Cities and Local Government Devolution Bill [HL] — House of Lords, 2016-01-12
Topic: Health
David Prior (Conservative, Centre-right): My Lords, I beg to move that the House do agree the Motion on Commons Amendments 45 to 51. I shall speak also to other amendments in the group, including the clause inserted in the Bill following Clause 19 by Amendments 51 and 74 Your Lordships will remember our debates on the issue of safeguards for the devolution of NHS functions, culminating in the insertion of the amendment from the noble Lord, Lord Warner, at Third Reading, against the Government’s wishes. We have now accepted this amendment and have worked to provide even further assurances. I am grateful to the noble Lord, Lord Warner, for his ongoing co-operation and for his support for the further amendments as introduced in Committee in the other place. These amendments provide further clarity about the role of the Secretary of State for Health and what may and may not be included in any future transfer order giving local organisations devolved responsibility for health services The clause as amended also includes clear provision to exclude from the scope of transfers the oversight role of NHS England in relation to CCGs, and makes it clear that local devolution settlements do not change the responsibilities of our NHS regulators or their functions in protecting the interests and safety of patients The provision of the noble Lord, Lord Warner, as amended, protects the integrity of the National Health Service and makes it clear that, whatever devolution arrangements might be agreed with a particular area, the Secretary of State’s core duties in relation to the health service will not be altered. These clear statements in legislation, making provision for the protection of the integrity of the National Health Service, are intended to provide further confidence in future devolution deals. The amendments to the clause give further definition and clarity to support the valuable principles behind the amendment of the noble Lord, Lord Warner, and I commend them to the House Places such as Greater Manchester and London are calling for the ability to design and deliver better health and care services and the ability to make decisions at a level that works best for their communities, either locally or, where it makes more sense, at a regional or sub-regional level As we know, devolution deals must be tailored to the particular needs and circumstances of a local area. The Bill already allows government to devolve a range of powers and functions currently carried out by Whitehall departments or bodies such as NHS England to a combined authority or a local authority. In seeking to introduce Schedule 3A, which amends the NHS Act 2006, we are now taking the opportunity to make available further options in health legislation for combined authorities and local authorities to work together with clinical commissioning groups and NHS England across a wider area, such as Greater Manchester, to improve integration of services Crucially, wherever a responsibility for NHS functions is delegated or shared in this way, accountability would remain with the original function holder, whether that is NHS England or a clinical commissioning group. The original function holder would continue to be accountable via the existing mechanisms for oversight which ultimately go up to the Secretary of State. In respect of the arrangements which may be made for the exercise of the Secretary of State’s public health functions, each partner is liable for its own actions and, as with the rest of the health service—both public health and NHS elements—the Secretary of State remains accountable to Parliament We are seeking to introduce Amendment 45 to provide that the requirements for local authority consent do not apply to regulations revoking previous transfers of health service functions. Noble Lords will be aware also that Amendment 22, to which the noble Baroness, Lady Williams, has spoken, includes a similar provision whereby consent from a combined authority and local authorities is not needed where an order solely revokes a transfer of public authority health functions These amendments mean that, in the event that it becomes appropriate to restore NHS functions in a local area to NHS bodies, this can be achieved without the need for the consent of the combined authority and local authorities concerned. This reflects the fundamental principle for health devolution in Clause 19—that the Secretary of State for Health’s key responsibilities for the NHS will remain unchanged in any devolution arrangements. We would envisage using the powers to revoke only in circumstances where it was clear that duties and standards such as those referenced in Clause 19 were not being met, and that revoking the transfer was the best option to achieve the necessary improvement in performance. I beg to move.