Baroness Williams of Trafford
Main Page: Baroness Williams of Trafford (Conservative - Life peer)Cities and Local Government Devolution Bill [HL]
Baroness Williams of Trafford Excerpts
The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Williams of Trafford) (Con)
My Lords, as noble Lords have said, Amendments 36D and 36E make specific provision for the transfer of health and social care and NHS responsibilities. It is probably important to say straightaway that the Government share and are committed to the views underpinning the substance of these amendments—namely, that whatever devolution arrangements are entered into in a particular area, health and social care services in that area must remain firmly part of the NHS and social care system, and the position of NHS services in the area in relation to the NHS constitution and mandate cannot change. I hope that that clarifies the position. There can be no question but that, whatever devolution arrangements for health and social care are agreed with an area, all national standards for health services, social care and public health services must, as a minimum, be complied with.
As we have discussed throughout our debates, the context in which the Bill’s powers will be exercised is that of implementing bespoke devolution deals agreed with individual areas and reflecting each area’s proposals and ambitions for devolution. That said, the agreement that Greater Manchester has reached with NHS England illustrates the kind of devolution of health and social care services which areas may be seeking and which the Bill will facilitate.
The noble Lord, Lord Bradley, asked whether health will be a mayoral function under the new section introduced by Clause 6. The answer is that NHS bodies are seen as public authorities for the purposes of the Bill. The Greater Manchester deal does indeed put health as a function of the combined authority and not of the mayor. However, we would not want to prejudice any other deal. We would want to hear from areas and discuss with them what they want.
Greater Manchester and NHS England have set out their agreement in a memorandum of understanding and there are several underpinning principles to that agreement. First, in the field of health and social care, all decisions about Greater Manchester will be taken with Greater Manchester. The second principle is that Greater Manchester will remain part of the National Health Service and social care system; it will uphold the standards set out in national guidance and will continue to meet statutory requirements and duties, including those of the NHS constitution and mandate.
The third principle is that new models of inclusive governance and decision-making will be created with the intention of enabling the clinical commissioning groups in Greater Manchester, providers, patients, carers and partners to shape the future of Greater Manchester together. It is in creating these new governance arrangements that the powers in the Bill may need to be drawn on, giving to local authorities, together in their combined authority, the powers to participate in the strong, collaborative partnerships that they, NHS commissioners and providers will form to deliver on the principle that all health decisions about Greater Manchester will be taken with Greater Manchester.
Without going into the detail of the Greater Manchester arrangements, I would mention that these governance arrangements will be centred on two bodies— noble Lords have already referred to them. The first is the Greater Manchester Strategic Health and Social Care Partnership Board—for short, the GMHSPB. The membership includes the clinical commissioning groups, providers, NHS England and the local authorities. This will prepare and take forward a comprehensive Greater Manchester strategic sustainability plan for health and social care. The second is the Greater Manchester joint commissioning board, comprising the local authorities, the clinical commissioning groups and NHS England. Its role will be to commission Greater Manchester-wide services.
This is a broad, enabling Bill, and I do not believe it is necessary to include in it specific requirements about how particular powers might be devolved. Within the legislative framework that the Bill is creating, the safeguards are to be provided not by making specific provisions but by the requirement that the implementation of any particular devolution deal must be debated and approved by both Houses of Parliament. For such debates, it will be important that the full details of the deal concerned, how it was arrived at and the outcomes expected from it will be fully available to Parliament. As I said in the earlier short debate on housing, I am ready to consider whether the standard explanatory memorandums are—
Lord Bradley
I have a question on that point, so as to be absolutely clear. The Minister said that any of those functions will be debated in both Houses. Is she confirming that any proposals around the devolution of health and social care will be subject to scrutiny in both Houses of this Parliament?
Baroness Williams of Trafford
Yes, my Lords, I am. They would be done by order, and any orders will be scrutinised through the affirmative process in both Houses of Parliament.
As to reporting on how a deal is proceeding, as I said in one of our debates earlier this week, a process for evaluating the progress on each deal will be discussed and agreed with each area as part of the deal. For example, the Greater Manchester deal has an extensive programme of evaluation, with evaluations being public documents available to all Members of the House, as well as to all with an interest in the area and the progress it is making. But again, I do not believe it is appropriate in our enabling Bill to make a requirement about the reporting or evaluation of some particular aspect of a deal, indeed an aspect that may not be in all the deals that are agreed.
I turn to specific questions that noble Lords have asked. The noble Lord, Lord Bradley, asked whether I would support the view that joint board membership should include representatives of the police, et cetera. In any one place, this will be a matter for the area concerned. In Greater Manchester, for example, it is for those concerned to agree who should be on the joint boards, which will reflect the responsibilities that the combined authority has. He asked the very simple question of whether the Secretary of State for Health will be ultimately responsible to the public for the delivery of health and social care. The answer is yes. He also asked about the Manchester MOU. Greater Manchester and all the health bodies concerned, including national bodies such as NHS England, as well as the Greater Manchester clinical commissioning groups, continue to work on the full details of the arrangements that they have agreed.
Lord Warner
I am sorry to interrupt the Minister’s flow, but I am becoming extremely confused. Twice in her response the Minister has said that all decisions about Greater Manchester will be taken “with” Greater Manchester—in other words, not “by” Greater Manchester. In this last set of responses to my noble friend, she makes it clear that the Secretary of State is responsible for decisions about health in Greater Manchester. What I am struggling with is this: what is the purpose of devolving some of these health responsibilities to the Greater Manchester Combined Authority if the Secretary of State reserves a right to overrule or vet those decisions? I thought that when the Chancellor announced the Greater Manchester project with a great song and dance, a very strong emphasis was given to the ability of local people to take the decisions that affect their area.
Let me give the Minister one example to chew on. Greater Manchester is proposing to remove a significant number of beds from acute hospitals to put more money into preventive medicine and community- based services. The Minister will know that closing hospital acute beds is a very contentious issue up and down the country. Who will take that decision? Is not Greater Manchester at risk of saying, “Our population’s health would be improved by removing some of those acute beds and spending some of that money on preventive public health and community-based services”? Can the Secretary of State then simply overrule it, using his powers in the 2012 Act? That is a very practical, real example of where we could have conflict. I would like to know where the Government stand on that issue.
Baroness Williams of Trafford
My Lords, Greater Manchester would work with clinical commissioning groups, et cetera, but would not itself deliver NHS services.
Lord Warner
That was not my question. Perhaps I could explain to the Minister what it is. The clinical commissioning groups in Manchester could all agree that they should take a large number of beds out of acute hospitals in Manchester—not anywhere else—because it was in the best interests of and would achieve better health outcomes for that population. Could they—all the interested parties, clinical commissioning groups and even NHS England, with the combined authority—agree that that is sensible to do? Could we then have a situation in which the Secretary of State, under pressure from some bits of the local community or from the acute hospital, declined to approve that well thought-out plan by the combined authority with the clinical commissioning groups? It is a straightforward question. Is the answer yes or no to whether the Health Secretary can overrule them?
Baroness Williams of Trafford
My Lords, perhaps I may clarify what exactly is being devolved. Greater Manchester will have the powers necessary to participate in a collaborative partnership which will develop health strategies for the place and commission health services. It would be a partnership arrangement. If within that partnership the Secretary of State thought that all of them collectively were making the wrong decision, I am sure that he would have something to say about it.
Lord Warner
So the result is the Secretary of State reserving unto himself all the authority to overrule a locally reached decision. We can talk about partnership till the cows come home, but is not the reality—and this is a critical issue—that the Secretary of State, as one of the partners but the partner with the power under the 2012 Act, can simply overrule them because he thinks that is the right thing to do?
Baroness Williams of Trafford
My Lords, I was not saying that the Secretary of State would overrule them for overruling’s sake, but if it was fundamentally a wrong decision, I am sure that he would have the power to intervene. I think that that is what the case would be. Does the noble Lord want to respond?
Lord Warner
I will read Hansard and come back on Monday, because this issue seems to me an Exocet under some of the principles in the Bill.
Lord Woolmer of Leeds
My Lords, surely devolution means giving power to the local level; it does not mean doing that—as long as the Government at the centre agree. Surely devolved authorities must in principle have the right to take local decisions, otherwise it is not devolution.
Baroness Williams of Trafford
Yes, my Lords, that is absolutely the case, but we have talked all along in this Committee about what happens if things go wrong and where the checks and balances are. We cannot have a situation where there is unfettered ability for people to do things without any checks and balances.
Lord Woolmer of Leeds
It is not a question of whether they have made a mistake or done something wrong, but of local choice. The Minister talked about a bad decision. To say that a local decision is a bad decision because it differs from a view that the Secretary of State takes does not seem to me to be in the spirit of devolution.
Baroness Williams of Trafford
My Lords, perhaps I am not being clear enough. What I meant by bad decision is a decision that is made where the consequences are negative for the end user and have a detrimental effect, for example, on the patient or elderly person. The Secretary of State would have to intervene or call into question the decision of the collective bodies that had made it in partnership. Is the noble Lord more satisfied with that answer?
Lord Warner
May I suggest to the Minister that we return to this on Monday afternoon because I do not think she will satisfy us this evening?
Baroness Williams of Trafford
I know that we will return to it, and I look forward to that.
The noble Lord, Lord Warner, asked what legal advice had been received about the relationship between the MOU and the 2012 Act. NHS England and Greater Manchester have developed the MOU, and any draft order that the Government bring before the House to implement any arrangements agreed will of course be compliant with the relevant primary legislation. The noble Lord also asked about further change to the terms of agreement with Greater Manchester. We can envisage that, with the agreement of all concerned, devolution in Greater Manchester will develop.
The noble Lord, Lord Beecham, asked what the statutory roles of health scrutiny committees are in the context of devolution. Health and well-being boards will continue to exercise their statutory functions.
Lord Beecham
The scrutiny committee of the local authority is not the same as a health and well-being board. If the Minister does not have an answer now, perhaps she can advise me later.
Baroness Williams of Trafford
I remember the health scrutiny committees in the context of AGMA and the combined authority. I am loath to deal with this point tonight, so I will come back with a firmer reply in due course and request that the noble Lord withdraw his amendment.
Lord Bradley
I am grateful to the Minister for the responses she has been able to make, and I am sure she will read the debate with as great an interest as we all will and write to us with further answers to the questions she has not been able fully to address this evening. I said at the beginning that this was the first, but I suspect not the last, debate we would have on health and social care. Our exchanges so far tonight have underlined that fact. We look forward to the next stage and further debate on Monday. In light of that, I beg leave to withdraw the amendment.
Baroness Williams of Trafford
My Lords, the noble Lord, Lord McKenzie, will obviously not be surprised to hear me say that what we do not want to be in this Bill is prescriptive—but that is in no way to belittle the importance of the issues touched on in this amendment. For example, we expect local planning authorities to adopt proactive strategies to mitigate and adapt to climate change, taking full account of flood risk, coastal change, and water supply and demand considerations. They must have a positive strategy to promote energy from renewable and low-carbon sources. While what we look for locally is set out in national planning policy and guidance, we have been very clear that local plans prepared by democratically accountable local councils are key to delivering sustainable development that reflects the vision and the aspirations of local communities.
Having said that, as we discussed in a number of our earlier debates, these prescriptive amendments go against the grain of the approach of the Bill, which is to start a conversation with each area about the powers and budgets that they would like to have devolved to them in order to improve their economy, deliver better local public services and build sustainable prosperity. We are definitely not in the position of trying to prescribe what they think they should be including and so we have no preordained list of powers which might devolve. In common with similar previous amendments, I am afraid that this amendment is out of step with the whole approach that the Bill is designed to deliver, and I would respectfully ask the noble Lord to withdraw it.
Lord Shipley
My Lords, we have tabled Amendments 41 and 42. I will not add to what the noble Lord, Lord Beecham, has said, but I subscribe to the views he has expressed.
Our amendments in this group relate to the membership of the overview and scrutiny committee. We said in the first day of Committee that we did not want to create one-party states, so we have been seeking ways in which we can propose amendments that will deliver that outcome. This is to take the proportion of votes cast for each political party at the most recent local government election for the combined authority’s constituent councils.
The reason why this matters is that, if you take seats only won under the first-past-the-post system, one particular party in most of the areas currently subject to or considering combined authorities would absolutely dominate the overview and scrutiny committee—indeed, the Conservative Party has very few seats in northern cities—so this would not be good for the democratic process. I think that the overview and scrutiny committees ought to have a significant number of opposition members and that that should be calculated on the basis of votes cast in the last election, rather than on the number of seats that they win under first past the post.
In terms of the chair, there are a number of examples in local government where scrutiny committees are chaired by a councillor who is a member of the opposition. That principle should extend to the combined authority. Amendment 42 says that the chair of such a committee must be a member of a political party other than the party of the mayor of the combined authority.
Baroness Williams of Trafford
My Lords, the issue of effective scrutiny has come up a lot during the course of the Bill. As I said during the debate on the previous group of amendments, I am ready to have discussions with noble Lords across the House about their ideas for strengthening scrutiny.
Amendment 39C would remove the power for the Secretary of State to make provision about the chair of an overview and scrutiny committee and about the appointment of a scrutiny officer. I am not sure that removing the ability of the Secretary of State to ensure, if it were deemed appropriate, that all overview and scrutiny committees have a scrutiny officer, or to make provisions about the chair, would achieve our joint aim of strengthening scrutiny and safeguarding against a one-party state.
Nor am I clear that Amendment 40A would strengthen overview and scrutiny. The amendment would remove from the scope of the order-making provision on overview and scrutiny issues the publication of reports et cetera and the information which must or must not be disclosed to an overview and scrutiny committee. I am clear that strong scrutiny needs the overview and scrutiny committees to have access to all the information that they consider necessary to pursue their work. Equally, it is important that their reports and recommendations are public, transparent and properly taken into account by those making decisions. The following amendments essentially set out some of the ideas that may achieve these aims and the substance of which we will wish to consider carefully.
Amendments 36H and 37B seek to expand the scope of overview and scrutiny so that it includes the possibility of an overview and scrutiny committee examining not only decisions made or actions taken, but decisions made or actions “under consideration”.
Amendment 41 would require that any order made by the Secretary of State about the membership of an overview and scrutiny committee must ensure that such membership reflects the proportion of votes that each political party received at the most recent local government election for the constituent councils. Amendment 42 would require that any order made by the Secretary of State about the chair of the overview and scrutiny committee or committees must include provision that the chair is to be a representative of a different political party from the party of the mayor of the combined authority. Amendment 49 provides the definition of “party” for these two amendments. While I believe that there are some practical issues with Amendment 41, given that not all parties who receive votes at an election may have an elected member, I understand the concern that underpins the amendments.
Finally, Amendments 39AA and 40B seek to introduce the affirmative procedure for orders and guidance about overview and scrutiny. Given the importance that we attach to overview and scrutiny, I have some sympathy with the aims of these amendments, and, indeed, in our wider consideration of how best to strengthen overview and scrutiny. We may consider that some matters might be better dealt with on the face of the Bill, rather than through secondary legislation. In our previous short debate I highlighted some of the important issues that we will wish to consider when looking at how to make scrutiny strong and effective in all areas. This, most importantly, includes those areas where the members of the combined authority come from one party.
Given this commitment, I hope that the noble Lord will feel able to withdraw his amendment.
Lord Beecham
I take it from that that the Minister is offering discussions on all these amendments and not ruling any of them out.
Baroness Williams of Trafford
I have given my view on certain amendments and certainly where I see there is scope in others.
Lord Beecham
That is welcome, and I am certainly prepared to withdraw my amendment. I have to say that I am not overimpressed with at least one of the amendments tabled by the noble Lord, Lord Shipley, relating to the percentage vote of parties that may well achieve no membership at all of the local authorities they have contested but will somehow appear on the combined authority. Of course, that general view is consistent with the proposals that the Liberal Democrats made for the composition of your Lordships’ House, about which I suspect we will hear very little for the next few years.
Baroness Williams of Trafford
I thank both noble Lords who spoke to these amendments and will say pretty much what I said in response to the last group of amendments—namely, that we have considerable sympathy with what noble Lords are saying. Therefore, I reiterate my willingness to have discussions and hope that the noble Lord will be willing to withdraw the amendment.
Lord Beecham
I am delighted with the Minister’s usual co-operative stance. I am happy to accept her acceptance of my suggestion and look forward, together with the noble Lord, Lord Shipley, and others perhaps, to see whether we can get something agreed between now and Report. In the circumstances, of course, I beg leave to withdraw the amendment.
Lord Beecham
My Lords, I pay tribute to the work of parish and town councils and to their national organisation, the National Association of Local Councils, I think it is called—NALC. Having said that, I do not think that the proposal that the noble Earl has made is really a very practical one. The area I live in, which I am afraid I keep citing, is enormous, and there are others like it. I do not know how many hundreds of parish councils and therefore parish councillors there are in the area between the Tees and the Tweed, but I suspect that there will be a very large number. Quite how you would appoint people from there to an overview and scrutiny committee, I am not entirely sure.
I also do not think that this is really what is needed. I have an alternative suggestion to make to the noble Earl, which perhaps will be considered by the Minister. Should there be parish councils in the area of a combined authority, there should be a requirement on the combined authority, and on the mayor if there is one, to meet at least annually with representatives of those parish councils. After all, we are talking here essentially about large strategic issues, not very specific local ones. Although there should be a local voice at some point in the process, I do not think that it is realistic to add them to an overview and scrutiny committee. It could not be very representative anyway unless you had large numbers of such people on such a committee; it would not cover the whole area.
A better way might be to require the combined authority and/or the mayor to meet on at least an annual basis—it could be more often than that—with a representative group from across the whole of the parish and town council interest in the area concerned, to discuss the overall position. It would be part of the consultations that those bodies would be having with a variety of bodies, but recognising the particular position of those who have been elected to their very important but very local office. That would meet the more important aspirations of those people better, if I may say so, than the attendance of perhaps one person, representing so many hundreds of others, on an overview and scrutiny committee. I am not moving anything at this stage, but we and the Minister may want to consider it as a possible alternative to the noble Earl’s amendment when we get to Report.
Baroness Williams of Trafford
My Lords, I say at the outset that we value very greatly the work that parish councils do up and down our country. As the tier of local government closest to their communities, they provide a democratically accountable voice for taking community action. Parish councils provide services to their communities and have also played an important role in neighbourhood planning, setting the priorities for their local area in line with the local plan.
It is entirely right that a wide range of people from the community are able to participate in scrutiny of the combined authority in one way or another. An overview and scrutiny committee can invite parish council representatives to its meetings. We do not see, however, that it is necessary to name them on the face of the Bill, as the Bill already provides that an overview and scrutiny committee may invite any persons to attend its meetings.
We must balance the wish to have a wide involvement in overview and scrutiny with the need for a committee to be of a suitable size to be effective. Having parish councillors as members of an overview and scrutiny committee may not be the best way to achieve that, but there may be other ways to encourage parish council involvement. The noble Lord, Lord Beecham, made a good suggestion which good practice might dictate that a mayor, combined authority or scrutiny committee might wish to take up.