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Mr. Ottaway: I shall comment briefly on the Liberal Democrat proposal to establish a regional health authority. It seems to us that, when the London regional office of the NHS executive was created in January, it was intended to fill the gaps in the strategic management of health care in London. That office was intended to work in partnership with local government social services, not under local government direction.

The London regional office was given five key issues to deal with: developing an understanding of health needs across London; improving primary care; developing intermediate and community care; putting a new focus on the most vulnerable Londoners; and modernising London hospitals. In the judgment of the Conservative party, direct provision of health care is best left to the professionals, rather than to those in local government.

Mr. Wilkinson: I broadly support my hon. Friend the Member for Croydon, South (Mr. Ottaway), but at the same time express a certain sympathy for the objectives behind the Liberal Democrat amendment. I think that all of us will have had experience, in our daily duties as constituency Members, of the problem that is caused by the undemocratic nature of health authorities that take decisions on behalf of our constituents.

Those decisions seem at times totally irrational. They certainly have been in the Hillingdon borough with regard to Mount Vernon hospital. If things go wrong, that may also be the case with decisions on the future of Harefield hospital. However, the problem extends well beyond London.

I am not clear how a body that is specifically directed to bringing forward a Londonwide health policy, under the control of the Greater London Authority, and thereby making it accountable would be the model for the nation as a whole. The London executive of the national health service has to disburse funds that are raised nationally. The London region allocates resources in competition with bodies that allocate resources elsewhere in the country. We have seen how resources have been taken away from London under the old RAWP--resource allocation working party--formula, to the benefit of the provinces.

There needs to be a re-examination of how to achieve better democratic accountability for the NHS as a whole, nationwide. I do not believe that the Bill is the way in which to do it. It would cause a distortion of administrative processes. As my hon. Friend the Member for Croydon, South has said, it is an area of public policy that is best left to the professionals.

Mr. Hughes: We share the hon. Gentleman's view that, ideally, accountability would be better achieved on an England-wide basis; Scotland, Wales and Northern Ireland would have their own arrangements. We do not have that for the time being. It is only because of the inability of any legislative vehicle to achieve accountability more widely that we seek to do it now. If we could do it for London this year, we could do it for the other parts of England next.

Mr. Wilkinson: I am not sure that the Labour Government are yet disposed to what the Liberal

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Democrats propose. It may come to that, but the Minister shakes his head. I am sure that some of the older members of his party who are behind him will be shaking their heads even more vigorously.

I appreciate the intentions. In our part of London, decisions have been driven through against the clear, majority will of local people. Huge petitions are raised and not a blind bit of notice is taken. However, it is not a purely London phenomenon. It is one that other Members have suffered elsewhere. We must acknowledge that fact and say that, laudable as the objective behind the amendment is, it is deficient.

Mr. Raynsford: I am surprised that the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) has returned to the issue at this stage of the Bill. I thought that I had made it clear in Committee that the Government had no intention of establishing a Greater London regional health authority under the direction of the Greater London Authority.

We want the GLA to have a clear and genuinely strategic role in considering the underlying determinants of health. We want it to have a duty to take action, as I have described, in promoting improvements to Londoners' health. That is what the Bill provides for, but there is no justification for another tier of health administration.

There are no regional health authorities in other parts of the country; they were abolished in 1996. Since 1 January, there has been a new strategic health body for London, the London regional office of the NHS executive. It is concerned with strategic health issues for the capital, as well as strategic management of health services. We expect it to work in close partnership with the GLA for the benefit of Londoners.

I detect a certain difference between the view of the hon. Member for Croydon, South (Mr. Ottaway), who speaks for the official Opposition and who broadly concurs with our policy, and that of the hon. Member for Ruislip-Northwood (Mr. Wilkinson). Perhaps the rethink going on in the Conservative party about its role in relation to health is an active debate, in which those two Members are on different sides, but I will leave their private grief to them and their party.

We are setting a clear provision for health to be at the forefront of the new Greater London Authority's mind when developing its services, but it should not be engaged in the administration of the NHS, which is better dealt with by other means.

Mr. Simon Hughes: The campaign to democratise the health service will go on. I was not expecting the Government to give in. They are resisting democracy in all sorts of places. Conceding that on this occasion they have the numbers against us, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Clause 26

Secretary of State's guidance about the Authority's purpose


Amendment made: No. 110A, in page 15, leave out lines 18 to 25.--[Mr. Dowd.]

Clause 27

General power of the Authority


Amendment made: No. 111A, in page 15, line 26, leave out from beginning to end of line 28 on page 16.--[Mr. Dowd.]

Clause 29

Functions to belong to Authority but be exercisable by Mayor, Assembly or both


Amendments made: No. 112A, in page 17, line 1, leave out subsection (2) and insert--
'(2) Any function--
(a) which is transferred to, or conferred or imposed on, the Authority by or under this Act or any other Act (whenever passed), and
(b) which (apart from this subsection) is not made exercisable on behalf of the Authority by the Mayor, by the Assembly, or by the Mayor and the Assembly acting jointly,
shall be exercisable only by the Mayor acting on behalf of the Authority.'.
No. 113A, in page 17, line 27, leave out 'Subsection (3) above is' and insert
'Subsections (2) and (3) above are'.--[Mr. Dowd.]

Clause 33

General duties of the Mayor in relation to his strategies

Mr. Simon Hughes: I beg to move amendment No. 64, in page 19, line 22, at end insert--


'(i) the strategy for the River Thames prepared and published under section (The River Thames) below.'.

Mr. Deputy Speaker: With this, it will be convenient to discuss new clause 13--The River Thames--


'(1) The Mayor shall prepare and publish a document to be known as the "River Thames Strategy".
(2) The River Thames Strategy shall contain the Mayor's proposals and policies for the use, enhancement and protection of the river and riverside known as the "Thames Policy Area".
(3) In preparing the strategy the Mayor shall seek to promote and encourage holistic and integrated approaches to the strategically significant features of the river:
(a) River Transport,
(b) River Economy,
(c) River Ecology and Wildlife Habitats,
(d) River Heritage and the Built Environment,
(e) Recreation and Leisure, and
(f) Public Access, Amenity and Open Spaces,
and may contain such other proposals and policies relating to the River Thames as the Mayor may consider appropriate.

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(4) The River Thames Strategy shall contain information about:
(a) the measures that are to be taken for the implementation of River Thames Strategy by the Authority, Transport for London, and the London Development Agency,
(b) the measures that other persons or bodies are to be encouraged to take by the Mayor, and
(c) how the strategy complies with the Rio Principles on Sustainable Development.
(5) In preparing or revising the River Thames Strategy the Mayor shall consult:
(a) the Port of London Authority,
(b) the Environment Agency,
(c) each riparian London Borough Council,
(d) the Common Council,
(e) British Waterways, and
(f) any other person or body who the Mayor considers it is appropriate to consult.'.

Mr. Hughes: This amendment is even less hopeful of success than the previous one.


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