(8 years, 10 months ago)
Commons ChamberThe hon. Gentleman tempts me to divert my attention from the amendments. The steps this Government are taking on business rates are generally welcomed by local government—that is my experience of the discussions I have had. They are another step towards giving local government the certainty, control and freedom it wants, and delivering on our agenda. They are broadly in line with the devolutionary approach that we are taking and is envisaged by the Bill.
The Minister mentioned that local areas can choose what area will bid for these devolved powers, based on their own local needs. What size of population or of economy would an area need to get this devolution? There has been some suggestion that the Nottinghamshire and Derbyshire bid is not large enough.
It is up to local areas to make proposals, and we will look at the offers and deals. Thirty-eight proposals were submitted before the 4 September deadline by areas interested in being part of this process. We will seek to ensure that any proposal makes economic sense, and that the deal takes account of all interested parties and their views, but we are not going to prescribe in this Bill, nor set out centrally, the geography that devolution should follow, because to do so would go counter to the bottom-up process that we envisage driving forward long-lasting and successful devolution in this country. I recognise my hon. Friend’s important question, but flexibility is the intention and it is what the Bill contains. We want agreement and to work with areas to deliver on their objectives.
We are open to discussing devolution proposals from all places. We have been clear that our approach is for areas to come forward with proposals that address their specific issues and opportunities. The Bill is therefore enabling legislation that will provide the legislative framework to give effect to the different aspects of devolution deals. The Government have not specified a list of functions that may be devolved, and there is good reason for that approach. It means that we can consider any area, idea or proposal. Perhaps more significantly, if we started to specify lists of functions or kinds of areas, those whose ambitions fell outside these ideas might be reluctant to come forward. The reality is that, as decades past have shown, if the man in Whitehall is asked to specify what might be devolved, the list is going to be pretty cautious.
It would not be right to restrict our ambition by taking such an approach, so I hope Opposition Front Benchers will accept and understand the position the Government are taking. In short, specifying functions or kinds of areas is simply not consistent with a genuinely bottom-up approach. We will therefore not be supporting amendment 59, or new clauses 23 and 25, and I hope hon. Members will not press them to a vote. I also hope that, with my explanations and assurances, the Committee will be able to support clause 1 and reject clause 2, accepting the consequential amendment to clause 1.
I hear what the hon. Lady says and that issue will be given a great deal of consideration. I will comment on the matter later in the course of the Committee, but the message has been heard loud and clear by Government. As I said in my opening remarks, we are keen to find consensus where we can on this agenda. I hope that at this stage, subject to the debate that might take place, that will sufficiently reassure the hon. Lady so that she can await those discussions in due course.
I cannot give way to my hon. Friend, because I must make some progress. I apologise to him, but there will be opportunity throughout today to discuss this matter.
I doubt that it would be right to accept this amendment, but we shall of course listen carefully to the debate, both on this amendment and on the amendments of my hon. Friends the Members for Hazel Grove and for Shipley. We recognise the strength of feeling and we want to find a way to ensure the broadest possible support for this legislation. I have put on record the Government’s views and the concerns that we have to the proposed approach, but we will of course listen to what is said later on today.
Amendment 46, which is in the name of my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), seeks to prevent the ceremonial county of Somerset— the administrative county of Somerset and also the two unitary authorities of Bath and North East Somerset and North Somerset—from adopting arrangements that include a mayor for the area of the combined authority. There are two difficulties with the amendment. I suspect that my hon. Friend will speak to the amendment later, and I will listen intently to the comments that he makes. The first is that it would single out Somerset, Bath and North East Somerset and North Somerset as some kind of special case.
It is a pleasure to speak in the debate, and I shall speak to amendment 39 in my name. The purpose of the amendment is not to divide the Committee, but to ask how these devolution deals will work in areas that have a partly unitary and partly two tier authority structure. It is not clear that that is an effective or desirable situation for various reasons.
The reason for proposing a consultation with local people is that I am not sure there will be much enthusiasm among local people to pay for three different tiers of local government. It is confusing. They have no idea now which council does what. In Heanor in my constituency, for example, people elect 21 town councillors, they elect councillors to a borough council that has 45 councillors, and county councillors to a county council that has 64 members. How many more people do they need to represent them on these issues?
It is worth having an open consultation. There has been too little information and consultation with the public on the Government’s proposals, and I fear that my constituents will wake up one morning and find that they are part of an elected mayor area, together with the constituents of the hon. Member for North East Derbyshire (Natascha Engel), who is chairing this debate, and of the hon. Member for Nottingham North (Mr Allen), without any of those constituents realising that that was going to happen.
I am not sure many people feel there is a natural community that covers the whole of those two counties or that they wish to be part of such a local government unit. I suspect that paying for three tiers, plus town and parish councils, will not be popular, so before the proposals are implemented people ought to have a say about whether they would rather have only one of the two existing tiers. That would be a more easily understood and more cost effective local government structure.
The reason for proposing a consultation, rather than an absolute condition that devolution could not take place and elected mayors could not be introduced without moving to unitary authorities, is that I feared that the pearl-handled revolver that the previous Secretary of State still has in his desk drawer might be drawn out and fired at me in this debate if I suggested compulsory local government reorganisation. But if we are saying to local areas, “You can choose whether you want to be part of devolution and whether you want an elected mayor,” we should allow them to choose what unitaries they want. That is the next step. Three tiers of local government are not sustainable. That would focus the mind on what local government would look like and how we could best deliver these important services to our local people.
As a matter of fairness, I am not sure how a city of 300,000 people can have one leader at the table, and a county which has, say, 700,000 or 800,000 people can have nine people at the table, all with a veto and a combined authority on certain issues. If I were a member of a city council, I do not think I would see that as fair. We have a multi-level local government system which looks a bit odd. It does not help, for example, with the new homes bonus. I am not sure how business rate setting can be devolved to a two-tier area with questions over who gets to set what and who gets to keep what. There is a need to look at how local government works, and this would be the perfect time to do it. We can say to local people before they get their devolution and their elected mayor, “You tell us what you want. Do you want unitaries or do you want to keep the existing structure, with the advantages of a very local council, but with the extra cost that that brings?”
In Greater Manchester work on the devolution proposals is very advanced. Amendment 51, tabled by the hon. Member for Hazel Grove (William Wragg), would put that work on hold until a referendum was held to determine whether the public supported having an elected mayor. It would also require 50% of the population to vote yes before a mayor could be introduced, which is a high bar. The turnout in the 1998 referendum on establishing the Greater London Assembly and the Mayor of London was 34.6%. Although the turnout in the 1997 referendum on Scottish devolution was higher, the percentage of the total electorate who voted yes was less than 50%, and the same goes for the 1997 referendum on Welsh devolution.
I am glad to have enabled my hon. Friend to speak for himself.
Amendment 42 seeks a very simple and not terribly onerous change. It would simply require the Government to report annually on how they have exercised their functions in order to demonstrate that they have not themselves exercised any of the devolved functions that rightly belong with the combined authority or the mayoral authority. There might be better ways of doing this, and I hope that my hon. Friend the Minister will put forward his own proposals in due course. However, the underlying point is that although the Government have been very pleased to place obligations on local authorities through the process of forming agreements or deals, as the Secretary of State likes to term them, very little in the Bill as it stands provides any mechanism to hold the Government to account and ensure that they fulfil their side of the bargain. I think that would be welcomed by everybody who is an evangelist for devolution—as I am sure we all are.
The Minister alluded to amendments 43 and 44, which seek to provide an easier route for exit. I happily accept that, as the hon. Member for Denton and Reddish (Andrew Gwynne) said, it would be very difficult for any authority to leave a combined authority, especially a mayoral authority, at some point in the future. An enormous number of functions, agreements, financial obligations and so on will bind local authorities together, increasingly so as the years pass, and therefore no local authority would do this lightly. However, the ability to leave, should the devolution arrangements not work in practice for any one or more of the local authorities in an area, is, in some ways, the ultimate guarantee that no abuse should take place. It is particularly important that we should have such a safeguard if we reach the end of our deliberations without a referendum lock in place. If the public are not to be given the choice as to whether they want to have the elected mayor and this new structure of governance put in place over them, surely there must be a safeguard so that if, at a future date, the new arrangements were not working for the people of Trafford, Bury, Stockport or Bolton, they could seek to leave, without penalty, to find a new way of providing services and representation to the local community.
Amendment 51 calls for a referendum test to be passed. This also relates to Government amendment 4. I think the only reason the Government are so determined to overturn the amendment passed in another place which seeks to prevent conditionality—local authorities being told they are allowed to have devolution only if they accept the model of an elected mayor as a condition—is that negotiations in Greater Manchester have moved as far as they have under those conditions. It seems wrong that the Government are expecting local authorities to accept a particular model of governance as the price for this kind of devolution settlement, particularly if the Government do not have the self-confidence to consult the people and to believe in their own argument such that they could persuade the public that it is something they ought to welcome. This is the ultimate test of the Government’s arguments. The Minister is a very persuasive man, as we have seen in the Chamber today. I am certain that with his enthusiasm, charm and powers of persuasion, he could go out and sell this proposition to the people of Greater Manchester, and perhaps to those in Sheffield and other parts of the country. I wish that he would have the confidence in his own abilities that we all have.
I am sorry, obviously, to interrupt the much deserved flattery. Does my hon. Friend accept that, especially in areas outside Manchester, none of the council leaders proposing these deals has been elected on such a mandate? I do not recall that in the 2013 county council elections there was any suggestion of “Vote Labour and we’ll try and create an elected metro mayor for Nottinghamshire and Derbyshire combined.” I agree with local decision making and I support these changes, but there is no local electoral mandate for them.
I absolutely agree with my hon. Friend. In my Greater Manchester constituency, the level of knowledge of what is being proposed on changes in governance is still remarkably low. Certainly, it was not a significant feature of the general election campaign or the last local election campaign. We need to try to create a better level of knowledge and engagement.
(9 years, 8 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Yes, and those are the facts that we are acting on with our winter plans. We are trying to reduce the amount of money spent on locum staff and to increase flow going into and out of A and E departments. There is a huge amount of practical things that can be done. I have absolutely no problem with dealing with constructive suggestions from both sides of the House on how we can help A and E departments to get through a difficult winter. It is unacceptable, however, constantly to turn this issue into a political football, when everyone knows that the pressures of an ageing population are making life very difficult for NHS staff and that those staff have a Government who are doing everything they can to support them.
I welcome the extra money for the NHS this winter, but what more can the Secretary of State do to improve awareness of and confidence in the 111 system, in order to stop people going to A and E when they do not really need to do so?
My hon. Friend asks an important question. The 111 service is one of the elements of the long-term solution that we have not touched on much this morning. There are definitely things that we can do to make the service better. For example, if someone is put through to a GP, that GP could, with the patient’s permission, access their medical records. That would give the GP access to information about the patient’s allergies, their medication history and other key information that would help the GP to give better advice. I am pleased to hear from NHS England that, by the end of this year, a third of 111 centres will be able to access GP records with the patient’s permission.
(10 years, 4 months ago)
Commons ChamberFirst, I must correct my hon. Friend on one thing. The Government are not proposing to ban anything. I made that quite clear. Secondly, alcohol that is enjoyed in moderation does not do people great harm, but there is no way of enjoying tobacco in moderation that does not harm people’s health. Smoking is a completely different subject from all the others that Members seek to link it to. My hon. Friend wrote to me recently to ask what Health Ministers were doing about cancer in Essex. The more we do to bear down on tobacco use among children, the greater our chances of tackling cancer in Essex and elsewhere.
The Minister must know that she will never satisfy the health lobby on this issue. It has moved on to the idea of banning smoking for anyone born after the year 2000. Will she confirm that that is not part of her strategy?
The Government have a tobacco strategy that has been published. Today, I am presenting a statement about standardised tobacco packaging and nothing else.
(10 years, 9 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I could not have made myself plainer during my first session of Health questions and when I responded to the Back-Bench debate. The policy is under active consideration, and it was under active consideration before—this is evidence of that.
Will my hon. Friend confirm that Sir Cyril is not only independent of big tobacco, but independent of the health lobby?
One of the reasons we asked a distinguished paediatrician to conduct the review, rather than someone from a public health background, was that he would be able to bring a fresh mind to it. Sir Cyril will set his own terms, which he will announce in the next few weeks.
(10 years, 11 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I think we have done everything we can, and we have tried to listen hard to the suggestions for what can help in the short term and what can address the underlying problems. I believe it is possible for the NHS to meet its targets this winter, but I do not want to say that it is going to be easy. It will be a very tough winter and we need to get behind the doctors and nurses on the front line who are doing their very best to deliver a great service to the public.
I welcome the extra £4.5 million for the Derby hospitals trust. On a separate matter, can the Secretary of State reassure my constituents that if they ring 111 they will now get a quality service that gives them the advice they need?
I thank my hon. Friend for mentioning the support that we are giving to Derby, which I hope will be a great help over this winter and next winter. Improving 111 is an important part of the long-term solution for A and E. If there is one thing that could persuade people not to go to their local A and E, it is to pick up the phone and get a good service. We have 92% satisfaction rates with 111 now, after the teething problems earlier in the year, but I think it can be even better. One of the things that would make the biggest difference is if we did something that has never happened before, which is to make it possible for doctors at the end of the 111 lines to access people’s medical records, with their consent. Then people would be talking to someone who knew about them, their allergies and their medical history. That is a big change. It never happened under the previous Government. Their attempts—[Interruption.] NHS Direct had no access to people’s medical records, which is what we are talking about. That would be a profound change and could make a big difference.
(11 years, 1 month ago)
Commons ChamberThose of my constituents who use King’s Mill hospital will understandably be concerned about their future treatment. What reassurance can my right hon. Friend give me that this summer those patients will get the treatment that they rightly expect?
It is important to recognise that even at the hospitals that we are talking about this afternoon, there is good care happening every single day. The way that we will reassure my hon. Friend’s constituents is by having an independent inspection system which has not existed before, where regulators are not leaned on by Ministers to say the right thing in the run-up to elections. It is only when his constituents have confidence in that regulatory system that they will know the truth about their own hospital, and we want them to get there as soon as possible.
(12 years, 1 month ago)
Commons ChamberI did indeed reduce the standard to 95%, on clinical advice, and currently the NHS is achieving 96.5%.
On a recent visit to observe the excellent work of my local ambulance station in Alfreton, I was shown the widely different times it takes certain hospitals to admit patients arriving by ambulance, which leads to ambulances being off the road for longer than they need to be. Is there anything the Secretary of State can do to strengthen the guidance on how hospitals should handle this process to avoid the problem?
My hon. Friend makes an important point. Part of the measurement of the performance of ambulance trusts, together with their hospitals, is to record the number of occasions when ambulances wait more than 15 minutes before discharging their patients into the service. The Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), is very concerned and pursues precisely those issues, so I will ask him to look into the matter further and respond to my hon. Friend.
(13 years, 2 months ago)
Commons ChamberI do not accept the hon. Lady’s premise. We do not intend that there should be an unrestricted market—or a free market, as she described it—in the NHS. It is a regulated, social market with powerful regulations governing how the participants in the provision of care meet their responsibilities. We are very clear that competition is a means to an end. It is not an end in itself; it is there to support the integration and delivery of services in the best interests of patients, but it does include giving patients choice. The hon. Lady highlights an important point. In our consultation earlier this year on the information revolution in the NHS, we set out how we felt we could empower patients, including those for whom in the past the NHS has provided a rather impenetrable route to getting the best treatment. I hope that when we respond to that consultation, we will demonstrate how we will make that better for all patients.
T10. Does the Minister agree with my constituent Susan Garrity that licensed treatments for multiple sclerosis such as Sativex should be accessible to all people, wherever they live?
Certainly I agree that MS patients should have access to clinically effective and cost-effective treatments. The National Institute for Health and Clinical Excellence has not issued any guidance on the use of Sativex, and it is for primary care trusts to make funding decisions based on the available evidence and the individual patients’ circumstances. Following consultation, NICE expects to make a decision later in the year on whether to update its clinical guidance on MS, and whether to re-evaluate Sativex as part of that.