Cities and Local Government Devolution Bill [HL]

Lord Hunt of Kings Heath Excerpts

Tuesday 21st July 2015 Lords Chamber

[Baroness Williams of Trafford]

My Lords, I shall speak also to government Amendment 4, which will prevent regulatory functions exercisable by a public authority across the whole of England being conferred on a combined authority or local authority which itself can exercise the functions regulated by the public authority; and to Amendments 9 and 10, which make exactly the same exclusion to functions being conferred on a local authority.

The noble Lord, Lord Hunt, spoke to an amendment tabled on Report to amend the provisions in the Bill to exclude the possibility of transferring regulatory and supervisory functions to a combined authority. He outlined some of the regulatory bodies to which he could see such exclusion applying; for example, the Nuclear Decommissioning Authority in Cumbria, the Environment Agency or NHS regulators. As I said on Report, I can see a case for excluding from the scope of what is now Clause 8 the functions of any national regulatory body overseeing the exercise of public functions.

Amendments 3 and 4 do just that. As I have said, Amendments 9 and 10 to Clause 16 do likewise in relation to the conferral of functions on county or district councils. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

I welcome the amendments in this group, which, as the Minister said, follows our earlier debate and concerns expressed that services could be transferred to a combined authority plus the regulatory functions which oversaw those services. So I am grateful to the Minister for bringing forward these amendments.

I wanted to clarify with the Minister just one point. We talked about the NHS but we then went wider, and this is a very wide amendment. I want to ensure that the provision would not have a negative impact where there are currently shared responsibilities for regulation. I am thinking of health and safety in particular, where both the Health and Safety Executive and a local authority share responsibilities. I would not want the amendment to get in the way of the flexibility that exists in those arrangements.

I would extend that to the practice of designation of one local authority as a primary authority. Let us take the example of a company such as Tesco, with stores in many parts of the country. One local authority can take a lead responsibility to deal with Tesco under health and safety legislation to avoid duplication and to ensure that there is a pretty standard approach. I take it that the amendment would not get in the way of sensible arrangements like that, where it is clear that the local authority has some regulatory functions. If the Minister is not able to respond now, I would quite understand if she wished to write to me on it.

[Baroness Williams of Trafford]

My Lords, the amendment has no effect on local authorities’ existing regulatory functions. I hope that clarifies things for the noble Lord.

--- Later in debate ---

[The Earl of Listowel (CB)]

My Lords, may I just remind your Lordships with this particular concern that health visitors have recently been put under the responsibility of local authorities, so this may be an opportunity to have a little test of how well local authorities manage health provision? I am sure that health visitors would be very grateful if your Lordships would keep a close eye on their development in the new circumstances, because we do not want to see a falling off, as we have seen in the past, in health visitor provision.

[Lord Hunt of Kings Heath]

My Lords, I start by echoing the noble and learned Lord’s comments about the co-operation that has clearly been evident during the passage of this Bill, and I hope that the noble Baroness might be prepared to accept the amendment. It may not be absolutely perfect, but of course the Government would have the opportunity of bringing amendments in the other place. I think that it is clear that the House would like the noble Baroness to do that.

It is clearly important that the NHS remains a national service, comprehensive and free at the point of use, where broadly we can get the same quality of service wherever we live in England. Equally, I think that most of us want the NHS to contribute to this new devolution world, and clearly the integration of health and local authority services offers much in itself.

Often, the NHS is the largest local employer in any local authority area, so it has an important contribution to make to the local economy. In my own city of Birmingham, the NHS is responsible for huge inward investment in R&D, and it will be the same in Greater Manchester and in other parts of the country—particularly where you combine medical schools, teaching hospitals, academic health science networks and the encouragement of local industry. One of the things that we all want to see is the NHS being prepared to invest in innovative new products and medicines that have been developed in the UK, which we have been slow to adopt generally.

What we are trying to do here is to take both the huge advantage that devolution gives us and the integration of health and local government but without undermining the essential, national nature of the NHS. Noble Lords have mentioned four areas where that is important. First, in the reconfiguration of services, we cannot have combined authorities getting in the way of the necessary centralisation of specialist and tertiary referral services. Secondly, when it comes to training doctors and nurses, the reason that we have seen a crisis in recruitment and high costs from agency nurses is that a decision was taken in 2010 to reduce training commissions; we have to have national planning and decisions about the number of doctors and nurses that we train. We cannot have local authorities opting out of their responsibilities in that regard.

The noble Earl mentioned health visitors, which is an excellent example of where there has been a transfer of responsibility of public health duties to local authorities. Those health visitors were given a guarantee that they would be employed when they went on their training courses, so we cannot have local authorities now saying, as some are doing, “We can no longer afford to employ you”. Those health visitors were given a guarantee, and as a national service we have to ensure that they are found a job.

What we need to do is ensure that the national characteristic and nature of the NHS—the national rules, the standards and, particularly important, the Secretary of State’s accountability to Parliament for the NHS—are retained in this new devolution package. That is what my noble friend Lord Warner is seeking to enshrine in statute: some clear safeguards that reflect those national characteristics. I hope that the Government will be prepared to accept his amendment.

[Baroness Williams of Trafford]

My Lords, Amendment 11 makes specific provisions in relation to a transfer of health functions from a public authority to a combined authority or other public body. It requires that the Secretary of State responsible for such services must continue to be able to fulfil his statutory duties conferred by existing legislation. It also requires that the combined authority or other public body to which the functions are transferred should adhere to national standards and accountabilities which are attached to those functions under existing legislation.

As I have said in previous debates, and as is set out in the Greater Manchester memorandum of understanding for devolution of health and social care, there is absolutely no intention through this Bill to remove or undermine the core duties on the Secretary of State, or to dismantle accountabilities for health services as enshrined in existing legislation. Whatever bespoke devolution arrangements are agreed with a particular local area, that principle will remain.

I state this as a clear commitment to this House. Thus, nothing in the Bill changes the position of the Secretary of State under Section 1 of the NHS Act 2006, which provides that,

“The Secretary of State must continue the promotion in England of a comprehensive health service”.

The Secretary of State retains in all circumstances ministerial responsibility to Parliament for the provision of that health service.

Likewise, the Secretary of State must always adhere to the core NHS duties. These duties include, when exercising functions in relation to the health service: a duty to secure continuous improvement in quality of services; a duty to have regard to the NHS constitution; a duty to have regard to the need to reduce inequalities; and a duty to promote autonomy. These duties are set out in Sections 1A to 1F of the National Health Service Act 2006.

As I have made clear, there is no intention or possibility of the Bill changing these duties of the Secretary of State. Further, as I have said in previous debates, any decision the Secretary of State takes about using the order-making powers in this Bill to confer health functions must be taken in conformity with these duties. Without in any way affecting these duties of the Secretary of State, if a combined authority were, for example, to have conferred upon it a function to commission certain health services, the provision in Clause 8—which the House agreed on Report about conditions and limitations when conferring functions—would allow us to require that the combined authority, when exercising its commissioning functions, must likewise be subject to these core NHS duties, such as to promote the NHS constitution.

On Report, the noble Lord, Lord Hunt, commented that the issue we are discussing is more about symbolism, but he also recognised that one should avoid unnecessary legislation. I agree that this issue is one of symbolism. I am also very clear that symbolism is important and tempting. However, legislation is not the place for symbolism. The place for symbolism is in the discussions we are having and the commitments given to this House. For this reason, while I understand and strongly support the intention behind this amendment—that is, to make clear to all that the vital principles for the NHS will be upheld—I do not believe that it is necessary, nor do I consider that it is appropriate. As I have said a number of times, this Bill is an enabling Bill which includes general rather than service-specific powers. If this amendment were to be accepted, health functions would be specified on the face of the Bill, which would change the whole approach we have taken.

Noble Lords asked some specific questions—for example, on how to retain national standards where health powers are devolved. It is important to note that, when transferring functions to a combined authority or conferring functions on it, the Bill allows us to additionally place on a combined authority duties such as those held by the Secretary of State under new Sections 1A to 1F of the relevant legislation, as I have mentioned previously, or other duties held by NHS England or CCGs.

The noble Lord, Lord Warner, talked about the purpose and design of the Bill. We see it as a broadly enabling Bill, as I have just said. We have always said that we will devolve powers only where there is a clear accountable body. This applies equally to any health powers as to other powers that are devolved.

My noble and learned friend Lord Mackay and the noble Lord, Lord Patel, asked specifically about Amendments 3 and 4 as applying to regulatory functions such as those of the Care Quality Commission. Amendments 3 and 4, which we have just approved, mean that the regulatory functions of a national regulator such as the CQC cannot be devolved to, say, a combined authority exercising functions that the Care Quality Commission would have regulated.

The noble Lord, Lord Hunt, mentioned the importance of health in devolution. Health is absolutely an important element of devolution. As the Chancellor has said:

“We will hand power from the centre to cities to give you greater control over your local transport, housing, skills and healthcare”.

That is our aim and we will do that within a strong NHS. A strong NHS relies on a strong local economy and devolution will enable strong local economies with strong local governance. In areas with such accountabilities in place, such as Manchester, health devolution is something we support.

Given that I have placed those comments on the record, I hope that the noble Lord will feel able to withdraw the amendment.