The
Committee consisted of the following
Members:
Chairs:
Mr
Jim Hood
, †
Mr
Mike Hancock
†
Abrahams,
Debbie (Oldham East and Saddleworth)
(Lab)
†
Barron,
Mr Kevin (Rother Valley)
(Lab)
†
Blenkinsop,
Tom (Middlesbrough South and East Cleveland)
(Lab)
†
Brine,
Mr Steve (Winchester)
(Con)
†
Burns,
Mr Simon (Minister of State, Department of
Health)
†
Burstow,
Paul (Minister of State, Department of
Health)
†
Byles,
Dan (North Warwickshire)
(Con)
†
Crabb,
Stephen (Preseli Pembrokeshire)
(Con)
†
de
Bois, Nick (Enfield North)
(Con)
†
James,
Margot (Stourbridge)
(Con)
†
Kendall,
Liz (Leicester West)
(Lab)
†
Lefroy,
Jeremy (Stafford)
(Con)
†
Morgan,
Nicky (Loughborough)
(Con)
†
Morris,
Grahame M. (Easington)
(Lab)
†
Poulter,
Dr Daniel (Central Suffolk and North Ipswich)
(Con)
†
Pugh,
John (Southport)
(LD)
Shannon,
Jim (Strangford)
(DUP)
†
Smith,
Owen (Pontypridd)
(Lab)
†
Soubry,
Anna (Broxtowe)
(Con)
†
Sturdy,
Julian (York Outer)
(Con)
†
Thornberry,
Emily (Islington South and Finsbury)
(Lab)
†
Turner,
Karl (Kingston upon Hull East)
(Lab)
†
Twigg,
Derek (Halton) (Lab)
†
Wilson,
Phil (Sedgefield) (Lab)
Chris
Stanton, Mark Etherton, Committee
Clerks
† attended the
Committee
Public
Bill Committee
Thursday
10 March
2011
(Afternoon)
[Mr
Mike Hancock
in the
Chair]
Health
and Social Care
Bill
Schedule
13
Local
Healthwatch
Organisations
1
pm
Question
(this day) again proposed, That the schedule, as amended, be the
Thirteenth schedule to the
Bill.
The
Minister of State, Department of Health (Paul Burstow):
Before we adjourned my hon. Friend the Member for Stafford was speaking
about the lessons we should learn from the way in which local
involvement networks have operated when considering the future of
healthwatch. One of the points that I take from his and other
contributions is the importance we attach to ensuring that the seldom
heard and hard-to-reach groups and, bearing in mind the comments of
Mind, Rethink and others, people with mental health problems are
properly engaged and involved in healthwatch. HealthWatch England will
provide guidance about sharing best practice across the network of
local healthwatches up and down
England,
We
were asked a number of questions about the funding mechanisms for
allocating resources. Just as LINks do now, local healthwatch
organisations will receive their funding via local authorities which,
in turn, will receive their funding via the formula grant mechanism, so
resources will be available for local authorities to discharge their
duties to commission these services. The vision for local healthwatch
is clear: it is to build on existing structures and experience and to
make sure that we share the best practice. All of that has to be done
and be firmly grounded in local determination—an approach that
is backed by many of the stakeholders who felt that some of the
previous iterations of public and patient involvement over the past
decade or so were top-down and heavy-handed and have not enabled the
patient voice to be articulated as strongly as we want. That is why
central Government will not decide every last detail of the way these
boards work.
The curious
thing about amendment 357, which we discussed this morning, was how it
highlighted the dichotomy in the Opposition’s approach to the
Bill. On the one hand, they are worried about the Secretary of State
appointing the chair of HealthWatch England, but on the other hand they
seem to want to prescribe in minute detail the membership and operation
of local healthwatch. That seems strange. I hope that the hon. Member
for Islington South and Finsbury will feel that we have had a good
debate on these issues and that I have reassured her enough that she
will not press her amendment to a vote.
The
Chair:
There is no
amendment.
Question
put and agreed
to.
Schedule
13, as amended,
accordingly
agreed
to.
Clause
168
Activities
relating to local care
services
Paul
Burstow:
I beg to move amendment 425, in
clause 168, page 140, line 38, at
end insert—
‘( )
At the end of that paragraph, insert “and to
the Healthwatch England committee of the Care Quality
Commission.”’.
I
apologise for the slight confusion just now. The amendment will ensure
that local healthwatch organisations can make known to HealthWatch
England the views of local people, as well as reports and
recommendations. It will help HealthWatch England to fulfil its role as
the national consumer champion for health and social care by ensuring
that matters that are important to the public, patients and other users
of care services can be brought to its attention.
Amendment
425 agreed
to.
Emily
Thornberry (Islington South and Finsbury) (Lab):
I beg to move amendment 349, in clause 168, page 141,
leave out lines 2 to
4.
The
Chair:
With this it will be convenient to discuss the
following:
Amendment 352,
in
clause 170, page 142, line 22, after
‘Independent’, insert ‘advice, information
and’.
Amendment
353, in
clause 170, page 142, line 22, at
end insert—
‘(1) Each local
authority must make such arrangements as it considers appropriate for
the provision of advice and information about access to local care
services and about choices that may be made with respect to aspects of
those services.(2) Where
arrangements under subsection (1) provide for the local Healthwatch
organisation for the authority’s area to provide the services or
to arrange for their provision, the arrangements are to be treated for
the purposes of this Part as arrangements made under section
221(1).’.
Government
amendments 426 to
433.
Emily
Thornberry:
Amendments 349, 352 and 353 are designed to
probe the various functions of local healthwatch organisations by
offering further discretion to local authorities.
The problem is
that local healthwatch members are being asked to do a number of jobs
at the same time, many of which are contradictory. As part of local
healthwatch boards, they will have commissioning responsibilities, but
they will also have the jobs of providing provide information and
advice on choices in local health and social care services; providing
advocacy and a complaints service; and playing a role in policing local
services—they will be doing it all. They will commission, say,
social care in a local area, provide information on that care and
police the care that they commissioned and provided advice on; and if
anything goes wrong, they will also provide advocacy and complaints
services in relation to the social care that they commissioned and
provided advice on. It may be that they commission a service, advise
someone to go to it, police it but fail in that policing, and thus
generating a complaint for which they then provide the advocacy
service.
Paul
Burstow:
I am grateful to the hon. Lady for giving way
while she is developing her argument, but I want to make it absolutely
clear that local healthwatch bodies will not commission services for
the public, in the sense of a social service. They may well commission
an advocacy service that they have a function to provide, but they
would not be commissioning direct services for the public of the sort
she
describes.
Emily
Thornberry:
Not as healthwatch, they will not, but as part
of the health and well-being board, as we understand it, they will have
a role in the commissioning of services and ensuring that services come
together
properly.
Paul
Burstow:
Again, the hon. Lady’s point is not
entirely correct. The health and well-being board will do the joint
strategic needs assessment and the joint health and well-being
strategy, but the commissioning responsibility will remain with the
local authority as the
commissioner.
Emily
Thornberry:
I do not want open up an argument about local
accountability that we will definitely be coming to soon. However,
there are times when one sits back and listens to Ministers seeming to
claim all kinds of powers for health and well-being boards, but one is
then disappointed to look at the Bill and see that it is an empty
promise.
What is the
role of people on the health and well-being board? What are they doing
there? What job are they fulfilling? Whatever job the health and
well-being board is supposed to be doing—it may be very
little—they will be doing that, and they will be providing
advice and information, providing advocacy and complaints services, and
playing a policing role. I am sure the Minister understands that, even
if we take out the commissioning role, the very fact that local
healthwatch give information on the service, police it, and provide
advocacy services creates a conflict. They are doing
everything.
I cannot think
of a parallel. I was thinking about it in terms of a magistrates court
and all the different roles people play there. Local healthwatch would
be the magistrates, the police, the prosecution counsel and the defence
counsel. Local healthwatch seems to do everything—that is all I
am saying. It seems contradictory to me, but if the Minister feels that
it can be dealt with and that local healthwatch can do all these
different things at the same time, I still come back to the question
how they will be able to fulfil all of those functions.
Local
healthwatch bodies will need a number of different skills to perform
all their functions; presumably, they will need a number of members of
staff who have those skills, and therefore a substantial budget, yet it
is unclear what budget local authorities will provide, if any. There
certainly does not seem to be a budget that is ring-fenced. Given the
appalling cuts to which the Government are subjecting local government,
it is unlikely that there will be available the substantial budget that
local healthwatches will need to fulfil the myriad tasks the
legislation gives them.
For that
reason, we tabled these probing amendments. We want the Minister to
tell us how local healthwatches can do all those different jobs, with
presumably very little funding and perhaps very little support. We want
reassurance from him that local healthwatches are not being set up to
fail, because there is concern that that is exactly what will
happen.
Paul
Burstow:
I hope that I can reassure the hon. Lady and
others who might have concerns about the policy intention and the
effect of the Bill. Our clear purpose is to amplify the voice of
patients and carers in the system. They have a chair at the local
authority table and on the health and well-being board for that very
reason—to make that their voice is heard loud and clear at key
points when discussions are taking place and decisions are being made
on the local population’s future and current strategic needs for
health and social care. In the framing and setting of priorities in the
strategy that comes from that joint strategic needs assessment, again,
we want to ensure that voice has real leverage, purchase and impact at
the most important time. Like the JSNA, that strategy will be an
important document because of the clauses of the Bill that place into
law, for the first time, the requirement that commissioners
“must have regard to” it. We know that that is more than
just words; it leads to legal interpretations. Looking at those two
pieces of work will require a degree of rigour and evidence of rigour,
so healthwatch will have a very important role locally.
The Opposition
amendments in the group relate to the functions proposed in clause
168(3) to be given to local healthwatch organisations to
provide
“advice and
information about access to local care services and the choices that
may be made with respect to aspects of those
services”.
Amendment
349 would remove that function from clause 168. Amendment
353 would relocate that aspect of clause 168(3) to clause 170, which
deals with the independent advocacy services, which the hon. Lady
touched on, but with the added provision that the local authority
would
“make
such arrangements as it considers
appropriate”.
Amendment
352 would change the title of the clause to, “Independent
advice, information and advocacy services”. Therefore, those
amendments would transfer responsibility for the relevant advice and
information functions from the local healthwatch to the local
authority.
Clause
168 amends the Local Government and Public Involvement in Health Act
2007 to include those additional functions, which local healthwatch
organisations will have to carry out. We want it them clear on the face
of the Bill as responsibilities of local healthwatch, not matters for
the local authority to subcontract to local healthwatch organisations.
That includes the provision of information and advice to the public
about accessing health and social care services and about choices in
aspects of local care services. Providing information and advice is
important if we are to ensure that the public and patients are given
the information to help them to make the informed decisions we want
them to be increasingly able to
make.
1.15
pm
Emily
Thornberry:
The hon. Gentleman and I are in agreement on a
number of issues. It is certainly important that people be given
information, particularly about social care, and especially when they
are self-funders. Far too often at our advice surgeries, we come across
people who are self-funders and simply do not know where to go to find
long-term care, so we must have a good source of information. However,
there is a question in that.
As
I understand it, the Government have changed their position on
independent advocacy services in response to the consultation. They
have allowed local authorities to respond to local needs and decide to
take on the responsibility of advocacy services. In those
circumstances, is there not the same argument in relation to
information, so that information could be taken from healthwatch and
put into local authorities? I do not suggest that one is preferable; I
just want to understand the Government’s
thinking.
Paul
Burstow:
The first point is that there is nothing in the
current statutory and legal framework to preclude local government from
commissioning other information and advice providers; it still has its
powers to provide grants to citizens advice bureaux and many other
organisations. That does not change. In that sense, transferring the
responsibility from local healthwatch to the local authority merely
transfers to local authorities something that they already have the
power to do. We want to make it clear in the Bill that local
healthwatch can do such things. The Government consider that to be an
appropriate function for local healthwatch, not the local
authority.
Local
healthwatch organisations will be the local consumer voice. They will
have the knowledge about local provision of health and social care
services, and that will be important in helping people to find out more
about the services. On the question of contradictory roles or roles
that might stretch their skills and capabilities, HealthWatch England
will provide leadership and advice to local healthwatch. It will make
sure that there is appropriate support. That could include a framework
for skills and training for local healthwatch, if that is deemed
necessary. There is ample opportunity through the new arrangements that
we are making at a national level to support the necessary development
of skills.
We want local
healthwatch to be instantly recognisable as a reliable source of
information and expertise on health and social care while allowing for
those functions to be carried out by local healthwatch. The amendment
would not make it a requirement; that would lead to confusion for
service users and members of the public who will not be able to rely on
advice and information services being offered by their local
healthwatches.
Clause
168 sets out a function of providing advice and information about
access to local care services and about choices that may be made with
respect to aspects of those services. That will be a local healthwatch
function. In providing that each local authority must make such
arrangements only as it considers appropriate, amendment 353, in
effect—I appreciate that it is a probing amendment—would
dilute the current requirement. I hope that I have been able to offer
the hon. Lady some reassurance and that she will not press the
amendment.
Government
amendments 426 to 433 are minor drafting or technical amendments
relating to clause 170, to which we will come in due course. It relates
to the provisions of independence advocacy that the hon. Lady mentioned
just now. Clause 170 inserts new section 223A into the 2007
Act, which imposes a duty on local authorities to commission
independent advocacy services, as they consider appropriate, for
complaints relating to the provision of health services. A local
authority may commission these services with a third party or arrange
for advocacy to be provided by a local
healthwatch.
Amendment
426 is a minor drafting correction. The current subsection (4) of new
section 223A provides that a local authority may make arrangements, as
it considers appropriate, in addition to arranging independent advocacy
services, for the provision of assistance to individuals in connection
with complaints about the provision of NHS services. The amendment
simply moves subsection (4) to a better place. Amendment 429 is
consequent to amendment 426 and is also a minor drafting amendment. It
removes what was previously subsection (4), consequent on the contents
of subsection (4) being moved.
Amendment 427
closes a potential loophole that would have allowed third parties
commissioned by local authorities to arrange to provide independent
advocacy services, to arrange for the provision of those services from
a local healthwatch. Amendment 428 ensures that arrangements for local
healthwatch to provide new section 223A services are treated as made
under section 221(1) and that the service provision is
treated as an activity specified in section 221(2).
Amendment 430
closes a gap in new section 223A. In arranging for the provision of
services, the local authority needs only to have regard to the
principle of independence in relation to the provision of services
under the arrangements—for example, where the arrangements are
between a local authority and a provider. The amendment will also
ensure that the duty on the local authority applies in relation to the
provision of services in pursuance of arrangements under new section
223A, where the local authority arranges for a person to commission the
provision of services from another
person.
Amendment
431 is another technical amendment. New section 223A(6) will enable a
local authority to make payments to any person providing services under
new section 223A, but as drafted it does not provide a power to make
payments to a person who arranges the provision of those services. In
certain cases, a local authority may wish to make arrangements under
new section 223A for a person to commission services, and we do not
want to prevent local authorities making such
payments.
Amendment
432 will make a minor drafting change to new section 223A, to ensure
that duplicate payments cannot be made. Amendment 433 will close a gap
in the legislation, conferring regulation-making powers in relation to
the duties of service providers to allow entry by LINks, which will be
replaced by local healthwatches. As drafted, an authorised
representative must be carrying out a viewing or observation for the
purposes of undertaking activities specified in section 221(2), under
the arrangements in section 221(1). The amendment extends that by also
providing for the viewing or observation to be carried out for the
purposes of undertaking such activities in pursuance of the section
221(1)
arrangements.
I
hope that I have clearly set out all those amendments for hon. Members
and for the record. I end by saying that the hon. Member for Islington
South and Finsbury will have noted the unprecedented transfer, made by
the Government, of resources for social care from the NHS to local
government, and the support that that provides the
NHS.
The
Chair:
I missed part of that, Mr Burstow; I wonder whether
you could repeat it without your cribsheet.
[Laughter.]
Emily
Thornberry:
In response to the last point that the
Minister made—gratuitously—I should say that I am sure
that he is aware that the Local Government Group and the Association of
Directors of Adult Social Services believe that there will be a
£4 billion shortfall in the funding for social care. Our
concerns are cumulative, continue and grow in relation to the next
clause. I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Clause
168, as amended, ordered to stand part of the
Bill.
Clause
169
Local
authority
arrangements
Emily
Thornberry:
I beg to move amendment 350, in
clause 169, page 141, line 38, at
end insert—
‘(7C) Before
preparing this report, A must consider such information and consult
such organisations and persons as it considers appropriate, including
an overview and scrutiny committee where operated. A must describe in
the report the nature of the information considered and the names of
the organisations and persons
consulted.’.
The
Chair:
With this it will be convenient to discuss
amendment 351, in
clause 169, page 141, line 39, at
end insert ‘and
insert—
‘(8) Before
determining the arrangements to be made under section 221(1) the local
authority must consult such persons and representatives of such persons
as it considers can provide advice about arrangements that will secure
the requirements in section 222(7A) and must have regard to
the advice it receives when determining the arrangements to be
made.”.’.
Emily
Thornberry:
I begin by apologising to the Committee for
the amendments, but they are consistent with the Bill. I have to say
that making the amendment refer to “A must consider” as
opposed to “local authority” is unnecessarily obscure,
but we need it for
consistency.
It
is a huge shame and a great missed opportunity that proposals should be
being put forward for establishing local healthwatches without there
first having been a proper evaluation of LINks. What emerged from LINks
was that a host often did not provide a proper understanding of
community needs. I am sure that Members are aware of the written
evidence submitted by the Patients Association. The eighth bullet point
of point 6
states:
“We
are concerned that there is an expectation there will be a free
transfer from personnel in LINks to local HealthWatch. But we hear from
patients phoning our Helpline that the local LINks are not working and
that the service they are providing is
substandard.”
It
goes on to comment on the transfer of personnel in those circumstances.
The Patients Association believes that LINks are not working. Some
LINks work, but some definitely do not. Before establishing anything
new, we should have found out why some worked and others did
not.
Having
listened to evidence and the people who come to see me, I think that
one of the reasons is that when local authorities give support to
LINks, they establish a
host organisation that then organises the committees and gives
secretarial and administrative support, but may not be entirely
sympathetic to the way in which the LINk wishes to work. It may be too
inward-looking and may not properly understand the importance of
engaging the whole community. Sometimes they are only interested in one
particular part of the community, either geographically, racially,
socially, culturally or whatever. That has been one reason why LINks
have not worked. It is important, therefore, that local authorities
listen to the local community in relation to how they are going to
establish LINks. That is what the amendments seek to
do.
Without
a clear understanding of respective roles, local authorities could
commission hosts to provide levels of support that do not match the
aspirations of LINks. This is where the system can break down at the
very start, as LINks want support that hosts cannot provide because
their contract does not allow it. There is also the point that the
focus of LINks was often on one area of the borough at the expense of
another, and they can be dominated by a narrow set of interests, as I
have already
said.
The
amendments seek to ensure that the local healthwatch consults widely on
what its priorities should be and what the needs of the communities
are, so that it is in the best position to put in place the appropriate
resources right from the start. That is the purpose of the amendments.
They attempt to strengthen local healthwatch, because it is in the
interests of all of us that patient voice should be heard loudly,
clearly, fairly and proportionately at a local
level.
Paul
Burstow:
Let us start by dealing with the very fair point
about the evaluation of LINks and how the Government intend to proceed;
that will help the Committee as it considers the role of HealthWatch
and how the Government are intending to develop that role. We are
planning—as we are with the GP commissioning consortia—to
establish a network of pathfinders to explore and to learn by doing
under the current structures.
Just as we are
working with colleagues in local government to encourage and support
the establishment of health and well-being boards, so, too, are we
planning a similar approach with HealthWatch. That, along with links to
a number of action learning sets that will be established as part of
the evaluation of the pathfinder activity, will be used to explore more
fully the lessons learned during the pathfinder period and from the
LINks around the
country.
It
is also worth noting—I suspect that this is the source of some
of the points that the hon. Lady made—that the Centre for Public
Scrutiny, the Patients Association and the Local Government Association
are carrying out the very evaluation that she suggests is necessary. I
understand that they will report their findings in May. Of course, we
wait avidly to see what they find and how that will inform the
practical guidance and support that HealthWatch England will be able to
supply to healthwatch as it
develops.
Emily
Thornberry:
May I make the obvious point? We have three
groups looking into LINks and how successful they have been. We have
another inquiry looking into what happened in Mid Staffordshire. We
need to learn from all that, and yet the Government continue to force
through legislation relating to national HealthWatch and local
healthwatch without the benefit of learning from the experiences of
people up and down the country. Does not the Minister understand that
it is time to stop, listen and come back with better
legislation?
1.30
pm
Paul
Burstow:
On the contrary, we are listening, responding
and, where necessary, making sure that the Bill is improved. That has
been the nature of the process since July when we published the White
Paper. We consulted. We had 6,000 responses. We listened. We understood
the concerns and have addressed them in the Command Paper and the Bill.
There has been a process of ensuring that the Bill is fit for purpose
and actually delivers the devolution of power in the NHS that the
Government believe is essential to liberate front-line staff to deliver
the best possible outcomes for patients. That is something that the
current system will never be capable of doing, because of constraints
and impositions from the
centre.
On
local authority duties, clause 169 amends the Local Government and
Public Involvement in Health Act 2007 to allow the local authority to
set up a contract with the local healthwatch organisation directly, or
with a host if it wants, to carry out the functions as set out in
section 221 of the 2007 Act, which includes the new functions added by
clause
168.
Amendment
350 seeks to place a requirement on the local authority to consult
persons as it considers appropriate before it prepares its report on
its findings on whether local healthwatch arrangements are performing
effectively and delivering value for money. As part of its functions,
the local authority will assess and prepare a report about the
performance and value for money of those arrangements.
Such
information is important to the public purse and to the local
healthwatch organisations, which will have a separate duty to operate
effectively, efficiently and economically. The amendments are
unnecessary, and, in reference to proposed new subsection (7C), if the
authority has considered particular information and consulted
particular people, we would expect it to say so in its
report.
Amendment
351 seeks to add a requirement on local authorities to consult with
persons and representatives of persons whom it considers able to
provide advice about arrangements. That would happen before it enters
into a contract with local healthwatch or a host organisation. It is
curious, because the hon. Lady is saying that we should evaluate, delay
and wait for the inquiry, and this morning’s exchanges made it
clear that we are open to and intend to consider the findings and
recommendations of the Francis inquiry.
Of course, we
will also look carefully and closely at findings of the work that the
Local Government Association is doing. Indeed, we are working closely
with it on many aspects of the implementation of the measures in the
Bill. The hon. Lady’s proposals are too prescriptive. They are
matters that should be decided on locally by elected local councils;
they are not for Members to prescribe in the House. Our approach is to
encourage
local authorities to consult, and it is good practice to do so. Local
authorities must decide how it would work for
them.
If
the amendments are not withdrawn, I invite my hon. Friends to oppose
them, but I hope that the hon. Lady feels able to withdraw
them.
Emily
Thornberry:
I will have more to say in the clause stand
part debate, but I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Question
proposed, That the clause stand part of the
Bill.
Emily
Thornberry:
I want to raise some other concerns about
clause 169 that have not fallen within the scope of the amendments. The
first is under the category of the relationship between local
healthwatches and local authorities. What if there is a conflict of
interest or a disagreement? What would the local authority
do?
The local
healthwatch could be, for example, an assertive, aggressive,
argumentative and difficult organisation that is giving the authority a
really hard time, particularly in the commissioning of social care. It
could be in the local paper every week, criticising the local authority
and having a go at the leader of the council and so on. The local
healthwatch, however, is dependent on the local authority for its very
funding and existence. One hopes that the local authority, in all good
will, will continue to fund it properly and to give it support, but
there would be a temptation not to do
that.
What
would happen in those circumstances? What if a local healthwatch was
doing its job in an aggressive, but nevertheless proper, way? If it
does not have sufficient independence from the local authority, how can
it fulfil its function? The local healthwatch has a particular concern
with social care, and it therefore has a job in scrutinising what local
authorities do in the commissioning of social care. That is an
important question, which requires a clear answer from the
Government.
Nicky
Morgan (Loughborough) (Con):
I understand the hon.
Lady’s point, and I am sure we are all aware of good local
authorities and bad ones. Does she not think, however, that if there
was an aggressive and effective local healthwatch that felt its funding
was threatened, the first thing it would do would be to go to the
press? Any sensible local authority would not have a battle in the
public domain about
funding.
Do
the hon. Lady’s comments not also suggest that she has little
confidence in the ability of local authorities and councillors to stand
up to decent scrutiny? Is that not rather insulting to all those
hard-working local authorities and councillors across the country that
are perfectly capable of dealing with effective scrutiny committees and
defending their policies if
necessary?
Emily
Thornberry:
Given the appalling level of cuts that local
authorities are facing, many different organisations will face the wall
very quickly; I suspect the first in line might well be those that are
giving the local authority the hardest time. I do not want that to be
the situation, and in an ideal world it would not happen, but we are
all living in the real world, at least on this side of the
Committee.
Dan
Byles (North Warwickshire) (Con):
Is the hon. Lady
confirming that it is Labour party policy at the local level to make
cuts based on political decisions, rather than try to make effective
savings?
The
Chair:
That is going way beyond the scope of the Bill, and
I would not want the hon. Lady to respond to
it.
Emily
Thornberry:
I am not tempted to respond. I do not think
that I could respond in language appropriate to the confines of this
room, but I would be happy to talk to the hon. Gentleman about it
afterwards.
One
very serious question that needs a serious answer is: what happens
where there is a conflict between local authorities and local
healthwatch, because we are dealing with people? The second question is
this: there is provision for one member of local healthwatch to sit on
the health and well-being board, is that sufficient? It seems to be
prescriptive that only one person from local healthwatch will be
sitting on a health and well-being board. Is that really
necessary?
I
would like to read into the record further evidence from the Patients
Association:
“Local
authorities will be responsible for the performance of Local
Healthwatch as the commissioners of this service. It will be the local
authority’s responsibility to performance manage Local
Healthwatch. There will be no nationally driven performance management
of Local Healthwatch. How will consistent standards between Local
Healthwatch be
monitored?”
If
that is right—perhaps the Minister could confirm that it
is—the organisation responsible for performance management of
local healthwatch will be the local authority. How can we ensure that
there is consistency of standards across the country? Or will it be
national Healthwatch that will monitor the performance of local
healthwatch? That would be odd because national Healthwatch would be
monitoring the performance, regulating it and ensuring there is best
practice across country, but it would be paid for by another body.
Being able to pay the piper is the source of much power. It is another
example of tension between those two bodies. We want local healthwatch
to succeed, rather than fail, but this seems to be a hole down which a
local healthwatch could
fall.
Local
healthwatches need to represent all the views and experiences in their
area, and they need to be able to gather views from across the
population. There needs to be a range of ways in which people can get
involved. Some LINks seem to have failed to create the
community-focused approach we envisaged for their work. There is always
a danger of capture by special interest and single issue groups. How
can we ensure that there will be more genuine participation in the new
local healthwatches? Will the Department of Health or local authorities
provide guidance on how the views of the vulnerable and the
hard-to-reach are expressed through healthwatch, because that seems to
be an important
area?
We
do not just want to have the articulate, the motivated and the
confident to be taking over these groups, nor do we want a subgroup of
the area that feels particularly hard done by taking over, when there
is a range of views that should be reflected by local healthwatch. How
can we ensure that does not happen with this new organisation? Could
the Minister offer us any guarantees? How will the views of the most
vulnerable be fed into the system? Those are our concerns on local
healthwatch and its
relationship with local authorities. We want to have some reassurance
from the Minister about how it will
happen.
We
are particularly concerned about a number of problems. I welcome what
the Minister says about pathfinder local healthwatches. That is the
sort of evidence-based policy making that we approve of so
much—one of the reasons why we should not be pushing the Bill
through as quickly as we are. Given that we are, that is perhaps one
way of patching things up. I am pleased about that, but I hope that
when we look at the performance of local pathfinder healthwatches, the
questions that have been asked this afternoon will set the standard
against which local pathfinders are
measured.
Paul
Burstow:
Again, I suspect that the Committee shares the
intention to ensure that the successors to LINks, local healthwatches,
are effective bodies that provide a much stronger patient voice in the
places that matter and in decisions about the health and social care
provision in communities.
With regard to
the hon. Lady’s questions, I shall start with the one about
conflicts of interest, which is important to deal with. We have made
clear in the Bill the duties of local authorities to establish
healthwatches, the nature of their relationship and the safeguards to
ensure that authorities do not overreach themselves and start to bully
a healthwatch; that is the fear she described. It intrigues me because
one group of amendments that we may consider in due course poses an
interesting challenge.
A concern is
that for example, a local authority might become so fed up with being
constantly challenged by its healthwatch that it seeks to have it
dissolved. We have provided an important safeguard against that in the
Bill. A local authority, having established a healthwatch, will not be
able to have it dissolved it unless it agreed with HealthWatch England
that that was the right thing to do and approached the Secretary of
State to do so. That will provide a check and balance in the system and
a view from HealthWatch England, and will secure the independent status
of local healthwatches, which is important for their ability at the
local
level.
Emily
Thornberry:
Again, that sounds fine and dandy on the face
of it. The difficulty is that although the local healthwatch might
continue to exist and not be dissolved by a local authority disgruntled
by its behaviour, the authority could starve it of funds or move its
support elsewhere. As I understand it, there will be nothing that the
national HealthWatch can do about that, and if I am wrong, I would be
grateful for a reassurance. If there is a bad relationship between a
local authority and a local healthwatch, will there be any way in which
the national HealthWatch or anyone else can step in to ensure that the
local healthwatch does not
shrivel?
Paul
Burstow:
Let me try to ensure that we
get that problem properly cleared up. People outside the Committee
might have a legitimate concern about how the Government’s
intention that local healthwatches be an independent and critical
friend of the system can be secured. Local authorities will need to
make funds available and will have a statutory duty to make
arrangements to ensure that the activities mentioned in section 221 of
the 2007 Act are carried out in their area, meaning that they have to
provide any necessary funding.
The legislation will also require a local authority to make arrangements
to ensure that the local healthwatch carries on with its
activities.
We
have also had discussions about the need to publish accounts—I
have moved amendments to deal with that—and the need for
transparency in understanding how resources are to be used. I am not
convinced about the underlying case for a ring fence, as that can also
become a constraint when it comes to the level of resources needed to
provide a service. I hope that I have given the necessary reassurances
about the statutory basis on which the provisions
rest.
Emily
Thornberry:
May I say how impressed I am with the
Government? The Minister was able to say with a straight face both this
morning and now that a ring fence might constrain a local authority, as
if in the current climate a ring fence would mean that local
authorities would not be able to spend more than the Government intend.
Given the terrible cuts that the Government are imposing on
authorities, that simply will not be the
case.
Paul
Burstow:
As the Government tackles the debt legacy we
inherited it is undoubtedly the case that local authorities are having
to deal with and make very difficult decisions, forced upon them by the
fact that £1 in every £4 we currently spend in
the public sector is borrowed. [
Interruption.
] I
will move on very swiftly, Mr Hancock, to make other points more
pertinent to the
clause.
1.45
pm
Let
us deal with the issue of membership and representation. The Secretary
of State has a power to make regulations on membership if it is
necessary to increase representation. The hon. Lady expressed her
concern about there being only one member of the local healthwatch on
the health and well-being board. It is important to stress again that
in the Bill we provide the de minimis requirements for the membership
of health and well-being boards. We do not want to be overly
prescriptive in terms of all sorts of organisations that it might be
good to have involved. It is very important that, in framing their
governance arrangements, democratically elected local authorities that
are accountable to their populations make and account for those choices
correctly. They should make those choices, rather than MPs who
sometimes miss things while adding longer and longer lists to the
requirements. The current plans will allow the local authority to
decide who and how many take part in the
arrangements.
In
terms of conflict between local authorities and local healthwatch, I
think there will be a creative tension, but we are not trying to
transfer—if you like—hon. Members’ experience of
the adversarial system that we have in this place. We are trying to
create a collaborative, consensual process that makes sure that the
patient’s voice is heard, respected, understood and acted upon.
That is what the Bill is all about. It is simply not possible for local
authorities to starve these organisations of funds, as I have already
set out, and of course HealthWatch England will be able to advise on
the building of effective relationships with local authorities, should
that become necessary. That is what these pathfinders
are all about; making sure that we learn through experience and that
that experience is disseminated throughout the system to get the very
best of healthwatch into the
system.
Question
put and agreed
to.
Clause
169 accordingly ordered to stand part of the
Bill.
Clause
170
Independent
advocacy
services
Amendments
made: 426, in
clause 170, page 142, line 40, at
end insert—
‘( ) Each local
authority may make such other arrangements as it considers appropriate
for the provision of services providing assistance to individuals in
connection with complaints relating to the provision of services as
part of the health
service.’.
Amendment
427, in
clause 170, page 142, line 40, at
end insert—
‘( )
Arrangements under this section may not provide for a person to make
arrangements for the provision of services by a Local Healthwatch
organisation.’.
Amendment
428, in
clause 170, page 142, line 42, leave
out from ‘provide’ to end of line 45 and insert
‘services—
(a) the
arrangements are to be treated for the purposes of this Part as
arrangements made under section 221(1),
and(b) the provision of the
services is to be treated for those purposes as an activity specified
in section
221(2).’.
Amendment
429, in
clause 170, page 143, line 1, leave
out subsection
(4).
Amendment
430, in
clause 170, page 143, line 6, after
‘under’ insert ‘or in pursuance
of’.
Amendment
431, in
clause 170, page 143, line 12, leave
out ‘; but this subsection’ and
insert
‘and to any person arranging
for the provision of services in pursuance of such
arrangements.‘( ) But
subsection
(6)’.
Amendment
432, in
clause 170, page 143, line 13, leave
out from ‘apply’ to ‘, by’ in line 14 and
insert
‘in a case where the person
is a person to whom’.—
(Paul
Burstow.)
Clause
170, as amended, ordered to stand part of the
Bill
.
Clause
171
Requests,
rights of entry and
referrals
Amendment
made: 433, in
clause 171, page 144, line 17, at
end insert—
‘( ) In
subsection (4), in paragraph (a), after “arrangements made
under” insert “or in pursuance
of”.’.—
(Paul
Burstow.)
Emily
Thornberry:
I beg to move amendment 355, in
clause 171, page 144, line 29, at
end add—
‘(13) Section 226
of that Act, as amended by subsections (9) to (12) above, shall apply
where a local Healthwatch organisation refers a matter relating to
social care services to an overview and scrutiny committee of a local
authority or to the authority itself where overview and scrutiny
committees are not
operated.’.
This
clause relates to requests, rights of entry and referrals, and
amendment 355 seeks a commitment from the coalition Government on their
intention to place all commissioners and providers of publicly funded
NHS and social care services under duties to respond to requests for
information and to comply with rights of
entry.
Paul
Burstow
rose—
Emily
Thornberry:
A “yes” will
do.
Paul
Burstow:
I may be a little longer, but I hope to get to
that point very quickly. Section 226 of the Local Government and Public
Involvement in Health Act 2007 relates to referrals of
social care matters to health overview and scrutiny committees by local
involvement networks, which are to be replaced by healthwatch
organisations. The amendment would enable the referral of such matters
to the local authority, where an overview and scrutiny committee is not
operated locally.
We agree that
it is appropriate to ensure that social care matters can be referred in
such local authority areas. However, the amendment is unnecessary
because proposed new schedule 16A(4) to the 2007 Act provides a general
power for local healthwatch organisations, under which
they
“may
do anything which appears to it to be necessary or expedient for the
purpose of, or in connection with, the exercise of its
functions.”
That
would include referral of social care matters to the local authority.
In the light of that and with an indication that it is certainly our
intention that, as now, such access should be available, I hope that
the hon. Lady will feel able to withdraw the
amendment.
Emily
Thornberry:
I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Clause 171,
as amended, ordered to stand part of the
Bill.
Clause
172
Dissolution
and transfer
schemes
Emily
Thornberry:
I tabled amendment 356, which would have
replaced “and” with “or”, but in the light
of what the Minister said about dissolution of local healthwatch, the
importance of there being some form of protection for those bodies and
the assistance they may get from HealthWatch England, I have a better
understanding of why we have the “and” instead of the
“or”—or whichever way round it is—and I
will not move the
amendment.
Clause
172 ordered to stand part of the Bill.
Clause
173
Annual
reports
Paul
Burstow:
I beg to move amendment 434, in
clause 173, page 146, line 7, at
end insert—
‘( ) After that
subsection insert—(2A)
Provision under subsection (2)(a)(ii) is not to be taken as requiring H
to prepare a report in relation to the provision by the Local
Healthwatch organisation concerned of services under arrangements made
under section
223A.”’.
The
amendment amends section 227 of the 2007 Act to clarify reporting
responsibilities for hosts. A host organisation is a body that a local
authority currently contracts with for the purpose of ensuring that
local involvement networks’ functions are carried out. The Bill
allows a local authority to decide whether to keep the existing host
arrangements or contract directly with
a local healthwatch organisation. If a local
authority decided to continue the existing host arrangements, amendment
434 will ensure that the arrangements do not need to require the host
to prepare annual reports on the provision by local healthwatch of
independent advocacy services or other services under section 223A of
the Local Government and Public Involvement in Health Act 2007. That is
because arrangements for the provision of such services by local
healthwatch would be separate to any arrangements under section 221
with the host to arrange for the local healthwatch to carry out its
functions. The amendment makes it clear in the Bill that it is local
healthwatch that discharges the function, not the host.
Amendment
434 agreed to.
Paul
Burstow:
I beg to move amendment 435, in
clause 173, page 146, line 16, after
‘(4)’ insert
‘—
(a) after paragraph (a)
insert—“(aa) the
National Health Service Commissioning
Board;(ab) each commissioning
consortium, whose area or any part of whose area falls within the area
of the local
authority;”,(b)
’.
The
Chair:
With this it will be convenient to discuss
Government amendment
436.
Paul
Burstow:
To ensure accountability and transparency, local
healthwatch organisations will have to produce annual reports each
financial year. Those reports will be sent to certain bodies, including
HealthWatch England. The amendments clarify the requirements relating
to the annual reports of local healthwatch organisations and are minor
and technical. For those reasons, I hope that the Committee will
support the
amendments.
Amendment
435 agreed to.
Amendment
made: 436, in
clause 173, page 146, line 18, at
end insert ‘, and
( ) omit
paragraph (d) (but not the following
“and”).’.—
(Paul
Burstow.)
Clause
173, as amended, ordered to stand part of the
Bill.
Clause
174
Transitional
arrangements
Paul
Burstow:
I beg to move amendment 437, in
clause 174, page 147, line 1, at
end insert—
‘( ) Omit
section 228 of the Local Government and Public Involvement in Health
Act 2007 (previous transitional
arrangements).’.
The
amendment is minor, but technical and drafted in the spirit of good,
legislative housekeeping. It removes the relevant section 228 from the
2007 Act, which made provision for transitional arrangements for local
involvement networks. Clearly, that is no longer
necessary—those transitional arrangements have been
and gone. The amendment is simply a tidying-up provision
that removes something that is no longer necessary.
Amendment
437 agreed
to.
Clause
174, as amended, ordered to stand part of the
Bill.
Clause
175
Scrutiny
functions of local
authorities
Emily
Thornberry:
I beg to move amendment 358, in
clause 175, page 147, leave out lines 8 to
10.
The
clause is important because of the substantial worries about what the
Government are doing with overview and scrutiny, which, in some ways,
are illustrated by the two amendments to the clause that we have
tabled. Some of the arguments are complex and I hope that I can do them
justice—I will do my best. We have a problem with the principle
and whether overview and scrutiny will be able to refer anything other
than changes to designated services to the Secretary of State
for
Health.
The
amendment would
exclude
“omit
‘an overview and scrutiny committee of’, for ‘the
committee’”.
In
many ways, overview and scrutiny committees are highly successful
vehicles, which gain a great deal of praise. I have received some
agreed wording about the importance of overview and scrutiny, which
essentially says that they are very far from being broke and certainly
do not need to be fixed. It states that
the
“Centre
for Public Scrutiny and the Local Government Group support the
retention of the current arrangements—independent health
scrutiny committees that can determine the service changes they engage
with and can make evidence-based referrals independently from executive
and
authorities.”
Our
concern is that the Bill will throw overview and scrutiny committees up
into the air and allow local authorities to reorganise them. That is a
walk into the dark that is simply unnecessary. The provisions of the
clause are consistent with what I understand to be in the Localism
Bill, under which all overview and scrutiny bodies are reorganised
except, rather bizarrely, health overview and scrutiny
committees—that Bill specifically excludes them. We have found
ourselves in the odd position where the trust and confidence that the
Department of Health has in health overview and scrutiny committees is
much greater than the trust and confidence that the Department for
Communities and Local Government has in health overview and scrutiny
committees.
I do not want
to draw obvious and
unnecessarily—
Paul
Burstow:
Petty?
2
pm
Emily
Thornberry:
Very far from petty. Very important, in fact.
I will spell it out. The Department of Health may not be terribly happy
with keeping overview and scrutiny as currently organised because it is
powerful. It is a way in which local communities are able to stop
service reconfiguration in its tracks and send it off to the Secretary
of State. The Department for Communities and Local Government has some
respect for that and has specifically excluded it from the Localism
Bill, but an attempt is now made in the Health and Social Care Bill to
exclude the part of the Localism Bill that excludes it. There is an
attempt to patch this up, but clearly in the two Bills we see clearly a
disagreement going on between the Department for Communities and Local
Government and the Department of Health. Perhaps those in local
government have been able to lobby the Department for Communities and
Local Government effectively so that the powers of overview and
scrutiny committees are kept in the Localism Bill, but the Department
of Health wants to chop its head off.
Concerns
such as those may be some of the reasons why the Liberal Democrats are,
according to the Evening Standard, in rebellion from the
“top to the bottom” of the party over the Bill.
[
Interruption.
] I am simply referring to what is
in the papers right now and to what will be happening this weekend. The
Minister has to answer those questions, because in the run-up to the
Bill’s passage through Parliament, he has been travelling up and
down the country and saying in all the local papers that one of its
purposes is to bring democracy to the heart of the NHS, but clause 175
conflicts with that. Much of my criticism has centred on the fact that,
despite the promises, we are not getting an increase in democracy as
the Minister has promised. The clause is much worse: not only are we
not getting an increase in democracy, but it removes some of the best
powers that local authorities have. That is our concern. Far from
fulfilling the promises that the Secretary of State has made to his own
Back Benchers that the legislation will increase local democracy, the
clause shows that some of local authorities’ most important
powers are being taken away. It is important to have a clear answer
from the Minister about what is happening.
As well as the
conflict caused by the reorganisation of overview and scrutiny and
health committees, a further difficulty is the removal of the power of
local authorities to refer anything other than designated services to
the Secretary of State. That is addressed in the next amendment, which
I will come to
next.
Paul
Burstow:
This is one of those debates where we are
effectively debating the phantom Bill that the Opposition choose every
so often to set up as an Aunt Sally that they can knock down, rather
than addressing the Bill before us. This is definitely one of those
areas where the rhetoric is intended to undermine rather than improve,
strengthen or probe. That is understood, however, and it is taken in
the spirit in which it is meant and, clearly, the spirit that was meant
when the reference was made to the pleasant time that I expect to have
with colleagues in Sheffield discussing this
Government’s health reforms.
To be clear,
clause 175 amends the scrutiny provisions in the National Health
Service Act 2006 to enable scrutiny functions to be conferred on local
authorities instead of individual committees within local authorities.
It also inserts a regulation-making power that allows the Secretary of
State to establish the circumstances in which the authority may refer a
matter on which it must be consulted to the Secretary of State and
others. That power also enables the Secretary of State to issue
directions in relation to referrals and to confer powers on the NHS
commissioning board to direct consortia. It also—this is an
important point, which the hon. Lady perhaps conveniently glossed
over—widens the scrutiny of regulation-making powers so that
they apply in relation to any provider of NHS services, in other words
extending the notion that wherever the NHS pound is spent, that
provider will be subject to scrutiny by a local authority in the
future. It would have been valuable to have had that when the previous
Government introduced the independent treatment centres. Perhaps we
would have been in a better position to look at some of the
cherry-picking that took place as part of that measure, as well as the
extra costs and waste of taxpayers’ money that was incurred as a
consequence.
I am grateful
for the opportunity to look at these issues, because they map out a
critical difference in our approach. Amendment 358 would remove the
flexibility for local authorities to choose how best to discharge their
overview and scrutiny functions by enabling regulations to be made
conferring such functions only on overview and scrutiny committees. I
think that the hon. Lady and I have a shared desire to retain a clear
separation between executive and scrutiny functions, which was a point
made during the consultation on the White Paper, when we floated the
possibility that the scrutiny role could be discharged by health and
well-being boards. Local government and many others told us that they
did not think that was a good idea, so we listened, understood, and
changed it in the Command Paper, and that is now reflected in the Bill.
We recognise that that original purpose was not to be achieved, but we
are also clear that we do not want to create unnecessary, artificial
barriers between different parts of the local authority scrutiny
architecture. The amendment retains a top-down prescriptive
requirement, which would act as a barrier to local authorities creating
scrutiny arrangements shaped around their activities.
The phantom
Bill cast before us today by the hon. Member for Islington South and
Finsbury is not the real Bill that we should be debating. She raises
the spectre of a difference of opinion between us and ministerial
colleagues in the Department for Communities and Local Government
taking the Localism Bill through. Let us be clear: the Localism Bill
stipulates that in local authorities that operate executive
arrangements, there must be a separate overview and scrutiny committee.
We want that separation, but we also want to enable councils to develop
health overview and scrutiny arrangements that can apply to any
arrangements that the local authority chooses. They are democratic
bodies which should be able to frame their own constitutions and
governance arrangements and account to their electors for doing just
that. We are clear that the clauses already prevent the executive
functions themselves from scrutinising, while ensuring that the
scrutiny function cannot be delegated to the health and well-being
boards. Clause 175(2) ensures that we can give local authorities
scrutiny functions, while ensuring, in combination with clause 180(4),
that we achieve the necessary separation between scrutiny and the
functions being scrutinised.
Emily
Thornberry:
Will the Minister have a stab at explaining
why subsection (8) is drafted as it is? It states:
“In
section 9F of the Local Government Act
2000”
—which
is somewhat
presumptuous—
“(overview
and scrutiny committees) (as inserted by Schedule 2 to the Localism Act
2011)—
(a) omit subsection
(2)(f)”
Is
that not where the heart of the battle is going on? As things stand, we
may have a situation where, if the Bill is passed, the Secretary of
State would be able to establish regulations to manage how overview and
scrutiny is developed in health. However, we could have, under the
Localism Act 2011—if that comes into being—further
regulations also being sent out about overview and scrutiny by the
Secretary of State for Communities and Local Government. There may well
be a conflict between the two of them. How would the Minister seek to
resolve that problem?
Paul
Burstow:
There is no such conflict. Government always act
collectively and come to a view, which is presented clearly, cogently
and powerfully. That is what we will do when it comes to dealing with
such matters as we take the two Bills through the
House.
Dr
Daniel Poulter (Central Suffolk and North Ipswich) (Con):
Does my hon. Friend the Minister agree with this point? There has been
a problem with overview and scrutiny committees in relation to local
authorities and joined-up thinking, particularly on care of the
elderly. When the overview and scrutiny committee in my local
authority, for example, said that closing community hospitals was a bad
idea, because we need to look after older people, have step-up care,
step-down care, and respite care for cancer patients, the PCT was able
to act independently against the interests of the wider community, and
in fact against medical advice which the overview and scrutiny
committee had taken on board. That is why things need to be changed, as
the Bill is doing.
Paul
Burstow:
My hon. Friend makes a good point, which shows
why we need to make such changes.
In this part
of the Bill, we have also balanced the separation, giving local
authorities greater flexibility to shape the scrutiny function to meet
local needs. This provides local authorities with greater certainty, so
that they can design their scrutiny arrangements with the medium and
long-term in mind. We have not done that in isolation. This is not a
way of diluting the crucial role of scrutiny. We have done this in
response to the consultation, where respondents recognised the
importance of scrutiny, and at the same time asked for greater
flexibility. The Association of Directors of Adult Social Services, for
example, said:
“there needs to
be local determination and flexibility to decide the best possible
arrangements for scrutiny
functions”.
Jessica
Crowe, executive director of the Centre for Public Scrutiny, said in
her response to the publication of the Command
Paper:
“It
is a tribute to the hard and constructive work of health overview and
scrutiny committees everywhere that the government has recognised that
their role should be not only maintained but
extended.”
That is what we are
doing with the Bill. We are making sure that it fits within the new
architecture but is still clearly separate from the executive roles
that are being
established.
Emily
Thornberry:
As the Minister quotes the representative of
the Centre for Public Scrutiny, may I cite the agreed wording between
the Local Government Group and the Centre for Public Scrutiny? It
states:
“The
powers currently set out section 244 and associated
regulations”—
that
is the overview and scrutiny
powers—
“are
possibly the strongest expression of democratic accountability in
public services. They allow for robust, independent scrutiny of health
care and health issues by elected councillors. Councillors on health
overview and scrutiny committees can make independent reports and
recommendations. They are a strong model for democratic accountability
in public services—they should be retained and not
diluted.”
How
strong an endorsement is that? Why are the Government meddling with
that in the Bill?
Paul
Burstow:
First, I do not believe that anything in the Bill
or what we are attempting to do here diminishes or dilutes the scrutiny
role. In fact, it extends the scope. That is what we are attempting to
do here. I reject the premise that this is the pinnacle of democratic
accountability when it comes to the reforms that we are making in the
Bill. The changes in the relationship between the NHS and local
government are brought about by the establishment of health and
well-being boards and their new responsibilities to set joint strategic
needs assessments and joint and health and well-being strategies. They
are a further extension of democratic accountability, control and
influence over the NHS that is very important.
Scrutiny is
not about democratic control. It is about challenge and examination of
what various other bodies that have specific responsibilities are
taking forward. Early implementer health and well-being boards are very
clear that their work is about increasing transparency and
accountability to local people and communities, and effective scrutiny
will be a key part of that.
Derek
Twigg (Halton) (Lab):
I understand what the Minister is
saying. One of the challenges to the ability to scrutinise is the
availability of information. The Minister or his colleague has made it
clear that it is up to the consortia to hold public meetings and to
decide what information they put in the public domain. Basically, the
scrutiny board can call the consortia and other bodies to come before
it, but it might not have all the information because the consortia can
make spending decisions in private. There is a resolution before the
Liberal party conference this weekend that no decisions about spending
of NHS funds should be made in private by GP groups. Senior members of
the coalition support that resolution. It is important when we are
talking about transparency and accessibility that we consider the
information that scrutiny boards can get hold
of.
The
Chair:
We need to be careful. I know that there is a great
deal of interest in this. I am sure that the hon. Gentleman would like
a walk-on part at the conference in Sheffield, which could be arranged,
but it is not really at the heart of this legislation. We need to
temper our comments according to what is in front of us
today.
Paul
Burstow:
I will follow that instruction. If the hon. Lady
would like to attend, I am sure an appropriate bill could be sent to
her for the charge of the appropriate rate for registration at a late
time to attend the conference. It is a curious moment, when a Liberal
Democrat Minister is dealing with this part of the Bill, to wind up
debating amendments to a Liberal Democrats conference motion. That says
something about how things change. I look forward to debating those
amendments that we come to in Sheffield
later.
It
is a nonsense that the intentions of the Bill, and the words on the
face of it, undermine our scope. Local authorities could continue to
have overview of scrutiny Committees in their current form if they see
fit. They will have to discharge a scrutiny role. We are saying
that it should be up to those authorities how they do it. I
do not understand the notion that we should not be prepared to trust
autonomous, democratically elected local authorities to make decisions
about their own governance arrangements, which is what the Bill
enables.
It does not remove the requirement that they do these things, but simply
gives them the scope to decide how best to do
it.
2.15
pm
Emily
Thornberry:
The whole point of overview and scrutiny
committees is that they are at an arms’ length from local
government. They are able to be in some ways independent. It is of
enormous concern that local authorities will be able to look again at
their overview and scrutiny committees generally, but the Localism Bill
is not my concern here. My concern is the Health and Social Care Bill
and the fact that local authorities may look again at overview and
scrutiny committees and dilute them. That is not just the
Opposition’s concern, but that of the Local Government Group and
the Centre for Public Scrutiny.
Paul
Burstow:
In response to the consultation, we have given
local authorities this flexibility—it is something that many in
local government said to us. Many outside this Committee will note the
level of Opposition Members’ distrust of their colleagues in
local government and their ability and willingness to have a very clear
separation between executive and scrutiny functions. Government Members
are very clear that scrutiny is an essential part of the role of local
authorities, both of the services they deliver and of those that the
NHS delivers.
To the
question about local authorities not having all the information they
need to exercise scrutiny, again, the straightforward answer is no. We
are extending scrutiny regulation-making powers to enable the scrutiny
function to require information and attendance. They will be able to
say, “You must come and you must provide
information.”
Derek
Twigg:
On a point of order, Mr Hancock, is the Minister
saying that no decision on spending by GP consortia will be taken in
private?
The
Chair:
That is not a point of
order.
Paul
Burstow:
The hon. Member’s question, which I am
answering, was can a scrutiny committee
ask—
Derek
Twigg
indicated
dissent.
Paul
Burstow:
That was the question the hon. Gentleman asked
first, and I am answering
it.
Derek
Twigg:
The question was very simple. I said very clearly
that the Bill accepts that GP consortia comes under the same scrutiny
as other NHS bodies. The concern, expressed by members of the
Minister’s own party, is that decisions on spending can be taken
in private by the GP consortia and, therefore, the local authority and
the scrutiny committee will not necessarily have all the information.
If the hon. Gentleman is saying that no spending decisions will be
taken in private by the GP consortia, I am happy for him to put that on
the
record.
Paul
Burstow:
I am saying that there is no information that a
scrutiny Committee cannot ask of a GP commissioning consortia. That is
the issue we are debating at the moment: scrutiny of health functions
by local
authorities. We have already debated, Mr Hancock, the fact that GP
commissioning consortia are required to produce constitutions setting
out how their governance arrangements will work, and that those
constitutions will provide more clarity and transparency than the
system we have inherited from the Labour Government. The measures are
about making sure that we can extend scrutiny to any provider who
provides NHS services, to make sure that there is a level playing field
and that local authorities can exercise the scrutiny role in a way that
works for them and their community, rather than just for the
convenience of the Opposition.
Emily
Thornberry:
I do not think I need to say anything else. I
shall press the amendment to a vote.
Question
put, That the amendment be made.
The
Committee divided: Ayes 9, Noes
12.
Division
No.
33
]
AYES
Abrahams,
Debbie
Barron,
rh Mr
Kevin
Blenkinsop,
Tom
Kendall,
Liz
Morris,
Grahame M.
(Easington)
Thornberry,
Emily
Turner,
Karl
Twigg,
Derek
Wilson,
Phil
NOES
Brine,
Mr
Steve
Burns,
rh Mr
Simon
Burstow,
Paul
Byles,
Dan
Crabb,
Stephen
de
Bois,
Nick
James,
Margot
Lefroy,
Jeremy
Morgan,
Nicky
Poulter,
Dr
Daniel
Soubry,
Anna
Sturdy,
Julian
Question
accordingly
negatived.
Emily
Thornberry:
I beg to move amendment 359, in
clause 175, page 147, line 25, at
end insert
‘, and in
addition to any regulations relating to the referral of proposals for
changes to services, the regulations may also provide for circumstances
where referrals may be made either to the Board or the Secretary of
State where local authorities or commissioning consortia are considered
not to have had due regard to their duties to have regard to relevant
health and well-being strategies when exercising their
functions;’.
The
Liberal Democrats might be knocked from the top to the bottom in the
revolt over NHS reforms because of the first part of the removal of the
power of overview and scrutiny; they certainly will be when people
learn about this. I would like the Minister’s clear confirmation
that my understanding is right. Will the legislation result in overview
and scrutiny committees no longer being able to refer to the Secretary
of State any changes of services that are not designated services? If
he wishes to reassure me, I have little else to
say.
Paul
Burstow:
indicated
dissent.
Emily
Thornberry:
He does not, so I will go on. I appreciate
that the mention of such things tends to result in a red mist
descending in front of the eyes of some hon. Members.
To give an
example, in my area of Islington, my local PCT, in its wisdom, decided
to close the Finsbury health centre. My overview and scrutiny committee
referred the matter to the Secretary of State after a great deal of
to-ing and fro-ing, and attempts to deal with the matter locally. My
PCT decided to consult not on the basis of whether the health centre
should be closed, but on how it should be closed and where the various
services should go. I have much sympathy with arguments that PCTs
should be more democratically accountable, because that is the sort of
issue that really gets people’s goats. If the provision were
about ensuring that PCTs were more democratically accountable, the
Government would find support from many Opposition Members.
This is the
difficulty: if there was an attempt to close the Whittington
hospital’s A and E department—given that it may not be a
designated service—is it right that the overview and scrutiny
committee would not be able to refer that to the Secretary of State? It
is of great importance and we need to know it. As I have said, the
power that local authorities have to do that is one of the strongest
models for democratic accountability in public services. It should be
retained and it should not be diluted. If it is the case that only
changes to designated services will be referred to the Secretary of
State, we need to know that. In response to the White Paper, it seemed
fairly clear that that was the Government’s intention. Can we
hear one way or the other what the situation is? It is of great
importance to us all, not only in our Front Bench roles, but as
constituency
MPs.
Section
244 of the National Health Service Act 2006 also relates the duties of
NHS bodies to consult relevant overview and scrutiny committees about
proposals for substantial variations to services, known as service
reconfiguration. Section 244 gives relevant overview and scrutiny
committees the power to refer proposals for substantial variations to
services to the Secretary of State for determination. Since 2003, those
referral powers have been available for many service reconfigurations.
It must be said that there have been few actual referrals. The local
authorities have used their powers wisely and carefully.
The
Independent Reconfiguration Panel has advised the Secretary of State
about referrals from health and scrutiny committees. It praised the
quality of the referrals that it has received in its report
“Learning from the Reviews.” It has not been so
complimentary about the NHS consultation process. So there we have
another example. The Independent Reconfiguration Panel is telling us
that local authorities are exercising those powers well. So why, why is
the Bill taking away that power from local government? It would be
interesting to know what the Secretary of State for Communities and
Local Government thought about that, although we will not. We were
hearing about his potential conflict on overview and scrutiny earlier.
What the panel found suggests that health scrutiny committees can be
the vehicle for building consensus around constructive change. Removing
independence, resources and support from health scrutiny risks losing a
crucial check and balance on the system, leaving communities with a
weaker voice in service reconfiguration.
There has
already been a great deal of debate on service reconfiguration issues
during earlier debates. We are sure that there is concern on both sides
of the Committee on how local services can best be protected under the
Bill and how proposed changes can be quality assured in the way that
they can be if local authority
overview and scrutiny boards are given a proper role. We are concerned
that the regulations made under clause 175(3) could restrict
councillors’ referral powers to very a narrow band of designated
services, meaning that the vast majority of services could be changed
with very little democratic accountability.
Currently,
overview and scrutiny committees decide which variations are
substantial variations about which they wish to be consulted, that are
subject to the referral power, even though that power is not often
exercised. Restricting referral powers to designated services would
mean that decisions about which service changes councillors could
consider and refer would be taken out of local control. That would
amount to a dilution of local democratic accountability.
There is also
a concern that the regulations might also require decisions to refer to
be taken by full council meetings. That risks breaching the principles
of Wednesbury reasonableness. It would mean that councillors who had
not scrutinised the issues or heard the full range of evidence, could
determine the outcome. It would be impractical for a full council to
seek to overcome that difficulty by carrying out reviews of service
changes, of the kind currently undertaken by health scrutiny
committees. Requiring votes at full council would also risk adding
bureaucracy and delay to the process of reconfiguration. If the
Minister can reassure us that regulations will not be introduced to
ensure that the full council refers to the Secretary of State, we would
like to hear that reassurance. I am sure that many people in Sheffield
would want to hear that
too.
The
Centre for Public Scrutiny and the Local Government Group support the
retention of the current arrangements and have helped me on the work
that I have done on these amendments. They believe that independent
health scrutiny committees can determine the service changes that they
engage with and can make evidence-based referrals independent of
executives and authorities. For consistency, they believe that health
scrutiny committees should also be able to refer to the NHS
commissioning board when they believe that commissioning plans do not
have sufficient regard to health and well-being strategies. Will that
be part of the regulations,
too?
2.30
pm
“Equity
and excellence” set out an intention to remove independent
health scrutiny powers by vesting them in health and well-being boards.
After reflecting on the outcomes of the consultation, the coalition
recognised that that would be wrong. The was welcomed. The Bill retains
separate health scrutiny powers for local authorities. The willingness
to listen and to change, as I have said, has been welcomed, especially
by the Centre for Public Scrutiny and the Local Government Group, which
have campaigned on behalf of councils against locating scrutiny powers
with the health and well-being boards. Given that those powers have
been retained, why undermine them? Why allow something that works well,
that ain’t broke, to be fixed in a way that effectively takes
away a great deal of the power? That is our genuine concern. We hope
the Minister will be able to answer it, but we fear that he may
not.
Clause 175 as
drafted risks the loss of independent health scrutiny—which the
coalition has already recognised would be wrong—by vesting the
health scrutiny powers in local authorities themselves, rather than
overview and scrutiny. As I have already argued, there is no guarantee
that they will be fully
independent.
Those
are the difficulties and concerns. This is not a ghost concern, and it
is not the Opposition arguing about a Bill that is, in some ways, a
fantasy Bill. We are looking at the clauses, and we are not alone in
our concerns. We want to have particular reassurance about whether or
not non-designated services can be referred to the Secretary of State
by overview and scrutiny. If not, why
not?
Paul
Burstow:
This is a curious place to have the debate that
the hon. Lady wants to have, because the amendment does not
provide the scope for it and the intention to explore the issue of
designation is not covered by these clauses. It is curious to revisit
the issue at this point in the
Bill.
I
suggest that I deal first with the amendment and what it does and then
address one or two of the hon. Lady’s
points.
Emily
Thornberry
rose—
Paul
Burstow:
If I could just develop my point, the hon. Lady
might not need to
intervene.
I
am again pleased to hear what the hon. Lady has said about the value of
introducing the joint health and well-being strategy. She recognises
that it is a valuable development. Although we can agree that such
changes, which include the role of the health and well-being boards,
are all very important, what we are also trying to do with the Bill is
to ensure that the arrangements are
proportionate.
Amendment
359 would enable regulations to provide for circumstances in which
referrals may be made to the NHS commissioning board or the Secretary
of State if the referrer feels the commissioning consortia or the local
authority have not had regard to its joint health and well-being
strategy. I entirely understand the policy intention that there must be
some recourse when it is felt that the local commissioners have not had
due regard to the locally developed joint health and well-being
strategy. That is what the amendment is about, which is why we have
made provision in the Bill to enable the health and well-being boards
to write to the NHS commissioning board if they are of the view that
the consortia plans have not taken proper account of joint health and
well-being
strategies.
We
are introducing a strong framework with clear incentives and a more
robust basis for local integrated working than has been the case thus
far. We do not want to undermine real and productive relationships by
returning to the days of process set by Whitehall that looked to
central Government to resolve matters that would have been much better
resolved by local debate, local scrutiny and local decisions. These
arrangements will make that more likely to
happen.
Although
the hon. Lady may want this to become a debate on designation, this
clause and this amendment are not the place to do that. If I were to
give lengthy answers to her questions, I would be straying well
outside the scope of the clause. I will give one piece of information to
ensure that the hon. Lady feels that I have responded a little to her
questions, notwithstanding the points that I have made about their
being outwith the
amendment.
How
are local authorities involved in changes to NHS services? First, they
will use the health and well-being board to discuss changes. Secondly,
the local authority will use its scrutiny function to discuss changes.
Thirdly, for service changes that are substantial or designated, the
scrutiny function of the local authority can start a process of appeal.
There are a number of aspects to that scrutiny function and it will be
referred to the local council for a full
vote.
As
a former member of a local authority, I have dealt on a number of
occasions over the years with other quasi-judicial roles that local
authorities have. For example, in discharging planning functions, it is
perfectly possible, without any threat of legal challenge, for a local
authority to consider a planning application, for that matter to be
referred to the full council by elected members and for it to be
reconsidered and debated there without any concern about the matter
that the hon. Lady described. I think that would equally be the case
when it comes to a local authority, which, after all, is a body
corporate that delegates functions to committees and other bodies. It
will be able to do just that when it comes to this new responsibility
that we are giving to the full
council.
If
the vote agrees to continue with the appeal, it is then referred to the
NHS commissioning board. If the local authority disagrees with the
commissioning board, it may then refer to the Independent
Reconfiguration Panel and to the Secretary of State. The Secretary of
State will ask for advice from the Independent Reconfiguration Panel.
Acting on the advice, the Secretary of State can reject the appeal, ask
for the proposer of the change to reconsult and, in some circumstances,
stop the service
change.
Undesignated
services are obviously not subject to the third stage that I have just
described. Every local authority must be consulted by Monitor—a
very important point—on their designation guidance and by the
relevant commissioners in applying that guidance once it is in place
and is used to designate services. We will come back to the details. I
do not propose to provide the detailed response to that debate, which
we will properly have when we get to the relevant
clauses.
Emily
Thornberry:
I want to make sure that I heard the Minister
correctly. Is it the case that only designated services can be referred
to the Secretary of State by overview and scrutiny? It is a simple
question. Does the fact that the hon. Gentleman may not have been able
to answer it directly, mean that I can assume that only designated
services will be referred to the Secretary of State? Let me put it
another way. Can the hon. Gentleman confirm that because he has not
answered the question, we can infer that only designated services will
be referred to the Secretary of State by overview and
scrutiny?
Paul
Burstow:
Let me try one final time to answer. We have
clauses later in the Bill that will provide a better place for this to
be examined in detail. The question is about the referral of designated
services. It is for local determination as to which services are
applied to for designation.
Emily
Thornberry:
We know
that.
Paul
Burstow:
I am just making sure that it is clear and on the
record so that there is the clarity that the hon. Lady seeks. It is
right that those services which are not designated should have more
flexibility to reconfigure. We have debated that already. They will, of
course, still be subject to section 242 duties to consult the public on
changes to services, and overview and scrutiny committees will of
course be able to conduct their scrutiny of such reconfiguration
decisions. So the answer is yes, only designated, through regulations;
but local authorities’ role in which services are designated is
also very important. These are a series of interlocking clauses that
provide a change in the nature of the scrutiny but actually strengthen
it, because decisions about designation are ones that local authorities
have a direct say over as
well.
Emily
Thornberry:
I want to put the amendment to a vote and for
it to be made perfectly clear that, as far as we are concerned, this is
a vote on whether overview and scrutiny committees should be allowed to
refer non-designated, threatened services to the Secretary of State.
Anyone voting against the amendment is voting for non-designated
services to no longer have that protection of being able to be referred
to the Secretary of State, and that includes A and E departments in
London.
The
Chair:
I am not altogether sure that that is what the
amendment says. The amendment before us is quite
clear.
The
Committee divided: Ayes 9, Noes
12.
Division
No.
34
]
AYES
Abrahams,
Debbie
Barron,
rh Mr
Kevin
Blenkinsop,
Tom
Kendall,
Liz
Morris,
Grahame M.
(Easington)
Thornberry,
Emily
Turner,
Karl
Twigg,
Derek
Wilson,
Phil
NOES
Brine,
Mr
Steve
Burns,
rh Mr
Simon
Burstow,
Paul
Byles,
Dan
Crabb,
Stephen
de
Bois,
Nick
James,
Margot
Lefroy,
Jeremy
Morgan,
Nicky
Poulter,
Dr
Daniel
Soubry,
Anna
Sturdy,
Julian
Question
accordingly negatived.
The
Chair:
May I say on behalf of the Committee, Mr Burstow,
that it may be appropriate for you to write to the Committee,
clarifying your answer to that last point, so that it is clear on the
record for people inside and outside the House that we know exactly
what the issue was. There could be some easy misinterpretation of that
answer.
Paul
Burstow:
On a point of order, Mr Hancock. I am, of course,
happy to do that and to make clear the reasoning behind why we felt
that this matter would not be debated under this
amendment.
Derek
Twigg:
Further to that point of order, Mr
Hancock. I am not 100% clear about what you were saying. We do not have
clarity as to why non-designated services are not
included.
The
Chair:
That is the question to which the Committee and
those outside Parliament would be interested to know the answer. It
would be appropriate if we were written to on that point, so that it is
clear.
Emily
Thornberry:
On a point of order, Mr Hancock. Given that
the clause relates to the scrutiny function of local authorities, what
is going to appear within the regulations and whether designated
services or anything other than designated services will be able to be
referred are things that are entirely within the remit of the clause.
It is for that reason that we need to have complete
clarity—
The
Chair:
That is a debate for clause stand
part.
Paul
Burstow:
I beg to move amendment 438, in
clause 175, page 148, line 31, at
end insert—
‘( ) Until the
coming into force of paragraph 26 of Schedule 3 to the Localism Act
2011, section 21 of the Local Government Act 2000 (overview and
scrutiny committees) is amended as
follows—(a) in
subsection (2)(f)—(i)
omit “section 244 of the National Health Service Act 2006
or”,(ii) for
“either of those sections” substitute “that
section”,(iii) for
“the Act concerned” substitute “that Act”,
and(iv) for
“the section concerned” substitute “that
section”,(b) omit
subsection (2A)(a) and (b),
and(c) in
subsection (4) at the end insert “or under section 244(2ZD) of
the National Health Service Act
2006.”’.
This
is a transitional provision, which is necessary as we are contingent in
part on the progress of the Localism Bill. The amendment will ensure
that local authorities have flexibility in how they discharge their
overview and scrutiny functions should we need to commence our
provisions ahead of the commencement of the relevant provisions in the
Localism Bill. Should those provisions be commenced before the
commencement of our provisions, this transitional provision will not be
necessary and the flexibility will be granted to local authorities
through the amendments that clause 175 will make to the Localism Bill
when it is enacted. For those reasons, I urge hon. Members to accept
the
amendment.
Amendment
438 agreed
to.
Question
proposed, That the clause, as amended, stand part of the
Bill.
The
Chair:
With this it will be convenient to discuss
Government new clause 4—Amendments consequential on section
175.
Emily
Thornberry:
I believe that we have had such a complete
debate that, tempting as it is, it would probably be wrong to go over
it
again.
Question
put and agreed
to.
Clause
175, as amended,
accordingly
ordered to
stand part of the Bill.
Clause
176
Joint
strategic needs
assessments
Paul
Burstow:
I beg to move amendment 439, in
clause 176, page 149, line 9, leave
out
‘for which a partner
commissioning consortium is
established’
and
insert
‘of a partner commissioning
consortium’.
The
Chair:
With this it will be convenient to discuss
Government amendments 440 to
442.
Paul
Burstow:
These minor and technical amendments will ensure
that the representatives of the relevant GP consortia are required to
be included in the health and well-being board, and that the amendments
to the provisions on the preparation of the joint strategic needs
assessment correctly refer to
consortia.
As
members of the Committee will know, commissioning consortia will set
out their geographical area in their constitution. Any consortium that
has a geographical area that overlaps with or is within the local
authority area will have a duty to send a representative to the health
and well-being board, and jointly prepare the joint strategic needs
assessment and joint health and well-being strategy through the health
and well-being board. The amendment makes it clear that references to
consortia in the relevant provisions mean those whose area overlaps
with or is within the local
authority.
As
such, I hope that all the members of the Committee can see that that
will ensure greater clarity and consistency with previous clauses and
the engagement of all relevant commissioning consortia in the work of
local health and well-being boards, and that they will therefore
support the
amendments.
Emily
Thornberry:
I make the simple point that the necessity to
attempt to tidy up the Bill arises from the fundamental problem that GP
consortia do not need to be coterminous with local authority areas. The
difficulty is trying to ensure that strategic needs assessments are
made in a way that makes sense in an area with a patchwork of GP
consortia.
Paul
Burstow:
In briefly responding, I make the simple point
that that is already the case with primary care trusts, many of which
are bigger than a local authority or cover many local authorities, and
in other circumstances the overlap is different. The problem is being
inflated and exaggerated, as is so often the case with proposals made
by the
Opposition.
Amendment
439 agreed
to.
2.48
pm
Sitting
suspended.
2.55
pm
On
resuming—
Emily
Thornberry:
I beg to move amendment 360, in
clause 176, page 149, line 25, leave
out from ‘consortium’ to end of line 26 and
insert
‘must consult any relevant
district councils in the area covered by the assessment and any other
person, groups of people or representatives of persons or groups it
considers can provide advice about the health and social care needs of
the population of its
area.’.
The
Chair:
With this it will be convenient to discuss
amendment 366, in
clause 176, page 149, line 25, leave
out from ‘consortium’ to end of line 26 and
insert
‘must consult the public and
all interested groups following the Cabinet Office’s code of
practice on consultations, making sure that consultation is an integral
part of preparing its joint strategic needs
assessment’.
Emily
Thornberry:
If we look at the clause, a fair
caricature of what it is doing might be taking out “PCT”
and putting in “partner commissioning consortia” instead.
Essentially, it is updating the current joint strategic needs
assessments, so that they are done by the local authorities and
doctors, as opposed to by the PCT. I hope that that is a fair summary
of the purport of the
clause.
Nevertheless,
the clause provides an opportunity to ensure greater accountability and
more involvement by more bodies—bodies as diverse as the Optical
Confederation, which contacted me, stating that it would wish to be one
of the bodies consulted under the clause before a joint strategic needs
assessment. That is why, in some ways, amendments 360 and 366, which
come in at the same point, in effect make the same point: if we are
putting together a joint strategic needs assessment, let us ensure that
we do not only have the local authority and doctors discussing it, but
a much wider group, so that we learn from everyone, including the
opticians. We would have a proper joint strategic needs assessment,
which was a distillation of the communal wisdom of an
area.
Paul
Burstow:
The lead amendment would place a requirement on
local authorities and commissioning consortia to consult with district
councils as well as any other relevant persons, groups or
representatives in the preparation of a joint strategic needs
assessment. The amendment is unnecessary as section 116 of the Local
Government and Public Involvement in Health Act 2007,
amended by the clause, will require partner commissioning consortia and
the relevant local authority—if a county council—to
consult each relevant district council. The provision retains the
current duty of local authorities and primary care trusts and
recognises the important role of district councils in offering local
insight and
expertise.
We
recognise the concern of the hon. Lady and of some district councils,
but hope it is addressed by the reading across of existing provisions
in the previous legislation. Moreover, consortia and the commissioning
board will also be expected to consult the public as part of their
obligations under section 242 of the National Health Service Act 2006
when planning for the provision of services. Local councils and
consortia should have the flexibility to consult any person they think
appropriate, as they do under the Bill. Decisions on whom to
consult, beyond the statutory minimum, are best made locally
and should be for local health and well-being
boards.
Nicky
Morgan:
I entirely agree with what the Minister said about
decisions on who to consult being up to local authorities, but I wanted
to reflect some of the concerns expressed by various charities,
including Rethink, which wanted confirmation that “any
person” could include the local healthwatch organisation, as
well as anyone else the authorities see fit to
consult.
Paul
Burstow:
I am grateful to my hon. Friend for asking that.
I can give her, Rethink and the other charities that posed the question
the assurance that the provision does do just that. In addition, the
local healthwatch, as a member of the health and well-being board, will
be able to influence and recommend who else should be consulted about
and included in the work around joint strategic needs assessments. The
clause puts in place a double lock by providing for the local
healthwatch to be consulted directly and for it to be able to ensure
that the local authority and the consortia discharge their consulting
role in a wider
way.
3
pm
Amendment
366 would require local authorities and commissioning consortia to
consult the public and interested groups in line with the Cabinet
Office code of practice on consultations when preparing the JSNA. We
want local authorities and consortia to consult their populations when
undertaking JSNAs as appropriate, and that should be a local choice.
Local authorities and primary care trusts can already consult relevant
organisations and people as part of the preparation of the JSNA. As I
mentioned, local authorities and consortia already have a duty to
consult district councils, and that will continue. Requiring them to
undertake a formal, 12-week consultation would be unnecessary, and we
would prefer to leave how commissioners properly consult and engage
with the people they serve to local
determination.
This
will be the first extension of the Cabinet Office code to a local
authority, and it will not apply to any other aspect of their
obligations to consult their public. Moreover, the code will not bind
local authorities, as it sets out the Government’s general
policy on formal, public, written consultation exercises. Other public
sector organisations are free to use the code, and local authorities
could, of course, avail themselves of it if they chose to, but it does
not apply to local government exercises unless they adopt
it.
The
amendments tabled by the hon. Member for Islington South and Finsbury
would require local authorities to consult particular persons when
preparing JSNAs and to follow the code. That would create an anomaly
and go beyond the current obligations on local authorities. As an
aside, we note that her colleagues on the Public Bill Committee on the
Localism Bill have not tabled similar amendments to extend the code to
other areas on which local authorities are expected to
consult.
For
all those reasons, we believe the amendments are unnecessary. I hope
that I have been able to reassure the hon. Lady about district
involvement. As she rightly said, clause 176 replaces PCTs with
consortia, and it also strengthens the JSNA requirement. This is the
important difference: whereas, at the moment, none of these bodies have
to have regard in law for JSNAs, once the Bill becomes an Act they will
have to. That is an important strengthening for the future and of the
relationship we wish to build between consortia and local
government.
Emily
Thornberry:
I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Amendments
made: 440, in clause 176, page 149, line 31, leave
out
‘established for an area
which’
and
insert “whose
area’.
Amendment
441, in
clause 176, page 149, line 38, leave
out
‘for which the commissioning
consortium is
established’
and
insert “of the commissioning consortium’.—(Paul
Burstow.)
Question
proposed, That the clause, as amended, stand part of the
Bill.
Mr
Kevin Barron (Rother Valley) (Lab):
The Minister will be
pleased to know that I am unable to be in Sheffield on Saturday
afternoon, but my season ticket is available for Rotherham United
versus Bury at the Sheffield Don Valley stadium. If he would like to
borrow it, he might find more friends there than in
conference.
The Minister
says that the clause is about replacing PCTs with consortia, but it
also extends the JSNA. Subsection (3)(c) says
“after ‘a
need’ insert ‘or to be likely to be a
need’.”
That
is better described in the explanatory notes, which say that the
amendments in the
clause
“also
widen the scope of the joint strategic needs assessment to require it
to cover both the current and future needs of the local population, and
not only current
needs.”
What
is that likely to bring in? I presume that that is pointing to
population health as opposed to health needs, but could he give us a
brief description of how the assessments we have at the moment will be
widened?
Debbie
Abrahams (Oldham East and Saddleworth) (Lab):
The Minister
will not be surprised that my comments will relate to the importance of
ensuring that there is an explicit reference to assessing comprehensive
health inequalities, which I have raised a number of times in
Committee.
The Bill has a
particular weakness, because although it refers to the importance of
health inequalities, and they are addressed under clause 3, the matter
has not been well dealt with in relation to the mandate for the
Secretary of State, the duties for consortia and so on. If we are
committed to reducing health inequalities, there must be a more
explicit reference in the Bill. We must have a comprehensive assessment
that looks at not only the individual, but wider economic determinants.
My concern links to a reference from the Faculty of Public Health, so
other people regard the matter as a particular weakness, too. I hope
the Minister will consider that and consider whether a designated
person should be responsible for such
assessment.
Paul
Burstow:
I shall start with the hon. Lady’s remarks
on explicitly referring to health inequality within the discharge of
the duty to produce a JSNA. It is important to keep in mind the simple
fact that when particular organisations carry out any function that the
Bill designates to them, such organisations must also have regard to
the duties that are placed on them. They must exercise such regard
through every function that they undertake. When discharging their
function to
produce a JSNA, they therefore have to demonstrate that they are also
taking into account health inequalities. In addition, we intend to
review and revisit the guidance on JSNAs, and we want to co-produce
that with colleagues in local government and more widely. We also want
to ensure that such a review addresses the point made by the right hon.
Member for Rother Valley about public health issues.
To answer the
right hon. Gentleman’s question, we want to ensure that
demographic trends are being understood and taken into account.
Understanding such trends are a key part of determining how services
might change over time to meet the changing needs of a population as a
result of its ethnic mix, its socio-economic mix, and its age profile.
We do not just want to get a snapshot of all those things in the here
and now and then fix services on that basis. We need to be thinking
into the future, too, as we are trying to ensure is clear in the
Bill.
Debbie
Abrahams:
Again, I stress that these points were made
through the Faculty of Public Health and arise from my experience. Why
is there a problem with making the importance of health inequalities
more explicit throughout the Bill? How will the matter be dealt with at
the different stages? If it is not dealt with, there is a danger that
health inequalities will not have the profile that is
needed.
Paul
Burstow:
We will make absolutely certain that the guidance
that supports the provision draws the attention of the parties that
will produce JSNAs to the duty around health inequalities.
It is a key part of the Bill, and this is the first time that a health
Bill has contained an explicit reference to such
inequalities—that has not existed in any previous NHS
legislation. The duty must be exercised in any function that is
discharged under the measures in the Bill, so it is a key part of the
architecture. I am sure that hon. Members are right to keep raising the
matter, and we are right to keep reassuring them. I am more than happy
to have further conversations with the faculty about its particular
concern, if it wishes.
The key point
is that when producing JSNAs, consortia must take account of the
relevant needs of the population, so they will have to take into
account the health inequalities that exist. The strategy will set out
how they will reduce such inequalities, and we would expect a joint
health and well-being strategy to do that.
Debbie
Abrahams:
What about having a designated person
responsible for
assessment?
Paul
Burstow:
With regard to a designated person being
responsible for producing the joint strategic needs assessment, we have
made the organisational responsibilities clear in the Bill. Given the
thrust of the Government’s intention not to be over-prescriptive
in autonomous organisations’ governance arrangements, it would
be odd to prescribe in the Bill a specific person as responsible, but
it is a clear function and duty for them to discharge. With that, I
hope that the clause can be
approved.
Question
put and agreed to.
Clause 176,
as amended, accordingly ordered to stand part of the
Bill.
Clause
177
Joint
health and wellbeing
strategies
Grahame
M. Morris (Easington) (Lab):
I beg to move amendment 220,
in
clause 177, page 150, line 19, at
end insert—
‘(4A)
In preparing a strategy under this section, the
responsible local authority and each of its partner commissioning
consortia must have regard to the most recent assessment of housing
need undertaken by the local planning
authority.’.
The
Chair:
With this it will be convenient to discuss
amendment 221, in
clause 178, page 151, line 16, at
end insert—
‘(fa) the
officer principally responsible for the exercise of the local
authority’s housing functions, or if thought fit, a
representative officer of a registered provider of social
housing,’.
Grahame
M. Morris:
The clause would impose a duty on local
authorities and commissioning consortia to produce a joint health and
well-being strategy to meet the needs identified in the joint strategic
needs assessment. There will be a duty on consortia, the local
authority and the NHS commissioning board to have regard to the joint
strategic needs assessment and the joint health and well-being strategy
when carrying out their commissioning
functions.
The
amendments would extend the duty to ensure that those strategies take
account of some of the most important determinants of health. My hon.
Friend the Member for Oldham East and Saddleworth just referred to
health inequalities. In a similar vein, the amendments intend to be
helpful and strengthen the
provisions.
Amendment
220 is designed to ensure that, in preparing local health and
well-being strategies, health and social care needs are considered
alongside local housing needs. It would give regard to local assessment
of housing needs. To reassure coalition Members, I should say that the
amendments would not divert resources in a particular direction. They
would give an opportunity to address health inequalities by identifying
that particular need. It would also ensure that local partners could
make this key determinant of health a priority when joint health and
well-being strategies are being put in place.
Amendment 221
would ensure that a housing representative sits on the health and
well-being boards. That person might be a director of housing or a
chief executive of a housing association, in the cases where stock has
already been transferred. Boards are expected to put in place a health
and well-being strategy for their local area and to work in an
integrated manner. To achieve that, a housing representative should be
on the local board, alongside people representing social services,
children’s services and other representative board members set
out in the legislation, because housing is a key determinant of
health.
Mr
Steve Brine (Winchester) (Con):
I do not doubt the hon.
Gentleman’s motives, and he is making his point well. In my
area, the city council owns stock and there are at least two—on
the edge, three—other housing association providers. Does the
hon. Gentleman propose that only the council’s housing
representative should sit on the board, or would there be four
individuals?
Grahame
M. Morris:
Without getting into an argument about numbers,
I should say that it would be sensible to have a representative. I do
not think it would be problematic. In my area, we have a large
arm’s-length management organisation in respect of local
authority housing stock. There could be a consensus on the
representative among the providers, as long as we had somebody there
with the expert knowledge to
contribute.
The
Committee should also be aware that any assessment of housing needs
will be removed by the Localism Bill. The Minister might want to
address that point later. My understanding is that that would mean
there would be no local needs assessment to guide and inform what is
decided and prioritised in local housing strategies. It is interesting
that the National Housing Federation suggested that that contradicts
the approach taken by this Bill—a point made eloquently by my
hon. Friend the Member for Islington South and Finsbury. Needs
assessment remains important for integrating services and prioritising
the appropriate
measures.
3.15
pm
By
accepting the amendment, we could ensure not only that housing need
informs local health and well-being strategies, but that there is some
sort of assessment of local housing needs in the first place. I
appreciate that housing need varies from area to area. For example, in
my own constituency—a traditional coal mining area—we
have a particular need for special-purpose accommodation because of a
large and growing elderly population, many of whom have disabilities.
Clearly, that has implications for health
provision.
Each
area has its unique problems. In areas such as Dudley or the London
borough of Islington, where the populations are younger, there may be
demand for more family accommodation. The amendment would not be
prescriptive; it would be left to local determination to assess housing
need and take appropriate
action.
The
amendment might be the only way to get the assessment of local housing
need on to the statute book, because, to the best of my knowledge, the
Localism Bill does not currently legislate for that, although I stand
to be corrected. The Department of Health team may be unaware of the
issue, and the amendments offer a vital opportunity to address the
problem.
Such an
assessment would benefit integration, cost-effectiveness and savings,
and give more credibility to local health and well-being strategies. It
may sit uncomfortably with the Government to enforce the membership of
housing representatives on the health and well-being boards, but it
could be of invaluable benefit for determining health needs. It would
make sure that the relevant people were at the table to make vital
decisions and have input into formulating
strategy.
If
the Government are serious about integration, as the Bill implies, the
amendment should help them to realise that aim. Proper integration
across health and social care cannot be fully achieved without
considering the role of housing and support. Indeed, National Housing
Federation research shows that currently only 20 PCTs are scoring well
on the “collaborative working” indicator, which is not
good enough. As the new health service comes into focus, this picture
must be improved. The amendment offers a mechanism for doing
so.
Both
sides of the Committee agree that there should be better integrated and
co-ordinated services, so I would like to share some relevant facts and
figures, which the National Housing Federation has provided.
Housing-related support services—funded through the Supporting
People programme, as Members will realise—save the NHS around
£315 million each year, according to Government figures. Some
42% of social housing households have a resident who is disabled or has
a limiting long-term illness, compared with a national rate of 17%. One
community-based falls prevention scheme—which might even have
been the one in my own area—reduced the rate of falls among
older people by
55%.
Housing
problems are frequently cited as a reason for a person’s being
admitted or readmitted to in-patient mental health care. The need to
find appropriate accommodation and a lack of appropriate move-on
housing are major reasons for delays in discharging people from
hospital back into the community. In an average homelessness project in
England, an estimated 43% of clients are likely to have mental health
needs and 59% may have multiple
needs.
I
point out to Government Members that the Government will be looking for
local authorities to deliver cost-effective and value-for-money
solutions to health challenges. For Opposition Members, putting housing
needs at the top of the agenda would help to deliver more efficient
health services, so I hope the Minister will look kindly at the
amendment.
Paul
Burstow:
I am more than happy to confirm that when it
comes to the representations that the National Housing Federation is
making about the essential contribution that housing makes to good
health, the hon. Gentleman is absolutely right. We do not disagree with
that contention in any way. Our difference is over how we give effect
to recognising that that is the case.
The difficulty
with the amendment, as was pointed out by my hon. Friend the Member for
Winchester, is that, given the large amount of housing provided by
registered social landlords, and in some cases because of stock
transfers, it would be challenging at the very least to decide who
should sit on the health and well-being board. That is why prescribing
membership in the way that the amendment seeks to is not the
answer.
Dr
Poulter:
Does my hon. Friend agree that there is a big
problem, and not just in the social rented sector? The worst housing is
often in the private rented sector. It is particularly difficult to
find any representation from that sector, so finding a coherent
representation on housing would be
difficult.
Paul
Burstow:
It is also why, in an earlier debate, we referred
to and gave reassurances about the obligations on local authorities to
consult with districts when discharging those responsibilities. They
have environmental health responsibilities that will be relevant to
concerns about housing in the private
sector.
Grahame
M. Morris:
Just because a problem is difficult, it does
not mean that we should not try to address it. In my area, we set up a
taskforce with various key working groups, housing being one of them,
and there is ample evidence that it was not difficult for the private
and
public sector to work together and have a representative. It is
perfectly possible to do that, and it clearly identifies the issue on
the
agenda.
Paul
Burstow:
We have great trust in the wit, wisdom and
ability of health and well-being boards and local authorities to make
judgments about who would be the most appropriate additional members of
a health and well-being board. We have set out the de minimis
requirements in the Bill, not the de maximis position that everyone
must be on the board. The danger with adding extra members to the board
in the provision is that it narrows the local authority’s scope
to make rational choices about who should sit around that table,
contributing to these very important roles.
On the point
about making sure that housing is properly taken into consideration in
joint strategic needs assessments and therefore informs joint health
and well-being strategies, the current guidance says that all factors
impacting on the health and well-being of residents in an area should
be considered. We intend that to continue. It rightly addresses the
fact that there are many factors that affect public health needs and
the social care needs of that population. The amendments would not give
local authorities, through health and well-being boards, the necessary
flexibility to deal with their local circumstances. That is why we
resist them; it is not because we have a disagreement about the
importance of housing. We do not. There is simply a need to ensure the
right level of flexibility in approaching the issues at a local
level.
Grahame
M. Morris:
I think we have covered the ground. The
amendment was an attempt to be helpful; I regret that the Minister
cannot accept it. I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Emily
Thornberry:
I beg to move amendment 367, in
clause 177, page 150, line 23, leave
out ‘may’ and insert
‘must’.
My
weasel word detector picked up this “may”. It is
completely unnecessary; it should be “must”. We all know
that if we want to make a big difference to health care, we have to
integrate health care and social care services. It is completely
unnecessary to use “may”, which is far too weak a word.
We should have “must”
instead.
Nicky
Morgan:
I want to put on record the fact that I have also
been contacted about the amendment by several organisations. I have
tried to amend various bits of legislation in my life before I came to
the House, and this is sort of proposal I would always put forward. I
am sure that the Minister will give us a full explanation of the
current wording. Parliamentary draftsmen take their jobs extremely
seriously and there are definitely rules and guidelines on why they
tend to use such words. Mind and other charities want an explanation.
The change could run right the way through the Bill. I am sure that
there is a good reason why it does not, and I look forward to my hon.
Friend’s explanation.
Paul
Burstow:
Let me try to reassure the Committee and give an
explanation, as I have been invited to do.
The amendment would require local authorities and commissioning
consortia to include a statement in the joint health and well-being
strategy of their view on how health-related service commissioning
could be more closely integrated with other health and social care
commissioning in their area. Currently, local authorities and their
consortia partners may include such a statement in their strategy, but
are not forced to do
so.
The
intention behind the wording was not to be weaselly, but simply to
follow parliamentary drafting conventions. The intention was to give
local commissioners the flexibility to decide whether such a statement
was helpful for their locality, rather than forcing them to include it.
It reflects more broadly our approach of allowing them to shape the
joint health and well-being strategy to reflect local challenges and
priorities. The respondents to the consultation were generally very
supportive of the flexible approach that we proposed, and we found no
appetite for a more prescriptive approach driven from the
centre.
Emily
Thornberry:
The Minister tells us that it will be up to
local authorities to decide whether it is more appropriate for their
locality to have better integration of health and social care. Has he
any particular locality in mind that may benefit from there not being
more integration between health and social
care?
Paul
Burstow:
I am sure every locality will benefit from the
integration of health and social care where that integration is
appropriate. That is exactly what the Bill sets out to achieve with the
new responsibilities that we are giving to the National Institute for
Health and Clinical Excellence by extending its remit to social care.
That is set out in the clauses that give the NHS commissioning board a
duty to promote the integration of services and use of the National
Health Service Act 2006 flexibilities on commissioning, and
in the clause that we are considering, in respect of the health and
well-being board. Integration is very much hardwired into the
architecture of the Bill and is part of what we want health and social
care commissioners actively to consider as part of their work on joint
health and well-being
strategies.
For
local integrated working to be effective, there needs to be a minimum
of central duties, especially unbalanced central duties, and the
maximum space for local commissioners to build relationships based on
trust and mutual respect. That is what we have learned from the fact
that the existing flexibilities, which have sat in statute for many a
year, have not been as extensively used as I am sure the previous
Government hoped. We intend the clauses to make sure that there is much
clearer focus on that, and much better working relationships in the
system at a local level.
We will talk a
great deal more about integration under later clauses, especially when
we deal with amendments tabled by the hon. Member for Islington South
and Finsbury to clause 179. However, I hope that I have been able to
reassure her that we continue to listen, and that we want to make sure
that the Bill achieves our intention of having greater integration of
services and commissioning.
Emily
Thornberry:
The Minister says that the integration of
health and social care is hardwired into the Bill. That
is another one of his well honed and florid phrases that sounds great,
but the provision is not hardwiring. It is as soft as it can be. It
states:
“The
responsible local authority and each of its partner commissioning
consortia may include in the strategy a statement of their views on how
arrangements for the provision of health-related services in the area
of the local authority could be more closely integrated with
arrangements for the provision of health services and social care
services in that
area.”
If
that is hardwiring the integration of social care and health care, I am
a monkey’s uncle. I want to press the amendment to a
Division.
3.30
pm
Question
put, That the amendment be
made.
The
Committee divided: Ayes 9, Noes
12.
Division
No.
35
]
AYES
Abrahams,
Debbie
Barron,
rh Mr
Kevin
Blenkinsop,
Tom
Kendall,
Liz
Morris,
Grahame M.
(Easington)
Thornberry,
Emily
Turner,
Karl
Twigg,
Derek
Wilson,
Phil
NOES
Brine,
Mr
Steve
Burns,
rh Mr
Simon
Burstow,
Paul
Byles,
Dan
Crabb,
Stephen
de
Bois,
Nick
James,
Margot
Lefroy,
Jeremy
Morgan,
Nicky
Poulter,
Dr
Daniel
Soubry,
Anna
Sturdy,
Julian
Question
accordingly negatived.
Question
p
roposed
, That the clause stand part of
the Bill.
Emily
Thornberry:
My point is simple. Clause 176 allows for
joint strategic needs assessments and clause 177 allows
there to be a joint health and well-being strategy, which is presumably
informed by the joint strategic needs assessment. We have a strategy
and an assessment, but we do not have any obligation to do those
things. Clause 177 imposes a duty on the local authority and the
partner commissioning consortia to prepare a strategy, and clause 176
imposes a duty to carry out an assessment. Under proposed new
section 116B of the Local Government and Public Involvement
in Health Act 2007, however, there is a duty to have regard
to assessments and
strategies:
“A
responsible local authority and each of its partner commissioning
consortia must, in exercising any relevant functions, have regard
to…the most recent assessment of needs and…the most
recent joint health and wellbeing
strategy.”
That
gets to the nub of things, and it is the reason why, from top to
bottom, the Liberal Democrats are in full revolt against the
Bill.
There is much
agreement about having more democratic accountability for health
authorities. However, the Bill sets up health and well-being boards
that are in some way democratic—in one way, there will be some
form of democratic accountability there—but have no power; and
there are to be GP consortia, with all the power and
no democratic accountability. The two of them come
together for joint strategic needs assessments, when they
do their strategy, but there is no obligation for
the commissioning consortia, who have the power to implement the
strategy—certainly in relation to health—to actually do
that.
As far as we
can see, if a GP consortium does not want to do something, no people
who represent the locality —not the local authority
or the health and well-being board—can force GPs to do anything.
The national commissioning board can, but it is made up of exactly the
sort of so-called faceless bureaucrats that the legislation is supposed
to take power away from, to give it to local areas instead. If all we
have is a strategy and a needs assessment, but no power to ensure that
commissioning consortia implement the strategy, what is the point? It
is simply a talking shop, and that is the problem. Health and
well-being boards are being set up to fail.
Much is said
about how we are going to bring democracy into the NHS and
decision-making down to a local level. From my reading of the
legislation, it seems that the only decision-making about health that
has been brought down to a local level is that doctors will be able to
sit down with patients and make decisions. Any influence that health
and well-being boards have on commissioning consortia is minimal. There
certainly does not seem to be any power to ensure that the strategy
that they agree together is implemented. That is yet another weakness
in the Bill. If the Government are serious about bringing democracy
into the NHS, why do we need to have such a pusillanimous clause as
this?
Paul
Burstow:
Again, we are debating the phantom Bill that the
Opposition would like people to think this is, and not the actual Bill
that we are taking through Committee and the House. If one simply
looked at the clause, one might give some credence to the hon.
Lady’s argument, but it really does not bear too much weight. In
the Bill we are, for the first time, putting on a statutory basis
something that local governments said they wanted. They said that they
wanted statutory health and well-being boards, and we have responded.
They will be responsible for producing joint strategic needs
assessments. At the moment, local authorities and primary care trusts
produce those documents. One might ask, “Well, what is the
difference?” The difference is very important. For the first
time, there will be a clear legal duty on all commissioners to have
regard to that.
We debated
what “having regard” meant early on in the Committee, but
it is worth reiterating what it means, so that it is absolutely clear.
One key way in which a duty to have regard to something has to be
carried out is to assess the impact of an opposed decision or policy on
that thing, so as to identify any positive or negative potential
impacts and to seek to mitigate any negative ones. The phrase is often
used to describe the duties of public bodies. The NHS constitution, to
which all hon. Members on the Committee are anxious to ensure that NHS
bodies have regard, is an example where that applies. We are therefore
talking about a difference of significant importance—a transfer
of power, in the sense that for the first time, local authorities will
provide the place where those discussions take place. They provide the
place where priorities are set through joint health
and well-being strategies. For the first time, those strategies will
have to be subject to the “having regard” test when it
comes to decisions by commissioners.
On top of that,
we are talking about two separate and sovereign organisations: the NHS,
with its responsibilities nationally to provide a comprehensive service
and to spend taxpayers’ money, provided by the NHS commissioning
board; and local authorities, with their responsibilities for
commissioning social care with the resources provided to them. The
health and well-being board effectively brings those two organisations
together to agree the issues on which they need to work together and to
ensure that health needs are assessed and then properly met.
The health and
well-being board needs to be consulted on the commissioning plan of the
GP consortium. If the health and well-being board takes the view that
all the things they had spent time working on together had been
ignored, it can make that absolutely plain. That would be taken into
account by the NHS commissioning board. I think the hon. Lady is
suggesting that we should import into that relationship the adversarial
nature of the way in which we scrutinise legislation. That is an
entirely destructive insertion into what has to be a collaborative and
co-operative set of relationships between the NHS and local
government.
The
extraordinary thing about the provisions is how positively local
government has responded to them. Local government sees that the
provisions represent opportunities to move forward the agenda on public
health, to move forward on the need to integrate public services for
health and social care better, and to act as system leaders. Local
government sees that, and it is signing up for it, and I am very sorry
that the hon. Lady does not feel able to do so. That is why we have
rejected the notion that we should be over-prescriptive, which is what
she suggests we should
be.
The
provisions reflect the fact that for far too long, while in government,
the hon. Lady and her party took the view that local government was
simply an agent doing what central Government told it to do. That is
not the Government’s view; our view is that local government has
its own mandate and its own right to take forward the needs of its
local population. The Bill recognises, respects and builds on
that.
Question
put, That the clause stand part of the
Bill.
The
Committee divided: Ayes 12, Noes
9.
Division
No.
36
]
AYES
Brine,
Mr
Steve
Burns,
rh Mr
Simon
Burstow,
Paul
Byles,
Dan
Crabb,
Stephen
de
Bois,
Nick
James,
Margot
Lefroy,
Jeremy
Morgan,
Nicky
Poulter,
Dr
Daniel
Soubry,
Anna
Sturdy,
Julian
NOES
Abrahams,
Debbie
Barron,
rh Mr
Kevin
Blenkinsop,
Tom
Kendall,
Liz
Morris,
Grahame M.
(Easington)
Thornberry,
Emily
Turner,
Karl
Twigg,
Derek
Wilson,
Phil
Question
accordingly agreed to.
Clause 177
ordered to stand part of the
Bill.
Clause
178
Establishment
of Health and Wellbeing
Boards
Emily
Thornberry:
I beg to move amendment 368, in
clause 178, page 151, line 14, leave
out ‘a representative’ and insert
‘representatives’.
The
Chair:
With this it will be convenient to discuss the
following:
Amendment
369, in
clause 178, page 151, line 16, at
end insert—
‘( ) the
director of housing services for the local
authority,‘( ) a
representative of the police service for the area of the local
authority.’.
Amendment
361, in
clause 178, page 151, line 18, at
end insert—
‘( ) a
representative of any relevant district
councils’.
Amendment
370, in
clause 178, page 151, line 28, after
‘appoint’, insert ‘more
than’.
Amendment
371, in
clause 178, page 151, line 31, leave
out subsection
(7).
Emily
Thornberry:
Before the Minister tells me that we are being
over-prescriptive, may I ask him why it is that when the Bill
establishes all kinds of boards and organisations there is no spelling
out, but when it comes to local government—when it comes to the
heart of the measure and to everybody allegedly being brought
together—the Government are being as prescriptive as they are?
In giving us this great long list of all the people who should be on
the health and well-being board, they should at least get it right.
That is why we have tabled the amendments.
3.45
pm
For
example, the Government prescribe that the health and well-being board
should have “a representative” of the local healthwatch
organisation for the area of the local authority. Why only one? Why
should we not have “representatives”, which is what we
propose in amendment 368? Amendment 369 raises the question why, if we
have a representative of each relevant commissioning consortium, should
we not also have a representative of people involved in housing and a
representative of the police? In modern life, the police probably have
a great deal to do with people with mental health issues, as well as
expertise in the local area.
Government
Members appear to be having very different reactions to that point, but
the reality is that many anti-social behaviour problems arise because
people have mental health problems and cannot relate properly to their
neighbours. In the end, there is a problem of how to deal with such
people. Their condition may not be sufficiently acute for an emergency
team to be brought in, but if their neighbours find such behaviour
difficult, they might involve the police. In some areas, therefore, the
police have a better understanding of the mapping out of acute mental
health problems, so it would be of value to have the police’s
wisdom and advice on the health and well-being
board.
Dan
Byles:
I make this point in a genuine attempt to help the
hon. Lady. I sat on the board of a mental health trust and several of
its committees and sub-committees, and although we often liaised with
the
ambulance service and the police, we found that it was incredibly
difficult to get the police to be regular attendees at committees or
sub-committees because they were so busy. They preferred to be invited
when specific issues were to be discussed, rather than to be standing
members. They were very resistant to being standing members on any of
our committees or
sub-committees.
Emily
Thornberry:
I am grateful to the hon. Gentleman for giving
us that interesting
information.
We
argue that other people ought to be considered, as well.
Representatives of district councils are also experts in their area,
and should be
included.
Nick
de Bois (Enfield North) (Con):
I sense that Opposition
Members regularly feel the need to prescribe for just about every
option. It strikes me that clause 178(8) leaves health and
well-being boards discretion in whom to invite—basically, they
can invite pretty much anyone to come in. We must assume that people
will act in the best interests of their residents and take advantage of
that provision, if the circumstances
arise.
Emily
Thornberry:
Clause 178(8) is not a stand-alone clause
stating:
“The
Health and Wellbeing Board may appoint such additional persons to be
members of the Board as it thinks
appropriate.”
The
clause also contains a detailed prescriptive list, so I am asking why
the Government include some people but not others. In this Committee,
it is important that we prise from the Government why they have chosen
certain bodies and not
others.
Amendment
370 relates to subsection (5), which
states
“Local
Healthwatch Organisation for the area of the local authority must
appoint one person to represent it on the Health and Wellbeing
Board.”
Again,
why does the local healthwatch organisation have only one
representative, given that we have heard from the Minister how
important that body is? If the Government prescribe that there is only
one representative, will health and well-being boards not feel unable
to appoint more than one? If there can be more than one, why does the
provision state
“one”?
The
most important and telling provision in the clause is subsection (7),
which strikes me as extraordinary. It
states:
“A
person may, with the agreement of the Health and Wellbeing Board,
represent more than one commissioning consortium on the
Board.”
According
to the explanatory notes, it seems that the provision is made out of
consideration for doctors or those from commissioning consortia who may
be terribly busy and have more important things to do than to appear on
health and well-being boards. In a local authority area with two or
three commissioning consortia, the Bill, if unamended, will allow one
representative of all the commissioning consortia to join the health
and well-being board—because that is more efficient, perhaps. An
alternative explanation is that health and well-being boards are only a
cover, and will not have the sort of power that the Minister claims
they will. Although the boards are supposed to be accountable, they may
actually be powerless, and perhaps we do not want such bodies to
impinge too much on the time of doctors, who are not powerless. Doctors
will spend the money, so perhaps
we do not need them to waste a great deal of time going along to
troublesome things such as health and well-being boards. If I am not
right, we should take out subsection (7).
Paul
Burstow:
The hon. Lady is right to say that she is not
right. She is also right to say that there is no reason to accept the
amendments. They are unnecessary. Had we done the exact opposite of
what we have done in the Bill, I suspect that the hon. Lady would have
argued that it was appalling that GP commissioning consortia would not
have the flexibility and the opportunity to
delegate—
Emily
Thornberry:
Will the hon. Gentleman give
way?
Paul
Burstow:
Let me deal with some of the hon. Lady’s
other points first.
Let me
reiterate a point that is key to understanding this part of the Bill.
It sets out the de minimis membership. It should not be seen by anyone
who reads it, after the Bill is enacted, as providing a mandate, saying
“These are the only people who can serve on this board”
and no one else could possibly sit on it. What is absolutely clear from
the White Paper consultation and discussions that we continue to have
with colleagues in local government is that the flexibility that the
Bill provides in relation to the arrangements for health and well-being
boards is widely welcomed. Manchester city council and the Manchester
adults health and well-being partnership have welcomed
the
“local
freedom to determine the most appropriate membership reflecting the
national statutory
framework”
that
the Bill establishes. Norfolk county council say it supports our
approach
“which
sees only a limited number of partners subject to a ‘duty to
cooperate’ leaving top-tier authorities with the freedom and
flexibility to decide any wider
representation”.
The
amendments detail bodies or organisations that it would be entirely
appropriate to have on a health and well-being board, such as the
police. Although my hon. Friend the Member for North Warwickshire has
given reasons why that may not always be appropriate, the police
certainly could be included. Government Members are not concerned about
having an incomplete list, but about having one that can be interpreted
not as a minimalist list, but one that excludes others and prevents
them from being added to the board. That is why we have crafted the
Bill as we have. It is about how best to ensure the maximum local
flexibility and that the arrangements work well when it comes to the
relationship between health and well-being boards and GP
consortia.
Debbie
Abrahams:
Perhaps the Minister is not aware that a
consequence of that minimalist approach is that some local authorities
are deciding to designate their directors of public health at third
tier level. In spite of what was advocated in the public health White
Paper, which said that directors should be directly accountable to the
chief executive, they are going to be at assistant director
level—not directly accountable, therefore. Their budgets will be
under the responsibility, perhaps, of directors of adults’
services, or children’s services. Those
are the unintended consequences, and we are trying to show what needs to
be firmed up in the Bill. Such points are very
important.
Paul
Burstow:
They are points; they are important; but
they are not points that relate to this set of amendments. The clause
is about who sits on health and well-being boards and about who
discharges the various functions that sit with such boards. We make it
clear, as a de minimis requirement—not a minimalist
requirement—that the director of public health should sit on the
health and well-being board. What we are not trying to do, and the
reason why we are resisting the Opposition amendments, is to construct
an ever-lengthening list that increasingly excludes anyone who is not
on it. That is why we are not having such a
list.
Debbie
Abrahams:
I was just using that as an example. The
Minister referred to a minimalist approach, and I gave an example of
what happens when such an approach is used. Unfortunately, there will
be unintended consequences that are directly counter to what the
Government are trying to achieve. We all share the ambition to improve
health and the quality of health services, and to reduce inequalities,
but unfortunately, if the Government use a minimalist approach—I
use that term again—that is what will happen. They will not
achieve what they say they are seeking to
achieve.
Paul
Burstow:
I reiterate that our position on the membership
of health and well-being boards is not minimalist but de minimis. To
make things absolutely clear to those who read our proceedings in
future to interpret what we intended for the membership of the board,
this is not about limiting the board’s ability to decide who
else should be a member or limiting the local authority’s
ability, when establishing the health and well-being boards, to think
carefully about who should be involved. Interestingly, the early
implementers of health and well-being boards are already exploring a
variety of options. That is good and creative, and we should allow such
practice rather than stifling it by imposing a long
list.
Dr
Poulter:
Is that not exactly the point? The local needs in
Eastbourne, for example, which involve looking after older people, are
completely different from those in the constituency of the hon. Member
for Easington, who is concerned about housing and the quality of
housing stock. That is why we need flexibility in the arrangements,
rather than being too prescriptive.
Paul
Burstow:
The hon. Gentleman is absolutely spot on, and he
underlines the difference between the two sides of the Committee. I
hope, none the less, that the purpose of this set of exchanges was to
probe and to seek clarification and reassurance that although the Bill
says that one healthwatch member should be on the board, that is a de
minimis requirement and does not preclude the possibility of more. I
hope that the hon. Member for Islington South and Finsbury will
withdraw the amendment. If she does not, we will resist
it.
Emily
Thornberry:
That was exactly the purpose, and I beg to ask
leave to withdraw the amendment.
Amendment,
by leave, withdrawn.
Amendment
made: 442, in clause 178, page 152, line 13, leave
out
‘established for an area
which’
and
insert “whose area’.—(Paul
Burstow.)
Clause
178, as amended, ordered to stand part of the
Bill.
Clause
179
Duty
to encourage integrated
working
Emily
Thornberry:
I beg to move amendment 362, in
clause 179, page 152, line 27, leave
out ‘encourage’ and insert
‘ensure’.
The
Chair:
With this it will be convenient to discuss the
following:
Amendment
372, in
clause 179, page 152, line 33, after
‘such’, insert
‘integrated’.
Amendment
363, in
clause 179, page 152, line 34, leave
out ‘encourage’ and insert
‘ensure’.
Amendment
364, in
clause 179, page 152, line 37, leave
out ‘encourage’ and insert
‘ensure’.
Emily
Thornberry:
I do not apologise for returning to a
recurring theme. Yet again, we have a duty, relating to
integrated working, and a weasel word. The duty is to encourage
integrated working. The health and well-being boards seem to have very
few functions, even though clause 179 comes under the heading
“Health and Wellbeing Boards: functions”. What are the
functions? They seem to be a “Duty to encourage integrated
working”—there does not seem to be any other sub-heading.
As it is such an important part of their functions—the main one,
really—why can they not ensure integrated working instead of
just encouraging it?
Given that
integrated working is such an important policy thrust and that the
Government and the Opposition agree that we must have more integrated
working and services, if the health and well-being board has a role, it
is to bring all parties together and ensure that. Encouraging it is not
sufficient. “Encourage” is a weasel word. Let us ensure
integrated working. If health and well-being boards cannot ensure it,
nobody can.
Amendment 372
would change subsection (2), which provides
for
“arrangements
under section 75 of the National Health Service Act 2006 in connection
with the provision of such
services”,
to
read “integrated services”. The whole purpose of the
clause is to ensure integrated working. Those are my arguments for the
amendments. I will speak further on clause stand part, Mr
Hancock.
4
pm
Paul
Burstow:
I start by reflecting on the fact that, for the
best part of 13 years, the question of how we better deliver integrated
services was one that I raised, in opposition, in relation to various
pieces of legislation. Interestingly, I was always told that the duties
provided through the NHS flexibilities would be sufficient. Of course,
one reason why they have not proved sufficient is the absence of the
right collaborative behaviours and
working relationships in many parts of the country, which has got in the
way of that happening. To drive that forward is one reason why we have
crafted the Bill as we have, conceived the idea of a health and
well-being board, and placed the duties in respect of joint strategic
needs assessments and joint health and well-being strategies in the
Bill in the way we
have.
Let
me address directly the suggestion from the hon. Member for Islington
South and Finsbury that we should move from the language currently in
the Bill, “encourage”, to “ensure”. The
issue for us is the fear of the law of unintended
consequences—unintended consequences that would follow from the
amendment. There are areas of NHS activity—services that the NHS
provides—in which integration with social care would never be
appropriate. Specialist health services may have very little overlap,
or indeed none, with social care, so requiring them to integrate would
have very little benefit, and would in fact be an unnecessary burden
placed on the NHS. We are trying to achieve a proportionate and
appropriate framing of the legislation, requiring the health and
well-being boards to drive forward integration where it is appropriate.
That is what this is all
about.
Emily
Thornberry:
Would the Minister be kind enough to clarify
another aspect of this? How is “encourage” to be defined
in the legislation? What criteria are envisaged as suitable to assess
whether the duty to encourage has been met? Given that it is so
important, how do we know whether a health and well-being board has
been successful? We must consider that the success of a health and
well-being board will lie in its ability and capacity to create a
culture of consensus across its membership. How do we know whether it
is doing its job properly? How do we define “encourage”
and how do we assess whether health and well-being boards have been
successful?
Paul
Burstow:
That question feels like the old style of
top-down process targets which we became familiar, but to answer it,
one way in which we would see evidence that integration was becoming
more the norm would be the increased use of the NHS flexibilities that
are available and which the Bill says the NHS commissioning board
should promote actively to consortia. In addition, the responsibility
for encouraging their use is placed on health and well-being boards.
That would be a tangible and obvious way in which we could see clearly
that commissioning was being undertaken in the form of lead
commissioning, use of pooled budgets and so on. That is the intention
behind the measure, and I think that it will provide opportunities for
local authorities, in collaboration with the NHS, to join up services
where that is appropriate, particularly in respect of care of older
people but in other areas as
well.
Jeremy
Lefroy (Stafford) (Con):
I draw the Minister’s
attention to an example of such integrated working in my county of
Staffordshire, where the local authority and the NHS are setting up a
joint trust to provide precisely the kind of integrated working that is
being discussed. Clearly, they have responded to encouragement and have
not needed to be forced into doing it. That is a good
model.
Paul
Burstow:
I certainly agree. I now want to draw attention
to amendment 372. Again, I fear an unintended consequence of the
amendment, because it would not do what the hon. Member for Islington
South and Finsbury intends. An amended clause 179 would be limited to
health and well-being boards providing advice, assistance or other
support for the purpose of encouraging section 75 arrangements only in
relation to already integrated services, rather than health and social
care services. Inserting the word “integrated” would have
that unintended and unfortunate consequence; it would narrow the scope
of the clause. I hope, therefore, that the hon. Lady will not press
that amendment or the
others.
Finally,
let me define the word “encourage”. In the absence of an
express definition in the Bill, “encourage” will have its
ordinary dictionary meaning, as in, for example, what will be done by
boards by way of encouragement. In other words, I refer the hon. Lady
to the Oxford English Dictionary for the necessary definition. I am
sure she will be delighted about that because she has advanced the need
for plain English in our legislation. I hope she will withdraw the
amendment.
Emily
Thornberry:
I beg to ask leave to withdraw the
amendment.
Amendment,
by leave, withdrawn.
Amendments
made: 444, in
clause 179, page 152, line 43, at
end insert—
‘ “health
service” has the same meaning as in the National Health Service
Act
2006;’.
Amendment
443, in
clause 179, page 152, line 45, after
‘service’ insert ‘in
England’.—(Paul
Burstow.)
Question
proposed, That the clause, as amended, stand part of the
Bill.
Mr
Barron:
I do not wish to delay the Committee for too long.
I support the aims of the clause, but I want to try to find out a
little more about how things are going to work on the ground.
Clearly, the
current sub-structure within primary care trusts in respect of local
pharmacies—I declare an interest as chair of the all-party
pharmacy group—and of dentistry, and to some extent of
ophthalmics as well, is pretty well known. I have had several meetings
over the years with the local medical committee, whose influence, I
assume, will be greatly strengthened because of how commissioning is
going to change. It is going to be GP-led, but I wonder where the local
pharmaceutical committee and dentist forum will sit in the new
structure.
The
clause is about integration, which I support. For far too long, the
health service has delivered down stovepipes and has not looked at
integrated care for individuals, particularly people with long-term
conditions. Hopefully, the Bill will allow that to happen.
On the
establishment of health and well-being boards, I accept entirely that
they have the power to appoint such additional persons to be members of
the board as they think appropriate. If we look at pharmacy, we see
that all of us will have a very similar pattern, although some may not
because of the differences between urban and rural areas. There are big
players in my local pharmacy sector—the Co-op, Lloyds,
Boots—but there are also regional players and some individuals
as well.
I hope the
Minister can reassure me, because I am worried that health and
well-being boards might say, “We will have somebody who is
representative of pharmacy on our board, so that they will be there all
the time.” I accept that that is their choice and that it is
probably a good thing, given the role that pharmacy plays now in the
population’s health, looking after individuals who sometimes do
not see doctors. But I am deeply worried that the big players could
say, “We will put somebody on that. It will be at no
cost.” They have the money to be able to take something to the
table, potentially, whereas small, independent pharmacies, which are
well known in their communities, may get their head turned away and
decide, “We will have a pharmacies rep and that’s
it.” Will the Minister give some assurance that that is unlikely
to be the case?
I agree that
we do not want to be too descriptive on these bodies, because
flexibility is needed. I would hate to think that only the big players
in the primary medical services were having the say in the community,
rather than all the players. That will apply to some extent to
dentistry, although it tends to be someone who has two or three
practices as opposed to a big dental player like there are in cities,
where companies are set up. I would like some reassurance that that
will be heard and that we will not see local people—who are
often described as members of the NHS family—who are effectively
given a service by a contractor on occasion, having their nose shoved
out of joint in being represented on local health and well-being
boards.
Paul
Burstow:
I can reassure the right hon. Gentleman that it
is not our intention to exclude the very people he has just talked
about—it is not how the Bill is drafted. I can also add, for the
interest and information of the Committee, that earlier today we
considered, albeit briefly, clause 190, which deals with the transfer
of the responsibility for pharmaceutical needs assessments to local
authorities. In discharging that responsibility, local authorities
will, of course, want to engage with local pharmaceutical committees to
ensure that they have access to the relevant insight, experience and
expertise. That will be one of the places they will go to in
discharging that responsibility, among others. That will play an
important part going forward in how the commissioning board discharges
its responsibilities as well. I hope that I have been able to say
enough to reassure the right hon. Gentleman, and with that I hope that
the clause can stand part of the
Bill.
Emily
Thornberry:
As I said earlier, the Government have talked
a great deal about health and well-being boards and what a panacea they
are going to be, yet when one looks at the legislation one realises how
little their function will be. They have the duty to—weasel
word—“encourage” integrated working, but little
else. That is a great concern. I hear a certain amount of groaning from
the Government side when I speak in these terms, but how many
Government Members were watching television a few weeks ago at 9
o’clock on a Sunday morning, when the Secretary of State was
being
interviewed?
The
Minister of State, Department of Health (Mr Simon
Burns):
He was very good.
Emily
Thornberry:
He said some things of interest. This is
another example of how over-excited the Government Front Benchers can
be, how far they can fly in flights of fantasy, and how far they can be
from the ball sometimes. I understood, from what the Secretary of State
said, that health and well-being boards would be allowed to agree
commissioning plans. That was what was reported in the press. When I
look at the Bill, I cannot see anything that says that health and
well-being boards will sign off commissioning plans of GP
consortia—far from it. The public need to understand how little
power health and well-being boards have, compared with GP consortia and
how little accountability there is of GP consortia compared with the
supposed accountability of health and well-being boards.
The Government
response to the White Paper makes it clear that the Government have
considered whether health and well-being boards should have formal
decision-making powers over GP consortia on their commissioning plan. I
read that with some interest. I refer Government Members to page 98 of
the Department of Health’s response to the White Paper, in the
chapter titled “Local democratic legitimacy”—they
cannot stop themselves can they?—which has an interesting
passage that
states:
“Sutton
and Merton PCT reflected the views of many respondents when seeking
clarity on what ‘health and wellbeing boards are accountable for
and how that accountability sits with clinical commissioning
consortia’s accountability to the NHS Commissioning
Board’.”
I
am sure that the Minister knows the argument well. The answer to that
was:
“Formal
approval rights for health and wellbeing boards would put them in a
more powerful position than the NHS Commissioning Board, to whom the
consortia are primarily
accountable”.
4.15
pm
We
have given double the amount of money that we spend on defence to GP
consortia, and they are not primarily accountable to health and
well-being boards. The Government have said it themselves. GP consortia
are primarily accountable to the NHS commissioning board, who are the
faceless bureaucrats from Whitehall and are supposed to be the enemy of
the Minister. Nevertheless, he has said time and time again that he
wants to shine the light of democracy on all corners of the national
health service and other phrases of that nature—I am afraid that
I do not know them off the top of my head. The point is that if the
Bill is to give health and well-being boards any power, such as signing
off the commissioning plans of GP consortia, clause 179 is
the time to do it. However, in many ways, it is an empty clause, which
is such a shame, because it is a missed opportunity. We want to focus
on the many things that are wrong with the Bill, and this provision is
certainly
wrong.
Another
section in the Department of Health’s response to the White
Paper
states:
“The
Government is also clear that it cannot grant authority without
responsibility: it would contravene the principles of financial
accountability to give local authorities the ability to make NHS
commissioning decisions that could commit additional expenditure from
GP consortia, without local authorities having to take responsibility
for that
expenditure.”
That,
however, is the whole point. I thought that the whole point was that
local people would start taking
responsibility for the NHS. It was going to be accountable. We were
going to be able to work in partnership. There was going to be
“no decision made about me without me” and all the other
associated flights of fancy that we have heard from Government Members.
When it comes down to it, however, they are exposed when they say that
GP consortia will be primarily accountable to the NHS commissioning
board and not to health and well-being boards, which is why health and
well-being boards cannot sign off the commissioning plans. There we
are. That is why the clause is as short, weak and disappointing as it
is.
Question
put and agreed
to.
Clause
179, as amended,
accordingly
ordered to
stand part of the
Bill.
Clause
180
Other
functions of Health and Wellbeing
Boards
Emily
Thornberry:
I beg to move amendment 365, in
clause 180, page 153, line 15, at
end insert
‘a Health and
Wellbeing Board preparing to give an opinion in respect of this section
shall have regard to the views of any relevant overview and scrutiny
committee on whether the authority is discharging its duty under
section 116B (duty to have regard to assessments and
strategies).’.
The
amendment speaks for
itself.
Paul
Burstow:
The amendment would blur the separation between
the executive and scrutiny functions, which is an issue that was
recognised as important not only by the Government in responding to the
consultation, but also in the county councils network’s
submission, which
stated:
“It
is not appropriate for Health and Well-being Boards to have both the
executive and scrutiny
functions”.
The
amendment has the effect of reversing that and making a link that would
be unhelpful to local authorities in properly discharging their
separate responsibilities for scrutinising. The hon. Lady is worried in
case concerns arise over joint strategic needs assessments—not
having proper regard for them with regard to commissioning health or
social care—but the scrutiny committee can look into such
matters. It can call colleagues from within the local authority; it can
call the relevant people from GP commissioning consortia to discuss the
matter; and it can make reports. That is the strength and value, which
the hon. Lady herself has identified earlier in the Committee, of
scrutiny committees. It is why we want to maintain it and why we will
resist the amendment.
Emily
Thornberry:
I beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Clause
180 ordered to stand part of the Bill.
Clause
181
Participation
of NHS Commissioning
Board
Amendments
made: 445, in clause 181, page 153, line 32, leave out
‘authority’s area’ and insert
‘area of the
authority that established the Health and Wellbeing
Board’.
Amendment 446,
in
clause 181, page 153, line 42, at
end insert—
‘
“health service” has the same meaning as in the National
Health Service Act 2006.’.—(Paul
Burstow.)
Clause
181, as amended, ordered to stand part of the
Bill.
Clause
182 ordered to stand part of the
Bill.
Clause
183
Supply
of information to Health and Wellbeing
Boards
Amendments
made: 447, in clause 183, page 154, line 14, leave out
‘(9)’ and insert ‘(8)’.
Amendment 448,
in
clause 183, page 154, line 16, leave
out ‘(9)’ and insert ‘(8)’.—(Paul
Burstow.)
Clause
183, as amended, ordered to stand part of the Bill.
Clause 185
ordered to stand part of the
Bill.
Ordered,
That further consideration be now adjourned. —(Stephen
Crabb.)
4.24
pm
Adjourned
till Tuesday 15 March at half-past Ten
o’clock.
