Draft Greater Manchester Combined Authority (Fire and Rescue Functions) Order 2017 Draft Greater Manchester Combined Authority (Transfer of Police and Crime Commissioner Functions to the Mayor) Order 2017

Debate between Lisa Nandy and Kate Green

Monday 13th March 2017 General Committees

[Lisa Nandy (Wigan) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, in a debate on a matter as important as this to me and the many people who live in Greater Manchester and will be affected by these changes.

Like my hon. Friend the Member for West Ham, I very much welcome the thrust of what the Government are trying to do, particularly pushing power out of Whitehall and Westminster and ensuring that decisions affecting our lives are made much closer to where we are. I echo her words by paying tribute to all those who have been involved—not only Tony Lloyd, the interim Mayor, who has done an excellent job, but the many politicians and officials who have done something quite unique in bringing together a whole range of diverse interests and circumstances across Greater Manchester and getting everybody pointing in the right direction. It has not been easy, and they deserve real credit.

These statutory instruments, quite understandably, concentrate a great deal of power in the hands of one individual. However, I do not think the Government have thought hard enough about the level of scrutiny and accountability that needs to be built into the system. There is considerable confusion among the general public in Greater Manchester about what the reforms mean. I heard what the Minister said about the consultation, but if he means the consultation on the legislation that gave rise to these statutory instruments, he should know that that was advertised on one Government website and ran for just three weeks and garnered only 12 responses, 10 of which were from the same council leaders who set up these arrangements in the first place.

People must be part of the conversation, not least because Greater Manchester is a very diverse area. For example, the needs in my borough of Wigan are very different from those in the constituency of my hon. Friend the Member for Stretford and Urmston. If we look at the details of what is being devolved to the Mayor and the Association of Greater Manchester Authorities through the statutory instruments, a very large borough such as mine obviously has different fire and rescue needs from the city of Manchester, which is very small. That is why scrutiny and accountability really matter.

The election of the Mayor is long overdue and very welcome, but the only real place where the Mayor will be accountable under these arrangements is to those same 10 council leaders who helped to establish this situation in the first place and who retain a great deal of decision-making power across Greater Manchester. As the Minister will know, ours is an area where one party dominates politics. Obviously, as a Labour Member of Parliament, I am very pleased about that, and long may it continue. However, that poses a question, particularly when we consider that Greater Manchester is intended to be the first of many areas to follow this model: where will the challenge come from? Of the council leaders who currently represent the boroughs across Greater Manchester, only one of them is a woman and only one is from an ethnic minority background.

In relation to the fire authority, I understand from the documents that a committee will be appointed by the Mayor. Members of that committee will be councillors or officers of the 10 borough councils, but they will be proposed by council leaders—the same council leaders who provide the primary scrutiny function for the Mayor. Those posts appear to come with an allowance; I imagine they will be hotly contested among councillors and officers.

We have a very centralised model of council leadership across Greater Manchester; council leaders are responsible for making the vast majority of appointments to their cabinets and to outside bodies as well. In such a system, what incentive does the Minister think there is to challenge decisions that are made? The documents reference the need to mirror the balance of political parties. I would be grateful to the Minister if he elaborated on the Government’s thinking, particularly on making sure that some cross-party scrutiny is built into the system. That is even more important because a report by the National Council for Voluntary Organisations recently found that, in areas where devolution is under way, the voluntary sector has had little or no involvement at all. As a representative of civil society, I think that is unacceptable; it mirrors what I have seen happening in my area of Greater Manchester so far.

I will say something about the police and crime commissioner functions, because I think that all the points I have made are more important in that area than any other. The Mayor will be scrutinised by a police and crime panel, but our police and crime panel in Greater Manchester is made up of those same council leaders I have just referred to. They also make up the Mayor’s cabinet and provide the only channel of accountability and scrutiny for the public outside of election times.

I understand that the diversity problems I have raised may be addressed by the Mayor via the appointment of up to five additional members to that panel—I would be grateful to the Minister if he confirmed that—but even so, it is likely that the scrutiny membership on that panel will be heavily weighted in favour of council leaders. What resources will those additional lay members have to ensure that they can do that job properly and effectively? I say that because Greater Manchester is an incredibly diverse area, which is not currently reflected in our political arrangements.

[Kate Green]

My hon. Friend is raising concerns that a number of us, although we welcome devolution, have raised throughout the process of designing the devolution settlement for Greater Manchester. Does she think it unlikely that, in making appointments to those five lay places, the Mayor will appoint people who are likely to be assertive and critical of his or her decisions?

[Lisa Nandy]

The problem with the vision set out in the documents is that it very much relies on the good will of the person who holds that post. In such an important area, I do not think that is an adequate safeguard.

The same seems to apply to the hearing of police and crime complaints. If those are criminal complaints, I understand that the responsibility will continue to lie with the Independent Police Complaints Commission. However, if they are non-criminal, they will be heard by the local authorities, which will of course take them straight back to the 10 people who sit on all those boards and provide that level of accountability. The Minister is shaking his head; I would be grateful to him if he cleared this up. One of the problems we have had in Greater Manchester is in trying to penetrate the arrangements that have evolved over the past couple of years. Obviously, with an election looming large, it will be helpful for the Committee and the wider public to understand where that outside scrutiny and challenge will come from.

Finally, the documents set out that the Government have not seen fit to do an impact assessment, which is a mistake. They say that there are no plans to build in any kind of review period for the arrangements because there will be elections for the position of Mayor three years after the first election and then four years after that. This could build up real problems threatening the very success of this enterprise. Real devolution has to be based on consent and built from the ground up. The people must be heard.

Grammar and Faith Schools

Debate between Lisa Nandy and Kate Green

Tuesday 8th November 2016 Commons Chamber

[Lisa Nandy]

My hon. Friend posed an interesting question to the Minister in the Education Committee’s evidence session this morning. She asked why, if he was keen to ensure that all schools improved, rather than recreating a system of grammar schools and secondary moderns, he did not just enable children to go to good schools by expanding the number of places in good comprehensive schools. The Minister did not seem to give an answer, but I hope that he will have an answer by the time he responds to the debate.

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

As my hon. Friend knows, in my local authority of Trafford we have selective education. We also have high-performing schools, but they do not perform well for every child, and particularly not for the most disadvantaged. Nor does every parent, or indeed the majority of parents, get a choice of school. Most parents, if they put their child forward for the entrance examination for the grammar school, find that their child is not successful and is not admitted. The choice of which school their child goes to is made by the schools, not by the parents.

[Lisa Nandy]

I suspect that the Minister would reply that the Government want to expand the number of places in grammar schools, so that more children will get in. There is no question but that grammar schools outperform non-selective schools in terms of exam results, but the Government make a great leap in claiming that grammar schools are somehow intrinsically better for the children in them than other similar schools in the area. I want the Minister to consider for a moment that there is evidence to the contrary.

We know that when grammar schools were the norm, working-class children were far more likely to drop out of those schools. The Robbins report revealed that only 2% of children whose parents were semi-skilled or low skilled then went on to university. The Minister’s claim that disadvantaged grammar school pupils are more likely to go on to a Russell Group university, which I have heard him repeat often, is based on research that does not control for prior attainment. He also often mentions the Sutton Trust research. The 2011 report concluded:

“Given their selective intake, grammar schools would appear to be underrepresented among the most successful schools for Oxbridge entry”.

All I am asking the Minister to do is consider the whole range of evidence on this subject and base education policy on it accordingly. This morning before the Education Committee we saw what happens when Ministers do not do that. He was forced to admit that in areas of selection, the impact on children in non-selective schools is mixed. Until now, he has been fond of citing one report by the Sutton Trust, which says that there is no negative effect on children who are not in grammar schools in areas where there is selection, but against that the Education Committee was able to cite Dr Becky Allen, the Institute for Fiscal Studies, the Education Policy Institute, and the education journalist Chris Cook, who found that the only thing that shifts in areas where selection is introduced is who does well, not how many do well, and that, put simply, the better-off do well at the expense of the rest.

Policy Exchange set out clearly the stark impact in terms of lost opportunities and earnings for those who do not attend grammar schools, and the Institute for Social and Economic Research says that for girls there was some raised wage potential, but not for boys.

Healthier Together Programme (Greater Manchester)

Debate between Lisa Nandy and Kate Green

Tuesday 22nd July 2014 Westminster Hall

[Kate Green]

The hon. Gentleman is absolutely right, and I am pleased to see that the hon. Member for Macclesfield (David Rutley) is also present this afternoon. The ripple effect of the consultation, on hospitals in neighbouring areas and indeed—as I will go on to talk about—on the wider north-west and northern region of the country is quite significant in one reading of what is going on.

It is true that the pressures of rising demand on the NHS are well recognised, as are the cost constraints on social care provision. However, my constituents in Trafford were told all that three or four years ago, and we went through our change programme. We feel that we have been here before and, for us, this is groundhog day and a bit worse than that. We underwent the consultation “A New Health Deal for Trafford”, which took place in 2012 and culminated in the downgrading of Trafford general hospital. Looking at how the current consultation has been launched, I am concerned that a number of lessons that were learned from that Trafford process are being totally ignored.

I say clearly that I am not against sensible reconfiguration of acute services. I am very much in favour of concentrating expertise and specialisms in a small number of expert sites. I am entirely in favour of as much provision as possible being pushed into the community to front-line, preventive, community-based care, and of keeping people at home to receive that care for as long as possible.

However, if this is a consultation about the provision of integrated community-based care, it is not possible to go down the road of consulting about that provision and withdrawing services in acute settings before we are clear what the landscape and the reality of that community provision is. Nor is it possible to go down the route of suggesting that some acute services might be rationalised or closed when existing acute services are under so much pressure already. In particular—I know that my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will talk about this issue too—one consequence of the downgrade of Trafford general hospital’s accident and emergency provision is that during the past nine months the waiting times and queues at Wythenshawe hospital have been significant, with little sign yet that they will be reduced.

In addition, I point out that we have some real uncertainty. My hon. Friend the Member for Blackley and Broughton mentioned the uncertainty that exists around trauma services, maternity services and so on, but we also have uncertainties in Trafford in relation to some of the primary provision that will be in place. We know that the NHS local team and the clinical commissioning group envisage a two-hub model of primary care and community-based care for our borough. The provision in the south is largely established, but in the north—including in my constituency, where we have some of the worst health outcomes in the borough—we are still completely unsure what sort of hub will be put in place, as the NHS local team and NHS England are quite unable to tell us what the funding for that kind of hub model will be.

I know that the Secretary of State for Health is aware of that particular situation and I am grateful to him and his office for what they are doing to try to unscramble it, but from the point of view of my constituents the idea that they will be consulted on a major reconfiguration, either of primary care or of acute services, does not inspire their confidence, because currently they simply see deficiencies in those services and particularly because they believe that their voice counts for little when it comes to the decision that will ultimately be taken.

Not only is there pressure in the system, but the NHS seems to make some really perverse decisions as it goes along, because of its rather hand-to-mouth approach to planning this kind of reconfiguration and strategic change. When the decision was taken to downgrade the A and E services at Trafford general hospital, the hon. Member for Altrincham and Sale West (Mr Brady) and the late Paul Goggins, my good friend and former colleague, managed between them to secure around £11 million of new investment in Wythenshawe hospital to provide for the extra capacity that it would need. We are now unclear, of course, about what will happen with that £11 million of investment; it would be good if the Minister could put it on the record today that it will continue. Given that the hospital cannot envisage even its short to medium-term future, that is a worrying situation.

We saw something similar in Trafford, when investment of around £300 million in the intensive care unit was pretty well written off two years later when the new health deal for Trafford was implemented and the ICU was closed down. That may have been the right decision, but it was certainly a waste of money if investment was being poured into a hospital just two or three years before the whole status of that hospital was changed.

[Lisa Nandy (Wigan) (Lab)]

I am grateful to my hon. Friend for giving way, and I apologise for being late for the start of this debate, Mrs Riordan.

Does my hon. Friend agree that part of the problem with the process is that it does not take into account the particular needs, circumstances and history of our individual communities? For example, in Wigan we have invested in a number of our specialist services. However, we are a big borough, we have our own particular health challenges and we have real transport issues as well, which are different from those affecting other areas of Greater Manchester. Quite simply, a centrally driven top-down process that lacks any kind of democracy whatever, as far as I can make out, is not capable of delivering the sort of services that we need in our areas.

[Kate Green]

I absolutely agree with my hon. Friend, and the issue about democracy that she raises is one that we are all particularly concerned about.

NHS Reorganisation

Debate between Lisa Nandy and Kate Green

Wednesday 17th November 2010 Commons Chamber

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

Let me begin by wishing the hon. Member for Winchester (Mr Brine) and his partner well for the pending new arrival. I am sure that they will receive an excellent service in their local NHS hospital, and that the whole House wishes them the very best.

I should like to use this opportunity to raise a few of the concerns that have been brought to my attention by people in my constituency. Many do not fully understand how the new proposals will work to deliver the outcomes we hope for, and I hope that the Minister can answer for them this afternoon. Essentially, people are anxious that where they live and who they are will begin to determine the level and quality of their care.

I am sure we all agree that consistency and guarantees of standards must be an integral part of the operation model that the Government seek to introduce. That is especially important in relation to health outcomes for the poorest and most vulnerable. There is a high level of health inequalities in my constituency. The people who live in the poorest wards suffer much worse health outcomes than those in the better-off wards in the south of the borough of Trafford. The local authority was quite slow to recognise that, so how will health inequalities receive strategic attention in the proposed new structures?

What will be the role of the public health director, who will be placed within the local authority? I am keen to know how that public health role in the local authority will devolve and relate to those at the sharp end in all health settings—those who provide front-line care. I hope that the Minister can fully explain that in his winding-up speech so that my constituents can be clear about it.

My constituents and I are concerned about how the wider drivers of health inequalities—income, education, employment and so on—will be addressed in the new structure, particularly when so many national policies seem to be taking us in the opposite direction, as my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) pointed out earlier.

[Lisa Nandy]

Does my hon. Friend agree that as well as the vast inequalities in life expectancy, the lingering issue of care for those who live longer and longer with chronic illnesses needs to be addressed? Those people are suffering now. Does she agree that it is an absolute disgrace that the Government have decided to tinker with the structures rather than put in urgent investment to help those people, including people in my constituency of Wigan?

[Kate Green]

Labour Members want to know whether the money spent on the restructuring of front-line care in our communities is the best use of that money. As the Health Secretary himself pointed out, we continue to have poor health outcomes and standards compared with our European neighbours, so why does it make sense to put more money into reorganisation and less directly into front-line care? I look forward to hearing what the Minister says about that.

The second issue that I want to address involves patient voice. That, too, has been raised in my constituency. A particular concern of mine is to ensure that the poorest and most vulnerable are heard. I am concerned about the lack of voice of those who do not have the sharp elbows and the articulacy to speak up for themselves to secure the best for themselves and their families. We know that that is the fate of many in our poorer communities, and especially of those with mental health problems.

I have been told a number of times in my constituency, including by GPs, that GPs are not particularly expert in, or equipped to deal with, mental health needs. How will those patients’ needs be identified, recognised and responded to in the new structure? What help will be available to enable patients to articulate such needs? There is uncertainty in my constituency on the future structure. How will patient voice, choice and opinion feed in to the new model?

The Trafford patient LINk—local involvement network—service is uncertain about its future role and status. I very much hope that Ministers will be able to give us more information about how we will get a clear opportunity for advocacy, so that every patient’s voice can be properly heard, and for proper support for patients who are perhaps less able to articulate their needs and secure services for themselves.

I am concerned also because I know—not just from my constituency, but from my long experience of supporting and working with vulnerable families—that different values pertain among different doctors and practitioners. I am particularly concerned, for example, for the young woman who may present herself to a GP who does not feel it appropriate to offer her advice on contraception or abortion. How can those minimum standards be protected, so that everybody—wherever they live, whoever their doctor is and whatever the structure is—knows that they will be guaranteed the care that they need.

Thirdly, I would like to raise with Ministers the issues that have been raised with me by health practitioners and professionals—and which have been highlighted in this afternoon’s debate—relating to GPs’ ability and willingness to take on the management aspects of their commissioning role. Many GPs have said to me—perhaps the Minister will be able to reassure them this afternoon—that what they see tanking towards them is a heavy burden of management, albeit without the additional resource with which to manage it. Many GPs have said to me that they have not really had the training—they lack the expertise—to be health managers as well as good-quality health practitioners and providers of front-line health care. I am interested to know whether Ministers have plans for training GPs and developing those skills and abilities in GP practices, or whether, as many of us on the Opposition Benches fear, the proposal will in fact be used as an opportunity to privatise that management function. If that is the case—this is not an ideological point, but an efficiency point—I shall be keen to know what financial model Ministers expect to operate if a substantial amount or even a proportion of the money that would otherwise be held in GP practices will go to fund the profits of private providers.

Those are the issues being raised with me in my constituency. They are issues that I am afraid I do not feel equipped to answer, because I do not fully understand how the new structures will work well in practice and, in particular, how they will work well for the poorest.

In concluding, I would like to highlight a point that has been made by a number of my hon. Friends this afternoon. The injection of extra uncertainty and disruption into our national health service at this time is further—and considerably—stretching our capacity to deliver excellent front-line care. I would urge Ministers to listen to the many GPs who have said to me—and who I am sure are saying to them—that what is proposed represents an element of change and disruption that they cannot yet see the benefits of. What they can see is that there is considerable uncertainty in the way that they are now working. There is certainly concern in my primary care trust. I hope that Ministers can offer some reassurance on that point, because at the moment there is considerable instability, and that cannot be good for any patient outcomes.