Baroness Walmsley
Main Page: Baroness Walmsley (Liberal Democrat - Life peer)Cities and Local Government Devolution Bill [HL]
Baroness Walmsley Excerpts
Baroness Walmsley (LD)
My Lords, I have not taken part in debates on the Bill before today but I have followed carefully what has been said about devolving health functions, and have had several conversations with my noble friends and the noble Lord, Lord Warner. I have agreed with the concerns expressed by my noble friend Lord Shipley and the noble Lords, Lord Warner and Lord Hunt of Kings Heath, that there is not enough specifically in the Bill to ensure the accountability of the new devolved entity in relation to healthcare, nor enough to ensure adherence to national standards. Despite the fact that national standards of course vary across England and the devolved nations—quite widely, in some places—it is important that at the very least we ensure minimum standards of care in the devolved entities in reality, not just in theory in the applications of the authorities to the Secretary of State in the first place.
It must be borne in mind that the Bill is breaking new ground at a time when the health and social care system is still settling down to the new structure introduced by the Health and Social Care Act 2012, and is doing so at a time when the NHS is being asked to make enormous efficiency savings, many acute health trusts are posting a deficit, and in some places the social care system is in danger of crashing. Thus it is not surprising that opposition parties are asking the Government to place safeguards in the Bill in the interests of patients in Greater Manchester and other places in future, and to be very clear what is intended.
On 13 July, during the first day of Report, the Minister said in response to these concerns that government Amendment 28,
“enables the Secretary of State to provide for the functions concerned to be exercisable by the combined authority or public authority, subject to specified conditions or limitations”.—[Official Report, 13/7/15; col. 439.]
She gave some examples, such as a condition that the combined authority must also meet the current statutory duties held variously by the Secretary of State for Health, NHS England and clinical commissioning groups, thereby ensuring the continuation of current NHS accountabilities and standards. The question is: will the Secretary of State impose such a condition? We need to know that now, not just after the Bill has passed. As the noble Lord, Lord Warner, has said, we are in danger of landing up not with a national health service but with a set of local health services. I hesitate to use the phrase “postcode lottery”, but I think noble Lords know what I mean.
The Minister gave other examples of possible conditions, such as reducing health inequalities, continuous improvements in service and so on. While I am very much in favour of the real devolution of powers as opposed to simple decentralisation, it is my view that it is not worth doing these things at all unless they actually result in service improvements and reductions in inequality. I therefore ask her to be very clear about the Government’s intentions in this respect.
We also need some assurance that the devolved authorities will still be subject to the same regulators that protect standards in the rest of the country; they cannot regulate themselves. We had some assurance about this from the Minister on Monday night when she accepted the points made, but I am sure that we would all be happier if this were reflected in the wording of the Bill. I am not satisfied that we should rely on the Secretary of State making a series of orders; there is a danger in that, and we need more than that.
Lord Patel (CB)
My Lords, in Committee I sat through an extensive exchange in the debate between the noble Lords, Lord Warner and Lord Hunt of Kings Heath, and the Minister. I thought at the time that the noble Lords were enjoying themselves while the Minister was not. While I accept in principle that the devolution of the NHS has no problems with it—after all, we used to have regional health authorities—what is a problem is ensuring that they should be bound by the same statutory national regulations so that they do not themselves invent new regulations that are neither statutory nor binding on others. The point made by the noble Lord, Lord Warner, is important: if one set of regulations could be found in the Bill that would be binding, we would get away from having to make different sets of regulations each and every time, which is what would cause confusion. That is what the noble Lord alluded to and it seemed sensible to me. In principle, though, I accept that the devolution of the NHS is not a bad idea.
Baroness Williams of Trafford
My Lords, I am not going back on what I said on Monday. I think that I made clear on Monday that the accountability and functions of the bodies do not change.
Baroness Walmsley
On a point of elucidation, the Minister said that the Secretary of State could impose those conditions. Is there any circumstance in which the Secretary of State should not impose such fundamental conditions as she has outlined?
Baroness Williams of Trafford
Sorry, would the noble Baroness say that again? I apologise.
Baroness Walmsley
I was just saying that the noble Baroness said that the Secretary of State could impose conditions such as meeting the current statutory duties of the Secretary of State or NHS England. I wondered whether there would be any circumstances in which the Secretary of State should not impose such conditions, because I think that they are pretty fundamental to standards.
Baroness Williams of Trafford
I do not know of any such situation where he should not, but obviously each deal will be different. I cannot speak to a theoretical situation, but no one is suggesting that the Secretary of State loses the powers, particularly in respect of his ultimate accountability to Parliament for the provision of NHS services.
Most of the limitations and conditions that the noble Lord, Lord Warner, outlines could be specified in an order using the provisions, if doing so were considered appropriate in the context of a bespoke devolution deal. For example, we could enable a conferral of health powers on a combined authority to be accompanied by a condition that the combined authority must also meet the current statutory duties held variously by the Secretary of State for Health, NHS England and clinical commissioning groups.
Further safeguards are already provided by other provisions in the Bill. Before making an order to transfer functions, the Secretary of State must consider that such a transfer will improve the exercise of statutory functions. The Secretary of State is also bound by various duties in relation to the health service when exercising his functions. These are set out in the NHS Act 2006, and concern duties such as the duty to act with a view to securing continuous improvement in the quality of services and to have regard to the need to reduce health inequalities. Such duties would be relevant here and, in making an order transferring health service functions, he would be obliged to discharge them.
The order implementing a particular devolution deal must be debated and approved by both Houses of Parliament, and Parliament’s consideration will be supported by the laying in Parliament of a report setting out the detail of the deal, a new requirement under the provisions in Amendment 33, which the House passed on Monday. Those reports will set out and explain the full deal—that is, the wider context in which any order is being made. Hence, the report will set out and describe any memorandum of understanding that councils in the area, the combined authority and the various NHS bodies involved have agreed. That memorandum of understanding will describe and make clear the nature of the devolution agreement, including the degree of permanence or how long it is expected to last. We can see this in the MoU which Greater Manchester has entered into.
Amendment 66 would also require a combined authority to publish an annual report on its deal in relation to health. As we have noted previously, there will be a process for evaluating the progress on each deal 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 with an interest in the area and the progress that it is making. In this context, it is not appropriate 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 which are agreed.
We do not feel there is a need to restrict the ability of the Secretary of State to intervene as set out in Amendment 66. The Secretary of State is already under a duty when exercising functions in relation to the health service to have regard to, always subject to the interests of the health service, the autonomy of the bodies exercising health functions.