House of Commons Hansard Debates for 16 Oct 1990

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(a) as respects premises to which section 59 of this Act applies and for the purposes of that section ; and

(b) in the case of other premises, as respects any period or periods after half-past two in the afternoon,

and the board shall refuse to grant such an application if it finds that the extension of permitted hours would cause undue disturbance or public nuisance in the locality.

(4A) Nothing in subsection (4) above shall prevent the granting of an application for an occasional or regular extension of permitted hours on a Saturday for a period which continues into Sunday morning.".'.-- [Lord James Douglas-Hamilton.]

New Clause 20

Supervised attendance orders as alternatives to imprisonment on fine default

.--(1) A court may make a supervised attendance order in the circumstances specified in subsection (3) below.

(2) A supervised attendance order is an order made by a court with the consent of an offender requiring him--

(a) to attend a place of supervision for such time, being 10, 20, 30, 40, 50 or 60 hours, as is specified in the order ; and (b) during that time, to carry out such instructions as may be given to him by the supervising officer.

(3) The circumstances are where--

(a) the offender is of or over 16 years of age ; and

(b) having been convicted of an offence, he has had imposed on him a fine which (or any part or instalment of which) he has failed to pay and either of the following sub-paragraphs applies--

(i) the court, prior to the commencement of this section, has imposed on him a period of imprisonment under paragraph (a) of subsection (1) of section 407 of the Criminal Procedure (Scotland) Act 1975 (power of court, when imposing a fine, to impose also imprisonment on default) but he has not served any of that period of imprisonment ;

(ii) the court, but for this section, would also have imposed on him a period of imprisonment under that paragraph or paragraph (b) of that subsection (power of court to impose imprisonment when a person fails to pay a fine or any part or instalment thereof) ; and (c) the court considers a supervised attendance order more appropriate than the serving of or, as the case may be, imposition of such a period of imprisonment.

(4) Where, in respect of an offender, a court makes a supervised attendance order in circumstances where sub-paragraph (i) of paragraph (b) of subsection (3) above applies, the making of that order shall have the effect of discharging the sentence of imprisonment imposed on the offender.

(5) Schedule ( --Supervised attendance orders : further provisions --) to this Act has effect for the purpose of making further and qualifying provision as to supervised attendance orders.

(6) In this section--

"local authority" means a regional or islands council ; "place of supervision" means such place as may be determined for the purposes of a supervised attendance order by the supervising officer ; and

"supervising officer", in relation to a supervised attendance order, means a person appointed or assigned under Schedule ( --Supervised attendance orders : further provisions --) to this Act by the local authority whose area includes the locality in which the offender resides or will be residing when the order comes into force.'.-- [Lord James Douglas- Hamilton.]

Brought up, and read the First time.

Lord James Douglas-Hamilton : I beg to move, That the clause be read a Second time.

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Mr. Speaker : With this, it will be convenient to take Government amendments Nos. 95, 94 and 96.

Lord James Douglas-Hamilton : The need for the new clause and the amendments arises as a consequence of clause 51(3), which restricts the use of community service orders to cases in which the court would otherwise have imposed a custodial sentence. Although cheaper than imprisonment, community service is still a relatively scarce resource and, if it is to make a real impact on the numbers sent to prison, it needs to be targeted effectively on more serious offenders. Research has shown that, in many cases, community service has been used in place of other non-custodial disposals in circumstances where imprisonment would have been unlikely.

Dr. Godman : What consultations have taken place with social work departments about the implementation of the proposal? Presumably social workers will play a key role. Do they need further training, or does the Minister believe that they are now entirely competent to perform the task that they will be called upon to perform? 9.45 pm

Lord James Douglas-Hamilton : Consultation took place in April and there was strong support for the proposal. About 10,000 people go to prison for fine default and it was felt not only that it would be better if they paid, but that it would be better if those who could not pay had a supervised attendance order of this type.

One likely result of the restriction of the use of community service is an increase in the number of offenders who receive fines and hence in the number of fine defaulters. At present, imprisonment is the only penalty available to the courts for fine default. As I said, some 10,000 people are imprisoned every year in Scotland for that reason. If we are trying to encourage the use of non-custodial penalties, such as community service for offences serious enough to justify imprisonment, it would be inconsistent to countenance an increase in the numbers going to prison for fine default when the original offence did not merit custody.

We believe that the solution is to offer the courts a limited alternative to prison for use in fine default cases. We have called this a supervised attendance order, which would be used only for fine default and would be the only penalty other than imprisonment available to the courts in default cases.

The supervised attandance order is intended to punish by imposing a fine on the offenders' free time and by the imposition of regular discipline through punctual attandance and satisfactory behaviour with a sanction throughout of return to court and, ultimately, the possibility of imprisonment for non-compliance.

The new order has several features in common with community service orders and the schedule follows closely the procedures laid down in the Community Service by Offenders (Scotland) Act 1978, but there are important distinctions. Supervised attandance orders will be of short duration. They will last for between 10 and 60 hours rising in discrete units of 10 hours while community service orders have a minimum of 40 hours and a maximum of 240.

Offenders on community service perform unpaid work of benefit to the community often organised on an individual placement basis. The intention is that offenders

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on supervised attendance orders will be placed on group activity that can be provided at low cost. As well as unpaid work, sessions will be devoted to tackling anti-social behaviour such as alcohol misuse and to drug education and responsibilities to society. It is intended to introduce supervised attandance orders on an incremental basis commencing with sheriff courts and subsequently to extend their availability to the stipendiary magistrates court and the district courts. We propose that the orders be supervised and managed by local authority social work departments in accordance with agreed national standards and that local authorities should be reimbursed in full for the agreed costs of provision. I can tell the hon. Member for Greenock and Port Glasgow (Dr. Godman) that I have every confidence in social workers and that this is something that they will welcome and be able to implement with great efficiency and effectiveness.

Dr. Godman : Like the Minister, I have every confidence in social workers, although he might suggest that I have to say that, given that I am married to one. In each and every case, will the supervising officer mentioned in new clause 20(2)(b) be a fully qualified social worker?

Lord James Douglas-Hamilton : I shall answer that when I reply to the debate. It is better that the hon. Gentleman should have a correct answer in a few minutes than that I should give an answer off the top of my head.

Dr. Godman : This is an important question.

Lord James Douglas-Hamilton : Of course it is. I believe that in most cases it would be a social worker, but I want to confirm whether that will be so in all cases.

Mr. Ernie Ross : The Minister said that the cost of activities carried out under the supervised orders would be wholly reimbursed to the local authority. Will it get the money beforehand or will it have to claim it afterwards?

Lord James Douglas-Hamilton : I shall check that, but I imagine that the authority will get the full funding beforehand. I shall let the hon. Gentleman know the answer.

In line with our present initiative in respect of other services such as probation, parole and social inquiry reports, we propose to form a consultative group, including representation from local authorities, the judicial and other relevant interests, to draw up guidelines to supervised attendance orders and to discuss the administrative and financial aspects involved. I should expect the point that the hon. Member for Dundee, West (Mr. Ross) mentioned to be looked at specifically by the group drawing up the guidelines.

Mr. Ian McCartney (Makerfield) : As an English Member, I am interested in the point that the Minister is making, in the sense that what happens in Scotland usually eventually finds its way to England. I do not think that the Minister adequately answered the point that was raised by my hon. Friend the Member for Dundee, West (Mr. Ross). Does the measure, for example, meet the needs of retraining or additional employment? A social work department in Scotland may require to employ one or two additional social workers to deal specifically with referrals under the system and, because of that, it will have revenue

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consequences for the employment or retraining of staff specifically to deal with the issues raised in the new clause. Will there be new resources to deal with that?

Lord James Douglas-Hamilton : The hon. Gentleman is quite right to raise that specific point. That precise issue will be looked at by the consultative group that is discussing the financial aspects involved. It also bears on the question that I was asked by the hon. Member for Greenock and Port Glasgow, about whether the supervising officer would always be a social worker. The answer is, not necessarily. Community service supervision is provided by non-qualified staff under the general management and control of social workers.

During the passage of the Bill in another place, various amendments were tabled which were intended to simplify and standardise the level of proof in respect of breaches of probation and community service orders. At that time the Lord Advocate advised that he was in sympathy with the intention of the amendments and that the Government would consider bringing forward an amendment that would meet their objectives at a later stage. Our proposals for supervised attendance orders in corporate such intentions by specifying that the evidence of one witness shall be sufficient to prove failure to comply with an order. The proposed amendment to schedule 7 achieves the same effect in relation to the Community Service by Offenders (Scotland) Act 1978.

The hon. Member for Dundee, West asked whether 100 per cent. funding would be made before or after expenditure was incurred. I am informed that an allocation will be made in advance, based on the projected number of orders, and then adjusted in the light of outturn numbers. The answer is exactly what the hon. Gentleman would wish. I commend the amendments to the House as a practical and humane alternative to the present provisions for dealing with fine default. I believe that they will be widely welcomed in Scotland.

Mr. Dewar : This is an important debate which I fear, if no other arrangements for our business can be made, will take a considerable period. Therefore, I hope that the House will bear with me if I set out some of the considerations fairly fully. I am sure that arrangements could be made for a more sensible disposal of the business, but I am awaiting news about that.

Of course I appreciate the intentions behind the new clause as the Minister has explained them, but I am still a little surprised that we are facing the new clause. I discovered the proposals because I happened to be listening to early morning radio last Saturday when the ever efficient British Broadcasting Corporation's Scottish arm--I do not mention any particular individual--happened to comment upon the matter. That comment also included the suggestion that it was all part of the implementation of the thoroughly unpleasant speech made by the right hon. and learned Member for Ribble Valley (Mr. Waddington) at the Conservative party conference

Dame Elaine Kellett-Bowman (Lancaster) : It was a splendid speech.

Mr. Dewar : The hon. Lady may well think that it was a splendid speech, but she will not be surprised to know

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that that confirms all my prejudices. It is a happy state of affairs when we reinforce each other's prejudices so completely and with such enthusiasm.

I have read the speech that the Home Secretary made at the Conservative party conference. It does not seem to throw much light on this new clause. I therefore exonerate him from that charge. In passing, however, I must add that the matter of the prison population which is, of course, connected with this new clause, is also bound up with the changes in parole that we shall presumably face as a result of the Kincraig report. When the Minister replies to the debate, I very much hope that he can say something about that. I further hope that we shall not see any legislation in the spirit of the Home Secretary's speech, and that the Kincraig report recommendations will not be a Scottish insert in the penny dreadful which is what I expect next Session's criminal justice Bill for England to be if the right hon. and learned Member for Ribble Valley has his way. If there is to be a major piece of legislation on parole, with all the ramifications for the courts and the prison system, I shall expect it to be taken as a Scottish measure in a Scottish setting. I hope that the Minister can reassure me on that point. Having made those preliminary points, I now turn to the new clause in some detail. I was interested in what the Minister said. The notes that he was good enough to circulate to me two or three days ago referred to the research suggesting that community service orders, which are analogous to the supervised attendance orders that we are discussing, were often imposed where a fine would be the appropriate alternative. The point was made--and was reinforced in statutory form in this Bill--that the Government intend that community service orders should be imposed only where the alternative would be imprisonment. I do not for a moment dissent from the general value of that and believe that it is sensible that the community service orders should be used for the purpose for which they were designed.

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The Minister's theory, as I understand it-- I hope that I am not misrepresenting him--is that, because a number of community service orders were used where the proper alternative would have been a heavy fine and as, in future, that heavy fine will be imposed rather than a community service order, we shall have more heavy fines and more non -payments as a result of clause 51(3). As I understand it, that is the mainstream of the Minister's argument to justify the new clause.

Dr. Godman : I am concerned about something that the Minister said earlier--that those supervising such offenders when carrying out attendance duties may not be social workers. Given my hon. Friend's wide experience, where does he think that such supervisors will be found? Paragraph 3 of the Minister's explanatory memorandum states that such attendance would cover constructive use being made of time and activities, alcohol and drug education, employment seeking and application, and responsibility to society. Who on earth will supervise someone in those circumstances other than the social worker who has had some training and experience in probation work. I say that because it is important, and I am sure that my hon. Friend the Member for Glasgow, Garscadden (Mr. Dewar) has not overlooked it.

Mr. Dewar : I am grateful to my hon. Friend. I have not overlooked the matter, and shall come to it later in my speech. I may say in passing that I have a voyeur's experience of social work. [Interruption.] It may be that, as someone who is married to one, my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) has had a voyeur's experience of social work as well.

Dr. Godman : My experience is legitimate.

Mr. Dewar : I will not go into that, but I was a professional observer--

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

Ordered,

That the debate be resumed tomorrow.

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Health Authorities (Membership)

10 pm

Mr. Robin Cook (Livingston) : I beg to move,

That an humble Address be presented to Her Majesty, praying that the Family Health Services Authorities (Membership and Procedure) Regulations 1990 (S.I., 1990, No. 1330) dated 2nd July 1990, a copy of which was laid before this House on 5th July, be annulled. I understand that it will be convenient to discuss also the second motion,

That an humble Address be presented to Her Majesty, praying that the Regional and District Health Authorities (Membership and Procedure) Regulations 1990 (S.I., 1990, No. 1331), dated 2nd July 1990, a copy of which was laid before this House on 5th July, be annulled.

To save time, I propose to confine my remarks to the regulations relating to regional and district health authorities. For the convenience of the House, I state that we intend to divide the House on those regulations at the end of the debate.

The debate's shortness is not a measure of its importance. The regulations provide for the creation of health authorities across England and Wales and give those countries health authorities explicitly modelled on the board of directors. Each health authority is to have five executive directors and five non-executive directors. There is no room within that small scope for representatives of the local authorities. At the very time when every progressive writer on health policy is urging us to break down the barriers between the health service and the social services, the Government have chosen to break the link between social service authorities and health authorities.

There is no prospect of community care ever succeeding if the local authorities which provide the community services are kept outside the doors while the health authorities decide which patients to put into the communities. In addition, no room has been found within those health authorities for the representatives of the people who work for them.

For the first time, so far as I am aware, the regulations write into law the offensive principle that, if one is a paid employee of a trade union, one will be debarred from that civic office. The full flavour of the regulations is contained in regulation 13, on which it is worth dwelling. Regulation 13(a) provides that one is disqualified for appointment if one has within the preceding five years been convicted ; sub-paragraph (b) provides that a person is disqualified if he or she has been bankrupt ; sub -paragraph (c) provides that someone is disqualified if he or she has been dismissed ; and sub-paragraph (h) provides that someone is disqualified if he or she holds any paid appointment or office with a trade union. Convicts, bankrupts and trade unionists are clearly an unsavoury bunch. Such institutionalised discrimination is thoroughly repugnant. People who work for trade unions are entitled to the same chance as anyone else of serving their communities on their local health authority. They should not be penalised because they work for an organisation of which the Government disapprove. Even more worrying is the fact that there is precious little room on the health authorities for the representatives of the people who use the hospitals.

This debate is not a theoretical one about how the regulations might work in the abstract. Characteristically, the Government did not wait until after the debate before going ahead with the appointments. They have already

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appointed people to almost every place on both regional and district health authorities. If the prayers are carried this evening, the Parliamentary Under-Secretary of State will tomorrow be in the embarrassing position of signing a thousand letters to appointees explaining what has happened.

I have the evidence of the people whom the Government want to run the authorities and I should like to share some of that evidence with the House. The most remarkable feature of those who have been appointed to the new health authorities is that they come from a dramatically narrow occupational base. I have completed a survey of 700 new members of these health authorities. There are exceptions to the rule. There are occasional areas in which it would appear that progressive chairs of district health authorities have succeeded in retaining a balance on health authorities, but the overwhelming majority of health authorities look more like local chambers of commerce than a public service.

The single largest professional group among non-executive members are company directors. Of the 700 whom we have surveyed, no fewer than 400 have a commercial background as industrialists, business men, accountants and lawyers.

Mr. David Ashby (Leicestershire, North-West) : Not enough.

Mr. Cook : In fairness to the Secretary of State, I must defend him against that claim by saying that, after a decade of decline in Britain's manufacturing base, he is to be congratulated on finding so many industrialists with whom to stuff the health authorities. I thank the right hon. and learned Gentleman for his honesty. He has given a clear signal to the House and to the nation that he intends the NHS to be run as just another commercial business. The notion that he frequently puts about--that the health authorities will be the voice of the consumer--is singularly droll, given the evidence of the people who have been appointed to the health authorities. This clutch of businessmen have spent their entire working lives on the opposite side of the fence from the consumers. It is not even obvious that they are consumers of the very health services that they are now appointed to run. There are some interesting conflicts of interest which would have bothered a previous Government, whether Labour or Conservative. East Hertfordshire health authority now contains a marketing manager of Glaxo, a retired manager of International Computers Limited and a director of Blue Arrow. All three of those companies are major contractors to the NHS. Why is it all wrong that paid employees of staff unions should be on the health authorities, because there would be a conflict of interest, but all right for paid employees of suppliers to the NHS to serve on the same boards?

I concede that there may be a case for having a representative of the local business community on the local health authority--

The Secretary of State for Health (Mr. Kenneth Clarke) : Very good.

Mr. Cook : I would not go so far as to suggest that they should command a clear majority of places, but I would concede a case for having a representative of the local business community.

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A remarkable feature of the appointments is that many of them are not even local business men. In Hull, none of the non -executive members lives in Hull. In Leicester, none of the non-executive members lives in the city of Leicester. In Lancaster, four out of the five non-executive members do not live in Lancashire. In Greenwich, the local authority representatives have been replaced by a double glazing executive from Bromley and a computer executive from Chislehurst-- [Interruption.] If the Secretary of State is interested in speaking in the debate, I am sure that he will succeed in catching the Chair's eye at the appropriate time. He seems to have overlooked the fact that it is not customary in this House to make one's speech while another hon. Member is on his feet.

This House insists--Conservative Members have themselves insisted in recent legislation--that all members of local authorities must live in the area covered by those local authorities. Why should it be so different for the health authorities that the Government appoint? There are of course a few stragglers surviving from the local councils, not because they are dominated by those councils but because they have been picked by the Secretary of State--or, if he wishes to be pedantic, picked by those whom he has picked on the regional health authorities. I hope that Conservative Members will forgive me for reminding them that, despite the wonderful illusions of presentation, Conservative councillors are currently a minority on local authorities throughout Britain. However, one would not know that from the councillors selected for appointment to the health authorities, which contain a healthy majority of Conservatives. Indeed, three fifths of all councillors appointed to the health authorities are Conservatives. In addition to those councillors, we have counted five chairs of Conservative constituency associations and one vice-chair of the Bow group.

At the very time when eastern Europe is booting out the party nomenclatura, the Secretary of State is busy filling health authorities with new Conservative nomenclatura. In some cases, the appointments are almost designed to promote conflict with the local authority. In Shropshire, the Conservatives are in opposition, and the chair of the social services authority is Labour. Of the five non-executive members appointed to the Shropshire health authority, three are councillors and all three are Conservative. Such appointments are an abuse of patronage--an abuse all the more serious because the posts are no longer filled out of a sense of duty : they are now paid posts, with part-time salaries of £5,000 for 20 days' work. Ministers cannot treat that patronage as a private pork barrel for friends of the Conservative party.

I wish to make it clear that the next Labour Government will not regard itself as bound by those appointments. [Interruption.] If the Secretary of State cares to listen, rather than lecture as I know is his preference in all circumstances, he may hear what the Labour party's position is. In the short term, we will replace many of the appointments with people who represent the local community, live in the local community and use the national health service.

In the longer term, we will scrap those health authorities, restore the representatives of local authorities and rebuild the partnership between the health authorities

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and the social services authorities. We will drop the ban on people who work for those who work for the health authorities. We will create health authorities that will be there to serve the local communities, not to serve a Secretary of State in Whitehall, and who are therefore accountable to their local communities and not to a Secretary of State.

The Labour party would bury the regulations with the short shrift that befits such an abuse of central power.

10.12 pm

Mr. Michael Morris (Northampton, South) : I want to contrast the two statutory instruments.

I do not share the concern of the hon. Member for Livingston (Mr. Cook) about the employment of business people and business techniques in the running of the health service ; for a long time some of those disciplines should have been there and used, and the employment of some of those people is therefore entirely appropriate. However, I do share his feeling that there should not be appointees--especially on the district health authorities or the family health services authorities--who are not local. It seems entirely wrong for us to appoint such people to those authorities, although I do not share his view in relation to a regional health authority. I reserve judgment on the operations of the regional health authorities : I want to see how they settle down, and whether they perform better than their predecessors.

I welcome the changes that have been made to the district health authorities, which are generally welcomed in my constituency by those who take an interest in the health service--apart from those who lost their seats. I shall contrast that with what is happening in the family health service authorities in my constituency and in the other area that I know well, which is where I live in Bedfordshire. Things are not going well on the ground in either of those areas. It appears that the chairmen do not know their areas very well. Why have I still not been briefed about the identity of "Mr. Mustard" in the family health services authority in my county? I wrote asking about that three weeks ago and it seems strange that I have not yet been told. Perhaps no one in Northampton has heard of him, but I am sure that he is an accomplished gentleman in the field of business. We wish him well in his assignment.

The original briefing on family health services authorities stated :

"The previous statutory framework for sub-committees within which FPCs worked has been largely removed."

That may be so, but the family health services authorities are now appointing hosts of associate members. What on earth is the difference between sub-committees, which on the whole were reasonably effective, certainly in my constituency, and this host of associate members? The matter seems to be getting out of hand and I hope that my right hon. and learned Friend the Secretary of State will take to task any family health services authority that appoints many associate members.

I hope that the war between the Department of Health and the medical profession is over. Our health service cannot be run without the good will of the medical profession, especially at family health service level. One of the problems is representation on the FHSAs. We must listen to medical professionals who are prepared to give time and energy and who know their areas exceedingly well. They are not listened to at the moment but I hope that in future they will be.

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10.16 pm

Mr. David Hinchliffe (Wakefield) : First, I should like to raise a couple of technical points. The National Association for Mental Health, MIND, is concerned about the implications of recent changes. It has made it clear to me that it is worried about the accountability of the new-style DHA members and the decisions taken about detained patients under the Mental Health Act 1984. I should like the Minister to comment on that. MIND says that the new regulations will remove the link that health authority members must have with the Mental Health Act Commission. MIND sees that as a retrograde step because it reduces the accountability which is healthy in relation to psychiatric patients who may be compulsorily detained by regulation.

MIND says tha the new regulations meean that the new-style health authorities and hospital trusts are not required to have health authority or trust members represented on the committee that decides on issues about detained patients. I am sure that the Minister is aware of the seriousness of that, especially for patients who have had their liberty removed by the exercise of the legal provisions of the Mental Health Act. MIND says that there is no doubt accountability by the Mental Health Act Commission to the DHA or the trust. Even at this late stage, I hope that the Government will consider that technical point.

I should like to restate the concern expressed in Committee by Opposition Members about the way in which the regulations will completely remove the formal links between local authorities and district health authorities on the issue of joint planning for community care. That is strange at a time when we see good examples in many parts of the country of local authorities and health authorities working together on community care. We are trying to refoirm community care and many Opposition Members support some aspects of the legislation on community care. However, the arrangements now before the House will destroy the formal liaison that exists.

I shall now refer to democracy in the national health service. I am proud to have spent all my life in a society that has enjoyed the tremendous achievement of the Labour Government of the 1940s. The NHS is supported by the vast majority of the electorate. From the word go, however, one of the major failures of the NHS has been the lack of any real democratic accountability to the patients, its users. Under this and previous Conservative Governments, there have been moves away from the limited accountability that existed in the organisation prior to 1974. The reorganisation in 1974 moved accountability further away from the patients ; the 1983 changes added to that problem, and the 1990 changes remove any element of local accountability in the NHS.

I am a supporter of community health councils : indeed, I am a former vice- chairman. However, if they posed any challenge or threat to Government policies and were a bulwark of defence of the NHS, I am sure that the Government would have abolished them in recent legislation. I shall continue to support CHCs, but their powers were emasculated some considerable time ago.

I want to be parochial and deal with the problems of Wakefield and question the sort of people who have been appointed to the new health authority. I speak as someone who served on a health authority for a number of years and, as I said, on a community health council. I take a

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close interest in health issues in my constituency. It has always struck me as strange that since the Wakefield district health authority came into existence, it has never appointed a chairperson who has lived within the area. Is there a problem with Wakefield? Are our people unsuitable to be chairpersons of health authorities? Why cannot someone who lives in the area be appointed? The chair of a health authority is an important job. What is so wrong with my constituents that they are not suitable for and do not have the ability to hold the chair of the local health authority?

It is interesting that, including the chair, one third of the non-executive members live outside the area served by the health authority. That is not an academic point ; it is important. If someone is in the position to make important decisions about the treatment of patients in the NHS, occasionally it might be useful for that person to be a patient and to sample the facilities available. I recently attended a clinic with a member of my family and I was appalled to see the number of people crammed into it. Large numbers of elderly people were standing because no chairs were available. I am not attacking the consultants or the nursing staff, who do their level best to ease the problems, but there is something radically wrong with a management that fails to provide chairs for people in their 70s, 80s and 90s while they are waiting for treatment. Sometimes they have to wait two or three hours before receiving basic treatment. I should like those who are making the decisions to sample the facilities, because they would then realise what people have to tolerate. I suspect that a number of those who serve on the health authority in Wakefield would never go anywhere near the NHS.

Another issue, which was a problem with the previous structure of health authorities and will be an even bigger problem now, is when such very busy people, with all their commercial and business interests, will find the opportunity to visit hospital wards and clinics, as they should, to see what is happening at the grassroots level. I do not suggest, nor do I need to suggest, any political bias in the appointments in Wakefield, but half the non-executive members who live in the area live in one electoral ward. I am sure that it is a coincidence, but it is the only ward in the entire Wakefield district to elect Conservative councillors. People who know the area will appreciate that Sandal is not representative of the Wakefield district, but it is very well represented on the new health authority.

One third of the people of Wakefield live on council estates. Would it be unreasonable to expect at least one member of the health authority to live on a council estate and therefore have some insight into the problems of the working class?

We should have health authorities that are composed entirely of people who live in the areas that they serve and who actually use health service facilities that are, or are not, available, as the case may be. The membership of the authorities should genuinely reflect the aspirations, needs and views of the local community. Why should not they include a few working-class mums who have experience of sitting in a clinic for two or three hours, waiting for treatment? Such people would properly be able to express the views and real concerns of the service users.

Why should there not also be direct democratic accountability? Why shy away from health authority elections? I would go further even than my own party and

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