Cities and Local Government Devolution Bill [HL] — House of Lords, 2015-06-29
Topic: Health
Philip Alexander Hunt (Labour, Centre-left): My Lords, I warmly welcome my noble friend’s amendment. I read with interest the debate in Committee last Wednesday about this very important issue, which goes right to the heart of the relationship between the combined authority and the National Health Service, and the integrity of the NHS as a national service providing uniformity of services across the nation Of course, our debate is mostly about Greater Manchester. I very much support the thrust of what is happening in Greater Manchester. I want to see the same in greater Birmingham. But we have to get to the bottom of the essential relationship between local authorities, the combined authority and the NHS. This is not an academic exercise. It would be all too easy for a Chancellor faced with enormous financial pressures, as he is, to transfer responsibility to local government or combined authorities and then deny responsibility, putting the blame firmly on local government and using local government legitimacy to defend the rationing of services to an extent that the NHS has never seen Of course, one can go back to the foundations of the NHS, to the arguments in the post-war Attlee Government between Morrison and Bevan. Morrison had been leader of the London County Council, which before 1948 had been the largest hospital authority in the world, and wanted local government to run the NHS, but Bevan was concerned that it would be a very patchy service. Bevan won the argument and we had a national NHS. So the arguments we are having today will be very familiar throughout the history of the NHS. The key question is: how do we get the advantage of local government leadership and democratic legitimacy while ensuring that we have what we would recognise as a national NHS? That is why this is such an important debate and why the Bill lacks clarity The Minister was very helpful on Wednesday and spelled out a number of principles. She said first that healthcare services, "must remain firmly part of the NHS … and the position of NHS services in the area in relation to the NHS constitution and mandate cannot change" She said that, "all national standards for health services … must … be complied with" I take that to mean that the NICE technology appraisals will be fully complied with as well. She said: "The Greater Manchester deal does indeed put health as a function of the combined authority and not of the mayor", but that it will not prejudice arrangements elsewhere, which is a very important factor—for me, certainly—in relation to greater Birmingham, although very few of us in greater Birmingham actually want a mayor and very much object to the blackmail that is being put upon us by the Government forcing us to have a mayor in order to accept the greater responsibilities that would be given. We had a referendum in Birmingham not so long ago when we voted very clearly not to have an elected mayor. It is highly objectionable for the Government now to come along and say, "We don’t really care what the public thought, we insist that you have a mayor". Significantly, the Minister went on to say that, "in the field of health and social care, all decisions about Greater Manchester will be taken with Greater Manchester", with, "clinical commissioning groups … providers, patients, carers and partners to shape the future of Greater Manchester together", and that the Bill will give local authorities within the combined authority, "the powers to participate in … strong, collaborative partnerships".—[Official Report, 24/6/15; col. 1672.] I would just say that they already have statutory freedom to enter into those partnerships.