I beg to move,
That an humble Address be presented to Her Majesty, praying that the National Health Service (Executive Councils) Amendment Regulations 1967 (S.I., 1967, No. 278), dated 24th February, 1967, a copy of which was laid before this House on 1st March, be annulled.
While I am more than aware that the Minister of Health understands this matter perfectly, it is nevertheless important that I should briefly place on record, in moving this Motion, that the only method open to the Opposition to secure the discussion of a Statutory Instrument of this nature is to appear at the outset to be praying against it. I make that clear because, both in this case and the one which follows, unless a wholly unforeseen matter arises, we are broadly in favour of what the right hon. Gentleman is doing.
This is a very narrow matter. It arises out of the National Health Service (Executive Councils) Regulations, 1954, which, for this purpose, are the instrument under which Executive Councils operate. They were indeed a consolidating Measure. The sole and narrow point of what we are discussing now is the power of these executive councils to pay a subscription to associations of themselves, raising from £20 the amount they may subscribe without reference to the Minster and to £50 the amount they may subscribe with his approval.
I would like the right hon. Gentleman to be good enough to explain a little further what these associations of executive councils are. I am sure he will agree that, in all these administrative matters, it is valuable from time to time for the light of publicity to be able to play upon the operations of various aspects of the National Health Service and before the House can judge whether it would be appropriate to increase these subscriptions it is necessary to know a little more of what they do.
I do not know that many people are aware that these councils operate a form of association. For example, do they do so by geographical region? Do they do so by medical interest? I myself think that they cannot be doing so by way of medical interest. Do they do it by problem—for example, such as problems which affect a country district or problems which affect urban districts? I understand that in the recent past one at least of the associations, or the association, has been discussing the question of car parking for doctors which, as we all appreciate, is very difficult in built-up areas. It would be helpful to know the associations for which the Regulations are designed. May we know in rather more detail what it is they do and the method by which they work?
Presumably the Minister has tabled this Statutory Instrument to cope with a fall in the value of money. But the new sums are still very small. We are talking in terms of petty cash. Therefore, one asks whether the amounts involved are commensurate with the results achieved. Is this money just what is necessary for the every-day working expenses of an association of councils? Ought we seriously to consider something more radical and drastic in terms of consultations of this kind? It would be very helpful equally if the right hon. Gentleman would say how many higher subscriptions he has already authorised under the Regulations as they stand at present. Has he had a large number of applications to go above the present figure of £10? Is this perhaps one of the reasons which led him to feel that the time had come for him to give the greater freedom now embodied in this Statutory Instrument?
Those are the essential matters. I want to draw his attention also to two very small points. The right hon. Gentleman will notice that the pilot regulations—the 1954 Regulations—were a Consolidation Measure. This will be appropriate to the next discussion we have, if we get that far. It is very convenient to have the whole thing under one roof, as it were.
Secondly—and this is merely for my own interest—apparently this Statutory Instrument will not apply to the Isles of Scilly. I am not going to make some lighthearted reference to holiday resorts, or something of that sort, but I am intrigued by this. Is it that the 1954 Regulations do not apply to the Isles of Scilly? Is this a regular feature of National Health Service legislation? It is a small point but one which might intrigue the House.
The hon. Member for Wokingham (Mr. van Straubenzee) has explained that the Regulations to which this Motion is addressed allow for increases in the subscriptions paid by executive councils to associations of executive councils. He asked me to explain just what these associations did.
The executive councils are the bodies responsible under Part IV of the National Health Service Act for making arrangements with practitioners to provide the family practitioner services in England and Wales. Many problems arise from day to day in the administration of these services which are not peculiar to one council but which affect them all. It is quite natural therefore that executive councils should have an association where these problems can be dealt with corporately. There are two associations affected by these regulations. One is the Association of Welsh Executive Councils, which, of course, represents the councils in Wales, and the other is the Executive Councils Association (England).
The associations serve as a forum for discussion of their common problems by members of executive councils. They also provide a means by which the collective voice of executive councils can be made known to the Minister. They provide a ready source of advice on all matters relating to the services and they provide representatives of the management sides of the Whitley Councils which deal with pay and conditions of service of staff. Successive Ministers since the beginning of the Service have had reason to be grateful for the help provided by the associations. I, perhaps, have more reason to be grateful to them than any of my predecessors because of the burden I have asked them to carry in the last few years both during negotiations with the medical profession and more particularly since the introduction of the new scheme of remuneration for general medical practitioners. There main expenditure is on office expenditure such as printing and postage and travelling expenses of management committee members.
It seems fitting that there should be a separate association for Wales—I assume that the hon. Member would not wish to challenge this—in order that special attention can be given to the family practitioner services in that country and separate consultations conducted with the Welsh Board of Health about matters which affect Wales in general.
The existence of two associations representing executive councils was envisaged in the National Health Service Act, 1946, and provision was made in the Fifth Schedule for the payment of subscriptions of executive councils to such associations. Of course the cost of those subscriptions, like all executive councils' expenditure, falls on the Exchequer. In the 1954 Regulations, which these Regulations amend, the maximum annual subscription which each executive council can pay to the Association was £10 or, with the Minister's approval, £20. Twenty pounds has been paid for some time both to the Welsh Association and to the English Association, but hon. Members will realise that with only 15 executive councils in Wales compared with 119 in England the income derived by the Welsh Association was severely limited and it was becoming increasingly inadequate to allow it to carry out its functions properly.
The finances of the Welsh Association have not been in a healthy condition for some time. Expenditure exceeded income for each financial year ended 31st March in 1964, 1965 and 1966 and from July, 1965 the Welsh Association has had separate representatives on the management side of the administrative and clerical staff; of General Whitley Councils, which has entailed extra expenditure. The position was reached towards the end of last year that the income of the Welsh Association at only £300 a year—the maximum which it could attain under the 1954 Regulations—was quite insufficient to cover expenditure. The Association was faced with a potential deficit of more than £200 a year. The English Association has not had such difficulties. With its much, larger membership the present subscription allows it to keep in balance. I have no reason to expect that the English Association will need an increase in the amount of subscriptions in order for it to keep its head above water, but if it has to increase its subscription beyond £20 a year, it can do so only with my agreement.
I am well aware that this is a time when we should keep expenditure to a minimum and I (Id not overlook this point when I made these Regulations, but it was clear that the Welsh Association was faced with increasing costs which could not be absorber' and it would have to close down, or at any rate lose its separate identity, unless I made arrangements for higher subscriptions to be made by each executive council than they had paid hitherto.
It seemed right to take the necessary steps to maintain the independent existence of the Welsh Association when the extra cost involved did not amount to more than £225 a year. I am accordingly authorising a yearly subscription of £35 for each executive council in Wales. With that explanation, I hope that the hon. Member will feel able to ask leave to withdraw the Prayer.
As always, the House is very grateful to the Minister for the detailed reply he has given. It is perfectly clear arising from this short but helpful discussion that the principal beneficiary, at any rate for the time being, will be the association covering Wales, and there is a great deal of sense for that continuing. I should not like to be the cause of in any way impeding that process and I therefore ask leave to withdraw the Motion.