Greater London Authority Bill

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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.
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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Prepared 12 January 2007