Covid-19 (Public Services Committee Report) — House of Lords, 2021-07-22
Topic: Health
Philip Alexander Hunt (Labour, Centre-left): My Lords, I am delighted to take part in this debate. I too congratulate my noble friend Lady Armstrong on her skilled chairing of the Select Committee and the clerk and his staff for their excellent work As the report says, the pandemic represented an unprecedented challenge to the United Kingdom’s public services. I take the positives from it: many of them rose to that challenge. Many public service providers developed remarkable innovations, as the noble Baroness, Lady Fox, just referred to. Decisions which before the pandemic took months were made in minutes. Good personal and organisational relationships broke down long-standing barriers between the statutory and voluntary sectors. New ways to deliver services flourished. I agree with the noble Baroness, Lady Fox, that we do not want to lock in certain behaviours, and we need to tackle the issue of the difficulty of face-to-face interventions. Yes, the NHS does have its challenges. I agree about the issues around "do not resuscitate" and the transfer of patients with Covid into care homes. But I would say to the noble Baroness that, when you look at the comparative statistics, the NHS has fewer beds, doctors and nurses than any comparable healthcare system, and we have to consider that in terms of funding decisions for the future Of course, it is not all good. We heard as a committee that the overall public health response was at times hampered by overcentralised, poorly co-ordinated and poorly communicated policies that were designed and delivered by central government, even though local-level providers were often better equipped. One of the key questions the committee poses is: how do we hold on to the positive behaviours we saw during the pandemic? I want to concentrate on just one issue: the over- centralisation of public services My noble friend Lord Liddle asked if our politics is up to the challenge of tackling this centralisation. The Government’s response was pretty wet, although the Prime Minister’s recent speech on levelling up did at least cover some of the ground. He spoke about the country being the most centralised of all the developed countries. He acknowledged that the big metro mayors were championing their hometowns, and that in the rest of the country, including the counties, local leaders needed to be given the tools to make things happen. Does this suggest a possible big move to decentralisation or even devolution? Well, up to a point, because I wonder whether the Government have themselves taken note. Last week in the Commons, the Health and Care Bill had its Second Reading. It did not show much commitment to devolving or decentralising power. Indeed, it faces the other way, with a power grab by Ministers and an imposition of powers of direction for the Secretary of State on the NHS. This suggests that there is a little way to go before government and Whitehall understand that devolution requires a huge shift in thinking In a really interesting paper about this, the Institute for Government has pointed out that, in recent decades, UK parties of all political persuasions have made commitments to decentralise power but in reality, coming into government, have found it very hard to do so. The institute’s analysis suggests that decentralisation requires at least three main groups to either support or acquiesce to reforms: national politicians, local politicians and, of course, the public. These groups often have different interests, are not internally cohesive and have different priorities and values—all factors which make securing sufficient support difficult. As important, all these groups have considerable, and not to be underestimated, power to block or undermine reforms they dislike Each of the obstacles the institute identifies is linked to one of these groups: national government lacks trust in regional or local government competence; those leading decentralising reforms are often unsuccessful at persuading other departments or Ministers to give away powers; taking powers from existing local politicians to give to a new sub-national government layer creates opposition; and the public generally lack interest in regional and local government reform and are sceptical of the value of more politicians. This goes perhaps some way to explaining why the bold talk of decentralisation is not always matched by deeds—and yet you come back to the conclusions of our report and to the argument that decentralisation could boost economic growth, better reflect differences in local identities and preferences and allow more variation and innovation in public services This, in the end, is the challenge for the noble Lord, Lord True, and the Government. Are they really serious about levelling up? If they believe that decentralisation and devolvement of powers is the way forward, if they want to build on the fantastic local innovation in evidence over the last 16 months, their forthcoming White Paper must be ambitious. I hope it will be.