English Devolution and Community Empowerment Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Monday 9th February 2026 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, in proposing that Clause 53 should not stand part of the Bill, I should emphasise that I am not opposed to the clause—far from it. We have now had three debates about the role of local government in the health service, and I want to probe how far the Government are really prepared to devolve and delegate responsibilities for both health improvement and the NHS to strategic local authorities.

I will not repeat what has been said in our earlier debates, but this clause is very important. It makes consequential amendments to Section 18 of the Cities and Local Government Devolution Act 2016 to reflect changes introduced into this Bill. The importance of Section 16 is that it provides Ministers with the ability to confer public authority functions on local authorities, including health and social care.

The debate about the role for local authorities in relation to healthcare and health improvement is as old as the NHS itself. But since the 1974 reorganisation, it seems to me that the NHS and healthcare delivery has often stood remote and disconnected from the rest of public services such as social care, housing and education, which are under some kind of integration within local government and democratic control. I see devolution in health as a way to reconnect services, at least at a strategic level. I do not think this will happen without a stronger drive through powers devolved locally.

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[Baroness Taylor of Stevenage (Lab)]

My Lords, I thank my noble friend Lord Hunt of Kings Heath and the noble Lord, Lord Gascoigne, for their amendments. I turn first to my noble friend Lord Hunt probing whether Clause 53 should stand part of the Bill.

Clause 53 places limits on the devolution of health functions to strategic authorities to ensure that the health service remains truly national. I know the noble Lord understands that. For instance, it prevents the transfer of the Secretary of State for Health’s core functions in relation to health. Where health functions are devolved to a strategic authority, it requires that provision is made to ensure that they adhere to national service standards.

Protections against devolving these functions are not new; as the noble Lord indicated, they have probably been going since the health service was first set up. They have certainly been in place since central government first began the process of devolving functions to combined authorities. The Bill merely retains those protections. I know my noble friend wishes to probe the Government’s intentions on devolving health functions in the future, and he is right to do so.

Health, well-being and public service reform is an area of competence for strategic authorities, as set out in Clause 2. The Bill also confers a new health improvement and inequalities duty on combined authorities and combined county authorities. As health is covered within the areas of competence, the Government could use the powers in this Bill to devolve health functions to strategic authorities in the future, if they believed it appropriate to do so. Mayors of established mayoral strategic authorities would also be able to request the devolution of health functions and get a response from government.

This demonstrates that the Government see a clear role for strategic authorities and mayors in health, both now and going forward. The example of Manchester is a very good one, and we will continue to look at what is happening there to make sure that lessons can be learned and that, if we get requests from other mayors to devolve health functions to them, we pick up on any lessons from Manchester. At the moment, the process is looking positive. But it will always be right, I fear, that limitations remain to make sure that the health service remains truly national. Whether that is in targeting or some of the processes, we will see.

I turn to the amendment from the noble Lord, Lord Gascoigne, which seeks to prevent the doubling up of powers and responsibilities in strategic authorities and Whitehall. I heard the Secretary of State speak over the weekend and his view is definitely that devolution by default is the way he wants to move this forward. He was very clear on that, and on the advocation of subsidiarity that sees powers and funding always held at the most appropriate level for delivering any service. The funding settlement will be announced this week; it may be out today. It is out—I thank the noble Baroness, Lady O’Neill. I had not kept up on that, although I have talked of nothing else all weekend.

Through the integrated settlement, we have instituted the principle that, where central government funding falls within the scope of an established mayoral strategic authorities’ functional responsibilities, that funding will be devolved. The Government are also committed to providing new strategic authorities with capacity funding to kick-start their organisations, so all areas on the devolution priority programme will receive mayoral capacity funding to help establish their new institutions once the legislation has been laid before Parliament. They will receive capacity funding in future years as well, so they are ready and prepared to deliver the benefits of devolution.

I agree with the noble Lord that, unless you have the funding to deliver these new functions, there is not much point in devolving them. We very much agree with the spirit of the noble Lord’s amendment. When responsibilities are devolved, they have to be devolved as thoroughly as possible to enable the true innovation and place-based approaches that we all want to see and that are the whole purpose of devolution in the first place. That is the position the Government have taken in the devolution framework in this Bill. The majority of powers will be exercised solely by the strategic authority or concurrently with the constituent authorities.

However, there are rare circumstances where the relevant Secretary of State and the strategic authority need to share powers. To give an example, the Secretary of State will retain the ability to provide funding in relation to adult education in addition to funding provided by the strategic authority. This will ensure that those areas in strategic authorities do not miss out on nationwide schemes. For example, I think there have been some announced today.

The amendment in itself is too restrictive and would prevent instances where it makes sense for powers to be held concurrently with government. I understand the noble Lord’s concern that, while functions may be devolved, funding may remain in Whitehall. However, the Government are committed to providing strategic authorities with the funding to deliver their functions.

We have committed to providing new strategic authorities with capacity funding, as I have said, and the integrated settlement institutes the principle that government funding will be devolved where the responsibilities fall within established mayoral authorities’ functional responsibilities. I hope that, with those explanations, noble Lords are able to support the clause standing part of the Bill.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to my noble friend. It has been a really interesting and encouraging debate. I share the view, concern and thrust of the amendment from the noble Lord, Lord Gascoigne, and I thought my noble friend was pretty positive in response.

The noble Lord, Lord Wallace, made a very pertinent point about the difference between delegation and devolvement. As the noble Lord, Lord Lansley, pointed out, although we talk about devo Manchester in relation to health, it was actually delegation, with the Secretary of State retaining responsibility.

I do not think that in the short term we will be able to move off the Secretary of State’s responsibility. That goes back to 1948. However, I think a lot more could be delegated, and there are issues where we could start to look at real devolvement. The noble Lord, Lord Lansley, reminded me that we have the joys of another NHS reform Bill coming to us in the next few months, and we will have an opportunity to discuss and debate this further. I will be looking particularly to see whether the Bill tries to nibble away at what is already contained in Clause 53.

One has to say that, at the time of the agreement over Greater Manchester, it is well known that NHS England was not in the loop in the original decision-making. I am afraid that, because of that, it has not been keen to see progress such as has occurred in Manchester. The noble Lord, Lord Shipley, said that Manchester was essentially a pilot and we should have a proper assessment; I agree with that.

My noble friend was very encouraging. I understand this whole question about the Secretary of State’s accountability to Parliament for the running of the National Health Service and how that squares with giving more authority to local authorities to have a role in it. We can find a way through. For instance, this always struck me: if we are going to have pilots, why on earth can we not have one mayoral authority taking on responsibility for an ICB—not having one place on it but actually doing it? Albeit it might be under delegated powers from the Secretary of State, at least let us dip in the water of freeing up the system. Looking at how the NHS is run at the moment, how many restructurings do we need to show that central command control simply does not work? Having said that, I withdraw my opposition to Clause 53.

Clause 53 agreed.