Public Health

Graham Brady Excerpts

Monday 4th May 2020 Commons Chamber

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

I am grateful to be called so early in this important debate.

I very much welcome the tone that has been adopted by both the Minister and the shadow Minister. The overriding point was that they accepted that these are extreme and unusual measures that no Government or Parliament would want to see lasting longer than is strictly necessary. I hope that as Ministers approach the second 21-day review, they will do so always with a view to removing restrictions and removing the arbitrary rules and limitations on freedom as quickly as possible. Where possible, they should also give advance notice. If restrictions are kept in the review on Thursday but may be lifted during the course of the following three weeks, it would be enormously helpful for people, and especially employers, to know in advance.

I hope that Ministers will always see the time limit as a long stop and not as a target to be met. In pressing that case, I ask Ministers to reflect carefully on the experience of the past few weeks and, as the shadow Minister said, the way in which the British people have responded. In essence, it has worked with that overriding objective of ensuring that NHS critical care capacity was not overwhelmed, and it has worked precisely because the British public have been prepared to comply voluntarily. It has not been about policing, in the main, and it has not been about the threat of enforcement; there has been a common desire to make this work. The public have been willing to assist. If anything, in some instances it may be that the public have been a little bit too willing to stay at home. I am sure I am not the only Member who has heard from employers who are struggling to fulfil orders because it is difficult to get employees back from furlough. We all know how critical it is that they ought to be able to get their workers back so that we make sure that the jobs remain when the furlough period ends.

As the Government begin to set out a staged return to work over the coming weeks—I hope that will be set out on Thursday—it will become even more important that we rely on common sense and voluntary co-operation rather than arbitrary rules. The shadow Minister referred to the 2-metre distancing rule; it is looking increasingly likely, from what I read—probably correctly—that Ministers will look to move to a more nuanced set of guidance, which may focus far more on the importance of hygiene. Perhaps there will be the use of disposable gloves if somebody is travelling on public transport, the regular cleaning of surfaces, and all the things that may apply in schools as well as in other workplaces. As these changes come forward, it will be far easier to make them work through a conversation with the British people—by giving people guidance as the Government’s views and the advice they receive evolve, rather than by seeking always to set out very clear, arbitrary rules and regulations.

It is perhaps more important that that approach should be taken in dealing with our more senior citizens. We have the healthiest, most active elderly generation of all time, and it would be tragic if the Government threatened that by trying to extend the so-called lockdown for those judged to be most at risk based on age. Why do we not just give them the best information and advice and let them limit their risk for themselves? There is no reason why the constituent that wrote to me who is a keen cyclist and turns 70 in November should not continue regularly to cycle 30 miles to 60 miles a day, as he did before the lockdown was imposed.

Finally, let me return briefly to the importance of parliamentary scrutiny. It is deeply regrettable that the current 21-day period of extension will end on a day when the House is not sitting. The announcements that will be made on Thursday would be better made in the House. We should hear them here first; it should not be the media that get to question Ministers on those announcements. I hope that when future periods of review are considered, the House, and perhaps the Government, might bear that in mind.

Covid-19 Response

Graham Brady Excerpts

Wednesday 22nd April 2020 Commons Chamber

[Matt Hancock]

We are testing all those who leave hospital for a care home setting, to make sure we control the spread of the disease and stop it moving from that group as much as possible. On the broader points about expansion, absolutely we are looking at these things. The hon. Lady makes some good points.

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

The Secretary of State is rightly making sure that all patients being discharged from hospital to care homes are being tested, but there remains concern in the care home sector about normal procedures and assessments to make sure that patients or new residents coming to them are appropriate for the care setting, given the emergency admissions that always take place. Before Easter, he kindly agreed to look at whether care homes could be indemnified or have some waiver of liability in these circumstances. I wonder whether he has reached a conclusion.

[Matt Hancock]

We are looking into that question and I will write to my hon. Friend as soon as we have an answer.

Covid-19 Update

Graham Brady Excerpts

Tuesday 24th March 2020 Commons Chamber

[Matt Hancock]

There are no proposals to change the abortion rules due to covid-19.

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

Care homes are being asked by local authorities to contract for block bookings of beds, but at the moment they would bear the liability if something were to go wrong—if residents were to come to them with the infection. May I urge my right hon. Friend to look urgently at the question of whether an indemnity can be provided?

[Matt Hancock]

I will get back to my hon. Friend on that very, very important point. I am grateful that he raised it with me privately earlier, and I am sorry that I have not been able to get a reply in time.

Coronavirus

Graham Brady Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

The answer is yes. Each A&E now has a pod in front of it, which we have funded since the outbreak of the virus, so that suspected cases do not need to go into the main A&E. That is to address exactly the sorts of problems that the hon. Lady raises.

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

Does contingency planning include steps to secure additional capacity in private hospitals, which often would lend themselves better to isolation of infectious patients?

[Matt Hancock]

The question of how we deliver and who delivers NHS services is a matter for the NHS, and making sure that we use all the health facilities available is of course something that the NHS is considering.

Specialist Neuromuscular Care and Treatments

Graham Brady Excerpts

Tuesday 15th December 2015 Westminster Hall

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I beg to move,

That this House has considered access to specialist neuromuscular care and treatments.

[Mr Graham Brady (in the Chair)]

Mrs Gillan, you have the opportunity to speak to the motion.

[Mrs Gillan]

Thank you very much, Mr Brady. I was not sure whether you were going to say something more from the Chair before I spoke again. May I welcome you warmly to the Chair? Perhaps we will get through this debate together without knowing too many details about the procedure.

I also welcome the Minister to his position. When one is a Minister, one sometimes finds oneself in debates where it is déjà vu all over again, as they say. I am afraid that this is probably going to be one of those debates, but it is no less serious than the debate that we had last week on this subject, and I am grateful for the opportunity that the House has given me to reinforce that debate, by allowing this debate today. I see colleagues in the Chamber who were also here last week, and they will know how passionately I feel about this subject; indeed, many of my colleagues, from all parties in the House, feel passionately about it.

I really am delighted to have an opportunity to speak about this subject, because as I think we all know, there are more than 60 different types of muscular dystrophy and related neuromuscular conditions. It is now widely accepted that approximately 1,000 children and adults for every 1 million of the population in the UK are affected by these muscle-wasting conditions, and it is estimated that some 70,000 people right across the UK are affected.

I appreciate that there are other areas that we could discuss under this topic, and I am sure that we will hear from colleagues about them. However, I will use this opportunity to concentrate on muscular dystrophies such as Duchenne muscular dystrophy, on which I have been working hard with my constituents, the Hill family, in order to gain access to a drug called Translarna.

Around 2,500 children and adults in the UK have Duchenne and almost all of them are male. The condition is caused by the lack of a vital muscle protein called dystrophin. It leads to muscles weakening and wasting over time, and to increasingly severe disability. The vital heart and breathing muscles are affected, which often causes devastating cardiac and respiratory difficulties. In older patients, assisted ventilation can be required, which necessitates 24-hour care. Some patients have to undergo a tracheostomy procedure and, sadly, few people live with this condition past their 30th birthday.

Duchenne has a huge impact on families and on the individuals who suffer from it. Only about 100 boys are diagnosed with it every year in the UK, but it is hard to overstate the devastation to the individual and the surrounding family that it causes. The diagnosis is really hard to come to terms with, and the family must deal with huge challenges as the condition progresses and the patient grows older. It usually leads to full-time wheelchair use, surgery for scoliosis, which often involves inserting iron rods into the patient’s back, and the use of full-time assisted ventilation.

As the Minister knows, there is a very brave little boy who is my constituent. He is called Archie Hill and his parents, Gary and Louisa Hill, together with his brother, Leyton, have campaigned tirelessly for access to Translarna. To put things in context for my colleagues who are here for this debate, I can do no better than to use the words, once again, of Gary and Louisa Hill, which I hope will help people to understand the devastation that this condition causes:

“Being told your child will probably die before you, has to be the most devastating thing you can tell anyone. Archie was diagnosed in 2008. Over the next couple of years we became very reclusive, barely getting out the car at school drop off, sometimes not even answering the phone...we wanted to grieve on our own (grieving is not too strong a word). We’re angry, we look at other families and wonder why us?”

They wonder why it has happened to their beautiful child. They blame themselves, even though they know it is not their fault.

The emotional effect on siblings is really apparent, although I have to say that, having met Leyton, I know he is a fantastic support to his brother and to his mother and father. He is an integral part of this team and should be equally praised for his courage and perseverance. I know that he struggles with his concentration, and that he is deeply affected by his brother’s condition, but he is also a very brave little boy coping with this in his family.

Archie faces huge day-to-day challenges. His parents say:

“He is taken out of lessons for physio on a daily basis. He suffers from…mood swings”.

I find that hardly surprising. They go on:

“Every so often he will ask us questions about his condition; does it only affect my legs? Do I always have to take this medicine? Why do I have to wear the night splints?”

He asks all the sorts of questions that a child of his age would ask their parents when they knew that they were suffering from this condition.

Despite that, Archie has great stamina, and he has spent whole days here campaigning, marching up to Downing Street and telling the Prime Minister what he wants and what the Prime Minister should do about it. Quite frankly, he is one of the pluckiest little spirits that I have ever met in my life.

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[Several hon. Members rose—]

[Mr Graham Brady (in the Chair)]

Order. Five or six Members want to participate and I want to get on to the winding-up speeches by no later than 3.35 pm. Although there is no formal time limit on speeches, if Members can keep their remarks to around six or seven minutes, we will be able to accommodate everybody.

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[Richard Arkless (Dumfries and Galloway) (SNP)]

I thank the right hon. Member for Chesham and Amersham (Mrs Gillan) for securing a debate on a subject that clearly touches many people for various reasons. It is also of course a pleasure to serve under your chairmanship, Mr Brady. Those Members who know my background as a lawyer and a businessman may be forgiven for asking, “Why are you here to speak about neuromuscular diseases?” I am not a member of the SNP health team, which is lucky to have the profound experience of my hon. Friends the Members for Central Ayrshire (Dr Whitford) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), but I am developing something perhaps even more important and certainly more profound: I am living with motor neurone disease within my family.

If I can declare an interest of sorts, Mr Brady, my mother has motor neurone disease and, if Members will allow me, I will restrict my comments to that experience. I do not mean to sideline the 59 other important neuromuscular diseases; I want to ensure that what I say comes from a real place, not just a bunch of briefing notes. That notwithstanding, I want to add my voice to the calls to the Minister to persuade him to get Translarna approved as quickly as is humanly possible. I know that he looks sympathetically on that cause, and we have heard many vivid stories today about how it would affect people quickly.

Like everybody, I would lay claim to my mother—and indeed my wife—being the best that there is. She is the most selfless, dedicated mother in the world. She has literally lived her life for me, my brother, Nicholas, and my baby sister, Poppy—a baby who is now in her twenties. We have been her life. She has lived her life exclusively for us. My brother and sister and I will always be grateful for that. My mother was diagnosed 20 months ago. She kept it a secret with my dad for 16 of those months—thank goodness that she has my dad, with whom she has an unbreakable bond—so I have only been living with it for a few months. It is difficult and, as may become obvious during this speech, extremely raw.

During those 16 months, we witnessed the deterioration of my mother’s speech and joints. She explained the speech by way of fictional dentures that she had apparently had implanted. She explained the hands with reference to a historical arthritis problem in our family. Both were plausible and not really questioned up until the point that she decided to tell us. She did not tell me, my brother or sister or our extended family until after I was lucky enough to be in this place and make my maiden speech. She was determined that I should pursue my dream, and of course her dream, of making Scotland a better nation. I suspect that what she really wants now is a second referendum before it is too late, but I suppose that you get the point.

I will return to my mother later, but I want to pick up on some points made by other Members in this enlightening and touching debate. The right hon. Member for Chesham and Amersham is right to say that there are 60 different types of neurological disease, and I hope that she will forgive me for indulging myself with only one of them today. She talked about the Hill family, particularly Archie. I have this vivid image in my mind of Archie running up to 10 Downing Street and giving the Prime Minister what for—if only all of us could get that opportunity.

The speech of the hon. Member for York Central (Rachael Maskell) was touching indeed. She brings a wealth of practical experience, to which the Minister ought to listen carefully. I was particularly captured by her assertion that equipment needs to be made available when needed. It needs to be the right equipment in the right place at the right time, because time moves too quickly with such diseases. I hope that the Minister will pay careful heed to the hon. Lady’s practical experience, which has substantially benefited the debate.

I was particularly touched by the story of Jagger from the hon. Member for Romsey and Southampton North (Caroline Nokes). I hope that he enjoys his break in Tenerife and that the Minister will listen to calls for Translarna to be approved as soon as possible.

The debate has been consensual so far, and I want to take the politics out of what I am going to say. I want to touch on some things that Scotland is doing well on motor neurone disease, but I do not mean that to be a criticism of the UK Government. I hope that everybody’s ears are open. If we are doing things right, I sincerely hope that the UK can learn. If the UK is doing things right, my ears are open and Scotland can certainly learn. There is no politics in this whatsoever. As an aside, as new Member I have been frankly dismayed at how health services are politicised by both sides of the House. I have become increasingly amenable to the suggestion that perhaps the health service should not be run by politicians at all, but by people who have at heart the interests of the people whom we are here to serve.

Motor neurone disease is a neurological degenerative disease. In simple terms, the mind is fine and continues to operate with full function, but the body gradually gives up. The signals do not go from the mind to the body to make it work: that is how I think of it. Patients are affected differently. My brother-in-law died from it a couple of years ago, and his limbs were affected first. His legs started to give way for no apparent reason. However, my mother’s speech was the first thing to go—this was a lady who liked to talk, who seriously liked to talk! To have that stripped away from her must be incredibly difficult—and I know it is.

Scotland is doing many things well on motor neurone disease. Over the past year we have announced that we will double the number of motor neurone nurses. We are very much in the early stages, but the Scottish Government have provided funding to local authorities to ensure that things happen. At the moment local authorities are recruiting and assessing the need, and I hope that process will be speeded up as we go on.

That funding is a recognition of the difference that specialist nursing can make to motor neurone disease. My mother has to rely on a motor neurone nurse who comes from another region and who can only come on a part-time basis. A very proud woman, she was initially most reluctant to consider any form of help, but she has since come to realise what a benefit the nurse is. She has asked me to take up the cause of getting more motor neurone nurses throughout not only Scotland, but the rest of the UK—we are all human beings, despite our political views.

The change in Scotland has been praised in all quarters. Huge thanks are due to people such as Archie and Jagger. In Scotland a gentleman called Gordon Aikman, Christina McKelvie MSP, and all the staff at MND Scotland have done an incredible job of persuading the Government of the immediate need for those services. We have committed to giving a free voice box on the NHS and to paying families directly for support, not as a patronising gesture to pay people to look after their relatives, but to ensure that support is available if needed. We have also increased investment in palliative care.

I live in a town called Stranraer. The UK average is two people with motor neurone disease per 100,000; the Stranraer average is 13 per 10,000—an astronomical figure. I have asked the chief executive of our local health board to figure out exactly why—

[Mr Graham Brady (in the Chair)]

Order. I am sorry, the hon. Gentleman must resume his seat. I am loth to interrupt a very personal story, but we need to leave time for both the official Opposition spokesperson and the Minister to wind up. I have allowed more than eight minutes, and I am keen to allow the same to the official Opposition.

Cities and Local Government Devolution Bill [Lords]

Graham Brady Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Betts]

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

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

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

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

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

[Mr David Nuttall (Bury North) (Con)]

In his speech on 14 May, the Chancellor of the Exchequer said:

“I will not impose this model on anyone.”

Does my hon. Friend agree that the best way to demonstrate that local people want the new system would be to hold a referendum?

[Mr Brady]

I agree wholeheartedly. I devoutly hope that Ministers even at this late hour will recognise that it is very much in their own interests and those of the Government, and entirely in the interests of the people of the combined authority areas which may face these new arrangements of governance, to accept the point. I am especially hopeful given the sterling work my hon. Friend the Minister did in the last Parliament trying to ensure that people had the opportunity to give consent on the arrangements surrounding our membership of the European Union. I know he will recognise that, given his deep commitment to democracy, it would be entirely consistent for him to recognise the wisdom of the proposal.

New clause 8 is in tune with the essence of the Bill and the essence of the Government’s intentions. There are very few of us on either side of the House who would argue with the proposition that it is generally better for power and decisions to be exercised as close to the people as possible. It is almost invariably better for decisions, including spending decisions, to be taken more locally, and new clause 8 seeks to place an extra protection in the Bill: a safeguard seeking to limit the occasions on which the legislation could be used to permit devolution in the wrong direction. That is not really devolution at all, of course. Rather, it is the opposite of devolution: it is the capacity that exists in the Bill as it currently stands for powers to be moved up, away from the people and away from local authorities which currently exercise powers, to the combined authority or to mayoral authority level. It is a very modest measure—[Interruption.] My hon. Friend the Member for Bury North (Mr Nuttall) endorses that view, and I was surprised at just how modest my aspiration had become during the course of this process, perhaps due to the endless courtesy and charm of the Secretary and State and the Minister.

All new clause 8 seeks to do is ensure that, if a local authority decides to transfer a power to the mayoral level, there would be a cooling-off period before it became permanent, and crucially that a local election must be held before such time that that transfer of power away from the people in the wrong direction—this anti-devolution—can become permanent. That is a modest but important safeguard, and I hope Ministers will accept it would be in their interests and the interests of good governance to incorporate it.

Perhaps the most important measure in this group is amendment 57, which sits, almost naturally, as a part of a couplet with the proposition for a referendum. In a way, if we do not have one of them, it becomes even more important that we have the other. If the Government are not going to consult the people directly on the new governance arrangements that will apply to them by allowing a referendum, it is even more important that the arrangements set out in amendment 57 should be incorporated, which would allow a local authority, in the event that the new arrangements do not work in the interests of that local authority area, to seek at a future date to leave, with a fair distribution of both the liabilities and assets of the combined authority.

I have sought to ensure proper fairness and a reasonable arrangement in the unlikely eventuality that a local authority would reach the point where it was convinced that the new arrangements were not in its best interests. That would provide the necessary reassurance to people that this is not an irrevocable step, and that if it does not work, there is a way out of it. Perhaps most importantly, it would also place a real discipline on an elected mayor and ensure that the holder of that office would at all times seek to behave reasonably and reflect the interests not just of the majority of the area of the mayoral authority, but of the whole of it. The risk that an elected mayor may at some point in the future seek to govern in a way that is clearly contrary to the interests of any one part of a conurbation would be massively greater if the Bill were to proceed unamended. Again, I very much hope Ministers will recognise that the Bill would be strengthened and improved by amendment 57.

[Norman Lamb]

I want to speak in support of new clause 10 and to make a brief comment on amendment 7. The new clause seeks to reinstate in the Bill, as brought from the Lords, the provision to allow votes for 16 and 17-year-olds in local government elections. As a matter of principle, I support the idea of votes for 16 and 17-year-olds, whether in national elections, local government elections or referendums. I supported the case for 16 and 17-year-olds to vote in the Scottish referendum. I have also argued the case, along with many others, for them to be able to vote in the European Union referendum, because it is their future that we will be debating.

In the context of the Bill, I strongly support the case for 16 and 17-year-olds having a say, for goodness’ sake, in the election of their local councillor. I find it extraordinary that the Government oppose the proposal so strongly. I appreciate that the Secretary of State has indicated that there is a debate to be had on the subject, and that we might explore it more fully on other occasions, but how long does this have to take? Those 16 and 17-year-olds can join our armed forces to defend the country, they can marry and they can pay taxes on their income if they are in work, yet they cannot have a say on how those taxes might be raised, on the extent of them or on how they might be applied. As citizens they ought to have the same rights as the rest of us enjoy, and I urge the Government to think further on this.

We often make points about the low turnout among those young people who are entitled to vote, and about the low engagement in the political process. I made the point in our previous debate on the issue that young people are very interested in a range of political issues, but there is no doubt that in many cases many of them are disengaged from the political process. If we are to seek to change that, surely giving these young people the right to a say in the political process would help. The turnout among 16 and 17-year-olds in the Scottish referendum, at about 75%, is indicative of a level of interest in the issues, which the Government ought to recognise.

David Willetts, the well respected former Minister in the coalition Government, has made a point about the breaking of the generational contract. This is a serious concern. Political parties tend to focus a lot of their attention on the interests of older people, who of course tend to vote. I would argue that there is a lack of attention being paid to the interests of young people, particularly 16 and 17-year-olds, who have no vote at all.

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[Mr Rees-Mogg]

I do not accept that. I am not a big-is-good advocate. I think that small can well be beautiful. The individual leaders of councils are the doughty defenders of the interests of the population that has chosen them, and they are in their way like Members of Parliament in that they represent a specific area and a specific interest, and they can combine with others to see how decisions can be made. I see no lack of democracy in a group of people coming together, each one of whom has an individual mandate. Indeed that can be a better democratic mandate than having a highfalutin mayor.

[Mr Graham Brady]

I am enjoying my hon. Friend’s speech very much and following it closely. He may be interested to know—he may already be aware of this—that in Greater Manchester, which is really the point of origin of many of the things that we are discussing today, the combined authority has worked extraordinarily well, and that those elected council leaders have worked very well together. It seems odd to many of us that we should move from a structure that is working well, and to which nobody has any objections, to the imposition of a completely different structure without popular consent.

[Mr Rees-Mogg]

I agree with my hon. Friend. Imposing structures does not give them legitimacy. What gives them legitimacy is that they should be built from the ground upwards. Fundamentally, that is a Conservative view of how Governments are constructed. I am talking about the little battalions coming together to do big things jointly, rather than a hierarchical system that says, “We know what’s best for you.” That is the approach of those on the Opposition Benches. The socialist approach, as it is now, once again, a Socialist party, is about telling people what to do and giving them the figures who do it. The Conservative evolutionary approach is to allow people to come together, each one of whom individually has legitimacy to do things. I absolutely accept his point that combined authorities have worked by consent and that they do not necessarily need super-mayors or metro mayors put on top of them. If that is done without referendums, we will be back here in 20 years’ time—[Interruption.] I very much hope that the hon. Member for Bolsover (Mr Skinner) is still here in 20 years’ time so that we can discuss these important matters.

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[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 Deputy Speaker (Mr Lindsay Hoyle)]

With this it will be convenient to discuss the following:

New clause 12—Review of devolution of health services—

‘(1) 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.

(2) The review must make an assessment of the extent to which the health services devolved under any of the provisions of this Act have maintained standards and, in particular, of the quality of services and outcomes achieved by those devolved health services 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 impact of devolving health services in order to make sure that standards and the quality of services and outcomes have not declined.

Government amendment 34

Amendment 60, in clause 17, page 19, line 30, at end insert—

‘(2C) The Secretary of State may revoke health functions from the relevant local authority under subsection (2A) only following advice from an independent panel, whose membership must include representation from local government and the NHS and which is to be convened as and when necessary.”

This amendment would safeguard the devolution of health functions by ensuring that any revocation of these functions is done under the advice of an independent panel, whose membership includes representatives from local government and the NHS.

Government amendments 35 and 46 to 49.

[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.

[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.”

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[Alistair Burt]

I am happy to respond to this short debate dealing with new clause 9, tabled by my hon. Friend the Member for Altrincham and Sale West (Mr Brady), amendment 60—to which the hon. Member for Nottingham North (Mr Allen) has just spoken—new clause 12, tabled by the hon. Member for Hemsworth (Jon Trickett), and the Government’s three technical amendments.

New clause 9 would amend secondary legislation to require that each constituent part of a combined authority should be consulted on any major healthcare reorganisation in its area, as well as the combined authority’s being consulted. Each constituent local authority would be able to refer any such reorganisation to the Secretary of State, without such a referral having to be made by the combined authority.

As my hon. Friend knows, proposals for reconfiguration must currently meet the Government's four tests for service change: support from local GP commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. At present, any local authority has the right and, indeed, the responsibility to raise issues about a reconfiguration. My understanding is that that right remains. I take my hon. Friend’s point about its having been given to the combined authority, but, because I do not know about the relationships between the local authorities in question, I do not know whether the combined authority would at any stage reserve the right back to itself if it wished to do so. In the meantime, however, I have one safeguard, and perhaps another, to mention to him. This also applies to the hon. Member for Nottingham North, because it is part of the same thing.

The Secretary of State is only going to accept a recommendation for devolution if it is in the best interests of health in the area and if it will improve health outcomes. He must do so by order. There is nothing in the Bill that requires an authority to take on a national health service function. Authorities can do so if they so wish, but the Secretary of State must be able to see a clear outcome, and he retains his duties and responsibilities for ensuring that the NHS mandate is maintained and that all his statutory duties and responsibilities are observed. The Secretary of State is not going to sign an order, therefore, if he does not think that the health outcomes for the area will be improved. The Secretary of State is entitled to put in the order what he wishes. That order is then debated in the House and has to be passed as an order.

It would be possible for the Secretary of State to include in the order the fact that the individual authorities that make up a combined authority have the right to make representations to him about any reconfiguration. I can give my hon. Friend the Member for Altrincham and Sale West that assurance, and if we find that the legislation is not as I believe it to be, which is that it has retained that right for the local authority, an order in relation to his local authority will contain that safeguard.

I also offer this to my hon. Friend: if he will consider withdrawing the new clause, we will check, before the matter goes before the House of Lords again, to see whether the legislation is as I believe it is, because if it is, the new clause will not be necessary; but if it is not as I believe it to be, the safeguard—the double assurance—will be included in the order and the present Secretary of State would intend to deliver on it.

[Mr Brady]

My right hon. Friend is seeking to be very helpful. The difficulty that exists is that the safeguards he proposes apply at the moment of devolution. My concern is that a reconfiguration might happen when a power has been devolved, which might not be in the interests of one of the constituent parts of a conurbation. What can be done at that point is what is crucial.

[Alistair Burt]

At that point, the order that the Secretary of State has signed to allow the devolution in the first place will allow the authority to make a representation to that effect. The order does not just apply to the moment of devolution; it applies to the substance of the devolution, which is the exercise of the health powers the combined authority will have taken on. In respect of a reconfiguration that takes place under the combined authority, the order will safeguard the right of the local authority individually to make representations to the Secretary of State. It is guaranteed not just at the point of devolution, but in the exercise of powers under devolution.

[Mr Brady]

Might I press my right hon. Friend a little further? I am avoiding being too specific about the Healthier Together proposals for obvious reasons, but in the event that those proposals were to be set aside this week and new reorganisation proposals were to be brought forward, can he give me an absolute assurance that, either under the existing legislation or measures he would introduce in the House of Lords, the individual local authority would retain the freedom to refer any reorganisation to the Secretary of State? If he can do that, I would be satisfied.

[Alistair Burt]

I believe that that assurance is present in existing legislation. If it is not, we will make sure in the House of Lords that it is. I would also query why my hon. Friend’s local authority has given up this right in the first place to the combined authority, because it if wants to retain that right, perhaps it might want to take it back from the combined authority.

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[Mr Brady]

The Minister has to understand that this is endemic in the nature of the process. It will become more and more commonplace as we see more powers being transferred from the local authorities to combined authority level, and the new arrangements will become entrenched. That is why it is so important that we ensure that the safeguards are in place at this point—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

[Mr Brady]

I am trying to assist the Minister, who I think needs just a moment longer.

[Mr Deputy Speaker]

Unfortunately it is me that makes the decisions—we could do this over two days—but I would have thought the Minister had at least some indication.

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[Liz McInnes]

I want to support new clause 12, although the Minister has made his case for turning it down. I think it is important that we build a review stage into the devolution of health simply because the implications of the Bill for the English NHS and social care system are not clear. The Bill regulates for important new powers to remove functions from NHS hospitals, commissioners and other bodies and to transfer them to the local regional authority. Depending on the implementation, interpretation and limits of the powers, such transfers might fundamentally reshape the health service in the years to come. We must ensure that the national health service stays national. We do not want a postcode lottery for healthcare.

Accountability and scrutiny remain crucial for a well-run national health service, delivering the best care it can for everyone no matter where they live. The Bill’s light-touch nature and the pace with which the agenda is moving leave a number of crucial and unresolved questions, some of which I would now like to ask. Will central and regional government argue over the responsibility for meeting population needs and making difficult decisions, such as those on whether to close hospitals or prop up overspending healthcare providers? What will happen to neighbouring areas?

Deals permissible under the Bill create the possibility of NHS funding melting into wider regional authority budgets, making ring-fencing or protecting impossible. Given the importance of healthcare spending as an issue, it needs clarity and scrutiny. Devolution to combined authorities under the Bill might actually have a centralising effect for many health and social care functions, taking power away from councils that represent smaller communities and the clinical commissioning groups that represent clinicians. Although that might be desirable in some cases, it is also important to consider how the positive developments brought to health and social care by these bodies can be preserved.

Clauses 7, 16 and 17 allowed the piecemeal transfer of health care commissioning responsibilities from clinical commissioning groups and NHS England to local government. I am concerned about the impact that will have on the NHS, especially as regards local variation in service levels, further allocation of resources and the cross-border impact of decisions. The Opposition believe that there should be a statutory duty on the Secretary of State for Health to secure and provide universal health care and that core national NHS standards should remain in place.

[Mr Brady]

I want to make it very clear, and this might be helpful to the hon. Lady, that after the Minister’s assurances to me I will seek the leave of the House to withdraw new clause 9. She might, of course, wish to do other things with her new clause.

[Liz McInnes]

I thank the hon. Gentleman for that intervention.

Although I see a range of possible potential benefits arising from the devolution agenda, particularly the opportunity for greater integration of services between health and social care and bringing public health and other areas under local government control, a number of outstanding questions will need to be resolved, largely focused on resolving the tension between local and national arrangements and the extent to which the “national” in the national health service will be preserved. What we are witnessing is not devolution. The models adopted in the deal so far appear to be closer to delegation than the formal devolution outlined in the Bill.

As the Opposition understand it, there are no plans to use the order-making power created through the Bill to transfer additional health functions to local authorities. Any health-related orders will be used only to enable combined authorities to share the health duty that already sits with local authorities. I seek the Minister’s assurance that the devolution of health service will be reviewed in a year to ensure that standards and quality of services and outcomes have not declined. That is what new clause 12 outlines—it seems an eminently reasonable request given an issue as important as our nation’s health.

[Mr Brady]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Cities and Local Government Devolution [Lords] Bill

Graham Brady Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

I recognise the hon. Gentleman’s diligence in raising his concern, particularly given that that is his area of expertise. Rather than my commenting on it in the debate on this Bill, however, I would gently suggest that it is a matter that should be discussed in a Welsh context in the debates on the Wales Bill.

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

The Minister has given the welcome assurance to my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) that no rural area neighbouring an urban or metropolitan area would be held to becoming a member of it. Will he also give the Committee an assurance that any rural area wishing to join a combined or mayoral authority will be able to do so?

[James Wharton]

That would be entirely a matter for the proposal put forward by the local area in question. We would certainly be open to whatever geography an area wished to present as the most logical for its economy and the most able to allow it to drive forward the changes and improvements we envisage being enabled by the Bill. So yes, that would be possible, but only by agreement and in line with the Government’s approach to devolution.

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[Mr Betts]

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

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

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

[Mr Graham Brady]

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

[Mr Betts]

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

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[Ann Coffey]

My hon. Friend is absolutely right; it is a good thing. When people talk to me—and, I am sure, when they talk to him—and ask who they can go to, to them having a mayor makes perfect sense.

Of course, there are outstanding issues with regard to health, but there is nothing in the Bill that will take away from the people of Manchester the right to national health services enjoyed by people elsewhere. The problem in Greater Manchester is the fragmentation of health, so it is good that these proposals will help reduce the number of commissioning organisations and allow providers to work together in a more collaborative way for the benefit of local people. However, we need a funding settlement that gives greater flexibility in developing high-quality health and social care services in the community across Greater Manchester as an alternative to hospital admissions, and at the moment it is difficult for each clinical commissioning group to free up resources in order to do that. Without that investment, the demand for expensive hospital care will continue. The authority cannot simply be a bank that hands out money under the current funding arrangements.

There has been a lot of talk about accountability, but in my experience accountability is at its best when well-informed elected representatives, such as my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), demand answers and are willing to make their case loudly and publicly. No complexity in the arrangements for governance can take the place of that, and that is the accountability that the public expect us to ask for.

Last year I did some work looking into child sexual exploitation across Greater Manchester, at the request of the police and crime commissioner, Tony Lloyd, and following that I published my report “Real Voices” last October. Talking to children at risk of child sexual exploitation, it is absolutely clear that they do not observe local government boundaries, health boundaries or police boundaries, and neither do their predators. The digital age has redefined boundaries. A lot of progress on that has already been made across Greater Manchester. In particular, I want to congratulate Project Phoenix, a cross-boundary, multi-agency response to child sexual exploitation across the whole of Greater Manchester, which is working to ensure that child victims receive the same standard of response regardless of where they live. It has also initiated a very successful “It’s not okay” campaign to build public awareness of child sexual exploitation and help young people recognise when they are being groomed. It is clear that work on this crucial agenda will be enhanced by more devolution powers for Greater Manchester. We must overcome the silos and boundaries that prevent people working together to protect children from abuse.

Amendment 51, if passed, would be a kick in the teeth for the people of Greater Manchester and their children, who have felt for years that their voices have been ignored by Whitehall and Westminster. Devolution and the creation of a mayor offer the opportunity to the people of Greater Manchester to develop services that reflect their priorities and needs. We should take that opportunity and be positive about the opportunities we are being offered.

[Mr Brady]

I am pleased to have an opportunity to participate in this brief debate in Committee. We have already had some useful exchanges, and my hon. Friend the Minister has, as usual, been courteous and helpful—I am sure that he will be even more helpful before the end of our proceedings.

The hon. Member for Stockport (Ann Coffey) spoke with obvious passion, and we all very much appreciate the work she did on child sexual exploitation, but I want to pick up on the point she made right at the end of her speech, despite my hon. Friend the Member for Hazel Grove (William Wragg) making it clear that amendment 51 would require a simple majority in the referendum, whatever the explanatory statement might say. I think that she can relax about the prospect of any kick in the teeth for local people.

[Ann Coffey]

I understand from my hon. Friend the Member for Nottingham North (Mr Allen), who is very knowledgeable in these matters, that it is the Member who writes the explanatory statement for an amendment, not the Clerks.

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[Mr Brady]

I should not speak for my hon. Friend the Member for Hazel Grove in this instance, although I will put on the record my gratitude to the Clerks for their assistance in drafting the amendments and explanatory statements that stand in my name. I will speak briefly to amendments 42, 43 and 44, allude to amendment 51—I am sure that my hon. Friend the Member for Hazel Grove will speak to it in due course—and comment on Government amendment 4.

[Mr Nuttall]

I want to try to clarify the point about the 50% threshold. In a referendum in which the electorate vote either yes or no, what we are trying to make clear is that it would have to have the support of over 50% of the people voting in the referendum. It is no more complicated than that.

[Mr Brady]

I am grateful to my hon. Friend, who expresses the matter clearly and succinctly.

We have already shed light on a number of important things. I particularly welcome the Minister’s reassurance, which is important to those of us who are evangelists for devolution for the Greater Manchester area, that in due course, when it has proved as successful as we all hope it will be, some of the neighbouring authorities such as Cheshire East Council—I am delighted to see my hon. Friend the Member for Macclesfield (David Rutley) here—might apply to be part of the journey to this great new world on which we are embarking. I am sure that he would not be alone in wishing to come and join us.

[David Rutley]

I have great respect for my hon. Friend, who is indeed a great friend. Like him, I would absolutely love to see devolution succeed in Greater Manchester, in partnership with authorities in the counties around it, including East Cheshire unitary authority.

[Mr Brady]

I am glad to have enabled my hon. Friend to speak for himself.

Amendment 42 seeks a very simple and not terribly onerous change. It would simply require the Government to report annually on how they have exercised their functions in order to demonstrate that they have not themselves exercised any of the devolved functions that rightly belong with the combined authority or the mayoral authority. There might be better ways of doing this, and I hope that my hon. Friend the Minister will put forward his own proposals in due course. However, the underlying point is that although the Government have been very pleased to place obligations on local authorities through the process of forming agreements or deals, as the Secretary of State likes to term them, very little in the Bill as it stands provides any mechanism to hold the Government to account and ensure that they fulfil their side of the bargain. I think that would be welcomed by everybody who is an evangelist for devolution—as I am sure we all are.

The Minister alluded to amendments 43 and 44, which seek to provide an easier route for exit. I happily accept that, as the hon. Member for Denton and Reddish (Andrew Gwynne) said, it would be very difficult for any authority to leave a combined authority, especially a mayoral authority, at some point in the future. An enormous number of functions, agreements, financial obligations and so on will bind local authorities together, increasingly so as the years pass, and therefore no local authority would do this lightly. However, the ability to leave, should the devolution arrangements not work in practice for any one or more of the local authorities in an area, is, in some ways, the ultimate guarantee that no abuse should take place. It is particularly important that we should have such a safeguard if we reach the end of our deliberations without a referendum lock in place. If the public are not to be given the choice as to whether they want to have the elected mayor and this new structure of governance put in place over them, surely there must be a safeguard so that if, at a future date, the new arrangements were not working for the people of Trafford, Bury, Stockport or Bolton, they could seek to leave, without penalty, to find a new way of providing services and representation to the local community.

Amendment 51 calls for a referendum test to be passed. This also relates to Government amendment 4. I think the only reason the Government are so determined to overturn the amendment passed in another place which seeks to prevent conditionality—local authorities being told they are allowed to have devolution only if they accept the model of an elected mayor as a condition—is that negotiations in Greater Manchester have moved as far as they have under those conditions. It seems wrong that the Government are expecting local authorities to accept a particular model of governance as the price for this kind of devolution settlement, particularly if the Government do not have the self-confidence to consult the people and to believe in their own argument such that they could persuade the public that it is something they ought to welcome. This is the ultimate test of the Government’s arguments. The Minister is a very persuasive man, as we have seen in the Chamber today. I am certain that with his enthusiasm, charm and powers of persuasion, he could go out and sell this proposition to the people of Greater Manchester, and perhaps to those in Sheffield and other parts of the country. I wish that he would have the confidence in his own abilities that we all have.

[Nigel Mills]

I am sorry, obviously, to interrupt the much deserved flattery. Does my hon. Friend accept that, especially in areas outside Manchester, none of the council leaders proposing these deals has been elected on such a mandate? I do not recall that in the 2013 county council elections there was any suggestion of “Vote Labour and we’ll try and create an elected metro mayor for Nottinghamshire and Derbyshire combined.” I agree with local decision making and I support these changes, but there is no local electoral mandate for them.

[Mr Brady]

I absolutely agree with my hon. Friend. In my Greater Manchester constituency, the level of knowledge of what is being proposed on changes in governance is still remarkably low. Certainly, it was not a significant feature of the general election campaign or the last local election campaign. We need to try to create a better level of knowledge and engagement.

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

It is correct that no political party has so far campaigned on a metro mayor, but can the hon. Gentleman tell me of any political party, in Greater Manchester or elsewhere, that has ever campaigned on more power for central Government? In fact, the opposite has always been true. Having written Labour party manifestos several times, I know that political parties have always asked for more decentralised power.

[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.

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Functions

[Mr Brady]

I beg to move amendment 45, in page 4, line 18, at end add

‘provided that in each exercise of that function the mayor has the consent of each constituent part of a combined authority.’

The intention of this amendment is that any constituent part of a combined authority may veto any decision made by a mayor of a combined authority.

[The Temporary Chair (Mr David Crausby)]

With this it will be convenient to discuss the following:

Amendment 40, in page 4, line 18, at end insert—

‘(1A) An order under subsection (1) may only be made with the consent of the relevant combined authority; and that consent must be obtained prior to the creation of the office of mayor in the combined authority concerned’.

The intention of this amendment is that a function of a mayoral authority may only be transferred to the mayor with the consent of the relevant combined authority, which must be obtained prior to the creation of the relevant office of mayor.

Government amendments 5 to 7.

Amendment 60, in page 5, leave out lines 9 and 10.

As it stands the Bill removes the right of the Secretary of State to give borrowing powers to an elected mayor but allows for borrowing powers to be given to a combined authority. The amendment will allow borrowing powers to be given to an elected mayor.

Government amendment 8.

Clause 5 stand part.

Government amendments 23 to 25.

That schedule 2 be the Second schedule to the Bill.

Clauses 6 and 7 stand part.

Amendment 41, in clause 8, page 8, line 20, leave out from beginning to end of line 12 on page 10 and insert—

‘(1) The Secretary of State may by order make provision for a function of the Secretary of State that is exercisable in relation to a combined authority’s area to be a function of a mayor of a combined authority;

(2) An order under subsection (1) may not include provision about the exercise of functions currently exercised by local authorities.’

The intention of this amendment is that the only powers that can be given to a mayor of a combined authority are powers currently exercised by central government.

Amendment 54, page 8, line 27, at end insert—

‘(c) make provision for conferring on a combined authority, upon the request of that authority in relation to its area the full retention of business rates, business rate supplements, council tax, stamp duty land tax, annual tax on enveloped dwellings, capital gains property disposal tax, and multi- year finance settlements.’

This amendment will allow local authorities to retain all of their local taxation, including Business Rates and Council Tax.

Amendment 55, page 8, line 27, at end insert—

‘(c) make provision for conferring on a combined authority in relation to its area discretionary control of council tax discounts, business rate discounts and supplements, and other local fees, charges and subsidies in relation to other retained taxes.’

This amendment will allow local authorities to control all of their local taxation discounts, including those applicable to Business Rates and Council Tax.

Clause 8 stand part.

Clause 17 stand part.

Amendment 48, in clause 18, page 17, line 48, after “consents,” insert

‘and in the County of Somerset, as defined by the Lieutenancies Act 1997, approved by a referendum in the local authority area’.

Government amendment 15.

Clause 18 stand part.

Clause 9 stand part.

Amendment 1, in schedule 3, page 32, line 12, after “persons” insert

‘including representatives of parish, neighbourhood, community and other councils in the area of the combined authority’.

This amendment would allow local representation from parish, neighbourhood, community and other council is to attend combined authority scrutiny meetings.

That schedule 3 be the Third schedule to the Bill.

Government amendment 9.

Amendment 58, in clause 10, page 11, line 26, at end insert—

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

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

Clauses 10 to 14 stand part.

Amendment 49, in clause 15, page 14, line 43, at end insert—

‘(d) In the County of Somerset, as defined by the Lieutenancies Act 1997, approved by a referendum in the local authority area.’

Clause 15 stand part.

Government amendment 10.

Amendment 2, in clause 16, page 16, line 6, at end insert—

‘(d) the creation of a Constitutional Convention to discuss further local authority governance, functions and related democratic issues.’

This amendment creates the means by which every UK citizen can participate in a national public discussion on local devolution in the context of the wider renewal of UK democracy.

Government amendment 11.

Amendment 47, in page 16, line 11, after “apply” insert

‘and in the County of Somerset, as defined by the Lieutenancies Act 1997, approved by a referendum in the local authority area’.

Amendment 50, in page 16, line 11, at end insert—

‘( ) In the case of two tier authorities, consent under section 16(3) may also be given where a majority of local authorities in the local authority area have indicated their support.’

Government amendments 12, 14 and 13.

Clause 16 stand part.

New clause 2—Subsidiarity—

‘That Subsidiarity as defined by the Maastricht Treaty 1992 Article 5(3) shall apply to the functions of national and local government.’

This new clause would build in local government’s independence by using the principle of subsidiarity found in European law.

New clause 4—Local Government Constitutional Convention—

‘(1) A convention is to be held to consider and make recommendations on the constitution of local government in the United Kingdom.

(2) The Secretary of State must make regulations to—

(a) appoint a day on which the convention must commence its operations,

(b) make fair and transparent rules about how the convention is to operate and how evidence is to be adduced,

(c) make further provision about the terms of reference prescribed under section (Local Government Constitutional Convention: terms of reference), and

(d) specify how those who are to be part of the convention are to be chosen in accordance with section (Local Government Constitutional Convention: composition).

(3) The date appointed under subsection (2)(a) must not be later than 31 December 2016.’

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—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 6—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 7—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 10—Housing devolution to London—

“In any enactment relating to housing, any power or duty of the Secretary of State applicable to any person or dwelling shall be exercisable in the Greater London area only by the Mayor of London, with the consent of the Greater London Assembly.’

This new clause provides for devolution to London of the Secretary of State’s housing powers.

New clause 11—Local property taxes devolution to London—

‘(1) There shall be London Consolidated Fund into which shall be paid each month a sum equivalent to the previous month’s tax receipts in relation to properties in the greater London area accruing from—

(a) the stamp duty land tax,

(b) capital transfer tax,

(c) the annual tax on enveloped dwellings, and

(d) capital gains property disposal tax.

(2) The Treasury must consult the Mayor of London and the Greater London Assembly on what band and rates should be applied in respect of the Greater London area for the next financial year in respect of each of the taxes mentioned in subsection (1).’

This new clause provides for devolution to London of the receipts from taxes on property and for formal consultation with the Treasury on the rates of those taxes to be set for the greater London area.

New clause 12—Local Government Financial Integrity—

‘(1) Local authorities shall be financially independent of central government, save as otherwise provided for by this section.

(2) Central government may not place any restriction on decisions by local authorities about the exercise of their financial powers.

(3) The distribution of central government funds between local authorities shall continue on the basis of existing equalisation arrangements. Distribution will continue to be based on the principle of ensuring fairness and balance between local authorities. The basis on which this distribution is carried out must continue to be made public.

(4) Each local authority shall receive from central government a guaranteed share of the annual yield of income tax, as follows. Central government must in each financial year assign to the Secretary of State responsible for the distribution of central government funds between local authorities an amount of money equivalent to the yield from ten pence in the pound of income tax. The Secretary of State must make arrangements to inform each taxpayer in England of the amount of their income tax which makes up the central government funding distributed to English local authorities as a whole.

(5) The amount of the income tax yield referred to in subsection (4) shall be renegotiated between central and local government whenever service provision responsibilities are transferred between central government and local authorities.

(6) Local authorities may raise additional sources of income in their areas in any way they wish, and with the consent of their electorates as expressed through arrangements to be determined and put in place by the local authority concerned.

(7) Local authorities shall be able to raise any loans, bonds or other financial instruments which their credit rating allows and as independent entities will be exclusively responsible for their repayment. All local authorities shall operate a balanced budget so that in any one financial year all outgoings, including interest repayments on borrowings, shall not exceed income.

(8) Central government may not cap, or in any other way limit, local authorities’ taxation powers.

(9) The financial transparency standards that apply to central government shall apply to local authorities.

(10) Central government and local authorities may contract with each other in order to pursue their own policy objectives.’

The intention of this new clause is that receipts from income tax should be assigned to the Department for Communities and Local Government who will then pass it on to councils.

New clause 14—Power to create new council tax bands—

‘(1) Section 5 of the Local Government Finance Act 1992 is amended as follows.

(2) In subsection (4) omit “The Secretary of State may by order, as regards financial years beginning on or after such date as is specified in the order” and insert “A local authority may for any future financial year”.

(3) Omit subsection (5).’

The intention of this new clause is to devolve to councils the power to create new council tax bands.

New clause 15—Abolition of referendums relating to council tax increases—

‘(1) In Part 1of the Local Government Finance Act 1992 (council tax: England and Wales) after Chapter 4 omit the Chapter set out in Schedule 5 to the Localism Act 2011.

(2) Schedule 6 to the Localism Act 2011(council tax referendums: further amendments) ceases to have effect.’

The intention of this new clause is to end the council tax referendum system.

New clause 16—Effective devolution committees—

‘(1) The functions of local authorities include the formation of committees to collect and analyse data on effective performance by local authorities of powers and functions devolved to them.

(2) The Secretary of State must not give any directions to such committees.’

The intention of this new clause is to enable Local Government to set up its own “what works” organisation on devolution to examine what’s effective, either independently or in partnership with, but separate from, the Department for Communities and Local Government.

New clause 17—Scale of devolution—

‘(1) The extent of the devolution of powers and functions to local authorities must not be dependent on the size of the population of the local authority.’

The intention of this new clause is to provide flexibility for devolution on varying scales and foot prints instead of linking the amount of devolution to the size of the recipient.

Government amendments 26, 30 and 31.

[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.

Hospital Services (South Manchester)

Graham Brady Excerpts

Tuesday 8th September 2015 Westminster Hall

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

I congratulate the hon. Member for Wythenshawe and Sale East (Mike Kane) on securing this debate. It is a pleasure to be working alongside him, the hon. Member for Stretford and Urmston (Kate Green) and other concerned Members from Greater Manchester, who are deeply worried and troubled by the proposals being put forward in Healthier Together as a whole and for Wythenshawe hospital, the university hospital of south Manchester, in particular.

It gives none of us any pleasure to be here and to have to raise this debate, any more than it gives the consultants at Wythenshawe hospital any pleasure or satisfaction to have been pushed to the point where they felt that the only way to make their voices heard and ensure that their fears about patient safety in the longer term did not come to pass was to pursue the initial stages of judicial review. I could not agree more with the hon. Member for Wythenshawe and Sale East that that is not the way that any of us would wish to have this question resolved.

As the hon. Gentleman said, throughout the Healthier Together process, colleagues on both sides of the House have warned that the process was deeply flawed. The consultation undertaken over a three-year period is the worst instance of public consultation that I have encountered in my 18 years in this place. It moved immediately from discussion of warm platitudes about improved collaboration, and the better results that that can achieve, to a table of possible outcomes that was so complicated that no member of the public could hope to understand the implications. The whole episode raises some profoundly serious questions, both about the delivery of the best possible health services in Greater Manchester and about accountability in the delivery of public services and the ways we can ensure that the public view is properly heard and respected.

As the hon. Gentleman—my colleague—said, in Greater Manchester we are poised to embark on some very exciting changes, which, if got right, will make dramatic improvements in our delivery of health and social care and could provide not just a great improvement for our constituents but a model for many other parts of the country to follow. If instead we see this sort of flawed decision-making process proceed, the danger is that people will see devolving power and decision making to a more local level not as something that will empower them and give them a stronger voice but as something that will result in less accountability and is less likely to deliver for local communities. We need to ensure that the Government understand and the Department recognises that there would be a significant cost if this episode were allowed to damage wider public trust. All of us want more devolved decision making in Greater Manchester, but we want it done right, not in the deeply flawed way presaged by this process.

Not only was the consultation flawed—it appeared to be designed to obfuscate and confuse members of the public, rather than to be a genuine exercise in seeking public opinion—but the decision-making process at its conclusion was pursued in a way that is clearly unreasonable. I concur with the hon. Member for Wythenshawe and Sale East that, given the unreasonable nature of the process from beginning to end, there is every likelihood that, should judicial review be pursued to its conclusion, it will be successful. That is an important reason why we need people throughout the process—whether power now lies with the Department of Health or with the commissioning bodies—to get a grip on this problem and to try to bring it to a more satisfactory conclusion.

I do not want to go into enormous detail about the decision-making process—the hon. Gentleman has given a good survey of the technical questions that Healthier Together raises for UHSM—but we have seen clear support among the members of the public who responded to the consultation for Wythenshawe to be the fourth specialist hospital. Of course, the weight of responses cannot always be the factor that leads to a decision, but it is incumbent on those involved in any decision-making process to take public views seriously. If those views are to be discounted, that should be only on the most serious grounds and on the basis of clearly reasoned arguments.

I have two principal concerns about the grounds on which the weight of opinion was disregarded. First, there is the deeply spurious decision not to take account of the current standard of care delivered at Wythenshawe hospital. Any lay person and—I venture to suggest, having had many conversations with senior clinicians—any senior clinician would regard it as patently absurd to discount the hospital’s current clinical standards on the grounds that all the other hospitals are expected to reach the same standard at some point in the future so the standard is of no consequence. It is Orwellian to run policy and decision making in that way. I hope that the Minister will accept that that should give serious pause and serious cause for concern.

The second significant point, which the hon. Gentleman also raised, relates to the decision finally being grounded on the travel time for a relatively small population in High Peak—I am not saying this because my hon. Friend the Member for High Peak (Andrew Bingham) has had to leave the Chamber to go to a Committee. The failure properly to take account of the A6 relief road, which is now being built, and which will deliver flows of patients from High Peak to Wythenshawe in a much shorter time, is again, frankly preposterous.

[Kate Green (Stretford and Urmston) (Lab)]

I am sorry to make this point in the absence of the hon. Member for High Peak (Andrew Bingham), because I am sure that he would want to say something about it. However, is it not also the case that, in looking at the travel time, the failure to consider other options for High Peak patients, outside the Greater Manchester conurbation, also calls the decision into question?

[Mr Brady]

Yes, absolutely; that is an important point. Without venturing too far into the realms of legal opinion and the judicial review that we could face, what makes the decision so demonstrably unreasonable is the failure to take account of a known factor that will materially change the travel times on which that decision is purported to have been based.

Furthermore, it is questionable policy to proceed with such profound changes to services at the same time as another review was going on. It may be sensible to proceed with some of the shared service propositions for UHSM and Central Manchester—that may be the way forward and may lead to better outcomes for patients in both trusts, and it should certainly be explored—but seeking to arrive at agreement on that while the Healthier Together process was still to conclude was deeply questionable and is a source of serious concern for us all.

I will not rehearse the long list of outstanding tertiary services offered by Wythenshawe not only to Greater Manchester, north Cheshire and north Wales but far beyond. We are debating hospital services in south Manchester, but as the hon. Gentleman reminded us, we are also talking about a hospital that provides the most complex tertiary services for a much wider area. Clearly, therefore, the issue is more significant, and it is more important to get it right, than would be the case were the hospital providing important tertiary services merely for a local population.

The consultants who have spoken to me—I am sure that they have also spoken to my friends on the Opposition Benches—have been very clear. There is no question that they are trying to defend their own patch or their own empire; some are constituents whom I have known for many years, and many of them are at a point in their careers when they really do not need to be concerned about those things. Some are very eminent in their fields, and when they tell me that their concerns are purely about patient safety—they say that they are entirely open to sensible proposals for reorganisation, shared service agreements and so on, but that they are worried that the work being done at UHSM could be threatened and could, in the hon. Gentleman’s words, suffer death by a thousand cuts—I am inclined to take those concerns seriously.

To boil the consultants’ concerns down to the simplest level, their analysis is that the high level of complex tertiary services at Wythenshawe can continue into the long term only if it benefits from an equally high level of general surgical support to ensure that different, co-dependent services and procedures can always be provided in the safest way. The hon. Gentleman said very clearly and correctly that, in the consultants’ view, the provision of general surgery would remain at an appropriate level only if Wythenshawe remained a receiving centre for complex general surgery. If the same level of support is not present—we have all seen how this works—it will be only a matter of time before we find ourselves here again, with a new review suggesting that it really is not safe to perform heart and lung transplants at Wythenshawe, because it lacks the necessary general surgical support when complications arise.

The consultants make a powerful and plausible case. First, there is the procedural case that Healthier Together has been flawed and that the process and decision were unreasonable. I also find it compelling when they say that having a certain level of general surgical support is the only way to protect the complex services that are provided at the moment.

[Graham Stringer]

I agree with the case that the hon. Gentleman makes about the importance of general surgery to the highly specialised tertiary services at Wythenshawe. Just over 30 years ago 55 people died on the runway at Manchester airport. I hope that such a thing will not happen again, but with the downgrading of Wythenshawe hospital is it not likely that, if people were to need services following an accident at the airport, those services would be of a lower quality? That is not acceptable.

[Mr Brady]

I am grateful to the hon. Gentleman, who makes a critical point. Most other airports probably envy the level of support that Manchester has almost on site—given the trauma centre and the combination of capabilities that Wythenshawe enjoys, so close to Britain’s third busiest airport, which is a major international airport. That is where someone planning with a clean sheet of paper would want a major trauma centre. Added to that, Wythenshawe even has its own helipad to receive emergency cases and get them into the operating theatres as quickly as possible. It is a lifesaving centre for many reasons.

I want to conclude with some thoughts about the way forward. As has been said, correctly, if judicial review proceeds there must be a good chance of success. Unlike most branches of the law, judicial review rather relies on reasonableness, which is viewed through the prism of a reasonable lay person’s views. It is pretty clear that the Healthier Together process fails on those grounds. However, if we get a successful judicial review the price will be at the very least a protracted delay in the reorganisation of services, which should bring benefits to patients across Greater Manchester and beyond. Potentially the price may be much worse, if it is to inhibit the move to the new world of integration of health and social care, for which we all have such high hopes.

The least that we need now is a sensible pause for reflection. We need the parties to draw back from the brink and get back to the table—not to the kind of negotiation in which the decision is restated and people are told they are being silly not to accept it, but to a genuine consultation and discussion with senior clinicians, who have previously felt excluded from the process and unable to make the input that they should have been able to make in the interest of patients. I do not think that any of us cares whether the pause is effected by Ministers at the Department of Health, commissioning groups or the interim Mayor of Greater Manchester.

We need people to be brought around the table, with the genuine good will that I think still exists on all sides. We need a genuine willingness to reopen the question, and an understanding that unless Wythenshawe either becomes an additional specialist centre in the terms of Healthier Together or, at the very least, is guaranteed a status as a receiving centre for acute general surgery, we will not arrive at a state of affairs that is good for Wythenshawe, for Greater Manchester or for the thousands of patients from north Wales and the north-west of England who depend on the complex tertiary services currently offered there.

--- Later in debate ---

[Ben Gummer]

The hon. Lady is right to say that there are concerns from some clinicians at Wythenshawe hospital, and we should listen to those. There is an established process by which those concerns should be brought to bear. If she does not mind me running through the detail of how reconfiguration policy works, I am sure that she will find answers to some of the questions in her speech.

Our first principle is that the service changes should be led by clinicians, which is the point of the process. In this instance, the service changes are being led by 12 clinical commissioning groups coming together to discuss the future of 10 hospitals. The service changes will affect just under 1% of in-patients, and just under 20% of patients receiving general surgery, at Wythenshawe hospital. Within the context of Wythenshawe hospital as a whole, we are talking about a very small number of patients. I appreciate the hon. Lady’s concerns about the interrelationship with other specialties, but let us keep it in mind that this is a small number of patients.

Once the commissioners have come to their decision, there are two ways of resolving complaints from one party or another. The first is by a recommendation from the joint overview and scrutiny committee to the Secretary of State for Health—such a recommendation has not been made in this case—or by a referral to the Independent Reconfiguration Panel, which the hon. Lady mentioned in her speech. The Independent Reconfiguration Panel has made a number of recommendations in the past. That is no predictor of future performance, but at no point in the past, under any Administration, has a Secretary of State gone against the Independent Reconfiguration Panel’s recommendations. The point of both those exercises is to retain clinical ownership of decisions, albeit by different clinicians from those who made the original decision. If we go back to the bad old days, when decisions were made for political purposes following a clinical recommendation, we would not listen to clinicians in the round and, therefore, would make decisions on the wrong basis, possibly putting lives in jeopardy.

The hon. Lady has raised clinicians’ concerns about the effect on tertiary services, which are impressive at Wythenshawe hospital. All I can say is that NHS England has undertaken a thorough clinically-led review of all tertiary services at the hospital and has concluded that the changes to general surgery for stomach and bowel accidents will not adversely impact on the tertiary specialties available at Wythenshawe hospital. That is the advice that the Department has received from clinicians at NHS England. I have described the other options open to parties in Manchester, and I reaffirm that, even if it might suit some Members present to take that decision-making process out of clinical hands at whatever level and to vest it in the Department, it is not a direction that anyone on either side of the House ultimately wishes to take. We must therefore trust the opinion of clinicians in the bodies that have made those decisions so far.

[Mr Graham Brady]

My hon. Friend, for obvious and very good reasons, is valiantly treading a tightrope between discussing the specific case and addressing the general points, but I must counter the suggestion that any of us is here to try to overturn clinically-led decisions. On the contrary, our concern is that very senior clinicians feel that they have had no voice in this process. As the hon. Member for Stretford and Urmston (Kate Green) said, they are now raising very serious concerns about patient safety. As I said earlier, the consultants I have dealt with at Wythenshawe hospital are serious professionals who do not say that lightly. I also suggest that the three local Members here today do not have a record of hysteria on such things, and we are united in our concerns. We are perfectly capable, and we have shown that we are capable, of making reasonable judgments about reconfiguration when that reconfiguration is reasonable.

[Ben Gummer]

I am acutely aware of the huge spread of sensibleness on both sides of the Chamber, and I would not want any of my remarks to be construed as suggesting otherwise. On the contrary, I restate that it is not only reasonable but right that local Members respond to the views expressed by very experienced clinicians in their local hospital.

In my short discussions so far with local commissioners —I am sure there will be more discussions—I have impressed on them the need to engage fully with all clinicians. I understand that they began the process afresh before I made that request and that they will continue that engagement. We will only get good reconfigurations across the country if we have the general buy-in of clinicians and the public. We are now doing that better than we were five, 10 or 15 years ago, when every reconfiguration of every kind was fought tooth and nail by everyone. There is now a general move to an understanding that we need to make some changes to some areas. Indeed, the shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), has made clear his desire to see some services centralised:

“If local hospitals are to grow into integrated providers of Whole-Person Care, then it will make sense to continue to separate general care from specialist care, and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

I could not agree with him more on that general principle, but it does not change the fact that commissioners need to engage with every single party.

My hon. Friend the Member for Altrincham and Sale West, and every other Member, can be sure that I will pass back to commissioners their specific concerns about that engagement. In the discussions, which I am sure will continue between all of us, I hope that he and other Members will notice continued engagement between commissioners and clinicians at the hospital, and I hope that there will be a happier outcome than the one that might come about through judicial action.

The hon. Member for Blackley and Broughton (Graham Stringer) and the shadow Minister both spoke about Manchester airport and made interesting and valid points about the need for a stated relationship between important national infrastructure and centres of major trauma care. I will respond to the shadow Minister in writing on that specific question, if he does not mind sharing that response with his colleagues. This is an important matter, and I want to ensure that I can answer it in detail and in full.

If I interpreted his remarks correctly, the shadow Minister also said that consultations had been taken out of the hands of clinical commissioning groups specifically to be conducted by a third party, such as health and wellbeing boards. Again, I have not previously heard that idea, but I am happy to respond to that specific point once I have been able to give it greater thought, with no implication for the current consultation.

I will now close in order to give the hon. Member for Wythenshawe and Sale East time to reply to my comments. We all agree that reconfiguration needs to happen. In this instance, there has clearly been support from those Members who have been the beneficiaries of the reconfiguration in their constituencies, but the most important beneficiaries will be the people of Manchester, who I expect will see world-leading trauma care connected to emergency stomach and bowel surgery as a result of these changes. We must be proud that clinicians are leading the review, we must be proud that clinicians have been prepared to make bold and difficult decisions and we must be proud that Members present have come forward to represent the concerns of some that clinicians have not made those decisions in the right way. Members have made those points with lucidity, care and passion.

I hope that in the next few weeks we will resolve this matter in a rather happier way than it might otherwise have been resolved, and I pledge to continue my discussions with Members on both sides of the House to ensure that that is the case.

NHS Reform

Graham Brady Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

The hon. Lady speaks with the authority of someone who works in hospitals, and I always listen to her very carefully. I do not think it is easy to make a rigid distinction between elective and emergency care. The opt-out in emergency care does apply, for example, to accident and emergency doctors. Sometimes when people are admitted to hospital because they are ill—they would not be admitted if they were not—their condition may not appear to be life-threatening on a Friday afternoon but then, over the course of the weekend, they deteriorate, and by the time they are seen by a senior consultant on a Monday or a Tuesday, it is too late. The trouble is that we have a culture in which a lot of major services are available only from Monday to Friday, and that is what is causing these avoidable deaths. The hon. Lady is right to say that this is not just about senior consultant cover; it is also about diagnostic care, handovers and many other things, and we are working at those. The Royal Edinburgh Infirmary has done a very good job of eliminating the difference between weekday and weekend mortality rates, as have Salford Royal and Northumbria hospitals in England. We need other hospitals to follow those examples.

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

Senior clinicians in my constituency are warning of a major threat to patient safety as a result of a proposed downgrade of one of Britain’s best hospitals, Wythenshawe. The regional transplant unit is a world-class centre for heart and lung and there is a major trauma centre adjacent to Manchester airport, where it should be. That must all be protected. The Secretary of State knows my view that the consultation has been opaque, and that the decision-making process has been flawed. Will he review the decision as urgently as possible, and meet me and other Members for local constituencies as a matter of urgency before the summer recess to discuss what can be done?

[Mr Hunt]

I am more than happy to meet my hon. Friend to discuss those matters. Wythenshawe is an excellent hospital—I have been there—and it has provided a number of staff who have helped to turn round the standard of care at Tameside hospital, which has seen dramatic improvements. I recognise that Wythenshawe is an excellent hospital, and I am very happy to meet him to listen to his concerns.

Health Services (North-West)

Graham Brady Excerpts

Thursday 11th July 2013 Commons Chamber

[Mr Hunt]

Thank you for that rare compliment, Mr Speaker.

The right hon. Member for Leigh asked a specific question about travel and I will ask the local NHS trusts to work closely with the overview and scrutiny committees to ensure that proper arrangements are put in place for people who have to travel further. He asked me about deferring the decision until the Healthier Together programme for the whole of Greater Manchester was decided, but the IRP specifically said that it would be wrong to defer the decision—the point is that local doctors are saying that doing so would not be safe for patients, and that is why I am accepting the advice.

The NHS is a great institution, but we have to take difficult decisions sometimes. The proposals will help patients, but I am afraid that the right hon. Gentleman is interested only in politics.

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

Many people will be disappointed, of course, by the decision on Trafford general, but I thank my right hon. Friend and his ministerial team for their openness in hearing the concerns of local Members and Trafford council in building up to what has obviously been a serious and carefully made decision. I thank him for the extra investment for Wythenshawe and for making the changes contingent on ensuring that the capacity is there in surrounding hospitals to ensure that this is safe. Will he also give us an assurance that the Trafford health economy will not suffer financially if those contingencies are not met in time?

[Mr Hunt]

I thank my hon. Friend for the constructive approach he has taken in this process. I assure him that this will help the local Trafford economy. Three major teaching hospitals are used by the people of Trafford. Two of the three are meeting their A and E targets and one is not. These proposals will help the one that is not meeting its target to do so. They will also mean that an extra £3.5 million can be invested in community and prevention services, including local geriatricians and community matrons. That will be of huge benefit to my hon. Friend’s constituents and to many other people in the local area.