Clause
24
The
general power of the Authority: duty to have
regard
Michael
Gove:
I beg to move amendment No. 15, in
page 26, line 7, at end
insert—
‘(3A) After
subsection (5)
insert—
“(5A) Any
strategy or revision to any strategy to which this section applies
shall subject to the approval of the
Assembly.”.’.
As
is clear from our debate earlier, there is substantial consensus among
Committee members that the Mayor should enjoy powers to address health
inequality. It is important to ensure that such powers are exercised as
effectively as possible. The amendment would ensure that the democratic
deficit alluded to by the hon. Member for Battersea is addressed even
more comprehensively. It would ensure that, although the Mayor has the
power to develop a strategy, the assembly will have the power to amend
it. On the principle that two heads are better than one, 26 are surely
better than one.
When
we talk about inequality with regard to the NHS, some people might be
tempted to ask whether that is the most important factor. Would
reducing inequalities in the NHS mean aiming at one target rather than
concentrating on others? Dealing with inequalities in health outcomes
is a vital measure of how successful the NHS
is.
My hon. Friend the
Member for Tunbridge Wells (Greg Clark) recently attracted a degree of
controversy by mentioning that, on poverty, Polly Toynbee might have a
better way with a metaphor than Winston Churchill. He was correct,
because Polly Toynbee’s metaphor of the caravan moving through
the desert applies to the NHS as powerfully as it does to any other
collective organisation seeking to deal with inequalities
in our society. Her arresting metaphor was intended to demonstrate or
underline that it is important that, as a society makes progress, it
does so in such a way that the gap between those at the top and those
at the bottom does not become too great, because if it does there are
problems. In the past,
some Conservatives have argued, when asked about their commitment to
social justice, that all that matters is that a rising tide lifts all
boats and the difference between people does not or need not matter so
much. This Committee sitting gives me the opportunity to stress
something that I am anxious to get across, which is that we
Conservatives believe that poverty can be measured in both relative and
absolute terms and that, on the NHS and its founding principles, the
way in which the NHS provides a guarantee of a base level of treatment
to all, regardless of income, is a vital way of ensuring social
cohesion and social justice. In that respect, the Mayor’s health
strategy is right, since he has a specific responsibility to address
inequality.
As I said,
the hon. Members for Battersea and for Mitcham and Morden talked about
the need to give people a voice in shaping the future of the NHS. Our
amendment would give those who serve on the GLA an opportunity to
influence the Mayor’s strategy. I suspect that the Mayor himself
would welcome this change. It is certainly a change that the assembly
seeks.
Stephen
Pound:
I am sure that the hon. Gentleman will correct me
if I am wrong, but I thought that, when the assembly considered this
matter on 6 December 2006, it voted against that and said that it did
not want this additional power. That was a minuted meeting of a full
assembly.
Michael
Gove:
I understand from my hon. Friend the Member for
Croydon, Central, who serves on the assembly, that there is an appetite
among assembly members for the chance to influence the strategy.
Extending this power to the assembly would be in its interest.
Politicians occasionally feel that they are overburdened, but I cannot
imagine that any part of policy is more important than the future of
the NHS and I cannot imagine anyone who is better fitted to influence
the Mayor when it comes to adopting this strategy than my hon. Friends
the Members for Bromley and Chislehurst and for Croydon, Central. In
fact, both my hon. Friends have mentioned that the need for a greater
degree of public involvement in shaping health strategies lies behind
an amendment that they have tabled on a different part of the Bill. The
power to shape or influence that strategy would be useful because of
the scale of the health challenges faced by Londoners. London has
specific problems that would be best addressed by the collective
endeavour of all those involved in the assembly, as well as the
Mayor.
When the Labour
party rewrote clause IV of its manifesto, the authors of the rewritten
clause IV said that we achieve more by collective endeavour than on our
own. It is in that spirit that this amendment is
tabled.
Martin
Linton:
Do I take it that we can welcome the hon. Member
for Surrey Heath not only to Toynbeeism, but to
socialism?
Stephen
Pound:
Actually, we’re full. There is a waiting
list.
2.45
pm
Michael
Gove:
There probably is a waiting list for membership of
the Ealing, North Labour party, but I suspect that the Battersea Labour
party has its doors wide open to welcome anyone. I merely wish to point
out that the logic of the Labour party’s constitution would
suggest that members, whether they are serving on the GLA or this
Committee, might look favourably on this
amendment.
I said that
it is through common endeavour that we can come up with better
solutions. The scale of the challenges facing NHS London is
significant. London has the highest level of sexually transmitted
infection and the fastest growth in HIV infection of any region in the
United Kingdom. That raises specific health challenges and those are
concentrated not exclusively but disproportionately in particular
geographical and socio-economic sets of the population. Having the
wider spread of voices that the GLA can provide to help the Mayor shape
his strategy will ensure that that concern is
addressed.
There is
another growing concern, which all of us who are concerned about the
health of Londoners have to address too, and that is the growth in
respiratory infections. Tuberculosis, which many of us would have
suspected was a disease that our grandparents knew but had been
banished from our lifetimes, has returned. It is inevitably associated
both with overcrowding and with migratory flows and is concentrated in
the east end of London.
The Mayor has taken an interest
in the health and welfare of the citizens of the east end of London but
it would be entirely appropriate if those who represent that area in
the GLA—and others who take an interest in health—were
also able to bring their expertise to bear when it came to shaping the
strategy.
I mentioned
migratory flows. One of the reasons for London’s success is that
it has been a city that is in every respect open for business. It has
been a uniquely welcoming global city for people who have come here and
contributed their skills, expertise and knowledge. However, we have to
acknowledge that not only have economic benefits been brought, but new
health challenges have arisen. The migratory flows have helped the NHS
because many of the people who work in it and on whom we rely for care
are new British citizens. We welcome that but it would be wrong to omit
the fact that along with all the benefits that these changes have
brought, there are new challenges. In order to address them
effectively, we believe that it would be appropriate to have the range
of voices that the GLA can provide to help shape the
strategy.
Stephen
Pound:
I am reluctant to interrupt the hon. Gentleman
because—it pains me to say this—he talks a great deal of
sense. His point about the changes in the health profile in London is
well made. However, in reference to the amendment to which he is
speaking, I
can tell him that in my borough of Ealing, particularly in the Southall
area of the constituency, we do have a problem with tuberculosis and it
is addressed by community representation on the primary care trust, on
the board and at public meetings and through elected representatives
from the council in partnership with the primary care trust. May I try
to convince him that where such a problem exists, as it does in my part
of my world, we have the democratic avenues to bring that to the
attention of the people who provide the cures and the treatments, and
that we do not seek the additional power that he is proposing
today?
Michael
Gove:
I thank the hon. Gentleman for his point. I am sure
that those dedicated professionals and others who collaborated in the
work of the PCT that covers his area and also cover Ealing, Southall
have done an exemplary job in addressing these new health
challenges.
However
the point that I was about to make in summing up is that the NHS has
had to endure a series of reorganisations under this Government. It
endured a series of reorganisations under the past Conservative
Government but let us look particularly at this
Government.
That
series of reorganisations has seen, for example, the abolition of
smaller-scale PCTs and their consolidation into larger PCTs. There
might be efficiency gains but there is also inevitably a loss of
accountability and closeness to those people who are most affected. One
thing that our amendment seeks to do is to reintroduce a degree of
accountability into one part of the strategic leadership of the
NHS.
One of the
consequences of reorganisation within the NHS is that individuals have
often had to apply, reapply and then reapply for the same job. My right
hon. Friend the Member for Witney (Mr. Cameron) at the
Conservative Party conference recently pointed out that the individual
who is currently director for public health for the south west has been
doing the same job since 1997 but has had to reapply for it at least
seven times.
The
previous clauses in this Bill will ensure that the current director for
public health for London becomes the Mayor’s health adviser. I
suspect that that individual will carry on doing an admirable job but
once again that individual will be forced to jump through another
reorganisational
hoop.
The consequence
of these reorganisations has tended to be—particularly in the
past two years—a drift away from local involvement in and local
control over the provision of health services. As the scale of the
challenges faced by the NHS increases—the funds available to it
face additional pressures and it moves away from local
people—this simple amendment would allow a re-injection of local
voices back into the process of setting health priorities. It is for
that reason that this simple amendment should recommend itself to the
Minister and indeed to the
Mayor.
Tom
Brake:
The hon. Gentleman is always persuasive, as he was
in outlining his arguments for the amendment. However, I have to
announce a temporary estrangement with the official Opposition on this
subject. Clearly the Government’s position is not to allow
wholesale change
to the Bill. Our role is to ensure that the scrutiny function is
enhanced, as we argued in the case of confirmation hearings. Our role
is also to ensure that the basic parameters within which the Mayor and
the GLA operate are appropriate—hence the debate that we had
over the budget and whether we should or should not agree a budget on a
simple majority.
We do
not particularly like the existing model of strategic government, which
we have sought to modify. Pushing through the amendment and in effect
giving the assembly the power of veto over every mayoral strategy
destroys the strategic model of government in London that one wants to
see and which we support. For the Mayor to operate in a strategic
manner would be impossible if each and every one of his strategies had
to be approved by a simple majority in the assembly. I will have to
part company with the hon. Gentleman on the amendment. If the matter is
pressed to a vote, then I may reluctantly join the larger numbers on
the other side of the
Committee.
Mr.
Pelling:
The assembly has done good scrutiny work in the
area of health—on TB, the immunisation of children, the sexual
health of young people, care for HIV sufferers, neonatal care and,
rather more controversially in the House, the cessation of smoking.
Clearly there is some confusion and controversy. I do not want to
regard myself as a messenger from the assembly—I have probably
done that far too often—but my understanding is that the
assembly supported all the clauses on health and health inequality, but
did not divine whether it should be involved in signing off any health
inequalities strategy of the Mayor. There has been no positive or
negative vote as the hon. Member for Ealing, North
suggested.
I am
interested in the comment by the hon. Member for Carshalton and
Wallington. He put the role of the assembly into clear relief. Is it
there primarily to scrutinise or does it, through its representation,
have some role in securing the effort from the Executive within
London’s governance in carrying its policies through the
assembly on important issues such as health? I would put it to the
Committee that, if the London assembly is purely to be a glorified
local government scrutiny committee, then expenditure of £11
million per year on such a project surely cannot be justified in terms
of value for the public
purse.
Martin
Linton:
In a genuine spirit of inquiry, I wondered whether
the hon. Gentleman agreed with the right hon. Member for Witney, who
said in his interesting pamphlet on the permissive
state:
“We
are...committed not only to keeping the Mayoralty but to enhancing
the powers of the
office.”
If the hon.
Gentleman agrees, could he explain how he squares that with supporting
an amendment that would give the assembly a veto over any health
strategy put forward by the
Mayor?
Mr.
Pelling:
I am grateful for the hon. Gentleman’s
constructive and helpful intervention. It allows me to place on the
record the fact that Conservative Members are firmly in favour of
devolution of significant powers to London’s governance, not
only those under the Bill, but direct powers over the learning and
skills council in
London, which has been parked into an arm’s length skills
commission with a powerless effect. We are in favour of NHS London
being within the powers of the Mayor. We would go a great deal further
than the
Minister.
However, if
we are to strengthen the powers of the Mayor, it is important to be
robust about the accountability to which he is held by the assembly. It
is depressing that in many ways so far in the debate the Government
have been dismissive of the role of the assembly as existing purely to
consider matters of general interest within London politics. If we are
to spend £11 million of public money in such a way, we must ask
ourselves whether the process of putting together an assembly for that
rather minor role is good value in respect of the expenditure of public
money.
Tom
Brake:
I am just wondering what thought the hon. Gentleman
has given to how a stalemate would be resolved if the amendment were
adopted and the assembly did not like a particular strategy that the
Mayor put forward. How would he resolve such a
conflict?
Mr.
Pelling:
Bearing in mind that the hon. Gentleman must be
dreaming of a hung Parliament, stalemates can sometimes be resolved by
discussion.
Tom
Brake:
I dream of much more exciting
things.
Mr.
Pelling:
I thought that the sobriety of the Liberals in
Carshalton would not allow such dreaming to take
place.
It is within
the ability of politicians, whether in London’s governance or
elsewhere, to discuss and negotiate. So far the response from the Mayor
under that strong mayoral model is that he has been elected, he decides
what happens and he can ignore what people say. We are in great danger
of creating a structure in which the mayoral model is far too strong.
If we are to invest so much money, £11 million a year, taking
into account all the salaries—[Interruption.]—one
of which I admit that I am taking, we must give the assembly more teeth
to hold a Mayor to
account.
Jim
Fitzpatrick:
We do not accept the amendment,
notwithstanding the important and serious health issues to which the
hon. Member for Surrey Heath referred. The hon. Member for Carshalton
and Wallington said that we have put forward the principle by which we
are addressing the mayoral strategies and the role of the assembly, and
sharpening up the role of the assembly to ensure that the Mayor has due
regard to the comments that assembly members make in helping to develop
strategies during
consultation.
The
Mayor is responsible for producing eight statutory strategies. The Bill
makes provision for a further four. The assembly has an important role
in developing those strategies. We have already included provision
under clause 2 to sharpen up the assembly’s role in policy
development. The clause places an explicit requirement on the Mayor to
have regard to the assembly’s comments and those of the
functional
bodies in response to consultation. It also requires the Mayor to write
to the assembly identifying which comments he accepts and, when he does
not, the reasons for not accepting its
recommendations. We do
not believe that the assembly’s powers should be extended
further to allow it to approve the Mayor’s strategies. That
would risk blurring the clear lines of accountability for the
strategies. It could also provoke the question of what the next steps
should be if the assembly does not approve a strategy. We ask that the
amendment be
withdrawn.
Michael
Gove:
I am very disappointed that the Minister is not
willing to accept the amendment. If anything, I am even more
disappointed that the hon. Member for Carshalton and Wallington feels
that he cannot support it. Faced with such overwhelming numerical
odds—
Stephen
Pound:
You will fight
on.
Michael
Gove:
I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
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