Levelling-up and Regeneration Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Monday 13th March 2023 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

89: After Clause 16, insert the following new Clause—
“Reports on transfer of NHS responsibilities to local government(1) A Minister of the Crown must prepare reports on proposals for the transfer of NHS functions to local authorities, combined metropolitan authorities, combined county authorities, and mayors as established under sections 15 to 20 of the Cities and Local Government Devolution Act 2016 (combined and local authorities). (2) The first report in relation to subsection (1) must be made within 12 months of the passing of this Act.(3) Subsequent reports in relation to subsection (1) must be made at 24-month intervals following publication of the first report.”Member’s explanatory statement
This amendment and another in this location in the name of Lord Hunt of Kings Heath are probing amendments designed to explore the Government’s commitment to transferring NHS responsibilities to local government as envisaged in the Cities and Local Government Devolution Act 2016.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have a number of amendments in this group, which ranges very far and wide; at points, it is difficult to know what connects one with another. However, I suppose that they all have something to do with functions to be devolved to local government, which I guess is good enough.

I have tabled three amendments in the group and have added my name to the Clause 59 stand part debate in the name of my noble friend Lord Bach. My first two amendments, Amendments 89 and 90, are very much probing amendments designed to get a feel from the Government as to whether they have any intention of extending the “Devo Manchester” arrangements in relation to the NHS to other parts of the country. I have long believed that local government should have a greater role in the National Health Service. When the NHS was set up in 1948, there had been a huge debate in the Attlee Government as to whether the new NHS should be part of local government or not. In fact, there was a great argument between Nye Bevan and Herbert Morrison. Herbert Morrison, who had been the leader of the London County Council, which had been the largest hospital authority in the world before the war, argued for local government, while Bevan said that he thought that it would be a second-rate, patchy service. He obviously won the argument, although, by the early 1950s, he had changed his mind. Of course, when he introduced the NHS Bill—in this Chamber, of course—he talked about the NHS being a national service, but he stated that most of the decisions would be made locally through hospital management committees. He also made the memorable quote that when a bucket of slops is kicked over in Merthyr Tydfil, its echoes should sound in the Palace of Westminster. I suppose he was expressing the great tension about the NHS, which is that, for all the efforts to try to run it locally, the centre has continually sucked up powers and has attempted the impossible: to run this massive service through a Whitehall system of targets and other methods to try to bring the service into line.

There have been various attempts to break out from that. I was part of a ministerial team led by Alan Milburn that brought in foundation trusts as an attempt, on the providers’ side, to get much greater local ownership. The problem was that, once Alan Milburn left office, there was no one else to champion the concept, because at heart the Department of Health was very unwilling to let go. The noble Lord, Lord Lansley—whom I always tempt into these debates if I can—tried another approach with the establishment of NHS England as a quasi-independent body, again to try to take some of the decision-making away from Ministers and Whitehall. However, I suggest that, post the noble Lord, the appetite for it among his successors was pretty limited.

So we are left with a service that is under great pressure at the moment. We see Ministers scrambling around announcing plan after plan to try to recover it, and, frankly, that is not the way—I almost said, “That ain’t the way to run a railway”, but perhaps that is not quite right for those of us who travel by Avanti on a frequent basis, as the noble Lord said. When George Osborne reached an agreement with Manchester City Council—without, I think, NHS England knowing anything about it—that Greater Manchester would be given powers, in essence, to co-ordinate the running of the NHS in Greater Manchester, I thought that it had great potential.

Rather like for many initiatives, once Mr Osborne moved on it seems that the appetite in Whitehall for developing this idea fell by the wayside. I really wanted to use my first two amendments to probe the Government on whether they can confirm that, in fact, there is no intention to replicate what is happening in Manchester and that they now see integrated care systems as the way forward. If that is the case, the point I make to the Minister is that all the indicators are that local government is being treated as a very junior partner within those integrated care systems.

I want to pray in aid some very good work by the County Councils Network, which will not be so pleased with me when we come back to the issue of district councils in a few weeks’ time. I pay great tribute to its work looking at current experience of working with the NHS. It found some great examples of partnerships but the conclusion of its work is that integrated care systems

“simply do not feel like a paradigm shift towards delivering truly local priorities based on local engagement, and the question remains as to whether they are ‘joint’ endeavours or NHS bodies with some local government participation.”

Noble Lords who took part in debates on the then Health and Care Bill will remember that we spent many happy hours debating these very points and were assured by the Government that they saw local government as full partners within the integrated care systems. But the reality is that particularly the integrated care boards which commission NHS services are seen to operate primarily to tackle immediate NHS issues rather than address local priorities. The County Councils Network concludes across three themes of its research that:

“Accountability structures for ICBs … lead to NHSE and the Secretary of State for Health and Social Care and not to local organisations”—


surprise, surprise—that

“Regular directives from ‘the centre’ … require senior ICB leadership to focus on immediate NHS operational issues”,


another surprise; and that there is also

“a ‘command and control’ culture that jars with collaboration and local political leadership”.

That also is a great surprise.

The County Councils Network makes a number of suggestions for improving the involvement of local government. Essentially, it argues that the department of health and NHS England

“need to fundamentally review the levels of centrally mandated activity and targets in policies and funding requirements, particularly in shared policy areas, to ensure that they are consistent with the principle of locally driven strategies.”

I hope the Minister will respond positively to it. If, as I suspect, the Government are not prepared to go down the “Devo Manchester” route, despite some encouraging signs about what it is beginning to achieve, then I think they have to show—as this is essentially a local government Bill—that local government is going to have a greater involvement in the NHS and healthcare in the future. Anyone looking at the challenges we face in health at the moment and the inequalities surely must conclude that, unless we get to grips with chronic ill health and the need to promote a much stronger preventive approach, this will not happen without full participation of local government. That is the only way we can possibly get through the crisis that our health service faces.

Let me move on to a different issue. I come to Clause 58 where, it seems to me, the Government are essentially saying, “You can have devolution, but only on our terms and by adopting this model of directly elected mayors”. I have just heard the Minister comment on this, but why the obsession with directly elected mayors, I do not know. Clause 58 typifies this. At the moment, Part 6 of the Local Democracy, Economic Development and Construction Act 2009 provides for public authority functions to be conferred on to a combined authority subject to various requirements about authorities locally consenting. Such functions can then be exercisable by the combined authority or by the mayor personally.

But Clause 58 now amends the current provisions whereby all the local authorities covered by the function to be transferred have to agree. Under this clause, the mayor of a combined authority may make a request to the Secretary of State to make such an order. The mayor is required to consult the constituent councils of the combined authority before making the request and requires the mayor to include within such a request to the Secretary of State a statement that all the constituent councils agree to the making of this order or, if this statement cannot be made, the mayor’s rationale for proceeding. My reading is that, despite a constituent authority not giving consent, the Secretary of State can simply agree to the mayor’s request and override objections from constituent authorities. To me, that is a fundamental change from the current provision. It allows a mayor to act in an extremely high-handed way and is something that we should be very wary of.

For an example of high-handedness, Clause 59 really takes the biscuit. I suppose we should call it the Andy Street clause because it has been put in only because he was very miffed that his proposal to take on the functions of the police and crime commissioner in the West Midlands was turned down by the local authorities in that region, as they have every right to do. At the last elections in the West Midlands, Mr Street was elected mayor and a Labour candidate was elected police and crime commissioner. That was a democratic wish of people in the West Midlands, and for the mayor to come along and say, “Forget that. I want to be the police commissioner”, and the Government to come along with this clause and say they going to take the power to do that, is utterly unacceptable. I hope very much, when it comes to it, we will be able to take this wretched clause out of the Bill. I beg to move.

[Baroness Randerson (LD)]

My Lords, I will speak to Amendment 91 to which I have added my name, and to Amendment 469 in the names of my noble friend Lady Pinnock and myself. I also want to express general support for the amendments in this very disparate group.

On Amendment 91, some noble Lords will be aware that I am also at the moment participating in debates on the Strikes (Minimum Service Levels) Bill and the retained EU law Bill. There are some overlapping issues, and one is the role of trade unions and the interaction between the powers of the UK Government and the powers of employers, including, of course, local government as employers.

Last week on the strikes Bill, I raised the issue of the powers of devolved Administrations. The Minister was unable to give assurances that the UK Government—who, by the way, on issues that are devolved are just the English Government—will not simply override the devolved Administrations. Applying that logic to this Bill, which purports to increase devolution within English local government, it is reasonable for us to ask what the status of trade unions within local government will be and whether the UK Government will seek to override English local authorities in the same way as they intend to override devolved Administrations. The lessons are similar in both Bills.

--- Later in debate ---

[Baroness Scott of Bybrook (Con)]

This is the responsibility of the Department for Transport. I will be in touch with the relevant Minister to explain the Committee’s deep concern about the issue of bus services and say that an early solution to this would be considered appropriate by the Committee. I will also find out how long it will be before we get this strategy in place. I will write that at the end of the letter, which will go to all noble Lords in Committee. I hope that noble Lords will withdraw their amendments.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this has been an interesting debate. The Minister made an interesting comment at the end when she said that basically a lot of the services we are talking about are the responsibility of other government departments. That seems to me to go to the heart of one of the problems of this legislation: is it not about devolution at all. If it were really about devolution, the Government would have a concerted approach to widespread devolution, which of course would involve bus services. It is a ludicrous proposition that under this grand new devolution and regeneration system you cannot run your own buses.

On health, what the Minister said was helpful up to a point in that she said there is no legal impediment to what is happening in Greater Manchester being extended, but I do not see any drive whatever. What I see is her own department taking a depressingly narrow view of what local government should do instead of embracing the whole government machinery to say, “We are serious about this.”

The clarification on Clause 58 was very helpful, and I am very grateful to the Minister. On Clause 59, I am pretty speechless. I spoke for the Opposition when the concept of police commissioners was coming through. We opposed it. Frankly, I still have great reservations about the system. My noble friend was an excellent example but, my goodness me, the evidence of poor behaviour by some police and crime commissioners is legion. None the less, we were promised directly elected police commissioners, that the public would decide who was going to be the police commissioner and there would then be accountability through the ballot box, but it seems that this is not to apply now in a number of places. From what the Minister said, it seems that the principle of coterminosity applies to many parts of the country in terms of future mayors and police commissioner areas.

I shall make two points. You cannot exclude local authorities. They form the police and crime panel. They have a direct interest in the precept which is set and have to consult on it. It is a big move to get rid of the police and crime commissioner and simply give it to the mayor—we know the mayor will appoint a deputy and will not really be accountable because the mayor has got other things to do—without consulting the constituent local authorities which play an important role in this whole area, not just in sitting on the police and crime panel. If we are serious about wanting our criminal justice system to be more effective, the local authority has a pivotal role to play in working with the police at local level.

I urge my noble friend on the Front Bench to bring this back on Report because I believe we should take out this clause. Having said that, I beg leave to withdraw the amendment.

Amendment 89 withdrawn.