Junior Doctors Contract

Clive Betts Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

My hon. Friend gives one example, but there are thousands of such examples. Such people are totally committed to the NHS, have a bright future in it and can make a huge contribution to its success by doing a good job in looking after patients, but they also have home responsibilities that are difficult to fulfil when there are very inflexible rostering systems. One of the big wins from yesterday’s agreement is that we will be able to look at the way the rostering system works to try to bring in such flexibility. If we do not do so, more and more doctors will want to be locums or to work for an agency and we will lose the continuity of care for patients, which is one of the best things about our GP system. That is why there is an urgent need—from the perspective of patients, as well as from that of doctors—to address that issue.

[Mr Clive Betts (Sheffield South East) (Lab)]

I am interested in the Secretary of State’s thoughts about the serious impact on morale that the dispute has had. I was talking to a junior doctor in Sheffield the other day who said that before the dispute he had never looked at his contract, he had simply got on and done what was needed, whenever it was needed. Does the Secretary of State realise that even if the dispute is now settled, as we hope, it has had a serious impact on good will in the health service, which could affect service delivery in the future?

[Mr Hunt]

If the hon. Gentleman looks at the latest NHS staff survey, it shows higher staff motivation, better communication and more staff recommending their organisation as a place to work or be treated. But I accept that when big changes are made to a contract such as the junior doctors contract, they can be contentious and have a short-term impact on morale. In the long run, morale goes up when doctors are able to give better care to patients, and that is what this agreement will allow.

Tobacco Control Strategy

Clive Betts Excerpts

Thursday 17th December 2015 Westminster Hall

[Kevin Barron]

May I also echo those comments? I wish everybody a happy Christmas and a peaceful new year as well.

The debate shows just how far the House, as a legislative body, has travelled over the past two decades, taking on these major issues on the basis of their effect on people, as opposed to their potential effect on political parties. That is greatly to the House’s credit, and I thank everybody who has spoken this afternoon.

I thank the Minister for leaving the door open in terms of what will be in the strategy next summer. Things may come forward that test us—such as what happens in the e-cigarette market and how we deal with that—and I am sure we will watch the issue with great interest. I thank everybody who has contributed.

[Mr Clive Betts (in the Chair)]

May I also take this opportunity to wish everyone here a very happy Christmas? I look forward to seeing you all again in the new year.

Question put and agreed to.

Resolved,

That this House has considered a new tobacco control strategy.

Cities and Local Government Devolution Bill [Lords]

Clive Betts Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

As chair of the all-party group on national parks, I do have some interest in this matter. Additionally, a third of Sheffield—the local authority in which my constituency is—is in the Peak District national park. The name “Sheffield” may conjure up past visions of lots of cutlery being produced, but much of it is very rural, very open and very beautiful.

I understand the concerns of my hon. Friends on the Front Bench about new clause 7, which is of some length and has been parachuted into the Bill right at the last minute. The Government had many opportunities to introduce it earlier, and to talk informally to my hon. Friends, which might have allayed some of their fears. In the end, though, it is the duty of the Opposition to oppose, and probably to be very suspicious of a Government who claim they have nothing but good intentions in proposing a four-page amendment.

Of course there is some suspicion, but let us look at what the national parks have been doing. They have told us at meetings that they would welcome the extension of the general power of competence to them—perhaps it was an oversight that it was not done in the first place. As I understand it, the new clause proposes that where national parks exercise functions in a national park area that are similar in nature to those exercised by a local authority in other places the local authority has the general power of competence, but a national park does not.

Everyone gets suspicious about fracking. Many people do not trust the Government on the issue. They think that, as the Government want to go fracking all over the place and national parks do not, the Government are probably happy to do it and have rather brought those suspicions on themselves. Perhaps the Government could make an absolutely clear statement that there is no way in which this proposed new clause gives any extension of planning powers or anything else that could possibly affect fracking in national parks.

[Jon Trickett (Hemsworth) (Lab)]

I can assure the House that we had no idea that this new clause was coming. It is almost five pages long. The nub of our argument is this: the national parks should be single-mindedly protecting our environment, but this power of general competence allows them to engage in commercial activities to bridge the funding gap that the Chancellor has left them with. Does my hon. Friend not worry that that single-minded concentration on protecting the environment might be lost in the search for additional revenue as a result of the commercial powers that are being conferred on the national parks?

[Mr Betts]

I see my hon. Friend’s concerns in that regard, but the reality is probably that many national parks do look at ways to raise revenue to help support their budgets. I share his views that national parks are subject to cuts and that they are finding it more difficult to do the job that we expect them to do with their much reduced resources. I think that they will look at other ways to raise funds. That happens anyway. I am not sure whether this new clause widens that possibility greatly. I understand that it simply puts the national parks in the same position as a local authority to try to fulfil their functions.

[James Wharton]

I wish to clarify that this proposed new clause has no impact on planning as it would affect national parks. It has nothing to do with shale gas extraction, or fracking. I hope that is clear enough for the hon. Gentleman, and that it will give him some reassurance about our intention, which is to deliver on a request from the national parks.

[Mr Betts]

I am aware that the national parks have been asking for it, and I accept the Minister’s statement. Will he think about the comments made by my hon. Friend the Member for Hemsworth (Jon Trickett) on fundraising and the extent to which the powers of general competence could be used by national parks in any way that undermined their primary purpose, which is to look after the national parks, their beauty and the environment while ensuring they are a place where people can live and work? That is an important function of national parks authorities.

[James Wharton]

I thank the hon. Gentleman for generously giving way again, and I can offer that reassurance. The primary purpose remains, as I said in my speech, that anything that a national park does must be in line with its statutory obligations. There is no legal basis for charging, and we are not looking to allow it. I hope that we might move to a position of greater consensus on the new clause, which I felt would be uncontroversial. I recognise the concerns expressed by hon. Members and I thank the hon. Gentleman for accepting my interventions and giving me the chance to put some of these matters to bed.

[Mr Betts]

I thank the Minister for his helpful comment. Perhaps more discussion could have been had before we reached this point; that might be something that everyone could learn from. The Minister’s intervention has been helpful to me and I thank him for it.

[Dr Julian Lewis]

rose—

--- Later in debate ---

[Mr Betts]

I shall speak specifically to Government amendment 27. The proposals for combined authorities are welcome. They are essentially about local authorities coming together where they wish to combine their approach, their workings and their functions to deliver better services and, hopefully, greater economic growth for the residents in their areas. The idea was pioneered in Manchester. The one fundamental difference between Manchester and some of the other areas that we are considering is that Manchester has had a number of authorities that have worked together over a period of time and these happen to be the authorities that were part of the old Greater Manchester metropolitan area. There were 10 districts that formed that old Greater Manchester metropolitan county, so they have always had a sense of being together and working together over a number of years. They are also unitary authorities that all have the ability to make their own decisions about whether they come together, how they do so and what they do to form the combined authority. It is a relatively simple and easy arrangement in constitutional terms.

The difficulty for some other areas is that the constitutional arrangements are slightly different. Obviously, I am now going to refer to my own area. Sheffield contains the four districts which used to form the old South Yorkshire metropolitan county, and which have worked together to varying degrees, and with varying degrees of success, since the counties were abolished. They came together to form what is now the Sheffield combined authority.

To an extent, the same applies to Leeds, which contains five districts that used to be the West Yorkshire metropolitan county, and which have been working together as a combined authority. There are, however, some differences, which have been recognised at various times by parties on both sides of the House. Sheffield contains not merely the four districts of south Yorkshire, but five other districts which form part of either Derbyshire county or Nottinghamshire county: Derbyshire Dales, Chesterfield, North East Derbyshire, Bolsover and Bassetlaw. They are not part of the old South Yorkshire county, but they are very much part of the local economy of the Sheffield city region—the travel-to-work area.

That has been recognised in a number of ways, and I remember when it was first recognised. I went to the first meeting between the leaders of those nine councils, which took place at Meadowhall shopping centre, and which had been called by David Miliband when he was number two in his Department. I am not sure which Department it was, but it was probably the Office of the Deputy Prime Minister. I expected a reaction from the districts outside south Yorkshire—I expected them to think that Sheffield Big Brother was going to take them over—but the leader of Bolsover district council said, “Actually, it is quite good that we are involved in this.” He said, “I know that not everyone who lives in Bolsover will have a job in Bolsover, and that many people have to travel to work in Sheffield. What happens in Sheffield matters to us, and how people transport themselves from Bolsover to Sheffield matters to us. It is right that we are sitting round the table having discussions and being involved in the decision-making process.” Those were wise words, which have stood the test of time.

The coalition Government adopted a similar approach. When they formed the local enterprise partnerships, they recognised that the historical regional boundaries were not always appropriate. I know that the previous Secretary of State had a thing about regions: people almost had to cross themselves, or put money in the Department’s swear box, if they mentioned them. He was not always right in damning the regional spatial strategies and blaming them for every evil on the planet, but I think he had a point nevertheless, in that the old regions did not necessarily represent local economies and the way in which areas worked in day-to-day life.

The districts of south Yorkshire were in the Yorkshire and Humber region, but the districts in Derbyshire and Nottinghamshire were in the old East Midlands region, and that often did not work because the two regional development authorities did not always speak to each other. That was a fundamental problem for the Sheffield regional economy, which the last Government recognised when it created the LEPs and allowed them to create themselves across the old regional boundaries to reflect the travel-to-work areas and the local sub-regional city region economies.

We now face a challenge. So far, the districts in that position in North Nottinghamshire and North Derbyshire have, to an extent, been able to have it both ways. They can continue as districts, as part of the two counties, but they can also be non-constituent parts of the combined authority in Sheffield. Ultimately, however, the districts will have to make some sort of choice.

We are to have an elected mayor in the Sheffield city region. We have had discussions and arguments about that, but it is going to happen. Should the people of Chesterfield, Worksop or any other parts of those districts be able to vote for the mayor in Sheffield, who will be in charge of transport in that area, or should they not be able to vote for the mayor, who will then cover only part of the travel-to-work area with his or her transport responsibilities? That strikes me as illogical, because it will not bring about a combined authority that really covers the city region and the travel-to-work area.

Is it possible that the people of Chesterfield will not have a vote for the mayor because Chesterfield will not become part of the Sheffield city region combined authority—although, under the proposals, the mayor will be involved in discussions and decision making about economic development matters that affect Chesterfield, even if it is only a non-constituent part of the combined authority? I do not think it reasonable for an individual who has not been not elected by the people of Chesterfield to have a say in what happens there.

What the amendment does is ensure that the districts of North Derbyshire and North Nottinghamshire will be able to make their own decision about the long-term position—about where they think they fit and where their future lies—without the county councils’ having a veto. Like my hon. Friend the Member for Nottingham North (Mr Allen), I hope that that will done by means of consensus and discussion. No one wants Chesterfield to feel that it is no longer part of Derbyshire county or Bassetlaw to feel that it is not part of Nottinghamshire county, for many other purposes.

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman is advancing a powerful argument. He is absolutely right about consensus. He is also right about the fact that businesses do not recognise local authority boundaries. Surely, when we talk about devolution, we must talk about it on the basis of economic rather than political areas, but there is a danger of our being sucked into those political areas.

[Mr Betts]

I entirely agree. In the end, of course, a district council as a whole will have to go to an area, but, as the hon. Gentleman says, the focus should be on what works for the economy in terms of job creation, growth and the development of skills, and on ensuring that the necessary transport links exist.

I hope that the Minister will clarify one important point. There may ultimately be a decision for the Secretary of State or the Minister to make on these matters. The districts in North Derbyshire and North Nottinghamshire, or some of them, may well decide to become part of the Sheffield city region—I hope that they will, because I think that it makes economic sense—but it is nevertheless possible that Derbyshire and Nottinghamshire will form another combined authority, an N2D2, and that there will then be a conflict between the two decisions.

I understand from the amendment that it will be up to the Secretary of State to decide which combined authority the districts should join, because they cannot join two; the people in those areas cannot have a vote for two elected mayors in different combined authorities. I hope when he decides that he will indicate that his key criterion will be what is right for the local economy—that point was made by the hon. Member for York Outer (Julian Sturdy)—and right for developing skills, for economic growth, and for the development of a proper transport strategy for those areas.

[James Wharton]

I absolutely hear what the hon. Gentleman says. We must do what is right. If devolution is to be successful, it must recognise the boundaries that are, as my hon. Friend the Member for York Outer pointed out, more than political: the economic boundaries and the community boundaries. We must take account of what local people want. I am sure that, in exercising whatever powers he has when discussions on the Bill have concluded, the Secretary of State will first seek to build that consensus, as he has throughout the devolution discussions, but will then seek to ensure that the deals that are done will stand the test of time.

[Mr Betts]

Standing the test of time is about what works economically and what works for growth, because that is the purpose of devolution in the first place.

[Nigel Mills (Amber Valley) (Con)]

I think I agree with the main thrust of the hon. Gentleman’s argument, but we might well grant the elected mayors powers to replace the police and crime commissioners, and if, for example, Chesterfield chose to join Sheffield rather than Derbyshire, the people would presumably lose the right to vote for the person who holds their police force to account. I am not sure that, in those circumstances, the Secretary of State could make his decision solely on the basis of economic powers.

[Mr Betts]

That is an added complication. At present, three separate police and crime commissioners cover the Sheffield city region: one for south Yorkshire, one for Derbyshire and one for Nottinghamshire. Those issues might be considered at some point way down the line, but the leaders of the Sheffield combined authority have— sensibly, in my view—decided not to incorporate the police and crime commissioners’ powers in their devolution deal, probably because that would lead to exactly the sort of further complications to which the hon. Gentleman has referred. They have confined their deal to economic, transport, skills and growth issues, which are precisely the issues to which the Secretary of State will have to give particular consideration if there is a decision to be made about which combined authority the districts are to go into.

[Graham Stringer (Blackley and Broughton) (Lab)]

I am sure my hon. Friend agrees that we live in an extremely complicated country both culturally and economically, and one of the things that has bedevilled attempts to devolve powers to local authorities has been searching for the perfect boundaries. The perfect boundaries do not exist. Does my hon. Friend agree that it is better to devolve than to spend for ever looking for those perfect boundaries?

[Mr Betts]

Absolutely, and therefore I support the principles of the Bill, but having said that, and while agreeing with my hon. Friend, if we can do something to improve the devolution process, which this amendment does, we should be looking to do that as well. I want devolution to happen, but I want it to work. There is a danger in the Sheffield city region proposals that, without those North Derbyshire and North Nottinghamshire districts, and without a true reflection of the whole travel-to-work area, the devolution will not be as economically successful.

I accept in the end that it is a matter of consensus, however. This amendment allows those districts to express their own view about where they think their economic future lies without pulling out of the county for all other services. It allows devolution to go forward without a veto from the county over the particular issues of economic devolution and transport powers. It makes a lot more sense for the Sheffield city region. It also offers the same opportunities for the same way forward for the West Yorkshire combined authority and probably for the west midlands as well.

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I shall be brief. I am pleased to follow the Chair of the Select Committee, not least because I thought one of his closing lines summed up our objective here this afternoon: we want devolution to happen, but we want it to work. I want to speak to new clause 8 and amendment 57 in my name and also touch on amendment 2 in the name of my hon. Friend the Member for Hazel Grove (William Wragg), all of which share exactly that objective.

Dealing with the question of consent and the referendum contained in amendment 2, it seems to me that if this process is to work it is essential that it should have the consent of the people who are going to be governed under these new structures. If the argument can be made for the new structures and new form of governance, the Government ought to have the self-confidence to give people a direct say on the changes that are about to be introduced. From a Greater Manchester perspective, I think it is entirely possible that the Government could put a case that would persuade people that the new arrangements should be approved in a referendum, but the very act of withholding that opportunity for them to express their will and to show real consent for what is being done in itself sows the seeds of difficulty and discord and makes it less likely that the new arrangements will work.

--- Later in debate ---

[Mr Betts]

I am trying to work out what the hon. Gentleman is trying to achieve by this amendment. Is he just probing the Government? They have made it clear that devolution deals, as negotiated, will go ahead only with an elected mayor. Is he working on the assumption that if the population turn down an elected mayor in a referendum, the whole devolution deal for that area will fall?

[William Wragg]

I thank the hon. Gentleman for his intervention. My amendment seeks not to ensure that such devolution deals fail, but that the mayor is not a prerequisite of such a deal. I am at variance with the Government on this issue and I would like my amendment to be included in the Bill.

--- Later in debate ---

[Mr Betts]

I said on Second Reading that I supported the general principles of the Bill and its underlying intentions—and I still do. I have reservations about the pace and the extent of the change—I would like to go faster and further—and about certain details such as elected mayors and their imposition. I think imposition is the right word, despite Ministers’ denials. Nevertheless, the Bill is important for its symbolism and its direction of travel. On that direction, when I was first elected in 1992 I never thought I would see this happening in this House of Commons. What we have here is a revelation by comparison with where thinking was in those days.

I thank the Secretary of State and Ministers for the way in which they have dealt with the debate in Committee and on Report. They have listened to the constructive comments made on both sides. Equally, I would like to place on record my thanks to local government leaders, particularly those on the Labour side who control most of the major cities. The reality is, as I am sure Ministers recognise, that while those leaders’ budgets are being cut to shreds by the Government, they are still prepared to sit down and work pragmatically with the very same Ministers to negotiate deals on devolution that will be to the benefit of the communities they represent. That says an awful lot for council leaders, and the way in which they have approached the offer that the Government have made to them.

I thank the Secretary of State and Ministers for recognising the concerns that I raised and tabling amendment 27. I shall not go into the details of the Sheffield city region again, but I think that the amendment demonstrates Ministers’ understanding of a wider issue. If more growth, better economic performance and new jobs are to result from these deals, the bodies that we are creating must reflect the real economies of their areas rather than having regard to the old administrative boundaries of regions that existed for many years but did not necessarily reflect those local economies. The fact that Ministers were prepared to recognise that, and to help with the construction of bodies that will indeed reflect the economies of their areas, demonstrates a very important principle.

I think that, at some point, we shall have to return to the House and discuss what we have achieved with devolution, and I think that we shall have to discuss three issues. First, we shall have to discuss the deals that have been agreed, how successful they have been, and what lessons can be learned. Deals in one area can throw up either problems or successes from which other areas will want to learn. We shall need to subject the deals to scrutiny, on the Floor of the House or in the Select Committee, to establish how well they have worked in practice, whether they have achieved the success that we wanted them to achieve, and whether such success can be extended to other areas.

Secondly, I think that the House will want to examine the performance of different Departments—and I noted the Secretary of State’s reference to his previous reports on performance. I suspect that there is still more enthusiasm in some parts of the Government than in others for the whole devolution idea. I am sure that the Secretary of State could not possibly say anything, but he knows exactly what the realities are from his experience of negotiating with his colleagues.

Finally, I think that after, say, two years of the workings of what are rightly disparate deals that reflect the particular needs of particular areas—for that is what the construction of these deals is all about—we shall want to examine the overall constitutional position of central and local government. We shall want to think about what the next stage should be, and about whether general principles that we have learnt from the deals need to be applied more widely. I am thinking particularly of fiscal devolution. If Members look at any of the local government systems in western Europe, they will find that those local authorities have the power not just to spend money that central Governments give them, but much greater power to raise their own revenues. I recognise that the Government have taken an initial step forward with the full localisation of business rates. We shall obviously want to scrutinise the way in which that is done, but I hope that it is merely the first stage of fiscal devolution, as well as the spending devolution with which this Bill is mainly concerned.

Cities and Local Government Devolution [Lords] Bill

Clive Betts Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

I will of course give the hon. Gentleman that undertaking, and I shall listen carefully to what he says later. I know that he has a great deal of expertise in this area, and I recognise some of his concerns. It is important that we find the right mechanism to address them as best we can in the Bill.

Amendment 59 and new clauses 23 and 25 have been tabled by the shadow Secretary of State, the hon. Member for Hemsworth (Jon Trickett), and his colleagues. Amendment 59 would require a report reviewing the Localism Act 2011. New clause 23 would require the Government to publish a report about the impact on combined authorities of the way in which resources had been distributed through the local government settlement. New clause 25 would require the Government to publish a list of the public authority functions which may be transferred.

We do not consider amendment 59 to be necessary. The Government are committed to a process of post-legislative scrutiny to review the effectiveness of legislation and to inform the development of future legislation. The lead Department submits a report to the Select Committee, usually within three to five years of the legislation receiving Royal Assent, with its preliminary assessment of how the Act has worked in practice in relation to its objectives and benchmarks, as identified during the passage of the Bill. This would inform the Select Committee’s view on whether to conduct a fuller post-legislative inquiry into the Act. The additional steps proposed in amendment 59 are therefore unnecessary.

[Mr Clive Betts (Sheffield South East) (Lab)]

When the Localism Act was passed, the Secretary of State for Communities and Local Government, the right hon. Member for Tunbridge Wells (Greg Clark)—in a previous guise—produced an annual report on how each Department was doing in regard to devolution. Unfortunately, that practice was stopped, but the right hon. Gentleman came to the Select Committee and argued strongly that it should be continued. Does the Minister think his boss has changed his mind?

[James Wharton]

The hon. Gentleman shares my admiration for my Secretary of State and for the work that he has done in this area of policy over an extended period. It is of course open to my right hon. Friend to do that again, and I suspect that the hon. Gentleman will wish to prevail upon him and to repeat his argument on the value of considering that course of action. However, I do not think it necessary to include amendment 59 in the Bill.

We also consider new clause 23 to be unnecessary. It would not add anything to the information we already provide. By separating Government funding from the other sources of income available to local authorities, as the new clause proposes, and by isolating deprivation from other drivers of spend—for example, the impact of population sparsity in rural areas—the report required by the new clause would fail to present a properly rounded picture of the settlement. As hon. Members know, we already publish an annual assessment of the impact of the settlement on authorities’ wider spending power and an equalities statement on the settlement’s effect. Moreover, the settlement is subject to wide-ranging consultation and comes before Parliament for approval. I am not persuaded that anything further of this nature is needed in the Bill.

On new clause 25, I remind hon. Members that this Government’s devolution policy is a bottom-up one. We want to ensure that devolution opportunities are available to all parts of England, including rural and coastal areas, counties, towns and cities. On Second Reading, we discussed at some length the devolution deal that has been done with Cornwall, a non-city area that wants to be part of this process and that has got behind a plan that it believes can drive real change for the better. The enthusiasm from hon. Members from Cornwall who spoke in that debate was obvious and is commendable.

--- Later in debate ---

[Mr Betts]

The Minister has just said that the Sheffield deal could be put at risk, but at this stage it is not a done deal—it is a proposal. If Sheffield were to say, “We actually rather like the proposal, but without the mayor,” what would be wrong with that, as the Bill stands?

[James Wharton]

The hon. Gentleman might recognise that that would then not be the agreement that has been proposed. Where there is devolution on the ambition and scale of Greater Manchester, we could not ensure that the strong, clear accountability necessary to support such devolution and provide the leadership to drive forward that area’s economy would be in place without a metro mayor. That strong, clear accountability needs to be a single point of accountability that only an elected metro mayor can provide. Where major powers and budgets have been devolved, people need to know who is responsible for decisions that can have a radical impact on their day-to-day lives. Mayoral governance for cities is a proven model that works around the world—it is indeed the model of governance for world-class cities. None of that is to say that we are imposing mayors; mayors are not being imposed anywhere. If any area has a mayor, it will be because that area, through its democratically elected representatives, has chosen to have one. The Bill specifically provides for that.

[Mr Betts]

The Minister is making the case that a mayor is required in order to have strong enough leadership and get things through, but in the proposed Sheffield deal only the transport functions go to the mayor—all the economic functions go to the combined authority. Is he therefore saying that there is not going to be strong leadership on these economic functions, because a mayor is not in charge of them?

[James Wharton]

Let me be absolutely clear about this: this Bill does not allow this Government or any future Government to impose mayors on anybody. But where we make a deal it is a two-way process, and it is the Government’s clearly stated intention for those metropolitan areas that the accountability a mayor brings is desirable and we want to see it as part of those deals.

--- Later in debate ---

[James Wharton]

The hon. Gentleman makes a salient and important point. The Government will not support the amendment for that very reason, but I will listen carefully to the speeches that are made because it is important that we address concerns to the fullest extent to which we are able without attracting from the intention of the Bill and the intention of the Government to deliver on our agenda.

Clause 3 provides flexibility to enable a single local authority to leave, in line with the comments that the hon. Gentleman has just made, if it does not wish to continue to be part of a combined authority. A council can also leave a combined authority once a mayor has been elected for the area of a combined authority without the need for the combined authority to be dissolved and reformed, using exactly the same process as is used to establish such an authority of undertaking a governance review demonstrating that the change would improve the exercise of functions. In addition, a council that wishes to leave a combined authority can do so if it obtains consent from the other constituent councils of the combined authority, and if there is one, the mayor. Again, I will listen carefully to the comments of hon. Members with a view to finding a position that can get broad agreement across the House as the Bill makes progress.

Amendment 39 is tabled by my hon. Friend the Member for Amber Valley (Nigel Mills). It applies to circumstances in which a combined authority is proposed and seeks to require that no order can be made for a combined authority unless local government electors have been consulted on replacing the existing county councils and district councils with unitary authorities. That moves away from the flexibility we want to be to deliver and puts conditions on deals that we might want to make but that we do not necessarily want to impose. Again, I will listen very carefully to my hon. Friend’s comments later on in today’s discussions.

[Mr Betts]

Will the Minister also listen to the problem in the districts in north Nottinghamshire and north Derbyshire? They are part of the Sheffield city region for economic purposes under the proposed deal but not for transport purposes, because in order to come under the mayor’s jurisdiction they need the permission of the county. Equally, the districts have to give their permission to join a county combined authority. This is a really complicated situation that needs resolution with Government help.

[James Wharton]

We will consider both the specific situation that the hon. Gentleman raises and more generally its application to our policy direction. I will listen carefully to the comments made in the rest of today’s debate.

Amendment 18 to 22, 27 and 28 are technical and simply provide that where the Secretary of State has powers in relation to electoral matters, those powers may also be exercised by the Chancellor of the Duchy of Lancaster. The provisions are similar to those in other legislation regarding local electoral matters, such as the election of mayors under the Local Government Act 2000, and ensure that the rules made on the election conduct of elections are consistent over wider electoral landscape. I hope that the explanation I have been to give in the time available adequately and sufficiently explains the Government’s position. I reiterate our commitment to listen to the comments of hon. Members and to build as broad a consensus as we can.

[Mr Betts]

I want to make a very few points, because I know that other Members want to speak, particularly my hon. Friend the Member for Nottingham North (Mr Allen), who has tabled a number of amendments and has a long track record of constructive engagement in matters of constitutional reform and devolution of which I am very supportive. He did excellent work on that in the last Parliament.

My first point is about the question of elected mayors and takes me back to the point I made on Second Reading. If the Government are committed to considering bespoke arrangements on devolution for particular parts of our country and considering requests from combined authorities—groups of authorities voluntarily coming together and proposing what they want to see devolved—why do we need one element of imposition in all this? Why do we need one element that says that they can have the powers they come up with providing that agreement is reached but that they must exercise them in a particular way and that there is no ability to discuss that or come to a different view? I find it completely inconsistent with the rest of the Government’s approach.

I do not know why the Government are so insistent on having a mayor as a solution. If it was left to the combined authorities, they would come up with different arrangements. The arrangement in Sheffield has been negotiated not because the combined authorities wanted it but because they were told that they had to have it or else they could not have devolution. That is the situation.

[Mr Graham Brady]

I absolutely agree with the thrust of the hon. Gentleman’s remarks. Does he share my view that the element of imposition in the proposals means that there is a danger that the devolution proposals put in place will enjoy lower levels of support than they otherwise might if communities had been properly consulted and allowed to choose their own models of governance?

[Mr Betts]

The right hon. Gentleman is absolutely right. Of course, the whole principle of the devolution that the Government propose, which I support, is that areas should come forward with their own ideas about what they want to see devolved. Why should they not also come forward with their own ideas about how that devolution should be exercised and about the governance arrangements for it?

[Mr Kevan Jones]

I agree with my hon. Friend, but it is obvious why the Government want mayors. In certain areas—in his area and in others—they are hoping to break up the powers of locally elected Labour local authorities in the hope that if they have an elected mayor, they will either get an independent or someone who claims to be independent but is actually a member of the Conservative party.

[Mr Betts]

I would not want to second guess the motives of the Secretary of State, so I will use my own arguments to resist what the Government are trying to do.

Apart from the inconsistency of approach, the proposals are confusing. That takes me back to the point I made in my intervention on the Minister. In the Sheffield city region the economic powers, which are important and cover skills, economic development and the infrastructure associated with it, are to be devolved to the combined authority, which will cover nine districts—four metropolitan and five non-metropolitan districts. But as I understand it from the deal, the mayor will have responsibility for just transport. So the mayor is to run transport, and the combined authority is to run economic development. The public want some consistency of approach on these matters. I do not believe that the combined authority, the district, would naturally have come forward with a proposal that broke up the responsibilities in this way.

[Andrew Gwynne]

My hon. Friend is making a powerful case. The difference between his deal and the Greater Manchester deal is that the Greater Manchester deal is within a single metropolitan county, so functions such as police and eventually fire and rescue can also be devolved to the Mayor’s office.

[Mr Betts]

There is a big difference in the Manchester case. I am not arguing that Manchester should have a mayor imposed on it. If Manchester wants that, that is a matter for it, but it is different. In Sheffield we have hybrid devolution, with transport going to the mayor, but the mayor is not going to cover the nine districts. The mayor will cover only four districts—the old south Yorkshire districts—so how are people to understand the devolution deal, which has one set of governance arrangements for economic powers and skills, and another set of governance arrangements for transport, where one set of governance arrangements covers four authorities, whereas the other set covers nine?

The whole purpose of combined authorities is to bring local authorities together on a voluntary basis to cover a travel to work area—the natural economic entity—yet transport, the mayor and the associated powers will not cover the whole travel to work area of Sheffield. This is a real dog’s dinner. It is not going to work, and it is certainly not going to be understood by the public.

That leads me on to my second point. There is a problem with mayoral imposition, which in Sheffield’s case will not cover all five areas. Other districts can choose to join the arrangements for mayors if they wish. My understanding—I may be wrong—is that the districts of north Derbyshire and north Nottinghamshire, which are part of the Sheffield city region, are going to join the combined authority, which they are part of, for the economic powers. However, for transport powers to be devolved to those areas through a mayor, those districts will not merely have to agree, but they will have to get the county, which is the transport authority, or two counties, to agree as well. Does the county have a veto over what happens to devolution in the Sheffield city region?

This is not workable. At the same time as the Sheffield city region has a mayoral possibility, Derbyshire and Nottinghamshire are looking at having a joint combined authority, which would have a mayor as well. As I understand it, the mayor can exist for the districts of north Derbyshire and north Nottinghamshire only if those districts agree to the county mayor for Derbyshire and Nottinghamshire being created. So they have a veto over that. At some stage, surely, Ministers have to take some responsibility for coming forward with proposals to sort out this mess, or it will stop devolution working effectively in these areas.

[David Rutley (Macclesfield) (Con)]

As the hon. Member for Macclesfield on the other side of the Pennines, I understand the hon. Gentleman’s concerns and enjoy working with him on the all-party parliamentary group on national parks. Does he agree that one of the fundamental points of having a mayor is to achieve clear accountability? The lesson from London is that probably the greatest accountability the Mayor has is for transport. At a local level, surely much of the work needs to be done to bring the partnerships together. It cannot all be imposed by the Minister. It has to be about dialogue, which may sometimes be uncomfortable, at a local level as well.

[Mr Betts]

I understand that argument, and it would be a lot easier to accept it from the Government if there was clear accountability and a clear understanding of what was happening, and if I had not just had to explain the situation in Sheffield city region, which has neither clarity nor accountability. Transport arrangements are to be devolved to a mayor who does not cover the whole travel to work area. That is not clarity or consistency, and it will not work.

Big issues are involved. I see the hon. Member for Carlisle (John Stevenson) in his place. We had discussions in the Select Committee, of which he was a valuable member in the previous Parliament, and I know he has clear views about moving towards unitaries if we are to have a combined authority that works. Otherwise we will have districts, counties and combined authorities, as well as parishes in some areas. I am not sure that that amounts to easy-to-understand government. The hon. Member for Amber Valley (Nigel Mills) has raised some interesting issues. I am not sure about his solution, but there is a problem, for which Ministers have to accept some responsibility.

I realise that others wish to speak. On the amendment tabled by my hon. Friend the Member for Nottingham North, I hope the Government will listen to the idea of some sort of independent body to look at these issues. That was discussed by our Select Committee last time. If there is genuine disagreement between central Government and local government, an independent body could bring the two sides together and produce a report for Parliament to consider. In the end it is not just about Government agreeing these deals; it is about Parliament taking a view where there is disagreement. Even if Ministers are not minded to accept the amendment today, it is an interesting idea to which they might give some thought.

Finally, we cannot legislate for double devolution because in the end, devolution has to allow areas to do things their own way, but there is a role for Ministers, parliamentarians and the LGA to get the message across that devolution does not stop at the town hall door. Where powers are devolved to local authorities, it is for them to move those powers into communities and to engage with communities in a positive way to make devolution happen even further down the line.

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[John Stevenson]

I do not feel that a referendum would be necessary, because the councillors on the various councils are the elected representatives of the people. My concern is that one authority might dig its heels in and prevent change that is in the beneficial interests of the rest of the council and all the other districts, particularly given that sacrifices will be made by those districts and the county council.

I ask the Minister to give serious consideration to what I consider to be a modest and sensible amendment. I look forward to him accepting it on Report.

[Mr Betts]

I agree with what my hon. Friend the Member for Nottingham North (Mr Allen) said about the need for a wider constitutional settlement. That was apposite, and at some point we will have to address those issues. I agree with his points about subsidiarity and taking that below the level of an individual local authority, and about encouraging the process down.

Fiscal devolution is a challenge, and Members have reflected different perspectives from different parts of the country. It is a challenge, but not one that we should duck. I am Chair of the Communities and Local Government Committee, on which the hon. Member for Carlisle (John Stevenson) sat in the previous Parliament. He made important and valuable contributions to our report. We found a way to take on board proposals from the London Finance Commission about the wider devolution of property taxes, while recognising the need to protect areas that will perhaps struggle to raise business rates and other property taxes easily, or to get back money from areas that simply watch property prices rise and receive enormous windfalls. We must have balance in the system.

The Committee has begun an inquiry into the workings of devolution and the Bill, but since then the Chancellor has made his announcement about the full localisation of business rates. The Committee will want to come back and look at how that will be done. I think most Members would support the principle behind such a move, but how will we implement it to ensure protection for poorer areas? How will we devolve more powers to local government to take account of the extra money made available as part of that process?

[Andrew Gwynne]

My hon. Friend is right to say that the Select Committee must consider business rates retention in detail. One possible solution for devolved city regions might be the pooling and sharing of business rates. For example, parts of Greater Manchester are key drivers of economic growth, and that wealth should be spread across the whole conurbation for the benefit of all.

[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

[Mr Gareth Thomas]

My hon. Friend’s point about poorer areas and the full devolution of business rates is apposite. Is the Chancellor’s suggestion to axe completely the revenue support grant for local authorities—that was in the same speech as plans for the full devolution of business rates—likely to have a dramatic impact on increasing inequality of income between areas? Will my hon. Friend’s Committee be considering that?

[Mr Betts]

We will certainly want to consider that issue. From reading what has been said, and the written statement that was presented to the House on the first day back after the recess, there does not seem to be a commitment simply to leave the amount of business rates collected in an area with that local authority. Instead there was a move to allow the full retention of the growth of business rates, and then a decision about what to do with the rest. I think that is the position, but Ministers will have to explain it further in due course. I am sure that the Committee will want to explore that.

The Minister and I have slightly different views about whether elected mayors should be a requirement for full devolution, but the Minister won the vote and that measure is back in the Bill. I am still concerned to have a level playing field, however, and I am surprised about one element in the Bill that Ministers have not sought to explain. Amendment 60 would delete from clause 5(1)(7) words that would devolve to a mayor who is exercising powers independently, any powers that are

“similar to any power exercisable by the mayoral combined authority…but the power conferred on the mayor may not include a power to borrow money.”

When a combined authority is set up, it can have the power to borrow money. In the Sheffield city region, the combined authority has to borrow money for the functions of economic development, skills and matters devolved to it. The mayor will effectively become the transport authority and exercise transport functions. In exercising those functions, however, the mayor will not be able to borrow money. Somebody else will have to do that if, for example, a new tram system is going to be developed. The mayor will have to go to somebody else and say, “Will you borrow money for me?”

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It is essential that we have the choice and that we do not get bundled into something, either deliberately or accidentally, that does not work for us. I do not think that that is the Government’s aim—

[Mr Betts]

My hon. Friend is reiterating the point that I was making earlier, and I entirely agree with him. Although Bassetlaw could not be forced into D2N2, could it not be prevented from joining the Sheffield city region as a full member? In other words, it could be left in limbo.

[John Mann]

I suppose Bassetlaw would have the option of declaring itself a unitary authority, of getting approval for that and of joining Sheffield city region. There may be routes around it, but the principle is fundamental. We need to have the ability to choose. If those two choices were put to the electorate, I suspect that I know which they would choose, and probably decisively. They may have a different view to me, but that is their prerogative—we have a word for that: democracy. What we do not want is “undemocracy”. Some people are very hostile to what the Government are doing and some are much more sympathetic. Either way, will these two options—is it the D2N2 model—lead to more councillors?

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[James Wharton]

I thank my hon. Friend and note that flattery can get you a long way in this business.

The hon. Member for Harrow West (Mr Thomas) tabled new clause 10, which would provide for the devolution of the Secretary of State’s housing powers to the Mayor of London. Since 2012, the Mayor of London has had overall responsibility for housing policy and delivery in London, taking over from the Homes and Communities Agency. The Mayor has powers to set strategic housing and regeneration policy through the London housing strategy. The Secretary of State has a legitimate role in relation to housing across England and it would be inappropriate to remove that role.

The amendment would weaken the Mayor’s role by requiring the Assembly’s consent. That fundamentally misinterprets the role of the London Assembly, which is a scrutiny not an Executive body. I recognise the hon. Gentleman’s desire to pursue the issue and to put it on the record. I am sure he will want it to be considered further as matters progress and that this is not the last time it will be discussed on the Floor of the House.

A significant number of other amendments relate to finance. Government amendment 9 provides greater flexibility in funding the functions to be devolved. Orders under the Local Democracy, Economic Development and Construction Act 2009 enable a combined authority to levy for transport purposes, and the constituent councils to make financial contributions to that combined authority to fund economic development and regeneration functions. The amendment provides flexibility to enable the constituent councils, if they so wish, to make financial contributions for any function of the combined authority, not just economic development and regeneration.

Opposition amendment 58—which the shadow Minister, the hon. Member for Croydon North (Mr Reed), has said he wishes to pursue further this evening—proposes that the Secretary of State be allowed the power to allow combined authorities to set multi-year finance settlements. For a combined authority to set multi-year budgets, it requires not a power from central Government, but the certainty of knowing what funding it is to get. The deals we have agreed with Greater Manchester and the Sheffield city region show how funding across the years can be agreed. We do not, though, need powers to put in place multi-year settlements for local authorities. We can already do that administratively as part of the wider local government finance settlement.

Amendment 60, tabled by the hon. Member for Sheffield South East (Mr Betts), would delete from clause 5 the exclusion of borrowing powers from the ancillary powers that can be given to a combined authority mayor. I listened very carefully to his contribution and understand his concerns. We agree that in appropriate cases there should be prudential borrowing for funding investment for which the mayor is responsible. The Bill provides for that, and the exclusion that the amendment seeks to remove is not about prohibiting such prudential borrowing.

Clause 10 makes provision for funding combined authorities and, in particular, provides that the Secretary of State may make regulations specifying the functions for which there can be borrowing. The Bill explicitly provides that those functions can include mayoral functions and that the constituent councils must consent to any regulations allowing borrowing.

I assure the hon. Gentleman that there are indeed borrowing powers for mayoral functions. In addition to devolving powers to a mayor, the Bill also allows ancillary powers to be conferred on a mayor to allow him or her to exercise the devolved powers. These ancillary powers could be those needed to ensure that there are no doubts about a mayor being able to run an office or to commission necessary studies, or they could include giving the mayor a general power of competence.

The exclusion, which the amendment seeks to remove, is to make it clear that those ancillary powers cannot include a power to borrow. They cannot be a back door to borrowing. The Bill sets up a proper regime for borrowing to fund mayoral powers, and that should be the route for a mayor being able to borrow.

[Mr Betts]

These are complicated issues and I am not totally sure that I followed all that, and I do not know whether anyone else did, either. The Minister seemed to be reading out a brief from civil servants. Could he provide a note with a thorough explanation of the issue? None of us wants to end up with mayors who need to create transport systems but then find that they do not have the powers to borrow in order to do so.

[James Wharton]

In line with my desire to retain my reputation as a benign velvet glove, I have already written a note to my officials asking that we write to Members following this debate, to ensure that we fully clarify those matters. I will, of course, write to the hon. Gentleman, and if he has any concerns, I would be delighted to discuss them further with him.

Amendment 55, tabled by the hon. Member for Nottingham North, would enable control over decisions on business rates and council tax discounts to be devolved, if that is what is wanted locally. We have always said that we are interested in hearing proposals from authorities and that nothing is off the table for conversation. The Government have signalled their intentions and enabled a large degree of the sorts of financial flexibilities sought by the amendment. We recently announced that, by the end of this Parliament, local government will be able to retain 100% of its business rates. Through the existing powers that govern the business rates retention scheme, we can already give mayoral combined authorities their own share of local rates income and ensure that they benefit from the local growth that that will help to establish. Of course, any decision to make use of the existing powers to extend the rates retention scheme would be taken alongside that on any wider transfer of powers and functions to mayoral combined authorities.

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[Alistair Burt]

I think this is the first time that I have served under your chairmanship, Mrs Main, and I am honoured to do so. Thank you for inviting me to speak this afternoon. As a former Member of Parliament for Bury North—a constituent part of the Greater Manchester devolution process—and a former sponsor Minister for the cities of Manchester, Salford, Wigan, Bolton and Blackburn, I am pleased to take part in this debate which has acute relevance to that part of the world.

May I too put on record my sadness at the loss of Michael Meacher? As a friend and colleague in the north-west for many years he performed great service for Oldham, and was a good colleague to his friends on all sides in the north-west. He will be much missed, and I am sure that the Committee sends its condolences to his family and all who mourn him.

Clause 19 contains valuable safeguards that will apply to the local devolution of health functions. It was inserted in the Bill by an amendment tabled by Lord Warner in another place. Amendments 32 to 38 will provide further definition and clarity, without altering the spirit or substance of the clause. Lord Warner has confirmed that he is supportive of these further amendments.

Clause 19 provides that regulations under clause 17, or an order under section 115A of the Local Democracy, Economic Development and Construction Act 2009, must not transfer any of the Secretary of State’s core duties in relation to the health service as set out in the National Health Service Act 2006 and the NHS constitution. It makes it clear that whatever devolution arrangements might be agreed with a particular area, the Secretary of State will remain bound by the key duties placed on him in respect of the health service.

Amendment 38 provides further clarity by listing the duties of the Secretary of State that may not be transferred, in so far as they are capable of such a transfer. First and foremost, section 1 of the 2006 Act provides for the Secretary of State to retain responsibility to Parliament for the provision of the health service in England. Others are overarching duties on quality, reducing health inequalities, research, education and training, and on the NHS constitution. They also include Secretary of State’s role under the Health Act 2009 in revising and publishing the NHS constitution, his role under the 2006 Act in setting strategic direction for the NHS in the mandate to NHS England, and his role in overseeing and reporting to Parliament on the health service generally, and in particular on NHS England’s performance.

In essence, although health service functions are capable of being devolved to local authorities and to groupings of local authorities, the main responsibility and overriding duty of the Secretary of State for the NHS is not affected by these arrangements and he remains accountable for them.

[Mr Betts]

I apologise, but I shall have to go to chair a meeting about black and minority ethnic coaches and managers in football, another issue that I know will be close to the Minister’s heart.

The Minister may be trying to reassure the Committee, but in some ways he is giving me cause for concern. Devolution deals will, in particular, try to link social care and health in a more real way to the benefit of constituents. My concern is that if every line of accountability goes back to the Secretary of State in Whitehall, it will stop local innovation happening. Will not the line of command back to the centre simply stop things happening?

[Alistair Burt]

That is a good question and I hope I can reassure the hon. Gentleman. No, the whole process being considered is to give powers to the various authorities to be, as he said, innovative in what they would like to do. They will have the powers and the responsibilities to do that. The reason the concern was expressed in another place was to make sure that in the process it would not be possible for the NHS to transfer its core duties and therefore have local authorities do things that are contrary to the main constituent parts of the NHS, such as on issues relating to quality and so on. The accountability of the Secretary of State therefore remains. The ultimate accountability he or she has standing here at the Dispatch Box remains, but it would not stop the work and the innovation. As I shall go on to say, the regulatory powers of organisations such as the Care Quality Commission, Monitor and others will also remain in place to ensure that none of the national quality standards we expect from the NHS will be deviated from. There will be different ways of doing things, but ultimately the quality standard remains a national quality standard.

[Mr Betts]

I see what the Minister is trying to achieve, but I just worry about whether it will work like that in practice. Given that we are in very new territory here and that things will be done differently with the delegation of powers to individual authorities as well as to combined authorities, does the Minister agree that it would be a good idea, perhaps two years after the devolution powers have been put in place, to have a thorough review of how they are working and whether there is anything in the Government’s proposals that might actually stop devolution working properly?

[Alistair Burt]

As the hon. Gentleman knows, we can plan to review things at any stage. For devolution to work, the different models that may be put in place, whether big urban city models or more rural models, must of course pass the test of whether they are doing something qualitatively different and better for people. It will certainly be possible and necessary to review that. I think the concern has been to make sure that national standards are not dropped in the process of innovation. That is why the ultimate duty and responsibility of the Secretary of State remain. That was much discussed in another place. The reason for tabling these amendments is to confirm that, under the overall umbrella of wanting greater innovation, national standards will be preserved and cannot be threatened. That is the idea.

Princess Royal University Hospital

Clive Betts Excerpts

Wednesday 25th March 2015 Westminster Hall

[Jane Ellison]

That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.

I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.

[Mr Clive Betts (in the Chair)]

Order. For the last time this Parliament, the sitting stands adjourned.

Question put and agreed to.

A and E and Ambulance Services

Clive Betts Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

It is totally unacceptable for people to create extra pressure on ambulance services when they should not be doing so. One of the encouraging aspects of the better care programme is the fact that we are starting to analyse the ambulance service, the local NHS and the social care system in order to establish where the highest volumes of ambulance calls are coming from and sort out the problem.

[Mr Clive Betts (Sheffield South East) (Lab)]

Two weeks ago, along with other Members of Parliament, I met executives of the Sheffield Teaching Hospitals NHS Foundation Trust, which, as I am sure the Secretary of State agrees, is an outstanding trust that invariably meets its care and financial targets. However, we were told that even that trust was not meeting its A and E targets. Would the Secretary of State care to reflect on the fact that if a trust as good as the Sheffield Teaching Hospitals trust is experiencing those problems now, there is a real prospect of crisis in the NHS this winter?

[Mr Hunt]

I agree that that is an excellent hospital, and I commend the leadership of Sir Andrew Cash, its chief executive. I have been to the hospital myself; it was absolutely spotless, and I was very impressed by what I saw.

The hon. Gentleman is right. What we cannot do, given the pressures faced by the NHS, is start pointing fingers at individual hospitals, because even well-run hospitals are experiencing a high level of pressure. Hospitals tell us that the solution is often not in their own hands. It is a question of the number of people who turn up at the front door and the number of people whom they are able to discharge at the back, and if neither of those problems is sorted out—which will require proper links with the rest of the local NHS—there will be further problems. The system resilience groups that are now working throughout the country are trying to deal with the issue.

NHS Care of Older People

Clive Betts Excerpts

Thursday 27th October 2011 Westminster Hall

[Several hon. Members]

rose—

[Mr Clive Betts (in the Chair)]

Order. There are slightly under two hours before the winding-up speeches start, so if Members take no more than about 10 minutes they should all be called.

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[Andrew George]

The hon. Lady is making a strong case. On the point about whistleblowing, or protected disclosure, her own research may have shown that when a nurse, for example, suggests to senior management that there is a resource problem on a ward, that does not necessarily enhance their likelihood of improving their job prospects in the hospital. Often, they are told, “Other members of staff seem to manage, so why don’t you?” Does the hon. Lady agree that we need to look at how whistleblowing can be done safely?

[Mr Clive Betts (in the Chair)]

Order. A lot of people clearly want to speak, and I do not want to stop or discourage interventions, but if they are made could they be brief and to the point so that we can keep things flowing?

[Barbara Keeley]

It is clear that what I said about culture must apply right through to things such as whistleblowing. It is a sad aspect of this case that none of the people involved with Mr D’s care or with dealing with the complaint could even rescue the situation by handling the complaint reasonably.

I understand, and we must be clear, that this case represents the NHS at its worst, but it did happen, and it happened to my constituent. I have never had a case as bad as this one again, but I have had others that have given me cause for concern, and I am currently pursuing cases with similarly bad aspects on behalf of constituents. Sometimes, however, there are cases where everything goes wrong and all the problems I have mentioned come together.

MPs’ interventions and the intervention of the ombudsman can remedy the injustice of such inadequate treatment to some extent, but we must accept that it is not possible even for such interventions, much though our constituents are grateful for them, to overcome the distress and anguish experienced by families such as my constituents. However, a swift apology would have helped, and we must have a system whereby an apology can be made swiftly, because that never happens.

The ombudsman talked about the need to listen to older people and to take account of feedback from families. One of my conclusions from having looked at this case is that it took many months—in fact, years—to get to the point where the family were anything like happy with the response to their complaint, and that made things worse.

I felt it was important to outline a case I had personal experience of, and there has not been time to touch on much else, but there are many things that could improve this situation. In the briefing for the debate, I was heartened to see a note from the Women’s Royal Voluntary Service describing ward support services it is setting up for older people, which is a wonderful idea. It wants to improve the experience of older people by using trained volunteers to support them and their families and carers. That would include training in dementia, which could be important.

Hospital support for carers is also important. The Princess Royal Trust for Carers has a carers centre in Salford, which the Minister knows, because he has met some of its staff. The centre has developed strong relationships with primary and secondary health care and works closely with Salford Royal hospital, which does excellent work—it is not the hospital I was talking about earlier; that was a different hospital. The centre supports carers in the hospital and on important issues around discharge. How could the discharge I described have happened if people had been there—even volunteers and people from a carers centre—to help the family? Such initiatives can help.

Developing awareness of family carers on hospital wards and giving them support might help to head off, or somehow deal with, dreadful situations such as the one I have described. NHS care is important, but it is important that we understand that it does not end when a person leaves hospital, particularly if they are terminal patients going home to die.

I hope the debate contributes to the improvement of NHS care for older people. As a Member of Parliament, I would never want to see another case like the one I have described.

Breast Cancer Screening (Young Women)

Clive Betts Excerpts

Tuesday 30th November 2010 Westminster Hall

[Grahame M. Morris]

On best practice and targeting available resources, the figures suggest that in some areas, as many as one third of women within the target group aged 50 to 70 do not attend routine screenings. There are various reasons for that. It might have to do with misconceptions about the nature of the screening test. In some urban areas, it might have to do with the fact that there is a large transient population. In my area, where we also have the problem of people failing to turn up for routine appointments, they may be reluctant or poorly educated, or a number of—

[Mr Clive Betts (in the Chair)]

Order. Interventions are meant to be brief.

[Grahame M. Morris]

I apologise. The Minister will see the point that I am trying to make.

Royal Liverpool University Hospital

Clive Betts Excerpts

Wednesday 9th June 2010 Westminster Hall

[Mr Clive Betts (in the Chair)]

Let me explain the protocol to new Members in the Chamber. If a Member wants to intervene, it is up to the Member who is speaking to give way. If a Member wants to speak, they have to get prior permission from the Member whose debate it is and the Minister; I hope that they would let me know as well.