Oral Answers to Questions

Graham Allen Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Speaker]

Order. I shall call the hon. Member for Nottingham North (Graham Allen) if he guarantees that his grey cells will produce a one-sentence, pithy question.

[Mr Graham Allen (Nottingham North) (Lab)]

Will the Minister responsible for dental matters meet me and the hon. Member for Mole Valley (Sir Paul Beresford) to discuss dental ill health in children and how we can change the dentist contract to make it more prevention-friendly? I have got a lot more to say, but I will sit down.

[Mr Speaker]

That was possibly the hon. Gentleman’s greatest inquiry in his membership of the House.

Child Dental Health

Graham Allen Excerpts

Wednesday 3rd February 2016 Commons Chamber

[Sir Paul Beresford]

I wish it were that simple. I personally believe that that would not make one iota of difference after a few months. One need only stand in the supermarket watching the kids pushing the mothers for sweets and the mothers feeding them to realise that, as I say, it will not make one iota of difference unless it is prohibited, in which case we would have other difficulties that I will not go into.

As I have said, the No. 1 reason for children aged five to nine being admitted to hospital in the United Kingdom is dental decay. The NHS spent £30 million on hospital-based extractions for children aged 18 and under in the year 2012-13. That is 900 children a week, who are being admitted primarily for tooth extraction—often under a general anaesthetic, which carries a slight risk in itself.

I am sure that the Minister is aware of the results of the 2013 child dental health survey. For the sake of those who have not read the statistics and who may glance tomorrow at the debate, I will touch on some of the figures. For example, 31% of five-year-olds had obvious decay in their primary teeth. That figure was higher in more deprived areas, where 41% of those eligible for free school meals had decayed primary teeth, in comparison with 29% of other children of the same age. Of five-year-olds who were eligible for free school meals, 21% had severe or extensive tooth decay, compared with only 11% of those who were not eligible.

By the age of 15, 46% of our children have tooth decay. Of the 15 year-olds, 59% of those eligible for free school meals had decay, compared with 43% of other children of the same age; 45% reported that their daily life had been affected by problems with their teeth and their mouth in the previous three months; and 28% reported being embarrassed to smile or laugh because of the condition of their teeth. Those are 15-year-olds, who are suddenly taking notice of the world and hoping to be taken notice of themselves.

[Mr Graham Allen (Nottingham North) (Lab)]

I thank the hon. Gentleman for kindly taking an intervention, as we discussed beforehand; I also obtained the Minister’s permission to intervene. The hon. Gentleman knows more than anyone else in the House about the matter, and he is widely respected for what he does. He knows that I am the chair of a charity in Nottingham North that has three public health ideas, one of which is that every three-year-old should have the free NHS dental check. I am attempting to work with local dentists to make that happen, but without success; believe me, I have tried. Will the hon. Gentleman facilitate for me a meeting with the British Dental Association to discuss the matter? If I may, I will use this opportunity to ask the Minister to see me, at his convenience, to discuss how we can get dentists to help three-year-olds, who are entitled to that check.

[Sir Paul Beresford]

I would be more than happy to do so, because that has to be one the key ways forward. Sadly, the problems are not new, and people are looking at them. One of the areas that I have discovered to be a considerable problem is the dental care of disabled children. I draw the Minister’s attention to a recent report entitled “Open wide”, published by an organisation called Contact a Family. In addition, I know from my local government days that dental care for children in care is exceedingly poor.

The situation is not new; it has gone on for decades. I am not sure whether it is getting worse, but it is certainly not getting any better. I first practised dentistry in this country on the NHS in east London. The state of our child patients’ dental health, compared with that which I left behind in New Zealand, was staggering. Every Thursday, I or the principal of the practice ran general anaesthetic sessions with an anaesthetist. Fortunately, it is forbidden to do so now. Those sessions were packed with patients, predominantly little children, who had to have all or most of their teeth out. It was appalling, but not as appalling as seeing those children in pain when they came in, having had sleepless nights as a result of dental decay.

I will touch on the issue of sweet things. I went to the local supermarket, where there were huge long racks of biscuits, cakes, sweets and sweet drinks. However, the racks of fruit, vegetables and meat were infinitely shorter. Most of the children I dealt with did not have toothbrushes, and most of the parents were unaware that their children had such damaged teeth because of their diet.

Prevention, with progressively increasing reductions to NHS costs, can be achieved. If one realises that the UK population eats about 700 grams of sugar a week—an average of 140 teaspoons of sugar a week—it is obvious that a reduction is a necessity. That intake is not spread evenly; it is higher in the north of the country and lower in the south-east. Teenagers, as we would expect, have the highest intake of all age groups, consuming some 50% more sugar, on average, than is recommended.

The Scottish Government have a recent programme called Childsmile, and more than 90,000 nursery school children currently take part in supervised tooth-brushing. The Scottish Government have also directed the distribution of fluoride toothpaste and toothbrushes in the first year of life at nursery and in the first year of primary school. They are having great success: they reckon that, because of the reduced dental care required, they have managed to save the health service £6 million between 2001 and 2009. Wales has a similar programme with similar benefits. In England, we do not have one.

If I may be so bold, I will suggest to the Minister some possible solutions. We need to invest in a national oral health programme, possibly like the one in Scotland. It should particularly target areas with problems of poor oral health. This should be done in nurseries and schools, with the backing of local authorities, which would need a small amount of funding from the Minister’s Department. It would not be too much of a burden on schools to run a check system to ensure that every child in a primary school has visited the dentist once a year. From what the hon. Member for Nottingham North (Mr Allen) said, dentists will obviously have to be persuaded, if not bullied or forced, into such a system.

Not just dental healthcare professionals, but all healthcare professionals, such as midwives, health visitors and pharmacists, should be given the opportunity and training to apply oral health education, including in relation to persuasion on fluoride. The tax on sugar has been mentioned, but I am sceptical about it. Other ways, such as education, will have to be used. Perhaps—just perhaps—we can persuade the producers of such products to tone down the sugar content.

Far and away the biggest—the proven and most successful—way of reducing tooth decay among children, and ultimately adults, is of course fluoride. Fluoride in toothpastes has made a remarkable change. However, that surface application is nowhere near as effective as the fluoridation of water supplies. With fluoridated water supplies, the fluoride builds up in teeth as they develop. As part of a health professional programme, use of oral fluoride for children should be promoted to parents and children until such time as the water supply in the area in which the children live is fluoridated.

We have very few fluoridated areas in England. The marked difference in the incidence of tooth decay in UK fluoridated areas, compared with those in almost identical neighbouring but non-fluoridated areas, is stark and obvious. In the United Kingdom, approximately 330,000 people have naturally occurring fluoride at the right level in their water supply. In addition, some 5.8 million people in different parts of the country are supplied with fluoridation. That is about 6 million out of a total population of about 64 million, which is about 10%. The percentage of fluoridated water supplies in the United States is 74%, in Canada 44% and in Australia 80%. I believe that the percentage in New Zealand is not far behind that of Australia.

I have just come back from the southern hemisphere, so perhaps I can use New Zealand as an example. Early in the last century, the New Zealand Government set up a programme to train dental nurses, or what in this country we call dental auxiliaries. They provided dental care and oral hygiene instruction for every child in primary school. Those services were provided in clinics within the grounds of the bigger schools. As hon. Members can imagine, every child in the country called such clinics “the murder house”. These young ladies turned around the dental health of the children of New Zealand. They were trained at three schools in the country, and they predominantly provided dental health care by restoring decayed teeth, whether permanent or deciduous. Since 1954, water supplies in New Zealand have increasingly been fluoridated, and I understand that the demand for treatment in schools for such children has diminished dramatically. There is now one school, not three, and the dental nurses spend about 50% of their time on oral education, not on drilling and filling teeth.

In England, the decision to fluoridate the water supply is, in essence, in the hands of elected councillors. However, I believe it is important that the Government, along with the dental profession, apply pressure on local authority wellbeing boards to implement fluoridation. These boards will need support, professional guidance and scientific advice. They will need to be aware that they will be harangued with misinformation and false scientific facts, and that scaremongering will abound.

I will conclude with an example from a debate in this House on fluoride and fluoridation under the last Labour Government. A Welsh MP claimed that fluoridated water induced brittle bone disease. In fact, research has proved that fluoride in the water supply infinitesimally increases the strength of bones. As I pointed out to the Welsh MP, the All Blacks had recently trampled through the fields of Wales and every one of them had almost certainly been brought up in a fluoridated area. The only broken bones were Welsh.

The extent of dental caries among children in England is sad and it is a disgrace. It has been a disgrace for decades. It is preventable and, if we prevent it, we can make considerable savings to our health service and save the pain and suffering of England’s children. Minister, it is in your hands.

--- Later in debate ---

[Alistair Burt]

This is possibly the fourth or fifth invitation that I have received from my hon. Friend to come to see different things in Northern Ireland, and he is right about every one. He finds in me a willing ear, and we will make a visit because there are several different things to see. Where devolved Administrations and the Department can learn from each other, that matters, and I will certainly take up my hon. Friend’s offer.

In older children there are challenges when comparing different countries, because of how the surveys are carried out. The available data still show that we have among the lowest rates of dental decay in Europe, but despite that solid progress we must do more. There is disparity of experience between the majority of children who suffer little or no tooth decay, and the minority who suffer decay that is sometimes considerable and can start in early life. In this House, we know the children who I am talking about—it is a depressingly familiar case. We can picture those children as we speak, as my hon. Friend the Member for Mole Valley described in the sometimes horrific parts of what he told the House. The fact that we know that such decay affects children in particular circumstances makes us weep.

Public Health England’s 2013 dental survey of three-year-olds found that of the children in England whose parents gave consent for their participation in the survey, 12% had already experienced dental decay. On average, those children had three teeth that were decayed, missing or filled. Their primary, or baby, teeth will only have just developed at that age, so it is highly distressing for the child, parents, and dental teams who need to treat them. Dental decay is the top cause of childhood admissions to hospitals in seven to nine-year-olds. In 2013-14, the total number of children admitted to hospital for extraction of decayed teeth in England was 63,196. Of those, 10,001 were nought to four-year-olds, and so would start school with missing teeth.

From April 2016, a new oral health indicator will be published in the NHS outcome framework based on the extraction of teeth in hospital in children aged 10 and under. That indicator will allow us to monitor the level of extractions, with the aim of reducing the number of children who need to be referred for extractions in the medium term. Extractions are a symptom of poor oral health, and the key is to tackle the cause of that. Today I commit that my officials will work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment.

The good news is that the transfer of public health responsibilities to local authorities provides new opportunities for the improvement of children’s oral health. Local authorities are now statutorily obliged to provide or commission oral health promotion programmes to improve the health of the local population, to an extent that they consider appropriate in their areas. In order to support local authorities in exercising those responsibilities, Public Health England published “Local Authorities improving oral health: commissioning better oral health for children” in 2014. That document gives local authorities the latest evidence on what works to improve children’s oral health.

The commitment of the hon. Member for Nottingham North to early intervention and the improvement of children’s chances is noteworthy and well recognised in this House and beyond, and of course he can come to see me. I would be happy to discuss with him what he wants to promote in Nottingham, which sounds just the sort of initiative we need.

Public Health England is also addressing oral health in children as a priority as part of its “Best Start in Life” programme. That includes working with and learning from others, such as the “Childsmile” initiative in Scotland, to which my hon. Friend the Member for Mole Valley referred. It is important that health visitors—I know that the Public Health Minister takes a particular interest in their work—midwives, and the wider early years workforce have access to evidence-based oral health improvement training to enable them to support families to improve oral health.

Public Health England and the Royal College of Surgeons Faculty of Dental Practice are working with the Royal College of Paediatrics and Child Health to review the dental content of the red book—the personal child health record—to provide the most up-to-date evidence-based advice and support for parents and carers. The National Institute for Health and Care Excellence has also produced recent oral health guidance that makes recommendations on undertaking oral health needs assessments, developing a local strategy on oral health, and delivering community-based interventions and activities for all age groups, including children. Community initiatives to improve oral health include supervised fluoride tooth-brushing schemes, fluoride varnish schemes and water fluoridation.

I agree with my hon. Friend that water fluoridation is an effective way of reducing dental decay. However, as the House knows, the matter is not in my hands. Decisions on water fluoridation are best taken locally and local authorities now have responsibility for making proposals regarding any new fluoridation schemes. I am personally in favour. I think I am the only Member in the Chamber who remembers Ivan Lawrence and the spectacular debates we had on fluoridation in the 1980s. He made one of the longest speeches ever. Fluoridation was bitterly and hard-fought-for and I do not think there is any prospect of pushing the matter through the House at present. I am perfectly convinced by the science and that is my personal view, but this is a matter that must be taken on locally.

Diet is also key to improving children’s teeth and Public Health England published “Sugar reduction: the evidence for action” in October 2015. Studies indicate that higher consumption of sugar and sugar-containing foods and drinks is associated with a greater risk of dental caries in children—no surprise there. Evidence from the report showed that a number of levers could be successful, although I agree with my hon. Friend that it is unlikely that a single action alone would be effective in reducing sugar intake.

The evidence suggests that a broad, structured approach involving restrictions on price promotions and marketing, product reformulation, portion size reduction and price increases on unhealthy products, implemented in parallel, is likely to have the biggest impact. Positive changes to the food environment, such as the public sector procuring, providing and selling healthier foods, as well as information and education, are also needed to help to support people in making healthier choices.

Dentists have a key role to play. “Delivering Better Oral Health” is an evidence-based guide to prevention in dental practice. It provides clear advice for dental teams on preventive care and interventions that could be delivered in dental practice and school settings. Regular fluoride varnish is now advised by Public Health England for all children at risk of tooth decay.

For instance, the evidence shows that twice yearly application of fluoride varnish to children’s teeth—more often for children at risk—can have a positive impact on reducing dental decay. In 2014-15, for children, courses of treatment that included a fluoride varnish increased by 24.6% on the previous year to 3.4 million. Fluoride varnishes now equate to 30.9% of all child treatments, compared with 25.2% last year. This is encouraging progress.

There are many measures that can and should be taken in order to reduce the prevalence of decay in children, but we recognise it is unlikely that we will be able to eradicate entirely the causes or the effects of poor oral health in children. This means that the continued provision of high quality NHS primary dental services will continue to be an important part of ensuring that every child in England enjoys as high a standard of oral health as possible. NHS England has a duty to commission services to improve the health of the population and reduce inequalities—this is surely an issue of inequality—and also a statutory duty to commission primary dental services to meet local need. NHS England is committed to improving commissioning of primary care dentistry within the overall vision of the “Five Year Forward View”.

[Mr Allen]

The Prime Minister announced an excellent initiative on life chances less than two weeks ago. The cornerstone of that was improving parenting skills. Will the Minister’s Department ensure that feeding into that process there is, within the parenting programmes, stuff around health in general, but dental health in particular?

[Alistair Burt]

Yes. [Interruption.] Immediate information passed to me by the Minister with responsibility for public health indicates that that is a very positive initiative and we are indeed taking it up.

Overall, children’s access to NHS dentistry remains consistently high, with the number of children seen in the 24 months to September 2015 by an NHS dentist standing at 8 million, or 69.6% of the population. There are localised areas where children have access difficulties, but the more common problem is that the parents and carers of the children most at risk do not seek care until the child has developed some disease—this again emphasises the importance of health visitors and others in the process.

To help focus on prevention, the Government are committed to reforming the current system of primary care dentistry to improve access and oral health further. In line with the welcome improvements in oral health over the last 50 years, we need an approach in primary care dentistry that can provide a focus on prevention, while also incentivising treatment where needed.

That is why, following the piloting of the preventative clinical pathway, we are now prototyping a whole possible new system remunerated through a blend of quality, capitation and activity payments. The aim is to allow dentists to focus on prevention and, where appropriate, treatment, and how effective that could be for the children we are talking about. The new approach will be tested until at least 2017. We need to do a proper evaluation and, if successful, numbers will increase with a possibility of a national roll-out for 2018-19.

I hope I have been able to demonstrate the seriousness with which the Government take this subject—a seriousness that I know is accepted by the whole House. It comes back to some fundamental issues of inequality in health that are, as I said, depressingly familiar and which we are all absolutely dedicated to removing. The concept of total clearance for a child—I suspect that none of us has had to contemplate that in our personal lives, but it affects some of our constituents—is something that brings us all up short. I am grateful to my hon. Friend the Member for Mole Valley for raising this subject for debate.

Question put and agreed to.

Conception to Age 2: The First 1001 Days

Graham Allen Excerpts

Thursday 17th December 2015 Commons Chamber

[Mr Graham Allen (Nottingham North) (Lab)]

First, I declare an interest as the founder of the Early Intervention Foundation, and take this probably unique opportunity to put on record my thanks to its chief executive, Carey Oppenheim, its director of evidence, Professor Leon Feinstein, its director of policy, Donna Molloy, and all the fantastic staff there.

Secondly, I pay tribute to colleagues who secured this debate. If I may say so, the inspiration behind a lot of this comes from the hon. Member for South Northamptonshire (Andrea Leadsom). I do not suppose that she is allowed to contribute today, but we are getting thought beams from her as our speeches progress and drawing great inspiration from that.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Member for South Northamptonshire (Andrea Leadsom) may, on this unusual occasion, acknowledge the praise being heaped on her, and rightly so, from around the House.

[Mr Allen]

I would gladly give way to the hon. Lady if it did not break all sorts of precedents.

I come to this issue as a constituency Member of Parliament representing the fifth most deprived constituency in the United Kingdom who is learning how to resolve some of the intergenerational problems that start with the very youngest in our communities—indeed, as “The 1001 Critical Days” implies, before birth. Trying to break some of these cycles is my own personal learning curve. I share that, surprisingly but very importantly, with the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), who has been on a similar journey to mine, in very different circumstances. I hope that those two strange bedfellows, he and I, have demonstrated that we must have an all-party view on this. As with the previous debate on the sexual abuse of 16 and 17-year-olds, we will make no progress unless we agree across the House, in all parties, because getting something from one Government only for it to fall under the next is no progress at all. The problems we tackle are intergenerational and long-running. They require us to invest in individuals, whether with love or with money, and take a very long-term approach. We must all unite across the House to make sure that this moves forward.

[Mr Sheerman]

I absolutely agree. Throughout my time in the House, there has been cross-party support on issues affecting very small children and children before they are born. The one thing that I always stipulated when I chaired the Children, Schools and Families Committee was that we should determine policy on the basis of good evidence and what works in countries such as ours.

[Mr Allen]

I hope that my own journey has exemplified that approach. The two reports the Prime Minister asked me to do in 2010 and 2011 were signed off, as it were, with very nice pictures of the then leaders of all the main political parties. The reports are still valid and they are still available, albeit not at all good bookshops, but if anybody who is viewing wishes to contact me, I would be very happy to share them. I hope they have been of some help and influence to the excellent “The 1001 Critical Days” campaign.

Whenever I dig out such reports, having not looked at them for a couple years, I look to see whether they are still relevant. In an opening paragraph, I use the term “early intervention” to refer to

“the general approaches, and the specific policies and programmes, which help to give children aged 0–3 the social and emotional bedrock they need to reach their full potential; and to those which help older children become the good parents of tomorrow.”

I hope that is in line with the superb work of my hon. Friend, the influential former Chair of the Children, Schools and Families Committee.

For me, early intervention is a philosophy, not a set of programmes. It is about changing the way we do business, whether as a political party, a family, a community or an individual. That philosophy is essentially about giving the nought-to-threes the social and emotional bedrock to become great people in their own right, and to be able to grow and flourish. It is about applying what we wanted for our own children to as many children as possible, not least those throughout the United Kingdom.

[Stephen Hammond (Wimbledon) (Con)]

Will the hon. Gentleman give way?

[Mr Allen]

I will give way, but I hope my virtual time limit will be extended by Madam Deputy Speaker.

[Stephen Hammond]

I will be extremely brief. The hon. Gentleman is absolutely right about ensuring that the nought-to-threes become great people in their own right. One of the things that can help is recognition of when in the school year they were born. Does he agree that the Summer Born campaign, which wants local education authorities to properly assess children born in July and August, and the anticipated change to the code of practice, which is welcome, will help those children?

--- Later in debate ---

[Mr Allen]

That is a classic case—we referred to this earlier—of the need to rely on the evidence and the science. Let us listen to people who know about these things, rather than do something because that is the way we have always done it or because it is a reflex reaction. That is why the Early Intervention Foundation is central. Best practice needs to be collected in and propagated from one place, so that anyone who visits the website or who makes a phone call can learn from the experience of all those who have gone before them.

I agreed with so much of what the hon. Member for East Worthing and Shoreham (Tim Loughton) said about how this will save us all not only a lot of grief, but a lot of money. I remember telling the Chancellor of the Exchequer that early intervention is the biggest deficit reduction programme he could possibly have. There are various views of the total amount that could be saved, but the Early Intervention Foundation puts the cost of late intervention at £17 billion a year. People are very quick to jump up and ask, “How much is this programme going to cost?”, but they are very slow to say that what we are currently doing is incredibly costly. If someone said, “I’ve got a budget for you: it’s called the late intervention budget and it’s going to cost you £17 billion a year,” there would be an uproar. People would cry, “We can’t afford that!” Of course we cannot afford it, but that is the cost of the criminal justice system having to deal with dysfunctional young people who could have had a chance earlier in life; of mental and physical ill-health; of the court system; and of educational underachievement.

We are wasting money, which we can ill afford, rather than spending a bit of money to start us off. It is received wisdom to talk about a stitch in time, and we often say that prevention is better than cure. In religious terms, we say, “Give me the boy and I’ll give you the man.” We use such phrases in our daily lives, but somehow we cannot bring them to bear on the political choices we make.

It is essential to support this 1001 days campaign. It is very important to underline that helping a child or a mum-to-be is money in the bank in terms of both the child’s development and financial prudence for us as a community and a society. Brain development was mentioned earlier. Given the plasticity of the brain, it is now absolutely without doubt—the neuroscience is incontrovertible—that if we can influence the development of a child’s brain pathways during the nought-to-three phase, we will be helping them for the rest of their life. It is absolutely essential to do so.

We will continue to do all this work together and to have overlapping campaigns, including with Governments of all parties. I must say that that was very difficult when my party was in government. I have to be honest and repeat that we made more progress with a Conservative Prime Minister in a coalition Government than we did with two Labour Prime Ministers.

This is an all-party campaign, and all parties need to use the vocabulary of early intervention. One thing that I and the right hon. Member for Chingford and Woodford Green did, if I may say so, was to make such vocabulary commonplace in this House. We now talk sensibly about early intervention, rather than about “ASBOs on embryos” or “hugging a hoodie”, and all the other terms of abuse bandied about, to no effect whatever, by both parties 10 years ago.

We are growing, improving and getting more mature. With the example of hard science and the example of practice—the Early Intervention Foundation has been involved in 20 local areas to prove what works—we are on the verge of breaking the philosophy out of purely children’s policy into something that we should do in every policy area of government.

Does devolution have anything to do with this issue? Of course it does, because if we allow people in our constituencies, boroughs or councils sensitively to develop things that they know will work, we will spend public money better, even when the early intervention grant is being abolished and austerity is striking at every local authority. At such times, we need to spend money more accurately and with more precision.

I would argue that there may be an early intervention aspect to confronting international questions. Some fascinating work has been done on trauma by Suzanne Zeedyk and Robin Grille from the National Consortium for the Study of Terrorism and Responses to Terrorism. What greater trauma is there for a growing child than to be involved in a civil war or appalling acts of violence? That is the very breeding ground of religious fundamentalism and terrorism.

Early intervention is a philosophy whose time is about to come. Let us make sure that late intervention as a philosophy is consigned to the dustbin of history. One of the best ways for us to do so is to continue to support early intervention, to back initiatives such as the Early Intervention Foundation and to give this motion on the 1001 most critical days a resounding cheer of support from both sides of the House as it is, I hope, approved unanimously.

[Fiona Bruce (Congleton) (Con)]

I must apologise to the Minister. I have a long-standing engagement in my constituency this evening, and I would be grateful to him if he released me to attend it. I will not therefore be able to listen to his winding-up speech.

I want to concentrate on the first part of the 1001 days—the period between conception and birth. A report was published earlier this year by a team from leading UK and US universities who had studied pregnant women in rural Gambia and the children to whom they gave birth. It is clear that the children conceived in the dry season, when there was not an abundance of leafy green vegetables, were seven times more likely to die in young adulthood than those conceived in the wet season, when their mothers’ diet was so much better. The research team said that later in life the impact could be seen in a lack of ability to fight viral infections and in their chances of surviving cancers such as leukaemia and lung cancer. That report shows the clear impact of what the mother ingests on her system and that of the unborn child.

Something that we ought to be much clearer about in this country, but that we sadly are not, is the effect of alcohol consumed by the mother during those first precious days of a child’s life in the womb. The National Society for the Prevention of Cruelty to Children estimates that about 7,000 babies born in the UK each year suffer the effects of alcohol drunk during pregnancy.

I pay tribute to the hon. Member for Sefton Central (Bill Esterson), who is chair of the all-party parliamentary group for foetal alcohol spectrum disorder, of which I am the vice-chair. This week, we published a report on the picture of FASD in the UK today, following an inquiry that ran throughout the autumn. We held a number of hearings with families and young people who have been affected by FASD, as well as with members of the medical professions and other interested organisations. The report is so substantial and so deeply concerning that, although you have been good enough to call me before the chair of the all-party group, Madam Deputy Speaker, it might have been more appropriate if we had been called the other way around. None the less, the report has such a lot of substance that I hope what I say will complement, rather than duplicate, what he will say.

The evidence that we gathered was severely alarming in respect of both the far wider impact of FASD compared with what is understood in this country and the lack of clinical and other support available to families who are affected. We learned that a mother need not consume large amounts of alcohol during her pregnancy to be affected, because individual women’s constitutions respond differently to alcohol consumption.

The impact on the unborn child, which can last for the rest of their life, can be profound. FASD causes organic brain damage in an unborn child. We were told that it causes heart defects, dental issues, eyesight problems, bladder difficulties, walking difficulties, cognitive challenges and memory and behavioural difficulties. Often it means that babies are premature. We heard about the emotional impact on those affected by FASD as they develop into young people and move into adulthood: they can withdraw from society, become unpredictable and even become suicidal. That places great stress on parents and carers, many of whom experience periods of isolation and ill health. The inquiry heard that it is likely that a much higher proportion of children are born with FASD than is currently recognised. Those children will have a variety of difficulties in childhood and in later life.

The tragedy is that, theoretically, FASD is 100% preventable if all pregnant women are given clear advice on the risks of alcohol intake to their unborn child. We were told that the best advice for young women is not to drink if they are considering becoming pregnant, since there are effects even at the earliest stage.

Equally tragic is the fact that in the UK there have been decades of mixed messages regarding the right level of alcohol intake during pregnancy. I remember that from when I had my children, which is well over 20 years ago. The all-party group was advised that a clear message should be given by Government Departments that, just as smoking during pregnancy affected the unborn child and should be avoided, so too did alcohol and it too should be avoided.

For the UK not to be sending that message is not only tragic for the families concerned; it goes against international best practice, which is to advocate that alcohol be avoided if a woman is pregnant, thinks she might be pregnant or is trying to conceive. In Canada, children as young as primary school age are taught that. Pregnant women in Denmark, France, Israel, Norway, Mexico, Australia, Ireland, New Zealand, Spain and the Netherlands are advised to abstain completely from alcohol. Since 1981, the USA has advocated that

“no alcohol is safest for baby and you.”

Without such a clear message, pregnant women in the UK are left confused and uncertain. I know from my work as the chair of the all-party group on alcohol harm that few people can accurately measure one unit of alcohol. If a message is sent out that one or two units a week is okay, it is probably easy to think, “Well, why not three or even four or more?”

One of the reasons that women are confused stems from the unclear guidelines provided by UK professional and governmental bodies. Although NICE and the Department of Health warn of the potential for alcohol to harm an unborn child, incredibly they do not go on to stipulate that women should abstain from drinking during pregnancy. The Government are currently carrying out an alcohol review, and I hope they will seriously consider that issue. By contrast, the British Medical Association advocates that no alcohol should be drunk during pregnancy. As a result of those mixed messages, not only are women confused but many midwives are uncomfortable about giving advice on alcohol. A study that questioned 200 midwives found that only 60% asked women about their drinking habits, 30% advised against binge-drinking, and only 10% were aware of FASD. As our report says:

“this is astonishing and deeply worrying, and something which must be rectified as a matter of urgency.”

More encouragingly, 93% of midwives said that they would be comfortable advising that no alcohol should be drunk during pregnancy if that was the consistent message from the Government. In the absence of such clarity, however, they are afraid to offer such advice.

Our inquiry also revealed a similar lack of in-depth knowledge about FASD across the medical profession. There is only one specialist FASD clinic in the UK, and it is wholly overstretched. That lack of in-depth knowledge means that children with FASD are often given multiple inaccurate diagnoses, such as ADHD, autism or an attachment disorder. Appropriate support mechanisms are rarely put in place, and families are left frustrated and confused. It is critical that FASD is given a higher priority within the NHS for research, diagnostic, and support services.

[Mr Graham Allen]

The hon. Lady is making a fascinating contribution. Given that the Minister is in his place, is this a good moment for her to comment on the failure to fund research into the prevalence of foetal alcohol syndrome? I am sure she is coming to that, but given that the Minister is paying great attention, perhaps this is a good moment to get that message sprayed on to the Department’s eyeballs.

[Fiona Bruce]

I thank the hon. Gentleman for that intervention. Our report states that because of inadequate research in this country, there is insufficient information to encourage those involved—including, we believe, Government representatives—to take action.

Several of our witnesses testified that there must be more appropriate training on FASD among the medical profession, and national standards must be adhered to. For example, we heard how diagnosis could take place as early as for a one-month-old child, or as late as at 10 years, or not at all. It appears to rely on which professional a child sees. Time and again we heard from families, including parents, grandparents, adoptive parents and foster carers, that they had to explain to medical staff the diagnostic nuances of FASD.

As I have said, the extent of this condition has been under-recognised by successive Governments. Research now indicates that 30% to 50% of children in foster care could be affected by FASD, and a study mentioned in our report from an audit in Peterborough, published in October 2015, showed that 75% of children referred for adoption had a history of pre-natal alcohol exposure. If those figures are extrapolated across the UK, that should have major implications for Government policy on fostering and adoption. Sadly, there are also impacts on the criminal justice system, and our inquiry heard of vulnerable young people with FASD who move into adulthood where they cannot meet societal expectations and behavioural norms. Those people are being exploited by criminal gangs and sexual predators, which is a result—certainly in part—of a lack of concern, understanding and support for them and their condition.

In conclusion, the seriousness of the problem cannot be overstated. Our report makes a number of recommendations that the hon. Member for Sefton Central may well go into in more detail. The impact on the early stages of a child’s life cannot be overstated. Even the alcohol industry has taken considerable steps to send warnings not to drink during pregnancy. Ninety-one per cent. of alcoholic drinks in bottles and cans now carry a warning.

That is not enough, however. A study by Drinkaware revealed that more than half of pregnant women in the UK receive no advice at all about drinking while pregnant. The original clinical diagnosis of FASD was made in 1973. Our inquiry showed that

“in the four decades since then, the UK as a whole has still barely acknowledged its existence.”

That must change, and the Government must take a lead.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, I commend and congratulate the hon. Members for East Worthing and Shoreham (Tim Loughton) and for Dwyfor Meirionnydd (Liz Saville Roberts) on securing this debate. I also pay tribute to the members of the all-party group for conception to age two—the first 1001 days for developing the manifesto and raising the profile of these important issues. All the Members who have spoken today have done so with great eloquence on these issues.

Let me go through some of today’s contributions. The hon. Member for East Worthing and Shoreham, in his opening remarks, correctly said that this is about challenging the mindset and going beyond the troubled families programme, which has proved to be a success around the country. He rightly highlighted the shocking statistics on suicide among new mothers and rightly said that much of it is preventable. He gave us a volley of statistics and they all point towards this manifesto as being something on which there should be widespread agreement, and I think that agreement has been apparent from today’s contributions.

It was also a pleasure to hear from my hon. Friend the Member for Nottingham North (Mr Allen), whose work in this area I was a keen reader of before entering this place. I was glad to hear his contributions today. He rightly said that this is about investment in individuals, that a consistent approach has to be taken across changes of Government and that this is about a philosophy in the way we do things. He made an interesting point when he said that, if we proposed spending £17 billion on an early intervention programme, we may have a little difficulty in getting that past the Treasury, but that is actually the potential saving that might be realised if this is done correctly. Of course, this is about so much more than simply making savings. He said that early intervention should mean that late intervention is consigned to the dustbin of history, and we would all welcome that.

[Mr Graham Allen]

Like the hon. Member for East Worthing and Shoreham (Tim Loughton), and many others who spoke, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), I did not have a chance to speak about a broad policy area in this field—social investment. There is now a way of monetising and finding out how much we can save ourselves, and the many social instruments and social investments out there are growing by the day. I hope my hon. Friend will consider that in his remarks, because massive savings can be made in this area—indeed, money can be made in order to reinvest in new services.

[Justin Madders]

I am grateful for that intervention, and my hon. Friend is right to say that this can be monetised. I recall that when my local authority carried out an examination of the early intervention scheme, a figure of about £100 million was mooted. There are challenges in getting different Departments to buy into that, because they are all quite protective about their own sources of money, but if we take a holistic approach, we can see that there will be savings right across Departments. I hope that we can begin to develop that approach.

The hon. Member for Congleton (Fiona Bruce) rightly highlighted the staggering and shocking statistics about alcohol intake during and indeed before pregnancy, and rightly said that a clear message needs to be sent out about the risks. She rightly paid tribute to the work of my hon. Friend the Member for Sefton Central (Bill Esterson) with his all-party group on foetal alcohol spectrum disorder. The group took a great deal of evidence in preparation for its report, which has been released today. It is unambiguous in its recommendations about the need for clear and consistent advice to be given on the dangers of alcohol during pregnancy and the need to improve training and education across the board. He has laid down a clear challenge for the Minister in this area and I look forward to hearing what his response will be.

The hon. Member for Foyle (Mark Durkan) spoke with his usual passion and sincerity on the subject. He gave us the memorable phrase, “What happens in our early years stays with us throughout our years.” I am not sure what he meant about the goings on in Las Vegas. Perhaps he will enlighten me outside the Chamber. He rightly pointed out the academic research that is set out in the manifesto. Clearly, an evidence-based approach is welcome, because the evidence is there and it is clear.

The hon. Member for East Kilbride, Strathaven and Lesmahagow spoke with great personal experience on this area. She rightly pointed out that early experiences can affect a child’s relationships throughout their lives. We have heard from a number of Members about how difficulties in relationships can perpetuate the cycle of despair that we currently see and have been discussing today. She made a valid point about early assessment of development disorders, especially autism. At the moment, that assessment does not happen quickly enough. She also talked about this idea of a named person being the point of contact for the families, and saw it as a positive development. I am certainly aware of a number of similar initiatives that have shown the benefit of such an approach.

We have had a great many informed, respectful and consensual contributions today. I will try my best in this season of goodwill to maintain that. I am speaking here as a member of the shadow Health team. The NHS is really where my focus is. It was first conceived to be a responsive treatment-based service that supports everyone in society from the cradle to the grave. It is only in recent years that we have begun to understand how that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a newborn baby’s life will be.

I will keep my remarks quite brief as we have been squeezed out by other business today. Let me just touch on a few areas that highlight why this period is so vital and a few areas where we should be doing a little better.

As we know, the manifesto takes its title from the period from conception to age 2 when a baby’s brain is developing at its fastest. We know that the earliest experiences have a lifelong impact on mental and emotional health. We also know that, when a baby’s development falls behind the norm during the first years of life, rather than catch up with those who have had a better start, they are actually more likely to fall even further behind in subsequent years. More than a quarter of all babies in the UK are living in complex family situations that present heightened risks to their wellbeing. The sad reality is that babies are far more likely to suffer from abuse and neglect and up to seven times more likely to die in distressing circumstances than older children. We have a duty to give every child an equal opportunity to lead a healthy and fulfilling life.

“The 1001 Critical Days” manifesto is the best chance for us to make that happen. Not only is it the right thing to do for our children, but it is the right thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early years intervention can yield a return on investment as high as 6% to 10%. My hon. Friend the Member for Nottingham North eloquently showed how that could be translated into significant savings across Government.

[Mr Allen]

I sense that my hon. Friend may be coming to the end of his remarks, so I am going to squeeze in one more intervention, if I may, and it is in respect of the next Government. There may be a change of Government in 2020. My hon. Friend has an opportunity to spend some time developing an early intervention philosophy across, as I mentioned, not only health and children’s services, but the economy and even international affairs. That preventive view, rather than attempting to cure, could be fundamental to the next Government, as it should be and increasingly is to the current Government. Will he give us an assurance that this will be in his thoughts as he develops policy in his area?

[Justin Madders]

I thank my hon. Friend for his intervention. I am certain that I will be able to take those comments on board. As I said, it is a subject in which I took an interest before I entered this place. I believe that is the right approach and I am confident that in four and a half years’ time we will have the opportunity to put it into practice. [Interruption.] Some may disagree about that. In the season of good will, a little latitude is surely permissible.

If it is done in the right way, early intervention can save money, save lives and improve the wellbeing of parents and children. The former Scottish Health and Finance Minister, Tom McCabe, summed it up perfectly when he said,

“We have heard evidence, stacked from the floor to the sky, that this is the right thing to do.”

Focusing on the first 1001 days is not just about ensuring the healthy development of future generations of children, but about making our NHS and many other public services sustainable.

I want to say a few words about perinatal mental health, as I know this is an issue that many Members feel passionately about, not least the shadow Minister for mental health. Perinatal mental health problems affect up to 20% of women at some point during pregnancy or in the year after childbirth. We heard from the right hon. Member for North Norfolk (Norman Lamb), who pointed out the impact not only on the mother, but on the child and the wider family. About half of all cases of perinatal depression and anxiety go undetected and even those that are detected fail to receive evidence-based forms of intervention. This is important because severe perinatal mental health problems are bad not only for the women affected, but for the development of the children involved, as the right hon. Gentleman highlighted.

In particular we need to ensure that all women affected have access to appropriate treatment, and that variation in access is addressed. The right hon. Gentleman referred to a map which starkly highlighted that. It is worrying that 41% of maternity units have no access to a trained mental health worker, 30% are unable to offer psychological support, and on a wider but connected issue, about a third have no overnight accommodation. It is also regrettably the case that under this Government there has been a reduction in the number of specialist in-patient mother and baby units. The Government’s pledge to spend £15 million on perinatal mental health was extremely welcome, but we need to see that pledge put into action. I would be grateful if the Minister could update the House on what he has been doing in that respect.

We will tackle the problems that parents and children might have in this period, and spot the problems early enough, only if we have joined-up multi-agency working between health services and local family support services. Children’s centres have a critical role to play in this mix in many areas. As a former member of the advisory board of the Stanlaw Abbey children’s centre in my constituency, I have seen at first hand what a welcoming and safe place it is for families to visit, as indeed are all children’s centres. In addition they have a wealth of experience and knowledge, and trained staff who have the skills to identify problems at an early stage, whether in bonding, the mother’s mental health or child development, so that that disadvantage can be tackled.

I have heard from Stanlaw Abbey the great strides made by children coming into the centre and how much progress they make, as well the support given to the parents, many of whom have re-entered education and the world of work, thanks to the help of the centre. The one challenge that continually remains, though, is how to engage with those families who do not come through the door. We know that they are out there. They will not all need support, but some will, and despite extensive efforts to reach out to these families, they simply stay outside the system for too long, missing out on the crucial support that this debate is trying to highlight.

For me children’s centres have to be the cornerstone of a successful early years policy. That is why it is so concerning that under this Government we do not appear to have any strategy for children’s centres. The Prime Minister famously promised to protect such centres, but there are 700 fewer designated children’s centres than there were in 2010.

Alongside that, many of the local government services that families used to rely on are taking a massive hit. The transfer to local authorities in October this year of the healthy child programme for children up to five years of age presents an important opportunity for local authorities to integrate health, education, social care and wider council-led services and to focus on improving outcomes for children from birth. But I find it difficult to square the circle of this announcement alongside the £200 million in-year cut to public health that this Government have introduced.

There is a real risk that the decision could cost more money than it saves and that the good intentions behind passing responsibility to local authorities could be stymied from the off as a result of the short-term approach to funding that the cuts represent. I would therefore be grateful if the Minister updated the House on what support he is giving to local authorities to ensure that commissioning is properly resourced when they assume this new responsibility. What steps is he taking to ensure that the cuts do not affect front-line services?

As we know, many local authorities have been forced to pare back to the statutory minimum, which is totally against the grain of what we are trying to achieve. Taken together, the failure to invest in early help services and the lack of priority the Government give to this type of provision mean that Ministers will fail to support adequately all children and families in those critical 1001 days. The cross-party agreement we have heard about today needs to be matched by cross-departmental harmony across Government.

In conclusion, the evidence is overwhelming. It is so obvious that it should have underpinned Government policy decades ago. Anyone who is a parent will recognise the intensity of feeling when observing how their child is developing. That innate desire for one’s offspring to grow up to be happy, healthy and wise should be all the encouragement we need to support this incredibly important document, not just for our children but for everyone’s children. On that note, I would like to wish everyone in the House a very merry Christmas.

--- Later in debate ---

[Mr Graham Allen]

If the Minister is moving on from foetal alcohol syndrome, it is important to put it on the record again that, as of a couple of weeks ago, the attempt to have a prevalence study on foetal alcohol syndrome has not found funding. It is really important that we try to understand the issue in depth and get some evidence on how widespread it is. Will the Minister please consider looking at the matter in the light of the report he will receive today?

[Alistair Burt]

I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

Cities and Local Government Devolution Bill [Lords]

Graham Allen Excerpts

Monday 7th December 2015 Commons Chamber

Brought up, and read the First time.

[Mr Graham Allen (Nottingham North) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 2—Local Government Constitutional Convention: terms of reference—

“The convention must consider the following terms of reference—

(a) the devolution of legislative and fiscal competence to local authorities within the United Kingdom;

(b) the reform of the electoral system for local government;

(c) constitutional matters relating to local government to be considered in further conventions; and

(d) procedures to govern the consideration and implementation of any future constitutional reforms in relation to local government.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 3—Local Government Constitutional Convention: recommendations—

“(1) The Local Government Constitutional Convention must publish recommendations within the period of one year beginning with the day appointed under section (Local Government Constitutional Convention).

(2) The Secretary of State must lay responses to each of the recommendations before each House of Parliament within six months beginning with the day on which the recommendations are published.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 4—Local Government Constitutional Convention: composition—

“(1) The Local Government Constitutional Convention must be composed of representatives of the following—

(a) registered political parties within the United Kingdom,

(b) local authorities, and

(c) the nations and regions of the United Kingdom.

(2) At least 50% of the members of the convention must not be employed in a role which can reasonably be considered to be political.”

This new clause creates the means by which every UK citizen can engage in a national public discussion of devolution, local government, governance and electoral systems and make recommendations and receive a response from government and parliament to that national debate.

New clause 5—Commission on devolution of fiscal powers and taxation—

“(1) The Secretary of State shall appoint a commission on devolution of fiscal powers and taxation to local authorities.

(2) The Commission shall consider the following issues—

(a) the desirability, impact and process necessary to implement an Income Tax rate of 10p in the pound on English tax payers;

(b) the desirability, impact and process necessary to give English Councils the same fiscal and taxation powers as those devolved to the Scottish Parliament in the 2012 Scotland Act, and

(c) any other issues that the Commission considers relevant.

(3) The Commission shall produce a report covering the issues listed in subsection (2) no later than 31 December 2017, and shall make such recommendations to the Secretary of State as it deems necessary.”

This new Clause would establish a Commission to consider the possibility of England local authorities being granted the same fiscal and taxation powers already devolved to Scotland in the Scotland Act 2012.

New clause 8—Combined authority functions: cool off period—

“(1) The Secretary of State shall amend any order made under a provision of this Act which transfers a power to exercise of a function from a constituent part of a combined authority to a combined authority, to devolve responsibility for that function back to a constituent part of that authority, if the following conditions are met—

(a) A constituent part of a combined authority requests that the Secretary of State amend an order to return responsibility for the exercise of a function to the constituent part of the combined authority from the combined authority, and

(b) Such a request is made within one year of the first local government election held in the constituent part of the combined authority since the original order was made.”

The intention of this amendment is to create a cooling off period for the transfer of any power to the level of a combined authority. If a constituent part of a combined authority requests that a power is returned to it within one year of next elections held in the constituent part, then the Secretary of State must amend the relevant order to return power to the constituent part.

New clause 10—Governance arrangements for local government: entitlement to vote—

“In section 2 of the Representation of the People Act 1983 (local government electors), in subsection (1)(d) for “18” substitute “16””

This Clause would re-instate the provision in the Bill, as brought from the Lords, allowing votes for 16- and 17-year olds in local government elections.

New clause 11—Review of fire and rescue services in combined authorities—

“(1) The Secretary of State must, within 15 months of this Act being passed, publish a review of the fire and rescue services affected by the provisions of this Act.

(2) The review must make an assessment of the extent to which the provisions of this Act affecting fire and rescue services have worked safely and efficiently for the protection of the public over the first 12 months from this Act being passed.”

This Clause would require a review, after 12 months of the Bill being passed, of the fire and rescue services to make sure the new system is working safely and efficiently for the protection of the public.

New clause 13—Fiscal and financial powers—

“Within six months of the passing of this Act, the Secretary of State must publish plans for further devolution of fiscal powers to local authorities in England, including—

(a) an equalisation model related to the retention of business rates, to ensure local authorities with lower business rate income are not negatively impacted;

(b) greater local authority control over local tax rates and discounts;

(c) provision for combined authorities to set multi-year finance settlements.”

This new clause allows the Secretary of State to ensure devolution continues beyond current devolution deals by setting out plans for further fiscal devolution and greater local freedom and stability in relation to budgets and tax rates. The clause also ensures a model is put in place to ensure authorities with lower business rate income do not lose out from the phasing out of central government grants.

New clause 14—Cooperation with peripheral authorities—

“No later than three months after the passing of this Act, the Secretary of State shall publish guidance to be considered by combined authorities while exercising a devolved function, in order to—

(a) have regard for any significant direct impact of decisions taken by the combined authority on neighbouring authority populations;

(b) encourage cooperation between combined authorities and their neighbouring authorities so as to encourage local growth;

(c) enable greater economic cooperation between combined authorities and their neighbours within a travel-to-work area.”

This new clause asks the Secretary of State to publish guidance to ensure neighbouring authorities are considered when devolved functions are exercised, and encourage economic cooperation between authorities within a regional economy or travel-to-work area.

Government amendments 4 to 6.

Amendment 58, in clause 2, page 2, line 10, at end insert—

“( ) The transfer of local or public authority functions to combined authorities shall not be dependent on an order being made under subsection (1).”

This amendment makes clear that devolution deals must not be dependent on a combined authority having a mayor.

Amendment 2, page 2, line 13, at end insert—

“(2A) An order under subsection (1) may not be made unless the proposition that the combined authority have a mayor is approved by a referendum of the electorate of that combined authority.

(2B) The Secretary of State shall, by regulations, establish the procedures to be followed in conducting a referendum under subsection 2A.

(2C) Before making a regulation under subsection 2B, the Secretary of State must consult the Electoral Commission.”

The intention of this amendment is that elected mayors will be introduced only if that proposal has been approved by a referendum of the residents of the combined authority. The rule for the conduct for such a referendum shall be made by the Secretary of State, in consultation with the Electoral Commission.

Amendment 57, page 2, leave out lines 21 to 26 and insert—

“(7) An order under this section providing for there to be a mayor for the area of a combined authority may be revoked or amended by making a further order under this section; this does not prevent the making of an order under section 107 abolishing the authority (together with the office of mayor) or providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority.

(7A) An order under this section providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority must make fair provision for a reasonable and proportionate division of resources between the former combined authority and the seceding local authority.

(7B) Where a combined authority has entered into a contractual arrangement with a third party and an order under this section is made to enable a constituent part of a combined authority to resume its existence as a separate local authority, that separate local authority shall be deemed to be a contracting party to that agreement unless an alternative agreement is reached with the third party.”

The intention of this amendment is allow for a constituent part of a combined authority to leave a combined authority without the combined authority being dissolved, with provision for “fair terms” for the leaving party (i.e. their resource is calculated on a per capita basis, or similar.) and the impact this may have on contractual arrangement with third parties.

Government amendments 7 to 25.

Amendment 59, in clause 10, page 12, line 32, at end insert—

“(1) Within 6 months of the passing of this Act, the Secretary of State must publish a report on the performance of the Localism Act 2011 and a review of the general power of competence provision in relation to its use by combined authorities.”

This amendment introduces a review of the use of the general power of competence by combined authorities.

Government amendments 26 to 29.

Amendment 1, in clause 15, page 17, line 7, at end insert—

“( ) all local authorities in a mayoral combined authority commencing a community governance review of their whole local authority area within two years of this Act coming into force.”

This amendment introduces further measures to support the creation of new local councils with mayoral and combined authorities required to conduct a community governance review within two years of the Act coming into force.

Amendment 56, page 17, line 23, at end insert—

“(4A) Regulations under this section, so far as including structural or boundary provision in relation to a non-unitary district council area, may be made if at least one relevant local authority consents.

(4B) Local authority in this case is defined as—

(a) a non-unitary district council whose area is, or forms part of, the non-unitary district council area;

(b) a county council whose area includes the whole or part of the non-unitary district council area.

(4C) Relating to 4a and 4b

(a) “non-unitary district council area” means the area or areas of one or more non-unitary district councils;

(b) “non-unitary district council” means a district council for an area for which there is also a county council;

(c) “structural or boundary provision” means provision about the structural or boundary arrangements of local authorities in regulations made by virtue of subsection (1)(c).”

The intention of this amendment is to allow the government to make changes to boundaries of local authorities if it has the consent of at least one relevant local authority.

Government manuscript amendment (a) to amendment 56, after subsection (4C), insert—

“(4D) Subsections (4A) to (4C) expire at the end of 31 March 2019 (but without affecting any regulations already made under this section by virtue of subsection (4A)).”

This amendment provides for the provisions in subsections (4A) to (4C) of clause 15, allowing structural and boundary provision in relation to a non-unitary district council area if at least one relevant local authority consents, to expire at the end of 31 March 2019.

Government amendments 30 to 33 and 36.

Amendment 3, in schedule 1, page 37, line 3, leave out paragraphs 4 and 5 and insert—

“4 (1) The mayor is to be returned under the simple majority system.”

This amendment would require the mayors of combined authorities to be elected using the simple majority system, also known as “first past the post”.

Government amendments 37 to 45, 50 and 52 to 55.

[Mr Allen]

One of the difficulties involved in the debates we have had on this so-called constitutional Bill is that they have taken place on the Floor of the House. If we were upstairs in Committee and having detailed debates about particular places and particular boundary issues, the Minister could say, “The hon. Gentleman has made a very good point. I will take it away, talk to one or two authority leaders and issue a few words of reassurance.” On the Floor of the House, however, given the rather clunky weapons at our disposal—such as a Division of the House—they become much bigger issues. I congratulate the Secretary of State and his team on bringing the devolution process to the House, but rather than it being seen as the first step of many, it is lapsing into the good old confrontational stuff that we seem to enjoy so much on the Floor of the House.

Even under that structure, however, we can do a number of things in the Chamber this evening. We need to seek a more consensual way forward and understand that devolution is an organic process and that it will evolve. Once the deals in England have been concluded, they will make progress and other demands will be made. People will see that they can do things that they could not do before. They will look at neighbours who have concluded deals and say, “I’d like to try a little bit of that. I think I’ll talk to the Secretary of State.” The Secretary of State may well suggest to some places, “Things have been done by another place that you could also do.” To other areas, the Secretary of State and/or councils may say, “Perhaps we bit off a little more than we could chew. Let’s take half a pace back, let this settle and then come forward with other proposals in the future.” That process is not very amenable to debate on the Floor of the House of Commons. Almost by definition, it is better done, first, in Committee, and secondly, by the key players—council leaders and Ministers—talking openly and transparently to take forward the process.

[John Redwood (Wokingham) (Con)]

The hon. Gentleman is making a very thoughtful speech. Does he not agree that the fact that devolution is being driven at pace by the Scottish agenda means that there is no time to have such a convention on the big devolution to Scotland, and is it not time for England to have matching devolution if Scotland is going to get so much?

[Mr Allen]

The right hon. Gentleman talks about moving at pace and then immediately suggests that England should have what Scotland has. I would go with the latter of his contradictory points: in such devolution Bills, England should have everything that has been obtained by the Scottish people. To round out the package, England should in particular have not just the powers but the financial capability to make the powers real.

I will talk later about new clause 5, which says that we can have income tax assignment to England, in just the way it pertains to Scotland, without civilisation as we know it falling apart. I would add that that would renew and strengthen the Union, which will need to happen in future decades, as a federal entity in which the nations of the Union work together very closely as a family, but all retain a degree of income tax in their areas to make their own country work effectively.

[Norman Lamb (North Norfolk) (LD)]

I share the hon. Gentleman’s view about financial powers going alongside the responsibility for providing services, but does he not agree that there is a case for devolving responsibility for income tax to below the England level? Most local services in Sweden, for example, are run through tax raised locally, rather than at national level.

[Mr Allen]

I am delighted to hear the Liberal Democrats proposing something in opposition that, sadly, they did not propose when they were a key member of the coalition Government during the past five years. Before Labour colleagues smile too much, however, the previous, Labour Government also did very little on this matter. [Interruption.] My hon. Friend the Member for Blackley and Broughton (Graham Stringer) says that they did. Obviously, I would never be so disloyal as to underline such remarks by repeating them on the Floor of the House, but—

[Mr Speaker]

Order. At any rate, the hon. Gentleman would certainly not have done so in those almost forgotten days when he was a Whip.

[Mr Allen]

Indeed, Mr Speaker. We all have scars and sins that are best left unrevealed; otherwise that can turn into rather a destructive process. If we look at the constructive process initiated by the Secretary of State, there is a way forward. To finish my answer to the right hon. Member for North Norfolk (Norman Lamb), double devolution has repeatedly been raised by colleagues from all parts of the House in different ways. Let me restate that it would be ludicrous for England to go the way of Scotland, where there is devolution down to Holyrood, but we can hear the sucking sound—Ross Perot used to hear a “sucking sound” in the United States from Mexico—of powers being sucked up from the localities in Scotland into Holyrood. We do not wish that to be repeated in England, which means, as the right hon. Gentleman said, that there must be a proper localisation of power if the devolution bandwagon and evolution are to continue.

--- Later in debate ---

[James Wharton]

I intend to speak at greater length on this issue, but as the hon. Gentleman has given me the opportunity to do so I would like to make it clear that the amendment gives any council, including districts, the permission to request to be removed from or added to a combined authority. My right hon. Friend the Secretary of State will review the case put forward by a council and make a decision on whether the request can proceed, but I can reassure the House that any such decision would, where possible, be made only following consultation and negotiation with relevant parties. In all cases, we would endeavour to seek and secure the consensus that I think has characterised many of the discussions we have had in a range of places so far, and which is so important in underpinning the Government’s approach to devolution more generally.

[Mr Allen]

I am sure that those words will have been heard throughout the Chamber and, more importantly perhaps, by all those who care about, or are in positions of authority in, local government. I very much hope that they take the message that the Government and the House are keen for there to be progress on devolution, and that it should occur on the basis of consensus, interaction and negotiation facilitated by the Secretary of State and the Government.

The people who have interacted with the Secretary of State and the Minister will make their own judgment on whether the Secretary of State can be trusted on these matters. As far as I am concerned, however, the Secretary of State has got us to this position on devolution, which, as I mentioned earlier, was not possible under the previous coalition Government or the previous Labour Government. Is it perfection? No. Is it genuine progress? I hope the answer to that is most definitely yes.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

All this consensus can sometimes feel a little bit disconcerting, but I think it is a good thing. The fact that the Minister has underlined and put it on the record, in respect of Government amendment 27, that consensus would have to be achieved—this is not about particular councils having vetoes or unilateral capability, but a negotiated process—is a very important step.

[Mr Allen]

I can barely believe that my hon. Friend would be anything other than consensual. In recent weeks he has perhaps been known as being on the provisional wing of the Labour party, but his innate character is that of seeking consensus. I agree very strongly, as I always do, with my constituency neighbour. I hope colleagues throughout the UK adopt a similar view and take us forward on this issue.

[Jenny Chapman (Darlington) (Lab)]

Is my hon. Friend concerned that there are absent voices from the consensus thus far, in the shape of the public, who are not always involved or even aware that these kinds of deals are going ahead? I realise it is difficult, but do their voices not need to be captured somehow, too?

[Mr Allen]

To an extent, their voices have to be captured by those who seek elected office, whether in this House or in the locality. Devolution is just one part of a broader democratic settlement. It is essential that it is not just the great and the good who are involved. As I outline in new clauses 1 to 4, there has to be the most tremendous unprecedented outreach. A citizens convention must go way beyond even what we saw in Scotland, either in the referendum campaign or in its own citizens convention, and use all the modern techniques of social media, technology and electronic polling, so that people can feel ownership. My hon. Friend is absolutely right that unless we build that in, and unless people feel that a proper debate has been had, the process could be stressed and fractured when people feel that the right thing has not been done. I would argue, therefore, as with new clauses 1 to 4, that we will need a broad-based exercise involving an unprecedented level of public participation in order to settle our democracy not just for the next four years but so that it holds for 100 years after that. That cannot be done on the back of us alone making these decisions.

Madam Deputy Speaker, I seek your advice on a matter of order, although I do not know if I am entitled to do so in the middle of a speech. There are amendments on health. Should we talk about those matters now or wait for a natural break?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The hon. Gentleman asks a perfectly reasonable question, and, just for once, it is a question that the Chair can answer. The answer is no. The matters relating to health are in the next group, of which the lead amendment is new clause 9. We should discuss health at that point.

[Mr Allen]

That is very helpful, Madam Deputy Speaker. In that case, I will limit my final remarks to a brief consideration of manuscript amendment (a) to amendment 56, which bears my name. Amendment 56, which I wish well, seeks to provide some welcome flexibility to allow for the organic growth and development of our devolution proposals. The Secretary of State, who needs to be reassured that the process will not drag on forever, has proposed a manuscript amendment that puts an end date on discussion. Colleagues and local authorities will have an opportunity, a gateway, a window—whatever metaphor we wish to use—in which to make representations. That process will not drag on forever, but there will be a lot of time to make those representations, which seems very appropriate. On that basis, I am pleased to have added my name to amendment 56.

This large group of amendments covers many other areas, including issues on which I could speak at some length, such as votes for 16 and 17-year-olds and a governance review. The latter will be very important. I believe that there are now 34 or so devolution deals. As we develop those, there will be much best practice, which, by definition, we cannot learn from mid-process, around what has been devolved and how, and around how local authorities can use their powers. It will all be at different levels and different speeds—because, again, devolution means people doing their own thing, not taking a one-size-fits-all approach—but there will be a place for a gathering and sharing of best practice by local government so that the next set of deals, building on the pre-existing deals, can be done in the best way.

We do not currently have an institution that can do that. Despite the excellence of the officials in the Department, we do not have what local government might regard as an independent institution to take that forward. It makes a lot of sense, therefore, to have a review at an appropriate time. It might not look that way to the Secretary of State, who is battling through a set of deals with lots of interested individuals—and that can only be his main priority—but, when the dust settles, it will make sense to have an adjunct to the Local Government Association, or whatever local and central Government come up with, to make sure that all the learning from the first set of proposals is carried over to the next set.

With that, I shall draw my remarks to a close. We now have a set of devolution deals, and the boulder is rolling forward. We need to keep the momentum going, so I hope that everyone will wish the Bill well.

--- Later in debate ---

[Alison Thewliss]

I wish briefly to go through some of the new clauses and amendments. The hon. Member for Nottingham North (Mr Allen) makes points in new clauses that have been made before in previous debates. His new clauses 1, 2, 4 and 6 include Scotland, as part of the United Kingdom. As local government is entirely devolved to the Scottish Parliament, and the UK Parliament has no scope in that matter, he has perhaps made an oversight in his proposals. In new clause 6, he wishes to make local councils in England equivalent to the Scottish Parliament, which also is not quite appropriate—after all, they are not the same things. The Scottish Parliament is a Parliament, rather than a local authority, and they are very different items.

[Mr Graham Allen]

The hon. Lady is misunderstanding me and I need to clarify my remarks. I am not at all equating a local authority with the Scottish Parliament. I welcome the Scottish Parliament, which is one of the Labour party’s greatest achievements. Donald Dewar and all those people who were in the citizens convention have created, often without the co-operation of the Scottish National party, a magnificent institution. I just have a degree of jealousy that the powers that have rightly gone to Scotland are not coming fast enough to England and to those of us in the rest of the Union. If we are Unionists, we think that the good things that can happen in one country can happen in all countries of the Union.

[Alison Thewliss]

I am not sure that the hon. Gentleman includes me in the statement that we are Unionists, because I am not necessarily—

[Mr Allen]

I say that only because the hon. Lady is elected now to the Union Parliament. This is not the Scottish Parliament and therefore we speak here, all of us, as part of the Union Parliament in Westminster.

[Alison Thewliss]

The hon. Gentleman’s new clause 5 refers to

“the desirability, impact and process necessary to give English Councils the same fiscal and taxation powers as those devolved to the Scottish Parliament in the 2012 Scotland Act”.

That seems to me as though he is drawing a comparison between the two, and I am not convinced that is entirely appropriate.

The right hon. Member for North Norfolk (Norman Lamb) eloquently put the case for new clause 10, and I, too, absolutely support votes for 16 and 17-year-olds. It is a shame that the Government are not taking the opportunity at least to trial it in local government, as it would be a worthwhile trial. If they are not prepared to bring forward comprehensive legislation to change the franchise for all elections, it would be nice if they were willing on this occasion at least to try it in this way, because it is very much worthy of examination. It has worked well in Scotland; the 16 and 17-year-olds who were given the vote on the referendum were very engaged and have remained engaged. Those who were younger were not able to participate but they still had greater interest in the democratic process as a result—they paid attention. A lot of them felt very aggrieved that they were not able to participate, but, as was said earlier, the bar has to be set somewhere and 16 is a reasonable place to put it. That has worked well in Scotland and I very much encourage it here.

On new clause 12, it seems reasonable to review how the NHS is treated in the devolution deals. It seems reasonable to see how that is working, and perhaps more powers need to go across if things could work better.

On amendment 2, tabled by the hon. Member for Hazel Grove (William Wragg), and amendment 58, I have lot of sympathy for his comments about the imposition of mayors on local authorities. Some of the evidence that we heard in Committee on this issue suggested that it is perhaps not being fair to local government to say, “You must take a mayor in exchange for these powers.” I have a lot of sympathy for the points he makes. As I said earlier in this process, the Glasgow and Clyde Valley city region deal did not require a mayor in Scotland, so it is not a blanket policy of the Government to apply this provision in every circumstance. I believe that the Duchy of Cornwall has not had a mayor imposed upon it at this stage. Evidence was given in that respect in Committee.

On amendment 3 and the supplementary vote system, I am not sure that that system is necessarily the best one for electing anybody. I have been elected under the single transferable vote in Scotland and under first past the post here, and I believe that the first- past-the-post system is far from ideal in terms of democracy. I cannot understand why anyone would want to put first past the post back into an electoral system—perhaps there will be more explanation of that later—when the majority of research suggests it is the least fair way of electing people to any system of government.

I thank you for your time, Madam Deputy Speaker. That is all I have to say today.

--- Later in debate ---

[Mr Rees-Mogg]

I do not think the Prime Minister had any intention of making me the Secretary of State for Health, but now that he has heard from the hon. Gentleman, I am sure that he will not.

We will return to the legitimacy of these changes if there are no referendums. Although the Government might well push the provisions through and order these mayors to be appointed, if there is not that validation through referendums the component parts of the super-areas will chafe. They will say, “We are paying taxes to pay for the centre of a city to which we have no real link. We would rather be run from Whitehall than by these funny people in a town hall with whom we have no real link.” The referendum lock follows the grain of the developing referendum theory of government in this country and will ensure that the process is more successful in the long run. In opposing the amendment, the Government are probably being short-termist.

I promised the hon. Member for Glasgow Central that I would come on to the amendment about first past the post and why I have put my name to it. I am very grateful that my hon. Friend the Member for Hazel Grove proposed it, and had he not done so I would have tabled my own amendment. I believe in first past the post as the fairest electoral system. I think that people get what they vote for rather than what they do not vote for. They get what they most like, not what they least dislike. The fundamental problem with proportional systems is that nobody gets what they want. Everybody gets something else, because the votes go off in all sorts of different directions.

[Mr Graham Allen]

Does the hon. Gentleman feel that the 50% of people in Scotland who voted for non-separatist parties got what they thought they were getting when they received only three Members of Parliament to represent them whereas the other 50% got 56?

[Mr Rees-Mogg]

The hon. Gentleman makes my point for me. They got exactly what they wanted. They got a referendum that decided that they would remain part of the United Kingdom and then they voted for champions to come to this place and represent them constituency by constituency. That is how first past the post works. I wish that they had all voted Conservative; it is a great shame that they did not. The system worked effectively to represent what most people in Scotland wanted. Sadly, most people in Scotland did not want the Conservatives to have 56 MPs. How that aberration could have come about, I do not know, and I am sure that in time it will change.

--- Later in debate ---

[James Wharton]

I will give way when I touch on some of the points discussed earlier if the hon. Gentleman wants to comment at that stage.

As I have already spoken about new clause 1, I want to talk about new clause 5. It proposes that a commission be set up to consider devolving tax and fiscal powers to local level. I well know that the hon. Member for Nottingham North (Mr Allen) is an advocate of devolving power from central Government, so he will be familiar with the successive inquiries that have covered similar ground to what he proposes. I therefore do not think that a further inquiry into tax power devolution to local government would serve a particularly useful purpose at this time, although I recognise, as always, his consistency and eloquence in bringing such matters before the House. I hope that he will not press his new clause 5 when we reach the end of this group of amendments.

[Mr Graham Allen]

Given that there is now no need for an inquiry, since there is a precedent in Scotland—I congratulate Scotland on being able to retain an element of income tax—there is nothing in the water in England to stop us having income tax assignment as well. On the basis that there is now something stronger than an inquiry in the form of a precedent, approved by the Treasury and by this House in the Scotland Act 2012, I gladly agree not to press new clause 5.

[James Wharton]

I thank the hon. Gentleman. I recognise what he says. There are complexities in devolving such matters to local government, but I am sure he will continue to argue, as such matters are discussed, that he wants those complexities dealt with in reality, rather than just in theory.

New clause 8, tabled by my hon. Friend the Member for Altrincham and Sale West (Mr Brady), would provide a cooling-off or probationary period for the conferral of functions from a local authority to a combined authority. I know that my hon. Friend has raised that matter in discussions during previous stages of the Bill, and that it is of great interest to him.

I can see the attraction that the flexibility to reverse a conferral of powers might have for an individual local authority, but there are considerable downsides. The very fact that the combined authority might be responsible for those powers for only a year or so might be conducive to little action being taken under what would perhaps be perceived as a temporary conferred function. The combined authority would almost certainly be reluctant to base any investment or other major activity on a function that it could lose in a few years’ time. Moreover, partners, whether businesses or other public bodies, would almost certainly be reluctant to enter into arrangements that could so quickly be reversed. We consider, therefore, that it would be very doubtful that activity within that probationary or cooling-off period of any such conferral of powers would give a realistic picture of how a combined authority might operate in the future or of the full range of improvements that might be achieved.

We consider that a better alternative, if local authorities are not sure whether they wish to confer a specific power, would be for them to trial such joint working across the area of a combined authority through informal arrangements, such as a shadow combined authority or joint committee. Those models are available to local authorities and combined authorities without the need for secondary legislation to be made. I therefore ask my hon. Friend the Member for Altrincham and Sale West not to press new clause 8 to a Division of the House.

New clause 10 seeks to reinsert the clause that was inserted in the other place to amend section 2 of the Representation of the People Act 1983 to lower the minimum voting age from 18 to 16 for the local government franchise in England and Wales. We debated that provision at length when we last met in Committee, after which we agreed to remove the clause by a significant majority of 95. The message was clear then and it remains clear now.

We have discussed quite widely the age of majority and the things that 16 and 17-year-olds are able to do or are prevented from doing by law. It has been suggested that because young people are politically engaged, and quite rightly so, they should be given the vote. That is a conclusion with which I do not agree. The debate has exposed the wider truth that there is a range of views, many of which are enshrined in legislation, that can best be described as encompassing the transition from childhood to adulthood. There is probably no clear point at which a person becomes an adult, but it is at 18, not 16, that society normally draws the line.

Any change to the entitlement to vote must be considered properly. We should not make piecemeal changes to the franchise. We cannot make changes and simply assume that there will be no implications for other areas where our laws and our society treat 16 and 17-year-olds differently. The voting age for UK parliamentary and local elections is set at 18. The age that is used in most democracies is 18. The Government have no plans to change it. Indeed, my right hon. Friend the Member for Wokingham (John Redwood) reminded the House last time we debated this matter that we have no manifesto mandate to do so. Recognising that the shadow Minister says that he intends to test the will of the House on this issue, I encourage all hon. Members to support the Government and oppose the reinsertion of this clause.

New clause 11 requires that the Secretary of State must, within 15 months of the Bill being passed, publish a review of the fire and rescue services affected by the provisions of the Bill. The new clause is not necessary. Devolution is about enabling local areas to determine how best their services are delivered. It is therefore only right that fire and rescue authorities, in agreement with local partners, should decide how and when to review and assess how the provisions of the Bill may affect fire and rescue services. I remind hon. Members that the requirements of the fire and rescue national framework will continue to apply. With those explanations, I hope the Opposition will not press the new clause.

Turning to new clause 13, we are already taking major steps to devolve local taxes and have only just set out plans for a radical devolution of fiscal powers. By the end of the Parliament, the local government sector will retain 100% of local taxes to spend on local government services. For the first time in decades, local areas will see the full direct benefit of business rate growth in their local area. We will also grant new powers to directly elected mayors and to authorities. We will give all local authorities the power to reduce business tax rates to support businesses in their areas. As was confirmed in the spending review, we will set out detailed proposals in due course. In the light of that, I hope the House will agree that this new clause, which would require the Secretary of State to set out a framework for further devolution of fiscal powers, is unnecessary. I hope, therefore, that the shadow Minister will agree not to press it.

New clause 14, which was tabled by the Opposition, would require the Secretary of State to issue guidance to combined authorities on co-operation with peripheral authorities. I do not believe that it is necessary or appropriate. Before making orders establishing a combined authority and orders devolving new functions to such an authority, the Secretary of State must consider that to do so is likely to improve the exercise of statutory functions in the area or areas to which they relate. Additionally, Parliament must approve such orders.

The new clause seeks to provide a further requirement about how, once established, a combined authority should go about the exercise of functions devolved to it. As with local authorities, combined authorities must have regard to all relevant considerations in taking their decisions. Just as local authorities cannot be blind to the impact of their decisions beyond their boundaries, nor can combined authorities. Neither local authorities nor combined authorities can be ignorant of what happens beyond their borders. We do not have these provisions for local authorities and it is the position of the Government that we should not impose them on combined authorities. Therefore, the new clause is neither necessary nor appropriate. I hope that the House will agree.

Amendments 4, 5 and 6 were tabled in response to an amendment tabled in Committee by my hon. Friend the Member for Altrincham and Sale West. The first of those amendments will ensure that the Secretary of State’s annual report on devolution to Parliament includes information on the extent to which powers that have been devolved to a mayor remain exercisable by a Minister of the Crown. Amendment 5 is a consequential amendment to amendment 4, while amendment 6 defines the phrases “combined authority” and “Minister of the Crown”. Although it is the Government’s intention that functions should be devolved as widely as possible, there may be circumstances in which they should be exercised either jointly or concurrently. With those explanations, I hope that hon. Members will accept amendments 4, 5 and 6.

If amendment 58 were accepted, it would mean that any transfer of functions to a combined authority must not be dependent on the combined authority having a mayor. In its intent, it is similar to the provisions of the old clause 3, which the Committee voted to remove from the Bill by a majority of 81. That provision imposed a specific requirement that a mayor could not be a precondition for transferring functions to a combined authority. As I told the Committee, that provision was at odds with our manifesto commitment, and amendment 58 is too.

In our manifesto, we committed to

“devolve far-reaching powers over economic development, transport and social care to large cities which choose to have elected mayors.”

We are not forcing this on anyone or on any place. Whether an area has a mayor is a matter of local choice. However, if an area wants to have a devolution deal of the scale and ambition of Greater Manchester’s, we do expect a mayor to be part of the deal. The effect of amendment 58 would be to stop our pursuing that manifesto policy. It would potentially put the whole future of devolution at risk of challenge. It is an amendment to which we are wholly opposed and that we hope will not be successful should the House choose to divide on it.

Amendment 2 provides that a combined authority mayor can be established only after a referendum. I listened with great interest to the comments of my hon. Friends the Members for Hazel Grove (William Wragg) and for North East Somerset (Mr Rees-Mogg). My hon. Friend the Member for North East Somerset was, as ever, persuasive and eloquent, but on this occasion, I am afraid to say, he was not quite persuasive enough. The amendment would require the Secretary of State to make regulations governing the conduct of such referendums and to consult the Electoral Commission before doing so. We had an interesting debate on the first day of Committee about this very matter. I recognise that I was repeatedly challenged by Members from both sides of the House about the degree of choice for local areas.

While I do not seek to reopen that debate, I must make it clear again that the Bill does not give the Government the power to impose devolution or a model of devolution in any area. The decision to approach the Government with a proposal for the devolution of powers and the decision on the degree of devolution required are entirely local ones. By the same token, we have always been clear that where areas make that approach to negotiate the significant transfer of powers, like the powers agreed with Greater Manchester, we would expect a mayor to form part of the mix, as that provides the levels of leadership and accountability that are necessary to ensure the effective delivery of such a deal.

--- Later in debate ---

[James Wharton]

The intention is to deliver what local areas want, and therefore the Bill gives us the flexibility to ensure that the county would not need to be reshaped, but equally, where that was wanted, it would give us the flexibility to deliver it. That is the point of the Bill, as an enabling Bill. We want to proceed by consensus, because that is how devolution will last.

Amendment 1 would enable the Secretary of State to make provision in secondary legislation to require all local authorities in the area of a mayoral combined authority to undertake a community governance review within two years of the Act coming into force. Whatever the merits of “parishing” an area, I do not believe the amendment is necessary or appropriate. I recognise the desire for further devolution and for the devolution debate to continue, including on the role of more local decision making and parishes, but this is not the time or place to go down the route set out in the amendment. I hope, therefore, that hon. Members will agree not to press it.

[Mr Allen]

I will be delighted not to press amendment 1, if the Minister can tell the House what shape or structure will be in place to pull together the best practice from all 34 devolution deals for drawdown by those who wish to do further deals.

[James Wharton]

We will be talking about that with the LGA and other interested parties, but we are still in the process of delivering those deals and it would be against the spirit of devolution were we to announce the format for such a forum. I recognise the hon. Gentleman’s comments, however, and the value that such a forum could bring. I am happy to put that on the record. It is our intention to have those discussions and to develop something that has broad agreement.

My hon. Friend the Member for Carlisle (John Stevenson), who cannot be with us today because of the terrible flooding that has afflicted his constituency, has tabled amendment 56, which would enable the Secretary of State to use a fast-track process for unitarisation or boundary changes in a particular area. I suspect I am going to take a few interventions on this amendment, but I wish to highlight this point: it enables a fast-track process and streamlines the use of existing powers; it does not bring in powers that do not already exist. He tabled a similar amendment on the first day of the Committee of the whole House, with a view to ensuring that no one council could effectively veto such a change, however sensible and supported such a proposal might be.

My hon. Friend wished to see a way of preventing one council from denying change that might be in the best interests of the wider area. We have heard further arguments today about the proposition, particularly from my hon. Friends the Members for Cleethorpes (Martin Vickers) and for Amber Valley (Nigel Mills). When we debated this last time, I made clear our approach: if such a governance change were to be made, there needed to be a level of consensus across the area and that we are not in the business of imposing change on any one. That remains our starting point and our intention.

--- Later in debate ---

[James Wharton]

I remind my hon. Friend of my earlier comments: those powers already exist. The Government’s intention is to find consensus, to build on the local desire for devolution and to deliver lasting devolution to areas that will benefit from it. Those powers are already there. This is about ensuring we can deliver, in a timely way, the devolution that local areas want, but I can absolutely reconfirm the Government’s commitment to seeking and building on consensus. That is how devolution will stand the test of time.

Amendments 16, 30 and 55 ensure that criminal liabilities of a public authority can be transferred to either a local government or combined authority on the same basis as other liabilities when public authority functions are conferred. Amendments 17 and 31 amend clauses 7 and 16 respectively and allow references in a transfer order or regulations to be made to a formal document, such as guidance, which can be amended from time to time.

Amendment 36 is a technical amendment substituting the original word “jointly” with the new word “concurrently”. The change is necessary to ensure that certain transport functions being carried out by strategic transport bodies and local authorities can be undertaken concurrently rather than jointly. Amendment 3 would change how mayors for combined authorities should be elected. We have debated this matter at length. We believe that, where we are electing an individual to exercise significant executive power, the voting system for which we have made provision is the right one, and that therefore the amendment should be rejected. Finally, amendments 10, 37 to 43, 45 and 44 are necessary to bring the Bill into line with the arrangement in London. They provide clarity and consistency in respect of mayoral deputies with police and crime commissioner functions.

I hope that hon. Members will accept the Government amendments and reject Opposition amendments and that the House will continue broadly to support the delivery of devolution, on which there is so much consensus and support.

[Mr Allen]

I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 9

Consultation on changes to healthcare provision

‘(1) Part 4 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 is amended as follows—

“(1) In section 20 (Interpretation) insert after “for which there is a country council (a);”—

“(c) combined authorities and each constituent part of a combined authority””—(Mr Graham Brady.)

This amendment requires that constituent parts of combined authority are consulted on any major healthcare reorganisation in their area in addition to the combined authority being consulted. It also allows constituent parts of a combined authority to refer any such reorganisation to the Secretary of State for Health without such a referral having to be made by the combined authority to which they are part.

Brought up, and read the First time.

[Mr Graham Brady]

I beg to move, That the clause be read a Second time.

[Mr Brady]

It might help if I indicate now that at the appropriate time I shall seek the leave of the House not to press new clause 8 and amendment 57. Ministers should not take that as indicating that I am entirely satisfied with the responses I have received, but I may be able to find other ways of expressing that dissatisfaction.

The immediate reason for tabling new clause 9 and why I am so concerned about this aspect of the Bill is that we already have a live example in Greater Manchester. I shall not go into huge detail, but because of the difficulties relating to the Healthier Together proposals for the reorganisation of hospital services, the matter will be decided by judicial review this week.

The new clause was tabled in the hope that we can frame the legislation in such a way that proper protection can be given to local authorities and local communities to ensure that this sort of development is not necessary in future. Should, furthermore, the judicial review overturn the existing proposals, it is important to ensure that they cannot simply be imposed in a different way.

The crucial problem is that the existing combined authority arrangements have combined the overview and scrutiny functions of individual local authorities. With the potential downgrading of the University hospital of South Manchester, for example, the usual route of going through Trafford’s or Manchester’s overview and scrutiny committee and referring the matter to the Secretary of State, asking for it to be put to an independent reconfiguration panel, was not available because the overview and scrutiny function was exercised not at the individual local authority level but at the combined authority level.

The Minister for Community and Social Care looks confused, but I assure him that when I had discussions with the Secretary of State he advised me that this was the route to be taken. I then took it to Trafford council, which said that it did not have the overview and scrutiny function and that it was exercised at the combined level. That is the nub of the problem. Significant parts of a conurbation such as Greater Manchester, which may in due course become a mayoral authority, might have no recourse, should a significant reorganisation of health services be proposed that was evidently not in the interest of the local community.

It is a simple proposition that I make in new clause 9. The Minister and I have had some extremely constructive conversations prior to this point, and I hope that he will reassure me that some measure will be introduced—if not today, via a Government amendment in the House of Lords—given that changes to these aspects of the Bill might be made through Government amendment 34. There is, I understand, a peg on which to hang that provision. All I am looking for is the simple reassurance that the Government will ensure that there will always be a route for an individual local authority to make the kind of reference that would have saved enormous cost, uncertainty and trouble in Greater Manchester had it been in place as of today. I very much look forward to hearing the Minister’s response and any reassurance that he might give.

[Mr Graham Allen]

I would like to comment on this group, which includes my own amendment 60. It is relevant to what the hon. Member for Altrincham and Sale West (Mr Brady) has talked about in moving his new clause 9. My anxiety is that the welcome devolution that is taking place—the precedent of devolving health powers to localities is particularly welcome—suggests something of “the Empire striking back”, with the Whitehall Leviathan seeking to place a caveat on the devolution of health powers. What is being set up is the ability of the Secretary of State to revoke health functions from the relevant local authority.

I fear that somebody in the Department of Health might not approve of a devolution proposal within a given area. Let us say that the cities of Nottingham or Manchester—or indeed anywhere represented by hon. Members in their places for this evening’s debate—wished to do something innovative and interesting on public health because it matched the demography in the area. What it might not match, however, is the view of people in the Department of Health. Such people might have a one-size-fits-all masterplan that they would like to impose on everybody.

My difficulty is that if we allow the Secretary of State to pull back to the centre any of these powers, there will be no safeguard in law to prevent that from happening. The Secretary of State could attempt to launch an effort at devolution, but we see again and again what can happen when the dead hand of Whitehall lies upon local government and the charitable and voluntary sectors. A year could be granted to get on with it, with a local authority either allowed to raise its own money or be given some money. If, however, the Department does not like it, it could be pulled up by the roots.

[The Minister for Community and Social Care (Alistair Burt)]

I should not be, but I am tempted to respond. If that is the hon. Gentleman’s concern, why should the Secretary of State sign the order agreeing the devolution in the first place if it does not fit in with his masterplan? If he is going to take back the powers in due course, why would he give them away in the first place?

[Mr Allen]

The Secretary of State does have the power to pull back those experiments and those efforts at devolution. That is why I am bringing forward my proposal. If the Secretary of State is not concerned, he would have no worry about the ability of an independent panel to say, “Hang on—give these guys the amount of time they need to experiment” rather than have to deliver to a Whitehall timetable. That amounts to a contradiction in terms: devolution on the one hand, with the Secretary of State pulling things back into the centre on the other hand. My proposal—which I am sure the Minister can understand—is for the establishment of an independent panel, which would not consist of the Secretary of State and his advisers, but would include representatives of local government where the devolution was taking place and representatives of the national health service. That would enable the medical side to be looked at effectively, and separately from the Secretary of State. It would end the constant process that has driven devolution: the interference of Whitehall, often in the very short term, because someone somewhere in the Department of Health—some unknown person—does not like what is being done in the locality.

[Mr Graham Brady]

Is not the fundamental point that the Bill that we are about to pass may remain on the statute book for many years? The current Secretary of State may be fully committed to devolving these powers, but a future Secretary of State might wish to suck all of them back to Whitehall.

[Mr Allen]

That is always a problem, but in that eventuality, if the amendment were passed, an independent panel would keep an eye on it to ensure that, if the Minister were not the one who is in the Chamber now but someone more malign than he, it would be possible for the independent panel to blow the whistle and say, “You have not given people in this particular area”—whether it was Enfield, Stoke or anywhere else in the country—“a chance to prove that this part of the devolution of the health service is working effectively. You have a particular view”—perhaps in connection with the need to react to a scandal or a financial problem—“and you are not acting on the basis of the good of the people in the area, but retrieving from them their ability to devolve effectively and use health powers effectively.”

--- Later in debate ---

[Alistair Burt]

I rest my case with my hon. Friend: I believe that legislation currently provides the reassurance that he seeks. However, I undertake that, before the matter is concluded in the House of Lords, we will ensure that that assurance is there so that he is covered. He is absolutely right to make sure that his local authority has the opportunity to make representations when it needs to. I am sure that the legislation does that, but we will make doubly certain that it does.

[Mr Graham Allen]

It may well be that the current legislation covers this eventuality, but the Government’s amendment 34 makes it very clear that local government will not be consulted. If the hon. Member for Altrincham and Sale West (Mr Brady) would like quickly to peruse that amendment, he will see that local authorities will have no say whatever if devolved powers are taken back to the Department.

[Alistair Burt]

I will happily cover amendment 34 in a moment. Indeed, perhaps I should speak to that amendment before I turn to amendment 60, which has been tabled by the hon. Member for Nottingham North (Mr Allen), just to make it clear what amendment 34 is about.

Amendment 34 mirrors part of amendment 19 and amends clause 17 to provide that the requirements for combined authority and local authority consent do not apply to regulations revoking previous transfers of health service functions under clause 16. Proposed new subsections 1E and 1F, which amendment 19 would add to section 105A to be inserted by clause 7 into the Local Democracy, Economic Development and Construction Act 2009, also have the same effect in relation to health functions transfers under section 105A which are revoked.

This means that in the event that it becomes appropriate to restore NHS functions in a local area to NHS bodies, this can be achieved without the need for consent of the combined authority and local authorities concerned. This reflects the fundamental principles for health devolution, as reflected in clause 18, which builds on an amendment moved by Lord Warner in the other place, that the key responsibilities for the Secretary of State for Health and the NHS remain unchanged in any devolution arrangements. We envisage using the powers to revoke only in those circumstances where it was clear that duties and standards such as those referenced in clause 18 were not being met and that revoking the transfer was the best option to achieve the necessary improvement in performance.

The Secretary of State’s ability to use this power supports the key principle, which this House has already agreed and which the House of Lords was also insistent on, that nothing about devolution settlements will impinge on his duties in respect of the national health service, including the duty to promote a comprehensive health service, to exercise his functions with a view to securing continuous improvement in the quality of services and to have regard to the NHS constitution. The other procedural requirements and preliminary conditions will continue to apply, such as the requirement that the Minister making the regulations must consider that the instrument is likely to lead to an improvement in the exercise of the functions concerned, and that Parliament must approve the secondary legislation.

Let me explain in straightforward terms what this is about. The House has already agreed that it wants to retain the national health service, even if NHS functions are devolved to local authorities. That means that the duties of the Secretary of State in relation to the NHS remain absolute. As I said earlier, if the Secretary of State is to sign off these powers to commission services to a local authority, he has to be sure that doing so is in the best interests of healthcare and that the quality of healthcare will be improved. Otherwise, he just will not do it. There will not be any consent involved, or anything else; he just will not do it. However, if he signs it off, it means that he is satisfied that there will be an improvement in the quality of healthcare. Should that fail—should the NHS functions transferred to a new authority fail—it is the Secretary of State’s duty to take those powers back, because he is responsible for the delivery of NHS standards. If he cannot be satisfied, he is going to have to take these powers back. In the circumstances, it is possible that local authorities might disagree and want to challenge that, but his duties are absolute. That is why the requirement for consent is coming out. We are talking about a circumstance that nobody expects to happen. The Secretary of State is not going to devolve unless he is certain, but if he needs to take powers back to maintain his duties, he must have the power to do so. Even if he has to do so, the matter goes before the House, which makes up its mind on it. That is the basis of Government amendment 34 and the answer to amendment 60.

[Mr Allen]

That is exactly the difference between decentralisation and devolution. This proposal is the Secretary of State pushing some power to the locality, purely on the basis that he can suck it back; it is not giving power and, as of right, allowing the local authority to exercise that. There is no way in which the local authority can intervene in this process. It is a bystander, as an agent of central Government.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

The interventions must be shorter, as I still have to get the Front Bencher in.

[Alistair Burt]

The hon. Gentleman is coming at this from the wrong point of view. He is coming at it from the point of view that the Secretary of State is deliberately pushing something towards an authority, but he is not—the authorities are asking him for something. He would not be doing that unless authorities came to him and said, “We want to do this.” The Secretary of State would not agree unless he thought it was in the best interests of healthcare, because it is not his personal judgment but his duty. If those functions are not performed properly, his ultimate duty, which the House has already agreed, must be to take the powers back. The hon. Gentleman is approaching it from the point of view that there is something malevolent about the Secretary of State which means he wants to challenge the authority. The duties he has, which are contained in statute and which the House says he must retain when NHS powers are devolved, are what impels the amendment, nothing else.

[Mr Allen]

rose—

[Alistair Burt]

I will give way one last time, but then I must finish dealing with the rest of the clauses.

[Mr Allen]

The Secretary of State may be doing the right thing—I am sure he would be, just as I am sure the local authority would think it was doing the right thing—but my amendment 60 and our new clause would allow there to be a local government representative and a medical NHS representative judging who is right in the decision about central power and local power. They, too, would make the right decision.

[Alistair Burt]

Let me turn to the independent panel idea in amendment 60, which the hon. Gentleman has tabled. The Bill provides an effective framework to support a more devolved, place-based approach to health and social care, while ensuring that there are appropriate safeguards in respect of the NHS and a clear line of accountability back to the Health Secretary. Our objectives for health devolution must be to improve the health and care outcomes for people residing in a particular local area. Clause 18 requires that where health functions are conferred by an order or regulations on a combined authority, provision must be made about standards and duties to be placed on that authority, including standards in the NHS constitution.

The Secretary of State needs to be satisfied that revoking the transfer would lead to an improvement of statutory functions in that local area. He is under the same duties if he revokes as he is when he grants the powers in the first place. The revocation would need to be debated and approved by both Houses of Parliament, and the Secretary of State would be required to make available to Parliament a report concerning his decision, including what representations had been made to him in the process. That demonstrates that the decision to revoke transfer regulations would be taken only as a consequence of in-depth consideration, as well as engagement with local organisations, and with the support of Parliament. For that reason, I resist the requirement to convene a panel to review the decision, which would not only be unnecessary, but could be burdensome and costly, and could lead to delays just at the time when swift action was required to address fundamental performance issues.

The amendment is not necessary. The Secretary of State, in the exercise of his powers, already has to do what the hon. Gentleman is asking, but the need to move sometimes at speed means he needs to retain the powers; this is therefore covered, there is accountability to Parliament and the Secretary of State has to say exactly why he is doing it. It is straightforward: either he has the power to deliver his duties, or he does not, and he can do it without convening an independent panel to second-guess him. It is his responsibility, and if he exercises those powers unreasonably, there is judicial review, which means that a local authority is doubly protected.

[Mr Allen]

If a local authority, which understands its own demography—it knows its people and its inner-city and rural areas—makes a decision on a public health matter, such as fluoridation or free dental checks for three-year-olds, and the centre does not like it, the Minister can pull back that power, which has been given in what is meant to be a devolution Bill.

[Alistair Burt]

It is not about the centre not liking the decision. The Secretary of State has statutory duties that Parliament has given him. He has to exercise his power both to grant and revoke power based on those duties, not because he likes or does not like a decision. It is that statutory duty for which he is responsible that is so important. The House of Lords pressed that matter, but the House of Commons has accepted it. It is the maintenance of those duties that is so important. Liking or disliking a decision does not come into it.

Let me make further progress on the other amendments that the Government wish to push through. Amendment 35 is a further amendment to clause 18, which applies valuable safeguards to local devolution of health functions, including where certain functions and duties should continue to be held nationally. The clause was inserted in the Bill by an amendment tabled by Lord Warner in the other place and was amended in Committee in the Commons to give further definition and clarity to support its valuable principles. Clause 18 provides that regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority.

Amendment 35 makes it clear that, in addition to NHS England’s responsibilities for assurance and review of clinical commissioning groups, all its supervisory and oversight functions set out in chapter A2 of part 2 of the National Health Service Act 2006 are out of scope of a transfer order. These include functions relating to CCGs’ institutional and constitutional arrangements, including their establishment.

Briefly, amendments 46, 47, 48 and 49 amend schedule 4, which makes amendments to the 2006 Act to provide a wider menu of flexible, voluntary options for local bodies, including combined authorities, to work with each other and with NHS England in respect of health functions.

One of the amendments introduced by schedule 4 includes provision under proposed new section 13ZA of the 2006 Act for new “devolved arrangements”, whereby NHS England is able to delegate its functions to a group of local commissioners exercising them together, or to make arrangements to exercise its functions jointly with that group. The group of local partners must consist of at least one clinical commissioning group and at least one combined authority or local authority, and the delegates or partners must exercise the function jointly.

Amendments 46, 47 and 48 are minor and technical amendments, which make it clear that “devolved arrangements” may relate to one or more of NHS England’s functions.

New clause 12, which was tabled by the hon. Member for Hemsworth, says:

“The Secretary of State must, within 15 months of this Act being passed, publish a review of health services devolved under the provisions of this Act.”

The review must include an assessment of how standards have been maintained, particularly of the quality and outcomes delivered by the devolved health service.

Maintaining the integrity of the NHS standards and ensuring that there is clear accountability for quality of outcomes is a key objective, as reflected by a number of vital safeguards provided for by the Bill. An order to confer health functions on a combined authority can only be made if a proposal to do so satisfies the Secretary of State that such a transfer will lead to the improvement of statutory functions.

As the House has debated a number of times, the requirements to monitor and regulate the functions that have been devolved remain exactly the same as if they had been with the NHS. It is the Secretary of State’s responsibility to ensure that the quality of services devolved is of NHS quality. For that reason, a full formal review is not necessary. There will be constant review of the quality of work done locally, and putting a formal review in the legislation is therefore not necessary. It is inconceivable that the authority delivering the functions on behalf of the NHS would not keep up a full review and the quality of regulatory work and monitoring work ensures that a full review is carried out in any case.

I hope that the new clauses will not be pressed to a vote and that I have been able to satisfy the House about the functions that need to be retained by the Secretary of State. I hope that the technical amendments will also be agreed to.

Cities and Local Government Devolution [Lords] Bill

Graham Allen Excerpts

Wednesday 21st October 2015 Commons Chamber

[Mr Graham Allen (Nottingham North) (Lab)]

The Minister is making a rational and cogent argument. I would like to take him back to the question of double devolution, which has been raised with me by many, including the key cities—those that I would perhaps describe as the second-tier cities, rather than the core cities. They are concerned that power should not simply go from Whitehall to town hall, and that there should be an evolutionary process in which power continues to be devolved to neighbourhoods, parishes and other smaller bodies. If the Minister will not accept my amendment, will he give those cities some reassurance that there will be strong Government oversight to ensure that the devolution does not stop at the town hall?

[James Wharton]

Yes, I can give the hon. Gentleman that reassurance. Every devolution proposal will involve a deal between the Government and those local areas that want devolution. As part of those deals, we will look at what further steps can be taken. We recognise the principle, which he advocates, that decisions should be taken at the lowest level of government at which they can effectively be taken. If an area with which we were having discussions wanted that to be part of the deal, and if we could work with it to deliver it, it would be our intention to do that.

Returning to clause 2, it would be easy for some future Government to parade their devolutionary credentials because every one of their Bills had a devolution statement, while in reality they might have done little to continue to meet what I confidently predict will be a continually growing appetite for devolution across the country. I suspect that the hon. Gentleman agrees with me about the existence of that appetite. Accordingly, the Government are opposed to clause 2 standing part of the Bill, and amendment 29 is consequential to the removal of the clause from the Bill, deleting the reference to that clause in clause 1.

The hon. Gentleman has tabled a number of amendments that would have constitutional implications. We will consider most of them later today, but new clause 1 is in this group. It would require the Secretary of State to publish a list of local government competences, having first agreed them with representatives from local government. Once published, the list could be amended only with the approval of two thirds of the membership of the House of Commons and the approval of the Local Government Association.

I understand the reason for new clause 1 but I cannot support it. When codification of the relationship between central and local government has been attempted in the past, it has failed, as was recognised by the Political and Constitutional Reform Committee of this House. In their response to a report from the Committee in 2013, the Government commented that codification fails because it is about processes, rather than about policy intended to improve outcomes. Instead of liberating local leaders, a codified relationship could simply serve to focus energy on theoretical debate, rather than on shared endeavour, problem solving and action.

[Mr Allen]

I will speak about this at greater length later, but may I make one specific point now? Historically, local government has felt uneasy about its relationship of subordination to central Government, and a means of reassuring local government of all political parties would be to entrench the settlement that the Minister is proposing and to find a way in which to reassure local government about its long-term sustainability and its independence from central Government. Will he undertake to have a think about this matter, so that he will be able to ensure even more co-operation from local government?

[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.

--- Later in debate ---

[James Wharton]

Although those places are indeed special, the amendment is completely at odds with the generic, enabling provisions of the Bill. To recognise the unique character of an area is not to seek to exclude it from the enabling provisions. Rather, it is through those enabling provisions that we can recognise the particular character of Somerset along with the particular character of any other area. That is at the heart of the Government’s flexible approach—the bottom-up approach—of delivering devolution that is bespoke to the areas that want it.

Secondly, the amendment would rule out the Somerset authorities from having the option of adopting one of the models for strong and transparent governance that is available. Clause 3 enables an area to adopt the model of a combined authority mayor, but it will be for the councils themselves to decide whether they wish to move to this form of governance. We will not impose devolution on anyone, but it should be possible for everyone. I look to my hon. Friend the Member for North East Somerset to withdraw his amendment, but I will listen with interest to the comments that he makes.

I also want to comment on amendments 53 and 56, which are tabled in the name of the hon. Member for Nottingham North. Amendment 53 seeks to extend the Secretary of State’s powers under the new section 107A, so that in addition to providing by order for there to be a mayor for a combined authority area, provision could be made in certain circumstances, following a proposal from the constituent authorities, for some other governance and accountability structures for the combined authority area. Amendment 56 seeks to provide that, where such other governance structure has been provided, the combined authority would be a major precepting authority, as it would be if there were a mayor for the combined authority area.

In general, I have some sympathy with what might be seen as the underlying idea of those amendments, which is to introduce some greater flexibility, but in this case I am not persuaded that this is the right approach. The amendments risk being seen as an attempt to hold out the possibility of some governance arrangement that does not have that sharp single point of accountability. Although we have been clear that the Government wish to impose that accountability on no one, it will be a requirement for those deals that are similar in their scope and ambition to that with Greater Manchester.

[Mr Graham Allen]

The Minister is being very generous in giving way. May I take him back to the point made by the hon. Member for Bury North (Mr Nuttall) about making arrangements that can be flexible and allow evolution, particularly of the larger areas that will be devolved? I know that Core Cities are particularly interested in this concept. It could be the equivalent of a pre-nup agreement with a smaller authority before it comes into full membership, almost like with the EU where there is a trial period, to see whether people get on before taking it forward as consenting authorities.

[James Wharton]

I hear the hon. Gentleman’s thoughts and recognise the intention behind the amendment. I will listen carefully to his comments later and will look to find consensus where we can to ensure that the safeguards that all Members want to see are included while ensuring that we deliver on this agenda and on the manifesto pledge made by my party at the election, only six months ago.

I am conscious that a number of hon. Members wish to speak, so I shall try to move through some of the other amendments reasonably quickly. Amendment 57 is tabled by the shadow Secretary of State and his colleagues and requests that a gender balance must be considered when the mayor appoints a deputy. I gently remind those on the shadow Front Bench that this approach was considered for the leadership of their party and rejected. The mayor, who will have a democratic mandate to govern, needs to be able to determine who will best assist him or her in delivering on the promises they have made to voters. That person should be the best person, regardless of gender, and I asked that the amendment is withdrawn.

--- Later in debate ---

[Mr Brady]

The hon. Gentleman and I agree in a distressingly large number of circumstances, and I absolutely agree with what he says now. Most of us are very firmly in favour of the devolution of powers from central Government to a level closer to the people, but we are discussing the mechanism for governance and whether people should have the right to consent to changes in that mechanism.

My hon. Friend the Minister says that this is a necessary package. Clearly, the position that the Government are seeking to establish is one where we can have these levels of devolution only with the particular type of accountability that comes through a directly elected mayor. In that case, does he not believe that that can be put to the people of Greater Manchester as a package? If the benefits of the devolution package are sufficiently good to make it an attractive proposition—if enough of the powers that the hon. Member for Blackley and Broughton (Graham Stringer) and I would like to come closer to the people are being devolved—perhaps even those who are sceptical about the elected mayor model might accept it as a whole. I hope that the Minister, in looking at how the Government might more effectively take on board the views of local people, will consider that possibility as well as the one we have put before the Committee in amendment 51.

[Mr Graham Allen]

Before I begin, I should inform the Committee of the breaking news that our good friend Michael Meacher, the right hon. Member for Oldham West and Royton, has passed away. He was a good friend to many people in this House, and I am sure there will be an appropriate moment for us all to pay tribute to a fine parliamentarian and good friend.

This is my first opportunity to put on record my gratitude and the thanks of the House to my hon. Friend the Member for Stockport (Ann Coffey), who seized the opportunity to produce a magnificent report on areas in and around her constituency. I hope she will take great pleasure in the fact that the Government are now actively considering creating a What Works institution to address the sexual abuse of children. It will ensure not only that people are not victimised, but that perpetrators do not repeat their offences. I hope she feels that her work has been rewarded. I know that was not what she was looking for, but she put a great amount of energy and thought into a very difficult subject.

Turning to the Bill, I want us to think about where we might be in 2020. As I said on Second Reading, I suspect there will be at least one more devolution Bill—possibly two—so the Bill under discussion is getting the ball rolling, and as we progress I think that many of the edges to which Members on both sides of the Committee have rightly referred will be knocked off.

If the Government were minded to approve the 38 bids they have received, that would give devolution to about 80% of English local authorities. There is, therefore, not a lot more to do in terms of taking coverage further, but there is a lot more to be done in a number of specific areas. I hope that the Minister, who kindly said he would listen carefully to my remarks on my proposed amendments, will be able to use them and others to ensure that we get a practical devolution settlement that sticks and delivers for people. That cannot happen under this Bill, which is about beginning the evolution of the process. I commend the Government for that.

I am pleased to see present one colleague from the Scottish National party, the hon. Member for Glasgow Central (Alison Thewliss). Whatever our differences with the SNP, it is not the only party that got votes in Scotland at the general election, although one could be forgiven for sometimes thinking that that was the case. In fact, if we were operating under a proportional system, many more Labour, Conservative and Liberal Members of Parliament would be representing Scotland.

Putting that aside, we can learn a great many things from the package given by the Westminster Parliament to Scotland after intense negotiations. It could be used as a template for further English, Welsh and Northern Irish devolution. We should try, with a lot of humility, to understand how the package—which resulted from negotiations prior to the referendum—works, how it came about and how it could be applied to the rest of the UK. The answer to any argument in favour of separatism is that everybody in the United Kingdom should enjoy the maximum amount of devolution and run as much of their own affairs as possible, whether that be nationally—as in Scotland, Wales, England and Northern Ireland—locally, or at the level below that of the local council.

[Jonathan Edwards]

I am grateful to the hon. Gentleman for tempting me to intervene on him. Does he share my disappointment with the draft Wales Bill, which was published with much fanfare yesterday, but which pales into insignificance when compared with the powers made available to Scotland? The ad hoc nature of devolution across the UK is inherently unstable. Of course, my hon. Friend the Member for Glasgow Central (Alison Thewliss) and I want to go further than the Scottish settlement, but surely that is the benchmark we should be working towards.

[Mr Allen]

Unless there is a written settlement, there has to be an evolutionary settlement and someone has to pile in first, make the breakthrough and be a pioneer. In terms of the nations of the United Kingdom, that has been Scotland. All those who contributed to that devolved settlement—including, obviously, Donald Dewar, but also the Scottish Constitutional Convention and many others in civic society—deserve acclaim for their achievements. It is up to the rest of us, whether we are in Wales, England or Northern Ireland, to go through the gap and say, “Devolution is a great thing.” It is not an expedient to buy off Scotland, but a matter of principle that should be applied equally, and at an appropriate pace, to Wales, England and Northern Ireland.

--- Later in debate ---

[Mr Kevan Jones]

My hon. Friend talks about the principles of devolution, but one of the key factors as to whether it will work will be the proper and fair allocation of resources. This Government have a track record of devolving responsibility to local authorities while at the same time top-slicing their budgets. Is not my hon. Friend concerned that this Government, who are committed to a small state, will devolve not only responsibility without resources, but blame for cuts?

[Mr Allen]

My hon. Friend makes a very sound point, of which we should all be wary. We need to break that system so that we are able to go with the begging bowl and say, “We can prove we need a little bit more than anyone else,” and take as much control as possible of our own areas and resources. The amendments I have tabled seek to achieve that. The localities need their own tax base and powers. Those powers also need to be entrenched so that they cannot be sucked back by any Government—by that black hole of magnetic force we call Whitehall—unless they are able to demonstrate that their stance can be defended constitutionally, as explained in a couple of my amendments.

We need not be afraid. As well as the tremendous example of what has happened in Scotland, we have the example of what happens in every other western democracy. People in western Europe and north America take as given the independence of their locality, state, region or länder from the centre. They cannot be told what to do. The idea that the President of the United States could tell the states of New York and Georgia how they should spend their money is laughable, as is the idea that all the money in individual areas in Germany, Italy and Scandinavia should go to the centre and then be redistributed. They would think we were crazy if we proposed that system for them, yet that is the system we operate for ourselves. We are the oddities—we are the odd ones out.

We need to mature as a democracy. Sometimes I think our democracy is a bit frail and feeble, but actually it is underpowered: we do not have enough of what other nations in the western world have and we are unable to take steps forward. That is why I welcome the Bill in general, but I want to propose a number of other steps for the Minister to take either now or, perhaps more realistically, in the next devolution Bill.

[Alison Thewliss (Glasgow Central) (SNP)]

Does the hon. Gentleman agree that the difference between the United Kingdom and many other countries is the lack of citizen engagement with the democratic process in this country, and that if devolution is to be properly embedded and truly work, people must be engaged at grass-roots level?

[Mr Allen]

I do, but I gently suggest that the hon. Lady does not push me too far on that point, because she will push me into talking about what the SNP has done to local government in Scotland. One of my new clauses, which may go some way to meeting her point, would entrench the rights of authorities below local councils—neighbourhood, community and parish councils—so that they too can have clear rights.

The hon. Member for Amber Valley (Nigel Mills) has left the Chamber, but people do get confused if there are lots of different tiers and nobody quite knows who does what. If the parish council looks after grass verges, everybody gets to know that and those who are interested can ask questions at that level. If the electrification of the midlands main line or the refurbishment of the M1 motorway is the responsibility of the combined authority for Nottinghamshire, Derbyshire, Nottingham and Derby, people will get to understand that mechanism. We could spend a lot of time talking about combined authorities. Let us let evolution take place and let us make sure, as part of that evolution, that, if we manage to secure this immense gain and step forward of going from Whitehall to town hall, we also go to the level below the town hall.

Entrenchment sounds like a very technical, dry constitutional question, but it is what just about every other country has. Just in case we ever got an unpleasant or tyrannical central Government of any political party, a local area would have justiciable rights to say, “I’m sorry. You cannot do that. You cannot impose that on us. We are an independent unit, with just as many rights as central Government.” Those rights might include the right to raise its own money, issue bonds or whatever it may ultimately be during the next five or 10 years as we catch up with the rest of Europe. Such entrenchment cannot be obtained, however, even by a Minister as benign as this one or his colleague the Secretary of State, because it is sometimes required to be in writing and to be defended.

The object of my new clause 1 is to defend the progress that the Minister and the Secretary of State are trying to make so that there cannot be changes unless there is consent. There are many ways of doing that. One way is to have a super-majority in the House. If someone came along and tried to terminate the life of a Parliament, just at the whim of the Executive, it could not now be done because there has to be a super-majority. Perhaps local government is as important as the question of how long the life of a Parliament is. Another way would be to have a check and balance, as it were, perhaps with local government itself—with the LGA, or any other institutional arrangement—being able to say, “No. We’re not yet prepared to relinquish that power, so we stand where we are.” It could also be defended behind the Parliament Act 1911, which says that the second Chamber shall not stick its nose into any affairs other than—this is the only one at the moment—five-year Parliaments. We could add that it shall also defend the rights of local government and its independence from the centre. Putting such constitutional or democratic blocks in the way of an erosion of some of the very good work that the Government are doing in the Bill is very important in my opinion. I hope that that will be addressed, if not only this occasion, then in a future Bill.

[Mr Rees-Mogg]

The whole concept of entrenchment in legislation is very interesting, but it is very difficult without a written constitution. Would the hon. Gentleman like to move to a written constitution to be able to entrench such powers?

[Mr Allen]

I would jump at the possibility of moving to a written constitution, because that would make it knowledge we could share with every schoolboy and schoolgirl, rather than having parliamentary archaeologists, such as the hon. Gentleman, tell us the right interpretation of a particular view. We could, however, have a halfway house; sadly, it does not necessarily require a written constitution. There are the means of a super-majority, a self-denying ordinance, a lock by an external body—in the case of local government, I have suggested it could be the LGA—or the 1911 Act. It is absolutely possible: every other western democracy has done it, and there is nothing in the parliamentary water that robs us of the wit to do something comparable.

I tabled new clause 13 on double devolution. The Minister has been very generous about considering how we can safeguard devolution pressed down below town halls to the localities. The new clause suggests that the Government should make a regular statement to talk through and enable Parliament to debate what happens when powers are given to town halls and to ask whether the powers get down to the people who really need them. There may be many powers that appropriately stop with the town hall or the combined authority. Equally, however, many others would be administered much better at a lower level. It is not about doing that for everything or forcing people into it, but about doing only what is appropriate. That is the way to follow this through and to continue the debate. This is not about trying to prevent the Government from doing what they are doing, but to facilitate the next stage.

My hon. Friend the Member for Sheffield South East (Mr Betts) talked about the need for public consultation and involving the public. It is absolutely imperative to take the public with us on this journey. It should not be seen just as a technical exercise. We should involve them by saying, “Look, we’ve had our devolution for a year or so. Let’s have a little look at what we’ve managed to do so far. What do people outside Government or Parliament think we could do better?” It would be very healthy to have such dialogue, promoted by the Government through a statement to the House or to the general public, and it would help us to move to the next stage of the evolution of devolution, particularly in England.

The Minister referred courteously to my new clause 18, so I will not go over the ground again in relation to parliamentary oversight. Let me, however, mention the other part of the new clause, which is about having an independent body to look at how devolution is going. This is comparable to my point about double devolution. However, they constitute it, the Government could create an arm’s length authority to say, “There are a lot of problems around x, or whatever it may be.” My hon. Friend mentioned cross-border difficulties, where one bit of territory is contested by more than one combined authority or metro mayor. Other colleagues spoke about powers being in one place, but not being relevant to another part of an authority. Many others have spoken about mayoralty.

An independent body—without the vested interests we sometimes have to have in Parliament, sadly—should look at this and say, “Well done, the Government. You’ve got us to first base, but if you want to get to second base, we think you should have a look at these things.” Again, that is not about binding Parliament or telling Ministers what to do, but about allowing ventilation of what is, for us, the very novel concept of devolution and the question of how it can work better.

I have already put a number of other points on the record. Like the Minister, I have spoken to Core Cities, Key Cities, the New Local Government Network and the National Association of Local Councils. They have all raised with me concepts, as well as detailed amendments, about where this ought to go, but I will not go through them. I will not detain the Committee much longer, suffice it to say that as well as getting this Bill through the House, we must look at where we want to be in 2020 and take steps to open a dialogue so that we can get to where we all want to go. We want to ensure that people control much more of their own affairs not only at United Kingdom level, but at national level, at combined authority devolved level and at the grassroots—on the ground in the localities. I hope that the Minister will take my remarks in the spirit in which they are intended and continue such a dialogue over the coming years.

[Several hon. Members rose—]

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[Mr Brady]

I shall be brief. Amendments 40, 41 and 45 relate to a variety of questions regarding the precise powers that are to be transferred under a devolution settlement, including whether powers can be devolved down from Government and whether there is any danger or any possibility that might preclude the danger of powers being pulled up from local government and vested at a level further from the people, which I believe to be the case under the Bill as it stands.

Essentially, amendment 45, by providing a veto for any one authority in a combined authority or mayoral authority area over any decision, would establish what, in the context of the Prime Minister’s negotiations on the EU relationship, we would refer to as sovereignty. It is the opposite of the arrangement in the Bill, which we would, I suppose, call qualified majority voting. The current provisions would clearly allow a majority position in the mayoral authority to prevail over a serious objection from one, two or perhaps three authorities. If I read the Bill correctly, in fact, I think that most of the vetoes in the Greater Manchester agreement would require two-thirds opposition to a measure to prevent it from proceeding.

Amendment 45 makes it very clear that although we are pleased to participate in the new arrangement, or to enhance the existing arrangement of a combined authority, which works very well, we believe that the fundamental power in this relationship ought to reside with the local authority or with each of the local authorities in the area. If the amendment were to be agreed, it would provide that protection. As with the amendments we discussed in the earlier group, which I did not press to a vote, I do not intend to press these amendments to a Division in Committee, in the hope that Ministers will reflect on them and consider whether there are more effective ways in which these guarantees and safeguards could be provided.

Similarly, amendment 40 seeks to establish what one might call a “foundation status”. It would give a special status to the original devolution agreement, which has been acceded to by the leaders of the local authorities in Greater Manchester, which is obviously the instance I know best. The intention is that it would limit the transfer of powers from local authorities, in particular, to any transfer that might take place before the establishment of the mayoral authority and would therefore prevent any further transfers. The amendment might not be perfect, and there might be flaws in how it is drafted, but I hope that my hon. Friend the Minister will accept that there is a real and important point that at the moment of the inception of the mayoral authority there is a degree of consent from the local authorities, but that consent might be less certain at a later stage.

Finally, amendment 41 seeks to provide an explicit guarantee. Ministers are very clear in their statements and Members on both sides of the House have been quite enthusiastic about the principle that we are seeking to move decision making and spending closer to people, taking functions away from central Government and moving them to a more local or regional tier. The hon. Member for Nottingham North (Mr Allen) spoke previously to his amendments seeking to establish a principle that could allow powers always to cascade down to the lowest level—something with which many of us feel a natural sympathy.

However, the Bill as it stands provides the possibility for powers to move in the opposite direction—for a local authority in any one year under any political control to decide that it wishes to cede decision making to the mayoral authority level. It is conceivable that the present Conservative Government will last for no more than another three or four Parliaments, and at some point in the future there could be a Government of another party in place. It is conceivable that a Minister less benign and less wise than my hon. Friend on the Front Bench may seek to lock into a mayoral tier of government powers sucked up from the local level.

Amendment 41 would provide a guarantee that what Ministers say they intend to achieve through the Bill and what most of us would like to see—the transfer of powers down from central Government—will indeed be the effect of the Bill, and not the reverse, the danger that the process will lead to decisions being taken further away from people, rather than closer to them.

[Mr Graham Allen]

Again, I shall speak about a number of issues that relate to the bigger principles and can perhaps be considered as a warm-up for the next devolution Bill, which must surely come within a couple of years, as I said in my earlier contribution, to knock the edges off this pioneering Bill, which brings serious devolution to England for the first time in my political lifetime. I tabled a number of amendments and I shall speak first to amendment 2, which is about a constitutional convention.

The work that I have been doing on a constitutional convention, which is the policy of my party and others, becomes ever more pertinent. We do not want to do parts of the jigsaw, but never see the bigger picture. Unless we step back and have a constitutional convention, we will not see how voting systems interlock with the role of a second Chamber, with the nations within the Union, and with the role of independent and devolved local government as the agents of devolution in England. This is an important Bill providing one part of that jigsaw, but at some point in the next five years we need a mechanism to allow us—hopefully, all parties—to get together, take a pace back and ask, “Where does this leave us? Where does it leave the Union? Where does it leave our democracy?”

I have spoken about the evolutionary approach to English devolution of the Minister and the Secretary of State, and I have commended both. Where does that necessarily piecemeal approach leave us in terms of the future of our country? That cannot be the property of any one party, nor should it be. The parties here have a role as a midwife, ensuring that this concept has a fair wind and is set up properly, is properly funded and provided for and has proper means of public participation, but that is all.

The political parties should take a step back from any convention, whether on local Government or on our wider democracy, and allow the citizens of the United Kingdom their say, perhaps under the auspices of one of the great and the good—an archbishop, a High Court judge or whoever they want to suggest—as worked so well in Scotland. That led to the smooth—it was also protracted, but necessarily so—development of devolution there, culminating in the Scotland Bill that was before us only a few weeks ago.

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[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I agree with my hon. Friend’s argument on income tax. Might the full suite of property taxes, not just business rates, also be worth considering in this context? I draw his attention to my amendment, clearly not as well drafted as his, suggesting that property taxes should be devolved in full to London. I hope to catch Mrs Main’s eye and say a few words on that later.

[Mr Allen]

Our London colleagues have done some fantastic work on how to localise taxation that is currently held by the centre. That has to be done sensitively and carefully, but as I said earlier—I do not think my hon. Friend was present then—every other western democracy manages that difficulty without a problem. In Sweden, America, Canada, Italy, Germany and Holland, it is second nature to retain money locally from business rates, landfill taxes and land taxes such as stamp duty. They get by pretty well. In fact, because that system is institutionalised, their local government has immense power over and above what we have as vassals. In effect, we do what we are commanded to do according to the crumbs left in the begging bowl after the Chancellor has done his bit for the national economy.

It is absolutely open to us to do work similar to that done by my hon. Friend, Professor Tony Travers and consecutive London Mayors to liberate people. Nottingham gets a lot of tourists because of the Robin Hood tradition and the castle, so we could have a hotel tax or a bed tax of £1 a night. That happens in other western democratic countries and the people endorse it. There is a big caveat though: no council should do this unless the people have okayed it and bought into it. Councils should also be able to borrow on the open market on the basis of their credit rating, but they need to have the consent of the people. It is perfectly possible for us to do what my hon. Friend suggests.

[Mr Kevan Jones]

I have been listening carefully to my hon. Friend and, while I do not disagree with him, the proposal to retain 100% of business rates will be a disaster for some poorer areas. It is fine for areas of central London, such as Westminster, to argue for the ability to retain 100% of their business rates. However, business rates in poorer areas of the north-east and elsewhere are never going to generate a great deal. In fact, one large closure can devastate the local income base. There has to be a redistribution mechanism.

[Mr Allen]

My hon. Friend is absolutely right. A proper redistribution mechanism—whether it is based on the amount received from income tax, business rates or any other taxation—must be in place; otherwise the system could be distorted and deeply unfair. That is why my amendments, which my hon. Friend will have read, suggest that equalisation should be central to the process; otherwise we will end up with the disjointedness he mentions.

[Jonathan Edwards]

In addition to the point made by the hon. Member for North Durham (Mr Jones), does the hon. Member for Nottingham North (Mr Allen) think there is a relationship between fiscal decentralisation and the geographical wealth of the countries that he mentioned, including the United States, which is far more balanced than the gross imbalances in the UK?

[Mr Allen]

No, I do not believe that is the case. That happens everywhere. Although I am very much an ardent devolver, I believe there is always a place for the federal level. President Clinton was not denied his wish to introduce Head Start to every state in the union. He did not impose it, but he offered it as a federal programme and virtually every state picked it up. Devolution would not diminish our role in this place to do good things, and it certainly should not diminish our role in insisting on the sort of equalisation that my hon. Friend the Member for North Durham (Mr Jones) has in mind.

[Mr Kevan Jones]

Does my hon. Friend agree, though, that that is not what is being offered by this Government? They are offering retention of 100% of business rates without equalisation, which will have a dramatic effect on those areas with low business rate receipts. It will also be to the advantage of some areas that perhaps do not need extra resources.

[Mr Allen]

I again agree with my hon. Friend. We are not there yet and it is not a done deal yet. We need to make the points that he very ably makes about equalisation. I will say to him, however, that if it is a choice between being instructed by Whitehall how to spend not very much money and having not very much money to spend locally, I would go for spending it locally every time, because we will maximise value and spend the money sensitively. Whatever money is available, it is better spent by those who know what they are doing, rather than by the man in Whitehall. I totally accept my hon. Friend’s points.

[Mr Gareth Thomas]

Will my hon. Friend give way?

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[Mr Allen]

I am very conscious of the time, but I will give way.

[Mr Thomas]

Is not a further argument for local taxes being controlled at local level that it allows local government a full range of policy responses to deal with local problems? I offer the example—I hope to catch your eye on this later, Mrs Main—of the housing crisis in London, where an ability to impose higher taxes on empty homes might be one part of the solution to the housing crisis.

[Mr Allen]

The nuance that I would add to my hon. Friend’s excellent point is that local taxation need not necessarily always be collected locally. Income tax is a very good example. Provided that it is distributed fairly from the centre, it makes a lot of sense for collection to be a central function, with Her Majesty’s Revenue and Customs simply continuing to do what it does, openly and transparently. Other things—he mentioned a hotel tax, business rates and so on—are much more amenable to local decision making, but we are long way from that.

[Graham Stringer]

Will my hon. Friend give way?

[Mr Allen]

I will, but if I may, I will make that the last intervention, otherwise you will start to twitch, Mrs Main.

[Graham Stringer]

My hon. Friend is committed to and searching for radical localist solutions. He mentioned the efficiency of decisions taken locally. My experience is that local government is much more efficient than central Government. Would not the most radical constitutional change be to make central Government responsible to local government, not the other way round?

[Mr Allen]

I would not ever wish to do to central Government what they have done to local government. I will therefore resist the temptation that my hon. Friend puts in my way. Sometimes, however, when we are being lectured about fiscal prudence, I ask myself: who has the triple A rating in this country? It is local government, rather than central Government. Who goes cap in hand to international lenders? Central Government. Who runs tight and balanced budgets? Local government. A central Government of any political colour who lectures local government should look in the mirror first.

I just want to mention one last new clause, new clause 16. It relates to having an institution, created by local government, as one of the What Works institutions that, thankfully, are now springing up across and outside government. They take the best possible practice out there and spread it around. A national-level inspectorate can tell local government what to do, but I am saying that there is a different model. We should draw up from the localities to national level something selected by the localities to spread best practice. We all want to do better and to hear who is doing the good stuff.

I will boast about the fact that the city of Nottingham has just come with the idea of an energy broker. Anybody can phone up and get the best deal—done. It will save people several hundred pounds a year. It is a not-for-profit service. As a Nottingham patriot, I could go on about our trams and many other innovations that we are introducing with two hands tied behind our back.

If we release people in the way I am describing, we can show them best practice and we can see what they are doing. I ask the Minister to consider that point very seriously. The Government have very generously created What Works institutions in policing and early intervention —I played a small part in creating the Early Intervention Foundation—and there are about 10 of them across the board. We need an organisation created by local government and that local government will respect—based in the LGA, the Department for Communities and Local Government or wherever—to give advice, offer evidence and fight local government’s corner. That is something for the Minister to take away and consider, and I hope it will reappear in the next of the two other devolution Bills I anticipate before 2020.

[John Stevenson]

I am grateful for the opportunity to say a few words about amendment 50, which I tabled. I will be interested to hear what the Minister says, but it is not my intention to press it to a vote.

As the Minister is well aware, I fully support the Government’s overall aims and intentions. It is sensible that this is an enabling Bill and that it allows the maximum possible flexibility. I think that it will lead to innovation and fresh thinking not just at the national level, but at the local level. Indeed over the past few years, local authorities have demonstrated that they are innovative and that they can change.

I appreciate that the Government want to reform local government with the support of local government. The Bill gives local government the opportunity to step up to the plate and embrace these opportunities. It gives local authorities the chance to take responsibility, to take on more powers and to achieve an awful lot more for their communities. I understand that the Government do not want to impose things on local authorities, but to discuss and negotiate with them in order to come to a deal that is beneficial for central and local government.

A key part of this change is not only about powers, but about governance and structure. There has been an extensive discussion about elected mayors, of which I am an enthusiastic supporter. Indeed, I believe that elected mayors should be the default position for all councils throughout the country. I will continue to support and encourage that idea. However, I accept that the Government want local areas to come up with their own solutions and ideas for change on both governance and structure. I understand the thinking behind that.

I do, however, have some concerns. If I may take this opportunity to be rather parochial, I would like to talk a little about Cumbria. I suspect that other areas face similar circumstances, but I will just discuss my own county. Cumbria has been described as a county that is over-governed and under-led. We have more than 380 councillors and seven councils, yet we have only half a million people. That system was created in 1974 and is now clearly not fit for purpose. It is recognised by everybody locally, including all the political parties, industry, business, the health service and local people, that it has to change, and that it has to do so soon if it is to be part of the devolutionary changes that are happening and to take the opportunities that are available to local government.

However, there is a potential problem. That is why I tabled amendment 50. I believe that it is wrong in a two-tier area for one authority effectively to have a veto over any change, even if it is a sensible and well-supported proposal made by the rest of the county and all the other districts. That allows one authority to stop popular and vital reforms going ahead. Anyone who understands Cumbrian politics will know that that is a distinct possibility.

Amendment 50 is not about allowing central Government to impose their will over what happens in Cumbria—I want to emphasise that. It is about stopping one authority denying progressive change that is in the interests of people throughout Cumbria. Cumbria is an obvious example of this problem because six of its authorities could be prevented from bringing about badly needed and well-supported reform by one maverick authority.

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[Peter Dowd (Bootle) (Lab)]

As a former leader of a council and a member of a combined authority and local enterprise partnership, I welcome the thrust of the Bill. There is no question about that. I said in a previous debate that the train is going out of the station—the cat is out of the bag, to mix metaphors. Whichever description we use, this is the reality.

I do not deny that the governance structure in local regions is important, but whatever that structure is we must move the debate on. Local government has changed over centuries. In the 19th century, it changed to reflect the industrial revolution. It changed at the beginning of the last century and at the end to reflect the patterns of population, demography, business and so on. It has changed over time. London changed in the early ’60s, we changed again in the 1970s and it is now time to change once more. People might have concerns, but that is life. It has to move on.

My hon. Friend the Member for Bassetlaw (John Mann) made a point about having too many councillors, but I am pretty agnostic on that. The United States have significantly more councillors proportionately than we do, and they get on okay, and the same applies to the French. It is part of the heart of a community that there might be lots of councillors. I am not arguing for that, but I do not think that it is a reason for not going ahead with changes.

I support the comments made by my hon. Friend the Member for Nottingham North (Mr Allen) about the principle. There will be changes to local government and devolution in the coming years, and we might as well recognise that while we are in this transition and get on board with the constitutional convention. That does not stop things happening now, but we really need to get on with it, and I ask the Government to consider that seriously.

I also support what my hon. Friend the Member for Sheffield South East (Mr Betts) said. He referred to some of the specifics. It seems remarkable that a mayor would not have the borrowing powers he described. I hope that is just a mistake—a lacuna in the legislation—that will be put right. It is important that the detail is picked up.

There is a danger that this debate will get a bit too esoteric. Do I think that devolution will be good for my city region of Liverpool? Yes, it will. Why? This is not unique to us, but we have a thriving visitor economy. For many years, that has been our direction of travel and Liverpool is now the fourth most popular city in England for national and international visitors. That could link into the point made by my hon. Friend the Member for Bassetlaw about hotel taxes and the ability, if that many people are coming into the city from abroad, to use that revenue if we so wish. I am not saying that we should, but we should have that flexibility if we want it. The visitors are coming to my city, not to anybody else’s, and that is important.

At the moment, the visitor economy brings in £3.8 billion and 40,000 jobs, and it is a major growth sector. Do I think that the city region would manage that, grow it and progress it better? Yes, I do. There is no question about that. If we wait for Whitehall to help us, we will be waiting until the cows come home, and I mean no disrespect to Whitehall.

[Mr Graham Allen]

My hon. Friend reminds me that Thomas Jefferson once said that were people to wait for Washington to tell them when to reap and when to sow, they would soon go hungry. The same probably applies if we wait for Whitehall to figure out how to do some of these things. Will my hon. Friend also comment on local government borrowing and social investment bonds? In America, there is a multi-trillion dollar local government capital market. People borrow, they return, they use their liquidity and they stash money overnight. That would be a fantastic source of revenue that is currently denied to local government.

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[James Wharton]

We have had an interesting and wide-ranging discussion. I recognise the comments made by hon. Members across the Committee and the range of amendments that have been tabled.

New clauses 2, 4, 5, 6, 7 and 16, and amendment 2, tabled by the hon. Member for Nottingham North (Mr Allen), are about the constitutional position of local government and putting in place arrangements for a constitutional convention to review this and implement any constitutional reforms considered necessary. I recognise his consistency in pursuing this issue; indeed, he also has a private Member’s Bill related to it. No one would deny the importance of constitutional matters. The traditions of this country are that we approach these matters in a pragmatic, evolutionary way. Our constitution has evolved over the centuries and continues to do so to meet the real needs of our people across the United Kingdom and to reflect the changes that are taking place in the wider world. I absolutely recognise the hon. Gentleman’s intentions and interest in this area, but I feel that this approach has served us well and I am confident that it will continue to do so.

The thrust of the hon. Gentleman’s amendments is that, for the first time in our history, we would put our constitution on a more rigid basis, seeking to codify issues and, in a sense, to set them in stone. Although they recognise the importance of constitutional issues and strongly support the passing of power down to the lowest practical level that this Bill will enable—the essence of devolution—the amendments are unnecessary and would be out of step with our traditions. They are also somewhat outwith the scope and intention of this particular Bill. However, I recognise his desire to put these matters on the agenda and his belief that they need to be addressed. I am sure it is not the last time that they will be discussed across the Floor of the House.

[Mr Graham Allen]

If the Minister thinks the system is serving us well, may I gently remind him that six or seven months ago we came within 6 percentage points of the Union breaking? We have all the shambles around English votes for English laws, and there are many other issues where people are clearly, given voter participation levels alone, disenchanted with politics. Does he not agree that the great work he is doing on English devolution could be the spark to re-engage a lot of people who are very jaundiced about our politics?

[James Wharton]

As I said, I recognise the hon. Gentleman’s interest and expertise in this area, and I am sure that we will have the opportunity to discuss it further across the Floor of the House, whether in relation to this Bill or other areas of policy. He tempts me to go further than I am willing to go in my comments today.

My hon. Friend the Member for Carlisle (John Stevenson) tabled amendment 50, which would give the Secretary of State powers to establish unitary authorities even if not all the councils concerned in a combined authority area agreed to the change. Our approach is that if a governance change is to be made, there needs to be a level of consensus about the choice over the whole area. We are not in the business of imposing change on anyone. However, I recognise my hon. Friend’s desire to raise this issue. He is not the only Member to have done so. The hon. Member for Bassetlaw (John Mann) has spoken about similar issues today and has met me to speak about them separately. We are about to engage in ongoing correspondence on the matter. I am of course happy to meet my hon. Friend if he would like to discuss this further, and I am pleased that he will not press his amendment to the vote.

My hon. Friend the Member for North East Somerset (Mr Rees-Mogg) tabled amendments 47, 48, and 49, which make a special case for Somerset. Just to be absolutely clear and to put it on the record, Somerset is a very special and exceptional place, but I explained earlier why I do not consider it appropriate to treat it differently in terms of this Bill. Nor do I believe that the substance of the amendments, which are about how the principle that changes in an area’s governance are a matter for local choice should be applied, are necessary given the existing safeguards. Somerset, or indeed any council, could be not required to join a combined authority or be conferred new central Government powers if those democratically elected to represent the people of the area did not consent. The councils of Somerset—or, indeed, the councils of some place less special—can themselves decide how they want to take their residents’ views into account. Those who have been elected should decide these matters. That is four square with our traditions of representative democracy, and therefore I hope my hon. Friend will not press his amendments to a vote.

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[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.

[Mr Graham Allen]

Does the Minister accept that the Scotland Act 2012 gives the Scottish Government the right to retain not only 10p in the pound of income tax, but, from April, the proceeds of landfill tax and stamp duty, which are two significant amounts of money? Is there some reason why local authorities in England should not be able to have similar retention of those taxes?

[James Wharton]

The hon. Gentleman is consistent with his theme of wanting to go further to take devolution to what I have no doubt he genuinely believes to be its logical next level. I acknowledge his comments, and I am of course happy to meet him after this Committee sitting to discuss them further. However, I do not want to hold out the false promise that a Bill that already goes so far and does so much will be amended in line with his desires. I am happy discuss with him his longer-term desires for constitutional change and for devolution to take what may well be its next steps at some point.

We made it clear in our 2015 manifesto at the last election that we would continue to help local authorities keep council tax low for hard-working taxpayers and to ensure that residents can continue to veto high rises in council tax via a local referendum. New clause 15, tabled by the hon. Gentleman, would abolish the system of council tax referendums put in place by the coalition Government. The referendum threshold is not a cap. Councils can set any council tax increase they like, provided they obtain the consent of their local electorate when they go over the threshold. We see no reason to take away the protection and the final say of local voters over excessive increases.

New clause 12, tabled by the hon. Gentleman—he has just raised this issue—would provide that income tax receipts amounting to 10p in the pound should be assigned to the Department for Communities and Local Government, which would then pass the money on to councils. We are already committed to boosting local growth: by the end of this Parliament, the local government sector will retain 100% of local taxes to spend on local government services. The new arrangements we are already committed to delivering will give the sector greater long-term certainty over its income. No longer will local authorities be reliant on central Government telling them how much money they will receive for the year ahead only weeks before they set their annual budgets. I recognise the hon. Gentleman’s desire to go further and I am very happy to discuss that issue further, but I ask him not to press the new clause to a vote at this time.

[Mr Allen]

On the Minister’s language, it is not so much a desire to go further as a desire for England to catch up with Scotland so that we can have a properly devolved settlement in the United Kingdom.

[James Wharton]

The hon. Gentleman is articulate and persuasive, but he will not tempt me to elaborate further.

New clause 11, tabled by the hon. Member for Harrow West, provides for the devolution to London of the receipts from taxes on property. I know the Mayor’s ambitions for London and we have announced the local retention of business rates, but devolving taxes such as stamp duty to London could create a distortive effect. There would be a significant increase in administration costs for both the Greater London Authority and businesses that purchase properties both in and outside London. I have heard what the hon. Gentleman has said, and I will consider his comments further, but I do not want to give him the false expectation that they are likely to be reflected in the Bill or to make a commitment that I cannot fulfil at this time. He has, however, made his case very effectively.

[James Wharton]

I hear the hon. Gentleman’s comments. The announcement that we will devolve business rates was made in the way it was exactly because we wanted to ensure that we talked to local government about how it should be done to make sure it works properly and effectively and meets our policy desires. To devolve certain taxes to just one area is a different proposition. He clearly supports it and argues for it effectively, but it does not have a place in this Bill at this time.

Amendment 1, which was tabled by the hon. Member for Nottingham North, clarifies that the persons who may be invited to attend an overview scrutiny committee meeting may include

“representatives of parish, neighbourhood, community and other councils in the area of the combined authority”.

I understand the hon. Gentleman’s intention and commend him for pursuing openness in the process, but the Bill already allows people to attend. To define them in a list risks the provision being narrowly interpreted, rather than broadly interpreted, which is what we want.

[Mr Graham Allen]

The intention is to ensure that those who operate below the council level at neighbourhood or parish level feel involved and engaged, rather than going along as members of the public, so that they can take the next step of pushing devolution down into double devolution. Surely engaging those people would be a very good thing to do.

[James Wharton]

I agree with the hon. Gentleman that that engagement is important. My contention is that the Bill provides for it with the power to allow persons to attend and invite persons to be present to scrutinise the process. My argument is that defining a list of particular types of persons or bodies risks narrowing the interpretation. However, I understand what the hon. Gentleman desires to achieve.

I will now discuss the amendments that relate to requirements on the exercise of mayoral powers. Amendments 40, 41 and 45, which were tabled by my hon. Friends the Members for Altrincham and Sale West (Mr Brady), for Hazel Grove (William Wragg) and for Bury North (Mr Nuttall) would place requirements on mayoral powers. Amendment 40 provides that a function may only be specified as a function of the mayor with the consent of the combined authority prior to the creation of the post of mayor. We have concerns over the latter part of that amendment, because it appears to rule out a further transfer of functions to a mayor once the position has been established. It seems to mean that the deal that is reached initially is the deal, full stop.

Amendment 45 underlines hon. Members’ concerns that the constituent councils must be content with the list of functions to be exercisable by the mayor. I understand hon. Members’ concerns and agree that no local authority functions should be conferred on a combined authority, with or without a mayor, without the consent of the councils involved. We make provision for that in clause 5. I am happy to continue the dialogue with the hon. Members who have raised this point and I understand the deeper points that they wish to address. I hope, therefore, that we can reach a consensus that allows us to pursue the matter in a different manner to the amendments that we are discussing.

Government amendments 5, 6, 7, 8 and 26 will provide greater flexibility in how a mayor will be able to undertake their functions. The amendments are reasonably straightforward. Amendments 5 and 6 will provide greater flexibility and create greater capacity to enable a mayor to be supported in undertaking functions, where that is wanted locally. Amendments 7, 8 and 26 enable mayors of combined authorities, if it is specified by order, to exercise any of their general functions jointly with other authorities or combined authorities with the same functions, if they so choose. They enable a joint committee comprising the mayors of two combined authorities or a combined authority mayor and local authorities to exercise jointly shared functions across the area, thus providing greater flexibility in how mayors, combined authorities and local authorities can work together.

Finally, I will mention some minor and technical Government amendments. Amendments 30 and 31 insert provisions that enable an order to specify that local authority functions must be exercised jointly by the councils and the combined authority. Amendments 23, 24 and 25 relate to police and crime commissioners. They clarify the timing of an order that transfers PCC functions to an elected mayor; ensure that drafting on PCC functions is consistent; and ensure that, in line with the provisions for PCCs generally, a person acting in place of a mayor with PCC functions temporarily cannot carry out particular strategic functions, such as issuing a police and crime plan. Finally, Government amendment 15 will mean that the power to make regulations under clause 17 includes a power to make incidental, supplementary and consequential provision. Those are tidying-up amendments that are not controversial. I certainly have not detected that they are from the debate.

I hope that right hon. and hon. Members, in the light of those explanations, will not press their amendments and will feel able to support the Government amendments.

Oral Answers to Questions

Graham Allen Excerpts

Tuesday 21st October 2014 Commons Chamber

[George Freeman]

My hon. Friend makes an important point. This is a matter for NHS England to deal with. I have made inquiries to ensure that the process is being followed as it should be. As I say, there is no immediate threat. The issues around the provision of congenital heart disease services are not limited to Leeds. NHS England is conducting a nationwide review of congenital heart services, which will look at the whole of life care pathways available across the country. The truth is that congenital heart diseases are often very serious illnesses affecting life expectancy and quality of life for patients, who will expect NHS England to put in place the very highest quality care and service available.

[Mr Graham Allen (Nottingham North) (Lab)]

12. What contribution his Department is making in support of the health objectives of the rebalancing project on dental checks for three-year-olds, foetal alcohol syndrome and lung screening for people over 60.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The hon. Gentleman and I have spoken a number of times about his valuable project. He knows that I am very interested in it and its outcomes. The Government are committed to improving oral health, with a particular focus on children, to reducing the incidence of foetal alcohol syndrome and to improving outcomes for all cancers. Results of major trials on lung cancer screening, including our own £2.4 million UK trial, are due in 2015. At that point, the UK national screening committee will review all the available evidence, looking towards a pilot.

[Mr Allen]

The rebalancing project, which covers my constituency, is I hope an innovative way of working that does not require additional money from the Government, but focuses on key health inequalities, such as a dental check for every three-year-old, the foetal alcohol syndrome prevalence study that we are trying to do and lung cancer screening for everyone over 60. Will the hon. Lady keep an eye on this work, use her reputation as a very committed Minister and visit us in Nottingham to see whether the work we are doing can be spread elsewhere in the UK?

[Jane Ellison]

All the issues that the hon. Gentleman outlines are extremely important. We, too, are very interested in the prevalence study on foetal alcohol syndrome. He may be aware that the World Health Organisation has just launched some work in that area, which will be of great interest to him. It would of course be a delight to visit the project.

Oral Answers to Questions

Graham Allen Excerpts

Tuesday 16th April 2013 Commons Chamber

[Mr Hunt]

I entirely agree with my hon. Friend the Member for Newark (Patrick Mercer). We must urgently tackle the variation in dementia diagnosis rates. In the end, the litmus test of whether we are able to cope with an ageing population in the NHS will be how we deal with dementia, which now affects one in three people over the age of 65. There is still a lot of misunderstanding about the impact that a good diagnosis and care plan can have, and for the sake of my hon. Friend’s constituents and everyone else, this is an area in which we need to make urgent change.

[Mr Graham Allen (Nottingham North) (Lab)]

9. If his Department will make early intervention a priority for clinical commissioning groups and public health officers.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I commend the tremendous amount of work undertaken by the hon. Gentleman on early intervention. Yesterday, he and I attended the Early Intervention Foundation, which he has set up. We are talking a lot about legacies this week, and his legacy and the work that he has done to promote early intervention will certainly stand the test of time. The Government are committed to supporting that work, both through his foundation and through the work that we are doing to expand the family nurse partnership programme and the number of health visitors available to young families.

[Mr Allen]

I thank the Minister for those remarks, and I would like to thank those on both Front Benches for their support for the Early Intervention Foundation, which is greatly appreciated. Would the Minister accept that, in addition to having police and crime commissioners and councils promoting early intervention, the role of GPs, of directors of public health and of health and wellbeing boards will be absolutely central to getting early intervention plans and programmes to scale across the whole of England?

[Dr Poulter]

The hon. Gentleman is absolutely right. The health and wellbeing boards in particular will be well placed to bring together and join up what goes on in early interventions and to break down some of the silos that have existed in education, social services and health care. It is through the health and wellbeing boards that a lot of the work being done by health visitors and others to improve the life chances of many children, particularly those in the poorest communities, can be taken forward locally in a much stronger way.

Oral Answers to Questions

Graham Allen Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

The right hon. Member for Leigh (Andy Burnham) did not publish a risk register during his tenure. His predecessor, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), did not publish the risk register on two occasions during his tenure. The bits relevant to the Health and Social Care Bill have been made public, but we will not be publishing the risk register because, as the hon. Gentleman knows, my right hon. Friend the Secretary of State is appealing, as he is entitled to do, against the Information Commissioner’s decision—[Interruption.] We have a right of appeal, which we are exercising, and we will have to wait until a decision has been reached on appeal. Until then, no we will not be publishing the risk register, because it is not necessary or appropriate.

[Mr Graham Allen (Nottingham North) (Lab)]

15. What steps his Department is taking to prevent ill health and its associated costs through early intervention.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The public health reforms have at their very heart the prevention of ill health and its associated costs, and the hon. Gentleman in his question clearly recognises the critical impact that intervening early can have. The health visitor work force are an important part of early intervention. We picked up a very demoralised and depleted health visitor work force, so I am pleased to report that training commissions for health visitors are up 200%, and we plan to double the number of family nurse partnerships available by 2015. We are also developing a vision for school nursing.

[Mr Allen]

The introduction of the family nurse partnership and the enhancement of the amount of money available to it is a great credit to the previous Labour Government and the current coalition Government. It enables single teen mums to get one-to-one help from a health visitor. Given the economic circumstances, does the Minister accept that we need to be a bit more inventive to ensure that that very good scheme goes even further? Will she discuss with the city of Nottingham and its health service a payment-by-results system to extend the family nurse partnerships further?

[Anne Milton]

Yes, we are supporting the development of social investment and outcome-based funding models, and I am pleased that the hon. Gentleman has raised the issue of being innovative about how we do that, because it is important. We had a rather static situation previously, so I welcome his interest in developing and testing a payment-by-results scheme in Nottingham, and we will be interested to see his detailed proposals and how that develops locally soon. What matters are the results that we get from the schemes.

Child Health (Nottingham)

Graham Allen Excerpts

Tuesday 6th July 2010 Westminster Hall

[Chris Leslie (Nottingham East) (Lab/Co-op)]

At the outset, I wish to provide a little context to the debate. Nottingham is the 13th most deprived authority in a total of 354, according to the Government’s 2007 deprivation index, with 81% of children falling within the first three deprivation deciles. In other words, the vast majority of young people form the poorest third of the population. There are some especially poor pockets of deprivation in the Nottingham constituencies. In my constituency, they can be found in the St Ann’s, Dales and Arboretum wards, and in Hyson Green and Forest Fields, to name only a few places.

In September 2009, about 700 young people were not in employment, education or training, the status of another 550 was not known, and 62% of all children lived in households where no adult worked or where earnings were so low that they received benefits or other state assistance. Although I am pleased to have the opportunity to debate child health in Nottingham, it is precisely because of the concentration of problems that afflict so many young people in the city that it was necessary to spend some time on that point.

It is important to recognise that much good work is being done, not least by the NHS services in Nottingham, the city council and others. I am glad that my hon. Friend the Member for Nottingham North (Mr Allen) is here, because it would not be possible to speak on the topic for more than 60 seconds without mentioning the early intervention approach of One Nottingham, the local strategic partnership that he has pioneered and championed. Breaking the cycle of poverty and poor lifestyle, and preventing problems from worsening or even occurring is critical to ensuring that we make progress. Poor health, particularly poor child health, is not new in Nottingham.

I pay tribute to Professors Elizabeth and John Newson—sadly John passed away last Monday—for their groundbreaking work on child health and psychology at Nottingham university. In their famous and influential book of 1963, “Infant care and motherhood in an urban community”, they followed 700 Nottingham families, particularly from the St Ann’s ward, considering the detailed habits of their lives and so forth. I shall briefly review some of the things that affect the city to illustrate the scale of the challenge that we face.

[Mr Graham Allen (Nottingham North) (Lab)]

I thank my hon. Friend for raising this important matter on behalf of the city. Will he tell the Minister about Nottingham’s fight-back with a set of early intervention policies that try to break the intergenerational nature of these problems? There is great concern in the city that the pioneering work that we have undertaken, which may go to national level, is now under threat because of the public expenditure cutbacks. We managed 14 early intervention programmes in Nottingham on a shoestring. If that shoestring is snipped, the work that has been started will not last the generation, which is necessary if it is to have its massive impact.

[Chris Leslie]

I could not agree more with my hon. Friend.

I shall take the opportunity to pay tribute to some of Nottingham’s councillors. Councillors Mike Edwards, David Mellen, Jon Collins and others have been involved in ensuring a strong early intervention approach. Partnership work needs to be supported, not undermined—particularly, in this context, the Nottingham children’s partnership. That partnership’s “think family” approach is holistic and integrated. Like my hon. Friend, I worry that such preventive partnership work may now be at a high water mark, going down again because of the pressures on those funds. Apart from the NHS, agencies that are not ring-fenced have hitherto put money into their pooled endeavours; now they will naturally and instinctively pull back from those activities, and it will be difficult for them to do anything more than their core work, which will endanger their crucial efforts.

I wish to review some of the key questions that need to be tackled. Sadly, there are many of them. Child mental health is important and is often hidden, but many young people can be held back by such difficulties because of the behavioural consequences. Studies suggest that as many as one in 10 young children or young people in Nottingham are diagnosable with some sort of classifiable mental disorder that might require intervention. Apparently, 10% of five-year-olds experience difficulties that cause distress or have other impacts on their lives. Nottinghamshire Community Health, along with the council, has much of the responsibility for safeguarding vulnerable children, and it does incredibly important work. Again, I am worried about the lack of ring-fencing for other less visible services, particularly social services. I urge the Minister to assure us that social services funding for mental health services will be maintained, because it is incredibly important.

On the question of substance misuse, it is estimated that 3,700 young people in Nottingham under 18 regularly use class A drugs of one sort of another, but the figure could be higher. Although the proportion of young people drinking alcohol has not risen in recent years, it is still far too high when compared with figures for the rest of the country. The number of young people whose carers or parents are involved in drug or alcohol abuse is high; it is estimated that parental alcohol abuse affects between 10,000 and 20,000 young people in the city, which is an incredibly high number.

Smoking is a widespread cause of respiratory problems among young people. The British Lung Foundation report, “Invisible lives” suggested that residents in Nottingham are 40% more likely to be admitted to hospital with chronic obstructive pulmonary disease than the UK average, and respiratory conditions are among the most commonly reported in children.

Another crucial problem is that of teenage pregnancy. By national standards, the figure for Nottingham is still very high. The latest annual data suggest that, within local authority boundaries, Nottingham had the ninth highest rate at nearly one in every 15 teenage girls. Again, that is a shocking statistic. Some Nottingham wards have an under-18 conception rate of twice the national average; 15 of the 20 wards have rates that are among the highest 20% for wards in England.

[Mr Allen]

My hon. Friend is generous in giving way a second time. I would be failing in my duty as chair of the teenage pregnancy task force in Nottingham if I did not point out that we have had a fall in eight consecutive quarters because of the sort of things that my hon. Friend has pointed out, such as working together in partnership, and having clear leadership and lines of accountability. We have fabulous people working on the front line who are pushing down the rates. We also have a family-nurse partnership which gives intensive health visiting for young mothers, and we are doing many other things. I am sure that my hon. Friend will want to pay tribute to those people, particularly the front-line workers.

[Chris Leslie]

My hon. Friend takes the words entirely out of my mouth. I was explaining that the problem is still significant, but thankfully some good progress has been made, particularly through partnership work. That crucial support is funded through the working neighbourhoods fund, but recent Treasury announcements suggest that Nottingham’s fund will cut by £1.2 million. The name on the tin—“working neighbourhoods fund”—does not say what it will do; supporting the programmes that help reduce teenage pregnancy is one purpose. It is incredibly important that we hear about its good work as well as about the shocking statistics.

I want to take the opportunity offered by this debate to highlight the issues of poor child dental health. Although the statistics and methodology of calculating such issues change from time to time, recent reports suggest that Nottingham children have, on average, three decayed missing or filled teeth each compared with just over one in typical parts of the rest of England. Shockingly, in some schools in Nottingham, a few children have been reported to have nearly six missing, decayed or filled teeth. Fluoride in toothpaste is improving matters, but the main factors are still poor diet and nutrition and poor oral hygiene. Although programmes such as the City Smiles dental health promotion programme and community-based services have promoted good oral hygiene and the use of fluoride varnish on teeth, much more still needs to be done. I want the funding for the City Smiles campaign to be confirmed and redoubled by the PCT, and I hope that the Minister will pass on that request. Moreover, we must think about the contentious issue of fluoridation of the water supply. In areas where fluoride is naturally occurring or where it is added, there is some protection against dental decay. Although I cannot claim to be a scientific expert in this area, I none the less hope that the PCT and the east midlands health authority will speed up their review and put some options on the table within the next year if possible.

There is not enough time to address all the crucial issues, which include young people leaving care, children with learning difficulties and serious disabilities and how people can access services. I want to pay tribute to the NHS staff who work so hard in Nottingham. They have recently consolidated the children’s services of City hospital with those of the Queen’s Medical Centre to create the Nottingham Children’s hospital at the QMC site with 15,000 inpatient occurrences and 50,000 outpatient contacts taking place annually. The hospital is very strong in renal and urology services, with 13 kidney transplants taking place last year. It is world renowned for its child integrated cancer services, with 135 children being treated there in 2009. There are also cystic fibrosis services and many others. None the less, there is still room for improvement. In particular, there is not enough accommodation for parents whose children are in hospital. It is important that young patients have the support of their family around them. I urge the Minister to find a way to provide capital support for the PCT and the hospital to ensure that more bed space is provided.

I am also concerned to hear that Nottingham’s speech and language therapy budgets, which are supported by the PCT, may be squeezed because of the financial pressures. Tragically, between 5% and 8% of pre-school children have speech and language problems, so there is a lot of concern about the loss of such resources in the Nottingham area.

I hope that the Minister will address recent policy changes. Childhood obesity and poor nutrition is one of the key underlying causal factors that come up time and again. A third of 10-year-olds in Nottingham are overweight or on the brink of the obesity category. Tragically, the free school meals pilot that had been on the cards has now been cancelled.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Paul Burstow)]

It is a delight to serve under your chairmanship today, Mr Amess; I know you have taken an interest in health debates over the years. I congratulate the hon. Member for Nottingham East (Chris Leslie) on securing this debate. He is right to say that he has brought a serious range of issues to the attention of the House. I applaud him for ensuring that the concern that he and his hon. Friends share about improving children’s health in Nottingham is kept on the agenda both here in the House and in Nottingham.

I am delighted to have the opportunity to respond to this debate and to acknowledge some of the work that has already been done by hon. Members in Nottingham. In particular, the hon. Member for Nottingham North (Mr Allen) has been a staunch advocate on the subject, and has a good track record both in the House and in the local area. The hon. Member for Nottingham East should pay tribute to his leadership, particularly in respect of the teenage pregnancy taskforce, which has done important pioneering work on early intervention that has started to make a significant difference. The Government are determined to do everything they can to ensure that the lessons learned from the taskforce are embedded and sustained as we go forward.

I also want to thank the hon. Member for Nottingham East for his positive remarks about the work of local NHS staff. They are keen to build on the equally strong relationship they have with him and other hon. Members in the area by extending to me an invitation to have discussions with them. A lot of what the hon. Gentleman has said today was concerned with how we ensure that local services are better aligned with each other and collaborating effectively, and that the culture is right to promote effective joint working. Members have a key part to play in that process as local community leaders, and we already have an exemplar in that regard: the hon. Member for Nottingham North.

The hon. Member for Nottingham East cited a lot of statistics on this subject that are compelling and in some ways quite depressing. He pointed out that there is a significant concentration of deprivation and poverty indicators in parts of his constituency, and across the city of Nottingham more generally. Sadly, the map of poor child health aligns all too readily with the wider issues of social and economic deprivation. Clearly, there are challenges to be faced in that regard.

The local NHS should be congratulated on the progress it has made, because significant improvements have been made in some areas during the last decade. Those areas show that strong, well integrated, well resourced and well targeted mainstream services can indeed make all the difference.

We know that there is much more to do in Nottingham—a point that the primary care trust emphasised when I spoke to its representatives yesterday, ahead of this debate. For example, it reassured me that children’s health, particularly in the poorest communities, will remain a strong priority for the future and that it will continue to invest in local health services as well as contributing strongly to the children and young people’s plan, which is important. I understand that that plan, which is very important in driving delivery on the ground, will go to the city council in a few weeks’ time.

That culture of strong partnership working is particularly important: we need much more in the way of joined-up planning, commissioning and delivery in the future. The PCT has reassured me that its priority is continuity, and I hope that that reassures the hon. Members for Nottingham North and for Nottingham East. We want to ensure that we are pushing ahead in areas where progress has been made—there has been progress—and quickening the pace of improvement elsewhere. The Government intend to support such efforts and to ensure that the work that has been started on early intervention and prevention is not lost or thrown aside, but is seen as an essential investment. In truth, that work is not a waste of resources but unlocks resources; to stop it would indeed be a false economy. Therefore, we want to ensure that the poorest communities can get the well targeted services, run by confident and assertive staff, that they need.

Reference has been made to spending pressures. Those pressures existed before this Government came into office; indeed, the last Government acknowledged that the deficit presented a significant challenge to the public sector, including the health service. Indeed, they mapped out the challenge that would have to be faced. Through our first, emergency Budget, the new Government have recognised that not to act promptly would be to fail to deal with the difficulties and the legacy we inherited. In failing to reduce the deficit, we would not only endanger the whole economy but some of the most vulnerable people in our communities, through an inability to secure sustainable public investment in key services. So the decisions we have made, some of which have undoubtedly been painful, are absolutely essential if we are to deliver the sustainable economy and growth that we all need, and the support that is essential to ensure that services continue to develop.

However, as part of making those tough choices, the Government took the decision to protect the NHS and to secure real-terms increases each year for the duration of this Parliament. The hon. Member for Nottingham East was right to say that that does not mean it will all be plain sailing from now on; there will be difficulties and challenges ahead, and there are real pressures on the NHS budget. However, we do not believe that the sick should pay the price for the debt crisis, and this funding will enable the NHS in Nottingham to continue improving services.

That does not necessarily mean “more of the same”. One of the lessons that I took from last week’s National Audit Office report on health inequalities is that success is not all about spending more money. In many cases, it is about spending money more wisely, and the type of schemes the hon. Member for Nottingham North has led in Nottingham are a case in point. In that way, big differences can be made with relatively small amounts of investment.

We need a fresh approach, with a health service that is more preventive, more integrated, more answerable to local communities and more responsive to local needs. We will say more about that approach in the health service White Paper that will be published in the near future, and which will clearly have an impact on the way that health and social care services are delivered in the Nottingham area.

[Mr Allen]

My hon. Friend the Member for Nottingham East pointed out that one way we can make small amounts of money go a long way is through inventive use of the working neighbourhoods fund or its predecessor, the neighbourhood renewal fund, for example. Sadly, however, as my hon. Friend pointed out, those funds are the first things to go when an organisation starts looking at its core operation and contracting inside its own silo, rather than reaching out in partnership with others. That is a problem and the Minister really must address it.

[Mr Burstow]

It is a challenge, and one that both the Government and local organisations understand. When we publish the White Paper, I hope the hon. Gentleman will see that we are addressing that challenge in a very direct way, to ensure that every pound the taxpayer invests in our health service really delivers the maximum possible benefit for the communities it is meant to serve.

The hon. Member for Nottingham East raised a number of specific points and I want to address as many as possible in the time remaining. On child and adolescent mental health services, he said that up to one in 10 young people in Nottingham are diagnosed with mental health problems. Clearly, deprivation, isolation and exclusion are often the harbingers of poor mental health, and children living in poverty are frequently the worst hit. That carries a cost of the sort the hon. Gentleman talked about—one borne not only by those children personally but by the wider community. The hon. Gentleman was therefore right to talk about the vital role that children’s mental health services play. The children and young people’s plan is focused, rightly, on greater prevention and earlier intervention. I can therefore assure him that this Government attach a very high priority to early intervention, preventive mental health services and public mental health services; they are very important to us.

The children and young people’s plan also aims to stop young people experiencing behavioural problems, mental illness, substance misuse and low educational achievement. Again, that requires a confident and well equipped work force who bring together skills across the statutory and third sectors. I understand that the local NHS and the local council plan to improve the training and development of staff in dealing with such behavioural problems.

The hon. Gentleman asked about smoking, which I acknowledge is an important issue that we need to keep a clear focus on. I understand that work is progressing in that field that is targeted at reducing smoking during pregnancy. He also talked about the work that has been done on teenage pregnancy in Nottingham. He is right to say that we should applaud the fact that the teenage pregnancy rate in Nottingham has fallen for eight consecutive quarters. The rate in Nottingham was among the highest not only in the UK but in Europe. Clearly, the rate is now going in a different direction—one secured by the integration of services and effective leadership on the ground. However, the figures remain stubbornly high, and we need to ensure that there is more effort and focus on reducing them. The local PCT has reassured me that a number of schemes it is taking forward, such as the C-card scheme and various other initiatives involving sexual health services, are being maintained. By way of reinforcement, reducing teenage pregnancy will be a feature of the joined-up working produced by the children and young people’s plan.

The hon. Gentleman cited statistics on dental health that were even more stark than those I was presented with by my officials, including on schools that reported having pupils with six teeth that were either missing, decayed or filled. In fact, the latest figures show a slightly different and hopefully better picture. They suggest that five-year-olds in the Nottingham city area have, on average, 1.73 decayed, missing or filled teeth. That places the city’s PCT as the 31st worst performer on that indicator, whereas it was the second worst the last time such figures were published. That figure of 1.73 compares with an average figure of 1.11 for five-year-olds for the whole country. The hon. Gentleman is therefore right to say that more needs to be done about oral health and hygiene in Nottingham. The City Smiles programme will certainly continue to play an important part in that work. On the direct provision of dental health services in Nottingham, the hon. Gentleman will be pleased to know that two new dental practices will open in October, in Bulwell and Bilborough, which will obviously improve access to such services. He also talked about fluoridation. Clearly, such matters are to be decided upon locally, but I will pass his comments on to my ministerial colleagues.

The hon. Gentleman also spoke about funding for speech and language therapy. When I talked to representatives of the local PCT yesterday, they certainly gave no indication of any intention or plan to cut those services. I can assure him that I asked the PCT a lot of questions in preparation for this debate. However, if I am misinformed on this subject, I will certainly write to him to give him further details.

You, Mr Amess, will know about the importance of the issue of obesity, as we both served on the Health Committee when it produced a report on obesity some years ago. Again, the local PCT has told me that it will continue its work on the active schools programme, which encourages more children to take up sporting activities.

I am afraid I will probably run out of time shortly, but the hon. Gentleman has certainly given us a run-around the important issues that this Government will continue to maintain a clear focus on. We see delivery on those issues being provided by effective local leadership, effective integration of commissioning and provision, and good leadership from politicians nationally and locally. By doing that, we believe we can improve the nation’s health.