Health and Social Care Budgets

Clive Betts Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Clive Betts (Sheffield South East) (Lab)]

It is a pleasure to follow the two Select Committee Chairs, my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) and the hon. Member for Totnes (Dr Wollaston); we have worked very closely on these issues. It is also a great pleasure to see so many other colleagues in the Chamber today. It is obvious that social care and health issues are now coming very high up the agenda, which is absolutely right.

I will refer to the report that the Communities and Local Government Committee has just produced, “Adult social care: a pre-Budget report”. In the next few weeks, we will produce a longer report about longer-term issues in social care. To begin in the here and now, the Committee welcomed the fact that the Government have allowed local authorities to increase the precept in the next two years and have encouraged local authorities to take up that offer, while still recognising that there are challenges around the fact that the precept raises very different amounts of money in different local authority areas. We asked for an immediate further injection of £1.5 billion, so it is welcome that the Chancellor announced an increase of £1 billion, even though £1.5 billion would have been more welcome—I think that is how the Committee will look at that.

Recognising that that would not be a permanent solution for this Parliament, however, we asked for the National Audit Office to be given the responsibility to look at what is required for the rest of this Parliament—the further two years of the spending rounds—to address the issues in social care. Those issues are very real, with an increase by a third in the number of people in their 80s or 90s over a 10-year period, with local authority spending on social care down by 7% since 2010 in real terms, with the increase in the minimum wage, with the Care Act 2014 and with all these other pressures.

[Paul Blomfield (Sheffield Central) (Lab)]

Does my hon. Friend recognise that there are two groups of victims of the crisis in social care? They are not only those who depend on the services, but those who work in the sector and who face, for example, widespread non-compliance with national minimum wage legislation, which the Government are aware of but not acting on. Does he agree that needs to be recognised in a future settlement? We need a paradigm shift in how we view care work.

[Mr Betts]

We will return to the proper training, long-term commitment and pay of staff in the care sector in our Committee’s further report, but we certainly had evidence to that effect.

We need another way of dealing with the funding gap for the rest of this Parliament. For the longer term, I very much welcome the announcement of the Green Paper, but I echo the comments of the two previous speakers. We need to get cross-party agreement on a sustainable, long-term settlement that will last not merely for the next Parliament, but for several Parliaments after that. There are major challenges. I agree that we should look at health and social care together, but there are fundamental differences in governance and accountability between the two systems, so how do we resolve that?

We should certainly look closely at what is happening in Manchester, to learn about the devolution deal there and how the two can work together within the same governance structure. Personally, I feel that losing the local accountability that the social care system currently has and simply centralising the whole system would be a mistake. That would take us in the wrong direction, so it is important to look at what is happening in Manchester. We have two very different funding systems. We have the health system, which is free at the point of use, but I do not think that anyone suggested in evidence that we could fund social care on exactly the same basis. We will have to consider something slightly different to fund social care, but how the two systems fit together will be a challenge.

If we are considering the future for social care funding, we should bear in mind that currently we have a mixture of funding. We have some central Government funding, local authority funding and the personal contributions that come through people paying for their care, particularly in residential homes, and what happens to their estate when they die. Will that mean a bit extra from those different elements—a bit more from central Government, local Government and personal contributions—so that the total whole grows? However, the Government have said that they will introduce the Dilnot proposals in the next Parliament—that is what the Minister said to us—which will cap and reduce the contributions that may come in from people’s private estates when they die, so does that mean more money from somewhere else?

I am sorry that the Chancellor did this, because everything should be on the table, but he ruled out a different way of taxing or receiving contributions from people’s personal estates when they die: taking a percentage of everyone’s estate. Currently, people contribute their estate if they end up with dementia and go into a care home, but if they have a heart attack, they tend to contribute nothing. Is that system fair? Is that a challenge we must look at? Even with Dilnot, the £72,000 limit would take most of the estate from a small house sold when someone in my constituency dies, but it would be only a fraction of the value of a property sold in the more expensive parts of London. Is that fair either? Do we simply scrap the whole thing and go on to a German system of social insurance?

The Communities and Local Government Committee went to Germany to have a look at its model. There are pros and cons to it, but we really need to put everything on the table and not rule out any possibilities. We need something that we can, in the end, reach cross-party agreement on, recognising that the social care system will probably be different in its funding from the health system. How they can fit together and be governed together will be absolutely crucial to the success of a long-term settlement, when we eventually reach one.

[Mr Adrian Bailey (in the Chair)]

I remind Back-Bench contributors that there is a three-minute time limit. I call Anne Marie Morris.

Health and Social Care

Clive Betts Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

The Communities and Local Government Committee is currently undertaking an inquiry into the funding of social care. We have not produced our reports yet, so anything I say should be taken not as the Committee’s considered view but as some of my own reflections on the evidence we have heard so far. I hope it will not be too long before we can provide a report for Members to look at on the immediate issues of social care, and then, in due course, we will go on to look at the longer-term issues as well. We have taken evidence from a variety of different organisations, including councils, care providers, directors of social care, the Nuffield Trust, and the King’s Fund. Carers and care providers, as individuals, have related their personal experiences to the Committee.

As a constituency MP, it is not terribly surprising to have heard what I have heard today. Unfortunately, as an MP, like everyone else here, I am sure, I see only the tip of the iceberg of problems. Cases about the nature, and number, of social care failings have undoubtedly been increasing in my surgery, my postbag and my emails in the past two or three years. Some of the cases are quite horrific. A council that has to cut its budget on social care does so by going out to the private sector, or agencies, and substituting their services for the service that the council used to provide through directly employed staff. The way in which those services are delivered—often the simple failure of people to turn up and provide the care when it is promised—causes real and increasing problems that I am certainly seeing as a constituency MP.

This is not surprising. The Chair of the Health Committee referred to the fact that we have had a 7% cut in real terms in spending on social care since 2010. Local authorities’ grants from central Government have been reduced by 37%. Councils have tried to prioritise social care—the evidence for that is absolutely clear—but they have not been able to protect it completely from the cuts. That is the reality. On top of that, not only has the money been going down but the number of elderly people requiring care is going up. We heard evidence that although the Care Act was great legislation in principle, all was not delivered in practice. The extra measures are welcome in trying to reward staff properly for the excellent work that many of them do in social care, but the increase in the minimum wage places additional costs on the system.

Amyas Morse, who wrote a very good article and made a good speech the other day about the relationship between health and social care, said that for a long time local authorities had been very successful in doing more for less, but have now got to the point of doing less for less, which is impacting on the people who received the services.

We should not blame local councils for failing to provide a certain standard of service. Simon Stevens told the Communities and Local Government Committee that even if every council did as well as the best, there would still be problems in the system. I challenged the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), to say whether there was a crisis in social care. He did not want to use the word “crisis”, but he did say that the system was “under stress”. Although we cannot agree about the word “crisis”, I think we can at least agree that the stress is obvious for all to see. An estimated 1.2 million people do not receive the care they need. That figure is 40% higher than it was in 2010.

We took evidence from people who were not getting the same amount of care as they had received in the past and others whose needs were increasing but whose care was not. We talked to care providers who were handing contracts back or pulling out of the service altogether, and to local authorities that are sacking care providers because the contracts were not being delivered properly. We also heard that people who pay for their care in care homes are subsidising local authorities because they cannot afford to keep increasing their fees. There is a cross-subsidy in the system, which does not seem fair to many people. At the same time, the turnover rate for care staff is 27%, so they do not have long-term experience and are not being trained regularly over time to deliver care. Those are all problems that we learned about from the compelling evidence that our inquiry received. The Committee will reflect on its conclusion, and I am sure that eventually we will, as always, come to an unanimous view in our report.

In the short term, of course the Government have done things, including the introduction of the council tax precept. I welcome the fact that, by and large, local authorities have taken that up, because the situation is so serious. There are problems, of course, with the fact that the council tax precept raises much more money for some local authorities than for others, and the better care fund, which is meant to stabilise the situation and help authorities that raise less, is back-end loaded. The new homes bonus cut and the additional grant are welcome for social care, but that causes real problems for some small district councils that are not social care providers and suddenly find that their budget position is fundamentally altered.

In his article, Amyas Morse described how the Government simply were not thinking through what would happen in the long term. They moved money—it is often a lack of money—around between social care and health without giving any real thought to the end result. Government officials, and sometimes Ministers, took decisions without any real understanding of what happened to the money at the end of the line, when local authorities faced with very difficult choices had to make decisions about the cuts that were being passed on to them. Those are just some of the issues on which we will reflect in our report.

Clearly, the link between health and social care is very important. We ought to join them up better and it will be interesting to see what comes out of the Manchester example, given that both services have been devolved. There is a clear link between the two, and not just with regard to delayed discharging; there is now virtually no money in the system for preventive social care. The only social care funding available is that for people with the highest need. If people do not get it in the early stages, that means that they are more likely to end up in hospital and cost the whole system much more. That is another thing that we learned.

I was pleased to sign, along with the Chairs of the Health Committee and of the Public Accounts Committee, the letter to the Prime Minister saying that we need longer-term arrangements. It is right, however, that the Government should respond to the here and now, because that is important. To put it bluntly, if we do not deal with the here and now, some people will not be around to see the long-term arrangements being put in place.

When the Communities and Local Government Committee went to Germany, we learned that it solved this problem 20 years ago. Those involved sat down on a cross-party basis and agreed a long-term solution. It might not be the right solution for this country—it is based on social insurance, because that is what the German health system, as well as its pensions system, is based on—but that is what they decided to do. It is interesting that it has stood the test of time for 20 years. They have recently decided, with cross-party agreement, to increase social insurance and there has been virtually no public opposition, because the system is seen to be reasonable and fair. The German system is not purely funded by the taxpayer—there are private contributions as well—but it is an example. For heaven’s sake, let us sit down on a cross-party basis, as the Chair of the Health Committee has said, and work out a solution that stands the test of time, whichever Government comes to power in the future.

[Dr Murrison]

There is much in the hon. Gentleman’s speech with which I agree. Does he agree that the fundamental issue is that countries such as Germany, France and Holland, to which people here would reasonably compare this country, spend a great deal more money through either the Bismarckian system that he describes or others—this country’s system is based on Beveridge—and that somehow or another we are going to have to close that gap, as it is highly likely that the difference in mortality, morbidity and outcomes generally in this country compared with those aforementioned countries is causally related to the amount of money that we put into healthcare?

[Mr Betts]

We heard quite a lot of evidence that, as a percentage of our national income, we do not spend as much as several others on health and social care combined. The Communities and Local Government Committee will reflect on that. Of course, it is not simply a question of asking for more public funding; I would not come to that conclusion, although I might personally believe it. There is, however, an issue with where we get the private funding from, because nobody has argued to us so far that the whole of social care can be publicly funded. There will be private contributions, so how do we raise that private money? Should it come from individuals who simply need care at that point in time, or should we ask people to pay more into an insurance system? How do we put in more money from the public sector? Indeed, can we rely on local authority funding alone, particularly if it comes largely from business rates, which will not grow at the same rate as the number of people who want social care?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

rose—

[Dr Murrison]

rose—

[Mr Betts]

I give way to my Select Committee colleague, the hon. Member for Thirsk and Malton (Kevin Hollinrake).

[Kevin Hollinrake]

It was a pleasure to join the hon. Gentleman and other members of the Select Committee on that visit. Does he agree that the German example is all the more pertinent given that its system was also funded by local authorities prior to the change to social insurance in 1995? It discovered 20 years ago that that system was not fit for purpose and moved to a new system that, as he says, has cross-party support and is a long-term, sustainable solution.

[Mr Betts]

I just want us to have a process that gets us to a similar position. Even if local authorities remain part of the funding solution, we cannot assume that the increase in business rates and council tax will keep pace with the level of demand.

I know that you have encouraged us to keep to a time limit, Madam Deputy Speaker.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I ought to say that, as the hon. Gentleman is the Chairman of a Select Committee, I do not apply the time limit as strictly to him.

[Mr Betts]

I have gone two minutes over time, so I had better not stray too far. Of course, health and social care need to work closely together. It is going to be very interesting to see how Manchester develops. It is not, however, a panacea; it is not going to solve all the problems.

I agree with the Chair of the Health Committee: the sustainability and transformation plans are an interesting way forward, but unfortunately they are seen as a way of making cuts. They will need some pump-priming to make them effective. They have not been done properly, with full co-operation, in every local authority area. If they are done properly and consider how we can better plan and pull together health and social care for the future, I think they will make an important contribution. Ultimately, however, we have to acknowledge that the process is going to take time and that it will need up-front funding to make it work.

We also have to acknowledge that there are big differences between health and social care. There are not many differences in culture, but the funding arrangements are different. Health is provided free at the point of use, whereas social care is not and probably will not after any changes are made. There is also a fundamental difference between the two on accountability: social care is accountable to directly elected local councillors, whereas health is ultimately accountable to the Secretary of State. If Members want to see the problems that creates, they should read the evidence that the former Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), gave to the Communities and Local Government Committee about his understanding of accountability in the Manchester system. It shows that the Government have not worked it out in such a way that they could flick a switch tomorrow and get it all operating smoothly. We have a lot of work to do. The Select Committee will consider all the evidence we have received and will produce reports on a range of issues.

--- Later in debate ---

[David Mowat]

The money is what we were asked to provide by NHS England’s senior management, and we provided it. At that time, the chief executive said that the Government had listened and acted. That is what we did, and that money is now available. That is not the same as saying that we do not accept that the system is under pressure in certain ways. Again, though, we talk about the money that is being spent in France and Germany. In Munich, 15 of the city’s 19 hospitals stopped taking people in over this winter. Right across the world—this is the point—there are challenges in national health systems, and we need to work to ensure that money is spent as effectively as possible. We know that £120 billion will be in our health system in 2020. What this Government have to do and what this ministerial team is doing is ensure that every penny is spent as effectively as possible.

We have talked about the five year forward view, and I accept that we are two years into it, but we know that the health system must tilt back towards community health, and the STPs are part of making that happen. We know that we need to get better than we are so far in terms of mental health and parity of esteem.

[Mr Betts]

I think the STP approach is capable of being a good one. The problem is that when I go to the chief executive of the Sheffield Teaching Hospitals NHS Trust, Sir Andrew Cash, who is respected in government as well, he tells me that the process of transferring resources to the community will not work unless there is some transitional upfront funding for the whole process. We cannot stop doing what is being done in the hospitals and simply transfer it to the community.

[David Mowat]

He is right about that. NHS England is evaluating the STPs at the moment and during March and April, and it will decide which STPs are high priority, which will be invested in and which will be taken forward at speed. We heard the phrase “accountable care organisations” used earlier, and it is the Government’s intention to ensure that those high-performing STPs that we proceed with—it will not be all of them; frankly, the standards are variable and locally driven—will in time become accountable care organisations.

The shadow Minister asked me to talk about social care, and I will do so. During the present Parliament, accessible funding for social care has risen by 6% in real terms; it fell during the last Parliament. Last year 42% of councils increased their social care budgets in real terms, and in December £900 million was provided in new homes bonus payments.

--- Later in debate ---

[David Mowat]

The Care Act 2014 was introduced by this Government, and it has transformed social care, although we accept that the system is under pressure. The number of delayed transfers of care in Newcastle, St Helens, Bedford and Nottingham is nil. The Chairman of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), said that she had been told by Simon Stevens that if the top-performing councils—in terms of delayed transfers—were emulated by all the rest, the consequence would be very small. The truth is that there is a 30 times difference between the top 10% of councils and the bottom 10%.

[Mr Betts]

Will the Minister give way?

[David Mowat]

No. I have given way to the hon. Gentleman twice already, and I need to finish my speech in two minutes.

We accept that there are challenges and pressures in social care, but we also know that we need to make progress in mental health care, and we are doing so by working towards parity of esteem. By 2020, there will be 5,000 more doctors in general practice and 2,000 more pharmacists. We have talked about the need for more pharmacists. I visited a pharmacist’s practice in Perivale on Friday, and I know that we can transform the way in which general practices work. There will be 3,500 mental health therapists as well.

Nearly 3 million people work in healthcare, in the NHS and care sectors. Many of them are remarkable people doing remarkable things, and they deserve our support. It is important for us not to weaponise this entire discussion. It is important for us not to produce election leaflets about dead babies, and all that that means. Our healthcare system and the NHS deserve our support, and the Government are committed to ensuring that they receive it. I commend the estimate to the House.

Social Care

Clive Betts Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.

[Mr Clive Betts (Sheffield South East) (Lab)]

The Communities and Local Government Committee is conducting an inquiry into the funding of social care. We have learned that not only are care providers handing contracts back, but councils are terminating contracts because of the inadequacy of the care that is provided. Ultimately, that means that individuals do not receive the care that they should be receiving. Their appointments are cancelled, or there are flying visits from under-trained care workers who are paid less than the minimum wage.

[Barbara Keeley]

My hon. Friend is right, and I shall come to that point shortly.

Carers UK reports that insufficient support from health and social care services is leaving the carers who are doing all that extra work

“isolated, burnt-out and unable to look after their own health.”

The Richmond Group of Charities published the story of Susan. She cares for her husband Bruce, who has been diagnosed with both Parkinson’s and dementia. The struggle that Susan underwent to find quality care is one about which I have been hearing from carers for some time. She was provided with respite care from a care home which was of such low quality that her husband was unrecognisable when she returned for him:

“He hadn’t been shaved, he couldn’t walk, and his eyes were crusted…with blepharitis.”

When Susan managed to get home care for her husband, it was also poor quality. She said:

“They didn’t know what they were doing. It seemed like they’d never cared before. They turned up at five o’clock in the afternoon to put my husband to bed. Or they turned up at ten, once I’d already helped him to bed. Absolutely awful.”

It is also telling how carers like Susan feel when dealing with the challenges of negotiating complex and fragmented care systems. She “felt small” and she said:

“You go in there, and you’ve got no idea about anything, about care. It’s like going in on the first day at school.”

Susan is not a rare case of a carer battling to get respite care or home care of an acceptable quality. Carers UK tell us that three out of 10 carers in its survey have experienced a change in the amount of care and support services that they receive. Six out of 10 of those carers experiencing a change said the amount of care and support received had been reduced.

--- Later in debate ---

[Mr Betts]

The Secretary of State said that the issues in social care were not only about funding, but it seems that funding is the only issue that he does not want to talk about. The Communities and Local Government Committee is taking evidence on social care. We have had evidence from local councils, including Conservative councils, council directors, unions, care providers in the private sector, care receivers, carers, academics and research institutions, all of whom say that there is a funding crisis in social care. Does the Secretary of State think he might just be wrong in being the only person to deny that such a funding crisis exists?

[Mr Hunt]

With great respect to the hon. Gentleman, I was coming on to talk about funding. I just wanted to make the point that the issue is not just about funding.

I respectfully disagree with some of the suggestions made by the shadow Health Minister in her comments earlier that this is essentially about party political choices, for the simple reason that at the last election, Labour promised less for social care and would have spent less than we are spending. I gently remind Opposition Members that Ed Balls as shadow Chancellor was absolutely explicit in 2015. He said that he would not reverse funding cuts to local government—indeed, he would have made further cuts. Under this Government, those cuts have started to be reversed. Spending on adult social care increased—[Interruption.] These are the facts. Spending on adult social care increased by around £600 million in the first year of the Parliament and is set to increase further because of the spending review, which will mean that up to an additional £3.5 billion can be spent during this Parliament.

National Arthritis Week

Clive Betts Excerpts

Thursday 20th October 2016 Westminster Hall

[Christina Rees]

rose—

[Mr Clive Betts (in the Chair)]

Liz McInnes. Sorry, Christina Rees.

[Christina Rees]

My arthritis is in many ways self-inflicted; it comes from a lifetime of playing sport. I have no cartilage in my right knee, which is severely arthritic. Then there is my lower back—I do not think anything much works any more. Does the hon. Gentleman think that there should be more research on people who have played sport and become arthritic? In this day and age we advocate participation in sport, without really looking at the long-term consequences.

[Jim Shannon]

The hon. Lady is right and I think many of us recognise what she says. We encourage people who are obese to do more sport. We encourage young people, rather than playing on computers and laptops, as they so often do, to take part in more physical activity. However, we must consider the side-effects of that as well, and ensure that we help with them. I hope that what I have said about responding early has been taken on board. With an early response to signs of deterioration, the hon. Lady might not today be in as much pain; although I can tell hon. Members that I have seen her moving around the House, and she moves at some rate. The hon. Lady is obviously not completely restricted, and I say well done to her.

Without the CRSF there would be less funding to invest in world-class research. The UK’s medical research landscape is currently undergoing major change with the formation of UK Research and Innovation through the Higher Education and Research Bill. I expect that the whole House would agree that is crucial that the CRSF should increase in line with charitable investment, within the new research funding system, to safeguard research in the long term.

I look forward to hearing the remarks that will follow in the debate, including the personal experiences of arthritis of Members’ constituents—and perhaps also those of Members themselves. Much more can be done to improve the quality of life of people with arthritis, and to push back the limits of that worrying condition. We have an opportunity in Parliament to play a huge part in ensuring that our constituents get a better quality of life. I look forward to hearing the speeches of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister.

[Mr Clive Betts (in the Chair)]

The hon. Member for West Ham (Lyn Brown) has apologised in advance for having to leave early on account of new Front-Bench responsibilities. It is normal protocol for hon. Members to stay for the whole debate, but on this occasion I accept her apology.

--- Later in debate ---

[Lyn Brown]

rose—

[Mr Betts in the Chair]

I say to the hon. Lady that four other hon. Members want to speak, and there are only 20 minutes left.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Betts in the Chair]

Four hon. Members want to speak, which means five minutes each. I call Fiona Bruce.

--- Later in debate ---

[Chris Stephens (Glasgow South West) (SNP)]

It is a pleasure, as always, to serve under your chairmanship, Mr Betts, and a pleasure to follow the hon. Member for Heywood and Middleton (Liz McInnes). In my time, I want to focus on discussing employment and the personal feelings of people with arthritis, because it is astonishing that only 59% of working-age people with arthritis are in work.

I employ a senior case worker, Pam Wilson, who was diagnosed with rheumatoid arthritis and osteoarthritis ten years ago, just after she turned 30. She has spoken to me about the taboos of her diagnosis and how people view her condition as being an old people’s problem, which we know is not the case. Arthritis can occur at any age during a person’s lifetime, can be extremely debilitating and, due to its nature, is not visible to others. Pam has described to me situations where she has been described as being lazy and excluded from certain situations in previous employments, purely on the grounds of her health issues. This situation is faced by many arthritis sufferers.

I would like to hear from the Minister today about how we can increase the number of people with arthritis in work. Can we ensure that employers understand these issues? Can we ensure they are working with trade unions, which know about these issues in terms of dealing with employees who require reasonable adjustments in the workplace? Can we look at the Access to Work programme to help those with arthritis? Can we look at the issue sensitively in terms of work capability assessments?

I visited the drop-in organised by Arthritis Research UK last week, talking about the many misconceptions people have about those with arthritis. Pam Wilson is not lazy; she is a hard-working employee in a hard-working team assisting the constituents of Glasgow South West on a daily basis.

As Pam says:

“Yes I have had bad days, some awful days too, but I also have days where I can cope with the pain and medication side effects. It’s all about managing your own expectations of yourself and understanding what your body is telling you. Sometimes though it is other people who don’t understand. They think you’re lazy because you’re not as active as they are, not walking anywhere, not running or cycling places. They are looking at you and think you’re OK. Because people with arthritis do look OK! Time and experience make you put on a face to the world—one that says I’m fine, but inside and behind closed doors we’re struggling in pain, we’re tired. But we still smile and get on with it, grateful that new medications keep us mobile.”

Hopefully this debate will make people understand arthritis. Sufferers are always grateful when someone understands the daily struggle, and it takes two minutes to ask how they are and understand their situation. I look forward to the Minister telling us what more can be done to improve arthritis sufferers’ employment prospects and how we can help to prevent and cure this condition.

[Mr Clive Betts (in the Chair)]

I thank the hon. Gentleman for being so succinct in his remarks. I call Martyn Day.

Blood Cancers

Clive Betts Excerpts

Thursday 7th July 2016 Westminster Hall

[George Freeman]

I am grateful to the hon. Gentleman for reading my mind—not for the first time—because the next paragraph in my speech is about the cancer drugs fund and the accelerated access review. His intervention gives me a moment to highlight some of the important points that colleagues have made. The hon. Gentleman, who is something of a biomedical stalker of mine on these occasions, as he acknowledged—we rarely appear in this House other than together—was right to highlight the great work that Queen’s University Belfast does on blood cancers. He spoke with great passion about his father’s experience.

My hon. Friend the Member for Erewash (Maggie Throup) spoke about her experience as a haematologist in this field and about being involved on the frontline of research. That is another example of the power of having Members with a range of career backgrounds in the House. She brings great expertise to these matters.

The hon. Member for Coventry North East (Colleen Fletcher), who is vice-chair of the all-party group, made some important points about the CDF, to which I will return, and described the experience of her husband Ian. She asked whether I would meet the Anthony Nolan Trust; I will. I have already had several meetings with the trust and will continue to meet it, and when I do, I will pick up on the issues she mentioned relating to post-transplantation care in particular.

My hon. Friend the Member for Crawley spoke powerfully about his mother’s experience and made some really important points, not least about data and the importance of our harnessing it and generating a new model of appraisal. I will pick up on the latter point when I discuss the accelerated access review.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) discussed NICE and how important it is that we tackle the new landscape and make sure we are quicker and better at assessing new medicines. The hon. Member for Hackney North and Stoke Newington raised several important issues in a spirit of cross-party non-partisanship that I hugely welcome and appreciate.

I return to the cancer drugs fund. At the beginning of the previous Parliament, the Government, led by the Prime Minister, made the important commitment that we would put in place a cancer drugs fund to ensure that UK patients got access to the very latest cancer drug treatments. We did that in response to a number of high-profile cases in which NICE, applying its standard, one-size-fits-all quality-adjusted life year, had turned down cancer drugs, and patients were desperate for some hope, wanting the system to be responsive to their needs.

I am proud that we have made a total commitment of more than £1 billion to the cancer drugs fund and that we are continuing to invest each year, with more than £300 million put in this year. However, the system as it was originally set up has not proved to be sustainable, because of the pressure—inevitable pressure, in some ways, given the extraordinary explosion of our medical advances—put on it. If drug companies are turned down by NICE and there is a fund available for a post-NICE approval, the companies simply go to it and it has become over-subscribed.

NHS England has moved in the right direction by taking our funding commitment and repositioning the CDF as an early access and managed-access fund that examines more innovative drugs, ensures that they are provided to patients more quickly and makes sure that the data from that early access is allowed to inform the selection of the drugs that are adopted.

The truth is that breakthroughs in 21st century drug discovery and the rise of better targeted medicines are bringing huge benefits for patients but they also place huge pressure on our traditional models of assessment, adoption and reimbursement. With a rapidly ageing society and an explosion of new treatments, we cannot continue with the old model of one size fits all, with the NHS acting as a late procurer at a retail price of every drug. At the heart of my portfolio is a mission to unleash the power of the NHS as a research partner in bringing new drugs to market and getting a dividend—a discount—in return for that work.

We spend around £14 billion on medicines in the NHS every year and over £5.5 billion of that is spent on cancer drugs. The new generation of cancer therapies are incredibly exciting. The immunotherapies that we are seeing do not just delay death or grant patients a few extra months or years; they are cures for cancer. Those Daily Mail headlines that have been promising cures for cancers for more than 20 years are finally true. We now have cancer cures coming through, which profoundly changes the way that we will have to price drugs.

Let me say something about the accelerated access review, NICE and the CDF. At the heart of the accelerated access review is a commitment from the Government to consider whether and how we can better harness our extraordinary NHS assets as an integrated healthcare system to become a partner in the development of new therapies, so that instead of the industry treating the NHS as an increasingly pressurised retail-based consumer that struggles with this explosion of ever more expensive technology, we become a partner. Then, in return for sharing our clinical assets, for working with charities and the industry around our £1 billion-a-year National Institute for Health Research network, and for our leadership in genomics and informatics, we can pull innovation through more quickly for patients, share a data package and be the first place on Earth that companies want to come to in order to have their innovations assessed.

The accelerated access review has been examining a whole range of complex issues in this field and its report is waiting for a post-referendum slot to be published. I can assure Members that in the time that the review team has been preparing that report for publication, I have not been sitting around waiting for it; along with NHS England, I have been doing the preparatory work to be ready for it. Without in any way wanting to pre-empt the report, let me just share with colleagues some thoughts about where I think there is a huge degree of consensus between the Department of Health and NHS England on how we might be able to make some moves.

There are three key areas. First, in specialist commissioning, which deals with many rare diseases and rare cancers, the drugs are commissioned nationally through the Department of Health and NHS England. We want to see whether we can pull together that commissioning function into a more innovative procurement unit, to pull through and do some more innovative deals with industry in return for discounts—acceleration for discounts.

Secondly, we want to consider the NICE pathways through to NHS England and ask whether we can make it easier for innovators either to go through a series of much clearer NICE pathways or to go straight to NHS England and do pricing, discounting, acceleration and volume deals, as well making sure that we have an transparency and accountability framework so that people can see which parties in the ecosystem are fulfilling their mandate.

[Mr Clive Betts in the Chair]

The evidence from recent NICE approvals is encouraging. Many thousands of people have benefited from blood cancer drugs that NICE has recommended, such as bortezomib, ofatumumab and rituximab, and the evidence is that if we gather the data properly from the drugs that we approve, then we can use that as an intelligent health service to inform which drugs we adopt and pull through more quickly. If we get that right, the CDF in its reformatted position as a managed-access fund operating earlier in the system could become a powerful vehicle for an accelerated-access model of cancer drugs assessment. That will require some careful work on the NICE/NHS England framework, but we are doing that work right now, as we speak.

I will close, Mr Walker, by saying that—ah, Mr Walker has been replaced by you, Mr Betts.

[Mr Clive Betts (in the Chair)]

Observant, Minister. [Laughter.]

[George Freeman]

That was achieved in an extraordinary manoeuvre, which was so seamless I did not even notice it happening over my left shoulder.

This summer, officials in the Department will work with the accelerated access review team and NHS England to try to strike a blow for an integrated healthcare innovation economy that makes best use of our budgets. Let me put it on the record that these are substantial budgets: we have committed an extra £10 billion a year to the NHS in 2020 and at the heart of that package is an extra commitment to new drugs worth £4 billion. Those are substantial sums, but we want to make sure that those funds are spent on getting the right drugs through to the right people quickly, and in return for that acceleration we will be able to get better discounts from the industry. I am confident that by bringing the CDF together with the accelerated access review, we will be able to deal with many of the issues that colleagues have raised this afternoon.

That brings me to the end of my comments. It only remains for me to thank hon. Members for raising these issues. I hope they can rest assured that I am committed to seeing these issues through and working with them in the days, weeks, months and—who knows?—years ahead.

[Mr Clive Betts (in the Chair)]

I call Jim Shannon. You have two minutes to wind up.

[Jim Shannon]

It is a privilege to sum up. First, I thank all the right hon. and hon. Members who have made valuable contributions today. In particular, I thank the Minister for his concluding remarks, which gave us lots of hope and comfort for the way forward. I genuinely mean it when I say that we very much appreciate his energy and his commitment to the issues that he is involved with. We know that when he says he will do things he will actually do them, and we very much appreciate that.

I thank all those Members who have made a contribution today. The hon. Members for Scunthorpe (Nic Dakin) and for Bootle (Peter Dowd) and my right hon. Friend the Member for Belfast North (Mr Dodds) told some personal stories to illustrate the issues. In particular, my right hon. Friend referred to the charitable work that is done in England. I think that theme came through in all the contributions that were made today.

The hon. Member for Erewash (Maggie Throup) referred to the stem cell infrastructure that needs to be improved and I thank her for her very helpful contribution. She referred to the suitability of patients for stem cells and drugs, and she also referred—as we all did—to the improvement of NICE, which is very much needed. In addition, she referred to the clinical research that is also needed.

There was a very valuable, detailed and comprehensive contribution from the hon. Member for Coventry North East (Colleen Fletcher). I am so pleased to have listened to the very personal story that she told us, and what a joy it is to know that she can point to the stem cells and to how her husband’s own health has improved, which in turn helps their entire family. I think that each and every one of us here today was particularly touched by that contribution. On behalf of us all, I wish her husband well. It is good to know that the Anthony Nolan trust was very much involved in his treatment, as it is in the treatment of many other people. We thank the trust for its work.

The one key comment by the hon. Lady that I wrote down during the debate was this: “Hope shines out from the darkness”. She also referred to the geographical variations in treatment that exist across the United Kingdom, and to giving a second chance. How true that is.

The hon. Member for Crawley (Henry Smith), who is the chair of the all-party group on blood cancer, also contributed today. First of all, we thank him for his initiative for starting that group. We are very happy to be behind him. He is the general and we are the soldiers; he leads in the direction that we wish to go in. He referred to 130 blood diseases, to the emotional support that is necessary for sufferers, to his concerns over delisting, to the need to improve performance and to how NICE and the pharmaceutical industry can work together, which I mentioned in my introduction, but it is so important it deserves repeating. He also referred to Bloodwise and said that everyone needs access to the drugs that they require now.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) spoke, as he always does; he never misses these debates. He always comes along and makes a very determined and considerable contribution. In many ways Scotland leads the way in what we could do in the rest of the United Kingdom. His contribution outlined what Scotland has done and the regional variations. He made many important points, but one of the ones that I thought was good—the Minister will have noticed this—was on how we can exchange our viewpoints regionally and then use the regional variations to the advantage of us all. In Northern Ireland, we can learn from what they do in Scotland and in England and Wales, and vice versa. That is important.

It is nice to see the shadow Minister in her place. She has certainly grasped her portfolio quickly. She has lots of experience, of course. We thank her for the comments she made. She referred to the evaluation of drug availability, relative costs, the rationale, transparency, the palliative effect and the absolute cost—

[Mr Clive Betts (in the Chair)]

Order. The format is for the mover of the debate to have literally two minutes to finish. I know we have got time, but there is normal procedure with this. Will the hon. Gentleman bear that in mind and come to a conclusion?

[Jim Shannon]

My apologies, Mr Betts. I did not realise that. I thought I had five minutes, and I presumed that was the case. I will bring my comments to an end.

I thank all those who have taken part. I thank the Minister for his concrete proposals and his response. My concluding point is that a single medicine for a cure takes 12 years, 1,600 scientists and 500,000 lab tests to develop. That is the importance of the work that is done. To put it into perspective, that is what we want to work towards: a cure for cancer. If we can get a cure for cancer, we will make lives better. Let us ensure that everyone in the United Kingdom of Great Britain and Northern Ireland can benefit from that.

Question put and agreed to.

Resolved,

That this House has considered blood cancers and the Cancer Drugs Fund.

Junior Doctors Contract

Clive Betts Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

My hon. Friend gives one example, but there are thousands of such examples. Such people are totally committed to the NHS, have a bright future in it and can make a huge contribution to its success by doing a good job in looking after patients, but they also have home responsibilities that are difficult to fulfil when there are very inflexible rostering systems. One of the big wins from yesterday’s agreement is that we will be able to look at the way the rostering system works to try to bring in such flexibility. If we do not do so, more and more doctors will want to be locums or to work for an agency and we will lose the continuity of care for patients, which is one of the best things about our GP system. That is why there is an urgent need—from the perspective of patients, as well as from that of doctors—to address that issue.

[Mr Clive Betts (Sheffield South East) (Lab)]

I am interested in the Secretary of State’s thoughts about the serious impact on morale that the dispute has had. I was talking to a junior doctor in Sheffield the other day who said that before the dispute he had never looked at his contract, he had simply got on and done what was needed, whenever it was needed. Does the Secretary of State realise that even if the dispute is now settled, as we hope, it has had a serious impact on good will in the health service, which could affect service delivery in the future?

[Mr Hunt]

If the hon. Gentleman looks at the latest NHS staff survey, it shows higher staff motivation, better communication and more staff recommending their organisation as a place to work or be treated. But I accept that when big changes are made to a contract such as the junior doctors contract, they can be contentious and have a short-term impact on morale. In the long run, morale goes up when doctors are able to give better care to patients, and that is what this agreement will allow.

Tobacco Control Strategy

Clive Betts Excerpts

Thursday 17th December 2015 Westminster Hall

[Kevin Barron]

May I also echo those comments? I wish everybody a happy Christmas and a peaceful new year as well.

The debate shows just how far the House, as a legislative body, has travelled over the past two decades, taking on these major issues on the basis of their effect on people, as opposed to their potential effect on political parties. That is greatly to the House’s credit, and I thank everybody who has spoken this afternoon.

I thank the Minister for leaving the door open in terms of what will be in the strategy next summer. Things may come forward that test us—such as what happens in the e-cigarette market and how we deal with that—and I am sure we will watch the issue with great interest. I thank everybody who has contributed.

[Mr Clive Betts (in the Chair)]

May I also take this opportunity to wish everyone here a very happy Christmas? I look forward to seeing you all again in the new year.

Question put and agreed to.

Resolved,

That this House has considered a new tobacco control strategy.

Cities and Local Government Devolution Bill [Lords]

Clive Betts Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

As chair of the all-party group on national parks, I do have some interest in this matter. Additionally, a third of Sheffield—the local authority in which my constituency is—is in the Peak District national park. The name “Sheffield” may conjure up past visions of lots of cutlery being produced, but much of it is very rural, very open and very beautiful.

I understand the concerns of my hon. Friends on the Front Bench about new clause 7, which is of some length and has been parachuted into the Bill right at the last minute. The Government had many opportunities to introduce it earlier, and to talk informally to my hon. Friends, which might have allayed some of their fears. In the end, though, it is the duty of the Opposition to oppose, and probably to be very suspicious of a Government who claim they have nothing but good intentions in proposing a four-page amendment.

Of course there is some suspicion, but let us look at what the national parks have been doing. They have told us at meetings that they would welcome the extension of the general power of competence to them—perhaps it was an oversight that it was not done in the first place. As I understand it, the new clause proposes that where national parks exercise functions in a national park area that are similar in nature to those exercised by a local authority in other places the local authority has the general power of competence, but a national park does not.

Everyone gets suspicious about fracking. Many people do not trust the Government on the issue. They think that, as the Government want to go fracking all over the place and national parks do not, the Government are probably happy to do it and have rather brought those suspicions on themselves. Perhaps the Government could make an absolutely clear statement that there is no way in which this proposed new clause gives any extension of planning powers or anything else that could possibly affect fracking in national parks.

[Jon Trickett (Hemsworth) (Lab)]

I can assure the House that we had no idea that this new clause was coming. It is almost five pages long. The nub of our argument is this: the national parks should be single-mindedly protecting our environment, but this power of general competence allows them to engage in commercial activities to bridge the funding gap that the Chancellor has left them with. Does my hon. Friend not worry that that single-minded concentration on protecting the environment might be lost in the search for additional revenue as a result of the commercial powers that are being conferred on the national parks?

[Mr Betts]

I see my hon. Friend’s concerns in that regard, but the reality is probably that many national parks do look at ways to raise revenue to help support their budgets. I share his views that national parks are subject to cuts and that they are finding it more difficult to do the job that we expect them to do with their much reduced resources. I think that they will look at other ways to raise funds. That happens anyway. I am not sure whether this new clause widens that possibility greatly. I understand that it simply puts the national parks in the same position as a local authority to try to fulfil their functions.

[James Wharton]

I wish to clarify that this proposed new clause has no impact on planning as it would affect national parks. It has nothing to do with shale gas extraction, or fracking. I hope that is clear enough for the hon. Gentleman, and that it will give him some reassurance about our intention, which is to deliver on a request from the national parks.

[Mr Betts]

I am aware that the national parks have been asking for it, and I accept the Minister’s statement. Will he think about the comments made by my hon. Friend the Member for Hemsworth (Jon Trickett) on fundraising and the extent to which the powers of general competence could be used by national parks in any way that undermined their primary purpose, which is to look after the national parks, their beauty and the environment while ensuring they are a place where people can live and work? That is an important function of national parks authorities.

[James Wharton]

I thank the hon. Gentleman for generously giving way again, and I can offer that reassurance. The primary purpose remains, as I said in my speech, that anything that a national park does must be in line with its statutory obligations. There is no legal basis for charging, and we are not looking to allow it. I hope that we might move to a position of greater consensus on the new clause, which I felt would be uncontroversial. I recognise the concerns expressed by hon. Members and I thank the hon. Gentleman for accepting my interventions and giving me the chance to put some of these matters to bed.

[Mr Betts]

I thank the Minister for his helpful comment. Perhaps more discussion could have been had before we reached this point; that might be something that everyone could learn from. The Minister’s intervention has been helpful to me and I thank him for it.

[Dr Julian Lewis]

rose—

--- Later in debate ---

[Mr Betts]

I shall speak specifically to Government amendment 27. The proposals for combined authorities are welcome. They are essentially about local authorities coming together where they wish to combine their approach, their workings and their functions to deliver better services and, hopefully, greater economic growth for the residents in their areas. The idea was pioneered in Manchester. The one fundamental difference between Manchester and some of the other areas that we are considering is that Manchester has had a number of authorities that have worked together over a period of time and these happen to be the authorities that were part of the old Greater Manchester metropolitan area. There were 10 districts that formed that old Greater Manchester metropolitan county, so they have always had a sense of being together and working together over a number of years. They are also unitary authorities that all have the ability to make their own decisions about whether they come together, how they do so and what they do to form the combined authority. It is a relatively simple and easy arrangement in constitutional terms.

The difficulty for some other areas is that the constitutional arrangements are slightly different. Obviously, I am now going to refer to my own area. Sheffield contains the four districts which used to form the old South Yorkshire metropolitan county, and which have worked together to varying degrees, and with varying degrees of success, since the counties were abolished. They came together to form what is now the Sheffield combined authority.

To an extent, the same applies to Leeds, which contains five districts that used to be the West Yorkshire metropolitan county, and which have been working together as a combined authority. There are, however, some differences, which have been recognised at various times by parties on both sides of the House. Sheffield contains not merely the four districts of south Yorkshire, but five other districts which form part of either Derbyshire county or Nottinghamshire county: Derbyshire Dales, Chesterfield, North East Derbyshire, Bolsover and Bassetlaw. They are not part of the old South Yorkshire county, but they are very much part of the local economy of the Sheffield city region—the travel-to-work area.

That has been recognised in a number of ways, and I remember when it was first recognised. I went to the first meeting between the leaders of those nine councils, which took place at Meadowhall shopping centre, and which had been called by David Miliband when he was number two in his Department. I am not sure which Department it was, but it was probably the Office of the Deputy Prime Minister. I expected a reaction from the districts outside south Yorkshire—I expected them to think that Sheffield Big Brother was going to take them over—but the leader of Bolsover district council said, “Actually, it is quite good that we are involved in this.” He said, “I know that not everyone who lives in Bolsover will have a job in Bolsover, and that many people have to travel to work in Sheffield. What happens in Sheffield matters to us, and how people transport themselves from Bolsover to Sheffield matters to us. It is right that we are sitting round the table having discussions and being involved in the decision-making process.” Those were wise words, which have stood the test of time.

The coalition Government adopted a similar approach. When they formed the local enterprise partnerships, they recognised that the historical regional boundaries were not always appropriate. I know that the previous Secretary of State had a thing about regions: people almost had to cross themselves, or put money in the Department’s swear box, if they mentioned them. He was not always right in damning the regional spatial strategies and blaming them for every evil on the planet, but I think he had a point nevertheless, in that the old regions did not necessarily represent local economies and the way in which areas worked in day-to-day life.

The districts of south Yorkshire were in the Yorkshire and Humber region, but the districts in Derbyshire and Nottinghamshire were in the old East Midlands region, and that often did not work because the two regional development authorities did not always speak to each other. That was a fundamental problem for the Sheffield regional economy, which the last Government recognised when it created the LEPs and allowed them to create themselves across the old regional boundaries to reflect the travel-to-work areas and the local sub-regional city region economies.

We now face a challenge. So far, the districts in that position in North Nottinghamshire and North Derbyshire have, to an extent, been able to have it both ways. They can continue as districts, as part of the two counties, but they can also be non-constituent parts of the combined authority in Sheffield. Ultimately, however, the districts will have to make some sort of choice.

We are to have an elected mayor in the Sheffield city region. We have had discussions and arguments about that, but it is going to happen. Should the people of Chesterfield, Worksop or any other parts of those districts be able to vote for the mayor in Sheffield, who will be in charge of transport in that area, or should they not be able to vote for the mayor, who will then cover only part of the travel-to-work area with his or her transport responsibilities? That strikes me as illogical, because it will not bring about a combined authority that really covers the city region and the travel-to-work area.

Is it possible that the people of Chesterfield will not have a vote for the mayor because Chesterfield will not become part of the Sheffield city region combined authority—although, under the proposals, the mayor will be involved in discussions and decision making about economic development matters that affect Chesterfield, even if it is only a non-constituent part of the combined authority? I do not think it reasonable for an individual who has not been not elected by the people of Chesterfield to have a say in what happens there.

What the amendment does is ensure that the districts of North Derbyshire and North Nottinghamshire will be able to make their own decision about the long-term position—about where they think they fit and where their future lies—without the county councils’ having a veto. Like my hon. Friend the Member for Nottingham North (Mr Allen), I hope that that will done by means of consensus and discussion. No one wants Chesterfield to feel that it is no longer part of Derbyshire county or Bassetlaw to feel that it is not part of Nottinghamshire county, for many other purposes.

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman is advancing a powerful argument. He is absolutely right about consensus. He is also right about the fact that businesses do not recognise local authority boundaries. Surely, when we talk about devolution, we must talk about it on the basis of economic rather than political areas, but there is a danger of our being sucked into those political areas.

[Mr Betts]

I entirely agree. In the end, of course, a district council as a whole will have to go to an area, but, as the hon. Gentleman says, the focus should be on what works for the economy in terms of job creation, growth and the development of skills, and on ensuring that the necessary transport links exist.

I hope that the Minister will clarify one important point. There may ultimately be a decision for the Secretary of State or the Minister to make on these matters. The districts in North Derbyshire and North Nottinghamshire, or some of them, may well decide to become part of the Sheffield city region—I hope that they will, because I think that it makes economic sense—but it is nevertheless possible that Derbyshire and Nottinghamshire will form another combined authority, an N2D2, and that there will then be a conflict between the two decisions.

I understand from the amendment that it will be up to the Secretary of State to decide which combined authority the districts should join, because they cannot join two; the people in those areas cannot have a vote for two elected mayors in different combined authorities. I hope when he decides that he will indicate that his key criterion will be what is right for the local economy—that point was made by the hon. Member for York Outer (Julian Sturdy)—and right for developing skills, for economic growth, and for the development of a proper transport strategy for those areas.

[James Wharton]

I absolutely hear what the hon. Gentleman says. We must do what is right. If devolution is to be successful, it must recognise the boundaries that are, as my hon. Friend the Member for York Outer pointed out, more than political: the economic boundaries and the community boundaries. We must take account of what local people want. I am sure that, in exercising whatever powers he has when discussions on the Bill have concluded, the Secretary of State will first seek to build that consensus, as he has throughout the devolution discussions, but will then seek to ensure that the deals that are done will stand the test of time.

[Mr Betts]

Standing the test of time is about what works economically and what works for growth, because that is the purpose of devolution in the first place.

[Nigel Mills (Amber Valley) (Con)]

I think I agree with the main thrust of the hon. Gentleman’s argument, but we might well grant the elected mayors powers to replace the police and crime commissioners, and if, for example, Chesterfield chose to join Sheffield rather than Derbyshire, the people would presumably lose the right to vote for the person who holds their police force to account. I am not sure that, in those circumstances, the Secretary of State could make his decision solely on the basis of economic powers.

[Mr Betts]

That is an added complication. At present, three separate police and crime commissioners cover the Sheffield city region: one for south Yorkshire, one for Derbyshire and one for Nottinghamshire. Those issues might be considered at some point way down the line, but the leaders of the Sheffield combined authority have— sensibly, in my view—decided not to incorporate the police and crime commissioners’ powers in their devolution deal, probably because that would lead to exactly the sort of further complications to which the hon. Gentleman has referred. They have confined their deal to economic, transport, skills and growth issues, which are precisely the issues to which the Secretary of State will have to give particular consideration if there is a decision to be made about which combined authority the districts are to go into.

[Graham Stringer (Blackley and Broughton) (Lab)]

I am sure my hon. Friend agrees that we live in an extremely complicated country both culturally and economically, and one of the things that has bedevilled attempts to devolve powers to local authorities has been searching for the perfect boundaries. The perfect boundaries do not exist. Does my hon. Friend agree that it is better to devolve than to spend for ever looking for those perfect boundaries?

[Mr Betts]

Absolutely, and therefore I support the principles of the Bill, but having said that, and while agreeing with my hon. Friend, if we can do something to improve the devolution process, which this amendment does, we should be looking to do that as well. I want devolution to happen, but I want it to work. There is a danger in the Sheffield city region proposals that, without those North Derbyshire and North Nottinghamshire districts, and without a true reflection of the whole travel-to-work area, the devolution will not be as economically successful.

I accept in the end that it is a matter of consensus, however. This amendment allows those districts to express their own view about where they think their economic future lies without pulling out of the county for all other services. It allows devolution to go forward without a veto from the county over the particular issues of economic devolution and transport powers. It makes a lot more sense for the Sheffield city region. It also offers the same opportunities for the same way forward for the West Yorkshire combined authority and probably for the west midlands as well.

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I shall be brief. I am pleased to follow the Chair of the Select Committee, not least because I thought one of his closing lines summed up our objective here this afternoon: we want devolution to happen, but we want it to work. I want to speak to new clause 8 and amendment 57 in my name and also touch on amendment 2 in the name of my hon. Friend the Member for Hazel Grove (William Wragg), all of which share exactly that objective.

Dealing with the question of consent and the referendum contained in amendment 2, it seems to me that if this process is to work it is essential that it should have the consent of the people who are going to be governed under these new structures. If the argument can be made for the new structures and new form of governance, the Government ought to have the self-confidence to give people a direct say on the changes that are about to be introduced. From a Greater Manchester perspective, I think it is entirely possible that the Government could put a case that would persuade people that the new arrangements should be approved in a referendum, but the very act of withholding that opportunity for them to express their will and to show real consent for what is being done in itself sows the seeds of difficulty and discord and makes it less likely that the new arrangements will work.

--- Later in debate ---

[Mr Betts]

I am trying to work out what the hon. Gentleman is trying to achieve by this amendment. Is he just probing the Government? They have made it clear that devolution deals, as negotiated, will go ahead only with an elected mayor. Is he working on the assumption that if the population turn down an elected mayor in a referendum, the whole devolution deal for that area will fall?

[William Wragg]

I thank the hon. Gentleman for his intervention. My amendment seeks not to ensure that such devolution deals fail, but that the mayor is not a prerequisite of such a deal. I am at variance with the Government on this issue and I would like my amendment to be included in the Bill.

--- Later in debate ---

[Mr Betts]

I said on Second Reading that I supported the general principles of the Bill and its underlying intentions—and I still do. I have reservations about the pace and the extent of the change—I would like to go faster and further—and about certain details such as elected mayors and their imposition. I think imposition is the right word, despite Ministers’ denials. Nevertheless, the Bill is important for its symbolism and its direction of travel. On that direction, when I was first elected in 1992 I never thought I would see this happening in this House of Commons. What we have here is a revelation by comparison with where thinking was in those days.

I thank the Secretary of State and Ministers for the way in which they have dealt with the debate in Committee and on Report. They have listened to the constructive comments made on both sides. Equally, I would like to place on record my thanks to local government leaders, particularly those on the Labour side who control most of the major cities. The reality is, as I am sure Ministers recognise, that while those leaders’ budgets are being cut to shreds by the Government, they are still prepared to sit down and work pragmatically with the very same Ministers to negotiate deals on devolution that will be to the benefit of the communities they represent. That says an awful lot for council leaders, and the way in which they have approached the offer that the Government have made to them.

I thank the Secretary of State and Ministers for recognising the concerns that I raised and tabling amendment 27. I shall not go into the details of the Sheffield city region again, but I think that the amendment demonstrates Ministers’ understanding of a wider issue. If more growth, better economic performance and new jobs are to result from these deals, the bodies that we are creating must reflect the real economies of their areas rather than having regard to the old administrative boundaries of regions that existed for many years but did not necessarily reflect those local economies. The fact that Ministers were prepared to recognise that, and to help with the construction of bodies that will indeed reflect the economies of their areas, demonstrates a very important principle.

I think that, at some point, we shall have to return to the House and discuss what we have achieved with devolution, and I think that we shall have to discuss three issues. First, we shall have to discuss the deals that have been agreed, how successful they have been, and what lessons can be learned. Deals in one area can throw up either problems or successes from which other areas will want to learn. We shall need to subject the deals to scrutiny, on the Floor of the House or in the Select Committee, to establish how well they have worked in practice, whether they have achieved the success that we wanted them to achieve, and whether such success can be extended to other areas.

Secondly, I think that the House will want to examine the performance of different Departments—and I noted the Secretary of State’s reference to his previous reports on performance. I suspect that there is still more enthusiasm in some parts of the Government than in others for the whole devolution idea. I am sure that the Secretary of State could not possibly say anything, but he knows exactly what the realities are from his experience of negotiating with his colleagues.

Finally, I think that after, say, two years of the workings of what are rightly disparate deals that reflect the particular needs of particular areas—for that is what the construction of these deals is all about—we shall want to examine the overall constitutional position of central and local government. We shall want to think about what the next stage should be, and about whether general principles that we have learnt from the deals need to be applied more widely. I am thinking particularly of fiscal devolution. If Members look at any of the local government systems in western Europe, they will find that those local authorities have the power not just to spend money that central Governments give them, but much greater power to raise their own revenues. I recognise that the Government have taken an initial step forward with the full localisation of business rates. We shall obviously want to scrutinise the way in which that is done, but I hope that it is merely the first stage of fiscal devolution, as well as the spending devolution with which this Bill is mainly concerned.

Cities and Local Government Devolution [Lords] Bill

Clive Betts Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

I will of course give the hon. Gentleman that undertaking, and I shall listen carefully to what he says later. I know that he has a great deal of expertise in this area, and I recognise some of his concerns. It is important that we find the right mechanism to address them as best we can in the Bill.

Amendment 59 and new clauses 23 and 25 have been tabled by the shadow Secretary of State, the hon. Member for Hemsworth (Jon Trickett), and his colleagues. Amendment 59 would require a report reviewing the Localism Act 2011. New clause 23 would require the Government to publish a report about the impact on combined authorities of the way in which resources had been distributed through the local government settlement. New clause 25 would require the Government to publish a list of the public authority functions which may be transferred.

We do not consider amendment 59 to be necessary. The Government are committed to a process of post-legislative scrutiny to review the effectiveness of legislation and to inform the development of future legislation. The lead Department submits a report to the Select Committee, usually within three to five years of the legislation receiving Royal Assent, with its preliminary assessment of how the Act has worked in practice in relation to its objectives and benchmarks, as identified during the passage of the Bill. This would inform the Select Committee’s view on whether to conduct a fuller post-legislative inquiry into the Act. The additional steps proposed in amendment 59 are therefore unnecessary.

[Mr Clive Betts (Sheffield South East) (Lab)]

When the Localism Act was passed, the Secretary of State for Communities and Local Government, the right hon. Member for Tunbridge Wells (Greg Clark)—in a previous guise—produced an annual report on how each Department was doing in regard to devolution. Unfortunately, that practice was stopped, but the right hon. Gentleman came to the Select Committee and argued strongly that it should be continued. Does the Minister think his boss has changed his mind?

[James Wharton]

The hon. Gentleman shares my admiration for my Secretary of State and for the work that he has done in this area of policy over an extended period. It is of course open to my right hon. Friend to do that again, and I suspect that the hon. Gentleman will wish to prevail upon him and to repeat his argument on the value of considering that course of action. However, I do not think it necessary to include amendment 59 in the Bill.

We also consider new clause 23 to be unnecessary. It would not add anything to the information we already provide. By separating Government funding from the other sources of income available to local authorities, as the new clause proposes, and by isolating deprivation from other drivers of spend—for example, the impact of population sparsity in rural areas—the report required by the new clause would fail to present a properly rounded picture of the settlement. As hon. Members know, we already publish an annual assessment of the impact of the settlement on authorities’ wider spending power and an equalities statement on the settlement’s effect. Moreover, the settlement is subject to wide-ranging consultation and comes before Parliament for approval. I am not persuaded that anything further of this nature is needed in the Bill.

On new clause 25, I remind hon. Members that this Government’s devolution policy is a bottom-up one. We want to ensure that devolution opportunities are available to all parts of England, including rural and coastal areas, counties, towns and cities. On Second Reading, we discussed at some length the devolution deal that has been done with Cornwall, a non-city area that wants to be part of this process and that has got behind a plan that it believes can drive real change for the better. The enthusiasm from hon. Members from Cornwall who spoke in that debate was obvious and is commendable.

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[Mr Betts]

The Minister has just said that the Sheffield deal could be put at risk, but at this stage it is not a done deal—it is a proposal. If Sheffield were to say, “We actually rather like the proposal, but without the mayor,” what would be wrong with that, as the Bill stands?

[James Wharton]

The hon. Gentleman might recognise that that would then not be the agreement that has been proposed. Where there is devolution on the ambition and scale of Greater Manchester, we could not ensure that the strong, clear accountability necessary to support such devolution and provide the leadership to drive forward that area’s economy would be in place without a metro mayor. That strong, clear accountability needs to be a single point of accountability that only an elected metro mayor can provide. Where major powers and budgets have been devolved, people need to know who is responsible for decisions that can have a radical impact on their day-to-day lives. Mayoral governance for cities is a proven model that works around the world—it is indeed the model of governance for world-class cities. None of that is to say that we are imposing mayors; mayors are not being imposed anywhere. If any area has a mayor, it will be because that area, through its democratically elected representatives, has chosen to have one. The Bill specifically provides for that.

[Mr Betts]

The Minister is making the case that a mayor is required in order to have strong enough leadership and get things through, but in the proposed Sheffield deal only the transport functions go to the mayor—all the economic functions go to the combined authority. Is he therefore saying that there is not going to be strong leadership on these economic functions, because a mayor is not in charge of them?

[James Wharton]

Let me be absolutely clear about this: this Bill does not allow this Government or any future Government to impose mayors on anybody. But where we make a deal it is a two-way process, and it is the Government’s clearly stated intention for those metropolitan areas that the accountability a mayor brings is desirable and we want to see it as part of those deals.

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[James Wharton]

The hon. Gentleman makes a salient and important point. The Government will not support the amendment for that very reason, but I will listen carefully to the speeches that are made because it is important that we address concerns to the fullest extent to which we are able without attracting from the intention of the Bill and the intention of the Government to deliver on our agenda.

Clause 3 provides flexibility to enable a single local authority to leave, in line with the comments that the hon. Gentleman has just made, if it does not wish to continue to be part of a combined authority. A council can also leave a combined authority once a mayor has been elected for the area of a combined authority without the need for the combined authority to be dissolved and reformed, using exactly the same process as is used to establish such an authority of undertaking a governance review demonstrating that the change would improve the exercise of functions. In addition, a council that wishes to leave a combined authority can do so if it obtains consent from the other constituent councils of the combined authority, and if there is one, the mayor. Again, I will listen carefully to the comments of hon. Members with a view to finding a position that can get broad agreement across the House as the Bill makes progress.

Amendment 39 is tabled by my hon. Friend the Member for Amber Valley (Nigel Mills). It applies to circumstances in which a combined authority is proposed and seeks to require that no order can be made for a combined authority unless local government electors have been consulted on replacing the existing county councils and district councils with unitary authorities. That moves away from the flexibility we want to be to deliver and puts conditions on deals that we might want to make but that we do not necessarily want to impose. Again, I will listen very carefully to my hon. Friend’s comments later on in today’s discussions.

[Mr Betts]

Will the Minister also listen to the problem in the districts in north Nottinghamshire and north Derbyshire? They are part of the Sheffield city region for economic purposes under the proposed deal but not for transport purposes, because in order to come under the mayor’s jurisdiction they need the permission of the county. Equally, the districts have to give their permission to join a county combined authority. This is a really complicated situation that needs resolution with Government help.

[James Wharton]

We will consider both the specific situation that the hon. Gentleman raises and more generally its application to our policy direction. I will listen carefully to the comments made in the rest of today’s debate.

Amendment 18 to 22, 27 and 28 are technical and simply provide that where the Secretary of State has powers in relation to electoral matters, those powers may also be exercised by the Chancellor of the Duchy of Lancaster. The provisions are similar to those in other legislation regarding local electoral matters, such as the election of mayors under the Local Government Act 2000, and ensure that the rules made on the election conduct of elections are consistent over wider electoral landscape. I hope that the explanation I have been to give in the time available adequately and sufficiently explains the Government’s position. I reiterate our commitment to listen to the comments of hon. Members and to build as broad a consensus as we can.

[Mr Betts]

I want to make a very few points, because I know that other Members want to speak, particularly my hon. Friend the Member for Nottingham North (Mr Allen), who has tabled a number of amendments and has a long track record of constructive engagement in matters of constitutional reform and devolution of which I am very supportive. He did excellent work on that in the last Parliament.

My first point is about the question of elected mayors and takes me back to the point I made on Second Reading. If the Government are committed to considering bespoke arrangements on devolution for particular parts of our country and considering requests from combined authorities—groups of authorities voluntarily coming together and proposing what they want to see devolved—why do we need one element of imposition in all this? Why do we need one element that says that they can have the powers they come up with providing that agreement is reached but that they must exercise them in a particular way and that there is no ability to discuss that or come to a different view? I find it completely inconsistent with the rest of the Government’s approach.

I do not know why the Government are so insistent on having a mayor as a solution. If it was left to the combined authorities, they would come up with different arrangements. The arrangement in Sheffield has been negotiated not because the combined authorities wanted it but because they were told that they had to have it or else they could not have devolution. That is the situation.

[Mr Graham Brady]

I absolutely agree with the thrust of the hon. Gentleman’s remarks. Does he share my view that the element of imposition in the proposals means that there is a danger that the devolution proposals put in place will enjoy lower levels of support than they otherwise might if communities had been properly consulted and allowed to choose their own models of governance?

[Mr Betts]

The right hon. Gentleman is absolutely right. Of course, the whole principle of the devolution that the Government propose, which I support, is that areas should come forward with their own ideas about what they want to see devolved. Why should they not also come forward with their own ideas about how that devolution should be exercised and about the governance arrangements for it?

[Mr Kevan Jones]

I agree with my hon. Friend, but it is obvious why the Government want mayors. In certain areas—in his area and in others—they are hoping to break up the powers of locally elected Labour local authorities in the hope that if they have an elected mayor, they will either get an independent or someone who claims to be independent but is actually a member of the Conservative party.

[Mr Betts]

I would not want to second guess the motives of the Secretary of State, so I will use my own arguments to resist what the Government are trying to do.

Apart from the inconsistency of approach, the proposals are confusing. That takes me back to the point I made in my intervention on the Minister. In the Sheffield city region the economic powers, which are important and cover skills, economic development and the infrastructure associated with it, are to be devolved to the combined authority, which will cover nine districts—four metropolitan and five non-metropolitan districts. But as I understand it from the deal, the mayor will have responsibility for just transport. So the mayor is to run transport, and the combined authority is to run economic development. The public want some consistency of approach on these matters. I do not believe that the combined authority, the district, would naturally have come forward with a proposal that broke up the responsibilities in this way.

[Andrew Gwynne]

My hon. Friend is making a powerful case. The difference between his deal and the Greater Manchester deal is that the Greater Manchester deal is within a single metropolitan county, so functions such as police and eventually fire and rescue can also be devolved to the Mayor’s office.

[Mr Betts]

There is a big difference in the Manchester case. I am not arguing that Manchester should have a mayor imposed on it. If Manchester wants that, that is a matter for it, but it is different. In Sheffield we have hybrid devolution, with transport going to the mayor, but the mayor is not going to cover the nine districts. The mayor will cover only four districts—the old south Yorkshire districts—so how are people to understand the devolution deal, which has one set of governance arrangements for economic powers and skills, and another set of governance arrangements for transport, where one set of governance arrangements covers four authorities, whereas the other set covers nine?

The whole purpose of combined authorities is to bring local authorities together on a voluntary basis to cover a travel to work area—the natural economic entity—yet transport, the mayor and the associated powers will not cover the whole travel to work area of Sheffield. This is a real dog’s dinner. It is not going to work, and it is certainly not going to be understood by the public.

That leads me on to my second point. There is a problem with mayoral imposition, which in Sheffield’s case will not cover all five areas. Other districts can choose to join the arrangements for mayors if they wish. My understanding—I may be wrong—is that the districts of north Derbyshire and north Nottinghamshire, which are part of the Sheffield city region, are going to join the combined authority, which they are part of, for the economic powers. However, for transport powers to be devolved to those areas through a mayor, those districts will not merely have to agree, but they will have to get the county, which is the transport authority, or two counties, to agree as well. Does the county have a veto over what happens to devolution in the Sheffield city region?

This is not workable. At the same time as the Sheffield city region has a mayoral possibility, Derbyshire and Nottinghamshire are looking at having a joint combined authority, which would have a mayor as well. As I understand it, the mayor can exist for the districts of north Derbyshire and north Nottinghamshire only if those districts agree to the county mayor for Derbyshire and Nottinghamshire being created. So they have a veto over that. At some stage, surely, Ministers have to take some responsibility for coming forward with proposals to sort out this mess, or it will stop devolution working effectively in these areas.

[David Rutley (Macclesfield) (Con)]

As the hon. Member for Macclesfield on the other side of the Pennines, I understand the hon. Gentleman’s concerns and enjoy working with him on the all-party parliamentary group on national parks. Does he agree that one of the fundamental points of having a mayor is to achieve clear accountability? The lesson from London is that probably the greatest accountability the Mayor has is for transport. At a local level, surely much of the work needs to be done to bring the partnerships together. It cannot all be imposed by the Minister. It has to be about dialogue, which may sometimes be uncomfortable, at a local level as well.

[Mr Betts]

I understand that argument, and it would be a lot easier to accept it from the Government if there was clear accountability and a clear understanding of what was happening, and if I had not just had to explain the situation in Sheffield city region, which has neither clarity nor accountability. Transport arrangements are to be devolved to a mayor who does not cover the whole travel to work area. That is not clarity or consistency, and it will not work.

Big issues are involved. I see the hon. Member for Carlisle (John Stevenson) in his place. We had discussions in the Select Committee, of which he was a valuable member in the previous Parliament, and I know he has clear views about moving towards unitaries if we are to have a combined authority that works. Otherwise we will have districts, counties and combined authorities, as well as parishes in some areas. I am not sure that that amounts to easy-to-understand government. The hon. Member for Amber Valley (Nigel Mills) has raised some interesting issues. I am not sure about his solution, but there is a problem, for which Ministers have to accept some responsibility.

I realise that others wish to speak. On the amendment tabled by my hon. Friend the Member for Nottingham North, I hope the Government will listen to the idea of some sort of independent body to look at these issues. That was discussed by our Select Committee last time. If there is genuine disagreement between central Government and local government, an independent body could bring the two sides together and produce a report for Parliament to consider. In the end it is not just about Government agreeing these deals; it is about Parliament taking a view where there is disagreement. Even if Ministers are not minded to accept the amendment today, it is an interesting idea to which they might give some thought.

Finally, we cannot legislate for double devolution because in the end, devolution has to allow areas to do things their own way, but there is a role for Ministers, parliamentarians and the LGA to get the message across that devolution does not stop at the town hall door. Where powers are devolved to local authorities, it is for them to move those powers into communities and to engage with communities in a positive way to make devolution happen even further down the line.

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[John Stevenson]

I do not feel that a referendum would be necessary, because the councillors on the various councils are the elected representatives of the people. My concern is that one authority might dig its heels in and prevent change that is in the beneficial interests of the rest of the council and all the other districts, particularly given that sacrifices will be made by those districts and the county council.

I ask the Minister to give serious consideration to what I consider to be a modest and sensible amendment. I look forward to him accepting it on Report.

[Mr Betts]

I agree with what my hon. Friend the Member for Nottingham North (Mr Allen) said about the need for a wider constitutional settlement. That was apposite, and at some point we will have to address those issues. I agree with his points about subsidiarity and taking that below the level of an individual local authority, and about encouraging the process down.

Fiscal devolution is a challenge, and Members have reflected different perspectives from different parts of the country. It is a challenge, but not one that we should duck. I am Chair of the Communities and Local Government Committee, on which the hon. Member for Carlisle (John Stevenson) sat in the previous Parliament. He made important and valuable contributions to our report. We found a way to take on board proposals from the London Finance Commission about the wider devolution of property taxes, while recognising the need to protect areas that will perhaps struggle to raise business rates and other property taxes easily, or to get back money from areas that simply watch property prices rise and receive enormous windfalls. We must have balance in the system.

The Committee has begun an inquiry into the workings of devolution and the Bill, but since then the Chancellor has made his announcement about the full localisation of business rates. The Committee will want to come back and look at how that will be done. I think most Members would support the principle behind such a move, but how will we implement it to ensure protection for poorer areas? How will we devolve more powers to local government to take account of the extra money made available as part of that process?

[Andrew Gwynne]

My hon. Friend is right to say that the Select Committee must consider business rates retention in detail. One possible solution for devolved city regions might be the pooling and sharing of business rates. For example, parts of Greater Manchester are key drivers of economic growth, and that wealth should be spread across the whole conurbation for the benefit of all.

[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

[Mr Gareth Thomas]

My hon. Friend’s point about poorer areas and the full devolution of business rates is apposite. Is the Chancellor’s suggestion to axe completely the revenue support grant for local authorities—that was in the same speech as plans for the full devolution of business rates—likely to have a dramatic impact on increasing inequality of income between areas? Will my hon. Friend’s Committee be considering that?

[Mr Betts]

We will certainly want to consider that issue. From reading what has been said, and the written statement that was presented to the House on the first day back after the recess, there does not seem to be a commitment simply to leave the amount of business rates collected in an area with that local authority. Instead there was a move to allow the full retention of the growth of business rates, and then a decision about what to do with the rest. I think that is the position, but Ministers will have to explain it further in due course. I am sure that the Committee will want to explore that.

The Minister and I have slightly different views about whether elected mayors should be a requirement for full devolution, but the Minister won the vote and that measure is back in the Bill. I am still concerned to have a level playing field, however, and I am surprised about one element in the Bill that Ministers have not sought to explain. Amendment 60 would delete from clause 5(1)(7) words that would devolve to a mayor who is exercising powers independently, any powers that are

“similar to any power exercisable by the mayoral combined authority…but the power conferred on the mayor may not include a power to borrow money.”

When a combined authority is set up, it can have the power to borrow money. In the Sheffield city region, the combined authority has to borrow money for the functions of economic development, skills and matters devolved to it. The mayor will effectively become the transport authority and exercise transport functions. In exercising those functions, however, the mayor will not be able to borrow money. Somebody else will have to do that if, for example, a new tram system is going to be developed. The mayor will have to go to somebody else and say, “Will you borrow money for me?”

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It is essential that we have the choice and that we do not get bundled into something, either deliberately or accidentally, that does not work for us. I do not think that that is the Government’s aim—

[Mr Betts]

My hon. Friend is reiterating the point that I was making earlier, and I entirely agree with him. Although Bassetlaw could not be forced into D2N2, could it not be prevented from joining the Sheffield city region as a full member? In other words, it could be left in limbo.

[John Mann]

I suppose Bassetlaw would have the option of declaring itself a unitary authority, of getting approval for that and of joining Sheffield city region. There may be routes around it, but the principle is fundamental. We need to have the ability to choose. If those two choices were put to the electorate, I suspect that I know which they would choose, and probably decisively. They may have a different view to me, but that is their prerogative—we have a word for that: democracy. What we do not want is “undemocracy”. Some people are very hostile to what the Government are doing and some are much more sympathetic. Either way, will these two options—is it the D2N2 model—lead to more councillors?

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[James Wharton]

I thank my hon. Friend and note that flattery can get you a long way in this business.

The hon. Member for Harrow West (Mr Thomas) tabled new clause 10, which would provide for the devolution of the Secretary of State’s housing powers to the Mayor of London. Since 2012, the Mayor of London has had overall responsibility for housing policy and delivery in London, taking over from the Homes and Communities Agency. The Mayor has powers to set strategic housing and regeneration policy through the London housing strategy. The Secretary of State has a legitimate role in relation to housing across England and it would be inappropriate to remove that role.

The amendment would weaken the Mayor’s role by requiring the Assembly’s consent. That fundamentally misinterprets the role of the London Assembly, which is a scrutiny not an Executive body. I recognise the hon. Gentleman’s desire to pursue the issue and to put it on the record. I am sure he will want it to be considered further as matters progress and that this is not the last time it will be discussed on the Floor of the House.

A significant number of other amendments relate to finance. Government amendment 9 provides greater flexibility in funding the functions to be devolved. Orders under the Local Democracy, Economic Development and Construction Act 2009 enable a combined authority to levy for transport purposes, and the constituent councils to make financial contributions to that combined authority to fund economic development and regeneration functions. The amendment provides flexibility to enable the constituent councils, if they so wish, to make financial contributions for any function of the combined authority, not just economic development and regeneration.

Opposition amendment 58—which the shadow Minister, the hon. Member for Croydon North (Mr Reed), has said he wishes to pursue further this evening—proposes that the Secretary of State be allowed the power to allow combined authorities to set multi-year finance settlements. For a combined authority to set multi-year budgets, it requires not a power from central Government, but the certainty of knowing what funding it is to get. The deals we have agreed with Greater Manchester and the Sheffield city region show how funding across the years can be agreed. We do not, though, need powers to put in place multi-year settlements for local authorities. We can already do that administratively as part of the wider local government finance settlement.

Amendment 60, tabled by the hon. Member for Sheffield South East (Mr Betts), would delete from clause 5 the exclusion of borrowing powers from the ancillary powers that can be given to a combined authority mayor. I listened very carefully to his contribution and understand his concerns. We agree that in appropriate cases there should be prudential borrowing for funding investment for which the mayor is responsible. The Bill provides for that, and the exclusion that the amendment seeks to remove is not about prohibiting such prudential borrowing.

Clause 10 makes provision for funding combined authorities and, in particular, provides that the Secretary of State may make regulations specifying the functions for which there can be borrowing. The Bill explicitly provides that those functions can include mayoral functions and that the constituent councils must consent to any regulations allowing borrowing.

I assure the hon. Gentleman that there are indeed borrowing powers for mayoral functions. In addition to devolving powers to a mayor, the Bill also allows ancillary powers to be conferred on a mayor to allow him or her to exercise the devolved powers. These ancillary powers could be those needed to ensure that there are no doubts about a mayor being able to run an office or to commission necessary studies, or they could include giving the mayor a general power of competence.

The exclusion, which the amendment seeks to remove, is to make it clear that those ancillary powers cannot include a power to borrow. They cannot be a back door to borrowing. The Bill sets up a proper regime for borrowing to fund mayoral powers, and that should be the route for a mayor being able to borrow.

[Mr Betts]

These are complicated issues and I am not totally sure that I followed all that, and I do not know whether anyone else did, either. The Minister seemed to be reading out a brief from civil servants. Could he provide a note with a thorough explanation of the issue? None of us wants to end up with mayors who need to create transport systems but then find that they do not have the powers to borrow in order to do so.

[James Wharton]

In line with my desire to retain my reputation as a benign velvet glove, I have already written a note to my officials asking that we write to Members following this debate, to ensure that we fully clarify those matters. I will, of course, write to the hon. Gentleman, and if he has any concerns, I would be delighted to discuss them further with him.

Amendment 55, tabled by the hon. Member for Nottingham North, would enable control over decisions on business rates and council tax discounts to be devolved, if that is what is wanted locally. We have always said that we are interested in hearing proposals from authorities and that nothing is off the table for conversation. The Government have signalled their intentions and enabled a large degree of the sorts of financial flexibilities sought by the amendment. We recently announced that, by the end of this Parliament, local government will be able to retain 100% of its business rates. Through the existing powers that govern the business rates retention scheme, we can already give mayoral combined authorities their own share of local rates income and ensure that they benefit from the local growth that that will help to establish. Of course, any decision to make use of the existing powers to extend the rates retention scheme would be taken alongside that on any wider transfer of powers and functions to mayoral combined authorities.

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[Alistair Burt]

I think this is the first time that I have served under your chairmanship, Mrs Main, and I am honoured to do so. Thank you for inviting me to speak this afternoon. As a former Member of Parliament for Bury North—a constituent part of the Greater Manchester devolution process—and a former sponsor Minister for the cities of Manchester, Salford, Wigan, Bolton and Blackburn, I am pleased to take part in this debate which has acute relevance to that part of the world.

May I too put on record my sadness at the loss of Michael Meacher? As a friend and colleague in the north-west for many years he performed great service for Oldham, and was a good colleague to his friends on all sides in the north-west. He will be much missed, and I am sure that the Committee sends its condolences to his family and all who mourn him.

Clause 19 contains valuable safeguards that will apply to the local devolution of health functions. It was inserted in the Bill by an amendment tabled by Lord Warner in another place. Amendments 32 to 38 will provide further definition and clarity, without altering the spirit or substance of the clause. Lord Warner has confirmed that he is supportive of these further amendments.

Clause 19 provides that regulations under clause 17, or an order under section 115A of the Local Democracy, Economic Development and Construction Act 2009, must not transfer any of the Secretary of State’s core duties in relation to the health service as set out in the National Health Service Act 2006 and the NHS constitution. It makes it clear that whatever devolution arrangements might be agreed with a particular area, the Secretary of State will remain bound by the key duties placed on him in respect of the health service.

Amendment 38 provides further clarity by listing the duties of the Secretary of State that may not be transferred, in so far as they are capable of such a transfer. First and foremost, section 1 of the 2006 Act provides for the Secretary of State to retain responsibility to Parliament for the provision of the health service in England. Others are overarching duties on quality, reducing health inequalities, research, education and training, and on the NHS constitution. They also include Secretary of State’s role under the Health Act 2009 in revising and publishing the NHS constitution, his role under the 2006 Act in setting strategic direction for the NHS in the mandate to NHS England, and his role in overseeing and reporting to Parliament on the health service generally, and in particular on NHS England’s performance.

In essence, although health service functions are capable of being devolved to local authorities and to groupings of local authorities, the main responsibility and overriding duty of the Secretary of State for the NHS is not affected by these arrangements and he remains accountable for them.

[Mr Betts]

I apologise, but I shall have to go to chair a meeting about black and minority ethnic coaches and managers in football, another issue that I know will be close to the Minister’s heart.

The Minister may be trying to reassure the Committee, but in some ways he is giving me cause for concern. Devolution deals will, in particular, try to link social care and health in a more real way to the benefit of constituents. My concern is that if every line of accountability goes back to the Secretary of State in Whitehall, it will stop local innovation happening. Will not the line of command back to the centre simply stop things happening?

[Alistair Burt]

That is a good question and I hope I can reassure the hon. Gentleman. No, the whole process being considered is to give powers to the various authorities to be, as he said, innovative in what they would like to do. They will have the powers and the responsibilities to do that. The reason the concern was expressed in another place was to make sure that in the process it would not be possible for the NHS to transfer its core duties and therefore have local authorities do things that are contrary to the main constituent parts of the NHS, such as on issues relating to quality and so on. The accountability of the Secretary of State therefore remains. The ultimate accountability he or she has standing here at the Dispatch Box remains, but it would not stop the work and the innovation. As I shall go on to say, the regulatory powers of organisations such as the Care Quality Commission, Monitor and others will also remain in place to ensure that none of the national quality standards we expect from the NHS will be deviated from. There will be different ways of doing things, but ultimately the quality standard remains a national quality standard.

[Mr Betts]

I see what the Minister is trying to achieve, but I just worry about whether it will work like that in practice. Given that we are in very new territory here and that things will be done differently with the delegation of powers to individual authorities as well as to combined authorities, does the Minister agree that it would be a good idea, perhaps two years after the devolution powers have been put in place, to have a thorough review of how they are working and whether there is anything in the Government’s proposals that might actually stop devolution working properly?

[Alistair Burt]

As the hon. Gentleman knows, we can plan to review things at any stage. For devolution to work, the different models that may be put in place, whether big urban city models or more rural models, must of course pass the test of whether they are doing something qualitatively different and better for people. It will certainly be possible and necessary to review that. I think the concern has been to make sure that national standards are not dropped in the process of innovation. That is why the ultimate duty and responsibility of the Secretary of State remain. That was much discussed in another place. The reason for tabling these amendments is to confirm that, under the overall umbrella of wanting greater innovation, national standards will be preserved and cannot be threatened. That is the idea.