Cities and Local Government Devolution Bill [Lords]
(Limited Text - Ministerial Extracts only)
Read Full debate17:08 - The House divided: - Ayes: 292 / Noes: 187 - Question accordingly agreed to.
21:00 - The House divided: - Ayes: 197 / Noes: 289 - Question accordingly negatived.
21:14 - The House divided: - Ayes: 195 / Noes: 290 - Question accordingly negatived.
Mr Graham Allen
I would like to comment on this group, which includes my own amendment 60. It is relevant to what the hon. Member for Altrincham and Sale West (Mr Brady) has talked about in moving his new clause 9. My anxiety is that the welcome devolution that is taking place—the precedent of devolving health powers to localities is particularly welcome—suggests something of “the Empire striking back”, with the Whitehall Leviathan seeking to place a caveat on the devolution of health powers. What is being set up is the ability of the Secretary of State to revoke health functions from the relevant local authority.
I fear that somebody in the Department of Health might not approve of a devolution proposal within a given area. Let us say that the cities of Nottingham or Manchester—or indeed anywhere represented by hon. Members in their places for this evening’s debate—wished to do something innovative and interesting on public health because it matched the demography in the area. What it might not match, however, is the view of people in the Department of Health. Such people might have a one-size-fits-all masterplan that they would like to impose on everybody.
My difficulty is that if we allow the Secretary of State to pull back to the centre any of these powers, there will be no safeguard in law to prevent that from happening. The Secretary of State could attempt to launch an effort at devolution, but we see again and again what can happen when the dead hand of Whitehall lies upon local government and the charitable and voluntary sectors. A year could be granted to get on with it, with a local authority either allowed to raise its own money or be given some money. If, however, the Department does not like it, it could be pulled up by the roots.
The Minister for Community and Social Care (Alistair Burt)
I should not be, but I am tempted to respond. If that is the hon. Gentleman’s concern, why should the Secretary of State sign the order agreeing the devolution in the first place if it does not fit in with his masterplan? If he is going to take back the powers in due course, why would he give them away in the first place?
Mr Allen
The Secretary of State does have the power to pull back those experiments and those efforts at devolution. That is why I am bringing forward my proposal. If the Secretary of State is not concerned, he would have no worry about the ability of an independent panel to say, “Hang on—give these guys the amount of time they need to experiment” rather than have to deliver to a Whitehall timetable. That amounts to a contradiction in terms: devolution on the one hand, with the Secretary of State pulling things back into the centre on the other hand. My proposal—which I am sure the Minister can understand—is for the establishment of an independent panel, which would not consist of the Secretary of State and his advisers, but would include representatives of local government where the devolution was taking place and representatives of the national health service. That would enable the medical side to be looked at effectively, and separately from the Secretary of State. It would end the constant process that has driven devolution: the interference of Whitehall, often in the very short term, because someone somewhere in the Department of Health—some unknown person—does not like what is being done in the locality.
Alistair Burt
I am happy to respond to this short debate dealing with new clause 9, tabled by my hon. Friend the Member for Altrincham and Sale West (Mr Brady), amendment 60—to which the hon. Member for Nottingham North (Mr Allen) has just spoken—new clause 12, tabled by the hon. Member for Hemsworth (Jon Trickett), and the Government’s three technical amendments.
New clause 9 would amend secondary legislation to require that each constituent part of a combined authority should be consulted on any major healthcare reorganisation in its area, as well as the combined authority’s being consulted. Each constituent local authority would be able to refer any such reorganisation to the Secretary of State, without such a referral having to be made by the combined authority.
As my hon. Friend knows, proposals for reconfiguration must currently meet the Government's four tests for service change: support from local GP commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. At present, any local authority has the right and, indeed, the responsibility to raise issues about a reconfiguration. My understanding is that that right remains. I take my hon. Friend’s point about its having been given to the combined authority, but, because I do not know about the relationships between the local authorities in question, I do not know whether the combined authority would at any stage reserve the right back to itself if it wished to do so. In the meantime, however, I have one safeguard, and perhaps another, to mention to him. This also applies to the hon. Member for Nottingham North, because it is part of the same thing.
The Secretary of State is only going to accept a recommendation for devolution if it is in the best interests of health in the area and if it will improve health outcomes. He must do so by order. There is nothing in the Bill that requires an authority to take on a national health service function. Authorities can do so if they so wish, but the Secretary of State must be able to see a clear outcome, and he retains his duties and responsibilities for ensuring that the NHS mandate is maintained and that all his statutory duties and responsibilities are observed. The Secretary of State is not going to sign an order, therefore, if he does not think that the health outcomes for the area will be improved. The Secretary of State is entitled to put in the order what he wishes. That order is then debated in the House and has to be passed as an order.
It would be possible for the Secretary of State to include in the order the fact that the individual authorities that make up a combined authority have the right to make representations to him about any reconfiguration. I can give my hon. Friend the Member for Altrincham and Sale West that assurance, and if we find that the legislation is not as I believe it to be, which is that it has retained that right for the local authority, an order in relation to his local authority will contain that safeguard.
I also offer this to my hon. Friend: if he will consider withdrawing the new clause, we will check, before the matter goes before the House of Lords again, to see whether the legislation is as I believe it is, because if it is, the new clause will not be necessary; but if it is not as I believe it to be, the safeguard—the double assurance—will be included in the order and the present Secretary of State would intend to deliver on it.
Mr Brady
My right hon. Friend is seeking to be very helpful. The difficulty that exists is that the safeguards he proposes apply at the moment of devolution. My concern is that a reconfiguration might happen when a power has been devolved, which might not be in the interests of one of the constituent parts of a conurbation. What can be done at that point is what is crucial.
Alistair Burt
At that point, the order that the Secretary of State has signed to allow the devolution in the first place will allow the authority to make a representation to that effect. The order does not just apply to the moment of devolution; it applies to the substance of the devolution, which is the exercise of the health powers the combined authority will have taken on. In respect of a reconfiguration that takes place under the combined authority, the order will safeguard the right of the local authority individually to make representations to the Secretary of State. It is guaranteed not just at the point of devolution, but in the exercise of powers under devolution.
Mr Brady
Might I press my right hon. Friend a little further? I am avoiding being too specific about the Healthier Together proposals for obvious reasons, but in the event that those proposals were to be set aside this week and new reorganisation proposals were to be brought forward, can he give me an absolute assurance that, either under the existing legislation or measures he would introduce in the House of Lords, the individual local authority would retain the freedom to refer any reorganisation to the Secretary of State? If he can do that, I would be satisfied.
Alistair Burt
I believe that that assurance is present in existing legislation. If it is not, we will make sure in the House of Lords that it is. I would also query why my hon. Friend’s local authority has given up this right in the first place to the combined authority, because it if wants to retain that right, perhaps it might want to take it back from the combined authority.
Mr Deputy Speaker
Unfortunately it is me that makes the decisions—we could do this over two days—but I would have thought the Minister had at least some indication.
Alistair Burt
I rest my case with my hon. Friend: I believe that legislation currently provides the reassurance that he seeks. However, I undertake that, before the matter is concluded in the House of Lords, we will ensure that that assurance is there so that he is covered. He is absolutely right to make sure that his local authority has the opportunity to make representations when it needs to. I am sure that the legislation does that, but we will make doubly certain that it does.
Mr Graham Allen
It may well be that the current legislation covers this eventuality, but the Government’s amendment 34 makes it very clear that local government will not be consulted. If the hon. Member for Altrincham and Sale West (Mr Brady) would like quickly to peruse that amendment, he will see that local authorities will have no say whatever if devolved powers are taken back to the Department.
Alistair Burt
I will happily cover amendment 34 in a moment. Indeed, perhaps I should speak to that amendment before I turn to amendment 60, which has been tabled by the hon. Member for Nottingham North (Mr Allen), just to make it clear what amendment 34 is about.
Amendment 34 mirrors part of amendment 19 and amends clause 17 to provide that the requirements for combined authority and local authority consent do not apply to regulations revoking previous transfers of health service functions under clause 16. Proposed new subsections 1E and 1F, which amendment 19 would add to section 105A to be inserted by clause 7 into the Local Democracy, Economic Development and Construction Act 2009, also have the same effect in relation to health functions transfers under section 105A which are revoked.
This means that in the event that it becomes appropriate to restore NHS functions in a local area to NHS bodies, this can be achieved without the need for consent of the combined authority and local authorities concerned. This reflects the fundamental principles for health devolution, as reflected in clause 18, which builds on an amendment moved by Lord Warner in the other place, that the key responsibilities for the Secretary of State for Health and the NHS remain unchanged in any devolution arrangements. We envisage using the powers to revoke only in those circumstances where it was clear that duties and standards such as those referenced in clause 18 were not being met and that revoking the transfer was the best option to achieve the necessary improvement in performance.
The Secretary of State’s ability to use this power supports the key principle, which this House has already agreed and which the House of Lords was also insistent on, that nothing about devolution settlements will impinge on his duties in respect of the national health service, including the duty to promote a comprehensive health service, to exercise his functions with a view to securing continuous improvement in the quality of services and to have regard to the NHS constitution. The other procedural requirements and preliminary conditions will continue to apply, such as the requirement that the Minister making the regulations must consider that the instrument is likely to lead to an improvement in the exercise of the functions concerned, and that Parliament must approve the secondary legislation.
Let me explain in straightforward terms what this is about. The House has already agreed that it wants to retain the national health service, even if NHS functions are devolved to local authorities. That means that the duties of the Secretary of State in relation to the NHS remain absolute. As I said earlier, if the Secretary of State is to sign off these powers to commission services to a local authority, he has to be sure that doing so is in the best interests of healthcare and that the quality of healthcare will be improved. Otherwise, he just will not do it. There will not be any consent involved, or anything else; he just will not do it. However, if he signs it off, it means that he is satisfied that there will be an improvement in the quality of healthcare. Should that fail—should the NHS functions transferred to a new authority fail—it is the Secretary of State’s duty to take those powers back, because he is responsible for the delivery of NHS standards. If he cannot be satisfied, he is going to have to take these powers back. In the circumstances, it is possible that local authorities might disagree and want to challenge that, but his duties are absolute. That is why the requirement for consent is coming out. We are talking about a circumstance that nobody expects to happen. The Secretary of State is not going to devolve unless he is certain, but if he needs to take powers back to maintain his duties, he must have the power to do so. Even if he has to do so, the matter goes before the House, which makes up its mind on it. That is the basis of Government amendment 34 and the answer to amendment 60.
Mr Deputy Speaker (Mr Lindsay Hoyle)
The interventions must be shorter, as I still have to get the Front Bencher in.
Alistair Burt
The hon. Gentleman is coming at this from the wrong point of view. He is coming at it from the point of view that the Secretary of State is deliberately pushing something towards an authority, but he is not—the authorities are asking him for something. He would not be doing that unless authorities came to him and said, “We want to do this.” The Secretary of State would not agree unless he thought it was in the best interests of healthcare, because it is not his personal judgment but his duty. If those functions are not performed properly, his ultimate duty, which the House has already agreed, must be to take the powers back. The hon. Gentleman is approaching it from the point of view that there is something malevolent about the Secretary of State which means he wants to challenge the authority. The duties he has, which are contained in statute and which the House says he must retain when NHS powers are devolved, are what impels the amendment, nothing else.
Alistair Burt
I will give way one last time, but then I must finish dealing with the rest of the clauses.
Mr Allen
The Secretary of State may be doing the right thing—I am sure he would be, just as I am sure the local authority would think it was doing the right thing—but my amendment 60 and our new clause would allow there to be a local government representative and a medical NHS representative judging who is right in the decision about central power and local power. They, too, would make the right decision.
Alistair Burt
Let me turn to the independent panel idea in amendment 60, which the hon. Gentleman has tabled. The Bill provides an effective framework to support a more devolved, place-based approach to health and social care, while ensuring that there are appropriate safeguards in respect of the NHS and a clear line of accountability back to the Health Secretary. Our objectives for health devolution must be to improve the health and care outcomes for people residing in a particular local area. Clause 18 requires that where health functions are conferred by an order or regulations on a combined authority, provision must be made about standards and duties to be placed on that authority, including standards in the NHS constitution.
The Secretary of State needs to be satisfied that revoking the transfer would lead to an improvement of statutory functions in that local area. He is under the same duties if he revokes as he is when he grants the powers in the first place. The revocation would need to be debated and approved by both Houses of Parliament, and the Secretary of State would be required to make available to Parliament a report concerning his decision, including what representations had been made to him in the process. That demonstrates that the decision to revoke transfer regulations would be taken only as a consequence of in-depth consideration, as well as engagement with local organisations, and with the support of Parliament. For that reason, I resist the requirement to convene a panel to review the decision, which would not only be unnecessary, but could be burdensome and costly, and could lead to delays just at the time when swift action was required to address fundamental performance issues.
The amendment is not necessary. The Secretary of State, in the exercise of his powers, already has to do what the hon. Gentleman is asking, but the need to move sometimes at speed means he needs to retain the powers; this is therefore covered, there is accountability to Parliament and the Secretary of State has to say exactly why he is doing it. It is straightforward: either he has the power to deliver his duties, or he does not, and he can do it without convening an independent panel to second-guess him. It is his responsibility, and if he exercises those powers unreasonably, there is judicial review, which means that a local authority is doubly protected.
Mr Allen
If a local authority, which understands its own demography—it knows its people and its inner-city and rural areas—makes a decision on a public health matter, such as fluoridation or free dental checks for three-year-olds, and the centre does not like it, the Minister can pull back that power, which has been given in what is meant to be a devolution Bill.
Alistair Burt
It is not about the centre not liking the decision. The Secretary of State has statutory duties that Parliament has given him. He has to exercise his power both to grant and revoke power based on those duties, not because he likes or does not like a decision. It is that statutory duty for which he is responsible that is so important. The House of Lords pressed that matter, but the House of Commons has accepted it. It is the maintenance of those duties that is so important. Liking or disliking a decision does not come into it.
Let me make further progress on the other amendments that the Government wish to push through. Amendment 35 is a further amendment to clause 18, which applies valuable safeguards to local devolution of health functions, including where certain functions and duties should continue to be held nationally. The clause was inserted in the Bill by an amendment tabled by Lord Warner in the other place and was amended in Committee in the Commons to give further definition and clarity to support its valuable principles. Clause 18 provides that regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority.
Amendment 35 makes it clear that, in addition to NHS England’s responsibilities for assurance and review of clinical commissioning groups, all its supervisory and oversight functions set out in chapter A2 of part 2 of the National Health Service Act 2006 are out of scope of a transfer order. These include functions relating to CCGs’ institutional and constitutional arrangements, including their establishment.
Briefly, amendments 46, 47, 48 and 49 amend schedule 4, which makes amendments to the 2006 Act to provide a wider menu of flexible, voluntary options for local bodies, including combined authorities, to work with each other and with NHS England in respect of health functions.
One of the amendments introduced by schedule 4 includes provision under proposed new section 13ZA of the 2006 Act for new “devolved arrangements”, whereby NHS England is able to delegate its functions to a group of local commissioners exercising them together, or to make arrangements to exercise its functions jointly with that group. The group of local partners must consist of at least one clinical commissioning group and at least one combined authority or local authority, and the delegates or partners must exercise the function jointly.
Amendments 46, 47 and 48 are minor and technical amendments, which make it clear that “devolved arrangements” may relate to one or more of NHS England’s functions.
New clause 12, which was tabled by the hon. Member for Hemsworth, says:
“The Secretary of State must, within 15 months of this Act being passed, publish a review of health services devolved under the provisions of this Act.”
The review must include an assessment of how standards have been maintained, particularly of the quality and outcomes delivered by the devolved health service.
Maintaining the integrity of the NHS standards and ensuring that there is clear accountability for quality of outcomes is a key objective, as reflected by a number of vital safeguards provided for by the Bill. An order to confer health functions on a combined authority can only be made if a proposal to do so satisfies the Secretary of State that such a transfer will lead to the improvement of statutory functions.
As the House has debated a number of times, the requirements to monitor and regulate the functions that have been devolved remain exactly the same as if they had been with the NHS. It is the Secretary of State’s responsibility to ensure that the quality of services devolved is of NHS quality. For that reason, a full formal review is not necessary. There will be constant review of the quality of work done locally, and putting a formal review in the legislation is therefore not necessary. It is inconceivable that the authority delivering the functions on behalf of the NHS would not keep up a full review and the quality of regulatory work and monitoring work ensures that a full review is carried out in any case.
I hope that the new clauses will not be pressed to a vote and that I have been able to satisfy the House about the functions that need to be retained by the Secretary of State. I hope that the technical amendments will also be agreed to.
Liz McInnes
I want to support new clause 12, although the Minister has made his case for turning it down. I think it is important that we build a review stage into the devolution of health simply because the implications of the Bill for the English NHS and social care system are not clear. The Bill regulates for important new powers to remove functions from NHS hospitals, commissioners and other bodies and to transfer them to the local regional authority. Depending on the implementation, interpretation and limits of the powers, such transfers might fundamentally reshape the health service in the years to come. We must ensure that the national health service stays national. We do not want a postcode lottery for healthcare.
Accountability and scrutiny remain crucial for a well-run national health service, delivering the best care it can for everyone no matter where they live. The Bill’s light-touch nature and the pace with which the agenda is moving leave a number of crucial and unresolved questions, some of which I would now like to ask. Will central and regional government argue over the responsibility for meeting population needs and making difficult decisions, such as those on whether to close hospitals or prop up overspending healthcare providers? What will happen to neighbouring areas?
Deals permissible under the Bill create the possibility of NHS funding melting into wider regional authority budgets, making ring-fencing or protecting impossible. Given the importance of healthcare spending as an issue, it needs clarity and scrutiny. Devolution to combined authorities under the Bill might actually have a centralising effect for many health and social care functions, taking power away from councils that represent smaller communities and the clinical commissioning groups that represent clinicians. Although that might be desirable in some cases, it is also important to consider how the positive developments brought to health and social care by these bodies can be preserved.
Clauses 7, 16 and 17 allowed the piecemeal transfer of health care commissioning responsibilities from clinical commissioning groups and NHS England to local government. I am concerned about the impact that will have on the NHS, especially as regards local variation in service levels, further allocation of resources and the cross-border impact of decisions. The Opposition believe that there should be a statutory duty on the Secretary of State for Health to secure and provide universal health care and that core national NHS standards should remain in place.