Orders of the Day — Clause 45. — (Local Health Authorities.)

– in the House of Commons at 12:00 am on 1st April 1963.

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Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West 12:00 am, 1st April 1963

I beg to move, in page 61, line 42, at the end, insert: (3) In its application to Greater London, section 31 of the National Health Service Act 1946 (which provides for Executive Councils for General Medical and Dental Services and Supplementary Ophthalmic Services) shall have effect as if for any reference to the local health authority area there were substituted a reference to one of the areas provided for in the Schedule (Areas, etc. of Executive Councils for General Medical and Dental Services, Pharmaceutical Services and Supplementary Ophthalmic Services). Perhaps it will be convenient to take with this Amendment my new Schedule entitled, "AREAS, ETC. OF EXECUTIVE COUNCILS FOR GENERAL MEDICAL AND DENTAL SERVICES, PHARMACEUTICAL SERVICES AND SUPPLEMENTARY OPHTHALMIC SERVICES":

London BoroughsExecutive Council
1–12Inner London (formerly London Executive Council).
13–17To remain part of the present Essex Executive Council with the inclusion of the former Executive Councils for the County Boroughs of East Ham and West Ham, in existence on 31st March 1965.
18–19To remain part of the Kent Executive Council.
20–24To remain part of the Surrey Executive Council.
Area which would incorporate also the Executive Council for the area formerly the County Borough of Croydon in existence on 31st March 1965.
25–32North West London (formerly Middlesex Executive Council).
We have proposed the Amendment because, although I raised the point in Committee, I was dissatisfied with the reply of the Parliamentary Secretary to the Ministry of Health. I therefore thought that the proper thing to do would be at this stage to get the matter clarified so that the House could decide the issues before us.

This Bill affects, in passing, so to speak, the National Health Service Act, 1946, which provided in Part IV and the Fifth Schedule that the organisation of the general medical services, the pharmaceutical services, the dental services and the supplementary ophthalmic services should be organised by local executive councils which would have the same area as that of each local health authority. This Bill, in altering the areas of the local health authorities, automatically alters the areas in which the family doctor services and the dentists and opticians in an area operate. In my new Schedule, which I understand we can discuss with this Amendment, I designate, instead of 33 executive councils, which would be the corollary of passing the Bill in its present form, just five executive councils more or less covering the areas which are at present covered for these purposes.

Yet this is not the status quo. The Amendment and the Schedule provide the changes which I believe to be necessary, and which I think would be more suited to the reorganisation of Greater London and the new boroughs than what the existing system provides. The main change, if my new Schedule were accepted, would be this, that whereas the London Executive Council and the Middlesex Executive Council would remain the same, Surrey, Essex and Kent Executive Councils would retain those sections which now fall within the purview of Greater London, but at the same time the three county boroughs which, if I may say so, have always seemed to me a little bit anomalous in the situation, would fall into the county areas in which they are geographically placed, so the County Boroughs of East Ham and West Ham would become part of Essex Executive Council and the County Borough of Croydon would become part of Surrey Executive Council.

This does not necessarily provide the ideal situation. I believe there is room for considerable change in this sphere, but in the situation in which we find ourselves with this major, drastic alteration of London Government coming on, this is the least which can be done to preserve the best in medicine, the best in dentistry, the best in pharmaceutical service for the local inhabitants.

This does not cover only the provision of a local executive council, because, as is inherent in the National Health Service Act, the executive councils work through sub-committees or local committees dealing with the specialties concerned, so that in each area of an executive council we have a local medical committee, consisting of general practitioners, we have a local dental committee, and we have a local pharmaceutical committee, dealing with the technical arrangements which are needed in the day-to-day administration of the National Health Service in the area.

The ramifications of this are quite formidable, and I think that all sections of the local services of the National Health Service dealing directly with the patients are horrified at the idea that perhaps we shall have 33 local medical committees, 33 dental committees, 33 local pharmaceutical committees, apart from the parent 33 executive councils. It is with a view to bringing this into more manageable proportions that I move this Amendment.

10.15 p.m.

Our concern is shared by the doctors. The Minister of Housing and Local Government will recall that he has received quite strong pressure from doctors in the London area about the possible results of the Bill. I quote again from the representations made by the local medical committee in the county of London.

It will be a tragedy for all concerned, and not least for the new boroughs, if this fragmentation results in less efficient health services. Vet the Government appears blind to this danger. We doctors, on the other hand, foresee that our patients will suffer. That is not the impression of people who are not thoughtful and knowledgeable about the National Health Service but of family doctors who are handling this matter day in and day out and can see the very difficult technical problems which will arise if the Bill goes through in its present form.

Photo of Mr Robert Mellish Mr Robert Mellish , Bermondsey

Perhaps my hon. Friend will put on record for the benefit of the hon. Member for Battersea, South (Mr. Partridge) that this move by the doctors is not politically inspired.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

I am sorry but I do not follow my hon. Friend the Member for Bermondsey (Mr. Mellish) on that point.

The doctors have also made representations to the Ministry of Health, which proved most sympathetic. I believe that the reply by the Joint Parliamentary Secretary indicated that at least he was aware of the problem and that the Ministry was seriously considering it. Unfortunately, the doctors did not come away from their interview with the Minister of Housing and Local Government feeling that he was very helpful. They received the impression that his major preoccupation was the reorganisation of local government and that in his scheme of things the problems of the National Health Service could be sorted out after the Bill had gone through. But it would be a great mistake to take that line.

It is always, of course, difficult to give consideration to all the things that will be affected by a Bill, but in dealing with such a specialised service, and when one sees that opinions are being put forward by people with such a great deal of experience, one should accord the maximum weight and sympathy to them.

In Standing Committee there was considerable discussion on the possibilities of having teams of health workers and family doctors, but each of these comes under separate provision. The National Health Service provides for local executive councils which are quite separate from the services provided by local health authorities. It is important, in considering the consequences of this Bill, that we should bear that separation in mind. It is no good talking about such teams of doctors and welfare workers if we make it almost impossible for them effectively to co-operate through the services which are to be provided by the new boroughs.

A plain and simple argument which I hope will be appreciated by the Government—it certainly should be by the Chancellor of the Exchequer—is that one of the prime functions of the local executive councils is to deal with the payment of general practitioners. This means a large accountancy scheme and each organises a complete accountancy administration. A chief clerk and other senior officers are employed in each of the eight executive councils existing at present. If we leave the Bill as it is it will means that we have to have four times that number of senior administrative officials.

At present the general practitioner may find himself under two executive councils, where the geographical area of his practice does not precisely coincide with that of the local authority. If the Bill goes through as it is now drafted there may be as many as six local health authorities responsible for paying the same doctor his remuneration.

What complications that would involve in separate arrangements about Income Tax and all the necessary arrangements involved between the executive councils governing the same doctor! This situation must obviously be remedied, as it would be if the Amendment were accepted.

The most important specialty which needs full co-operation is probably that of obstetrics. Most people who are concerned with matters of health were shocked by the recent perinatal survey and the evidence given about the large number of mothers and infants dying unnecessarily in childbirth. It is in this respect that the Health Service meets its greatest difficulty, because the provisions of local government, through the local health authorities, provide for the midwife service and for ante-natal and post-natal clinics, the general practitioner and the G.P. obstetrician provide another part of the service, and the hospitals yet a third. It is only by a careful co-ordination of all those three parts of the service that we can be assured of the greatest efficiency in the matter of bringing children into the world.

Quoting again from what the doctors say: If a midwife working in one borough is taken ill, another can be sent from another borough. Would independent boroughs be as quick to do the same? What would happen to the woman in labour? This refers to the present situation in the L.C.C. area. In spite of the fact that the general practitioner will have a larger number of local health authorities to deal with in respect of matters concerning organisation, it would be far better for him to have fewer executive councils, local medical committees and local obstetric provisions with which to comply.

The local executive council is also responsible for any disciplinary action. If a patient feels that she has not had the right attention from her doctor, or has called him and he has failed to attend, the National Health Service Act, 1946, provides for redress, through the local executive council. This arrangement will be made even more complicated when the woman is not certain to which local executive council she ought to apply. What happens to a doctor who is reprimanded by one executive council and finds himself dealing with similar problems in two or three other executive council areas?

The executive council is also responsible for ensuring that a general practitioner provides an adequate service for his patients, including the right kind of surgery accommodation. In the past it has been possible for a doctor to use a lock-up shop, with hard wooden forms. What will be the position of a general practitioner if the accommodation he has provided is regarded as satisfactory by one authority but not to another? How will he know where he stands? The executive council has a right to inspect. Does it mean that if the doctor is under four or five local executive councils there will be four or five inspection teams, all visiting him and all asking for different standards?

On the death of a doctor the executive council is responsible for filling the vacancy created, yet a practice may extend over three or four different areas. How will a vacancy be advertised? Which executive council will be responsible? Again we get complication. The same applies to the very vexed question of trainee assistantship and the right to employ assistants.

In the past there have been—not by many doctors, but by a few—abuses of the system. A doctor has as an assistant a young doctor whom he more or less keeps as a paid salaried aid doing perhaps two-thirds of his work for insufficient cash and thus abuses the system which rightly used, brings doctors into general practice. The only sanction there is is that of the executive council and the local medical committee. Unless provision is made he may be in the position of having to deal with three or more bodies when his practice spreads over a wider area.

It is when we come to all the kinds of services which the G.P. is supposed to carry out that we run into difficulty if we are to maintain thirty-three local executive councils responsible for the local medical services. We had considerable discussion in Committee upstairs on the question of mental health. I regret very much that it was not possible for you, Mr. Speaker, to select the Amendment in my name on that question: in page 61, line 32, after "1946", insert: with the exception of duties in relation to persons suffering from mental disorders imposed upon local health authorities under the National Health Service Act 1946 and the Mental Health Act 1959, which shall be the responsibility of the Greater London Council". This impinges on the medical practitioner. We have moved away from asylums and institutions towards domiciliary care and this has thrown extra work on the general practitioner. The Mental Health Act of 1959 brings the general practitioner into responsibility with those suffering from mental disorders, yet by this change he will find it increasingly difficult to find his place in the new setup.

The same will apply in regard to welfare. The care of children often comes back to the general practitioner. The general practitioner may find a number of problems which he needs to discuss with his local committee and then find that there are three or four local medical committees. The general practitioner also needs to deal with problems of patients who require health certificates to obtain special points for a Council house application. A patient may be dealt with under one local executive council and the housing authority under the new Act will be something quite different. What kind of standing will the G.P. have in that relationship?

When it comes to the question of the services he will use and the local medical committee, he may find that he has to negotiate through the local executive council. He may have 100 per cent, coverage for home helps and midwives and other services in one area while perhaps under another authority he has only 50 per cent, coverage. He will never be quite sure of the ancillary support he can get from the local authority in his area. In the way in which the general practice area falls out it may be that on one side of the road he has certain facilities while neighbours on the other side have entirely different circumstances.

No doubt the Parliamentary Secretary will say that there is a new regulation which came into force recently designating for the general practitioner the responsibility of a principal executive council so that where three or four executive councils are involved one can be designated as being primarily responsible for that particular practice. Even if that argument is used against streamlining what would have been a rather absurd fragmentation of the local medical services, this will inevitably lead to a great increase in paper work.

In Committee in connection with another Clause we heard that one of the purposes of this Bill was to ensure that shorter lines of communication should be provided. I shudder to think what will happen in the Health Service if there are to be thirty-three executive councils and the various problems there will be in communications between one local executive council and another, one local dental committee and another, one local pharmaceutical committee and another and all the other kinds of ancillary forces needed to be lined up to provide a comprehensive service for the patient.

10.30 p.m.

I want to make it clear to the House that in moving the Amendment I am not resisting change in the National Health Service. Indeed, I should like to see more radical changes than we now propose. I do not think it right that the National Health Service in London should be fundamentally and basically weakened, not after great consideration of the health matters involved but in order to fit into a London government plan conceived from the point of view of local government and not of the National Health Service.

I had hoped to see springing from the Act an end of the present tripartite system in the National Health Service. At the moment we have three administrations—one for the hospitals, one for the local health authorities and one for the family doctor and the general medical service. The Government have missed a great opportunity, because it would have been possible to have included in the Bill a pilot scheme which might have shown the way for other places throughout the country. They failed to do that, and all we can do now is to hold the situation as best we can in the hope that when we come to future changes in the National Health Service we shall not be so be-devilled by what has happened under the Bill as to find it difficult to move forward into a more logical and more effective pattern of service for the person who needs that service at a time of illness or the citizen who needs the authority's service to prevent illness.

At the moment there is a sharp division between the curative and the preventive services. The preventive services are mainly the responsibility of the local health authorities provided for in the London area in the Bill. The division which exists at the moment will be widened unless we can maintain some form of the present organisation of the local executive councils and the local medical committees. This is an opportunity of doing so. I realise that even if he rejects my Amendment the Minister can later make a move by order within the terms of the Act to bring together a number of authorities for specific purposes. But this is not sufficient. There is a good deal of uncertainty throughout the London area among general practitioners, doctors employed in the local health authorities and other doctors, among dispensing chemists, and among dentists, who are not certain what will happen as a result of the Bill.

I beg the Government to accept the Amendment, which would clear up the situation and make it plain that they will preserve that which is best in the present system. They should not attempt so to fragment it that it will not only bring a period of uncertainty but inevitably will bring distress to patients and make the constructive task of healing the sick even more difficult.

Photo of Miss Patricia Hornsby-Smith Miss Patricia Hornsby-Smith , Chislehurst

I endeavoured to follow the hon. Member for Willesden, West (Mr. Pavitt) closely, but I confess that he confused me with his interchange of the terms "local health authority" and "National Health Service Executive Committee". Unless I have misread the Bill. I think that he interchanged their functions and applied criticisms, which he may feel strongly, against the new provision for local health authorities which equally applied to National Health Service Executive Committees.

If my memory serves me, there are 137 National Health Service Executive Committees. Their function is to deal with the provision made by doctors, dentists, and those in the ophthalmic and pharmaceutical services. They are appointed by the Ministry. They have never been under the local authority and, to the best of my knowledge, they will not come under the local authority for the purposes of the Bill. There may be some question of nomination, but they are not linked to the local authority and they are not local authority committees. Nor have they ever been such.

For these reasons the hon. Member, however unwittingly, was misleading the House in thinking that the Bill made any alterations in the functions of the National Health Service committees. As I understand it, they will still be appointed by the Ministry, as they have always been. These are quite distinct from the local health authority committees which deal with child welfare clinics, dental services and so on. The executive committees, on the other hand, have never been appointed by local authorities. They are bodies formed of the four professional sections. They appoint 12 members. Other members are appointed from the lay side, while some are appointed from local authorities. There is an independent chairman and there are 25 members in all. There are 137 of these committees covering the country, but they have never been a local authority function.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

It is not a question of my having misunderstood the difference between the local health authority and the local executive council. Under the 1946 Act the area is' designated as the same area as that of the local health authority. If the Bill is passed in its present form, then, inevitably, the area of the local executive council will then be the area of the local health authority, which means 33 and not six.

Photo of Miss Patricia Hornsby-Smith Miss Patricia Hornsby-Smith , Chislehurst

I think the hon. Member is wrong, because if it were merely a question of them being local authorities we could not have reached the number of 137 health executives by authorities amalgamated together to provide a medical health executive. As I say, if this were not so the figure would not be 137.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

Canterbury is merged with Kent and Carlisle is merged with the area which surrounds it. I cannot remember its name. This has been done by voluntary arrangement since 1948.

Photo of Miss Patricia Hornsby-Smith Miss Patricia Hornsby-Smith , Chislehurst

Since it was one of the jobs of the then Parliamentary Secretary to deal closely with National Health executive committees I think, with great respect to the hon. Member, that having had six years in that office I have some experience of these matters. I think the hon. Member will find that he is wrong.

It is for this reason that the criticism expressed by the hon. Member for Willesden, West is ill-founded. There is no question of the functions of these members or committees or of the London Executive Committee, which is appointed by the Minister and not by the L.C.C., being broken up or fragmented into 33 areas. I am sure that I am right and that my right hon. Friend would interrupt me if I am wrong.

As to the local health authority services, certainly the large county authorities—and I am sure that this would apply in London—are divided into divisional areas for their services of maternity, child welfare clinics, dental and other services. Regarding Kent, the very area which was designated and operated with considerable local autonomy in north west Kent was in fact, exactly the area which will be Borough No. 19; Dagenham, Penge, Orpington, Bromley and the whole of Chislehurst; save that it will actually be a half of Chislehurst. On the northern side the areas grouped together will now be grouped into Borough No. 18.

Local districts or divisional committees are already operating under the Kent county authority and the officers who have worked in these services—in ambulances and various other services ranging from child welfare clinics to dental services—are divided under the authority into areas, with the exception of half of my constituency. Under the new arrangement the same officers will do that same work under what will be a division of Kent. That division, virtually in toto, will be Bromley; Borough No. 19.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

They go into Greater London.

Photo of Miss Patricia Hornsby-Smith Miss Patricia Hornsby-Smith , Chislehurst

They may go into Greater London, but, for instance, there is an ambulance division which is sectionalised to the Kent County at Beckenham, Penge, Orpington, Bromley and Chislehurst. That will now go over to the London service, but at the moment it is Kent. It already operates as a subsection of the Kent service. It will go over as a group, operating as it is operated sectionally for the north-west division as a functioning unit.

The county services have been divided into areas. In fact, the area for nearly every service is exactly that which is now going into the county group. I do not think it is fair to suggest therefore that the proposals outlined in the Bill will cause fragmentation or any wrecking of the services. In many cases —and, I am sure, equally in other borough areas—the divisional sections that have operated under county authority will continue their same functions and duties and, in many cases, within identically their same bounds.

Photo of Mr Michael Maitland Stewart Mr Michael Maitland Stewart , Fulham

The right hon. Lady the Member for Chislehurst (Dame Patricia Hornsby-Smith) has misunderstood nearly everything that my hon. Friend the Member for Willesden, West (Mr. Pavitt) said. The point at issue is fairly straightforward and simple. We all know the difference between the functions of an executive council and a local health authority. The Minister is here and can correct me if I am wrong, but the point is that under the National Health Service Act the normal rule is for the area of the executive council to be the area of the local health authority. It is possible to avoid that by agreements made between the local health authorities, but that is the normal rule— the rule with which one starts.

It follows from that, I think, and I understood this to be the burden of my hon. Friend's argument—and he, too, will correct me if I am wrong—that if the Bill is passed as it stands without anything to safeguard the position we destroy certain existing local health authorities, of which the L.C.C. is one, and we make the Greater London boroughs local health authorities. If we do nothing else, therefore, we should start off with the areas for the executive councils being the areas of those 32 local health authorities. One might be able subsequently to correct that by agreements between those authorities, but that is not what we would start with. That, surely, is not a satisfactory position. I do not think that anyone would really want to see the new set-up having to start off with these 32 different areas each an area of a separate executive council.

My hon. Friend has provided a way of remedying that defect. It seems to me possible for the Minister to say that there is another way of remedying it, which is by order made under Clause 81. If he argues that, we shall be interested to hear why he thinks that to be a better way. He may be right—we are prepared to suspend judgment until we have heard him—but we cannot agree with the right hon. Lady's suggestion that there is not a problem here. It is undoubtedly right that the Bill as it stands, unaltered by this Amendment and unsupplemented by any order under Clause 81, would result in there being, to start with, as many executive councils as there are local health authorities under the Bill. That is an unsatisfactory position. That was what my hon. Friend was saying, and the right hon. Lady did not seem to grasp what was at issue at all.

10.45 p.m.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

I should like to be brief, because we wish to hear the Joint Parliamentary Secretary to the Ministry of Health on this point. As I understand the situation, changing a local health authority's area does not affect the existence or the area of the corresponding executive council at the moment. The area of that executive council has been defined in the past by reference to the boundaries of the local health authority's area, but its ground will still remain even if the local health authority disappears. The extent of the two bodies is not dependent one upon the other.

I want to thank the hon. Member for Willesden, West (Mr. Pavitt) for raising the point, because a little clarification from the Parliamentary Secretary will be useful. In raising the matter, however, the hon. Member made very heavy weather of the problems and difficulties which, if he will allow me to say so, I do not think will exist. At present, it so happens, if a doctor is practising at a point where four executive councils meet he will be already coping with the sort of problems which the hon. Member has indicated. The same thing is true where a doctor's practice extends over the area of four local authorities. We shall not be creating any new problem by the passage of the Bill in its present form.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

Will the hon. Member concede that doctors who are in that situation are always having great difficulties and that this is one of the matters which the medical profession is always raising at B.M.A. annual meetings in an effort to find ways and means of avoiding it? The Bill will multiply these situations.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

The hon. Member's speech gave the impression that we were here creating something new and chaotic which was to be avoided, whereas he will find that over the whole country this is a general pattern which has been achieved not only in the London area but in other parts of the country by common sense and the creation of a principal executive council. I agree with the hon. Member, however, in saying that I am sure that the Greater London Council is too big to be a single executive council area whereas the 33 boroughs are probably too small to be each such an area. What will be called for, though not here and now in the Bill, is a review by the Minister of Health of the areas of executive councils to work out a new pattern for them not only for the Greater London area but possibly elsewhere, which my right hon. Friend can do under existing powers.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

The hon. Member says that the boroughs will be too small, and he is right, but it is contrary to the arguments we have had so far on other parts of the Bill. Will he tell us why he thinks that they will be too small?

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

It will take too long to explain, but it is probably for the same reasons as the hon. Member thinks that they are too small. We might leave the matter there.

I would make a specific reference, merely to illustrate my point, to the new Schedule which the hon. Member for Willesden, West proposes and which we are discussing with this Amendment. I would agree that the Inner London Area should remain under one executive council, but on the next three proposals in that Schedule I would have grave doubt on whether it is desirable that counties no longer within the Greater London Area should have their executive councils spreading into the Greater London Area. I do not think, however, that this sort of problem should be dealt with by means of a solution fixed into the Schedule of a Statute. That would be a mistake. I am sure that it would be right for the Minister of Health to look at the problem when the Bill is passed and decide under his existing powers how best the problem can be solved.

Photo of Bernard Braine Bernard Braine , Essex South East

I appreciate that the hon. Member for Willesden, West (Mr. Pavitt) put down his Amendment to seek information about the Government's intentions concerning executive councils. The effect of the Amendment and the accompanying Schedule would be to impose a certain pattern of executive council administration on the Greater London area. As the hon. Member said, it would preserve the existing London, Kent and Middlesex executive council areas and extend the existing Essex and Surrey executive council areas to include the three county boroughs at present within the geographical boundaries of those counties. It would, therefore, reduce the existing number of executive councils in the London area by three.

As the hon. Member made plain, those executive councils are an integral part of the National Health Service. They play an important role. They are responsible for the general medical services. They make arrangements with medical practitioners to provide the personal medical services in their area, provide general oversight of practice arrangements through the co-operation with the local medical committees with somewhat similar arrangements for the dental, ophthalmic and pharmaceutical professions and are responsible for the general administration and payment for these services.

There is nothing in the Bill which says that there shall be an executive council in each of the new London boroughs. My hon. Friend the Member for Putney (Sir H. Linstead), with his customary skill, went to the heart of the matter. In general, it is desirable to avoid having more executive councils in the Greater London area than is administratively necessary.

The hon. Member's proposal is unacceptable to the Government, for three reasons. If I may develop my argument, I think the hon. Member will see that there is no great difference between us. First, it is premature at this stage to settle the future pattern of executive council administration in the Greater London area, because a number of important interests still have to be consulted. My right hon. Friend has not yet concluded those consultations and is not yet ready to make his provisional proposals in relation, to this matter.

The second reason is that it is not necessary in the Bill to make an express provision of the kind which the hon. Member has in mind. My right hon. Friend has ample powers under Clause 81 and under Section 31 of the National Health Service Act, 1946, to make the necessary arrangements by an order which would be subject to annulment in pursuance of a Resolution of either House of Parliament. Any order that my right hon. Friend must make under Section 31 inviting two or more local health authority areas to get together for local executive council purposes does not require the consent of each local health authority. In other words, my right hon. Friend has complete powers to provide the kind of arrangement which the circumstances in the Greater London area require.

The third reason why the hon. Member's proposal is unacceptable is that even if the pattern proposed in the new Schedule were the best arrangement for the immediate futures—I am not for one moment saying that it is—the definition of areas in the Schedule would prevent any rearrangement that might be found desirable, except a combination of these large areas. I cannot think that it is satisfactory to lay down an inflexible pattern before consultation has been completed.

It is true that Section 31 of the National Health Service Act provides that an executive council shall be constituted for the area of every local health authority. That point has been made, and it is that which led the hon. Member for Willesden, West into the error of thinking that 33 executive councils will be created in London.

Photo of Mr Michael Maitland Stewart Mr Michael Maitland Stewart , Fulham

May I interrupt the hon. Gentleman? This is really crucial. Will he tell us, failing my hon. Friend's Amendment or an order under Clause 81 or an order made by the Minister under section 31 of the National Health Service Act, what would happen? Are we right in thinking that unless some special provision is made to the contrary the creation of so many health authorities would necessarily result, failing any other action by the Minister, in the existence of so many executive councils?

Photo of Bernard Braine Bernard Braine , Essex South East

I do not think that can be read into what I have said. I have acquainted myself with the question, I am well aware of the anxieties that have been expressed and I am anxious to remove them.

As I was saying, my right hon. Friend has the power to make an order combining two or more local health authorities for the purpose. True, the powers available to my right hon. Friend would, as I said in Standing Committee on 7th March, permit a very wide range of possibilities. They could range from virtual preservation of the existing councils through a large number of possible combinations of the areas of the local health authorities in the Greater London area. But clearly it would not be appropriate for my right hon. Friend to formulate proposals for discussion with the various interests involved until it has been possible for him to have some preliminary consultations to ascertain what might be the view of the local health authorities when they are established and also the professional interests involved.

The reason why I am emphasising the importance of the local health authorities is that they appoint one-third of the members of the local executive councils, and it is obviously important that their view should be taken fully into account. The new authorities do not yet exist. Accordingly, we propose to consult the joint committees of the existing local authorities, for which provision is made in Clause 83.

I can, therefore, give the Committee a firm undertaking that no decision will be taken with regard to the future pattern of administration without the formulation of provisional proposals for discussion and consultation with all the interests concerned, including the professions—the very people about whom the hon. Gentleman has been speaking tonight. Therefore, I think that it can be assumed that common sense will prevail in making an arrangement of this kind.

The existing executive councils will continue to function up till 1st April, 1965. Thereafter, the new councils, which may or may not cover the same area, will come into existence. I would hope, therefore, in the light of the assurance that I have given, that the hon. Gentleman will not press the Amendment. My right hon. Friend will take very much into account what has been said here tonight in formulating his proposals and in his consultations.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

What we have been asked to rely on is the common sense of right hon. and hon. Members sitting on the Treasury Bench, and that, to be honest, is asking a little too much in the present state of affairs. Even if one looks at the way in which this Bill has been handled—

Photo of Sir Hugh Munro-Lucas-Tooth Sir Hugh Munro-Lucas-Tooth , Hendon South

Is not that what the late Mr. Bevan did in the National Health Service Act? Why does the hon. Gentleman want to change that?

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

I was referring to the present occupants of the Treasury Bench and the circumstances in which they find themselves, which are very different from those which existed then.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

I thought the party opposite expected a change.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

I do not know what is going to happen between now and 1st April, 1965, in that respect; nor does the House know what is going to happen as far as the executive councils are concerned. I think we are entitled as a House to rather more information—

Photo of Bernard Braine Bernard Braine , Essex South East

The hon. Gentleman cannot say that. I was not seeking to speak at any great length; I could have spelt it out in greater detail. When I said that my right hon. Friend will seek consultations with those concerned, I am including the professions. I am including those who run the executive councils today. I am, of course, considering the existing committees, set up under the appropriate Clause, of the existing authorities. This decision will not be taken in a vacuum, and the hon. Gentleman has no right to make a charge that an assurance that I have given from this Bench—

It being Eleven o'clock, the debate stood adjourned.

Debate to be resumed Tomorrow.