Cities and Local Government Devolution [Lords] Bill

Debate between Steve Reed and Victoria Borwick

Wednesday 21st October 2015 Commons Chamber

[Victoria Borwick (Kensington) (Con)]

Turning to another aspect of devolution, I would like to talk about the importance of health devolution. I obviously welcome the Government’s devolution revolution, which the Bill will help to deliver. In London, the Mayor has been campaigning for greater fiscal devolution and I know he applauds the recent announcement on business rate reform, as this will benefit our capital.

The devolution revolution that the Bill champions will ensure that Greater Manchester becomes the first English region to have full control of its health spending. However, as the Minister will be aware, London government has also been exploring how a similar model could work in the capital. As we all know, health is no respecter of ward or council boundaries. People live in one area and work in another, and may receive treatment for complex conditions in more than one area. That is why it is so important, in cities such as London and others that have been instanced today, that it should be viewed as a whole.

For a patient receiving many different treatments, it is far more effective for their care to be under one authority. As the previous deputy Mayor of London watching over this brief, I chaired many cross-London forums where councils and health authorities have come together to share resources and work together for better outcomes instead of being able to afford a smaller service in their locality. I would therefore argue that London, like Manchester, should explore ways to reform health and care provision, including a rebalancing towards prevention, early intervention, and proactive personal care and support. The aim should be to reduce hospitalisation, invest more in primary care, and integrate planning and decision-making for both the health and care services. Inevitably, there needs to be a review of NHS properties, including underused facilities, so that new integrated care centres can be opened and we have a more efficient use of the health estate.

There is agreement among London partners that the scale and complexity of health and care issues in London means that a model of reform should include actions at local, sub-regional and pan-London level. As part of their submission to the comprehensive spending review, London government made the case for greater devolution over health and social care. In the interests of brevity as we are short of time, I shall reduce the list substantially and just mention public health powers, including regulatory and fiscal interventions; multi-year allocations of NHS and local authority funding on a borough footprint; and London’s share of national NHS transformation funding.

As the Minister will know, representatives from the Greater London Authority, London Councils, NHS England, the London office of clinical commissioning groups and Public Health England are developing a memorandum of understanding to progress this work and to look at the powers that could and should be devolved to London. The recent London Health Commission report also advocated a London health commissioner, who could focus on the particular concerns of our growing city with its transient population. In London, we see diseases that many of us thought had died out, such as tuberculosis and rickets. They are often seen in people who were born or have grown up elsewhere, bringing pressures to the health system in London.

I am asking the Minister to welcome the approach being taken by London and support the aspiration for the greatest possible speed of reform to improve the health of Londoners.

[Mr Steve Reed (Croydon North) (Lab)]

I start by putting on record my condolences to the family and the many friends of Michael Meacher on the very sad news we have heard this afternoon. I am sure that we will have the opportunity to pay our respects to him properly and recognise the huge contribution he made to politics, Oldham and the life of this country and this House.

Turning to the Bill, this is a very exciting and long-overdue agenda. The UK, and England in particular, is deeply over-centralised. This holds back our regions, cities and communities. We welcome the Bill. It is a positive step forward. It is broadly, as the Minister said, of a consensual nature and I welcome his readiness, as he expressed it earlier, to listen to this debate before coming back with his final proposals. That does not mean, however, that there are no areas where the Bill could not go further or be improved. We have heard, across the Chamber this afternoon, plenty of examples of such areas.

Listening to the Minister, it struck me that he was on his weakest ground on the issue of mayors. A number of MPs from all sides spoke very eloquently about imposed mayors. It is right that areas that want mayors should have mayors. The Greater Manchester combined authority made it absolutely clear that it supports its mayoral model and we absolutely back it on that. When that applies to other areas, that is absolutely fine: if that is the model they want, that is the model they should have. However, the Secretary of State should not be able to force mayors on areas that do not want them. He has not been at all clear on how a metropolitan area that wants to proceed with devolution but without a mayor, is able to do so. He has made the one conditional on the other.

Clause 3, as it stands, is an important clause. It ensures that mayors cannot be made a condition of devolution and we believe the Government are wrong to seek to remove this important safeguard. We will wish to test the opinion of the Committee on that.