|Health and Social Care Bill
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 strategythe health improvement plan and so onof 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 authoritiessome 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.
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.
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