Cities and Local Government Devolution Bill [HL]
Debate between Baroness Walmsley and Lord Patel
Baroness Walmsley (LD)
My Lords, I do not think that I need to say very much because this amendment has been very ably introduced by the noble Lord, Lord Warner, but I do support it. I thank the Minister for introducing Amendments 3 and 4 today because they address part of the concerns we have had. However, many concerns remain, regarding accountability, information service standards and, of course, supervision. There are many functions that would never be appropriate to devolve to a local authority, such as the duty to ensure a supply of appropriately trained personnel in the health service, a matter for which Public Health England—which is answerable to the Secretary of State—has responsibility. It would never be appropriate to devolve those functions, and there are many of them. The noble Lord, Lord Warner, has crafted a very clear statement of what is required. Although the noble Baroness did her very best on Report to assure us that the Government share this amendment’s intentions, we need the amendment on the face of the Bill. Legislation needs to be clear, and that is what this is.
Lord Patel (CB)
My Lords, I shall be brief. I said on Report, and say again today, that I support the Government’s intention to devolve NHS functions. I think that a lot of good will come out of it. For a start, we might explore a possible model of integrating primary, secondary and social care, which may lead to useful innovations elsewhere in the NHS. However, what is important, and as the noble Lord, Lord Warner, said, is that certain key characteristics of the National Health Service have to be maintained, particularly when it comes to regulatory and supervisory functions. I agree with the noble Lord that the proposals should not inadvertently lead to fragmentation and variation in healthcare. The risk is that individual transfers of functions will do exactly that.
The noble Baroness, Lady Walmsley, and I appear on the Marshalled List as supporters of Amendment 11, which was tabled by the noble Lord, Lord Warner. I shall not comment on paragraph (a) of the proposed new clause because it has been adequately referred to, particularly in the intervention by the noble and learned Lord, Lord Mackay of Clashfern, on Report, which was very helpful. Paragraph (b) states that the Secretary of State,
“must not transfer health service regulatory or supervisory functions”.
The noble Lord has mentioned NICE, the CQC and Monitor, but there are many other bodies, including the key one, Health Education England, in terms of training all healthcare workers.
Paragraph (c) of the proposed new clause refers to national service standards. I would mention patient safety issues in particular, as those have become paramount in our National Health Service following the Mid Staffs fiasco. I would also mention the requirement to report on mortality ratios in all hospitals and health authorities, to report on unexplained deaths and the need to reduce the excessive number of deaths that are occurring from cancer, diabetes and other diseases.
I had hoped, as I have said, that government Amendment 3 would cover all those issues, but it does not. The amendment does not in any way stop devolving NHS functions, as proposed in the Bill; it just clarifies the functions that a devolved authority itself cannot change because they are national, regulatory and supervisory. It is for those reasons—to protect those functions—that I support the amendment.
Cities and Local Government Devolution Bill [HL]
Debate between Baroness Walmsley and Lord Patel
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.