Cities and Local Government Devolution Bill [HL]
Debate between Lord Hunt of Kings Heath and Lord Mackay of Clashfern
Lord Hunt of Kings Heath (Lab)
My Lords, this has been a very useful short debate. I think that the Minister will know that those of us who take an interest in NHS matters have no problem at all with the aims of the Bill, particularly in Greater Manchester; we all see the advantage and the potential of pulling together the NHS, local government, the university sector and the hugely important life sciences sector within Greater Manchester. We are also very grateful to the Minister, both for the meeting that she arranged and for agreeing that we can come back to my Amendment 31 at Third Reading in order to ensure that regulatory and supervisory functions cannot be included in a transfer of responsibility.
I also say to her that I take it this will also involve the funding of local Healthwatch being taken away from constituent local authorities. I do not expect her to respond to this; I merely make the point that their job is to provide an independent assessment of local health services. If health is transferred to local government in the way provided, there is no way that local authorities should continue to have the money routed through them to fund local Healthwatch. Clearly, it should be allocated by national Healthwatch directly to local Healthwatch. We will certainly come back to this at Third Reading; it is a very important matter that I wanted to give her notice of.
Then there is the issue that a piecemeal approach by order could inadvertently undermine the national nature of the NHS. We are looking for a response at Third Reading that recognises that there has to be some statement about the integrity of the NHS as a national service. Those are the two issues that I put to the Minister. Perhaps people in local government do not understand that a lot of what is done in the NHS is done not through statute but by what has been described as soft power. In other words, at the end of the day the Secretary of State for Health can ring up any chairman or chief exec of any NHS body and, in the end, they will do what they are asked to do because they all recognise that they are part of the national NHS family. It is very important that we do not lose that sense of belonging if you are transferring functions to local authorities. The DCLG relationship with local authorities is very different from the relationship between the Department of Health and NHS bodies.
Many of the actions that are taken are not done through statute. For instance, none of the fantastic reconfiguration of stroke services in London, a reduction from about 20 to nine services that has led to hugely improved outcomes, was done through statute; it was done because people recognised that there was a lead from the centre and they responded to it. My concern is that once we move in the direction of the Bill, we will lose a lot of that sense of national cohesion. That is why some statement in the Bill rather than through individual orders would be so important and, in supporting where we are going with the Bill, would give some measure of comfort to people in the NHS.
Lord Mackay of Clashfern (Con)
Having listened to this debate, and with a certain interest in these matters, it occurs to me that the devolution proposed in the Bill is a devolution from one subsidiary authority to a local authority. There is no devolution of the responsibility of the Secretary of State, which is guaranteed under the 2012 Act. The Secretary of State remains responsible, in the same way as he is in relation to the existing health services. In a way, therefore, that is the theoretical guarantee for the National Health Service, except of course that the practical implications in which these things are worked out may be affected by this. The relationship between the Secretary of State and a local health authority may be a bit different from his relationship with the Greater Manchester authority. There is a possible problem in that area, but I think that we should emphasise that the Secretary of State is not by the Bill being empowered to devolve his responsibility as Secretary of State for the National Health Service.