Clause
22
The
health inequalities
strategy
Question
proposed, That the clause stand part of the
Bill.
Siobhain
McDonagh:
I welcome the clause, which allows the Mayor
responsibility to look at health inequalities across London. I fear
that the way in which the NHS is currently organised is deficient in
taking into account all areas within London and in appreciating the
effect that something done in one primary care trust might have on a
hospital in another.
I
am saddened and disappointed that the powers given in the clause are
not larger. I should be grateful if the Minister would consider whether
in future the Mayor might also have the right to be consulted on any
hospital reconfiguration project that occurs in the London area. Areas
of health inequality within a primary care trust—generally a
combination of five or six constituencies—can often be quite
small, and the people who live there are often not represented on any
health boards, be they those of the primary care trusts or of the
hospitals. They need a voice and need to be listened to; the Mayor can
provide that function, as he can for any plan to close a hospital in
the London area, which has an immediate impact on neighbouring
hospitals.
In my own
area, consideration is being given to whether a critical care hospital
should be placed on the current St. Helier site—which I stress
is not in my constituency, but in that of the hon. Member for
Carshalton and Wallington, but serves half of my constituency. The
possible movement of that hospital, even only a few miles away, will
have a drastic impact on the ability of St. George’s in Tooting,
the Mayday in Croydon and Kingston hospital to
function.
Martin
Linton (Battersea) (Lab): Does my hon. Friend agree that
while the NHS is superbly equipped to carry out its job of providing
health for the
population, the structure has a democratic deficit? That is, the NHS is
not so well equipped to carry out large reconfigurations that involve
public consultation and taking account of the strong feelings that
there might be in an area. Giving the Mayor an automatic right to be
consulted on such cases would introduce a much-needed sense of
political representation and accountability into a system that was
never really designed so. My hon. Friend and I share a local hospital
trust, which, while very good, does not have much experience of
carrying out such large
consultations.
Siobhain
McDonagh:
I wholeheartedly agree with my hon. Friend.
Unlike what appears to be the direction of travel of the Front Benches
of the Government and the Opposition, I believe that there is need for
a greater democratisation of the health service, not less. If people
democratically had responsibility for the health service, our hospitals
would not sometimes be dirty, but always clean, because that would
determine the life of the elected officials or politicians and whether
they were going to be re-elected or not. I appreciate that that is a
radical view for this particular matter, but I believe that the clause
is a step in the right direction. I urge my Government to consider
allowing the Mayor to have responsibility for considering all hospital
reconfigurations, because of London’s densely populated nature
and the huge impact that a decision made miles away can have on
everyone’s health service.
Tom
Brake:
I should perhaps have begun my earlier remarks by
apologising for not being here earlier because I had to attend a
private event in my constituency.
I support the clause, but I
also support what the hon. Lady has just said. It is clear that a
health inequalities strategy devised by the Mayor has every prospect of
being totally derailed by decisions taken on hospital reconfigurations.
Had her amendment been selected, I would have spoken in favour of it
too. She referred to our local hospital—St. Helier—which
is located in an area of great health need. There is a prospect that it
might go in the hospital reconfiguration, and if that were to happen,
the impact on any health inequalities strategy drawn up by the Mayor
would be huge. If he is not involved in consultations, his health
inequalities strategy becomes almost
meaningless.
The hon.
Lady might say that we could take this even further, because the
consultation could be extended to local authorities. However, that is
outside the remit of the Bill and of this debate. I support the clause,
but the Mayor should be given greater powers to be involved with the
key decisions so as to provide a first step in terms of democratic
accountability in an area of major service provision that is singularly
lacking in
it.
Mr.
Andrew Pelling (Croydon, Central) (Con): It is a great
pleasure to serve under your chairmanship once again, Mr.
O’Hara. I support the comments made by the hon. Members for
Mitcham and Morden, for Battersea and for Carshalton and Wallington,
because this Bill was an opportunity to go further in terms of the
responsibility of London’s governance. That is not to deny the
excellence of the clauses that we are discussing. I know that there is
a variation in life expectancy of
more than 10 years between one part of my borough of Croydon and
another. That loss for the people whom we represent is an important
consideration and should be an important consideration for
London’s governance.
It is important for the
Committee to know that Conservative Members would go further than the
proposals suggested so far; we should have confidence in
London’s governance, and NHS London should be run by the Mayor
and the Greater London authority. There has been a tremendous amount of
change in the strategic health authority organisation in London. It was
a confusing process in terms of having a sub-regional structure. Given
the move to NHS London, it would have made a great deal of sense for
that power to have gone to London’s governance as part of the
process.
I accept that
the Government must have told the Mayor that there was no way that he
was going to get his hands on NHS London, but there has been a great
deal of talk about accountability. Even Members of Parliament have
frustrations in understanding the opaqueness in the governance of our
health services in London. One of the great benefits of the
reintroduction of London’s governance is the ability to quiz the
Mayor for two and a half hours every month. There could be an
opportunity for London’s representatives to ask questions,
through the London assembly, on important issues such as St. Helier
hospital, which was raised by the hon. Member for Mitcham and Morden,
although the hospital is located in the constituency of the hon. Member
for Carshalton and Wallington. Perhaps the democratic process
represented by many thousands of people marching to save that hospital
would have found its way of being communicated through London’s
governance much more effectively had NHS London been within the London
power
structure.
2.30
pm
It seems odd
to propose so many responsibilities for the Mayor to drive forward the
health inequalities strategy, but in previous clauses to provide for
health advisers to address it through a separate process run by NHS
London, which would denude the Mayor of the power to improve
London’s health. I am sure that much of the local governance
legislation that passed through this House over 120 years ago concerned
public health. It was seen to be important then that city leaders
involved themselves in that matter, and we too should have confidence
in
them.
Michael
Gove:
I thank the hon. Member for Mitcham and Morden for
her contribution. I thank also my hon. Friend the Member for Croydon,
Central and the hon. Members for Battersea and for Carshalton and
Wallington for the valid points that they made. We support the clause,
and as my hon. Friend the Member for Croydon, Central pointed out,
accept and endorse the argument that there is a lack of effective
public scrutiny and oversight of the reconfiguration of hospital and
other NHS facilities. As the hon. Member for Battersea pointed out,
there is a democratic deficit, which has been exposed by the way in
which Members of the Government have felt the
need to take to the streets and join picket lines in order to emphasise
their unhappiness with the NHS’s central direction. That is an
unprecedented situation—Government Ministers joining the public
to protest the Government’s own
policy.
Siobhain
McDonagh:
On that point, I feel the need to rise in
support of the Minister without Portfolio, my right hon. Friend the
Member for Salford (Hazel Blears). I believe that she was doing her job
as a constituency MP, as is her right. The Government set policy and
local decisions are made locally. I do not feel that there is enough
democracy in decisions made at ground level and so applaud my right
hon. Friend’s support of her
constituents.
Michael
Gove:
I am glad to put it on the record that we support
entirely the Minister without Portfolio, who is simply following in the
footsteps of those of us campaigning against Gordon Brown’s NHS
cuts. A campaign was launched at the Conservative party conference and
has been followed up by work in the media and particularly on the
ground. Rallies have been organised up and down the country to protest
NHS cuts. The Conservative party has taken a lead in that and I am
delighted that the chairman of the Labour party has joined one of our
initiatives.
Stephen
Pound:
I realise that I might be trespassing on your
patience, Mr. O’Hara, but I think that the hon.
Gentleman’s point must be addressed for the record. I appreciate
that it is not immediately germane to the matter under discussion, but
my right hon. Friend the Minister without Portfolio was actually
protesting the position of Hope hospital, not the Manchester
reconfiguration plan. As I am sure the hon. Gentleman is aware, her
constituency is between the areas served by the Royal Bolton hospital
and St. Mary’s hospital. She was protesting the particular issue
relating to Salford Hope hospital and not condemning either the
Manchester reconfiguration plan or the Government’s
policy.
The
Chairman:
Order. I think that the relevance of the point
has been established. May we return to Mr.
Gove?
Michael
Gove:
I am grateful for that clarification, but broadly,
the Minister Without Portfolio was objecting to the way in which the
NHS, operating under the constraints placed on it by the Chancellor of
the Exchequer, is unfortunately having to make decisions that do not
satisfy the public. That lay behind the point made by the hon. Member
for Mitcham and
Morden.
The
Chairman:
Order. I think that we should return to the
matters under
debate.
Michael
Gove:
On the attempted amendment tabled by the hon.
Member for Mitcham and Morden, which sadly has not been selected for
debate in Committee, I invite her, if the opportunity exists, to
resubmit it on Report. I think that we could have a very interesting
debate and perhaps other Members, not just those representing London
constituencies, who want a more
democratic structure in the NHS, could contribute. I would invite her
also to speak in that debate. It would be interesting to see which
members of the Labour party take that view because, as she rightly
pointed out, the Treasury and the Chancellor seem to think that were
the latter to have full control of the NHS, such decisions would be
made even further from individuals with the creation of an independent
structure that insulates NHS decisions from political
influence.
As I
suspect most of us know, the hon. Member for Mitcham and Morden is also
the Parliamentary Private Secretary to the Home Secretary. I do not
want to intrude into internal Labour party matters, but if there were a
Reid-Brown split on the NHS, with the Reidites on the side of greater
democracy and the Brownites on the side of greater centralisation, I
would love to hear the hon. Lady’s contribution to that debate,
as well as that of the Minister for Housing and
Planning.
Siobhain
McDonagh:
As a clarification, I am speaking completely on
my own behalf and not on anybody
else’s.
Michael
Gove:
It is an interesting reinterpretation of the
doctrine of collective responsibility, but whenever the hon. Lady
speaks, we all pay close attention. I believe that the Conservative
party sympathises with the substance of her comments and the principle
behind her speech and
amendment.
Jim
Fitzpatrick:
In respect of the public’s view on our
unprecedented expenditure on health in the past decade—compared
with £21 billion in prospective tax cuts in the
Conservatives’ report last October—they will have an
opportunity to express it in due
course.
The clause
will require the Mayor to prepare and publish a statutory health
inequalities strategy containing proposals for promoting a reduction in
health inequalities. The strategy will identify the role of any
relevant strategic body in implementing it. The clause defines
“health inequalities”
as
“inequalities in
respect of life expectancy or general state of
health”
as a result
of
“general health
determinants”.
General
health determinants include housing, transport services, employment
prospects, ease or difficulty of access to public services and
lifestyle or behaviour aspects. Genetic or biological factors are
excluded. Although the Mayor is not responsible for health policy or
health services delivery, he is responsible for some of the major
health determinants outside the NHS’s
responsibility.
The
new powers that the Bill will bestow on the Mayor could impact on
health and health inequalities. The Mayor must collaborate and
co-operate with the health adviser in preparing or revising the health
inequalities strategy and have regard to any guidance given by the
Secretary of State. The Mayor must also consult relevant bodies likely
to be affected by the strategy. The Mayor’s new powers are in
line with his strategic role and are concerned primarily with the
general health determinants that he influences or for which he is
responsible. The NHS is the national health service accountable to
Parliament, and the delivery of
health services will remain its responsibility. The Mayor will meet
regularly with the health adviser as well as the chief executive of the
London strategic health authority, which will provide an opportunity
for regular discussions on major health issues of strategic importance
to London. A mechanism
for consulting the Mayor has been established in a memorandum of
understanding between him and NHS London, and the Secretary of State
has set the national policy framework within which the NHS must
operate. Any future reconfiguration in London will also have to comply
with the principles outlined in NHS London’s plan,
“Health Care for London: A Framework for Action”. The
Mayor and his health advisers are working together to ensure that the
London framework and the Mayor’s health inequalities strategy
are developed in tandem and are consistent and
complementary.
I know
that that does not answer many of hon. Members’ comments, but I
thank my hon. Friend the Member for Mitcham and Morden for raising the
issue. It has been an important exchange, and I know that people would
like the Bill to go further, but for the moment I urge that the clause
stand part of the
Bill.
Question put
and agreed to.
Clause 22 ordered to stand
part of the
Bill.
Clause 23
ordered to stand part of the
Bill.
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