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22 Jan 2007 : Column 1144

Orders of the Day

Local Government and Public Involvement in Health Bill

Order for Second Reading read.

Mr. Speaker: I inform the House that I have selected the amendment in the name of the Leader of the Opposition.

3.33 pm

The Secretary of State for Communities and Local Government (Ruth Kelly): I beg to move, That the Bill be now read a Second time.

The Bill implements the majority of the proposals set out in “Strong and prosperous communities”, the local government White Paper, which was published in October. Local government has a long and proud history as a driving force behind public services and the success of our towns and cities. The House will be familiar with some of local government’s great historic figures and their achievements—for example, Joseph Chamberlain, Mayor of Birmingham, who left the city, in his words “parked, paved and improved”, or Herbert Morrison, who did much to shape the London we know. Let us not forget the more than 1.5 million men and women working in local government on whom we rely, day in, day out. We are never more aware of their service than in times of adversity, such as the current storms. I pay tribute to them.

History teaches us that local government works best when there is a constructive partnership with central Government to deliver what local people want and need.

Mr. John Redwood (Wokingham) (Con): Will the Secretary of State give way?

Ruth Kelly: In a moment.

For decades, the relationship between local and central Government has swung between suspicion and trust, between tension and harmony. In the late 20th century, the atmosphere reached a low with the central Government and councils at loggerheads over the poll tax—perhaps that is the point on which the right hon. Gentleman wants to intervene.

Mr. Redwood: As an opponent of it, I would be happy to do so, but I want to ask the Secretary of State a very simple question: is not local government best when it is not bossed around by regions? What part of the “No” in the north-east did she not understand?

Ruth Kelly: Of course we listened to the view of people in the north-east, but surely the right hon. Gentleman would agree that the £19 million that it costs to run the regional assemblies is money well spent. Voluntary bodies administer hundreds of millions of pounds, largely on behalf of local authorities: they plan regionally, they spend for local authorities, they are often led by local authority leaders and 60 per cent. of the members are from local authorities.

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Mr. Bernard Jenkin (North Essex) (Con): May I suggest that the Secretary of State conduct at least a consultation, but preferably a referendum, on the existing unelected assemblies, to find out exactly how unpopular they are?

Ruth Kelly: The hon. Gentleman would do well to listen to Councillor Keith Mitchell, Conservative chair of Oxfordshire county council and leader of the South East England regional assembly. He says:

Good value.

With hard work on the part of local and central Government, things have improved immensely over the past few years. Massive investment and reform have driven standards up, and in many areas local government is not just up to the job, it is leading public service reform. I believe that we have now reached a point where local government can once again embrace its place-shaping role to meet the demands of the 21st century. I want to see all our councils leading the drive for sustainable communities, regenerating our city centres, lifting people out of poverty and improving local public services. It is the job of central Government to enable local government to play that role. That is the purpose of the White Paper and, indeed, the Bill.

The White Paper was the result of extensive consultation. I believe that we have forged a high degree of consensus in the local government community. In particular, it has been welcomed by Sir Sandy Bruce-Lockhart, the Conservative chair of the Local Government Association, who said:

Mr. John Baron (Billericay) (Con): The Secretary of State rightly focuses on local government. Given that part 11 of the Bill fundamentally alters the way in which public and patients are involved in the NHS, does she not think it very wrong that no health Minister will be accountable to the House for the measures contained in the Bill, including the scrapping of patient forums? Is that not a reflection of the low priority accorded by the Government to patient and public involvement in health?

Ruth Kelly: The hon. Gentleman will see my right hon. Friend the Member for Doncaster, Central (Ms Winterton) the Minister of State, is on the Bench beside me to listen to the debate and of course to reflect on it. The hon. Gentleman is right to draw attention to measures on public involvement in health, because they are designed to give more power to service users in local areas to raise issues of concern to them. They represent a huge advance on patients forums, because they allow an independent voice to be expressed.

Mr. Andrew Pelling (Croydon, Central) (Con): Will the Secretary of State concede that by involving just local government in the process, it will be a closed process between public sector providers? There will be a complete loss of accountability from independent people who are able to express serious views about the
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performance of our health service. What are the Government afraid of when it comes to CPPIH—Commission for Patient and Public Involvement in Health—and patients forums? Surely it is inappropriate to take away that power.

Ruth Kelly: The hon. Gentleman has completely misunderstood the proposals in the Bill. This is about involving a far broader range of patients and service users—the public—in delivering improvements for that service. As I understand it, patients forums have an average membership of only eight at the moment. In future, hundreds, if not thousands, of people will be able to register for the new local involvement in health networks—LINKs—in which local people can get involved in delivering service improvements.

Tony Baldry (Banbury) (Con): The Secretary of State must understand the House’s confusion on the issue. Only last year, the National Health Service Act 2006 set up the patients forums and the Commission for Patient and Public Involvement in Health. One year later, the Government are scrapping the patients forums and the commission. Each year, we see yet another change to public involvement in the NHS. Why did the Government ever get rid of community health councils? We all understood what those councils did: they ensured that the Government and the NHS locally were accountable.

Ruth Kelly: I am afraid that hon. Members are showing their ignorance of the proposals in the Bill. In fact, patients forums were not established last year; they were established five years ago and have been in operation for some considerable time. Of course, the name in the legislation had to change as a result of other changes that were made last year.

Tony Baldry: The explanatory notes—

Ruth Kelly: The hon. Gentleman wants to intervene again. I shall be generous and let him have a go.

Tony Baldry: One thing that I think I can do is read the Queen’s English:

Last year, legislation was introduced for patients forums and trusts; this year, it is being scrapped.

Ruth Kelly: I thought that I had just made myself clear that there were reasons why the legislation had to be drafted in that way. In fact, patients forums were introduced five years ago and have been in operation for a considerable time. Of course, over that five-year period, considerable changes have been made, and it is now right, particularly as primary care trusts have become more coterminous with local authority areas, for the local involvement in health networks to have a geographic focus on the local authority area and a wider remit to consider health and social services and to involve a far wider range of users.

Mr. Nick Raynsford (Greenwich and Woolwich) (Lab): Might my right hon. Friend not reflect with me that it is rather bizarre for the Opposition to criticise
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proposals that enhance the role of local government in the overall scrutiny and improvement of health services locally, when they have spent much time criticising the Government for not enhancing the role of local government? Why do they not applaud the measure, which will enhance the role of local authorities?

Ruth Kelly: I completely agree with my right hon. Friend, who makes a very important point: the measure will take forward proposals to make it much easier for the public and, indeed, the voluntary sector to get involved with service improvement, and it represents a considerable advance on the previous measures.

Mr. Kevan Jones (North Durham) (Lab): Does my right hon. Friend agree that one of the fundamental issues of representation and accountability is the ability to remove the people who make the decisions? Does she not agree that the thing that is missing from the Bill is a direct power for either local people or local councils to remove the unelected quangos that we now have in local health authorities? At the same time, is this not also an opportunity to abolish the unrepresentative NHS Appointments Commission?

Ruth Kelly: I understand the point that my hon. Friend makes, although he will of course recognise that the commission is an independent body that makes appointments on their merits. He will have an opportunity to discuss that in Committee, as the Bill progresses.

I hope that, given the consensus in the local government community and despite the reasoned amendment tabled by the Opposition, the Opposition will decide today that they at least support the principles behind the Bill: to give a stronger voice to citizens and communities to shape the places where they live and the services that they receive; to encourage local authorities to provider stronger and more strategic leadership for the places that they serve; and to reduce central prescription, so that local authorities and their partners can respond to local needs and demands.

Mr. Peter Bone (Wellingborough) (Con): The Secretary of State is making the point that local people should become more involved in decision making. If a council decides that it wants to become a unitary authority, will it need to get the approval of the people in its area?

Ruth Kelly: The hon. Gentleman will be aware that we are currently going through a process of inviting proposals from local government and that all bids have to be in to the Department by 25 January. One of the criteria for assessment of the bid is whether there is a broad cross-section of support for those proposals.

Several hon. Members rose—

Ruth Kelly: I know that a number of colleagues want to come in on this issue. I will give way to my hon. Friend the Member for Blyth Valley (Mr. Campbell).

Mr. Ronnie Campbell (Blyth Valley) (Lab): Talking about referendums in local government, we had the
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assembly vote in Northumberland, when people said no, and a vote for a two-tier system in Northumberland, when the people of Northumberland said yes. I presume that, as that is the wish of the people, we are going to get a two-tier system in Northumberland.

Ruth Kelly: My hon. Friend will understand that I am not able to comment on specific bids that may or may not have been received. However, if a council puts forward a bid for unitary status that meets the criteria, it will be seriously considered on the basis of the criteria that have already been set out. If, on the other hand, local people and local councillors decide that they want to put forward a bid for a two-tier pathfinder, where they work together to create efficiencies, we would want to encourage that as well.

David Howarth (Cambridge) (LD): I welcome the part of the Bill that makes it easier for councils to become single tier, but is not the deadline of 25 January far too short, especially given that the Bill allows, for the first time, proposals for unitary authorities to cross county boundaries? That is an important reform, but it is also a complex one.

Ruth Kelly: It was clear when we set up this process that local councils wanted us to provide a short window of opportunity for them to put forward proposals so that, after decisions have been made, they can get on with the business of delivering local government. The House will remember the Banham reforms, which dragged on year in, year out. People were distracted from the job of delivering for local people. We wanted to avoid that, hence the short deadline for councils to submit their bids. There will then be an opportunity for us to consider those bids. I hope that we will then move on from the debate on restructuring and that local authorities will be allowed to get on with the job of governing.

Daniel Kawczynski (Shrewsbury and Atcham) (Con): The Secretary of State has encouraged me greatly, because she has given the House the impression—this has already been said to me—that the Government will not be prescriptive on this matter and will allow the people in the areas to make the decisions. Bearing it in mind that the council in Shrewsbury is overwhelmingly opposed to unitary status and that we wish to keep our borough council in the proud, beautiful town of Shrewsbury, will she respect the wishes of my borough council, myself and the local people of Shrewsbury?

Ruth Kelly: I understand the position that the hon. Gentleman is taking towards the potential submission of a proposal on unitary status. The criteria against which we judge proposals are clearly set out. One is that the proposal must command a broad cross-section of support. The others are that it must not put upward pressure on council tax, that it must deliver real value-for-money savings, that it must be able to be met from the council’s own resources, and that it must offer strong leadership and deliver for local people.

Sir Paul Beresford (Mole Valley) (Con): Does the Secretary of State agree that if there is a proposal, whatever its source, to go from two-tier to unitary,
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there will be a referendum—a vote with the local people involved—as suggested to the Prime Minister and the Deputy Prime Minister, both of whom agreed, last February?

Ruth Kelly: The hon. Gentleman will be aware that that has not been the case under different Governments. We have set out a process that involves inviting local people to put forward propositions, but they must be able to demonstrate a broad cross-section of support for them.

Mr. Gordon Prentice (Pendle) (Lab): The Liberal-controlled authority in Pendle talks about an “exciting vision” of a unitary authority with Burnley, which is

There is no evidence for that at all. I return to the point that was just mentioned: are councils expected to canvass the views of the electorate if they are going to dissolve the two-tier system and move towards a unitary system?

Ruth Kelly: It will be for councils to demonstrate that they have a broad cross-section of support. Clearly that is one factor that we will have to take into account, alongside the other criteria that we have set out in the invitation document. I have already said that I expect only a small number of propositions to meet the strict criteria that we have drawn up for unitary status.

Patrick Hall (Bedford) (Lab): If my right hon. Friend reflects on the Banham process, she will agree that it did a lot of good work. It took a long time, but it came up with well thought through proposals. The disadvantage was that the Conservative Government threw Banham out—or most of it, at any rate. We do not want to make that mistake again. Does she not agree that the more focused process in which she invites councils to engage will enable us to get down to the nitty-gritty with those who wish to opt in and debate the matter seriously?

Ruth Kelly: My hon. Friend sets out extremely clearly and concisely my own view, which is that it is much better to have a focused, short debate, in which local people can opt into the process on the basis of strict criteria, than to have a drawn-out, lengthy debate that may or may not end up with a particular resolution being taken some years in the future.

Mr. Kevan Jones: Like the hon. Member for Cambridge (David Howarth), I support unitary authorities and welcome the measures in the Bill. I am sure that my right hon. Friend agrees that local people should have a say, but will she explain why her civil servants told chief officers that bids, such as that which will be made by Durham county council, will be successful and top of the pile only if they include one of the barmy ideas about directly elected executives?

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