Doncaster and Bassetlaw NHS Trust STP
Lord Mann Excerpts(9 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Mann (Bassetlaw) (Lab)
At this late hour, I rise to talk about the South Yorkshire and Bassetlaw sustainability and transformation plan. Sustainability and transformation plans are a huge part of the direction of travel in the NHS, but I find that the general public know nothing about them and that consultation is not reaching people—unlike their implications, including the cuts that they are disguising, which are reaching more and more people.
When I heard about the plans and met people to discuss them, it struck me that this was a chance for people in our area to have a vision of an NHS fit for today. I thought that it would enable us to move beyond the clapped-out buildings and outdated technologies into a new era, perhaps without all the funding in place, but with a vision of what would be there in 10 or 20 years’ time if that money became available. I find myself dismally disappointed.
I expected a vision across South Yorkshire and Bassetlaw of what a new surgical hospital of the future would look like. I recalled that, 25 years ago, my own company was working at Addenbrooke’s hospital. During a “live time” operation, we connected with consultants from Japan so that they could give their precise view on what should be done to a patient many thousands of miles away. I expected that—the best expertise and the most modern technologies—to be part of the vision. I expected tomorrow’s technology, but what I see is yesterday’s technology.
I expected to see, beyond smartphones, smart health. I expected that if someone of our age, Mr Deputy Speaker, should require paramedics, today’s smart technology would enable his medical records to be accessible to them immediately on their arrival. I expected screening, testing and all the real “before and afters” of any operation, and any highly specialised input, to become increasingly localised. I expected both our brilliant universities in Sheffield to be in the middle of the new future of the NHS. I expected an area that had been blighted by the impact of the coal and steel industries on the health of people and families to be able to look to the future, with a clear vision of how health services would be configured and how they would be linked to the super new health provision. That is what I expected from the plan.
I expected to be able to challenge my local communities to become engaged in prevention—in education, sport, recreation and healthy living—and to use the NHS less because they were fully involved in a modern plan for a modern health service. I expected to see mental health services that were a support, not a stigma, in the community. I expected to see the integration of social care and the NHS. Let me say to the Minister—I have said it before, but I will say it again now—that I am happy for Bassetlaw to be the first area to hand over the entire social care budget to the clinical commissioning group to put the two together. Working together but delivering from a single budget, they can be much more effective. I hope that the Minister will oblige by making our area the pathfinder for change of that kind.
This dismal plan is a smokescreen for cuts. But there is an opportunity, because of those cuts, to engage the population. The population does not know about the STP, but it certainly knows about the breast care unit that, behind the smokescreen of these changes, is being cut at Bassetlaw hospital, possibly never to be returned. It is a state-of-the-art system as good as that anywhere in the country, brilliantly put together by Mr Kolar and his team, but it is being dismantled at this moment. Women who, previously, from first appointment to consultant were seen, diagnosed and in treatment in 24 hours are now waiting weeks. It is a system that even in the olden days of the last two decades has been prompt and to the point, but it has now shifted back 30 years in its thinking. I hope the Minister will look at precisely how this dangerous cut is being done, because the people of Bassetlaw are not happy about it.
The management of the hospital—the chief executive went on Friday and is still to be replaced, and a new chair was appointed at the turn of the year—has decided to pick on the children’s ward of Bassetlaw hospital, which is perhaps not the smartest of moves. The STP gets nobody other than me and one or two officials to participate in its consultation, but then there is the parents’ Facebook campaign against the overnight closure and the video blog—fancy words—that I did to expose it. Some 9,000 people watched my video blog within the first 24 hours, and 7,000 have joined the Facebook group in the first 24 hours. So there is some consultation feedback for the NHS. The people of Bassetlaw, particularly the mothers and grandmothers, are saying, “We do not want this children’s ward shifting or closing, as it has been; we want that reversed.”
What is their vision, and my vision, of an NHS? Let me give the Minister the views of some of the real people—not the theory, not the stats, but the views of humans. Let me tell the Minister about the twins Leon and William, with autism spectrum disorder, milk allergies and other food intolerances, and learning difficulties, poor eyesight and sensory processing disorders. William has had eight chest infections since birth, with each one becoming more serious. What does his mother Kelli say? Her twins
“thrive on continuity of care and are routine driven and to take an unwell child who has no communication (non verbal) and understanding could be devastating.”
These twins are
“not critically ill but suffer from an acute neurological condition so severe that they attend St Giles”
special school in Retford.
Kelli says:
“My boys know Bassetlaw Hospital and it is all they have ever known, if they have to go elsewhere this will have a detrimental effect on their mood and stress levels. This also may mask a real problem and when a child is non verbal you rely on the subtle hints they give. Even I”—
the mother—
“struggle to understand what their main cause of upset is when they are panicked.”
They need “continuity of care”, but what does this modern, new NHS offer us—this year, brought in two weeks ago? It does not offer continuity of care. If those twins go in in the daytime, they will go into Bassetlaw children’s ward, but if they go in overnight they are automatically transferred to another hospital, and asked to go back to Bassetlaw the next morning. I have already got mothers who are told to go to Sheffield or to Doncaster and arrive there and, after an hour or two—having spent the night getting there, waiting at Bassetlaw for an ambulance, going in an ambulance, getting transferred—are then told, “You need to get back to Bassetlaw.” What a farcical, 1960s health system we are now having imposed on my local hospital.
That is not good enough for the twins Leon and William, and it is not good enough for the six-year-old asthmatic who is admitted to the children’s ward two or three times a year when he is struggling to breathe and requires nebulisers, oxygen and steroids. His parents say:
“The service has…been efficient and relatively quick, which as you can imagine is paramount when you have a child who is fighting for breath…My son gets the treatment he needs without us having to bother the ambulance service. However if we have to travel to Doncaster, which is over 30 miles away and have the nightmare of parking there too it fills me with complete dread. It stops us being able to access home as easily when he has to stay in sometimes for 3 days but also takes the security and familiarity out of the stay for my son, who is already quite poorly”.
Distance is a crucial factor, and it is total nonsense that the distance their son has to travel should be determined by whether he is ill at night or in the daytime.
A four-year-old from Beckingham was treated three times in the children’s ward at Bassetlaw last year. Her mother says:
“The care was absolutely fantastic. I was really scared that she was so poorly, but all the staff were so kind and couldn’t do enough to help. Other mums I spoke to said exactly the same. The thought of having to drive to Doncaster with a sick small child, particularly my own, fills me with dread…I couldn’t have driven her to hospital on my own with her as she was at that age and I asked if we could have an ambulance but it was going to be well over an hour before one could be sent.”
We struggle to get ambulances at any time, never mind in the middle of the night. Ambulances cost money, yet in my area parents will be expected to get into ambulances and travel vast distances—in some cases 40 miles there and 40 miles back. That is not sensible planning in the modern national health service.
Another parent told me:
“My daughter was born 3 months premature in 2012. Due to this she has several health issues, in particular problems with her lungs which has caused her to be admitted on to the children’s ward at Bassetlaw hospital on many occasions.”
Her parents described an occasion when they were told that
“her organs were shutting down as her lungs were not getting enough oxygen. The children’s ward staff were amazing and gave her high dependency care on the ward as she was too unstable to move her to Doncaster hospital. If it had not been for them our daughter would have died.”
She was too unstable to be moved, yet now she would automatically be moved after 8 o’clock at night. That is an abomination, and there are many more.
Another example is 16-month-old Isla, who went to A&E twice in November. Her parents said that
“with her already being distressed with feeling so poorly we felt that the added ordeal of waiting for an overnight transfer by ambulance was added distress and unfair on our daughter. We had been warned we could wait up to three hours for an ambulance to be available and this was on top of the time we had already spent there. For such a young child to be subjected to a seven hour wait and an ambulance transfer in the middle of the night is grossly unfair and doesn’t fit with the ethics and duty of care we believe the NHS should stand for.”
This is not theoretical; it is actually happening.
Mylor, aged 10, was also born prematurely at Bassetlaw hospital. He suffered a brain injury, periventricular leukomalacia. He has quadriplegic cerebral palsy and is unable to sit or stand independently. He has had major hip surgery and has complex health needs. Rarely a week goes by without his needing an associated appointment related to his health needs. His parents say:
“It is of great comfort and reassurance to have a children’s hospital 8 miles from our home with staff who know Mylor and his medical background, a hospital he is familiar with. The decision to cut back admissions on the ward will greatly impact on disabled children and their families—families who already face enough challenges and worry caring for their loved ones.”
The impact on those young disabled children is enormous. They know the children’s ward. They know the staff.
Courtney has autism and learning difficulties. The family said
“we have always been allowed an open door policy if Courtney has ever been very ill. It has been of great comfort to our family to have the reassurance of the excellent medical staff at Bassetlaw. The staff have got to know Courtney and her condition, and her illness has quickly been addressed and this—“
the open-door policy—
“has often prevented her condition from getting worse.”
Dr Leonard Williams, a paediatrician at Bassetlaw for 30 years, pioneered this open-door policy. Most parents do not even go through A&E; they go straight into the children’s ward, technically through the back door, with their children and their conditions known. All of that has been thrown out of the window in the last two weeks. Charlotte has many issues and
“contracted pneumococcal meningitis at 4 weeks of age which left her severely disabled, profoundly deaf and epileptic to name some of her conditions. She has spent many days/weeks on the Children’s Ward at Bassetlaw and the care has always been fantastic. We have always been allowed an open door policy if Charlotte has ever been very ill. It has been of great comfort to our family to have the reassurance of the excellent medical staff at Bassetlaw.”
There is a lot of repetition, but each of these is a different case.
Ollie is six. He has Hirschsprung’s disease and has had a colostomy. He has multiple problems and has had multiple surgeries. His family said
“you never know when you may need the hospital and it’s absolutely vital we have a local one accessible 24/7. It also is very distressing for families and children to be far away from loved ones when members of the family are poorly. Having a local hospital is very important”
to them. I can go on and on with example after example.
Chloe is a 13 year old with a huge number of issues. She has been to Sheffield children’s hospital because she has so many conditions, but she also regularly attends Bassetlaw, where she has grown to trust the staff. Being in hospital for her is not a one-off. Chloe has been treated in the children’s ward for more than a decade, and her mother says it is
“how we live our lives.”
Emily has an extremely rare condition. She has seizures and
“often stops breathing while having them.”
She frequently stays at the children’s ward for one or two nights. Her mother said:
“We moved into this area to be close to the hospital for this reason and Emily’s illness has always been quickly addressed at Bassetlaw and this has often prevented her condition from getting worse.”
There is a three-year-old with chronic asthma who is severely disabled, profoundly deaf and epileptic. There is a 10-month-old, born prematurely, whose father’s employment means that he will not be able to be there if she does not go to Bassetlaw. Zac was the one for whom we launched the campaign. He is three years old. He is blind. He is permanently in a wheelchair and cannot speak. Zac’s father is an industrial worker who works nights. How is he meant to get in with his son if he does not even know which hospital he is going to on his regular admissions to the children’s ward? Those are just some of the children. There are many, many more.
The staff say that seven hours for a non-blue light ambulance is the norm. We have seen cases already of kids waiting six or seven hours at night for a transfer after already waiting all day. There was case in which a blue-light ambulance arrived at Bassetlaw at 8 pm, just missing the deadline, which means a blue-light transfer and the child still going through A&E in Doncaster at midnight—four hours later. In Bassetlaw that would have been minutes, not hours.
We know about the financial black hole across South Yorkshire and Bassetlaw. We are aware of the massive black holes in some of the health trusts and that not enough money is being put in. We are also aware of the additional cuts, with the latest one being the cutting of health visitors in Bassetlaw. Mothers have been told in the last week that they have to weigh their own baby. There have been eye tests in schools since the inception of the NHS—stopped in the last week. Height tests in school—stopped in the last week. Those are major and significant cuts, and they are going to have to be reversed. “Weigh your own baby in the current national health service because we haven’t got any health visitors, and when they’re ill you can’t go into the children’s ward.” “There is no ambulance waiting for you. Drive your own kid to another hospital.” That is what families in my area are being told.
The STP states:
“Improving our population’s health and wellbeing…means re-imagining, re-designing and re-forming our public services and public budgets to improve the health and wellbeing of our population.”
Those changes and this plan are not forward-looking, they are old-fashioned, unimaginative and consultant-focused. It is a 1960s solution to the health service, not critical interventions in the right place, not key operations by specialist surgeons and not decentralised local services. For the young, the old and the seriously ill, it is already traumatic.
The support of my neighbour, the hon. Member for Newark (Robert Jenrick), for the children’s ward and breast care unit is on the record, in the traditions of his predecessor, and I thank him for his cross-party work in Bassetlaw and in this place to save our NHS, but there are a few local politicians who seem to think that they are cleverer than the rest of the world. Well, their ignorance is no excuse, and my message to each and every one of them is: “Will you hold your head up high and proud by joining us in fighting these appalling changes and this appalling plan?”
This month and this year, these children have been given a third-class ticket. My constituents and I demand that the children are given a first-class ticket and an equal chance to all other children in this country. They are being denied that chance. Every child in Bassetlaw will benefit from keeping the children’s ward fully functional and fully operational 24 hours a day, seven days a week. The kids in Bassetlaw are united, and if the kids are united, they will not be defeated.
The Minister of State, Department of Health (Mr Philip Dunne)
I start by paying tribute to the passion with which the hon. Member for Bassetlaw (John Mann) laid his case before us this evening, and I share his welcome to my hon. Friend the Member for Newark (Robert Jenrick), who joins him here.
The hon. Gentleman’s remarks are clearly timely, and he started his contribution by laying out his vision for innovative technology to be brought to bear for the people of South Yorkshire and Bassetlaw through the emerging sustainability and transformation plan. He drew on his experience from across the world in his previous life to try to bring innovation to bear, and I will touch on the STP towards the end of my remarks.
The hon. Gentleman spent most of his contribution talking about the more immediate issue of the challenge of maintaining a 24-hour children’s ward in Bassetlaw hospital. He has given us many examples of the impact of the current closure—or the fear of the impact of the closure—on families in his constituency and their children who have had experience in the ward. He did so with considerable empathy and conviction, and I am sure his constituents will be grateful for that.
I wish to start my remarks by setting out the facts as they have been presented to me in preparing for this debate. It is the case that Bassetlaw hospital stopped providing an overnight children’s service today. Children who would have been treated at Bassetlaw overnight will now be treated at the Doncaster royal infirmary or Sheffield children’s hospital. The closure is being undertaken by the trust on safety grounds, as there are workforce shortages for both paediatric medical and nursing staff, despite attempts to fill the gaps with locum staff. This is a patient safety issue; the current situation does not offer a safe and sustainable service, which the hon. Gentleman would expect for his constituents. That is the fundamental premise on which this decision has been taken. The replacement service will be monitored to ensure it is safe and effective prior to any decision in October about the long-term future of the service.
In December 2016, the trust identified an emerging issue with safely staffing children’s nursing, as there were gaps of six whole-time-equivalent registered children’s nurses. The trust has attempted to source children’s nurses through locum agencies but has been unsuccessful. Additionally, there is currently a three-person gap on the junior doctor rotation at the trust. I am advised that the trust has undertaken an overseas recruitment drive for medical staffing through an agency, but this has also, unfortunately, not been successful.
The situation with the workforce and the unpredictability of the locum doctor cover has resulted in the ward being temporarily closed at night to new admissions on many occasions in recent months, but children admitted earlier in the day who are stable have remained on the ward overnight. To put this into context, between 1 November and last Friday the trust had transferred 23 children out of the ward, averaging two per week. The total number of children remaining in the ward overnight from 1 September was 452, an average of three per night. I want to assure the hon. Gentleman that the trust appreciates that some children are admitted to the ward regularly—he gave us such examples from constituents’ emails—but due to the nature of their illness it is impossible to predict when this will be. The trust is contacting regular users of the children’s ward individually to discuss their particular care needs and how these can be best delivered under the new system. The trust will continue to provide a seven-day “hot clinic” service for ill children who need to be seen quickly for clinical diagnosis but are unlikely to need an admission for assessment. I understand that this clinic will also invite children discharged from the assessment unit on the previous day for a consultant review, if clinically necessary. This will offer parents confidence about their child’s progress if they have been in the assessment unit the day before.
The service that has become operational as of today is a consultant-led paediatric assessment unit, providing services seven days a week. The intention is that this will run from 8 am to 10 pm, with a cut-off time for the last admitted child for assessment of 8 pm each day. At the moment, the cut-off time for assessment is 7 pm, and that will move to 8 pm following a review after the new model has been operational for two months. As ever, the paramount consideration is the safety of the children.
Children admitted during the day who have been assessed by a consultant as “acutely unwell” will be rapidly transferred to a centre such as the Doncaster royal infirmary or Sheffield’s children’s hospital. I understand that the new model of care for the trust is consistent with Royal College of Paediatric and Child Health guidance, and represents the latest and safest national guidance.
The hon. Gentleman referred to long waits for non-urgent patient transport, and I can provide some reassurance on that. The trust and the CCG have, from today, jointly commissioned a dedicated urgent transport facility to be available from 4 o’clock in the afternoon to 2 o’clock in the morning, seven days a week, specifically to cater for any necessary children’s transfers. The trust is committed to providing the highest-quality care for children, as recently demonstrated when it invested around £250,000 to build the assessment unit and new children’s out-patient area.
We should remember that the decisions on how to provide safe care for children, which come into force today, are a matter for the local NHS. It is right for these issues to be addressed at a local level, where the local healthcare needs and demands are thoroughly understood and considered. The local NHS makes decisions to ensure the safety and welfare of patients. Although the decision may cause upset and disruption for patients and families, it is for the local NHS to ensure that the services provided are of the highest quality possible and are safe and sustainable. Above all, parents with sick children need to have confidence that their child will be treated at the safest level and by the most appropriately qualified staff. I am sure the hon. Gentleman will agree that that is paramount.
Nottinghamshire County Council’s scrutiny committee has been informed of the service changes, and I understand that no decision was made to refer the changes to the Secretary of State.
John Mann
Part of the weakness of the structure is that not a single person from Bassetlaw sits on Nottinghamshire County Council’s scrutiny panel. Not a single person from Bassetlaw has been consulted, including none of the staff who work at the trust. Is it not time that the people of Bassetlaw, including the staff, were listened to? At my public meetings on Saturday, there will be an opportunity for the trust to come along and hear precisely what parents, staff and others have to say.
Mr Dunne
I understand that the hon. Gentleman has already held a meeting for the public to discuss this matter. I am also aware that, as would be expected, he has been in touch with the trust and the CCG to make his representations directly. I am sure that if he has not yet had the opportunity to discuss this matter with the scrutiny committee at the local authority, he will have every opportunity to do so.
The South Yorkshire and Bassetlaw sustainability and transformation plan covers an area that has funding in the current year of £2.7 billion. Under the current plans, funding will rise over the remainder of this Parliament by £400 million to 2021—a cash increase of just under 14%. The plan is one of 44 STPs that are being developed by local NHS leaders and local authorities, with providers, commissioners and other health and care services coming together to propose how, at local level, they can improve the way that health and care is planned and delivered in a more person-centred and co-ordinated way. That is the ambition, and one that I think the hon. Gentleman shared in his hope that the STP will generate an NHS fit for the future.
For all STPs, there will be no changes to the services that people currently receive without local engagement. If plans propose service changes, formal consultation will follow in due course, in line with legislative requirements and procedures. The Government are clear that all service changes should be based on clear evidence that they will deliver better outcomes for patients. Any changes proposed should meet four tests: they should have support from GP commissioners; they should be based on clinical evidence; they should demonstrate public and patient engagement; and they should consider patient choice. I am also aware of a consultation that is currently under way on children’s surgery and anaesthesia services in South Yorkshire, Mid Yorkshire, Bassetlaw and North Derbyshire.
I reassure the hon. Gentleman that the changes happening in the children’s ward at Bassetlaw hospital are unrelated to the STP or to the current consultation on changes to children’s surgery and anaesthetic services, which are not currently conducted at Bassetlaw. The decision was taken as a result of insufficient staffing to maintain patient safety.
In conclusion, I fully appreciate the concerns that the hon. Gentleman expresses on behalf of his constituents, particularly the families of the young children who have been used to the service being provided 24 hours a day in Bassetlaw. I encourage him and his constituents—he has told us he is doing this—to maintain a proper, open dialogue over the coming weeks and months with Doncaster and Bassetlaw Hospitals NHS Foundation Trust, and the Bassetlaw clinical commissioning group to ensure that there continues to be a safe and sustainable service for the children of Bassetlaw. That service should be provided in the hospital during the day and, for those who are stable, overnight. However, children who have an urgent problem that needs attention overnight must go somewhere safe for that service.
Question put and agreed to.
Oral Answers to Questions
Lord Mann Excerpts(9 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.
John Mann (Bassetlaw) (Lab)
Mr Jeremy Hunt
First, I absolutely commend the hon. Gentleman for standing with his constituents and championing individual cases. I will happily look into the proposed changes and how they will affect people like Zac. I assure the hon. Gentleman that when we make these changes it is to improve the services of people and his constituents; that is why we are making them.
Oral Answers to Questions
Lord Mann Excerpts(9 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)
I commend my right hon. Friend, and we have had numerous discussions over the last year on this subject. She can rest assured that I am actively doing everything I can to make sure we expedite this. She will understand that there are important negotiations with NHS England, NICE and the company at the moment, which are key to making sure we can get this drug accelerated quickly.
John Mann (Bassetlaw) (Lab)
T6. Other EU countries charge us £650 million a year more for the health treatment of our citizens abroad than we do for the treatment of their citizens here. Is that because we cannot charge them, or because we have not got our act together?
Mr Jeremy Hunt
The answer, regrettably, is that for many years we have not got our act together. That is why I have changed the system of incentives for trusts to make sure that they get a premium for identifying EU nationals they treat and that we can then recharge the treatment to their home countries. We are, as a result, now seeing significant increases in the amount we are reclaiming from other countries.
Cities and Local Government Devolution [Lords] Bill
Lord Mann Excerpts(10 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Kevan Jones
Amendment 2, tabled by my hon. Friend the Member for Nottingham North (Mr Allen), calls for the creation of a constitutional convention, which I think is very important.
As we heard earlier from my hon. Friend the Member for Sheffield South East (Mr Betts), the Government’s proposals are likely to end up as a dog’s breakfast. The Bill does not represent a movement for devolution or an attempt to improve local government or governance; it represents a clear political agenda. It is about the Chancellor’s vision of a small state Britain that will make it easier for him to push through draconian cuts. Once he has pushed responsibilities down to local government or regional tiers, he will be able to top-slice the budgets, while the difficult decisions will have to be faced locally, by mayors and councils. Those individuals will get the blame for the tough decisions that will be taken. The Chancellor and this Government will step back and say, “I’m sorry, it’s not our fault; it’s your local decision-making process.”
This is a unique way of approaching the devolution debate in this country. There have been other approaches. There was the Crowther debate in the late 1960s and early 1970s, which stood back and looked at not only Scotland, Northern Ireland and Wales, but how to devolve power locally. The Redcliffe-Maud reorganisation of local government took time to look at future structures for local government. That was controversial at the time—some of the historical counties were abolished, for example— but at least there was an evidence base.
That is not what is on offer now, which is why amendment 2 is so important. We need a properly thought-out national debate on devolution and what the structures will be. What we have now in this so-called enabling legislation is legislation with a big stick attached to it. Local areas such as the north-east have been told they can have devolution but only if there is an elected mayor, even though the Minister keeps denying that. He said an interesting thing in response to the previous set of amendments; he said no area would be disadvantaged if it did not go down the devolution route. That is not what he has been saying in the region or what his supporters in the Conservative party have been arguing in the region. The argument there is that if these truculent local authorities do not agree to devolution, they will lose out on all this money. The Minister has changed his tune this afternoon and said that is not conditional. It will be welcome if there is still an option to get those extra resources without necessarily going down the route he wants.
This is about local decision making, but what is key in any organisation is who holds the purse-strings. The Chancellor still holds the purse-strings under what is being proposed, and when the tough decisions come down the line his fingerprints will not be on them.
My hon. Friend the Member for Harrow West (Mr Thomas) mentioned business rates. I take his point: allowing local councils and others to have the powers to regenerate areas and try to create extra revenue is welcome, but he will appreciate—as my hon. Friend the Member for Nottingham North noted earlier—that there is not a level playing field across the UK. Without any mechanism for redistribution in local business rates, areas such as the north-east—those that have already been hit disproportionately by this Government taking the need element out of grant formula, which rewards richer areas more than poorer areas—are going to lose out.
Westminster city council will benefit if it gets to retain 100% of its business rates and gains from any new development it can have. Its situation will be easy compared with that of the poor people of Redcar; Redcar council is going to find it very difficult to attract new development that plugs the hole left by the closure of the steelworks.
We need to ensure we put in place structures that not only will work and have the support of people, but are practical. If we have a Teesside mayor and a mayor for the north-east, both will have responsibility for transport in their area. Where that will leave the A19, the M1 or any of the other transport links that cross the area, no one seems to know. Will the mayor of Teesside be responsible for the section of the A19 as far as the border of the area? Will the mayor for the north-east assume responsibility for the road network beyond that point? Therein lies one of the issues.
The Government said that they were against regions, but they have now divided quite a small geographical area. Supporters of the proposals have not explained how all this will work in practice. They have been out there in the north-east vigorously putting forward their case. Many of them have been posing as business people while forgetting to tell everyone that they are actually Conservatives.
There is a similar problem with resource allocation. The Government are proposing to impose a new tier of regional government, but how will it relate to the existing local authority tiers? The Minister keeps saying that this will be different because it involves moving power down from Whitehall to the region, but I can envisage people starting to ask whether they really need the large numbers of councils that they have at the moment. That will certainly happen in Manchester, for example. I know that turkeys do not usually vote for Christmas, but some local authorities need to think about where the Government’s agenda will lead. The Conservative party has traditionally been quite passionate about local government—it has always been supportive of it—but I believe that the Bill represents a move to reduce those tiers of local representation.
We need to step back and look not only at how the new system will work in practice but at the levels of local support. The Government are refusing to allow the people of the north-east a say in whether they want an extra tier of local government. The Minister is adamant that he is not prepared to give those people a say over whether they want an elected mayor whose responsibilities would stretch from the Scottish border down to Barnard Castle. As I said earlier, when we proposed a regional assembly in 2004, we quite rightly put it to the people. The Conservatives and their supporters argued vigorously against the proposal, and I am sure that if the then Labour Government had imposed an assembly on the region without taking the proposal to the people, we would rightly have been criticised. There would have been an outcry. Those same advocates who argued against us then are keeping very quiet now, however.
I have some sympathy with the amendment tabled by the hon. Member for Carlisle (John Stevenson). He has raised various issues, and I agree that there is a problem. One question that some of the smaller district councils will face is whether they will have capacity as a result of the cuts that will be imposed in the autumn statement, on top of those that have already been imposed. The last Labour Government introduced unitary councils in the north-east, in Durham, and it was one of the best things that happened making decisions more straightforward. I hate to think what some of those smaller councils would do if they were still in existence now, given the cuts that this Government have imposed. I doubt that they would have the capacity to deliver their services.
I put it to the Minister that these larger areas will need an effective mechanism for ensuring that local people are engaged in the decision-making process. I used to work in Cumbria and I know it well. I understand some of the attitudes he has referred to. Having a veto over decisions on what is needed there could be a disadvantage for Cumbria rather than an advantage.
We need the measures that my hon. Friend the Member for Nottingham North is proposing. We should have had them in place before we embarked on this process, but the Government know exactly what they are doing. This is not about devolution. It is about the clear political agenda of the Conservatives and the Chancellor. They know what they are doing, and it has nothing at all to do with the proper devolution of decision making.
John Mann (Bassetlaw) (Lab)
I concur that a constitutional convention would be very sensible, as my hon. Friend the Member for Nottingham North (Mr Allen) said.
I hear the idea of a hotel tax in London—I hope it is not on my constituents coming down for a good overnight stay, but on those coming from abroad. I am not sure a hotel tax would work particularly well in Bassetlaw, although it is worth considering. I recall that until the last few years Welbeck Estates levied £3 on every tonne of coal produced for a century. If local government had been allowed to do that, Bassetlaw would be a very different place, because the infrastructure and so on would have been appropriately remunerated for the coal that we provided for the rest of the country in wartime and in peacetime, at great cost. That concept of local decision making is a very good one, so I would accord with the idea, but I hope there would be some exemptions to anything that is done in relation to the good people of Bassetlaw.
Mr Betts
My hon. Friend is reiterating the point that I was making earlier, and I entirely agree with him. Although Bassetlaw could not be forced into D2N2, could it not be prevented from joining the Sheffield city region as a full member? In other words, it could be left in limbo.
John Mann
I suppose Bassetlaw would have the option of declaring itself a unitary authority, of getting approval for that and of joining Sheffield city region. There may be routes around it, but the principle is fundamental. We need to have the ability to choose. If those two choices were put to the electorate, I suspect that I know which they would choose, and probably decisively. They may have a different view to me, but that is their prerogative—we have a word for that: democracy. What we do not want is “undemocracy”. Some people are very hostile to what the Government are doing and some are much more sympathetic. Either way, will these two options—is it the D2N2 model—lead to more councillors?
Mr Kevan Jones
I am very interested in what my hon. Friend is saying. He knows that I am very familiar with his constituency, having grown up there. Does he think that the fundamental weakness of this Bill is that there is nowhere for the people to have a say in what actually happens?
John Mann
The Minister will clarify whether, legally, people can have a say, but I am sure that there are ways in which a say can be created to ensure that there is popular consent. There are ways in which we could choose to do that. I am not talking about my own informal consultations, which are pretty huge. It would be interesting to get the Minister’s take on that. Those are key points.
Can we have some assurance that, over time, these measures will not lead to more elected representatives? If people are honest, they understand that if we have a two-tier scenario linked in with unitaries, either the districts or the counties will inevitably go at some stage, and probably sooner rather than later. That is bound to happen. Some may say that that is a good thing. As I have said, I have argued for unitaries before, but it is important that councillors understand that that is what is happening. Similarly, it must be clear that we will be able to choose, and the Derbyshire districts will be able to choose, where we will go. I am sure that the Government want that. They say that it is a brilliant idea, so they must want us to be part of it. It is really how we do that with guarantees. It would be useful to have that on the record.
Peter Dowd (Bootle) (Lab)
As a former leader of a council and a member of a combined authority and local enterprise partnership, I welcome the thrust of the Bill. There is no question about that. I said in a previous debate that the train is going out of the station—the cat is out of the bag, to mix metaphors. Whichever description we use, this is the reality.
I do not deny that the governance structure in local regions is important, but whatever that structure is we must move the debate on. Local government has changed over centuries. In the 19th century, it changed to reflect the industrial revolution. It changed at the beginning of the last century and at the end to reflect the patterns of population, demography, business and so on. It has changed over time. London changed in the early ’60s, we changed again in the 1970s and it is now time to change once more. People might have concerns, but that is life. It has to move on.
My hon. Friend the Member for Bassetlaw (John Mann) made a point about having too many councillors, but I am pretty agnostic on that. The United States have significantly more councillors proportionately than we do, and they get on okay, and the same applies to the French. It is part of the heart of a community that there might be lots of councillors. I am not arguing for that, but I do not think that it is a reason for not going ahead with changes.
I support the comments made by my hon. Friend the Member for Nottingham North (Mr Allen) about the principle. There will be changes to local government and devolution in the coming years, and we might as well recognise that while we are in this transition and get on board with the constitutional convention. That does not stop things happening now, but we really need to get on with it, and I ask the Government to consider that seriously.
I also support what my hon. Friend the Member for Sheffield South East (Mr Betts) said. He referred to some of the specifics. It seems remarkable that a mayor would not have the borrowing powers he described. I hope that is just a mistake—a lacuna in the legislation—that will be put right. It is important that the detail is picked up.
There is a danger that this debate will get a bit too esoteric. Do I think that devolution will be good for my city region of Liverpool? Yes, it will. Why? This is not unique to us, but we have a thriving visitor economy. For many years, that has been our direction of travel and Liverpool is now the fourth most popular city in England for national and international visitors. That could link into the point made by my hon. Friend the Member for Bassetlaw about hotel taxes and the ability, if that many people are coming into the city from abroad, to use that revenue if we so wish. I am not saying that we should, but we should have that flexibility if we want it. The visitors are coming to my city, not to anybody else’s, and that is important.
At the moment, the visitor economy brings in £3.8 billion and 40,000 jobs, and it is a major growth sector. Do I think that the city region would manage that, grow it and progress it better? Yes, I do. There is no question about that. If we wait for Whitehall to help us, we will be waiting until the cows come home, and I mean no disrespect to Whitehall.
John Mann
Is there anything in the Government’s proposal that would impact on a district such as Bassetlaw —the hospital trust crosses the border into south Yorkshire, but the clinical commissioning group money remains entirely within the district—electing to join Sheffield city region, in another region, where other decisions will be needed? Are there any hidden nasties we should be aware of?
Alistair Burt
No, I do not think so. There are neither hidden nor unhidden nasties. Local decisions will still be made, and CCGs will still be monitored for quality, effectiveness and the like. I am just coming on to talk about the regulation.
Clause 19 provides that the regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority. This makes it clear that local devolution settlements will not devolve the regulatory functions of Monitor, the Care Quality Commission or other health service national regulatory bodies as defined. This means that a transfer order may not change the way in which our national health service regulators operate to protect the interests and safety of patients. Amendment 38 inserts a provision clarifying that a “health service regulatory function” means a regulatory function within the meaning given by section 32 of the Legislative and Regulatory Reform Act 2006, in relation to the health service. Amendment 35 omits the word “supervisory” but clarifies that the supervisory functions of NHS England in relation to CCGs are also expressly protected from transfer.
The safeguards set out in clause 19 would support the Secretary of State in ensuring in a transfer order that where a combined authority or local authority was to exercise transferred health functions, using the Bill’s new powers, that authority could be held to account as to the exercise of its health service functions, just as NHS commissioners are currently held accountable. Amendment 36 amends clause 19 to require that in a transfer of functions to a combined authority or a local authority, provision must be made about standards and duties to be placed on the authority.
Amendment 38 provides further explanation of the national service standards to which the Secretary of State must have regard when making such provision. These include, for example, those in the standing rules set for NHS England and CCGs, recommendations and quality standards published by the National Institute for Health and Care Excellence, and of course the standards set out in the NHS constitution, which sets out pledges and codifies requirements, statutory duties and rights that NHS services in England must, as a minimum, meet. These include national access standards, including waiting times. Amendment 38 also provides definitions for “national information obligations” and “national accountability obligations”.
As amended, clause 19 provides further clarity about the role of the Secretary of State for Health and what will and will not be included in any future transfer order giving local organisations devolved responsibility for health services. This clear statement in legislation, making provision for the protection of the integrity of the NHS, is intended to provide further confidence for future devolution deals. In essence, they will be underpinned by the basic core duties of the NHS, and that cannot be shifted. Amendments 32 to 38 give further definition and clarity to support the valuable principles behind this clause.
New schedule 1, which inserts schedule 3A in the Bill, provides for amendments to the National Health Service Act 2006, and new clause 8 is a clause to introduce that schedule. These amendments concern the making of arrangements with combined or local authorities for the exercise of health commissioning functions under the 2006 Act, including provisions allowing greater flexibility over how partners to such arrangements may work together. This will enable greater integration of health and care services and support local leaders to take collective steps towards better health and care for their local population.
New schedule 1 also makes small amendments to the 2006 Act concerning the provision that may be made in regulations concerning local authorities’ social care information.
Places such as Greater Manchester and Cornwall are calling for the ability to design and deliver better health and care services, and the ability to make decisions at a level that works best for their communities—locally or, where it makes more sense, at a regional or sub-regional level. As we know, devolution deals will be tailored to the needs and circumstances of a local area. The Bill will already allow the Government to make orders to devolve to a combined authority or a local authority a range of powers and functions currently carried out by Whitehall Departments or bodies such as NHS England.