposes, and the requirements of different descriptions of children. If, therefore, a local authority decided to withdraw its designation of a controlled or assisted home, and, as a result of its subsequent closure, the special needs of children being fulfilled by that particular home could not be met elsewhere, the local authority would be in breach of its statutory duty under that provision.

In taking action which would result in the closure of a controlled or assisted home under the new Section 43A proposed by the clause, the local authority is required to give two years' notice. This is the same period of notice that voluntary organisations must give under Section 43 of the Child Care Act 1980 if they wish to withdraw a home from the community home system. There is, therefore, strict comparability between the existing provision and the one proposed. Two years is long enough for alternative arrangements to be completed satisfactorily both for the children in the home and for any children with similar needs who might be placed in that home in future.

Although the proposed Section 43A allows my right honourable friend to make an order which would effectively shorten the period between the giving of notice and closure—again comparable with Section 43—he is, under subsection (4) of this clause, required to consult both the voluntary organisation and the local authority before doing so. One of the purposes of this requirement to consult is for him to satisfy himself that earlier closure will not create a situation where hasty alternative arrangements for the children have to be made or that no provision will exist for children with special needs which were being fulfilled by the home in question. He will be concerned, therefore, with the appropriate timing of any effective closure earlier than two years, and such factors would have a bearing on the date when the order would come into effect. I am satisfied, therefore, that the provisions introduced by both Clauses 3 and 4 of the Bill are sufficient to meet my noble friend's intentions and anxieties and I hope, in consequence, that she will agree not to press her amendment.

Baroness Faithfull

I am grateful to my noble friend the Minister for his explanation. Despite present legislation, I think that I have to say that there have been children withdrawn by local authorities from voluntary homes without consultation. However, perhaps I may write to my noble friend the Minister at a later stage asking, if this is done and it is against the legislation, what action can be taken and by whom.

Lord Trefgarne

I shall be very happy to look into any specific case that my noble friend brings to my attention and, if the response that I give her is not satisfactory, doubtless she will feel free to raise this matter at the next stage.

Baroness Faithfull

I thank my noble friend for that. I will look at this and think about it and, if I may, discuss it with him. At this stage, I beg leave to withdraw my amendment.

Clause 4 agreed to.

Clause 5 agreed to.

Schedule 1 [Children and Young Persons.]

Lord Lyell moved Amendment No. 12:

Page 23, line 38, leave out ("or section 55 of the Adoption Act 1976").

The noble Lord said: It may be for the convenience of the Committee if we discuss Amendments 12 and 13 together. These are drafting amendments which clarify the wording of paragraph 9 of Schedule 1. They express more clearly the fact that the adoption Act 1976 consolidates existing adoption law, and that Section 55 of that Act merely restates Section 25 of the Children Act 1975. I beg to move.

On Question, amendment agreed to.

Lord Lyell moved Amendment No. 13:

Page 23, line 48, at end insert— ("(3) After the commencement of section 55 of the Adoption Act 1976 subsection (1)(c) above shall have effect with the substitution of "55 of the Adoption Act 1976" for "25 of the Children Act 1975".").

On Question, amendment agreed to.

6.36 p.m.

Lord Wallace of Coslany moved Amendment No. 14:

Page 24, line 5, at end insert ("and has requested not to be brought before the court.").

The noble Lord said: I beg to move Amendment No. 14, standing in my name and that of my noble friend. This is a very important amendment but one not easily explained. I fully understand the Government's purpose in including in the Bill the amendment to Section 22 of the Children and Young Persons Act 1969. Children become alienated by long delays in the juvenile court awaiting the short and predictable outcome. In some cases, children may find these hearings and the sight of their parents traumatic.

On the other hand, there is the experience of children who are anxious to attend every hearing of their case and I am concerned that it may become a routine matter for the courts to exclude children if they are legally represented. Given the ultimate significance of these hearings for the children concerned, the presumption should be that they will attend all the hearings. This amendment would ensure that legal representatives and their clients and not the court take the initiative in this matter.

It is a relatively straightforward task for lawyers to ask children over five whether or not they wish to attend subsequent hearings and to convey these wishes to the court, which may then take appropriate action. I think this is a sensible and reasonable human way to do it to avoid some of the difficulties that could arise otherwise. I hope the Government will see their way to accepting it or at least will show some degree of sympathy to it. I beg to move.

Lord Trefgarne

We are hoping to introduce, by virtue of paragraph 10 of Schedule 1 to this Bill, provision for juvenile courts not to require the attendance of a legally represented child at court when an interim order in respect of him expires and where it is clear that the case will not be completed that day. The proposed amendment will remove the discretion of magistrates not to require the child's attendance where the legally-represented child wishes to attend the court on the expiry of the interim order, or where he expresses no clear view on the matter. Perhaps I may tell your Lordships of some of the misgivings we have about the amendment.

First, we are talking about children of all ages between the ages of 5 and 16. It is difficult to see how young children would be in a position to express an informed view on the question of their future attendance at court hearings. Unnecessary suffering might be caused in respect of those children who had to attend court for a further interim hearing through either not having expressed a clear view on their attendance or through having requested to attend but not knowing the full implications that a court attendance would have.

Secondly, the way that the Bill is drafted at present does not prevent the child's solicitor from making representations to the court on the question of the child's attendance. While the court would have the final say on the matter, it would take into account the views expressed by the child's solicitor along with all other relevant factors, including the child's welfare. Furthermore, if it became apparent that the case would be concluded at the hearing, the court could rescind any earlier decision not to require the child's attendance, and, if necessary, adjourn the hearing so that there would be time to bring the child before the court.

To summarise, I consider that the proposed amendment will not have the effect of avoiding unnecessary suffering caused to children by their having to attend repeated interim hearings, and I hope therefore that the noble Lord will see fit not to press his amendment.

Lord Wallace of Coslany

I can see the points that the noble Lord is making. He makes one slight mistake and, as a family man, he will understand this well, because he has got some lively children. Children are a little more mature today and can reach decisions for themselves a little earlier than we used to in our days. I am correcting him only on that point. I have gone beyond the age of having young children but I have got some very energetic grandchildren. They know their own minds at times. I will not tease him on that point too much because it is not relevant. I see the point that he has made. I fully understand it. I want to read what he said in Hansard. I apreciate the way that he has spoken on the matter. In the circumstances, at this stage I shall withdraw my amendment.

Amendment, by leave, withdrawn.

Lord Lyell moved Amendment No. 15:

Page 28, line 38, leave out from ("following") to end of line 44 and insert ("paragraph shall be inserted after subsection (5)(g)—. (ga) Part II of the Children Act 1975." ").

The noble Lord said: This is a simple drafting amendment to paragraph 39(c) of Schedule 1. It does not alter the effect of the provision, which is to add Part II of the Children Act 1975 to the specified enactments on which the Secretary of State can obtain information from local authorities. I beg to move.

On Question, amendment agreed to.

Schedule 1, as amended, agreed to.

Clause 6 [The Central Council for Education and Training in Social Work]:

6.42 p.m.

Baroness Faithfull moved Amendment No. 16:

Page 10, line 43, at end insert— ("( ) Grants for the training of social workers shall be mandatory and funded either by local education authorities or from central funds.").

The noble Baroness said: This amendment concerns the financing of the training of social workers. At the moment social workers may be seconded from the local authority department for which they work. They can receive a grant from the Department of Health and Social Security or they can receive a discretionary grant through their local education authorities, but there are no mandatory grants for the training of social workers.

I move this amendment on two counts. First, may I ask my noble friend the Minister to clarify exactly what are to be the financial responsibilities to be given to the Central Council for Education and Training in Social Work in allocation of grants for students and allocation of grants for training courses? Secondly, I want to make to the Committee and to the Government a reasoned appeal—but an appeal with deep feeling behind it—for mandatory awards for training to be given for social work students instead of discretionary awards as at present. I think that the social services departments in this country—and I apoligise, for I have not looked up the figures—are the second biggest in the local authority. The education department is probably the biggest. In every other department of the local authority it is requested and required that there shall be professionals. I have in mind the architect's department, the surveyor's department, and so on. Indeed, the architect's department has just been made the subject of mandatory awards for training.

The fact that there are not mandatory awards for the training of social workers means that social work in this country is uneven among all the local authorities. Sadly, the local authorities who can least afford to send social workers on courses are very often the local authorities where there is most need for good, experienced and qualified social workers. This is really an indictment of our system. I believe—and I hope that your Lordships will agree with me—that society cannot have it both ways. If there is a case, the media take it up; for example, a battered baby who should or should not have been removed from its home, or a mother who should or should not be the subject of a Section 2 resolution—and we have just heard a debate on this. If there are complaints from magistrates or judges that social workers do not always know their law or court procedure then there is an outcry from the public through the media and from other professionals from all over the country. Yet the authorities are not prepared to train social workers under the mandatory system. Social workers cannot have it laid at their door that they are not doing their job properly if society—the taxpayer—is not prepared to pay. I suggest that if the exercise were to be costed, it probably would not involve an enormous amount of extra money for there to be mandatory awards.

There is another point. Working in the department in Oxford, I found that a member of staff would be seconded for training and although they may have been very happy in the department, and enjoyed the work, after they had trained they had a view of the wider world. They wanted to move away and work in another sector of social work in a different part of the country. But because they had been seconded, they had to return to the local authority that had seconded them. This does not always make for happy relationships. They are in fact trapped, at any rate for two years.

In the residential sector in this country, only 14 per cent. of those who care for children in residential accommodation are trained, and it has to be remembered that those children are the most difficult children. They are not easy children, they are children with particular and peculiar difficulties. Of those working with the handicapped, the disabled and with the elderly, only 3 per cent. are trained in this country. Residential social workers are in a very vulnerable position. I think that in this Bill the time has come to face up to whether or not we want a good social work service? If we do, and we regard our social workers and value the residential, community and field staff—and I do—has the time not come to look and see whether we ought to make mandatory awards so that they can be well trained and well qualified to give a service which this country deserves? I beg to move.

Lord Davies of Leek

Briefly, this amendment is of great importance. I do not know whether the noble Baroness will divide the Committee on this amendment. Maybe we do not want to divide because we hope to get a reply which will satisfy the noble Baroness. Despite the scoffing that takes place, social workers are still of paramount importance to this country in many areas. Those of us who have had some experience—and I had a little, particularly in a social security department—know that it is important to have people especially in these areas who have had the chance of practical and theoretical experience. They must be trained in dealing with the particular types of people against whom they sometimes help to legislate or guide.

This amendment does not need long speeches. It is obvious that if we leave a blank in the forces that are working for social security, working for the benefit of these under-privileged youngsters and people, then it is a great blot on the escutcheon of our society. I hope that the Government will look at this matter. Unfortunately, there is so much in this vast Bill that we can talk for hours and hours about these matters. Without boring noble Lords any further, I hope that the Minister—who always gives these matters his attention—will give a reply which at least will be favourable on this point.

Lord Mottistone

I should like briefly to support my noble friend's amendment. Training in this sort of area is now becoming essential: social workers have been going for some time and we really have reached the stage when we must have properly trained people. I would suggest to my noble friend that although that may appear to be an added expense it may in fact be an economy in the long run, because trained preople can do more work than untrained people. This is a matter which I should have thought deserved particular care, and I would hope that he would be able to respond sympathetically to my noble friend's amendment.

Lord Seebohm

May I just add my comments on that? Since the Seebohm Report, if I may so call it. probably one of the most important documents has been the Barclay report, which came out very recently. I have in fact been talking about that today in another place. I really think that the urgency for additional training at the present time, in view of the Barclay Report and the changes in social work likely to take place in the next year or so, makes this amendment very important, and I sincerely hope that we shall give this amendment serious thought.

Lord Banks

I should like briefly to support the amendment of the noble Baroness. I think the absence of mandatory grants for the training of social workers in this country is a great handicap to that important branch of training. The training is vital, as the noble Baroness made clear, and I think the statistics she gave about the numbers of people trained in particular spheres were very telling indeed and they indicate how great the need is.

Lord Trefgarne

The question of which types of professional and vocational training should attract mandatory awards from local education authorities was debated fully during the discussion of what was then the Education (No. 2) Bill in 1980. Local education authorities make awards under Section 1 of the Education Act 1962, which specifies the categories of courses which may be designated for mandatory awards. Students on degree courses in social work are thus eligible for mandatory awards, but the majority of students on non-graduate or postgraduate social work training courses do not qualify. They do, however, attract support from other sources such as local authorities, who release their employees on secondment, local education authorities' discretionary awards and from certain central Government departments, notably the DHSS.

In principle the Government would not oppose the designation of courses of professional and vocational training for mandatory awards. However, the cost of making such a change, I am sorry to say to my noble friend Lord Mottistone, was estimated as an additional £8 million a year in 1980, and doubtless it will be more this year. In the light of the need to contain public expenditure, this was considered too high to merit inclusion in such a provision as the Education (No. 2) Act.

As for central Government support for students on social work training courses, I am afraid that the need to contain public expenditure still applies. Nonetheless, in 1981–82 my department alone spent more than ever before (some £4.1 million) on the support of students on social work training courses. The major employers of social workers in this country are local authority social services departments and they have traditionally seconded staff for professional training. Such authorities are in a position to know their staffing and training requirements best; yet this amendment would effectively exclude social services departments from sponsoring the training of their staff.

Finally, lest this amendment should give the impression that the number of social workers going through training has dried up for lack of mandatory grants, I should like to point out that some 3,361 students received the basic social work qualification—the Certificate of Qualification in Social Work—in 1981 and there are no indications that the number qualifying this year will have dropped by a significant degree.

My noble friend Lady Faithfull also asked me specifically about the grant-making responsibilities which may be transferred to CCETSW. The grants which will in future be made by the council will be subject to discussion with them, but at present we do not propose that the council should make any new grants, other, that is to say, than those already made by the DHSS. In the field of grants to individual students, these will be limited to postgraduate students undertaking basic training—the Certificate of Qualification in Social Work to which I have already referred—and certain limited grants to social workers attending specialised post-basic courses. Nevertheless, I hope the range of grants I have described, which are available from other sources, will persuade my noble friend not to proceed with her amendment, particularly having regard to the very considerable cost it would involve.

Baroness Faithfull

I have listened with great care to the reply given by my noble friend the Minister, and inevitably it is deeply disappointing. If, as he has said, great care is being taken over the training of social workers, I have to come back to my original point: How is it that only 14 per cent. of people working in residential care with children (and with the most difficult children) are trained and only 3 or 4 per cent. of those working with the elderly and handicapped are trained? This really means that local authorities are not seconding or supporting those who are most in need of training at the moment, although I would wish to say that with the new CSS certificate great efforts are being made towards this end.

I think I must consider this because it is one of the most vital parts of this Bill, at any rate so far as I am concerned. I think it is something which the country has to face up to; and when my noble friend talks about £8 million it is a question of priorities—where do we put our money? I wish it to be clearly known that I support my party in its fiscal policies and always have done so; but, having said that, I think one has to look at where the priorities lie, and I believe they lie in this area.

Finally, I have to say that money not spent here will have to be spent elsewhere. Could it be costed out? I agree with my noble friend Lord Mottistone, who supported me, that it would not cost more, although, of course, I know it is very difficult to cost out. I hope that my noble friend the Minister will discuss this matter with me before we come to the Report stage. I am unrepentant in bringing it forward: I think it is right. I will now seek leave to withdraw the amendment but will bring it forward again at Report stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Lyell moved Amendments Nos. 17, 18 and 19: Page 11, line 39, leave out ("or"). line 40, after ("Ireland") insert "or education and library boards in Northern Ireland"). line 42, leave out ("and aftercare services") and insert ("service").

The noble Lord said: It may be for the convenience of the Committee to consider Amendments Nos. 17, 18 and 19 together. Subsection (16) of Clause 6 of the Bill defines "relevant social work" for the purposes of training. One of the services for which social work training is required is the education welfare service. Indeed, the service throughout the United Kingdom is covered by the provisions of the Health Visiting and Social Work (Training) Act 1962, which set up what is now the Central Council for Education and Training in Social Work.

The education welfare service, which in broad terms concerns itself with the problems of truancy and non-attendance at school, is organised by local education authorities in Great Britain. In Northern Ireland, however, it is organised centrally by the Department of Education for the Province and, as such, is not covered by the existing wording of the subsection. This exclusion was unintentional and I trust your Lordships will agree with me that it should be rectified with this amendment.

Section 65 of the Criminal Justice Act 1982 changes the designation of the "probation and after-care services" to what are called "probation services". This minor consequential amendment to the wording of subsection (16)(b) is accordingly intended to bring the Bill's designation of the service up to date. With that brief explanation, I beg to move these three amendments en bloc.

On Question, amendments agreed to.

Clause 6, as amended, agreed to.

Lord Denham

I think that this would probably be a convenient moment to adjourn for a short period until a quarter to eight.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 7.1 p.m. to 7.45 p.m.]

Schedule 2 [The Central Council for Education and Training in Social Work]:

Baroness Faithfull moved Amendment No. 20: Page 29, line 16, at end insert— (" . Members of the Council shall be appointed from—

  1. (a) qualified experienced practitioners in social work, including field, residential and community social workers and probation officers; and
  2. (b) the sector of education responsible for the training of social workers").

The noble Baroness said: This amendment concerns the composition of the Central Council for Education and Training in Social Work, which, by this Bill, will be reduced from, I think, 65 to 26. May I say to my noble friend the Minister how much so many of us approve of this reduction in the number of the Central Council.

I now come to the point of who should serve on the Central Council for Education and Training in Social Work. I have consulted with a number of other professions. I have consulted with the General Medical Council and various other professions as to exactly how they set their standards of training and their standards of performance of the training courses. I believe that the Central Council for Education and Training in Social Work should he a professional body consisting of, as I say in the amendment, qualified experienced practitioners in social work, including field, residential and community social workers and probation officers".

Although I have not set this out in the amendment, I should like to add "and paediatricians", with whom social workers have to work so closely.

Secondly, I believe that the sector of education responsible for the training of social workers should be represented on the Central Council for Education and Training in Social Work. I believe that those two sectors must work in partnership with one another, because the courses for any good, trained social worker consist of practical work in the field, linked with the theoretical, academic work at the centre of training in the colleges or in the universities. At that stage, I believe that those two sectors have to work out between them what are the right methods to use, and what is the right training to give to social workers.

I should like to link Amendment No. 22 with this amendment, and, in order to save your Lordships' time, I shall also speak to that, so that when we come to it I shall not have to speak again. But the two amendments are linked. I equally believe that it is very important that the employing authorities and the relevant trade unions are involved in a consultative capacity concerning the training of social workers, concerning the number of social workers and the planning, and, of course, concerning the way in which local authority social services are run, and their needs. I believe that on page 30, line 12, we should insert that, One of these committees"—

which are referred to in the Bill— shall consist of representatives of the employing authorities and relevant trade unions to act in a consultative capacity to the Council.

So my very strong recommendation is that the Central Council for Education and Training in Social Work should be a professional body and that, having worked out the methods of training over the whole country, they should then consult with local authorities, employing authorities and trade unions. These two amendments, therefore, go together. I beg to move.

Lord Wallace of Coslany

I rise very briefly to say that I fully support the noble Baroness. The first amendment is an obvious one, which is worthy of support, and the second is a very sensible one which I also entirely support. I hope that the Government will see fit to accept them.

Lord Trefgame

I wonder whether it would be for the convenience of your Lordships, and agreeable to the noble Lord, Lord Seebohm, if he were to speak to his amendment now. I had it in mind to reply to Amendments Nos. 20, 21 and 22 together, although, naturally. I am in the hands of the Committee to do otherwise, if your Lordships so wish.

Lord Seebohm

I am in a little difficulty over this, but I shall speak to my amendment. If the previous amendment is passed, mine may become slightly superfluous. The appointment of the members of the Central Council for Education and Training in Social Work is very important, and I feel that what is in the Bill, which is, Before appointing a member other than the chairman the Secretary of State shall consult any body that appears to him to be appropriate". is quite inadequate. My amendment is very simple and just states, in addition, including such bodies concerned with training in social work and with the employment of social workers, and such bodies representing social workers, as appear to him to be appropriate. In other words, I am not making it mandatory that the council should be restricted to the people mentioned in the noble Baroness's amendment, but certainly these bodies should be consulted.

I must declare my interest as the present and past chairman for many years of the National Institute of Social Workers. I hope the Committee will not think that I am therefore biased in what I say.

It is worth pointing out the duties of the council. It will probably strengthen both amendments. The council operates by making statutory training rules, issued with the authority of the Privy Council, which lay down minimum standards for entry and student assessment as well as specifying in broad terms the required content of courses. Within these rules, the council makes detailed regulations and guidelines for education and training and for the assessment of students. The CCETSW is also giving urgent attention to the training of approved social workers under the provisions of the new Mental Health (Amendment) Act, and will be considering any special training needs arising from the provisions of the Criminal Justice Act: training staff for working with disturbed and difficult adolescents, and for working with cases of child abuse; probation and after-care hostel staff, and all the matters which are currently concerning the council and its officers. It is a highly technical body. To be a generalist body is not good enough. The least that I should like, therefore, is agreement to my amendment to consult these bodies.

May I also mention that the previous regulations laid down that these bodies should be consulted. To leave out this requirement seems to me to be a slight insult to the institutions concerned. For one reason or another the confidence of the public in the competence of social workers is not at its highest. Simply to refer to any institution or body that the Secretary of State feels appropriate is far too slender.

In a sense I support both amendments. My slight objection to the amendment moved by the noble Baroness, Lady Faithfull, is that it is exclusive. It just says, "shall be appointed from". There must be freedom for the Secretary of State to appoint somebody he wants to be on the council who is not in those particular categories.

Lord Trefgarne

Before turning to the detailed effect of Amendments Nos. 20, 21 and 22, perhaps I may touch briefly on the underlying principles. As I said at Second Reading, the CCETSW has become too large and the arrangements whereby a large number of appointing bodies are prescribed by statutory instrument has become unwieldy. But one of the important principles within the existing arrangements has been an equal partnership on the council between the social work profession, the social work educators in colleges and universities and the employers, particularly in local authorities and voluntary organisations. It is this principle which the amendment proposed by the noble Lord, Lord Seebohm, seeks to reflect explicitly in the Bill, and it is a principle which I know the present council considers to be important.

For reasons that I shall explain, it is, moreover, a principle which the Government wish to uphold in the reconstituted council. When considering appointments to the council, the Government will indeed consult organisations which they consider to be representative of the professional, the educational and the employer interests and will seek to reflect their views in a balanced membership of the council. In the light of that explicit undertaking I hope the noble Lord will not feel it necessary to press his amendment.

My noble friend Lady Faithfull argued cogently that the council proper should be drawn solely from the professional and educational interests. She acknowledges, none the less, that the employers have a part to play in the council's deliberations. But she seems to relegate them to a place some way below the salt, to be co-opted to one of the council's committees. We believe that the part to be played by employers in the council demands better representation than that. It is not simply, as my noble friend argued earlier this evening, that the absence of mandatory grants for social work training makes this necessary. Even if there were mandatory grants in their field—which, as I have argued, we cannot at present afford—and even if as a result the employers were relieved of some of the cost of training, we would still think it right for employers to be fully represented on the council.

There are two main reasons for this. The first is that the training which people need to work in the personal social services is substantially affected by the way the services are organised and by the way the services are managed. This was well brought out in the recent Barclay report, to which the noble Lord, Lord Seebohm, referred earlier this evening, on the role and tasks of social workers, and it is very much a question for employers.

The second main reason is that the training itself is increasingly dependent upon the co-operation of the employers themselves. The Certificate in Social Services—a qualification of growing value within the personal services—is a mixture of regulated in-service training and college-based training. It is run locally by groupings of employers and education interests, within a structure laid down by CCETSW. As demonstrated by the proposals for the training of the approved social workers called into being by the Mental Health (Amendment) Act, this is a useful pattern which may be adopted again in the future. Employers have a right to expect that training will be relevant to their needs, and that their part in providing in-service training is properly represented. We believe that there should be a proper balance with the other two interests concerned.

My noble friend drew parallels—I believe it was at Second Reading—with other professions. I do not think these parallels are exact. What may be the right arrangements for regulating, say, the architects' profession or the medical profession are not necessarily the right arrangements for considering the training of social services personnel.

In the light of these thoughts. I hope that my noble friend will see fit not to press her two amendments and that the noble Lord, Lord Seebohm, will not wish to press his. either.

Baroness Faithfull

I thank my noble friend the Minister for his reply, with which, inevitably. I do not agree. First, I certainly did not mean that the employing authorities should be looked upon as being relegated to the position of a consultative committee. If one is working out a professional method of training, I believe it is for the professionals to discuss it among themselves first, before submitting it to a lay committee. The employing authorities are lay members of social services departments.

Secondly, from the point of view of argument on the question of the co-operation of employers, I am still not convinced that social services, as a service of local government, are any different from education. I should very much like to know from my noble friend the Minister—not now, but perhaps he and I might discuss it or he might kindly write to me—whether or not the employing parties are represented on whatever is the training medium for teachers. I was visiting the Department of Education the other day and asked about this, and I do not think that they are represented. I am not quite sure why social workers should be different from teachers.

From the point of view of medicine, I phoned up the General Medical Council and was told that they did not think it was wise to have lay people advising on training for the General Medical Council. The same goes for architects and others. We would have a much more productive service if, in the first instance, the professions thought about and worked out their schemes and then submitted them to the employing authorities for consultation—not relegating them, but using them as a consultative body. I am sure it is right that this should happen.

I know when I am beating my head against a brick wall—if my noble friend will excuse me for describing him as such—and I do not propose at this time of night to divide the committee. At this stage I will withdraw the amendment but will ask my noble friend the Minister if he is prepared to see me on this matter and to discuss it and whether I should bring this matter forward again at Report stage. I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

Lord Seebohm had given notice of his intention to move Amendment No. 21: Page 29, line 19, at end inssert ("including such bodies concerned with training in social work and with the employment of social workers, and such bodies representing social workers, as appear to him to be appropriate")

The noble Lord said: I feel that this is a completely harmless amendment; it purely concerns consulting and does not give a direction to anyone. These people must be consulted and I do not feel that there can be any harm in adding these few words to this particular schedule. If we are not to have the amendment of the noble Baroness, Lady Faithfull, my amendment would be a very gentle improvement to the Bill.

Lord Trefgarne

Before the noble Lord, Lord Seebohm, decides whether or not to press his amendment may I simply repeat the assurance that my right honourable friend will conduct the consultation for which the noble Lord is asking, in a rather more informal basis than the one which the noble Lord predicates in his amendment? I believe that is a better way to proceed and hope that the noble Lord will let it rest at that.

[Amendments Nos. 21 and 22 not moved.]

On Question, Whether Schedule 2 shall be agreed to?

Lord Renton

The point I wish to make has not been covered by an amendment. If your Lordships will look at paragraph 3 of Schedule 2, you will see that, Before appointing a member other than the chairman the Secretary of State shall consult any body that appears to him to be appropriate". In view of the very strong feelings which the Royal Society for the Mentally Handicapped have had about the way in which the Central Council for Education and Training in Social Work has governed its affairs—a censure which caused us much concern—we feel that we should be consulted among the bodies which seem to be appropriate. We feel that if we were consulted we could give advice which would be of great value and which would help to prevent certain mistakes which have occurred in the past being repeated in the future. I hope that there will be an undertaking from my noble friend Lord Trefgarne that such a consultation might take place.

Lord Trefgarne

My noble friend Lord Renton is the distinguished president of the Royal Society and I happily give him the assurance for which he has asked.

Schedule 2 agreed to.

Clause 7 agreed to.

Schedule 3 [Residential homes and nursing homes]:

8.5 p.m.

Lord Wallace of Coslany moved Amendment No. 23: Page 32, line 12, after ("age") insert ("(defined as the minimum state pension age)").

The noble Lord said: Quite frankly, this amendment does not need any explanation. The amendment would clear up what we mean by "old age". There may be moments in a late Sitting in this House when the noble Lord the Minister might feel that he knows something about old age, but that is temporary in so far as he is so young. I feel it is necessary that we should define this because, after all, what is old age? We can argue the toss about whether we are old or whether we are young and it is far better to bring in the little amendment I am proposing to define old age as, the minimum state pension age". and then we know where we are. I beg to move.

Lord Kilmarnock

I should like to support the noble Lord, Lord Wallace of Coslany, in this amendment. Looking at the schedule, there is the phrase "old age", which is not defined; "disablement", which is capable of definition; and "past or present mental disorder", which is also capable of definition. So one of the three main conditions mentioned in that subsection is not defined and I consider that the amendment proposed by the noble Lord, Lord Wallace of Coslany, is extremely sensible.

Lord Trefgarne

As the noble Lord, Lord Wallace of Coslany, has said, the effect of this amendment would be to define "old age" as meaning the minimum state pension age—a reference, I suspect, to the definition of pensionable age in the Social Security Act 1975. We consider that it is not necessary and perhaps not prudent to define old age in this way for the purposes of the registration system. There is a general conception of old age and whether or not a person receives personal care in a residential setting does not depend upon the attainment of a specific age but rather on his or her need for such care.

It is often the case that not until after the age of 75 does the proportion of persons with some degree of disability rise sharply. On the other hand, there are some young persons who are in need of personal care and for whom provision would be appropriate. In that case they could be suffering from disablement or from a mental disorder—conditions which also give rise to registration. Old age and these conditions are not exclusive. I might add that using an age such as 65 to define "old age" would be particularly inappropriate in the case of your Lordships House, where there are a number of distinguished members greatly in excess of 65 years of age. I do not consider that there is any real merit in this amendment and I hope that the noble Lord will withdraw it.

Baroness Faithfull

Before my noble friend sits down, may I just point out that men and women are different? Also, the minimum state pension age for a woman is 60 but for a man it is 65—and I do not believe that the women look any older than the men.

Lord Wallace of Coslany

I am not going to get involved in that argument. I know that there is a difference between men and women; I have been married for 50 years and I have found out. I am not too happy with the reply given by the noble Lord the Minister, "old age" is a phrase that does not define anything. If it were taken to mean the minimum state pension age, it would be defined. I am not going to argue the toss at this late hour because I have already been made to feel older than I am and, goodness knows, I am old enough. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Lyell moved Amendment No. 24: Page 32, line 24, at end insert—

The noble Lord said: I beg to move Amendment No. 24 in the name of my noble friend. Your Lordships will see that the Bill as drafted, with certain listed exceptions, requires any institutions which cater for four or more disabled students to register as residential care homes. This could include some higher and further educational establishments. Those establishments which are managed or provided by local authority or a body incorporated by Royal Charter or constituted by an Act of Parliament are excepted. This is a long-standing exemption which we see no reason to change, and above all tonight.

However, those university institutions which have no Royal Charter or special Act of Parliament—for example, some university colleges—and other colleges such as those linked to the various Churches which have been established under charitable trusts and are supported by grants from the Department of Education would at present be required to register. This is inconsistent and it would place what we feel to be unnecessary constraints on some institutions. The amendment I am proposing seeks to achieve what we hope will be more equitable treatment of certain higher and further educational establishments. I hope that on this relatively simple basis your Lordships would agree to the inclusion of Amendment No. 24.

On Question, amendment agreed to.

Lord Banks moved Amendment No. 25: Page 35, line 4, at end insert— ("( ) The Secretary of State shall keep a national register of licensed residential and nuring homes, and a register of owners and managers of such homes who have had their registrations cancelled or refused.").

The noble Lord said: I beg to move Amendment No. 25. In order that local authorities are in a better position to satisfy themselves of the suitability of a person to organise and manage a home for dependent people, we think the Secretary of State should keep a national register of licensed residential and nursing homes and a register of owners and managers of such homes who have had their registrations cancelled or refused. I think the purpose of such a register would be self-evident. It is, first, to prevent people whose licences have been cancelled or refused from going to other areas to undertake similar work where their previous history is unknown; and, secondly, to indicate who the licence holders are. I hope the Minister will feel that this is a sensible purpose.

Lord Trefgarne

As the noble Lord has explained, the effect of this amendment would be to require the Secretary of State to keep a register of all licensed—that is, registered—residential homes and nursing homes in the country, and he would also be required to maintain a register of owners and managers of such homes whose registration had been either cancelled or refused. Local social services authorities are the registration authorities for residential homes, and while the Secretary of State is the registration authority for nursing homes he has delegated that function to district health authorities. In the circumstances the Secretary of State is not in possession of the information necessary to compile a register of all registered homes.

Moreover, it would be needlessly cumbersome. I suggest, for him to attempt to do so. There were some 4,100 homes in 1981 registered in England and Wales under the residential Homes Act 1980, and over 1,000 nursing homes and mental nursing homes registered under the Nursing Homes Act 1975. It is sensible and practicable for the authorities which actually register and inspect the homes to maintain registers of the homes which are so registereed.

I turn now to the question of a register of persons whose registrations have been cancelled or refused. In the debate on Second Reading I said that we were considering how best to keep a record of undesirable people who have lost their registration. We shall shortly be consulting the local authority associations about this. However, we do not think it would be practicable or desirable to keep a register of all whose applications for registration were unsuccessful. The reasons for not accepting an application for registration can be varied and can be influenced by local circumstances. I hope that the noble Lord will now appreciate the difficulties, or some of them, which are inherent in the amendment proposed and that he will not see fit to press it.

Lord Kilmarnock

May I ask the noble Lord this? I take his point about the difficulty in keeping a register of all persons whose applications have been refused, but would it not be possible to keep a smaller register of those who have had their application accepted and later cancelled? Those are the ones in which we are perhaps most interested.

Lord Trefgarne

I have no doubt it would be possible to do that, even having regard to the difficulties I have indicated, but I think the objection is that, however you define the list of undesirables, if I can call them that—those to be included in the list—it would take on the nature of a black list. I must say I find black lists a somewhat undesirable, almost distasteful, thing, principally because of the possibility of an injustice. As I said, the reasons for which people might find themselves on such a list are sometimes influenced by purely local considerations.

It might well be that an application which had been unsuccessful in a certain area or a registration which had been cancelled in a certain area would not fall to be so treated in another area. Thus, there would be a clear injustice in that somebody had been included, because of that local difficulty, in the black list—I can only call it that. This is a matter to which Ministerial colleagues and I have given some thought, and we have concluded that the difficulties of a central arrangement are rather great and that it would be better to proceed along the lines I have suggested.

Lord Gibson-Watt

May I support my noble friend in relation to this? On the face of it there is something to be said for the amendment, but like my noble friend I abhor black lists. My modest experience of being responsible for health affairs in Wales for a short period, and having been engaged in the knowledge of certain people being sacked for running these residential homes in a bad way, leads me to believe that any local authority or any authority taking on somebody to run one of these homes will inquire whether they have done it before. Short of that person lying to the authority, they will then be able to check up. I agree with my noble friend that we should not have any black list in regard to this.

Lord Banks

I wonder if I may ask the noble Lord this question, because from what he said I was not quite clear what he and his colleagues are considering. I understood him to say that administrative difficulties made it impracticable to have a list of all registrations. But I thought he went on to say that, while it was not desirable, to have a list of everybody who had had their registration refused or cancelled, nevertheless it was desirable to have some kind of list of people who might be described as undesirable. Yet in the second part of his reply he seemed to say that this was not the case and that he did not approve of what he called black lists. I am not quite clear what it is that he and his colleagues are contemplating as a possibility.

Lord Trefgarne

The noble Lord, Lord Kilmarnock, asked about the possibility of a list of those whose registrations had been cancelled, and although I poured some cold water on that because it presents difficulties, that is actually one of the things we are considering. I cannot prejudge the outcome of that consideration, because all lists of this kind entail difficulties, as my noble friend has pointed out. It might equally be possible to have a list of those convicted of some offence in connection with these matters. We take the problem on board. There is a problem where people might conceivably offer themselves for an appointment for which they were manifestly unsuitable and had been found to be so in a previous appointment. I am much attracted to the line proposed by my noble friend because I am sure that responsible authorities will want to inquire into the background of their applicants and anyone who lies to conceal his background would be clearly obtaining the post under false pretences.

This is a matter which ministerial colleagues and I are considering. One of the possibilities, not without its difficulties but one which we are examining, is a list of those who have had their registration cancelled. I understand that such a list would not require legislation. Therefore, it is not necessary to make specific provision as suggested by the noble Lord. I can give the assurance that this is a matter of which we are fully seized and I hope that we shall be able to bring forward sensible proposals in due course.

Lord Kilmarnock

In his departmental consultation will the noble Lord take care to draw the distinction which I strove to make between refusal of a licence which might be on technical grounds—for example, the unsuitability of a building—and cancellation through malpractice?

Lord Trefgarne

The noble Lord is right to draw attention to that necessary distinction. We want to make sure that people who are held to be unsuitable really are unsuitable and have not simply been found so for some local reason, as I described earlier.

Lord Banks

Since I understand from the Minister that the matter is under consideration, that the Government are seized of the nature of the problem and that there is a possibility of some kind of list, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

8.21 p.m.

Lord Wallace of Coslany moved Amendment No. 26: Page 37, leave out lines 16 to 18 and insert— (" "(3A) The registering authority shall ensure that all homes to which this Act applies shall be, as a minimum, inspected annually, and that one additional annual visit shall be undertaken without notice.".").

The noble Lord said: This question arose on Second Reading and the Minister indicated that it was in the Department's mind that inspection would be on the basis of its taking place once per annum. That may be so, but I felt on consideration that we should put something into the Bill. If I may briefly explain, the purpose of this amendment is to ensure regular inspection of homes and, in particular—this is very important—to ensure that inspections occur during normal circumstances rather than on a special occasion with ample opportunity given for a brief and transitory improvement in standards and conditions.

I emphasise that the inspection should occur during normal circumstances. Those of us who served in Her Majesty's Forces in some capacity or another will know that regular inspections were (shall we say?) often a bit of a fiddle. I remember when I was a rookie in training at Cardington, before I was allowed out wearing Her Majesty's uniform, that we were a dustbin short in one group of huts. In fact, as the inspecting officer went into one hut so a dustbin was rapidly moved to the next hut. The point I am seeking to illustrate is that it is essential to have an inspection that is not prearranged or notified beforehand, otherwise people will get away with murder. I beg to move.

Lord Renton

I agree with the noble Lord, Lord Wallace of Coslany, but I feel that his amendment does not go far enough. I suggest that these residential homes should be inspected at least twice a year. If that is done it would save the cumbersome business of renewing registrations. If we are to have only rare inspections then we must have registrations renewed fairly frequently. The more frequent the inspections, the less need there is for renewal of registration. Therefore, I should have thought it worth the Government's thinking again about this. Inspections at least twice a year might save a certain amount of administration as well as ensuring higher standards.

Baroness Masham of Ilton

I spoke on this point on Second Reading. I could tell your Lordships some horrifying stories about unemptied bed-pans and young people, only 17 or 18 years old, on duty at night. Although it may look good on paper and the staff qualifications are there on paper, it does not always happen in practice. I have recently dealt with a most horrifying case concerning an elderly woman in a home in Leeds. Happily she has been transferred to another home and is now happy. What is in the Bill is just not good enough and I agree with the noble Lord, Lord Renton. The clause states that the Secretary of State "may". We all know there is a considerable difference between "may" and "shall". Therefore, I hope that your Lordships will accept the amendment, or even strengthen it.

Lord Trefgarne

The effect of the amendment, as has been described, is to substitute in the Bill itself a minimum frequency of twice a year for inspections, one of which is to be without notice, with power to make regulations prescribing the occasion and frequency of inspections. The expressed intention is that the regulations should prescribe at least one inspection a year. I believe I referred to this on Second Reading. This frequency is considered appropriate for residential care homes. It would be a minimum—I underline that—and registration authorities would be able to inspect more frequently if circumstances warranted. On average this is about the level of inspections carried out by local authorities at present.

I suggest that the occasion and frequency for inspections is a matter that is more appropriate to regulations, which would be able to respond more readily to changed circumstances than a substantive provision in the Bill itself. The regulations will have to come before your Lordships and be subject to annulment by either House. I hope that your Lordships will agree that that is a more appropriate way to proceed and that the noble Lord will feel able not to press this amendment.

Baroness Masham of Ilton

May I ask the Minister one more question? What does he think about spot checks and unprepared visits? I should think them to be very important.

Lord Trefgarne

That is a matter for the registering authority. Speaking personally I think that is a very good idea. I do not think that we want to put into the regulation any provision which made it necessary for authorities to pre-announce their visit.

Lord Wallace of Coslany

I do not agree that regulations are necessarily the best thing. This is so vitally important, as the noble Baroness, Lady Masham of Ilton, so graphically described, that we should in fact have this provision stated very clearly in the Bill. I go further and say I would certainly accept the suggestion made by the noble Lord, Lord Renton. Obviously the Government will not agree, and there is no point in pressing this tonight, but between now and Report stage the noble Lord, Lord Renton, the noble Baroness, Lady Masham of Ilton, I myself and others will have to think seriously about a suitably phrased amendment which will meet the case. I still think that it should be covered in regulations, but I will not delay the Committee at this stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

On Question, Whether Schedule 3, as amended, shall be agreed to?

Lord Renton

I do not wish to detain your Lordships for long, but this is a very important schedule and I welcome it as a serious attempt to curb the activities of a small number of people who have been exploiting the field of residential care. Some rather bad cases have come to light and one therefore feels in sympathy with the schedule.

I must comment that it runs to seven pages. Perhaps that is difficult to avoid, but I take the view that the Minister was expressing just now the view that regulations are often a better place for detail, especially administrative detail, rather than the schedules to a Bill. However, we have this very long schedule in front of us and it seems to me that, from its wording, the schedule is much more concerned with provision for the elderly than with provision for any category of disablement, other than the elderly. We should bear in mind in our further thoughts about the administration which will arise under this schedule, that the disabled, including the mentally handicapped, are not always in the kind of residential homes which are suitable for the elderly. A good deal of specialisation has to take place.

I am anxious that the scheme should be effective. As I understand it, registration will be mandatory upon those voluntary and private homes which declare themselves to be giving accommodation, board and suitable attention. But there is nothing in the Bill which compels people to register those establishments which do, in fact, provide such services, but which call themselves guest houses or something like that. That is a point to which I would invite the Government's attention for further thought.

I am sure that it is right to require, where there is registration, that both the manager of the establishment and its owner should be named as part of the registration, provided that a change of either of those personalities is notified and accompanied by a fresh inspection when that occurs. We do not want what seems to be a well-run establishment suddenly finding itself in fresh hands with people who are not of the same high standards as those expected when registration took place.

Another point that I wish to make is that the appeals procedure that is envisaged specifies that, in addition to a chairman with legal experience, there shall be two other members of the tribunal, and they should have, I suggest, experience in the field of operating either a residential home or a nursing home. There is nothing that specifies the particular experience required. It could mean that an appeal being made by a voluntary organisation running a residential care home for the mentally handicapped could be heard by a tribunal consisting of a lawyer, the administrator of an old people's home and a psychiatric social worker—with deep respect to all such categories. But surely it would be better to ensure that someone with the specialised experience of, let us say, looking after the mentally handicapped was brought in when there was such an appeal.

I know that the points that I have raised are not the type of points that it would be reasonable to expect my noble friend to answer immediately. But I hope for an undertaking that they will be carefully considered.

Lord Trefgame

I am happy to give my noble friend the assurance for which he asks. Certainly the points which he raises will be carefully considered—indeed, the points that my noble friend raises are always carefully considered. There is perhaps one point which I am able to deal with now and that is his anxiety about the possibility of guest houses, or so-called guest houses, escaping the net of this system.

I understand that the revised definition of "establishment to be registered" does provide for the registration of those places which call themselves guest houses but which do, in fact, provide personal care. So that anxiety at least I am able to set at rest. However. I will certainly study what my noble friend has said and write to him between now and the next stage.

Lord Renton

I am much obliged.

Schedule 3, as amended, agreed to.

Clause 8 agreed to.

Schedule 4 agreed to.

Clause 9 [Constitution etc. of Family Practitioner Committees]:

8.36 p.m.

Lord Banks moved Amendment No. 27: Page 13, line 36, leave out subsection (3).

The noble Lord said: I beg to move amendment No. 27 and also, with the leave of the Committee, to speak to Amendment No. 30. The subsection referred to in the amendment says that the Secretary of State can do anything having regard to Schedule 5. The actual terms are as follows: The Secretary of State may by order under this subsection make such repeals in or other modifications of any enactment or instrument as appear to him to be necessary having regard to this section and Schedule 5 to this Act".

Schedule 5 says at paragraph 2(b) at page 44 line 23 that the family practitioner committee can do anything which may be prescribed.

If we put those two parts of the Bill together, the Bill appears to say that the Secretary of State can do anything to allow anything. That would appear to be a rather absurd and perhaps dangerous extension of delegated legislation. The object of these two amendments is to remove these sweeping powers. I beg to move.

Baroness Jeger

We share some of the anxieties to which the noble Lord has referred and I would like to put one or two points to the Minister about these two amendments. In the first case, I wish to make it clear that the suggestions under the Bill about family practitioner committees—which go directly against the recommendations of the Royal Commission—are opposed by the Labour Party. It is our policy to follow the advice of the Royal Commission. We do so because we believe that there will be more integration of the services if that is done and also because there will be more accountability to local people.

However, as I understand it, the suggestion in the Bill is that the Minister is to appoint both the chairman and the vice-chairman. I know that that is the subject for another amendment, but it is part of the whole picture. There is also, of course, the problem that was raised on Second Reading about whether the districts will be coterminous or whether there will be overlapping boundaries.

I must remind the noble Minister that he did say on Second Reading that the Government did not accept the views of the Royal Commission on this point. He said that he had consulted many people. I am referring to col. 774 of the Official Report for 22nd November, when he said that the Government had consulted with interests working in this field. I do not know who was consulted and he did not make clear the evidence on which the Government rejected the recommendations of the Royal Commission. For those reasons I very much hope that he can give us some more information tonight, because this is a very fundamental change which seems to go against so much current thinking about the need to integrate primary care with hospital care and with the type of social care about which we were talking earlier in our deliberations. It is really a puzzle to many of us that not only has the recommendation of the Royal Commission been abandoned, but there does not seem to have been adequate explanation of the Government's point of view on this. I very much hope that, before we take the matter further and decide what action to take, the noble Lord can help us on this very important question.

Lord Trefgarne

Perhaps I can first deal with Amendment No. 27, and then I shall move on swiftly to Amendment No. 30, because the noble Lord has rightly chosen to speak to both together. First, Amendment No. 27 would have the effect of removing the provision for consequential amendments to Acts and regulations which may be occasioned by the FPC provisions of the Bill but have not yet been identified.

Schedule 5 to the Bill already contains substantial amendments to the National Health Service Act 1977 which fall to be made as a consequence of the new status of FPCs. Schedule 9 includes consequential amendments of other enactments, while Schedule 10 contains repeals and revocations relating to FPCs. So far as I am aware, we have identified all the amendments needing to be made, but subsection (3) provides a fallback power should any others come to light.

I trust that your Lordships will accept that this is a customary "failsafe" provision, and will accept my assurance that it is not intended as the means of getting substantial changes through, as it were, the back door. Incidentally, I understand that a similar provision was included in the Health Services Act 1980, in Section 1(8) of that measure. In the light of that assurance I hope that the noble Lord, Lord Banks, will not wish to proceed with that amendment.

I turn now to Amendment No. 30. This amendment would certainly have the effect of removing the longstanding statutory provision for FPCs to exercise functions in addition to the administration of arrangements for the provision of general medical and other family practitioner services. Paragraph (b) of the new Section 15 of the 1977 Act, as substituted by paragraph 2 of Schedule 5 to the Bill, simply carries forward the provision in the existing Section 15 for FPCs to perform such other functions relating to the Part II services—that is family practitioner services—as may be prescribed. The provision derives originally from Section 7(3)(b) of the National Health Service Re-organisation Act 1973, which first established the functions of FPCs.

There is, therefore, nothing new in this provision. It is not itself affected by the change in status of FPCs and is restated only for ease of reference. To remove it would be to stop FPCs, whatever their chain of responsibility may be, carrying out certain important activities—for example, in relation to the training and study leave of general practitioners—which are, of course, already their responsibility. I hope, therefore, that the noble Lord will agree that we are not actually proposing anything new in this provision and that his anxieties are therefore unfounded.

I turn now to the remarks of the noble Baroness, Lady Jeger, who was anxious to know who the Government had consulted. Consultation on our proposals for FPCs was wide-ranging. It included health authorities, family practitioner committees, community health councils and a considerable number of other interested bodies. I would be very happy to write to the noble Baroness with an even longer list of those who were consulted if she would find that helpful.

Lord Avebury

When the Minister says that my noble friend's second amendment would interfere with the arrangements that have already been made under Section 7(3)(b) of the National Health Service Reorganisation Act 1973 for training and study leave of general practitioners, does he mean that those arrangements are not included in the provisions of what is now the new Section 15(a)—that is to say, the arrangements made for the provision of general medical services, et cetera? It seems to me that if you are making arrangements for medical services, those could well include the arrangements for training and study leave. I do not understand why it was necessary to prescribe separately under additional powers what should be done under this heading. It seems to me that it is already included in the wording that we have.

Further, I wonder whether the Minister could tell me on what occasions since the equivalent provision in the 1973 Act other functions relating to those services have been so prescribed, and what they were. Is training and study leave the only example that he could have given and, if so, why could it not be written into Section 15(a), if indeed that is necessary at all?

Returning to the first of my noble friend's amendments, are we not really encouraging parlia- mentary draftsmen to be idle in putting something of this kind into any Bill? Because what the noble Lord the Minister is telling us is that just in case they have not been able to spot all the repeals that should have been incorporated in this Bill, the Government want this failsafe clause which enables them to be picked up later on. I know that we do not yet have the statutes on computer, but I should have thought that it is not beyond the wit of man to go through all the references and to identify them, as is done in every other Bill. In such complex amending legislation as the Nationality Bill last year, we had to go through many previous enactments and no one ever suggested that we should put in clauses there which enabled us to go back and carry out additional repeals by an administrative procedure, such as is proposed here. In fact, that is not the only example of complicated legislation in recent years that one could cite. I do not recall this happening in the old days. It must be a comparative innovation to find in a Bill of this kind a blanket power given to Secretaries of State to amend enactments by instrument.

I agree with my noble friend that, however much one trusts the intentions of Ministers on the Front Bench—and I am not saying that they would in any way use these powers in an irregular manner—I do not at all like the idea of giving such sweeping powers to any Government. If we create the precedent of legislation by statutory instrument, as we appear to be doing—and the noble Lord says that this is not the first instance of its kind, but I do not recall any—we are opening the door not just to the parliamentary draftsmen being less assiduous than they might otherwise be in picking up those enactments that need to be amended, but also to scattering across the statute book very wide powers which in the future may be used in a manner that your Lordships would not like.

Therefore, I wish that the noble Lord would have another thought about my noble friend's first amendment. I hope that in the end. on reflection, he will agree that it should be accepted.

Baroness Faithfull

I am in some difficulty, and would seek the help of my noble friend the Minister. I find it difficult to presume to speak about another profession and make recommendations, and therefore I ask a question. When the health service was set up the principle behind it was to have a unified health service, with all branches co-operating with one another for the benefit of the patients. It seems to me that in the Bill there is fragmentation and not unification. But, equally, it seems to me that the amendments moved by the noble Lord, Lord Banks, also lead to fragmentation. How does the Minister think that the Bill will lead to a unified health service with all the different parts of that service?

Lord Trefgarne

Answering my noble friend first, if I may, it is of course the case that ever since the inception of the health service the family practitioners—that is to say, the general practitioners—have not, strictly speaking, been part of the health service. They have all been self-employed contractors to the health service. What we are doing in this measure is not making that position worse or better, but are changing the responsibility of the family practitioner committees within the health service. I am not sure that the fundamental problem my noble friend saw arises.

As for the questions of the noble Lord, Lord Avebury, who addressed his remarks first to Amendment No. 27. I do not think I can go further than to repeat what I have said already, which is that the power contained in this provision is one which will be used only with the greatest care, and certainly not in furthering any substantial change to the legislation. That is not the purpose for which this power is sought, and it will not be used for that purpose. A similar provision was included in the 1980 Health Services Act.

I can assure the noble Lord that we have culled the statutes to the best of our ability. I honestly believe that we have got right all the repeals that we need and all the other references that we need, but I could not put my hand on my heart to say that we have so achieved it, and that is why we need this particular provision. Even Parliamentary draftsmen are human beings (do I hear dissent from behind me?) and it is for that reason that we need to include this provision.

Turning to Amendment No. 30, I think we have it about right. I do not think I have anything to add to what I said just now in connection with that amendment. It would be wrong to prevent the FPCs carrying out the duties to which I referred. The noble Lord, Lord Avebury,. asked me whether there were any other particular activities that had been prescribed. I do not in truth know the answer to that, but I shall certainly find out and let the noble Lord know.

Lord Banks

There is no doubt that these powers are far reaching, as my noble friend emphasised, however lacking in novelty they may be, however conventional they may be. The very fact that the noble Lord the Minister gave an assurance that they would not be used to introduce major changes indicates that they could be, which is further proof of the extent of the powers. Nevertheless, I should like to consider what the Minister has said in his reply to these amendments, and we may well return to this subject at a later stage. For the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

8.53 p.m.

Lord Kilmarnock moved Amendment No. 28:

Leave out Clause 9 and insert the following new Clause—

("Abolition of Family Practitioner Committees

.—(1) Subject to subsection (2) below, section 10 of the National Health Service Act 1977 is hereby repealed.

(2) The following section shall be substituted for section 15 of the National Health Service Act 1977

"15. It is the duty of each District Health Authority in accordance with regulations—

  1. (a) to make arrangements in pursuance of this Act for the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services for their locality, and
  2. (b) to perform such other functions relating to those services as may be prescribed.".

(3) All Family Practitioner Committees shall cease to exist on the appointed day.

(4) All functions which immediately before the appointed day were functions exercisable by a Family Practitioner Commitee shall be conferred upon the District Health Authority or jointly upon those District Health Authorities which established that Family Practitioner Committee.

(5) Wherever in the National Health Service Act 1977, as amended by the Health Services Act 1980 and in other enactments, orders and regulations, the functions of a Family Practitioner Committee are prescribed, those references shall from the appointed day be read as references to the functions of a District Health Authority.

(6) It shall be the responsibility of the District Health Authority in pursuance of its responsibilities under section 15 of the National Health Service Act 1977 to establish a Primary Care Commitee which shall include persons nominated by the Local Medical Committee for that locality, the Local Dental Committee for that locality, the Local Optical Committee for that locality, the Local Pharmaceutical Committee for that locality, and such other persons as the Secretary of Stale shall prescribe in regulations.

(7) Schedule 5 to this Act shall have effect.").

The noble Lord said: In rising to move this new clause I should make clear that it was attributed in error to the noble Lord, Lord Winstanley, the noble Baroness, Lady Robson, and the noble Lord, Lord Banks, by the Public Bill Office. They placed a note to that effect in the Printed Paper Office, and I believe that they have written to the noble Lords and the noble Baroness concerned. I apologise to them. It may be for the convenience of the Committee if, with permission, I speak also to my amendments to Schedule 5: Amendments Nos. 29, 31, 33 to 35, 37 to 79 excluding 53, which is also printed in error, and 84. These are all related to, or consequential on, the new clause.

The intention of Amendment 28, replacing the Government's Clause 9, is pretty clear. It is to abolish FPCs and to vest their functions in the district health authority or in authorities to which they were previously linked. It also obliges district health authorities—and this is the most important point—to establish primary care committees for the planning of primary care and prevention in their districts. I would have retitled the schedule to reflect this intention but I am advised that this cannot be done by an amendment. If the clause were to be accepted the schedule would later be provided with a title more appropriate to its new content.

It requires some temerity to speak on these matters in the presence of the noble Lords, Lord Richardson, Lord Hunter of Newington. Lord Stone and Lord Rea, but I think in health matters it is vital also that we should have a lay view of the problem. Amendment 28 derives from the proposition that it should be a principal aim of the National Health Service not only to cure the sick and care for the dying but also to promote the health of the country as a whole. The noble Baroness, Lady Faithfull, asked whether the National Health Service should not be seen in a more integrated light.

My party attaches great importance to the prevention of disease and the development of primary and community care. The aim is to pick up problems as soon as possible and prevent as many as possible, and to treat as many cases as possible within the home, or within the practice, rather than referring them to hospital. This can be achieved only by the greater integration of prevention and primary care with the other branches of the National Health Service. It appears to me that in Part V this Bill sets out to do the opposite.

The Government have in effect moved in the opposite direction to that advocated by the Royal Commission on the National Health Service which reported in 1979 and which recommended, the abolition of FPCs in England and Wales"— they do not, of course, exist in Scotland or in Northern Ireland— and the assumption of their functions by health authorities as a step towards integration.

This appeared in Chapter 20, paragraph 57, and in their Recommendation 110.

But what the Government are proposing in Clause 9 is to promote family practitioner committees to the status of fully-fledged independent health authorities. As my noble friend Lady Stedman said at Second Reading, this is a retrograde step which will not assist the National Health Service in providing an integrated primary care service. If my reading of the impressive speech of the noble Lord, Lord Hunter of Newington, who followed her, is correct, he quite largely agreed with her. I am delighted to see that he is here this evening, and I hope that he will speak. It seemed to me that he had a number of worries, prominent among them being that the new system would lead to a further isolation of GPs from hospital practice and that the development of new methods of primary care involving collaboration with other professions and new technology would not be made any easier.

To these objections I would add the overwhelming one that it cannot be a good idea for three totally independent authorities to be responsible for primary care—that is, the district health authority, the local authority personal and social services department, and the family practitioner committee, which is now "beefed-up" in status and distorted in membership by the reduction from 11 to four of the representatives of the health authorities concerned and the creation of seven unspecified appointments in the direct gift of the Secretary of State. Apart from the undesirable extension of direct patronage, how this is going to assist integration (as I think was claimed the other day by the Minister of Health) I cannot for the life of me see.

Winding up the Second Reading debate the noble Lord, Lord Trefgarne, said that it was a function of family practitioner committees to administer the contracts of self-employed GPs and that this was a specialist area and ought to remain so. There is nothing in my proposal to prevent district health authorities sharing, or pooling, adminstrative arrangements for this purpose. The noble Lord also said that practitioners themselves attached great importance to their independent status. Here it is of interest to note that according to the Review Body on Doctors' and Dentists' Remuneration, which reported in 1974: Work in hospitals for local authorities and Government departments gives the average GP less than 2 per cent. of his income, and private practice probably accounts for another 6 per cent.

This may have changed somewhat in recent years, but even so a very large percentage of GP income will still come from the National Health Service.

Despite these figures, or perhaps because of them, we fully understand the legitimate concern of GPs who do not want to become direct employees of the state. Nothing in my amendments threatens their contractual arrangements. I have also, incidentally, taken note of the Royal Commission's concern that the position of existing FPC staff should be safeguarded and handled sensitively, I imagine that most of them will continue doing much the same work as before.

However, when all that is acknowledged, there remain some other important considerations. Not all GPs I have spoken to have felt a great bond with their FPC. I have heard the criticism that they are remote and out of touch. Another consideration is the continuity of care on discharge from hospital, at present defective in many cases; it could be much enhanced by more integrated GP services. And without forcing GPs into a straitjacket, the salary option recommended by the Royal Commission in paragraph 82 of Chapter 14 should, in my view, at least be available, if only on a limited scale. If conditions arose, say, in an inner city area in which a DHA wanted to employ a GP directly, and the doctor was willing, what is wrong with that?

Can the noble Lord, Lord Trefgarne, tell the Committee a little more about the Government's consultative process, and in particular which bodies were opposed to the Royal Commission's line, and which were in favour? He said he consulted the FPCs and community health councils, and I think that when answering the previous amendment he mentioned simply "a number of other interested bodies". It seems that we have not really been informed about the Government's consultative process, and one of the objects of my amendments is to ask the Government to be rather more open about that. I should be grateful therefore if the Minister would enlighten the Committee on these points because I believe them to be substantial.

At this hour I do not want to detain your Lordships. A number of attractive and even cost-effective possibilities would follow from the adoption of this series of amendments. Had the Government left the status quo, perhaps I should not have tabled them at this time, but since they have chosen to move in the diametrically opposite direction to that recommended by the Royal Commission, and have not revealed to us the nature of the advice on which they have based their decision, it is important that the contrary case should be put at this stage of the Bill in your Lordships' House. That, after all, is one of the main reasons for our existence. I beg to move.

Lord Hunter of Newington

We discussed this matter at considerable length on Second Reading. I consider that there are probably three very important functions which the family doctor has under the circumstances existing today. The first, of course, is his daily work, in which capacity he is, as the Minister said, an independent contractor doing the ordinary day-to-day work with his patients. But, secondly, in the present climate, which has been clearly stated by the Government, the whole question of accountability in the National Health Service is paramount, and one thing that is not clear is how family doctors will be accountable in future. We have heard of important meetings between Ministers and regional health authorities, and those authorities are required to have similar consultations with the district authorities. On that aspect, therefore, we require an answer.

My third point concerns to regional planning. It is not clear how the family practitioner committee fits into the regional plan. In 1973 the area health authority, to which they were closely attached, was responsible for the planning. How will the planning be done in the future? Is it clearly stated that the regional health authority is the planning authority? The chief medical officer of that regional health authority must obviously have an important function in relation, one would have thought, to planning by the family practitioner committee to ensure proper integration with the complex local authority health services, occupational health and other things which are developing all the time in the community.

Without being nostalgic again about the medical officer of health in the past, a gap was created in 1973, when the family practitioner committee was brought nearer to the NHS, and the gap created by getting rid of the medical officer of health has not been filled. Therefore, one wants to know whether the regional health authority, and particularly the regional medical officer, will play a new role in the forward planning. Or does the Secretary of State feel that all the planning for family practitioner committees should be done centrally?

Lord Rea

Speaking also as a member of the medical profession, I should like to know from the Minister why he disregarded the commission's suggestions, and I think it reasonable to spell them out once more. The Royal Commission felt that to abolish the family practitioner committees and merge their administration with the district health authorities would enable those authorities to influence more positively than they can now, first, the distribution and quality of surgeries and other practice premises, some of which are still well below standard, as many of your Lorships will be aware; secondly, to create a better balance and relationship between hospital and community care; and, thirdly, to enable the freer movement of staff across institutional boundaries, together with the better control and supervision of deputising services.

It could be that there are many general practitioners who are nevertheless pleased with the idea that family practitioner committees will have a direct link with the department. They feel, perhaps, that their needs will be better cared for. They are worried, for instance, about the contractor status of general practitioners being a difficult matter for a district health authority to manage, when they are also dealing with a salaried service which is also controlled on a cash limit basis, whereas the general practitioner service at the moment has a rather more free arrangement for financing.

The only anxiety that I really have about general practitioners in connection with the commission's recommendation that they should come under the jurisdiction of the district health authorities would be that they might lose out in competition with some of the strong voices which would be sounding loudly from the hospitals, who will have urgent and expensive needs. If the family practitioners have to be in direct competition on a local basis with hospitals, they may lose out. So it is possible that the arrangement that is suggested in the Bill may be the best for primary care, despite the disadvantages that I have mentioned.

One other matter that I should like to mention is the question of boundaries and the extraordinary business—in particular in London—of overlap of boundaries. I should like to read from Schedule 5, paragraph 5, which states: The Secretary of State shall have power by order to provide for any matter relating to joint consultative committees, and such an order may in particular"— I ask the Committee to listen to this— (d) authorise or require a joint consultative committee to appoint any sub-committee or to join with another joint consultative committee or other joint consultative committees in appointing a joint sub-committee". To me that sounds like administrative gobbledygook and a multiplication of committees. Many doctors sit on committees and waste a lot of time on them. They are not paid for sitting on them, and some of them find them very boring. This means that they are becoming uninterested in the administration of the health service. That is a bad thing, and unless there is a tightening up on boundaries, the situation will become worse.

Baroness Faithfull

I should like to ask the noble Lord a question before he sits down. With whom is he saying the family practitioner committees should work—the district, the region, or the Secretary of State?

Lord Rea

In reply to the noble Baroness, I would say that I am really asking for guidance. Personally, I should like to see a situation in which we can work in integration with the district health authority, but many of my colleagues have misgivings about this, and those are the views that I voiced. I am sorry if what I had to say came out in a somewhat disorganised way, but I had not prepared my speech.

Lord Trefgarne

What is being proposed here is an alternative form of organisation for the administration of family practitioner services which the Government have considered and rejected—namely, that of integrating them with the district health authorities. As I made clear at Second Reading, the majority of those whose views we sought last year about possible changes in the arrangements for FPCs favoured the solution that we now seek to implement. As I mentioned earlier, our consultations extended to health authorities and community councils. I at this precise moment cannot provide a definitive list of the rest of the people whom we consulted, but, as I earlier undertook to the noble Baroness, Lady Jeger, I shall most certainly prepare a list in the cold light of tomorrow morning and write to the noble Baroness. Certainly I shall be willing to pass a copy of the letter to other noble Lords who referred to the same point.

What is wanted is legislation that will enable FPCs to manage their own affairs. That was the view of the great majority of the people whom we consulted. It is the wish of the contractor professions, and indeed of the bodies which represent the family practitioner committees and their administrators. In the case of the FPC administrators, these are the very people whose duty it would continue to be to administer the contracts if the amendment were to be accepted.

As I have previously said, what we are dealing with here is a specialised area of administration of the contracts of self-employed practitioners, which has always been a function separate from that of the rest of the NHS administration. As noble Lords present who are doctors will no doubt appreciate, the practitioners themselves attach great importance to this, and it is right that proper regard should be paid to their wishes, but separation does not mean isolation. We intend that there shall be adequate safeguards to ensure effective collaboration between all those concerned with the delivery of primary care. This means full and effective arrangements between FPCs and DHAs, and between those bodies and the local authorities. What we are proposing is something tangible and lasting which will foster and strengthen the development of community health services to the lasting benefit of patients. We are creating a firm focus for family practitioner services as part of the wider system of primary care.

The noble Lord's amendment, if accepted, would, I believe, create a great deal of bitterness and alienation among those practitioners upon whose services we rely so heavily as the first line of defence against illness and infirmity. It would have the opposite effect to that which the noble Lord desires; that is to say, we are convinced that it would make co-operation in the provision of primary health care and between those services and other parts of the health service both less easy to achieve and less effective. I hope, therefore, that the noble Lord will not wish to pursue his amendment.

I was asked particularly about the problems of co-terminosity. It was the noble Lord, Lord Rea, who raised that. It is a new word which I have discovered only recently but its meaning will no doubt be obvious to your Lordships. There are two main arguments for FPCs keeping to their original boundaries. The first is administrative efficiency. Some 90 per cent. of the day-to-day transactions in FPCs relate, most conveniently, to the old boundaries which match up with postal districts. National bodies associated with FPCs, for example, the Prescription Pricing Authority, the Dental Estimates Board and the NHS Central Register, follow similar patterns.

The second argument has to do with the avoidance of disruption and costs. If the FPCs in boundary-change areas were required to work within new boundaries, the cost of sorting and transferring all the affected records would be between £1 million and £½ million. Change would also be disruptive when at the same time the FPCs will be having to come to terms with their new status. I hope that these arguments will persuade the noble Lord, Lord Kilmarnock, not to proceed with his amendments, but I shall be happy to provide further confirmation if I can.

9.16 p.m.

Lord Kilmarnock

I am grateful to noble Lords who have spoken and to the noble Lord, Lord Trefgarne, for his reply. I must confess that I still feel that the Government have not got it quite right. I should like to stress that the main burden of my amendment was the recommendation for primary care committees at district health authority level; in other words, the administrative arrangements for dealing with contracts could remain very much as they are at the present time. I was at pains to stress that we were in no way trying to tamper with the cherished, independent, self-employed status of the general practitioner.

I thought that a number of quite interesting points emerged from this short debate. I noted particularly Lord Rea's worry that direct competition with hospitals for scarce resources could lead to the GP at the front line of the National Health Service being squeezed out. I think this is a real worry. It was taken up in the first place by the Resource Allocation Working Party which reported in 1976 and I think that if there were to be another change we would need another Resource Allocation Working Party. The Royal Commission, in the chapter on finance, say under "Family Practitioner Services": However, there are some obvious practical problems to be overcome and we recommend that a study of the desirability and feasibility of a common budget for the family practitioner and hospital and community services should be undertaken". I think that is a road down which we should have to go.

I am also grateful to the noble Lord for having offered to write to the noble Baroness. Lady Jeger, and I hope he will write to me, too, for I must confess that I am slightly confused about the consultation process. I think it would be extremely helpful to know who was consulted, apart from the health authorities themselves and the community health councils. The debate seems to me to have revealed a number of areas of concern about coterminosity, overlapping, lack of integration and things of that nature in relation to the NHS. I go back to my first point that we see the NHS as being not only concerned with cure and care of the dying but with the front-line promotion of the health of the nation. We are not at all sure that the Government have chosen the right option in upgrading the family practitioner committees to totally independent status. I do not want to detain the Committee any more at this late hour.

Lord Trefgarne

I apologise for interrrupting the noble Lord. I wonder whether he will allow me to make one point arising out of what he said. I intervene now because I suspect that he is about to withdraw his amendment. I failed to make one point in answer to the noble Lord, Lord Hunter of Newington. I apologise for not mentioning this earlier. The noble Lord, Lord Hunter, put to me two points about accountability and forward planning. In fact, may I take the Committee into my confidence: the noble Lord, Lord Hunter, had given me advance notice that he was going to raise those matters. It was particularly remiss of me therefore not to deal with them when I was on my feet earlier.

One of our main objectives—and I am referring now to the accountability anxiety to which the noble Lord, Lord Hunter, referred—in this part of the legislation is to secure greater accountability of FPCs to Ministers for the exercise of their functions. This is why it is our intention that the Secretary of State should appoint the chairman, vice-chairman and members. With the removal of the administrative dependence of these committees on district health authorities, there will be clear lines of delegation and accountability between FPCs and the Secretary of State. Like health authorities, they will not only be accountable but be called to account. There will be cash limited administrative management costs and a performance review. Both internal and external audit arrangements will be made, the latter to be undertaken by the department. There will be a further safeguard of the involvement of the Exchequer and audit. Finally, we are taking, in paragraph 3 of Schedule 5, powers of direction as to the exercise of the functions.

There is, as your Lordships may know, at present under way an independent consultant's review of forecasting and controlling the family practitioner services. We hope to receive the report before Easter. Turning to forward planning, FPCs will not be the planning authorities for primary health care. This is to be the function of the DHAs. It will be for the FPCs to make the necessary input to the district plans, especially with regard to the supply of necessary information for planning purposes. This we are sure will bring plans for the services administered by FPCs much more closely into the simplified NHS planning cycle, where they will be subject to monitoring and review by regional health authorities and the department. That system is wholly the product of administrative action, and it will not be appropriate therefore to make legislative provision with regard to planning in respect of the FPCs only. I apologise again for intervening at a rather inapproriate moment, but I felt I had to take my chance while I could do so.

Lord Kilmarnock

The noble Lord, Lord Trefgarne, is perfectly correct. I was about to withdraw my amendment. I was interested in his remarks to the noble Lord, Lord Hunter. He seems to have rather played into my hands when he confessed that it will be the district health authorities who will do the strategic primary health care planning. That would have been very much facilitated by arrangements along the lines proposed in my amendment. I shall read Hansard and think about what has been said. I shall possibly come back to the matter at the next stage; or indeed others may wish to take it up in another place when the Bill moves there. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 9 agreed to.

Schedule 5 [Family Practioner Committees]:

[Amendments Nos. 29 to 31 not moved.]

Lord Banks moved Amendment No. 32: Page 46, line 50, at end insert— ("(7) The Secretary of State shall annually lay before Parliament a Report of all orders laid under subsection (5) above and of all requests received that an order be laid and of the disposal of such requests.").

The noble Lord said: Health authorities which manage large institutions of the kind that we were discussing earlier, institutions which take patients from many districts, will have to help get their patients back into the community, since that is the object we have in view, via those districts. They will have to be represented on the appropriate joint consultative committee in order to make a payment to the appropriate district. That would depend on variation orders issued by the Secretary of State. If the Government should decline to allow orders under subsection (5) of this paragraph of this schedule, they will in many cases in fact be impeding the implementation of their own purported policy. I am not saying that the Government will do that, but what I am saying is that Parliament has a right to monitor the implementation of the policy, and that is what this amendment seeks to achieve. I beg to move.

Lord Trefgarne

My right honourable friend the Secretary of State for Social Services has made only two orders affecting joint consultative committees since these bodies were first set up in 1974. The first of these orders provided for most of the matters specified in subsection (5). There is no record of any request ever having been made for an order.

It will be necessary to make an order in relation to the inclusion of FPCs in the JCC structure, but the need for further orders should rarely arise. Any order made under this section takes the form of a statutory instrument and would therefore be laid before Parliament, It is, of course, open to your Lordships to table a Question at any time. In essence, therefore, I do not think there is need for this provision. The noble Lord makes a good point, but I think it is already covered by the procedure I have outlined.

Lord Banks

Is the noble Lord saying that the need for these large institutions to be represented on a large number of joint consultative committees will not be the occasion for an increasing number of orders?

Lord Trefgarne

Indeed I am, yes.

Lord Banks

I am surprised to hear that, but I will look again at the Bill. In the meantime, I beg leave to withdraw this amendment.

Amendment, by leave, withdrawn.

The Deputy Chairman of Committees (Lord Renton)

I assume that Amendments Nos. 33, 34 and 35, in the name of the noble Lord, Lord Kilmarnock, are not moved?

Lord Kilmarnock

They are not moved.

[Amendments Nos. 33, 34 and 35 not moved.]

Lord Lyell moved Amendment No. 36: Page 47, line 18, leave out from ("for") to end of line 19 and insert ("persons in the Committee's locality").

The noble Lord said: I beg to move Amendment No. 36, which stands in the name of my noble friend Lord Trefgarne. As your Lordships will know, we are considering Schedule 5, and the purpose of paragraph 6 of that schedule is to carry out a minor amendment to Section 30 of the National Health Service Act 1977 in such a manner as to reflect the replacement of the district health authority by the family practitioner committee as the body to which medical practitioners must apply for inclusion in a medical list. As worded, the paragraph implies that the inclusion of a medical practitioner in the medical list of an FPC obliges him to provide general medical services for all persons in the committee's locality who wish to take advantage of the arrangements the committee has made with general medical practitioners to provide personal medical services. Indeed, it states that he gives such an undertaking, but he does not in fact do so and he is not under an obligation so to do. We feel that is the important point.

Once on an FPC's medical list, a general practitioner is entitled, within certain limitations, to accept any person for NHS general medical services. However, he is not, and indeed cannot be, expected to provide those services for all persons in the committee's locality who might wish to use them. He is in fact entitled to refuse to admit a person to his list and need give no reason for his refusal. There is, too, an upper limit prescribed in regulations to the number of patients a doctor may have on his list. The amendment is fairly simple, and I hope that I have been able to clarify the reasons why we believe it is necessary. I beg to move.

Baroness Jeger

May I briefly ask the Minister what happens to a doctor who is working in two localities and has surgeries in two different districts? In which locality or territory does he function?

Lord Lyell

I believe that the Government Front Bench, just like the doctor suggested by the noble Baroness, is not all-powerful. I shall certainly inquire as to which of the districts the doctor should belong to at any one time, or to whom he should administer his services, and will write to the noble Baroness with expedition.

On Question, amendment agreed to.

[Amendments Nos. 3779 not moved.]

9.31 p.m.

Lord Banks moved Amendment No. 80: Page 53, leave out lines 36 to 38.

The noble Lord said: Sub-paragraph (3) of paragraph 6 enables the Secretary of State to appoint a member to be vice-chairman of a family practitioner committee. It seemed to us on these Benches that the family practitioner committees should elect their own vice-chairmen, as do the district health authorities. It also seemed to us to be an unnecessary bit of central control to have this appointment made by the Secretary of State. I beg to move.

Baroness Jeger

On these Benches, we support this amendment, and I am very surprised to find that the British Medical Association itself has written me a letter of support for this amendment. This is an organisation with which I do not always agree, but I am glad that they agree with me on this matter. It does not seem right that the Secretary of State should have direct appointment of both the chairman and the vice-chairman. That is a change from the present practice, and I do not know the justification for the Secretary of State now wanting to appoint both the chairman and the vice-chairman.

This view is strongly held by the General Medical Services Committee of the BMA, which represents the general practitioners in the National Health Service. I understand that previously there has been an accepted practice of having either a lay chairman and a medical vice-chairman or the other way round. But there always has been a lay element and the BMA is asking that there should be a balance of lay and medical representation, as has been the case in most areas. The General Medical Services Committee fears that this balance might be lost if both appointments were made by the Secretary of State. It is a late hour, but to those who are seasoned old people from another place it is early hours yet, so I hope we can hear what your Lordships think, I shall also be very interested to hear the views of the Minister on this.

Lord Kilmarnock

We on this Bench also agree with the amendment of the noble Lord, Lord Banks. I have already referred this evening to undesirable extension of the Secretary of State's patronage, and this seems to be a further example of it.

Lord Trefgarne

There are two factors which we took into account when deciding that it would be right for the Secretary of State to appoint vice-chairmen as well as chairmen, although he does not, of course, do so in respect of health authorities. The first stems from the long-established practice of maintaining a balance between contractor and non-contractor membership of the committees: not a feature of health authority membership. It is our intention that in all the new FPCs the vice-chairmen should not be drawn from the same group of members as that of the chairman. Thus a contractor chairman would have a non-contractor vice-chairman, and vice versa. There will also be instances where we identify a potential chairman whom we would wish to appoint when he had acquired more experience of the work of the committee. It might well be that we would feel that experience could best be gained by a spell as vice-chairman and we need to be able to ensure that such experience would be made available.

I hope what I have said will persuade the noble Lord not to press his amendment—I believe that they are compelling points—and that the arguments I have adduced will convince the noble Lord.

Baroness Jeger

When the noble Lord referred to a contractor chairman having a non-contractor vice-chairman, and vice versa, he did not make clear whether one of them could be a lay person or whether both of them would have to be medical.

Lord Trefgarne

A non-contractor could certainly be a lay person.

Lord Banks

The noble Baroness, Lady Jeger, indicated the support which the amendment has attracted from people who will be very much concerned with the development of family practitioner committees. I did not find the reply of the noble Lord to be altogether convincing. However, I do not wish to divide the Committee. Therefore, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Lyell moved Amendment No. 81: Page 54, line 13, leave out ("any local authority whose area is wholly or partly included") and insert ("local authorities any part of whose area is").

The noble Lord said: With the leave of the Committee, I beg to move Amendment No. 81 and at the same time to speak to Amendment No. 82. Both amendments stand in the name of my noble friend the Minister. As your Lordships will see, paragraph 30 of Schedule 5 to the Bill substitutes a major new Part II in Schedule 5 to the 1977 Act. This deals, among other things, with membership and appointments to family practitioner committees. In the new paragraph 6A(1), paragraphs (f) and (g) relate to nominations by local authorities and district health authorities. As at present drafted, the words "includes/is included" are used in the definition of interested authorities. However, legal opinion now suggests that a strict interpretation of these words is liable, in certain circumstances, to exclude nominations from one or more authorities, even though their territory is wholly or partly in the locality of the family practitioner committee.

I understand that this difficulty is particularly likely to arise in the case of district health authorities because of the particular wording of paragraph (g). I hope your Lordships will agree that it is only reasonable that we should be able to consider nominations from all authorities which share at least some of their territory with the family practitioner committee. The new wording which we suggest in the two amendments removes any doubt or ambiguity about this. For that reason, I beg to move.

On Question, amendment agreed to.

Lord Lyell moved Amendment No. 82: Page 54, line 16, leave out ("any District Health Authority whose district wholly or partly includes") and insert ("District Health Authorities any part of whose district is in").

The noble Lord said: I spoke to this amendment, which is consequential, at considerable length. I beg to move.

On Question, amendment agreed to.

Lord Banks moved Amendment No. 83: Page 55, line 12, at end insert— ("Paragraph 2 of Schedule 7 shall apply to Family Practitioner Committees in the same way as it applies to District Health Authorities.").

The noble Lord said: This amendment is designed to give community health councils the same rights with respect to family practitioner committees as they currently have with respect to district health authorities. At present, with the family practitioner committees being to some extent subordinate to the district health authorities many of the community health councils' rights can in principle be enforced against the district health authorities. This will no longer apply under the Bill.

The rights referred to are in the 1977 Act and concern the right to be consulted, the right to information, the right to inspect premises controlled by the family practitioner committee—which does not include general practitioners' private surgeries, the right to comment on services, and the right to respond to the Community Health Council's annual report. In that these rights are currently defined in regulations rather than in the 1977 Act, it seems appropriate to deal with the family practitioner committees in the same way. I beg to move.

Lord Trefgarne

I believe I can save a lot of your Lordships' time by saying that I accept this amendment in principle. If the noble Lord, Lord Banks, will be good enough to withdraw his amendment at this stage, I will undertake to bring forward a suitable Government amendment, embodying the principle which the noble Lord has enunciated, at the next stage.

Lord Banks

I am grateful to the noble Lord the Minister for his acceptance in principle of this amendment. I beg leave to withdraw the amendment at this stage.

Amendment, by leave, withdrawn.

[Amendment No. 84 not moved.]

On Question, Whether Schedule 5, as amended, shall be agreed to?

9.42 p.m.

Lord Pitt of Hampstead

I want to make a few comments on the schedule, even though I do not wish to make any amendments to it. I am worried by a few points in this schedule. I will not delay your Lordships too long because it is late. First, there is the whole question of the family practitioner committee and its control on new medical entrants. In order to explain my worries, I will describe my own experiences. In 1950, having been an assistant in a general practice in Chiswick, I decided to open a practice far away from my previous boss. I discovered the area in Euston where I now practise. I was able to start a practice, which I built up from scratch. It was not until I built it up that I went to the committee and eventually secured from the committee the initial practice allowance. As I see the present regulations, and as I know from colleagues, it seems almost impossible for anybody to do today what I did in 1950. In 1950 I started a practice from scratch and built it up.

If your Lordships will allow me to digress for a moment, it is rather amusing that I did not stay in the surgery to worry. When I started, I was taking a course in child health at Great Ormond Street Hospital. When I attained my DCH I decided to do a course on skin diseases and attended the Hospital for Skin Diseases near Leicester Square. When I finished that, I decided to do a course in psychiatry and I used to go to Maudsley Hospital and to Cane Hill. Finally, I was attending Maudsley Hospital and Belmont. By the time I reached the stage when I was attending both Maudsley Hospital and Belmont my practice had reached such a size that I could no longer go to Maudsley in the afternoons as I had done. I am merely using that as an illustration. I was aiming to be in practice just from scratch.

As a result, when I went into County Hall in 1961 as a member of the LCC I had a practice of 3,500 patients, and I was doing midwifery. Naturally, I had to give up midwifery; I had to reduce the practice. I do not mind if the Minister gives an undertaking that the Secretary of State will see that doctors can do what I did, but as I see it, and as things are at the moment, it is not possible for a doctor to do what I did. I personally think that would be a loss to the community. I genuinely believe that. Therefore, I am concerned about the rigid control which the medical practices committee is allowed to have which makes it difficult for new doctors to establish practices. That was the first point I wanted to make. I hope the Minister can give me some assurance. I am not really trying to get the law changed. What I am trying to do is to get an undertaking from the Secretary of State that these things will be facilitated.

There is another point I was a little worried about, and that is paragraph 21. I cannot see how a person can be in general practice in the National Health Service and not on any FPC list. I do not understand paragraph 21(2) and 21(3). I do not understand how you can have a practice, which you could sell, without being on the list, unless of course it is a private practice, in which case I do not see the point. I would like the Minister to explain what paragraph 21(2) and 21(3) mean. I know it was in the 1977 Act: I did not understand it then and I do not understand it now. I would be happy to have an explanation of that.

The other point on which I need some reasurance is the whole question of whether or not FPCs would be cash limited. So long as you accept demand-led general practice—I do not necessarily defend it: I do not believe it is so difficult to have a salaried GP practice, but at the moment general practice is demand-led—I do not quite see how you can cash-limit it. I am trying to get an undertaking from the Minister that there is no thought in the Ministry of trying to cash-limit FPCs. I am very serious about this, because I would not like to happen the sort of thing that has happened in the hospital service, under which, for example, in Birmingham, people have been told that they must say to kidney patients that they must go home and die. That is virtually what you are saying to them if you say they can no longer have treatment.

I therefore want an undertaking from the Ministry that they appreciate the point in terms of service, in terms of the principles underlying this demand-led service in which the doctor who is doing it is a contractor rather than an employee. The mere acceptance of the FPC as a separate branch I agree with, regardless of what anyone says, and, once you have decided that the GP has to be an independent contractor, then it is right that the FPCs should be separate from the area or district health authorities, particularly because they can cover a larger area than any district, and in fact many areas.

It is right that they should be controlled directly from the Ministry. What I do not want, however, is for the Ministry to now say, "You can have £X and £Y must be spent on general practice, but X plus Y means that a certain number of patients cannot have treatment." It is possible, as I see it on my reading of the schedule, for the Ministry to be able to do that. I genuinely hope that the Minister will tell me that the Ministry have no such ideas. I should be unhappy if I thought that it had.

There are one or two other things I am worried about, but they are not as important as the two points that I have just made. I hope that the Minister can reassure me on those points and that we can allow Schedule 5 to pass.

9.52 p.m.

Baroness Gardner of Parkes

I speak against the acceptance of Schedule 5, in particular with regard to Part II. I have been asked to make a number of points by the Conservative Medical Society, which is concerned about the totally new structure proposed for the family practitioner committees. The society is not happy that the chairman will be appointed. I was not able to support the amendment of the noble Lord, Lord Banks, because his amendment started after the matter of the chairman. As I understood it, his amendment commenced with the vice-chairman. The society is not happy because it considers that the past tradition of family practitioner committees, where the chairmanship alternated between a professional and a lay member, is a system that has operated very well and happily for many years. It is rather a pity to throw it out and to superimpose possibly a completely outside person on a very localised and well-knit local family practitioner committee, which it would normally be. I ask the Minister to consider that point.

I am not aware whether or not this chairman will be someone who is salaried or carrying a large honorarium and intended to be fairly full-time in the job. If so, that would make a difference and it would perhaps be understandable to have someone appointed for his administrative ability as much as anything else. The Conservative Medical Society is very keen to have the Government ratify an appointment put forward by the members of the family practitioner committee. It believes that that would be a better system.

In discussion at another meeting that I attended, the point was made that some local medical committees are already saying that if the Government are to choose eight people they will give only eight names. In that way the Government will have no choice as to the people nominated. If the medical profession adopt that technique everywhere it will be going back to the original system, because whatever number there are on the family practitioner committee at present are elected by the local medical committee, who are themselves elected from the local general practitioners. It has been quite a fair and democratic system. I have never served on a family practitioner committee, but I did serve on the Inner London Executive Council which was the predecessor of that body.

I wish to make only one other point, because the hour is late. I noticed that there is provision under Part II for the medical and optical committees to require the Secretary of State to allow them to have deputies. But there is no such provision made for the dentists, nor the pharmacists. I ask the Minister why that is so. I also ask that he look into that matter and rectify it because it seems wrong that some professional people can nominate deputies while others are not mentioned in that way. With those comments I would ask the Minister to consider these matters.

Lord Trefgarne

First. I should like to deal with the points raised by the noble Lord, Lord Pitt of Hampstead, or at least as many of them as I can and I will gladly write to the noble Lord on some of the more arcane matters that he mentioned. As to the first point raised by the noble Lord, who recounted his own experience in this matter, in particular about starting a practice from scratch, it remains possible for a suitably qualified doctor to put up his plate and build from scratch his practice in any area classified as designated or open. Indeed, in the former case financial inducements are offered by the department to encourage him to do so.

The noble Lord also questioned the provision in paragraph 21 of Schedule 5 for a new subsection (2) of Section 54 of the 1977 Act which relates to the sale of medical practices. This subsection has only been altered in respect of the reference to "a locality" rather than the district of a DH A in accordance with the new arrangements for FPCs. The provision remains the same and, indeed, is a longstanding one. Its effect is to exempt purely private general medical practices from the general prohibition on the sale of goodwill of medical practices. It contains safeguards to make sure that the sale of a private practice cannot benefit from any NHS interest which the doctor in question may have had, because of course a number of practices are both private and health service. If he has never had an NHS practice in the locality in question—that is, if his name has never been on the medical list of the FPC for that locality—he will be debarred from selling the goodwill of any practice, private or otherwise, in that locality. This is an equitable arrangement and one which we would not wish to see changed.

The noble Lord also asked me about the financial arrangements, or cash limits in particular. The Government have commissioned an independent review by consultants of the arrangements for forecasting and controlling spending on family practitioner services which is to be completed next year—1983. The rest of the NHS has found such limits to be a stimulus to the better use of resources, but we certainly do not seek to minimise the major problems which would be involved if it were decided to try to translate a cash limit system from the different conditions and statutory frameworks of health authorities to the family practitioner services. These have traditionally been regarded as demand-led for expenditure purposes and a reflection on the fact that it is the acts and decisions of individual contractors which commit resources, not so much the family practitioner committee themselves.

We are not expecting easy answers to what is a problem of immense complexity, but we shall study with great care the outcome of the review. The noble Lord recited some of the major difficulties in the way of a change that he feared, and we of course will be confronted by those difficulties too. The administrative costs of family practitioner committees will be subject to cash limits in the same way as the rest of the health service and we shall be looking to the newly constituted committees to contribute their share to savings in public expenditure.

My noble friend Lady Gardner of Parkes referred to the appointment of chairmen of the new FPCs. The appointment of FPC chairmen by the Secretary of State is central to the Government's policy of securing direct accountability of these committees. We cannot accept the principle that appointments should be just a rubber stamp, and we could not therefore agree to confirm a recommendation originating locally. My noble friend raised some other points, some of which, frankly, have been dealt with on earlier amendments to this Bill. But I shall certainly study what my noble friend said and write to her if there are no obvious answers to the points she has raised.

Schedule 5, as amended, agreed to.

Clause 10 agreed to.

10 p.m.

Baroness Masham of Ilton moved Amendment No. 85: After Clause 10. insert the following new clause: ("Power to provide for cenital funding of certain hospital facilities. . The Secretary of State shall have power by order to designate hospitals or specialised hospital units as national hospital facilities: and such hospital facilities shall be funded from central funds.").

The noble Baroness said: If the Government are really interested in keeping standards as high as possible in the National Health Service, and if they want to have the power to protect our finest and most excellent medical specialtiies, then they should welcome this amendment before your Lordships. Our National Health Service has been the envy of many countries throughout the world. I am a strong supporter of this service, putting it at the top of my priorities.

Like many other noble Lords I have been worried, and I still am worried, about the growing pressures on the National Health Service. This amendment, if accepted by the Government or if your Lordships accept it should the Government not, would give power to provide for central funding for specialised hospital or hospital units which serve a national need and are concerned with a speciality. I hope that the Government will accept this.

I have always believed that our health service should not be too parochial but that there should always be a cross-boundary flow of patients when this is necessary. All regions cannot cover all specialties. In some small vital problems the numbers may be small, the experts scarce; and the need of the individual may be the choice between life and death. I do not know how many units dealing with such special patients there are. Every specialty is a priority. The National Health Service must cover all needs. Everybody's life is a unique and important one. But many specialties are covered by regions or districts. It is the national units which this amendment seeks to safeguard. The Government must know which these are.

I quote from an article published in the Yorkshire Post on Tuesday this week. It is headed "Hospital Fear", and says: The only specialist diabetes hospital in the country, the 30-bed Langwith Lodge near Mansfield. Nottinghamshire, may be forced to close because of a lack of funds. Nottingham Health Authority said yesterday". Because of this fear many people with diabetes may feel threatened.

After a visit to Africa, my noble kinsman was sent to the Hospital for Tropical Diseases in London, Yorkshire having no such facilities to deal with a tropical specialty. The national spinal unit at Stoke Mandeville Hospital, which deals with patients from all over Britain and from other countries throughout the world who break their backs and their necks, nearly went down a few years ago. The Oxford Regional Health Authority had not kept that hospital in satisfactory repair. The ceilings fell down on top of patients. With the pressure of needs on the Oxford region it is not surprising that a national unit such as this is not popular with the regional health authority. The goodwill of the country came to the rescue of the spinal unit, and all over the country people raised money on a voluntary basis for the National Health Service hospital with a special unit, and now this hospital is being rebuilt.

That unit has many patients who are at risk from urinary complications and pressure sore problems and special psychological needs. It needs specially trained staff and facilities which many general hospitals have not got. It has to treat old and new lesions. The unit has to be funded once it is rebuilt. I should be grateful if the Minister would tell the Committee how the cross-boundary flow works for supra-regional units. I cannot see any reason why this amendment would not be helpful to the Government, should they need to use it. I hope your Lordships will support it. I beg to move.

Lord Pitt of Hampstead

I support this amendment. Some of your Lordships will remember that on a previous occasion when we had a debate on the National Health Service I instanced the haemophilia unit at the Royal Free. The Government need to look at this question of central funding of some services. For example, the issue about kidneys that I raised earlier in my other speech on Birmingham illustrates the point. The Government need to look at this.

There are some issues that need to be funded centrally. The Government should take power to deal with those issues. In terms of the general service, the way in which we have arranged the service—the regional health authorities, the district health authorities, and so on—is quite right, but there are some issues which can be better rationalised by being centralised. I hope that the Government will think seriously about accepting this amendment.

Baroness Trumpington

I should like to support this amendment. I speak entirely personally. I hope I am not out of date, although I well may be, and I am sure the Minister will tell me if I am. I speak as a past member of the United Cambridge Hospitals Board. Addenbrooke's Hospital, for instance, has specialties which are led by professors of world-wide distinction. If you have a department dealing with a particular disease which brings people in from all over the country and that department has an international head, he is going to be away from the hospital a great deal. This means that he has to have a great deal of additional back-up which normal professors of medicine do not have to have. That is costing the area health authority a great deal of money for one particular hospital.

To my certain knowledge this in the past caused enourmous unhappiness and feelings of jealousy, whether well-founded or ill-founded, on the part of the other hospitals in the area, though the amount of finance at the disposal of that particular authority was being channelled for a very good reason into, let us say, kidney dialysis or liver research—liver research happens to be one of the particular specialties of Addenbrooke's. This meant that the other peripheral hospitals were suffering financially as a result of the very important international work which was being done by a particular department. It must follow that such a department, because it will advance science and therefore lessen the suffering of people who happen to have a particular disease, needs money for the back-up and research involved.

I strongly support the amendment if the result will be that the right amount of money can be spent in order to make medical progress, and there should not be a niggling doubt among those running the area health authorities that maybe they cannot spend what they want to spend because they have a number of other hospitals which they must service and look after at the same time.

Baroness Lane-Fox

The amendment gives me the chance to voice our deep concern about the future of the Phipps Respiratory Unit, and I shall try at this late hour to keep my remarks short. Although this unit belongs to St. Thomas' Hospital—that illustrious hospital which is going through such traumatic times—it is based in the South-Western Hospital at Stockwell. The unit is unique. It deals with severely disabled cases who also have respiratory problems. To see patients in iron lungs, on life-support respirators with tracheostomies, on the cuirass pump method, on rocking-beds and other forms of respiratory assistance, appears to encourage those who sometimes visit the unit to describe it as "a dump for moribunds". Of course, that is a shocking and quite inaccurate description. Nevertheless, it is clear that it is only those of us who have been treated or worked there who know how far from the truth that description is.

Under the brilliant ministrations of Dr. Geoffrey Spencer, the consultant, who was there to set up the unit in 1969, with a dedicated team, many patients, who on admission appear to be material for the rubbish heap, are transformed and go back into the community as useful members of society, limited only by their disability. To achieve this, many have to take home with them breathing aids of various kinds which must be serviced by expert technicians from the hospital. Even so, for some, life would end within three minutes of failure of the machine. But. with the machine, they live useful lives as secretaries, computer programmers, housewives, students of Open University courses and so on. All know that the Phipps Unit is their lifeline, and they recognise that it is the success of the endeavours of Dr. Spencer, with his team, that has given them this new lease.

The patients' association was formed in 1979 and, as their chairman. I have been astounded by the funds they have raised and given—over £50,000 in the last two years—to ensure the ward's future. Alas, it is that future which is now in grave danger. Not that the unit is likely to be closed down, but it looks all too likely to be killed from strangulation for lack of funds. The reason is simply that it does not fit into the RAWP budgets, which work on a local per head of population basis.

Being of such a specialised nature, as my noble friend Lady Trumpington mentioned, patients are admitted to Phipps from all parts of the country—from Scotland. Wales, East Anglia, Devon and so on—and many had been shunted round numerous other hopsitals without success and several had practically given up in despair before being admitted to Phipps. It is as a result of the expertise which is there given, combined with the constructive atmosphere of Phipps, that many of all ages—children, young marrieds, senior citizens—find themselves suddenly getting better. It is then that they make their contributions to our association, which is busily and carefully trying to improve and update the respiratory equipment and other ward amenities.

Ten years ago the total of patients in the ward was about 40. Now the numbers attached to the unit, and living in or out of the hospital, are about 220. This spring the bed occupancy was about 115 per cent., and there are three or more referals per week. The same number of staff still has to cope, and technicians undertake a six-fold increase of work, compared with six years ago, and now travel over 100,000 miles per annum to maintain the breathing and other equipment that is essential for the patients.

The consultant cannot see how he can retain even useful standards if the suggested financial cuts are imposed. The hope had been that, partly for economic reasons, the unit could be rehoused in St. Thomas', thus reducing costs and greatly facilitating medical care. But on account of St. Thomas' budgetary cuts of an expected 20 per cent. or over during the next five years, understandably the space that we wanted for the unit has been filled by St. John's Hospital for Diseases of the Skin and, it is hoped, the Dreadnought Hospital, both of which have financial resources and do not suffer our budgetary nightmare. Who can blame our district health authority for being less attracted to our needs, for we deal with only two or three patients from the district, when the authority has plenty of local hospitals needing to augment financial resources?

Our patients know that each day of their life they depend on Phipps Unit. There is nothing else for it; it is their lifeline. No wonder they are rigid with fear about what may happen. The only solution would be if the unit, serving a national need, receives national, or supra-regional, status.

Baroness Darcy (de Knayth)

I should like to add a brief, but none the less wholehearted, word of support on my noble friend's amendment. The ground has already been very eloquently covered by the three noble Baronesses, and so I shall not paint any more pictures of the state of things. The amendment is not really asking for much. It is asking only for the Secretary of State to have power to provide for central funding of certain hospitals. As my noble friend said, it is very important to maintain the standards. Perhaps the Minister will say that the power already exists—I do not know. But if he does say so, I shall be delighted, though I think that the power should be written into the Bill, and should be used.

I should like to underline what my noble friend said about the problems at the National Spinal Injuries Centre at Stoke Mandeville Hospital. Recovering the money for the cross-boundary flows—which is for patients coming from outside the region—takes about two years. So it really is a grossly unsatisfactory arrangement, and I hope that the Minister can accept my noble friend's amendment.

Baroness Jeger

I rise very briefly just to associate my noble friends with the amendment. The ground has been very well covered, as it certainly was in part on Second Reading, when the noble Lord the Minister agreed that RAWP was a very blunt instrument, but that it provided for the cross-boundary flows. But clearly things are not working satisfactorily. I shall not detain your Lordships tonight beyond mentioning hospitals such as the National Hospital for Nervous Diseases, Moorfields Hospital, and Great Ormond Street Hospital. They are hospitals for the whole world, as one can see when one visits them. When one tries to speak to the patients it is difficult before it is time to leave to find one who speaks English.

If the Minister feels unable to designate certain hospitals in this way for total funding, as the amendment seems to seek, I wonder whether, by some mark of generosity, he could establish a partial funding that did not come out of local or regional budgets. The noble Baroness, Lady Trumpington, was quite right when she referred to some of the tensions in some areas where it is felt that all the money is going to the splendid centres of excellence, while the mental hospitals and the geriatric wards are the Cinderellas of the health service. That we must not allow to be said; it certainly should not be true. But, if we do not do something exactly as the amendment proposes, we must take on board the real problems of our finest hospitals.

Baroness Gardner of Parkes

I should like to speak very briefly, since I think that a slight misconception arose in the speech of the noble Baroness when she referred to funding. The amendment is not actually asking for funding, and, if it comes through in that way, the Minister may be more inclined to turn it down. It is asking for the power to provide funding. This means that the Minister could actually decide about the question of funding, and which units were to be funded, afterwards. All that we are pressing tonight is for the power to have this facility. I appreciate that in the form of the postgraduate hospitals there are certain specially designated hospitals that are national hospitals already. This is really to cover in particular the small units within the present, ordinary health structure within the district health authorities which are being swallowed up because, as I know from having served on health authorities myself, they are reluctant to spend any money on people who live outside their own area: it is the national element which is important. We are asking here only for the power to provide the funds. I cannot imagine why the Government would refuse to have those powers.

Viscount Ingleby

In supporting this amendment, may I just remind the Minister of the undertaking given by Dr. Vaughan in 1979 that, if money for building the new spinal injuries unit at Stoke Mandeville was raised by voluntary subscription, the Government would ensure that the running costs would be met?

10.22 p.m.

Lord Trefgarne

Strictly speaking, this amendment is not necessary because it is already open to the Secretatry of State to provide funds specifically for individual hospitals and units if he so chooses. In addition, the implication that highly specialised services can somehow be insulated from judgments about the relative priority of different claims on the limited resources of the National Health Service is not one that we can accept. However, we are now well advanced with proposals for a new method of funding those services which are recognised as having a supra-regional character, and it may be helpful to the noble Baroness if I say something briefly about these.

There already exists a group of services which were identified in 1979, in consultation between the department and the medical profession, as falling into the supra-regional category. There are four of these: they are paediatric haemodialysis, spinal services (including Stoke Mandeville), the management of chorioncarcinoma and the National Poisons Information Service. These services already receive a degree of special treatment, under arrangements which started in 1980, in the allocation of health authority funds. These arrangements have not proved satisfactory. I will not go into the detailed reasons, which are somewhat complex but briefly, the point is that, while an allowance for these services is made in health authorities' revenue targets, its effect on their actual allocations is negligible in the short term. Following further discussions with health authorities and the medical profession, we have accepted the principle that services which draw patients from an area much wider that that of their own region should not have to complete directly for funds with services which the same authority has to provide for its own district.

We have now reached agreement with regional health authorities on proposals for earmarking funds for these and similar sevices, and we will be discussing them with the medical profession next month. A key point in these proposals is that we shall be setting up a forum comprising representatives of both health authorities and the profession, whose job will be to advise on which services should be covered by the new arrangements and the level of funding they should receive. This will achieve two purposes. First, it will eliminate direct competition between district and supra-regional services—which we think is unfair to both—for the limited funds available at local level. But it will also ensure that the priority for highly specialised services, as against those provided by health authorities collectively from their normal allocations, is properly considered at the right level—that is, the national one. I cannot emphasise too strongly that more money for services funded nationally means less for all the others that health authorities have to provide; and that is why we think it so important for authorities to be involved in these decisions.

We hope to make a start with the new funding arrangements in the coming financial year. Initially, they will be limited to the four services I have mentioned, but once we have the new forum in being we expect it to be looking at the case for bringing in other services which can claim to be performing a supra-regional function.

My noble friend Lady Lane-Fox referred particularly to the Phipps Respiratory Unit. My noble friend warned me that she would be raising this point and I have therefore caused to have made particular inquiries about the Phipps unit. I have been assured today by the chairman of the West Lambeth Health Authority that there is no threat at all to the future of the Phipps unit. The authority is fully aware of the importance of this unit and intends to maintain it. Clearly its expenditure cannot be unlimited but its budget has not been cut in the current year, and there is no intention to reduce its budget next year.

What we are talking about is priorities, and I want to tell your Lordships that that is probably the most difficult decision that we have to take in the National Health Service. I, like all my ministerial colleagues in the department, visit a great many hospitals in the health service around the country. I visited a little hospital in Maidenhead a month or so ago which housed a small number of profoundly physically and mentally handicapped children. I defy any Member of the Committee to look those children in the eye and tell them that they are a lower priority than some others to which reference has been made tonight. These decisions are extraordinarily difficult.

We are living in a time of financial constraint within the health service—not of cuts, as some people sometimes accuse us. We have not imposed cuts on the health service. The decisions that we have to take are very difficult. The amendment before your Lordships will not make those decisions any easier. It will not provide any further funds for these services. I hope that, in the light of the assurances that I have been able to give about the supra-regional services, the noble Baroness will feel able to withdraw the amendment.

Baroness Masham of Ilton

I should like to thank all noble Lords and noble Baronesses who have supported this amendment. I consider it very important. I should also like to thank the noble Lord the Minister for what he has said. But I am worried that he has a fear about this very helpful amendment. I want to study what he said, go back and take advice from other people working in the field to see why the Government should be frightened of this amendment—because I have a feeling that they are frightened.

I should also like to say to the Minister that I too have visited many places for multiple handicapped children. I opened a centre for rubella-damaged children in Leeds. Those children were blind, deaf and otherwise handicapped. I agree with him. But the really specialised centres are very important for other reasons apart from just treating patients. They are important for teaching and research purposes so that future children will not be born handicapped such as those children that the Minister visited. That is why we need these highly specialised units. Excellence is worth preserving, and that should be part of our National Health Service.

The hour is late and I am sorry that so many of your Lordships and members of the staff have been kept so long; but, as the noble Baroness, Lady Jeger, said, when we have an important matter we must discuss it fully. I consider this to be a very important matter. I shall come back at the next stage maybe with a different amendment but with the same aim. With that, I beg leave to withdraw this amendment.

Amendment, by leave, withdrawn.

Clause 11 agreed to.

Lord Denham

I think that as it is very nearly half-past 10 we may take this opportunity of rising. I should like to thank noble Lords for the careful way in which they have been considering this Bill without too much time attached to it.

I beg to move that this House do now resume.

Moved, That the House do now resume.—(Lord Denham.)

On Question, Motion agreed to.

House resumed.