Health and Social Care Bill

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Mr. Denham: As a former member of a land drainage committee, I can bring relevant knowledge to bear on the subject. I recall that the committee often involved an extremely good lunch, and that a suspiciously large number of farmers who owned low-lying land seemed to be co-opted on to it.

I understand the points that both hon. Members raise. Guidance will clearly be needed about how local authorities come together, although we would want to leave some flexibility for people to work matters out locally. I shall take the example of the Southampton and South West Hampshire health authority, which I share with the hon. Member for New Forest, West. It is clear that there would be cases where there would be a desire to scrutinise the overall strategy—the health improvement plan and so on—of the health authority. At the very least that would require co-operation between Southampton city council, which is a unitary authority, and Hampshire county council. Other areas, such as that of the operation of primary care trusts in Southampton, might be solely a matter for the unitary authority in Southampton, because it happens in its area. Some flexibility in arrangements on topics is likely to be necessary, over time. It would not be possible or desirable for us to prescribe, from the centre, exactly what arrangements should be made in each case.

I do not agree with the hon. Member for Isle of Wight (Dr. Brand) that because two authorities come together the democratic element is lost. After all, both organisations are democratic, and would need, within the guidance, to agree on the way in which they brought their functions together. Such co-operation would provide a sensible and practical way for the scrutiny committees to operate at local level. One would expect reports to be made not just to the NHS body that is being scrutinised, but to the host local authority, to be considered by the wider body of council members.

Dr. Brand: On a practical point, would it be possible for the joint authority to publish minority reports, or would that depend on the report going back to one of the host authorities, which would then evaluate it. I doubt whether there can be a mechanism for doing that, as it would be very difficult. In the Minister's own patch, where Eastleigh and Romsey share health services, there are two distinct views of how those services should be delivered by the local authorities.

Mr. Denham: First, minority reports are, and would be, possible under the scrutiny committee approach. During the scrutiny process, one would expect different local perspectives to come through from the councillors who were involved. The process is not a way of expressing the view of the local authority per se. It is a similar scrutiny process to those that apply to other local authority services. I do not see any major difficulty in local authorities sensibly co-operating with each other, and being able to explore, through the scrutiny process, all the relevant issues. Surely that is the most important point. The LGA was keen to make a similar provision for district councils for fear that a particular local perspective, or view of a topic, would otherwise be lost. With the new clause, we are ensuring that such perspectives are not lost.

Dr. Brand: I fully agree with the latter part of the Minister's reply, but he also implied that we were talking about pure scrutiny. I thought that the new body would take over the strategic planning commentary, which was such an important part of the role of CHCs. Clearly, such a commentary is not just a matter of scrutinising what is currently happening, but of monitoring the direction in which local health provision is moving. That can be very different for different authorities—some may gain and some may lose.

Mr. Denham: The hon. Gentleman is right, and I had included, in my mind, the scrutinising of those major reconfigurations within ``scrutiny,'' so we agree on that. The hon. Gentleman seems to be concerned that the Government would somehow try to run the system so that geographically distinct or minority views were corralled into a wider body and thereby suppressed. I understand his concern. We must deal with that in the guidance on when scrutiny committees can come together to share their functions. I acknowledge his point, but that is something for which we can make proper provision.

Amendment agreed to.

Question proposed, That the clause, as amended, stand part of the Bill.

5.15 pm

Mr. Swayne: Although our debates have covered most aspects of the clause, it is still not clear how local authorities will find the resources to discharge the responsibilities that we are placing on them. We have been given no inkling. Equally, our debates on the amendments have made it clear that those who will be discharging the scrutiny function will not have the benefit of having handled complaints or of having been inspected, which are two vital elements of scrutiny. In my view, those three counts place a large question mark over the fundamental nature of the clause.

Mr. Denham: There is some danger of going over old ground, but it is the Government's view that enabling local government to scrutinise the health service is a step forward because it will allow them start dealing with the democratic deficit in the NHS. It is inevitable that the pattern of health provision will not map directly on to local authority provision. We therefore need to make flexible arrangements to allow that to happen effectively. As scrutiny committees develop their role, they will gain great expertise, prove to be effective and, for the first time, bring a democratically elected local authority voice into shaping health services.

I acknowledge, as I have throughout, that it will be useful for the scrutiny committee to be informed by a range of information provided by the NHS, patients' organisations in general and patients forums, which undertake the inspections. We have set out in the explanatory notes a number of arrangements to ensure that it happens. I believe that it will be an informed process of scrutiny.

Question put and agreed to.

Clause 7, as amended, ordered to stand part of the Bill.

Clause 8

Overview and Scrutiny Committees: Exempt Information

Question proposed, That the clause stand part of the Bill.

Mr. Burstow: I have a question on the Government's thinking about the difference in operation between NHS bodies, which are governed by the access arrangements made under 1960s legislation on access to public bodies, and local authorities, which are governed by the Local Government Act 1972. Can the Minister tell us a little more about how, through regulations, he can ensure that a trust cannot decide that it would be embarrassed to provide information that was not exempted under the Local Government Act that might nevertheless be exempt under the 1960s legislation? How can we ensure that local authorities, with their new powers of overview and scrutiny, can obtain all the necessary information, including information that trusts might not want published under the 1960s legislation but which they would have to publish if they were covered by the Local Government Act?

Mr. Swayne: I echo what the hon. Gentleman said, but I would go further. I believe that we have the chance to review the two sets of rules under which the two bodies will operate. If the scrutiny committees operate under one set of confidentiality rules and health authorities and the NHS enjoy a much wider discretion to withhold information, a measure of suspicion is bound to grow between two bodies that we want to work to a large extent in partnership.

It strikes me that the Bill may provide an opportunity for the Government to review the issue to see whether there is a means of introducing proposals for a common set of standards for confidentiality. I suspect that there will always be the temptation, and it might be a quite legitimate concern for NHS bodies, that information that they might regard as confidential, would not be regarded as confidential within the rather narrower terms under which local government bodies operate once they had been handed over to the scrutiny committee. That might result in a reinforcing of what might be an administrative inertia to hand over information in the first place.

Dr. Brand: I am concerned about what information the scrutiny committee may have and what sort of paperwork there may be. A very relevant question was asked this morning by the hon. Member for Woodspring (Dr. Fox) in relation to clause 15 on who would become the custodian of files and information held by community health councils. The Minister did not answer at the time. Perhaps he could now let us know where that information will go? It will obviously include a mix of personal and clinical information as well as more strategic information.

Mr. Denham: The clause is essentially about the openness of the business of the scrutiny committee. Under clause 7, the Secretary of State can require the NHS to provide information to the scrutiny committee. So we will use that route to ensure that the necessary information is made available to the scrutiny committee.

The Local Government Act 2000 provided that meetings of the overview and scrutiny committee must be held in public. The Local Government Act 1972 provided for two exceptions to that general obligation: first, where certain confidential information may be disclosed and secondly where the scrutiny committee agrees by resolution of the committee or council that certain exempt information may be disclosed.

Section 12A of the Local Government Act 2000 sets out the categories of exempt information, such as information relating to a particular employee of the local authority or to a person receiving services from the authority. Where a scrutiny committee is discussing NHS matters, for example where it has asked the chief executive of the local health authority to attend, it is possible that the committee may discuss matters that would lead to the disclosure of information relating to the NHS that would not be appropriate to disclose to the public at large, such as information relating to personnel. The function of clause 8 in combination with schedule 1 to the Bill sets out the information that local authorities do not have to disclose at a public meeting of the scrutiny committee.

Where the restrictions on NHS bodies that are governed by the Public Bodies (Admission to Meetings) Act 1960 are more restrictive than the provisions that now apply to overview and scrutiny committees, we have modelled our approach on the approach in the Local Government Act 2000 rather than on the 1960 Act. The provision for public access to meetings and documents of NHS bodies is more restrictive than is the case for local government and overview and scrutiny committees. We think that the more open and legislative approach to overview and scrutiny committees when they are discussing health service bodies is justifiable. They are local authority committees and should be subject to the same regime of public access whatever the matter under scrutiny. That is the broad thrust of our approach.

The hon. Member for Isle of Wight was quite right to say that I failed this morning to address the specific point about material held by CHCs. It will be necessary to develop arrangements whereby, as a result of the winding-up of the CHCs, the Secretary of State will clearly be responsible for handling those files in the appropriate way. That may require returning information to individuals.

 

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Prepared 30 January 2001