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Lord Hunt of Kings Heath: I am grateful to the noble Lord. One has to draw a distinction here. Clause 1(5), which is the subject of the noble Earl's amendment, refers to the consultation concerning strategic health authorities, their abolition—
Lord Clement-Jones: I recognise that that is very limited and a very narrow duty of consultation on those specific matters.
Lord Hunt of Kings Heath: Indeed. But the point my honourable friend Mrs Blears was making was that there are other sections of legislation which cover the wider area of consultation over services. Her reference to Section 11 of the Health and Social Care Act 2001 is a very good example of that. It states,
- "It is the duty of every body to which this section applies to make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on".
Surely, the important point is whether the NHS of the future will take a vigorous approach to consultation both over issues such as strategic health authority boundaries and, much more importantly, over the future provision of services. We shall have some enormously interesting debates later in Committee on patient and public involvement. It is fully our intent that the health service should continue to be more effective in consultation and public involvement in service provision. I hope that I have reassured noble Lords that it is the Government's intention to issue regulations in relation to Clause 1(5) to ensure that when it comes to changes in strategic health authorities, there will be full consultation that will cover the sort of organisations and bodies to which the noble Earl, Lord Howe, referred.
Baroness Thomas of Walliswood: I am sorry to continue this discussion but may I bring it down to a mundane level? Subsection (5) is in two halves. If it were terminated after the words, "Strategic Health Authority", it would have exactly the same meaning as it does now. It would not have curious phrases such as,
- "and if he does make such regulations",
and "requirements (if any)" as it does now. It would say the same as it does now at half the length and without those unusual and complicating phrases.
Lord Hunt of Kings Heath: I am always willing to look again at proposed legislation to see whether we can cut some words from it. The wording is clear. It starts by saying
- "The Secretary of State may make regulations . . . and if he does make such regulations he shall not make such an order".
Earl Howe: I am a little disappointed at the Minister's reply to my proposal for affirmative parliamentary procedure. I should not have thought that consultation, however wide, should itself preclude the affirmative resolution procedure in Parliament. Indeed, I have never heard of consultation being given as a reason for denying Parliament an automatic right to debate a question. Nevertheless, I note what the Minister said and I shall consider the matter further.
I am grateful to the Minister for his assurance about making regulations and for setting out the Government's intentions on the persons and bodies to be consulted. I agree with the noble Baroness, Lady Thomas, that subsection (5) has the look of a discretionary power rather than a mandatory one. On the other hand, we have the Minister's assurance on the record, which is a comfort, but the wording does seem somewhat unnecessarily tentative. I am grateful to the Minister for throwing light on this part of the clause and I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 32 to 35 not moved.]
On Question, Whether Clause 1 shall stand part of the Bill?
Baroness Noakes: I rise to oppose Clause 1 standing part of the Bill and, if I may, I shall oppose Clause 7 and Schedule 1 standing part of the Bill because it is convenient to take these together.
The Minister may have gathered by now that there are several noble Lords who are not enthusiastic about strategic health authorities. Indeed, in opposing Clause 1 standing part, I echo what my noble friend Lord Howe said in moving Amendment No. 14 and what the noble Lord, Lord Clement-Jones, said in relation to Amendment No. 15 and the others in that group.
We should be under no illusion about the content of these parts of the Bill. With some minor exceptions, they are there to do one thing only, which is to change the name from health authorities to strategic health authorities. To do that the Bill takes the first 44 lines, several lines within Clause 2, 25 lines comprising Clause 6 and six-and-a-half pages of Schedule 1. I suggest that that has wasted the time of parliamentary draftsmen; it was a waste of time in another place when those parts of the Bill were considered; and it is now a waste of time in this Committee. Nothing of substance would be changed by this wasteful legislation. It would be simply changing name plates. With the NHS failing to deliver on all fronts, it is staggering that the Government have wasted so much time to achieve so little.
All this legislative effort is being undertaken in order that the organisations currently called "health authorities" can in future be called "strategic health authorities". That might be acceptable if they were indeed "strategic" bodies, but several Members of the Committee have already cast significant doubt on that.
Let us look at what these strategic bodies will do. The paper Shifting the Balance of Power states that the strategic health authorities will have three key functions. The first key function will be to create a coherent strategic framework—but I could not find anywhere in the document what strategy they will be responsible for. As it is clearly the Government's intention that delivery will be in the hands of other bodies—in particular, PCTs and NHS trusts—it is difficult to understand what the creation of a strategic framework will mean in practice.
Can the Minister say what the creation of a strategic framework will mean in practice and explain how, if the requirement is to deliver these strategies somewhere else, such bodies can create strategies but not deliver them? The Minister referred earlier to strategic health authorities "banging heads together", but I am not quite sure how strategic that is.
We have already spoken about specialist services—an issue to which we will return later—where again responsibility filters down to the level of primary care trusts, with the rather vague involvement of strategic health authorities. We were told that it is important that care networks should be coterminous with strategic health authorities, but I am not clear what
strategic—or, indeed, operational—involvement the strategic health authorities will have with the care network. That is the first key function.The second key function is to agree annual performance targets and performance management. I have never seen performance management described as "strategic". It is quintessentially an operational matter and no amount of fancy words can turn it into a strategic activity.
The third key function is building capacity and supporting performance improvement. It would appear that this will involve matters such as supporting systems development across a number of PCTs, NHS trusts and networks. Is that strategic? I think not. It is simply an operational matter at a higher level. Can the Minister explain how supporting systems development and so on is strategic?
The question is whether all this amounts to the creation of strategic bodies? It certainly amounts to the creation of smaller bodies, as are the current health authorities, and while smallness might be associated with strategic bodies it is not a conclusive indicator of strategy.
The Minister referred to the new strategic health authorities being involved in leadership, but the leadership issues seem to concern operational matters. So again I have difficulty in understanding what these strategic health authorities are.
To call the bodies anything but what they are currently called—that is, "health authorities"—is vanity. There is no substance to the proposed title. I would not object to these bodies being a tier above the primary care trusts and the NHS trusts—that is sensible and would provide local focus—but they would not be strategic in intent or likely effect; they would be simply an intermediate tier.
By opposing Clauses 1 and 7 and Schedule 1 stand part, we would leave things exactly as they are—health authorities would remain health authorities and that would be an end to the matter. The noble Lord, Lord Clement-Jones, proposed calling them "regional health authorities" rather than "strategic health authorities". I certainly prefer that as a more honest description—although 28 of them would be rather a lot—but that, too, would be a waste of the statute book. I commend my simple leave-things-as-they-are approach to the Committee.
9.45 p.m.
Lord Clement-Jones: I should like to add a brief word in support of what the noble Baroness, Lady Noakes, said. She absolutely hit the nail on the head when she said that the status quo is preferable to anything to be found in this Bill in respect of the structure of this clause.
We know that in probably a minimum of nine months' time there will be another NHS Bill with further proposals for reorganisation. Whether as a result of the aftermath of Kennedy, the aftermath of Adair Turner, further consideration of the King's Fund report, further inspiration on the part of the Secretary of State for Health, there will be further
proposals. These strategic health authorities—I think the noble Baroness has punched an enormous hole through the Minister's rationale for them—have no real substance. They come within the definition of "a rose by any other name". The Minister would do well to put Clause 1 into early retirement and reconsider its structure.
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