Cities and Local Government Devolution Bill [HL] — House of Lords, 2015-06-24
Topic: Health
Keith Bradley (Labour, Centre-left): My Lords, in moving Amendment 36D, I shall also speak to Amendment 36E. Both amendments are in the names of my noble friends Lord McKenzie and Lord Beecham. This is the first opportunity to debate health and social care, but it may not be the last. I declare an interest as a resident of Greater Manchester, former city councillor in Manchester and former MP for the city. My interest in devolution to Greater Manchester is particularly strong These are essentially probing amendments regarding the devolution of health and social care to the combined authority—initially to Greater Manchester. I say "combined authority" because it is my understanding that health and social care is not a responsibility to be exercised by the elected mayor. In fact, the memorandum by the DCLG and the Home Office specifically rules out the integration of health and social care as a mayoral function. I would be grateful if the Minister would confirm that there is no intention in future to make that a mayoral function The devolution of health and social care in Greater Manchester has arguably provoked the most interest among the public, stakeholders, politicians and, of course, healthcare professionals amongst others. From a position of, in principle, supporting devolution, I believe it is important to clarify some of the points about the way that this proposal will unfold over the coming weeks and months The legislation we are debating makes not a single reference to health and social care. That is reinforced by the fact that in the Explanatory Notes, under "Legal background", no reference is made to any health legislation, particularly the Health and Social Care Act 2012. We know that the original Greater Manchester devolution agreement did not cover health and social care and that a very belated memorandum of understanding was agreed between the Government and the Greater Manchester Combined Authority to set in train the process of devolution of health and social care. Therefore, probing amendments have been tabled under Clause 6, "Other public authority functions", to elicit further information in this area. First, we seek clarification: does the Bill apply in any way to public authorities other than district, unitary and county councils? Specifically, do any NHS organisations—clinical commissioning groups, NHS trusts, foundation trusts or arm’s-length bodies, to name but a few—fall within the powers that Clause 6 gives to the Secretary of State for Communities and Local Government to transfer functions and property or rights to a combined authority? I anticipate that the answer to this is no, but that means that the Bill has no bearing on the health devolution proposals and its provisions cannot be used to enact health devolution. As I noted earlier, the Explanatory Notes do not include the Health and Social Care Act 2012, which also suggests that it has no competence in this area. I would therefore be grateful if the Minister could confirm the Government’s interpretation is the same as mine Secondly, having read the health devolution memorandum of understanding, I suggest that implementing many of its provisions may require, sooner or later, primary or secondary legislation. This could be desirable, not only to set out clearly the statutory basis on which responsibilities may move between existing bodies—for example, CCGs, local authorities, foundation trusts and so on—but also to frame accountability relationships. Where such arrangements are currently set out in the Health and Social Care Act 2012, it would seem that amendments to that Act, whether made using the powers of this Bill or made directly through further legislation, would be required. For example, if the Greater Manchester Strategic Health and Social Care Partnership Board required statutory powers—and many commentators are of the view that, for such bodies to really shape the services locally, they will require such powers, and this view has often been argued in relationship to health and well-being boards being the strategic body at a local level without any statutory powers—clearly, amendments to primary legislation will be required. I would be grateful if the Minister would confirm the position. We do not want to leave NHS organisations and their boards, which implement policies, open to legal challenge that they are acting outside or in conflict with legislation.