Lord Bradley
Main Page: Lord Bradley (Labour - Life peer)Cities and Local Government Devolution Bill [HL]
Lord Bradley Excerpts
Lord Bradley
“Transfer of functions: health and social care
A local or combined authority which is the recipient of any transfer of functions under this Act in relation to health and social care must abide by the following principles—(a) they must remain part of the National Health Service and social care system;(b) they must uphold the standards set out in national guidance;(c) they must continue to meet statutory requirements and duties including those contained in the NHS Constitution and Mandate; and(d) they must uphold the standards that underpin the delivery of social care and public health services.”
Lord Bradley (Lab)
My Lords, in moving Amendment 36D, I shall also speak to Amendment 36E. Both amendments are in the names of my noble friends Lord McKenzie and Lord Beecham. This is the first opportunity to debate health and social care, but it may not be the last. I declare an interest as a resident of Greater Manchester, former city councillor in Manchester and former MP for the city. My interest in devolution to Greater Manchester is particularly strong.
These are essentially probing amendments regarding the devolution of health and social care to the combined authority—initially to Greater Manchester. I say “combined authority” because it is my understanding that health and social care is not a responsibility to be exercised by the elected mayor. In fact, the memorandum by the DCLG and the Home Office specifically rules out the integration of health and social care as a mayoral function. I would be grateful if the Minister would confirm that there is no intention in future to make that a mayoral function.
The devolution of health and social care in Greater Manchester has arguably provoked the most interest among the public, stakeholders, politicians and, of course, healthcare professionals amongst others. From a position of, in principle, supporting devolution, I believe it is important to clarify some of the points about the way that this proposal will unfold over the coming weeks and months.
The legislation we are debating makes not a single reference to health and social care. That is reinforced by the fact that in the Explanatory Notes, under “Legal background”, no reference is made to any health legislation, particularly the Health and Social Care Act 2012. We know that the original Greater Manchester devolution agreement did not cover health and social care and that a very belated memorandum of understanding was agreed between the Government and the Greater Manchester Combined Authority to set in train the process of devolution of health and social care. Therefore, probing amendments have been tabled under Clause 6, “Other public authority functions”, to elicit further information in this area.
First, we seek clarification: does the Bill apply in any way to public authorities other than district, unitary and county councils? Specifically, do any NHS organisations—clinical commissioning groups, NHS trusts, foundation trusts or arm’s-length bodies, to name but a few—fall within the powers that Clause 6 gives to the Secretary of State for Communities and Local Government to transfer functions and property or rights to a combined authority? I anticipate that the answer to this is no, but that means that the Bill has no bearing on the health devolution proposals and its provisions cannot be used to enact health devolution. As I noted earlier, the Explanatory Notes do not include the Health and Social Care Act 2012, which also suggests that it has no competence in this area. I would therefore be grateful if the Minister could confirm the Government’s interpretation is the same as mine.
Secondly, having read the health devolution memorandum of understanding, I suggest that implementing many of its provisions may require, sooner or later, primary or secondary legislation. This could be desirable, not only to set out clearly the statutory basis on which responsibilities may move between existing bodies—for example, CCGs, local authorities, foundation trusts and so on—but also to frame accountability relationships. Where such arrangements are currently set out in the Health and Social Care Act 2012, it would seem that amendments to that Act, whether made using the powers of this Bill or made directly through further legislation, would be required. For example, if the Greater Manchester Strategic Health and Social Care Partnership Board required statutory powers—and many commentators are of the view that, for such bodies to really shape the services locally, they will require such powers, and this view has often been argued in relationship to health and well-being boards being the strategic body at a local level without any statutory powers—clearly, amendments to primary legislation will be required. I would be grateful if the Minister would confirm the position. We do not want to leave NHS organisations and their boards, which implement policies, open to legal challenge that they are acting outside or in conflict with legislation.
The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Williams of Trafford) (Con)
My Lords, as noble Lords have said, Amendments 36D and 36E make specific provision for the transfer of health and social care and NHS responsibilities. It is probably important to say straightaway that the Government share and are committed to the views underpinning the substance of these amendments—namely, that whatever devolution arrangements are entered into in a particular area, health and social care services in that area must remain firmly part of the NHS and social care system, and the position of NHS services in the area in relation to the NHS constitution and mandate cannot change. I hope that that clarifies the position. There can be no question but that, whatever devolution arrangements for health and social care are agreed with an area, all national standards for health services, social care and public health services must, as a minimum, be complied with.
As we have discussed throughout our debates, the context in which the Bill’s powers will be exercised is that of implementing bespoke devolution deals agreed with individual areas and reflecting each area’s proposals and ambitions for devolution. That said, the agreement that Greater Manchester has reached with NHS England illustrates the kind of devolution of health and social care services which areas may be seeking and which the Bill will facilitate.
The noble Lord, Lord Bradley, asked whether health will be a mayoral function under the new section introduced by Clause 6. The answer is that NHS bodies are seen as public authorities for the purposes of the Bill. The Greater Manchester deal does indeed put health as a function of the combined authority and not of the mayor. However, we would not want to prejudice any other deal. We would want to hear from areas and discuss with them what they want.
Greater Manchester and NHS England have set out their agreement in a memorandum of understanding and there are several underpinning principles to that agreement. First, in the field of health and social care, all decisions about Greater Manchester will be taken with Greater Manchester. The second principle is that Greater Manchester will remain part of the National Health Service and social care system; it will uphold the standards set out in national guidance and will continue to meet statutory requirements and duties, including those of the NHS constitution and mandate.
The third principle is that new models of inclusive governance and decision-making will be created with the intention of enabling the clinical commissioning groups in Greater Manchester, providers, patients, carers and partners to shape the future of Greater Manchester together. It is in creating these new governance arrangements that the powers in the Bill may need to be drawn on, giving to local authorities, together in their combined authority, the powers to participate in the strong, collaborative partnerships that they, NHS commissioners and providers will form to deliver on the principle that all health decisions about Greater Manchester will be taken with Greater Manchester.
Without going into the detail of the Greater Manchester arrangements, I would mention that these governance arrangements will be centred on two bodies— noble Lords have already referred to them. The first is the Greater Manchester Strategic Health and Social Care Partnership Board—for short, the GMHSPB. The membership includes the clinical commissioning groups, providers, NHS England and the local authorities. This will prepare and take forward a comprehensive Greater Manchester strategic sustainability plan for health and social care. The second is the Greater Manchester joint commissioning board, comprising the local authorities, the clinical commissioning groups and NHS England. Its role will be to commission Greater Manchester-wide services.
This is a broad, enabling Bill, and I do not believe it is necessary to include in it specific requirements about how particular powers might be devolved. Within the legislative framework that the Bill is creating, the safeguards are to be provided not by making specific provisions but by the requirement that the implementation of any particular devolution deal must be debated and approved by both Houses of Parliament. For such debates, it will be important that the full details of the deal concerned, how it was arrived at and the outcomes expected from it will be fully available to Parliament. As I said in the earlier short debate on housing, I am ready to consider whether the standard explanatory memorandums are—
Lord Bradley
I have a question on that point, so as to be absolutely clear. The Minister said that any of those functions will be debated in both Houses. Is she confirming that any proposals around the devolution of health and social care will be subject to scrutiny in both Houses of this Parliament?
Baroness Williams of Trafford
Yes, my Lords, I am. They would be done by order, and any orders will be scrutinised through the affirmative process in both Houses of Parliament.
As to reporting on how a deal is proceeding, as I said in one of our debates earlier this week, a process for evaluating the progress on each deal will be discussed and agreed with each area as part of the deal. For example, the Greater Manchester deal has an extensive programme of evaluation, with evaluations being public documents available to all Members of the House, as well as to all with an interest in the area and the progress it is making. But again, I do not believe it is appropriate in our enabling Bill to make a requirement about the reporting or evaluation of some particular aspect of a deal, indeed an aspect that may not be in all the deals that are agreed.
I turn to specific questions that noble Lords have asked. The noble Lord, Lord Bradley, asked whether I would support the view that joint board membership should include representatives of the police, et cetera. In any one place, this will be a matter for the area concerned. In Greater Manchester, for example, it is for those concerned to agree who should be on the joint boards, which will reflect the responsibilities that the combined authority has. He asked the very simple question of whether the Secretary of State for Health will be ultimately responsible to the public for the delivery of health and social care. The answer is yes. He also asked about the Manchester MOU. Greater Manchester and all the health bodies concerned, including national bodies such as NHS England, as well as the Greater Manchester clinical commissioning groups, continue to work on the full details of the arrangements that they have agreed.
Baroness Williams of Trafford
I remember the health scrutiny committees in the context of AGMA and the combined authority. I am loath to deal with this point tonight, so I will come back with a firmer reply in due course and request that the noble Lord withdraw his amendment.
Lord Bradley
I am grateful to the Minister for the responses she has been able to make, and I am sure she will read the debate with as great an interest as we all will and write to us with further answers to the questions she has not been able fully to address this evening. I said at the beginning that this was the first, but I suspect not the last, debate we would have on health and social care. Our exchanges so far tonight have underlined that fact. We look forward to the next stage and further debate on Monday. In light of that, I beg leave to withdraw the amendment.