Cities and Local Government Devolution Bill [HL]

Lord Smith of Leigh Excerpts

Tuesday 12th January 2016 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I also support the amendments moved by the noble Lord, and I thank him for his explanation. When the noble Lords introduced the amendment in the name of the noble Lord, Lord Warner, they obviously had a suspicion about what was going on in Greater Manchester— understandably so. We heard the phrase “postcode lottery” from the previous noble and learned Lord. One reason why Greater Manchester wants to take control of health is that there is a current postcode lottery. The average outcomes for health in Greater Manchester, despite the efforts of Governments of all persuasions since 1948, have remained doggedly subject to that postcode lottery. We want to use the powers that we can use locally to start to do something about it.

With the permission of your Lordships’ House, I shall try to explain what we are doing in Greater Manchester and why we need not fear. It is only 11 months since we signed the original memorandum of understanding with NHS England to share health. The combined authority has not taken control of health; we share responsibility with our health partners. Our number one achievement is to raise the governance. We have 37 different organisations in Greater Manchester with some responsibility for this agenda. I have the dubious task of chairing the strategic partnership board, but colleagues across the piece are working collectively to achieve an outcome. In our collaboration with NHS England, the regulators are being as sympathetic as possible.

Already we have seen clinical benefits. We have made sure that every area of Greater Manchester has access to a hub seven days a week so that people can receive medical advice—which was not the case before—and that has continued to expand. We have started to commission collectively more work on public health, recognising that this will be a key to achieving significant change in population health. We set up an organisation called Dementia United, which is going to join all the partners together to look at dementia in terms of acute services, primary care services and social care. In December, we agreed a strategic plan to take us forward for the next few years in Greater Manchester. It complies with all national objectives and reflects the needs of Greater Manchester as a sub-region, but also the localities within Greater Manchester.

The focus, first, is on prevention. If we can get people not to need healthcare, that is the best way for people, for the health system and for care. We need to make sure that each locality addresses the issues that exist in those 10 areas of Greater Manchester. There is quite wide variation in provision, as one might expect, between GP services in one area and another. We just got those up to the same level and have made a great improvement. With acute care services, again there is huge variation between the outcomes of hospitals in Greater Manchester. We need to improve that, and we need to give better support both in the clinical and the back-office sense. To fund this, apart from the money we get from the Government, we think we can operate more efficiently and effectively by integrating lots of services; that will be important.

We are also grateful to the Government for allowing us an initial injection of funding from the transformation fund. Skilled negotiation on our part and obviously the generosity of the Government meant that we got £450 million from that fund. That will kick-start some major changes in Greater Manchester. The benefits will include better clinical outcomes; we have targets on those. We will make sure that children get to school at the age of five in better health and are more ready for school than they are at the moment. We are supporting the elderly so that they can live longer in their own homes.

This is not just about health, however. If we can start to improve the health of people in Greater Manchester, it will reduce some of the barriers to employment and help us to get more people into work. The next step, obviously, will be better engagement with the public and, crucially, with the staff across both NHS and social care. We are making sure that we have detailed implementation plans, so that this does not become a dusty strategic report—one that is very worthy but stays on the shelf—but is actually implemented. The strategy will make a difference, we believe, to the lives of people in Greater Manchester.

I should emphasise that, the more I have gone into this, the more I have come to realise that there is no boundary between health and social care. The figures vary, but they say that some 40% of the people who come to see the GP in his surgery are not really seeing him on medical matters but on social matters. For example, they may have housing problems or employment problems, so they are not sleeping at night and need support, and so they come to the doctor for tranquillisers. Some GPs are good at dealing with that; some simply give the tranquillisers. We need to make sure that we start to address the issues that people have and not assume all the time that it must be a medical issue.

My noble friend Lord Beecham asked what happens to the areas around Greater Manchester. Obviously, that is not determined, although we have already made a decision on acute provision in Greater Manchester that reflects Derbyshire, because, clearly, many in north-west Derbyshire—in Glossop and so on—look to Greater Manchester rather than elsewhere, and so we clearly need to reflect that. However, such areas would need their own locality plan for what they are doing in that area, working together with all the local health and social care partners. There is a need to reflect that some stuff is done at the regional level, some stuff is done at the sub-regional level and some stuff is done at the local level.

Social care is an important element of this. In some parts of Greater Manchester, under the locality plan the acute hospital will run the social care services. In other areas, such as Wigan, we will have a care organisation to ensure that everyone looks at how we can stop people getting ill—that is our main intention—rather than treating them once they are ill. That will vary slightly in different areas, but we will reflect those different localities.

We are making good progress and there is great collaboration going on. I thank the Government for the opportunity, and I think we will make a difference.

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[Lord Shipley]

My Lords, first, I thank the Minister for his briefing note, which I received last week, on the proposals in this amendment for sub-national transport bodies. I welcome the switch in emphasis that he has referred to. The noble Lord, Lord Beecham, talked about levels of expenditure and, in particular, the enormous amount that is spent on London and the south-east in comparison with the north of England. Having a sub-national transport body of this kind will be extremely helpful in refocusing the attention of Whitehall on the need to fund the north better than it currently does. Therefore, I thank the Minister for that and I think that the proposals are absolutely right but I want to say two things.

The first concerns the question of to whom the sub-national transport bodies will be accountable—in other words, the extent to which the constituent councils of those sub-national bodies will have a regular reporting mechanism. It seems to me very important that there should be a regular means of providing feedback from those councils to the sub-national transport body. Secondly, I hope that the Minister will agree to a system of annual reporting, which occurs elsewhere in the Bill in relation to combined authorities, elected mayors and other matters. Can he confirm that there will also be annual reporting by the sub-national transport bodies? I would find that extremely helpful.

My last point relates to the use of the negative procedure as opposed to the affirmative procedure. The Minister will have seen the report of the Delegated Powers and Regulatory Reform Committee, which challenges the use of the negative procedure. The grounds are that the powers will exist for a limited period of time. The definition of a “limited period of time” does not appear anywhere. Is it a matter of a few months or of two or three years, or is it a matter of something more significant?

I hope that the Government might be persuaded of the importance of using the affirmative procedure. Given the scale and magnitude that this proposal represents in reality, I think that using the affirmative procedure would be better than using the negative procedure. Does the Minister have any comments on that?

[Lord Smith of Leigh]

My Lords, I also welcome these amendments, and I thank the Minister for the way that he has introduced them. Obviously, this is very important activity, and without statutory backing Transport for the North has already had a major in-fight over agreeing the northern franchises for the rail networks that affect all our northern counties.

In terms of reporting back, I assure the noble Lord, Lord Shipley, that in the process of franchising we in Greater Manchester have had regular reports from our delegates at Transport for the North. There is accountability for what goes on.

I will probably upset the Minister but, while I am on my feet, I will say that one of the great aspects of the deal for devolution in Greater Manchester was the prospect of franchising the buses, which of course account for the vast majority of transport movements in those areas that are involved. I recognise that that will come under separate legislation, a buses Bill, but we still await sight of that Bill and hope that it is not going to be too long.

[Lord Ahmad of Wimbledon]

My Lords, I thank all noble Lords for their contributions.

I want to pick up on the point made by the noble Lord, Lord Smith, in response to the noble Lord, Lord Shipley. There is accountability, and that accountability is very much to the stakeholders that make up the particular STB. As for the limits or extension of these areas, that will very much be dependent on the local authorities themselves and the collaboration that takes place. The key point I emphasise is one of strategic decision-making, which is the intention behind the creation of such bodies, as we are already seeing with the creation of TfN. Indeed, the reason behind putting TfN on a statutory footing is that the very bodies that make it up have also requested this.

I will now pick up some of the questions raised by noble Lords. The noble Lord, Lord Shipley, also asked about annual reporting. The legislation makes it clear that STBs shall produce and publish their strategy and updates to that strategy. That can be seen with TfN, which produced its additional reports in March 2015 and has plans for annual updates, the next being in March 2016.

The noble Lord, Lord Beecham, asked about the extent to which different modes of transport are covered by STBs. The whole essence of sub-national transport bodies will be to cater for all modes of transport within a defined geography, including ports and airports. This can already be seen in the work of TfN, which has set out quite clearly its plans for all modes of transport, including ports and airports. I take on board totally the point the noble Lord made that this is not just about linking up rail and roads; it is about ensuring that, where there are ports and airports, these also form part of the strategic transport strategy for a given geographical region.

The noble Lord, Lord Beecham, also asked about the size of STBs. As I have already said, it is really up to the local areas to come forward with proposals; it is about bringing together local authorities. There may be some traditionally defined areas, but it is about how local authorities can come together and collaborate across traditional borders to ensure the best result for a particular region. In terms of the requirements, there must be two appropriate authorities to form an STB.

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[Lord Ahmad of Wimbledon]

It is dependent on how the STB proposals come back. However, in practice, I cannot see a deterrent to that because this is about providing strategic links. I am sure all noble Lords will welcome a linking up between the noble Lords, Lord Beecham and Lord Smith, on strategic transport arrangements. The idea behind this is to empower local authorities to make the right decisions for their particular area.

As to specific local authorities belonging to two networks through legislation, what would happen in the scenario painted by the noble Lord is that if a local authority is already part of an STB, there is nothing stopping that local authority, after the creation of a new STB, being co-opted on to the other to ensure that that strategic link is operational.

The noble Lord, Lord Shipley, referred to placing a limit on the period for regulations. The very nature of the temporary transfer of functions is that there will be a clearly limited interim time for this. If a temporary transfer of functions works well and there is evidence to show that there would be value in effecting a permanent transfer, there would be further regulations to ensure that that could take place.

I hope I have answered the questions that have been raised.

[Lord Smith of Leigh]

Could the Minister comment on the buses Bill and when we are likely to see it?

[Lord Ahmad of Wimbledon]

I raised the issue of the buses Bill when I was being briefed for this Bill. I know that it is being drafted and we are looking for appropriate parliamentary time to ensure that we can introduce it at the earliest opportunity.

I again thank all noble Lords for their support for the amendment.