Cities and Local Government Devolution [Lords] Bill

Debate between Alistair Burt and Karin Smyth

Wednesday 21st October 2015 Commons Chamber

[Karin Smyth]

I am grateful for that clarification. My concern then would be who the Minister sees as driving the development and improvement of, particularly, the specialised commissioners. We are talking in fairly transactional terms about who might be contracting or who might be accountable but, as he will appreciate, these services, as well as others, require a long lead-in time and a lot of consideration owing to their very technical and, by definition, specialised nature. Who is driving this forward—the local group, if they so choose, who may not have the expertise, or the Department?

[Alistair Burt]

NHS England and the Department must retain the overall control of the quality of the specialised services, and that will not be relinquished if there is no sense that they can be handled any better, because otherwise there is no point. The number of specialised services that are devolved might ultimately be very few. Of course, there is only any point in devolving them if they are going to improve, and that must be demonstrated before they are devolved and moved on.

Let me say a little about the wider concern of the hon. Member for Heywood and Middleton that by devolving these powers and running with the grain of greater devolution, we are losing the “national” in the national health service. We are absolutely determined that that will not be the case. The safeguards that are now in the Bill as a result of concerns expressed elsewhere were never going to be lost, but they are now made more explicit to demonstrate that what she worries about cannot happen. It is not the case that an authority will apply for these powers and they will be handed over without no further consideration, because there is the transfer order that Parliament will be involved in.

What are the Government going to think about when people ask to do this? The Government have invited local areas to develop their own proposals. There is no blueprint for the devolution of health and social care. The substance of devolution deals will be determined on a case-by-case basis, with Government agreeing bespoke deals that correspond to the needs and specific context of each area. There are some important preconditions that we might expect to support the development of local devolution deals, including health and social care. These include a clear vision for the benefits to the local area; a history of successful collaboration and partnership working; support and input from local health and social care organisations for the proposals being put forward; a strong commitment to further engagement with local patients and communities as plans develop; upholding the standards set out in national guidance; and continuing to meet statutory requirements and duties, including the NHS constitution and the Government’s mandate to NHS England. Most importantly, the first overarching principle of any agreement is that all areas will remain part of the NHS. This requirement to adhere to the constitution of the NHS and the ultimate safeguard of the Secretary of State’s responsibilities answers the point about a local area getting hold of NHS money and then deciding to build a new leisure centre. It would not be able to do that because it would not be complying with its duties under the NHS. It would fail and the duties and responsibilities would soon be taken away. That is why the safeguard is there.

To deal with the hon. Lady’s concerns about potential confusion, let me say a little more about the role of NHS England under devolved arrangements. NHS England and CCGs would continue to be bound by their duties under the National Health Service Act 2006 even after devolution of functions. For example, NHS England will remain bound by duties to promote the NHS constitution, and to exercise its functions effectively, efficiently and economically and with a view to securing continuous improvement in the quality of services, including in terms of outcomes.

NHS England must exercise its functions having regard to the need to reduce inequalities in relation to both access to health services and outcomes achieved for patients. When NHS England exercises its functions, it must also promote the involvement of patients and their carers and representatives in decisions made about diagnosis, prevention and care and treatment. It must take appropriate advice and act with a view to enabling patients to make choices with respect to aspects of the health service provided to them.

Those safeguards show that the powers simply cannot be devolved to people who want them without any check or balance on how they would exercise them, even if they persuade people locally that signing a blank cheque for help is in any way acceptable. I cannot see local representatives agreeing to that. That is where the control comes in.

How will the Department of Health and NHS England be involved in agreeing the deals? We have been working closely with other Government Departments to respond to proposals. NHS England has developed its own set of assessment criteria, by which it will assess the potential of proposals from a particular local area. It is not an automatic process: if the deal will not work in terms of the quality of healthcare provided, the House will not pass a transfer order because the proposal will not pass the test set by NHS England and the Department of Health.

Will devolution mean that local areas can set their own strategy for NHS capital estates and management? No, we do not envisage any changes to capital financing and asset ownership.

Finally, I want to address a very important issue raised by the hon. Lady. Who will have the final say over the opening and closing of hospitals and other services? This is issue concerns every single one of us in the Chamber. Reconfiguration of NHS services will continue to be a matter for the local NHS. However, proposals for service change must meet the Government’s four tests: support from local GP commissioners; clarity on the clinical evidence base; robust patient and public engagement; and support for patient choice. The same elements of contest available when reconfiguration has been proposed will remain even after devolution, so nothing is taken away.

I hope that has been helpful. Working with the grain of what people want, we all think this is a better idea, but there are safeguards to make sure that people’s worries will not come to fruition.

Amendment 32 agreed to.

Clause 8, as amended, ordered to stand part of the Bill.

Clause 17

Power to transfer etc. public authority functions to certain local authorities

Amendment made: 33, page 17, line 32, at end insert—

‘( ) See also section 19 (devolving health service functions) which contains further limitations.”—(Alistair Burt.)

This amendment inserts a new subsection into clause 17 which alerts the reader to clause 19 which contains limitations on the power to make regulations under that clause.

Clause 17, as amended, ordered to stand part of the Bill.

Clause 18

Section 17: procedure etc.

Amendment made: 15, page 18, line 6, after “make” insert “incidental, supplementary, consequential,”—(Alistair Burt.)

This amendment provides that the power to make regulations under clause 17 of the Bill includes a power to make incidental, supplementary and consequential provision.

Clause 18, as amended, ordered to stand part of the Bill.

Clause 19

Devolving health service functions

Amendments made: 34, page 18, leave out lines 29 to 33 and insert—

‘(1) Regulations under section 17 of this Act or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009 (transfer of public authority functions to combined authorities) (“the 2009 Act”)—

(a) must not transfer any of the Secretary of State’s core duties in relation to the health service;”

This amendment confines the limitations contained in clause 19 to the exercise of the power to make regulations under clause 17 or an order under section 105A of Local Democracy, Economic Development and Construction Act 2009. Those powers concern the transfer of public authority functions to local or combined authorities. New clause 19(1)(a) prevents those powers being used to transfer any of the Secretary of State’s core duties in relation to the health service (as defined in clause 19(2) which is inserted by Amendment 38).

Amendment 35, page 18, line 34, leave out “or supervisory”

This amendment removes the prohibition in clause 19(b) on the transfer of health service supervisory functions of national bodies by regulations under clause 17 or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009.

Amendment 36, page 18, line 36, leave out from “must” to first “the” in line 37 and insert

“, if transferring functions relating to the health service to a local authority or a combined authority, make provision about the standards and duties to be placed on that authority having regard to”

This amendment and Amendment 37 replace the limitation in clause 19(c) with a requirement that regulations under clause 17 or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009 which transfer functions relating to the health service to a local or combined authority must make provision about the standards and duties to be placed on that authority having regard to certain standards and obligations placed on the authority responsible for the functions being transferred.

Amendment 37, page 18, line 38, leave out from “on” to “being” in line 39 and insert

“the authority responsible for the functions”

See the statement for Amendment 36.

Amendment 38, page 18, line 40, at end insert—

‘(2) For the purposes of subsection (1)(a), “the Secretary of State’s core duties in relation to the health service” means the duties of the Secretary of State under—

(a) sections 1 to 1G of the National Health Service Act 2006 (“the NHSA 2006”) (duty to promote comprehensive health service etc.),

(b) sections 6A to 6BB of that Act (duties regarding the reimbursement of costs of services provided in another EEA state),

(c) section 12E of that Act (duty as respects variation in provision of health services),

(d) sections 13A, 13B, 13U and 223B of that Act (duties regarding mandate to, and annual report and funding of, the NHS Commissioning Board),

(e) section 247C of that Act (duty to keep health service functions under review),

(f) section 247D of that Act (duty to publish annual report on performance of the health service in England),

(g) section 258 of that Act (duty regarding the availability of facilities for university clinical teaching and research), and

(h) sections 3 to 6 of the Health Act 2009 (duties in relation to the NHS Constitution and the Handbook to it),

in so far as those duties would (apart from subsection (1)(a)) be transferable by regulations under section17 or an order under section 105A of the 2009 Act.

(3) For the purposes of subsection (1)(b)—

(a) “health service regulatory function” means a function in relation to the health service which is a regulatory function within the meaning given by section 32 of the Legislative and Regulatory Reform Act 2006,

(b) the functions of the National Health Service Commissioning Board under sections 14Z16 to 14Z22 of the NHSA 2006 (assessment of clinical commissioning groups and intervention powers) are to be treated as “health service regulatory functions” in so far as they do not fall within the definition in paragraph (a), and

(c) functions exercisable by a body by virtue of directions given under section 7 of the NHSA 2006 (functions of Special Health Authorities) are not “vested in” that body.

(4) But subsection (1)(b) does not prevent the transfer of functions of the National Health Service Commissioning Board which—

(a) arise from arrangements under section 1H(3)(a) of the NHSA 2006 (provision of services for the purpose of the health service), and

(b) relate to those providing services under those arrangements.

(5) For the purposes of subsection (1)(c), “national service standards” means the standards contained in any of the following—

(a) the NHS Constitution (within the meaning of Chapter 1 of Part 1 of the Health Act 2009);

(b) the standing rules under section 6E of the NHSA 2006 (regulations as to the exercise of functions by the NHS Commissioning Board or clinical commissioning groups);

(c) the terms as to service delivery required by regulations or directions under the NHSA 2006 for contracts or other arrangements for the provision of primary medical services, primary dental services, primary ophthalmic services or pharmaceutical services under Part 4, 5, 6 or 7 of that Act;

(d) the recommendations or guidance of the National Institute for Health and Care Excellence made or given pursuant to regulations under section 237 of the Health and Social Care Act 2012;

(e) the quality standards prepared by that Institute under section 234 of that Act;

(f) the guidance published under section 14Z8 of the NHSA 2006 (guidance on commissioning by the NHS Commissioning Board);

and such standards are “placed on” a body if the body is required to have regard to or comply with them.

(6) For the purposes of subsection (1)(c)—

(a) “national information obligations” means duties regarding the obtaining, retention, use or disclosure of information, and

(b) “national accountability obligations” means duties (for example, those to keep accounts or records, or to provide or publish reports, plans or other information) which enable the management of a body, or the way in which functions are discharged, to be examined, inspected, reviewed or studied.

(7) For the purposes of this section, a function is transferred by regulations under section 17 or by an order under section 105A of the 2009 Act, if—

(a) provision is made under subsection (1)(a) of the section in question for the function to be the function of a local authority or a combined authority, or

(b) provision is made under subsection (1)(b) of that section for a function corresponding to the function to be conferred on a local authority or a combined authority.

(8) Nothing in this section prevents the conferral on a local authority or a combined authority of duties to have regard to, or to promote or secure, the matters mentioned in sections 1 to 1F of the NHSA 2006 when exercising a function transferred to it by regulations under section 17, or by an order under section 105A of the 2009 Act.

(9) In this section, “the health service” has the meaning given by section 275(1) of the NHSA 2006.”—(Alistair Burt.)

This amendment adds provision to clause 19 which defines terms used in, and clarifies the scope of, the limitations contained in paragraphs (a) to (c) of the clause.

Clause 19, as amended, ordered to stand part of the Bill.

Clause 9 ordered to stand part of the Bill.

Schedule 3 agreed to.

Clause 10

Funding of combined authorities

Amendment made: 9, page 11, line 26, at end insert—

‘( ) In section 105 of the Local Democracy, Economic Development and Construction Act 2009 (constitution and functions of combined authorities: economic development and regeneration), omit subsection (4).”—(Alistair Burt.)

This amendment removes the restriction on orders under section 105 of the Local Democracy, Economic Development and Construction Act 2009 only being able to make provision in relation to the costs of a combined authority that are reasonably attributable to the exercise of its functions relating to economic development and regeneration.

Amendment proposed: 58, page 11, line 26, at end insert—

‘(5) The Secretary of State may by order make provision for conferring powers on a combined authority to set multi-year finance settlements.” —(Jon Trickett.)

This amendment is intended to offer financial stability to city regions, allowing them long-term planning which is something not currently offered by the finance settlement or the funding of local enterprise partnership (LEPs).

Oral Answers to Questions

Debate between Alistair Burt and Karin Smyth

Tuesday 2nd June 2015 Commons Chamber

[Alistair Burt]

I thank my hon. Friend for his question, and the Secretary of State will have picked up his thanks for the visit. Seeing GPs is really important. I will let the House into something that I am likely to say again, which is that my dad is a GP. I pay tribute to him, as he has just passed his 93rd birthday. I thank him and all other GPs for their devotion to practice and to looking after people so well. They are a vital part of the service. I will be keen and rather soft on GPs. I want to see them enjoy their profession as much as my father has enjoyed his.

[Karin Smyth (Bristol South) (Lab)]

What is the Minister’s plan to make GP premises fit for the 21st century?

[Alistair Burt]

I welcome the hon. Lady to her place. Briefly, there is a £1 billion fund to improve, over the next five years, GP surgeries and premises and access to GP practices. It is an important part of the process of improving access to GPs, which is good not only for patients but for GPs, who can feel fully engaged in their work without being overburdened. This support should certainly help.