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Lord Harris of Haringey: I apologise for labouring the point. Can my noble friend say where in Clause 8 there is a power for a joint committee to co-opt?

Lord Hunt of Kings Heath: I am trying to find it myself. There is no question but that the committee can co-opt. Perhaps I may write to my noble friend on

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that matter. The key point of Clause 8(2) is the ability of local authorities themselves to appoint a joint committee.

Lord Clement-Jones: I thank the Minister for his response. As I anticipated, the noble Lords, Lord Smith and Lord Harris, made rather better arguments than I managed to muster because of their knowledge of the regions and the GLA respectively. They made rather telling points, particularly the quotation of Ministers in support of their arguments. The Minister responded more positively than at many other times today by describing this as an interesting debate. We must be making progress if this is interesting, no doubt in contrast to some of the previous debates.

I recognise the Minister's genuine belief in a constructive relationship at regional level, but when he went on to describe what that consisted of they were really crumbs from the legislative table. It is a very unsatisfactory situation if we are to stitch together the joint committees under Clause 8, when clearly the GLA for that purpose does not appear to be a local authority, with the possibility of co-option under a provision of the clause which is extremely well hidden, to say the least. We must then fall back on the formation of a protocol between the GLA and Department of Health, which in a sense gives the DoH the whip hand in all those circumstances. It would be far more satisfactory to recognise the strategic role of regional government, starting with the GLA. I give way to the Minister who appears to be about to tell the Committee the reference to co-option.

Lord Hunt of Kings Heath: It is not surprising that I cannot find it in the Bill because it is not there. The power is in Section 21(10) of the Local Government Act 2000 whereby a local authority may co-opt any persons who are not members of the authority. That would relate to the establishment of the joint overview committee which could cover London.

Lord Clement-Jones: I thank the Minister for his reply, which emphasises that we must pray in aid other bits of existing legislation and stitch them together to come up with a solution that is in any way satisfactory. Clearly, the Bill would benefit enormously from an addition which recognised the role of the GLA and future regional assembles. We may well wish to return to this amendment in various forms at a later date. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

7 p.m.

Earl Howe moved Amendment No. 40:

    Page 6, line 25, at end insert--

"( ) Where a county authority comprises district councils, it shall, where appropriate, include in the membership of the scrutiny committee representatives of each or all of the district councils within the authority's area of responsibility for health services."

The noble Earl said: I was contemplating not moving this amendment. However, I hope that the Minister will allow me to return to the subject raised

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by the noble Lord, Lord Clement-Jones, in Amendment No. 38, because I think that there perhaps is a broader dimension to the question than he suggested.

Clause 7 seeks to enhance patient and public influence in the development and operation of the NHS by introducing democratic scrutiny of the NHS through local authority overview and scrutiny committees. As the Committee will know, the clause provides for scrutiny by county councils, county borough councils, unitary authorities and London borough councils. Amendment No. 40 seeks to extend the scrutiny rights to district councils.

To back up the thought behind the amendment, it may be helpful to remind the Committee of a few key points. The NHS primary care reorganisation into primary care groups, evolving into primary care trusts, was devised so that decision making on primary care services could be devolved to communities of approximately 100,000 people. Many of the boundaries of primary care groups, and hence PCTs, are exactly those of their district councils. For rural communities, the county council may seem fairly remote and be located quite some distance away. This amendment seeks to honour the local accountability objective of primary care reorganisation; and it may prove particularly valuable if there is an important local issue such as the closure of a community hospital.

There is a further issue. A primary care group acts as a sub-committee of a health authority. Primary care groups are encouraged to become primary care trusts independent of, but accountable to, their health authorities. The next stage of the evolution, as we shall debate in later amendments, is to become care trusts under the provisions of this Bill. The care trust will probably provide its services within the same boundary of the PCT, if it has evolved from a PCT.

The budget of a care trust for social care is to be delegated from the authority providing social services. It may be worthy of consideration by the Government that that combined role should be democratically accountable to the community that it serves. The Minister said that he thought that this proposal would lead to some unwelcome bureaucracy. I am all for getting rid of unwelcome bureaucracy. However, I should like to suggest that there are all sorts of good reasons relating to democratic representation and the contribution of local knowledge that serve to recommend it. I beg to move.

Lord Hunt of Kings Heath: I understand the noble Earl's point. I have already made it clear that I have sympathy with non-metropolitan district councils and that I would certainly encourage the NHS locally to develop as strong a partnership as possible with those councils. Their housing and other roles make that doubly important.

My concern is that unless it is absolutely clear which local authority in any given area is the overview and scrutiny committee, there will be many problems and potential disputes. That is why I consider that the way

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in which it is expressed in Clause 8 provides a satisfactory way through. Clause 8(2)(b) makes it clear that,

    "a local authority may arrange for relevant functions in relation to that authority to be exercisable by an overview and scrutiny committee of another local authority".

I can assure the noble Earl that in relation to Clause 8 that could be a non-metropolitan district council.

To take the noble Earl's example, if a matter arose concerning a primary care trust, it would be perfectly appropriate and possible for the county council to arrange for that oversight function to be exercisable by the overview and scrutiny committee of a non-metropolitan district council which covered the area of the PCT; but the decision whether or not to do it would be a matter for the county council. I believe that we have the capacity to make it abundantly clear that within any locality one local authority has that overall responsibility.

Earl Howe: I am grateful to the Minister. I shall reflect on what he has said. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 41 not moved.]

Lord Clement-Jones moved Amendment No. 42:

    Page 6, line 27, at end insert--

"( ) as to the composition of the committee so as to include representatives of the voluntary sector and the Patients' Council,"

The noble Lord said: This amendment relates to scrutiny committees, which we have discussed at some length. But we have not discussed the composition of the scrutiny committees as set out in the Bill. This is another provision designed to join up some of the current proposals. It seems to us that it would be very important to have on the scrutiny committees, as of right, representatives of the voluntary sector and patients' councils--not simply co-optable under the provisions outlined by the Minister but as an integral part of the scrutiny process. I beg to move.

Lord Astor of Hever: I rise to speak to Amendments Nos. 59 and 61, which are designed to ensure that there is fair political representation on local authority overview and scrutiny committees. That would mean that they reflect as closely as possible the aggregate representation of the different political groups of the local authorities and ensure that the Secretary of State cannot, by regulations, change this balance.

We have two concerns. First, while the powers and changes to local government in England and Wales, as created by Part II of the Local Government Act 2000, are in their infancy, this clause of the Bill proposes to extend the role of scrutiny councillors into non-local authority functions. No doubt many scrutiny committees will contain a number of able councillors. However, against the background of continuing doubts about the executive/scrutiny split and the likely experience of scrutiny members, we are concerned that the necessary time, scrutiny and weight given to these functions may be lacking.

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Our second concern is to ensure that each scrutiny committee's membership reflects the political make-up of the area for which it is responsible. That is of particular importance, as health authorities' boundaries do not always correspond with those of local authorities. In addition, each local authority is likely to have a different political composition.

Section 21(11) of the Local Government Act 2000 brings into force Section 15 of the Local Government and Housing Act 1989--the duty to allocate seats to political groups. However, under powers in Sections 20(e) and 24 of the 2000 Act, the Secretary of State has the power to modify any arrangements made by local authorities.

We would therefore be grateful if the Minister could confirm what arrangements will be put in place to ensure a fair and equitable settlement of political representation between authorities.

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