Cities and Local Government Devolution Bill [HL] — House of Lords, 2015-07-13
Topic: Health
Susan Williams (Conservative, Centre-right): My Lords, in moving Amendment 28, I wish to speak also to Amendments 29, 30, 71, 72, 80, 82 and 83. It may also assist the House if I comment on opposition Amendments 31, 32, 34 and 67 These amendments are all about devolving functions. Underpinning the government amendments in this group is consideration we have given to issues raised in Committee about devolving health functions and devolution not only in cities but in counties where there may not be combined authorities, such as Cornwall Government Amendments 28, 29, 30, 80 and 82 relate to discussions we have had on devolving health matters and would provide greater flexibility over how functions can be exercised jointly by a public authority and combined authority. They are intended to provide assurance that any future devolution arrangements will continue to uphold existing accountabilities and national standards for the NHS. This was a core principle set out in the memorandum of understanding concerning health and social care functions agreed with Greater Manchester in February I have listened carefully to the points made by noble Lords, particularly the noble Lords, Lord Warner and Lord Hunt, both during Committee and Second Reading, and during the very useful meeting we had last week. I am bringing forward these amendments and providing further assurances today, which I hope will go at least some way to meeting the concerns that noble Lords have Clause 6 enables the Secretary of State by order to confer on a combined authority functions held by a public authority. Such functions could be exercisable by the combined authority instead of the public authority, or the functions could be exercisable concurrently by each authority Amendment 28 enables the Secretary of State to provide for the functions concerned to be exercisable by the combined authority or public authority, subject to specified conditions or limitations. This would enable conditions to be attached to any conferral of powers from a public authority to a combined authority. This could, for example, enable a conferral of health powers on a combined authority to be accompanied by a condition that the combined authority must also meet the current statutory duties held variously by the Secretary of State for Health, NHS England and clinical commissioning groups, thereby ensuring continuation of current NHS accountabilities and standards. So, for example, the Secretary of State could transfer powers attaching the duty to seek continuous improvement in the quality of services, reduce health inequalities, promote the NHS constitution, seek to achieve the objectives in the NHS mandate or act consistently with those objectives. Other conditions might be attached that were specific to the two authorities’ arrangements for working together Amendments 29 and 30 provide greater flexibility to ensure that combined authorities and public authorities can work effectively together. They enable Ministers to specify that functions are to be exercised by the public authority and combined authority working jointly, in addition to the powers to require that functions are exercised concurrently or are fully transferred to the combined authority. Amendments 80 and 82 are minor changes which support these amendments by enabling the Secretary of State to amend or modify legislation; for example, the National Health Service Act 2006 might need some amendments or modifications in relation to the particular combined authority to which functions were being transferred. These amendments allow greater flexibility for devolved arrangements to be specified according to local context and the function concerned, and would give greater assurance that the combined authority or council would have to work co-operatively in the exercise of functions I understand that Amendment 31 is also prompted by health considerations. It seeks to limit Clause 6 to exclude public authority functions, "of a regulatory or supervisory nature", from being conferred on a combined authority. I understand the intent behind this amendment, having discussed it with noble Lords last week and again now, and I agree that a combined authority should not be able to act as the regulator or supervisor of functions that it is responsible for exercising. Indeed, I can see a case for excluding from the scope of Clause 6 the functions of any national regulatory or supervisory body overseeing the exercise of functions by public authorities. Such an exclusion would put it beyond any doubt that the regulator responsibilities of, say, Monitor and the Care Quality Commission could not be devolved to combined authorities. Moreover, if a combined authority is provided, by order, health functions, perhaps to be exercised jointly with the local clinical commissioning groups, the combined authority should not also be conferred with the functions of the clinical commissioning groups’ regulators. As I have already indicated, I can assure noble Lords that we are absolutely committed to upholding existing accountabilities and national standards; for example, for the NHS. This core principle was set out in the health and social care memorandum of understanding with Greater Manchester. As I have said in earlier debates, the Government are committed to the view that health and social care services in any area, whatever devolution arrangements are entered into, must remain firmly part of the NHS and social care system; that all existing accountabilities and national standards for health, social care and public health services will still apply; and that the position of NHS services in the area in relation to the NHS constitution and mandate cannot change. The exclusions sought by Amendment 31 could be made by excluding them from the set of functions which are transferred and, if it were necessary, the Secretary of State’s power to attach conditions or impose limitations could be used, as provided for in Amendment 28. However, I am prepared to consider further and reflect on today’s discussion and, if we consider it appropriate, for the Government to return to these issues at Third Reading Government Amendments 71, 72 and 83 will enable the Secretary of State to confer functions of a public authority on local authorities as well as combined authorities. These amendments are ensuring that we have the powers we may need to devolve powers in county areas where there may not be a combined authority. In previous stages of the Bill, concerns have been raised that the Bill focuses on devolution to those large cities with combined authorities, and questions have been asked about how the Bill’s provisions apply in non-metropolitan areas, where perhaps there may not be combined authorities As I have explained on more than one occasion, we are very clear that devolution applies equally across all parts of England—cities, counties and towns—and that we are looking to do bespoke deals with all areas that want them. We are also ready to have conversations with any area about the powers and budgets it wants devolved to it and the governance arrangements it proposes to support those powers. This amendment is to put it beyond doubt that there is a level playing field for all areas, including areas where there is no combined authority. That we are serious about this is unequivocally demonstrated by the Chancellor’s announcement in the Budget: "The government intends to support towns and counties to play their part in growing the economy, offering them the opportunity to agree devolution deals, and providing local people with the levers they need to boost growth. The government is working with towns and counties to make these deals happen and is making good progress towards a deal with Cornwall" Clause 6 enables the Secretary of State to confer functions of a public authority on to a combined authority, subject to appropriate consent and process. Amendments 71 and 72 replicate these powers for application to local authorities to enable the Secretary of State to confer functions of a public authority on to a county or district council. Amendment 83 makes some minor amendments to tidy up Section 15 of the Localism Act accordingly. These amendments will enable, for example, devolution deals to be made with individual local authorities such as Cornwall, as I have mentioned, in the same way as for a combined authority. Functions of a public authority could be conferred on a local authority to be exercised individually by the local authority, concurrently with the public authority or jointly with the public authority. All these powers can be transferred with limitations and conditions, as for the transfer of powers from a public authority to a combined authority. As with combined authorities, such a conferral of power can be made only with consent from the local authority and if the Secretary of State considers that doing so would be likely to improve the exercise of statutory functions in the local authority area. Such a conferral of power would also need approval from each House of Parliament and to support Parliament’s consideration, the Secretary of State would lay a report before it setting out the reasoning for the proposed conferral of powers. I hope that noble Lords will agree that these amendments respond to their earlier questions about what the Government are offering to non-metropolitan areas.