Local Advisory Committees

NATIONAL HEALTH SERVICE REORGANISATION BILL [Lords] – in the House of Commons at 12:00 am on 12th June 1973.

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Photo of Mr Brynmor John Mr Brynmor John , Pontypridd 12:00 am, 12th June 1973

I beg to move Amendment No. 13, in page 8, line 22, leave out from 'persons' to 'it' in line 29 and insert 'in any substantial category of workers in the health service'.

Mr. Deputy Speaker:

With this amendment we will take the following amendments: No. 14, in page 8, line 28, at end insert 'Or(f) the scientific and research workers in the health service in the region'. No. 15, in page 8, line 45, leave out 'the Secretary of State may' and insert 'it shall be the duty of the Secretary of State to'.

Photo of Mr Brynmor John Mr Brynmor John , Pontypridd

It may be of help if I speak about each of these amendments when dealing with Amendment No. 13.

Clause 8, as it stands, forms local advisory committees for certain categories of workers in the National Health Service. As originally drafted, it divided people who work in the health service into two categories. The first category is an élite, mentioned in subsection (1), for which a local advisory committee is, of necessity, to be recognised by the Secretary of State. The second category is another representative body which had to pass many hurdles and, even then, was permitted to be recognised only if the Secretary of State felt it right to do so.

I therefore welcome Government Amendment No. 15 in which the Secretary of State has conceded that any category of persons who fulfil the twin functions laid down in subsection (2)"shall" be recognised by him instead of "may". I referred to this point in Committee. Therefore, I am grateful that to that extent the right hon. Gentleman has been able to meet it.

I stress that this is a small advance in the concept of the health service as it is developing. It is no longer good enough to divide the categories of people who work in the health service. Common tribute has been paid to the integrated work of the health service in these days. We have heard how dependent each category of worker in the health service is upon every other category who service or back up the expertise of a particular person. The surgeon could not work without the laboratory technicians, and he certainly could not work without the biologists and various other categories who provide technical and other data for him. Certainly for the clause to distinguish between certain named categories, who enjoy the privilege of having their wants automatically acceded to by the Secretary of State, and other people in the health service is to draw an invidious comparison in professional services which I believe are steadily growing together.

I do not believe that there are rigid demarcations in attitudes between senior consultants and, for example, laboratory technicians. Therefore, we must try to encourage the narrowing of that gap, because in every special sphere there are highly skilled and knowledgeable people who can impart their expertise in advice to the Secretary of State. So Amendment No. 14 is an attempt to recognise the contribution of the scientific and research workers in the health service in the regions.

The Under-Secretary said that not only is the category of professions ancillary to medicine a large one, larger than we could ever hope to list, but it is constantly changing and growing. It is worth reminding the House that we are talking about physicists, biologists, mathematicians and psychologists. I understand that there are as many as 1,200 clinical biochemists in the health service, and their expertise could be available to the Secretary of State.

The hon. Gentleman said that the purpose of the advisory committee was not to represent the service interests of the groups of workers but to advise on the best interests of the patient. But in the fields in which they are competent, there is none who can tender better advice on their specialities than committees of the scientists and research people themselves. Therefore, the acceptance by the Minister of Amendment No. 14, partial though it is, goes some way towards filling the long-standing need for recognition of these people and their rôle in the National Health Service.

After all, the Under-Secretary paid these people many encomiums about their role in providing a valuable health service. But it is not enough to be sentimental and say "We are one big team, chaps" when recognition is given to dental practitioners, medical practitioners nurses and ophthalmic technicians while the biologists and physicists must come within a lesser category, with lesser status.

But even Amendment No. 14 would not fully meet our view of the developing health service, which is that any substantial category of workers should be able to form local advisory committees which will be recognised by the Secretary of State and turned to for advice by the Secretary of State. Our concept of the health service is that it is one whole, that the doctor depends on the theatre attendant, the hospital porter and every other person.

Although it might be said that the advice of some of these people is not very valuable on the working of the health service, I would reply that often the theatre attendant and hospital porter know far more about the working of a hospital and what is needed to improve the service than the specialist who comes for a brief period and then goes off again.

Therefore, Amendment No. 13 has two merits. First, it avoids any list and, therefore, any embarrassment caused by the omission of any category. Second, it recognises that an integrated health service is vital to its future development.

Photo of Mr Ken Lomas Mr Ken Lomas , Huddersfield West

I am in some confusion. I agree with what has been said about Amendment No. 13. Any substantial number of people in the National Health Service must include the large body of ancillary workers, so why we have decided in Amendment No. 14 to add yet another section to the élitism which has been mentioned and divorce it from the theatre attendants and porters I do not understand.

It seems a most peculiar situation.

The best way out would seem to be to accept Amendment No. 13 and simply say that Where the Secretary of State is satisfied that a committee formed for the region of a Regional Health Authority is representative of persons in any substantial category of workers in the health service … it shall be the duty of the Secretary of State to recognise the committee and so on.

I object to tributes being paid to ancillary workers, hospital porters, theatre attendants, and the rest, for the great work they do, yet when there is an opportunity of giving them a chance to serve not only the health service but the nation we cut them off. That is wrong.

There is a contradiction here. It seems quite wrong to add just one group. If the hour were not so late I should be inclined to tell my right hon. Friend the Member for Deptford (Mr. John Silkin)—I rarely disagree with him, and I served under him when he was Chief Whip and in his numerous other capacities—that I recognise his logical thinking but that in this instance he has gone astray. It would be wrong to add to this élitism. We should include representatives of all sections of the health service and not pick out medical and dental practitioners, nurses and midwives, registered pharmacists, and ophthalmic and dispensing opticians, and then add a few more. We want those who can be of most benefit to the service. Why chop off at the professions and draw a line there, saying "Those below this line can do the donkey work but cannot be represented on these committees"?

When we conclude the debate on the Amendments I hope that the Minister will accept Amendment No. 13. I would reject Amendment No. 14, if the hour were not so late, because it brings in one more elite sector. If I am any judge of what my party has been thinking about for the last 30 years of the health service, this is exactly what it wants to get rid of. I am not thinking of the historical connotations. We are concerned with the new health service. This is a reorganisation of the health service. For that reason, if we are to have categories of people who are to serve on committees, ancillary workers and such people should be included, and we should use the simple overall phrase "any substantial category of workers in the health service". That would recognise the fact that those who work in the theatres as porters and in other essential jobs ought to be taken into account in decided who should be appointed to various committees. It is no use drawing lines. I appeal to my right hon. Friend to press Amendment No. 13 and not to move Amendment No. 14. I hope that he will also agree to Amendment No. 15.

2 a.m.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

If it is not presumptuous of me, I should, perhaps, start by congratulating the hon. Member for Pontypridd (Mr. John) on his maiden speech as official Opposition spokesman. I would celebrate it with champagne if it were in order, but it is not, alas—so I shall do the next best thing. I shall move Amendment No. 15, which is a Government Amendment selected with this group and gives effect to the promise which I made to the hon. Gentleman in Committee.

The amendment makes it mandatory, instead of permissive, to recognise any committee representing a category of persons, other than members of the five key professions, where my right hon. Friend the Secretary of State is satisfied that it is representative of that category and that recognition is in the interests of the health service. The amendment also has the effect of making it mandatory, on similar conditions, to recognise a committee representing two or more categories of workers.

I hope that the hon. Member for Pontypridd will recognise this as a fair response to the argument that he used in Committee and as the nearest thing to a glass of champagne that I can offer him on the occasion of his maiden appearance at the Dispatch Box on this subject.

But I must now sound a slightly more doleful note in coming to the other amendments. The general objective of Clause 8 is to set up machinery by which the views of the professions directly concerned in patient care can be made known to health authorities. This could be secured by including in the clause a comprehensive list of all groups whose advice it might conceivably be of advantage to the health service to seek through the medium of committees representing those groups. This would be cumbersome and would make for rigidity. Alternatively, the clause could avoid specifying any particular groups and this is in effect what the amendment would do. This would be unsatisfactory in turn because there would be no certainty that the professions for which advisory committees are clearly needed would all be represented in all regions or areas. Moreover, there would be difficulty in defining what is a "substantial category of workers".

The clause as drafted achieves a compromise in the recognition of advisory committees where the need for these is already clearly established, while providing, in Clause 8(2), for any other professions or groups to be added where this is considered to be in the interests of the service. This arrangement achieves flexibility while at the same time ensuring proper representation of professions with a key rôle in advising management authorities.

Photo of Mr Brynmor John Mr Brynmor John , Pontypridd

I am sorry to repay good by evil, but the hon. Gentleman must not make points which are not valid in trying to reject the amendments. His point now, as I understand it, is that if we do not specify paragraphs (a) to (e) in Clause 8(1) it could be that people who ought to be represented will not be recognised as a committee for a particular reason. That is only so if the Secretary of State refuses to recognise them. But it would be the duty of the Secretary of State to recognise such a category under our amendment and that seems to admit of no doubt that such people would have their committees recognised along with all others.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

It is the vagueness of the omnibus term which the hon. Gentleman's amendment uses which puts us in a difficulty. It is the general reference to a "substantial category of workers".

The distinction between subsections (1) and (2)—I stress this again because it is important—is not one between staff whose services are regarded as valuable and staff whose services are not so valuable—second-class staff, as I think the hon. Gentleman put it. It is simply a distinction between those services for which the health authorities must have expert advice, in order to be able to discharge their functions, and other services. The purpose of the advisory committees is, therefore, not to represent the service interests of groups of workers—I make this point in response to the arguments used by the hon. Member for Hudders-field, West (Mr. Lomas)—professional workers or otherwise, because there is established machinery for representing the interests of groups of workers. It is simply to make available to regional and area health authorities expert advice as to how the interests of patients can best be served.

Clearly, in this context the advice of doctors, dentists and nurses, and so on, must be forthcoming. That is not so necessary in the interests of patients in the case of other workers, but if in any region or area it can be shown that this is so, then under subsection (2), as amended by Amendment No. 15, committees representative of such workers can and will be recognised. There is, therefore, all the needed flexibility. It is on this basis that we must ask the House to reject Amendment No. 13.

Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West

Is the Under-Secretary saying that the advice which he can receive from large sections other than the professional people is of no importance in the National Health Service? Who knows more about it than those working in the service in a number of different capacities? Surely their advice, as I was able to demonstrate in Committee when I instanced the case of a hospital board and a hospital management committee, is invaluable.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

It is indisputable that the interests of patients demand that the immediate curing and healing professions should be able to proffer professional advice, but we do not exclude anybody. If other groups are held to be relevant to the needs of patients, they can be brought in by subsection (2).

As for Amendment No. 14, as I explained, it is not practicable to specify in subsection (1) all the categories of persons whose advice might at some time or other be needed by health authorities. It is necessary to draw a line somewhere. I submit that the criterion we have used, in aligning the list initially with the healing professions directly responsible for patient care, is a reasonable one.

It is going rather beyond this immediate first list to add scientific and research workers to the five categories who must be included. The hon. Member for Huddersfield, West demonstrated the difficulty of trying to add any more categories to the immediate short list we have prescribed in subsection (1).

Our adoption of the criterion to which I have referred in no way reflects upon the importance of the work of scientific staff in the functioning of the service or indeed upon that of other professional or non-professional groups all of whom contribute to the effectiveness of the National Health Service.

I stress that the list in subsection (1) is the initial and basic list. Subsection (2) provides for committees representative of other categories, which could of course include scientific and research staff, to be set up and recognised where the Secretary of State is satisfied that this is in the interests of the service.

I urge the House to accept Amendment No. 15 and to reject Amendments Nos. 13 and 14.

Photo of Hon. John Silkin Hon. John Silkin , Deptford

The speeches of my hon. Friend the Member for Hudders-field, West (Mr. Lomas) and of the Under-Secretary to a great extent illustrate the difficulty we are in and which I thought my hon. Friend the Member for Pontypridd (Mr. John) succeeded in putting to the House very eloquently at this late or early hour of the night or morning depending on which way we look at it.

The difference between subsections (1) and (2) is that subsection (1) lists categories which the Secretary of State believes are essential to the running of the National Health Service and subsection (2) tells us that there may be categories which are of assistance to the running of the health service but that at present the Secretary of State does not know what they are.

My hon. Friend the Member for Huddersfield, West delivered a very courteous, though justified, lashing to myself. We have forgotten the pilot. Health service workers are a vital category. Therefore, I should like to think again about this. When I discussed these amendments with my hon. Friends I was looking at the categories in subsection (1). There seemed to me to be a glaring omission in the case of the scientific and research workers to whom my hon. Friend so eloquently referred. They are a large and influential group of health service employees. Many of them have medical qualifications as well as scientific qualifications. Therefore, the list did not seem to be complete.

I am not satisfied with the Under-Secretary's definition of healing. In that sense, is a pharmacist somebody who heals or somebody who provides the means by which healing is achieved? The two things are rather different. If we go to that extent, we must include scientific and research workers.

Under subsection (2) we are dealing with groups of people whom the Secretary of State under his powers does not at present recognise but whom he thinks might become recognisable in future.

From that point of view we can see that we are right up against the problem of the health service worker. I therefore accept my hon. Friend's rebuke, which is right and justified, and I wish that in the same spirit the Under-Secretary could accept Amendment No. 13. If he were able to do that I should be willing not to press Amendment No. 14, which would be subsumed in it.

This shows, first, the weakness we all have for trying to categorise those who serve the health service. This is not a finite list. It goes on increasing. Secondly, perhaps we have, and this may have been inherited from 1946—a some-what élitist view of the health service and perhaps it is time we changed our minds and became more realistic.

I suggest therefore that if the Under-Secretary, or even the Secretary of State, whom we are glad to see here, were to ask the leave of the House to reply further, having given even more consideration to the matter, we should be very glad to welcome that familiar voice again.

Amendment negatived.

Amendment made: No. 15, in page 8 line 45, leave out 'the Secretary of State may' and insert 'it shall be the duty of the Secretary of State to '.—[Mr. Alison.]