Cities and Local Government Devolution [Lords] Bill

Debate between Karin Smyth and Dan Poulter

Wednesday 21st October 2015 Commons Chamber

[Karin Smyth]

I welcome the devolution of some health and care services to local areas. My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) recalled our manifesto pledges for the “what” and the “how”, and I have a lot of concerns about the structural changes that might come as a result of all this. As has been mentioned, Bristol, an area of nearly half a million people surrounded by more rural areas, has two major acute hospitals, both of which offer a range of services, including highly specialised ones. I would like the Minister to say something on the issue of specialised commissioning. Patients are drawn from across the south-west; one hospital draws half its patients from Bristol and the other half from neighbouring South Gloucestershire. Two different clinical commissioning groups are involved, and a plethora of different organisations are involved in both the commissioning and the provision of services. In an earlier exchange on this type of devolution, the Minister sometimes talked about the provision of services and sometimes about the commissioning of services. It would be helpful to understand the devolution aspects: are we talking about provision in the new marketplace or about commissioning, and how will we bring those two things together? That is problematic for us in Bristol.

I am a former board member of a primary care trust and I spent many happy hours discussing the correct configuration of primary care and CCGs in Bristol—whether it should be a stand-alone Bristol or not. We started off with Bristol divided into two and we then talked about doughnuts. The Minister missed an earlier discussion involving the hon. Member for North East Somerset (Mr Rees-Mogg), who wanted to make sure that Bristol stayed Bristol and did not include other areas. [Interruption.] That was a shame, because it is always a joy. We never quite resolved that issue, and similar issues are applicable to many other cities and city regions. I fear that the approach being taken could make an already difficult situation for Bristol much more difficult.

The Minister and I were both at the King’s Fund discussion last week about devolution and health, and I think it was people from Manchester who talked about the fact that they had to bring 38 different organisations around the table to talk about some of these matters. My concerns relate to further structural reorganisation. Given the organisations involved and given the situation in Bristol, I wonder how I, as a patient on my pathway from prevention through primary care to community services, hospital care and possibly specialised services, would understand who is really accountable for that pathway. As we know, we can map a pathway but people do not always map closely to that. In general, I welcome this move, but of course we have concerns about financial stability, particularly of those hospitals and of wider community services. At last week’s King’s Fund event, as was quietly pointed out, we do not want a situation where money is moved from GP services into fixing potholes. We need to be very concerned about such things.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I rise to make a few brief remarks in support of this clause and the Government amendments. Clearly, the direction of travel that is outlined is desirable in health and care terms. The amendments will put in place clear safeguards to deal with national regulatory structures, which are there to protect patients and to ensure that the quality of care is universally high throughout the whole country.

The importance of devolving health and care at a local level is something that we have often talked about in this place, but we have sometimes struggled to find the legislative mechanisms to make it happen. These powers will be a desirable step forward in encouraging a more integrated model of health and care. We often talk about how we can move the focus in many parts of our health service towards delivering more services in the community and a more preventative approach to healthcare. Clearly, this Bill is a big step in that direction.

By 2018, we know that there will be 3 million people with three or more long-term health conditions. Many of those people will require support not just from the health service, but from adult social care services, local voluntary and charitable organisations and, in the case of some people with special educational needs, education services. It is vital that we properly link and join up the services that are in place to support these people. Personalised care and mechanisms of support are often found at a local level, which is exactly what this devolution is about.

Other measures have been put in place to integrate better adult health and social care, including the better care fund, which was part of the Care Act 2104. The coalition Government also introduced some strong measures to improve the provision for children with special educational needs. But these measures go further and allow more bespoke and personalised local solutions to be put in place to support people with more complex care needs. Importantly, they also recognise that parts of the country are different in terms of not just their geography, but their cultural make up and their demographics. That is particularly important when we talk about devolving health and care. We know that some city areas have high black and minority ethnic populations with specific healthcare needs. These measures will put us in a much better place to help such areas support those communities, as well as more rural areas, in dealing with the challenges of an ageing population and increasing numbers of people with complex healthcare needs.

This Bill is an important step forward, which builds on many strong measures that have already been put in place over the past few years by both the coalition Government and the previous Labour Government. We all believe in integration and in the need to bring healthcare services closer to the individual and make them more personalised. We know that there is too much duplication in the health service and in adult social care, which costs money. That money should be going to the frontline, but duplication often gets in the way of front-line professionals helping patients. This is a big step forward in allowing local health economies and local areas to put in place the right mechanisms to support the people they look after.