Cities and Local Government Devolution Bill [HL]
Debate between Lord Bradley and Baroness Williams of Trafford
Lord Bradley (Lab)
My Lords, very briefly, I support this probing amendment which has been so eloquently moved and spoken to by my noble friends Lord Warner and Lord Hunt. I said in our debate last week that I suspected that we would need a second debate for clarification of NHS responsibilities and their relationship with the combined authority. I know that the Minister will be anxious to come to the Dispatch Box to give us much clarification this evening, because that relationship needs to ensure that there is no confusion at local level between the combined authority and the NHS.
In our debate last week, I raised 10 questions with the Minister, which I am not going to repeat. I am sure that she will be writing to me with detailed responses, but I want briefly to refer to two of the questions which my noble friends raised again tonight. First, I said that we do not want to leave NHS organisations and their boards, which implement policies by the combined authorities, open to legal challenge that they are acting outside or in conflict with legislation. I am sure that the Minister will want to clarify that point again.
Secondly, I raised the issue of whether the Greater Manchester strategic health board and its relationship with the combined authority needed any statutory powers and whether there was any requirement to amend the Health and Social Care Act 2012. Again, the issue in that general relationship has been raised tonight and I am sure that the Minister will want to clarify that point further. This probing amendment is surely to ensure that the devolution which we all support for Greater Manchester in health and social care can be effected efficiently. We will reflect further on the questions raised tonight in the light of the Minister’s response as we move towards Report.
Baroness Williams of Trafford
My Lords, I thank all noble Lords who have made remarks this evening. A number of questions have been raised. Perhaps I might address the amendment generally and then come to specific questions that noble Lords asked.
Amendment 44DD makes specific provisions about the transfer of health and social care NHS responsibilities, as noble Lords have said, including a requirement for an annual report by a combined authority which has assumed NHS responsibilities. It is important to reiterate this evening what I have said in earlier debates. The Government are committed to the view that health and social care services in any area, whatever devolution arrangements are entered into, must remain firmly part of the National Health Service and social care system—the noble Lord, Lord Hunt, alluded to this—that all existing accountabilities and national standards for health services, social care and public health services will still apply, and that the position of NHS services in relation to the NHS constitution and mandate cannot change.
As we have discussed throughout our debates on the Bill, 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. The Bill is an enabling Bill and I do not believe that it is necessary to include specific requirements about how particular powers will be devolved. However, I hope that tonight I can provide more clarification on specific questions that noble Lords asked.
Within the legislative framework that the Bill is creating, the safeguards are to be provided by not making specific provision in the Bill, such as provision about any memorandums of understanding and their relationship with the National Health Service Act 2006, as amended by the Health and Social Care Act 2012. Safeguards are in fact provided by the requirement that the implementation of any particular devolution deal must be debated and approved by both Houses of Parliament.
Cities and Local Government Devolution Bill [HL]
Debate between Lord Bradley and Baroness Williams of Trafford
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.