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Lord Turnberg: Before the Minister sits down, is it not the singular name which is at fault? The Bill states that the Secretary of State may by order,
- "change the name by which a Strategic Health Authority or Health Authority are known".
Earl Howe: Is the Minister satisfied that this is a consistent feature throughout the Bill? It seems extraordinary to me. In ordinary language we simply do not say "a health authority are". We say, "a health authority is". I know that we speak of the Government
in plural terms. That is perhaps a different case; it is a collective noun for a number of people. A health authority is a single body; it is a constituted legal body. As such, it is grammatically singular.It seems extraordinary that this should occur. Is the Minister satisfied that it is not just a slip-up and that it is consistent throughout?
Lord Hunt of Kings Heath: The point is that, if it is a slip-up, we are being consistent in slipping up. The noble Earl, Lord Howe, has raised a vitally important point. My understanding is that we are being entirely consistent with the 1977 Act. Of course, I would be happy to examine the matter again. No doubt, we will welcome a return to it on Report.
Earl Howe: I shall not ask the Minister to spend a lot of his time considering it. However, it is interesting that a primary care trust should be treated as a singular noun in the Bill, whereas a health authority is not. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Earl Howe moved Amendment No. 31:
- Page 2, line 27, at end insert—
The noble Earl said: It is a commonplace in Committee for amendments to be tabled that propose a requirement for consultation and the substitution of the affirmative resolution procedure for the negative. Nevertheless, in moving Amendment No. 31 and speaking to Amendment No. 35, I make no apology for following that well worn path. I hope that the Minister may be persuaded to follow my lead and my argument.
In this part of the clause, we are dealing with a substantial power to be conferred on the Secretary of State. It is the power to establish a new strategic health authority, vary the area of a strategic health authority or abolish a strategic health authority. Any of those things would constitute a significant change in the structure of the health service. Despite the Minister's helpful explanations this evening, the clause is an empty box.
When the Bill was debated in another place, the Government helpfully conceded that there should be provision for consultation before a strategic health authority order could be made. When it arrived, the amendment looked rather odd. Subsection (5) of the new Section 8 gives the Secretary of State a power to make regulations about consultation. We are usually assured by Ministers that what may seem to be a permissive power is, in practice, a requirement. However, here we also have the uncommon addition of the words,
The subsection has a more than usually permissive and discretionary ring to it. It also says nothing at all about who will be consulted. With any major change, such as the one we are discussing, there will be a wide range of interested parties, not only doctors, nurses and other healthcare professionals but local authorities which may be directly affected, voluntary organisations and, of course, patients. The patients are, perhaps, especially important. We would do well to remind ourselves that decisions on who plans and directs services can have a major effect on what services are provided and where. Such questions are important to local communities. At present, CHCs have a right to be consulted by the Secretary of State on reorganisation in the health service. I hope that the Minister will take the opportunity to confirm today that regulations for consultation will be drawn up soon and that he will be able to flesh out the detail of those regulations.
I turn briefly to the question of parliamentary procedure. If we leave the procedure as it is, Ministers will be able to alter fundamentally the size, remit or even the existence of a strategic health authority, with only a small chance that another place will have an opportunity to debate and, therefore, contest what is proposed. There is less of a problem in this House with finding debating time for a prayer to annul. In another place, as we know, life is different, and only a fraction of the number of prayers to annul result in a parliamentary debate. It would be possible, therefore, with the barest minimum of parliamentary scrutiny, for a Secretary of State to amalgamate two or more strategic health authorities and in doing so radically alter the relationship between an SHA and the PCTs for which it had responsibility.
I am uncomfortable with that prospect. It may be that after consultation there is general agreement on the proposal, in which case an order would be likely to go through more or less on the nod. But it may equally be that the scheme contains controversial features on which a debate in Parliament should be guaranteed to the Opposition party. It is for that reason that I tabled Amendment No. 35.
I hope that the Minister will be sympathetic to the amendments and the reasons for them. I beg to move.
Lord Clement-Jones: I support the noble Earl in these two amendments. As he said, the way subsection (5) is worded is extraordinary,
We have had discussions in the past, certainly when the Health Bill went through, on the nature of consultations. Of course the Minister does not like
Lord Hunt of Kings Heath: One thing the National Health Service could never be accused of is undertaking too little consultation. I hope that I can reassure the Committee that consultation will be effective in the matter of strategic health authorities in the future.
As the noble Earl, Lord Howe, suggested, this new section was inserted in another place. It effectively ensures that provision will be made for consultation in respect of the names, boundaries and mergers of strategic health authorities. I make it clear that the Minister, in moving that amendment, gave an undertaking that the Secretary of State would make regulations on the matter.
Given the level of detail required, it is appropriate to deal with this issue by means of regulations rather than on the face of the Bill. That will have the effect of ensuring that consultation on strategic health authorities is broadly in line with consultation requirements for other NHS bodies such as primary care trusts and NHS trusts, the detail of which is also set out in regulations.
Making provision for consultation requirements is in line with many of the other provisions in the Bill. If power and resources are to be devolved to front-line organisations, it is only right that those organisations, together with local partners, patients and the public, should be consulted on changes to the health service.
As I indicated, the exact scope of any consultation requirements will be a matter for regulations. What we currently have in mind is that consultees might include local NHS trusts, primary care trusts, neighbouring strategic health authorities, staff representatives, voluntary organisations, local authorities and patient forums. I hope that, having given the general intent of the Government, the Committee will agree that Amendment No. 31 is unnecessary and are reassured that the Government will ensure that the consultation is appropriate and as wide-ranging as I suggested.
As regards orders made under this subsection, they would contain a high level of detail concerning the proposed local arrangements. I do not believe that a case has been made that in the circumstances surrounding strategic health authorities there is a need for the affirmative resolution procedure for every order made under this particular subsection. It does not seem to me that that is proportionate. One has to remember that any orders made will already have been subject to local consultation. Obviously, that would have allowed for a great deal of discussion and input at local level. It seems to me that as regards parliamentary scrutiny we have the balance about right.
Lord Clement-Jones: Perhaps I may probe a little further regarding particular mechanisms. I accept the generality of what the Minister says. For example, in the Minister's letter to my honourable friend she says,
I come to a second example, which is arrangements for consulting on the decisions of strategic health authorities to delegate functions to PCTs. Mrs Blears assures my honourable friend that it comes within Section 11 of the Health and Social Care Act 2001. The letter continues,
"( ) Regulations made under subsection (5) shall include the requirement for consultation with health professionals, local authorities, bodies representing patients and such other interested parties as the Secretary of State considers appropriate."
"and if he does make such regulations".
"and if he does make such regulations".
I read a letter from Hazel Blears to my honourable friend Dr Harris in the Commons which makes the consultation procedures generally no clearer. I have a letter which deals with the mechanism for consultations above strategic health authority level and with the arrangements for consulting on the decision of strategic health authorities to delegate functions to PCTs. All of that appears to be vague and discretionary. It is therefore an absolutely valid point to make that it should be written on the face of the Bill.
9.30 p.m.
"Mechanisms for consultation above strategic health authority level. This is an important issue and one that is provided for in existing legislation. The NHS Act 1977 provides for the Secretary of State to direct Strategic Health Authorities to work together to undertake their functions. It is intended that consultation on changes that span strategic health authority boundaries will be undertaken by Strategic Health Authorities working together, and this will be achieved through directions. How this will operate in practice is still to be decided".
Those are rather important issues. It is not even going to be in the regulations, but by way of direction, as far as I can see. The letter continues,
"We see benefits in Strategic Health Authorities working together in a federated way, and also a single Strategic Health Authority taking lead responsibility for the consultation exercise".
We are in very vague territory here.
"If delegation would not have any impact on services this would make public consultation unnecessary and indeed irrelevant".
I do not quite understand that. If something is delegated to a PCT, ipso facto that requires a level of consultation. But she goes on to say,
"We intend to issue practice guidance to the NHS in relation to its duty to 'involve and consult', and it will be this vehicle that is used to make explicit that delegation of functions must be consulted upon where it will impact on the services that are used by the public".
We are getting into very complicated areas here. It seems rather strange that we have these myriad ways of consultation whereas something in the Bill which is relatively straightforward and over-arching would be preferable.
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