Cities and Local Government Devolution Bill [HL] — House of Lords, 2015-06-24
Topic: Health
Norman Warner (Labour, Centre-left): My Lords, I support my noble friend’s amendments, which provide us for the first time with an opportunity to discuss the relationship between the Bill and existing NHS legislation. I have degrouped my own amendment on NHS responsibilities for later discussion, because I wish first to hear the Minister’s response to this group of amendments. However, I promise the Minister that I will be returning to this matter on Monday. I decided on this approach when I heard the Minister’s reply on Monday to my question about where the Health Secretary fitted in to the accountable Ministers in relation to the Bill, given the decision in February to delegate £6 billion a year of the NHS budget to the Greater Manchester Combined Authority. Her response was that Greater Manchester had agreed a memorandum of understanding with NHS England. That is true, and it may well be a good and sensible thing to do. However, it does not tell us very much about where this leaves the Health Secretary and his many duties and powers under the monster Health and Social Care Act—all 457 pages of it The Bill certainly does not make clear what happens when other areas come forward with their own proposals for delegating chunks of the NHS functions and budgets to combined authorities. I have read the current memorandum of understanding, which relates largely to 2015-16 as a build-up year for what will come later. The memorandum leaves a large number of loose ends relating to later years and the relationship of the combined authority with the Health Secretary under existing NHS legislation Having said all this, I make it clear that I am a strong supporter of the Bill and its approach to devolution. I very much share the views of the noble Lord, Lord Heseltine, about it. Unlike many of my colleagues on these Benches, I do not particularly oppose the idea of elected mayors; as a lifelong Londoner, I have experienced the benefits of a mayoralty. This year I also co-authored a policy paper for the think tank Reform entitled Letting Go, which discusses how English devolution could help solve the NHS care and cash crisis. Here I should declare my interests as a member of the advisory council of Reform and an adviser on health and care to the law firm Capsticks In the conclusion of our policy paper, my co-author and I went on to say about Greater Manchester: "For the first time, a large city region has offered a model of healthcare in the UK that focuses on preserving and improving the health of all citizens rather than merely treating them when they are sick. It could provide a step change in health outcomes, particularly for the worst off. If successful in fixing the care model, this innovative approach could help make the NHS more financially sustainable, by controlling the numbers needing expensive acute care" This is a very big prize, but why are the Government so shy about putting some of this stuff in the Bill? Those are outcomes that we would all desire. We want them all for most parts of the country from our NHS, so why can we not be upfront and clear in the Bill about where the health and social care stuff—particularly the NHS functions and budgets—sits in relation to this Bill and combined authorities and sort out more precisely than at the moment the relationship between a combined authority and the Health Secretary, not just NHS England The key issue is how the Bill interrelates with the Health and Social Care Act 2012. If we want successfully to devolve NHS responsibilities in the way envisaged for Greater Manchester, as I hope we do, does not Parliament have to insert some provisions in this Bill which explain the relationship between those functions and the role of the combined authority and the Health Secretary and his duties and powers in the 2012 Act? This House spent months on that Bill and had to have a pause because there was so much difficulty and controversy over that legislation Only three years ago, Parliament and the previous Government set the future path for the NHS in a monster of an Act. Now we seem to be going into dark corners, shuffling away, trying to undermine that Act by slipping some functions through something called a memorandum of understanding to a combined authority without being clear where that leaves the Health Secretary and his duties I am not normally particularly sympathetic to the Health Secretary or to the problems of the 2012 Act, which was not one of Parliament’s finest hours, but the facts of life are that that is the legislation which governs the way the NHS is run in England now and for the foreseeable future, so trying to slide a set of changes through with combined authorities without being clear in the Bill what is going to happen in relation to the Secretary of State’s powers is a surefire recipe for confusion in the minds of the public, of the NHS and its staff and of the combined authorities My key questions to the Minister are: first, what collective discussions have taken place in government on the interrelationship of this Bill to the Health and Social Care Act 2012 when NHS responsibilities, funding and assets are to be devolved to combined authorities? Secondly, will the Minister tell the Committee whether the terms of the agreement with Greater Manchester will be further amended following the passage of this Bill before the Greater Manchester changes go live in 2016-17? Thirdly, what legal advice have the Government had on whether actions could be taken by authorities or the public under the terms of the 2012 Act to overrule the terms of a memorandum of understanding with a combined authority? Fourthly, is the process used with Greater Manchester going to be the way that subsequent transfers of NHS responsibilities to combined authorities will be handled after the passage of the Bill? We need answers to questions of that kind to be certain what is going to happen when the Bill goes on the statute book with relation to any transfer of NHS responsibilities In conclusion, I am a supporter of this Bill and of using it to devolve more responsibility from the NHS to local and regional levels, linked to other devolution to combined authorities. I do not want the Government’s proposals in the Bill to fail because insufficient thought has been given to the issues I have raised. We saw what happened with Andrew Lansley’s rushed and ill-thought-through NHS legislation, when its implications were not seriously addressed before Parliament passed it. I remind the Minister that the Prime Minister had to impose a pause on the consideration of that legislation because so much of it was ill considered and undeliverable I would very much like to work with the Government on the Bill and try to get it right; this is not a partisan matter. I hope that the Minister will clarify, either today or later in a meeting, how we can progress this issue. In the mean time, I can promise a debate next Monday on a revised version of Amendment 44D that seeks to define how NHS responsibilities can be devolved to combined authorities in a way consistent with the 2012 Act. I hope that the Government will accept in principle that something in this area has to be put in the Bill.