First, I congratulate the hon. Member for Berwick-upon-Tweed (Mr. Beith) on his maiden speech, particularly as I agreed with everything he said. We look forward to many more equally fluent, witty and informed speeches from him.
Secondly, I want to reply to a point raised by my hon. Friend the Member for Woolwich, East (Mr. Mayhew). My right hon. Friend the Member for Dept-ford (Mr. John Silkin) was suggesting three possible matters for discussion by the inquiry we would like to see set up, but he has authorised me to say that it was his own particular view that he was expressing.
When the Secretary of State moved the Second Reading of the National Health Service Reorganisation Bill, he said that its whole purpose was to provide an improved service for the patients, and he repeated it today. But, for this to happen, the service must reflect and be responsive both to the needs of the people it serves, as has been pointed out by my hon. Friends the Members for Southwark (Mr. Lamborn) and Ealing, North (Mr. Molloy), and to the needs of the people who work in it. I think our debate has shown that on both these counts the newly-reorganised service is not succeeding.
The voices of people served by the service are to be suppressed, with the emphasis upon selection and ministerial appointment instead of upon election. A similar arrogance of attitude is shown in the lack of consultation with those who work in and for the service, and taken together these are a recipe not so much for reorganisation as for disorganisation. They cannot provide, as the right hon. Gentleman intended, an improved service for the patients.
We warned the Government during the passage of the Bill that they could treat the National Health Service as if it were a biscuit factory with the Secretary of State's appointees as the board of directors. It is about the care of the sick, not the management of the sick. We stressed the need for continuous concentration on the administrative staff, who are the keystone of the service, and particularly during this critical transitional period.
As the right hon. Gentleman reminded us, the reorganisation will involve the work of nearly 1 million people in a service costing the taxpayers over £2,500 million a year. This Act has created an intricate, complex piece of machinery, and, like one of the early flying machines, it crashed as soon as it left the ground. The pilot and the designers should have given it greater thought.
My right hon. Friend has illustrated the basic similarity between the new regional health authorities and area health authorities and the old oligarchic, undemocratic, self-perpetuating hospital boards and hospital management committees. The Secretary of State reminds me of one of those apothecaries who practised in the Middle Ages—limited in vision but obstinate in purpose. After prolonged stirring and mixing, he finally produced with a great flourish a potion for treating the National Health Service, but it is no better than the one the patient has taken for years, except that it has a different name, and, in fact, the patient becomes a great deal worse.
Where are the promised new brooms to sweep the service clean? We find that the identikit chairman of a new regional health authority appointed by the Secretary of State will be a middle-aged male, a holder of the British Empire Medal, and he will have no qualifications at all to work in any branch of the service. The Secretary of State's appointees as chairmen of the area health authorities include less than one-third local democratically-elected representatives, and some token trade union representatives of the people who actually work in the service. Presumably this is because they have not the drive, humanity, judgment and diplomacy which the Secretary of State said he was looking for. So, how can the Government's new management be more efficient than the old when it will simply be the mixture as before?
My right hon. Friend mentioned the dearth of women amongst the Secretary of State's appointees. The figures are extremely revealing. Of the regional health authority chairmen, there will only be two women out of 14. Of the area health authority chairmen, there are only 11 women out of the 88 appointees so far. Out of a total of 217 appointees to the regional health authorities, only 47 are women. I am not advocating a specific quota for women, but I cannot believe that, in a population the majority of which is female, a larger number of women with suitable qualifications was not available for this important work, especially as at least half, if not more than half, of the people who work in the service are women.
I now come to the serious effect of the reorganisation on the senior administrative staff, whose traditional dedication and loyalty we take for granted. Their morale is desperately low, and the right hon. Gentleman must accept the fact, unpleasant though it is, that there is a crisis of confidence within the service today, as has been well illustrated by my hon. Friend the Member for Willesden, West (Mr. Pavitt) and my hon. Friend the Member for Nottingham, North (Mr. Whitlock). Because of the deplorable lack of consultation and information, there is widespread anxiety and uncertainty about future posts and new salary scales. The National and Local Government Officers' Association representing key administrative, professional and technical staffs, will be lobbying Parliament next week. It has written to every Member already. It wants to ensure a cohesive management and staffing structure. The right hon. Gentleman started off on the wrong foot when he arbitrarily fixed the salaries of the chief officers, and it was only after NALGO protested and saw the Prime Minister that an adjustment was made.
The right hon. Gentleman is also aware of the widespread dissatisfaction about the selection procedures and the method of short-listing for the appointment of senior hospital management staff and senior nursing staff to new posts in the new service. Several hundred top posts are involved, some with salaries of £8,000, yet the right hon. Gentleman claimed on Second Reading that the purpose of the Staff Commission was to safeguard the interests of the staff.
As a result of all this, last week the right hon. Gentleman admitted to the House, in what must be the understatement of the Session that:
Some officers in local authority health departments are not showing keen enthusiasm to join the new health service."—[OFFICIAL REPORT, 4th December 1973; Vol. 865, c. 1067.]
The fact is that a great many are taking jobs in local government because there is no guarantee as to their future conditions of employment in the new service or
of the protection of their present pay and conditions of service.
Perhaps I can bring this serious situation nearer home to the right hon. Gentleman, right on to his political doorstep. The Leeds area health authority is to lose no fewer than four of its top community health service administrators, including the chief administrative officer. They are going to work in other local government departments. One of them, Mr. John Maury, has said:
I do not know what my prospects would have been had I remained here. So when the local government structures were announced I had to make up my mind whether to opt for something I coupld see or for some thing I could not see. Security was doubtful.
Another chief health service administrative officer from the West Riding, who is leaving, with his deputy, for local government, has said:
If we had stayed here we would have had no idea, either on April 1st or in the future, where we would work, what we would have done, how much we would have been paid in the National Health Service.
I could give many more examples. It is tragic that the valuable experience and expertise of so many senior administrative staff is being lost to the National Health Service at this very critical time. As for the rest of the staff, too many of them are afraid of being trampled underfoot by the mighty, all-powerful elephant under the Secretary of State's remote control. If one talks to nurses, dentists, medical officers of health, general practitioners, social workers and nonprofessional health service workers, one finds confusion, bewilderment and anxiety about their future rôle in the National Health Service, to helping which they have dedicated their lives. They are concerned about their inadequate representation on the health authorities.
It is 25 years since the Labour Government proudly created the National Health Service. Under the present Government we have witnessed increasing and unprecedented unrest among people who staff the service, culminating in the present industrial action of the ambulance men. Today we are trying to save the service, the patients and the staff from bureaucratic management and all that goes with it. The Government should postpone the introduction of the new service on April Fool's Day. We want a full-scale inquiry into this reorganisation, a reorganisation which is based on a regressive and undemocratic Act which will do irreparable harm to the National Health Service.